Impact and determinants of nurse turnover: a pan-Canadian study

Identifying, describing, and assessing interventions that support new graduate nurse transition into critical care nursing practice: a systematic review protocol

BACKGROUND

Given a persistent nursing shortage in Canada and a decline in new nurses entering the profession, new graduate nurses (NGNs) are being hired into positions historically reserved for more experienced staff. Critical care settings, which are areas of specialty nursing practice, are now routinely hiring NGNs in many hospitals. While evidence on NGN transition into critical care is emerging, best practices around training and support for these nurses are limited internationally, and non-existent within the Canadian context. Therefore, the aim of this systematic review is to identify, describe, and assess the effectiveness of interventions that support NGN transition into critical care clinical practice settings.

METHODS

This is a systematic review of interventions using the Joanna Briggs Institute Methodology. Data sources will include MEDLINE, CINAHL, PsychINFO, Education Source, and Nursing and Allied Health electronic databases. Two independent reviewers will screen titles and abstracts using predetermined inclusion criteria. A consensus meeting will be held with a third reviewer to resolve conflicts when necessary. Full texts will also be screened by two independent reviewers and with conflicts resolved by consensus. Data will be extracted using a standardized extraction form. We will assess the quality of all included studies using Joanna Briggs Institute quality assessment tools. Data describing interventions will be reported narratively and a meta-analysis will be conducted to determine effectiveness, if appropriate.

DISCUSSION

This systematic review will identify interventions that support NGN transition into critical care nursing practice. The findings of this study will provide a foundation for developing strategies to support NGN transition into these areas of specialty nursing practice.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42020147962.

Cost impact of high staff turnover on primary care in remote Australia

Objectives The aim of this study was to estimate the costs of providing primary care and quantify the cost impact of high staff turnover in Northern Territory (NT) remote communities. Methods This cost impact assessment used administrative data from NT Department of Health datasets, including the government accounting system and personnel information and payroll systems between 2004 and 2015, and the primary care information system from 2007 to 2015. Data related to 54 government-managed clinics providing primary care for approximately 27200 Aboriginal and non-Aboriginal people. Main outcome measures were average costs per consultation and per capita, cost differentials by clinic, year and levels of staff turnover. Linear regression and dominance analysis were used to assess the effect of staff turnover on primary care costs, after adjusting for remoteness and weighting analysis by service population. Both current and constant prices were used. Results On average, in constant prices, there was a nearly 10% annual increase in remote clinic expenditure between 2004 and 2015 and an almost 15% annual increase in consultation numbers since 2007. In real terms, the average costs per consultation decreased markedly from A$273 in 2007 to A$197 in 2015, a figure still well above the Medicare bulk-billing rate. The cost differentials between clinics were proportional to staff turnover and remoteness (both P<0.001). A 10% higher annual turnover rate pertains to an A$6.12 increase in costs per consultation. Conclusions High staff turnover exacerbates the already high costs of providing primary care in remote areas, costing approximately A$50 extra per consultation. This equates to an extra A$400000 per clinic per year on average, or A$21million annually for the NT government. Over time, sustained investments in developing a more stable primary care workforce should not only improve primary care in remote areas, but also reduce the costs of excessive turnover and overall service delivery costs. What is known about the topic? Population size and geographical remoteness are important cost drivers in remote clinics, whereas elsewhere in Australia the high use of short-term staff to fill positions has been identified as a major contributor to higher nurse turnover costs and to overall health service costs. Nursing staff expenditure accounts for a large proportion (46%) of total expenditure in NT remote health services, whereas expenditure on Aboriginal Health Practitioners (AHPs) comprises only 6%. Annual nurse turnover rates in remote NT clinics average approximately 150%, whereas levels of 40% in other contexts are considered high. What does this paper add? Annual expenditure for NT remote clinics has increased, on average, by 10% per annum between 2004 and 2015, but small declines in real expenditure have been observed from a maximum in 2012. Expenditure on nursing staff comprises 40% of overall expenditure in remote clinics, whereas expenditure on AHPs comprises less than 5%. The cost impact of every 10% increase in remote nurse and AHP annual turnover has been quantified as an extra A$6.12 per primary care consultation, which equates, on average, to an extra A$400000 per remote clinic, and an extra A$21million overall for the NT Department of Health each year. The average real expenditure per primary care consultation has decreased from A$273 in 2007 to A$197 in 2015, representing a statistically significant linear trend reduction of A$7.71 per consultation annually. What are the implications for practitioners (and other decision-makers)? Adjusting policy settings away from the high use of short-term staff to investment in appropriate training 'pipelines' for the remote primary care workforce may, in the medium and longer term, result in reduced turnover of resident staff and associated cost savings. Targeted recruitment and retention strategies that ensure individual primary care workers are an optimal fit with the remote communities in which they work, together with improved professional and personal support for staff residing in remote communities, may also help reduce turnover, improve workforce stability and lead to stronger therapeutic relationships and better health outcomes.

Exploring the Relational Intervention of Storytelling: A Qualitative Study of the Patient Stories Project in a Single ICU

Objectives:

Our study objective was to explore nurses’ experiences of how the Patient Stories Project, an intervention consisting of garnering and sharing ICU survivor stories with the ICU team, influenced their perceptions of the value of their work and their nurse-patient relationships.

Design:

This was a qualitative descriptive case study that used thematic analysis.

Setting:

This study was conducted in a single, 34-bed adult ICU in a Canadian tertiary care teaching hospital, serving a mixed medical and surgical patient population and employing over 200 nurses.

Subjects:

Semistructured focus groups with 12 ICU nurses were conducted between June 2019 and July 2019.

Intervention:

The Patient Stories Project is a systematic process for collecting and sharing former patients’ stories. On a regular basis, former ICU patients return to the ICU to say, “thank you,” share their experiences, and tell their stories to staff.

Measurements and Main Results:

Storytelling through the Patient Stories Project gives meaning to nurses’ work and provides avenues for nurses to think about their work more positively. Key themes were as follows: 1) perspective taking, 2) emphasizing the value in caring, 3) providing positive closure, 4) engendering team belonging, and 5) building a sense of hope.

Conclusions:

This study addresses the Critical Care Societies Collaboratives “call to action” to create a healthy work environment. Nurse focus group participants articulated how an initiative such as the Patient Stories Project may augment the relational aspects of work that are important to nurses, as well as their patients and families. Our study results have implications for the importance of using storytelling as a relational strategy to protect against depersonalization and cynicism, elements of burnout.

