Critical Care Nurses’ Work Environments Value of Excellence in Beacon Units and Magnet Organizations

The development and validation of the hospital organizational environment scale for medical staff in China

Objectives

There is currently no measure of the hospital organizational environment targeting both clinicians and nurses in China. This study was conducted with the aim of developing and testing an instrument to assess the properties of the hospital organizational environment that is applicable to Chinese medical staff.

Methods

Items were developed based on a literature review, semi-structured interviews and an expert review and finalized based on corrected item-total correlation, content validity, construct validity, convergent validity, discriminant validity and reliability. The two samples for testing the first and final version of the Hospital Organizational Environment Scale (HOES) included 447 and 424 participants, respectively.

Results

The primary test, which comprised 18 items, contained four factors: hospital culture, work situation, organizational support and scientific research situation. The Cronbach's alphas were 0.935, 0.824, 0.943, and 0.920, respectively. The results of the validation test showed that the questionnaire had good validity and reliability.

Conclusion

The HOES is a comprehensive instrument with demonstrated validity and reliability that can be adopted among medical staff to assess the organizational environment in hospitals.

The implementation of a professional practice model to improve the nurse work environment in a Dutch hospital: A quasi-experimental study

Aims

To evaluate the effects of the implementation of a professional practice model based on Magnet principles on the nurse work environment in a Dutch teaching hospital.

Design

A quasi‐experimental study.

Methods

Data were collected from registered nurses working on the clinical wards and outpatient clinics of the hospital in June/July 2016 (baseline) and in June/September 2019 (measurement of effects). Participants completed the Dutch Essentials of Magnetism II survey, which was used to measure their perception of their work environment. After baseline measurements were collected, interventions based on a professional practice model incorporating Magnet principles were implemented to improve the nurse work environment. Descriptive statistics and independent t‐tests were conducted to examine differences between survey outcomes in 2016 and 2019.

Results

Survey outcomes revealed significant changes in the nurse work environment between 2016 and 2019. Seven of the eight subscales (essentials of magnetism) improved significantly. Score for overall job satisfaction increased from 7.3 to 8.0 and score for quality of care increased from 7.0 to 7.6. On unit level, 17 of the 19 units showed improvement in the nurse work environment.

Conclusion

The implementation of a professional practice model positively affects the nurse work environment, job satisfaction and quality of care.

Impact

Nowadays, the quality of care is threatened by workload pressure and the low autonomy experienced by nurses. Considering the global shortage of nurses and growing complexity of healthcare, it is important to invest in improving the nurse work environment. The Magnet concept created a work environment in which nurses can deliver optimal quality of care. Knowledge of how Magnet principles affect the nurse work environment in the Netherlands is missing. These study results, including the description of how the interventions were implemented, will assist other hospitals to develop improvement strategies by focusing on the nurse work environment.

The Beacon Collaborative: A Journey to Excellence

TOPIC

The development of the Critical Care Beacon Collaborative to achieve meaningful recognition.

CLINICAL RELEVANCE

Recognizing nurses for contributions to their work environment and care delivery is important for their professional and personal fulfillment, job satisfaction, and retention; such recognition can occur at the individual, unit, or organizational level. The American Nurses Credentialing Center's Magnet Recognition Program acknowledges nursing excellence at the organizational level. It would, however, be difficult for an organization to achieve Magnet designation without nursing excellence at the unit level. To recognize excellence at the unit level, the American Association of Critical-Care Nurses developed the Beacon Award in 2003.

OBJECTIVE

To describe one academic medical center's journey toward winning Beacon Awards across 8 units within the adult critical care service.

CONTENT COVERED

The Critical Care Beacon Collaborative resulted in a Beacon Award for each unit and important staff outcomes. This article describes the organization, the process before the Critical Care Beacon Collaborative convened and the desired state, and the methods used to achieve our goal. It also discusses unit- and service-level stakeholder involvement. The successes, lessons learned, sustainability, and growth of the Critical Care Beacon Collaborative are shared to assist readers who aspire to pursue a Beacon Award.

Quality and Safety in Healthcare, Part LXXXI: Critical Care Nursing and the Beacon Award for Excellence

When the "Standards for Establishing and Sustaining Healthy Work Environments" set forth by the American Association of Critical-Care Nurses are met in a health care system, there is enhanced safety and quality care for the patient, better job satisfaction, and less turnover by the staff. The American Association of Critical-Care Nurses started the Beacon Award for Excellence not only to recognize those who have such high standards but also to encourage units who already have achieved this distinction or are applying for it to do better.

