Date of Award


Document Type

Campus Access Dissertation

Degree Name

Doctor of Philosophy (PhD)



First Advisor

Priscilla K. Gazarian

Second Advisor

Ling Shi

Third Advisor

Robert Coulam


Improvements in healthcare quality are often the result of measurement, interventions, and reassessment. Patient experience is a valuable measure of healthcare quality. The Hospital Consumer Assessment of Healthcare Providers and Systems is a reliable and valid tool used to capture acute care patient experience data. Nursing quality is captured through several measures, the most frequently cited being nurse sensitive quality indicators existing in obscurity and brought to light by the National Quality Forum. Guided by the Nursing Role Effectiveness Model, this cross-sectional study assessed relationships between elements of nursing quality and patient experience. Nursing-metrics included three categories of measures—structure (hospital characteristics), process (nursing communication), and outcome (adverse events).

A six-state sample of 620 acute care hospitals was obtained from publicly available data sources. In multivariate regression models, Magnet status, nurse staffing legislation, and nursing communication were significantly correlated to overall hospital rating. Of the nurse sensitive outcome measures included, only central-line associated blood stream infections was significantly (negatively) associated with overall hospital rating. Catheter-associated urinary tract infections, falls, and pressure injuries were not significantly associated with overall hospital rating. The results of this study offer implications for future research, including the need for more robust measures of nursing quality.


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