Group cohesion and organizational commitment: protective factors for nurse residents' job satisfaction, compassion fatigue, compassion satisfaction, and burnout

[Registered nurses' experience of necessary performed and missed nursing care: a qualitative study]

Registered nurses' experience of necessary performed and missed nursing care: a qualitative study Abstract: Background: Providing high quality care based on their caring attitude is essential for nurses. Missed Care can cause feelings of guilt and dissatisfaction among them. Studies on their experiential transition between fully performed and missed care are lacking. They may contribute to a more comprehensive understanding of influencing factors and the impact on nurses' experience. Aim: The aim was to explore how nurses at a centre hospital in German-speaking Switzerland describe performance of nursing interventions in terms of the different expressions between performed and missed care. Methods: Between September 2020 and March 2021 the first author conducted eleven qualitative guide-based individual interviews with registered nurses which were analysed using Mayring's qualitative content analysis and knowledge maps. Results: The analysis resulted in five main categories: Optimal care, satisfaction in mediocrity, a huge lack, patients' reactions and influencing factors. Nurses described, in addition to personal experience and expertise, different coping strategies to prevent missed care and maintain patients' and their own satisfaction. Conclusions: In addition to interventions that can prevent missed care, nurses' experience of performed care should be explored further. This can deepen the understanding of its relationship with professional caring attitudes as well as with patient-related and professional satisfaction.

Factors that contribute to turnover and retention amongst emergency department nurses: A scoping review

BACKGROUND

Internationally, the emergency nursing workforce shortage is of critical concern.

AIM

To synthesise the evidence and assess the scope of literature regarding factors that contribute to turnover and retention amongst emergency nurses.

METHOD

A scoping review using the Joanna Briggs Institute approach was undertaken. Fivedatabases (Embase, MEDLINE, PsycINFO, CINAHL, and Business Source Complete) were searched for papers published in English between January 2011 and June 2023 where the population was nurses, context was the emergency department, and the concept was turnover or retention. A quality appraisal was performed on included studies.

RESULTS

A total of 31 articles met the inclusion criteria. Twenty-six studies focussed on turnover and five studies focussed on retention. Factors that contribute to ED nursing turnover included workplace violence, personal aspects (e.g., burnout or depression), organisational characteristics, and environmental/ job characteristics. Factors that contributed to ED nursing retention included mentoring programs, the advancement in nursing skills, and the transition to practice speciality (emergency) programs.

CONCLUSIONS

A large body of literature exists regarding ED nurses' reasons for leaving their area of practice, yet limited evidence exist on retention. Research exploring factors that promote retention of emergency nurses that leads to subsequent stability and growth in the emergency nursing workforce is needed.

Qualitative assessment of nurse satisfaction in the paediatric cardiac ICU

The objective of this qualitative assessment, utilising the constant comparative method, was to identify satisfiers and dissatisfiers that influence paediatric cardiac ICU nurse retention and recognise areas for improvement. Interviews for this study were performed in a single, large academic children's hospital from March of 2020 through July of 2020. Each bedside paediatric cardiac ICU nurse underwent a single semi-structured interview. Among 12 interviews, four satisfiers were identified: paediatric cardiac ICU patient population, paediatric cardiac ICU care team, personal accomplishment, and respect. Four dissatisfiers were identified: moral distress, fear, poor team dynamics, and disrespect. Through this process of inquiry, grounded theory was developed regarding strategies to improve paediatric cardiac ICU nurse retention. Tactics outlined here should be used to support retention in the unique environment of the paediatric cardiac ICU.

Effect of total quality management intervention on nurse commitment and nurse performance: A quasi-experimental study

BACKGROUND

The purpose of this study is to design, implement, and evaluate the impact of a total quality management intervention on job performance and commitment among Jordanian nurses working in government hospitals.

METHODS

A quasi-experimental multiple time series was conducted starting in September 2017 and ending in June 2018. 140 nurses were sampled using the proportionate stratified random sampling technique; 132 were completed the study 67 the intervention group, while 65 in the control group.

RESULTS

There were no significant differences in nurses' job performance or commitment between the 2 groups (control and intervention). A repeated measure MANOVA test for both groups revealed that the interaction between group and time was statistically significant (F (4, 127) = 144.841; P = .001; Wilk's Λ = 0.180; η2 = .820), indicating that groups had a significantly different pattern of job performance and commitment over time. A repeated test The MANCOVA test for both groups across time revealed significant differences in nurses' job performance and nurses' commitment at a less than 0.05 significance level (F (2127) = 320.724; P = .001; Wilk's Λ = 0.165; η2 = 0.835), and the overall effect of time was significant for all dependent variables (F (4125) = 36.879; P = .001; Wilk's Λ = 0.459; η2 = 0.541).

CONCLUSION

The educational intervention was effective in improving nursing job performance among the study sample. The improved commitment of respondents in the intervention group was attributed to the improvement in job performance.

A successful nursing education promotes newly graduated nurses' job satisfaction one year after graduation: a cross-sectional multi-country study

BACKGROUND

Job satisfaction is a key factor for the successful transition of newly graduated nurses (NGNs) and for retaining NGNs in their workplaces. However, there is limited evidence of the relationship between satisfaction regarding the nursing education program and NGNs' job satisfaction in the first year after graduation. Therefore, this study aims to examine the association of the nursing education related factors and NGNs' job satisfaction.

METHODS

A cross-sectional study design with the utilization of data collected from the same respondents one year earlier as educational factors was applied. The data were collected from NGNs (n = 557) in 10 European countries using an electronic survey between February 2019 and September 2020, and analyzed in detail for four countries (n = 417). Job satisfaction was measured with three questions: satisfaction with current job, quality of care in the workplace, and nursing profession. Nursing education related factors were satisfaction with nursing education program, level of study achievements, nursing as the 1st study choice, intention to stay in nursing, and generic nursing competence. The data were analyzed statistically using logistic regression.

RESULTS

Most of the NGNs in the 10 countries were satisfied with their current job (88.3%), the quality of care (86.4%) and nursing profession (83.8%). Finnish, German, Lithuanian and Spanish NGNs' satisfaction with the nursing education program at graduation was statistically significantly associated with their job satisfaction, i.e., satisfaction with their current job, the quality of care, and the nursing profession. Moreover, NGNs who had fairly often or very often intention to stay in nursing at graduation were more satisfied with their current job, with the quality of care, and with the nursing profession compared with NGNs who had never or fairly seldom intention to stay in nursing at graduation.

