Effects of nurse work environment on job dissatisfaction, burnout, intention to leave

Psychometric properties of the Persian version of the workplace fun scale among nurses: a cross-sectional study

Previous research has highlighted the importance of workplace fun in enhancing employee satisfaction and performance, particularly in high-stress professions like nursing. However, a notable gap exists in understanding how workplace fun is perceived and measured among nurses in Persian-speaking countries. This study addresses this gap by translating the Workplace Fun Scale and assessing its psychometric properties among nurses. The findings will provide insights into the scale's applicability in these contexts and pave the way for healthcare organizations to significantly explore ways to enhance nurses' enjoyment of work in Persian-speaking countries. This survey, which involved 321 nurses from medical education centers in Ardabil, was conducted with a meticulous and rigorous methodology. Standard questionnaires collected the data, including a demographic form and the translated Workplace Fun Scale. The study examined the three aspects of workplace fun: fun activities, coworker socializing, and manager support for fun. Confirmatory factor analysis was used to validate the structure, and reliability was assessed through retest coefficients, Cronbach's alpha coefficients, and composite reliability coefficients. The data were analyzed using SPSS version 14 and LISREL version 8.8, ensuring the highest research standards. The validity of both form and content was confirmed through translation and reverse translation. The Workplace Fun Scale showed high internal consistency and reliability, with significant Cronbach's alpha coefficients, composite reliability, and two-week retest coefficients of 0.859, 0.885, and 0.459, respectively (all at the p < 0.01 level). Fit indices, including GFI (0.97), AGFI (0.94), CFI (0.99), NFI (0.98), TLI (0.97), and SRMR (0.04), indicated a good fit of the measurement model, confirming the validity of the scale in assessing workplace fun. The confirmatory factor analysis results indicated that the translated version of the workplace fun scale, adapted from Tews, exhibited a robust factor structure and internal homogeneity within the Iranian sample. Furthermore, the scale demonstrated positive internal validity and reliability in Persian translation. These findings suggest that the scale possesses acceptable psychometric properties, making it a valuable tool for assessing workplace fun among nurses in Persian-speaking countries.

Addressing Registered Nurse Retention and Attrition in Thailand Hospitals: An Integrative Review

Thailand is one of the Southeast Asia countries that has been significantly impacted by Registered Nurse (RN) workforce shortages. This integrative review aims to critically analyze factors influencing the attrition and retention of RNs practicing in Thailand's hospital sector. The databases searched included CINAHL (via EBSCOhost), EMBASE, Nursing Allied (via ProQuest), Ovid, Scopus, Web of Science, and Medline. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were utilized to record the search strategy findings in compliance with the review standards, while the Mixed-Methods Appraisal Tool (MMAT) was used to appraise quality. Sources for review totaled 35, using quantitative methods (n = 30), qualitative methods (n = 3), and mixed methods (n = 2). Thematic analysis revealed factors that challenge RNs' job motivation fueled by a lack of autonomy, a loss of confidence and sense of competence, and negative workplace relations with co-workers, resulting in poor job satisfaction. Future research is needed to elicit an understanding of "how" Thai RNs sense of autonomy, competence, and relatedness in their workplace practice provides insight into "why" they choose to remain employed or leave the nursing workforce.

The impact of the nursing work environment on compassion fatigue: The mediating role of general self-efficacy

AIM

To explore the interplay between the perceived nursing work environment, general self-efficacy, and compassion fatigue among registered nurses in Chinese hospitals.

BACKGROUND

Compassion fatigue emerges as a significant occupational stress response globally, with the nursing work environment being a pivotal influencer. There is a knowledge gap in understanding how the nursing work environment and general self-efficacy interrelate to affect compassion fatigue, particularly among Chinese nurses.

METHODS

Employing a cross-sectional, descriptive design, this study utilized validated questionnaires to gather data from 7085 nurses across public and private hospitals in China. The analysis focused on assessing the interrelations among the perceived nursing work environment, general self-efficacy, and different dimensions of compassion fatigue.

FINDING

More than half (65.67%) of the participants experienced moderate or high burnout levels, with 76.43% experiencing secondary traumatic stress. The lowest rating in the nursing work environment was for nurse/physician collaboration (10 ± 2.07), while general self-efficacy scored higher (27.54 ± 6.26). A positive relationship existed between the work environment and both general self-efficacy and compassion satisfaction, with a negative correlation to burnout and traumatic stress. General self-efficacy was a partial mediator in the link between work environment and compassion fatigue, suggesting that improving the work environment can decrease compassion fatigue by boosting nurses' self-efficacy.

CONCLUSION

This study underscores the profound impact of the nursing work environment on compassion fatigue, mediated by general self-efficacy. It highlights the necessity of fostering a supportive work environment to enhance nurses' self-efficacy and overall well-being.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Healthcare managers and institutions must create supportive work environments to reduce compassion fatigue among nurses. This includes professional development programs to enhance self-efficacy and job satisfaction. Policies should address high workloads and inadequate support. Nurse leaders should foster environments that promote psychological well-being, improving outcomes for both nurses and patients. Regular assessments and adjustments of work conditions are essential to maintain a healthy work environment.

Influence of nurse work environment and psychological distress on resignation from hospitals: a prospective study

With the global nurse shortage, identifying nurse work environments that allow nurses to continue working is a common concern worldwide. This study examined whether a better nurse work environment (1) is associated with reducing nurses' psychological distress; (2) reduces nurse resignations; (3) weakens the influence of psychological distress on their resignation through interaction effect; and (4) whether psychological distress increases nurse turnover. Multilevel logistic regression analyses were performed using data obtained in 2014 from 2,123 staff nurses from a prospective longitudinal survey project of Japanese hospitals. The nurse work environment was measured by the Practice Environment Scale of the Nursing Work Index (PES-NWI) consisting of five subscales and a composite, and psychological distress by K6. All the PES-NWI subscales and composite (ORs 0.679-0.834) were related to K6, significantly. Regarding nurse turnover, K6 had a consistent effect (ORs 1.834-1.937), and only subscale 2 of the PES-NWI had a direct effect (OR 0.754), but there was no effect due to the interaction term. That is, (1) and (4) were validated, (2) was partly validated, but (3) was not. As better work environment reduces K6 and a lower K6 decreases nurses' resignation, high-level hospital managers need to continue improving the nurse work environment.

Effects of job demands, job resources, personal resources on night-shift alertness of ICU shift nurses: a cross‑sectional survey study based on the job demands-resources model

BACKGROUND

A positive work environment can enhance nursing safety and patient satisfaction while alleviating nurse stress. Conversely, a poor work environment can harm nurses' physical and mental health and compromise the quality of care, particularly in the high-intensity and shift-based setting of the ICU.

OBJECTIVES

Based on the Job demands-resources (JD-R) model, this study examined the effects of job demands and job resources in the work environment, as well as personal resources, on the night-shift alertness of ICU shift nurses.

METHODS

This cross-sectional correlational exploratory study, conducted from July to September 2022, recruited 291 ICU shift nurses from a hospital in Beijing, China. The Copenhagen Psychosocial Questionnaire (COPSOQ), the Self-resilience scale, the General Self-Efficacy Scale (GSES), and the Psychomotor Vigilance Task (PVT) were used to subjectively and objectively measure the job demands, job resources, personal resources, and night-shift alertness. SPSS 26.0 and Mplus 8.3 were used to analyze the data and construct the structural equation model.

