title: Practice environments of nurses employed in ambulatory oncology settings: measure refinement.
abstract: OBJECTIVE
  To examine the reliability and validity of modified items from the Practice Environment Scale of the Nursing Work Index (PES-NWI) for use in the understudied ambulatory oncology setting.
  
  
  METHODS
  Cross-sectional mailed survey using a modified Dillman method.
  
  
  METHODS
  Southeastern United States.
  
  
  METHODS
  Population-based statewide sample of 1,339 oncology nurses who reported employment outside of hospital inpatient units.
  
  
  METHODS
  After examining for nonresponse bias, confirmatory factor analysis using structural equation modeling and Cronbach coefficient alphas were employed to examine construct validity and internal consistency, respectively. After calculating revised subscale means for each nurse, the researchers used t tests to compare subscale means between nurses who reported their practice environment as favorable versus those who reported it as mixed or unfavorable.
  
  
  METHODS
  Reliability and validity of items on the adapted version of the PES-NWI.
  
  
  RESULTS
  Despite a response rate of 31%, no differences in demographic characteristics were observed between the analytic sample and nonresponders. After reducing the number of items to 23, acceptable model fit was achieved with a comparative fit index of 0.95 and a root mean square error of approximation of 0.057. All five existing PES-NWI subscales, plus the new medical assistant support subscale, were significantly higher for nurses who reported favorable practice environments versus those who reported mixed or unfavorable environments.
  
  
  CONCLUSIONS
  A revised set of items derived from the PES-NWI has acceptable reliability and validity to measure the quality of nursing practice environments in ambulatory oncology settings. Medical assistant support is a new contribution to the item pool.
  
  
  CONCLUSIONS
  Additional testing of this revised measure in diverse samples of nurses, including studies that correlate with patient outcomes, is a necessary next step.
authors.affiliation: Division of Nursing Business and Health Systems, School of Nursing, University of Michigan in Ann Arbor, USA. cfriese@umich.edu
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Friese
mesh_terms: D000554:Ambulatory Care Facilities / Q000458:organization & administration*; D001291:Attitude of Health Personnel; D002173:Cancer Care Facilities / Q000458:organization & administration*; D003430:Cross-Sectional Studies; D005240:Feasibility Studies; D017144:Focus Groups; D006272:Health Facility Environment; D006801:Humans; D015403:Nursing Evaluation Research; D015404:Nursing Methodology Research; D009740:Nursing Staff / Q000523:psychology*; D015203:Reproducibility of Results; D015144:Southeastern United States; D011795:Surveys and Questionnaires; D017132:Workplace / Q000458:organization & administration / Q000523:psychology