Nurse retention: A review of strategies to create and enhance positive practice environments in clinical settings

Healthy work environment: A systematic review informing a nursing professional practice model in the US Military Health System

AIM

The aim of the study was to develop recommendations for creating a healthy work environment based on current literature for nurses working within the US Military Health System (MHS). However, our findings would likely benefit other nursing populations and environments as well.

DESIGN

Systematic literature review.

DATA SOURCES

We conducted a systematic literature search for articles published between January 2010 until January 2024 from five databases: PubMed, Joanna Briggs, Embase, CINAHL and Scopus.

METHODS

Articles were screened, selected and extracted using Covidence software. Article findings were synthesized to create recommendations for the development, implementation and measurement of healthy work environments.

RESULTS

Ultimately, a total of 110 articles met the criteria for inclusion in this review. The articles informed 13 recommendations for creating a healthy work environment. The recommendations included ensuring teamwork, mentorship, job satisfaction, supportive leadership, nurse recognition and adequate staffing and resources. Additionally, we identified strategies for implementing and measuring these recommendations.

CONCLUSIONS

This thorough systematic review created actionable recommendations for the creation of a healthy work environment. Based on available evidence, implementation of these recommendations could improve nursing work environments.

IMPACT

This study identifies methods for implementing and measuring aspects of a healthy work environment. Nurse leaders or others can implement the recommendations provided here to develop healthy work environments in their hospitals, clinics or other facilities where nurses practice.

REPORTING METHOD

PRISMA 2020 guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

How can strategies based on performance measurement and feedback support changes in nursing practice? A theoretical reflection drawing on Habermas' social perspective

Strategies based on performance measurement and feedback are commonly used to support quality improvement among nurses. These strategies require practice change, which, for nurses, rely to a large extent on their capacity to coordinate with each other effectively. However, the levers for coordinated action are difficult to mobilize. This discussion paper offers a theoretical reflection on the challenges related to coordinating nurses' actions in the context of practice changes initiated by performance measurement and feedback strategies. We explore how Jürgen Habermas' theory of Communicative Action may shed light on the issues underlying nurses' collective actions and self-determination in practice change and the implications for the design of strategies based on performance measurement and feedback. Based on this theory, we propose differences between communicative and functional coordination according to the nature of the actions and the purposes involved. The domains of action underlying these coordination processes, which Habermas referred to as the lifeworld and the system, are then used to draw a parallel with aspects of nursing practice. Further exploration of these concepts allows us to consider the tensions between the demands of the system and the self-determination of nurses within their practice.

[It] Does Harden a Person Working in Such a Stressful Environment: U.S. Correctional Nurses Share Spillover Effects of Their Work

BACKGROUND

The United States makes up 4.4% of the world's population but nearly a quarter of the world's incarcerated population. Despite caring for nearly 2 million incarcerated persons and managing their unique needs, little is known about how this work spills over and affects the nurses who work in correctional settings.

STUDY OBJECTIVE

This descriptive study aimed to (a) examine write-in answers regarding correctional nurse perceptions of how their work impacts their health and their home lives and (b) explore correctional nurse responses for how to improve the work environment to better support their well-being.

METHOD

The researchers compiled and analyzed qualitative data from a cross-sectional study where U.S. correctional nurses ( N = 270) completed an online survey. Manifest content analysis was used to analyze optional write-in data.

RESULTS

Approximately 41% ( n = 111) of participants answered qualitative questions. Participants were primarily White (77.3%) and non-Hispanic or Latino (88.7%), working in prisons (65.8%), and employed by the state (63.8%) as registered nurses (70%). Three major themes emerged: (a) "personal impact": increased stress and burnout, overwhelming work hours, and emotional and physical effects; (b) "social relationships and family impacts": withdrawn, strained homelife, and uncertainty; and (c) "need for change": improved staffing, reduced mandatory overtime, and better support from management.

CONCLUSIONS

Correctional organizations may consider ways to support the well-being of their nurses through adequate staffing, flexible scheduling, decreased mandatory overtime, and hiring effective nurse managers as key members of the correctional team.

The Effects of the Spiritual Well-Being Levels of Surgical Nurses on Care Satisfaction in Liver Transplant Recipients After Transplantation: The Case of a Turkish Sample

This study examined the effects of the spiritual well-being levels of surgical nurses on care satisfaction in liver transplant recipients after transplantation. The sample in this cross-sectional study consisted of 69 surgical nurses working in the organ transplant centre of a research and training hospital in Turkey and 79 liver transplant recipients. The data of this study were collected between 1 August 2020 and 30 August 2021. The "Three-Factor Spiritual Well-being Scale" and the "Newcastle Satisfaction with Nursing Scale" were used for data collection. A statistically significant relationship was found between the spiritual well-being levels of the surgical nurses and the care satisfaction levels of the transplant recipients. Surgical nurses should be capable of treating patients holistically and be knowledgeable enough to support the mental health of patients. High levels of spiritual well-being in surgical nurses contribute to increased satisfaction with care among organ transplant recipients.

Comparison of student nurses' expectations and newly qualified nurses' experiences regarding clinical practice: A secondary analysis of a cross-sectional survey

AIM

To compare student nurses' expectations and newly qualified nurses' experiences regarding clinical practice in Switzerland 1 year after graduation.

DESIGN

A secondary explorative analysis of a cross-sectional survey.

METHODS

The data were sourced from the Swiss National Graduate Survey of Health Professionals covering six universities of applied sciences between 2016 and 2019, with information on three cohorts of bachelor student nurses, with a 1-year follow-up between each year. The participants were 533 bachelor-prepared nursing graduates.

RESULTS

The student nurses' overall expectations included the following top two prioritized aspects: 'contributing to something important' and 'adequate time to spend with patients'. Newly graduated nurses' clinical practice experiences demonstrated that not all expectations were met 1 year after graduation. The largest gaps were found in 'adequate time to spend with patients', 'work-life balance' and experiencing 'good management'.

CONCLUSION

The most crucial expectation gaps are related to having sufficient time to spend with patients and a good work-life balance. The most important result is whether there is a shortage of places for nurses to work rather than the oft-cited shortage of nurses.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

The expectations of Swiss newly qualified nurses can be better met by an assessment in the first year about which individual perceptions of workplace characteristics cause them to make choices to change something about their work, affect their job satisfaction or influence their intention to stay.

IMPACT

Few of the student nurses' expectations were met 1 year after graduation, therefore Swiss healthcare institutions should improve needs assessments to strengthen the nurse workforce starting early in employment. The results underscore the importance of a constructive management culture, such as that in magnet hospitals in the United States which underpins the philosophy of changing in nursing. The results can be used internationally as a benchmark and as a basis for introducing potential interventions for nurse retention.

REPORTING METHOD

This study was reported following the Standardized Reporting of Secondary Data Analyses Checklist.

PATIENT OR PUBLIC CONTRIBUTION

There were no patient or public contributions.

TRIAL AND PROTOCOL REGISTRATION

This study has not been registered.

