Nurse and Patient Outcomes Across Pathway to Excellence Designated and Prospective Hospitals

ABSTRACT Background: The Pathway to Excellence (Pathway) program recognizes healthcare organizations that support positive nurse work environments, yet the impact of Pathway designation and engagement in the Pathway journey before designation on outcomes remain understudied. Purpose: To examine nurse job outcomes, nurses' assessments of the work environment, and patient satisfaction in Pathway-designated hospitals and hospitals pursuing Pathway designation. Methods: This cross-sectional study integrated data from the 2021 RN4CAST Study, the American Hospital Association Annual Survey, and Hospital Consumer Assessment of Healthcare Providers and Systems. The sample included 5,497 nurses across 360 hospitals in New York and Illinois, including Pathway, prospective Pathway, and non-Pathway hospitals. Outcomes included nurse job outcomes, work environment assessments, and patient satisfaction. Multilevel modeling was used to compare nurse outcomes, and multiple linear regression models were used to compare patient satisfaction across two contrasts: (1) Pathway versus non-Pathway hospitals and (2) prospective Pathway versus non-Pathway hospitals. Results: Compared with nurses in non-Pathway hospitals, nurses in Pathway hospitals reported lower burnout, lower job dissatisfaction, more favorable work environment assessments, and higher patient recommendation scores. Nurses in prospective Pathway hospitals reported lower job dissatisfaction and more favorable work environments. Conclusion: Engagement in the Pathway journey was associated with more favorable nurse outcomes. Pathway designation was further associated with higher patient satisfaction. Implications: Investments in supportive nurse work environments represent a transformative organizational process with potential benefits for both nurse well-being and patient experience.