Relationships among structural empowerment, psychological empowerment, intent to stay and burnout in nursing field in mainland China-based on a cross-sectional questionnaire research

Perceived structural empowerment, resilience, and intent to stay among midwives and registered nurses in Saudi Arabia: a convergent parallel mixed methods study

BACKGROUND

Retaining midwives and registered nurses in the Obstetrics and Gynecology department/unit (OB/GYN) is not just a matter of organizational effectiveness and financial wellness. It's a crucial aspect of ensuring quality healthcare delivery. This study aimed to discuss the degree to which midwives and nurses in OB/GYN departments are structurally empowered, resilient, and committed to remaining at the organizations and to examine whether nurses' and midwives'sense of structural empowerment and resilience is a good predictor of their decision to stay with the organization.

METHODS

This study employed a unique convergent parallel mixed methods approach. The research was conducted in two distinct phases. The first phase involved a cross-sectional quantitative survey with a convenience sample of 200 midwives and nurses in OB/GYN departments. The second phase was a qualitative study utilizing semi-structured, open-ended interviews. Eighteen nurses and midwives, specifically chosen as the target population, were invited to participate in individual interviews. The data collection took place at three major hospitals in Saudi Arabia, starting in January 2023 and concluding in February 2023.

RESULTS

The study results revealed that structural empowerment and resilience were statistically significant predictors of the intent to stay in the organization (F = 35.216, p < 0.001), with 26.3% variation, the structural empowerment is higher predictor (β = 0.486, p < 0.000) to intent to stay if compared to resilience (β = 0.215, p < 0.008). Five major themes emerged from the narratives of the nurses and midwives: the nurturing of the physical and physiological, the development of the psychological, the managing finances, the restructuring of the organization, and the enrichment of the professional and occupational.

CONCLUSION

The study's findings have significant implications for healthcare organizations. They highlight the importance of cultivating a culture of empowerment and resilience, which can serve as a powerful tool to encourage registered nurses and midwives to remain in their organizations. This insight empowers healthcare administrators, human resource managers, and obstetrics and gynecology professionals to take proactive steps toward improving retention rates.

Impact of Structural Employee Empowerment on Hospital Ratings: Mediating Role of Social Climate and First-Line Managers' Resilience

Objective

The purpose of this article is to investigate the relationship between the structural empowerment of first-line health managers and health facility performance, examining the mediating roles of resilience and social climate in shaping the ratings of Slovak hospitals. Additionally, we aim to investigate the deeper mechanisms of this relationship, particularly the impact of resilience and the social climate, which can positively influence it.

Materials and Methods

The data collection was conducted through a questionnaire survey in February 2022. Respondents included 540 healthcare managers at the first level of management from 44 Slovak hospitals, all of which were part of the evaluation by the Institute for Economic and Social Reforms (INEKO). The analysis involved the use of the PLS-SEM method to examine the relationships between variables and assess direct and indirect effects, utilizing SmartPLS 3.3 software.

Results

The findings reveal a positive association between the structural empowerment of first-level managers and the ranking of health facilities. The hypotheses regarding the mediation of both variables - First-Level Managers' (FLMs) resilience and social climate - are supported, whether considered separately or jointly. In the case of joint mediation, a significant portion of the indirect effect is conveyed through FLMs' resilience, suggesting a potential avenue of support from hospital management to enhance health facility ratings.

Conclusion

Structural empowerment of first-line managers establishes the conditions for improving the ratings of health facilities. The total effect is significantly more pronounced in promoting their resilience and fostering a supportive social climate.

Structural and Psychological Empowerment of Learners Enrolled in Continuing Nursing Leadership Education in Finland: A Quasi-Experimental Longitudinal Study

BACKGROUND

This study was conducted to assess structural and psychological empowerment among learners enrolled in a continuing leadership education program. Although the number of nurse leadership development interventions has increased, there is little evidence on how they influence leaders' empowerment.

METHOD

A longitudinal study was employed, with learners (N = 85) enrolled in a continuing leadership education program as the participants. Data were collected in the beginning, at the end, and 8 months after the completion of the program using internationally validated instruments. Data were analyzed statistically.

RESULTS

A total of 25 learners (29%) responded to the questionnaire at all three data collection points. The education significantly increased psychological and structural empowerment across all dimensions except formal power. These increased levels of empowerment were partially sustained at the 8-month follow-up time point.

CONCLUSION

Continuing education seems to benefit nurse leaders, and the continuing nursing leadership education program was positively associated with learners' perceived empowerment. [J Contin Educ Nurs. 2023;54(10):462-471.].

Factors related to turnover intention among emergency department nurses in China: A nationwide cross-sectional study

BACKGROUND

Turnover intention among nurses is high, especially in the emergency department. However, factors that are associated with Chinese emergency department nurses' turnover intention have been scarcely studied.

AIMS

The present study examined relationships between turnover intention and demographic characteristics, job-related factors, depressive symptoms, and organizational commitment among emergency department nurses.

