Nursing Work Index Research Articles

Predictors of physical restraint use on critical care units: An observational structural equation modeling approach

BackgroundModifiable unit characteristics, including nurse work environment, education, certification, and staffing have been shown to impact patient safety. Physical restraints are an important patient safety issue, however the relationships between these modifiable unit characteristics and physical restraint use on critical care units has not been explored. ObjectivesOur objective was to determine the role of nursing work environment, nurse education and certification, and nurse staffing on physical restraint use. DesignThe study was a secondary analysis of 2017–2018 unit-level restraint rates from the National Database of Nursing Quality Indicators linked to Registered Nurse survey and hospital characteristics data. MethodsWork environment was examined at the unit-level using total Practice Environment Scale of the Nursing Work Index and subscale scores. Unit-level nurse expertise included the percent of nurses with at least a Bachelor of Science in Nursing degree and percent with certification. Nurse staffing was the unit-level Registered Nurse hours per patient day and skill mix. Analyses included descriptive statistics, bivariate correlations, and Structural Equation Modeling. We used a first order model to estimate predicted restraint use from the five subscales of the Practice Environment Scale of the Nursing Work Index. A higher order model predicted restraint use from a total work environment factor score. ResultsThe sample included 408 critical care units from 226 hospitals. Mean restraint rate was 15% (SD 12, range 0–53%). In the first-order model, the Collegial Nurse-Physician Relations subscale had a positive relationship with restraint use (β = 0.167, 95% confidence interval 0.010–0.333). In the higher order model, the total work environment score had a negative relationship with restraint use (β = −0.088, 95% confidence −0.178– −0.014). Registered Nurse hours per patient day had a negative relationship to restraint use in both the first order (β = −0.114, 95% confidence interval −0.222–−0.025) and higher order models (β = −0.117, 95% confidence interval −0.223– −0.012). ConclusionWe found that better nurse-physician relationships were associated with higher restraint use. This finding is supported by previous literature and may reflect physician trust in nursing judgement when using restraints. However, a better work environment overall was associated with lower restraint rates. Further, Registered Nurse hours per patient day, but not skill mix, was associated with lower restraint rates. We conclude that improving the overall nurse work environment and nurse staffing, as well as using interprofessional interventions, may be successful in decreasing restraint use on critical care units.

Validation and Psychometric Assessment of the Practice Environment Scale of the Nursing Work Index in the Portuguese Hospital Context.

The nursing work environment has an impact on patient safety outcomes and its measurement should be a regular practice. To assess the reliability and construct validity of the Practice Environment Scale of the Nursing Work Index in the Portuguese context. An exploratory factor analysis followed by a confirmatory factor analysis to assess model adjustment quality was performed with a sample of 3,686 nurses. The final solution for the exploratory factor analysis comprised 26 items and five factors (56.6% of the total variance). The confirmatory factor analysis, after refinement, showed a stable factor structure. The final model showed good construct validity and high reliability, which supports the decision to exclude the items that are not essential to the construct being measured.

Predictors of professional quality of life among nurses–A cross sectional study

A good practice environment is a vital aspect of the staffing and retention of health care workers, especially of nurses affecting patient care. This study investigates the predictors of nurses’ Professional Quality of Life working in public hospitals and private hospitals. A cross-sectional design was utilized, including 374 nurses conveniently sampling selected in two public hospitals and two private hospitals in the Philippines using a Practice Environment Scale of the Nursing Work Index and Professional Quality of Life scale having a good psychometric property, respectively. The overall mean score for practice environment for Nurses is at a low level, whereas the mean Professional Quality of Life score was at a moderate level. Age is significantly associated with the burnout subscale (r=-0.119, p<0.021) and with secondary traumatic stress (r=-0.193, p<0.001). Monthly salary is significantly associated with the compassion satisfaction subscale (r=-0.140, p=0.007) and STS (r=0.107, p=0.038). Meanwhile, the working hours' figure is significantly associated with compassion satisfaction subscale (r=-0.133, p=0.010). Finally, the practice environment of nurses shown is significantly associated with compassion satisfaction subscale (r=-0.426, p=0.007) and secondary traumatic stress (r=0.524, p<0.001). Filipino nurses have a lower practice environment and moderate professional quality of life. The predictors of the professional quality of life of nurses were age, monthly salary, working hours, and their practice environment. Specifically, the higher the salary and the shorter the working hours, the better their professional quality of life. Additionally, the poorer the practice environment, the lower the professional quality of life.

