Measuring direct care nurses' and nurse leaders' perceptions of a healthy work environment within acute care settings

Healthy work environments (HWEs) have been described as policies, procedures, and processes designed to empower nurses to meet the organizational objectives and achieve personal satisfaction in the work environment (American Association of Critical-Care Nurses, 2005; Lake, 2007; Schmalenberg & Kramer, 2008; Shirey, 2006). Unhealthy work environments (UWEs) throughout healthcare organizations have been linked to absenteeism, ineffective delivery of healthcare to patients and families, higher stress levels, poor communication, and ineffective collaboration and teamwork among healthcare professionals (Heath, Johanson, & Blake, 2004). The American Association of Critical-Care Nurses (AACN) developed a Healthy Work Environment Assessment Tool (HWEAT) for nurses to use to assess the health of the work environment. Through the adaptation and modification of the AACN HWEAT (AACN, 2005) for nurses, the researcher was able to develop two tools to measure HWEs entitled Healthy Work Environment Scale (HWES) for Direct Care Nurses and Healthy Work Environment Scale (HWES) for Nurse Leaders (who are in formal positions). The purposes of these studies were to modify the AACN HWEAT (AACN, 2005) to develop the HWES for Direct Care Nurses and the HWES for Nurse Leaders in formal positions (through the adaptation of the AACN HWEAT); to assess the validity and reliability of the HWES for Direct Care Nurses and the HWES for Nurse Leaders; and to describe the direct care nurses' and nurse leaders' perceptions of a HWE using a non-experimental descriptive design.;The sample of the HWES for Direct Care Nurses consisted of 986 subjects. Principal component analysis (PCA) on the HWES Direct Care Nurses version 3 revealed a fairly simple structure with 39 items. Five components of a HWE were identified. Component one encompassed the HWE characteristics of authentic leadership and meaningful recognition. Component two encompassed the HWE characteristics of effective decision-making and skilled communication. Component three was identified as genuine teamwork. Component four was identified as appropriate staffing. Component five was identified as physical and psychological safety. The HWE standard of true collaboration loaded on all five of the components. The eigenvalues were 15.08, 2.36, 1.36, 1.26, and 1.02 respectively. The direct care nurses perceived health of the work environment mean scores ranged from 2.79 (standard deviation 0.59) to 3.51 (standard deviation 0.43). The Cronbach alpha was .957, which demonstrated strong internal consistency of HWES for Direct Care Nurses.;The sample of the HWES NL in formal positions consisted of 314 subjects. PCA of the HWES Nurse Leaders in formal positions (version 3) revealed a fairly simple structure with 40 items. Four components were identified. Component one encompassed the HWE standard of authentic leadership, effective decision-making, genuine teamwork, and true collaboration. Component two was identified as meaningful recognition. Component three was identified as appropriate staffing. Component four was identified as skilled communication. Physical and psychological safety loaded on all four of the components. The eigenvalues were 20.47, 2.02, 1.20, and 1.14 respectively. The nurse leaders perceived health of the work environment mean scores ranged from 2.96 (standard deviation 0.56) to 3.30 (standard deviation .51). The Cronbach alpha was .974, which demonstrated strong internal consistency of the HWES for Nurse Leaders. Based on the results of these studies, the HWES for Direct Care Nurses' and the HWES for Nurse Leaders' instruments demonstrate promising psychometric properties to measure a HWE for nurses at all levels in acute care hospital settings.