CONCLUSIONS

Nursing education plays a significant role in NGNs' job satisfaction one year after graduation, indicating the importance to start career planning already during nursing education. Both nursing education providers and healthcare organizations could plan in close collaboration a transition program for NGNs to ease the transition phase and thus increase the NGNs' job satisfaction and ultimately the high-quality care of the patients.

Understanding the impact of transformational leadership on nurse compassion provision through a time-lagged field study

BACKGROUND

A large volume of literature identifies positive, rejuvenating benefits associated with giving compassion to others. However, the relationship between giving compassion and feelings of exhaustion remains underexplored. Understanding when giving compassion can potentially lead to feelings of emotional exhaustion is particularly important for nurses who are called upon to provide high levels of compassion to suffering patients in their daily work. We suggest that by engaging in transformational leadership behaviors, frontline supervisors can help nurses realize the positive benefits associated with giving compassion.

PURPOSE

The aim of this study was to examine the impact of nurses' perceptions of transformational leadership offered by their supervisors on the relationship between the levels of compassionate behaviors nurses report engaging in with patients and feelings of emotional exhaustion and job satisfaction.

METHODOLOGY/APPROACH

A time-lagged field survey was conducted across two waves of 112 full-time employed inpatient nurses within the United States.

RESULTS

Providing high levels of compassionate behavior to patients was associated with reduced (increased) perceptions of emotional exhaustion and increased (decreased) job satisfaction when supervisors engaged in higher (lower) levels of transformational leadership.

DISCUSSION

Transformational leadership serves as an important resource to help caregivers such that nurses feel invigorated and satisfied, as opposed to drained or fatigued, when engaging in high levels of compassionate behaviors toward suffering patients.

PRACTICE IMPLICATIONS

For nurses to fully reap the established positive benefits associated with providing compassion to patients, frontline supervisors should be encouraged to engage in behaviors reflective of transformational leadership.

Work-family conflict, burnout, and related factors among nurses during the COVID-19 pandemic in the Northwest of Iran

BACKGROUND

Nurses, as the largest working group in the hospital, experience many problems, conflicts, and stressors in the workplace and family especially after the widespread distribution of coronavirus 2019 (COVID-19).

OBJECTIVE

The perceived conflict and burnout among nurses, as well as the correlation between these two variables and the associated factors, were the main subjects of this study.

METHODS

This cross-sectional study involved 256 nurses from three COVID-19 referral hospitals in northwest Iran. Participants completed demographic, work-family conflict (WFC), and burnout questionnaires. The nonparametric tests including Mann-Whitney U, Kruskal-Wallis, and Spearman correlation coefficient were applied to statistical analysis.

RESULTS

The overall score of conflict was 55.3 (12.7). The time dimension received the highest score 11.4 (2.9). In terms of intensity 27.6 (8.7) and frequency 27.6(8.8), nurses had the most burnout in the lack of personal accomplishment dimension. All aspects of WFC, emotional exhaustion, and depersonalization characteristics of burnout had statistically significant positive correlations (p < 0.01). The ward, hospital and employment status variables were associated with WFC (p < 0.05). The association between taking the crisis management course and the severity of depersonalization, and the frequency of lack of personal accomplishment was confirmed (p < 0.01). Additionally, the frequency and severity of emotional exhaustion were associated with employment status and work experiences (p < 0.05).

CONCLUSION

The findings showed that nurses had WFC and burnout rates that were above average. Regarding the negative effects of these two phenomena on health, and also nurse's clinical practices, rearranging work conditions and providing better organizational support seem necessary.

Compassion satisfaction, compassion fatigue, and vicarious trauma

A descriptive study of the impact of the COVID-19 pandemic on non-direct care nurses.

Organizational climate and interpersonal interactions among registered nurses in a neonatal intensive care unit: A qualitative study

AIM

The aim of this work is to describe the organizational climate and interpersonal interactions experienced by registered nurses in a level III neonatal intensive care unit.

BACKGROUND

Neonatal nurses have a demanding task in caring for a varied, highly vulnerable patient population and supporting patients' families. Nurses' psychosocial work environment affects quality of care as well as nurses' job satisfaction and organizational commitment.

METHOD

Semistructured interviews with 13 nurses, covering numerous aspects of their psychosocial work environment, were analyzed using thematic analysis.

RESULTS

High staff turnover and a preponderance of inexperienced nurses were described as stressful and detrimental to group cohesion. Work at the unit was considered overly demanding for newly qualified nurses, while senior nurses expressed frustration at the work of training new nurses who might not stay. While some were very satisfied with the group climate, others complained of a negative climate and incivilities from some experienced nurses toward new recruits.

CONCLUSIONS

High turnover and variable competence among staff present challenges for maintaining a positive organizational climate.

IMPLICATIONS FOR NURSING MANAGEMENT

Management should communicate a clear sense of the nature of neonatal intensive care when recruiting, foster group cohesion (e.g., by creating stable work teams) and reward commitment to working at the unit.

Compassion fatigue in mental health nurses: A systematic review

WHAT IS KNOWN ON THE SUBJECT?: Compassion fatigue is the result of the unique stressors inherent in caregiving work, leading to a loss of compassion in clinical practice that may result in negative outcomes for mental healthcare consumers. Compassion fatigue has clear emotional and physical costs and significant impacts on staff recruitment and retention. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This review is the first to evaluate the quantitative literature on compassion fatigue in mental health nurses. Research on compassion fatigue in mental health nurses does not accurately account for the unique care relationship between nurse and consumer. Competency-based education, strong mental health nurse leadership, positive organizational cultures, clinical supervision and reflection alongside individual self-care strategies may mitigate compassion fatigue. WHAT ARE THE IMPLICATIONS FOR FUTURE PRACTICE?: Resources are urgently needed for education and workforce development that addresses compassion fatigue in mental health nurses. Interventions addressing the physical, cognitive and emotional demands of care work are needed to ensure mental health nurses have the capability to provide sustainable compassionate care to consumers. ABSTRACT: Introduction Although compassionate care is an essential component of mental health nursing, understandings of the impact of compassion fatigue is poorly understood. Aims/Questions To examine and synthesize available data on the prevalence of compassion fatigue within mental health nurses and consider what variables impact compassion fatigue. Method A search of MEDLINE, EMBASE, PsychINFO, Emcare, Web of Science, Scopus, CINAHL and grey literature for articles published between 1992 and February 2021 was conducted. Data were extracted from articles meeting inclusion criteria and integrated using narrative synthesis. Results Twelve articles were included. Prevalence of compassion fatigue ranged from low to high. Variables were identified that may mitigate the risk of compassion fatigue. Strong leadership and positive workplace cultures, clinical supervision, reflection, self-care and personal well-being may protect mental health nurses against compassion fatigue. Discussion Future research is needed on mental health nurses lived experience of compassion fatigue and their understandings of compassion. Implications for Practice Interventions should focus on increasing awareness of compassion fatigue and building individual and organizational resilience. Both organizations and individuals should be aware of the role they play in maintaining the capacity and capability for mental health nurses to provide sustainable and compassionate mental healthcare.