Effects of Nurse Staffing on Missed Breastfeeding Support in Maternity Units With Different Nurse Work Environments

PURPOSE

To examine the effect of nurse staffing in varying work environments on missed breastfeeding teaching and support in inpatient maternity units in the United States.

BACKGROUND

Breast milk is the optimal food for newborns. Teaching and supporting women in breastfeeding are primarily a nurse's responsibility. Better maternity nurse staffing (fewer patients per nurse) is associated with less missed breastfeeding teaching and support and increased rates of breastfeeding. We examined the extent to which the nursing work environment, staffing, and nurse education were associated with missed breastfeeding care and how the work environment and staffing interacted to impact missed breastfeeding care.

METHODS

In this cross-sectional study using the 2015 National Database of Nursing Quality Indicator survey, maternity nurses in hospitals in 48 states and the District of Columbia responded about their workplace and breastfeeding care. Clustered logistic regression models with interactions were used to estimate the effects of the nursing work environment and staffing on missed breastfeeding care.

RESULTS

There were 19 486 registered nurses in 444 hospitals. Nearly 3 in 10 (28.2%) nurses reported missing breastfeeding care. In adjusted models, an additional patient per nurse was associated with a 39% increased odds of missed breastfeeding care. Furthermore, 1 standard deviation decrease in the work environment was associated with a 65% increased odds of missed breastfeeding care. In an interaction model, staffing only had a significant impact on missed breastfeeding care in poor work environments.

CONCLUSIONS

We found that the work environment is more fundamental than staffing for ensuring that not only breastfeeding care is not missed but also breastfeeding care is sensitive to nurse staffing. Improvements to the work environment support the provision of breastfeeding care.

IMPLICATIONS FOR RESEARCH AND PRACTICE

Both nurse staffing and the work environment are important for improving breastfeeding rates, but the work environment is foundational.

Effectiveness appraisal of interventions to increase retention of newly qualified nurses implemented in the final year of pre-registration programmes: A literature review

AIM

To understand the effectiveness of interventions to increase retention of early career nurses, implemented during the pre-registration programme.

BACKGROUND

Retention of nurses is an issue of global concern. The transition period spanning the final year of pre-registration nurse education programmes and the first year of qualified practice is a point of high risk for attrition from the profession.

DESIGN

A systematic review without meta-analysis and a thematic synthesis of wider literature, reported using SWiM and ENTREQ guidelines.

METHODS

A convergent segregated approach was used to capture qualitative and quantitative study designs. A systematic review of quantitative papers reporting intervention and retention data and scoping review of a wider body of literature related to interventions supporting transition to qualified practice were conducted. Searches used Medline and CINAHL databases in October 2021. Data extracted from wider literature were inductively collated into themes relating to the intervention type and synthesised.

RESULTS

Six papers were included in the systematic review and 27 papers were included in the scoping review. Interventions included internships, externships, clinical immersion programmes, capstone projects, preceptorships and psychological wellbeing programmes. There was a lack of consensus about the benefits of implementing interventions during the final year of pre-registration programmes, but some evidence that interventions incorporating preceptors, expose students to the clinical environment and involve academic/clinical collaboration, report positive outcomes related to transition to qualified practice, which potentially has an impact on motivation to stay in the profession.

CONCLUSION

Greater understanding of interventions supporting student nurses to reduce likelihood of leaving once qualified has been achieved. There is some evidence these interventions lead to increases in retention, but this is limited by the quality of the reporting and the scarcity of data. Consideration should be given to maximizing students' exposure to clinical practice and the benefits that interventions with alternative approaches such as psychological wellbeing programmes may bring. This review has potential to influence effective implementation of interventions to increase retention of early career nurses if clinical practice and academic settings review proposed or actual interventions to maximise added value. REPORTING METHOD: the manuscript has been written in adherence with the EQUATOR guidelines following the SWiM reporting guidelines for the systematic review and the ENTREQ guidelines for the scoping review.

Nurses' motivations to leave the nursing profession: A qualitative meta-aggregation

AIM

To systematically provide an overview of the qualitative evidence available on the motivations for nurses to leave the nursing profession.

DESIGN

A qualitative systematic review using the meta-aggregation design of the Joanna Briggs Institute.

DATA SOURCES

Qualitative studies in English, dating from 2010 until January 2023, were obtained from CINAHL, PsycINFO and PubMed.

REVIEW METHODS

Studies were selected using predetermined inclusion and exclusion criteria. Quality assessment was done using the Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research. The assessment of confidence in the review findings was done according to the ConQual approach.

RESULTS

Nine papers that investigated nurses' motivations to leave the profession were included. We developed four synthesized findings from 11 synthesized categories and 31 categories to reflect nurses' motivations to leave the profession, including (1) challenging work environment, (2) emotional distress, (3) disappointment about nursing reality, and (4) culture of hierarchy and discrimination.

CONCLUSION

This review provides an in-depth and meaningful understanding of motivations for nurses to leave the profession. Among others, poor working conditions, a lack of opportunities for career development, a lack of support from managers, work-related stress, a discrepancy between nursing education and practice and bullying behaviour were motivations to leave the profession, which calls for targeted action to retain nurses in the profession.

IMPACT

Findings of this study shine a light on reasons why nurses leave the profession, providing evidence to support nurse managers and policymakers to develop retention strategies to move out of current crisis into recovery of sustainable global healthcare.

PATIENT OR PUBLIC CONTRIBUTION

There was no direct patient or caregiver contribution to this study because this study originated from the process of a Master study. However, two of the authors are still involved in clinical nursing practice and provided the necessary link between research and practice.

Relationship between nurses' perception of professional shared governance and their career motivation: A cross-sectional study

Objectives

This study aimed to investigate the level of professional shared governance and career motivation and their relationship among nurses in Egypt.

Methods

A cross-sectional survey was conducted. A total of 724 nurses working in inpatient medical, surgical, and critical care units in Alexandria Main University Hospital were recruited from May to August 2022. The Index of Professional Nursing Governance (IPNG) version 3.0 and the Career Motivation Scale were used for evaluation.

Results

The IPNG version 3.0 total score was 109.18 ± 22.76, that nurses perceived had a low level of professional shared governance; the access to information dimension achieved the highest average mean score (2.81 ± 0.76), followed by the ability to set goals and conflict resolution dimension (2.75 ± 0.53). On the other hand, the dimension of participation in the committee structure achieved the lowest average mean score (1.65 ± 0.37). The total score of career motivation was 69.82 ± 9.70 this reflects that nurses perceived a moderate level of career motivation. The career insight dimension achieved the highest average mean score (3.56 ± 0.34), while the career resilience dimension achieved the lowest average mean score (3.07 ± 0.49). Male nurses, less than 30 years old, had a bachelor's degree in nursing sciences, and worked in the ICU had higher total scores of the IPNG and career motivation (P < 0.001). There was a positive correlation between the IPNG version 3.0 score and the Career Motivation Scale score (r = 0.239, P = 0.003).

Conclusions

The study's findings can serve as a theoretical foundation for nursing managers to re-plan the management model and develop appropriate methods to give better career planning for nurses.

Retention and turnover intention of foreign-trained physicians (FTPs): A scoping review

BACKGROUND

In many high-income countries, there is a regional or indication-specific shortage of physicians. One way to alleviate these shortages is to recruit physicians from abroad. However, the high turnover rate of foreign-trained physicians (FTPs) makes it difficult to maintain stable medical care. The purpose of this scoping review was to analyze recent studies on turnover intentions and retention in order to, first, understand how they are assessed and, second, to identify the parameters that contribute to reducing turnover and improving the retention of FTPs.

METHOD

A total of six articles were included, and a thematic analysis was conducted. The literature search was limited to English-language articles from bibliographic databases related to public health and health services research (MEDLINE, CINAHL, Web of Science, PsycINFO) between 2010 and 2022.

RESULTS

The topis identified were: (1) the quality of working relationships, (2) the quality of the work environment, (3) personal life and migration issues, (4) employment-related issues, and (5) career and training opportunities. Three approaches were considered in examining the retention and turnover intentions of FTPs: satisfaction, motivation for migration, and professional integration. Underrepresented fields are discrimination and social integration.

CONCLUSIONS

The processes of turnover intention and retention are still poorly understood. Standardizing definitions and certain parts of the methodology would help researchers navigate the process with more accuracy. Further studies should look at the causal relationships that can be collected in the form of qualitative data, as these are currently lacking.

Factors Influencing RNs' Intention to Stay in Nursing Homes: Multilevel Modeling Approach

The current study investigated factors that influence the intention to stay (ITS) of RNs working in South Korean nursing homes (NHs). Thirty-six questionnaire responses from organizational NHs and 101 from individual RNs were analyzed using multilevel regression analysis. At the individual level, RNs' ITS increased with years of work at their current NH, and that of RNs who received emergency calls to work at night was lower than that of RNs with fixed night shifts. At the organizational level, ITS was higher when the ratios of RNs to residents and RNs to nursing staff were higher. To improve ITS, NHs should consider adopting mandatory deployment of RNs, increasing their RN to resident ratios, and implementing a fixed night shift RN system, wherein night shift working hours count as twice the daytime hours, and night shift is voluntary. [Journal of Gerontological Nursing, 49(7), 40-48.].

Realist synthesis of factors affecting retention of staff in UK adult mental health services

OBJECTIVES

The shortage of healthcare staff is a global problem. UK mental health services have, on average, a higher turnover of staff than the NHS. Factors affecting retention of this staff group need to be explored in more depth to understand what is working for whom, for what reasons and in what circumstances. This review aims to conduct a realist synthesis to explore evidence from published studies, together with stakeholder involvement to develop programme theories that hypothesise how and why retention occurs in the mental health workforce and identify additional evidence to explore and test these theories thereby highlighting any persistent gaps in understanding. This paper develops programme theories that hypothesise why retention occurs and in what context and tests these theories thereby highlighting any persistent gaps in understanding.

METHODS

Realist synthesis was used to develop programme theories for factors affecting retention of UK mental health staff. This involved: (1) stakeholder consultation and literature scoping to develop initial programme theories; (2) structured searches across six databases to identify 85 included relevant literature relating to the programme theories; and (3) analysis and synthesis to build and refine a final programme theory and logic model.

RESULTS

Phase I combined findings from 32 stakeholders and 24 publications to develop six initial programme theories. Phases II and III identified and synthesised evidence from 88 publications into three overarching programme theories stemming from organisational culture: interconnectedness of workload and quality of care, investment in staff support and development and involvement of staff and service users in policies and practice.

CONCLUSIONS

Organisational culture was found to have a key underpinning effect on retention of mental health staff. This can be modified but staff need to be well supported and feel involved to derive satisfaction from their roles. Manageable workloads and being able to deliver good quality care were also key.

Job demands and resources as drivers of exhaustion and leaving intentions: a prospective analysis with geriatric nurses

BACKGROUND

Nurses show a high prevalence of exhaustion and increased leaving intentions. With this study, we integrate established research about turnover intention with recent burnout literature and present a theoretical model that combines both. The aim of this study was to examine job demands (time pressure, social conflicts) and resources (job control, supervisor support, task identity, person-organisation fit) as drivers and health and age as moderators for the relationships between exhaustion and nurses' organisational and professional leaving intentions.

METHODS

We analysed data from a standardised paper-pencil questionnaire survey with a prospective, two-wave (12 months apart) study design. In total, 584 nurses participated at Time 1 (t1). The final sample at Time 2 (t2) was n = 222 nurses (38%; age: M = 41.1 years, SD = 11.0; 88% females).

RESULTS

We identified time pressure as job demand and job control, task identity, and person-organisation fit as resources that drive the relationships of exhaustion (mean between both times of measures) and organisational and professional leaving intentions. The relationships to organisational leaving intentions decreased with nurses' age and the relationships to professional leaving intentions increased for nurses who had poorer self-rated health. We found indirect effects of exhaustion for relationships between job demands and nurses' leaving intentions. Relationships to exhaustion remained significant after adjusting for depressive mood.

CONCLUSION

Insights from this study can be used both by employers and employees. Redesigning work might be a promising approach to improve nurses' well-being and retention in this profession. Geriatric care facilities should include the concept of person-organisation fit into their personnel selection process.

Strategies to Stay: Role Enrichment Models for Retaining Millennial Nurses

Nurse retention strategies are top of mind for nurse leaders as they face an unprecedented staffing crisis. A strategic approach that includes innovative models to enhance nurse satisfaction and nurse retention may include role enrichment strategies such as blended roles, alternative work arrangements, and shared staffing. Effective implementation requires authentic, transformational leadership, as well as structures and processes for replication, sustainability, and improved outcomes. This case study illustrates the potential of this strategy to positively influence key factors contributing to nurse retention, especially for millennial nurses. Nurse leaders in one critical care unit shared their experience with cross-training for blended roles, skill expansion for professional development for unit staff as well as float team members, leadership development opportunities, and shared staffing. Creating a staffing strategy that includes the leadership and infrastructure to support blended or dual roles is one promising element in a nurse leader tool kit for millennial nurse retention.

Vicarious Trauma Experienced by Health Care Providers Involved in Traumatic Childbirths: A Meta-Synthesis

Health care providers are often "second victims" of traumatic childbirth events and should be adequately supported by their organizations to alleviate occupational stress and burnout. Therefore, this review aimed to explore and understand the vicarious traumatic childbirth experiences of health care providers, including obstetricians, midwives, nurses, and students. A systematic review of qualitative studies was conducted. Seven electronic databases, namely, PubMed, CINAHL, Embase, PsycINFO, Cochrane, Scopus, and Web of Science, were searched from each database's inception to May 2020. In total, 1,575 studies were retrieved and screened according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Seventeen studies were included in this review and were meta-summarized and then meta-synthesized using the Sandelowski and Barroso approach. The overarching theme of "Tunneling through the trauma with a hope of finding an end" was derived, and four main themes along with 15 subthemes were identified. The four main themes were (1) "instantaneous response to the trauma," (2) "finding hope in the midst of chaos," (3) "dealing with the aftermath," and (4) "resolution to move on." Communication and teamwork among health care team members were identified as challenges contributed by professional hierarchy and lack of role clarity. Midwives and labor and delivery nurses expressed powerlessness in advocating for women on many occasions, and health care providers often had feelings of guilt and self-blame after adverse events. Health care providers also reported inadequate support from their colleagues and organizations, which influenced their ability to cope with the aftermath of trauma and their decision to stay in the profession.

