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. 2025 Nov 7;22(6):e70082. doi: 10.1111/wvn.70082

The Association Between Nursing Work Environment and Evidence‐Based Practice

Alberto Lana 1,2,3, Lucía Fernández‐Arce 1,2,3,✉, María González‐García 2,4, Rocío Fernández‐Iglesias 1,3,5, Elena Andina‐Díaz 6,7, Ana Fernández Feito 2,8
PMCID: PMC12595286  PMID: 41204679

ABSTRACT

Introduction

Evidence‐based practice (EBP) is essential for improving the quality of care and health outcomes in healthcare organizations. This study aimed to analyze the association between the nursing work environment and EBP elements, including attitude, training, implementation and quality of care.

Methods

A multicenter, cross‐sectional study was conducted with 1022 registered nurses from 57 primary care centers and four public hospitals in northern Spain. The Practice Environment Scale of the Nursing Work Index (PES‐NWI) was used to assess the nursing work environment. Data collection also included the Health Sciences Evidence‐Based Practice (HS‐EBP) questionnaire to evaluate attitudes toward EBP, and self‐reported measures of EBP training, EBP implementation, and overall quality of care. Odds ratios (OR) and 95% confidence intervals for the association between the nursing work environment and EBP elements were calculated using logistic regression adjusted for sociodemographic and occupational characteristics.

Results

Compared to nurses who reported working in unfavorable environments (n = 220; 21.5%), those working in favorable environments (n = 437; 42.8%) exhibited a positive attitude toward EBP (OR = 2.89; 95% CI [2.00, 4.18]), EBP implementation (OR = 2.30; 95% CI [1.52, 3.39]) and higher quality of care (OR = 2.35; 95% CI [1.61, 3.44]). Using a composite measure that considered all EBP elements, favorable environments were associated with overall EBP engagement (OR = 3.47; 95% CI [2.38, 5.07]). The most influential environmental dimensions were adequate staffing and strong nursing foundations.

Linking Evidence to Action

A favorable nursing work environment was strongly associated with a positive attitude toward EBP, the implementation of EBP, and a commitment to providing high‐quality care. Key strategies to promote EBP should involve healthcare and academic institutions working together to establish a healthy work environment with appropriate staffing and care foundations rooted in nursing theory.

Keywords: evidence‐based practice, nurses, nursing staff, organizational culture, quality of health care, working environment

1. Introduction

Evidence‐based practice (EBP) is an ongoing process combining critical evaluation of scientific evidence, advanced clinical experience, and patient preferences (Dusin et al. 2023). In nursing, EBP integrates nursing theory with these three elements to provide high‐quality, holistic care (Melnyk and Fineout‐Overholt 2023). As a person‐centered, problem‐solving approach, EBP is considered a basic pillar of the nursing discipline.

Replacing traditional, unsystematized practices based on the replication of roles and procedures with EBP reduces healthcare variability and costs and leads to higher‐quality care (Melnyk et al. 2014; Connor, Beckett, et al. 2023). While it is difficult to measure the direct impact of EBP on clinical outcomes (Wu et al. 2018), studies have shown that EBP improves length of stay, nosocomial infections, physical and psychological complications (e.g., pressure ulcers, falls or stress), quality of life, and mortality (Connor, Beckett, et al. 2023; Emparanza et al. 2015; Xue et al. 2024; Doran et al. 2014).

For decades, international nursing organizations have committed to lobbying governments and healthcare providers to support the development of EBP. However, transferring research results to clinical practice in increasingly complex healthcare settings remains challenging (Camargo et al. 2018). To successfully implement EBP, it is crucial to remove barriers through programs that are acceptable to nurses and that align with the goals of healthcare organizations.

Some barriers can be considered at the personal, patient/family, and scientific evidence levels, particularly the difficulty of translating knowledge into action in real clinical practice settings (Zhao et al. 2022). However, most barriers to implementing EBP are interposed by health care organizations themselves and include a lack of institutional support, poor nurse leadership, scarcity of resources, competing priorities, and a high workload (Li et al. 2019; Furtado et al. 2024; Mick 2017; Clavijo‐Chamorro et al. 2020). These factors reflect the characteristics of the work environment, which can either support or hinder EBP. The work environment encompasses a set of physical and social factors that comprise the concrete day‐to‐day conditions where nursing work takes place (Medina‐Córdoba et al. 2024). The work environment is largely shaped by the culture of the health care organization. The organizational culture is a system of shared meanings, including values, beliefs, behaviors and norms that define the institution (Rafi'I et al. 2025). It is an invisible social thread that binds healthcare workers together, shaping the way they work, relate to each other, and make decisions. Organizational culture has been shown to modulate the implementation of EBP (Alodhialah 2025; Li et al. 2018). For these reasons, establishing and maintaining structured organizational conditions has been suggested as an essential basis for ensuring quality of care (Teixeira et al. 2023; Alodhialah 2025).

Although specifically measuring the organizational culture is complex due to its abstract nature (Ost et al. 2020), accurate measurement tools exist for nursing work environments (Campbell et al. 2024). Additionally, there is a consensus that more robust evidence is necessary to understand how the work environment specifically promotes the implementation of EBP (Teixeira et al. 2023). First, it is essential to identify the specific contribution of each dimension of the nursing work environment to EBP. Second, as most studies addressing the impact of organizational culture on EBP originate from North America and Asia (Li et al. 2018; Lake et al. 2024), examining this association in Europe, where work environments are significantly weaker (Lake et al. 2024), is of prime interest.

This study hypothesized that a better nursing work environment is associated with the autonomous EBP implementation in real clinical settings, and that EBP could therefore act as a mediator between the nursing work environment and better patient health outcomes. This study aimed to explore the association between registered nurses' perceptions of the clinical practice environment in Spain and some EBP elements, including attitude, training and implementation.

2. Subjects and Methods

2.1. Study Design and Participants

This multicenter, cross‐sectional study involved a sample of primary and specialized care registered nurses from Spain. Participants were recruited from 57 public primary care centers and four public hospitals in northern Spain, between January and March 2020. The primary care centers included both urban and rural facilities. Among specialized care facilities, two were level 3 hospitals with 500–1000 beds, and two were level 2 hospitals with fewer than 500 beds. Since previous studies have shown that primary care and hospital nurses face similar barriers and facilitators when implementing EBP, our study examined both settings together (Mallion and Brooke 2016). Trained staff personally visited all clinical units of the selected health centers to collect standardized data. At least three reminder rounds were conducted in units with lower initial participation. We excluded registered nurses who were assistant or associate professors of nursing at the university level because we deemed their knowledge of EBP to be unrepresentative.

In total, this study recruited 1197 nurses: 262 (21.9%) from primary care settings and 935 (78.1%) from hospitals. Then, of the initial sample, 157 were excluded due to missing information on any of the PES‐NWI items, and 9 due to missing data on any of the EBP variables. Participants without data on any sociodemographic (n = 2) or occupational (n = 7) variables were also excluded. Thus, 1022 nurses were included in the analysis.

All registered nurses provided informed consent prior to participating in this study. Participation was voluntary, unpaid and did not impact the nurses' professional duties. The study was approved by the Research Ethics Committee of Asturias (ref. 19/18).

2.2. Study Variables

2.2.1. Nursing Work Environment

The nursing work environment was assessed using the Practice Environment Scale of the Nursing Work Index (PES‐NWI), a 31‐item scale developed by Lake (2002) in 2002 from two previous instruments: the NWI, developed by Kramer and Hafner (1989), and the revised NWI, proposed by Aiken and Patrician (2000). For the RN4CAST study, a group of European and American researchers—including the creators of the original scales—adapted and extended the PES‐NWI to 32 items (Fuentelsaz‐Gallego et al. 2013; Orts‐Cortés et al. 2013). This final version was used in the present study. The scale consists of 32 items on a four‐point Likert scale, ranging from 1 = strongly disagree to 4 = strongly agree. Additionally, the items can be grouped into 5 subscales that reflect 5 dimensions: (1) nurse participation in hospital affairs (8 items); (2) nursing foundations for quality of care (9 items); (3) nurse manager ability, leadership, and support of nurses (4 items); (4) staffing and resource adequacy (4 items); and (5) collegial nurse‐physician relations (7 items). Subscale scores were calculated by adding the points for each item and dividing by the number of items in the subscale. The overall score was calculated as the mean of the 5 subscale scores. Higher scores on the overall score and on the subscales indicated better nursing work environments. Following Lake and Friese (2006), PES‐NWI scores were used to define three categories of settings: favorable (if 4 or more subscales obtained mean scores > 2.5 points), mixed (if two or three subscales obtained mean scores > 2.5 points), and unfavorable (if one or fewer subscales obtained mean scores > 2.5 points).

