Individual and organizational factors of nurses' job satisfaction in long-term care: A systematic review

Factors influencing the formation of balanced care teams: the organisation, performance, and perception of nursing care teams and the link with patient outcomes: a systematic scoping review

BACKGROUND

The composition of care teams is crucial for delivering patient-centered healthcare, yet assembling a well-balanced team remains a challenge. This difficulty stems from the intricate dynamics of team capacity, culture, context, and the demands of the job. The current literature offers limited guidance for decision-makers on how to effectively navigate these dynamics to compose a balanced care team.

METHODS

We conducted a systematic scoping review of literature spanning from 2009 to 2022. The aim was to identify factors that significantly influence the work environment, team performance, nursing outcomes, and patient outcomes within healthcare settings. Our review focused on extracting and synthesizing evidence to uncover these influencing factors.

RESULTS

Our analysis identified 35 factors that play a significant role in shaping the work environment and influencing team performance, nursing outcomes, and patient outcomes. These factors were categorized into nine key domains: workload, leadership, team composition, stress and demands, professional relationships, safety, logistics and ergonomics, autonomy and responsibility, and transparency and task clearness.

CONCLUSIONS

To improve patient care and nursing job satisfaction, policymakers and decision-makers can consider these influencing factors in the design and management of care teams. The findings advocate for strategic adjustments in these domains to enhance a team's balance. Furthermore, our review underscores the need for further research to fill the identified gaps in knowledge, offering a directive for future studies into optimal care team composition. This systematic approach to team composition can significantly impact patient outcomes and nurse satisfaction, providing a roadmap for creating more effective and harmonious teams.

[Job satisfaction and violence in the clinical relationship in Physical Therapists in Spain]

OBJECTIVE

To assess the job satisfaction (JS) of physiotherapists in Spain and their relationship with occupational violence, as with other socio-demographic, health, and occupational factors.

DESIGN

A cross-sectional study was conducted. Setting Primary, community, and hospital attention level at public and private care in Spain.

PARTICIPANTS

Physiotherapists in Spain who have been working for at least 3months during the last year, and with complete answer to the required variables (n=2,590).

MAIN MEASUREMENTS

Information was collected through a questionnaire distributed online. A descriptive quantitative analysis and 3 logistic regression models were performed. In the first model, sociodemographic and violence variables were included as independent variables, in the second, health-related variables, and in the third, occupational variables.

RESULTS

The average JS of physiotherapists is 7.26 points, being 8 or more in 46.8% of the cases, with a higher percentage in men". Referring not having suffered psychological violence was related to a higher probability of having JS, even controlling for the rest of the variables studied (OR1=0.485; OR2=0.611; OR3=0.697, respectively for each model). Variables related to health (state of health, symptoms, consumption of tobacco/alcohol/other substances) and to the work environment (working day, work area, autonomy, relationship with superiors/colleagues) were statistically significantly related to JS.

CONCLUSIONS

Almost 47% of the respondents had very high JS values. Certain areas of work as well as positive health factors have been linked to very high JS. Psychological violence is the form of violence that, independently of the other factors analysed, leads to lower JS.

Registered nurses' experiences on job satisfaction in nursing home settings

AIM

To describe what registered nurses' experience to be important to job satisfaction in nursing home settings.

DESIGN

This is a qualitative study based on data from individual interviews.

METHODS

Sixteen registered nurses working in nursing homes were interviewed, and their responses were analysed with systematic text condensation.

RESULTS

A total of six categories were developed to describe various aspects of job satisfaction among registered nurses at nursing homes: meaningfulness is essential, to possess control and manageability is central, a possibility to balance daily challenges with professional development, supportive leadership is imperative, the nursing team's competence and companionship, and being confident in one's own profession.

CONCLUSION

In the present study, meaningfulness was essential to job satisfaction, and work was experienced to be meaningful and engaging when the demands were manageable, the workload controllable, and when the registered nurses felt supported by management and co-workers. Conversely, if the demands were too high, the workload was beyond their control and the nurses felt unsupported, then the work felt meaningless and thus unsatisfactory.

Job satisfaction and the role of self-esteem and self-efficacy: A cross-sectional study among Iranian nurses

AIM

This study aims to investigate the relationship between nurses' self-efficacy and self-esteem, and their job satisfaction.

DESIGN

A cross-sectional study was conducted.

METHODS

Employing a random sampling method that included 234 nurses from three hospitals in Iran enrolled. This study utilized the General Self-Efficacy Questionnaire, Coppersmith Self-Esteem Inventory, and Minnesota Job Satisfaction Questionnaire. Descriptive analysis, independent t-tests, Pearson correlation analyses, and linear regression were employed for data analysis.

RESULTS

The mean self-efficacy score for nurses was 26.73 ± 5.62 (out of 40), while self-esteem and job satisfaction scored 37.13 ± 6.87 (out of 50) and 68.27 ± 12.65 (out of 100), respectively. Significant correlations were found between self-efficacy, self-esteem, and job satisfaction. Moreover, self-esteem and the age group >40 years were identified as important predictors of nurses' job satisfaction. This study highlights the influential role of self-esteem in determining nurses' job satisfaction.

Personal care workers' intention to stay in residential aged care: An integrative review

AIM

To identify key factors that influence personal care workers' (PCW) intention to stay in residential aged care (RAC).

BACKGROUND

PCWs are the 'backbone' of providing direct care in RAC settings. The well-being of older people hinges upon their dedication and commitment; thus, enhancing their intention to stay is a priority to reduce turnover and ensure continuity of care.

METHODS

Six databases were searched for articles focusing on factors influencing PCWs' intention to stay in RAC. Studies were independently assessed for quality using the Joanna Briggs Institute Methodology for systematic review tools. Reporting of the results followed the PRISMA guidelines.

FINDINGS

Eight articles published between 2010 and 2022 were included. The key issues were categorized as: (a) sociodemographic characteristics; (b) psychological factors; (c) workplace factors and (d) job satisfaction. Older age, being married and immigration status were positively associated with intention to stay. Work stress and burnout contributed towards demotivation, while a supportive and engaging organizational culture that recognized workers' contributions and provided appropriate remuneration and benefits, enhanced job satisfaction and retention.

CONCLUSION

This review affirms the complexity of the decision-making process influencing workers' intention to stay. A comprehensive understanding of the interplay of these factors and the personal and sociocultural challenges faced by PCWs is essential to design strategies to provide support and enhance job satisfaction and retention.

IMPLICATIONS FOR AGED CARE

This review showed that support from the organization is critical in improving PCWs' intention to stay in aged care. Given the interconnectedness of a range of key factors, decision-makers need to address modifiable factors holistically. Including PCWs in planning retention strategies could be the missing link in tailoring interventions towards workforce retention.

IMPACT

Personal, psychological and workplace factors alone and in combination influence personal care workers' intention to stay in residential aged care (RAC). The interrelationships among the factors impacting PCWs' intention to stay are complex, wherein a change in one often influences other factors. Addressing the causes of psychological stress, improving workplace culture and understanding their interrelationships provide a foundation for co-designing strategies to promote intention to stay among PCWs in RAC.

REPORTING METHOD

The authors have adhered to relevant EQUATOR guidelines PRISMA.

NO PATIENT OR PUBLIC CONTRIBUTION

This integrative review is conducted with no involvement or contribution from patients or the public.

Bridging Educational Grant in Nursing (BEGIN) students' intentions for retention in long-term, home and community care: A survey protocol

INTRODUCTION

Retention of nurses in long-term care (LTC) and home and community care (HCC) settings is a growing concern. Previous evidence underscores factors which contribute to nurses' intentions for retention in these sectors. However, perspectives of nursing students preparing to enter the workforce, and their intentions for short-term and long-term retention, remain unknown. This study aims to explore relationships between short-term and long-term intentions for retention with psychological empowerment, work engagement, career commitment, burnout, prosocial motivation, self-care and personal resilience among students enrolled in nursing educational bridging programs supported by the Bridging Educational Grant in Nursing (BEGIN) program in Ontario, Canada.