RESULTS

The night-shift reaction time was 251.0 ms (Median), indicating a relatively high level of alertness. Job demands were negatively correlated with both job resources (r=-0.570, P < 0.001) and personal resources (r=-0.462, P < 0.001), while a positive correlation existed between job resources and personal resources (r = 0.554, P < 0.001). The results show that increased job demands can lead to higher levels of nurse strain (β = 0.955, P < 0.001), whereas job resources were found that it can decrease strain (β=-0.477, P = 0.047). Adequate job resources can enhance motivation directly (β = 0.874, P < 0.001), subsequently reducing reaction time (β=-0.148, P = 0.044) and improving night-shift alertness among ICU shift nurses.

CONCLUSION

Enhancing ICU shift nurses' work motivation through bolstering job resources can boost night-shift alertness. However, it is noteworthy that, in this study, neither strain nor individual resources significantly influenced nurses' night-shift alertness. This may be attributed to the complexity of the ICU environment and individual differences. Future research should explore the relationship between these factors and nurses' work alertness.

Supporting and Retaining Nurses in Trying Times

The nursing profession has witnessed its share of challenging and trying times including toxic or unhealthy work environments, unsustainable workloads, an aging workforce, inadequate staffing, nurse burnout, staff retention, inadequately trained staff, an increase in workplace violence, and several pandemics. Both individually and collectively, these thorny issues have placed a heavy burden on nurses. Unfortunately, many capable and competent nurses have left the profession altogether, which further compounds an already problematic situation. This article highlights several important strategies for recruiting, retaining, and supporting a high functioning nursing workforce in challenging and trying times.

The humanistic care ability of nurses in 27 provinces in China: a multi-center cross-sectional study

Background

Currently, studies found that the humanistic care ability of nurses is at low level in China, resulting in patients' concerns and dissatisfaction regarding the lack of empathy among nurses. We aimed to explore the factors that influence nurses' humanistic care ability, providing a new perspective on improving patient satisfaction and promote high quality medical services.

Methods

A multi-center cross-sectional study recruited nurses from tertiary and secondary hospitals in China between July 2022 and August 2022. Data concerning self-developed questions on nurses' socio-demographic data and Caring Ability Inventory (CAI) were collected through the Questionnaire Star Platform, using a multi-stage sampling method.

Results

The total score for the level of caring ability among the 15,653 surveyed Chinese nurses was 192.16 ± 24.94. Various factors significantly influence the level of humanistic care ability, including professional title, department, degree of passion for the job, job satisfaction, emphasis on self-care, participation in humanistic care training, support from family for the job, relationships with colleagues, satisfaction with salary, and previous experience working in pilot wards emphasizing humanistic care (p < 0.01).

Conclusion

At present, nurses exhibit a comparatively modest proficiency in humanistic care ability. Numerous factors contribute to this situation. Nursing administrators ought to enhance the scope of humanistic care practices, conduct consistent professional training sessions, advocate for the implementation of model wards emphasizing humanistic care, foster a supportive organizational culture conducive to nurses, and underscore the significance of both nurturing nurses and promoting self-care among them.

Learning from a crisis: a qualitative study on how nurses reshaped their work environment during the COVID-19 pandemic

BACKGROUND

The global nursing shortages exacerbated by the COVID-19 pandemic necessitated a drastic reorganization in nursing practices. Work routines, the composition of teams and subsequently mundane nursing practices were all altered to sustain the accessibility and quality of care. These dramatic changes demanded a reshaping of the nurses' work environment. The aim of this study was to explore how nurses reshaped their work environment in the early stages of the COVID-19 pandemic.

METHODS

A descriptive study comprising 26 semi-structured interviews conducted in a large Dutch teaching hospital between June and September 2020. Participants were nurses (including intensive care unit nurses), outpatient clinic assistants, nurse managers, and management (including one member of the Nurse Practice Council). The interviews were analysed with open, axial, and selective coding.

RESULTS

We identified five themes: 1) the Nursing Staff Deployment Plan created new micro-teams with complementary roles to meet the care needs of COVID-19 infected patients; 2) nurse-led adaptations effectively managed the increased workload, thereby ensuring the quality of care; 3) continuous professional development ensured adequate competence levels for all roles; 4) interprofessional collaboration resulted in experienced solidarity, a positive atmosphere, and increased autonomy for nurses; and, 5) supportive managers reduced nurses' stress and improved work conditions.

CONCLUSIONS

This study showed that nurses positively reshaped their work environment during the COVID-19 pandemic. They contributed to innovative solutions in an environment of equal interprofessional collaboration, which led to greater respect for their knowledge and competencies, enhanced their autonomy and improved management support.

Exploring the Relationship between Surface Acting, Job Stress, and Emotional Exhaustion in Health Professionals: The Moderating Role of LMX

Rapid organizational changes due to technological advancements, high-efficiency expectations, and uncertainties, particularly in healthcare, have led to a global stress epidemic among em-ployees. This has been exacerbated by the COVID-19 pandemic and evolving workplace practices. Surface acting, or the suppression and faking of emotions, significantly contributes to this stress and burnout, impacting not only individual healthcare professionals but also healthcare systems' overall effectiveness and sustainability. Providing adequate resources in high-demand work environments is, thus, essential to mitigate these negative experiences. Leader-member exchange (LMX) can play a pivotal role in understanding and addressing the needs and expectations of healthcare professionals. Drawing on Conservation of Resources (COR), Job Demands-Resources (JD-R), Social Exchange theories, and Grandey's Emotional Regulation Model, this study analyzed data from a convenience sample of 350 healthcare professionals. The results reveal that surface acting intensifies healthcare professionals' experiences of job stress and emotional exhaustion. Notably, the study empirically demonstrated that high levels of LMX in healthcare professionals' relationships with their leaders can mitigate the impact of surface acting on job stress and emotional exhaustion. These findings offer valuable insights for managers and policymakers, highlighting the importance of LMX in maintaining sustainable management practices in complex and stressful healthcare organizations.

New nurses' practice environment, job stress, and patient safety attitudes: a cross-sectional study based on the job demands-resources model

BACKGROUND

Patient safety is paramount for all healthcare agencies. Health professionals' lack of patient safety competencies threaten patients' lives, and increase patients, families, hospitals, and social burdens. The new nurse-related patient safety issues have particularly attracted much attention. The aim of this study was to examine the impacts of practice environment and job stress on new nurses' patient safety attitudes by employing the job demands-resources model.

METHODS

The study used a cross-sectional structural equation modeling (SEM). A convenience sample of 370 new nurses was recruited from seven tertiary hospitals in Anhui province, China, from April 2022 to August 2022. Data were collected using self-report questionnaires including the Chinese version of the Nurse Job Stressors Scale, the Practice Environment Scale, and the Safety Attitudes Questionnaire.

RESULTS

New nurses' patient safety attitudes scores were moderate (126.99 ± 14.39). Practice environment had a significant direct effect on job stress (β = -0.337, t = 6.120), patient safety attitudes (β = 0.604, t = 13.766), practice environment had an indirect effect on patient safety attitudes through job stress (β = 0.066, t = 3.690), and the indirect effect accounted for 9.9% of the total effect. This model was able to explain 48.3% of patient safety attitudes with moderate prediction accuracy.

CONCLUSIONS

This study emphasizes the importance of improving new nurses' attitudes toward patient safety. Hospital administrators should develop policies and strategies to address job characteristics, and establish a favorable work environment to reduce new nurses' job stress as well as to improve patient safety.