STUDY DESIGN

A cross-sectional study of emergency department nurses was conducted in China between July and August 2018. The questionnaire included demographic characteristics (age, gender, level of education, and self-rated health status), job-related factors (qualification title, job seniority, night shifts, and workplace violence), depressive symptoms, organizational commitment, and turnover intention. A hierarchical linear regression model was used to identify factors that are associated with turnover intention among emergency department nurses.

RESULTS

A total of 17 582 emergency department nurses participated in the study. The response rate was 68.9%. The findings indicated that poor self-rated health status (β = 0.25, p < .001), working more than 11 night shifts per month (β = 0.14, p < .01), experiencing workplace violence in the past year (β = 0.08, p < .05), and higher depressive symptom scores (β = 0.07, p < .001) positively correlated with turnover intention. More years of service (β = -0.38, p < .001) and higher organizational commitment scores (β = -0.45, p < .001) negatively correlated with turnover intention.

CONCLUSIONS

Health status, job seniority, night shift frequency per month, workplace violence, depressive symptoms, and organizational commitment were significantly associated with emergency department nurses' turnover intention.

RELEVANCE TO CLINICAL PRACTICE

To reduce turnover intention in the emergency department nurses, hospital administrators and managers should implement measures to improve their physical and mental health, increase organizational commitment, develop staff acceptable shift schedules, and reduce incidences of workplace violence.

Safeguarding the retention of nurses: A systematic review on determinants of nurse's intentions to stay

AIM

To explore factors that influence registered nurses' intention to stay working in the healthcare sector.

DESIGN

A systematic review and narrative synthesis.

METHODS

CINAHL, Medline and Cochrane library databases were searched from Jan 2010 to Jan 2022 inclusive and research selected using a structured criterion, quality appraisal and data extraction and synthesis were guided by Campbell's Synthesis Without Meta-analysis.

RESULTS

Thirty-four studies identified that nurses stay if they have job satisfaction and/or if they are committed to their organizations. The factors permeating these constructs weigh differently through generations and while not an infallible explanation, demonstrate stark differences in workplace needs by age, which influence the intention to stay, job satisfaction, organizational commitment and ultimately nurse turnover.

PUBLIC CONTRIBUTION

Environmental, relational and individual factors have bearing on improving nurse satisfaction and commitment. Understanding why nurses stay through a generational behavioural and career stage lens can bolster safeguarding nurse retention.

Determinants of burnout among nurses and midwives at a tertiary hospital in Ghana: A cross-sectional study

AIM

This study determined the prevalence and key determinants of burnout among nurses and midwives in Kumasi, Ghana.

DESIGN

Hospital-based cross-sectional study.

METHOD

A questionnaire was used to obtain data from 391 nurses and midwives at a tertiary hospital in Kumasi, Ghana using simple random sampling.

RESULTS

About 84.4% of the participants were females. The majority of the study participants experienced low burnout for all dimensions (58% in emotional exhaustion, 55.5% poor personal accomplishment and 38.3% depersonalization). Multiple regression analysis revealed that high emotional exhaustion was independently predicted by post-graduate education (β = 6.42, p = .003), lack of support from management (β = 2.07, p = .024), dislike for leadership style, (β = 3.54, p < .001) and inadequate number of staff (β = 2.93, p = .005). Age (β = 0.35, p = .004), lack of support from management (β = 1.60, p = .012), and inadequate number of staff (β = 1.49, p = .034) independently predicted high depersonalisation. Female sex (β = 4.36, p < .001) and years of practice (β = -0.26, p < .001) independently predicted low personal accomplishment.

The Relationship Between Occupational Stress and Turnover Intention Among Emergency Physicians: A Mediation Analysis

Background

There is evidence that occupational stress is a risk factor for turnover intentions. However, the structural relationship between occupational stress and turnover intention among emergency physicians has rarely been studied. This study aimed to examine the pathways of occupational stress on turnover intention through job satisfaction and depressive symptoms among emergency physicians in China.

Methods

A cross-sectional study was conducted in China from July 2018 to August 2018. Data were collected using a structured questionnaire that included demographic characteristics, occupational stress, job satisfaction, depressive symptoms, and turnover intention. Hierarchical linear regression was performed to explore the related factors of turnover intention. Structural equation modeling was used to examine the pathways from occupational stress to turnover intention.

Results

A total of 10,457 emergency physicians completed the questionnaire. The score of turnover intention was 11.34 (SD = 3.25), and the average item score of turnover intention was 2.84 (SD = 0.81). In structural equation modeling, the occupational stress not only had a direct effect on turnover intention (standardized direct effect = 0.311, bias-corrected 95% confidence interval [0.261, 0.361], P < 0.001), but also had an indirect effect through job satisfaction and depressive symptoms (standardized indirect effect = 0.448, bias-corrected 95% confidence interval [0.412, 0.484], P < 0.001). However, the effect of depressive symptoms on turnover intention was weak (standardized coefficient [β] = 0.08, P < 0.001).

Conclusions

Job satisfaction partially mediated the relationship between occupational stress and turnover intention. However, due to the weak effect of depressive symptoms on turnover intention, the mediating role of depressive symptoms between occupational and turnover intention had little practical value. It is recommended that hospital administrators prioritize increasing job satisfaction of emergency physicians to reduce the impact of occupational stress on their turnover intention.

