Kathryn A. Connell

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.

Mechanical ventilation is lifesaving yet harmful when paired with deep sedation and immobility. The ABCDEF, or intensive care unit liberation bundle (assessment and treatment of pain, spontaneous awakening and breathing trials, judicious choice of analgesia/sedation, delirium prevention/management, early mobility, and family engagement) mitigates these risks, improving survival, reducing delirium and coma, shortening time receiving ventilation, and promoting recovery. This article synthesizes evidence for the awake-and-walking intensive care unit, in which wakefulness and mobility are the default. We define the role of the advanced practice registered nurse in reliable implementation of this model: embedding bundle elements into workflows, aligning sedation and mobility targets, coordinating interprofessional teams, and driving culture change through measurement and feedback. A case example illustrates a patient’s trajectory under high versus low adherence. We close with pragmatic strategies to overcome workflow fragmentation, staffing variability, and safety concerns, mapping barriers to solutions such as protocol standardization, nurse-respiratory therapist coleadership, daily goal alignment, and data transparency.

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.