Effects of work environments on satisfaction of nurses working for integrated care system in South Korea: a multisite cross-sectional investigation

BACKGROUND

Nurses' satisfaction has an impact on organizational and patient outcomes. Integrated care system in South Korea was established in 2015 to improve care quality and decrease caregiving burden. Since then, nurses' satisfaction has increased due to an increase in nursing staffing. However, besides nurse staffing, various work environments still affect nurse satisfaction.

METHODS

Individual online surveys were conducted with participants to determine their personal characteristics, work environments, and hospital characteristics. We used mixed-effects linear regression equation contained both fixed and random effects.

RESULTS

This study included 2,913 nurses from 119 hospitals. Their average job satisfaction was less than 6 points out of 10 points. Age, shift type, perceived workload, and delegation criteria were significant factors influencing nurses' satisfaction. There was no significant factor among hospital characteristics. The satisfaction level of nurses was high for no-night rotating shift, low perceived workload, and clear delegation criteria.

CONCLUSIONS

Nurses' satisfaction is affected by several work environmental factors. Low nurse satisfaction has a substantial impact on both patients and nurses. Therefore, nurse managers and hospitals should determine factors influencing their satisfaction and develop strategies to improve their satisfaction.

Variables that predict nurses' job stress and intention to leave during the COVID-19 pandemic in Turkey

AIM

To investigate the variables predicting job stress and intention to leave the job among nurses during the COVID-19 pandemic in Turkey.

DESIGN

This research was designed as an analytical cross-sectional study.

METHODS

The population of the study consisted of 450 nurses working in a training and research hospital (N = 450). The study sample consisted of 178 nurses who worked in that hospital between February and July 2021. The Nurse Information Form, Job Stress Scale, and Intention to Leave Scale were used as data collection tools. The independent-sample t-test, one-way analysis of variance, and Pearson correlation analysis were applied for univariate analysis while multiple regression analysis was used for multivariate analysis.

RESULTS

It was determined that the main factors predicting nurses' job stress levels were their Intention to Leave Scale scores, level of organizational satisfaction. The main factors predicting intention to leave were their Job Stress Scale scores, working conditions, and job satisfaction. A positive moderate correlation was found between job stress and intention to leave.

CONCLUSION

This study demostares that among nurses during the COVID-19 pandemic, the predictors of job stress were intention to leave and organizational satisfaction, while the predictors of turnover intention included job stress, working conditions, and job satisfaction. Hospital managers, especially nursing services managers, should develop strategies for extraordinary situations such as pandemics and evaluate the professional satisfaction of nurses while providing a healthy working environment.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contributions.

Factors that contribute to turnover and retention amongst emergency department nurses: A scoping review

BACKGROUND

Internationally, the emergency nursing workforce shortage is of critical concern.

AIM

To synthesise the evidence and assess the scope of literature regarding factors that contribute to turnover and retention amongst emergency nurses.

METHOD

A scoping review using the Joanna Briggs Institute approach was undertaken. Fivedatabases (Embase, MEDLINE, PsycINFO, CINAHL, and Business Source Complete) were searched for papers published in English between January 2011 and June 2023 where the population was nurses, context was the emergency department, and the concept was turnover or retention. A quality appraisal was performed on included studies.

RESULTS

A total of 31 articles met the inclusion criteria. Twenty-six studies focussed on turnover and five studies focussed on retention. Factors that contribute to ED nursing turnover included workplace violence, personal aspects (e.g., burnout or depression), organisational characteristics, and environmental/ job characteristics. Factors that contributed to ED nursing retention included mentoring programs, the advancement in nursing skills, and the transition to practice speciality (emergency) programs.

CONCLUSIONS

A large body of literature exists regarding ED nurses' reasons for leaving their area of practice, yet limited evidence exist on retention. Research exploring factors that promote retention of emergency nurses that leads to subsequent stability and growth in the emergency nursing workforce is needed.

Exploring nurses' experiences: Abandoning the profession and migrating for improved opportunities

AIM

This study explores nurses' experiences in migration for employment and professional abandonment in Barcelona (Spain).

METHODS

Employing a mixed-design approach comprising 1) a qualitative descriptive phenomenological study, followed by 2) a subsequent cross-sectional study, 20 and 225 nurses participated in each study, respectively. Qualitative data, gathered through 4 focus group discussions, underwent inductive thematic analysis, following the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines, while quantitative data were descriptively analyzed.

FINDINGS

Three qualitative themes emerged: 1) Migration motives, such as improved job opportunities, permanent contracts, continuous training, and professional recognition; 2) Reasons for leaving or contemplating leaving the profession, including excessive workload, lack of recognition, limited development, and exhaustion; 3) Nurses' needs, encompassing more staffing, improved remuneration, permanent contracts, flexible schedules, greater autonomy, and career growth. The cross-sectional study revealed a 13.5 % professional abandonment rate at some point across all demographics and seniority levels. Migration trends varied by professional experience, with younger nurses seeking better conditions and opportunities elsewhere.

CONCLUSIONS

Multifactorial causes underlie job migration and professional abandonment, necessitating comprehensive interventions to improve nurses' working and professional conditions.

Turnover intention and its associated factors among nurses in Ethiopia: a systematic review and meta-analysis

BACKGROUND

Nurses turnover intention, representing the extent to which nurses express a desire to leave their current positions, is a critical global public health challenge. This issue significantly affects the healthcare workforce, contributing to disruptions in healthcare delivery and organizational stability. In Ethiopia, a country facing its own unique set of healthcare challenges, understanding and mitigating nursing turnover are of paramount importance. Hence, the objectives of this systematic review and meta-analysis were to determine the pooled proportion ofturnover intention among nurses and to identify factors associated to it in Ethiopia.

METHODS

A comprehensive search carried out for studies with full document and written in English language through an electronic web-based search strategy from databases including PubMed, CINAHL, Cochrane Library, Embase, Google Scholar and Ethiopian University Repository online. Checklist from the Joanna Briggs Institute (JBI) was used to assess the studies' quality. STATA version 17 software was used for statistical analyses. Meta-analysis was done using a random-effects method. Heterogeneity between the primary studies was assessed by Cochran Q and I-square tests. Subgroup and sensitivity analyses were carried out to clarify the source of heterogeneity.

RESULT

This systematic review and meta-analysis incorporated 8 articles, involving 3033 nurses in the analysis. The pooled proportion of turnover intention among nurses in Ethiopia was 53.35% (95% CI (41.64, 65.05%)), with significant heterogeneity between studies (I2 = 97.9, P = 0.001). Significant association of turnover intention among nurses was found with autonomous decision-making (OR: 0.28, CI: 0.14, 0.70) and promotion/development (OR: 0.67, C.I: 0.46, 0.89).

CONCLUSION AND RECOMMENDATION

Our meta-analysis on turnover intention among Ethiopian nurses highlights a significant challenge, with a pooled proportion of 53.35%. Regional variations, such as the highest turnover in Addis Ababa and the lowest in Sidama, underscore the need for tailored interventions. The findings reveal a strong link between turnover intention and factors like autonomous decision-making and promotion/development. Recommendations for stakeholders and concerned bodies involve formulating targeted retention strategies, addressing regional variations, collaborating for nurse welfare advocacy, prioritizing career advancement, reviewing policies for nurse retention improvement.

