Confirmatory factor analysis of the practice environment scale of the nursing work index in British Columbia

Relationships between nurse practice environment (NPE) characteristics and patient and nurse outcomes have been the focus of a growing body of healthcare research worldwide, including in Canada. Validated instruments which measure NPE factors are important for better understanding their associations to patient and nurse outcomes, yet there is a lack of evidence for such validated instruments in British Columbia (BC), Canada. The Practice Environment Scale of the Nursing Work Index (PES-NWI) is a commonly used survey instrument to measure NPEs in the published nursing research literature (Lake et al., 2024; Lake et al., 2019; Lee & Scott, 2018). The original PES-NWI was described as a 31-item, 5-factor model (Lake, 2002). The primary objective of this study was to evaluate the validity the PES-NWI in the BC nursing context using a sample of BC acute care registered nurses (RN), using confirmatory factor analysis methods and Mplus statistical software. An additional objective for this study was respecify the PES-NWI factor structure to optimize model fit for the BC nursing context using recommended model respecification procedures (Brown, 2015). This was a secondary analysis study which used data from the British Columbia Nurses’ Workload Impact Study (BCNWIS) collected during 2014. This thesis study findings yielded a second-order 32-item, 8-factor model reflecting the NPE, which showed a moderately good fit to the BC nurse data. Contributions include a validated, second-order 32-item, 8-factor PES-NWI model recommended for use in the BC nursing context. Findings also showed statistical validity to support the theoretical associations between PES-NWI factors. In addition, second-order models also provide options for instrument scoring (i.e., use of a single “total score) and evaluation (i.e., testing and comparing first-and second-order models across different contexts) (Brown, 2015; Furr, 2022).