The Impact of Organizational Support on Practice Outcomes in Nurse Practitioners in Taiwan

Preventing Inpatient NP Burnout: The Power of Adequate Staffing and Leadership

BACKGROUND

Nurse practitioner (NP) burnout related to high patient-to-NP ratios needs to be addressed.

OBJECTIVES

To survey inpatient pediatric NPs, assess burnout and characterize associated workload and support.

DESIGN

Online cross-sectional survey conducted in three phases from March 2022 to August 2023.

SUBJECTS AND SETTING

Inpatient specialty NPs from 32 hospitals.

RESULTS

Fisher's exact test and logistic regression were implemented. A patient-to-provider (NP or resident) ratio of more than 5:1 was associated with NP burnout (OR = 3.5, 95% CI 1.0, 12.0 and OR = 4.1, 95% CI 1.1, 16.2, respectively, p < .05). Among NPs without burnout, 100% had organizational NP leadership (p = .012).

INTERPRETATION

Though limited by a small convenience sample, a patient-to-provider ratio over 5:1 was associated with NP burnout, and NP leadership was protective. Further research of cost analysis, retention, and patient quality and safety measures are needed.

CONCLUSION

Lower patient-to-NP ratios and NP leadership play a pivotal role in preventing burnout.

Nurse Practitioner Care Environments and Racial and Ethnic Disparities in Hospitalization Among Medicare Beneficiaries with Coronary Heart Disease

BACKGROUND

Nurse practitioners care for patients with cardiovascular disease, particularly those from racial and ethnic minority groups, and can help assure equitable health outcomes. Yet, nurse practitioners practice in challenging care environments, which limits their ability to care for patients.

OBJECTIVE

To determine whether primary care nurse practitioner care environments are associated with racial and ethnic disparities in hospitalizations among older adults with coronary heart disease.

DESIGN

In this observational study, a cross-sectional survey was conducted among primary care nurse practitioners in 2018-2019 who completed a valid measure of care environment. The data was merged with 2018 Medicare claims data for patients with coronary heart disease.

PARTICIPANTS

A total of 1244 primary care nurse practitioners and 180,216 Medicare beneficiaries 65 and older with coronary heart disease were included.

MAIN MEASURES

All-cause and ambulatory care sensitive condition hospitalizations in 2018.

KEY RESULTS

There were 50,233 hospitalizations, 9068 for ambulatory care sensitive conditions. About 28% of patients had at least one hospitalization. Hospitalizations varied by race, being highest among Black patients (33.5%). Care environment moderated the relationship between race (Black versus White) and hospitalization (OR 0.93; 95% CI, 0.88-0.98). The lowest care environment was associated with greater hospitalization among Black (odds ratio=1.34; 95% CI, 1.20-1.49) compared to White beneficiaries. Practices with the highest care environment had no racial differences in hospitalizations. There was no interaction effect between care environment and race for ambulatory care sensitive condition hospitalizations. Nurse practitioner care environment had a protective effect on these hospitalizations (OR, 0.96; 95% CI, 0.92-0.99) for all beneficiaries.

CONCLUSIONS

Unfavorable care environments were associated with higher hospitalization rates among Black than among White beneficiaries with coronary heart disease. Racial disparities in hospitalization rates were not detected in practices with high-quality care environments, suggesting that improving nurse practitioner care environments could reduce racial disparities in hospitalizations.

The Effect of Work Engagement and Perceived Organizational Support on Turnover Intention among Nurses: A Meta-Analysis Based on the Price–Mueller Model

