Validation of the Practice Environment Scale-Nursing Work Index for Measuring Hospital Case Management Practice Environment.

Purpose of study: The Practice Environment Scale of the Nursing Work Index (PES-NWI) is widely used to measure the practice environment across nursing populations. Case management is a specialty focused on care coordination to meet the clinical and financial goals of medically and socially complex individuals across the care continuum. Despite its importance, limited research exists on the hospital case management practice environment, and no instrument currently measures this concept. This study aimed to adapt and validate the psychometric properties of a hospital case management version of the PES-NWI.

Primary practice setting: Acute care hospitals where case managers practice.

Methodology and sample: Following expert panel feedback, the PES-NWI was adapted and shortened from 31 to 23 items for use in hospital case management. A convenience sample of 160 hospital case managers across the United States was recruited via social media and professional networks. The psychometric evaluation included assessments of validity (content validity via expert panel review, known-groups construct validity, and factor analysis) and reliability (Cronbach's alpha and item-total correlations).

Results: Participants included case managers working in 34 states. Most were female (92%) from the nursing discipline (79%) and social work (21%). Nearly 60% held case management certification, and 40% had over 10 years of experience in the field of case management. Factor analysis revealed a four-factor structure with items cleanly loading between 0.44 and 0.74. The four factors represented Supportive and Participatory Leadership, Staffing and Resource Adequacy, Opportunities for Professional Development, and Fostering Teamwork and Collaboration. The factor structure of the adapted instrument differs from that of the original PES-NWI, indicating a need for further testing. Nevertheless, the adapted instrument demonstrates strong internal consistency (overall Cronbach's alpha of 0.93) and item-to-total correlations from 0.37 to 0.80.

Implications for case management practice: The adapted instrument, Practice Environment Scale for Hospital Case Management, the first to measure the hospital case management practice environment, demonstrates adequate reliability and validity. It provides a critical foundation for future research and supports the development of evidence-based strategies to enhance hospital case management practice. Understanding this environment is crucial for advancing workforce development, enhancing professional satisfaction, and maximizing the impact of case management in acute care settings.