Professional Practice Environment Research Articles

Springtime: A time to nourish organizational roots

It's the time of the year where we witness the thawing of winter and the beauty of the first flowers of spring. Although the roots of the plant may have been in the earth for years or decades, the flower pre-sents a new path or a new creation and it is as if we are seeing the plant for the first time. Springtime brings to us a surge of creative energy and new hopes to build on past knowledge and experience. The roots of the National Association of Pediatric Nurse Practitioners go back for three decades and grow from the core organizational values of advocating for children and families, commitment to members, passion for practice, and leadership for all Nurse Practitioners caring for children. These core values remain strong in our strategic plan and continue to guide the executive board and chapter officers as we plan for future opportunities to strengthen the role of the nurse practitioner and address the health care needs of children and families. One such opportunity lies in planning how to best support the changing demographics of the NAPNAP membership. Over the last decade, NAPNAP's membership has become increasingly clinically diverse, with a trend toward members shifting their clinical practice from primary care to acute and specialty care settings. We have responded to this change in membership by actively pursing a greater integration of the acute and specialty care perspectives on national committees and in the Journal of Pediatric Health Care, providing an acute care track in the upcoming national conference, and publishing a position statement on the acute care pediatric nurse practitioner. Meeting the evolving needs of members requires periodically taking on a fresh perspective and knowing when to make substantial changes. In planning for the upcoming conference in Phoenix, the NAPNAP Executive Board and conference planning team has developed an innovative and expanded educational program. We have strengthened the research component of our conference, with specific offerings on evidence-based practice, a session highlighting the newest clinical research results, and a one-on-one research consultation session to discuss your own clinical research and receive ideas and feedback about your research project to include identifying potential research funding sources. In addition, the theme of NAPNAP's 26th annual conference “Grand Challenges in Child Health and Fitness” complements NAPNAP's national Healthy Eating and Activity Together (HEAT©) initiative, with a designated track focused on nutrition and fitness. Also in the plans will be the unveiling of the newly designed NAPNAP Web site in the conference exhibit hall. The new Web site is a work in progress, and we look forward to our members' ideas about how we can improve and expand our Web site content, usability, and access. This spring, as we capture the energy from the return of warm, sunny days, we continue to advocate for and collaborate with other NP associations to achieve improvements in our professional practice environment, including reimbursement parity, licensure, certification, and credentialing issues. Access to care for all patients remains at the forefront of our health policy efforts. We are also tackling new challenges such as the emergence of the practice doctorate and clinical nurse leader roles and the integration of new technologies into research and clinical practice. In addition to these domestic issues, NAPNAP members continue to selflessly serve overseas providing humanitarian relief to the people and nations affected by the tsunami and the war in Iraq. So it is as it should be that this spring we have a renewed enthusiasm for the challenges, opportunities, and privileges of our profession. “Anything is one of a million paths. Therefore you must always keep in mind that a path is only a path. If you feel you should not follow it, then you must not stay with it under any condition. Your decision to keep on the path or to leave it must be free of fear or ambition. Look at every path closely and deliberately. Then ask yourself, and yourself alone, one question: Does this path have heart?”—Carlos Castaneda

A Professional Nursing Practice Environment and Its Impact on Nurses' Task Motivation

This study was aimed at (a) describing professional nursing practice environments embedded in nursing care units and (b) examining its relationships to nurses' task motivation. Using the Nursing Work Index Revised (NWI-R) and the Work Preference Inventory (WPI), a descriptive study was conducted with a sample of 320 registered nurses on 26 nursing care units in one University hospital in Korea. Mean scores were 12.9 on a 5-20 score range of an autonomous environment scale, 7.3 on a 3-12 score range of a collaborative environment, and 15.8 on a 7-28 score range of control over nursing practice. Nurses' age, educational level, job position, working period at the hospital and employment status were significantly related to the degree of a professional practice environment. The extent to which a professional practice environment accounted for task motivation was 19.5%. There is a certain degree of professionalism in the workplace environment that nurses perceived within the nursing care units. When nurses care for patients, the degree of task motivation depends on the work environment supporting the professional nursing practice.

