Practice Environments of Nurses Employed in Ambulatory Oncology Settings: Measure Refinement

Purpose/Objectives: To examine the reliability and validity of modified items from the Practice Environment Scale of the Nursing Work Index (PES-NWI) for use in the understudied ambulatory oncology setting. Design: Cross-sectional mailed survey using a modified Dillman method. Setting: Southeastern United States. Sample: Population-based statewide sample of 1,339 oncology nurses who reported employment outside of hospital inpatient units. Methods: After examining for nonresponse bias, confirmatory factor analysis using structural equation modeling and Cronbach coefficient alphas were employed to examine construct validity and internal consistency, respectively. After calculating revised subscale means for each nurse, the researchers used t tests to compare subscale means between nurses who reported their practice environment as favorable versus those who reported it as mixed or unfavorable. Main Research Variables: Reliability and validity of items on the adapted version of the PES-NWI. Findings: Despite a response rate of 31%, no differences in demographic characteristics were observed between the analytic sample and nonresponders. After reducing the number of items to 23, acceptable model fit was achieved with a comparative fit index of 0.95 and a root mean square error of approximation of 0.057. All five existing PES-NWI subscales, plus the new medical assistant support subscale, were significantly higher for nurses who reported favorable practice environments versus those who reported mixed or unfavorable environments. Conclusions: A revised set of items derived from the PES-NWI has acceptable reliability and validity to measure the quality of nursing practice environments in ambulatory oncology settings. Medical assistant support is a new contribution to the item pool. Implications for Nursing: Additional testing of this revised measure in diverse samples of nurses, including studies that correlate with patient outcomes, is a necessary next step.