The Architectural Layout of Long-Term Care Units: Relationships between Support for Residents' Well-Being and for Caregivers' Burnout and Resilience

With a growing need for long-term care facilities in general, and for specialized dementia units in particular, it is important to ensure that the architectural layouts of such facilities support the well-being of both the residents and the unit caregivers. This study aimed to investigate correlations between the support provided by the architectural layout of long-term care units for enhancing residents' well-being and for decreasing unit caregivers' burnout and increasing their resilience-as layouts may impact each party differently. The Psycho Spatial Evaluation Tool was utilized to assess the support provided by the layouts of seventeen long-term care units (ten regular nursing units and seven specialized dementia units) for the residents' physical and social well-being (five dimensions); a questionnaire was used to measure the unit caregivers' burnout and resilience. When analyzing layouts' support for residents' physical and social well-being, inconsistencies emerged regarding correlations with caregivers' burnout and resilience across the two types of long-term care units. Supporting residents' physical well-being was correlated with increased caregiver resilience in dementia units, and with increased burnout and decreased resilience in regular nursing units. Layouts supporting social well-being showed inconsistent correlations with caregivers' resilience indexes in dementia units, and with burnout and resilience indexes in regular nursing units. The findings underscore the role of the architectural layout of long-term care units in enhancing residents' well-being; the results also highlight the possible unintentional yet negative impact of the layout on the caregivers' burnout and resilience. This study emphasizes the need to identify and rectify design shortcomings as a means of enhancing residents' well-being, while increasing the unit caregivers' resilience and decreasing their burnout. These insights should be addressed when developing strategies and interventions for ensuring optimal care environments for all parties involved.

Exploring the relationships between resilience, burnout, work engagement, and intention to leave among nurses in the context of the COVID-19 pandemic: a cross-sectional study

BACKGROUND

Nurses have faced significant personal and professional stressors during the COVID-19 pandemic that have contributed to increased rates of burnout, intention to leave, and poorer work engagement. Resilience has been identified as a critical factor influencing job outcomes; however, the dynamics of this association have not yet been investigated within the context of the Thai workforce. The study objective was to determine the associations between resilience and job outcomes, including burnout, intention to leave, and work engagement among nurses working in Thailand during the COVID-19 pandemic.

METHODS

This cross-sectional study gathered data from a sample of 394 registered nurses employed across 12 hospitals. The research instruments comprised the Connor-Davidson Resilience Scale (CD-RISC), the Maslach Burnout Inventory-Health Services Survey (MBI-HSS), a questionnaire assessing the intention to leave the job, and the Utrecht Work Engagement Scale (UWES). To determine the associations among the measured variables, multivariate logistic regression analyses were conducted.

RESULTS

One-third of nurses experienced emotional exhaustion and depersonalization, and about half experienced reduced personal accomplishment; one-tenth of nurses intended to leave their job. Nurses who exhibited higher levels of resilience were found to have a significantly reduced likelihood of experiencing high emotional exhaustion, depersonalization, and a diminished sense of personal accomplishment. Conversely, these nurses were more likely to report higher levels of work engagement than their less resilience.

CONCLUSION

The COVID-19 pandemic offers important lessons learned about promoting the well-being of the nursing workforce and protecting against adverse job outcomes. While we identified resilience as a significant predictor of several nurse outcomes, other work environment factors should be considered. Government and hospital administrations should allocate resources for individual and organizational-level interventions to promote resilience among frontline nurses so that hospitals will be better prepared for the next public health emergency and patient and nurse outcomes can be optimized.

Systematic RADaR analysis of responses to the open-ended question in the Culture of Care Barometer survey of a Dutch hospital

OBJECTIVES

Systematically measuring the work environment of healthcare employees is key to continuously improving the quality of care and addressing staff shortages. In this study, we systematically analyse the responses to the one open-ended question posed in the Dutch version of the Culture of Care Barometer (CoCB-NL) to examine (1) if the responses offered new insights into healthcare employees' perceptions of their work environment and (2) if the original CoCB had any themes missing.

DESIGN

Retrospective text analysis using Rigorous and Accelerated Data Reduction technique.

SETTING

University hospital in the Netherlands using the CoCB-NL as part of the annual employee survey.

PARTICIPANTS

All hospital employees were invited to participate in the study (N=14 671). In total, 2287 employees responded to the open-ended question.

RESULTS

2287 comments were analysed. Comments that contained more than one topic were split according to topic, adding to the total (n=2915). Of this total, 372 comments were excluded because they lacked content or respondents indicated they had nothing to add. Subsequently, 2543 comments were allocated to 33 themes. Most comments (n=2113) addressed the 24 themes related to the close-ended questions in the CoCB-NL. The themes most commented on concerned questions on 'organisational support'. The remaining 430 comments covered nine additional themes that addressed concerns about work environment factors (team connectedness, team effectiveness, corporate vision, administrative burden and performance pressure) and themes (diversity and inclusion, legal frameworks and collective bargaining, resilience and work-life balance, and personal matters).

CONCLUSIONS

Analysing responses to the open-ended question in the CoCB-NL led to new insights into relevant elements of the work environment and missing themes in the COCB-NL. Moreover, the analysis revealed important themes that not only require attention from healthcare organisations to ensure adequate improvements in their employees' work environment but should also be considered to further develop the CoCB-NL.

Relationship between workplace violence, job satisfaction, and burnout among healthcare workers in mobile cabin hospitals in China: Effects of perceived stress and work environment

Background

Although workplace violence is prevalent in the healthcare system, the relationship between workplace violence, job satisfaction, and burnout among healthcare workers (HCWs) in mobile cabin hospitals in China during the COVID-19 pandemic has not yet been investigated. This study analyzes the mediating effects of perceived stress and work environment in the relationship between workplace violence, job satisfaction, and burnout.

Methods

A cross-sectional study was conducted in December 2022 on 1,199 frontline HCWs working in mobile cabin hospitals in Chongqing, China, during the COVID-19 pandemic. Multiple linear regression and mediation analysis were performed.

Results

A positive correlation was observed between workplace violence and burnout (r = 0.420, P < 0.01) and perceived stress (r = 0.524, P < 0.01), and a negative correlation was observed with job satisfaction (r = -0.254, P < 0.01). The perceived stress was positively correlated with burnout (r = 0.528, P < 0.01) and negatively with job satisfaction (r = -0.397, P < 0.01). Job satisfaction was negatively correlated with burnout (r = -0.300, P < 0.01). Perceived stress plays a significant mediating role between workplace violence and job burnout and between workplace violence and job satisfaction. The work environment has a significant moderating effect between workplace violence and job burnout and between workplace violence and job satisfaction.

Conclusion

To reduce burnout among HCWs, hospital administrators should focus on reducing the incidence of workplace violence and perceived stress from work and on improving the work environment and job satisfaction.

Surgery, innovation, research and sustainable development

In the healthcare sector, surgery (especially in the operating theatre) is responsible for emission of greenhouse gases, which is a source of global warming. The goal of this largely quantitative assessment is to address three questions on carbon footprint associated with surgery, the role of primary and secondary prevention prior to surgical procedures, and incorporation of the carbon footprint into judgment criteria in research and surgical innovations. It appears that while the impact of surgery on global warming is undeniable, its extent depends on means of treatment and geographical location. Before and after an operation, primary, secondary and tertiary prevention accompanied by surgical sobriety (avoiding unnecessary or unjustified actions) can be virtuous in terms of sustainable development. However, the sanitary benefits of these actions are often opposed to environmental benefit, which has yet to be satisfactorily assessed. Lastly, the carbon footprint has yet to be incorporated into research protocols or the innovations under development. This should impel us not only to sensitize the different healthcare actors to relevant issues, but also to improve working conditions.