"The hardest job you will ever love": Nurse recruitment, retention, and turnover in the Nurse-Family Partnership program in British Columbia, Canada

Background

Nurse turnover is a significant issue and complex challenge for all healthcare sectors and is exacerbated by a global nursing shortage. Nurse-Family Partnership is a community health program for first-time pregnant and parenting girls and young women living in situations of social and economic disadvantage. In Canada, this program is delivered exclusively by public health nurses and only within a research context. The aim of this article is to explore and describe factors that contribute to recruitment, retention, and turnover of public health nurses delivering Nurse-Family Partnership in British Columbia, Canada between 2013 and 2018.

Methods

Interpretive description was used to guide sampling, data collection and analytic decisions in this qualitative component drawn from the British Columbia Healthy Connections Project mixed methods process evaluation. Semi-structured, individual interviews were conducted with 28 public health nurses who practiced in and then exited Nurse-Family Partnership.

Results

Nurses were motivated to join this program because they wanted to deliver an evidence-based program for vulnerable young mothers that fit with their personal and professional philosophies and offered nurse autonomy. Access to program resources attracted nursing staff, while delivering a program that prioritizes maintaining relationships and emphasizes client successes was a positive work experience. Opportunities for ongoing professional development/ education, strong team connections, and working at full-scope of nursing practice were significant reasons for nurses to remain in Nurse-Family Partnership. Personal circumstances (retirement, family/health needs, relocation, career advancement) were the most frequently cited reasons leading to turnover. Other factors included: involuntary reasons, organizational and program factors, and geographical factors.

Conclusions

Public health organizations that deliver Nurse-Family Partnership may find aspects of job embeddedness theory useful for developing strategies for supporting recruitment and retention and reducing nurse turnover. Hiring nurses who are the right fit for this type of program may be a useful approach to increasing nurse retention. Fostering a culture of connectivity through team development along with supportive and communicative supervision are important factors associated with retention and may decrease turnover. Many involuntary/external factors were specific to being in a study environment. Program, organizational, and geographical factors affecting nurse turnover are modifiable.

Professional characteristics and work attitudes of hospital nurses who leave compared with those who stay

AIM

To compare characteristics and attitudes of nurses who resigned and those who remained in two Israeli hospitals and assess the reasons for leaving.

BACKGROUND

Nurse turnover is a current global problem in health care system, especially given the severe nurse shortages. Retention of nurses requires an understanding of the characteristics of the resigning nurses, their attitudes and their reasons for leaving.

METHODS

A matching case-control study was conducted among 100 resigning nurses and 200 matched remaining nurses. Questionnaires were used to survey the professional characteristics and attitudes of the participating nurses. In addition, exit interviews were used to assess the reasons to leave of resigning nurses.

RESULTS

Resigning nurses had higher education, less seniority and fewer managerial positions compared with remaining nurses. In addition, resigning nurses had lower professional autonomy and higher aspirations for professional advancement. The reasons to leave cited by the resigning nurses were distance of the workplace from home and working conditions as well as aspiring for professional advancement.

CONCLUSIONS

The interface between high education and having few opportunities for advanced positions may lead to resignation.

IMPLICATIONS FOR NURSING MANAGEMENT

We recommend organisational interventions for training new hospital nurses through professional career path development, such as mentoring programme.

New Graduate Nurse Transition Into the Intensive Care Unit: Qualitative Insights From a Longitudinal Study-Part 1

BACKGROUND AND PURPOSE

Patients admitted to intensive care units (ICUs) are critically ill and suffer from life-threatening sickness of injury. To work in ICU, registered nurses require additional knowledge and skills. While practices regarding the hire of new graduate nurses (NGNs) into settings such as the ICU vary, it is common that NGNs are being hired. However, NGNs in general, are at a higher risk for turnover within the profession as compared to their more experienced colleagues. NGNs in ICU settings may be at higher risk of turnover due to the complexity of the care context. It is of particular importance that the experiences of NGNs in ICU be explored with the intent of identifying what these nurses experience but also to consider how they can be best supported during a period of transition. This manuscript reports the findings from a mixed design study that sought to understand the transition of a cohort of NGNs over a period of 2 years.

METHODS

This study used both a purposive and convenience sample of NGNs. The qualitative component incorporated Thorne's (2016) interpretive description. Face-to-faceinterviews were completed.

RESULTS

Five themes were identified: an emotional transition, a social transition, a transitioning mindset, transitioning through firsts, and transitioning with confidence. Within each theme, there is a distinct difference and elements of transition were evident. Findings demonstrate that the NGNs appeared to be more confident in their skills and in their nursing practice over time. Findings from this study provide important insight into the experiences of NGNs in ICUs.

Leadership Styles of Nurse Managers and Turnover Intention

The shortage of experienced nurses is a concern in health organizations. This study investigated the leadership styles of nurse managers' impact on turnover intention among nurses in hospitals. A descriptive correlational research design was used. Samples of 250 nurses working in five hospitals were selected to complete self-administered questionnaire. Findings show that participatory and transformational leadership styles are predominantly practiced. Correlation analysis revealed that participative and transformational leadership styles decreases turnover intention while autocratic and laissez-faire leadership styles increases turnover intention. Therefore, leadership styles of nurse managers are determinants of nurses' turnover intentions.

Prevalence of Coping Strategy Training in Nursing School Curricula

BACKGROUND

Stress and burnout are plaguing critical care nurses across the globe and leading to high levels of turnover. Resilience-building strategies such as mindfulness, self-care, and well-being can help shield nurses from the negative effects of workplace stress. As the first line of defense, nursing schools could provide students with strategies that build resilience; however, little is known about the availability of such resources in nursing education.

OBJECTIVES

To determine the prevalence of resources and curricula targeting resilience training and stress reduction at nursing schools across the United States.

METHODS

Raters analyzed publicly available college/ university websites and course catalogs of a sample of nursing schools in the United States to determine the availability of resilience resources and curricula.

RESULTS

None of the schools surveyed regularly screened their students for burnout syndrome, and only 9% of schools had a formal curriculum that included resilience training.

CONCLUSIONS

Training in practices to build resilience and prevent burnout is essentially absent from accredited nursing schools. This highlights an important opportunity to modify existing curricula to include preventative strategies-such as developing positive coping skills- that could mitigate symptoms of workplace stress in future generations of nurses.

The Relationship Between the Quality of Work and Organizational Commitment of Prison Nurses

BACKGROUND

Nurses working in prisons are exposed to security problems while serving those who may be uninterested in their own healthcare, face high risks of drug and alcohol addiction, and may have aggressive personalities. For this reason, nurses working in prisons may have more problems with work-related quality of life than their non-prison-nurse peers.

