| Learning Objective #1: Describe the theoretical framework linking the hospital nursing practice environment and nurse staffing to patient outcomes | |||
| Learning Objective #2: Describe the measurement of the hospital nursing practice environment using the Practice Environment Scale of the Nursing Work Index |
Objectives: To compare the nursing practice environments of a broad set of hospitals with those of nursing “magnet” hospitals; to estimate in a broad sample the proportion of hospitals with "magnet-like" environments; to examine the associations between better or worse practice environments and hospital characteristics (e.g., bedsize) and nurse staffing.
Design: Secondary analysis of nurse survey data.
Population, Samples, Setting, Years: Community hospitals: 16 reputational magnet hospitals (1985-1986), 7 ANCC-certified magnet hospitals (1998), and 154 Pennsylvania hospitals (1999).
Concepts: nursing practice environment, staffing
Methods: The Practice Environment Scale of the Nursing Work Index (PES-NWI) was used to measure and compare the nursing practice environment across the samples. Associations between the practice environment and hospital structural characteristics and staffing were analyzed by ordered logit regression and ANOVA, respectively.
Findings: About 20% of the broad sample had practice environments similar to those of magnet hospitals. Better or poorer environments were not associated with hospital structural characteristics. Hospitals with better practice environments also had higher staffing.
Conclusions: A sizable proportion of hospitals not recognized formally for nursing distinction have good nursing practice environments. No particular hospital structural characteristics appear to be necessary to provide better nursing practice environments. It appears that hospital managers address the organization of nursing as a package of social structural (i.e., the practice environment) and human resource (i.e., staffing) decisions: they either invest in nursing or they do not.
Implications: The common occurrence of better staffing with better practice environments, and vice versa, has theoretical and empirical implications. Both aspects of the organization of hospital nursing may operate in concert to influence nurse and patient outcomes; their separate effects may be impossible to disentangle. Research that has linked staffing ratios to patient adverse events, including death, may have accounted for the unmeasured influence of the practice environment on outcomes.
Back to Health Policy
Back to 14th International Nursing Research Congress
Sigma Theta Tau International
10-12 July 2003