The Healthcare Environment Survey: A multicountry psychometric evaluation of nurses’ job satisfaction

John Nelson, Dominika Vrbnjak, Patricia L. Thomas, Sebahat Gözüm, Alba Lucia Bottura Leite de Barros, Michal Itzhaki

Research output: Contribution to journalArticlepeer-review


Aim: To evaluate the properties of a reduced-item Healthcare Environment Survey measuring nurses’ job satisfaction across eight countries. Background: There is currently no rigorously tested international measure of nurses’ job satisfaction that can be used internationally to improve the nurse work environment. Methods: Nursing staff from 11 hospitals in eight countries participated in this study. The original 57-item, 11-facet Healthcare Environment Survey was evaluated for reliability, validity, and measurement invariance: Cronbach's alpha was used to test for reliability; construct, discriminate, and convergent testing were used to test validity; and invariance testing including configural, metric, and scalar tests were used to study measurement invariance between the countries. Results: 2,046 nursing staff completed the survey. Reliability was established for all six subscales and the combined composite score. Both validity and measurement invariance were supported in every test conducted. An excellent model fit was found for the final 19-item, 6-facet Healthcare Environment Survey that explained 82% of the variance of nurses’ job satisfaction. Conclusions: Findings suggest the instrument is an efficient measure of nurses’ job satisfaction across multiple countries. Longitudinal testing for invariance will be needed to ensure the model remains a good fit. Testing more countries will also verify model fit. Implications for nursing: The instrument can be used to measure nurse job satisfaction globally. Implications for nursing policy: The instrument can be used to assess interventions to improve the social (patient, unit manager, and coworker) and technical (professional rewards, autonomy, and professional growth) aspects of nurse job satisfaction.

Original languageEnglish
JournalInternational Nursing Review
StateAccepted/In press - 2022


  • capacity building
  • instrument development
  • international collaboration
  • job satisfaction
  • nursing care
  • patient safety
  • psychometric testing


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