Article

Practice Environments of Nurses Employed in Ambulatory Oncology Settings: Measure Refinement

Christopher R. Friese
communication, nursing
ONF 2012, 39(2), 166-172. DOI: 10.1188/12.ONF.166-172

Purpose/Objectives: To examine the reliability and validity of modified items from the Practice Environment Scale of the Nursing Work Index (PES-NWI) for use in the understudied ambulatory oncology setting.

Design: Cross-sectional mailed survey using a modified Dillman method.

Setting: Southeastern United States.

Sample: Population-based statewide sample of 1,339 oncology nurses who reported employment outside of hospital inpatient units.

Methods: After examining for nonresponse bias, confirmatory factor analysis using structural equation modeling and Cronbach coefficient alphas were employed to examine construct validity and internal consistency, respectively. After calculating revised subscale means for each nurse, the researchers used t tests to compare subscale means between nurses who reported their practice environment as favorable versus those who reported it as mixed or unfavorable.

Main Research Variables: Reliability and validity of items on the adapted version of the PES-NWI.

Findings: Despite a response rate of 31%, no differences in demographic characteristics were observed between the analytic sample and nonresponders. After reducing the number of items to 23, acceptable model fit was achieved with a comparative fit index of 0.95 and a root mean square error of approximation of 0.057. All five existing PES-NWI subscales, plus the new medical assistant support subscale, were significantly higher for nurses who reported favorable practice environments versus those who reported mixed or unfavorable environments.

Conclusions: A revised set of items derived from the PES-NWI has acceptable reliability and validity to measure the quality of nursing practice environments in ambulatory oncology settings. Medical assistant support is a new contribution to the item pool.

Implications for Nursing: Additional testing of this revised measure in diverse samples of nurses, including studies that correlate with patient outcomes, is a necessary next step.

