Using the Practice Environment Scale to Inform Strategic Decisions

Purpose:
In 2007, as part of the new CNO's initial assessment, a nursing survey was conducted using the PES. Results helped guide changes to improve the nurse work environment. The survey was repeated in 2011 to validate effectiveness of interventions evidenced by improved perceived work environment.

Significance:
Outcomes such as nurse satisfaction,intention toleave,burnout and occupational injuries have been linked to aspects of organizational climate.Taking deliberate action to improve the nurse work environment can lead to increased nurse satisfaction & retention,and improved nurse outcomes.

Strategy and Implementation:
Based on the scores from the initial survey, an aggressive action plan was developed and implemented over the next several years.Soem signficant actions are described.A shared governance structure was put into place,with representatives from all levels of nursing.A Staff Nurse Advisory Board was instituted to advise the CNO about factors effecting nursing practice.The Department of Clincal Education was re-organized,& support was decentralized to the units.Nursing is represented at all levels of the organization and on hospital committees. Nurse Managers without a BSN were required to return to school to advance their education.Now many of the managers are Masters prepared.The hospital offers tuition reimbursement, and has partnerships with several schools of nursing to facilitate staff returning to school.Specialty certifications are recognized and rewarded.The CNO maintains consistent visibility.The complete list of actions taken to improve the nurse work environment is extensive.

Evaluation:
2011 survey results were substantially improved.Although there was variation across our 3 hospitals, our system sub-scores all increased(range=.16–2.6).Nursing job satisfaction was moderate.On average, nurses reported quality of care >3.5 out of 4, and that it improved by 30% in the past year.

Implications for Practice:
Taking deliberate actions based on staff feedback promotes a more positive work environment.This is well supported in the literature. Improved survey scores,and perceived improvement in quality, desmonstate that changes have been positive. Future action will be beased on recent survey results/