title: Practice environments and their associations with nurse-reported outcomes in Belgian hospitals: development and preliminary validation of a Dutch adaptation of the Revised Nursing Work Index.
abstract: OBJECTIVE
  To study the relationship between nurse work environment, job outcomes and nurse-assessed quality of care in the Belgian context.
  
  
  BACKGROUND
  Work environment characteristics are important for attracting and retaining professional nurses in hospitals. The Revised Nursing Work Index (NWI-R) was originally designed to describe the professional nurse work environment in U.S. Magnet Hospitals and subsequently has been extensively used in research internationally.
  
  
  METHODS
  The NWI-R was translated into Dutch to measure the nurse work environment in 155 nurses across 13 units in three Belgian hospitals. Factor analysis was used to identify a set of coherent subscales. The relationship between work environments and job outcomes and nurse-assessed quality of care was investigated using logistic and linear regression analyses.
  
  
  RESULTS
  Three reliable, consistent and meaningful subscales of the NWI-R were identified: nurse-physician relations, nurse management at the unit level and hospital management and organizational support. All three subscales had significant associations with several outcome variables. Nurse-physician relations had a significant positive association with nurse job satisfaction, intention to stay the hospital, the nurse-assessed unit level quality of care and personal accomplishment. Nurse management at the unit level had a significant positive association with the nurse job satisfaction, nurse-assessed quality of care on the unit and in the hospital, and personal accomplishment. Hospital management and organizational support had a significant positive association with the nurse-assessed quality of care in the hospital and personal accomplishment. Higher ratings of nurse-physician relations and nurse management at the unit level had significant negative associations with both the Maslach Burnout Inventory emotional exhaustion and depersonalization dimensions, whereas hospital management and organizational support was inversely associated only with depersonalization scores.
  
  
  CONCLUSIONS
  A Dutch version of the NWI-R questionnaire produced comparable subscales to those found by many other researchers internationally. The resulting measures of the professional practice environment in Belgian hospitals showed expected relationships with nurse self-reports of job outcomes and perceptions of hospital quality.
authors.affiliation: Department of Nursing, University Hospital Antwerp, Operating Room, Wilrijkstraat 10, B-2650 Edegem, Belgium.
authors.forename: Peter
authors.initials: P
authors.lastname: Van Bogaert
authors.forename: Sean
authors.initials: S
authors.lastname: Clarke
authors.forename: Karel
authors.initials: K
authors.lastname: Vermeyen
authors.forename: Herman
authors.initials: H
authors.lastname: Meulemans
authors.forename: Paul
authors.initials: P
authors.lastname: Van de Heyning
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001291:Attitude of Health Personnel / Q000208:ethnology; D001530:Belgium; D002055:Burnout, Professional / Q000209:etiology / Q000523:psychology; D005163:Factor Analysis, Statistical; D005260:Female; D006272:Health Facility Environment / Q000458:organization & administration*; D006801:Humans; D007400:Interprofessional Relations; D007588:Job Satisfaction; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015401:Nursing Administration Research; D015403:Nursing Evaluation Research; D009741:Nursing Staff, Hospital / Q000458:organization & administration / Q000523:psychology; D017063:Outcome Assessment, Health Care; D010865:Pilot Projects; D011594:Psychometrics; D011795:Surveys and Questionnaires / Q000592:standards; D014177:Translations; D017132:Workplace / Q000458:organization & administration / Q000523:psychology
references.citation: Nurs Res. 2003 Mar-Apr;52(2):71-9
references.pmid: 12657982
references.citation: J Adv Nurs. 2000 Aug;32(2):454-64
references.pmid: 10964195
references.citation: J Adv Nurs. 2001 Aug;35(4):533-42
references.pmid: 11529953
references.citation: Nurs Res. 2006 Mar-Apr;55(2):82-93
references.pmid: 16601620
references.citation: Res Nurs Health. 2007 Feb;30(1):31-44
references.pmid: 17243106
references.citation: Am J Nurs. 2000 Mar;100(3):26-35; quiz 35-6
references.pmid: 10738398
references.citation: Appl Nurs Res. 2006 Feb;19(1):51-3
references.pmid: 16455443
references.citation: Res Nurs Health. 2002 Jun;25(3):176-88
references.pmid: 12015780
references.citation: Nurs Outlook. 2002 Sep-Oct;50(5):187-94
references.pmid: 12386653
references.citation: Int J Health Care Qual Assur Inc Leadersh Health Serv. 2004;17(6):313-22
references.pmid: 15552386
references.citation: Res Nurs Health. 2002 Aug;25(4):256-68
references.pmid: 12124720
references.citation: J Nurs Manag. 2006 May;14(4):262-70
references.pmid: 16629840
references.citation: Int J Nurs Stud. 2009 Jul;46(7):920-7
references.pmid: 17229425
references.citation: J Appl Psychol. 1996 Apr;81(2):123-33
references.pmid: 8603909
references.citation: Med Care Res Rev. 2007 Apr;64(2 Suppl):104S-22S
references.pmid: 17406014
references.citation: J Adv Nurs. 2007 Jan;57(1):32-44
references.pmid: 17184372
references.citation: Am J Public Health. 2002 Jul;92(7):1115-9
references.pmid: 12084694
references.citation: Nurs Res. 2005 Mar-Apr;54(2):74-84
references.pmid: 15778649
references.citation: Nurs Res. 2007 Nov-Dec;56(6):416-24
references.pmid: 18004188
references.citation: Am J Infect Control. 2007 Jun;35(5):302-9
references.pmid: 17577476
references.citation: J Nurs Adm. 2006 May;36(5):259-67
references.pmid: 16705307
references.citation: Nurs Res. 1989 May-Jun;38(3):172-7
references.pmid: 2717441
references.citation: Nurs Res. 2004 Nov-Dec;53(6):370-8
references.pmid: 15586133
references.citation: J Nurs Adm. 2002 Nov;32(11):564-76
references.pmid: 12464774
references.citation: J Nurs Adm. 2003 Jul-Aug;33(7-8):410-22
references.pmid: 12909793
references.citation: J Adv Nurs. 2005 Aug;51(3):276-87
references.pmid: 16033595
references.citation: N Engl J Med. 2002 May 30;346(22):1715-22
references.pmid: 12037152
references.citation: Health Aff (Millwood). 2001 May-Jun;20(3):43-53
references.pmid: 11585181
references.citation: J Nurs Scholarsh. 2004;36(3):279-85
references.pmid: 15495499
references.citation: Nurs Res. 2000 May-Jun;49(3):146-53
references.pmid: 10882319
references.citation: Health Serv Res. 2008 Aug;43(4):1145-63
references.pmid: 18248404
references.citation: Int J Nurs Stud. 2006 Aug;43(6):745-54
references.pmid: 16321387
references.citation: J Nurs Adm. 2008 May;38(5):223-9
references.pmid: 18469615
references.citation: Am J Infect Control. 2002 Jun;30(4):207-16
references.pmid: 12032495
references.citation: Nurs Res. 2006 Jan-Feb;55(1):1-9
references.pmid: 16439923