PURPOSE

This descriptive research study was conducted to evaluate the work-related quality of life and organizational commitment of nurses who work at prisons and detention centers.

METHODS

According to 2015 data, approximately 513 nurses currently work in prisons in Turkey. The study group consisted of 224 nurses who currently work in prisons or detention centers. The data were collected by sending a created link address to the e-mail addresses of nurses who work in these facilities. A 13-item sociodemographic information form, including a demographics datasheet, a work-related quality of life scale, and an organizational commitment scale, was used to collect data.

RESULTS

The participants reported a moderate level of work-related quality of life and organizational commitment. Moreover, work-related quality of life was shown to affect organizational commitment, with 20% of the total variance in organizational commitment explained by work-related quality of life.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

This study supports that work-related quality of life affects organizational commitment positively. Therefore, regulating working conditions by taking into consideration employee security will positively affect job satisfaction in terms of both the institution and the employee. Moreover, as nurses do not only work in hospitals, taking this action should also work in different settings. Administrators should ensure the work-related quality of life of the prison nurses by understanding the difficulties of prison nursing.

Motivators and Stressors for Canadian Research Coordinators in Critical Care: The MOTIVATE Survey

BACKGROUND

Critical care research coordinators implement study protocols in intensive care units, yet little is known about their experiences.

OBJECTIVE

To identify the responsibilities, stressors, motivators, and job satisfaction of critical care research coordinators in Canada.

METHODS

Responses to a self-administered survey were collected in order to identify and understand factors that motivate and stress research coordinators and enhance their job satisfaction. Items were generated in 5 domains (demographics, job responsibilities, stressors, motivators, and satisfaction). Face validity pretesting was conducted and clinical sensibility was evaluated. Items were rated on 5-point Likert scales. Descriptive analyses were used to report results.

RESULTS

The response rate was 78% (66 of 85). Most critical care research coordinators (71%) were employed full time; they were engaged in 9 studies (7 academic, 2 industry); and 49% were nurses. Of 30 work responsibilities, the most frequently cited were submitting ethics applications (89%), performing data entry (89%), and attending meetings (87%). Highest-rated stressors were unrealistic workload and weekend/holiday screening; highest-rated motivators were a positive work environment and team spirit. Overall, 26% were "very satisfied" and 53% were "satisfied" with their jobs.

CONCLUSIONS

Critical care research coordinators in Canada indicate that, despite significant work responsibilities, they are satisfied with their jobs thanks to positive work environments and team spirit.

First-line managers dealing with different management approaches

Purpose

The purpose of this paper is to contribute new knowledge about how first line managers (FLMs) in elderly care perceive their situation, with a focus on differences in management approaches at the intersection of the central and local parts of the organization.

Design/methodology/approach

The present study has a qualitative approach and is part of a larger project on FLMs in elderly care. The results presented here are based on a secondary analysis of 15 of the total of 28 interviews carried out in the project.

Findings

The main results are twofold: the majority of FLMs perceived differences in management approaches between local and central management; the differences caused some struggle because FLMs perceived that the management system did not support the differences. The two main aspects that caused the FLMs to struggle were differences in the foci of the management levels and difficulties in influencing the conditions of management.

Originality/value

The results contribute to the debate on what aspects are important to sustainable management of elderly care. It is common knowledge that FLMs have a complex position, intermediate to the central, upper level management and their subordinates at the local level – levels with different foci and interests. The study contributes new knowledge about what these differences consist of and the dilemmas they cause and offers suggestions as to what can be done to reduce both energy waste and the risk of low job satisfaction.

Understanding how nurse managers see their role in supporting ICU nurse well-being-A case study

AIM

To explore how nurse managers perceive and experience their role in supporting the well-being of intensive care nurses.

BACKGROUND

While it is known that nurse manager behaviours affect nurse well-being, literature indicates that intensive care nurses may not receive the support they require. Understanding how nurse managers see their role in supporting nurse well-being is crucial to offer recommendations for improvement.

METHODS

Qualitative multiple case study design. Twelve semi-structured, in-depth interviews were conducted with nurse managers from Australian intensive care unit settings. Data were analysed using thematic analysis.

RESULTS

Nurse manages felt unsure about what their supportive role involved, lacked training on how to support nurse well-being and called for organisational backup to carry out their role effectively. The study also provided insight into the strategies that enabled nurse managers to support nurse well-being.

CONCLUSION

There is currently no consensus on the role of the nurse manager in supporting nurse well-being resulting in inconsistencies and wide practice variations. Furthermore, nurse managers need support and training if they are required to support nurse well-being.

IMPLICATIONS FOR NURSING MANAGEMENT

A clear definition of the nurse manager supportive role describing the purpose and core functions involved in this role must be developed to support nurse well-being.

Turnover intention of hospital staff in Ontario, Canada: exploring the role of frontline supervisors, teamwork, and mindful organizing

BACKGROUND

This study contributes to a small but growing body of literature on how context influences employee turnover intention. We examine the impact of staff perceptions of supervisory leadership support for safety, teamwork, and mindful organizing on turnover intention. Interaction effects of safety-specific constructs on turnover intention are also examined.

METHODS

Cross-sectional survey data were collected from nurses, allied health professionals, and unit clerks working in intensive care, general medicine, mental health, or the emergency department of a large community hospital in Southern Ontario.

RESULTS

Hierarchical regression analyses showed that staff perceptions of teamwork were significantly associated with turnover intention (p < 0.001). Direct associations of supervisory leadership support for safety and mindful organizing with turnover intention were non-significant; however, when staff perceived lower levels of mindful organizing at the frontlines, the positive effect of supervisory leadership on turnover intention was significant (p < 0.01).

CONCLUSIONS

Our results suggest that, in addition to teamwork perceptions positively affecting turnover intentions, safety-conscious supportive supervisors can help alleviate the negative impact of poor mindful organizing on frontline staff turnover intention. Healthcare organizations should recruit and retain individuals in supervisory roles who prioritize safety and possess adequate relational competencies. They should further dedicate resources to build and strengthen the relational capacities of their supervisory leadership. Moreover, it is important to provide on-site workshops on topics (e.g., conflict management) that can improve the quality of teamwork and consequently reduce employees' intention to leave their unit/organization.

Health indicators as moderators of occupational commitment and nurses' intention to leave

AIM

This study examined the hypothesis that health indicators moderate the relationship between occupational commitment and intention to leave among nurses, using a large sample in Japan.

