Variations in Nursing Practice Environments: Relation to Staffing and Hospital Characteristics

Background: While improvements in nursing practice environments are considered essential to address the nursing shortage, relatively little is known about the nursing practice environments in most hospitals.

Objectives: The objectives of this study are to describe variations in nursing practice environments across hospitals and to examine their associations to hospital bed size, community size, teaching intensity, and nurse staffing levels.

Methods: The research design was cross-sectional analyses of nurse survey and administrative data for 156 Pennsylvania hospitals from 1999. For comparative reference, nurse survey data from earlier years from two small samples of nursing magnet hospitals were analyzed. The nursing practice environment was measured by the Practice Environment Scale of the Nursing Work Index (PES-NWI).

Results: Nursing practice environments varied greatly among the hospitals studied. The nursing practice environments of the small samples of magnet hospitals were superior to those of the Pennsylvania sample. About 17% of the hospitals in the Pennsylvania sample had favorable practice environments. Pennsylvania hospitals with better practice environments had higher RN-to-bed ratios. Practice environment differences were not associated with hospital bed size or community size. Hospitals with a modest teaching level had less favorable environments.

Discussion: Considerable variation exists in the quality of hospital nursing practice environments. Five out of six hospitals are targets for improvement. Favorable nursing practice environments can be achieved in a wide variety of hospital settings.