Evaluation of the professional practice environment of nursing in health institutions

Gasparino, Renata Cristina; Ferreira, Thelen Daiana Mendonça; Carvalho, Kamila Mariana Adami de; Rodrigues, Elke Sandra Alves; Tondo, Juliana Cristina Abatte; Silva, Vanessa Abreu da

doi:10.1590/1982-0194201900061

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Acta Paulista de Enfermagem

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Original Articles • Acta Paul Enferm 32 (4) • Jul-Aug 2019 • https://doi.org/10.1590/1982-0194201900061 copy

Evaluation of the professional practice environment of nursing in health institutions

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To evaluate the hospital environment where nursing performs its practice comparing public and private hospitals and describing the characteristics that received unfavorable evaluation (≤ 2.5 points) in the professionals’ perception.

Methods

A comparative and cross-sectional study was conducted in five hospitals (two public hospitals - A and B; and three private ones - C, D and E) from a city in the countryside of the state of São Paulo, with a total of 1773 nursing professionals. The instruments used were: data sheet for characterization of the sample and the Brazilian version of the Practice Environment Scale. In the data analysis, we used descriptive and inferential statistics. To compare the hospitals, we used the Kruskall Wallis test, followed by the Dunn post-test and the multinomial regression.

Results

In the comparison of hospitals, D and E hospitals reached mean above the others and significant differences (p<0.0001) were obtained in relation to the five subscales of the instrument used. In the multinomial regression, hospital D obtained 5.8; hospital E 5.2; hospital C 3.0 and hospital A 2.7 chances of having a more favorable environment when compared to hospital B. Items with a score lower than 2.5 were associated, especially, lack of opportunity for development, recognition, participatory management and proper sizing.

Conclusion

Private hospitals showed better performance when compared to the public ones, and the characteristics that received the worst evaluation were related to the participation of nurses in hospital affairs based on quality, support of the managers to the team and adequacy of resources.

Health facility environment; Nursing; Hospitals, private; Hospitals, public; Health services administration

PES Subscales	A				B				C				D				E				p-value ^§

	n	x̄^*	SD^†	Md^‡	n	x̄^*	SD^†	Md^‡	n	x̄^*	SD^†	Md^‡	n	x̄^*	SD^†	Md^‡	n	x̄^*	SD^†	Md^‡
Participation^††	510	2.3	0.7	2.2	314	1.9	0.7	1.6	242	2.4	0.7	2.4	267	2.6	0.8	2.6	390	2.7	0.7	2.6	< 0.0001
Fundamentals^‡‡	497	2.6	0.6	2.6	311	2.2	0.7	2.0	247	2.8	0.6	2.8	264	2.9	0.6	2.9	384	3.0	0.6	3.0	< 0.0001
Leadership^§§	511	2.6	0.7	2.6	309	2.4	0.8	2.4	244	2.5	0.8	2.6	266	2.9	0.7	3.0	396	2.7	0.7	2.8	< 0.0001
Resources^\|\|	510	2.3	0.7	2.3	310	1.9	0.7	1.8	245	2.4	0.7	2.5	268	2.7	0.7	2.8	394	2.7	0.7	2.8	< 0.0001
Relations^¶	523	2.8	0.6	2.3	319	2.6	0.8	2.7	251	2.6	0.7	2.7	267	3.0	0.7	3.0	401	2.8	0.6	3.0	< 0.0001
Classification	Miscellaneous				Unfavorable				Miscellaneous				Favorable				Favorable

Dependent variable	Independent variables	Odds Ratio	95% Confidence interval		p-value

			Lower limit	Upper limit
Environment	A	2.7	2.1	3.6	< 0.0001
	C	3.0	2.2	4.2	< 0.0001
	D	5.8	4.2	8.1	< 0.0001
	E	5.2	3.9	7.1	< 0.0001

Subscale	Items
Participation in the discussion of hospitals subjects	Opportunity for career development.
	Opportunities for improvement.
	The institution management listens and responds to workers’ concerns.
	The nursing manager/coordinator/supervisor, of the unit, consults the staff about the daily procedures and problems.
Fundamentals focused on the quality of care	Active quality assurance program.
Fundamentals focused on the quality of care	Program of monitoring/mentoring of newly hired nursing professionals.
Ability, leadership and managers’ support	The nursing manager/coordinator/supervisor, of the unit, use errors as learning opportunities and not as criticisms.
Ability, leadership and managers’ support	Recognition and praise for a well-done job.
Adequacy of the staff and resources	Sufficient time and opportunity to discuss problems with patient care with other nurses.
	A sufficient number of nursing staff to provide quality care to the patients.
	A sufficient nursing staff to accomplish the job.

Escola Paulista de Enfermagem, Universidade Federal de São Paulo R. Napoleão de Barros, 754, 04024-002 São Paulo - SP/Brasil, Tel./Fax: (55 11) 5576 4430 - São Paulo - SP - Brazil
E-mail: actapaulista@unifesp.br

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[1] Corresponding author. Renata Cristina Gasparino E-mail aderess: grenata@unicamp.br