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. 2025 May 16;25(1):709.
doi: 10.1186/s12913-025-12720-x.

Association of emergency department nurse and physician work environment agreement on clinician job and patient outcomes

K Jane Muir  1   2   3 , Anish K Agarwal  4   5   6 , Daniela Golinelli  7 , Karen B Lasater  7   4 , James Ballinghoff  6 , Colleen Mattioni  8 , Matthew D McHugh  7   4 , Linda H Aiken  7   4 ; United States Clinician Wellbeing Study Consortium
Collaborators, Affiliations

Association of emergency department nurse and physician work environment agreement on clinician job and patient outcomes

K Jane Muir et al. BMC Health Serv Res. .

Abstract

Background: Emergency medicine is a highly interdisciplinary field, and emergency nurses and physicians have high rates of burnout compared to other specialties. National and international agencies prioritize investments in systems-based solutions to improve clinicians' work environments. The objective of this study was to determine whether emergency department (ED) clinicians agree on the quality of work environments, and whether their agreement is associated with job outcomes, patient safety, and quality of care.

Methods: This cross-sectional study used data from 1,604 ED nurses (n = 1,190) and physicians (n = 414) who completed the 2021 US Clinician Wellbeing Study in 47 Magnet hospitals. A K-means algorithm classified hospitals into 'profiles' based on nurse and physician agreement on work environment assessments. Hospital-level linear regression models determined the relationship between hospital profiles and clinician job and patient outcomes.

Results: The overall clinician sample (n = 1,604) was on average 39.4 years of age (SD = 11.2), 72.3% female, with 8.3 years of experience (SD = 7.9), 77.7% White, and 93.6% non-Hispanic. Two hospital profiles indicated clinician agreement: "Agree, Unfavorable Environment" (n = 10 hospitals), and "Agree, Favorable Environment" (n = 15); the third profile indicated disagreement: "Disagree, Less Favorable Environment among Nurses" (n = 22). There were no hospital profiles with physicians rating their work environment less favorably than nurses. Compared to the "Agree, Favorable Environment" hospitals, the "Agree, Unfavorable Environment" and "Disagree, Less Favorable among Nurses" hospitals were associated with higher burnout (e.g., β = 25.8%, 95% CI 11.6, 40.1, p <.001 and β = 15.4, 95% CI 3.7, 27.2, p <.001, respectively), job dissatisfaction, and intent to leave; and unfavorable patient care quality and unfavorable patient safety grades (e.g., β = 29.1%, 95% CI 18.4, 39.8, p <.001 and β = 11.9%, 95% CI 3.0, 20.8, p <.01, respectively).

Conclusions: In this cross-sectional study, emergency nurses and physicians in almost half of study hospitals disagreed on the quality of the work environment, suggesting that two essential collaborators in high-stakes care do not agree on deficiencies in ED work environments. Sustainable systems-based solutions to improve ED work environments involve bridging these disparate workplace experiences.

Keywords: Burnout; Emergency care; Well-being; Work environment.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study protocol was approved by the University of Pennsylvania Institutional Reviewer Board. Participants provided written informed consent before initiating the survey informing the data for the study analysis. Consent for publication: N/A. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
K-means clusters identifying hospital profiles of clinician work environment agreement. Note. Green values indicate “Agree, Favorable Environment”; Red values indicate “Disagree, Less Favorable for Nurses”; Black values indicate “Agree, Unfavorable Environment” using the proportion of clinicians rating their work environment as “poor or fair” from the Clinician WellBeing Study of emergency nurses and physicians
See this image and copyright information in PMC

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