Hyunmin Yu

Purpose: Moral distress is a pervasive challenge in nursing and has been associated with burnout, job dissatisfaction, and turnover. Although Magnet Recognition has been associated with more favorable nursing practice environments and nurse outcomes, little is known about the association between Magnet status and nurses' experiences of moral distress or the role of leadership responsiveness in this association. This study examined whether management responsiveness to patient care concerns accounted for part of the association between hospital Magnet status and nurse moral distress. Design: This was a cross‐sectional observational study. Methods: Data from the 2024 Penn Nurses4All Survey and the 2023 American Hospital Association Annual Survey were linked. The analytic sample included 18,678 direct care nurses from 1829 hospitals across 10 US states. The dependent variable was nurse moral distress, the independent variable was hospital Magnet status, and the mediator was nurse‐reported management responsiveness to patient care concerns. A 2‐1‐1 multilevel mediation model using multilevel structural equation modeling was estimated to distinguish within‐ and between‐hospital associations while accounting for the clustering of nurses within hospitals. Models adjusted for nurse‐ and hospital‐level characteristics. Results: Nurses in Magnet hospitals reported lower levels of moral distress and more favorable assessments of management responsiveness than nurses in non‐Magnet hospitals. At the between‐hospital level, Magnet status was associated with higher management responsiveness (unstandardized coefficient b = 0.18, 95% CI = 0.15 to 0.21, p < 0.001), and higher management responsiveness was associated with lower moral distress ( b = −0.31, 95% CI = −0.39 to −0.23, p < 0.001). Greater management responsiveness was also associated with lower moral distress at the within‐hospital level ( b = −0.34, 95% CI = −0.35 to −0.33, p < 0.001). The direct between‐hospital association between Magnet status and moral distress remained statistically significant after accounting for management responsiveness ( b = −0.05, 95% CI = −0.08 to −0.01, p = 0.011). The between‐hospital indirect association between Magnet status and moral distress involving management responsiveness was statistically significant ( b = −0.06, Monte Carlo 95% CI = −0.08 to −0.04, p < 0.001). Similar findings were observed using administrative responsiveness to nurse concerns. Conclusions: Nurses working in Magnet hospitals reported lower levels of moral distress and more favorable assessments of management responsiveness than nurses working in non‐Magnet hospitals. Management responsiveness statistically accounted for part of the observed between‐hospital association between Magnet status and moral distress. Clinical Relevance: Leadership responsiveness to nurses' patient care concerns may represent an important and potentially modifiable organizational factor associated with moral distress. Organizational strategies to strengthen management responsiveness and nurses' ability to raise patient care concerns warrant further evaluation as approaches to supporting nurse well‐being.

Background: The nurse practitioner (NP) workforce is rapidly expanding in hospital settings, yet limited evidence exists on how organizational practice environments influence NP burnout. Identifying modifiable workplace factors is critical to improving NP well‐being and retention. Objective: To examine the associations between dimensions of the NP practice environment and burnout among hospital‐based NPs. Methods: This cross‐sectional observational study used data from the 2024 Penn Nurses4All Study. The analytic sample included 1405 NPs working in hospital settings. The independent variables were the four dimensions of NP practice environment (i.e., professional visibility, NP‐administration relations, NP‐physician relations, and independent practice and support), and the dependent variable was burnout. Structural equation modeling was conducted to examine associations between the practice environment and burnout, adjusting for age, sex, employment status, and work setting. Results: Among the 1405 hospital‐based NPs, the mean age was 50.3 years (SD = 11.2). Most respondents were female (87.1%) and worked full‐time (83.9%). Approximately 28.2% worked in emergency department or intensive care unit settings. More favorable practice environment domains, including professional visibility (standardized coefficient β = −.15, p = .035), NP–administration relations ( β = −.36, p < .001), and NP–physician relations ( β = −.22, p < .001) were significantly associated with lower burnout. Independent practice and support were not significantly associated with burnout. Conclusions: Organizational features of the practice environment play a central role in shaping burnout among hospital‐based NPs. Strengthening leadership engagement, interprofessional collaboration, and NP integration within healthcare organizations may be key strategies to reduce burnout and improve workforce retention.