Positive Psychology: Supervisor Leadership in Organizational Citizenship Behaviors in Nurses

Introduction: In nursing, identifying factors encouraging positive work attitudes is extremely important since a nurse’s performance directly impacts the quality of the care they provide, and, therefore, their patients’ health. Objective: The main objective of this research is to analyze whether the supervisor–nurse relationship is positively correlated with a nurse’s organizational citizenship behaviors. Thus, we established a main hypothesis as follows: the quality of the supervisor–nurse interpersonal relationship is positively related to the job satisfaction of the nurse, controlled by moderating the effects of psychological empowerment, the perceived organizational support, and leader–leader exchange. Methodology: This is a cross-sectional descriptive study with individuals as the units of analysis. The population studied comprised all the nurses and supervisors working in nine public hospitals in the autonomous community of Aragon (Spain). The sample consisted of 2541 nurses, 192 supervisors, and 2500 paired dyads. Self-report questionnaires were used to ensure workers’ anonymity. The dependent variable was the nurse’s organizational citizenship behaviors; the main independent variable was the supervisor’s leadership; the moderating variables were the nurse’s empowerment, the organizational support the nurse perceived, and the quality of the supervisor–superior relationship. Results: Empirical evidence demonstrates that the quality of the supervisor–nurse relationship is positively correlated with organizational citizenship behaviors. The results also confirm the moderating effect of nurses’ empowerment and of the organizational support they perceive. Discussion: Our research shows how important it is for organizations to establish management practices promoting high-quality nurse–supervisor relationships; thus, hospital management should monitor both the supervisors’ performance and leadership. Conclusions: The quality of the relationship the supervisor establishes with their nurses is vitally important since it is a necessary requirement for beneficial results for the organization as a result of citizenship behavior practice.

The mechanism underlying the relationship between empowering leadership and work passion

OBJECTIVE: The purpose of this paper is to investigate the effect of empowering leadership (EL) on work passion by developing a moderated mediation model. The model focuses on the mediating effect of intrinsic motivation (IM) in the relationship between EL and work passion, as well as the moderating effect of role clarity (RC) in influencing the mediation. METHODS: Data were obtained from a sample of 515 workers, who work in 17 five-star hotels in Sharm El-Sheikh. RESULTS: Findings reveal that IM fully mediates the positive relationship between EL and work passion. It also concluded that RC moderated the mediated relationship between EL and work passion via IM, with individuals with higher RC benefiting more from the mediation. CONCLUSION: The findings have far-reaching implications for both employees and leaders. Furthermore, they add to our understanding of self-determination theory and cognitive evaluation theory in terms of consolidating employees’ work passion.

Empowerment Predicting Nurses' Work Motivation and Occupational Mental Health

INTRODUCTION

Empowering nurses is essential for improving work outcomes, and understanding the role of structural and psychological empowerment in supporting nurses' work motivation and occupational mental health are essential to stimulate nurses' productivity and preserve their mental health.

OBJECTIVES

To evaluate nurses' perspectives about the levels of structural and psychological empowerment in their working areas. Additionally, to evaluate nurses' motivation and occupational mental health, and to predict the nurses' motivation and occupational mental health through structural and psychological empowerment.

METHODS

A descriptive correlational design and quota sampling were used. Two hundred registered nurses were recruited from two hospitals in Jordan. Data were collected using four valid and reliable self-report questionnaires.

RESULTS

Nurses who participated in this study were young and have an average total experience in nursing of fewer than 10 years. Nurses in this study reported a moderate level of structure empowerment and a low level of psychological empowerment. Significant positive relationships were documented between both structural, psychological empowerment, and nurses' work motivation (r = 0.85), (r = 0.83) respectively. A significant negative relationship found between both structural, psychological empowerment, and nurses' occupational mental health (r = -0.31), (r = -0.29) respectively.

CONCLUSIONS

The levels of nurses' work motivation and occupational mental health can be predicted through the levels of structural and psychological empowerment. The higher workplace empowerment was associated with increased work motivation, as well as reduced the feeling of occupational stress among nurses. Thus, administrators should invest in fostering structural and psychological empowerment in the work environment.

Staff structural empowerment-Observations of first-line managers and interviews with managers and staff

AIM

The aim was to study how first-line managers act to make structural empowerment accessible for nursing staff and furthermore to relate these observations to the manager's and their nursing staff's descriptions regarding the staff's access to empowering structures.

BACKGROUND

Staff access to empowering structures has been linked to positive workplace outcomes. Managers play an important role in providing the conditions for structural empowerment.

METHOD

Five first-line managers were observed for two workdays. Managers and staff (n = 13) were thereafter interviewed. Field notes and interviews were analysed using directed content analysis.

RESULTS

The managers displayed intentional actions that could enable their staff access to empowering structures. Managers and staff described the importance of staff's access to empowering structures.

CONCLUSION

Staff who perceive to have access to structural empowerment have managers who are present and available. Unanimity among managers and staff existed in regard to the importance of staff having access to structural empowerment. The managers work continually and intentionally, doing many things at the same time, to provide the staff access to empowering structures.

