The role of the psychological contract in the motivation of nurses

The straw that broke the nurse's back-Using psychological contract breach to understand why nurses leave

AIM

To deepen our understanding of why nurses decide to leave their occupation instead of changing jobs, we examined the antecedents that led to this decision through the theoretical lens of psychological contract breach.

DESIGN

A qualitative design with semi-structured interviews.

METHODS

We collected 28 interviewees from our social networks and a social media platform. We included professional nurses who had decided to leave or had left the occupation. We analysed our data with reflexive thematic analysis, thereby giving space for the interviewee voices to rise.

RESULTS

We identified various experiences of dissonance between interviewee expectations and reality. The interviewees expressed unfulfilled expectations or psychological contract breaches in relation to their occupation on different levels and over extended time periods. The psychological contract breaches and decisions to leave the occupation were built up over time because of continuous disappointment and dissonance between expectations and reality. The frustration, dissonance and unfulfilled expectations were expressed towards the institution of nursing rather than a specific employer or organization.

CONCLUSION

Unfulfilled expectations over a longer period might cause psychological contract breach, leading to turnover intentions. Our research brings novel insights into the psychological contract, as our findings indicate that the psychological contract can be formed and breached, also between the employee and the occupation. This means that turnover intentions might result in nurses leaving the profession rather than seeking work in new organizations.

IMPACT

The study addresses the problem of nurse shortage by showing the root reasons for deciding to leave the occupation. Our findings show how psychological contract breaches over time erupt as turnover intentions regarding the occupation rather than a job. The results guide healthcare managers and decision-makers to recognize factors leading to a psychological contract breach, thereby enabling the retention of nurses.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

The relationship between psychological contract and occupational wellbeing of mother-infant care helpers in Zhejiang Province

BACKGROUND

Mother-infant care (MIC) helpers have become an indispensable part in hospital services. In order to stabilize the MIC workforce, it is essential for administrators to have a solid understanding of what may influence occupational wellbeing. This article aims to explore how demographic characteristics and psychological contract affect occupational wellbeing among MIC helpers in Zhejiang Province, China.

METHODS

This is a quantitative, cross-sectional study with MIC helpers in obstetrics from 20 hospitals in Zhejiang Province. A questionnaire including demographic data, a psychological contract scale and an occupational wellbeing scale was used in this study. Multiple linear regression was conducted to investigate the relationships between demographic characteristics, psychological contract and occupational wellbeing.

RESULTS

This study surveyed 260 MIC helpers and found out the mean score of the psychological contract was 4.38 and the mean score of the occupational wellbeing was 4.01. Monthly income and psychological contract were significant predictors of occupational wellbeing (F = 142.167, p < 0.001), which explained 62.1% of the total amount of variance in occupational wellbeing. Psychological contract was the most important predictor of occupational wellbeing.

CONCLUSIONS

Administrators should pay attention to the effect of psychological contract on occupational wellbeing of the MIC helpers in China. Focusing on the inner needs should be considered as a strategy for stabilizing the team.

Barriers and Enablers of Second-Order Problem-Solving Behavior: How Nurses Can Break Away From the Workaround Culture

BACKGROUND AND OBJECTIVES

Nurses are challenged by numerous day-to-day unexpected problems due to poorly performing work systems that hinder patient care. These operational failures persist in hospitals, partly because nurses tend to prefer quick fixes or workarounds over real improvements that prevent recurrence. The aim of this review is to shed light on the barriers to and enablers of nurses' second-order problem-solving behavior and their consequences, so that hospitals can learn from failure and improve organizational outcomes.

METHODS

We conducted a systematic review, with quantitative, qualitative, and mixed-method articles, searching 6 databases (PubMed, Embase, Web of Science, CINAHL, and Google Scholar) following the Preferred Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Quality assessment for inclusion was performed by 2 independent authors using the Mixed Methods Appraisal Tool (MMAT). A descriptive synthesis was used for analysis.

RESULTS

This study reveals the barriers and enablers for second-order problem-solving behavior, and synthesizes improvement proposals within 3 perspectives, namely the "empowerment" perspective, the "process improvement" perspective, and the "time" perspective. Furthermore, we found that limited attention is given to the patient's perspective, and the existence of a no-action behavior.