Investigating Nursing Leadership in Intensive Care Units of Hospitals of Northern Greece and Its Relationship to the Working Environment.

The relationship between leadership and the work environment has been studied by many authors at the organization level, but not specifically in intensive care units (ICUs). The aim of this study was to investigate the possible relationship between the work environment and nursing leadership in intensive care units. This is a correlation study. The study population consisted of nurses and nursing assistants with at least 6months of experience in ICUs of Northern Greece hospitals. Data were collected using the Greek version of the Practice Environment Scale of the Nursing Work Index (PES-NWI) and the Multifactor Leadership Questionnaire (MLQ). Statistical analysis of data was done with IBM SPSS v. 22.0. A total of 64 nurses aged 43.6±6.4years were included. In the work environment, the dimensions of nursing staff competence (2.4±0.6) and relationships between nursing staff and physicians (2.4±0.6) were higher, and the dimensions of nursing staff involvement in decision-making in hospital (2.3±0.6), nursing authorities on the quality of healthcare (2.2±0.6), and supervisor abilities and support to nursing staff (2.2±0.6) had the lowest score. The highest scores on the leadership questionnaire were personalized interest (2.6±0.8), and exceptional management (passive) (2.6±0.9). The work environment was not related to nursing leadership. Nurses need individual development plans that include the type of knowledge, skills, attitudes, and values required for leadership. In this context, continuing training centers play an important role because they are responsible for training and developing leaders who are fit for work in intensive care.

Study of the Strengths and Weaknesses of Nursing Work Environments in Primary Care in Spain.

Background: Nursing work environments are defined as the characteristics of the workplace that promote or hinder the provision of professional care by nurses. Positive work environments lead to better health outcomes. Our study aims to identify the strengths and weaknesses of primary health care settings in Spain. Methods: Cross-sectional study carried out from 2018 to 2019. We used the Practice Environment Scale of the Nursing Work Index and the TOP10 Questionnaire of Assessment of Environments in Primary Health Care for data collection. The associations between sociodemographic and professional variables were analyzed. Results: In total, 702 primary care nurses participated in the study. Responses were obtained from 14 out of the 17 Spanish Autonomous Communities. Nursing foundation for quality of care, management and leadership of head nurse and nurse–physician relationship were identified as strengths, whereas nurse participation in center affairs and adequate human resources to ensure quality of care were identified as weaknesses of the nursing work environment in primary health care. Older nurses and those educated to doctoral level were the most critical in the nursing work environments. Variables Age, Level of Education and Managerial Role showed a significant relation with global score in the questionnaire. Conclusion: Interventions by nurse managers in primary health care should focus on improving identified weaknesses to improve quality of care and health outcomes.

Environment, workload, and nurse burnout in public hospitals in Chile.

To analyze, from an organizational perspective, the problem of nurse burnout in highly complex public hospitals in Chile. Multicenter, observational, cross-sectional study. According to established inclusion criteria, the universe of hospitals and nurses was the object of work. Data collection was carried out through a nurse survey. Work environment was measured with the instrument Practice Environment Scale of the Nursing Work Index, staffing through the nurses' report on patient load, and burnout with the Maslach Burnout Inventory emotional exhaustion subscale. Thirty-four hospitals (92%) and 1,395 nurses (75.3%) participated in the study. The prevalence of burnout was 34.7%, being higher in Santiago than in other regions of the country (p = 0.001). The logistic regression analyses showed a significant association between work environment and burnout (OR 0.57, 95% CI 0.41-0.79, p = 0.001). No association was established between staffing, skill mix and burnout. A high percentage of nurses in Chile has burnout, which is significantly associated with the quality of the environment. The implementation of organizational strategies to improve work environments could reduce burnout and improve the quality of care.

Hemşirelerin Bireysel, Mesleki ve Çalışma Ortamı Özelliklerinin Bakım Kalitesi Algılarına Etkisi