IMPLICATIONS FOR NURSING MANAGEMENT

The study shows the importance of promoting managers' awareness of staff's access to structural empowerment and maximizing managers' presence and availability to their staff.

Socio-demographic predictors of structural empowerment among newly qualified nurses: Findings from an international survey

Objective

To examine the socio-demographic predictors of structural empowerment among an international sample of newly qualified nurses.

Methods

A cross-sectional survey was conducted on 367 newly qualified nurses with up to 18 months of clinical experience. The nurses were recruited from 15 acute care hospitals across KSA, Jordan, and the UK. Data analysis was conducted using the t-test, ANOVA, and hierarchical regression analysis.

Results

Significant differences in the total structural empowerment score were found among participants based on the type of universities where they graduated from (t = 2.36, p < 0.05), if they have received assertive communication training during undergraduate nursing education (t = 3.53, p < 0.05), number of months as qualified nurses (F = 4.79, p < 0.05), type of clinical ward settings they were working in (F = 5.1, p < 0.05), and the country where they were recruited from (F = 14.66) (p < 0.05). Furthermore, the country, type of clinical ward settings they were working in, and type of the university the participants graduated from were found to be significant predictors of the participants’ total structural empowerment score (F = 16.6, p < 0.05).

Conclusions

The findings underscore the unique contributions of the cultural contexts, type of clinical ward setting, and type of former educational setting towards the level of structural empowerment among newly qualified nurses.

Relationship Between Psychological Empowerment and the Retention Intention of Kindergarten Teachers: A Chain Intermediary Effect Analysis

Objective: To investigate the relationship between psychological empowerment, psychological capital, job involvement, and the retention intention of kindergarten teachers in mainland China and the internal mechanism of action.

Methods: A total of 554 kindergarten teachers were investigated by scales for psychological empowerment, psychological capital, job involvement, and retention intention.

Results: (1) Psychological empowerment was positively correlated with psychological capital and job involvement. Psychological capital was positively correlated with job involvement. Psychological empowerment, psychological capital, and job involvement were significantly and positively correlated with retention intention. (2) Psychological empowerment influences kindergarten teachers' retention intention mainly through three indirect effects: the single intermediary effects of psychological capital and job involvement and the chain intermediary effect of psychological capital → job involvement.

Conclusion: Psychological empowerment can not only indirectly predict the retention intention of kindergarten teachers through the single intermediary effects of psychological capital and job involvement, but also indirectly predict the retention intention of kindergarten teachers through the chain intermediary effect of psychological capital and job involvement.

Professional empowerment among Portuguese nursing staff: A correlational study

AIM

To identify the level of professional empowerment in hospital nurses and describe the relationship between sociodemographic variables and professional empowerment.

BACKGROUND

Professional empowerment is positively related to work effectiveness, job satisfaction and organisational and professional commitment.

METHOD

Data on professional empowerment were collected by surveying 365 nurses in a Portuguese hospital, with the Portuguese versions of 'Conditions of Work Effectiveness Questionnaire-II' and the 'Psychological Empowerment Instrument'.

RESULTS

Overall, psychological empowerment scored 66.2 (standard deviation = 8.9, with 'meaning' scoring highest and 'impact' scoring lowest), whereas structural empowerment scored 18.6 (standard deviation = 3.3, with 'opportunity' and 'informal power' scoring highest and 'resources' scoring lowest). The factor 'age' correlated positively with 'self-determination', 'impact' and 'psychological empowerment', as well as with 'informal power', 'resources' and 'structural empowerment'. Lastly, 'competence' correlated negatively with 'formal power', 'information' and 'structural empowerment'.

CONCLUSION

There is a relationship between demographic variables and empowerment, and between structural and psychological empowerment.

IMPLICATIONS FOR NURSING MANAGEMENT

Professional empowerment is related to organisational results, so it is important to reinforce and optimize organisational structures. Empowerment can be achieved with access to structures that promote empowerment, particularly resources.

Staff Working Life and Older Persons' Satisfaction With Care: A Multilevel, Correlational Design

BACKGROUND

The importance of staff working life for staff well-being has been demonstrated in several studies; less research has focused on staff working life and older persons' satisfaction with care.

PURPOSE

The study aim was to study relationships between 1) staff assessments of their structural conditions/empowerment in elderly care, psychological empowerment, and job satisfaction and (2) older persons' satisfaction with care.

METHODS

A multilevel, cross-sectional, and correlational design was applied using questionnaire data on working life (1021 staff members) and unit-level data (40 elderly care units) on older persons' satisfaction with care.

RESULTS

Statistically significant relationships were found between all 3 working life variables and older persons' satisfaction with care. Furthermore, the results revealed an indirect/mediating effect of job satisfaction between structural empowerment and satisfaction with care, but not for psychological empowerment.

CONCLUSIONS

Staff structural empowerment, psychological empowerment, and job satisfaction are linked to older persons' satisfaction with care.