Evidence of the Association between Nurse Staffing Levels and Patient and Nurses' Outcomes in Acute Care Hospitals across Japan: A Scoping Review

We aimed to summarize the evidence of an association between nurse staffing and nursing sensitivity outcomes in Japanese hospitals. A scoping review was conducted and reported following the PRISMA-SR 2020 statement. The ICHUSHI and CiNii databases were searched for published articles written in Japanese and PubMed and CINAHL for those written in English. Out of the 15 included studies, all observational studies, 3 were written in Japanese and the others in English. The nurse staffing level measures were grouped into three categories: patient-to-nurse ratio, nursing hours per patient day, and nurse-to-bed ratio. The outcome measures were grouped into three categories: patient outcome, nursing care quality reported by nurses, and nurse outcome/nursing care quality. Some studies reported that the nursing staff increasingly favored positive patient outcome. Conversely, the findings regarding failure to rescue, in-hospital fracture, and post-operative complications were inconsistent. Although some studies indicated that more nurse staffing was favored toward better patient and nurse outcomes, due to the sparse accumulation of studies and heterogeneity among the findings, it is difficult to draw robust conclusions between nurse staffing level and outcomes in Japanese acute care hospitals.

Because they're worth it? A discussion paper on the value of 12-h shifts for hospital nursing

The organisation of the 24-h day for hospital nurses in two 12-h shifts has been introduced with value propositions of reduced staffing costs, better quality of care, more efficient work organisation, and increased nurse recruitment and retention. While existing reviews consider the impact of 12-h shifts on nurses' wellbeing and performance, this discussion paper aims to specifically shed light on whether the current evidence supports the value propositions around 12-h shifts. We found little evidence of the value propositions being realised. Staffing costs are not reduced with 12-h shifts, and outcomes related to productivity and efficiency, including sickness absence and missed nursing care are negatively affected. Nurses working 12-h shifts do not perform more safely than their counterparts working shorter shifts, with evidence pointing to a likely negative effect on safe care due to increased fatigue and sleepiness. In addition, nurses working 12-h shifts may have access to fewer educational opportunities than nurses working shorter shifts. Despite some nurses preferring 12-h shifts, the literature does not indicate that this shift pattern leads to increased recruitment, with studies reporting that nurses working long shifts are more likely to express intention to leave their job. In conclusion, there is little if any support for the value propositions that were advanced when 12-h shifts were introduced. While 12-h shifts might be here to stay, it is important that the limitations, including reduced productivity and efficiency, are recognised and accepted by those in charge of implementing schedules for hospital nurses.

Best practice recommendations for healthy work environments for nurses: An integrative literature review

Healthy work environments that maximise the health and well-being of nurses are essential in achieving good patient and societal outcomes, as well as optimal organisational performance. While studies have been conducted on healthy work environments, there is no available evidence that an integrative literature review summarising best-practice recommendations related to healthy work environments has been conducted before. This review aimed to summarise existing best-practice recommendations related to a healthy work environment for nurses. An integrative literature review following the approach adapted from Whittemore and Knafl was used. Existing guidelines related to healthy work environments for nurses were searched. EBSCOhost (CINAHL, Medline), Biomed Central, Science Direct, PubMed and Google Scholar and organisational websites via Google were searched, followed by a citation search. Twelve guidelines were identified for data extraction and synthesis, and themes were subsequently formulated. Four themes emerged from the integrative literature review regarding a healthy work environment for nurses: (1) the need for effective nursing leadership, (2) effective communication as central to enhancement of a healthy environment, (3) effective teamwork as an integral part of a healthy work environment and (4) the need for professional autonomy. In summary, a healthy work environment for nurses requires leadership, effective communication, teamwork and professional autonomy.

Occupational Stress and the Quality of Life of Nurses in Infectious Disease Departments in China: The Mediating Role of Psychological Resilience

Aim

We aim to explore the impact of occupational stress on the quality of life of nurses in infectious disease departments and to explore the mediating role of psychological resilience on this impact.

Background

Sudden public health events and the prevalence of infectious diseases give nurses in infectious disease departments a heavy task load and high occupational stress, which can affect their quality of life, and which is closely related to the quality of clinical care they provide. There are few existing studies on occupational stress, psychological resilience, and the quality of life of nurses in infectious disease departments.

Methods

We collected data from infectious-disease-specialized hospitals or infectious disease departments of general hospitals in China. In total 1,536 nurses completed questionnaires: the Effort-Reward Imbalance Questionnaire, the Connor-Davidson Resilience Scale, and the World Health Organization Quality of Life Brief Scale. We use a structural equation model to test the mediating role of the psychological resilience in the relationship between occupational stress and quality of life.

Results

Among 1,536 participants, 88.2% experienced an effort-reward imbalance. The average scores for psychological resilience and quality of life were 56.06 (SD = 14.19) and 51.80 (SD = 8.23), respectively. Our results show that occupational stress is negatively correlated with psychological resilience (r = -0.28, p < 0.01) and quality of life (r = -0.44, p < 0.01). In addition, we find that psychological resilience is positively correlated with quality of life (r = 0.55, p < 0.01) and that the indirect effect of occupational stress on quality of life through psychological resilience is significant (β = -0.036, 95% CI: 0.027 to 0.426), indicating at least a partial mediating role of psychological resilience.

Conclusion

A high proportion of nurses in infectious disease departments felt that their jobs' effort-reward imbalance was high. These nurses' scores for psychological resilience were in the middle level among Chinese people generally, but their quality of life was lower than the Chinese norm. We conclude that occupational stress has an important impact on their quality of life, and psychological resilience plays a partial mediating role on this impact.

Implications for Nursing Management

Hospital managers can benefit from paying attention to the occupational stress of nurses and helping to improve the quality of life of nurses by alleviating this occupational stress and improving psychological resilience.

Why do nursing students leave bachelor program? Findings from a qualitative descriptive study

Background

Over the past few years, the phenomenon of “nursing student attrition” has been unevenly studied. Investigators often focused on independent predictors as age, family obligations, final grade of high school, demanding physical and mental workload and others. Specifically, just a few studies applied qualitative methods to better comprehend the very needs of first year students enrolled in a bachelor’s degree in nursing sciences (BSN), to sustain their learning process and define effective strategies to reduce student drop-out.

