title: Changes to nurses' practice environment over time.
abstract: OBJECTIVE
  To examine changes in the nursing practice environment, retention-related factors, unit stability and patient care tasks delayed or left undone, over two periods between 2004 and 2013.
  
  
  BACKGROUND
  Positive nurse practice environments have been linked to nurse retention and care quality outcomes.
  
  
  METHODS
  The collection of the Practice Environment Scale of the Nursing Work Index, job satisfaction, intent to leave, unit instability and tasks delayed or not done at six acute-care hospitals across three Australian states, in two waves between 2004 and 2013; results from the two waves are compared.
  
  
  RESULTS
  On average, practice environment scores declined slightly; nurses reported a greater difficulty in finding another nursing position, lower intent to leave their current job and greater instability in their current position. Rates of delayed tasks increased over the period, whereas rates of tasks left undone have decreased over the period.
  
  
  CONCLUSIONS
  The decline in nurses' perceptions of the quality of the practice environment is disappointing, particularly given the protracted workforce shortages that have persisted. Significant organisational restructuring and turnover of nurse executives may have contributed to this decline.
  
  
  CONCLUSIONS
  Managers need to apply existing evidence to improve nurse practice environments and manage instability.
authors.affiliation: Centre for Health Services Management, University of Technology, Sydney, NSW, Australia.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Roche
authors.affiliation: Centre for Health Services Management, University of Technology, Sydney, NSW, Australia.|University of Technology, Sydney, NSW, Australia.|Edith Cowan University, Joondalup, WA, Australia.
authors.forename: Christine
authors.initials: C
authors.lastname: Duffield
authors.affiliation: Centre for Health Services Management, University of Technology, Sydney, NSW, Australia.
authors.forename: Sarah
authors.initials: S
authors.lastname: Friedman
authors.affiliation: Edith Cowan University, Joondalup, WA, Australia.|Centre for Nursing Research, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.
authors.forename: Di
authors.initials: D
authors.lastname: Twigg
authors.affiliation: Centre for Health Services Management, University of Technology, Sydney, NSW, Australia.
authors.forename: Sofia
authors.initials: S
authors.lastname: Dimitrelis
authors.affiliation: Centre for Health Services Management, University of Technology, Sydney, NSW, Australia.
authors.forename: Samantha
authors.initials: S
authors.lastname: Rowbotham
mesh_terms: D000328:Adult; D001315:Australia; D005260:Female; D006801:Humans; D033182:Intention; D007400:Interprofessional Relations; D007588:Job Satisfaction; D007857:Leadership; D008297:Male; D008875:Middle Aged; D009726:Nurses / Q000523:psychology*; D009936:Organizational Innovation; D010563:Personnel Turnover / Q000639:trends*; D011787:Quality of Health Care / Q000592:standards / Q000639:trends; D011795:Surveys and Questionnaires; D017132:Workplace / Q000592:standards*
keywords: employment instability; missed or delayed care; nurses; practice environment; turnover