The Practice Environment Scale of the Nurse Work Index: Translating Scores for Practice

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1 The Practice Environment Scale of the Nurse Work Index: Translating Scores for Practice Creating Healthy Work Environments Conference Sigma Theta Tau International Indianapolis, IN Nora Warshawsky, PhD, RN University of Kentucky April 13, 2013

Environments Conference Sigma Theta Tau International

2 Theoretical Model Nurse Outcomes Work Environment Patient Outcomes

3 Practice Environment Scale of the Nurse Work Index Nurse Participation in Hospital Affairs Nursing Foundations for Quality Care Nurse Manager Leadership, Ability, & Support Adequate Staffing & Resources Collegial Nurse-Physician Relationships Lake, E. T. (2002). Development of the Practice Environment Scale of the Nursing Work Index. Research in Nursing & Health, 25(3),

Staffing & Resources Collegial Nurse-Physician Relationships Lake, E. T. (2002).

4 Nurse Participation in Hospital Affairs Subthemes Items CNO and Administration A chief nursing officer who is highly visible and accessible to staff. A chief nursing officer equal in power and authority to other top-level hospital executives. Administration that listens and responds to employee concerns. Nursing administrators consult with staff on daily problems and procedures. Staff Nurses Involved in Governance Staff nurses are involved in the internal governance of the hospital (i.e. practice and policy committees). Opportunity for staff nurses to participate in policy decisions. Staff nurses have the opportunity to serve on hospital and nursing committees. Career Development Opportunities for advancement. Career development/ clinical ladder opportunity.

Nursing administrators consult with staff on daily problems and procedures. Staff Nurses Involved in Governance Staff nurses are involved in the internal governance of the hospital (i.e. practice and policy committees).

5 Nursing Foundations for Quality Care Subthemes Items Competent Nurses Working with nurses who are clinically competent. A preceptor program for newly hired nurses. Active staff development or continuing education programs for nurses. Quality Culture A clear philosophy of nursing that pervades the patient care environment. High standards of nursing care are expected by the administration. An active quality assurance program. Nursing care is based on a nursing, rather than medical model. Patient Care Management Use of nursing diagnosis. Patient care assignments that foster continuity of care, i.e., the same nurse cares for the patient from one day to the next. Written up-to-date care plans for all patients.

High standards of nursing care are expected by the administration. An active quality assurance program. Nursing care is based on a nursing, rather than medical model.

6 Nurse Manager Leadership, Ability & Support Subthemes Items Nurse Manager A nurse manager who is a good manager and leader. A nurse manager who backs up the nursing staff in decision making, even if the conflict is with a physician. Praise and recognition for a job well done. Supervisor?? Supervisors use mistakes as learning opportunities, not criticism. A supervisory staff that is supportive of nurses.

A nurse manager who backs up the nursing staff in decision making, even if the conflict is with a

7 Adequate Staffing & Resources Enough staff to get the work done. Enough registered nurses to provide quality patient care. Enough time and opportunity to discuss patient care problems with other nurses. Adequate support services allow me to spend time with my patients. Collegial Nurse- Physician Relationships A lot of teamwork between nurses and physicians. Physicians and nurses have good working relationships. Collaboration (joint practice) between nurses and physicians.

Enough time and opportunity to discuss patient care problems with other nurses.

8 Practice Environment Scale Data Composite 2.72 RN - MD Relationships 2.91 Foundations for Quality 2.81 Nurse Manager 2.80 Nurse Participation 2.62 Adequate Resources

9 HOSPITAL Medical ICU Surgical ICU Med-Surg 1 Med-Surg 2 Med-Surg 3 Peri-op 1 Peri-op 2 1. Create excel file displaying data and benchmarks. ADULT CRITICAL CARE ADULT Med/Surg Peri-Operative Mean PES Score 2011 Benchmark Nursing Participation in Hospital Affairs 2011 Benchmark Nursing Foundations for Quality Care 2011 Benchmark Nurse Manager Ability, Leadership and Support of Nurses 2011 Benchmark Staffing and Resource Adequacy Benchmark Collegial Nurse Physician Relations 2011 Benchmark

42 Nursing Participation in Hospital Affairs 2011 Benchmark 2.84 2.77 2.86 2.86 2.90 2.85 2.79 2.79 2011 2.62 2.76 2.72 2.50 3.11 2.81 2.54 2.49 Nursing Foundations for Quality Care 2011 Benchmark 3.

10 2. Apply stop light color coding. > 5% Below Benchmark Within 5% of Benchmark Meet or Exceed Benchmark

11 HOSPITAL Medical ICU Surgical ICU Med-Surg 1 Med-Surg 2 Med-Surg 3 Peri-op 1 Peri-op 2 ADULT CRITICAL CARE ADULT Med/Surg Peri-Operative Mean PES Score 2011 Benchmark Nursing Participation in Hospital Affairs 2011 Benchmark Nursing Foundations for Quality Care 2011 Benchmark Nurse Manager Ability, Leadership and Support of Nurses 2011 Benchmark Staffing and Resource Adequacy Benchmark Collegial Nurse Physician Relations 2011 Benchmark

49 Nursing Foundations for Quality Care 2011 Benchmark 3.08 3.05 3.10 3.10 3.11 3.09 3.02 3.02 2011 2.81 2.98 2.92 2.81 3.17 2.98 2.68 2.

12 3. Count the number of subscales by benchmark status to create summary report. Subscale Nurse Manager Ability, Leadership, and Support Collegial Nurse-Physician Relationships Nursing Participation in Hospital Affairs Nursing Foundations for the Quality Care Met or Exceeded Benchmark Within 5% of Benchmark > 5% below Benchmark Staffing and Resource Adequacy 0 2 5

Nursing Participation in Hospital Affairs Nursing Foundations for the Quality Care Met or

13 3. Draw conclusions Strengths Med-Surg 2 Nurse Manager Leadership Opportunities Peri-operative Services Staffing & Resources

14 Favorability Classification Subscale scores >2.5 Favorable if 4-5 subscales >2.5 Mixed if 2-3 subscales >2.5 Poor if 1 subscales >2.5 Lake, E. T., & Friese, C. R. (2006). Variations in nursing practice environments: Relation to staffing and hospital characteristics. Nursing Research, 55(1), 1-9.

5 Poor if 1 subscales >2.5 Lake, E. T., & Friese, C. R. (2006).

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