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Background: Research has established a relationship between favorable nurse work environments and better nurse, patient, and organizational outcomes. However, the instrument most frequently used to measure the nurse work environment, the Practice Environment Scale of the Nursing Work Index (PES-NWI), has not had its items significantly re-evaluated since the 1980s. Objective: We sought to examine the psychometric properties of an updated PES-NWI and create an instrument suitable for further testing and refinement to measure the present-day nurse work environment. Specifically, we sought to establish construct, structural, discriminative, and concurrent validity. For reliability, we desired to establish interrater reliability and internal consistency reliability. Methods: We administered a modified PES-NWI to a national sample of direct-care hospital nurses (n = 818) in the United States. We then assessed the psychometric properties of the instrument. Results: While the modified PES-NWI displayed adequate validity and reliability properties, further testing and refinement of the instrument is necessary. Conclusions: With this updated measure of the nurse work environment, researchers and hospital leaders can identify modifiable opportunities for improvement in contemporary hospital nurse work environments which may enhance nurse and patient outcomes. [ABSTRACT FROM AUTHOR]

The 31‐item Practice Environment Scale of the Nursing Work Index (PES‐NWI) has been frequently used globally to measure the nurse work environment. However, due to its length and subsequent respondent burden, a more parsimonious version of the PES‐NWI may be desirable. Item response theory (IRT) is a statistical technique that assists in decreasing the number of items in an instrument without sacrificing reliability and validity. Two separate samples of nurses in the United States (one called the "internal data source" and the other called "external data source"; sample sizes = 843 and 722, respectively) were analyzed. The internal data source was randomly split into training (n = 531) and validating data sets (n = 312), while a separate whole external data source was used as the final validating data set. Using IRT with training data, we removed nine items; two additional items were removed based on recommendations from a previous study. Confirmatory factor analyses supported the validity of the measurement model with the 20‐item of PES‐NWI in both internal and external validation data sources. The correlations among subscales between 31‐ and 20‐item versions were high magnitude for five subscales in both validation data sets (τ = 0.84–0.89). Ultimately, we identified a 20‐item version of the PES‐NWI which demonstrated adequate validity and reliability properties while decreasing data collection burden yet maintaining a similar factor structure to the original instrument. Additional research may be necessary to update the items themselves on the PES‐NWI. NO PATIENT OR PUBLIC CONTRIBUTION: Patients were not involved in setting the research question, the outcome measures, the design, or implementation of the study. [ABSTRACT FROM AUTHOR]

Background: Bullying may undermine patient safety in healthcare organizations threatening quality improvement and patient outcomes. Purpose: To explore the associations between the nursing work environment, nurse‐reported workplace bullying, and patient outcomes. Method: Cross‐sectional analysis of nurse survey data (N = 943). The Practice Environment Scale of the nursing work index was used to measure the work environment, nurse‐reported bullying was measured with the short negative acts questionnaire, and single items measured care quality and patient safety grade. Random effects logistic regressions were used to determine associations controlling for individual, employment, and organizational factors. Findings: Fourty percent of nurses reported experiencing bullying. A higher work environment composite score was significantly associated with a lower risk of bullying (OR = 0.16 [0.12, 0.22], p <.0001). Nurses experiencing bullying were less likely to report good/excellent quality of care (OR = 0.28 [0.18, 0.44], p <.0001) or a favorable patient safety grade (OR = 0.36 [0.25, 0.51], p <.0001). Discussion: The nursing work environment influences the presence of bullying, which can negatively impact patient outcomes. Improving nurse work environments is one mechanism to better address nurse bullying. [ABSTRACT FROM AUTHOR]