Aim: The aim of this study is to examine the effect of nurses’ individual, professional and work environment characteristics on their perceptions of quality of care. Method: This cross-sectional study was conducted in a university hospital where 400 nurses were employed, and conducted with 154 nurses who have been working in this hospital for at least one year and volunteered to participate in the study. The data were collected with an online questionnaire consisting of three parts. The survey form contained questions about the personal, professional characteristics, and workplace environment of the nurses, and their satisfaction levels about their perceptions of quality of nursing care, the Practice Environment Scale of the Nursing Work Index. Descriptive statistics and logistic regression analysis were used in data analysis. Results: Nurses rated their perceptions of quality of nursing care (mean score: 7.53±1.85; range: 0-10). The mean score of nursing work environment scale was 2.77±0.54. In the logistic regression analysis, it was determined that nurses’ perception of quality of nursing care was affected by “provision of necessary funding sources for quality of nursing care, competency level, staffing and resource adequacy total professional experience, nurse participation in hospital affairs (Nagelkerke R2=58%, p<.05). Conclusion: The nurses’ perception of the quality of care is closely related with nursing work environment in the hospital, their perceived self-competence and duration of their professional experience. Support provided by the managers about participation in management processes, providing opportunities for employees to develop their competencies, as well as providing adequate human and other resources in the working environment, will contribute and increase the quality of care.

Rationing of Nursing Care and its Relationship to Nurse Practice Environment in a Tertiary Public Hospital

Objectives. The purpose of the study is to determine the level of rationing of nursing care and its relationship to nurses’ perception of their practice environment. Methods. The study employed a descriptive, cross-sectional study design. The Basel Extent of Rationing of Nursing Care (BERNCA) was administered to assess the level of care rationing while the Practice Environment Scale of the Nursing Work Index (PES-NWI) was used to describe nurses’ practice environment. A total of 147 nurses participated in the study. Multiple regression analysis was conducted to determine the effect of various respondent characteristics and nurse practice environment on care rationing. Results. Only practice environment total score was significantly associated with rationing of care total scores (B = -0.20, p < 0.05). Results of the regression show that for every unit increase in nurse practice environment total score, indicating a better work environment, there is a 0.20 unit decrease in rationing of nursing care total score, which indicated less rationing of care. Respondent characteristics are not significantly related. Conclusion. Nurses most frequently rationed tasks in the areas of caring/support and monitoring. The less frequently rationed tasks involved medical, technical, and therapeutic aspects of care. The identification of rationing predictors can aid in determining starting points for hospital policy reforms. Prevalence levels can indicate when care rationing exceeds identified thresholds, if any. Nursing administrators can use implicit rationing of nursing care as a crucial indicator of the impact of strategies and changes in the nurse practice environment (e.g., changes in staffing levels, skill mix, and other resources).

Nursing practice environment in intensive care unit and professional burnout.

To evaluate and compare the nursing practice environments in Intensive Care Units of a public and private hospital and the prevalence of burnout among nursing professionals. Cross-sectional, descriptive study with a quantitative approach to the data. The data collection took place between October 2018 and March 2019, and it was carried out through a questionnaire with socio-occupational variables and with metrics of intensity. The practice environment was assessed through the Nursing Work Index Revised (NWI-R); and the burnout was assessed by the Maslach Burnout Inventory (IBM). We included professionals with, at least, six months of employment, and those who were on leave or on a fixed-term employment contract were excluded. The sample consisted of 296 professionals. We found Favorable environments in both institutions, however, low results in the subscales autonomy, control and organizational support in the private hospital. The prevalence of burnout among nurses was 2.5% in the public hospital and 9.1% in the private hospital, and among nursing technicians, it was 9.5% and 8.5%, respectively. The control of the environment, autonomy and support were considered critical points, referring to the importance of assessing institutions factors, that can improve the working conditions for the nursing team.

Association of changes in nursing work environment, non-professional tasks, and nursing care left undone with nurse job outcomes and quality of care: A panel study

BackgroundStrengthening quality of care without compromising nurse job outcomes by building a safer health care system is a common concern worldwide including in China. Most of the current evidence comes from cross-sectional studies conducted in western countries, which limits inferences of causality and generalization. ObjectiveThe objectives of this longitudinal study were to compare changes in quality of care, nurse job outcomes, nursing work environment, non-professional tasks, and nursing care left undone in acute hospitals in China between 2014 and 2018. Secondly, we wanted to determine the association of changes in nursing work environment, non-professional tasks, and nursing care left undone with nurse job outcomes and quality of care. Design, settings, and participantsA prospective two-stage panel study conducted in 108 adult medical and surgical units from 23 hospitals in Guangdong province, China in 2014 and repeated in 2018. MethodsWork environment was measured by the Practice Environment Scale of the Nursing Work Index. Non-professional tasks were measured with a seven-item scale surveying the performance of and time spent on non-professional tasks. Nursing care left undone was measured by 12 items addressing necessary nursing activities. Nurse job outcomes included burnout, dissatisfaction, and retention. Quality of care was measured by four items indicating overall quality of care as assessed by nurses (three items) and patients (one item). Generalized estimating equations with linear regression were employed to analyze data. ResultsIn 2018, compared with 2014, the nursing work environment had improved, and non-professional workloads had decreased minimally. The average number of the 12 nursing care tasks left undone had increased to 6.5 from 5.6 in 2014. Fewer nurses reported job dissatisfaction or intention to leave. Quality of care was improved slightly as assessed by nurses and patients. As for the changes of hospital organizational factors on quality of care, a better nursing work environment was related to better nurse job outcomes and quality of care. More non-professional tasks were related to higher levels of nurse job burnout. Less nursing care left undone was associated with better nurse-assessed quality of care. Units with more nurses experiencing job burnout and dissatisfaction were likely to have poorer nurse-assessed quality of care. ConclusionsImproving nursing work environment and supporting nurses to engage in professional and direct patient care as opposed to non-professional work may be beneficial to nurse job outcomes and promote quality of care.

