Essentials of a productive nurse work environment.

BACKGROUND Staff nurse work environments must be improved. To do so, their quality must be measured. The Essential of Magnetism (EOM) tool measures eight characteristics of a productive and satisfying work environment identified by staff nurses in magnet hospitals as essential to quality patient care. The EOM items are based on grounded theory and are used to measure attributes of the work environment as functional processes. The EOMII is a revision of two of the subscales of the EOM. OBJECTIVES To test the hypotheses that staff nurses in hospitals designated as having excellent work environments (Magnet) will score significantly higher on the EOMII and on two outcome indicators than will their counterparts in Comparison hospitals. Additional aims include establishing the psychometric properties of the EOMII; updating the National Magnet Hospital Profile; ascertaining relationships between nurse attribute, work, and contextual variables and the characteristics of a productive work environment; and investigating the relationship between the magnet structure, care processes and relationships and two single-item indicators, overall job satisfaction, and nurse-assessed quality of patient care. METHODS This was a secondary analysis of aggregated data from 10,514 staff nurses in 34 hospitals who completed the EOMII and the two outcome indicators. RESULTS The EOMII is a valid and reliable measure of the quality of work environment from a staff nurse perspective. The hypotheses were confirmed. There are differences in essentials and outcome variables by (a) context-nurses in magnet hospitals report the most productive work environment; (b) education-master's prepared nurses report the most favorable environments; (c) experience-the most inexperienced and the most experienced report the most satisfying, productive environments; and (d) clinical unit-medical and surgical specialty and outpatient units report the healthiest work environments. DISCUSSION The primacy of magnet designation as a contextual variable indicating a quality work environment was affirmed. A larger percentage of magnet hospitals meet the magnet profile now than in 2003. Item analysis of the EOMII subscales provides guidance on how to improve the unit work environment. Suggestions are made for additional study and research.