Pathways to Quality: Nurse Work Environment, Unfinished Nursing Care, Job Satisfaction, and The Electronic Health Record

  • Terry L. Jones Virginia Commonwealth University School of Nursing, U.S
  • Caitlin Marley Campbell University of Alabama at Birmingham, U.S
  • Aoyjai Montgomery University of Alabama at Birmingham, U.S
  • Colleen Anusiewcz Pogue University of Pennsylvania, U.S
  • Marianne Baernholdt University of Virginia, U.S
  • Patricia A. Patrician University of Alabama at Birmingham, U.S
Keywords: nursing care quality, electronic health record, missed nursing care, unfinished nursing care, nurse work environment


Better nurse work environments are associated with patient and nurse outcomes reflecting nursing care quality. Mechanisms through which the work environment influences nursing care quality are not well documented. Unfinished nursing care, electronic health records, and job satisfaction may be involved. Clear mechanistic pathways that explain how these variables might interact to influence care quality are lacking. This study examined how satisfaction with the electronic health record, unfinished care, the work environment, and job satisfaction collectively affect nursing care quality. A secondary analysis of cross-sectional data was performed using survey data collected from inpatient hospital staff nurses in a single U.S. state. Survey responses (n=916) were analyzed using bivariate correlations and path analysis. Moderate bivariate correlations were documented among all study variables. However, smaller effects were identified in the full path analysis model. The nurse work environment had direct and indirect effects (through unfinished nursing care and job satisfaction) on nursing care quality. Satisfaction with the electronic health records affected nursing care quality indirectly through an inverse relationship with unfinished nursing care. More research is needed to better understand the mechanisms through which the electronic health record influences the nurse work environment and nursing care quality are needed.

Author Biographies

Terry L. Jones, Virginia Commonwealth University School of Nursing, U.S

Terry L. Jones PhD, RN

Associate Professor Department of Adult Health & Nursing Systems

Program Director, Graduate Practice Programs

Caitlin Marley Campbell, University of Alabama at Birmingham, U.S

Caitlin Marley Campbell PhD, RN

Research Assistant, School of Nursing

Aoyjai Montgomery, University of Alabama at Birmingham, U.S

Aoyjai Montgomery, PhD, RN

Scientist I  School of Public Health Department of Epidemiology

Colleen Anusiewcz Pogue, University of Pennsylvania, U.S

Colleen Anusiewcz Pogue, PhD, RN

Postdoctoral Fellow, School of Nursing Center for Health Outcomes and Policy research

Marianne Baernholdt, University of Virginia, U.S

Marianne Baernholdt, PhD, MPH, RN, FAAN

Sadie Heath Cabaniss Professor and Dean School of Nursing

Patricia A. Patrician, University of Alabama at Birmingham, U.S

Patricia A. Patrician, PhD, RN, FAAN

Professor & Rachel Z. Booth Endowed Chair

Colonel, US Army (Retired))


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How to Cite
Jones T, Campbell C, Montgomery A, Pogue C, Baernholdt M, Patrician P. Pathways to Quality: Nurse Work Environment, Unfinished Nursing Care, Job Satisfaction, and The Electronic Health Record. NHSJ [Internet]. 2023Mar.5 [cited 2024Feb.21];3(1):1-10. Available from: