Health care work environments affect patient outcomes, staff satisfaction and retention, and organizational financial viability. The American Association of Critical-Care Nurses (AACN) Healthy Work Environment Assessment Tool (HWEAT) is a resource for patient care units and organizations to assess the work environment and track progress on their journey to excellence.


To validate interprofessional use of the AACN HWEAT across a large free-standing children’s hospital.


The AACN HWEAT was administered to staff members across professional categories. Responses were averaged to achieve an overall score and a score for each standard included in the instrument. Nurses’ and physicians’ scores were further stratified. Test-retest reliability and internal consistency were assessed. Construct validity was measured by correlating the AACN HWEAT and the Agency for Healthcare Research and Quality (AHRQ) Hospital Survey on Patient Safety Culture (H-SOPS).


Of 2621 AACN HWEAT surveys, 1030 (39.3%) were returned for review. The organization-wide HWEAT mean overall score was 3.58 (3.87 for physicians vs 3.54 for nurses, P= .02). Test-retest reliability was indicated by Spearman correlation coefficients of 0.50 to 0.68. Internal consistency was shown by a Cronbach α of 0.77 overall (range for standards, 0.77–0.81). Convergent validity between AACN HWEAT standards and AHRQ H-SOPS items was shown by correlation coefficients of 0.30 to 0.52.


The AACN HWEAT was both reliable and valid, supporting its interprofessional use as an organizational measure. Active evaluation of health care environments is critical to achieving optimal patient outcomes.

You do not currently have access to this content.