This study explored the relationships between nurse-sensitive structures, processes (work engagement [WE], frequency of fall risk discussion during report, and frequency of purposeful rounds), and patient falls.Strong WE is associated with better nurse-assessed quality of care, but previous research is limited by self-reported outcome measures.We used a descriptive, cross-sectional, survey design with 41 nursing units from 7 hospitals. Nurses completed a survey including the Utrecht Work Engagement Scale. National Database of Nursing Quality Indicators reports provided falls data.WE was not related to patient falls, even after controlling for RN staffing and skill mix. The nursing units that had more nurses performing frequent purposeful rounds experienced greater falls with injury. Highly engaged nurses participated more in purposeful rounding and discussion of fall risk during bedside report than less engaged nurses.Further research is needed to understand the impact of WE on patient outcomes.