2.2.2. Evidence‐Based Practice

This study examined four self‐reported elements of EBP: beliefs/attitudes, training, implementation, and the overall quality of care.

The Health Sciences EBP (HS‐EBP) questionnaire was used to measure nurses' beliefs and attitudes (Fernández‐Domínguez et al. 2017). The HS‐EBP consists of 60 10‐point Likert‐type items (from 1 = strongly disagree to 10 = strongly agree). The latent structure of the HS‐EBP contains five subscales: beliefs/attitudes, literature findings, professional practice, outcome evaluation, and barriers/facilitators. For this study, we only used the first subscale, consisting of 12 items. The score was determined by adding up the points for each item. Thus, the possible range was 12–120 points. Because there were no pre‐established cutoff points to define positive attitudes toward EBP, and in accordance with the methodology of the creators of the scale (Fernández‐Domínguez et al. 2020), we used the median value to categorize participants into two groups. Nurses were considered to have a positive attitude if they scored 100 points or higher.

The following questions were used to assess EBP training, implementation, and overall quality of care: “Have you undertaken any specific training in EBP?” (yes/no), “Do you provide nursing care based on scientific evidence in your daily work?” (yes/no), and “Overall, how would you rate the quality of care provided during your professional practice?” The last question was evaluated using a numerical scale from 1 to 10 points, with higher scores indicating a higher quality of care. In this study, the median value was used to categorize the quality of care. Therefore, a score of at least 8 points was suggestive of good quality of care in our sample.

Finally, a composite EBP indicator was constructed by adding the number of EBP elements met by each study participant. Nurses received one point for each of the following four criteria: obtaining a HS‐EBP score of at least 100 points, responding affirmatively to having received EBP training and to working daily according to EBP, and reporting an overall quality of care score of at least 8 points. In this study, a composite EBP indicator of ≥ 3 was considered indicative of high overall EBP engagement.

2.2.3. Other Variables

Basic sociodemographic variables were collected, including sex and age. In addition, the following self‐reported data on occupational variables were collected: professional experience (in years); highest academic degree (graduate or postgraduate, including master's and doctoral degrees); number of students per year in the unit (1–4, 5–9, or ≥ 10); professional category (clinical nurse or supervisor/coordinator); work shift (8‐h morning‐only, 8‐h rotating schedule, or other less frequent types of shifts, e.g., 8‐h evening‐only or 8‐h night‐only); unit (medical‐surgical, intensive care and emergency services, primary care, or other); and frequency of emotional exhaustion (never, occasionally during the year, monthly, weekly, or daily).

2.3. Data Analysis

Sample characteristics were described using means and standard deviations for continuous variables, and absolute and relative frequencies for categorical variables. Differences across categories of the nursing work environment were assessed using chi‐square tests for categorical variables and one‐way ANOVA for continuous variables.

Associations between the nursing work environment‐used as the independent variable and categorized as unfavorable, mixed, or favorable‐ and each EBP‐related outcome‐considered as the dependent variables were analyzed using both crude and adjusted logistic regression models. These EBP outcomes included the four dichotomous elements (positive attitude toward EBP, EBP training, EBP implementation, and overall quality of care) as well as a binary variable derived from the composite indicator, representing high overall EBP. Models were adjusted by sex, age (< 35, 35–49, ≥ 50 years), professional experience (< 10, 10–29, ≥ 30 years), degree (undergraduate, graduate), students‐unit/year (< 5, 5–9, ≥ 10), position (clinical nurse, supervisor), shifts (morning, rotating, other), unit (medical‐surgical, intensive care/emergency, primary care, other), and emotional exhaustion (never or occasionally during the year –rarely–, monthly –occasionally–, weekly or daily –often–). Similarly, the contribution of each subscale of the nursing work environment on EBP was studied.

Analyses were performed using the STATA v.18 statistical package (StataCorp, College Station, TX). Only p‐values less than 0.05 were considered statistically significant.