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    References

    Adams, A., Bond, S., & Arber, S. (1995). Development and validation of scales to measure organisational features of acute hospital wards. International Journal of Nursing Studies, 32, 612-627.
    Aiken, L. H., & Patrician, P. A. (2000). Measuring organizational traits of hospitals: The Revised Nursing Work Index. Nursing Research, 49, 146-153.
    Aiken, L. H., Smith, H. L., & Lake, E. T. (1994). Lower Medicare mortality among a set of hospitals known for good nursing care. Medical Care, 32, 771-787.
    American Association for Public Opinion Research. (2011). Standard definitions: Final disposition of case codes and outcome rates for surveys (7th ed.). Retrieved from http://www.aapor.org/Standard_Definitions1.htm
    American Cancer Society. (2012). Cancer facts and figures 2012. Retrieved from http://www.cancer.org/Research/CancerFactsFigures/CancerFactsFigures/cancer-facts-figures-2012
    Association of American Medical Colleges. (2007). Forecasting the supply of and demand for oncologists: A report to the American Society of Clinical Oncology from the AAMC Center for Workforce Studies. Retrieved from http://www.asco.org/ASCO/Downloads/Cancer%20Research/Oncology%20Workforce%20Report%20FINAL.pdf
    Bollen, K., & Lennox, R. (1991). Conventional wisdom on measurement: A structural equation perspective. Psychological Bulletin, 110, 305-314.
    Buerhaus, P. I., Auerbach, D. I., & Staiger, D. O. (2009). The recent surge in nurse employment: Causes and implications. Health Affairs, 28, w657-w668. doi:10.1377/hlthaff.28.4.w657
    Choi, J., Bakken, S., Larson, E., Du, Y., & Stone, P. W. (2004). Perceived nursing work environment of critical care nurses. Nursing Research, 53, 370-378.
    Cummings, G. G., Hayduk, L., & Estabrooks, C. A. (2006). Is the Nursing Work Index measuring up? Moving beyond estimating reliability to testing validity. Nursing Research, 55, 82-93.
    DeVellis, R. F. (2003). Scale development: Theory and applications (2nd ed.). Thousand Oaks, CA: Sage.
    Diamantopoulos, A., & Siguaw, J. A. (2006). Formative versus reflective indicators in organizational measure development: A comparison and empirical illustration. British Journal of Management, 17, 263-282.
    Diamantopoulos, A., & Winklhofer, H. M. (2001). Index construction with formative indicators: An alternative to scale development. Journal of Marketing Research, 38, 269-277.
    Dillman, D. A., Smyth, J. D., & Christian, L. M. (2009). Internet, mail, and mixed-mode surveys: The tailored design method (3rd ed.). Hoboken, NJ: Wiley.
    Erickson, J. I., Duffy, M. E., Ditomassi, M., & Jones, D. (2009). Psychometric evaluation of the Revised Professional Practice Environment (RPPE) scale. Journal of Nursing Administration, 39, 236-243.
    Erickson, J. I., Duffy, M. E., Gibbons, M. P., Fitzmaurice, J., Ditomassi, M., & Jones, D. (2004). Development and psychometric evaluation of the Professional Practice Environment (PPE) scale. Journal of Nursing Scholarship, 36, 279-285.
    Estabrooks, C. A., Tourangeau, A. E., Humphrey, C. K., Hesketh, K. L., Giovannetti, P., Thomson, D., … Shamian, J. (2002). Measuring the hospital practice environment: A Canadian context. Research in Nursing and Health, 25, 256-268. doi:10.1002/nur.10043
    Flood, A. B., & Scott, W. R. (1987). Hospital structure and performance. Baltimore, MD: Johns Hopkins University Press.
    Friese, C. R., Lake, E. T., Aiken, L. H., Silber, J. H., & Sochalski, J. (2008). Hospital nurse practice environments and outcomes for surgical oncology patients. Health Services Research, 43, 1145-1163.
    Friese, C. R., Lee, C. S., O'Brien, S., & Crawford, S. D. (2010). Multi-mode and method experiment in a study of nurses. Retrieved from http://surveypractice.org/2010/10/27/multi-mode-nurses-survey
    George, D., & Mallery, P. (2003). SPSS for Windows step by step: A simple guide and reference, 11.0 update (4th ed.). Boston MA: Allyn and Bacon.
    Groves, R. M. (2002). Survey nonresponse. New York, NY: Wiley.
    Hewitt, M., & Simone, J. V. (Eds.). (1999). Ensuring quality cancer care. Washington DC: National Academies Press.
    Institute of Medicine. (2009). Ensuring quality cancer care through the oncology workforce: Sustaining care in the 21st century. Washington, DC: National Academies Press.
    Kalisch, B. J., & Lee, K. H. (2010). The impact of teamwork on missed nursing care. Nursing Outlook, 58, 233-241.
    Kamimura, A., Schneider, K., Lee, C. S., Crawford, S. D., & Friese, C. R. (2012). Practice environments of nurses in ambulatory oncology settings: A thematic analysis. Cancer Nursing, 35, E1-E7.
    Knafl, K., Deatrick, J., Gallo, A., Holcombe, G., Bakitas, M., Dixon, J., & Grey, M. (2007). The analysis and interpretation of cognitive interviews for instrument development. Research in Nursing and Health, 30, 224-234. doi:10.1002/nur.20195
    Kramer, M., & Hafner, L. P. (1989). Shared values: Impact on staff nurse job satisfaction and perceived productivity. Nursing Research, 38, 172-177.
    Lake, E. T. (2002). Development of the practice environment scale of the Nursing Work Index. Research in Nursing and Health, 25, 176-188.
    Lake, E. T. (2007). The nursing practice environment: Measurement and evidence. Medical Care Research and Review, 64(2, Suppl.), 104S-122S.
    McClure, M. L., Poulin, M. A., Sovie, M. D., & Wandelt, M. A. (1983). Magnet hospitals: Attraction and retention of professional nurses. Kansas City, MO: American Nurses Association.
    Moos, R. H., & Insel, P. M. (1994). A social climate scale: Work environment scale manual (3rd ed.). Mountain View, CA: Consulting Psychologists Press.
    National Quality Forum. (2012). Nursing-sensitive care: Initial measures. Retrieved from http://www.qualityforum.org/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=22094
    Nolan, M., Grant, G., Brown, J., & Nolan, J. (1998). Assessing nurses' work environments: Old dilemmas, new solutions. Clinical Effectiveness in Nursing, 2, 145-154. doi:10.1016/s1361-9004(98)80011-3
    Page, A. (Ed.). (2004). Keeping patients safe: Transforming the work environment of nurses. Washington, DC: National Academies Press.
    Sims, H. P., Jr., Szilagyi, A. D., & Keller, R. T. (1976). The measurement of job characteristics. Academy of Management Journal, 19, 195-212.
    Van Bogaert, P., Clarke, S., Roelant, E., Meulemans, H., & Van de Heyning, P. (2010). Impacts of unit-level nurse practice environment and burnout on nurse-reported outcomes: A multilevel modelling approach. Journal of Clinical Nursing, 19, 1664-1674.
    Vogus, T. J., & Sutcliffe, K. M. (2007). The Safety Organizing Scale: Development and validation of a behavioral measure of safety culture in hospital nursing units. Medical Care, 45, 46-54.
    Whitley, M. P., & Putzier, D. J. (1994). Measuring nurses' satisfaction with the quality of their work and work environment. Journal of Nursing Care Quality, 8, 43-51.
    Willis, G. B. (2004). Cognitive interviewing: A tool for improving questionnaire design. Thousand Oaks, CA: Sage.
    Yabroff, K. R., Lawrence, W. F., Clauser, S., Davis, W. W., & Brown, M. L. (2004). Burden of illness in cancer survivors: Findings from a population-based national sample. Journal of the National Cancer Institute, 96, 1322-1330. doi:10.1093/jnci/djh255