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The N2N instrument to evaluate healthy work environments: an Italian validation

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Abstract

Objectives

The aims of the study were to (a) validate N2N Healthy Work Environment tool, (b) assess the healthiness of work environments as perceived by nurses themselves and (c) identify the factors associated with Italian nurses’ perception of work environment healthiness.

Methods

The linguistic and cultural adaptation of USA-N2N Healthy Work Environments was achieved through a process of forward/backward translation. Content validity was assessed by three expert nurses. The stability of the instrument was checked with a test/retest evaluation. The instrument psychometric properties, the confirmatory factor analysis as well the healthiness of the work environment and its determinant factors were evaluated with a sample of 294 nurses.

Results

The content and face validity of the N2N Healthy Work Environment instrument was confirmed. The instrument demonstrated good internal consistency (α of 0.82), excellent stability values (ρ > 0.70) and high levels of acceptability (response rate: 96.4 %). The confirmatory factor analysis has corroborated the existence of two factors as documented in the original instrument (Mays et al. in J Nurs Manag 19:18–26, 2011). Eighty-seven (29.6 %) nurses perceived the work environment where they work as “healthy”. Working under a functional model of care delivery (χ2 24.856, p 0.000) and being responsible for one project or more (χ2 5.256, p 0.021) were associated with healthy environments.

Conclusions

The instrument—valid and reliable, short in the number of items, easy to understand and based on international standards—allows a systematic assessment of the healthiness of the environment and might provide not only the opportunity to evaluate the effects of new organizational models and interventions, but also the possibility to activate a process of self-analysis and a process of ongoing review. The instrument can be used to systematically check the healthiness of Italian working environments, allowing for organizational diagnosis, targeted interventions and international comparisons.

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References

  • Addley K, McQuillan P, Ruddle M (2001) Creating healthy workplaces in Northern Ireland: evaluation of a lifestyle and physical activity assessment programme. Occup Med (Lond) 51:439–449

    Article  CAS  Google Scholar 

  • Aiken LH, Clarke SP, Sloane DM, Sochalski J, Silber JH (2002) Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA 288:1987–1993

    Article  Google Scholar 

  • Aiken LH, Havens DS, Sloane DM (2009) The magnet nursing services recognition program: a comparison of two groups of magnet hospitals. J Nurs Adm 39:5–14

    Article  Google Scholar 

  • American Association of Critical-Care Nurses (AACCN) (2005) AACN standards for establishing and sustaining healthy work environments: a journey to excellence. Am J Crit Care 14:187–197

    Google Scholar 

  • Anderson JC, Gerbing DW (1988) Structural equation modelling in practice: a review and recommended two-step approach. Psychol Bull 103:411–423

    Article  Google Scholar 

  • Bagozzi RP, Foxall GR (1996) Construct validation of a measure of adaptive-innovative cognitive styles in consumption. Int J Res Mark 13:201–213

    Article  Google Scholar 

  • Bator VD, Yoder LH (2012) Managerial coaching: a concept analysis. J Adv Nurs 18(7):1658–1669

    Google Scholar 

  • Bollen KA (1989). Structural equations with latent variables. Wiley Series in Probability and Mathematical Statistics, Wiley, New York, USA

  • Bortoluzzi G, Palese A (2010) The Italian economic crisis and its impact on nursing services and education: hard and challenging times. J Nurs Manag 18:515–519

    Article  Google Scholar 

  • Bortoluzzi G, Caporale L, Palese A (2012) Does participative leadership reduce the onset of mobbing risk among nurse working teams? J Nurs Manag (in press)

  • Chang EM, Hancock KM, Johnson S, Daily J, Jackson D (2005) Role stress in nurses: review of related factors and strategies for moving forward. Nurs Health Sci 7:57–65

    Article  Google Scholar 

  • Chu CI, Hsu YF (2011) Hospital nurse job attitudes and performance: the impact of employment status. J Nurs Res 19:53–60

    Article  Google Scholar 

  • Clarke SP (2004) Failure to rescue: lessons from missed opportunities in care. Nurs Inq 11:67–71