Coping Distress through Harvesting Resilience Among Indian Physicians: Role of Mediating–Moderating Variables

The study proposes to understand the dynamics of work stress and turnover relationship of physicians in Indian context. It also intends to understand the mediating and moderating roles of burnout and resilience on the relationship between work stress and turnover intentions. The article has taken the support of conservation of resources (COR) theory to develop the conceptual framework. The study uses the survey method for data collection which was analysed using quantitative statistical methods like confirmatory factor analysis and mediated and moderated regression. The result showed a significant moderating effect of resilience on burnout and turnover intentions relationship and a strong mediating effect of burnout on the relationship between stress and turnover intentions. Physicians who are regarded as ‘saviours’ should be treated with respect. Certain activities dealing with work–life balance, engaging in leisure activities, getting support from family and friends may help the physician in coping with the demands of stress and thereby reducing the burnout. Future research can take into account other states of India as well as other countries for generalisation of results. The demographic differences among the physicians can also be a new area of research. Although there is lot of available research on the study variables, but none of the studies have taken into context resilience as a moderator between burnout and turnover intention specially in reference to Indian context. The results can add value to the prevailing studies on stress, burnout, resilience and turnover intention.

Compassion fatigue and compassion satisfaction among Chinese midwives working in the delivery room: A cross-sectional survey

BACKGROUND AND AIMS

Compassion fatigue can negatively affect not only healthcare professionals' physical and mental health but also the quality of care they provide and organizational outcomes. However, little is known about compassion fatigue among Chinese midwives working in the delivery room. This study aimed to examine compassion fatigue and compassion satisfaction levels among Chinese midwives working in the delivery room and correlate their compassion fatigue and compassion satisfaction.

METHODS

A multisite cross-sectional study with a convenience sampling approach was conducted at 62 hospitals in Henan Province, central China, from May to July 2020. The participants were recruited through an online survey. A self-designed sociodemographic and work-related data sheet, the Social Support Rating Scale (SSRS), and the Professional Quality of Life Scale (ProQoL) were used to measure the participants'basic information, level of social support, compassion fatigue(consists of burnout and secondary traumatic stress) and compassion satisfaction. Descriptive analysis was used to describe the characteristics of the participants' social support, compassion fatigue and compassion satisfaction. Multiple linear regression analysis was employed to identify associations with the participants' sociodemographic and professional characteristics, compassion fatigue and compassion satisfaction.

RESULTS

A total of 213 questionnaires were completed, 206 of which were valid (96.71%). The majority of the participants reported moderate risks for compassion satisfaction (75.24%) and burnout (59.71%) and low risks for secondary traumatic stress (61.65%). Higher job satisfaction as a midwife, lower average working hours per week in the past year, higher social support, extroverted personality, and work recognition in the past month were positively associated with compassion satisfaction, explaining 48.7% of the total variance. Always considering giving up a midwifery career, lower social support, working a day-night shift, poor health condition, more exposure to traumatic birth events per month on average in recent years, and lower job satisfaction as a midwife were negative factors for burnout, explaining 35.3% of the total variance. Four factors, including more exposure to traumatic birth events per month on average in recent years, always considering giving up a midwifery career, working a day-night shift and poor sleep quality, were negatively related to secondary traumatic stress, explaining 14.2% of the variance.

CONCLUSIONS

In this study, midwives showed moderate levels of compassion satisfaction and burnout and low levels of secondary traumatic stress which should attract the attention of health institutions. A healthy and supportive work environment is crucial to midwives' health, well-being and job satisfaction. Tailored strategies such as trauma management, emotional literacy, peer and social support networks should be implemented to support midwives' compassion satisfaction, while prevent and lower midwives' burnout and secondary traumatic stress.

Structural and psychological empowerment and organizational commitment among staff nurses in Jordan

AIM

The purpose of this study was to examine the relationships between structural empowerment, psychological empowerment, and organizational commitment in Jordanian staff nurses.

BACKGROUND

Empowering nurses is one of the most effective strategies for increasing efficiency. Therefore, studying the contribution of structural and psychological empowerment to organizational commitment will provide a base for future interventions to improve nurses' working environment.

MATERIALS AND METHODS

This cross-sectional study used snowball sampling to recruit staff nurses working in Jordanian public and private hospitals. The sample consisted of 180 nurses. Data were collected using three valid and reliable self-reporting questionnaires that were distributed in electronic format.

RESULTS

Nurses reported a moderate level of both structural and psychological empowerment, and a high level of organizational commitment. Significant positive relationships were found between structural empowerment and psychological empowerment and organizational commitment (r = .62, p < .001) and (r = .57, p < .001) respectively.

CONCLUSION

Staff nurses reported moderate levels of both structural and psychological empowerment, and have a high level of organizational commitment. Positive relationships between structural empowerment, psychological empowerment, and organizational commitment were found among Jordanian staff nurses.

Caring for sick kids: An integrative review of the evidence about the prevalence of compassion fatigue and effects on pediatric nurse retention

PROBLEM

Compassion Fatigue (CF) in healthcare professionals has been explored in multiple studies, but few focused on hospital-based pediatric nurses. The purpose of this integrative review is to synthesize the evidence about CF prevalence in nurses caring for pediatric patients, and to describe its effects on retention and job satisfaction.

ELIGIBILITY CRITERIA

Included studies were in English from any date describing research or quality improvement studies about CF in pediatric nurses.

SAMPLE

An integrative review of nine electronic databases yielded 13 articles about 1921 nurses. Data were synthesized from four qualitative and nine quantitative studies separately before integrating results. A risk of bias analysis was included for evidence level and quality.

RESULTS

Overall CF prevalence was low, but 14% of nurses were at high risk of burnout and 10% were at high risk for secondary traumatic stress. Studies examining the effects of CF on retention found no significant relationship. Most studies were about critical care or oncology nurses.

