Background: The impact of registered nurse (RN) staffing on patient care quality has been extensively studied.Identifying additional modifiable work environment factors linked to patient care quality is critical as theprojected shortage of approximately 250,000 RNs over the next 15 years will limit institutions’ ability to rely on RNstaffing alone to ensure high-quality care.Purpose: WeexaminedtheassociationbetweenRNs’ratingsofpatientcarequalityandseveralnovelworkenvironmentfactorsadjustingfortheeffectsoftwostaffingvariables:reportedpatient-to-RNratiosandratingsofstaffingadequacy.Methodology: We used a cross-sectional, correlational design and a mailed survey to collect data in 2009 from anationalsampleofRNs(n=1,439)intheUnitedStates.Amultivariatelogisticregressionwasusedtoanalyzethedata.Findings: Workgroup cohesion, nurseYphysician relations, procedural justice, organizational constraints, and physicalwork environment were associated with RNs’ ratings of quality, adjusting for staffing. Furthermore, employment in aMagnet hospital and job satisfaction were positively related to ratings of quality, whereas supervisory support was not.Practice Implications: Our evidence demonstrates the importance of considering RN work environment factorsotherthanstaffingwhenplanningimprovementsinpatientcarequality.Healthcaremanagerscanuse the resultsofour study to strategically allocate resources toward work environment factors that have the potential to improvequality of care.Key words: nurse staffing, nurse work environment, nursing practice environment, patient care quality, work environment redesignMaja Djukic, PhD, RN, is Assistant Professor, College of Nursing, New York University, New York. E-mail: md1359@nyu.edu.Christine Kovner, PhD, RN, is Professor, College of Nursing, New York University, New York. E-mail: ctk1@nyu.edu.Carol S. Brewer, PhD, RN, is Professor, School of Nursing, University at Buffalo, New York. E-mail: csbrewer@buffalo.edu.Farida K. Fatehi, MS, is Junior Research Analyst, College of Dentistry, New York University, New York. E-mail: fkf200@nyu.edu.Daniel Cline, MSN, RN, CRNP, is PhD Candidate and John A. Hartford Foundation BAGNC Scholar 2010Y2012, College of Nursing,New York University, New York. E-mail: ddc272@nyu.edu.This work was supported by the Robert Wood Johnson Foundation. Permission to conduct the study was granted by the New York University andthe University at Buffalo Institutional Review Boards.This paper was presented on April 2011 at the American Association of Nurse Executives 44th Annual Meeting and Exposition Meeting inSan Diego, California.The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.DOI: 10.1097/HMR.0b013e3182388cc3