METHODS AND ANALYSIS

This cross-sectional design study will use an open online survey to investigate perspectives of current nursing students enrolled in educational bridging programs on factors relating to psychological empowerment, work engagement, career commitment, resilience, burnout, prosocial motivation, self-care and intentions for retention. Additionally, the survey will collect demographic information, including age, gender, ethnicity, citizenship, income, family status, nursing role, and years of employment and/or education. Open-ended questions will elicit participants' perspectives on financial considerations for career planning and other factors impacting intentions for retention. Descriptive data will be presented for contextualisation of participants' demographic characteristics to enhance generalisability of the cohort. Descriptive statistics will be used to summarise participants' scores on various assessment measures, as well as their short-term and long-term intentions for retention in LTC and HCC after completion of BEGIN. A Pearson's product moment r correlation will determine relationships between intentions for retention and other measures, and linear regression will determine whether any potential correlations can be explained by regression.

ETHICS AND DISSEMINATION

This research protocol received ethical approval from a research-intensive university research ethics board (#123211). Findings will be disseminated to nursing knowledge users in LTC and HCC through publications, conferences, social media and newsletters.

Predictive effects of organizational justice on job satisfaction in bus drivers: the moderating effects of role overload and proactive personality

BACKGROUND

There have been few longitudinal studies on Chinese bus drivers and the individual differences in the relationships between organizational justice and job satisfaction. This study examined the organizational justice and job satisfaction in bus drivers and the individual differences in this relationship.

METHODS

A two-wave longitudinal study design was employed. A first survey was conducted on 513 Chinese bus drivers in October 2021 that collected socio-demographic information and asked about their perceptions of organizational fairness. A second survey was conducted six months later that asked about role overload and job satisfaction and assessed their proactive personality type. An effect model was then used to explore the moderating effects of role overload and proactive personality type on the relationships between organizational justice and job satisfaction.

RESULTS

Both procedural and interactive justice predicted the bus drivers' job satisfaction. Proactive personalities and role overload were found to enhance this relationship.

CONCLUSIONS

Organizations could benefit from screening at the recruitment stage for drivers with highly proactive personalities. Relevant training for drivers with low proactive personalities could partially improve employee job satisfaction. When viewed from a Chinese collectivist cultural frame, role overload could reflect trust and a sense of belonging, which could enhance job satisfaction. Finally, to improve employee job satisfaction, organizations need to ensure procedural and interactive justice.

The relationships between certified nursing assistants' voice behaviour and job satisfaction, work engagement and turnover intentions: A two-wave survey study

AIM

Whereas voice behaviour has been identified as a key precursor to safe and high-quality patient care, little is known about how voice relates to key workforce outcomes. This study aimed to investigate the relationships between certified nursing assistants' perceived promotive voice behaviour (speaking up with suggestions for future improvement) and prohibitive voice behaviour (speaking up about problems or potentially harmful situations) and their self-reported levels of job satisfaction, work engagement and turnover intentions.

DESIGN AND METHODS

Dutch certified nursing assistants were recruited for a two-wave survey study through non-random convenience sampling. The final sample contained 152 respondents. The data were analysed using multiple linear regression analyses. In all analyses, the dependent variable at time one was controlled for.

RESULTS

Certified nursing assistants' promotive and prohibitive voice behaviour at time one were found to be positively related to their level of job satisfaction at time two while controlling for job satisfaction at time one. No relationships with work engagement or occupational turnover intentions were found.

CONCLUSION

While previous research has found positive effects of voice on patient safety outcomes and team and organizational improvements in care organizations, we demonstrate that voice is also related to a key workforce outcome, that is, certified nursing assistants' job satisfaction.

IMPLICATIONS AND IMPACT

Recognizing the interplay between voice behaviour and job satisfaction underscores the importance of creating work environments where certified nursing assistants feel able and willing to make their voices heard-with ideas and suggestions, as well as information regarding problems and concerns.

PATIENT OR PUBLIC INVOLVEMENT

Three certified nursing assistants have contributed to the development of the survey.

Challenges faced by human resources for health in Morocco: A scoping review

BACKGROUND

Human resources for health (HRH) play a pivotal role in effective health system operation, yet various impediments challenge sustainable development. This scoping review aimed to explore these challenges and potential solutions in aligning the health workforce to meet the evolving healthcare needs of the Moroccan population.

METHODS

We conducted a scoping review searching PubMed, Science Direct, Cairn and Google Scholar for relevant articles published between 2014 and 2023. Additionally, non-peer-reviewed literature sourced from Ministry of Health consultations and allied websites was included.

RESULTS

Among the nineteen studies meeting our inclusion criteria, the majority were cross-sectional and predominantly focused on challenges faced by nurses. While some papers delineated multiple HRH challenges (5/19), the rest addressed specific challenges. The identified challenges span organizational and personal levels. Organizationally, the focus was on training, lifelong learning, continuing education, health coverage and shortages, and job satisfaction. At a personal level, HRH in the public health sector encountered challenges such as burnout, stress, and broader occupational health concerns.

CONCLUSIONS

The reviewed publications underscored a spectrum of challenges necessitating robust policy interventions. Despite promising developments in the Moroccan healthcare system, addressing the unequal urban-rural HRH distribution, augmenting funding, and enhancing HRH quality of life stand as pivotal imperatives.

The Architectural Layout of Long-Term Care Units: Relationships between Support for Residents' Well-Being and for Caregivers' Burnout and Resilience

With a growing need for long-term care facilities in general, and for specialized dementia units in particular, it is important to ensure that the architectural layouts of such facilities support the well-being of both the residents and the unit caregivers. This study aimed to investigate correlations between the support provided by the architectural layout of long-term care units for enhancing residents' well-being and for decreasing unit caregivers' burnout and increasing their resilience-as layouts may impact each party differently. The Psycho Spatial Evaluation Tool was utilized to assess the support provided by the layouts of seventeen long-term care units (ten regular nursing units and seven specialized dementia units) for the residents' physical and social well-being (five dimensions); a questionnaire was used to measure the unit caregivers' burnout and resilience. When analyzing layouts' support for residents' physical and social well-being, inconsistencies emerged regarding correlations with caregivers' burnout and resilience across the two types of long-term care units. Supporting residents' physical well-being was correlated with increased caregiver resilience in dementia units, and with increased burnout and decreased resilience in regular nursing units. Layouts supporting social well-being showed inconsistent correlations with caregivers' resilience indexes in dementia units, and with burnout and resilience indexes in regular nursing units. The findings underscore the role of the architectural layout of long-term care units in enhancing residents' well-being; the results also highlight the possible unintentional yet negative impact of the layout on the caregivers' burnout and resilience. This study emphasizes the need to identify and rectify design shortcomings as a means of enhancing residents' well-being, while increasing the unit caregivers' resilience and decreasing their burnout. These insights should be addressed when developing strategies and interventions for ensuring optimal care environments for all parties involved.

Professional attractiveness among long-term care workers in nursing homes in China: a cross-sectional study

BACKGROUND

The population aging trend and the shortage of elderly care workers require the long-term care profession to become more attractive. However, the professional attractiveness among long-term care workers has yet to be extensively studied. This study aims to identify the factors that influence the attractiveness of the long-term care profession for nursing home (NH) care workers..

METHODS

A cross-sectional study was conducted in more than 50 NHs. Perception of professional attractiveness among long-term care workers and potential associated factors were measured using the Attractive Work Questionnaire (AWQ) and structural instruments including the Fraboni Scale of Ageism (FSA) and the Maslach Burnout Inventory (MBI). A multiple linear regression method was employed to explore the influence of potential independent variables on professional attractiveness.

