Revolutionizing nurse work environment research

PHILADELPHIA (May 9, 2024) – New research from Penn Nursing’s Center for Health Outcomes and Policy Research (CHOPR) – recently published online in the journal Research in Nursing & Health – has successfully validated a new, streamlined version of the Practice Environment Scale of the Nursing Work Index (PES-NWI), originally authored in 2002 by Eileen T. Lake, PhD, RN, FAAN, Professor of Nursing, the Edith Clemmer Steinbright Professor in Gerontology, and Associate Director of CHOPR, who is also lead author on this publication. This innovative tool, known as the PES-5, is designed to revolutionize how nurse work environments are measured across the United States.

For over two decades, the PES-NWI has been a cornerstone in surveying and assessing the organizational traits that support or undermine professional nursing practice. These traits include whether nurses are empowered to make decisions, are respected as professionals by physicians, and whether staffing and resources are sufficient for quality patient care. This instrument has crucially shown that the work environment is the principal factor contributing to nurse burnout, which is now an international crisis. However, the instrument’s length—31 traits across five domains—has often been a barrier to widespread and frequent use due to the significant time commitment required from respondents.

The PES-5 directly addresses this issue by condensing the original tool into a version that covers all five domains without sacrificing the robustness or reliability of the full survey and assessment. This new form was derived from extensive research involving cross-sectional analyses of survey data from nurses across 760 hospitals in six US states.

To validate this dramatically streamlined instrument, a team of CHOPR nurse investigators followed a proven abridgment procedure to find the shortest possible way to measure while maintaining the tool’s integrity.

Key findings from the study include:

• The PES-5 shows promise for measuring nurses’ work environments by reducing participant burden and maximizing the response rate.
• The PES-5 maintains strong predictive validity with respect to nurse-reported work environments and patient outcomes.
• The classification accuracy into hospitals with “better,” “mixed,” and “poor” work environments of the PES‐5 was high, with 88% of hospitals classified identically by both versions.

“In the context of pervasive surveying in our society, the PES‐5 can alleviate survey burden while still providing vital data for managers and policymakers,” said Lake. “Thus, the practical significance and applicability of the PES-5 are wide-ranging, from single-institution dashboards to regulatory body oversight.”

The PES-5 represents a major step forward in efficiently gathering data on nursing practice environments. It will help ensure that more hospitals can regularly assess their work environments without overburdening nursing staff, potentially improving nurse satisfaction and patient care quality. Dr. Lake, who is steward of the PES-NWI national quality measure, will add the PES-5 to the national endorsement.

Co-authors of this article include Penn Nursing’s Jennifer Gil, MSN, RN; Lynne Moronski, PhD, MPA, RN; Karen B. Lasater, PhD, RN, FAAN; Linda H. Aiken, PhD, RN, FAAN, FRCN; and Matthew D. McHugh, PhD, JD, MPH, RN, CRNP, FAAN. This study was supported by funding from the National Institute of Nursing Research, Grant/Award Numbers: NINR ‐ T32‐NR‐ 007104, NINR‐2R01NR014855‐06; and the National Council of State Boards of Nursing, Grant/Award Number: NCSBN CRE R201011.

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