Linking the Practice Environment to Nurses' Job Satisfaction Through Nurse-Physician Communication


  • Milisa Manojlovich

    1. Milisa Manojlovich, RN, PhD, CCRN, Rho, Assistant Professor, University of Michigan School of Nursing, Ann Arbor, MI. This project was funded by the Janet Gatherer Boyles Endowed Clinical Research Award and Carl Pursell Endowed Nursing Research Award provided through the University of Michigan School of Nursing Grants and Research Office. The author thanks Drs. Deanna Isaman, Shaké Ketefian, and Heather Laschinger for their review of earlier drafts of this manuscript. Correspondence to Dr. Manojlovich, University of Michigan School of Nursing, 400 N. Ingalls, RM 4306, Ann Arbor, MI 48109–0482. E-mail:
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Purpose: To investigate direct and indirect relationships among the practice environment, nurse-physician (RN-MD) communication, and job satisfaction, as is posited in the nursing role effectiveness model (NREM).

Design: Survey.

Methods: Surveys were sent to a random sample of 500 hospital nurses throughout Michigan, and 332 (66%) responded. Main study instruments were the Conditions for Work Effectiveness Questionnaire-II (CWEQ-II), the Practice Environment Scale of the Nursing Work Index (PES-NWI), the ICU Nurse-Physician Questionnaire, and the Index of Work Satisfaction (IWS), Part B. Inferential statistical tests included multiple regression, t tests, and one-way analysis of variance.

Findings: Practice environment (PES-NWI) and empowerment (CWEQ-II) scales explained 20% of the variance in RN-MD communication. The combination of both environment scales (PES-NWI and CWEQ-II) and RN-MD communication explained 61% of the variance in nursing job satisfaction scores. RN-MD communication was also a significant mediating variable in the relationship between structure (practice environment and empowerment scales) and outcome (nursing job satisfaction).

Conclusions: Factors in the practice environment contributed both directly to nursing job satisfaction and also indirectly through RN-MD communication. Study findings showed that a practice environment favorable to nurses improved both nurses' perceptions of their communications with physicians and their job satisfaction.