Methods

We conducted a qualitative descriptive study. Thirty-one nursing students at Verona University were interviewed using a semi-structured guide. Data analysis was performed according to a descriptive approach by Sandelowski & Barroso (2000).

Results

A total number of 31 students were interviewed. The most recurrent themes regarding the reasons behind BSN drop-out were: understanding that they were not suited to be nurses, perception of missing/lack of psychological, physical and practical resources needed to successfully cope with both nursing school and the nursing profession, inconsistencies between the image of the profession and the reality of the job, feelings of disappointment for the experiences of internship, perceived lack of support from the clinical teacher while going through difficult experiences.

Conclusions

We can consider a part of these drop-out decisions normal, even physiological when students come to realise that they are not suited for the nursing profession. However, it’s important to guide nursing students with adequate counselling in order to give them the essential tools to cope with the training and the future as health professionals.

Determining the relationship between magnet properties of hospitals and the professional values of the nurses: A cross-sectional study

AIM

To identify the relationship between the characteristics of hospitals in recruiting and retaining nurses (magnet properties) and nurses' professional values.

BACKGROUND

In Turkey, there is a limited number of hospitals with the characteristics to enable nurses to stay in their institutions. The magnet properties of these hospitals and the professional values of the nurses working in these hospitals are not known.

METHODS

This descriptive cross-sectional research included 612 nurses working in 6 hospitals accredited by the Joint Commission International. Data were collected using the Nursing Professional Values Scale-Revised (NPVS-R) and the Essentials of Magnetism Scale (EOM II).

RESULTS

The mean NPVS-R score was high 102.0 (26-130). However, the mean EOM II score was found to be low at 2.2 (1.0-3.4). As the magnet properties of the hospitals increased, the professional values of the nurses decreased.

CONCLUSION

There was a negative correlation between the magnet properties of hospitals and the professional values of the nurses.

IMPLICATIONS FOR NURSING MANAGEMENT

The findings of this study highlight the necessity of creating a working environment with high magnet characteristics, which also includes the professional values of nurses. Nurse Managers should investigate the reasons behind the low magnet properties of hospitals, raise awareness, and plan interventions to increase magnet properties of hospitals. Creating a supportive working environment, promotion of the salaries and work environment and decreasing workload are some of the important intervention areas in attracting and keeping nurses in the institution.

Inequal distribution of nursing personnel: a subnational analysis of the distribution of nurses across 58 countries

BACKGROUND

Nursing personnel are critical for enabling access to health service in primary health care. However, the State of the World's Nursing 2020 report showed important inequalities in nurse availability between countries.

METHODS

The purpose of this study/analysis was to describe the differences in nurse-to-population density in 58 countries from six regional areas and the relationship between differences in access to nurses and other indicators of health equity.

RESULTS

All countries and income groups showed subnational inequalities in the distribution of nursing personnel with Gini coefficients ranging from 1 to 39. The latter indicated situation such as 13% of the population having access to 45% of nurses in a country. The average max-to-min ratio was on average of 11-fold. In our sample, the African region had the highest level of subnational inequalities with the average Gini coefficient of 19.6. The European Region had the lowest level of within-country inequalities with the average Gini coefficient being 5.6. A multivariate analysis showed a clustering of countries in three groups: (1) high Gini coefficients comprised mainly African countries; (2) moderate Gini coefficients comprised mainly South-East Asian, Central and South American countries; (3) low Gini coefficients comprised mainly Western countries, Japan, and Korea. The analysis also showed that inequality in distribution of nurses was correlated with other indices of health and inequality such as the Human Development Index, maternal mortality, and life expectancy.

CONCLUSIONS

This study showed that there is a high level of geographic inequality in the distribution of nurses at subnational level. Inequalities in nursing distribution are multifactorial, to improve access to nurses, policies should be bundled, tailored to the local context and tackle the various root causes for inequalities.

Implementing the Synergy Model: A Qualitative Descriptive Study

Hospitals across our nation are seeking to implement models of care that meet the primary goals of Quadruple Aim: Improved population health, cost-effective care delivery, and patient and provider satisfaction. In an effort to address the Quadruple Aim and our patients’ care needs, Hamilton Health Sciences (HHS) embarked on a model of care delivery redesign, beginning with nursing care delivery. From 2013 to 2018, 12 clinical programs at HHS implemented the Synergy Model with its accompanying synergy patient needs assessment tool for nurses to objectively assess patients’ acuity and dependency needs. Data on patients’ priority care needs were used to inform a nursing model of care redesign at HHS, including skill mix and staffing levels. This five-year project was an organization-wide quality improvement initiative. As part of the evaluation, HHS leaders partnered with health services nurse researchers to conduct a mixed methods study. This paper describes the evaluation outcomes from the qualitative component of the study, which included interviews with clinical nurse leaders and direct care nurses. Data were analyzed using descriptive thematic analysis. Some key findings were increased nurse awareness of patients’ holistic care needs and leaders’ capacity to plan staffing assignments based on patients’ priority care needs. Themes helped inform recommendations for key stakeholders, including nurse leaders and direct care nurses.

Mindfulness-Based Program for Anxiety and Depression Treatment in Healthcare Professionals: A Pilot Randomized Controlled Trial

In primary health care, the work environment can cause high levels of anxiety and depression, triggering relevant expert and individual change. Mindfulness-Based Stress Reduction (MBSR) programs reduce signs of anxiety and depression. The purpose of this sub-analysis of the total project, was to equate the effectiveness of the standard MBSR curriculum with the abbreviated version in minimizing anxiety and depression. This randomized controlled clinical trial enrolled 112 mentors and resident specialists from Family and Community Medicine and Nurses (FCMN), distributed across six teaching units (TU) of the Spanish National Health System (SNHS). Experimental group participants received a MBRS training (abbreviated/standard). Depression and anxiety levels were measured with the Goldberg Anxiety and Depression Scale (GADS) at three different time periods during the analysis: before (pre-test) and after (post-test) participation, as well as 3 months after the completion of intervention. Taking into account the pre-test scores as the covariate, an adjusted analysis of covariance (ANCOVA) showed significant depletion in anxiety and depression in general (F (2.91) = 4.488; p = 0.014; η² = 0.090) and depression in particular (F (2, 91) = 6.653; p = 0.002; η² = 0.128 at the post-test visit, maintaining their effects for 3 months (F (2.79) = 3.031; p = 0.050; η² = 0.071-F (2.79) = 2.874; p = 0.049; η² = 0.068, respectively), which is associated with the use of a standard training program. The abbreviated training program did not have a significant effect on the level of anxiety and depression. The standard MBSR training program had a positive effect on anxiety and depression and promotes long-lasting effects in tutors and resident practitioners. New research is needed to demonstrate the effectiveness of abbreviated versions of training programs.

Intensive Care Unit Utilization Following Major Surgery and the Nurse Work Environment

BACKGROUND

Across hospitals, there is wide variation in ICU utilization after surgery. However, it is unknown whether and to what extent the nurse work environment is associated with a patient's odds of admission to an intensive care unit.