3. Results

The sample consisted primarily of middle‐aged women with approximately 17 years of professional experience. Table 1 shows other occupational characteristics. Most nurses (42.8%) worked in a favorable environment. Compared to nurses working in an unfavorable environment, those working in a mixed or favorable environment worked in clinical units with fewer students per year, following a morning shift and in primary care. They also rarely or never experienced emotional exhaustion (Table 1).

TABLE 1.

Sample characteristics according to categories of nursing work environment (n = 1022).

Overall Nursing work environment p
Unfavorable Mixed Favorable
Participants, n (%) 1022 220 (21.5) 365 (35.7) 437 (42.8)
Women, n (%) 905 (88.6) 198 (90.0) 329 (90.1) 378 (86.5) 0.123
Age, years, mean (SD) 40.5 (11.2) 40.5 (9.27) 40.5 (10.2) 41.1 (12.0) 0.464
Experience, years, mean (SD) 16.9 (11.3) 16.1 (9.08) 16.5 (10.2) 17.1 (17.3) 0.227
Postgraduate, n (%) 157 (15.4) 34 (15.5) 61 (16.7) 62 (14.2) 0.977
Students‐unit/year, mean (SD) 11.4 (15.3) 14.8 (19.9) 12.7 (15.5) 8.67 (11.8) < 0.001
Professional category, n (%)
Clinical nurse 979 (95.8) 218 (99.1) 351 (96.2) 410 (93.8) 0.002
Supervisor/coordinator 43 (4.21) 2 (0.91) 14 (3.84) 27 (6.18)
Work shift, n (%)
Morning only 297 (29.1) 36 (16.4) 88 (24.1) 173 (39.6) < 0.001
Rotating 709 (69.4) 178 (80.9) 268 (73.4) 263 (60.2)
Other 16 (1.57) 6 (2.73) 9 (2.47) 1 (0.23)
Unit, n (%) < 0.001
Medical‐surgical 446 (43.6) 91 (41.4) 176 (48.2) 179 (41.0)
ICU/Emergency 231 (22.6) 74 (33.6) 97 (26.6) 60 (13.7)
Primary care 191 (18.7) 13 (5.91) 49 (13.4) 129 (29.5)
Other 154 (15.1) 42 (19.1) 43 (11.8) 69 (15.8)
Emotional exhaustion, n (%) < 0.001
Rarely 355 (34.7) 51 (23.2) 96 (26.3) 208 (47.6)
Occasionally 414 (40.5) 84 (38.2) 160 (43.8) 170 (38.9)
Often 253 (24.8) 85 (38.6) 109 (29.9) 59 (13.5)
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Abbreviations: ICU, intensive care units; SD, standard deviation.

Figure 1 shows that the percentage of nurses with positive EBP elements increased as the work environment became more favorable (p‐trend < 0.001 in all cases). Additionally, the percentage of nurses with a high overall EBP score (≥ 3 points) doubled for those in a favorable environment compared to those in an unfavorable one (64.8% vs. 31.4%; p‐trend < 0.001).

FIGURE 1.

FIGURE 1

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Evidence‐based practice elements (%) according to nursing work environment categories.

Table 2 summarizes the association between categories of the nursing work environment and elements of EBP. Working in a favorable environment was associated with all positive EBP elements except EBP training (OR = 1.32; 95% CI [0.92, 1.89]). Additionally, a dose–response gradient was observed (p‐trend < 0.001). Compared to nurses in an unfavorable environment, nurses in a mixed environment were 1.7 times more likely to have high overall EBP engagement (OR = 1.71; 95% CI [1.19–2.46]), while those in a favorable environment were nearly 3.5 times more likely (OR = 3.47; 95% CI [2.38, 5.07]). All five dimensions of the nursing work environment contributed positively to EBP. Staffing and resource adequacy, as well as nursing foundation for quality of care, were the two most relevant contributors to overall EBP engagement (Table 3).

TABLE 2.

Association between nursing work environment categories and EBP elements (n = 1022).