    Article  Google Scholar 

  • Clegg A (2001) Occupational stress in nursing: a review of the literature. Occup Med (Lond) 9:101–106

    CAS  Google Scholar 

  • De Vellis RF (2003) Scale development theory and applications. Sage Publications, Thousand Oaks

    Google Scholar 

  • Disch J (2002) Creating healthy work environments. Creat Nurs 8:3–4

    Google Scholar 

  • Donahue MO, Piazza IM, Griffin MQ, Dykes PC, Fitzpatrick JJ (2008) The relationship between nurses’ perceptions of empowerment and patient satisfaction. Appl Nurs Res 21:2–7

    Article  Google Scholar 

  • Erenstein CF, McCaffrey R (2007) How healthcare work environments influence nurse retention. Holist Nurs Pract 21:303–307

    Article  Google Scholar 

  • Federazione Nazionale Collegi IPASVI (2010) Albo IP: analisi dei flussi. IPASVI Publishing http://www.ipasvi.it/archivio_news/pagine/96/Albo%20IP%20analisi%20dei%20flussi%20-%20Rapporto%202009.pdf

  • Ferketich S (1991) Focus on psychometrics: aspects of item analysis. Res Nurs Health 14:165–168

    Article  CAS  Google Scholar 

  • Fortunato E (2012) Gli infermieri stranieri in Italia: quanti sono, da dove vengono e come sono distribuiti. L’infermiere 1:9–14

    Google Scholar 

  • Gillespie BM, Chaboyer W, Wallis M, Chang HY, Werder H (2009) Operating theatre nurses’ perceptions of competence: a focus group study. J Adv Nurs 65:1019–1028

    Article  Google Scholar 

  • Hasselhorn HM, Muller BH, Tackenberg P (2005) NEXT scientific report. University of Wuppertal, Germany

    Google Scholar 

  • Healh J, Johanson W, Blake N (2004) Healthy work environments: a validation of the literature. J Nurs Adm 34:524–530

    Article  Google Scholar 

  • Iavicoli S, Valenti A, Persechino B (2011) The management of foreign workers in Italy. G Ital Med Lav Ergon 33(3):355–362

    Google Scholar 

  • Im EO, Page R, Lin LC, Tsai HM, Cheng CY (2004) Rigor in cross-cultural nursing research. Int J Nurs Stud 41(8):891–899

    Article  Google Scholar 

  • Institute of Medicine (IOM) (2004) Keeping patients safe: transforming the work environment of nurses. The National Academic Press, Washington

    Google Scholar 

  • Khowaja K, Merchand RJ, Hirani D (2005) Registered nurses perception of work satisfaction at a Tertiary Care University Hospital. J Nurs Manag 13:32–39

    Article  Google Scholar 

  • Kimberly JR (1976) Issues in the design of longitudinal organizational research. Soc Meth Res 4:321–348

    Article  Google Scholar 

  • Kramer M, Schmalenberg C (2008) Healthy work environments. Crit Care Nurse 28:56–63

    Google Scholar 

  • Kristensen T (1999) Challenges for research and prevention in relation to work and cardiovascular diseases. Scand J Work Environ Health 25:550–557

    Article  CAS  Google Scholar 

  • Laschinger HKS (2008) Effect of empowerment on professional practice environments, work satisfaction, and patient care quality: further testing of the Nursing Worklife Model. J Nurs Care Qual 23:322–330

    Article  Google Scholar 

  • Laschinger HKS, Finegan J (2005) Using empowerment to build trust and respect in the workplace: a strategy for addressing the nursing shortage. Nurs Econ 23:6–13

    Google Scholar 

  • Laschinger HKS, Leiter MP (2006) The impact of nursing work environments on patient safety outcomes: the mediating role of burnout/engagement. J Nurs Adm 36:259–267

    Article  Google Scholar 

  • Laschinger HKS, Shamian J, Thomson D (2001) Impact of magnet hospital characteristics on nurses’ perceptions of trust, burnout, quality of care and work satisfaction. Nurs Econ 19:201–219

    Google Scholar 

  • Laschinger HKS, Finegan J, Shamian J, Wilk P (2004) A longitudinal analysis of the impact of workplace empowerment on work satisfaction. J Organ Behav 25:527–545

