Nurses' perceptions of the organizational attributes of their practice environment in acute care hospitals.

AIM: The aim of the present study was to examine Estonian nurses' thinking with regard to how they perceive their autonomy, control over practice, teamwork and organizational support in regional, central and general hospitals. BACKGROUND; Despite the well-documented fact that there is a need to improve nurses' working environments in hospitals to promote safe patient care, in Europe broader studies on this topic have not received priority thus far.

METHODS: A nationally representative stratified random sample of 478 acute care hospital nurses was surveyed using the Nursing Work Index-Revised (NWI-R) instrument in 2005/2006.

RESULTS: Nurses perceived their autonomy, control over practice and organizational support remarkably lower than nurse-physician relationships. Age and tenure were highly related to the nurses' perceptions.

CONCLUSIONS: The Estonian nurses' ambivalent perceptions of the organizational attributes reflected the effects ascribed to hospital reforms.

IMPLICATIONS FOR NURSING MANAGEMENT: There is an urgent need for nurse managers to be particularly alert and attentive with regard to nurses who have been practising the profession for more than a decade. Support for their practice should be provided with the long-term goal of assuring the retention of those experienced nurses. Continuous monitoring of nurses' perceptions should be used systematically as a tool for staffing decisions at the hospital level.