The state of the science of nurse work environments in the United States: A systematic review

A healthy nurse work environment is a workplace that is safe, empowering, and satisfying. Many research studies were conducted on nurse work environments in the last decade; however, it lacks an overview of these research studies. The purpose of this review is to identify, evaluate, and summarize the major foci of studies about nurse work environments in the United States published between January 2005 and December 2017 and provide strategies to improve nurse work environments. Databases searched included MEDLINE via PubMed, CINAHL, PsycINFO, Nursing and Allied Health, and the Cochrane Library. The literature search followed the PRISMA guideline. Fifty-four articles were reviewed. Five major themes emerged: 1) Impacts of healthy work environments on nurses' outcomes such as psychological health, emotional strains, job satisfaction, and retention; 2) Associations between healthy work environments and nurse interpersonal relationships at workplaces, job performance, and productivity; 3) Effects of healthy work environments on patient care quality; 4) Influences of healthy work environments on hospital accidental safety; and 5) Relationships between nurse leadership and healthy work environments. This review shows that nurses, as frontline patient care providers, are the foundation for patient safety and care quality. Promoting nurse empowerment, engagement, and interpersonal relationships at work is rudimental to achieve a healthy work environment and quality patient care. Healthier work environments lead to more satisfied nurses who will result in better job performance and higher quality of patient care, which will subsequently improve healthcare organizations' financial viability. Fostering a healthy work environment is a continuous effort.

Resolving Communication Challenges in the Intensive Care Unit

Communication in the intensive care unit (ICU) is challenging because of complexity, high patient acuity, uncertainty, and ethical issues. Unfortunately, conflict is common, as several studies and reviews confirm. Three types of communication challenges are found in this setting: those within the ICU team, those between the ICU team and the patient or family, and those within the patient’s family. Although specific evidence-based interventions are available for each type of communication challenge, all hinge on clinicians being culturally competent, respectful, and good communicators/listeners. Critical care advanced practice nurses promote a positive team environment, increase patient satisfaction, and model good communication for other clinicians. All advanced practice nurses, however, also need to be adept at having difficult conversations, handling conflict, and providing basic palliative care, including emotional support.

A longitudinal analysis of nursing specialty certification by Magnet® status and patient unit type

The objective of this study was to examine nursing specialty certification trends by Magnet® status and unit type. Research exploring organizational and unit attributes associated with higher specialty certification rates is timely given the beginning evidence that certification is associated with lower patient adverse events. The sample included 6047 units in 1249 National Database of Nursing Quality Indicators hospitals. Hierarchical linear modeling was used to predict growth in percentage of specialty-certified RNs within each unit type and Magnet status. Data (Bayesian Information Criteria = 224 583.30) demonstrated significant growth in specialty certification rates over time (P < .0001). Magnet-designated organizations had significantly different starting certification rates (P = .0002) and rates of change (P = .0002). Unit types also had significantly different starting certification rates (P < .0001) and different rates of change (P < .0001). Magnet recognition is associated with increases in specialty certification rates. Certification rates have risen faster in unit types such as pediatric critical care than in unit types such as adult step-down and adult surgical.

The relationship between nurses' perception of work environment and patient satisfaction in adult critical care

BACKGROUND

Patient satisfaction in critical care is rarely measured yet has a major impact on hospital reimbursement. The critical care setting is characterized by high patient acuity and a fast-paced work environment. Nurses' perception of work environment in relation to various patient outcomes including patient satisfaction has not been explored exclusively in critical care.

OBJECTIVES

(a) Examine patient's perception of nursing care associated with their hospitalization in the intensive care unit. (b) Describe nurses' perception of work environment within a defined sample of adult critical care units, using the Practice Environment Scale of the Nursing Work Index (PES-NWI). (c) Explore the relationships between nurses' perception of work environment and patient satisfaction in adult critical care.

METHODS

This study used existing data to address the study aims. Unit-level comparisons were examined using analysis of variance. The final aim was examined using multilevel modeling for longitudinal data.

RESULTS

Patients were very satisfied with their hospitalization (4.48 out of 5.0). Significant differences were noted among all unit level comparisons (p < .001). Nurses also reported moderate satisfaction with work environment as measured by the PES-NWI, with perception of the role of their nurse manager receiving the highest scores. Perception of nurse manager leadership and ability was significantly related to patient satisfaction (p= .018). Favorable perception of the nurse manager was associated with a .424 point increase in patient satisfaction.

