Nursing Practice Environments and Professional and Care-Related Outcomes in Portuguese Emergency Services: A...

Background/Objectives: Emergency Services (ESs) are highly demanding clinical settings where Nursing Practice Environments (NPEs) play a critical role in shaping professional- and care-related outcomes. International evidence suggests that unfavorable NPEs are associated with reduced job satisfaction, compromised care quality, and increased safety risks. This study aimed to describe NPEs and selected professional and care-related outcomes among ESs nurses in Portugal in 2018 and 2022. Methods: A descriptive, cross-sectional study was conducted using data from two national surveys of ESs nurses collected in 2018 (n = 390) and 2022 (n = 434). Data were collected through an online questionnaire including the Practice Environment Scale of the Nursing Work Index (PES-NWI), measures of job satisfaction, intention to leave, perceived quality and safety of care, safety culture, incident occurrence, and missed nursing care. Descriptive statistics were used to summarize results across both samples. Results: NPEs were predominantly classified as unfavorable in both samples, with around 70% of nurses working in unfavorable environments. The most compromised dimensions were staffing and resource adequacy, nurses' participation in hospital affairs, and nurse manager ability, leadership, and support of nurses. Job satisfaction was low in both samples, and a high proportion of nurses reported an intention to leave the organization. Differences were observed between samples in perceived quality and safety of care, incident occurrence, and missed nursing care, particularly in relational and autonomous interventions. Collegial nurse-physician relations emerged as the only favorable dimension in both samples. Conclusions: The findings indicate that NPEs in Portuguese ESs were predominantly unfavorable in both study periods, reflecting structural and organizational challenges. These findings may be associated with nurses' professional outcomes and perceived care quality and safety, highlighting the importance of targeted organizational interventions to improve practice environments.