Predictors of Professional Nursing Practice Behaviors in Hospital Settings

BACKGROUND 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 a nurse's ability to practice autonomously and according to professional standards. OBJECTIVES The purpose of the study was to explore how certain factors in the environment and personal characteristics interact to affect hospital nursing practice behaviors. METHODS The study used a nonexperimental, comparative design. Surveys were sent to a random sample of 500 nurses throughout the state of Michigan. Three instruments,measuring structural empowerment, self-efficacy for nursing practice, and professional practice behaviors,were included. Path analysis was used for statistical analysis. RESULTS Three hundred sixty-four nurses responded (73%), of whom 251 provided usable protocols for the final analysis. Environmental factors (structural empowerment) contributed both directly to professional practice behaviors as well as indirectly through self-efficacy. Self-efficacy mainly exerted its effect as a mediator in the relationship between environmental factors and practice behaviors. Support for the proposed theoretical model was mixed, although the proposed model fit the data well (chi2 = 11.02 [(5, N = 251), p < .05, CFI = .999, NNFI = .991, RMSEA = .069]). An alternative model emerged from the data analysis. DISCUSSION 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.