METHODS

A self-administered questionnaire was distributed to all registered nurses (N = 11,171) working in group hospitals in western Japan in 2014. The questionnaire evaluated intention to leave, occupational commitment, psychological distress, cumulative fatigue, and demographic variables. After a preliminary analysis of the bivariate and multivariate associations between variables and intention to leave, we tested the interactions between occupational commitment and health indicators on intention to leave.

RESULTS

Of the 5,768 returned questionnaires, data from 5,505 (49.3%) participants were analyzed. Participants' mean age was 36.27 years (SD = 10.37). Most (95.14%) were women. According to a generalized estimating equation, the interaction of continuance occupational commitment and cumulative fatigue was significantly related to intention to leave (b = -0.0055). Additionally, the interaction of affective occupational commitment and psychological distress was significantly related to intention to leave (b = 0.0079).

CONCLUSIONS

This study clarified that the relationship between occupational commitment and intention to leave was robust for nurses in good health. Interventions aimed at reducing fatigue and improving psychological distress should be implemented to prevent the protective effects of occupational commitment on nurses' intention to leave from being compromised.

Nurse staffing models in acute care: A descriptive study

AIMS

To identify nurse staffing groups in acute care facilities.

DESIGN

This retrospective descriptive study used a configurational approach.

METHODS

Data from a two-month target period from January-March 2016 were collected for 40 facilities in four different hospitals in one of the largest regions of Quebec. Multiple factorial analysis and hierarchical ascendant classification were used to generate a limited number of nurse staffing groups.

RESULTS/FINDINGS

Four distinct nurse staffing groups emerged from this study. The least resourced model relied mainly on less qualified personnel and agency staff. The moderately resourced basic model was assessed as average across all staffing dimensions, but employed less overtime, relying mostly on auxiliary nurses. The moderately resourced professional group, also moderate in most variables, involved more overtime and fewer less qualified personnel. The most resourced group maximized highly qualified personnel and minimized instability in the nursing team.

CONCLUSION

This study covered multiple staffing groups with widely varying characteristics. Most groups entailed risks for quality of care at one or more levels. Few care units approached the theoretical staffing ideal.

Nurse turnover and perceived causes and consequences: a preliminary study at private hospitals in Indonesia

Background

Despite the inevitable growing rate of nurse turnover worldwide and its consequences, limited empirical data has been published in Indonesia. This study aims to describe the nurse turnover pattern at private hospitals, its causes and consequences as perceived by the hospitals' managers.

Methods

A survey method was used to obtain secondary and primary data from five private general hospitals in three administrative regions in East Java, Indonesia. The data of nurse turnover and demographic characteristics were collected. Mann Whitney test and relative risk analysis was performed to explore the role of nurse characteristics on nurses' decision to leave their job. To explore the causes and consequences of nurse turnover, an online survey was conducted to twelve hospital managers. The data was then classified based on similar themes.

Results

The data show that nurse turnover is between 12 and 34%. Being up to thirty years old, single, and having worked in the hospital up to three years significantly increase the risk of turnover. Personal reasons, external attractions and unsuitable working conditions are the three common nurse turnover reasons revealed by hospital managers. Hospital managers admitted that nurse turnover disturbs hospital operations, further impacting the hospital's revenue and costs.

Conclusions

The nurse turnover is higher than the acceptable level which is significantly predicted by age, marital status and job tenure. Further research is needed to develop nurse retention strategy in their early years of employment, based on the nurse's point of view.

Interprofessional Simulations Promote Knowledge Retention and Enhance Perceptions of Teamwork Skills in a Surgical-Trauma-Burn Intensive Care Unit Setting

BACKGROUND

The current state of health care encompasses highly acute, complex patients, managed with ever-changing technology. The ability to function proficiently in critical care relies on knowledge, technical skills, and interprofessional teamwork. Integration of these factors can improve patient outcomes. Simulation provides "hands-on" practice and allows for the integration of teamwork into knowledge/skill training. However, simulation can require a significant investment of time, effort, and financial resources. The Institute of Medicine recommendations from 2015 include "strengthening the evidence base for interprofessional education (IPE)" and "linking IPE with changes in collaborative behavior." In one surgical-trauma-burn intensive care unit (STBICU), no IPE existed. The highly acute and diverse nature of the patients served by the unit highlights the importance of appropriate training. This is heightened during critical event situations where patients deteriorate rapidly and the team intervenes swiftly.

PURPOSE

The aims of this study were to (1) evaluate knowledge retention and analyze changes in perceptions of teamwork among nurses and resident physicians in a STBICU setting after completion of an interprofessional critical event simulation and (2) provide insight for future interprofessional simulations (IPSs), including the ideal frequency of such training, associated cost, and potential effect on nursing turnover.

DESIGN

A comparison-cohort pilot study was developed to evaluate knowledge retention and analyze changes in perceptions of teamwork.

METHODS

A 1-hour critical event IPS was held for nurses and resident physicians in a STBICU setting. A traumatic brain injury patient with elevated intracranial pressure, rapid deterioration, and cardiac arrest was utilized for the simulation scenario. The simulation required the team to use interventions to reduce elevated intracranial pressure and then perform cardiac resuscitation according to Advanced Cardiac Life Support guidelines. A semistructured debriefing guided by the TENTS tool highlighted important aspects of teamwork. Participants took knowledge and Teamwork Skills Scale (TSS) pretests, posttests, and 1-month posttests. Mean scores were calculated for each time point (pre, post, and 1-month post), and paired t tests were used to evaluate changes.

RESULTS

Mean knowledge test and TSS scores both significantly increased after the simulation and remained significantly elevated at 1-month follow-up. Participants recommended retraining intervals of 3 to 6 months. Cost of each simulation was estimated to be $324.44. Analysis of nursing turnover rates did not demonstrate a statistically significant reduction in turnover; however, confounding factors were not controlled for.

CONCLUSION

Significant improvements on both knowledge test and TSS scores demonstrate the effectiveness of the intervention, and retention of the information gained and teamwork skills learned. Participants valued the intervention and recommended to increase the frequency of training. Future studies should develop a framework for "best practice" IPS, analyze the relationship with nursing turnover, and ultimately seek correlations between IPS and improved patient outcomes.

How to keep registered nurses working in New Zealand even as economic conditions improve

BACKGROUND

Many registered nurses (RNs) increased their participation in the New Zealand health workforce during the Global Financial Crisis (GFC), resulting in low vacancy rates. However, based on the documented impact of improving economies, a mean RN age of about 50, and just-agreed substantive increases in RN pay rates, it is likely that many will soon leave or reduce the hours they work. This study aims to investigate whether improved financial security will encourage RNs to leave or reduce their work commitment and to identify the factors that influence such intentions.

METHODS

An exploratory study using a cross-sectional survey design. Data were collected in 2014-2015 via an e-survey of 2,910 RNs in New Zealand. Data were analysed by regression.

RESULTS

We found that due to "burnout" and low "work engagement", both of which are strongly affected by workload and work-life interference, 22.6% of the RNs surveyed plan to leave work altogether and a further 32% plan to reduce their workforce participation when their financial situations improve.

CONCLUSIONS

The findings justify the urgent cooperative development, implementation and evaluation of a comprehensive suite of RN 'retention' measures involving national nursing organisations, the RN regulator and health system employers and funders.

Job satisfaction among critical care nurses: A systematic review

BACKGROUND

Nursing shortages, particularly in critical care units, are a major concern worldwide. Job satisfaction is a key factor associated with the high turnover of critical care nurses.

OBJECTIVES

The purpose of this systematic review was to synthesize the evidence on critical care nurses' job satisfaction. Specific research questions were: 1. How is job satisfaction defined and measured in studies of critical care nurses? 2a. What is the level of job satisfaction among critical care nurses? 2b. How has it changed over time? 2c. Do nurses' levels of job satisfaction differ by type of critical care unit? 3. What factors are associated with critical care nurses' job satisfaction?

DESIGN

Systematic review.

DATA SOURCES

We searched five electronic databases from January 1980 to May 2015: MEDLINE, CINAHL, PsychINFO, EMBASE, and Proquest Nursing & Allied Health Source.

REVIEW METHODS

Two team members independently screened all titles and abstracts and extracted data and assessed methodological quality on all included papers. A narrative synthesis with vote counting was undertaken.

RESULTS

A total of 1995 titles were identified, of which 61 satisfied our inclusion criteria. Only 24 (39%) of the included studies reported a conceptual definition of job satisfaction. Forty-two different quantitative measures of job satisfaction were identified, of which only 10 (24%) were used in multiple studies. The weighted mean job satisfaction score for critical care nurses across all studies was 56% satisfied and demonstrated fluctuations over time. Four factors showed significant positive relationships to job satisfaction: 1. shift worked - rotating 8- to 12-h and rotating days, evenings or nights; 2. Autonomy; 3. personnel resources and staffing; and 4. teamwork and cohesion; while two factors showed significant negative relationships to job satisfaction: 1. job stress; and 2. burnout-emotional exhaustion.

CONCLUSION

From this review, we did not find any evidence to support relationships between individual (socio-demographic) factors and critical care nurses' job satisfaction. We did however find evidence to support relationships between several employment and organizational factors and job satisfaction. Several of these factors are different from those reported among general hospital nurses and long-term care nursing staff, supporting the need for differential strategies to improve critical care nurses' job satisfaction. While the findings from this review hold promise as potential targets of future job satisfaction interventions, there were several methodological problems inherent in many of the studies.

The perceived and experienced role of the nurse unit manager in supporting the wellbeing of intensive care unit nurses: An integrative literature review

INTRODUCTION

The number of patients requiring admission into intensive care units (ICUs) is increasing worldwide. Concurrently, recruitment and retention of the ICU nursing workforce is becoming a major challenge due to the high intensity environment, heavy workloads, and decreasing nurse wellbeing. Nurse unit managers play a vital role in promoting and supporting ICU nurse wellbeing, yet little is known about perceptions and experiences of this role.

OBJECTIVES

To examine the perceived and experienced role of the nurse unit manager in supporting the wellbeing of ICU nurses.

REVIEW METHODS

A comprehensive review of the literature was undertaken using Whittemore and Knafl's five stage approach: (i) problem identification, (ii) literature search, (iii) quality appraisal, (iv) data analysis, and (v) presentation of findings.

DATA SOURCES

The following databases were searched for literature published between January 2007 and December 2017: Cumulative Index to Nursing and Allied Health Literature, Cochrane, Informit, Joanna Briggs Institute Library of Systematic Review, ProQuest, PubMed, Scopus, and Wiley online library digital databases. Variations and synonyms of key words included: nurse unit manager, ICU, compassion fatigue, burnout, stress, job satisfaction, bullying, wellbeing, and work environment.

RESULTS

Rigour and trustworthiness of the included studies were assessed using the Critical Appraisal Skills Program qualitative research checklist,⁷¹ a modified Critical Appraisal Skills Program Cohort study checklist for quantitative research,⁷² and the Mixed Methods Appraisal Tool for mixed-method studies.⁷³ The critical review guidelines by Shenton⁷⁴ and Polit and Beck⁷⁵ were also used to make judgements about the worth of the evidence. All of the 11 qualitative studies provided moderate to strong evidence. The overall quality of the quantitative studies was lower, with three of seven studies providing only adequate evidence. The majority of the 19 included studies represented the voices of ICU nurses. Three major themes emerged from the analysis; '1) building professional relationships', '2) leading the way' and '3) satisfying the needs of ICU nurses'.

CONCLUSION

Nurse unit manager behaviours clearly affect the wellbeing of ICU nurses. However, the role of supporting ICU nurses is complex and challenging. More research is needed to investigate the needs of ICU nurses and the facilitators and barriers nurse unit managers face when supporting the wellbeing of nurses in their unit.

Interpersonal Conflict and Organizational Commitment Among Licensed Practical Nurses

The shortage of nursing professionals in the United States is unquestionable. This shortage, which is predicted to continue into the foreseeable future, is a particularly salient problem within the nursing profession. This is especially true for long-term care facility administrators who not only are faced with the challenge of increasing numbers of aging residents but also regularly struggle with turnover among more cost-effective nursing staff, such as licensed practical nurses (LPNs). The primary purpose of this study was to examine whether perceived interpersonal conflict influences organizational commitment among LPNs. To accomplish this, we analyzed responses from 1165 LPNs throughout a Midwestern state who were queried on their perceptions of interpersonal conflict and organizational commitment in their work settings. Considering a wide range of potential confounding influences such as age and years working as an LPN, for example, we found that higher perceived interpersonal conflict was associated with significantly lower levels of organizational commitment. The implications of these findings, along with recommendations for nurse administrators to reduce LPN turnover, are discussed in the article.

