Hospital Nurses' Perceptions of the Ethical Climate of Their Work Setting

PURPOSE: To develop an instrument to measure how hospital nurses perceive the ethical climate of their work setting and to evaluate its psychometric properties. A way to measure ethical climate can help nurses understand the work setting influences on their practice and can be used to diagnose areas for organizational change as well as to evaluate effectiveness of organizational interventions. DESIGN: Descriptive. Instrument developed was the Hospital Ethical Climate Survey (HECS). Sampled were 360 RNs (48% response rate) employed in clinical practice at two acute-care hospitals in one U.S. midwestern city. The nurses completed a questionnaire in 1993-1994 consisting of items developed to assess their perceptions of ethical climate, along with the 43-item Integrity Audit, a social desirability scale, and a demographic inventory. METHODS: Construct validity was assessed by confirmatory factor analysis (CFA) using the LISREL 7 statistical program. RESULTS: The final CFA model consisted of 26 variables in five factors, which were organized according to the relationships of nurses with peers, patients, managers, hospital, and physicians. Internal consistency reliability, using Cronbach's alpha, for the final 26-item instrument was 0.91 (range 0.68 to 0.92) for the subscales. CONCLUSIONS: The Hospital Ethical Climate Survey has acceptable initial reliability and validity.