Development and validation of Nurse Managers' Empowering Behavioral Scale for staff nurses

Aim

In this study, we developed and verified the Nurse Managers' Empowering Behavioral Scale for Staff Nurses (NMEB-SN).

Design

A cross-sectional survey.

Methods

The NMEB-SN was developed based on the staff nurses' perspectives. Nurses working in 10 hospitals in Japan were surveyed using a questionnaire to test the scale's validity using construct and criterion-related validity and reliability using internal consistency and test-retest method. There were 1,146 eligible participants included in the process.

Results

The scale items resulted in five subscales comprising of 48 items altogether. The goodness-of-fit indices for confirmatory factor analysis were CFI = 0.903 and RMSEA = 0.076. The correlation with external criteria for criterion-related validity was near the expected standard. Further, Cronbach's α coefficient was 0.95-0.97 for each subscale and 0.99 for the overall scale. The reliability and validity of the developed NMEB-SN were verified for staff nurses in Japan.

Predicting Nurses Burnout through Quality of Work Life and Psychological Empowerment: A Study Towards Sustainable Healthcare Services in Malaysia

The nursing profession is a much-demanded profession that requires the individual capacity to work under intense physical and emotional dynamics in the workplace. Work related factors cause burnout and need attention from scholars and professionals to reduce the effects of the burnout among nursing staff. This study aimed to examine the meditational role of psychological empowerment and work-life quality on the burnout experiences of nursing staff in Malaysia. This study investigated a sample of 432 nursing staff from 10 registered hospitals in the Selangor area that have been listed on the Malaysian Health Tourism Council (MHTC) website. The responses collected via a self-reported questionnaire, and the data was analyzed using partial least square regression structural equation modelling (PLS-SEM). The findings statistically support the argument that the provision of quality of work-life (adequate and fair compensation, constitution in the work organization, safe and healthy working conditions, social integration in the work organization, social relevance of work-life, and work and life span) could promote psychological empowerment among nurses. Psychological empowerment statistically resulted in reducing the burnout effects by mediating the effect of work-life quality (QWL) on burnout. This study contributes to the literature that QWL factors need to be studied separately, and its affects on psychological empowerment, and how psychological empowerment permits curtails the effects of the burnout among nursing staff providing the services to health tourists. This study also provided important implications for the management staff of the nursing industry to initiate the management of burnout with the provision of psychological employment. The present study contributed to the current literature of burnout management through the psychological empowerment provided by the factors of the quality of work life.

Effect of Psychological Empowerment on Nurses Burnout

Objective:

The health industry needs motivated and satisfied nursing staff to provide quality health services to medical tourists, as well as in other sectors. This study aimed to examine the effects of psychological empowerment on the dimensions of burnout among the Malaysian nursing staff, as well as exploring the role of age, gender, experience, and marital status on the perception of burnout dimensions.

Methods:

This survey used a sample of 432 nursing staff, using measures of the perception of empowerment and comparing variables with another measure of burnout, collected via a self-reported questionnaire. Data were analyzed using PLS-SEM. Moreover, the group analysis in PLS-SEM estimated the differences among the nursing staff’s perception of psychological empowerment on burnout factors.

Results:

The findings reveal that psychological empowerment reduces the impact of burnout symptoms. Moreover, gender and age are different for depersonalization by the perception of psychological empowerment among the nursing staff in Malaysia. The Malaysian nursing staff’s marital status influences the relationships between psychological empowerment and depersonalization, as well as emotional exhaustion and personal unfulfillment. Moreover, the experience of the nursing staff influences the perception of personal unfulfillment in a significant manner.

Conclusion:

This study offered important managerial implications, such as considering the nursing staff’s needs according to age, gender, material status, and working experience to address burnout issues of emotional exhaustion, depersonalization, and personal unfulfillment. Moreover, it is important to note that the different factors of burnout are perceived differently by the nursing staff based on their attributes. There is a need to utilize the provision of psychological empowerment needs.

Impact at two years of an intervention on empowerment among medical care teams: study protocol of a randomised controlled trial in a large French university hospital

BACKGROUND

Empowerment of hospital workers is known as a key factor of organizational performance and occupational health. Nevertheless, empowering workers remains a real challenge. As in many traditional organizations, hospitals follow a bureaucratic model defined by a managerial culture of control and a stratified organization, which at once weaken professionals' mastery of their work and hinder their commitment and performance. Based on the existing literature this protocol describes a new managerial and organizational transformation program as well as the study design of its effect on worker empowerment in a large French public hospital. The project is funded by the French Ministry of Health for a total of 498,180 €.

METHODS

This study is a randomized controlled trial conducted in a French university hospital complex (CHU). The CHU comprises 12 sub-centers (SC) with about 20 care units and 1000 employees each. Randomization is performed at SC level. The intervention lasts 12 months and combines accompaniment of healthcare teams, frontline managers and SC directors to empower first-line professionals in the experimental SC. Quantitative outcome measurements are collected over 2 years during mandatory check-ups in the occupational medicine department. The primary outcomes are structural and psychological empowerment, motivational processes, managerial practices, working conditions, health and performance. Mixed linear modeling is the primary data analysis strategy.

