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Nursing Practice Environment and Outcomes for Oncology Nursing

Shang, Jingjing PhD, RN, OCN; Friese, Christopher R. PhD, RN, AOCN; Wu, Evan BA; Aiken, Linda H. PhD, RN, FAAN, FRCN

doi: 10.1097/NCC.0b013e31825e4293

Background: It is commonly assumed that oncology nurses experience high job-related burnout and high turnover because their work involves inherent stressors such as caring for patients with serious and often life-threatening illness.

Objectives: The objectives of this study were to examine the differences in outcomes such as job dissatisfaction and burnout between oncology nurses and medical-surgical nurses, and to identify factors that affect oncology nurse outcomes.

Methods: A secondary analysis of nurse survey data collected in 2006 including 4047 nurses from 282 hospitals in 3 states was performed; t test and χ2 test compared differences between oncology nurses and medical-surgical nurses in nurse outcomes and their assessments of nurse practice environment, as measured by the Practice Environment Scale of the Nursing Work Index. Logistic regression models estimated the effect of nurse practice environment on 4 nurse-reported outcomes: burnout, job dissatisfaction, intention to leave the current position, and perceived quality of care.

Results: Oncology nurses reported favorable practice environments and better outcomes than did medical-surgical nurses. All 4 subscales of the Practice Environment Scale of the Nursing Work Index studied were significantly associated with outcomes. Specifically, nurses who reported favorable nursing foundations for quality of care (eg, active in-service or preceptorship programs) were less likely to report burnout and leave their current position.

Conclusions: Better practice environments, including nurse foundations for quality care, can help to achieve optimal nurse outcomes.

Implications for Practice: Improving hospital practice environments holds significant potential to improve nurse well-being, retention, and quality of care. Specifically, hospitals should consider preceptor programs and continuing education and increase nurses’ participation in hospital decision making.

Author Affiliations: School of Nursing, Columbia University, New York (Dr Shang); School of Nursing, University of Michigan, Ann Arbor (Dr Friese); Center for Health Outcomes & Policy Research, School of Nursing, University of Pennsylvania, Philadelphia (Mr Wu and Dr Aiken).

This research was supported in part by grants from the National Institutes of Nursing, National Institutes of Health T32NR0714, and R01NR04513 (Dr Aiken, principal investigator).

Dr Friese was supported by a Pathway to Independence Award from the National Institute of Nursing Research, National Institutes of Health (R00NR010750).

The content is solely the responsibility of the authors. The funding sources had no role in the study design, data collection, analysis, interpretation, or writing of the article.

The authors have no conflicts of interest to disclose.

Correspondence: Jingjing Shang, PhD, RN, OCN, School of Nursing, Columbia University, 630 W 168th St, New York, NY 10032 (

Accepted for publication May 5, 2012.

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins