Measuring the Direct Care Nurses' and Nurse Leaders' Perceptions of a Healthy Work Environment

Healthy work environments (HWEs) have been described as policies, procedures, and processes designed to empower nurses to meet the organizational objectives and achieve personal satisfaction in the work environment. Unhealthy work environments (UWEs) throughout healthcare organizations have been linked to absenteeism, ineffective delivery of healthcare to patients and families, higher stress levels, poor communication, and ineffective collaboration and teamwork among healthcare professionals. The American Association of Critical-Care Nurses (AACN) developed a Healthy Work Environment Assessment Tool (HWEAT) for nurses to use to assess the health of the work environment. Through the adaptation and modification of the AACN HWEAT (AACN, 2005) for nurses, the researcher was able to develop three tools to measure HWEs entitled Healthy Work Environment Scale for Nurse Leaders (HWES for NLs), Healthy Work Environment Scale for Direct Care Nurses (HWES for DCNs), and Healthy Work Environment for Unlicensed Assistive Personnel (HWES for UAP). The purposes of these studies were to modify the AACN HWEAT (AACN, 2005) to develop new instruments; to assess the validity and reliability of the HWES for NLs, HWES for DCNs, and HWES for UAP; and to describe the NLs, DCNs, and UAP perceptions of a HWE using a non-experimental descriptive design. The research study was conducted throughout a large urban healthcare system in Texas. The sample sizes ranged from 300 to 1000 subjects for the studies. Principal component analysis revealed that each instrument had a fairly simple structure with four to seven HWE components including appropriate staffing, authentic leadership, effective decision-making, genuine teamwork, meaningful recognition, physical and psychological safety, skilled communication, and true collaboration with eigenvalues 1.0 or greater. The Cronbach alphas were 0.96 or above, which demonstrated strong internal consistency on all three instruments. Based on the results of these studies, the HWES for NLs, HWES for DCNs, and HWES for UAP instruments demonstrated promising psychometric properties to measure a HWE for nurses at all levels in acute care hospital settings.