RESULTS

The overall response rate was 99%. The results showed the score of professional attractiveness (185.37 ± 20.034), as well as the scores of each component (99.26 ± 11.258 for work condition, 30.13 ± 3.583 for work content, and 55.99 ± 7.074 for job satisfaction). Findings of multiple linear regression analysis indicated that age(β = 0.129, p<.05), years of work(β = 0.156, p<.05), 12-hour shifts(β = 0.185, p<.05), and training times per year(β = 0.148, p<.05) positively associated with long-term care workers perceived professional attractiveness. Whereas only ageism(β=-0.267, p<.05) significantly and negatively influenced professional attractiveness.

CONCLUSIONS

The perceived professional attractiveness of long-term care workers in NHs was acceptable. Age, years of work, shifts, training opportunities, and ageism contributed to the professional attractiveness of nursing home care workers in China. Target intervention measures should be taken to enhance the attractiveness of long-term care careers so as to avoid the shortage of long-term care workers.

Study protocol for the development, trial, and evaluation of a strategy for the implementation of qualification-oriented work organization in nursing homes

BACKGROUND

Staffing ratios in nursing homes vary among the federal states of Germany, but there are no rational grounds for these variations. In a previous study, a new instrument for the standardized calculation of staffing requirements in nursing homes was developed (Algorithm 1.0). The development was based on a new empirical data collection method that derives actual and target values for the time and number of care interventions provided. Algorithm 1.0 found an increased requirement of 36% of staff in German nursing homes. Based on these results, the German legislature has commissioned a model program to trial and evaluate a complex intervention comprising increased staffing combined with strategies for organizational development.

METHODS

The mixed-methods study consists of (i) developing a concept for restructuring the work organization, (ii) the application of this concept combined with increased staffing in 10 nursing homes (complex intervention), and the further development of the concept using a participatory and iterative formal evaluation process. The intervention consists of (a) quantitative measures of increased staffing based on a calculation using Algorithm 1.0 and (b) qualitative measures regarding organizational development. The intervention will be conducted over one year. The effects of the intervention on job satisfaction and quality of care will be evaluated in (iii) a comprehensive prospective, controlled summative evaluation. The results will be compared with ten matched nursing homes as a control group. Finally, (iv) prototypical concepts for qualification-oriented work organization, a strategy for the national rollout, and the further development of Algorithm 1.0 into Algorithm 2.0 will be derived.

DISCUSSION

In Germany, there is an ongoing dynamic legislation process regarding further developing the long-term care sector. The study, which is the subject of the study protocol presented here, generates an evidence-based strategy for the staffing requirements for nursing homes.

ETHICS AND DISSEMINATION

This study was approved by the Ethics Committee of the German Association of Nursing Science (Deutsche Gesellschaft für Pflegewissenschaft) on 02.08.2023 (amended on 20.09.2023). Research findings are disseminated through presentations at national and international conferences and publications in peer-reviewed scientific journals.

TRIAL REGISTRATION NUMBER

German Clinical Trails Register DRKS00031773 (Date of registration 09.11.2023).

Sustainable employability of long-term care staff in self-managing teams: A qualitative study

AIM

To discover what long-term care (LTC) staff working in self-managing teams consider necessary to remain sustainably employable.

DESIGN

Qualitative study with semi-structured interviews.

METHODS

In 2020, semi-structured interviews were conducted one-on-one with 25 LTC workers from a medium-large Dutch organization providing long-term care. All interviews were audio-recorded, anonymously transcribed verbatim and analysed with thematic content analysis in the software program Atlas.ti.

RESULTS

LTC workers indicated a need for autonomy. They wanted their control and involvement in decisions to be strengthened. Furthermore, LTC workers indicated a need for relatedness, by experiencing support, a feeling of togetherness and more time to have attention for the residents. Lastly, LTC workers expressed a need for (assistance in) further developing their competence.

CONCLUSION

In order to remain willing and able to work, LTC workers in self-managing teams want their needs for autonomy, relatedness and competence to be addressed. Working conditions are important to these LTC workers' sustainable employability since they can hinder or promote the satisfaction of their needs.

IMPLICATIONS

It is important that management in LTC is aware of the importance of LTC workers' needs for sustainable employability. We recommend that management critically reflect on and invest in addressing these needs by enhancing indicators and limiting inhibitors of the needs.

IMPACT

A robust LTC workforce is necessary to provide care to the aging population. In the context of the increasing implementation of self-managing teams in LTC organizations, understanding what workers in self-managing teams need in order to remain sustainably employable is crucial. For sustainable employability (i.e. to remain willing and able to work), interviewees indicated a need for autonomy, relatedness, and competence. Nearly all participants stressed the importance of belonging and feeling connected. Working conditions seemed to relate not only directly to the sustainable employability of LTC staff but also indirectly through their lack of contribution to the satisfaction of workers' psychological needs. The outcomes of this study primarily impact workers and management within LTC organizations with self-managing teams. They benefit from recognizing the significance of addressing workers' needs to ensure their essential and sustainable employability in the sector.

REPORTING METHOD

The Standards for Reporting Qualitative Research and the Consolidated Criteria for Reporting Qualitative (COREQ) research were used.

PATIENT OR PUBLIC CONTRIBUTION

Two LTC workers provided advice and feedback regarding the materials and set up of the interviews. These two ambassadors additionally helped in reaching our population, by disseminating information about the study.

The Relationship between Bachelor's-Level Nursing Roles and Job Satisfaction in Nursing Homes: A Descriptive Study

The greatest shortages in the nursing discipline are expected in nursing homes. Although job satisfaction is an important factor in the retention of Bachelor's-level nurses (BNs), little is known about the relationship between the BN roles that are performed on a daily basis and job satisfaction. A cross-sectional, descriptive, questionnaire study was conducted which was based on a convenience sample. The extent of performing seven BN roles was assessed by a self-developed questionnaire. Satisfaction was investigated at three levels: satisfaction with the BN role performance, satisfaction with the work packet (the combination of all roles performed) and satisfaction with job function (all things considered). Respondents (N = 78) were satisfied with the performance of all BN roles (range 3.71-4.42), generally satisfied with the work packet (M = 3.96; SD = 0.96) and neutral about the job function (M = 3.15; SD = 1.12). Not one single BN role correlated with job satisfaction, and the work packet (as a combination of all roles) was significantly related to job satisfaction (r = 0.551; p = 0.000). Four BN roles correlated significantly with satisfaction with the work packet, of which one was meaningful, the role of reflective Evidence-Based Practice professional (r = 0.476; p = 0.000), and three roles related less strongly: the roles of Organiser (r = 0.364; p = 0.001), Communicator (r = 0.224; p = 0.049), and Professional and Quality Enhancer (r = 0.261; p = 0.021). It is important for nurses to create interesting packets of BN roles for themselves. For nurses and care managers, it is essential to create interesting BN descriptions, with highly recognisable BN roles in the work packet, and to stimulate a work environment in order to enhance job satisfaction.

Organizational characteristics of nursing practice environments related to registered nurses' professional autonomy and job satisfaction in two Finnish Magnet-aspiring hospitals: structural equation modeling study

BACKGROUND

Nurses are leaving their profession because of poor personal job satisfaction, heavy workload, and unfavorable work environments with low professional autonomy. Professional autonomy involves the possibility to influence one's work and have a sense of control - the ability to contribute to a workplace culture and influence how decisions are made. This study explores registered nurses' perceptions of the nursing practice environment, using the Nursing Work Index-Revised (NWI-R), and its relationships with professional autonomy and job satisfaction.

METHODS

A cross-sectional study along with instrument re-validation was conducted using a web-based survey for nurses in two Magnet-aspiring hospitals in Finland in September 2021 (n = 586). Structural equation modeling was used to find out the relationships of the NWI-R components with professional autonomy and job satisfaction.

