Nursing Satisfaction, Part 2: Impact on Patient Experience

Patrice Hatcher, MBA, BSN, RNC-NIC / March 2018


After writing recently on nursing satisfaction strategies for improvement, I wanted to investigate a related phenomenon: Is there a direct correlation between nurse and physician satisfaction with patient satisfaction?

Let’s take a closer look.

Over the years, nursing satisfaction has been a priority of hospitals with the goal of improving nursing environment, developing a healthier culture, and ultimately decreasing nursing turnover. Like many other professions, nursing has very slowly and subtly undergone culture changes. Many of these changes have had a lasting impact on the nurse’s role and work environment, resulting in an increase in nurse satisfaction.

In my own experience, having worked both as a direct care nurse and in nursing leadership, I’ve observed significant changes in both roles. One of the largest and most extensive changes in healthcare workload that I have experienced was with the introduction of patient satisfaction/patient experience in the form of HCHAPS survey.

Patient satisfaction has always been a priority

It’s not that we weren’t monitoring satisfaction or that we applied a low value to patient experience. We were actively monitoring, reviewing, and improving results.

In my opinion, patient satisfaction difficulty is related to the complexity of patient surveys and low response rates, and the impact on hospitals financially incentivized to receive full payment, minimize reduction in payment, and mandatory participation as a requirement by CMS for Medicaid Medicare value-based healthcare.

Nursing satisfaction impact

The directive to improve patient experience was well intended, with the goal of improving quality of healthcare delivery. And yet, those intentions directly impacted nurses, their role, and where they spent their time. This is where a few difficulties arose.

A few cited dissatisfaction factors include lack of autonomy, lack of opportunity to advance, patient-nurse workloads, and nurse staffing ratios.1,2, 3 Transitioning from paper documentation to electronic medical records (EMR) is just another example of job change having high impact on nurses’ daily work, taking time away from accomplishing assigned tasks.  All have had significant impact on nursing and healthcare workers job satisfaction and retention.

Fee for performance

The implementation of fee for performance with the Affordable Care Act (ACA) has required healthcare leaders to have laser focus on the quality of health care delivery. Hospital HCHAPS survey results are visible to consumers, requiring hospitals to be publicly accountable for the results.

The results of the survey have far-reaching impact on employees to have a service-based mindset. How hospitals handled improving their scores have the greatest impact on employees, requiring change to how care is provided, implement activities, and action plans with initiatives to improve scores.

Nursing is already a demanding profession

Nurses enter the profession to provide quality care for people and improve their health outcomes. Their goal is to somehow make a small (or large) contribution toward improving the overall health of patients and their families.

Unfortunately, over the last three decades, more tasks continue to be added to nurses’ already long list of responsibilities, limiting the time to get to all that must be completed on the daily to-do list.

Service excellence and high quality care requires time. Time with patients for the more important tasks of teaching and educating is the only way to make lasting changes to improve their health or family’s health.

It is well documented that nurses continue to have low retention rates and moderate satisfaction. A high percentage of nurses indicate if they had the choice, they might not choose nursing as a career.

Nursing satisfaction = Patient satisfaction

This all brings me back to the question: does nursing satisfaction have an impact on patient satisfaction? If so, what are the specific areas of nursing satisfaction impacting patient satisfaction?

Seke and colleagues conducted a study with the aim of assessing at what level healthcare worker satisfaction affects patient satisfaction. They identified factors affecting the quality of work and services that create a basis for the careful forethought of factors which affect both the healthcare worker satisfaction and patient satisfaction.3 Indicators for healthcare worker satisfaction include the following:

  • Receiving clear instructions on the expectations they need to meet at their work place
  • Opportunities with professional development
  • Personal relationships
  • Adequacy of work equipment
  • Opportunities offered for continuous education
  • Time for accomplishment of tasks

It is noteworthy that satisfaction with time available to accomplish tasks was identified as the most significant correlation.

Kutney-Lee, et al., published a comprehensive paper examining the relationship between nursing and patient satisfaction across 430 hospitals. 98,000 nurses responded. The results were not surprising: “The quality of the nurse work environment is highly associated with all 10 factors they measured with patient satisfaction.” And, the most noticeable measure was nurse work environment and patient-to-nurse staffing ratios.1

Data leads to a better understanding of nurse satisfaction

The results of the latest research and data collected indicate patient satisfaction is directly impacted by employee satisfaction. The data suggests there is higher job satisfaction when clinicians have time to accomplish tasks and workloads are manageable.

The correlation between patient outcomes and quality management is connected to improving nurse work environment in hospitals. Healthcare workers and nurses cannot be overlooked when it comes to having more time available to accomplish tasks.

More research is needed

In closing discussions of recently published papers, many of the authors indicate that more research on this topic would be beneficial to hospitals and healthcare facilities. Improving the work environment and investing in all healthcare workers, and especially nurses, is a worthwhile investment toward improving patient satisfaction.

What do you think about the relationship between nursing satisfaction and patient satisfaction? Tell us in the comments below!



  1. Kutney-Lee A, McHugh, M, Sloane, DM, Cimiotti JP, Flynn L, Neff DF, Aiken LF. Nursing: a key to patient satisfaction. Health Aff (Millwood). 2009;28(4):w669-w677.
  2. Molyneux, J. Nurses’ job satisfaction linked to patient satisfaction. Amer Journ of Nur. 2011. 111(5); 5-16.
  3. Seke JI, Djokovic A, and Filipovic J. Healthcare workers satisfaction and patient satisfaction: where is the linkage? Hippokratia. 2013. 17(2); 157-162.


About the Author

Patrice Hatcher, MBA, BSN, RNC-NIC, began her practice more than 24 years ago as a neonatal nurse working in NICU. She has experience in various nursing leadership roles including neonatal transport nurse, outpatient nurse manager, and administrative nurse manager overseeing operations of large intensive care units. She has special interest in quality improvement and improving clinical outcomes for neonates. Patrice currently works full-time as a Clinical NICU Specialist for Medela LLC.