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Learning Objective 1: Describe the nurse practice environment in rural hospitals.
Learning Objective 2: Distinguish differences between the perceptions of the practice environment by Registered Nurses (RN) and Licensed Practical Nurses (LPN).
Methods: Survey data were collected from RNs and LPNs employed by 23 rural hospitals that were enrolled in a quality collaborative. The Practice Environment Scale (PES) (Lake, 2002) was used to assess the practice environment. Data were collected at baseline, 6 months and 12 months after the baseline survey. The baseline sample (N= 672) included 87% RNs (N=585) and 13% LPNs (N=87).
Results: At baseline, hospital PES means for RNs in descending order were: Nursing Foundation for Quality Care (2.93) Collegial Nurse Physician Relationship (2.83), Nurse Manager Ability, Leadership and Support of Nurses (2.77), Nursing Participation in Hospital Affairs (2.66), and Staffing and Resource Adequacy (2.55). There are no significant differences between PES total or subscale scores at baseline, 6 or 12 months. When comparing RN and LPN responses, RNs report significantly higher scores for Nursing Participation in Hospital Affairs, Nurse Manager Ability, Leadership and Support of Nurses and Collegial Nurse Physician Relationship (p < .05). There is no difference in the total PES score, Nursing Foundation for Quality Care or Staffing and Resource Adequacy.
Conclusion: The work environment in rural hospitals is similar to reported Magnet and non-Magnet samples, and is stable over time. In absence of interventions to improve the work environment, PES scores will not change. Since better environments are linked to higher quality, targeted interventions should focus on fostering staffing adequacy and increase participation in hospital affairs. RNs and LPNs differ in their perception of participation, relationships with physicians and support from managers in the practice environment. The PES subscales reflect components of professional nursing practice.