A computational application for multi-skill nurse staffing in hospital units

Background

Approaches to nurse staffing are commonly concerned with determining the minimum number of care hours according to the illness severity of patients. However, there is a gap in the literature considering multi-skill and multi-shift nurse staffing. This study addresses nurse staffing per skill category, at a strategical decision level, by considering the organization of work in shifts and coping with variability in demand.

Methods

We developed a method to determine the nursing staff levels in a hospital, given the required patient assistance. This method relies on a new mathematical model for complying with the legislation and guidelines while minimizing salary costs. A spreadsheet-based tool was developed to embed the model and to allow simulating different scenarios and evaluating the impact of demand fluctuations, thus supporting decision-making on staff dimensioning.

Results

Experiments were carried out considering real data from a Brazilian hospital unit. The results obtained by the model support the current total staff level in the unit under study. However, the distribution of staff among different skill categories revealed that the current real situation can be improved.

Conclusions

The method allows the determining of staff level per shift and skill depending on the mix of patients’ illness severity. Hospital management is offered the possibility of optimizing the staff level using a spreadsheet, a tool most managers are familiar with. In addition, it is possible to evaluate the implications of decisions on workforce dimensioning by simulating different demand scenarios. This tool can be easily adapted to other hospitals, using local rules and legislation.

Electronic supplementary material

The online version of this article (10.1186/s12911-018-0638-2) contains supplementary material, which is available to authorized users.

Individual and organizational predictors of allied healthcare providers' job satisfaction in residential long-term care

Background

Job satisfaction is a predictor of intention to stay and turnover among allied healthcare providers. However, there is limited research examining job satisfaction among allied health professionals, specifically in residential long-term care (LTC) settings. The purpose of this study was to identify factors (demographic, individual, and organizational) that predict job satisfaction among allied healthcare providers in residential LTC.

Methods

We conducted a secondary analysis of data from Phase 2 of the Translating Research in Elder Care program. A total of 334 allied healthcare providers from 77 residential LTC in three Western Canadian provinces were included in the analysis. Generalized estimating equation modeling was used to assess demographics, individual, and organizational context predictors of allied healthcare providers’ job satisfaction. We measured job satisfaction using the Michigan Organizational Assessment Questionnaire Job Satisfaction Subscale.

Results

Both individual and organizational context variables predicted job satisfaction among allied healthcare providers employed in LTC. Demographic variables did not predict job satisfaction. At the individual level, burnout (cynicism) (β = −.113, p = .001) and the competence subscale of psychological empowerment (β = −.224, p = < .001), were predictive of lower job satisfaction levels while higher scores on the meaning (β = .232, p = .001), self-determination (β = .128, p = .005), and impact (β = .10, p = .014) subscales of psychological empowerment predicted higher job satisfaction. Organizational context variables that predicted job satisfaction included: social capital (β = .158, p = .012), organizational slack-time (β = .096, p = .029), and adequate orientation (β = .088, p = .005).

Conclusions

This study suggests that individual allied healthcare provider and organizational context features are both predictive of allied healthcare provider job satisfaction in residential LTC settings. Unlike demographics and structural characteristics of LTC facilities, all variables identified as important to allied healthcare providers’ job satisfaction in this study are potentially modifiable, and therefore amenable to intervention.

Electronic supplementary material

The online version of this article (10.1186/s12913-018-3307-3) contains supplementary material, which is available to authorized users.

The Role of the Registered Nurse Working in Substance Use Disorder Treatment: A Hermeneutic Study

Substance Use Disorders (SUDs) are a national public health crisis. However, there is minimal existing research literature on the role of the nurse working in SUD treatment. The purpose of this study was to describe the meaning of the professional role of the registered nurse working in the SUD setting. The study utilized a Heideggerian Phenomenological approach with a modified Colaizzi method for analysis and interpretation. The nine study participants, two males and seven females, aged 27-60 had worked in SUD treatment for 1-37 years. Three major themes, with sub-themes, emerged: Defining the Role for Self; Learning the Role; and Navigating with Ease in an Unchangeable Culture. Findings demonstrated that nurses in SUD treatment value their role and the care of patients with SUDs. Patient recovery or relapse influenced job satisfaction. Significantly, the findings highlighted an outdated role with rigid boundaries and no real contemporary identity. Findings can be used to address the need for a contemporary SUD nursing identity and to support ongoing involvement of nurses in health policy related to SUDs.

Perceptions of organizational support and its impact on nurses' job outcomes

PROBLEM

Strong organizational support can promote a sense of well-being and positive work behaviors in nurses. However, despite the importance of organizational support in nursing, this topic remains unexplored in the Philippines.

PURPOSE

The aim of this study was to examine the impact of organizational support perceptions on nurses' work outcomes (organizational commitment, work autonomy, work performance, job satisfaction, job stress, and turnover intention).

METHODS

A descriptive, cross-sectional research design was adopted in this study to collect data from one hundred eighty (180) nurses in the Philippines during the months of September 2015 to December 2015. Seven standardized tools were used: the Job Satisfaction Index, the Job Stress Scale, the Burnout Measure Scale, the Work Autonomy Scale, the Six Dimension Scale of Nursing Performance, the Turnover Intention Inventory Scale, and the Perception of Organizational Support Scale.

FINDINGS

Nurses employed in government-owned hospitals perceived low levels of organizational support as compared to private hospitals. Significant correlations were identified between perceived organizational support (POS), hospital bed capacity, and nurses' work status. No significant correlations were found between perceived organizational supportand the six outcomes perceived by nurses in the Philippines (organizational commitment, work performance, job autonomy, job satisfaction, job stress, and turnover intention).

CONCLUSION

Perceptions of organizational support were low in Filipino nurses compared to findings in other international studies. Perceived organizational support did not influence job outcomes in nurses.

Evaluating the relationship between job stress and job satisfaction among female hospital nurses in Babol: An application of structural equation modeling

Background: This study was designed to investigate job satisfaction and its relation to perceived job stress among hospital nurses in Babol County, Iran.

Methods: This cross-sectional study was conducted on 406 female nurses in 6 Babol hospitals. Respondents completed the Minnesota Satisfaction Questionnaire (MSQ), the health and safety executive (HSE) indicator tool and a demographic questionnaire. Descriptive, analytical and structural equation modeling (SEM) analyses were carried out applying SPSS v. 22 and AMOS v. 22.

