Patient adverse outcomes include every type of error, mistake and accident that occurs within hospital regardless of any damages received by patients (Lee, 2012). Patient adverse outcomes that occur in hospital not only have adverse effects directly on patients but also cause serious financial burden on health & medical service system (De Vries et al., 2008). Since the issue of patient related adverse outcomes is directly related to the lives of patients, it is an important determinant of the quality of medical service (Kim, 2011).
In the US, the number of the deceased from medical mistake in 1999 was annually 44,000～98,000, and the number of the deceased from medication error was annually 7,000. Additionally, the total medical expense of preventable patient adverse outcomes was reported to be at a serious level of 1.87～3.19 trillion won (Kohn et al., 2003).
Attempts are also being made domestically centering on certain advanced general hospitals to obtain the certification of the Joint Commission International (JCI) (Kong & Sohn, 2012). The JCI is a certification system reserved only for medical institutions that have satisfied over 90% of about 1,200 items of international standard medical services focusing on improving the quality of patient safety and medical care. Accordingly, hospitals that have obtained the JCI certification are regarded both domestically and internationally as hospitals that place the highest priority on patient safety, which is being perceived as an opportunity to enhance the reliability of hospital (Nam & Choi, 2011).

In this study that was conducted with the participants of 3,096 nurses working at the general inpatient unit of 60 hospitals, two-level logistic regression analysis was conducted to examine the present condition of the nurse-perceived level of patient adverse outcomes and the nurse-assessed quality of nursing care in hospitals in our country, as well as examine their correlations with the nurse practice environment factor at nurse level and hospital level. As for the dependent variables used in this study, they were nurse-perceived patient adverse outcomes(medication error, patient fall, nosocomial infection, pressure sore) and nurse-assessed nursing care in their department, and the Korean General Unit Nursing Work Index was used as the main explanatory variable. The major results of this study are as follow.

First, the level of patient adverse outcomes perceived by nurses working at general inpatient unit in hospitals in our country was relatively higher than that abroad, and among the four areas of patient adverse outcomes, the frequency of ‘patient fall’ and ‘nosocomial infection’ occurrences was relatively high.

Second, ‘doctor-nurse relationship’ was an important factor of nurse practice environment among the four areas of nurse-perceived patient adverse outcomes. In addition, ‘nurse manager support’ was an important factor of nurse practice environment for medication error, while ‘education to improve medical care quality’ and ‘application of nursing process’ were important factors of nurse practice environment respectively for patient fall and medication error & pressure sore.

Third, nurse-assessed ‘quality of nursing care provided in their department’ was significantly lower than that abroad, and the important factors of nurse practice environment in the nurse-assessed ‘quality of nursing care provided in their department’ were ‘application of nursing process’, ‘adequacy nursing staff’, ‘doctor-nurse relationship’ and ‘education to improve medical care quality’.

Fourth, it was possible to examine the nurse practice environment at hospital level in this study unlike existing studies. The hospital level ‘doctor-nurse relationship’ and ‘education to improve medical care quality’ were important nurse practice environment for nurse-perceived adverse patient outcomes. In addition, the hospital level ‘application of nursing process’ and adequacy nursing staff’ were important nurse practice environment for nurse-assessed ‘quality of nursing care in their department’.

Conclusively, it was found that the level of patient adverse outcomes perceived by nurses working at general inpatient unit in hospital in our country was high, and nurses assessed that the quality of nursing care provided in their department is not good. It was also found that nurse practice environment was an important factor in patient adverse outcomes and the quality of nursing care provided in their department. Accordingly, it would be necessary to create a work environment with good doctor-nurse relationship and provide education to improve the quality of medical care at hospital level in order to decrease patient adverse outcomes. For the purpose of increasing the quality of nursing care provided by nurses in their department, it would be necessary for hospitals to create and apply standardized nursing process and ensure sufficient nursing staff.