Assessment of Nursing Practice Environment and Its Influencing Factors: A Cross-Sectional Study at Shandong Province, Jinan

Objective

To investigate the current nursing practice environment in Jinan, Shandong Province, and to identify the factors influencing the practice environment.

Methods

This study is a cross-sectional study for nurses. From October to December 2022, using the clustering and stratified sampling methods, 2426 nurses from internal Medicine, Surgery, Obstetrics and Gynecology, Outpatient Department and Intensive Care Department of the Provincial Hospital of Shandong Medical University were selected and then investigated and analyzed using the revised Nurse Practice Environment Assessment Scale.

Results

The overall mean evaluation of the practice environment scored 75.13±19.87, with a minimum value of 59.74 and a maximum value of 95.82. The items with higher scores were "the hospital has systematic training for new nurses", "the work system is perfect", and "the hospital can provide continuing education for nurses in accordance with the needs of their positions". The items with lower scores were "nurses enjoy legal benefits", "nurses have the opportunity to participate in hospital management decisions", and "nurses have the opportunity to participate in hospital internal management". The results of the multiple linear regression analysis of the factors influencing nurses' practice environment showed that gender, education, position, and years of work were independent influences on nurses' practice environment scores (p < 0.05), and they explained 48.127% of the variation in the total scores of the nurses' practice environment scale. The estimated values (β) of sex, education, cheif nurse, nurses staff, work experience (year), and whether the only child variables were 3.141, 3.237, 2.713, 5.471, 2.074 and 0.732, respectively.

Conclusion

The nurse practice environment still needs to be improved, mainly in terms of hospital management participation, human resource allocation and salary distribution system.

Influence of the work environment of nurses on the 30-day mortality of patients hospitalized in Polish hospitals. cross-sectional studies

BACKGROUND

An optimal work environment for nurses is characterized primarily by appropriate staffing, good team relations, and support from the management staff. These factors are consistently associated with a positive assessment of patient safety by a hospital's employees and a reduction in hospital mortality rates.

AIM

To understand the relationships between the work environment as perceived by nurses on the 30-day mortality of patients treated in Polish hospitals.

BACKGROUND

An optimal work environment for nurses is characterized primarily by appropriate staffing, good team relations, and support from the management staff. These factors are consistently associated with a positive assessment of patient safety by a hospital's employees and a reduction in hospital mortality rates.

MATERIAL AND METHODS

The analysis used discharge data from 108,284 patients hospitalized in internal medicine and surgery departments in 21 hospitals (with 24/7 operations) in Poland. Administrative data included coded data to estimate 30-day mortality. A Nurses' satisfaction questionnaire, including the PES-NWI scale and the SAQ questionnaire, was used to assess the work environment of nurses (n = 1,929). Correlations between variables were assessed using the Pearson coefficient. The analysis used a Poisson regression model, which belongs to the class of generalized linear models.

RESULTS

A lower 30-day mortality rate amongst patients was found among those treated in hospitals where the personnel feel that they may question the decisions or actions of their superiors regarding the care provided (r = - 0.50); nurses are informed about changes introduced on the basis of reports about negligence and mistakes (r = - 0.50); the ward nurse is a good manager (r = - 0.41); nurses receive timely information from the head of the department that may have an impact on their work (r = - 0.41).

CONCLUSIONS

Factors related to care during hospital stay such as the organization of care at the ward level, analysis of care errors, the number of staff providing direct patient care, informing nurses about mistakes without punishment, and the possibility of nurses challenging the decisions or actions of superiors, which concerns care providing, affect the 30-day mortality of patients after the end of hospitalization in Polish hospitals.

Exploring factors that affect nurse staffing: a descriptive qualitative study from nurse managers' perspective

BACKGROUND

The appropriate nurse staffing reflects the situation of nursing management of human resources. Nurse managers have a pivotal role in determining a competent and sufficient number of nurses. It is important to understand the factors influencing nurse staffing to promote appropriate staffing levels. The study aimed to explore the factors affecting nurse staffing from the perspective of nursing managers.

METHODS

Purposive sampling was adopted to recruit 14 nurse managers from secondary and tertiary hospitals located in the central region of China, and semi-structured interviews via telephone were conducted from April to May 2022. Interview transcripts were analyzed and collated using thematic analysis.

RESULTS

This research identified four themes and ten subthemes influencing nurse staffing. Extracted themes include: government level (inadequacy of mandatory policies, budgetary constraints), hospital level (hospital characteristics, the control of nurse labor costs, inadequate support on nursing), patient level (patient characteristics, increasing care needs), and nurse level (nurse shortage, skill-mix, individual high-level needs).

CONCLUSION

The findings indicate that it is crucial for decision-makers or policymakers to legislate for safe nurse staffing and establish effective supervision and funding incentives. Tailored interventions are also needed to improve the organizational context, address the nurse workforce and balance the structure of nurse staff.

The Effects of a Participatory Intervention in Mental Health Units on Nurses' Perceptions of the Practice Environment: A Mixed Methods Study

BACKGROUND

The practice environment influences the quality of care and the nursing outcomes achieved in their workplaces.

AIMS

To examine the perception of the clinical practice environment among nurses working in mental health units in the context of their participation in an action research study aimed at improving the nurse-patient relationship.

METHOD

An explanatory sequential mixed methods study was designed. The data were collected in three phases in 18 mental health units (n = 95 nurses). Quantitative data were collected through the Practice Environment Scale of the Nursing Work Index, and qualitative data were collected through reflective diaries and focus groups in the context of participatory action research.

RESULTS

The nurses' assessment of their practice environment shifted from positive to negative. Nurse manager leadership was the aspect that worsened the most. In addition, the perception of their participation in the affairs of the center and nursing foundations for quality of care decreased. The nurses considered it essential to be able to influence decision-making bodies and that the institution should promote a model of care that upholds the therapeutic relationship in actual clinical practice.

CONCLUSIONS

Nurses perceived that they should be involved in organizational decisions and required more presence and understanding from managers. Furthermore, nurses stated that institutions should promote nursing foundations for quality of care. This study contributes to understanding how nurses in mental health units perceive their work environment and how it affects the improvement of the nurse-patient relationship in clinical practice.

Emotional burnout, job satisfaction, and intention to leave among pre-hospital emergency healthcare workers during the COVID-19 pandemic

BACKGROUND

With the onset of the COVID-19 pandemic, pre-hospital emergency healthcare workers (PHEHW) assumed critical responsibilities in controlling and preventing the spread of the virus.

OBJECTIVE

This descriptive study aimed to explore the emotional burnout, job satisfaction, and intention to leave among PHEHW during the COVID-19 pandemic.

METHODS

The study was conducted with 401 emergency medical technicians and paramedics. The Sociodemographic Data Form, the Emotional Burnout Scale, the Job Satisfaction Scale, the Intention to Leave the Profession Scale were used to collect data. The findings were assessed with a significance level set at p < 0.05 and a 95% confidence interval.

RESULTS

The participants demonstrated moderate scores in emotional burnout, job satisfaction, and intention to leave the profession. The analysis revealed a negative correlation, indicating that as emotional burnout increased, job satisfaction decreased, and the intention to leave the profession heightened. Notably, the participants who had 6-9 years of service, lacked knowledge about COVID-19, had no COVID-19 training, underwent COVID-19 testing, and experienced the loss of a healthcare worker due to COVID-19 exhibited higher levels of burnout. Furthermore, those who had 6-9 years of service, lacked knowledge about COVID-19, had no COVID-19 training, and lost a healthcare worker due to COVID-19 reported lower levels of job satisfaction. Additionally, participants who had 6-9 years of service, lacked knowledge about COVID-19, had no COVID-19 training, and experienced the loss of a healthcare worker due to COVID-19 displayed a greater intention to leave the profession.

