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Practice Environments of Nurses in Ambulatory Oncology Settings: A Thematic Analysis

Kamimura, Akiko PhD, MSW; Schneider, Karin MA; Lee, Cheryl S. MS, RN, ACNP-BC; Crawford, Scott D. MS; Friese, Christopher R. PhD, RN, AOCN

doi: 10.1097/NCC.0b013e31820b6efa

Background: The practice environments of nurses have been studied extensively in inpatient settings, but rarely in the ambulatory context. As the majority of cancer care is delivered in ambulatory settings, a better understanding of the nursing practice environment may contribute to quality improvement efforts.

Objective: We sought to examine the features of nursing practice environments that contribute to quality patient care and nursing job satisfaction.

Methods: In 2009–2010, we conducted focus groups with nurses who cared for adults with cancer outside inpatient units. A semistructured moderator guide explored practice environment features that promoted safe, high-quality care and high job satisfaction. We also asked nurses to identify practice environment features that hindered quality care and reduced job satisfaction. We conducted thematic analysis to report themes and to construct a conceptual framework.

Results: From 2 focus groups, composed of 13 participants, nurses reported that variability in workloads, support from managers and medical assistants, and the practice’s physical resources could facilitate or hinder high-quality care and job satisfaction. High-quality communication across team members improved patient safety and satisfaction.

Conclusions: Consistent with research findings from inpatient settings, nurses identified staffing and resource adequacy, management support, and collegiality as important inputs to high-quality care.

Implications for Practice: These findings can inform quality improvement initiatives in ambulatory oncology practices. Strengthening nurse–medical assistant relationships, smoothing patient workload variability, and implementing strategies to strengthen communication may contribute to quality cancer care. Studies to test our proposed conceptual framework would bridge existing knowledge gaps in ambulatory settings.

Author Affiliations: Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor (Dr Kamimura); Survey Sciences Group, LLC, Ann Arbor, Michigan (Ms Schneider and Mr Crawford); M. D. Anderson Cancer Center, Houston, Texas (Ms Lee); and Division of Nursing Business and Health Systems, University of Michigan School of Nursing, Ann Arbor (Dr Friese).

This research was supported by Pathway to Independence award (R00 NR10750) from the National Institute of Nursing Research, National Institutes of Health (to Dr Friese). This research was also supported in part by the National Institutes of Health through the University of Michigan’s Cancer Center support grant (5 P30 CA46592).

The authors have no conflicts of interest to disclose.

Correspondence: Christopher R. Friese, PhD, RN, AOCN, University of Michigan School of Nursing, Division of Nursing Business and Health Systems, 400 N Ingalls #4162, Ann Arbor, MI 48109-5482 (

Accepted for publication December 12, 2010.

© 2012 Lippincott Williams & Wilkins, Inc.