Development and Validation of the Nursing Organizational Well-being Questionnaire (NOW-Q): A Theory-Based Questionnaire to Identify Organizational Well-being Profiles

Abstract

Introduction. Nurses’ organizational well-being is crucial for workforce stability and care quality. However, existing instruments often assess isolated work environment dimensions, are not grounded in nursing-specific theory, and rarely support person-centered analyses. This study aimed to develop and validate the Nursing Organizational Well-being Questionnaire (NOW_Q).

Methods. A two-phase study was conducted following COSMIN guidance. Phase 1 included item generation, expert review, and content validation. Phase 2 was a multicenter cross-sectional study involving 461 nurses from seven Italian hospitals. Construct validity was tested through exploratory and confirmatory factor analyses with cross-validation. Reliability was assessed using ordinal omega, concurrent validity through correlations with a global organizational well-being item, and cluster analysis explored person-centered profiles.

Results. The final NOW_Q included 28 items and eight dimensions: emotional demands, work-family conflict, workload, available resources, nurse-nurse relationship, nurse-head nurse relationship, nurse-physician relationship, and autonomy. The final CFA showed good fit (RMSEA = 0.051; CFI = 0.938; TLI = 0.927; SRMR = 0.067). Ordinal omega ranged from 0.75 to 0.87. Three profiles emerged: Nurturing, Observed-Detached, and Withstanding.

Discussion. The NOW_Q showed satisfactory psychometric properties and practical utility. As a theory-based, nursing-specific measure, it may support targeted assessment of organizational well-being and identification of distinct nurse profiles to inform interventions in clinical settings.