RESULTS

Principal component analysis and confirmatory factor analysis supported seven components with 34 items. Collegial nurse-doctor relationships, organization's quality standards, and nursing involvement and expertise sharing (means of 3.23, 2.96, and 2.66, respectively) demonstrated a favorable nursing practice environment; professional nursing standards, nurse management and leadership, staffing and resource adequacy, and professional advancement (means of 2.38, 2.18, 2.15, and 2.13, respectively) demonstrated an unfavorable nursing practice environment. The presented model (RMSEA 0.068, CFI 0.987, TLI 0.946) indicated that nursing involvement and expertise sharing, organization's quality standards, nurse management and leadership, and collegial nurse-doctor relationships were related to professional autonomy. Nurse management and leadership, staffing and resource adequacy, and organization's quality standards were related to job satisfaction. Moreover, professional autonomy was related to job satisfaction.

CONCLUSION

Nurses' professional autonomy is important due to its relationship with job satisfaction. When factors that increase professional autonomy are taken into account and attention is paid to the promotion of autonomy, it is possible to improve nurses' job satisfaction. These issues cannot be solved at the unit level; investment is needed at the organizational and political levels. The results introduce nurses, managers, researchers, and stakeholders to improvements in the nursing practice environment toward an organizational culture where nurses may utilize their professional autonomy to its full potential.

Nurses' Workplace Perceptions in Southern Germany-Job Satisfaction and Self-Intended Retention towards Nursing

Our cross-sectional study, conducted from October 2022 to January 2023, aims to assess post-COVID job satisfaction, crucial work dimensions, and self-reported factors influencing nursing retention. Using an online survey, we surveyed 2572 nurses in different working fields in Bavaria, Germany. We employed a quantitative analysis, including a multivariable regression, to assess key influence factors on nursing retention. In addition, we evaluated open-ended questions via a template analysis to use in a joint display. In the status quo, 43.2% of nurses were not committed to staying in the profession over the next 12 months. A total of 66.7% of our surveyed nurses were found to be dissatisfied with the (i) time for direct patient care. Sources of dissatisfaction above 50% include (ii) service organization, (iii) documentation, (iv) codetermination, and (v) payment. The qualitative data underline necessary improvements in these areas. Regarding retention factors, we identified that nurses with (i) older age, (ii) living alone, (iii) not working in elder care, (iv) satisfactory working hours, (v) satisfactory career choice, (vi) career opportunities, (vii) satisfactory payment, and (viii) adequate working and rest times are more likely to remain in the profession. Conversely, dissatisfaction in (ix) supporting people makes nurses more likely to leave their profession and show emotional constraints. We uncovered a dichotomy where nurses have strong empathy for their profession but yearn for improvements due to unmet expectations. Policy implications should include measures for younger nurses and those in elderly care. Nevertheless, there is a need for further research, because our research is limited by potential bias from convenience sampling, and digitalization will soon show up as a potential solution to improve, e.g., documentation and enhanced time for direct patient time.

Challenges and coping experiences faced by nursing staff in long-term care facilities in China: a qualitative meta-analysis

Objective

The aim of this study is to discern the challenges and coping experiences encountered by nursing staff in long-term care facilities in China. This will be achieved through the identification, evaluation, and qualitative synthesis of comprehensive data.

Design

This is a qualitative meta-analysis.

Methods

The research systematically examined relevant literature sourced from six databases, concluding the search in August 2023. The inclusion criteria encompassed qualitative and mixed-methods studies in both Chinese and English, focusing on challenges faced by nursing staff in long-term care facilities and their corresponding coping strategies. The application of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework facilitated the qualitative meta-integration process. Three independent researchers meticulously screened and assessed the quality of the chosen studies. The synthesis process sought to amalgamate and structure analogous findings into novel categories through multiple readings of the original literature. These categories were subsequently distilled into comprehensive themes.

Results

Analyzed 15 articles revealed 14 sub-themes and 4 overarching analytical themes. These encompassed Sources of Challenges such as multitasking, clinical emergencies, workplace conflict, demand exceeding resources, and occupational discrimination. Psychological impacts included suppressed emotion, compassion fatigue, and self-doubt. Practical consequences involved damaged health, imbalanced life, and occupational disappointment. Coping strategies identified were self-adjusting, feeling validation and belonging, and finding support.

Conclusion

Our research identified the challenges faced by nursing staff in Chinese long-term care facilities and their coping experiences. We found that most challenges could be mitigated through appropriate adjustments in managerial strategies, such as reasonable human resources planning, and providing resource support, including material, emotional, and informational support. Similarly, institutions should have offered necessary emotional and psychological support to nursing staff to overcome the negative impacts of challenges and encourage them to adopt positive coping strategies.

Antecedents and outcomes of work engagement among nursing staff in long-term care facilities-A systematic review

AIM

To determine antecedents and outcomes of work engagement (WE) among nursing staff in long-term care (LTC) using the Job Demand-Resources model.

DESIGN

A systematic review following the Preferred Reporting Items for Systematic Review and Meta-Analysis statement and Synthesis Without Meta-analysis in systematic reviews guideline. A study protocol was registered in PROSPERO (registration number CRD42022336736).

DATA SOURCES

The initial searches were performed in PsycInfo, Medline, Academic Search Premier, CINAHL and Scopus and yielded 3050 unique publications. Updated searches identified another 335 publications. Sixteen studies published from 2010 to 2022 were included.

REVIEW METHODS

The screening of titles and abstracts, and subsequently full-text publications, was performed blinded by two author teams using the inclusion/exclusion criteria. When needed, a mutual consensus was obtained through discussion within and across the teams. A descriptive and narrative synthesis without a meta-analysis of the included studies was performed.

RESULTS

The extent of research on WE in LTC facilities is limited and the factors examined are heterogeneous. Of forty-two unique antecedents and outcomes, only three factors were assessed in three or more studies. Antecedents-in particular job resources-are more commonly examined than outcomes.

CONCLUSION

Existing literature offers scant evidence on antecedents and outcomes of WE among nursing staff in LTC facilities. Social support, learning and development opportunities and person-centred processes are the most examined factors, yet with ambiguous results.

IMPACT

Antecedents and outcomes of engagement among nursing staff in LTC facilities have not previously been reviewed systematically. Engagement has been correlated with both more efficient and higher-quality service delivery. Our findings suggest opportunities to improve health and care services by enhancing engagement, whilst at the same time better caring for employees. This study lays the groundwork for more detailed research into the contributing factors and potential results of increasing caregivers' engagement. No patient or public contribution.

Association between Resilience, Professional Quality of Life, and Caring Behavior in Oncology Nurses: A Cross-Sectional Study

PURPOSE

The degree of caring behavior of oncology nurses is a crucial factor in the care provided to patients with cancer. In this study, we aimed to investigate factors related to oncology nurses' caring behavior, including their resilience and professional quality of life.

METHODS

A cross-sectional descriptive study was conducted with 107 oncology nurses at an urban tertiary hospital from May 18 to 24, 2015. We used a self-report questionnaire to measure resilience, professional quality of life, and degree of caring behavior. Data analysis included descriptive statistics, correlations, and multiple regression analysis using SPSS/WIN 20.0.

RESULTS

Oncology nurses presented with low levels of resilience and caring behavior, and high levels of compassion satisfaction, burnout, and secondary traumatic stress. There was a statistically significant relationship between the degree of caring behavior, resilience (r = .43, p < .001), compassion satisfaction (r = .51, p < .001), and burnout (r = -.42, p < .001), as well as between secondary traumatic stress and burnout (r = .34, p < .001). Factors associated with oncology nurses' degree of caring behavior were compassion satisfaction (t = 6.00, p < .001) and educational level (t = 3.45, p = .001).