CONCLUSIONS

A subset of pediatric nurses is highly vulnerable to CF, but more high-quality evidence is needed to fully address this topic. Leaders should study CF prevalence, protective and exacerbating factors, relationships between CF and retention, and targeted strategies to resolve CF in high-risk nurses.

The Impact of Job Stress and State Anger on Turnover Intention Among Nurses During COVID-19: The Mediating Role of Emotional Exhaustion

Based on the social exchange theory, the aim of this study is to identify the association between job stress state anger, emotional exhaustion and job turnover intention. This study postulates that job related stress and state anger among nurses during COVID-19 subsequently leads to their job turnover intentions. In addition, the study also aims to see the mediating role of emotional exhaustion between COVID-19-related job stress, state anger, and turnover intentions. The sample of this study is gathered from 335 registered nurses working in Pakistani hospitals dealing with COVID-19-related patients. The interrelationships between variables are checked by using structural equation modeling through AMOS. Key findings confirm that COVID-19-related job stress and state anger had a significant effect on nurses' turnover intentions. Furthermore, emotional exhaustion mediated the relationship between COVID-19-related job stress, state anger, and turnover intentions. There is a lack of research which has assessed the impact of Novel COVID-19-related job stress and state anger on nurses' turnover intentions in hospitals, providing empirical evidence from a developing country-Pakistan. This study offers managerial implications for hospital management and health policymakers. Moreover, nursing managers need to pay attention to nurses' turnover intentions who are facing the issue at the front line as patients receive their initial treatment from nurses in the COVID-19 outbreak.

Work-related violence and organizational commitment among health care workers: does supervisor's support make a difference?

INTRODUCTION

Work-related threats and violence are major occupational hazards, with potentially serious consequences for both victims and the organization that employs them. Only a few studies have prospectively examined the mitigating effect of social support from supervisors on organizational commitment following exposure to work-related violence and threats.

OBJECTIVE

This study aimed at examining the effect of immediate supervisor's support on affective commitment within 1, 3, 6 and 12 months after exposure to violence and threats.

METHODS

After exposure to work-related violence and threats, the employees received a questionnaire within the first month and after 3, 6 and 12 months. Right after the incident, 398 employees filled out the questionnaire, and 138 employees answered the questionnaire at all four time points. Prospective associations and mean differences between groups were calculated using linear mixed models.

RESULTS

Employees receiving very high levels of social support from supervisors immediately after being exposed to work-related violence or threats had a significantly higher level of organizational commitment across all four time points when compared to the group experiencing middle/low levels of support. Furthermore, at 1- and 3-month follow-up employees receiving very high levels of social support from supervisors following work-related violence and threats reported significantly higher levels of commitment than did the group with high levels of social support from supervisors.

CONCLUSION

Organizations should enhance the availability of social support from supervisors for employees experiencing work-related violence and threats. Training of supervisors to be very much concerned about employees exposed to work-related violence may be of critical importance to both the health and work outcomes of employees.

Feeling the Burnout: Perceptions of Burnout, Anxiety, Depression, and Personal Achievement in US Podiatric Medical Students

Medical student burnout is a significant problem, which has led to the introduction of institutional intervention initiatives to combat the phenomenon. However, the incidence of burnout among podiatric medical students has not been previously assessed. The purpose of this cross-sectional study was to determine the perceptions of burnout, anxiety, depression, and personal achievement among podiatric medical students. A 50-question anonymous survey containing the Maslach Burnout Inventory-Human Services Survey and the Hospital Anxiety and Depression Scale was distributed to all students of eight US podiatric medical schools. Demographic and personal information regarding the student's free time, study time, family support, class or exam failures, loan debt, and previous work experience were recorded. Four hundred and eighty students completed the survey, and 479 responses were eligible for inclusion (response rate of 22.2%). Overall, 65.1% reported moderate or high self-perceived rates of burnout, a rate comparable to allopathic and osteopathic medical students. Respondents also reported high levels of emotional exhaustion and anxiety, but low levels of personal achievement. A predisposition for burnout was identified for third-year students between the ages of 26 to 35 years with borderline or abnormal levels of reported anxiety. The present study contributes to the growing body of literature regarding burnout with respect to the podiatric profession. Despite inherent limitations, the findings suggest institutional interventions for the promotion and development of protective factors may be warranted.

New graduate nurse wellbeing, work wellbeing and mental health: A quantitative systematic review

BACKGROUND

The contribution of work to positive mental health is increasingly apparent. Transition into the workplace causes a range of stressors for new graduate nurses who experience both psychological wellbeing and illbeing in their first year of practice.

OBJECTIVE

To determine published prevalence, predictors, barriers and enablers of new graduate registered nurse wellbeing, work wellbeing and mental health.

DESIGN

Systematic review of quantitative research.

DATA SOURCES

Databases included Cumulative Index of Nursing and Allied Health Literature, Excerpta Medica database, Medical Literature Analysis and Retrieval System Online and Psychological Information. Quantitative and mixed-methods studies were considered for inclusion if published in English from 2009 to 2019 reporting primary data analysis including new graduate nurses' wellbeing, work wellbeing and mental health.

REVIEW METHODS

Quantitative studies were systematically identified then screened and appraised against pre-determined inclusion criteria. Analysis was conducted by grouping according to analytical methods and results reported as a narrative synthesis.

RESULTS

Thirty-four studies were included. The quality of the evidence was variable with just a quarter of the studies being assessed as meeting the quality criteria on all nine measures. For the new graduate nurses prevalence of wellbeing, levels of resilience, optimism, and hope were found to be high. For work wellbeing, most reported higher job satisfaction by 12-months. For work illbeing, levels of burnout were moderately high, predominantly in terms of emotional exhaustion, and stress was initially high, particularly in terms of workload, but decreased over time. For the predictors, job satisfaction was positively predicted by structural empowerment and career satisfaction, and negatively predicted by co-worker incivility, supervisor incivility and emotional exhaustion. For work illbeing, stress was a positive predictor for intent to leave. Stress reductions were associated with momentary levels of high task mastery, social acceptance and role clarity.

CONCLUSIONS

For new graduate nurses, levels of emotional exhaustion, workload and stress were moderately high to high initially, decreasing over time as the graduate nurses' job satisfaction increased. Most studies focused on the nurses' intent to resign or stay and both psychological capital and work engagement positively predicted intent to stay whereas work stress positively predicted intent to resign. Resilience and group cohesion moderated the negative effects of some variables, thus may be potential enablers of work wellbeing. The standards of research reporting or design were generally sub-optimal according to quality indicators. Systematic review registration number: (CRD42020148812).

