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Defining an evidence-based work environment for nursing in the USA


  • Anne Marie Kotzer PhD, RN, CPN, FAAN,

  • Kerry Arellana ND, BSN, RN

Anne Marie Kotzer
The Children's Hospital 13123 East 16th Ave Box 444 Aurora CO 80045 USA
Telephone: +1-720 777 6984


Aims.  To describe and compare staff nurses’ perceptions of their real and ideal work environment in a tertiary paediatric facility; to provide administrators with research evidence for identifying areas for improvement.

Background.  The workforce shortage of hospital nurses is a global problem having an impact on the financial resources and efficient operations of an organisation and the quality of care delivered to patients. A direct relationship exists between job satisfaction, retention, turnover and elements of the nurses’ work environment. Research identifying specific elements of the current work setting that are in conflict with nurses’ views of their preferred practice milieu can help define an evidence-based work environment for nursing.

Design and methods.  Using a descriptive survey design, a convenience sample of 385 nurses on five inpatient units and the float team completed two forms (real and ideal) of the work environment scale. The work environment scale consists of 10 subscales within three dimensions: relationship, personal growth and system maintenance and change.

Results.  A consistent pattern was seen across all units with reported high levels of involvement, peer cohesion, task orientation and managerial control. Scores for work pressure and autonomy were moderate-high and physical comfort, supervisor support, clarity and innovation were moderate. Overall, highest scores were reported for involvement and lowest for physical comfort. Significant differences were found between real and ideal subscale scores suggesting that staff were able to identify areas for improvement.

Conclusions.  Despite moderate work pressure, staff affirmed a highly positive work environment on their units. Specific areas in their current work setting that were not congruent with their preferred work environment were identified and targeted for change.

Relevance to clinical practice.  Understanding dimensions of the nurses’ work environment needing improvement and involving staff in making and evaluating change supports an evidence-based environment to attract and retain qualified staff.