PURPOSE

To estimate the relationship between hospitals' nurse work environment and a patient's likelihood of ICU admission and mortality following surgery.

METHODS

A cross-sectional study of 269 764 adult surgical patients in 453 hospitals was conducted. Logistic regression models were used to estimate the effects of the work environment on the odds of patients' admission to the intensive care unit and mortality.

RESULTS

Patients in hospitals with good work environments had 16% lower odds of intensive care unit admission and 15% lower odds of mortality or intensive care unit admission than patients in hospitals with mixed or poor environments.

CONCLUSIONS

Patients in hospitals with better nurse work environments were less likely to be admitted to an intensive care unit and less likely to die. Hospitals with better nurse work environments may be better equipped to provide postoperative patient care on lower acuity units.

Relationship Between Work Experience and Safety Climate in Veterans Affairs Nursing Homes Nationwide

OBJECTIVES

Staff values and beliefs about resident safety (safety climate) represent one potential driver of nursing home safety. Staff with more work experience (length of service) may possess richer knowledge of resident safety for strengthening safety climate. We investigated the association of length of service with safety climate in the U.S. Department of Veterans Affairs nursing homes or Community Living Centers (CLCs).

METHODS

Fifty-six of 134 CLCs participated in 2017 and then 2018 in the previously validated CLC Employee Survey of Attitudes about Resident Safety, which comprised 7 safety climate domains and employee characteristics. We conducted 2 cross-sectional analyses of length of service on each safety climate domain, controlling for occupation, shift, work hours, and clustering by VA hospital, service network, and geographic region, in mixed random-effect regression models.

RESULTS

A total of 1397 and 1645 staff participated in the survey (26% and 28% response rates) at round 1 and 2, respectively. At each round participants working greater than 6 months were less positive than those working less than 6 months about supervisor commitment to safety, coworker interactions around safety, and CLC global ratings.

CONCLUSIONS

Differences in work experience contributed to incongruence in perceptions about supervisors, coworkers, and the facility. Workers with more experience may have higher perceived job aptitude and thus higher expectations of supervisory recognition and more criticisms of coworkers. Pairing experienced workers with newer ones may narrow the knowledge gap and increase collaboration. Huddles, team meetings, and organizational initiatives represent opportunities to recognize and leverage experienced workers' accumulated safety knowledge.

Factors influencing nurse retention within children's palliative care

Retention of staff presents major challenges within children's palliative care; this has substantial implications for children, families and the nursing workforce. To address this, a programme was undertaken that provided pathways of professional development for senior nurses working in this field. This study reports the views of nurses completing this programme, the overall project manager (PM) and the day-to-day programme lead (PL) as well as factors that influence nurse retention within children's palliative care nursing. The study drew on an Appreciative Inquiry approach that comprised of interviews with the PM and PL as well as focus groups and questionnaires with senior nurses from the children's palliative care sector, who participated in the training programme. Thematic analysis of data from interviews and focus groups revealed factors influencing nurse retention: speciality, positivity and making a difference, support, provision of adequate resources, tailored education/professional development and resilience. These themes were supported by the questionnaire findings. The programme was perceived as having a positive influence on nurse retention within the children's palliative care workforce. In addition, it was felt to be very beneficial in terms of shared learning and development. Participants highlighted the need for similar opportunities in the future.

Impact of the Work Environment on Patients' Safety as Perceived by Nurses in Poland-A Cross-Sectional Study

Numerous studies have found that organizational features connected with the work environment of nurses have a significant influence on patients' safety. The aim of this research was to capture nurses' opinions about patients' safety and discern relationships with work environment characteristics. This cross-sectional study surveyed 1825 nurses. The research used questionnaire consisting of four parts: (1) covered The Practice Environment Scale of the Nursing Work Index (PES-NWI); (2) assessed the quality of nursing care and care safety; (3) contained information on the most recent duty served by the nurses and (4) captured social and demographic data of participants. The research identified strong association between patient safety assessment and work environment of nurses in the aspect of employment adequacy, cooperation between nurses and doctors, support for nurses from the managing staff, the possibility to participate in the management as well as professional promotion of nurses employed in the hospital (p < 0.001). Nurses rated patient safety higher when responsible for a smaller number of patients. Work environment factors such as proper staffing, good cooperation with doctors, support from the management, as well as professional independence are significantly related to nurses' assessment of patients' safety.

Effectiveness of a Mindfulness and Self-Compassion Standard Training Program versus an Abbreviated Training Program on Stress in Tutors and Resident Intern Specialists of Family and Community Medicine and Nursing in Spain

Stress is one of the most common problems among healthcare professionals, as they are exposed to potentially stressful and emotionally challenging situations in the workplace. Mindfulness-based stress reduction (MBSR) training programs have been shown to decrease stress. The objective of this study was to compare the effectiveness of an abbreviated 4-weeks MBSR training program in relation to a standard 8-weeks one on the stress levels. A controlled and randomized clinical trial was designed, in which 112 tutors and resident intern specialists in Family and Community Medicine and Nursing of six Spanish National Health System teaching units (TUs) participated. Participants included in the experimental groups (EGs) received a MBRS training program (standard or abbreviated), while control group (CG) participants did not receive any intervention. The stress levels were assessed by the Perceived Stress Questionnaire (PSQ) in three different moments during the study: before, immediately after, and 3 months after the intervention. Adjusted covariance analysis (ANCOVA), using pretest scores as the covariate, showed a significant reduction in stress (F_(2,91) = 5.165; p = 0.008; η² = 0.102) in the post-test visit, attributable to the implementation of the standard training program, but without the maintenance of its effects over time. No significant impact of the abbreviated training program on stress levels was observed in the intergroup comparison. A standard 8-weeks MBSR training program aimed at tutors and resident intern specialists in Family and Community Medicine and Nursing produces significant improvements in stress levels compared with the abbreviated intervention and no intervention. New studies about abbreviated training programs are needed to provide effective treatments which improve well-being of these professionals.

Licenced practical nurses' perceptions of their work environments and their intention to stay: A cross-sectional study of four practice settings

Aims and objectives

This study aimed to understand how licenced practical nurses perceive their work environments across different work settings and to analyse the association between these nurses’ perceptions of their work environments and their intentions to stay employed at their current nursing unit.

Design

A cross‐sectional descriptive survey was conducted with Licensed Practical Nurses in Alberta, Canada.

Methods

The study population consisted of 598 licenced practical nurses. Survey measures included demographic information, the Perceived Work Environment‐Nursing Work Index, and an intention to stay scale. Descriptive statistics were calculated and mean scores for perceptions about the work environment were compared by work setting. The associations between perceived work environment and intention to stay were analysed using linear regression.

Results

Overall, licenced practical nurses rated their work environment as mixed, with statistically significantly lower scores in acute care settings. Nurse manager ability and adequate staffing and resources were the highest contributing variables.

Explaining nursing attrition through the experiences of return-to-practice students: a mixed-methods study

BACKGROUND

Nurse shortage is an international issue that has adverse effects on health and the quality of care of whole populations.