Supplemental digital content is available in the text. OBJECTIVE: The aim of this study was to describe the relationships between intent to leave, reasons nurses intend to leave, and the nursing work environment in military hospitals. BACKGROUND: Intention to leave is a precursor of nurse turnover. The reasons nurses intend to leave may be influenced by leader interventions and potentially preventable. METHODS: This descriptive, correlational secondary analysis included 724 nurse survey responses from 23 US Army hospitals. Bivariate correlations and predictive modeling techniques were used. RESULTS: Forty-nine percent of nurses indicated they intended to leave, 44% for potentially preventable reasons. Dissatisfaction with management and the nursing work environment were the top potentially preventable reasons to leave. Nurses who intended to leave for potentially preventable reasons scored aspects of the nursing work environment significantly lower than those intending to leave for nonpreventable reasons. CONCLUSIONS: Identifying potentially preventable reasons in conjunction with intent to leave can provide leaders opportunities to intervene and influence turnover intention. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore how workplace bullying influences nurses' abilities to provide patient care. Background: Nurses' experiences of workplace bullying undermine nursing work environments and potentially threaten patient care. Although there is a link between nurses' experiences of workplace bullying and poor patient care, additional exploration is necessary as current evidence remains underdeveloped and inconclusive. Design: Qualitative descriptive study. Methods: Fifteen inpatient staff nurses who have experienced workplace bullying while working in one hospital located in the southern region of the USA participated in individual, semi‐structured interviews. Inductive thematic analysis was used to analyse interview transcripts in NVivo 12 software. The COREQ checklist for qualitative studies has been used in reporting this study. Results: Three themes, and respective subthemes, were generated from data analysis: (a) workplace bullying as part of the nursing work environment, (b) workplace bullying's influence on nurses and (c) workplace bullying's influence on patient care. Workplace bullying was perceived to be inherent in the nursing work environment; nurses felt that they were targets of workplace bullying because (a) they were new nurses, (b) there was an abuse of power, or (c) the nature of the work occasioned it. Nurses were mentally and emotionally influenced by the bullying. Some nurses perceived that workplace bullying did influence their ability to provide patient care; however, others did not. Conclusions: Organisations must support new nurses and manage relational attributes of the nursing work environment to reduce workplace bullying. Nursing leaders should receive education on fostering and sustaining favourable nursing work environments and be held accountable for behavioural expectations of the organisation. Relevance to clinical practice: Understanding how nurses perceive the work environment to influence their experiences of workplace bullying informs the development of organisational interventions to reduce the behaviour. Furthermore, exploring how nurses' experiences of workplace bullying influences their abilities to provide patient care increases our understanding of workplace bullying implications. [ABSTRACT FROM AUTHOR]

Aim The aim of this study was to confirm the psychometric properties of Practice Environment Scale of the Nursing Work Index in a military population. This study also demonstrates association rule analysis, a contemporary exploratory technique. Background One of the instruments most commonly used to evaluate the nursing practice environment is the Practice Environment Scale of the Nursing Work Index. Although the instrument has been widely used, the reliability, validity and individual item function are not commonly evaluated. Gaps exist with regard to confirmatory evaluation of the subscale factors, individual item analysis and evaluation in the outpatient setting and with non-registered nursing staff. Design This was a secondary data analysis of existing survey data. Methods Multiple psychometric methods were used for this analysis using survey data collected in 2014. First, descriptive analyses were conducted, including exploration using association rules. Next, internal consistency was tested and confirmatory factor analysis was performed to test the factor structure. The specified factor structure did not hold; therefore, exploratory factor analysis was performed. Finally, item analysis was executed using item response theory. The differential item functioning technique allowed the comparison of responses by care setting and nurse type. Results The results of this study indicate that responses differ between groups and that several individual items could be removed without altering the psychometric properties of the instrument. Conclusion The instrument functions moderately well in a military population; however, researchers may want to consider nurse type and care setting during analysis to identify any meaningful variation in responses. [ABSTRACT FROM AUTHOR]

To more precisely evaluate the effects of nurse staffing on hospital‐acquired pressure injury (HAPI) development, data on nursing care hours per patient day (NCHPPD), nursing skill mix, patient turnover (i.e., admissions, transfers, and discharges), and patient acuity were merged with patient information from pressure injury prevalence surveys that were collected annually for the Military Nursing Outcomes Database (MilNOD) project. The MilNOD included staffing and adverse events from 56 medical‐surgical, stepdown, and critical care units in 13 military hospitals over a 4‐year‐period. Data on 1,643 patients were analyzed with Cox proportional hazards models and generalized estimating equations. Staffing was not associated with pressure injuries in stepdown or critical care patients. However, among the 1,104 medical‐surgical patients, higher licensed practical nurse (LPN) nursing care hours per patient day (NCHPPD) 3 days and 1 week prior to the HAPI discovery date were associated with fewer HAPI (HR 0.27, p < .001), after controlling for patient age, Braden mobility score, and albumin level. Neither total staff number, nor RN NCHPPD, nor the proportion of staff who were RNs (RN skill mix) were associated with HAPI. These findings suggest that on military medical‐surgical units, LPNs play a major role in HAPI prevention. Although the national trend in acute care is to staff hospital units with more RNs and patient care technicians, and fewer LPNs, hospitals should reconsider LPNs as valuable members of the nursing care team. © 2016 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]