CONCLUSION

This study demonstrates that oncology nurses' degree of caring behavior is related to their professional quality of life and education. These findings suggest that enhancing oncology nurses' healthy coping strategies at both the individual and organizational levels can further develop holistic nursing care. Additionally, it is necessary to examine the factors affecting nurses' compassion satisfaction and to try to promote this aspect.

Exploring the impact of nursing home managers' leadership on staff job satisfaction, health and intention to leave in nursing homes

AIMS AND OBJECTIVES

To explore the impact of nursing home leadership and staffing characteristics on staff job satisfaction, health and intention to leave.

BACKGROUND

The number of older people has outpaced growth in the nursing home workforce worldwide. Identifying predictors with the potential to positively impact staff job satisfaction, health and intentions to leave are important. Leadership of the nursing home manager can be one such predictor.

DESIGN

Cross-sectional design.

METHODS

A sample of 2985 direct care staff in 190 nursing homes in 43 randomly selected municipalities in Sweden completed surveys on leadership, job satisfaction, self-rated health and intention to leave (response rate 52%). Descriptive statistics and Generalised Estimating Equations were conducted. The STROBE reporting checklist was applied.

RESULTS

Nursing home managers' leadership was positively related to job satisfaction, self-rated health and low intention to leave. Lower staff educational levels were related to poorer health and lower job satisfaction.

CONCLUSIONS

Nursing home leadership plays a significant role in the job satisfaction, self-reported health and intention to leave of direct care staff. Low education levels among staff seem to negatively influence staff health and job satisfaction, suggesting that educational initiatives for less-educated staff could be beneficial for improving staff health and job satisfaction.

RELEVANCE TO CLINICAL PRACTICE

Managers seeking to improve staff job satisfaction can consider how they support, coach and provide feedback. Recognising staff achievement at work can contribute to high job satisfaction. One important implication for managers is to offer continuing education to staff with lower or no education, given the large amount of uneducated direct care workers in aged care and the impact this may have on staff job satisfaction and health.

NO PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution was required to outcome measures in this study. Direct care staff and managers contributed with data.

Earnings, job satisfaction, and turnover of nurse practitioners across employment settings

Nurse practitioners (NPs) are an important part of the health care workforce. However, little information is available on NP earnings, job satisfaction, or turnover. National survey data from 2018 offer a pre-COVID-19 baseline for ongoing NP workforce monitoring. We found evidence that NPs earned approximately $92 500 annually, ranging from $82 800 in long-term care to $95 600 in hospital settings. Wages increased with tenure in the workforce and varied considerably by geography. Approximately 1 in 5 NPs switched jobs annually, with some net in-flow to ambulatory settings. Both NPs who left their position or considered leaving reported better pay and benefits, burnout, management role, stressful work environment, career advancement, and inadequate staffing as the primary explanations. These findings were augmented by analysis of 2012-2022 Bureau of Labor Statistics data that illustrated substantial growth in the NP workforce. Improving NP job satisfaction has the direct benefit of supporting a critical and growing segment of the health workforce; it has the additional benefit of reducing job turnover and the associated costs, potentially increasing earnings for NPs. Policies that improve working conditions for NPs in different employment settings will not just increase immediate job satisfaction but also ideally strengthen the longer-term labor market to improve patient outcomes.

Changes in work conditions and well-being among healthcare professionals in long-term care settings in the Netherlands during the COVID-19 pandemic: a longitudinal study

BACKGROUND

Healthcare professionals working in long-term care facilities reported heavy job demands and a lack of job resources during the 2019 coronavirus disease (COVID-19) pandemic. However, how job demands and resources in these facilities changed during the pandemic, and how possible changes affected professionals' work-related well-being, remains unclear. Thus, we explored changes in job demands and resources in the face of surging COVID-19 infection rates, and investigated associations of these changes with changes in burnout and work engagement, among healthcare professionals working in long-term care facilities in the Netherlands.

METHODS

This longitudinal study was conducted with healthcare professionals working in five long-term care facilities in the Netherlands. Data were collected in early and late 2021, when infection rates in long-term care facilities were low and high (mean, 29.1 and 275.4 infections/day), respectively. In total, 173 healthcare professionals completed the validated Job Demands and Resources Questionnaire, Copenhagen Burnout Inventory, and Utrecht Work Engagement Scale at both timepoints. We performed paired-samples t tests to examine changes in job demands and resources, and fixed-effects linear regression analyses to examine associations of within-person changes in job demands and resources with those in burnout and work engagement.

RESULTS

Healthcare professionals perceived increased workloads, associated with increased burnout and decreased work engagement during the study period. Within-person increases in perceived collegial support were associated positively with work engagement and negatively with burnout symptoms.

CONCLUSIONS

Healthcare professionals in long-term care facilities perceived increased workloads in the wake of surging infection rates during the COVID-19 pandemic, resulting in increased burnout and decreased work engagement. These changes in burnout and work engagement were also perceived in response to declining collegial support. Efforts to protect the work-related well-being of healthcare professionals working in long-term care facilities in the pandemic context that focus on workload reduction and the promotion of collegial support may be most beneficial.

Nursing Home Patient Safety Culture Perceptions Among Licensed Practical Nurses

BACKGROUND

Licensed practical nurses (LPNs) working in nursing homes are the primary licensed nurses providing care and ensuring patient safety in New Jersey. As such, it is important to understand LPNs' perception of patient safety culture (PSC) and job satisfaction, which may impact resident safety.

PURPOSE

To describe the relationship between LPNs' perception of PSC in nursing homes and job satisfaction.

METHODS

A cross-sectional study design was used to survey LPNs in New Jersey.

RESULTS

LPNs working in nursing homes were less satisfied than LPNs working in other settings, and their perception of PSC was lower than that in 2019 national data report.

CONCLUSION

LPNs in nursing homes indicated that PSC needs improvement. Now is an opportune time to implement initiatives to foster a culture of safety in nursing homes.

Administrative burden in Swiss nursing homes and its association with care workers' outcomes-a multicenter cross-sectional study

BACKGROUND

Care workers in nursing homes often perform tasks that are rather related to organizational or management activities than 'direct patient care'. 'Indirect care activities', such as documentation or other administrative tasks are often considered by care workers as a burden, as they increase overall workload and keep them away from caring for residents. So far, there is little investigation into what kind of administrative tasks are being performed in nursing homes, by which type of care workers, and to which extent, nor how administrative burden is associated with care workers' outcomes.

PURPOSE

The objective of this study was to describe care workers' administrative burden in Swiss nursing homes and to explore the association with four care worker outcomes (i.e., job dissatisfaction, emotional exhaustion, intention to leave the current job and the profession).

METHODS

This multicenter cross-sectional study used survey data from the Swiss Nursing Homes Human Resources Project 2018. It included a convenience sample of 118 nursing homes and 2'207 care workers (i.e., registered nurses, licensed practical nurses) from Switzerland's German- and French-speaking regions. Care workers completed questionnaires assessing the administrative tasks and burden, staffing and resource adequacy, leadership ability, implicit rationing of nursing care and care worker characteristics and outcomes. For the analysis, we applied generalized linear mixed models, including individual-level nurse survey data and data on unit and facility characteristics.

RESULTS

Overall, 73.9% (n = 1'561) of care workers felt strongly or rather strongly burdened, with one third (36.6%, n = 787) reporting to spend 2 h or more during a "normal" day performing administrative tasks. Ratings for administrative burden ranged from 42.6% (n = 884; ordering supplies and managing stocks) to 75.3% (n = 1'621; filling out the resident's health record). One out of four care workers (25.5%, n = 561) intended to leave the profession, whereby care workers reporting higher administrative task burden (OR = 1.24; 95%CI: 1.02-1.50) were more likely to intend to leave the profession.

CONCLUSION

This study provides first insights on care workers' administrative burden in nursing homes. By limiting care workers' burdensome administrative tasks and/or shifting such tasks from higher to lower educated care workers or administrative personnel when appropriate, nursing home managers could reduce care workers' workload and improve their job satisfaction and retention in the profession.

The Impact of Union Membership on Nursing Turnover and Job Satisfaction

OBJECTIVE

The present study examines the scope of nursing unions and the relationship with turnover and job satisfaction among RNs.

BACKGROUND

There is no recent empirical literature documenting evidence on workplace performance measures (turnover and job satisfaction) among unionized nurses at the national level.

METHODS

This cross-sectional study analyzed secondary data (n = 43 960), the 2018 National Sample Survey of Registered Nurses.

RESULTS

Approximately 16% of the sample reported being represented by labor unions. The overall nursing turnover rate for the sample was 12.8%. Unionized nurses were less likely than their counterparts to report turnover (mean, 10.9% vs 13.16%; P = 0.02) and less job satisfaction (mean, 3.20 vs 3.28). Union nurses were more likely than nonunion nurses to be male (12.72% vs 9.46%; P = 0.0004), minorities (37.65% vs 25.67%, P < 0.001), be employed in hospital settings (70.1% vs 57.9%, P = 0.001), but report fewer hours of work per week (mean, 36.73 vs 37.66; P = 0.003). Regression results revealed a positive association between union status and nursing turnover (odds ratio, 0.83; P < 0.05), whereas union status was inversely associated with job satisfaction (B = -0.13, P < 0.001) after adjusting for age, gender, race/ethnicity, care coordination time per week, weekly hours of work, and employment settings.

CONCLUSION

Overall, job satisfaction was high among all nurses, regardless of union membership. However, when comparing specifically union and nonunion members, unionized nurses were less likely to report turnover, but were more likely to experience job dissatisfaction.

Stressors inherent to clinical practices and their relationship with emotional intelligence in nursing students: A cross sectional study

BACKGROUND

There is a wide body of knowledge about Emotional Intelligence and its benefits in health care, generating better productivity, clinical performance and communication with work teams, patients and families. Its relationship with stress and with performance of clinical practices has also been studied, although the results are not conclusive or up-to-date.

OBJECTIVES

To study and correlate the perception of Emotional Intelligence and the stressors inherent to Nursing students' clinical practices.

DESIGN

A multicenter and observational study was carried out through cross-sectional surveys with Nursing students during the 2021/2022 academic year.

PARTICIPANTS

377 students were included in the study, recruited through non-probabilistic sampling in four Spanish universities.

METHODS

Sociodemographic and academic variables were collected, as well as the following main variables: perceived Emotional Intelligence and stressors in clinical practices.

RESULTS

The study sample consisted of 377 students (89.1 % women; mean age of 23.15 ± 5.50). The perception of Emotional Intelligence obtained adequate ranges. The stressors that generate most concern are being attacked by the patients, lack of competence, and impotence and uncertainty. There are statistically significant differences in Emotional Intelligence by gender and university, as well as in stressors between each other. The Emotional Intelligence dimensions are weakly correlated with the stressors, although with statistical significance.

CONCLUSIONS

This study shows that Emotional Intelligence slightly influences the stressors inherent to clinical practices, so that EI can help cope with the difficulties of clinical work. Specifically, emotional clarity has an inverse relationship with some stressors. However, the attention and repair dimensions do not present such a clear relationship in our study or in previous ones. This shows the need to include Emotional Intelligence training in Nursing training curricula.

Effects of hierarchical nursing management in patients with acute pulmonary embolism

BACKGROUND

Acute pulmonary embolism (acute PE) is the most serious manifestation of venous thromboembolism. Hierarchical nursing management is an improved option for nursing, but no study that indicated the effects of hierarchical nursing management in patients with acute PE could be found. This study aimed to explore the effects of hierarchical nursing management on the quality of nursing care and the prognosis of patients with acute PE. Methods From January 2020 to January 2022, 92 patients with acute PE were recruited and divided into the study group and the control group. The study group was designated with our hierarchical nursing care and the control group was designated with a conventional nursing care. The data of general characteristics, nursing quality, the improvement of clinical symptoms, the job satisfaction of nursing was collected and compared. Results The door-to-needle time, the thrombectomy time and length of emergency staying the study group were shorter than those in the control group (P < 0.005). The rate of complications in the study group was lower than that in the control group (P = 0.158). The scores of the nursing quality and the nursing satisfaction levels in the study group were remarkably higher than that in the control group. Conclusion For acute PE patients, the using of hierarchical nursing management can shorten the rescue time, reduce the rate of complications and improve the nursing quality of nursing care.

Psychosocial Work Environment and Well-Being of Direct-Care Staff Under Different Nursing Home Ownership Types: A Systematic Review

This systematic review investigated the psychosocial work environment and well-being of direct-care staff under different nursing home ownership types. Databases searched: Scopus, Web of Science, Cinahl, and PubMed, 1990-2020. Inclusion criteria: quantitative or mixed-method studies; population: direct-care staff in nursing homes; exposure: for-profit and non-profit ownership; and outcomes: psychosocial work environment and well-being. In total, 3896 articles were screened and 17(n = 12,843 participants) were assessed using the Joanna Briggs Institute Critical Appraisal tools and included in the narrative synthesis. The results were inconsistent, but findings favored non-profit over for-profit settings, for example, regarding leaving intentions, organizational commitment, and stress-related outcomes. There were no clear differences concerning job satisfaction. Job demands were higher in non-profit nursing homes but alleviated by better job resources in one study. The result highlights work environment issues, with regulations concerning for-profit incentives being discussed in terms of staff benefits.

Job satisfaction and wellbeing among migrant care workers in nursing homes: An integrative review

AIM

To systematically analyse and synthesize studies investigating job satisfaction (including turnover and turnover intention) and wellbeing (physical, social and psychological including work stress, acculturation stress and sick leave) among migrant care workers in nursing homes.

DESIGN

An integrated review was conducted.

METHODS

Joanna Briggs Institute's manual guided the analysis of qualitative data (n = 31). Quantitative data (n = 17) were summarized and integrated with the qualitative findings.

RESULTS

Migrants described high job demands, limited control and social support, and stress possibly related to acculturation. Although, compared to natives (born in the country), inconsistent results were reported about wellbeing and job satisfaction, migrant care workers reported enjoying the relational aspects of work and feeling pride when providing care. A satisfying work environment for migrant care workers enables them enjoying working in elderly care with pride.

PUBLIC CONTRIBUTION

Help managers to promote an inclusive working life in line with the United Nations Sustainable Development Goal number 8.

Organization factors influencing quality of work life among seniors' care workers with severe low back pain

OBJECTIVES

The prevalence of work-related low back pain (LBP) is high among care workers and can negatively affect quality of work life (QWL). To improve workplace satisfaction, this study aimed to identify factors influencing QWL among seniors' care workers with severe LBP.

METHODS

A questionnaire survey including items on demographics, qualifications, basic job responsibilities, job stressors, LBP severity, QWL, and job satisfaction was conducted in 2018. In total, 1000 senior care facilities were selected via random sampling and eight care workers per institution were asked to complete the survey. Multiple logistic regression analysis was used to identify independent factors influencing QWL of care workers with and without severe LBP.

RESULTS

Data from 1247 care workers with severe LBP and 2009 with nonsevere LBP were included in the analysis. Overall QWL was lower in the severe LBP group than in the nonsevere LBP group. In both groups, human relationships, workplace support, discretionary responsibility level, and working hours or time off were identified as common factors influencing QWL. In the severe LBP group, the salary was also a significant influence on QWL, while in the nonsevere LBP group, the number of workers, promotion or official position, and caregiving technique were identified as significant QWL factors.

