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Aims: To explore the relationship between nurse practitioner work environment and nurse practitioner outcomes (job satisfaction and intent to leave) in the United States. Design The study used a cross‐sectional survey design to collect survey data from primary care nurse practitioners in six states in the United States. Methods: We sent mail surveys to 5689 eligible nurse practitioners in Arizona, New Jersey, Washington, Pennsylvania, California and Texas. The mail also contained an online link. Participants could complete either the paper or online questionnaire. In total, 1244 participants completed the survey in 2018–2019. The work environment was measured using the Nurse Practitioner‐Primary Care Organizational Climate Questionnaire comprised of four subscales: Nurse Practitioner‐Administration Relations, Nurse Practitioner‐Physician Relations, Independent Practice and Support and Professional Visibility. Global items measured job satisfaction and intent to leave. We used mixed‐effect proportional‐odds cumulative logit models to assess the association between work environment and job satisfaction and intent to leave. Results: Overall, 90% of participants were either very satisfied or somewhat satisfied with their job and 22% reported intent to leave their job in 1 year. With a one‐unit increase in the organizational‐level Nurse Practitioner‐Administration Relations score, the odds of having a higher job satisfaction level increased by about four times and the odds of intent to leave job decreased by about 60%. A higher organizational‐level Nurse Practitioner‐Physician Relations score was significantly associated with higher job satisfaction and lower odds of intent to leave. Conclusion: Improvements in work environments may improve nurse practitioner job satisfaction and retention. Impact This study examined the relationship between work environment, job satisfaction and turnover intention of nurse practitioners. Better work environment is associated with higher job satisfaction and lower turnover intention. Findings have implications for clinical leadership who can take actions to create better work environments to increase the nurse practitioner workforce capacity. [ABSTRACT FROM AUTHOR]

Aims: To assess the impact of community‐level characteristics on the role of magnet designation in relation to hospital value‐based purchasing quality scores, as health disparities associated with geographical location could confound hospitals' ability to meet outcome metrics. Design: This cross‐sectional study was carried out between October 2021 and March 2022 using data from 2016 to 2021. Methods: Propensity score analysis was used to match hospital and community‐level characteristics, implementing nearest neighbour matching to adjust for pre‐treatment differences between magnet and non‐magnet hospitals to account for multi‐level differences. Secondary data were obtained from all operational acute‐care facilities in the United States that participated in the Centers for Medicare and Medicaid Services' hospital value‐based purchasing (HVBP) program. Dependent variables were the four value‐based purchasing domains that comprise the Total Performance Score (TPS; Clinical Care, Person and Community Engagement, Safety, and Efficiency and Cost Reduction). Results: Magnet hospitals had increased odds for better scores in the HVBP domains of Clinical Care and Person and Community Engagement, and decreased odds for having better Safety. However, no statistically significant difference was found for the Efficiency domain or the TPS. Conclusion: Measuring performance equitably across organizations of various sizes serving diverse communities remains a key factor in ensuring distributive justice. Analysing the TPS components can identify complex influences of community‐level characteristics not evident at the composite level. More research is needed where community and nurse‐level factors may indirectly affect patient safety. Impact This study's findings on the role of community contexts can inform policymakers designing value‐based care programs and healthcare management administrators deliberating on magnet certification investments across diverse community settings. No patient or public contribution: For this study of US hospitals' organizational performance, we did not engage members of the patient population nor the general public. However, the multi‐disciplinary research team does include diverse perspectives. [ABSTRACT FROM AUTHOR]