The impact of nurse practice environment on patient outcomes and mediation effects of registered nurse outcomes in Middle Eastern acute care hospitals: A cross-sectional study

Examining associations between unit nurse practice environment and four patient outcomes (catheter-associated urinary tract infections [CAUTIs], central line-associated bloodstream infections [CLABSIs], falls, and pressure injuries) and mediation effects of three RN unit workgroup outcomes (job enjoyment, psychological safety, and intent to stay at 1 and 3 years) on these relationships. A cross-sectional correlational design, using the National Database of Nursing Quality Indicators® (NDNQI®) unit-level data from 2018 on inpatient units from seven Middle Eastern hospitals. Ninety units were included, where the sample of units for each patient outcome varied (n = 73–90) based on outcome data availability. Higher unit nurse practice environment scores were significantly associated with higher CLABSIs (exp(b) = 8.181, 95 % CI = [2.204, 30.371], p = .002) and lower pressure injuries (exp(b) = 0.153, 95 % CI = [0.032, 0.730], p = .018). However, mediation analysis showed no significant direct effects of unit nurse practice environment on patient outcomes. Mediation analysis showed that nurses' psychological safety-respect significantly mediated the relationship between unit nurse practice environment and CAUTIs (β = 2.620, p = .013, 95 % bcb CI = [0.837, 5.070]). Nurses' intent to stay at 1-year and psychological safety-respect had significant direct effects (β = −4.784, p = .017 and β = 3.073, p = .012, respectively) on CAUTIs. Nurse practice environment was significantly associated with two patient outcomes and a mediation role of RN outcomes was supported when examining one patient outcome. Future research should examine these relationships in a larger sample for replication. Although nurse practice environment can impact patient outcomes directly, nurse outcomes play a crucial role in mediating this relationship. What is already known about the topic? • Reports from leading institutes, such as Institute of Medicine (2004), highlight the role of supportive and healthy nurse practice environment in optimizing patient outcomes. • There is no evidence from Middle East hospitals that examines the potential impact of nurse practice environment on patient outcomes. What this paper adds. • This study empirically examined the impact of nurse practice environment on patient outcomes directly as well as indirectly through nurse outcomes. • Findings of this study establish a baseline for further exploration of the impact of nurse practice environment on patient safety outcomes in the Middle East context.