Measuring the hospital practice environment: a Canadian context

Area of Science:

• Nursing
• Healthcare Management
• Psychometrics

Background:

• Assessing the hospital practice environment is crucial for registered nurse (RN) retention and patient outcomes.
• The Nursing Work Index-Revised (NWI-R) is a widely used tool, but its psychometric properties require validation in diverse healthcare settings.
• Understanding the RN practice environment in Canada is essential for targeted quality improvement initiatives.

Purpose of the Study:

• To document the psychometric properties of the revised Nursing Work Index (NWI-R) within a large Canadian sample of registered nurses.
• To validate the NWI-R's applicability and reliability in the Canadian acute care hospital context.
• To explore the factor structure of the NWI-R for measuring the RN practice environment.

Main Methods:

• A self-administered survey utilizing the NWI-R was distributed to 17,965 registered nurses across 415 hospitals in three Canadian provinces.
• Exploratory principal components analysis with a forced one-factor solution was employed to derive the practice environment index.
• Key assumptions supporting the aggregation of NWI-R responses were statistically tested.

Main Results:

• The one-factor solution for the NWI-R demonstrated a parsimonious and valid measure of the registered nurse practice environment in Canadian acute care hospitals.
• The psychometric properties of the NWI-R were confirmed for this large Canadian sample.
• Assumptions regarding the aggregation of NWI-R data were supported within the Canadian context.

Conclusions:

• The revised Nursing Work Index (NWI-R) is a psychometrically sound instrument for assessing the practice environment of registered nurses in Canadian acute care settings.
• The one-factor solution provides a reliable index for evaluating the RN practice environment.
• Further research is recommended to ascertain the predictive validity of this index and its cross-national applicability.