Environmental and personal predictors of professional nursing practice behaviors in hospital settings.

Abstract

The purpose of the study was to test a theoretical model explaining how selected environmental and personal factors affect hospital nursing practice behaviors. Many hospital nurses perform isolated, routine tasks, rather than use their professional training because they are subject to control by organizational and medical divisions of labor. The environment may interfere with nurses' ability to practice autonomously, and according to professional standards. Nursing may not be an attractive career option because of the task-centered focus of a lot of nursing work, and patient outcomes may be adversely affected by task-oriented behaviors. The study used a non-experimental, comparative design. Surveys were sent to a random sample of 500 nurses in Michigan. Four instruments, measuring structural empowerment, self-efficacy, professional nursing practice, and nursing leadership were included. Path analysis was used for statistical analysis. Three hundred and sixty-four nurses responded (73%), of which 266 provided usable protocols for the final analysis. Findings did not support the theoretical model as proposed, but an alternative model emerged. Environmental factors (structural empowerment) contributed both directly to professional practice behaviors and indirectly through self-efficacy. Self-efficacy mainly exerted its effect as a mediator in the relationship between environmental factors and practice behaviors. Level of education and specialty certification were also found to positively affect practice behaviors directly. Nursing leadership had an indirect impact only, and helped to predict 46% of the variance in the overall model explaining nursing practice behaviors. Nurses may practice more professionally when the environment provides opportunities and power through resources, support, and information. Self-efficacy may contribute to professional practice behaviors, especially in an environment that has the requisite factors that provide empowerment, and where strong nursing leadership exists. Strong nursing leadership may influence nurses' self-efficacy by providing more access to structural empowerment factors. Future research should continue testing of the revised theoretical model to be able to fully understand professional nursing practice behaviors, and incorporate the impact of those behaviors on patient outcomes.