CONCLUSIONS

The QWL of care workers with severe LBP was strongly influenced by salary. Since care workers suffering from severe LBP are working for a salary while enduring the pain and do not have found a worth doing, they need to prevent LBP and get job satisfaction and self-progress.

Care-home Nurses' responses to the COVID-19 pandemic: Managing ethical conundrums at personal cost: A qualitative study

INTRODUCTION

The COVID-19 pandemic had an unprecedented effect on those living and working in care-homes for older people, as residents were particularly vulnerable to contracting the SARS-CoV-2 virus, associated with high morbidity and mortality. Often undervalued, care-home nurses (RNs) are leaders, managing complex care while working in isolation from their professional peers. The pandemic made this more apparent, when care and treatments for COVID-19 were initially unknown, isolation increased due to withdrawal of many professional health services, accompanied by staff shortages.

OBJECTIVE

To explore RNs' experiences of working in older people's care-homes during the COVID-19 pandemic.

DESIGN

Qualitative interview study.

SETTING

Care-homes for older people in England and Scotland, UK.

METHODS

Recruitment via direct contact with care-homes, social media, and links provided by national partners, then purposive sampling for age, gender, type of care-home, and location. Data collected through one-to-one online interviews using topic guide developed collaboratively with care-home nurses, focusing on how COVID-19 impacted on nurses' resilience and mental wellbeing. Data analyzed thematically using Tronto's ethics of care framework to guide development of interpretative themes.

RESULTS

Eighteen nurses (16 female; 16 adult, and two mental health nurses) were interviewed March-June 2021; majority aged 46-55 years; mean time registered with Nursing and Midwifery Council: 19 years; 17 had nursed residents with COVID-19. RNs' experiences resonated with Tronto's five tenets of ethical care: attentiveness, responsibility, competence, responsiveness, and solidarity. All nurses described being attentive to needs of others, but were less attentive to their own needs, which came at personal cost. RNs were aware of their professional and leadership responsibilities, being as responsive as they could be to resident needs, processing and sharing rapidly changing guidance and implementing appropriate infection control measures, but felt that relatives and regulatory bodies were not always appreciative. RNs developed enhanced clinical skills, increasing their professional standing, but reported having to compromise care, leading to moral distress. Broadly, participants reported a sense of solidarity across care-home staff and working together to cope with the crisis.

CONCLUSION

Care-home nurses felt unprepared for managing the COVID-19 pandemic, many experienced moral distress. Supporting care-home nurses to recover from the pandemic is essential to maintain a healthy, stable workforce and needs to be specific to care-home RNs, recognizing their unique pandemic experiences. Support for RNs will likely benefit other care-home workers either directly through wider roll-out, or indirectly through improved wellbeing of nurse leaders.

CLINICAL RELEVANCE

The COVID-19 pandemic, an international public health emergency, created many challenges for Registered Nurses (RNs) working in long-term care facilities for older people, as residents were particularly vulnerable to the impact of the SARS-CoV-2 virus. Care-home RNs faced challenges distinct from their hospital-based nursing peers and non-nursing social care colleagues due to their isolation, leadership roles, professional legal obligations, and ethical responsibilities, leading to psychological distress on the one hand, but also a newly found confidence in their existing and newly developed skills, and increased recognition by the wider health community of their specialisms.

Sequence analysis of the combinations of work shifts and absences in health care - comparison of two years of administrative data

BACKGROUND

In health care, the shift work is arranged as irregular work shifts to provide operational hours for 24/7 care. We aimed to investigate working hour trends and turnover in health care via identification of time-related sequences of work shifts and absences among health care employees. The transitions between the work shifts (i.e., morning, day, evening, and night shifts), and absences (days off and other leaves) over time were analyzed and the predictors of change in irregular shift work were quantified.

METHODS

A longitudinal cohort study was conducted using employer-owned payroll-based register data of objective and day-to-day working hours and absences of one hospital district in Finland from 2014 to 2019 (n = 4931 employees). The working hour data included start and end of work shifts, any kind of absence from work (days off, sickness absence, parental leave), and employee's age, and sex. Daily work shifts and absences in 2014 and 2019 were used in sequence analysis. Generalized linear model was used to estimate how each identified sequence cluster was associated with sex and age.

RESULTS

We identified four sequence clusters: "Morning" (60% in 2014 and 56% in 2019), "Varying shift types" (22% both in 2014 and 2019), "Employee turnover" (13% in 2014 and 3% in 2019), and "Unstable employment (5% in 2014 and 19% in 2019). The analysis of transitions from one cluster to another between 2014 and 2019 indicated that most employees stayed in the same clusters, and most often in the "Varying shift types" (60%) and "Morning" (72%) clusters. The majority of those who moved, moved to the cluster "Morning" in 2019 from "Employee turnover" (43%), "Unstable employment" (46%) or "Varying shift types" (21%). Women were more often than men in the clusters "Employee turnover" and "Unstable employment", whereas older employees were more often in "Morning" and less often in the other cluster groups.

CONCLUSION

Four clusters with different combinations of work shifts and absences were identified. The transition rates between work shifts and absences with five years in between indicated that most employees stayed in the same clusters. The likelihood of a working hour pattern characterized by "Morning" seems to increase with age.

Value-Based Health Care: Long-Term Care Insurance for Out-of-Pocket Medical Expenses and Self-Rated Health

Long-term care insurance (LTCI) is a significant approach in the effort to actively manage aging and the currently unmet need for aged care in China. Based on data from the 2011, 2013, 2015, and 2018 phases of the China Health and Retirement Longitudinal Study, we used the propensity score matching-difference in difference (PSM-DID) approach to explore the impact of LTCI on out-of-pocket medical expenses and self-rated health. Results showed that LTCI can significantly reduce out-of-pocket medical expenses by 37.16% (p < 0.01) per year and improve self-rated health by 5.73% (p < 0.01), which conforms to the spirit of “value-based health care”. The results were found to be stable in the robustness tests conducted. Currently, China is at the intersection of “low-value-based health care” and “value-based health care”. Improving the health level of aged individuals while keeping medical costs under reasonable control is crucial for formulating and implementing a new round of healthcare reform in China.

Effect of Nurses’ Autonomy Levels and Problem-Solving Skills on Job Satisfaction

Objective: This study aimed to determine the effect of nurses’ autonomy levels and problem-solving skills on job satisfaction and was conducted in public, private and university hospital between July and September 2021. Methods: This descriptive and relational – screening study was conducted with 278 nurses. Data were collected through the Socio-demographic Form, the Problem-Solving Inventory, the Sociotrophy-Autonomy Scale, and the Minnesota Job Satisfaction Questionnaire (MJSQ). Data were analyzed using SPSS 26 and AMOS 24 programs using numbers, percentages, minimum/maximum values, means, and standard deviation values. Results: Modern mediation analysis findings performed using the Bootstrap method showed that the indirect effect of the autonomy score on the overall satisfaction score with the mediation of the problem-solving skills was significant (p< .05). Conclusion: Problem-solving skills were found to have a partial mediating role in the effect of nurses’ autonomy levels on their job satisfaction.

Factors associated with retention intention of Registered Nurses in Korean nursing homes

AIM

To identify the factors associated with retention intention among Registered Nurses in South Korean nursing homes.

BACKGROUND

Although nurses are not mandatory personnel, Korean nursing homes employ Registered Nurses.

INTRODUCTION

Determining the factors related to Registered Nurses' retention intention is important for their job stability and ensure provision of quality care.

METHODS

This mixed-methods study employed a sequential explanatory design. A self-reported questionnaire survey was conducted between May 1 and July 3, 2019, with 155 Registered Nurses providing direct care from 37 nursing homes. In-depth qualitative interviews were conducted with 10 participants from August 1 to September 30, 2019. Data were analyzed using multilevel analysis for quantitative study and thematic analysis for qualitative study.

