Nurse practice environments and outcomes: implications for oncology nursing.

PURPOSE/OBJECTIVES To examine practice environments and outcomes of nurses working in oncology units or Magnet hospitals and to understand the association between the two. DESIGN Secondary analysis of survey data collected in 1998. SETTING Medical and surgical units of 22 hospitals, of which 7 were recognized by the American Nurses Credentialing Center Magnet program. SAMPLE 1,956 RNs, of whom 305 worked in oncology units. METHODS Chi-square tests compared nurse-reported outcomes by work setting, analysis of variance tested practice environment differences by setting, and logistic regression estimated the effects of practice environment, specialty, and Magnet status on outcomes. MAIN RESEARCH VARIABLES Practice environments, emotional exhaustion, job satisfaction, and quality of care. FINDINGS Oncology nurses had superior outcomes compared with nononcology nurses. Emotional exhaustion was significantly lower among oncology nurses working in Magnet hospitals. Scores on the Collegial Nurse-Physician Relations subscale were highest among oncology nurses. Outcomes were associated with Practice Environment Scale of the Nursing Work Index scores and Magnet status. Oncology nurses with favorable collegial nurse-physician relations were twice as likely to report high-quality care. CONCLUSIONS Oncology nurses benefit from working in American Nurses Credentialing Center Magnet hospitals. Adequate staffing and resources are necessary to achieve optimal outcomes. Collegial nurse-physician relations appear to be vital to optimal oncology practice settings. IMPLICATIONS FOR NURSING In addition to pursuing American Nurses Credentialing Center Magnet recognition, nurse managers should assess practice environments and target related interventions to improve job satisfaction and retention. High-priority areas for interventions include ensuring adequate staff and resources, promoting nurse-physician collaboration, and strengthening unit-based leadership.