Development and Psychometric Evaluation of the Professional Practice Environment (PPE) Scale

To describe the Professional Practice Environment (PPE) scale, its conceptual development and psychometric evaluation, and its uses in measuring eight characteristics of the professional practice environment in an acute care setting. The 38-item PPE Scale was validated on a sample of 849 professional practice staff at the Massachusetts General Hospital in Boston. Psychometric analysis included: item analysis, principal components analysis (PCA) with varimax rotation and Kaiser normalization, and internal consistency reliability using Cronbach's alpha coefficient. Eight components were shown, confirming the original conceptually derived model's structure and accounting for 61% of explained variance. Cronbach's alpha coefficients for the eight PPE subscales ranged from .78 to .88. Findings showed the 38-item PPE Scale was reliable and valid for use in health outcomes research to examine the professional practice environment of staff working in acute care settings.

Creating a professional practice environment on a shoestring

Did you ever think, “If we just had a little money we could…”? The current health care environment is wrought with financial stressors that can be overwhelming and take up most of our time. Such stress can limit the development of a professional practice environment if you let it. How do you not only survive but thrive in this financial climate?

The scholarship related to nursing work environments: where do we go from here?

Nursing shortages within American hospitals are in part associated with problematic work environments. Scholarship related to work environments is multidisciplinary and has been conducted using traditional and constructivist approaches to science and knowledge development. Nursing research related to nurses' work environments in hospitals is often conceptualized around variables such as job satisfaction, professional practice environment, and job stress. Macro-level variables associated with political, economic, and social aspects of the work environment have received less attention. Philosophical issues are considered. Person-Environment Congruence Theory is proposed as a framework capable of addressing environmental incongruence in hospital nursing work environments. Implications for theory and research using the framework are described.

Patient safety to frame and reconcile nursing issues.

Canadian nursing leadership is called to advance a national patient safety agenda for the delivery of safe, quality care in professional practice environments. Yet, the nursing discipline is burdened by issues and challenges related to clinical practice and workplace dilemmas that contribute to barriers and obstacles to safe, quality and humane care. We propose that the many clinical challenges faced by nurses in Canada can be more fully understood when framed by a patient safety perspective. Nurse executive leaders and nurse scientists are called to reform clinical practice and conduct research to reconcile patient care safety issues. This paper applies findings obtained from nurses via focus groups led by the Academy of Canadian Executive Nurses (ACEN) and integrates these findings into a patient safety perspective via a conceptual framework.

Agency characteristics most valued by home care nurses: findings of a nationwide study.

The demand for home care services is continuing to rise at such a rate that the home care nursing workforce will need to double by 2020. Struggling to recruit and retain an adequate clinician supply in the midst of a severe shortage, administrators may find help in the magnet hospital approach, which focuses on creating a professional practice environment. This study identified, in a national sample of home care nurses, organizational traits reported most important in supporting nurses' professional practice and job satisfaction.

Turnover rate in nursing and midwifery: The Irish experience

It became apparent in 1998 that there was a significant shortage of nurses and midwives in the Republic of Ireland. Because of the lack of data on the reasons for this, a national study was commissioned to estimate the turnover rate among registered nurses and to identify the underlying reasons for the loss of so many trained staff to the profession. Both quantitative and qualitative methodologies were used. Participants were drawn from 128 health service agencies, and 1,921 questionnaires were completed over a one-year period by nurses and midwives leaving the service. Telephone interviews were also conducted with 140 participants. The results indicate a mean turnover rate of 12%, with considerable variations across services. Reasons for leaving included wanting to pursue other employment in nursing (35%), travel abroad (21%) and a desire to undertake further study (12%). It appeared that a considerable number of nurses would have been retained if retention strategies focusing on promotion of greater autonomy, professional development, managerial support, or improved professional practice environments had been introduced.

“Magnet” Status as Markers of Healthy Work Environments

This issue’s interview on healthy work environments is with the chief nurse executives of two hospitals that have attained Magnet Nursing Services Recognition: Doreen Frusti, RN, MSN, MS, is chair of the Mayo Clinic Department of Nursing in Rochester, Minn.; and Carol Robinson, RN, CNAA, MPA, is associate director of Patient Care Services at the University of California, Davis Medical Center. These two have led their organizations in establishing professional practice environments that are known for drawing and retaining nurses locally and nationally. Joanne Disch, RN, PhD, FAAN, conducted the interview.

