Towards Healthy Work Environments: Development and Validation of the Nursing Organizational Well-Being Questionnaire—A Theory-Based Measure

Background/Objectives: Nursing organizational well-being has important implications for nurses, patients, and healthcare organizations. From a nursing-specific perspective, it arises from the balance between nursing demands and nursing resources in the work environment. However, most available instruments are not grounded in explicit nursing theory and do not allow the identification of well-being profiles through person-centered approaches. This study aimed to develop and evaluate the psychometric properties of the Nursing Organizational Well-being Questionnaire (NOW_Q). Methods: Following COSMIN guidelines, a two-phase design was adopted. Phase 1 involved item generation and expert evaluation, resulting in a 28-item instrument rated on a 5-point frequency scale. Phase 2 consisted of a multicenter cross-sectional study. Construct validity was examined through exploratory and confirmatory factor analyses using cross-validation. Reliability was assessed using ordinal omega coefficients, concurrent validity through associations with a global organizational well-being item, and cluster analysis to explore practical utility. Results: Findings (n = 461 nurses; 7 hospitals) supported an eight-dimension structure: workload, emotional demands, work–family conflict, autonomy, available resources, nurse–nurse relationship, nurse–head nurse relationship, and nurse–physician relationship. The confirmatory model showed good fit (RMSEA = 0.051; CFI = 0.938; TLI = 0.927; SRMR = 0.067), and all dimensions demonstrated satisfactory internal consistency (ordinal omega = 0.75–0.87). Significant associations with global organizational well-being were observed. Three distinct profiles emerged (Nurturing, Observed-Detached, and Withstanding), reflecting different configurations of nursing demands and resources. Conclusions: The NOW_Q is a theory-based, nursing-specific instrument with satisfactory psychometric properties and practical utility for identifying organizational well-being profiles and supporting targeted interventions in clinical settings.