CONCLUSIONS

It is important to implement improvement initiatives that will increase the motivation and job satisfaction of PHEHW. These include the regulation of working hours and shifts, augmenting staff numbers, enhancing working conditions, improving salaries, and implementing strategies aimed at fostering motivation and job satisfaction.

Understanding the Workplace-Violence-Related Perceptions and Coping Strategies of Nurses in Emergency Rooms

BACKGROUND

Workplace violence (WPV) is a well-known and serious issue in most countries, and WPV against healthcare providers is of particular concern, especially among nurses working in emergency rooms (ERs).

PURPOSE

We aimed to develop a deeper understanding of nurses' perceptions and coping strategies related to WPV that took place over a 1-year period from the perspective of nursing victims still working in ERs in southern Taiwan.

METHODS

This is a qualitative study with in-depth and semistructured interviews. Nineteen ER nurse victims were recruited from six hospitals in southern Taiwan from June 2015 to April 2016. All of the interview recordings were analyzed using content analysis.

RESULTS

The content analysis identified two themes of perceptions and two themes of coping strategies toward WPV. The two themes of perceptions were "adversity" and "dilemma," with the former covering the three subthemes of "misunderstanding of health policy," "unsafe environment," and "nursing shortage" and the latter covering the two subthemes of "burnout" and "keeping or quitting the job." The two themes of coping strategies were "adjustment" and "resilience," with the former covering the three subthemes of "acceptance of the reality of WPV," "self-regulation," and "culture and belief" and the latter covering the two subthemes of "living with WPV" and "problem solving."

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

The findings revealed that ER nurse victims of WPV experienced a complicated journey after encountering WPV. Their coping strategies may be referenced by other ER nurses to better prevent and manage violent events in ERs. To prevent and manage violence in ERs, hospital managers should create a safe working environment through, for example, assigning sufficient security personnel and staff; provide relevant training to ER nurses in communications and other skills; and implement support systems to strengthen nurse resilience.

Professional engagement: Connecting self-efficacy to actual turnover among hospital nurses

AIMS

To examine how nurses' self-efficacy impacts professional engagement (professional opportunities exploration and workplace improvement participation), nurses' turnover intention and further on actual turnover.

BACKGROUND

The problem of nursing shortage has become a common global issue. Nurses' self-efficacy could reduce nurses' turnover intention. However, whether professional engagement could connect nurses' self-efficacy and their actual turnover remains unknown.

DESIGN

This study adopts a three-wave follow-up design.

METHODS

This study uses proportionate random sampling to survey nurses in a large medical centre in Taiwan. Totally, 417 participants were enrolled from December 2021 to January 2022 (first wave) and followed up from February 2022 to March 2022 (second wave). The data of nurses' actual turnover (or not) were traced in May 2022 (third wave). STROBE statement was chosen as the EQUATOR checklist.

RESULTS

Self-efficacy was positively linked to outcome expectation, which is positively linked to professional opportunities exploration. Self-efficacy was positively linked to career interest and workplace improvement participation. Professional engagement was negatively linked to nurses' intention to leave the target hospital, which was positively linked to actual turnover.

CONCLUSION

This study uniquely finds that professional engagement is the key to the mechanism underlying the influence of nurse' self-efficacy on their actual turnover.

IMPACT

Our findings impact nursing management that professional engagement is as well important as nurses' self-efficacy, with an aim to maintain the professional nursing workforce.

PATIENT OR PUBLIC CONTRIBUTION

Nurses complete the questionnaires, return them to the investigators and permit investigators to check their personnel data.

Verbal violence and missed nursing care: A phenomenological study

AIM

To define the missed care experiences of nurses exposed to verbal violence from patients.

BACKGROUND

Verbal violence takes the first place among the types of violence that nurses face in healthcare settings. This can cause negative emotional and physical responses in nurses and issues in patient and nurse interaction. As a result, it may lead to missed nursing care, defined as skipped, postponed or incomplete care during the patient's care.

METHODS

This is a phenomenological study. The study sample included 16 nurses working in inpatient clinics who reported experiencing verbal violence at least once in Turkey. The study was conducted between January and February 2022 with institutional permission and ethics committee approval (09/12/2021-2021/357). A semi-structured interview method was used to collect data. The information gathered from the interviews underwent thematic analysis using an inductive approach. The 'Consolidated Criteria for Reporting Qualitative Research (COREQ)' was used to report this qualitative study based on a comprehensive protocol.

RESULTS

The types of verbal violence most frequently faced by nurses were determined as swearing, insulting, shouting and threats. Study findings were classified into three main themes: (i) response to verbal violence, (ii) missed nursing care experiences and (iii) suggestions to cope with verbal violence. The most felt emotions in the face of verbal violence were feeling sad, unsafe and worthless. Nurses common behaviours, in response to verbal abuse were ignoring, getting used to, and wishing to get away. The examples of missed care included using non-therapeutic communication, postponing care or withdrawing from care.

CONCLUSION

Verbal violence caused negative emotional and behavioural responses in nurses, which, in turn, negatively affected the nurse-patient interaction. These findings mean that verbal violence may pave the way for missed nursing care.

IMPLICATIONS FOR NURSING POLICY

According to these findings, an uninterrupted nursing care process needs to focus on preventive measures against verbal violence and increase the administrative and legal support offered to nurses.

[Effects of Nursing Work Environment on Intention to Stay of Hospital Nurses: A Two-Mediator Serial Mediation Effect of Career Motivation and Job-Esteem]

PURPOSE

This study aimed to identify the mediating effects of career motivation and job-esteem and the effect of the nursing work environment on intention to stay among hospital nurses.

METHODS

Data were collected from 289 nurses working at an advanced general hospital. The research model design was based on the PROCESS macro proposed by Hayes and analyzed using SPSS 24.0 program.

RESULTS

The results showed a positive correlation between intention to stay and nursing work environment (r = .19, p = .001), career motivation (r= .34, p < .001), and job-esteem (r = .37, p < .001). Nursing work environment (B = 0.34 [.09~.59]) and job-esteem (B = 0.27 [.04~.49]) had a direct effect on intention to stay. There was a two-mediator sereal mediation effect of career motivation and job-esteem. The nursing work environment showed a significant effect on the intention to stay among hospital nurses through career motivation and job-esteem.

CONCLUSION

In order to increase the retention rate of hospital nurses, it is suggested that government and medical institutions provide multifaceted support that can increase nurses' motivation for career development and recognition of the nursing profession through improvement of the nursing work environment.

Different Results from Varied Angles: The Positive Impact of Work Connectivity Behavior After-Hours on Work Engagement

With the development of communication technology and the COVID-19 pandemic, it has become increasingly common for employees to maintain work connectivity after-hours, which has a significant impact on their psychological state at work. However, most of the existing studies have not reached a consensus on the impact of work connectivity behavior after-hours on employees' psychological state at work, and the existing studies have led to theoretical and practical disagreements. Based on the Job Demands-Resources model, we built a two-path model of work autonomy and emotional exhaustion to explore the impact of work connectivity behavior after-hours on work engagement. In addition, we compared the differences between different workplace statuses (managers and ordinary employees). Through surveys and analyses of 257 employees, the results show that work connectivity behavior after-hours positively impacts employees' work engagement by increasing managers' work autonomy and reducing ordinary employees' emotional exhaustion. This study not only reveals that work connectivity behavior after-hours positively affects work engagement but also illustrates the differences in impact between managers and ordinary employees; these findings contribute to the development of a consensus on the influence of work connectivity behavior after-hours on employees' psychological state at work, which provides insights for organizations seeking to manage work connectivity behavior after-hours, for example, by adopting different connectivity management strategies for employees with different workplace statuses.

