Date of Award


Degree Name

PhD Nursing

Dissertation Committee

Linda D. Urden, DNSc, RN, CNS, NE-BC, FAAN, Chairperson; Eileen K. Fry-Bowers, PhD, JD, RN, CPNP, Committee Member; Laurie Ecoff, PhD, RN, NEA-BC, Committee Member


health care management, workload, patient outcomes, patient satisfaction, patient falls, pressure ulcers, in-hospital mortality


Aim. The purpose of this study is to examine the impact of nursing practice environment and perceived nursing workload on 4 dependent variables of patient outcomes including patient satisfaction, patient falls, pressure ulcers, and in-hospital mortality.

Design. A cross-sectional, descriptive, correlational design was utilized with self-administered questionnaires and secondary data analysis.

Method. A convenient sample of 355 full-time registered nurses (88.7% response rate) was recruited from 4 governmental hospitals in Saudi Arabia to complete anonymous surveys that measured their perception of practice environment and nursing workload. The PES-NWI was used to measure nursing practice environment and the IWPS-R was used to capture the perceived nursing workload. The 4 patient outcomes were retrieved from electronic patient records during a 6-month period from June 2016 to November.

Findings. The results showed significant negative correlations between nursing practice environment and the patient outcomes of patient falls and mortality rate. Patient satisfaction and pressure ulcers did not show any significant correlation with nursing practice environment. The second independent variable of nursing workload showed a significant negative correlation with the patient outcomes of pressure ulcers and mortality rate. Hierarchical multiple regression analysis that nurses’ demographic variables, nursing practice environment, and nursing workload explained 16% of the variation in patient satisfaction, 20% in patient falls, 14% in pressure ulcers, and 18% in mortality rate.

Conclusion. The evaluation of the associations between the variables of interest supported the conceptual model that were guided by Donabedian’s model of healthcare quality, which emphasized the importance of the professional practice environment and nursing workload on patient outcomes.

Document Type

Dissertation: USD Users Only