Advancing team cohesion: Using an escape room as a novel approach

Objective

An escape room was used to study teamwork and its determinants, which have been found to relate to the quality and safety of patient care delivery. This pilot study aimed to explore the value of an escape room as a mechanism for improving cohesion among interdisciplinary healthcare teams.

Methods

This research was conducted at a nonprofit medical center in Southern California. All participants who work on a team were invited to participate. Authors employed an interrupted within-subjects design, with two pre- and post-escape room questionnaires related to two facets of group cohesion: (belonging – (PGC-B) and morale (PGC-M)). Participants rated their perceptions of group cohesion before, after, and one-month after the escape room. The main outcome measures included PGC-B/M.

Results

Sixty-two teams participated (n = 280 participants) of which 31 teams (50%) successfully “escaped” in the allotted 45 minutes. There was a statistically significant difference in PGC between the three time periods, F(4, 254) = 24.10, p < .001; Wilks’ Λ = .725; partial η2 = .275. Results indicated significantly higher scores for PGC immediately after the escape room and at the one-month follow-up compared to baseline.

Conclusions

This work offers insights into the utility of using an escape room as a team building intervention in interprofessional healthcare teams. Considering the modifiability of escape rooms, they may function as valuable team building mechanisms in healthcare. More work is needed to determine how escape rooms compare to more traditional team building curriculums.

Caring for victims of child maltreatment: Pediatric nurses' moral distress and burnout

BACKGROUND

Moral distress is a significant concern for nurses as it can lead to burnout and intentions to leave the profession. Pediatric nurses encounter stressful and ethically challenging situations when they care for suspected victims of child maltreatment. Data on pediatric nurses' moral distress are limited, as most research in this field has been done in adult inpatient and intensive care units.

AIM

The purpose of this study was to describe pediatric nurses' moral distress and evaluate the impact of caring for suspected victims of child maltreatment on nurses' moral distress, burnout, and intention to leave. Design and method: This descriptive cross-sectional correlational study was conducted in a mid-Atlantic, urban area Magnet pediatric level I trauma center that cares for over 1800 cases of suspected child maltreatment annually. An anonymous electronic survey was sent to all the nurses working at the hospital.

ETHICAL CONSIDERATIONS

Institutional Review Board approval was received from the first author's university and the hospital where the study was conducted.

FINDINGS

Overall, nurses (N = 146) reported low levels of moral distress with a mean score of 59.54 (SD = 49.22) and a range of 0-300 on the Moral Distress Scale Neonatal-Pediatric version. Although the frequency of caring for suspected child maltreatment victims did not affect nurses' moral distress, caring for victims with fatal maltreatment contributed to nurses' intention to leave, χ² (1) = 5.35, p = 0.02.

CONCLUSION

The results of this study add to the understanding of moral distress in pediatric nursing. Caring for victims with fatal maltreatment impacts pediatric nurses' intention to leave.

How organisational commitment influences nurses' intention to stay in nursing throughout their career

BACKGROUND

The current COVID 19 pandemic brings into sharp focus the global necessity of having sufficient numbers of nurses and the dire impacts of nursing shortages throughout health systems in many countries. In 2020 retaining skilled experienced nurses continues to be a major global challenge. The dominant and consistent concentration of workforce research to date has focused on attitudinal factors including job satisfaction and burnout and there is limited research on how organisational commitment in combination with job satisfaction and burnout may explain what keeps nurses in nursing.

OBJECTIVES

To measure how organisational commitment in combination with job satisfaction and burnout relate to the intention of Registered General Nurses' staying in nursing (ITSN).

DESIGN & METHODS

A quantitative descriptive design using a cross-sectional survey was utilised. A national postal survey of a representative sample of registered general nurses employed within the Republic of Ireland (ROI) health services was undertaken in 2010. A number of established valid and reliable instruments were used to measure attitudinal factors and their relationship with intention to stay (ITSN). Data were analysed using IBM SPSS version 24.0 and descriptive, correlational and multiple regression analysis were undertaken.

RESULTS

A total of 756 registered nurses participated in this study. The strongest predictor of intention to stay in nursing was organisational commitment (β=0.32, p=.000) while burnout and job satisfaction had a significant relationship with ITSN.

CONCLUSION

Results reveal the complex and multidimensional nature of ITSN with the majority of nurses having a strong intention to stay in nursing. Organisational commitment and low burnout represented predictors which are influential in nurses remaining in nursing throughout their career lifespan. These results remain relevant in 2020 particularly in light of the ongoing pandemic when retention and recruitment of skilled and experienced nurses to the workforce will be critical to the management of health care, considering the increased nurse vacancy rates in many countries and the evident lack of resolution of the issues raised from this study.

Nurses' Job Burnout: A Hybrid Concept Analysis

Introduction: Job burnout can significantly affect nurses’ physical and mental health and the quality of the care services they provide. Yet, there is no clear definition for job burnout in nursing. This study aimed to analyze the concept of nurses’ occupational burnout.

Methods: This concept analysis was conducted, using the three-phase hybrid model. In the theoretical phase, online databases, namely Iranmedex, Scientific Information Database (SID), Science Direct, MagIran, ProQuest, Web of Sciences, Scopus, and PubMed were searched to retrieve studies published from 2007 to 2018. In the fieldwork phase, twelve semi-structured interviews were conducted with nurses and head-nurses selected from teaching hospitals in Isfahan, Iran. The interviews were transcribed and analyzed through thematic analysis. In the final analytic phase, the findings of the first and the second phases were combined.

Results: Based on the findings of the theoretical and the fieldwork phases, job burnout can be defined as, “a state of physical, mental, emotional, and social exhaustion resulting from the negative effects of unmanaged occupational stress and inadequate managerial and social support, which reduces interest in and motivation for work, affects care quality, and results in negative attitudes and behavior towards self, clients, and the work”.

Conclusion: This study provides an in-depth understanding of the concept of job burnout in the nursing context of Iran. Managers need to develop strategies for job burnout prevention and management based on its contributing factors.

The Role of Medical Specialization on Posttraumatic Symptoms in Pediatric Nurses

PURPOSE

Comparison of medical specialization of repeated exposure to secondary trauma and Post-Traumatic Stress Disorder (PTSD) symptoms in pediatric nurses was examined.