Nursing work environment p‐trend
Unfavorable Mixed Favorable
Positive attitude to EBP
Crude model, OR (95% CI) 1.00 1.26 (0.89–1.78) 3.12 (2.23–4.37) < 0.001
Adjusted model a , OR (95% CI) 1.00 1.20 (0.84–1.72) 2.89 (2.00–4.18) < 0.001
Trained in EBP
Crude model, OR (95% CI) 1.00 1.20 (0.86–1.69) 1.60 (1.16–2.22) 0.003
Adjusted model a , OR (95% CI) 1.00 1.15 (0.81–1.63) 1.32 (0.92–1.89) 0.137
Implement EBP
Crude model, OR (95% CI) 1.00 1.94 (1.35–2.79) 2.76 (1.91–3.97) < 0.001
Adjusted model a , OR (95% CI) 1.00 1.78 (1.22–2.58) 2.30 (1.52–3.39) < 0.001
High quality of care
Crude model, OR (95% CI) 1.00 1.60 (1.13–2.26) 2.57 (1.82–3.64) < 0.001
Adjusted model a , OR (95% CI) 1.00 1.59 (1.12–2.27) 2.35 (1.61–3.44) < 0.001
High overall EBP
Crude model, OR (95% CI) 1.00 1.81 (1.27–2.57) 4.02 (2.85–5.68) < 0.001
Adjusted model a , OR (95% CI) 1.00 1.71 (1.19–2.46) 3.47 (2.38–5.07) < 0.001
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Abbreviations: CI, confidence interval; EBP, evidence‐based practice; OR, odds ratio.

a

Adjusted by sex, age (< 35, 35–49, ≥ 50 years), professional experience (< 10, 10–29, ≥ 30 years), degree (graduate, postgraduate), students‐unit/year (< 5, 5–9, ≥ 10), professional category (clinical nurse, supervisor), shift (morning, rotating, other), unit (medical‐surgical, intensive care/emergency, primary care, other), and emotional exhaustion (rarely, occasionally, often).

TABLE 3.

Adjusted odds ratio a (95% confidence intervals) for the association between subscales of the nursing work environment and EBP (n = 1022).

Nursing work environment
Nurse participation in hospital affairs Nursing foundations for quality of care Nurse manager ability, leadership, and support Staffing and resource adequacy Collegial nurse‐physician relations
Positive attitude to EBP 2.35 (1.78–3.10) 1.81 (1.37–2.39) 1.32 (0.96–1.81) 2.04 (1.57–2.64) 1.63 (1.24–2.14)
Trained in EBP 1.08 (0.82–1.42) 1.22 (0.92–1.60) 0.96 (0.70–1.32) 1.39 (1.07–1.80) 1.04 (0.80–1.37)
Implement EBP 1.42 (1.02–1.96) 2.14 (1.57–2.91) 1.60 (1.13–2.26) 1.63 (1.21–2.21) 1.09 (0.80–1.48)
High quality of care 1.67 (1.23–2.26) 1.81 (1.36–2.41) 1.31 (0.94–1.83) 1.75 (1.32–2.31) 1.54 (1.15–2.05)
High overall EBP 2.09 (1.58–2.76) 2.25 (1.69–3.00) 1.40 (1.01–1.93) 2.28 (1.74–2.97) 1.55 (1.18–2.04)
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Abbreviation: EBP, evidence‐based practice.

a

Logistic regression adjusted by sex, age (< 35, 35–49, ≥ 50 years), professional experience (< 10, 10–29, ≥ 30 years), degree (graduate, postgraduate), students‐unit/year (< 5, 5–9, ≥ 10), professional category (clinical nurse, supervisor), shift (morning, rotating, other), unit (medical‐surgical, intensive care/emergency, primary care, other), and emotional exhaustion (rarely, occasionally, often).

4. Discussion

According to the findings of this multicenter, cross‐sectional study conducted in Spain, a favorable nursing work environment was associated with improved EBP elements, including a positive attitude toward EBP, implementation of EBP and high quality of care. The environmental dimensions that contributed the most to this association were related to staffing adequacy and nursing foundation.

