The Social-Ecological Context for Work

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Nursing Work Environments

Many characteristics need to come together to create working environments for nurses that support them in practicing according to their values and to the full extent of their competence. When you want to change a situation, do you start by trying to change the overall culture, and letting the changes trickle down, or do you try to change the local environment, in the expectation that eventually the larger culture will evolve to fit?

At the summit, and in accord with the conviction that nurses are empowered to improve health care, participants focused their attention on changes in local work environments. These are the situations over which individual nurses have the most direct influence. We believe that developing a preponderance of worksites offering positive environments for nurses will lead to rethinking and redesign at the level of culture.

Nurses interviewed for this project described aspects of a good working environment in the video below.

The Social-Ecological Context for Work

At the ethics summit, participants were asked to reflect on the social-ecological context in which nurses work. Many layers of relationships and interactions make up a nurse’s working environment, whether they work in a hospital, nursing home, rehabilitation services provider, physician’s office, home health agency, school, prison, or public health program.


The social-ecological framework proposed includes the following:

  • Individual characteristics of the nurse
  • Individual characteristics of the patient and family, including the patient’s health condition
  • Relationships between nurses and patients
  • Relationships between nurses and other health care professionals
  • The organizational system in which these professionals work
  • Professional and educational regulation and standards
  • Community norms and expectations
  • Broad social, political, and economic context

Additional Resources

Marion Broome, PhD, RN, FAAN looks at the importance of quality and safety in care environments in a #nursingethics blog post.
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