    Article  Google Scholar 

  • Lautizi M, Laschinger HK, Ravazzolo S (2009) Workplace empowerment, job satisfaction and job stress among Italian mental health nurses: an exploratory study. J Nurs Manag 17:446–452

    Article  Google Scholar 

  • Legislative Decree 81/2008 (2008) Management of a prevention of risk in the work environment, Rome, Italy

  • Li J, Fu H, Hu Y, Shang L, Wu Y, Kristensen TS, Mueller BH, Hasselhorn HM (2010) Psychosocial work environment and intention to leave the nursing profession: results from the longitudinal Chinese NEXT study. Scand J Public Health 38:69–80

    Article  CAS  Google Scholar 

  • Malfa R (1987) In: AIDP (Associazione Italiana per la Direzione del Personale), Atti del Seminario “Qualità dell’aria negli uffici: la sindrome dei palazzi malati”, AIDP, Milan, Italy

  • Mays MZ, Hrabe DP, Stevens CJ (2011) Reliability and validity of an instrument assessing nurses’ attitudes about healthy work environments in hospitals. J Nurs Manag 19:18–26

    Article  Google Scholar 

  • McGillis Hall D, Doran D (2007) Nurses’ perceptions of hospital work environments. J Nurs Manag 15:264–273

    Article  Google Scholar 

  • McKenna BG, Poole SJ, Smith NA, Coverdale JH, Gale CK (2003) A survey of threats and violent behaviour by patients against registered nurses in their first year of practice. Int J Ment Health Nurs 12:56–63

    Article  Google Scholar 

  • Minister of Health (2012) Il Personale del Sistema Sanitario. Direzione Generale del Sistema informativo e statistico sanitario Direzione Generale delle Professioni sanitarie e delle Risorse Umane del SSN. Publishing http://www.salute.gov.it/imgs/C_17_pubblicazioni_1816_allegato.pdf

  • Nunnally J, Bernstein I (1994) Psychometric theory. McGraw-Hill, New York

    Google Scholar 

  • OECD (2010) Employment and the crisis on employment and unemployment in the OECD countries. OECD Publishing, Paris, p 2010

    Google Scholar 

  • Palese A, Regattin L, Bertolano T, Brusaferro S (2006) La dotazione di personale infermieristico nei reparti di chirurgia e ortopedia italiani: risultati preliminari di uno studio pilota. Assist Inferm Ric 25:206–213

    Google Scholar 

  • Palese A, Mesaglio M, De Lucia P, Guardini I, Dal Forno M, Vesca R, Boschetti B, Noacco M, Salmaso D (2012a) Nursing effectiveness in Italy: findings from a grounded theory study. J Nurs Manag. doi:10.1111/j.1365-2834.2012.01392.x

    Google Scholar 

  • Palese A, Vianelli C, De Maino R, Bortoluzzi G (2012b) Measures of cost containment, impact of the economical crisis, and the effects perceived in nursing daily practice: an Italian crossover study. Nurs Econ 30(2):86–93 119

    Google Scholar 

  • Papastavrou E, Efstathiou G, Acaroglu R, Antunes Da Luz MD, Berg A, Idvall E, Kalafati M, Kanan N, Katajisto J, Leino-Kilpi H, Lemonidou C, Sendir M, Sousa VD, Suhonen R (2011) A seven country comparison of nurses’ perceptions of their professional practice environment. J Nurs Managi. doi:10.1111/j.1365-2834.2011.01289.x

    Google Scholar 

  • Pisanti R, Van der Doef M, Maes S, Lazzari D, Bertini M (2011) Job characteristics, organisational conditions, and distress/well-being among Italian and Dutch nurses: a cross-national comparison. Int J Nurs Stud 48:829–837

    Article  Google Scholar 

  • Purdy N, Spence Laschinger HK, Finegan J, Kerr M, Olivera F (2010) Effects of work environments on nurse and patient outcomes. J Nurs Manag 18:901–913

    Article  Google Scholar 

  • Rodham K, Bell J (2002) Work stress: an exploratory study of the practices and perceptions of female junior healthcare managers. J Nurs Manag 10:5–11

