New Study Proves Happy Nurses = Happy Hospital

The results come as no surprise to anyone who has ever worked in the nursing field, but now a new study proves it beyond a reasonable doubt - quality care and success depend on the happiness of the hospital's nursing staff.

A study out of University of Pennsylvania focused on the role of Kaiser Permanente's nursing organization in promoting quality of care. The Kaiser Permanente model of integrated health delivery is highly regarded for high-quality and efficient health care. Efforts to reproduce Kaiser's success have mostly failed. One factor that has received little attention and that could explain Kaiser's advantage is its commitment to and investment in nursing as a key component of organizational culture and patient-centered care.

Patient and nurse outcomes in Kaiser hospitals were significantly better compared with non-Magnet hospitals. Kaiser hospitals had significantly better nurse work environments, staffing levels, and more nurses with bachelor's degrees. Differences in nursing explained a significant proportion of the Kaiser outcomes advantage. Kaiser hospital outcomes were comparable with Magnet hospitals, where better outcomes have been largely explained by differences in nursing.

“We are proud to be recognized as a leader in providing quality nursing care,” said Marilyn Chow, vice president, Kaiser Permanente, National Patient Care Services and Innovation. “This study validates what we know and witness every day at our medical centers: our patients benefit because Kaiser Permanente nurses are among the best in the country.”

The study was a cross-sectional analysis of linked secondary data from multiple sources, including a detailed survey of nurses, for 564 adult, general acute care hospitals from California, Florida, Pennsylvania, and New Jersey in 2006-2007. Using logistic regression models to examine whether patient (mortality and failure-to-rescue) and nurse (burnout, job satisfaction, and intent-to-leave) outcomes in Kaiser hospitals were better than in non-Kaiser hospitals, researchers assessed whether differences in nursing explained outcomes differences between Kaiser and other hospitals. Finally, the study examined whether Kaiser hospitals compared favorably with hospitals known for having excellent nurse work environments-Magnet hospitals.

An important element in Kaiser's success is its investment in professional nursing, which may not be evident to systems seeking to achieve Kaiser's advantage. The results suggest that a possible strategy for achieving outcomes like Kaiser may be for hospitals to consider Magnet designation, a proven and cost-effective strategy to improve process of care through investments in nursing.

“This has enormous implications in hospital settings, given nurses’ key role in the process of clinical surveillance,” said Matthew McHugh, PhD, JD, MPH, RN, professor at University of Pennsylvania Nursing and primary author of the study “Achieving Kaiser Permanente Quality.”

What do you think? Do you agree with the study's results and how does "happiness" impact your day-to-day nurse life? Share your thoughts in the comments section below.



  1. I’ve been an RN for 28 years and have worked in multiple hospitals. I feel sorry for the nurses who work in the hospital where night shift nurses are almost out of the picture where Nursing recognition and appreciation is concerned. What caught my attention is that Night nurses are always under appreciated in this Hospital. Despite the sacrifices these nurses made as the shift is always short staff every night, a little pat on the back will go a long way for these nurses to help their moral. The CNO encourages every nurse to call for safe harbor because they know they will have unresolved Staffing issues everyday, although that protect the nurses but the benefit is mostly for the hospital and their budget. I strongly agree that when you make your nurses happy they will stay, work harder and are more productive with proven better outcomes … and that’s why this hospital is always short staff as nobody cares about their nurses, so when they hire nurses- they will not last long….and more nurses are leaving.

  2. I am a retired RN. I have an AA degree. I think that not only nurses with many degrees can do a better job at nursing. If the staffing is sufficient then the work is better as a result. An administration that cares for its employees is a big help as well. Thank you for this information. I have been a nurse for 43 years . And most of that time I worked in and environment of little help . When we had enough help things were better and the patients got better care.