Aim. To elaborate on the relationship between work engagement, perceived organizational support, and the turnover intention of nurses by analysing some potential moderators. Background. Nurses’ turnover intention is negatively impacted by their level of work engagement and perceptions of organizational support. However, it is challenging to reach a consistent conclusion. Methods. Data were acquired from six electronic databases. Each study was evaluated using the quality assessment tool for cross-sectional studies of the Agency for Healthcare Research and Quality (AHRQ). STATA 15.0 was used to analyse the data, and a random effects model was used. The groups that included two or more studies were added to the moderator analysis. Results. A total of 40 study articles involving 23,451 participants were included. The turnover intention of nurses was inversely associated with work engagement (coefficient: −0.42) and perceived organizational support (coefficient: −0.32). A substantial moderating role was played by cultural background, economic status, working years, and investigation time ( $P<0.05$ ). Conclusion. Work engagement and organizational support significantly reduced turnover intention among nurses. Considering the acute shortage of nurses worldwide, nurses with lower wages, fewer working years, and lower levels of work engagement should be given more attention and support from their organizations. Implications for Nursing Management. The meta-analysis suggested that managers should give their employees a more organizational support and promote their work engagement to motivate nurses’ retention intention and maintain a stable workforce with little employee turnover.

Key determinates of job satisfaction for acute care nurse practitioners in Taiwan

BACKGROUND

Taiwan is a super-aged society, and the shortage of hospital doctors; nurse practitioners (NPs) became vital healthcare providers to fulfill the healthcare demands of the population. The purpose of this study was to explore the key determinates of job satisfaction for NPs in acute care practices using significant practice variables, such as empowerment and burnout.

METHODS

Participants of this descriptive survey study were recruited from a national sample of NPs with membership in the Taiwan Association of Nurse Practitioners. The data were collected utilizing an online questionnaire based on demographic and practice variables, the Misener Nurse Practitioner Job Satisfaction Scale (MNPJSS), the Condition for Work Effectiveness Questionnaire II (CWEQ II), and the Copenhagen Burnout Inventory (CBI). A total of 1,211 NPs completed the online survey. A multiple regression model with the stepwise selection was used to explore job satisfaction.

RESULTS

The mean overall satisfaction score indicated that the level of satisfaction was between slightly dissatisfied and slightly satisfied. Regression results indicated that formal power, work-related burnout, access to information, and needed resources were critical components of job satisfaction, and accounted for 63% of the variance. Moreover, NPs who were married, had a higher annual salary, worked only during the day shift, and had lower patients-related burnout showed better job satisfaction.

CONCLUSIONS

This study provides evidence for healthcare organizations to formulate policies to strengthen NP job satisfaction. Empowerment and burnout are vital factors in NPs' job satisfaction. Healthcare organizations have an obligation to implement policies to empower NPs in practice and provide interventions to mitigate burnout. Implementing these changes will improve job satisfaction and with it the quality of patient care.

Organizational support and perceived environment impact on quality of care and job satisfaction: a study with Pakistani nurses

Purpose

Referring to the theory of organizational empowerment, the purpose of this study is to examine the relationship of organizational support and perceived environment on quality of care and job satisfaction, with organizational commitment as a mediator for the first variable.

Design/methodology/approach

This study employed a cross-sectional research design and data was collected from seven private and public sector hospitals in Pakistan, involving 352 nurses on a voluntary basis through a self-administered survey.

Findings

The results showed that organizational commitment mediates the relationship between organizational support and job satisfaction with the quality of care. Moreover, the perceived environment has an impact on job satisfaction and quality of care.

Originality/value

Healthcare service quality seems strictly dependent on the perceived quality of care and job satisfaction among healthcare workers. Theoretical and practical implications for policymakers and HR management are discussed.

Application of a Hybrid Multi-Criterion Decision-Making Model for Evaluation and Improvement of Nurses' Job Satisfaction

Background

The global shortage and turnover of nurses is a current challenge. Past studies have shown that nurse job satisfaction may ameliorate nurse shortage. Although there are many studies on the criteria influencing nurses' job satisfaction, few have examined the causal relationships and weight of each criterion from a systematic perspective.

Objective

Identify the key criteria and causal relationships that affect nurses' job satisfaction, and help nurse leaders identify high-weight, high-impact dimensions and contextualize them for improvement.

Methods

The study developed a hybrid multi-criterion decision-making model, which incorporated the McCloskey/Mueller satisfaction 13-item scale (MMSS-13), and the Decision-Making Trial and Evaluation Laboratory and the Importance-Performance Analysis methods the model was used to analyze key factors of nurse satisfaction and their interrelationships based on the experience of 15 clinical nurse specialists.