    Article  CAS  Google Scholar 

  • Rosenstein AH (2002) Original research: nurse-physician relationships: impact on nurse satisfaction and retention. Am J Nurs 102:26–34

    Article  Google Scholar 

  • Rosenstein AH, O’Daniel M (2005) Disruptive behavior and clinical outcomes: perceptions of nurses and physicians. Am J Nurs 105:54–64

    Article  Google Scholar 

  • Scherer P, Devaux M (2010) The challenge of financing health care in the current crisis: an analysis based on the OECD data. OECD Health Working Papers, No. 49, OECD Publishing. http://dx.doi.org/10.1787/5kmfkgr0nb20-en

  • Setti I, Argentero P (2011) Organizational features of workplace and job engagement among Swiss healthcare workers. Nurs Health Sci 13:425–432

    Article  Google Scholar 

  • Stringhetta F, Dal Ponte A, Palese A (2012) Evoluzione della carenza infermieristica e strategie adottate per affrontarla: studio longitudinale in undici aziende sanitarie. Assist Inferm Ric 31:203–210

    Google Scholar 

  • Ulrich BT, Buerhaus PI, Donelan K, Norman L, Dittus R (2007) Magnet status and registered nurse views of the work environment and nursing as a career. J Nurs Adm 37:212–220

    Article  Google Scholar 

  • Valenti A, Boccuni F, Rondinone BM, Vonesch N, Iavicoli S (2007) Migration, work flexibility and early retirement of nurses in Italy. G Ital Med Lav Ergon 29:706–708

    CAS  Google Scholar 

  • Vessey JA, Deamarco RF, Gaffney DA, Budin WC (2009) Bullying of staff registered nurses in workplace: a preliminary study for developing personal and organizational strategies for the transformation of hostile to healthy workplace environments. J Prof Nurs 25:299–306

    Article  Google Scholar 

  • Warshawsky NE, Havens DS (2011) Global use of the practice environment scale of nursing index. Nurs Res 60:17–31

    Article  Google Scholar 

  • White M, Elander G (1992) Translation of an instrument. The US-Nordic family dynamics nursing research project. Scand J Caring Sci 6:161–164

    Article  CAS  Google Scholar 

  • Yildirim A, Yildirim D (2007) Mobbing in the workplace by peers and managers: mobbing experienced by nurses working in healthcare facilities in Turkey and its effect on nurses. J Clin Nurs 16:444–453

    Article  Google Scholar 

  • Zohar D, Livne Y, Tenne-Gazit O, Admi H, Donchin Y (2007) Healthcare climate: a framework for measuring and improving patient safety. Crit Care Med 35:1312–1317

    Article  Google Scholar 

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Acknowledgments

The original project was supported in part by funds from the Division of Nursing, Bureau of Health Professions, Health Resources and Services Administration (HRSA), Department of Health and Human Services under HRSA grant # 1 D11HP07364-01-00, Nurse-to-Nurse: Improving RN Retention & Patient Care. Authors thank Mary Z. Mays, David P. Hrabe, Carol J. Stevens (USA), for their authorization and supervision. Authors also thank Laura Pilotto and Ilario Guardini (Italy) for their valuable contribution to the backward and forward translation.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. School of Nursing, University of Udine, Viale Ungheria, 20, 33100, Udine, Italy

    Alvisa Palese

  2. Cardiological Unit, Teaching Hospital, Udine, Italy

    Laura Tonzar

  3. School of Nursing, University of Trieste, Trieste, Italy

    Angelo Dante

  4. Department of Economics ‘Marco Biagi’, University of Modena and Reggio Emilia, Modena, Italy

    Bernardo Balboni

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  1. Alvisa Palese
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  2. Angelo Dante
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  4. Bernardo Balboni
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Correspondence to Alvisa Palese.

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Palese, A., Dante, A., Tonzar, L. et al. The N2N instrument to evaluate healthy work environments: an Italian validation. Int Arch Occup Environ Health 87, 217–228 (2014). https://doi.org/10.1007/s00420-013-0851-3

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