AIMS

The study aimed to explore attrition experienced by return-to-practice students attending higher education institutions in England.

METHODS

A mixed-methods design, involving questionnaires (n=114) and in-depth interviews (n=20), was used.

FINDINGS

Just over half (52%) of respondents left nursing after ≥10 years. Most of these (84%) stayed in alternative employment during their break from nursing. There were two distinct reasons for leaving nursing: the inability to maintain a positive work/life balance and a lack of opportunity for career advancement while retaining nursing registration. Respondents reflected positively on their nursing experience yet frequently reported significant personal or professional incidents prompting their decision to leave.

CONCLUSION

The reasons nurses leave are complex. Professional bodies and managers need to work together to address concerns many nurses have during their careers that lead to them deciding to leave the profession.

Nurse turnover: A longitudinal survival analysis of the Korea Nurses' Health Study

AIMS

To identify factors influencing turnover among Korean female nurses from a longitudinal perspective.

DESIGN

A national cohort study called the Korea Nurses' Health Study (2013-2020) was used.

METHODS

A national sample of female nurses from module 1 (N = 20,613, 2013-2014), module 5 (N = 11,527, 2016-2017), module 7 (N = 8,658, 2018-2019) and module 8 (N = 10,253, 2019-2020) was used. Based on a nurse turnover model, individual, health-related, social work environment and work organizational factors were considered explainable variables for nurse turnover. Kaplan-Meier survival analysis and multivariate Cox regression analysis were used to identify the factors influencing female nurse turnover in South Korea.

RESULTS

Female nurses who had less education, were unmarried, were pregnant, and had higher stress levels and an increased probability of experiencing turnover as they aged. Those who perceived moderate health rather than good/very good health, had depressive symptoms, had a higher salary, were charge nurses/unit managers/supervisors or advanced practice nurses, were advanced practice nurses rather than registered nurses, worked shifts, worked in special care units or outpatient wards/administration as opposed to general wards, and worked in larger hospitals had a decreased probability of experiencing turnover as they aged. A two-way interaction analysis revealed that those who had depressive symptoms and increased perceived stress were more likely to experience turnover as they aged.

CONCLUSION

Multiple factors influenced female nurse turnover, including individual, health-related, social work environment and work organizational factors. A multidimensional approach is needed to reduce nurse turnover.

IMPACT

Various factors predict nurse turnover as nurses age, implying that a multifaceted approach is needed to manage nurse turnover. The influence of depressive symptoms on turnover should be evaluated by considering the perceived stress level. Nursing managers and policy makers could use our results to develop programs/policies to reduce nurse turnover.

An integrative review on interventions for strengthening professional governance in nursing

AIM

To identify the interventions for strengthening professional nursing governance and describe their outcomes.

BACKGROUND

The ever-changing health care environment requires empowering governance structures and shared decision-making. The costly nature of reshaping governance makes the identification of effective interventions vital.

EVALUATION

An integrative review was carried out between January 2007 and May 2020 in the CINAHL, PubMed, Scopus, PsycINFO, Business source, Cochrane and Medic databases. The quality of the 12 included studies was evaluated with the Joanna Briggs Institute critical appraisal tools.

KEY ISSUES

Eight studies reported that the implemented interventions had positively influenced organisation regarding creating positive work environments, building new leadership competencies and increasing personnel's ability to take part in decision-making. The overall quality of the evidence was judged to be moderate.

CONCLUSION

Comprehensive decision-making structures, efficient teamwork and transformational leadership competencies among nurse leaders enable personnel to participate in decision-making. Further research is needed to identify the most effective interventions for improving professional governance.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse leaders have to ensure that personnel have adequate opportunities to congregate and decide over matters concerning their work. Positive organisational climate and relational leadership style, along with highly functioning teams, are important prerequisites to nursing councils producing the desired outcomes.

The impact of workplace culture on the accountability of mental health nurses to involve consumers in care planning: A focused ethnography

Recovery-oriented mental health practice guidelines recommend regular consumer involvement in care plans, yet in many acute settings, these are not routinely created thereby compromising accountability. This study explored the impact of workplace culture on the capacity of mental health nurses to involve consumers in care planning and consequently to work accountably. A focused ethnography was undertaken in one Australian inpatient unit involving mental health nurses and other health professionals. Data were derived from in-depth semistructured interviews with 12 nurses and 6 months of nonparticipant observation of multidisciplinary meetings and clinical handovers. Workplace culture had an impact on mental health nurses' accountability practices. A culture that prioritized reduction in length of stay resulted in less recovery-oriented care. Health professionals who paid more attention to crisis and risk management resulted in fewer opportunities for consumer-involved care planning.

A model for psychiatric nurses to facilitate the mental health of women living with borderline personality disorder

Background

Borderline personality disorder (BPD) is characterised by emotional dysregulation, feelings of worthlessness, impulsivity, suicidality and poor relationships. As a result of the challenges in the treatment of women living with BPD and the lack of skills from the psychiatric nurse, there was a need to develop a model for psychiatric nurses to facilitate the mental health of women living with BPD.

Objectives

To describe the process that was followed in developing, describing and evaluating a model that could be used as a framework of reference for psychiatric nurses to facilitate the mental health of women living with BPD.

Method

A theory-generative, qualitative, exploratory, descriptive and contextual study design was used to develop the model. The central concept of the model was derived from a previous study: ‘The experiences of women living with borderline personality disorder’. The process entailed the identification of the central concept and other essential criteria, the classification of the central concepts and describing the relationships between the concepts.

Results

The central concept was identified as ‘facilitation of self-empowerment’ of women living with BPD. The concepts ‘facilitation’ and ‘self-empowerment’ were defined and classified. The identified and defined central concepts were placed into interrelated statements. The model to facilitate self-empowerment of women living with BPD was developed, described and evaluated. The model has not been implemented.

Conclusion

The model provides a framework of reference for psychiatric nurses to facilitate self-empowerment of women living with BPD.

A hermeneutical study of professional accountability in nursing

AIMS AND OBJECTIVES

This paper presents findings from a hermeneutical study which sought to explore how registered nurses experienced and perceived their professional accountability in clinical settings.

BACKGROUND

Professional accountability encompasses the ideals and standards of nursing practice. Nurses are accountable for their actions under civil, criminal and contract law to their; employing organisation, their regulatory body and the patients for whom they care.

DESIGN

This paper reports on a Heideggerian hermeneutical study involving seven registered nurses, working in clinical practice in the National Health Service in the United Kingdom. Methods The study adopted purposive sampling, collecting data by means of in-depth interviews. Data were analysed using the hermeneutic circle. COREQ checklist was used as a reporting guideline for this study.

RESULTS

The findings suggest that professional accountability in nursing practice is a complex phenomenon, which can be compromised by many factors which are historically, socially or politically driven Participants experienced challenges through a lack of resources and poor managerial support, which compromised their ability to deliver high-quality patient care. However, collegiality strongly impacted upon resilience and positively influenced their well-being.

