Longitudinal evaluation of professional nursing practice redesign

A seven country comparison of nurses' perceptions of their professional practice environment

Papastavrou E., Efstathiou G., Acaroglu R., da Luz M.D.A., Berg A., Idvall E., Kalafati M., Kanan N., Katajisto J., Leino-Kilpi H., Lemonidou C., Sendir M., Sousa V.D. & Suhonen R. (2011) Journal of Nursing Management A seven country comparison of nurses' perceptions of their professional practice environment Aims  To describe and compare nurses' perceptions of their professional practice environment in seven countries. Background  There is evidence of variation in the nursing professional practice environments internationally. These different work environments affect nurses' ability to perform and are linked to differing nurse and patient outcomes. Methods  A descriptive, comparative survey was used to collect data from orthopaedic and trauma nurses (n = 1156) in Finland, Cyprus, Greece, Portugal, Sweden, Turkey and Kansas, USA using the 39-item Revised Professional Practice Environment instrument. Results  Differences were found between participants from the northern countries of Europe, Kansas, USA, and the Mediterranean countries regarding perceptions about control over practice. No between-country differences were reported in the internal work motivation among the nurses from any of the participating countries. Conclusions  Although between-country differences in nurses' professional practice environment were found, difficulties related to demographic, cultural and health system differences and the way in which nursing is defined in each country need to be considered in the interpretation of the results. Implications for Nursing Management  The results support investment to improve nurse's work environment, which is important for improving the quality of patient care, optimizing patient outcomes and developing the nursing workforce.

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

AIM

As part of a large study of nursing turnover in Canadian hospitals, the present study focuses on the impact and key determinants of nurse turnover and implications for management strategies in nursing units.

BACKGROUND

Nursing turnover is an issue of ever-increasing priority as work-related stress and job dissatisfaction are influencing nurses' intention to leave their positions.

METHODS

Data sources included the nurse survey, unit managers, medical records and human resources databases. A broad sample of hospitals was represented with nine different types of nursing units included.

RESULTS

Nurses turnover is a major problem in Canadian hospitals with a mean turnover rate of 19.9%. Higher levels of role ambiguity and role conflict were associated with higher turnover rates. Increased role conflict and higher turnover rates were associated with deteriorated mental health. Higher turnover rates were associated with lower job satisfaction. Higher turnover rate and higher level of role ambiguity were associated with an increased likelihood of medical error.

CONCLUSION

Managing turnover within nursing units is critical to high-quality patient care. A supportive practice setting in which role responsibilities are understood by all members of the caregiver team would promote nurse retention.

IMPLICATIONS FOR NURSING MANAGEMENT

Stable nurse staffing and adequate managerial support are essential to promote job satisfaction and high-quality patient care.

Occupational musculoskeletal and mental health: Significance of rationalization and opportunities to create sustainable production systems - A systematic review

This literature review aims to identify occupational musculoskeletal and mental health effects of production system rationalization as well as organizational-level measures that may improve health outcome ("modifiers" in this review). A short review of the effect of ergonomic interventions is included as background and rationalization is discussed as a theoretical concept. Indicator variables for occupational musculoskeletal and mental health and related risk factors are presented. Variables with a generalized format were allowed in the literature searches (e.g., job satisfaction and absenteeism were accepted as risk factor and health indicator, respectively), suitable for the research fields of work sociology, organization science, human resource management (HRM) and economics research. One hundred and sixty-two studies of rationalization effects on health and risk factors and 72 organization-level modifier results were accepted into the final database. Entries were sorted by rationalization strategy and work life sector, and trends in outcome (positive, mixed, no effect, or negative effect on health and risk factors) were determined. Rationalizations have a dominant negative effect on health and risk factors (57% negative, 19% positive); the most negative effects were found for downsizing and restructuring rationalizations in general (71 studies negative, 13 positive) and for the health care sector in particular (36 studies negative, 2 positive). The rationalization strategy High Performance Work System (HPWS) was associated with the highest fraction positive outcome studies (6 of 10 studies). Other rationalization strategies (lean practices, parallel vs. serial production and mechanization level) reported intermediate results, in part dependent on work life sector, but also on the year when studies were carried out. Worker participation, resonant management style, information, support, group autonomy and procedural justice were modifiers with favourable influence on outcome. It is concluded that production system rationalization represents a pervasive work life intervention without a primary occupational health focus. It has considerable and mostly negative influence on worker health, but this can be reduced by attention to modifiers. The results create a basis for new priorities in ergonomic intervention research.