DISCUSSION

The protocol was approved by the CHU health ethics committee. The results of the analysis of the intervention effects will be reported in a series of scientific articles. The results will contribute to reflection on prevention and management policies, and to the development of Workplace Quality-of-Life. If the intervention is a success, the system will warrant replication in other SCs and in other health facilities.

TRIAL REGISTRATION

The study was retrospectively registered at ClinicalTrials.gov on July 4, 2019 (NCT04010773).

Nurse graduates' experiences and support needs: A qualitative systematic review of South Africa's community service programme

BACKGROUND

The student-to-nurse graduate transition is a pivotal phase in the professional development of nurses. In South Africa, this transition is part of a compulsory community service programme, which requires newly graduated nurses to work in rural and/or underserved areas for a period of 1 year.

OBJECTIVES

The aim of this study was to review nurse graduates' experiences and support needs during their transition in the compulsory community service programme.

METHODS

A qualitative systematic review of experiences was conducted. Qualitative research studies that addressed nurses' experience in South Africa (2008-2017) were identified in Cochrane, Joanna Briggs Institute (JBI), Academic Search Complete, CINAHL, PubMed, SABINET, Science Direct, SCOPUS and Google Scholar databases. The systematic review methods included searching, sifting, abstracting and quality assessment of relevant qualitative studies by two reviewers and cross-checking by a third reviewer. Two reviewers independently performed blinded data extraction and quality assessment using the confidence in qualitative synthesis findings (ConQual) approach.

RESULTS

A total of 1257 studies were identified of which 12 met the inclusion criteria. Seven of the 12 studies were published articles and six were theses. The quality of the studies was found to be of high standard based on the ConQual rating. Four main themes emerged from the analysis: (1) rich developmental experiences through practice exposure, (2) difficulties in reconciling theory and practice, (3) contextual challenges in the workplace and (4) need for professional support structures, educational measures and public guidelines.

CONCLUSION

Although positive experiences were reported, various challenges emerged, indicating the need for more systematic support mechanisms during transition.

Core Burnout and Power in Portuguese Nursing Staff: An Explanatory Model Based on Structural Empowerment

In the nursing context, structural empowerment has proved to be an organizational tool leading to the prevention of stress and burnout. Structural empowerment is defined as the perception of the presence or absence of empowering conditions in the workplace. However, few studies have explored the particular relationships between power in organizations, structural empowerment, and burnout. The aim of this study was to examine the mediator role of structural empowerment (access to opportunities, information, support, and resources) in the relationship between formal and informal power, and core burnout among Portuguese nurses. We administered a questionnaire among a convenience sample of 304 nurses employed in public hospitals. Model fit and mediation analysis were conducted using path analysis and bootstrapping methods. Formal power, informal power, access to opportunities, and access to resources were significant and negative predictors of core burnout. Opportunities, resources, and informal power had a direct influence on core burnout. Formal power and informal power showed an indirect influence, mediated by opportunities and resources, on core burnout. These findings suggest that by providing nurses with high levels of formal and informal power, as well as access to resources and opportunities, their risk of core burnout can be lowered.

Selected Socio-Demographic and Occupational Factors of Burnout Syndrome in Nurses Employed in Medical Facilities in Małopolska-Preliminary Results

The study examined the relationship between socio-demographic and occupational factors and the level of occupational burnout using the dimensions of emotional exhaustion (EE), depersonalization (DEP), and personal accomplishment (PA). It examined 560 nurses working in hospitals and primary healthcare units. We used: Maslach Burnout Inventory and a questionnaire including socio-demographic (sex, age, marital status, education, parental status) and occupational (period of employment, workplace, managerial functions, additional employment) factors. An average respondent was 38.13 (SD = 10.16) and had a BA degree (56.0%). The respondents reported average values of the EE (22.8), a low level of DEP (Me = 6), and a low PA (27.63). Nurses working on the intensive care unit had a chance of a high level of DEP that was 75% lower (OR = 0.25, 95% CI = 0.13–0.50) than nurses working in conservative treatment units. Additional employment increased the risk of a high level of DEP (OR = 2.86, 95% CI = 1.70–4.84). The chance of low PA was 64% lower in the case of nurse managers (OR = 0.36, 95% CI = 0.13–0.998) than other nurses. Education, period of employment, additional employment, and managerial position had a significant influence on the level of occupational burnout. An analysis of nurses’ work overload and additional employment can be an interesting research area.

Connection between organizational culture and climate and empowerment: The perspective of nurse managers

Health-care organizations differ from other institutions due to their unique structure and management. Organizational culture and climate are the key constructs that compose the organizational social context, and might have an impact on employees, such as nurse managers, and the organization itself. The aim of this study was to analyze the connections between organizational culture and climate and work-related empowerment, and also to present culture and climate profiles at team and organization levels. The research was carried out in Lithuania among 193 nurse managers in seven hospitals using a questionnaire that measured organizational culture and climate (Organizational Social Context instrument), and work-related empowerment (Conditions for Work Effectiveness Questionnaire-II and Work Empowerment Questionnaire). The findings showed that nurse managers were both structurally and psychologically empowered when the organizational culture was proficient and resistant, and the climate was engaged and functional. These results suggest that nurse managers are more likely to be empowered when there is an appropriate organizational culture and climate in the workplace. Creating an empowering work environment might have a positive impact on individual and organizational outcomes.

