The Magnet Nursing Services Recognition Program: a comparison of two groups of magnet hospitals

Experience of violence, social support, nursing practice environment, and burnout on mental health among mental health nurses in South Korea: A structural equation modeling analysis

AIMS

This study examined the relationship between the experience of violence, social support, nursing practice environment, and mental health among South Korean mental health nurses.

METHODS

Structured questionnaires were distributed to participants who worked in twelve mental health hospitals, each with at least 200 beds, in South Korea. We analyzed 243 questionnaires and used AMOS 25.0 to explore the relationships between the constructs.

RESULTS

The total and indirect effects of the experience of violence and of social support on mental health were significant. The effects of burnout and of the nursing practice environment on mental health were positively significant. Burnout revealed a mediating association with the relationship between the experience of violence, social support, and mental health.

CONCLUSION

The study confirmed that the experience of violence negatively affects burnout among mental health nurses, while social support relieves burnout and strengthens mental health.

IMPLEMENTATION

Our research model shows that the experience of violence could affect burnout and mental health among mental health nurses. Therefore, nursing administrators should develop violence prevention policies and manuals for coping with the violence that can frequently occur in psychiatric wards.

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

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

Taking command of continuity-An interview study with agency nurses

AIM

The aim of the study was to describe continuity from the perspective of working as an agency nurse (AN).

DESIGN

Qualitative design was applied using individual semi-structured interviews.

METHOD

Individual interviews with fifteen registered nurses working at agency companies were conducted in 2020. The interviews were analyzed with thematic analysis. The study followed the guidelines addressed in the COREQ (Consolidated Criteria for Reporting Qualitative Research) framework.

RESULTS

Thematic analysis yielded one theme - standing strong and taking command - and four categories: being competent and experienced, being prepared and at ease, ensuring an unbroken chain of care, and belonging on my own terms. The categories illustrated the engagement, professionalism, and natural leadership showed by the ANs to uphold quality and continuity.

To what extent does hierarchical leadership affect health care outcomes?

Hierarchical leadership is an antiquated practice seen commonly in health care, whereby strictly defined roles and their importance are overemphasized. This can have unintended negative consequences in a pressurised environment. In contrast, flat hierarchies are gaining popularity, as they afford the flexibility and equality that is vital in a caring environment, where no one should be afraid to raise concerns and voice their opinions. Are hierarchical power structures inhibiting hospitals from achieving effective medical leadership and quality care? With increasing pressures on the health care system, is it time to move away from a hierarchical power structure that has been present for over 70 years? To inspire culture change, is it time to explore alternatives, such as a flat hierarchy?

Involvement in decision-making processes and retention of health workers: findings from a cross-sectional study in the Rwandan Public District Hospitals

Introduction

Methods

Results

Conclusion

Assessment of the nursing practice environment in Greek Hospitals: a cross-sectional study

Background

The organisational characteristics of the nursing practice environment play a crucial role in nurses' job satisfaction, job retention, quality-of-care service provision and patient outcomes. The widely used Practice Environment Scale of the Nursing Work Index assesses the favourability of these traits, showing the grade of magnetism of these factors in the workplace.

Aims and methods

This study aims to assess the nurse working environment at five public hospitals in Greece, and to compare these data with those of Magnet and non-Magnet hospitals. The Practice Environment Scale of the Nursing Work Index was completed by 532 nurses.

Results

Findings have shown that all five hospitals were assessed by nurses as unfavourable working environments. Four of five subscales were identified as unfavourable by the participants and only Collegial Nurse-Physician Relations were evaluated as a positive organisational trait. The mean scores in all five subscales of favourability were significantly lower than the corresponding scores of non-Magnet hospitals in the US.

Conclusions

The present study shows the favourability grade of Greek hospitals. When compared with Magnet and non-Magnet hospitals in the US, Greek hospitals were perceived as more unfavourable than non-Magnet hospitals. Action to improve the current situation must be taken by hospital management, supporting nurse involvement, continuous education, changing human resources management and adopting evaluation procedures.