RELEVANCE TO CLINICAL PRACTICE

Amid the challenges of the clinical workplace, a positive workplace culture with visible managerial support is a fundamental requirement in supporting professional accountability, development and retention of nurses. Findings highlight the view that leadership should be seen as a collective responsibility, which empowers staff to positively change the practice environment.

Turnover Intention Among Nurses in Nurse Managers, Directors, and Executives: Developing a Tool for Measuring Environmental Factors

Background and Purpose

Turnover among nurse managers, directors, and executives is associated with staff nurse retention and patient outcomes. The purpose of this article is to describe the development of an instrument to evaluate factors associated with intent to leave among these leaders within acute care facilities.

Methods

The Nurse Leader Environment Support Survey (NLESS) was developed and evaluated using exploratory factor analysis and reliability testing (Cronbach's α). Data was obtained as part of a large nationwide electronic survey (N = 1,903).

Results

Factors converged into three major themes (organizational culture, professional vulnerability, and workplace relationships) which were consistent across all three leadership groups. Factor subscales exhibited Cronbach's α > .7.

Conclusions

The NLESS is a useful tool in comparing reasons for turnover among nursing leadership groups. Future refinement may prove useful in identifying and clarifying foundational causes of turnover.

Perceived and sources of occupational stress in surgical intensive care nurses

Aim:

The study aimed to determine sources of stress and stress levels of nurses working in surgical intensive care units in addition to understanding the stress level in nurses, drawing attention and raising awareness.

Material and methods:

The study was conducted using a descriptive design with the participation of nurses ( n=132) working in surgical intensive care units of a university hospital. The data were collected through the source of stress identification form and perceived stress scale. The data obtained in the study were transferred to a computer environment, and for statistical analyses, the package for social sciences for Windows 25 software was used. In the analyses of the data, descriptive statistics, independent t-test, one-way analysis of variance and regression analysis, and the Bonferroni test were employed.

Results:

It was also determined that 28.8% of the surgical nurses were working in an organ transplant intensive care unit and 25% worked in an anaesthesia intensive care unit, that 49.3% had professional experience of between 6 and 11 years and that 92.4% worked on both day and night shifts. In the study, the rate of nurses who perceived a high level of stress was found to be 45.5%, and it was identified that 78.8% needed training in stress management.

Conclusion:

Imperative funding and human resources should be provided in order to give nurses problem-solving abilities and a stress management course. The financial support of the managers and spiritual support of health professionals and organising regular meetings with nurses can help nurses to experience less stress.

Ethical leadership and decision authority effects on nurses' engagement, exhaustion, and turnover intention

AIM

The aim of the present study was to investigate emotional exhaustion, work engagement, and turnover intention in the nursing profession by exploring the antecedent effects of ethical leadership and job components such as decision authority.

BACKGROUND

Emotional exhaustion, low work engagement, and high turnover intention are prevalent issues in the nursing profession. The experience of feeling overworked has led to feelings of burnout and low morale among nurses in Ireland, which has prompted the authors to identify potential variables that reduce these outcomes-in this case, ethical leadership and decision authority.

DESIGN

A descriptive, cross-sectional survey design was used across three hospital sites.

METHODS

A cross-sectional sample of 89 nurses was recruited from three Irish hospitals to capture the experience of nurses between December 2017 - February 2018. Hypotheses were tested using path model analysis.

RESULTS

Ethical leadership positively predicted decision authority among nurses. Ethical leadership also had an indirect effect on all three outcome variables (work engagement, exhaustion, and turnover intention). Further effects were noted in relation to the mediators in relation to the three outcome variables. Decision authority had a positive effect on work engagement and related to lower turnover intention.

CONCLUSIONS

The present study demonstrated the role of ethical leadership as a mechanism to positively affect job control and work experience outcomes for nurses at work. Ethical leadership style in hospitals and providing nurses with the authority to make decisions can improve their work experience and help to engage, support, and retain nurses.

IMPACT

The study found support for the positive role of ethical leadership in relation to decision authority and as a positive predictor of work engagement, negative predictor of emotional exhaustion, and turnover intention among nurses.

Nursing turnover intentions: The role of leader emotional intelligence and team culture

AIM

To explore the influence of leader emotional intelligence on the working culture prevailing in teams that ultimately impacts nurses' intent to leave the job.

BACKGROUND

Global shortages of nursing professionals have been concerning issues of extreme vitality in the delivery of superior services. Though the state-of-the-art system provides relief, the hospital management continued worrying about losing highly skilled nursing professionals due to a higher level of emotional exhaustion exhibiting progressive turnover.

METHODS

A survey technique was employed for data collection from nurses. Further data were analysed by structural equation modelling in the light of 313 substantial responses by using SmartPLS.

RESULTS

The findings revealed that leader emotional intelligence impulses critical constructive effects by fulfilling the needs of nurses and has an impact on their turnover intentions simultaneously.

CONCLUSION

The research provides an empirical lens of leadership and culture, which noticeably explain turnover intention. This study affirmed solid connections amongst the leader emotional intelligence, team culture and turnover intentions.

IMPLICATIONS FOR NURSING MANAGEMENT

The study provides valuable insight for health management organisations to focus on factors that decrease the turnover intention of nurses. Considering a global shortage of nurses, nursing management must consider crucial aspects of the work environment and plan interventions to restrain nursing turnover intentions.

Negative workplace behavior and coping strategies among nurses: A cross-sectional study

Negative workplace behavior affecting nurses is an internationally recognized problem. This study examines the types and extent of negative workplace behavior experienced by nurses in non-metropolitan, regional acute care settings and their ways of coping when subject to that behavior. A cross-sectional study was conducted involving 74 nurse participants in four regional hospitals in Australia. The structured questionnaire consisted of four parts: demographic questions, the Negative Acts Questionnaire - Revised, questions on exposure to bullying and/or incivility and policy awareness and use of pathways, and the Ways of Coping Questionnaire. Overall, 34% of participants were exposed to bullying and 49% to incivility over the previous month. The most common type of negative workplace behavior reported was "work-related bullying," which included exposure to excessive workloads, unrealistic deadlines, and information being withheld. Nurses reported the use of a variety of coping mechanisms, including problem-focused coping strategies and seeking social support. The findings imply that negative workplace behaviors occur not only at individual nurses' level but also derive from the broader contexts of organizational management and systemic factors.

"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.

Being conductor of the orchestra: an exploration of district nursing leadership

The purpose of the present study was to gain insight into how district nurses understand their leadership role. Data were generated through interviews and audio-journals and analysed using interpretive phenomenological analysis. Findings suggested that district nurses managing teams and caseloads experienced a burden of responsibility. Being creative problem solvers, they adopted facilitative ways of engaging with patients but directive approaches to team management. District nurses sharing leadership with multidisciplinary colleagues did not appear to experience this burden. Their leadership drew on their facilitative approaches to care-giving. If nurses enabled, rather than directed teams, they could create a context for developing autonomy and growth, easing the burden of responsibility.