Results

In MMSS-13's dimension level, “satisfaction with work conditions and supervisor support” (C₅) had the highest impact, and “satisfaction with salary and benefits” (C₁) had the highest weight. In criteria level, “salary” (C₁₁), “flexibility in scheduling time off” (C₂₄), “maternity leave time” (C₃₁), “opportunities for social contact after work” (C₄₁), and “your head nurse or facility manager” (C₅₁) had high influence under their corresponding dimensions. The “benefits package” (C₁₃) was the top criterion with the highest impact on MMSS-13.

Conclusions

This study assessed nurses' job satisfaction from a multidimensional perspective and revealed the causal relationships between the dimensions. It refined the assessment of nurse job satisfaction to help nurse leaders better assess nurse job satisfaction and make strategic improvements. The study found that compensation and benefits had the highest weight in nurses' job satisfaction. Meanwhile, support for family responsibilities and working conditions, and support from supervisors were the cause dimensions of job satisfaction. Among the more detailed criteria, salary, benefits package, maternity leave time, and leadership had a greater impact on nurses' job satisfaction. Nurse leaders should start with these dimensions to achieve efficient improvement of nurses' job satisfaction.

The impact of organisational commitment and leadership style on job satisfaction of nurse practitioners in acute care practices

AIM

To determine the main factors that affect nurse practitioners' job satisfaction, especially the relationship between organisational commitment and leadership styles in acute care practices.

BACKGROUND

There is little known about the influence of organisational commitment and leadership on NPs' job satisfaction within acute care hospitals.

METHODS

A cross-sectional design with a national online survey that enrolled 1,205 nurse practitioners from the Taiwan Association of Nurse Practitioners to identify potential variables associated with job satisfaction using the multiple regression model.

RESULTS

Organisational commitment (mean=59.47), job satisfaction (mean=173.47), and leadership style (mean ranged from 13.29 to 28) were at a moderate level. Organisational commitment, leadership style, patient load and nurse practitioner advancement levels explained 63% of the variance in nurse practitioners' job satisfaction.

CONCLUSIONS

Organisational commitment and leadership styles, such as idealised influence and individual consideration, are major factors that impact nurse practitioners' job satisfaction.

IMPLICATIONS FOR NURSING MANAGEMENT

Healthcare organisations should develop policies targeting organisational commitment and managers' leadership styles to improve nurse practitioners' job satisfaction.

Determining factors affecting job strain for nurse practitioners in acute care practice

PURPOSE

To investigate nurse practitioners' (NPs) experience of job strain in acute care settings, and to examine the factors that may affect job strain in that context.

DESIGN

Descriptive design using a national survey was employed.

METHODS

A total of 1396 NPs completed online surveys that recorded demographic characteristics and included a Job Content Questionnaire (JCQ), a Condition for Work Effectiveness Questionnaire (CWEQ), and the Dempster Practice Behavior Scale (DPBS). Multiple logistic regressions were conducted to explore the factors associated with job strain types.

FINDINGS

NPs were classified into job strain categories of passive (24.4%), active (31.4%), low (19.2%), or high (24.9%). The passive job strain type was associated with overtime hours, organizational empowerment, and autonomy. The active job type was associated with higher organizational empowerment and autonomy. The high-strain and low-strain job types were both associated with overtime hours and autonomy.

CONCLUSION

Nearly 25% of acute care NPs are in a high job strain type. Organizational empowerment and autonomy were two major factors associated with the passive and active job strain types. Overtime hours and autonomy were both associated with the high-strain and low-strain job types.

CLINICAL RELEVANCE

Supportive hospital/nursing leadership should acknowledge the impact of NP practice as they can contribute to the operational efficacy of their organization. Hospital administrators should provide a supportive practice environment by empowering NPs, enhancing autonomy, and addressing working conditions for NPs to decrease the odds of having a passive or high-strain job type in practice.