Reliability and validity of an instrument assessing nurses' attitudes about healthy work environments in hospitals

AIM: To examine the psychometric properties of an instrument used to evaluate the work environment of direct care nurses employed in hospital settings. BACKGROUND: Healthy work environments are associated with increased retention and high-quality patient care. METHODS: Items for the instrument were based on the American Association of Critical Care Nurses' standards for a healthy work environment. Six items measured the individual's contribution to the work environment and six measured co-workers' contributions. Each item was graded on a scale from 'A=well above average' to 'F=failing'. The instrument was administered by nurse leaders to 210 direct care nurses in six hospitals. RESULTS: The Cronbach α was 0.75 for the self-rating subscale and 0.89 for the co-workers rating subscale. Administrators rated their co-workers significantly higher [n=32, mean (M)=2.69, standard deviation (SD)=0.63] than direct care nurses rated theirs (n=209, M=2.31, SD=0.83, P=0.03). Direct care nurses intending to stay in nursing rated co-workers significantly higher (n=170, M=2.35, SD=0.81) than those not intending to stay (n=22, M=1.87, SD=0.81, P=0.01). CONCLUSION: The instrument is a feasible, reliable and valid method for assessing the work environment. IMPLICATIONS FOR NURSING MANAGEMENT: The instrument can be used to assess the relationship of the work environment to nurse retention in hospitals.