Background: The Pathway to Excellence (Pathway) program recognizes healthcare organizations that support positive nurse work environments, yet the impact of Pathway designation and engagement in the Pathway journey before designation on outcomes remain understudied. Purpose: To examine nurse job outcomes, nurses' assessments of the work environment, and patient satisfaction in Pathway-designated hospitals and hospitals pursuing Pathway designation. Methods: This cross-sectional study integrated data from the 2021 RN4CAST Study, the American Hospital Association Annual Survey, and Hospital Consumer Assessment of Healthcare Providers and Systems. The sample included 5,497 nurses across 360 hospitals in New York and Illinois, including Pathway, prospective Pathway, and non-Pathway hospitals. Outcomes included nurse job outcomes, work environment assessments, and patient satisfaction. Multilevel modeling was used to compare nurse outcomes, and multiple linear regression models were used to compare patient satisfaction across two contrasts: (1) Pathway versus non-Pathway hospitals and (2) prospective Pathway versus non-Pathway hospitals. Results: Compared with nurses in non-Pathway hospitals, nurses in Pathway hospitals reported lower burnout, lower job dissatisfaction, more favorable work environment assessments, and higher patient recommendation scores. Nurses in prospective Pathway hospitals reported lower job dissatisfaction and more favorable work environments. Conclusion: Engagement in the Pathway journey was associated with more favorable nurse outcomes. Pathway designation was further associated with higher patient satisfaction. Implications: Investments in supportive nurse work environments represent a transformative organizational process with potential benefits for both nurse well-being and patient experience.

This commentary discusses the emerging role of nurse practitioner (NP) clinician-scientists and its implications for strengthening advanced practice within acute care health systems. Although NPs have transformed health care delivery in acute care settings, research describing their optimal deployment, system-level impact, and workforce sustainability remains limited. We argue that NP clinician-scientists, clinically active NPs with formal research training, are uniquely positioned to bridge frontline practice and rigorous scientific inquiry. Their embedded roles within Learning Health Systems enable pragmatic trials and workflow redesign that directly reflects real-world care delivery. We highlight the growth and impact of NPs in acute care settings, explain why NP clinician-scientists matter, and outline what they can uniquely contribute. Finally, we describe organizational and academic strategies to cultivate this emerging role. Intentional investment in NP clinician-scientists represents a strategic opportunity to generate actionable evidence, strengthen interdisciplinary care models, and advance quality and workforce sustainability in health systems.

Background: While the nursing profession has advocated for workforce diversity, limited research has examined how institutional inclusion efforts are associated with the experiences of nurse practitioners (NPs), particularly in hospital settings. Purpose: To examine whether institutional inclusion efforts were associated with NPs’ strong recommendation of their hospital and whether this relationship was explained by NPs’ assessments of organizational climate. Methods: This cross-sectional study analyzed 2023 data from 742 NPs across 412 U.S. hospitals, drawing on the Penn Nurses4All Survey, the Healthcare Equality Index (HEI), and the American Hospital Association Annual Survey. The independent variable was employment in an HEI-participating hospital, and the dependent variable was NPs’ strong recommendation of their hospital to family and friends. Mediating variables included NPs’ assessments of organizational climate. Mediation analysis using weighting estimators was conducted to adjust for confounding and evaluate the extent to which organizational climate explained the relationship between HEI participation status and hospital recommendation. Results: NPs in HEI-participating hospitals were 15% more likely to strongly recommend their hospital (95% CI: .07–.22). Significant indirect associations were observed and accounted for the total association through overall organizational climate (26.6%), professional visibility (26.6%), and NP–administration relations (20%), respectively. Practice Implications: Hospital participation in the HEI is associated with stronger hospital recommendations among NPs, partly through more favorable assessments of organizational climate. As health care systems work to improve work environments and job outcomes for a diverse workforce, cultivating a climate of inclusion through meaningful, everyday practices will be essential.

