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Measuring Nurse Leaders’ and Direct Care Nurses’ Perceptions of a Healthy Work Environment in Acute Care Settings, Part 3: Healthy Work Environment Scales for Nurse Leaders and Direct Care Nurses

Huddleston, Penny PhD, RN, CCRN; Mancini, Mary E. PhD, RN, NE-BC, FAHA, ANEF, FAAN; Gray, Jennifer PhD, RN, FAAN

JONA: The Journal of Nursing Administration: March 2017 - Volume 47 - Issue 3 - p 140–146
doi: 10.1097/NNA.0000000000000456

BACKGROUND Survey items on the Healthy Work Environment Scales (HWES) for nurse leaders (NLs) and direct care nurses (DCNs) were developed using statements from 2 qualitative research studies conducted in a healthcare system.

PURPOSE The purposes of 2 quantitative studies were to develop items on the HWES for NLs and DCNs, to assess the validity and reliability of these new tools, and to describe the NLs and DCNs perceptions of a healthy work environment (HWE) using nonexperimental descriptive designs.

METHODS Each research study had 2 separate phases. In phase 1 of the studies, NLs and DCNs assigned each item to 1 of the 8 characteristics of an HWE to assess face validity. Content validity was determined by calculating the scale content validity and item content validity indices. Based on these results, the items were revised or deleted to obtain version 3 of both tools. In phase 2 of the studies, principal component analysis (PCA) assessed the validity of the tools, Cronbach’s α served as the test for reliability, and the NLs and DCNs perceptions of an HWE were measured.

RESULTS Samples included 314 subjects for the HWES for NL study and 986 subjects for the HWES for DCN study. Principal component analysis for the HWES for NLs (version 3) revealed 40 items comprising 4 components, and PCA for the HWES for DCNs (version 3) revealed 39 items comprising 5 components. Internal consistencies of the tools were 0.974 and 0.957, respectively. Based on the findings of these studies, the tools demonstrated promising psychometric properties to measure a HWE in acute care settings.

Author Affiliations: Manager of Education, Magnet® Coordinator, and Nurse Scientist (Dr Huddleston), Baylor Scott & White Health—Irving; Senior Associate Dean and Chair, College of Nursing and Health Innovation, University of Texas at Arlington, and Professor, Healthcare Research, Baylor Health Care System, Dallas (Dr Mancini), Texas; and Associate Dean (Dr Gray), College of Natural and Health Sciences, Oklahoma Christian University, Edmond.

The authors declare no conflicts of interest.

Correspondence: Dr Huddleston, Baylor Scott & White Health—Irving, 1901 N MacArthur Blvd, Irving, TX 75061 (

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