Factors affecting performance of hospital nurses in Riyadh Region, Saudi Arabia

PURPOSE

The purpose of this paper is to identify factors influencing performance of hospital nurses in Riyadh Region, Saudi Arabia. Specific objectives were to estimate self-reported performance, and determine whether differences in employee demographics, job satisfaction, and organizational commitment, influenced performance.

DESIGN/METHODOLOGY/APPROACH

In total, 15 hospitals were randomly selected. The questionnaire was sent to all nurses (1,834) in these facilities and 923 nurses responded. Statistical analysis included correlation, t-test, and regression analysis.

FINDINGS

The study finds that job performance is positively correlated with organizational commitment, job satisfaction and personal and professional variables. Both job satisfaction and organizational commitment are strong predictors of nurses' performance. Job performance is positively related to some personal factors, including years of experience, nationality, gender, and marital status. Level of education is negatively related to performance.

RESEARCH LIMITATIONS/IMPLICATIONS

The findings of this study have a limited generalisability due to the fact that all measures used are based on self-reports. Future research may be directed to other objective measures of performance.

PRACTICAL IMPLICATIONS

Emphasis should be placed on effective supervision, empowerment, and a better reward system. Cultural diversity is a reality for most health organizations in Saudi Arabia; therefore, they need to adopt effective human resources strategies that aim to improve commitment and retention of qualified workers, and build a high performance organizational culture based on empowerment, open communication, and appreciation of impact of national culture on work attitudes.

ORIGINALITY/VALUE

This study fulfills a research gap in the area of nursing performance, and its relationship with work attitudes in Saudi Arabia. The paper also highlights the impact of national culture on job performance and work attitude among nurses in Saudi Arabia, and other countries facing the issue of multi-national work force.

Job satisfaction in a Norwegian population of nurses: A questionnaire survey

BACKGROUND

Although job satisfaction is a factor that influences retention, turnover and quality of nursing care globally, there are few studies exploring these factors in European countries.

OBJECTIVES

To describe job satisfaction among hospital nurses in Norway, to explore the relationship between nurses' job satisfaction and participation in a clinical ladder program and to explore relationships between several variables and intent to stay. A secondary purpose was to investigate the use of a job satisfaction instrument in a different culture than its origin.

DESIGN

In a survey, 2095 nurses in four different hospitals answered a questionnaire that included demographic data, intent to stay and a job satisfaction instrument covering the importance of and actual satisfaction with different job factors.

RESULTS

Interaction, followed by pay and autonomy were the most important job factors for Norwegian nurses. Actual job satisfaction was similar to nurses in other countries. There was no significant difference in job satisfaction between participants and non-participants in a clinical ladder. Nurses intending to stay more than a year were significantly more satisfied in their job. Further education and 1 day or more scheduled for professional development were factors that were positively related to intent to stay in the hospital.

CONCLUSIONS

Norwegian nurses' views on the importance of different job factors mirrored views of the importance ascribed to working milieu in the Norwegian society. As such, the instrument used seemed sensitive to cultural differences. Nurses' actual satisfaction with their job was similar to respondents in many other countries and may imply that structures and content defining nurses' working situation are similar in many parts of the world. Participation in a clinical ladder did not increase nurses' overall job satisfaction. However, further education and the opportunity for professional development increased nurses' intention to stay in the organization.

Documentation of medication management by graduate nurses in patient progress notes: a way forward for patient safety

Nursing documentation provides evidence of nurses' management, the patient response, and evaluation of care. The aim of the study was to examine how graduate nurses document their medication management in the progress notes. A prospective clinical audit of patient medication charts and the progress notes made by 12 graduate nurses was undertaken. Graduate nurses were also individually interviewed and asked clarifying questions about their medication management. Documentation was examined based on four areas: assessment, planning care, administration of medications, and evaluating outcomes of medications. Recorded information about assessment focused on cues of a biomedical rather than a psychosocial nature. Planning care involved non-specific documentation of discharge planning needs, and little information about communication with doctors, pharmacists, nurses, patients and next of kin. Administration of medications included details about the names of medications given to patients, but no information about medication education provided to patients during this time. Evaluation of outcomes of medication administration was poorly documented. Graduate nurses tended to focus on assessing medications before their administration without considering how the patient responded to treatment. Recommendations are proposed for improving the quality of graduate nurses' progress notes. These recommendations include implementing and evaluating protocols that link nurses' decision-making to documentation processes. Adopting a supportive multidisciplinary approach to quality improvement and providing education that emphasises written documentation of verbal communication are also recommended.