Does international nurse recruitment influence practice values in U.S. hospitals?

To determine if both U.S. and international nurses place high value on organizational attributes that comprises the elements of professional nursing practice and if the absence of these attributes is associated with high levels of burnout in both U.S. and international nurses. A secondary analysis of survey data was conducted with a sample of 799 nurses; 547 were born in the United States (US) and 252 were from 34 other countries. Culture of origin was coded according to Hofstede's classification system. Nursing values related to the professional practice environment were measured using the Nursing Work Index, and burnout was measured using the Maslach Burnout Inventory. Analysis of variance and least-squares regression procedures were used to test hypotheses. No significant differences were found between U.S. and international nurses in the overall degree to which they valued a professional nursing practice environment. A professional practice environment had a significant, inverse effect on job-related burnout on both U.S. and international nurses. These findings challenge a prevailing sentiment that international nurses hold values inconsistent with professional practice models as defined in the U.S. context. These findings also show that absence of a professional practice environment will produce similar high levels of burnout in both U.S. and foreign-born nurses. To address the nursing shortage, administrators should ensure that organizational attributes are consistent with a professional nursing practice environment.

Measuring organizational traits of hospitals: the Revised Nursing Work Index.

The organizational context in which nurses practice is important in explaining variation in patient outcomes, but research has been hampered by the absence of instruments to measure organizational attributes empirically. To report on the development and utility of the Revised Nursing Work Index (NWI-R) in measuring characteristics of professional nursing practice environments. The NWI-R was used in a national acquired immunodeficiency syndrome (AIDS) care study. The sample consisted of 40 units in 20 hospitals. Of these 20 hospitals, 10 provided AIDS care in both dedicated AIDS units and general medical units, thus introducing to the design an element of internal control. The remaining 10 hospitals were selected through a matching procedure. Three of the matched control hospitals were magnet hospitals. Nurses were recruited into the study if they worked at least 16 hours per week on the study unit. The nurses completed the NWI-R in addition to other measures. A response rate of 86% was attained. Response rates per unit ranged from 73% to 100%. Cronbach's alpha was 0.96 for the entire NWI-R, with aggregated subscale alphas of 0.84 to 0.91. Validity of the NWI-R was demonstrated by the origin of the instrument, its ability to differentiate nurses who worked within a professional practice environment from those who did not, and its ability to explain differences in nurse burnout. The NWI-R has been found to capture organizational attributes that characterize professional nursing practice environments.

Achieving magnet status.

Creating and maintaining a professional practice environment that ensures quality patient outcomes continues to be a challenge in a cost-constrained health care environment. The ability to be recognized for excellence by nursing colleagues is made possible by the Magnet Nursing Services Recognition Program. This article will describe the application preparation, site visit, and evaluation experience of Robert Wood Johnson University Hospital.

Successful Interview Strategies

Every newly hired staff member will affect hundreds of patient outcomes as well as the success of the team at large. An interview determines the applicant's values and identifies if he/she is congruent to the professional practice environment.

Differences in professional practice model outcomes

Over the past several years, involvement strategies such as professional practice models and shared governance strategies have been implemented in a variety of nursing practice settings. This article reviews the results of a secondary analysis of an evaluation of a professional practice model at a large academic medical center. This review compares critical care and general acute care nurses in terms of their perceptions of and satisfaction with work in a professional practice environment and identifies and contrasts significant predictors of general job satisfaction and turnover intent within the two groups. Implications of differences in outcomes in different settings are explored.

Organizing for communication and integration.

Using the departmental philosophy as its foundation, an integrated organizational model was designed for a nursing department. This patient-centered model was implemented to streamline operations, focus resources, and provide a professional practice environment for nursing staff. The "molecule" is used as a teaching tool and organizational framework, with applications ranging from orientation of new staff to management of daily operations.

A center of nursing excellence: supporting the professional practice environment.

The Center of Nursing Excellence is a unique, multifaceted program that promotes the professional practice environment. The Center provides programs and services in six areas: career planning and development, nursing practice review, research and grants support, scholarly affairs, nursing outreach, and nursing resources. The Center serves as a resource to nurses at St. Louis Children's Hospital and in the nursing community at large.