A robust body of evidence has linked a better nursing practice environment to improved patient safety, including shorter lengths of stay, fewer readmissions and lower mortality rates (Pogue et al. 2022; Nascimento and Jesus 2020; Aiken et al. 2012). Specifically, the health outcomes of Magnet‐recognized hospitals have been studied extensively (Aiken et al. 2023; Connor, Dean, et al. 2023). Compared with non‐Magnet hospitals, Magnet‐designed hospitals are characterized by excellent work environments and more satisfied nursing staff. Magnet recognition is associated with better health outcomes for patients, including lower mortality rates, increased satisfaction and higher returns on investment (McHugh et al. 2013; Kelly et al. 2011; Aiken et al. 2008). One plausible explanation for these findings is that the favorable nursing work environments of Magnet hospitals foster engagement with EBP, a relationship supported by the findings of our study in Spain.

However, very few studies have specifically addressed the association between the nursing work environment and EBP. Pérez‐Campos et al. (2014) conducted an online survey to assess knowledge, attitudes, and use of EBP among nurses active in online nursing communities from Spain and Latin America. According to their cross‐sectional analysis, a perceived unfavorable practice environment negatively influenced the implementation of EBP. These findings are consistent with those of our study. Similarly, González‐Torrente et al. (2012) found that a more favorable nursing work environment in primary care settings was associated with more positive perceptions of EBP. Our study adds to the scientific literature by including a larger sample from both hospital and primary care settings, with a better adjustment by confounders than previous research (Pérez‐Campos et al. 2014; González‐Torrente et al. 2012). This is particularly relevant because some authors suggest that a healthy work environment may simply reflect lower patient complexity, which could be the actual driver behind better health outcomes during admission and after hospital discharge, rather than improvements in EBP (Griffiths et al. 2016). Furthermore, using the PES‐NWI to measure the nursing work environment allowed us to effectively approximate what constitutes a healthy work environment. The American Nurses Association (ANA 2021) considers critical dimensions of a healthy work environment to be optimal staffing, effective communication and collaboration within a complex organizational structure, and authentic leadership, including the authority to advocate—all aspects covered by the PES‐NWI. Finally, our study provides a more comprehensive measurement of EBP than previous research. Thus, we verified that a favorable nursing environment is associated with a positive attitude and implementation of EBP but not with EBP training. According to our findings, improving EBP training specifically requires improving staffing and resources. This would likely allow nurses to have more free time during the workday to study, participate in research, and keep up with the latest evidence‐based nursing care.

Although few studies have examined the nursing work environment, there is substantial evidence regarding the barriers and enablers to EBP implementation in the general clinical context. This evidence largely supports our findings regarding the nursing work environment in Spain. Using a systematic review, Li et al. (2018) found six organizational context characteristics that frequently influence EBP implementation in a wide range of clinical settings: organizational culture, leadership, networks and communication, resources, evaluation, and champions. Organizational culture was the most relevant of these characteristics, although leadership was also important due to its ability to influence the others. Williams et al. (2015) conducted a scoping review to identify organizational barriers to EBP use and found five: excessive workload, insufficient managerial support, inadequate resources, lack of authority to modify practices, and a work culture resistant to change. In summary, previous literature highlights that organizational culture, nursing workload and leadership styles play a significant role in EBP. Even highly motivated and competent health workers may struggle to sustain EBP implementation in an unfavorable work environment. Therefore, structured programs grounded in deep, sustained organizational changes are needed to create empowering environments that strengthen EBP. Achieving this requires strong commitment from both managers and healthcare workers.

The two PES‐NWI dimensions most strongly associated with EBP were resource provision and nursing foundations for quality of care. Because Spanish public healthcare facilities have sufficient and appropriate material resources, staffing is likely the most important factor in resource provision. Indeed, according to healthcare workforce statistics, Spain falls below the European average in terms of the number of nurses and midwives per inhabitant (Galbany‐Estragués and Millán‐Martínez 2024). Clearly, an appropriate level of workload is the cornerstone of an adequate environment for clinical nursing practice, as it reduces work stress and allows nurses to train in and implement EBP. Insufficient nurse staffing is known to lead to a lower quality of care, greater occupational risks (e.g., burnout and sick leave), a greater likelihood of care‐related adverse events, prolonged hospitalizations, and a higher risk of death (Dall'Ora et al. 2022; Shin et al. 2018). Our study also revealed that nursing foundations play a crucial role in strengthening EBP in real‐world care settings. Ensuring a healthy work environment conducive to EBP is considered a shared responsibility among clinical nurses, supervisors, coordinators, healthcare organizations, and community stakeholders. However, in light of this finding, another key player should be included: the academic field. The academic field is primarily responsible for selecting candidates for nursing degree programs and must guarantee core competencies related to the foundations of nursing. These competencies include nursing thought, care models, care planning, quality assurance, and ethics of care.

