The N2N instrument to evaluate healthy work environments: an Italian validation.

Objectives The aims of the study were to (a) validate N2N Healthy Work Environment tool, (b) assess the healthiness of work environments as perceived by nurses themselves and (c) identify the factors associated with Italian nurses' perception of work environment healthiness. Methods The linguistic and cultural adaptation of USAN2N Healthy Work Environments was achieved through a process of forward/backward translation. Content validity was assessed by three expert nurses. The stability of the instrument was checked with a test/retest evaluation. The instrument psychometric properties, the confirmatory factor analysis as well the healthiness of the work environment and its determinant factors were evaluated with a sample of 294 nurses. Results The content and face validity of the N2N Healthy Work Environment instrument was confirmed. The instrument demonstrated good internal consistency (a of 0.82), excellent stability values (p > 0.70) and high levels of acceptability (response rate: 96.4 %). The confirmatory factor analysis has corroborated the existence of two factors as documented in the original instrument (Mays et al. in J Nurs Manag 19:18-26, 2011). Eighty-seven (29.6 %) nurses perceived the work environment where they work as "healthy". Working under a functional model of care delivery (X2 24.856, p 0.000) and being responsible for one project or more (X2 5.256, p 0.021) were associated with healthy environments. Conclusions The instrument-valid and reliable, short in the number of items, easy to understand and based on international standards-allows a systematic assessment of the healthiness of the environment and might provide not only the opportunity to evaluate the effects of new organizational models and interventions, but also the possibility to activate a process of self-analysis and a process of ongoing review. The instrument can be used to systematically check the healthiness of Italian working environments, allowing for organizational diagnosis, targeted interventions and international comparisons.