CONCLUSIONS

This study offers preliminary support for the relationship between nurses' perception of work environment and patient satisfaction in critical care. It also highlights the pivotal role of the nurse manager in both nurse and patient satisfaction.

CLINICAL RELEVANCE

This study examines two important aspects that are both relevant and important to clinical nursing. The first aspect is the healthy work environment. Multiple studies have linked the nursing work environment to patient outcomes and this is an area that deserves further attention. The second aspect, patient satisfaction, is now associated with hospital reimbursement. The relationship between the nursing work environment and patient satisfaction highlights an important link to improving patient care.

How magnetic are Finnish hospitals measured by transformational leadership and empirical quality outcomes?

AIM

  The overall aim of this study was to examine nurses' and patients' perceptions of the Magnet model components of transformational leadership and empirical quality outcomes in four Finnish hospitals and to determine if the evidence for transformational leadership and empirical quality outcomes is the same or different in the four hospitals.

BACKGROUND

  This report presents baseline measurements for a longitudinal study of the adaptation of the Magnet model in Finnish hospitals.

METHODS

  Web-based surveys and mailed questionnaires were used in 2008-2009 to collect data from patients (n = 2566) about their satisfaction with care, and from nursing staff about transformational leadership (n = 1151), job satisfaction (n = 2707) and patient safety culture (n = 925) in the selected hospitals.

RESULTS

  Awareness of the work of nursing leaders was low. Nurses reported a high level of job satisfaction. Patient safety culture varied considerably between the four hospitals. Patients believed they generally received excellent quality care.

CONCLUSIONS

  Leadership systems are in transition at the hospitals. Patient safety culture is a complex phenomenon that may be unfamiliar to respondents. The results of the study provide a baseline description to guide the journey toward development of Magnet standards.

IMPLICATIONS FOR NURSING MANAGEMENT

  Finnish nursing leaders, especially nursing directors, should increase their visibility by working more closely with their staff. They should also pay attention to giving direct feedback about work generally and patient safety issues in particular.

Moral distress and structural empowerment among a national sample of Israeli intensive care nurses

AIM

The aim of this study was to determine levels of structural empowerment, moral distress, and the association between them among intensive care nurses.

BACKGROUND

Structural empowerment is the ability to access sources of power. Moral distress is the painful feelings experienced when a person knows the right thing to do but cannot do so due to external constraints. Several studies suggest a theoretical relationship between these concepts.

DESIGN

Cross-sectional, descriptive correlational study.

METHODS

Members of the Evidence Based Nursing Practice Committee of the Israeli Society for Cardiology and Critical Care Nurses recruited a convenience sample of intensive care nurses from their respective institutions and units. Nurses were asked to complete three questionnaires (demographic and work characteristics, Moral Distress Scale, and the Conditions of Work Effectiveness Questionnaire-II). Data were collected between May-September 2009.

RESULTS

Intensive Care nurses had moderate levels of structural empowerment, low levels of moral distress frequency, and moderately high moral distress intensity. A weak correlation was found between moral distress frequency and structural empowerment. No other structural empowerment component was associated with moral distress. Work characteristics as opposed to demographic characteristics were more associated with the study variables.

CONCLUSIONS

This study weakly supports the association between structural empowerment and moral distress. It also provides further evidence to the theory of structural empowerment as characterized in the critical care environment. Further studies are indicated to determine what other factors might be associated with moral distress.

Hospital and unit characteristics associated with nursing turnover include skill mix but not staffing level: an observational cross-sectional study

BACKGROUND

Nursing turnover is expensive and may have adverse effects on patient care. Little is known about turnover's association with most hospital and nursing unit characteristics, including nurse staffing level and registered nurse skill mix.

OBJECTIVE

To explore associations between nursing unit turnover rates and several hospital- and unit-level variables, including staffing level and skill mix.

DESIGN

Observational cross-sectional study of longitudinal data.

SETTINGS

1884 nursing units in 306 U.S. acute care hospitals.

METHODS

During a 2-year period units reported monthly data on staffing and turnover. Total nursing staff turnover and registered nurse turnover rates were modeled as dependent variables in hierarchical Poisson regression models. The following hospital characteristics were considered as predictors: Magnet(®) status, ownership (government or non-government), teaching status, locale (metropolitan, micropolitan, or rural), and size (average daily census). The U.S. state in which the hospital was located was included as a covariate. Unit-level variables included total nursing hours per patient day, size of nursing staff, registered nurse skill mix, population age group (neonatal, pediatric, or adult), and service line (critical care, step-down, medical, surgical, medical/surgical, psychiatric, or rehabilitation).