Introduction: Psychiatric Mental Health Registered Nurses (PMH‐RNs) are the largest group of healthcare providers working within inpatient mental health settings. Despite longstanding concerns about the emotional demands and safety of nurses practicing in these settings, few studies have examined associations between organizational factors and nurse job outcomes among inpatient PMH‐RNS. Aim/Question: To examine burnout, job dissatisfaction and intent to leave among PMH‐RNs employed in inpatient psychiatric units and how these job outcomes are associated with the quality of their nurse work environments. Method: This cross‐sectional study combined data from the 2023/2024 Penn Nurses4All and 2023 American Hospital Association (AHA) survey data. Results: Approximately 4 out of 10 inpatient PMH‐RNs experience high burnout as well as high levels of job dissatisfaction and intent to leave their roles. More favourable nurse work environments were associated with reduced negative job outcomes among inpatient PMH‐RNs. Discussion: Our findings provide insight into the current state of the PMH‐RN workforce and how the nurse work environment may represent a modifiable factor to improve nurse wellbeing, job satisfaction and job retention among this group. Policymakers and administrators should prioritize this vital group of health care professionals by improving interdisciplinary teamwork, promoting adequate staffing levels and creating a safe and inclusive environment for PMH‐RNs.

Community health workers (CHW) programs are effective at reducing hospitalizations, improving mental health, and supporting health‐promoting behaviors. Research suggests awareness and use of CHW services remain uneven across communities nationally. This study describes awareness, use and satisfaction with a city‐wide CHW program among racial/ethnic minority individuals in Philadelphia. Data come from a web‐based health survey conducted February–March 2024. Participants reported sociodemographic characteristics, health conditions, barriers to social resources, and awareness and use of the city's CHW program. Among 522 participants, the majority were Black (55.4%), women (70.1%), with mean age 39 years. Less than half (44.6%) were aware of the CHW program; of those, 30.5% (13.6% of whole sample) had used it. Among users, 80.3% reported being satisfied with services. In multivariate models, Asian, Hispanic/Latine, privately insured, unemployed, those without barriers to social resources, those with chronic conditions, and West Philadelphia residents had lower odds of awareness. Education, income, and anxiety symptoms were not associated with program awareness. Awareness and use of this CHW program is low to moderate among key populations in Philadelphia. Given variations in awareness, scale‐up of CHW programs should include evaluation of program reach, especially to individuals who are not employed and have chronic health conditions.

Introduction: Transgender and gender-diverse (TGD) individuals face health disparities and workplace discrimination, yet the job and health outcomes of TGD nurses remain underexplored. Purpose: To investigate how gender identity affects job and health outcomes. Methods: This cross-sectional observational study included 52,491 nurses (52,455 identifying as cisgender and 36 as TGD) in New York and Illinois surveyed in 2021. Job outcomes were burnout and job dissatisfaction. Health outcomes were depression, anxiety, and overall health ratings. Propensity score weighting was used to address confounding factors. Doubly robust methods were applied to refine estimates. Results: Compared with cisgender nurses, TGD nurses had higher odds of high burnout (adjusted odds ratio [aOR] = 2.60, p = .036), job dissatisfaction (aOR = 2.21, p = .044), poorer overall health (aOR = 3.98, p < .001), and more depressive ( b = 0.82, p = .013) and anxiety symptoms ( b = 0.76, p = .044). Conclusions: TGD nurses reported poorer job and health outcomes than cisgender nurses, underscoring the need to identify workplace factors associated with these disparities.

Nursing surveillance has been identified as a core clinical process through which organizational conditions may influence patient safety; however, its explanatory role in the relationship between the nurse work environment and patient safety culture is not well established. This study examined whether nursing surveillance practices account for part of the association between the nurse work environment and patient safety culture in medical–surgical units. Cross‐sectional data were drawn from 1,597 medical–surgical nurses who participated in the RN4CAST‐Australia 2018 survey. The nurse work environment was measured using the Practice Environment Scale‐5, nursing surveillance using a validated 16‐item scale assessing the frequency of patient assessment practices for early detection of deterioration, and patient safety culture using a validated short form of the Hospital Survey on Patient Safety Culture. Structural equation modeling was used to estimate direct associations between the nurse work environment and patient safety culture and indirect associations via nursing surveillance. A more favorable work environment was directly associated with a more positive patient safety culture and more frequent surveillance practices. More frequent surveillance was also directly associated with a more favorable patient safety culture. In addition, the nurse work environment was indirectly associated with patient safety culture through increased surveillance. These findings suggest that nursing surveillance represents a specific, actionable mechanism linking work environment conditions to patient safety culture. Efforts to improve patient safety may therefore require both structural enhancements to the work environment and targeted strategies to strengthen proactive nursing surveillance.