Innovative behaviour and career success: Mediating roles of self-efficacy and colleague solidarity of nurses

Objectives

The purpose of the study is to explore the relationships amongst innovative behaviour, self-efficacy, colleague solidarity of nurses and career success of nurses in Mainland China.

Method

This study used the cross-sectional investigation method and nurses were recruited from eight tertiary hospitals and four secondary hospitals in Tianjin, China. A convenience sample of 848 nurses was included in this survey. Structural equation model analysis was performed as well.

Results

Results revealed that the nurses' career success score was at the medium degree, whilst innovative behaviour and self-efficacy were in the medium–high level and had high level of colleague solidarity. The four variables include innovative behaviour, self-efficacy, colleague solidarity of nurses and career success; each dimension showed positive correlation (r = 0.145 to 0.923, P < 0.05). Independent sample T-test showed no significant differences between the two types of hospitals in the main variables (P > 0.05). Multiple linear regression analysis showed that innovative behaviour, self-efficacy and academic solidarity entered the career success regression equation (β = 0.091 to 0.560, P < 0.05), thereby possibly explaining 52.0% of the total variation. Hierarchical regression analysis and path analysis model showed that self-efficacy and colleague solidarity of nurses played mediating roles between innovative behaviour and career success (β = 0.132 to 0.221, P < 0.05).

Conclusion

The level of career success of nurses remains to be improved. Additionally, high innovative behaviour, self-efficacy and colleague solidarity of nurses can improve the career success of Chinese nurses.

Development of an empowerment model for burnout syndrome and quality of nursing work life in Indonesia

Objectives

This study aimed to develop an empowerment model for burnout syndrome and quality of nursing work life (QNWL).

Methods

This study adopted a mixed-method cross-sectional approach. The variables included structural empowerment, psychological empowerment, burnout syndrome and QNWL. The population consisted of nurses who have civil servant status in one of the regional hospitals in Indonesia. The participants were recruited using multi-stage sampling measures with 134 respondents. Data were collected using questionnaires, which were then analysed using partial least squares. A focus group discussion was conducted with nurses, chief nurses and the hospital management to identify strategic issues and compile recommendations.

Results

Structural empowerment influenced psychological empowerment (path coefficient = 0.440; t = 6.222) and QNWL (path coefficient = 0.345; t = 4.789). Psychological empowerment influenced burnout syndrome (path coefficient = −0.371; t = 4.303), and burnout syndrome influenced QNWL (path coefficient = −0.320; t = 5.102). Structural empowerment increased QNWL by 39.7%.

Conclusion

The development of a structural empowerment model by using the indicators of resources, support and information directly influenced the psychological empowerment of the sample of nurses. As an indicator of meaning, psychological empowerment decreased burnout syndrome. In turn, burnout syndrome, as the indicator of personal achievement, could affect the QNWL. Structural empowerment directly influenced the QNWL, particularly within the workplace context. Further studies must be conducted to analyse the effects of empowerment, leadership styles and customer satisfaction.

Correlates of structural empowerment, psychological empowerment and emotional exhaustion among registered nurses: A meta-analysis

OBJECTIVE

To conduct a meta-analysis on the relationship between structural empowerment, psychological empowerment and burnout for registered nurses.

METHODS

Cross-sectional studies that focused on the correlation between burnout, structural empowerment and psychological empowerment of nurses from 1990 to date were searched in Cochrane Library, Web of Science, BMJ, Elsevier, PubMed and CNKI databases. Two reviewers conducted critical appraisal, and extracted correlation coefficient (r) values. Tests of heterogeneity (Q-statistic) were performed to investigate the effect sizes.

RESULT

Twenty-four studies met the inclusion criteria. For registered nurses, the results of the meta-analysis indicated that there were weak relationship between structural empowerment and emotional exhaustion (r = -0.2450). In addition, there was a low correlation between structural empowerment and emotional exhaustion (r = -0.4301). However, a moderate relationship was seen between structural empowerment and psychological empowerment (r = 0.5717).

CONCLUSION

These results are considered useful guides for hospital managers and nursing professionals in formulating policies and regulations aimed at decreasing emotional exhaustion among nurses.