Determinants of emotional exhaustion among nursing workforce in urban Ghana: a cross-sectional study

BackgroundThe subject of emotional exhaustion organisations has become important because of the emerging trends in employment and its associated challenges. Unhealthy practice environment is a major threat in the incidence of emotional exhaustion among nurses; and any organisational culture that do not support its personnel has huge burnout costs. The study aimed at assessing rate of emotional exhaustion; determining factors that accounts for it and also ascertaining the coping strategies used by nurses to overcome it in the Ghanaian health care setting.MethodsA cross-sectional study with a proportionate stratified sampling was used to draw a sample from five health facilities. A standardized questionnaire of Professional Practice Environment Scale of Nursing Work Index, Maslach Burnout Inventory and Coping Scale were used to assess variables under study. The STROBE guidelines were followed in reporting this study.ResultsOut of the 232 registered nurses studied, 91.1% of them reported experiencing moderate to high rate of emotional exhaustion. The practice environment of the nurses explained 39.6% of the variance in emotional exhaustion. Emotion-focused and problem-focused approaches were identified to be used by registered nurses to cope with emotional exhaustion.ConclusionWhen appropriate and effective intervention are employed, emotional exhaustion will be reduce and this will enrich the effectiveness of quality care delivery to patients.

Magnet hospital attributes in nursing work environment and its relationship to nursing students' clinical learning environment and satisfaction.

To analyse nursing students' perception of the Magnet hospital attributes of the work environment at the hospitals where they perform their clinical placement and the relationship of this factor to their clinical learning environment and supervision, satisfaction and intention to stay in those hospitals once graduated. This study had a cross-sectional, correlational, design. Data were collected using self-reported questionnaires from 180 nursing students at a university in southeast Spain between September-October 2018. Nursing work environment and clinical learning environment were measured using the Practice Environment Scale of the Nursing Work Index and Clinical Learning Environment, Supervision and Nurse Teacher scale, respectively. Students' satisfaction with the work environment and with the clinical learning process were measured using a four-point Likert scale developed by the researchers. Percentages, frequencies, mean, standard deviation, χ2 test, Mann-Whitney U test, Spearman and phi correlation were used to analyse the data. Nursing students' perception of greater Magnet-like features at work environment was associated with better clinical learning environment (Spearman rs=|0.22-0.54|; p<.01) and satisfaction with the work environment (Spearman rs=0.18; p=.01) and with their learning process (Spearman rs=0.21; p<.01). Greater intention to stay working in the hospital after graduation was significantly associated with greater satisfaction with the learning process (phi=0.31; p<.01) and the work environment (phi=0.23; p=.02). Magnet-like features at the work environment lead to superior clinical learning environment and higher students' satisfaction, two factors that play a decisive role in their decision to stay at hospitals where they performed clinicals after graduation. In the face of a global nurse shortage, nursing managers and faculty leaders should consider the improvement of nursing workplaces as a strategic alliance to promote satisfactory clinical learning experience and aid recruitment of nurses.

Strain-based work-to-family conflict as a predictor of lumbar and cervical pain in Tunisian nursing staff

Objective. This study aimed to examine the association of the different dimensions and forms of work–family conflict with the occurrence of neck and lower back pain (LBP) in Tunisian nurses. Methods. We conducted a cross-sectional study on nurses assigned to a district hospital in Tunisia. The work–family interface was assessed with the work–family conflict scale of Carlson et al. Psychosocial and organizational constraints at work were assessed through the nursing work index – extended organization in its specific version designed for nurses. Assessment of neck and lumbar pain was carried out with the standardized Nordic musculoskeletal questionnaire. Results. Seventy-two nurses participated in the present study (participation rate = 100%) with a mean age of 42.38 ± 10.85 years. Binary logistic regression analyses retained strain-based work-to-family conflict as a significant determinant of both LBP (p < 10−3; odds ratio [OR] = 5.07; 95% confidence interval [CI] [2.1, 11.7]) and neck pain (p = 0.001; OR = 6.8; 95% CI [2.13, 22]). Conclusions. Strain-based work-to-family conflict was found to predict lumbar and cervical pain more than the other types of conflict in nursing staff. Thus, reducing strain in health-care settings should be a central component of the preventive approach of musculoskeletal disorders in nursing staff.

Undergraduate nurses' perception of the nursing practice environment in university hospitals: A cross-sectional survey.

To describe the psychometric properties of the Practice Environment Scale of the Nursing Work Index (PES-NW) among undergraduate nurses and to compare their perceptions of the nursing practice environment by academic year and unit type. Despite the fact that nursing students develop most of their undergraduate learning and training in the nursing practice environment, their perception about it has not been considered to date. The psychometric properties were analysed on a sample of 180 undergraduate nurses. Data collection was carried out in 2018. Data were analysed using percentages, frequencies, mean, standard deviation and Mann-Whitney U test. Factor structure was evaluated with exploratory factor analysis, and reliability was evaluated with Cronbach's alpha. Psychometric analysis showed an adequate construct validity and reliability for the PES-NWI. Cronbach's Alpha was 0.884. Undergraduate nurses perceived most hospitals as favourable, scoring the 'Nurse-physician relationships' factor highest and 'Staffing and resource adequacy' factor lowest. The PES-NWI is a valid and reliable instrument that could be applied in future research to explore nursing students' perceptions of the nursing practice environment. Nurse managers are responsible for supervising and ensuring that the nursing practice environment at university hospitals meets the necessary criteria to support the workplace learning of undergraduate nurses.

The work environment of haemodialysis nurses and its mediating role in burnout.

The work environment can contribute to the occurrence of nurses' burnout. This study assessed the work environment of haemodialysis nurses andthe extent of burnout they have suffered, and it explored the connection between work environment and burnout. A multicentre cross-sectional study was conducted in 53 public, hospital-based haemodialysis units in Greece. A total of 537 haemodialysis nurses participated. The majority consisted of females (90.8%) who possessed a university degree or a degree from a technological institute (72.6%). They had an average of 15 years of experience in dialysis. The Practice Environment Scale of the Nursing Work Index and the Copenhagen Burnout Inventory (CBI) were used. The demographic characteristics of the participants were also collected. Although the nurses rated their work environment as healthy, they were experiencing a moderate degree of burnout. The multivariate linear regression analysis with the CBI scales as dependent variables was applied. The increased nurses' participation in hospital affairs was associated with decreased personal (coefficient β = -9.4, 95% confidence interval [CI] = -17.4 to -1.3, p = 0.023), work-related (coefficient β = -12.9, 95% CI = -22.5 to -3.5, p = 0.008) and patient-related burnout (coefficient β = -15.9, 95% CI = -24.5 to -7.4, p = < 0.001). The better collegial nurse-physician relationships were associated with decreased personal (coefficient β = -10.7, 95% CI = -18.3 to -3.0, p = .007) and work-related burnout (coefficient β = -15.1, 95% CI = -23.3 to -7.0, p = < 0.001). The work environment of haemodialysis nurseswas associated with burnout. Its improvement is an important tool in administrations' effort to ensure the nursing staff's well-being.

Impact of the implementation of best practice guidelines on nurse's evidence-based practice and on nurses' work environment: Research protocol.

AimTo determine the impact of the Best Practice Spotlight Organization® initiative on nurses’ perception of their work environment and their attitudes to evidence‐based practice.DesignQuasi‐experimental, multicentre study. The intervention is the participation in Best Prectice Spotilight Organizations to implement Best Practice Guidelines.MethodsThe study will include seven centres in the interventional group and 10 in the non‐equivalent control group, all of them belonging to the Spanish national health system. The Practice Environment Scale of the Nursing Work Index, and the Health Sciences Evidence‐Based Practice Questionnaire will be administered to a sample of 1,572 nurses at the beginning of the programme and at 1 year. This 3‐year study started in April 2018 and will continue until December 2021. Statistical analyses will be carried out using the SPSS 25.0. This project was approved by the Drug Research Ethics Committee of the Parc de Salut Mar and registered in Clinical Trials.DiscussionThe study findings will show the current state of nurses’ perception of their work environment and attitudes to evidence‐based practice, and possible changes in these parameters due to the programme.ImpactThe findings could provide a strong argument for health policymakers to scale up the Best Practice Spotlight Organization® initiative in the Spanish national health system.