DESIGN AND METHODS

The PTSD Checklist-Civilian Version (PCL-C) was administered to 182 nurses over their first year on the job at a pediatric hospital (three time-points: baseline, 3 month follow-up, and 1 year follow-up). Demographic characteristics (age groups, gender, education, and race) and previous healthcare experience on whether nurses met criteria for no, partial, or full PTSD across all three time-points was examined. Differences in unit assignment on total PTSD symptoms and symptoms of each criterion of PTSD (re-experiencing, avoidance, and arousal) were also examined.

RESULTS

No significant differences of both demographic characteristics and previous healthcare experience were found on these PTSD categories. However, both ICU and Hematology/Oncology units were more at risk for developing partial and full PTSD, respectively compared to other units. Nurses in the rehabilitation units had significantly higher re-experiencing, avoidance, and arousal symptoms than those assigned to medical/surgical and intensive care units.

CONCLUSIONS

Results demonstrate a need for hospitals to assess why nurses from certain units are reporting more PTSD symptoms and screen for PTSD symptoms and other mental health concerns throughout their career.

PRACTICE IMPLICATIONS

Being aware of which units may be more at-risk should inform unit-specific prevention and intervention programs to decrease negative outcomes, including burnout, compassion fatigue, and job dissatisfaction.

Short Index of Job Satisfaction: Validity evidence from Portugal and Brazil

Job satisfaction is an important construct that is known to be associated with workers' performance and wellbeing. As such, to properly measure it, one must use adapted measures that show adequate validity evidence for the desired context. Such measures should preferably be short to allow the parsimonious use of various measures/constructs in the same data collection. The aim of this paper is to adapt the Portuguese version for Brazil and Portugal of the Short Index of Job Satisfaction (SIJS). The SIJS is a psychometric instrument that measures job satisfaction through five items. A cross-sectional study was conducted with two multi-occupational workers samples, one from Brazil (n = 599) and one other from Portugal (n = 572). The SIJS presented good validity evidence based on its internal structure, namely dimensionality, reliability, and measurement invariance across countries and sexes. It also revealed to be positively correlated with work engagement, and quality of work life (convergent evidence). It also has shown to be negatively associated with burnout (discriminant evidence). The SIJS showed promising validity evidence. The SIJS can be useful to be used together with other instruments, due to its small number of items, producing data with good psychometric properties.

What is known about paediatric nurse burnout: a scoping review

Burnout in healthcare providers has impacts at the level of the individual provider, patient, and organization. While there is a substantial body of literature on burnout in healthcare providers, burnout in pediatric nurses has received less attention. This subpopulation may be unique from adult care nurses because of the specialized nature of providing care to children who are typically seen as a vulnerable population, the high potential for empathetic engagement, and the inherent complexities in the relationships with families. Thus, the aim of this scoping review was to investigate, among pediatric nurses, (i) the prevalence and/or degree of burnout, (ii) the factors related to burnout, (iii) the outcomes of burnout, and (iv) the interventions that have been applied to prevent and/or mitigate burnout. This scoping review was performed according to the PRISMA Guidelines Scoping Review Extension. CINAHL, EMBASE, MEDLINE, PsycINFO, ASSIA, and The Cochrane Library were searched on 3 November 2018 to identify relevant quantitative, qualitative, and mixed-method studies on pediatric nurse burnout. Our search identified 78 studies for inclusion in the analysis. Across the included studies, burnout was prevalent in pediatric nurses. A number of factors were identified as impacting burnout including nurse demographics, work environment, and work attitudes. Similarly, a number of outcomes of burnout were identified including nurse retention, nurse well-being, patient safety, and patient-family satisfaction. Unfortunately, there was little evidence of effective interventions to address pediatric nurse burnout. Given the prevalence and impact of burnout on a variety of important outcomes, it is imperative that nursing schools, nursing management, healthcare organizations, and nursing professional associations work to develop and test the interventions to address key attitudinal and environmental factors that are most relevant to pediatric nurses.

Mediating effects of empathy on the association between nursing professional values and professional quality of life in Chinese female nurses: A cross-sectional survey

Aim

This study aimed to examine whether and to what extent, empathy mediates the association between nursing professional values and professional quality of life (ProQOL) in Chinese female nurses.

Design

Cross-sectional study design.

Methods

A convenience sample of 733 nurses from Xi'an, Shaanxi Province, China, was recruited. Each participant was invited to complete a self-administrated socio-demographic questionnaire, the Nursing Professional Values Scale, the Jefferson Scale of Empathy and the Professional Quality of Life Scale. Descriptive statistics, Pearson correlation analysis and the bootstrap method were employed to analyse data using SPSS 23.0 software.

Results

The participants reported a medium level of ProQOL. Nursing professional values were positively associated with compassion satisfaction but negatively associated with burnout. Empathy mediated 9.2% and 57.1% of the total observed effect of nursing professional values on compassion satisfaction and burnout, respectively.

Needing permission: The experience of self-care and self-compassion in nursing: A constructivist grounded theory study

BACKGROUND

Healthcare is delivered in a culture of ongoing change, with many nurses highlighting the impact of this on their own wellbeing. However, there is a dearth of literature focusing on how nurses care for themselves as they try to provide compassionate care in a challenging job.

OBJECTIVES

This study explored nurses' experience of self-care and self-compassion and how this may relate to compassionate care giving towards patients.

DESIGN

A constructivist grounded theory approach was used to develop a theoretical understanding of nurses' experience.

SETTINGS

This study included participants from two National Health Service (NHS) Trusts within the United Kingdom (UK).

PARTICIPANTS

Purposive and theoretical sampling were used to recruit general, mental health and learning disability nurses, at different levels of seniority.

METHOD

Between September 2015 and March 2016 semi-structured interviews were conducted. Analysis was completed in line with the process set out within constructivist grounded theory. Using constant comparison and memo writing, analysis moved from initial coding to focused coding, through to theoretical coding, resulting in the production of core concepts and categories, and theory development.

RESULTS

Thirty participants were included in the study. Three concepts were derived from the data: (1) 'Hardwired to be caregivers' - vocation versus role, (2) needing a stable base, (3) Managing the emotions of caring. All three concepts linked to a core process: needing permission to self-care and be self-compassionate. Nurses needed permission from others and from themselves to be self-caring and self-compassionate. An inability to do this affected their wellbeing and compassionate care giving to others. Interviewees described how they struggled particularly with self-compassion. Helping nurses to be proactively more self-caring and self-compassionate may increase their ability to manage emotions and prevent some of the negative consequences of nursing such as burnout and compassion fatigue. A conceptual framework is proposed which identifies that formal permission (e.g., within nursing guidance) may be necessary for some nurses to look after themselves.

CONCLUSION

Findings identified the need for permission as key in enabling nurses to self-care and be self-compassionate, which may facilitate them to address patients' needs. The study highlights the importance of self-care and self-compassion within nursing education and nursing guidance.

Development and Psychometric Assessment of Risk Factors of Compassion Fatigue Inventory in Nurses

BACKGROUND AND PURPOSE

Identifying the risk factors of compassion fatigue is the basic step in designing effective interventions to prevent and manage compassion fatigue. This study developed an inventory of compassion fatigue risk factors and investigated its psychometric properties.

METHODS

This methodological study consisted of two phases: item pool generation through semistructured interviews with 13 nurses and reviewing of 38 related articles and the psychometric validation.

RESULTS

The initial item pool contained 62 items. The psychometric properties was examined and exploratory factor analysis revealed a four-factor structure. Risk Factors of Compassion Fatigue Inventory (RFCFI) contained 20 items. The Cronbach's alpha, intra-class correlation coefficient (ICC), and standard error of measurement (SEM) were .86, 0.83, and 5.73 respectively.

CONCLUSION

RFCFI is a short, self-reporting, valid, and reliable inventory for determining the risk factors of compassion fatigue in nurses and can be easily used by managers, nurses, and scholars.

Factors Influencing Organizational Commitment and Turnover in Nurse Residents

BACKGROUND

Newly licensed RNs (NLRNs) are at risk for leaving employment in the first year. Nurse residency programs have demonstrated success for NLRN retention, yet other variables remain to be explored.

METHOD

A retrospective correlational approach was used to determine the effect of autonomy, competence, group cohesion, structural empowerment, and job satisfaction on organizational commitment, turnover intent, and actual job turnover using secondary data of 1,498 nurse residents.

RESULTS

At 1 year post-residency, turnover intent was low. The turnover rate at year 2 was 8.3% (n = 125). Group cohesion, job satisfaction, and structural empowerment had a significant effect on organizational commitment. Organizational commitment had a significant effect on turnover intent.

CONCLUSION

As part of the global NLRN population, findings based on the U.S. residency programs provide nursing professional development with information to foster the needs of NLRNs and nursing administrators with information to support the development and effectiveness of nurse residency programs in the organization. J Contin Educ Nurs. 2018;49(10):482-488.

The Role of the Nurse Educator in Sustaining Compassion in the Workplace: A Case Study From an Intensive Care Unit

Intensive care unit (ICU) nurses are frequently exposed to emotional and stressful situations in the workplace, which has changed little over the decades. Compassion fatigue is caused by sustained exposure to situations that conflict with one's values and beliefs in the ICU, eroding clinical team relationships and ultimately the quality and safety of patient care. Continuing education in the intensive care setting is a priority, as ICU nurses need to remain abreast of the rapid developments in high-acuity care delivery; however, attention also needs to be directed to nurses' emotional well-being. Nurse educators are well positioned to create and sustain open dialogue that contributes to group cohesion and assists nurses' well-being. J Contin Educ Nurs. 2018;49(5):221-224.

The Veterans Health Administration Registered Nurse Transition-to-Practice Program: A Qualitative Evaluation of Factors Affecting Implementation

This qualitative evaluation was conducted to assess factors affecting implementation of the Veterans Health Administration Registered Nurse Transition-to-Practice program. Factors commonly mentioned in semistructured telephone interviews with Chief Nurse Executives, Program Coordinators, and their teams as affecting implementation fell into four primary domains: materials and support from the Office of Nursing Services, facility-level dynamics and resources, program-specific requirements, and program outcomes. Initiatives to provide support for program implementation are proceeding.

Perceived career opportunities, commitment to the supervisor, social isolation: Their effects on nurses' well-being and turnover

AIM

This research investigated the relationship between perceived career opportunities, affective commitment to the supervisor, and social isolation from colleagues on the one hand and nurses' well-being and turnover intentions on the other. In addition, this study explored the mediating role of affective commitment to the organisation in these relationships.

BACKGROUND

Previous research suggested that organisational commitment explained the effect of nurses' work environment on their turnover intentions. However, less is known about how organisational commitment may contribute to explain nurses' well-being.

METHOD

This research used a cross-sectional design. A sample of 244 nurses completed a questionnaire survey.

RESULTS

Results indicated that affective commitment to the organisation partially mediates the relationships between perceived career opportunities, affective commitment to the supervisor, and social isolation on one hand, and turnover intentions and well-being on the other hand.

CONCLUSION

This study showed that the way nurses assess various aspects of their work experience transposes to their emotional bond to their organisation, which in turn explains their well-being and turnover intentions.

IMPLICATIONS FOR NURSING MANAGEMENT

This paper identifies factors that could contribute to reduce nurses' intent to quit and promote their well-being.

Organizational commitment and turnover intention among rural nurses in the Philippines: Implications for nursing management

Objectives

The unrelenting migration trend of Filipino nurses to other countries has threatened the quality of patient care services in the country. This study explored the extent of nurses' organizational commitment and turnover intention in the Philippines. Furthermore, predictors of nurses' organizational commitment and turnover intention were identified.

Methods

A cross-sectional research design was adopted for this study. Two hundred nurses from nine rural hospitals in the Central Philippines were asked to participate in the study and 166 nurses responded (an 83% response rate). Two standardized instruments were used: the Organizational Commitment Questionnaire and the Six-item Turnover Intention Inventory Scale.

Results

Findings revealed that Philippine nurses were moderately committed (3.13 ± 0.24) to and were undecided (2.42 ± 0.67) whether or not to leave their organization. Nurses' age (P = 0.006), gender, (t = -2.25, P = 0.026), education (t = 2.38, P < 0.001), rank(t = 4.38, P < 0.001), and work experience (t = 2.18, P = 0.031) correlated significantly with organizational commitment, while nurses' age (P = 0.028) and education (t = 1.99, P = 0.048) correlated significantly with turnover intention. An inverse relationship was identified between the organizational commitment and turnover intention (r = -0.22, P = 0.005).

Conclusion

The findings of this study highlight the need for formulation and implementation of interventions to promote life-long commitment in nurses and to reduce turnover rates.

