Francis Byron Opinion - Assistant Director of Nursing for Quality & Accreditation, King Hamad University Hospital, Busaiteen Street, P.O. Box ۲۴۳۴۳, Kingdom of Bahrain.
Yvonne Villamor Bedrejo - Accreditation Manager, King Hamad University Hospital, Busaiteen Street, P.O. Box ۲۴۳۴۳, Kingdom of Bahrain.
Fairouz Alhourani - Director of Nursing, King Hamad University Hospital, Busaiteen Street, P.O. Box ۲۴۳۴۳, Kingdom of Bahrain.
Maria Irene Tolentino - Nursing Quality Development Coordinator, King Hamad University Hospital, Busaiteen Street, P.O. Box ۲۴۳۴۳, Kingdom of Bahrain.
Perpetua Vianney Ardenaso - Nursing Quality Development Coordinator, King Hamad University Hospital, Busaiteen Street, P.O. Box ۲۴۳۴۳, Kingdom of Bahrain.
Asha Sudha - Deputy Manager, Nursing Research and EBP Department, King Hamad University Hospital, Busaiteen Street, P.O. Box ۲۴۳۴۳, Kingdom of Bahrain.

Introduction:In order to promote patient safety, the organization began a systematic approach to monitor, assess, and improve the quality of the nursing practice environment. The purpose of the study was to learn about registered nurses' general perceptions of the practice environment and to develop quality improvement efforts to improve patient safety.Materials and Methods: An observational longitudinal study was done for four years by using the Practice Environment Scale – Nursing Work Index (PES-NWI). The sample size of ۳۷۰ was calculated and data were collected from registered nurses working in all patient care areas by using convenience sampling. Each year, the items scored less than ۲.۵ were identified, discussed with the nursing stakeholders and quality improvement measures were designed and implemented.Results: Over the four-years, nurses’ perception of the nursing work environment was found favorable with mean values above ۲.۵ for all the subscales. However registered nurses perceived concerns with their participation in hospital affaires, staffing and resource adequacy. The PES-NWI mean scores improved significantly over the four years because of the quality improvement initiatives such as registered nurses' participation in hospital committees, transformational leadership training, the Quality Link Nurse (QLN) program, and staffing based on dependency assessment and skill mixing.Conclusion: According to the registered nurses in this study, the tertiary hospital provides a favorable working environment. The nurses' opinions of the working environment improved as a result of regular monitoring and quality improvement measures, as well as the involvement of registered nurses in new policies.

Nurses, PES NWI, Quality Improvement, Work Environment