Framing the Problem of Measuring and Improving Healthcare Quality

OBJECTIVE

The objective of this study was to determine the uses of the Quality Health Outcomes framework and indicator categories in the healthcare literature.

DATA SOURCES

We studied personal communications and conducted a literature search using computerized databases since 1997, when the recommendations of the Invitational Conference on Measures and Outcomes of Care Delivery were available.

PRINCIPAL FINDINGS

The Quality Health Outcomes Model has been used explicitly to frame a small number of research summaries and programs. The outcome indicator categories can be found in several "report card" initiatives in the United States and Canada. Use of these outcome categories, thought to be sensitive to nursing care inputs, has grown since 1977, with a rising number of uses linked to system or organizational factors or interventions.

CONCLUSIONS

This model and others like it are increasingly forming the conceptual framework for studies that evaluate quality and system interventions to improve care. However, the available data continue to require the linking of negative outcomes (adverse events, complications) to structural and process inputs that reflect nursing care. An urgent need remains to incorporate this broader range of outcomes into available databases.

The impact of restructuring on professional nursing practice

Through the 1990s most hospitals were involved in restructuring. As a result, maintaining professional nursing practice is challenging in these cost-constrained hospital environments. In new models of care, professional nursing practice expectations are often reconceptualized into multidisciplinary care team structures in which the team is empowered and becomes the focus rather than the individual nurse caring for her or his patient. Given that nurses provide the greatest part of patient care in hospitals, professional nursing practice has the potential to differentiate one hospital from another. Consequently, it is in the strategic interest of organizational policy makers to implement initiatives that support professional nursing practice.

Measuring Nursing Practice Models using Multi-Attribute Utility theory

Nursing Practice Models (NPMs) represent the structural and contextual features that exist within any group practice of nursing. Currently, measurement of NPMs relies on costly and nonreproducible global judgments by experts. Quantitative measurement techniques are needed to provide a useful evaluation of nursing practice. Guided by Multi-Attribute Utility theory (MAU theory), an expert panel identified 24 factors representative of N PMs. The factors became elements in a computational index that, when summed, assigns a score to a given nursing unit reflecting the extent to which that unit's nursing practice model achieves the nursing professional ideal. Initial validation of the index and its elements consisted of comparing assessments of 40 nursing units generated by the index with a global evaluation provided by each of the expert panelists who proposed the model factors. Pearson correlations between the index-generated scores and the global assigned scores provided evidence supporting the preliminary validation of the index.

A clinical advancement program: evaluating 10 years of progressive change

OBJECTIVE

To report the evolution of a clinical advancement program, UEXCEL, at a western teaching hospital and the outcomes associated with evaluation over time.

BACKGROUND

The clinical ladder program was initiated in 1989 to provide a professional framework for developing, evaluating, and promoting registered nurses. The program is derived from Benner's Novice to Expert model. Over a 10-year period, the program has undergone three significant revisions. Program evaluation data have been used to guide institutional change.

METHODS

Structure and progression of program development and change are outlined. Evaluation data were collected using a 23-item clinical ladder satisfaction scale developed by Strzelecki. Data were collected in 1993, 1994, 1996, and 1998 using standard survey methods after institutional review board approval. Subjects were registered nurses holding clinical positions at the University of Colorado Hospital. Data were trended across units and time periods and were compared with other institutional evaluation data sets.

RESULTS

Improvement in nurse satisfaction with the UEXCEL program has been steady and incremental, after low baseline measurement. Satisfaction has improved after each program revision. A significant demographic variable over time is the correlation between higher registered nurse education and program satisfaction. Human resources issues are reported with data results.

CONCLUSIONS

Sustaining a clinical advancement program represents a challenge in the current health-care environment. Institutional commitment, staff involvement in revisions, and activities to improve professional nurse development are critical strategies so progress can be achieved.