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Effects of Work Environment on Quality of Care in ICUs

A Multisite Survey in China

Liu, Jiali BSN; You, Liming PhD, RN; Zheng, Jing PhD, RN; Ross, Amy Miner PhD, RN, CNS; Liu, Ke PhD, RN

doi: 10.1097/NCQ.0000000000000160

This study estimated the effects of the work environment on the quality of care in intensive care units (ICUs). Nurses in ICUs with good work environments or high nurse staffing were significantly less likely to report poor or fair quality of care (odds ratio [OR] = 0.37-0.47), rationing of nursing care (OR = 0.38-0.76), and health care–associated infections (OR = 0.28-0.68). Favorable ICU work environments and adequate nurse staffing can predict better quality of care.

School of Nursing, Sun Yat-sen University, Guangzhou, China (Ms Liu and Drs You, Zheng, and Liu); and School of Nursing, Oregon Health & Science University, Portland (Dr Ross).

Correspondence: Liming You, School of Nursing, Sun Yat-sen University, 74, Zhongshan Rd II, Guangzhou 510089, China (

The authors thank the team members of the CMB China Nursing Network and technical support from Dr Linda Aiken.

This research was supported by the China Medical Board (CMB), Liming You, PI; the Ministry of Health, China, Liming You, PI.

The authors declare no conflict of interest.

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (

Accepted for publication: September 6, 2015

Published ahead of print: January 19, 2016

Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved