title: Differences in nursing practice environment among US acute care unit types: a descriptive study.
abstract: BACKGROUND
  The hospital nursing practice environment has been found to be crucial for better nurse and patient outcomes. Yet little is known about the professional nursing practice environment at the unit level where nurses provide 24-hour bedside care to patients.
  
  
  OBJECTIVE
  To examine differences in nursing practice environments among 11 unit types (critical care, step-down, medical, surgical, combined medical-surgical, obstetric, neonatal, pediatric, psychiatric, perioperative, and emergency) and by Magnet status overall, as well as four specific aspects of the practice environment.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  5322 nursing units in 519 US acute care hospitals.
  
  
  METHODS
  The nursing practice environment was measured by the Practice Environment Scale of the Nursing Work Index. The Practice Environment Scale of the Nursing Work Index mean composite and four subscale scores were computed at the unit level. Two statistical approaches (one-way analysis of covariance and multivariate analysis of covariance analysis) were employed with a Tukey-Kramer post hoc test.
  
  
  RESULTS
  In general, the nursing practice environment was favorable in all unit types. There were significant differences in the nursing practice environment among the 11 unit types and by Magnet status. Pediatric units had the most favorable practice environment and medical-surgical units had the least favorable. A consistent finding across all unit types except neonatal units was that the staffing and resource adequacy subscale scored the lowest compared with all other Practice Environment Scale of the Nursing Work Index subscales (nursing foundations for quality of care, nurse manager ability, leadership, and support, and nurse-physician relations). Unit nursing practice environments were more favorable in Magnet than non-Magnet hospitals.
  
  
  CONCLUSIONS
  Findings indicate that there are significant variations in unit nursing practice environments among 11 unit types and by hospital Magnet status. Both hospital-level and unit-specific strategies should be considered to achieve an excellent nursing practice environment in all hospital units.
authors.affiliation: College of Nursing Science, Kyung Hee University, Seoul, South Korea. Electronic address: jchoi14@khu.ac.kr.
authors.forename: JiSun
authors.initials: J
authors.lastname: Choi
authors.affiliation: Fay W. Whitney School of Nursing, University of Wyoming, Laramie, WY, United States.
authors.forename: Diane K
authors.initials: DK
authors.lastname: Boyle
mesh_terms: D000208:Acute Disease; D006739:Hospital Administration; D006801:Humans; D009736:Nursing Process; D009741:Nursing Staff, Hospital; D014481:United States
keywords: Acute care units; NDNQI; Registered nurse; Unit nursing practice environment