A Needs Assessment for Recognizing Midwifery Educational Programs That Meet the International Confederation of Midwives Global Educational Standards

BACKGROUND: Quality midwifery education globally is essential to improving maternal and infant outcomes worldwide.

PURPOSE: Determine midwife educators’ perceptions of the need for an international recognition program identifying a midwifery educational program having met the International Confederation of Midwives’ (ICM) Global Standards for Midwifery Education.

STUDY DESIGN: A descriptive web-based survey available in English, French, and Spanish. Midwife educators were asked about (a) perceived need for a recognition program identifying programs meeting ICM Education Standards, (b) ability and resources to complete a self-evaluation report, (c) kinds of verification activities expected and needed resources, and (d) willingness of local educators to be trained as evaluators.

RESULTS: Surveys completed from 52 countries and all four ICM regions (n = 197) with 14% from low-/lower middle income countries. Majority of respondents (79%) endorsed a need for a recognition program. Most were capable of creating a self-evaluation report (88%), only 18% identified not needing any additional resources. The vast majority favored an on-site process to verify the report with over 81% stating local midwife educators would volunteer to be trained as validators.

CONCLUSION: There is a perceived need for an international process that recognizes midwifery education programs that meet the ICM Education Standards.

Magnet® Hospital Recognition Linked to Lower Central Line-Associated Bloodstream Infection Rates

Central-line-associated bloodstream infections (CLABSI) are among the deadliest heathcare-associated infections, with an estimated 12-25% mortality rate. In 2014, the Centers for Medicare and Medicaid Services (CMS) began to penalize hospitals for poor performance with respect to selected hospital-acquired conditions, including CLABSI. A structural factor associated with high-quality nursing care and better patient outcomes is The Magnet Recognition Program®. The purpose of this study was to explore the relationship between Magnet status and hospital CLABSI rates. We used propensity score matching to match Magnet and non-Magnet hospitals with similar hospital characteristics. In a matched sample of 291 Magnet hospitals and 291 non-Magnet hospitals, logistic regression models were used to examine whether there was a link between Magnet status and CLABSI rates. Both before and after matching, Magnet hospital status was associated with better (lower than the national average) CLABSI rates (OR = 1.60, 95%CI: 1.10, 2.33 after matching). While established programs such as Magnet recognition are consistently correlated with high-quality nursing work environments and positive patient outcomes, additional research is needed to determine whether Magnet designation produces positive patient outcomes or rewards existing excellence.

Predictability of a Professional Practice Model to Affect Nurse and Patient Outcomes

Thousands of patients experience needless deaths and injuries as a result of errors while hospitalized for an unrelated problem. The lack of an established professional practice model (PPM) of nursing may be a contributing factor to patient care quality and safety breaches. The PPM of nursing was tested for its ability to affect nurse and patient outcomes. Using a retrospective/prospective research design, secondary data were collected from 2395 staff nurses on 15 inpatient-nursing units covering a 6-year timeframe. Data were analyzed using ANOVA and the Pearson correlation. Nurse and patient outcomes on 2 hospital campuses reached statistical significance. Positive correlations were seen between the initiation of a PPM and subsequent nurses' perception of quality of care, nurse interactions, decision making, autonomy, job enjoyment, and patient satisfaction. This study provides empirical evidence that a uniquely designed PPM in alignment with organizational context can indeed impact nurse and patient outcomes in a community health system.

Determinants of hospital fall rate trajectory groups: a longitudinal assessment of nurse staffing and organizational characteristics

BACKGROUND

Patient falls in acute care hospitals represent a significant patient safety concern. Although cross-sectional studies have shown that fall rates vary widely between acute care hospitals, it is not clear whether hospital fall rates remain consistent over time.

PURPOSE

The aim of this study was to determine whether hospitals can be categorized into fall rate trajectory groups over time and to identify nurse staffing and hospital characteristics associated with hospital fall rate trajectory groups.

METHODOLOGY/APPROACH

We conducted a 54-month (July 2006-December 2010) longitudinal study of U.S. acute care general hospitals participating in the National Database for Nursing Quality Indicators (2007). We used latent class growth modeling to categorize hospitals into groups based on their long-term fall rates. Nurse staffing and hospital characteristics associated with membership in the highest hospital fall rate group were identified using logistic regression.

FINDINGS

A sample of 1,529 hospitals (mean fall rate of 3.65 per 1,000 patient days) contributed data to the analysis. Latent class growth modeling findings classified hospital into three groups based on fall rate trajectories: consistently high (mean fall rate of 4.96 per 1,000 patient days), consistently medium (mean fall rate of 3.63 per 1,000 patient days), and consistently low (mean fall rate of 2.50 per 1,000 patient days). Hospitals with higher total nurse staffing (odds ratio [OR] = 0.92, 95% confidence interval [CI] [0.85, 0.99]), Magnet status (OR = 0.49, 95% CI [0.35, 0.70]), and bed size greater than 300 beds (OR = 0.70, 95% CI [0.51, 0.94]) were significantly less likely to be categorized in the "consistently high" fall rate group.

PRACTICE IMPLICATIONS

Over this 54-month period, hospitals were categorized into three groups based on long-term fall rates. Hospital-level factors differed among these three groups. This suggests that there may be hospitals in which "best practices" for fall prevention might be identified. In addition, administrators may be able to reduce fall rates by maintaining greater nurse staffing ratios as well as fostering an environment consistent with that of Magnet hospitals.

The N2N instrument to evaluate healthy work environments: an Italian validation

OBJECTIVES

The aims of the study were to (a) validate N2N Healthy Work Environment tool, (b) assess the healthiness of work environments as perceived by nurses themselves and (c) identify the factors associated with Italian nurses' perception of work environment healthiness.

METHODS

The linguistic and cultural adaptation of USA-N2N Healthy Work Environments was achieved through a process of forward/backward translation. Content validity was assessed by three expert nurses. The stability of the instrument was checked with a test/retest evaluation. The instrument psychometric properties, the confirmatory factor analysis as well the healthiness of the work environment and its determinant factors were evaluated with a sample of 294 nurses.

RESULTS

The content and face validity of the N2N Healthy Work Environment instrument was confirmed. The instrument demonstrated good internal consistency (α of 0.82), excellent stability values (ρ > 0.70) and high levels of acceptability (response rate: 96.4 %). The confirmatory factor analysis has corroborated the existence of two factors as documented in the original instrument (Mays et al. in J Nurs Manag 19:18-26, 2011). Eighty-seven (29.6 %) nurses perceived the work environment where they work as "healthy". Working under a functional model of care delivery (χ(2) 24.856, p 0.000) and being responsible for one project or more (χ(2) 5.256, p 0.021) were associated with healthy environments.

CONCLUSIONS

The instrument--valid and reliable, short in the number of items, easy to understand and based on international standards--allows a systematic assessment of the healthiness of the environment and might provide not only the opportunity to evaluate the effects of new organizational models and interventions, but also the possibility to activate a process of self-analysis and a process of ongoing review. The instrument can be used to systematically check the healthiness of Italian working environments, allowing for organizational diagnosis, targeted interventions and international comparisons.

Nurse outcomes in Magnet® and non-Magnet hospitals

The important goals of Magnet® hospitals are to create supportive professional nursing care environments. A recently published paper found little difference in work environments between Magnet and non-Magnet hospitals. The aim of this study was to determine whether work environments, staffing, and nurse outcomes differ between Magnet and non-Magnet hospitals. A secondary analysis of data from a 4-state survey of 26,276 nurses in 567 acute care hospitals to evaluate differences in work environments and nurse outcomes in Magnet and non-Magnet hospitals was conducted. Magnet hospitals had significantly better work environments (t = -5.29, P < .001) and more highly educated nurses (t = -2.27, P < .001). Magnet hospital nurses were 18% less likely to be dissatisfied with their job (P < .05) and 13% less likely to report high burnout (P < .05). Magnet hospitals have significantly better work environments than non-Magnet hospitals. The better work environments of Magnet hospitals are associated with lower levels of nurse job dissatisfaction and burnout.