RESULTS

The participants' average age was 48.48 years. Personal factors related to retention intention were Registered Nurses' role, educational level, and job satisfaction. Institutional factors were ownership, number of beds, and working environment. The qualitative study revealed five themes: "Satisfaction with meaningful relationships," "Potential for professional growth," "Nursing service accompanied by emotional labor," "Poor working environments in nursing homes," and "Unprotected nursing expertise."

DISCUSSION

A nursing home's work environment is related to the Registered Nurses' retention intention. Most Registered Nurses in Korea received low wages, lacked access to career management programs, and experienced emotional labor.

CONCLUSION

This study highlighted the personal and institutional factors related to retention intention among Registered Nurses in South Korean nursing homes.

IMPLICATIONS FOR NURSING AND NURSING POLICY

A law that designates Registered Nurses as an essential nursing home workforce is required. Further, nursing homes should increase the number of Registered Nurses to improve working conditions and thereby job satisfaction. It is also necessary to foster a working environment that facilitates professional development opportunities and job clarity.

Nurses' experiences of an outreach interprofessional mental health service for nursing homes: a qualitative descriptive study

WHAT IS KNOWN ON THE SUBJECT?: Treatment and mental health care in familiar environments are beneficial for older people experiencing mental health issues. But there are not enough qualified and specialized nurses who can meet the complex needs of nursing home residents experiencing mental health issues. The University Hospital of Psychiatry Zurich, Switzerland, established an outreach interprofessional mental health service to foster the care for residents experiencing mental health issues in nursing homes. Based on existing studies, little can be said about whether nurses in nursing homes find these types of services helpful. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: Nurses in nursing homes caring for residents experiencing mental health issues felt relieved by having inclusive support from the interprofessional mental health service. Nurses appreciated the mental health team and felt accompanied and more confident in their daily work. Results showed that nurses wanted to be included in the care and treatment processes and to work as partners on an equal footing with the mental health team. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Outreach interprofessional mental health services for nursing homes should take into account nurses' views and professional experience, and value and respect their role as nurses. Outreach interprofessional mental health services for nursing homes should offer further training in psychiatric nursing, include an accessible contact person in the team, and develop clear processes and responsibilities.

ABSTRACT

INTRODUCTION: Outreach interprofessional mental health services for nursing homes can increase the quality of care for residents experiencing mental health issues but research on how nurses in nursing homes experience such a service is lacking worldwide.

AIM

To describe how nurses experience the involvement of an outreach interprofessional mental health team in the care for older people experiencing mental health issues in nursing homes and to identify barriers to and facilitators of interprofessional collaboration.

METHOD

Qualitative descriptive analysis based on 13 semi-structured interviews. Framework analysis and complex adaptive systems theory were applied.

RESULTS

One core theme with two main categories: Nurses experienced relief from burden through inclusive support provided by the mental health team. Main categories were feeling accompanied and confident as a nurse and partnership-based collaboration.

DISCUSSION

Results showed for the first time that nurses felt supported by the mental health team and were encouraged to find new ways of coping with challenging situations.

IMPLICATIONS FOR PRACTICE

To empower nurses, mental health teams should take into account nurses' perceptions in the treatment process, value and respect their role as nurses, transfer knowledge in both formal and informal settings, establish a steady and reliable contact person, and define processes and responsibilities.

Analysis of occupational stress and its correlation with oxidative-antioxidant levels among employees of a power grid enterprise in Guangdong

BACKGROUND

Occupational stress and its health effects on occupational populations have attracted extensive attention from researchers in public health. The stressors faced by employees of power grid enterprises are increasing progressively, which is easy to cause occupational stress. The balance of the body's oxidative-antioxidant levels plays an essential role in maintaining the body's health status. This study aims to explore occupational stress and its correlation with oxidative-antioxidant levels in employees of a power grid enterprise.

METHODS

A cluster random sampling method was used to investigate the basic information of 528 employees in a power grid enterprise and investigate the two occupational stress models of employees by using the Job Content Questionnaire based on the job demand-control-support (JDC) model, and the Effort-Reward Imbalance Questionnaire based on the effort-reward imbalance (ERI) model, respectively. Peripheral blood samples were collected from the employees to measure the levels of malondialdehyde (MDA), total antioxidant capacity (TAC), and superoxide dismutase (SOD). The correlation between different models of occupational stress level and the body's oxidation-antioxidation level was further explored.

RESULTS

The detection rate of high JDC model occupational stress was 50.6% and the detection rate of high ERI model occupational stress was 50.9%. The JDC model occupational stress was significantly associated with high-temperature and high-altitude operation, visual display terminal operation, monthly income, and exercise (all P < 0.05). The ERI model occupational stress was significantly associated with visual display terminal operation (all P < 0.05). The results of the generalized additive model showed that SOD levels had a non-linear relationship with the D/C ratio as well as the E/R ratio. With the D/C ratio close to 1, SOD levels raised rapidly. When the E/R ratio exceeded 1, the SOD level raised rapidly (all P<0.05) . TAC levels were negatively associated with the E/R ratio (P < 0.05).

CONCLUSION

The detection rates of occupational stress in both models among employees in a power grid enterprise are higher. ERI model occupational stress was associated with body TAC and SOD levels, and JDC model occupational stress was associated with body SOD levels.

''We usually choose safety over freedom'': results from focus groups with professional caregivers in long-term dementia care

Background

People with dementia living in nursing homes are mostly sedentary, which is a consequence of various personal, environmental and organizational factors. Until now, studies on physical activity and safety in dementia have focused on residents and caregivers from the viewpoint of (individual) care provision and health benefits. There has been little to no focus on the possible influence of group dynamics between care providers with regard to physical activity and safety. The aim of this study is to gain more insight into the viewpoints and intentions of groups of professional caregivers towards safety and physical activity and the potential influence of the group-oriented setting in long-term care on physical activity of individual residents.

Methods

A qualitative study comprising three focus group discussions including professional caregivers (n = 15) was conducted within two long-term care organizations in the Netherlands. Focus group discussions were structured using an interview guide derived from a preliminary framework, based on existing literature and complemented with clinical expertise.

Results

Seven themes could be derived from the focus group discussions that influence physical activity and safety: 1) Individual health and abilities; 2) Balancing physical activity and safety; 3) Physical restraints; 4) Group interests versus the individual interests; 5) Organization of care and physical environment; 6) Perceived responsibilities and tasks of professional caregivers and 7) Change is challenging.

Conclusions

Due to multiple influencing factors, the balance for care providers in long-term care generally tends towards safety over physical activity. Furthermore, in order to stimulate physical activity various limitations are experienced, including the organization of care, the general health of the residents and difficulty to achieve changes in daily care. Most importantly, the group interests of both the professional caregivers and the residents have a substantial influence on the incorporation of physical activity in daily care.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-07952-0.

Influence of Supervisors’ Fairness on Work Climate, Job Satisfaction, Task Performance, and Helping Behavior of Health Workers During COVID-19 Outbreak

The need for supervisors to exhibit fairness was a key motivating tool for effective health service delivery during the initial stages of the COVID-19 outbreak. Nonetheless, the number of deaths and hospitalization was alarming health workers were actively working throughout the time. This study explores the role of supervisors’ fairness in creating a work climate and job satisfaction that promote workers’ task performance and helping behaviors. The researchers adopted a quantitative method with a questionnaire used for data collection. SPSS and AMOS were used for data analysis, and statistical models of correlation and hierarchical regression were used to examine relationships among the variables. The study established that supervisors’ fairness has a positive effect on work climate, job satisfaction, task performance, and helping behavior of health workers. Work climate has positive effects of task performance and helping behaviors, whereas job satisfaction also has positive effects on employees’ task performance and helping behavior. The researchers recommended the need for supervisors to exhibit fairness to workers at all times and create room for the workers to appeal their decision to avoid the feeling of supervisors’ biasness.