Relationship of the nursing practice environment with the quality of care and patients' safety in primary health care

BACKGROUND

Nursing practice environment has impact on the quality of nursing care and on patients' and nurses' outcomes, namely better performances of these healthcare workers. Improving the nursing practice environment is a low-cost organizational strategy to achieve better patients' outcomes and retain qualified nurses, thus improving nursing care of units, healthcare organizations and healthcare system. This study aims to analyse the relationship between nursing practice environment and the nurses` perception of quality of care, patient safety, and safety culture in Primary Health Care in Portugal.

METHODS

We conducted a descriptive, analytical, and cross-sectional study using data from RN4CAST Portugal. The sample was composed of 1059 nurses from 55 Health Center Groups of the mainland Portugal, 15 Health Centers of the Autonomous Region of Madeira and 6 Health Centers of the Autonomous Region of the Azores. Multivariate analysis and correlation analysis methods were used for data processing.

RESULTS

Nurses consider that, in the Portuguese Primary Health Care, there is a mixed and unfavourable nursing practice environment, with a perception of a good quality of care, and both acceptable patients' safety and safety culture. The Collegial Nurse-Physician Relations and Nursing Foundations for Quality of Care dimensions to have the best ratings. The perception of Primary Health Care nurses on the dimension Nurse Participation in Organization Affairs was the one that showed the lowest score, followed by Staffing and Resource Adequacy and Nurse Manager Ability, Leadership, and Support of Nurses. Based on perception of nurses, the relationship between the nursing practice environment and the safety culture is higher, followed by the quality of care and patients' safety.

CONCLUSIONS

The perception of Primary Health Care nurses is that there is an unfavourable and mixed nursing practice environment, with good quality of care, and acceptable patient safety and safety culture. The quality of the nursing practice environments is associated to better quality and safety of care. Thus, improving the nursing practice environments in healthcare organizations is a low-cost organizational strategy to achieve greater patients and nurses' outcomes, improving the quality of nursing care to patients in the Primary Health Care units.

The relationship between healthcare workers' satisfaction level and patients' satisfaction: Results of a path analysis model

INTRODUCTION

Patient and healthcare workers' satisfaction is an important issue in the healthcare sector today. This study aims to evaluate the relationship between healthcare workers and patient satisfaction levels among Turkish individuals, with particular emphasis on the contribution of the former to the latter.

MATERIALS AND METHODS

The current study was conducted in a state hospital in İstanbul, Türkiye. Face-to-face surveys were conducted from January to April 2022 to administer two diverse questionnaires for inpatients and attending healthcare workers in the same clinic. Path analysis was used to examine the relationships.

RESULTS

The path analysis demonstrated that 25.2% of patient satisfaction was constituted by the satisfaction of healthcare workers. The final model had an excellent fit with the data x2 (112.89), x2/df (2.130); SRMR=0.0679, CFI=0.956, RMSEA=0.0798. According to the results of this analysis, healthcare worker satisfaction positively influences patient satisfaction and causes it to increase.

CONCLUSION

Healthcare satisfaction plays a central role in providing patient satisfaction, which in turn helps with the challenges that healthcare faces today.

Direct and Moderating Effects of Work Environment and Structural Empowerment on Job Stress and Job Satisfaction Among Nurses in Oman

Objectives

This study aimed to explore the relationships between nurses' work environment, job stress and job satisfaction, along with the moderating effects of work environment and empowerment on the relationship between job stress and job satisfaction.

Methods

A descriptive correlational design was utilised for this study. The study encompassed a convenience sample of 1,796 hospital nurses from the 11 governorates in Oman. Moreover, a self-report questionnaire that included a set of instruments was used to collect the data.

Results

Nurses who perceived higher levels of job stress reported lower levels of satisfaction and empowerment and perceived their work environment as less favourable and supportive. The findings only confirmed the direct effects of work environment and empowerment on satisfaction, whereas no support was found for indirect or moderating effects. Furthermore, the hierarchical regression model showed that 46.5% of the variation in the level of job satisfaction was explained by the study variables.

Conclusion

The results of this study demonstrate the importance of implementing strategies that empower staff, provide a supportive and positive work environment and tackle job stress to enhance levels of job satisfaction.

Evaluation of a blended training solution for critical care nurses' work environment: Lessons learned from focus groups in four European countries

AIM

The aim of this study was to evaluate a blended pilot training course on Healthy Work Environments (HWEs) for critical care nurses as follows: 1) to explore the experience of trainees and trainers who took part in the training; and 2) to identify the strengths and weaknesses of the training program in its potential transferability to nursing practice in Intensive Care Units (ICUs).

BACKGROUND

Despite the evidence supporting the association between HWEs and job satisfaction, nursing retention, and patient outcomes, nurses still have high rates of burnout, mental health problems and intent to leave. To address this challenge, a blended training was created and piloted with the aim to highlight the relevance and impact of HWEs, enhancing its transferability to daily practice. The training was based on the six standards of HWEs as proposed by the American Association of Critical Care Nurses and created within an Erasmus + project. The pilot was delivered by trainers (critical care nursing educators) to critical care nurses and included six workshops of eight hours each (48 h in total) in each country.

DESIGN

After the pilot testing, a qualitative approach, with focus group discussions was used.

METHODS

All the trainees (n=82), who had attended at least one workshop were invited to participate in the focus groups. Overall, eight focus groups were held with critical care nurses who participated as trainees (n=39) from four testing countries: Cyprus, Croatia, Spain and Poland. One international focus group was held with trainers who conducted the training (n=4). Four more trainers completed the questionnaire online. All focus group were video recorded, and transcribed verbatim. Then, the national transcripts were translated into English. An inductive thematic analysis was carried out.

FINDINGS

Three themes were identified: 1) Valuing the relevance of the training program and a positive learning experience; 2) A powerful insight leading to increased awareness and empowerment in personal and professional life; 3) Challenges identified in terms of training, follow up and management of change. Both trainees and trainers expressed a positive opinion with regard to the content of the training and the didactic methods used. They emphasized the strong influence of the training on their understanding of a HWEs, its impact in an ICU context and the need for action, mainly related to communication issues.

CONCLUSION

The proposed blended training program may be used by trainers, who can enable nurses develop the competencies required to influence their work environment, in a context of shared responsibility.

Health status, resources, and job demands in geriatric nursing staff: A cross-sectional study on determinants and relationships

BACKGROUND

According to current estimates, the number of people needing care will double in the next 40 years. It is expected that between 130,000 and 190,000 additional nurses will be needed by 2030 in Germany. Physical and psychological burdens associated with nursing in long-term care facilities can develop into serious health risk factors and significantly impact occupational factors such as absenteeism, especially when linked to difficult working conditions. However, demands and resources specific to the nursing profession have not been analyzed extensively to preserve and promote nurses' workability and health adequately.

OBJECTIVE

Our study aimed to examine the extent to which perceived health among geriatric nursing staff in Germany is predicted by personal resources, job demands, and job resources. In addition, we analyzed the impact of different behavior and experience patterns on these relationships.