Nurse outcomes in Magnet® and non-magnet hospitals

The important goals of Magnet hospitals are to create supportive professional nursing care environments. A recently published paper found little difference in work environments between Magnet and non-Magnet hospitals. The aim of this study was to determine whether work environments, staffing, and nurse outcomes differ between Magnet and non-Magnet hospitals. A secondary analysis of data from a 4-state survey of 26,276 nurses in 567 acute care hospitals to evaluate differences in work environments and nurse outcomes in Magnet and non-Magnet hospitals was conducted. Magnet hospitals had significantly better work environments (t = -5.29, P < .001) and more highly educated nurses (t = -2.27, P < .001). Magnet hospital nurses were 18% less likely to be dissatisfied with their job (P < .05) and 13% less likely to report high burnout (P < .05). Magnet hospitals have significantly better work environments than non-Magnet hospitals. The better work environments of Magnet hospitals are associated with lower levels of nurse job dissatisfaction and burnout.

The relationship between healthy work environments and retention of nurses in a hospital setting

AIM

The purpose of the present paper was to determine the effect a healthy work environment has on the retention of nurses in a hospital setting.

BACKGROUND

There is a nursing shortage that has been ongoing and is expected to continue, resulting in challenges for the healthcare system in the United States. The significance of this issue is the impact the nursing shortage will have on healthcare organizations and patients.

EVALUATION

The present paper included an extensive review of the current literature. The literature reviewed encompassed scholarly peer-reviewed journal articles. This article focused on nurses, work environments and the impact of the work environments on retention.

KEY ISSUES

Important issues that emerged from this analysis were the dangers of an unhealthy environment, the impact a healthy work environment has on patient outcomes and retention, the Magnet link to healthy work environments and the manager's role in creating and sustaining a healthy work environment.

CONCLUSION

The literature provided evidence of the link between healthy work environments and the retention of nurses in a hospital setting.

IMPLICATIONS FOR NURSING MANAGEMENT

The implications for management are to implement changes now to create a healthy work environment that will recruit and retain nurses to secure their position in the future.

Transformative impact of Magnet designation: England case study

AIMS

To test the impact of the implementation of Magnet principles of improving nurses' work environments.

BACKGROUND

Magnet hospital designation developed in the USA in the 1980s to recognise hospitals that had created excellent patient care environments and supported the professional practice of nursing. A pilot initiative in England was the first test of the applicability of Magnet standards outside the USA.

METHODS

Research methods included surveys of nurses in the demonstration hospital in a predesign and postdesign and comparisons to survey results of nurses practicing in a national sample of 30 National Health Service Trusts.

RESULTS

Prior to beginning the Magnet journey, the demonstration hospital had a nurse work environment that was somewhat less positive than the national sample NHS hospitals. Nurses practicing in the demonstration hospital were somewhat less satisfied with their jobs than nurses in other NHS hospitals. Following a two-year period during which the evidence-based Magnet standards were implemented and Magnet Designation was awarded, the quality of the nurse practice environment had improved significantly, as had job satisfaction of nurses and their appraisals of the quality of patient care. The quality of the nurse practice environment after Magnet designation was better than that of a national sample of NHS trusts. Improved nurse outcomes were because of the improved practice environment rather than staffing enhancements.

CONCLUSIONS

Implementation of the Magnet hospital intervention was associated with a significantly improved nursing work environment as well as improved job-related outcomes for nurses and markers for quality of patient care.

RELEVANCE TO CLINICAL PRACTICE

Nurses can use Magnet principles to improve the quality of their work environments.