  3. Do I believe happy nurses equals happy patients and good outcomes yes I do but in that statement of more nurses with bachelor degrees cause better outcomes no. There are Lpns/Lvn that are just as exceptional nurses as nurses with bachelor degrees. No matter how many initials are behind a nurses name the key to exceptional patient care and fewer mortality rates starts with having the staff to accomplish this goal. For example I work a medicare/rehab unit the patients we get are sicker aka more complicated than we previously had as a result the nurse actually spends less time with them how is this possible you ask. 1 nurse has 15 patients 1 cna has 15 patients. So as a result you may have 1-3 patients that may not need as much care as the other 10-12 patients. Now figure this the nurse is doing CNA patient care, scheduling appts, doing treatments and possible passing the medications as well as running meals, rounding with the physicians among other non nursing duties as well as all the charting so tell me how this nurse is being a nurse and keeping patients from being sent back to the hospital, again staffing is a key element.Ltc has it even worse 30-40 patients per 1 nurse

  4. Please always leave a link/ reference. When you say “new” I assumed this was recently published. I believe this is the article from 2016:
    Achieving Kaiser Permanente quality

    McHugh, Matthew D.; Aiken, Linda H.; Eckenhoff, Myra E.; Burns, Lawton R.
    Health Care Management Review: July/September 2016 – Volume 41 – Issue 3 – p 178–188
    doi: 10.1097/HMR.0000000000000070

  5. I am in my 40th year of meg surg nursing mostly orthopedics I totally agree with when your treated with respect from the management you just want to work harder. What I don’t agree with is that having more bachelor degrees make it better. I have found out just the opposite it has really hurt the bedside because they all want to move on away from the bedside where the need really is because they can. Your associate degree nurses coming out much better prepared to work. I precept many bachelor degree nurse who are ready to graduate within the next few months its so unbelieveable what they cant do or havent been exposed to I feel the schools are doing them a great disservice putting more added cost on the hospitals to provide 6 months of interships before they are ready to take care of patients. The focus in these programs are definitely away from pt care and scares them to death when handling 5-7 pt throughout the day so they pursue higher degrees. We need to figure out in this country how to retain good nurses at the bedside believe me pt hospitals days would go down. We need to retain critical thinkers at the bedside to teach the new ones and make them feel this type of nursing is just as important as the manager.

  6. I work in Imaging for Northwell Health and couldn’t agree more. All employees are valued and treated the same(!) and thus carries over to our excellent patient care….people first and the institution will be cared for as well.

  7. Just need to add California has mandated break laws, and staffing ratio laws, these were not given to the nurses by Kaiser. More taken by the nurses when they organized into a union. The nurses at Kaiser fight hard and often for their “happiness”. *note I am not a Kaiser employee nor have I ever been on

  8. I did burn out thanks to Martin Health Systems in Stuart Fla. Took early retirement rather than return after taking 3 mo.of disability. Being an RN,BSN for over 30 years, I realized my practice was not compatible with this organization. The final straw involved a meeting, requested by my peers. The meeting resulted in being told “It’s a new day at Martin and this is the way it will be” no compromise. Nurses left this meeting crying and totally stressed out…although we had answers to share, we were not heard. Now I have a great job at an MD’ s office, making the same salary, being respected and treated like the professional nurse I am, my faith in our profession is restored.

  9. Absolutely!!! I am a graduate student focusing my capstone on moral distress and burnout in relation to retention and resiliency. I feel this is my calling, and I hope to advocate for fellow nurses. We must invest in our nurses!

  10. If your nurses are happy; they will go over & beyond! This always results in Happy Patients. You can catch more bees with honey than vinegar!!’

  11. I’m not sure I get the connection between happy nurses and a BSN. Respect and dignity have little to do with alphabet soup after your name

    • Amen…I have seen LPNs that i would trust to take care of me before a BSN. Just because you can type a good paper or are good at school does not mean you have good critical thinking.
      Yes i am an RN but i would never assume i am a better nurse just because i have more education.
      It is how you apply the knowledge that makes you a good nurse not the letters after your name.

  12. If the hospital is fair and takes care of it’s nurses it certainly makes for a happy nurse! Thank God for St. Luke’s in NYC (now Mt. Sinai).

  13. I graduated in 1974. Still working. I have been in every unit in a hospital. It is true that we are all subjected to burn out. When the supervisor ask you to cover for the 3d shift in a row they are not thinking about your feet and legs or back, or the people you have dealt with for the last 12 hours, or the co-workers and all the drama. We have to take care of ourselves. Set limits. I have been that person looking to fill a empty spot on a shift, worried about patient to staff ratio and compliance. I have also been that nurse that agreed to work another 12 hour shift, and after about 2 hours wondering what was wrong with me. To be the best we can be you must feel good and that requires sleep, family time, me time. After a couple extra shifts it all goes to taxes anyway.

  14. I think all of us already knew that, especially those of us who have been in the hospital environment for many years. We have seen the good, bad and the ugly, we know that nurses are the backbone of every hospital. When they are treated with respect and valued, pt care always improves.


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