All ETDs from UAB

Advisory Committee Chair

Patricia Patrician

Advisory Committee Members

Emily Cramer

Peng Li

Danielle Olds

Pauline A Swiger

Nora Warshawsky

Document Type


Date of Award


Degree Name by School

Doctor of Philosophy (PhD) School of Nursing


The Practice Environment Scale of the Nursing Work Index (PES-NWI) is the most frequently used instrument for measuring the nursing work environment. The original PES-NWI obtained its items directly from the parent instrument, the Nursing Work Index, which was developed in the 1980s. However, potential value change among younger generations and vast historical, social, and technological transformations in the way healthcare is provided may have led to different factors that compose a favorable work environment for nurses working today. The purpose of this dissertation was to evaluate and revise the PES-NWI for use in today’s nursing workforce. To accomplish this goal, a three-article dissertation has been prepared. Article 1 is a literature review chronicling the lineage of instruments derived from the Nursing Work Index. Articles 2 and 3 describe the findings of a descriptive, cross-sectional survey administered in May-July of 2021 to a national sample of direct care hospital nurses. As part of this survey, a modified version of the PES-NWI was administered. The modified instrument contained additional selection options that allowed nurses to indicate an item’s importance to their job satisfaction and ability to provide quality patient care, as well as 19 new items that may be relevant to contemporary nursing practice. Additionally, open-ended questions were asked, to allow nurses to suggest additional relevant items. To evaluate each individual item on the instrument, individual item-level content validity indices were used. Items maintaining a iii value of greater than 0.80 were retained for further analysis. The responses to the openended questions were analyzed via content analysis. The modified instrument then underwent a thorough psychometric analysis, including exploratory and confirmatory factor analyses. Findings from this dissertation verify that descendent instruments of the Nursing Work Index, particularly the PES-NWI, have been administered to hundreds of thousands of nurses globally in the last 40 years. Further, the addition of several new items and removal of previous items on the PES-NWI is supported to measure current nursing practice. Lastly, the modified PES-NWI, and the subsequently derived instrument, the PES-v2021, are suitable for further testing and refinement in other samples.

Included in

Nursing Commons



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