RESULTS

Government ownership, Magnet designation, and higher skill mix were associated with lower total turnover and registered nurse turnover. Neonatal units had lower total and registered nurse turnover than pediatric units, which had lower total and registered nurse turnover than adult units. Unit service line was associated only with total turnover. Psychiatric, critical care, and rehabilitation units had the lowest mean turnover rates, but most differences between service lines were not significant. The other explanatory variables considered were not significant.

CONCLUSIONS

Several hospital and unit characteristic variables have significant associations with nursing turnover; these associations should be taken into account in nursing turnover research and need to be explored further. Controlling for hospital ownership, Magnet status, unit service line, and unit population age group, registered nurse skill mix is apparently more important than total nurse staffing level in predicting nursing turnover.

Integrating quality and safety science in nursing education and practice

Worldwide, health care delivery systems are applying new quality and safety science in response to startling reports of negative patient outcomes. Many health care professionals lack the knowledge, skills and attitudes to change the systems in which they work, calling for radical redesign of nursing education to integrate new safety and quality science. This paper describes the transformation underway in nursing education in the United States to integrate quality and safety competencies through the Quality and Safety Education for Nurses (QSEN) project. A national expert panel defined the competencies and surveyed US schools of nursing to assess current implementation. To model the changes needed, a 15-school Pilot Learning Collaborative completed demonstration projects and surveyed graduating students to self-assess their achievement of the competencies. A Delphi process assessed level and placement of the competencies in the curriculum to offer educators a blueprint for spreading across curricula. Specialty organisations are cross-mapping the competencies for graduate education, educational standards have incorporated the competencies into their essentials documents, and a train the trainer faculty development model is now helping educators transform curriculum. Two key questions emerge from these findings: Are any of these projects replicable in other settings? Will these competencies translate across borders?

Factors that influence pediatric intensive care unit nurses to leave their jobs

The purpose of this qualitative study was to discover why 10 nurses voluntarily left the pediatric intensive care unit (PICU) at 1 large pediatric hospital in the southwest. Critical theory provided the philosophical framework, whereas action research and Heideggerian hermeneutic phenomenology provided the methodological framework. Data analysis was conducted using the circular hermeneutic process described by Heidegger and explicated by Diekelmann. From the findings of this study, it was concluded that there is an inescapable and inevitable tension between the human factors and the PICU work environment. Nurses identified the constitutive pattern of unrelieved job stress as the major reason they left the PICU. The multidimensional and interactive environmental characteristics of nature of the job, insufficient resources, and negative perceptions of managers/team leaders contributed to the development of job stress. The results of this study revealed the evidence needed to begin to focus on interventions in the areas of nursing practice, education, and research required, reducing the likelihood of losing more PICU nurses.

Neonatal intensive care unit and emergency department nurses' descriptions of working together: building team relationships to improve safety

Teamwork is considered a critical factor in delivering high-quality, safe patient care although research on the evidence base of the effectiveness of teamwork and communication across disciplines is scarce. Health care providers have limited educational preparation for the communication and complex care coordination across disciplines required by today's complex patients. Complex work environments are affected by little understood human factors including the intricacies of human communication and behavior. To understand how nurses view teamwork, this secondary qualitative analysis examined nurses' perceptions of working in high-performance areas with interdisciplinary teams. Results from 4 focus groups of 18 nurses from a neonatal intensive care unit and emergency department trauma resuscitation teams, revealed 3 themes with descriptive meanings to help understand the complexities of teamwork. These findings illustrate the rewards and challenges for teams working together in the current health care environment. Continuing to investigate teamwork can add to our understanding of what nurses and health professionals need to know about teamwork to help develop evidence-based team training in prelicensure education and in practice settings.

The relationship between healthy work environments and retention of nurses in a hospital setting

AIM

The purpose of the present paper was to determine the effect a healthy work environment has on the retention of nurses in a hospital setting.

BACKGROUND

There is a nursing shortage that has been ongoing and is expected to continue, resulting in challenges for the healthcare system in the United States. The significance of this issue is the impact the nursing shortage will have on healthcare organizations and patients.

EVALUATION

The present paper included an extensive review of the current literature. The literature reviewed encompassed scholarly peer-reviewed journal articles. This article focused on nurses, work environments and the impact of the work environments on retention.