Examining Perceptions of Teammates’ Burnout and Training Hours in Athlete Burnout

Perceptions of teammates and training load have been shown to influence athletes’ physical and psychological health; however, limited research has investigated these factors in relation to burnout. Athletes (N = 140) from a variety of competitive team sports, ranging in level from regional to professional, completed questionnaires measuring individual burnout, perceptions of teammates’ burnout, and training hours per week on two occasions separated by three months. After controlling for burnout at time one, training hours were associated with athletes’ burnout and perceptions of teammates’ burnout at time two. Multilevel modeling indicated actual team burnout (i.e., the average burnout score of the individual athletes in a team) and perceived team burnout were associated with individual’s own burnout. The findings highlight that burnout is dynamic and relates to physiological stressors associated with training and psychological perceptions of teammates’ burnout. Future research directions exploring potential social influences on athlete burnout are presented.

Compassion fatigue in nursing: A concept analysis

AIM

The aim of this article is to clarify the concept of compassion fatigue to develop methods for prevention and mitigation of compassion fatigue in the nursing profession.

BACKGROUND

Compassion fatigue occurs when nurses develop declining empathetic ability from repeated exposure to others' suffering. Conceptual clarity is vital to curtail compassion fatigue via preventative and restorative measures at the individual and organizational level.

DESIGN

Concept analysis.

DATA SOURCES

Databases searched were OVID, CINAHL Complete, Science Direct, Academic One File, Criminal Justice Abstracts, Education Full Text (H.W. Wilson), PsycARTICLES, PsycINFO, Social Work Abstracts, and Teacher Reference Center. Keywords included concept analysis, compassion fatigue, secondary traumatic stress, burnout, vicarious traumatization, compassion satisfaction, nursing, psychology, and social work. The timeline for data collection was from 1990 to 2017.

METHODS

Walker and Avant's method of concept analysis.

RESULTS

Compassion fatigue occurred across disciplines. Nurses were predisposed to compassion fatigue by repeated exposure of others' suffering, high stress environments, and the continuous giving of self. The consequences of compassion fatigue negatively impacted the nurse, patient, organization, and healthcare system.

CONCLUSION

All nurses are at risk for compassion fatigue. Prevention of compassion fatigue is achieved through professional boundaries, self-care measures, self-awareness, and education on the concept at the individual and organizational level.

The role of workplace social capital, compassion satisfaction and secondary traumatic stress in affective organisational commitment of a sample of Iranian nurses

Background

Affective organisational commitment (AOC) refers to employees' emotional attachment to the organisation and identification with it. It is vital that nurses explore contributors to their AOC because they stand as the largest group of employees in healthcare organisations.

Aim

This cross-sectional, analytical study explored the role of workplace social capital (WSC), compassion satisfaction (CS), and secondary traumatic stress (STS) in AOC in a sample of Iranian nurses.

Method

The study sample consisted of 250 nurses working in eight hospitals affiliated with Birjand University of Medical Sciences, eastern Iran. Participants' WSC was measured using the Social Capital at Work Scale developed by Kouvonen et al. (2006). CS and STS were measured using CS and STS dimensions of the Professional Quality of Life measure (Version 5) developed by Stamm (2010).

Results

Significant positive associations were found between WSC and AOC (p < 0.001), between the cognitive dimension of WSC and AOC (p < 0.001), between the structural dimension of WSC and AOC (p < 0.001), and between CS and AOC (p < 0.001). The correlation between STS and AOC (p < 0.001) was negatively significant.

Conclusion

Effort to promote WSC and CS on the one hand and prevention and early recognition of STS on the other hand can enhance nurses' AOC.

Prevalence of burnout in paediatric nurses: A systematic review and meta-analysis

INTRODUCTION

Although burnout in paediatric nurses has been addressed in previous research, the heterogeneous nature of the results obtained and of the variables studied highlights the need for a detailed analysis of the literature.

OBJECTIVE

The aim of this study was to analyse the literature on burnout characteristics, reported prevalence, severity and risk factors, to achieve a better understanding of the risk of emotional exhaustion, depersonalisation and feelings of low personal accomplishment.

METHOD

For this purpose, we carried out a systematic review and meta-analysis of the literature. The databases consulted were CINAHL, LILACS, PubMed, the Proquest Platform (Proquest Health & Medical Complete), Scielo and Scopus. This study used the search equation "burnout AND "pediatric nurs*"", and was conducted in July 2017.

RESULTS

The search produced 34 studies targeting burnout in paediatric nurses, with no restrictions on the date of publication. Many of these studies detected moderate-high values for the three dimensions of burnout, and highlighted sociodemographic, psychological and job-related variables associated with this syndrome. The sample population for the meta-analysis was composed of 1600 paediatric nurses. The following prevalence values were obtained: (i) emotional exhaustion, 31% (95% CI: 25-37%); (ii) depersonalisation, 21% (95% CI: 11-33%); (iii) low personal accomplishment, 39% (95% CI: 28-50%).

CONCLUSIONS

A significant number of paediatric nurses were found to have moderate-high levels of emotional exhaustion and depersonalisation, and low levels of personal accomplishment. These nurses, therefore, were either experiencing burnout or at high risk of suffering it in the future. These results support the need for further study of the risk factors for burnout in paediatric nurses. They also highlight the importance of developing interventions or therapies to help prevent or attenuate the above symptoms, thus helping nurses cope with the workplace environment and with situations that may lead to burnout.

Interventions to improve working conditions of nursing staff in acute care hospitals: Scoping review

AIM

To conduct a scoping review to examine and map the interventions proposed for the improvement of the working conditions of nursing staff in acute care hospitals.

BACKGROUND

The Registered Nurse Forecasting (RN4CAST) project and other studies have determined the impact that the nursing staff has on the quality of care. The nursing staff's higher levels of burnout, job dissatisfaction and negative perception of the quality of care provided caused worse health outcomes.

METHODS

A scoping review was carried out. By searching in SCOPUS, PubMed, CINAHL, Cochrane, Dialnet and in the grey literature, 705 potentially relevant papers were identified. The final analysis included 21 papers and three grey documents.

RESULTS

The studies analysed proposed interventions at the macro-management, meso-management and micro-management levels, although the interventions at the macro- and meso-levels produce better staff outcomes.

CONCLUSIONS

The findings of this review can be applied to management at different levels: measures to improve the patient-nurse ratio at the macro-management level, the horizontal hierarchies at the meso-management level, the mind-body techniques at the micro-management level.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers and leaders should implement interventions at different organisational levels to improve the working conditions of the nursing staff and other health outcomes.