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Open Access Highly Accessed Research article

How nurses and their work environment affect patient experiences of the quality of care: a qualitative study

Renate AMM Kieft1*, Brigitte BJM de Brouwer1, Anneke L Francke23 and Diana MJ Delnoij4

Author Affiliations

1 Dutch Nurses’ Association, PO Box 8212, 3503, RE Utrecht, The Netherlands

2 1/ NIVEL, Netherlands Institute for Health Services Research, PO Box 1568, 3500, BN Utrecht, The Netherlands

3 2/ EMGO+/VU medical center, Van der Boechorststraat 7, 1081, BT Amsterdam, The Netherlands

4 Professor of Transparency in Healthcare from the Patient's Perspective, Tranzo, Tilburg University, PO Box 90153, 5000, LE Tilburg, The Netherlands

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BMC Health Services Research 2014, 14:249  doi:10.1186/1472-6963-14-249

Published: 13 June 2014



Healthcare organisations monitor patient experiences in order to evaluate and improve the quality of care. Because nurses spend a lot of time with patients, they have a major impact on patient experiences. To improve patient experiences of the quality of care, nurses need to know what factors within the nursing work environment are of influence. The main focus of this research was to comprehend the views of Dutch nurses on how their work and their work environment contribute to positive patient experiences.


A descriptive qualitative research design was used to collect data. Four focus groups were conducted, one each with 6 or 7 registered nurses in mental health care, hospital care, home care and nursing home care. A total of 26 nurses were recruited through purposeful sampling. The interviews were audiotaped, transcribed and subjected to thematic analysis.


The nurses mentioned essential elements that they believe would improve patient experiences of the quality of nursing care: clinically competent nurses, collaborative working relationships, autonomous nursing practice, adequate staffing, control over nursing practice, managerial support and patient-centred culture. They also mentioned several inhibiting factors, such as cost-effectiveness policy and transparency goals for external accountability. Nurses feel pressured to increase productivity and report a high administrative workload. They stated that these factors will not improve patient experiences of the quality of nursing care.


According to participants, a diverse range of elements affect patient experiences of the quality of nursing care. They believe that incorporating these elements into daily nursing practice would result in more positive patient experiences. However, nurses work in a healthcare context in which they have to reconcile cost-efficiency and accountability with their desire to provide nursing care that is based on patient needs and preferences, and they experience a conflict between these two approaches. Nurses must gain autonomy over their own practice in order to improve patient experiences.

Patient experiences; Quality improvement; Nurses; Nursing work environment