Nurse Perceptions of Their Work Environment: Perspectives from the ICU through Ambulatory Care

Purpose:
To Study nurse perceptions of their work environment in order to better understand what drives satisfaction and identify barriers to satisfaction, using a collaborative effort between nursing leadership and RN staff providing direct patient care.

Background/Significance:
In response to NDNQI RN Satisfaction 2006 survey results, nursing leadership requested further research be completed to better understand nurse perceptions of their work environment in three clinical areas identified as needing improvement. Six additional clinical areas were studied to determine trends among nurse satisfaction drivers in our organization. This information would be used to impact the practice environment and contribute positively to nurse perceptions of their work environment.

Methods:
A research team, comprised of direct care nurses and nurse leaders from the Nurse Practice Council, completed a qualitative study that was approved by the Institutional Review Board of the hospital. A semi-structured interview approach was used to obtain data from three clinical areas: acute, moderate, and ambulatory care. Data were coded using a heuristics research methodology, with an emphasis on Coordinated Management of Meaning. Interviews were completed in three cycles during the summers of 2007, 2008, and 2009.

Results:
Preliminary results were shared with nursing leadership and shared governance direct care RN leaders after the first two cycles. Distinct themes arose in individual units, but common themes revealed that nurses are highly concerned with time, patient flow, and technology. Current initiatives within the organization relate to these identified themes. Perception of time to provide care, necessary equipment, staffing, hours worked in a day, communication between peers and with leadership all influenced perceptions across nursing units.

Conclusions and Implications for Practice:
Specific opportunities and recommendations were acted upon immediately, including addressing role revisions for nursing support staff and charge nurses. Positive communication strategies for creating a culture of respect were shared with all nurses during a formal education program in 2008.