CONCLUSION

Although operational failures have several important consequences for hospital staff and organizations, there has been hardly any research into the barriers and enablers that initiate second-order problem-solving behavior; stemming this nursing behavior has thus rarely appeared as a suggestion for improvement.

Development and Validation of Psychological Contract Scale for Hospital Pharmacists

Objective

To set up a psychological contract scale for hospital pharmacists to strengthen the management of pharmacists and improve the occupational health of pharmacists.

Methods

A psychological contract scale for hospital pharmacists with structured questionnaires was designed according to the professional characteristics of hospital pharmacists and validated through the investigation of pharmacists in 77 public medical institutions in Zunyi, China, which were included through stratified random sampling. Kaiser-Meyer-Olkin (KMO) Measure of Sampling Adequacy and Bartlett’s Test of Sphericity were used to assess the suitability of the sample for factor analysis. Validity of the dimensions was investigated with exploratory factor analysis. The principal component analysis and varimax rotation methods were used to identify the factor structure. The internal consistency was assessed by the Cronbach’s alpha coefficient.

Results

The psychological contract scale for hospital pharmacists was composed of pharmacists’ perceptions regarding the hospital, pharmacists themselves, and government/society responsibility. The KMO values of the three perceptions were 0.957, 0.930 and 0.917, respectively, all greater than 0.6. The significance probability of the Bartlett spherical test was 0.000, indicating good structural validity. The Cronbach’s alpha coefficient and half coefficient of the responsibilities in three sub-scales were all greater than 0.6, indicating good internal reliability of the scale. The average scores of the pharmacist responsibility, the hospital responsibility and the government/society responsibility in the pharmacists’ perception were 5.42±0.637, 4.64±1.069 and 4.49±1.134, respectively. In the pharmacists’ perception, their own responsibility has been better fulfilled than those of hospitals and government/society.

Conclusion

The psychological contract scale for hospital pharmacists can be a useful tool to evaluate the psychological contract of hospital pharmacists for research and occupational health assessments and management in the area of hospital pharmacy.

Moving Into Action: The Master Key to Patient Education

Background:

Illness and hospitalization are situations that increase the need for assistance and education. Poor education is currently the most common source of patient complaints in the health sector in Iran.

Purpose:

The aim of this study was to explore the perspectives and recommendations of nurses to improve patient education.

Methods:

This research followed a qualitative exploratory design with a qualitative content analysis approach. The study participants, including eight head nurses and 16 staff nurses, were selected through purposive sampling. The data were collected through semistructured interviews, focus group sessions, and observations during 2016.

Results:

Coding and analysis of the data generated one main theme, two subthemes, and four categories. The subthemes were “strengthen total commitment” and “reconstructing the infrastructure,” and the categories were “developing motivational factors,” “facilitating change by every impetus,” “systematizing activities,” and “contextual promotion.”

Conclusions:

Study findings provide a complete picture of patient education and challenge managers to develop new strategies to plan and implement appropriate changes.

Intensive care nurses in South Africa: Expectations and experiences in a public sector hospital

AIM

To explore the content, fulfilment and potential breach of nurses' psychological contracts and provide a nuanced understanding of the expectations and lived experiences of intensive care unit (ICU) nurses.

BACKGROUND

The challenges presented by the South African healthcare system have implications for the motivation and retention levels of ICU nurses. In an environment such as the ICU, personnel dynamics and nursing management's role are crucial to success.

METHOD

A qualitative study of 44 ICU nurses from a South African tertiary hospital. Template analysis was used to identify themes. Manifest content analysis established the frequency of those themes.

RESULTS

Psychological content elements were predominantly relational in nature. Nurses' contracts were fulfilled by nursing managers, peers and patients. Examples of breach included unfairness, abuse of trust and public reprimands.

CONCLUSIONS

The nature of the work, the emphasis on professional and caring values, as well as the relational and intrinsic aspects associated with these, provide important indicators for the composition of nurses' psychological contracts.

IMPLICATIONS FOR NURSING MANAGEMENT

Understanding ICU nurses' expectations can ensure that their psychological contracts remain positive and fulfilled. Practical suggestions include public and private appreciation, autonomy, and management visibility and discretion.