Pathway to Excellence Designation, Nurse Work Environment, and Hospital Quality and Safety: A Multi‐State Hospital Study

The Pathway to Excellence (Pathway) program administered by the American Nurses Credentialing Center, recognizes organizations that foster positive nursing practice environments. However, evidence linking Pathway designation to nurse-reported outcomes remains limited. This cross-sectional study integrated data from the Penn 2024 Nurses4All Study and the American Hospital Association Annual Survey. The sample included 16,979 direct care nurses from 1672 hospitals in 10 US states (866 nurses in 63 Pathway hospitals and 16,113 nurses in 1609 non-Pathway, non-Magnet hospitals). The independent variable was Pathway status. Outcomes included nurse-reported work environment, care quality, patient safety, and hospital recommendations. Multilevel linear and logistic regression models estimated associations. Pathway hospitals showed more favorable work environments (γ, the fixed-effect coefficient from multilevel linear models = 0.08, 95% confidence interval [CI] = 0.01-0.16), driven by responsive administration (γ = 0.15, 95% CI = 0.05-0.24) and a clear philosophy of nursing (γ = 0.11, 95% CI = 0.01-0.20). Pathway hospitals also demonstrated a more favorable patient safety climate (γ = 0.51, 95% CI = 0.02-0.99), including more positive perceptions of a non-punitive response to mistakes (γ = 0.12, 95% CI: 0.02-0.23), discussions about error prevention (γ = 0.12, 95% CI: 0.03-0.21), and leadership prioritization of safety (γ = 0.14, 95% CI: 0.02-0.26). Nurses in Pathway hospitals had higher odds of rating the overall work environment as excellent/good (adjusted odds ratio [aOR] = 1.32, 95% CI: 1.06-1.63), quality of nursing care as excellent/good (aOR = 1.35, 95% CI: 1.06-1.71), and of "definitely" recommending their hospital (aOR = 1.32, 95% CI: 1.03-1.69). These results underscore the central role of positive practice environments in delivering high-quality, safer patient care.