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Assessing the Practice Environment: Relationships Do Matter

Primary Author: Sandra L. Siedlecki, PhD, RN, CNS
Co-Principal Investigators/Collaborators: N/A
Organization: Cleveland Clinic






The purpose of this project was to develop an instrument that examined the positive rather than the negative aspects of the professional practice environment, to assess its psychometric properties, and to examine its usefulness in examining how relationships potentially impact patient outcomes.


The quality of the professional practice environment has been associated with patient outcomes. However, instruments previously used assessed the presence or absence of negative physician behaviors; or looked at a single aspect of the nurse-physician relationship, such as communication or collaboration. Instruments that assessed the positive aspects of the practice environment were not found.

Materials & Methods

Items in the Professional Practice Environment Assessment Scale (PPEAS) were selected using a 3-stage Delphi technique and were based upon the assumption that a positive professional practice environment is more than and different from the absence of negative, abusive or disrespectful behaviors by physicians. Following IRB approval, emails were sent to nurses and physicians asking them to share their perceptions of the professional environment where they practiced by completing the PPEAS. 


The sample (N = 1332) consisted of 801 nurses and 531 physicians. Principal component analysis found the PPEAS consisted of four subscales; physician characteristics, nurse characteristics, collaborative decision-making, and beliefs about the importance of nurse physician relationship. Both nurses and physicians rated their practice environments similarly, but physicians rated it higher than nurses and this difference was significant (p < .001). Of particular interest was the finding that a physician’s behavior affected a nurse’s decision to call a physician or report a change in a patient’s condition. 


The PPEAS provides a single instrument to assess both nurse and physician perceptions of the professional practice environment. Using the total score, organizations can examine the current status of their professional practice environment and examine changes in the environment over time; and subscale analysis can identify specific characteristics in need of change. 



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© Improvement Science Research Network, 2012

The ISRN published this as received and with permission from the author(s).

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