Key strategies to promote EBP should involve healthcare and academic institutions working together to establish a healthy work environment with appropriate staffing and care foundations rooted in nursing theory. Below are some specific strategies for implementing this recommendation. First, healthcare institutions and nursing schools should strengthen their ties and collaborate to achieve their shared goals. Open, two‐way communication between managers and employees at both institutions should be encouraged. They should also promote more positions that connect academia with healthcare centers. Second, understaffing in nursing should concern not only managers, but also society as a whole. Therefore, the shortage of nurses should be a topic on the social and media agendas. Central and local governments should incentivize an increase in offer and admission rates in nursing degrees at universities. At the same time, it would be helpful to implement a national policy regulating nurse staffing levels, offering financial incentives to institutions that improve their nurse‐to‐patient ratios (Kim et al. 2024). However, the usual temptation to hire more temporary staff should be avoided. According to scientific literature, a sufficient baseline number of staff must be rostered to ensure nursing care quality and reduce the risk of harm to patients (Griffiths et al. 2023). Plans to replace high‐level nurses with less qualified personnel are also not efficient or effective solutions to nurse shortages (Griffiths et al. 2023). Lastly, universities should strengthen the basic level of training, ensuring that nursing theories are well represented in their curricula. Students should be well‐versed in frameworks that give shape to the scope of nursing care and practice.

4.1. Limitations

Our study has some limitations. The most significant limitation relates to its cross‐sectional nature, which prevented us from determining the direction of the association. While it is possible that nurses who practice EBP influence a positive work environment, the inverse relationship—as proposed in this study—is much more likely. Another limitation is the lack of data on the nurse‐to‐patient ratio for each service and health center, which would have helped us better understand this issue in Spain and internationally. Finally, surveys addressing work‐related and organizational aspects always carry a risk of selection bias as they may disproportionately attract responses from either dissatisfied participants or nurses highly committed to their profession and organization. Nevertheless, this bias likely leaned toward the null, and the sufficiently large sample size helped to mitigate its impact. Despite these limitations, the study benefits from a large and diverse sample, the use of validated instruments and the application of a multivariate statistical analysis controlling for key sociodemographic and occupational variables.

4.2. Linking Evidence to Action

  • Working in favorable nursing environments was associated with a positive attitude toward EBP, implementation of EBP and higher quality of care.

  • The two most influential work environment dimensions on EBP were adequate nurse‐to‐patient ratios and a strong nursing foundation.

  • Healthcare and academic institutions share the responsibility of fostering EBP in real‐world settings.

  • Healthcare institutions should improve nurse staffing, ensuring a sufficient number of rostered nurses.

  • University nursing schools should ensure the study of nursing theories and their application in advanced nursing practice.

5. Conclusions

In conclusion, a favorable nursing work environment was associated with improved EBP elements, including a positive attitude toward EBP, EBP implementation, and commitment to high‐quality care. The main contributors to EBP were adequate staffing and strong nursing foundations. Therefore, nurses and supervisors are responsible for achieving full implementation of EBP in Spanish clinical settings; however healthcare and academic institutions bear the greatest responsibility. These institutions are best positioned to foster a healthy nursing work environment based on the profession's theoretical, ethical, and deontological framework.

Conflicts of Interest

The authors declare no conflicts of interest.

Lana, A. , Fernández‐Arce L., González‐García M., Fernández‐Iglesias R., Andina‐Díaz E., and Fernández Feito A.. 2025. “The Association Between Nursing Work Environment and Evidence‐Based Practice.” Worldviews on Evidence‐Based Nursing 22, no. 6: e70082. 10.1111/wvn.70082.

Funding: This work was supported by grants from Instituto de Salud Carlos III, Spanish State Secretary of R + D + I, Fondo Europeo de Desarrollo Regional (FEDER) and Fondo Social Europeo (FSE) [grant number PI18/00086] as well as Instituto de Investigación Sanitaria del Principado de Asturias (ISPA). The study funders had no role in the study design and in the collection, analysis, and interpretation of data, and the authors have sole responsibility for the manuscript content.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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