Practice environments of nurses employed in ambulatory oncology settings: measure refinement.

The urgent need to improve quality of cancer care coincides with a looming shortage of health care providers to deliver said care. In 1999, the National Cancer Policy Board of the Institute of Medicine identified a “wide gulf” between the gold standard of cancer care and the quality of care delivered to many patients, and gaps in quality of care persist today (Hewitt & Simone, 1999). The Centers for Disease Control and Prevention and National Cancer Institute (NCI) estimate approximately 1.5 million new cases of invasive cancer in 2010 (Jemal, et a., 2009). The NCI estimates the number of patients living with cancer will increase by 50 percent between 2005 and 2020 (Yabroff, Lawrence, Clauser, Davis, & Brown, 2004). This explosive growth in cancer care demand is coupled with only a meager increase in the number of oncology health care providers. The American Society of Clinical Oncology predicts a shortage of 2,550 to 4,080 medical oncologists by 2020 (Association of American Medical Colleges, 2007). While not specific to oncology nursing, one leading nurse workforce research predicts a shortage of 500,000 registered nurses by 2025 (Buerhaus, Auerbach, & Staiger, 2009). The gaps in both cancer care quality and the cancer workforce necessitate a remedy. In 2009, the Institute of Medicine convened a workshop to address these issues (Institute of Medicine, 2009). Workshop attendees endorsed two related strategies to mitigate the shortage of providers and the potential impact on quality of care. The first is to encourage oncology providers, including nursing, to postpone retirement. Strongly related to this recommendation is to create favorable environments to practice clinical care. A favorable environment for clinical practice, defined as the characteristics of a health care organization that support the highest functioning of nurses, is likely to reduce turnover and premature retirement (Lake, 2007). Nursing practice environments have received increased attention as a mechanism to improve care quality. From a conceptual perspective, nursing practice environments are features of settings where nurses are employed that promote job satisfaction, quality of care, or patient safety (Lake, 2007). Organizational sociologists postulate that practice environments with professional, as opposed to bureaucratic orientations, are more likely to result in positive employee, customer, and/or organizational outcomes (Flood & Scott, 1987). Several studies have identified significant relationships between positive nursing practice environments and improved patient outcomes (Aiken, Smith, & Lake, 1994; Friese, Lake, Aiken, Silber, & Sochalski, 2008; Van Bogaert, Clarke, Roelant, Muelemans, & Van de Heyning, 2010). An Institute of Medicine panel affirmed the necessity and feasibility of improving work environments to improve patient safety (Page, 2004). However no reliable and valid measures of this phenomenon exist for the ambulatory setting. Most of the reviewed studies occurred in the inpatient setting. Increased attention to measuring and improving the practice environments of ambulatory oncology settings is warranted, as the overwhelming majority of chemotherapy treatments occur outside of inpatient units. This paper reports on a study to examine the feasibility of a measure designed originally for the inpatient setting to measure the practice environment of nurses in ambulatory oncology settings.