KEY ISSUES

Important issues that emerged from this analysis were the dangers of an unhealthy environment, the impact a healthy work environment has on patient outcomes and retention, the Magnet link to healthy work environments and the manager's role in creating and sustaining a healthy work environment.

CONCLUSION

The literature provided evidence of the link between healthy work environments and the retention of nurses in a hospital setting.

IMPLICATIONS FOR NURSING MANAGEMENT

The implications for management are to implement changes now to create a healthy work environment that will recruit and retain nurses to secure their position in the future.

Certification, empowerment, and intent to leave current position and the profession among critical care nurses

BACKGROUND

This study was based on the American Association of Critical-Care Nurses' (AACNs') interest in determining the value and influence of specialty certification.

OBJECTIVES

To examine relationships between AACN specialty certification and empowerment, and, secondarily, to examine these variables as related to intent to leave the current position and the nursing profession.

METHODS

AACN members were asked to participate in a Web-based survey; 6589 AACN members completed the surveys.

RESULTS

Perceptions of empowerment differed significantly among nurses certified by AACN and nurses without such certification. Additional analyses revealed significant differences in empowerment related to position, education, salary, ethnicity, sex, intent to leave the current position, and intent to leave the profession. Forty-one percent of the participants indicated intent to leave their current position in the next year; only 6.9% indicated their intent to leave the profession in the next year. Intent to leave current position differed significantly according to age, sex, years of experience, ethnicity, educational level, and certification.

CONCLUSIONS

The value of specialty certification and the importance of empowerment among critical care nurses are affirmed. The next step in the continued journey toward increasing retention of critical care nurses, and thereby improving patient care, is to evaluate existing programs focused on retention and identify needed enhancements.

HIPP lead to self-health: healthy infection prevention practices in intensive care units

Healthy infection prevention practices (HIPP) include hand hygiene, respiratory etiquette, environmental cleanliness, and use of personal protective equipment. These healthy practices are most used to protect individuals against exposure to bacterial and viral infections in the workplace, as well as in the home. Most often these infection prevention behaviors in critical care units are promoted to protect the patient from healthcare-associated infections. Yet, these practices are just as important to the health of the critical care nurse. Self-health in the workplace is essential to creating a healthy workplace environment, which is the goal of many intensive care units today. The benefits of creating a healthy work environment are improvement of patient/nurse satisfaction and nurse retention. HIPP reduce the risk of the critical care nurse's exposure to microbial pathogens such as methicillin-resistant Staphylococcus aureus and influenza. Pathogens that cause infections may contaminate the hands, the clothing, equipment, and blood, putting the nurse at risk for unhealthy hands, unhealthy flora, and unhealthy blood. The intensive care nurse is encouraged to embrace HIPP to nurture self, as well as protect the patient.

The American Association of Critical Care Nurse's Beacon Award: a framework for quality

The Beacon Award for Critical Care Excellence recognizes individual critical care units that have met rigid criteria for excellence, exhibiting high-quality standards and exceptional care of patients and their families. Used as a framework for quality, the award criteria focus on structure, process, and outcomes that enable quality to emerge in the critical care environment. The journey toward meeting Beacon Award criteria can produce long-lasting changes that transform unit-based culture and lead to sustained excellence.

The American Association of Critical Care Nurses standards for establishing and sustaining healthy work environments: off the printed page and into practice

There is a growing body of evidence suggesting that an unhealthy work environment has an adverse impact not only on patients and families but on employees and organizations. The purpose of this article is to introduce the American Association of Critical-Care Nurses standards for establishing and sustaining a healthy work environment and to discuss ways to implement the standards in the acute and critical care workplace.

A comprehensive systematic review of evidence on determining the impact of Magnet designation on nursing and patient outcomes: is the investment worth it?

OBJECTIVE

The overall objective is to examine the current evidence of the impact of Magnet designation on patient and nurse outcomes.

INCLUSION CRITERIA

This review considered any quantitative or qualitative study comparing organizational, nurse, patient or economic outcomes in Magnet designated hospitals with a comparison to a non-Magnet facility. Studies which used case-controlled, descriptive comparative, descriptive correlational and qualitative designs were considered due to the nature of the question. Participants included nurses in four hospital types: ANCC Magnet, Reputational Magnet, Magnet-Aspiring, and non-Magnet. Interventions included: Magnet hospitals (ANCC), Reputational Magnet; Magnet-Aspiring hospitals and non-Magnet hospitals.