Quality and Safety in Health Care, Part LXXX: The National Database for Nursing Quality Indicators and the Practice Environment Scale of the Nursing Work Index.

The National Database for Nursing Quality Indicators is an important source of information used to benchmark nursing by unit category in multiple areas related to not only structure and process but also outcome. It also provides some information regarding best practices and the cost to achieve certain results. The Practice Environment Scale of the Nursing Work Index is a frequently used way to measure the professional practice environment of nurses and the relationship of the latter to quality, safety, and other outcomes.

Nursing work environment, professional self-actualization and marketing of the nursing profession: Cross-sectional study.

AimTo explore associations between nurses' sense of professional self‐actualization, nursing work environment and their involvement in promotion and marketing of the nursing profession.DesignA descriptive cross‐sectional study.Methods144 nurses from various clinical fields completed a promotion and marketing activity questionnaire, selected items from the Brief Index of Self‐Actualization and a part of the Revised Nursing Work Index.ResultsNurses' perception of their work environment and holding a master's degree in nursing were associated with their involvement in promotion activities [R 2 = 0.27, F(4, 113) = 10.4, p < .001]. Nurses' perception of their work environment was associated with their sense of professional self‐actualization [R 2 = 0.21, F(2, 121) = 16.5, p < .001]. Nurses' sense of professional self‐actualization did not contribute to the explanation of variance in their involvement in promotion of the nursing profession.

RN4CAST Study in Portugal: Validation of the Portuguese Version of the Practice Environment Scale of the Nursing Work Index

Objective: This study aims to validate the Portuguese version of the Practice Environment Scale of the Nursing Work Index (PES-NWI) and assess construct validity through exploratory and confirmatory factor analyses. Materials and Methods: This cross-sectional study validates the psychometric properties of the PES-NWI in Portugal. Exploratory factorial analysis is used to analyze the psychometric properties of the PES-NWI in a sample of 5,075 Portuguese nurses; the data sample covers all geographic regions in the country. Confirmatory factor analysis is performed to confirm the model’s data adequacy. Results: Factorial analysis explained 54.6 % of the variance and a five-dimension structure. The five factors identified were Nurse Participation in Hospital Affairs, Nurse Manager Ability, Leadership and Support of Nurses, Nursing Foundations for Quality of Care, Staffing and Resource Adequacy, and Nurse-Physician Relations. The confirmatory analysis showed that the five-factor model fit well with the data in the Portuguese context. Conclusion: In a Portuguese health context, the PES-NWI is a valid scale to access the nursing environment and improve working conditions.

Assess the Causes of Absenteeism Among Nurses Working in Hospitals, Eastern Region, Saudi Arabia

Background: The largest groups of health care providers in the country are nurses; they delivered the high percentage of health care. Despite the fact that being the largest group of health providers, the nursing workforce has experienced an acute shortage affecting the delivery of health care. Saudi Arabia is challenged with a chronic shortage of qualified Saudi nurses, accompanied by high rates of absenteeism due to uncertain causes. Aim: This study aims to assess the causes of absenteeism among nurses working in General hospital, and to compare it with other nurses working in psychiatric hospital in Eastern region, Saudi Arabia. Method: Descriptive study design was utilized to conduct in Eastern region of Saudi Arabia. A survey containing an adapted (PES) Practice Environment Scale of Nursing Work Index with where distributed to three hospitals: Erada complex for Mental Health at Al-Dammam, the Prince Saud bin Jalawi Hospital in Al-Ahsa, and Qatif Central Hospital and Dammam Medical Tower. 257 nurses participated on this survey. Result: There was a significant difference in absenteeism between Prince Saud Bin Jalwi (mean =2.94, SD = .885) and Qatif Central Hospital (mean = 2.34, SD = 1.073). Among the reasons of absenteeism, majority is having health problem, stress working, and (47 % ) personal and family problem (60 % ) no cooperative from supervisor, working different shift without weekend off. And no supportive and appreciate from head of department. Conclusion: Nurses were found to have lack of commitment to their present job/work and are extremely dissatisfied in the administrative section. Since majority of the respondents answered they have never been absent for a month, thus considering their level of satisfaction and commitment scale, developing a motivation strategy, to make employees feel that their work is valued and creating flexibility by providing a flextime.