Nurses' Burnout: The Influence of Leader Empowering Behaviors, Work Conditions, and Demographic Traits

Nurse burnout is a widespread phenomenon characterized by a reduction in nurses' energy that manifests in emotional exhaustion, lack of motivation, and feelings of frustration and may lead to reductions in work efficacy. This study was conducted to assess the level of burnout among Jordanian nurses and to investigate the influence of leader empowering behaviors (LEBs) on nurses' feelings of burnout in an endeavor to improve nursing work outcomes. A cross-sectional and correlational design was used. Leader Empowering Behaviors Scale and the Maslach Burnout Inventory (MBI) were employed to collect data from 407 registered nurses, recruited from 11 hospitals in Jordan. The Jordanian nurses exhibited high levels of burnout as demonstrated by their high scores for Emotional Exhaustion (EE) and Depersonalization (DP) and moderate scores for Personal Accomplishment (PA). Factors related to work conditions, nurses' demographic traits, and LEBs were significantly correlated with the burnout categories. A stepwise regression model-exposed 4 factors predicted EE: hospital type, nurses' work shift, providing autonomy, and fostering participation in decision making. Gender, fostering participation in decision making, and department type were responsible for 5.9% of the DP variance, whereas facilitating goal attainment and nursing experience accounted for 8.3% of the PA variance. This study highlights the importance of the role of nurse leaders in improving work conditions and empowering and motivating nurses to decrease nurses' feelings of burnout, reduce turnover rates, and improve the quality of nursing care.

Empowerment and performance of managers and subordinates in elderly care: A longitudinal and multilevel study

AIM

To investigate relationships between first-line managers' ratings of structural and psychological empowerment, and the subordinates' ratings of structural empowerment, as well as their ratings of the managers' leadership-management performance.

BACKGROUND

Work situations in elderly care are complex. To date, few studies have used a longitudinal, correlational and multilevel design to study the working life of subordinates and managers.

METHOD

In five Swedish municipalities, questionnaires were answered twice during 2010-12 by 56 first-line managers and 769 subordinates working in nursing homes or home-help services.

RESULTS

First-line managers' empowerment at Time 1 partially predicted subordinate's structural empowerment and ratings of their managers' leadership-management performance at Time 2. Changes over time partially revealed that the more access managers had to structural empowerment, i.e. increase over time, the higher the ratings were for structural empowerment and managerial leadership-management performance among subordinates.

CONCLUSIONS

Findings strengthen research and theoretical suggestions linking first-line managers' structural empowerment to their subordinates' structural empowerment and ratings of their manager's leadership-management performance.

IMPLICATIONS FOR NURSING MANAGEMENT

Managers with high access to structural empowerment are more likely to provide subordinates access to structural empowerment.

Validation of work pressure and associated factors influencing hospital nurse turnover: a cross-sectional investigation in Shaanxi Province, China

Background

Nurses' turnover is a major contributor to nursing shortages, strongly influenced by nurses’ intentions to leave. Several factors influencing the turnover intention have been well identified in Western countries and large cities in China. However, whether these factors also contribute to nurses' work stress in Midwest China are still unclear. The main purpose of this study was to examine the work pressure and associated factors influencing the nurses’ intent to leave.

Methods

A cross-sectional questionnaire-based survey with multistage sampling was conducted by recruiting 800 employed registered nurses with >1 year of work experience. Chi-square test and multi-factor logistic regression were applied to attain the relative comparisons. Sub-group analysis was conducted to explore the different turnover intention patterns in different age groups.

Results

The turnover intention was classified as strong/very-strong (19%), weak (62%), and very-weak (19%). Among the factors influencing the nurses’ desire to leave the profession, work pressure was the most prominent. The predominantly associated factors contributing the work stress were age, experience, and workload. However, the scale of income did not affect the intent to leave decision. Pediatrics was identified to be the highest tormented department with a significant (P < 0.05) turnover of nurses. Among different age sub-groups, 30–39 age group nurses in Secondary hospitals demonstrate a stronger intent to leave.

Conclusion

Nurses’ turnover intentions were associated with stress, age, job duty, and career commitment in Shaanxi Province. The intent to leave is dynamically multifactorial, and effective managements and supportive strategies are needed to reduce the nurses work stress accordingly.

The effect of a psychological empowerment program based on psychodrama on empowerment perception and burnout levels in oncology nurses: Psychological empowerment in oncology nurses

Objective:

Oncology nursing is stressful by its nature, and nurses in the field experience a high amount of stress and burnout. In order to cope with occupational stress, nurses need to employ flexible adjustment mechanisms that allow them the power to process their experiences. Failure of efficient stress management causes burnout, and burnout is closely related to powerlessness. It is therefore believed that the occurrence of burnout can be reduced by means of psychological empowerment of nurses. Our study was conducted to determine the effect of a “psychodrama-based psychological empowerment program” on (1) the perception of empowerment and (2) the levels of burnout in oncology nurses.

Method:

The sample was made up of 82 oncology nurses (38 nurses in the study group and 44 in the control/comparison group). Study data were collected using the Psychological Empowerment Scale, the Nurse Work Empowerment Scale, and Maslach's Burnout Inventory. The study group attended a “psychodrama-based psychological empowerment program” (2 hours, 1 day a week, for 10 weeks). For data assessment, we employed an independentttest and one-way analysis of variance.

Results:

The psychological empowerment and workplace empowerment scores of nurses in the study group increased and their burnout scores decreased following attendance in the psychodrama-based psychological empowerment program.

Significance of results:

We found that the psychodrama-based psychological empowerment program increased psychological empowerment and enhanced perception of workplace empowerment while decreasing levels of burnout in oncology nurses. The program is recommended and should allow oncology nurses to benefit from their personal experiences and thus increase self-empowerment, to enhance their perception of empowerment, and to prevent burnout.