Results: The Normed Fit Index (NFI), Non-normed Fit Index (NNFI), Incremental Fit Index (IFI)and Comparative Fit Index (CFI) were greater than 0.9. Also, goodness of fit index (GFI=0.99)and adjusted goodness of fit index (AGFI) were greater than 0.8, and root mean square error of approximation (RMSEA) were 0.04, The model was found to be with an appropriate fit. The R-squared was 0.42 for job satisfaction, and all its dimensions were related to job stress. The dimensions of job stress explained 42% of changes in the variance of job satisfaction. There was a significant relationship between the dimensions of job stress such as demand (β =0.173,CI =0.095 - 0.365, P≤0.001), control (β =0.135, CI =0.062 - 0.404, P =0.008), relationships(β =-0.208, CI =-0.637– -0.209; P≤0.001) and changes (β =0.247, CI =0.360 - 1.026, P≤0.001)with job satisfaction.

Conclusion: One of the important interventions to increase job satisfaction among nurses maybe improvement in the workplace. Reducing the level of workload in order to improve job demand and minimizing role conflict through reducing conflicting demands are recommended.

Job burnout and turnover intention among nurses in China: the mediating effects of positive emotion

Objective

The aim of this study was to explore whether positive emotion mediates the relationship between job burnout and turnover intentions among Chinese nurses.

Methods

A cross-sectional survey was conducted in the present study. Full-time registered nurses (n = 150) from Grade A hospitals in Tianjin were surveyed. Pearson correlation, hierarchical regression analyses, and the Sobel test were used in the study.

Results

The results illustrated that positive emotion mediated the relationship between burnout and nurses’ turnover intention.

Conclusions

Nursing administrators should pay more attention to the benefits of positive emotions on working motivation. It is helpful to relieve burnout in the working process so that nurses are willing to remain in their current employment.

Turnover among Filipino nurses in Ministry of Health hospitals in Saudi Arabia: causes and recommendations for improvement

BACKGROUND

Nurse turnover is a critical challenge for healthcare organizations as it results in a decreasing nurse/patient ratio and increasing costs.

AIM

Identify factors influencing the termination of Filipino nurses in Ministry of Health (MOH) hospitals and record nurse recommendations to improve retention.

DESIGN

Cross-sectional.

METHODS

Data was gathered from a convenience sample of Filipino nurses with previous experience in MOH hospitals in Saudi Arabia who attended recruitment interviews at the Saudi employment office in Manila.

RESULTS

The sample included 124 nurses. Major turnover factors included low salary (18.3%), low nurse/patient ratio (15%), end of contract (14.5%), discrimination (13.5%), and bad accommodations (9%). Suggested areas of improvement included financial motivations (34%), administration support (25%), quality of life (25%), and work environment (16%).

CONCLUSION

Managing nurse turnover can be implemented on the organizational as well as at MOH levels. The recommendations given by the participants provide direct targets to improve retention.

LIMITATIONS

With convenience sampling, the sample is probably not representative of the Filipino nursing population.

CONFLICT OF INTEREST

None.

Stress and ways of coping among nurse managers: An integrative review

AIMS AND OBJECTIVES

To appraise and synthesise empirical studies examining sources of occupational stress and ways of coping utilised by nurse managers when dealing with stress.

BACKGROUND

The Nurse Manager's role is challenging yet draining and stressful and has adverse consequences on an individual's overall health and well-being, patients' outcomes and organisational productivity. Considerable research has been carried out; however, an updated and broader perspective on this critical organisational issue has not been performed.

DESIGN

An integrative review.

METHODS

Five databases (Cumulative Index to Nursing and Allied Health Literature, SCOPUS, PubMed, PsychINFO and MEDLINE) were searched to identify relevant articles. Search terms and MeSH terms included: "charge nurse," "coping," "coping strategy," "coping style," "psychological adaptation," "psychological stress," "stressors," "nurse manager" and "unit manager." Twenty-two articles were included in this review. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines.

RESULTS

Four themes were identified: moderate stress levels, common sources of stress, ways of coping and the impact of nurses' characteristics on stress.

CONCLUSIONS

Nurse managers experienced moderate levels of stress mainly from heavy workloads, lack of resources and financial responsibilities. Enhancing social support and promoting job control were seen as important in reducing work stress and its related consequences. Additional studies using a more rigorous method and a larger sample size preferably in multicultural settings would shed more light on this topic.

RELEVANCE TO CLINICAL PRACTICE

Hospital and nurse administrators play an important role in promoting supportive structures for daily professional practice for nurse managers through staffing, organisational resources, support services, leadership and stress management training.

Understanding the factors which promote registered nurses' intent to stay in emergency and critical care areas

AIMS AND OBJECTIVE

To explore the influential factors and strategies that promote an experienced nurse's intent to stay in their emergency or critical care area.

BACKGROUND

Turnover among registered nurses (herein referred to as nurses) working in specialty areas of practice can result in a range of negative outcomes. The retention of specialty nurses at the unit level has important implications for hospital and health systems. These implications include lost knowledge and experience which may in turn impact staff performance levels, patient outcomes, hiring, orientating, development of clinical competence and other aspects of organizational performance.

DESIGN

This qualitative study used an interpretive descriptive design to understand nurses' perceptions of the current factors and strategies that promote them staying in emergency or critical care settings for two or more years.

METHODS

Focus groups were conducted with 13 emergency and critical care nurses. Data analysis involved thematic analysis that evolved from codes to categories to themes.

RESULTS

Four themes were identified: leadership, interprofessional relationships, job fit and practice environment. In addition, the ideas of feeling valued, respected and acknowledged were woven throughout.

CONCLUSIONS

Factors often associated with nurse attrition such as burnout and job stresses were not emphasised by the respondents in our study as critical to their intent to stay in their area of practice. This study has highlighted positive aspects that motivate nurses to stay in their specialty areas.

RELEVANCE TO CLINICAL PRACTICE

To ensure quality care for patients, retention of experienced emergency and critical care nurses is essential to maintaining specialty expertise in these practice settings.

A Cyclic Model Describing the Process of Sustaining Meaningfulness in Practice: How Nurses Continue Working at One Home Care Agency

This study aimed to elucidate the experiences of home care nurses who had continued working a single agency, to gain insight into the prevention of premature turnover. We adopted a grounded theory approach to qualitative exploration of the experiences of 26 Japanese nurses working in a home care agency, using semistructured interviews and participant observation. Nurses' experience progressed through three phases: "encountering difficulty," "enjoying the fruitfulness," and "becoming dissatisfied." Nurses' cognitive rounding involving these phases was conceptualized as "cycle of sustaining meaningfulness." To move from encountering difficulty to enjoying the fruitfulness, nurses needed to discover the meaningfulness of practice, and to move from becoming dissatisfied to encountering difficulty, they needed to requestion their practice. During their time at the agency, nurses progressed through the phases of the cycle of sustaining meaningfulness repeatedly. Knowing the point at which nurses are in the cycle and assisting their further progress could aid in their retention.