SEARCH STRATEGY

The search strategy aimed to find both published and unpublished studies and papers, limited to the English language. An initial search of the Joanna Briggs Institute for Evidence Based Nursing and Midwifery and Cochrane Library databases was conducted. A three-step search strategy was then used. A first-stage, limited search of MEDLINE and CINAHL using preliminary key words was done. In consultation with an information scientist experienced in database searching, a comprehensive search strategy incorporating the key words from the preliminary search was undertaken. The third approach was to review the reference lists from all retrieved papers meeting the inclusion criteria to identify any further research not identified in the first two stages.

METHODOLOGICAL QUALITY

Each paper was assessed by two independent reviewers for methodological quality prior to inclusion using the appropriate critical appraisal instrument from the Joanna Briggs Institute.

RESULTS

A total of 17 papers were included in the review. All were descriptive comparative studies with the majority using a cross sectional survey approach comparing outcomes across either two or three categories of Magnet designation. Comparison across studies using the same instrument was limited as survey instruments were not used in the same manner and studies had different Magnet designation comparison groups. Majority of studies investigated professional nurse practice environment, nurse burnout, nurse satisfaction, perception of quality care, and intent to leave. Limited studies found related to patient outcomes, and no studies met criteria for inclusion for economic review.

CONCLUSION

The investment is worth it. There is evidence to support the positive effect of Magnet designation on the professional nurse practice environment (PNPE). Stronger PNPE and Magnet status are associated with lower levels of nurse burnout, higher levels of nursing satisfaction, higher perceptions of quality of care, and decreased intent to leave. There is a need to further investigate the linkage between PNPE and/or Magnet designation with patient outcomes. Understanding the economic implications of a PNPE requires further study.

Magnet forces: a structure for a transformation in inpatient psychiatric nursing

Recovery is a cornerstone of the federal government's transformation vision for mental health care. Recovery is most often depicted as a process by which people with serious mental illness reengage with activities that create a meaningful existence and a purpose in life. Psychiatric nurses are expected to partner with patients in the recovery process during inpatient treatment. This may prove difficult given the current emphasis on medical models of care and the state of the science in inpatient psychiatric nursing. In this article, the authors describe how magnet forces that focus on empowering nurses, empowering evidence-based care, and strengthening unit-based leadership have the potential for generating transformational change at the point of service. Engaging in the recovery movement within the magnet structure may generate innovations critical to the growth of the specialty. J Am Psychiatr Nurses Assoc, 2008; 14(5), 346-352.

Essentials of a productive nurse work environment

BACKGROUND

Staff nurse work environments must be improved. To do so, their quality must be measured. The Essential of Magnetism (EOM) tool measures eight characteristics of a productive and satisfying work environment identified by staff nurses in magnet hospitals as essential to quality patient care. The EOM items are based on grounded theory and are used to measure attributes of the work environment as functional processes. The EOMII is a revision of two of the subscales of the EOM.

OBJECTIVES

To test the hypotheses that staff nurses in hospitals designated as having excellent work environments (Magnet) will score significantly higher on the EOMII and on two outcome indicators than will their counterparts in Comparison hospitals. Additional aims include establishing the psychometric properties of the EOMII; updating the National Magnet Hospital Profile; ascertaining relationships between nurse attribute, work, and contextual variables and the characteristics of a productive work environment; and investigating the relationship between the magnet structure, care processes and relationships and two single-item indicators, overall job satisfaction, and nurse-assessed quality of patient care.

METHODS

This was a secondary analysis of aggregated data from 10,514 staff nurses in 34 hospitals who completed the EOMII and the two outcome indicators.

RESULTS

The EOMII is a valid and reliable measure of the quality of work environment from a staff nurse perspective. The hypotheses were confirmed. There are differences in essentials and outcome variables by (a) context-nurses in magnet hospitals report the most productive work environment; (b) education-master's prepared nurses report the most favorable environments; (c) experience-the most inexperienced and the most experienced report the most satisfying, productive environments; and (d) clinical unit-medical and surgical specialty and outpatient units report the healthiest work environments.

DISCUSSION

The primacy of magnet designation as a contextual variable indicating a quality work environment was affirmed. A larger percentage of magnet hospitals meet the magnet profile now than in 2003. Item analysis of the EOMII subscales provides guidance on how to improve the unit work environment. Suggestions are made for additional study and research.