Factors predicting Registered Nurses' intentions to leave their organization and profession: A job demands-resources framework

AIMS

To develop a comprehensive model of nursing turnover intention by examining the effects of job demands, job resources, personal demands and personal resources on burnout and work engagement and subsequently on the intention to leave the organization and profession.

BACKGROUND

The ageing population and a growing prevalence of multimorbidity are placing increasing strain on an ageing nursing workforce. Solutions that address the anticipated nursing shortage should focus on reducing burnout and enhancing the engagement of Registered Nurses (RNs) to improve retention.

DESIGN

A cross-sectional survey design.

METHOD

Data were collected in 2014-2015 via an e-survey from 2,876 RNs working in New Zealand. Data were analysed with structural equation modelling.

RESULTS

Higher engagement results in lower intention to leave the organization and profession. Burnout has significant effects on intentions to leave through lower engagement. While most of the demands and resources' variables (except professional development) have effects on intentions to leave, greater workload and greater work-life interference result in higher burnout and are the strongest predictors of intentions to leave. Greater emotional demands (challenges) and greater self-efficacy also have strong effects in lowering intentions to leave through higher engagement.

CONCLUSIONS

Employee burnout and work engagement play an important role in transmitting the impacts of job demands, job resources, personal demands and personal resources into RN intention to leave the organization and profession. Work-life interference and high workloads are major threats to nursing retention while challenge demands and higher levels of self-efficacy support better retention.

Importance of Leadership Style towards Quality of Care Measures in Healthcare Settings: A Systematic Review

Effective leadership of healthcare professionals is critical for strengthening quality and integration of care. This study aimed to assess whether there exist an association between different leadership styles and healthcare quality measures. The search was performed in the Medline (National Library of Medicine, PubMed interface) and EMBASE databases for the time period 2004-2015. The research question that guided this review was posed as: "Is there any relationship between leadership style in healthcare settings and quality of care?" Eighteen articles were found relevant to our research question. Leadership styles were found to be strongly correlated with quality care and associated measures. Leadership was considered a core element for a well-coordinated and integrated provision of care, both from the patients and healthcare professionals.

Proposta de gestão do absenteísmo da enfermagem hospitalar: uma revisão sistemática

Resumo Objetivo: Investigar na literatura o conhecimento disponível sobre a interdependência dos agentes desencadeantes do absenteísmo da enfermagem hospitalar para inferir, a partir de uma perspectiva multicausal, possíveis ações de gestão e controle. Métodos: Revisão sistemática compreendendo o recorte temporal de 2013 à 2017, utilizando descritores operacionalizados em bases de dados indexadas do portal da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES). A busca seguiu a metodologia Statement Preferred Reporting items For Systematic Reviews And Meta-Analyses (PRISMA) auxiliada pelo software EndNote®. Resultados: Finalizado o processo de depuração dos 269 artigos recuperados, 39 atenderam aos critérios de inclusão estabelecidos e, deles, 23,08% atribuiu a origem do absenteísmo a causas diversas não específicas. A organização do trabalho foi identificada como causa em 20,51% do material analisado, os adoecimentos musculoesqueléticos 15,38% e, os transtornos mentais e comportamentais totalizaram 10,26%. A síndrome de Burnout, 7,69% dos artigos, a satisfação no trabalho e os aspectos psicossociais 5,13% cada, relacionamento com demais membros das equipes, assédio e resiliência, ambiente laboral, fadiga e conflitos com o paciente, cada um, com 2,56% dos artigos analisados na revisão sistemática. Conclusão: Pelos resultados obtidos, concluiu-se que o absenteísmo deve ser tratado a partir de uma perspectiva múltipla, holística, epidemiológica e prospectiva através de variáveis organizacionais, físicas e cognitivas compatíveis com as análises multicausais.

Supporting clinical leadership through action: The nurse consultant role

AIMS AND OBJECTIVES

To evaluate the effectiveness of an action learning set to enhance clinical leadership and extend their scope and confidence more strategically.

BACKGROUND

As the most senior clinical role in most healthcare systems, the consultant nurse role is a solitary one. They are required to develop personal resilience, commitment and a belief in their ability to lead, with new consultants needing a strong support network to succeed.

DESIGN

Following a 2-year action learning set, four nurse consultants, one therapy consultant, and a university educationalist engaged in a cooperative inquiry approach using four cycles of discussion, reflection, analysis and action over an 18-month period from March 2015-July 2016, to learn how to change and enhance their working practices. Data were analysed thematically.

RESULTS

Four themes emerged where the action learning set (i) offered structure and support, (ii) enabled a wider influence and (iii) empowered them to lead. The cooperative inquiry helped them realise how much they had gained from their collective learning and they felt empowered to lead.

CONCLUSION

Their motivation to "make a difference" remains palpable. The outcomes of the cooperative inquiry included an enhanced understanding of the importance of openness and trust and a willingness to share and learn from each other in a respectful and confidential environment with a receptiveness to change. Self-leadership has clearly been accepted and embraced, and their collaboration has improved communication across the organisation, enhanced their strategic leadership capability and given confidence to disseminate externally.

RELEVANCE TO CLINICAL PRACTICE

The action learning set offered structure to support these clinical leaders to keep them focused across the breadth of their role. Additionally, peer review with external facilitation has enabled these clinical leaders to gain a wider influence and empowered them to lead.

Job stress and burnout: A comparative study of senior and head nurses in China

Senior nurses can suffer from high job stress and burnout, which can lead to negative patient outcomes and higher turnover rates; however, few studies have examined this topic. We recruited 224 head and senior nurses from September to December 2015 using convenience and cluster sampling, to compare job stress and burnout levels between the two groups. The Nurse Job Stressors Inventory and Maslach Burnout Inventory scales were used to evaluate job stress and burnout, respectively. Results indicated that job stress scores significantly differed between head and senior nurses. The highest scoring subscales in both groups were time allocation and workload problems. Scores for the three burnout dimensions also significantly differed between the groups. Positive correlations between job stress and burnout were stronger among senior nurses than head nurses. Burnout may be higher among senior nurses given head nurses' potential for greater perceived job control. Our findings suggest that measures need to be taken to reduce burnout and turnover rates among senior nurses.