DESIGN, SETTING, AND PARTICIPANTS

An observational study was conducted between August 2018 and February 2020 in 48 nursing home facilities with 854 staff members in Germany as part of the project 'PROCARE - Prevention and occupational health in long-term care'.

METHODS

The survey contained instruments that measure workplace exposure, musculoskeletal complaints, physical and mental well-being, chronic stress, and work-related behavior and experience patterns. In addition, health-related information on physical activity and nutrition was collected. Data were analyzed using structural equation modeling.

RESULTS

The combined physical and mental workload for geriatric nurses is very high, with 75 % showing chronic stress. In the overall model, job and personal resources have a stronger association with mental health than physical health, while job demands have an equal impact on mental and physical health. Coping behavior also plays an important key role that should be assessed and considered. A behavior and experience risk pattern (health-endangering) is more strongly associated with a lower health status than a health-promoting behavior pattern. Results of the multigroup test showed that work-related behavior and experience patterns significantly moderate the relationship between physical health and mental health (χ2 = 392/p ≤ .001/df = 256/RMSEA = 0.028/CFI = 0.958/TLI = 0.931). Only 43 % show a health-friendly coping pattern.

CONCLUSIONS

Our findings underline the importance of holistic health promotion, which not only aims at changes at the behavioral level and the development of coping strategies but also takes on the task of reducing the workload and including measures to improve the working climate.

TRIAL REGISTRATION NUMBER

DRKS.de (DRKS00015241); August 9, 2018.

TWEETABLE ABSTRACT

Healthier coping patterns can benefit geriatric nurses' health. However, this is not a substitute for improving working conditions.

Global prevalence of nursing burnout syndrome and temporal trends for the last 10 years: A meta-analysis of 94 studies covering over 30 countries

AIMS AND OBJECTIVES

To determine the global prevalence of nursing burnout syndrome and time trends for the last 10 years.

BACKGROUND

The prevalence of burnout syndrome varied greatly in different regions in the last 10 years, so the average prevalence and time trends of nursing burnout syndrome for the last 10 years were not completely clear.

DESIGN

A meta-analysis conducted in the PRISMA guidelines.

METHODS

CINAHL, Web of Science, and PubMed were searched for trials on the prevalence of nursing burnout syndrome from 2012 to 2022 systematically. Hoy's quality assessment tool was used to evaluate the risk of bias. The global prevalence of nursing burnout syndrome was estimated, and subgroup analysis was used to explore what caused heterogeneity. Time trends for the last 10 years were evaluated by meta-regression using Stata 11.0.

RESULTS

Ninety-four studies reporting the prevalence of nursing burnout were included. The global prevalence of nursing burnout was 30.0% [95% CI: 26.0%-34.0%]. Subgroup analysis indicated that the specialty (p < .001) and the region (p < .001) and the year (p < .001) were sources of the high heterogeneity. Meta-regression indicated that it tended to increase gradually for the last 10 years (t = 3.71, p = .006). The trends increased in Europe (t = 4.23, p = .006), Africa (t = 3.75, p = .006) and obstetrics (t = 3.66, p = .015). However, no statistical significance was found in ICU (t = -.14, p = .893), oncology (t = -0.44, p = .691) and emergency department (t = -0.30, p = .783).

CONCLUSIONS

A significant number of nurses were found to have moderate-high levels of burnout syndrome for the last 10 years. The meta-analysis also indicated an increased trend over time. Therefore, more attention to the prevalence of nursing burnout syndrome is urgently required.

RELEVANCE TO CLINICAL PRACTICE

High prevalence of nursing burnout may attract more attention from the public. This analysis may serve as an impetus for relevant policy to change nurses' working conditions and reduce the occurrence of burnout.

The Global Prevalence and Associated Factors of Burnout among Emergency Department Healthcare Workers and the Impact of the COVID-19 Pandemic: A Systematic Review and Meta-Analysis

BACKGROUND/AIM

Emergency medicine (EM) settings are very stressful, given the high workload, intense working environment, and prolonged working time. In turn, the rate of burnout and its three domains have been increasingly reported among healthcare workers (HCWs). Therefore, we conducted this meta-analysis to determine the prevalence and risk factors of burnout among EM HCWs.

METHODS

Six databases were searched in February 2023, yielding 29 articles (16,619 EM HCWs) reporting burnout or its three domains (emotional exhaustion "EE", depersonalization "DP", and personal accomplishment "PA"). The primary outcome was the prevalence of burnout and its domains, while secondary outcomes included the risk factors of high burnout, EE, DP, or low PA. Burnout rates were pooled across studies using STATA software. The prevalence was measured using the pooled effect size (ES), and the random-effects model was used when heterogeneity was encountered; otherwise, the fixed-effects model was used.

RESULTS

The prevalence of overall burnout was high (43%), with 35% of EM HCWs having a high risk of burnout. Meanwhile, 39%, 43%, and 36% of EM workers reported having high levels of EE and DP and low levels of PA, respectively. Country-specific changes in the rate of burnout were observed. The rate of high burnout, high EE, high DP, and low PA was higher during the COVID-19 pandemic as compared to the pre-pandemic period. The type of profession (nurses, physicians, residents, etc.) played a significant role in modifying the rate of burnout and its domains. However, gender was not a significant determinant of high burnout or its domains among EM workers.

CONCLUSIONS

Burnout is a prevalent problem in emergency medicine practice, affecting all workers. As residents progress through their training years, their likelihood of experiencing burnout intensifies. Nurses are most affected by this problem, followed by physicians. Country-associated differences in burnout and its domains are evident.

Work-related burnout among public secondary school teachers is significantly influenced by the psychosocial work factors: a cross-sectional study from Ethiopia

Introduction

Work-related burnout (WRB) is the degree of physical and psychological fatigue and exhaustion perceived by individuals as related to their work. Even though the condition is widespread across various occupations, teachers inevitably experience high levels of burnout in their work, which can have long-term effects on their health and well-being. However, in developing countries such as Ethiopia, the lack of reliable data on psychosocial hazards, including work-related burnout, often encumbers officials from planning preventive measures. This study investigated the prevalence and contributing factors of work-related burnout among public secondary school teachers in Gondar City, northwestern Ethiopia.

Methods

An institution-based cross-sectional study was conducted from May to June 2022. A sample of 588 teachers was recruited using simple random sampling. Work-related burnout was assessed using a standardized seven-item Copenhagen Burnout Inventory (CBI). The data were collected through a self-administered questionnaire. The collected data were entered into EpiData and analyzed using SPSS. A multivariable logistic regression analysis was used to identify factors associated with work-related burnout.

Results

The overall response rate was 94.05% (N = 553). The majority of participants, 356 (64.4%), were male. The mean (±SD) age of the participants was 38.74 (±7.65) years. This study demonstrated that the prevalence of work-related burnout among school teachers in the past 12 months was 37.4% (n = 207). High job demands, job stress, job dissatisfaction, low role clarity, and student demotivation were found to be the psychosocial work factors that significantly influenced the prevalence of work-related burnout among school teachers.

Conclusion

This study highlights the high prevalence of work-related burnout among public secondary school teachers. Psychosocial work factors such as job demands, job stress, job satisfaction, role clarity, and student demotivation were significant factors influencing work-related burnout. To reduce the condition, it is recommended to take measures to cope with high job demands, improve stress management skills, promote job satisfaction strategies, clarify teachers' responsibilities, and use effective teaching practices to motivate students. In general, addressing psychosocial work factors needs to be central to efforts to prevent teacher burnout.

Exploration of System Chief Nurse Executive's Leadership Practices to Support, Mentor, Develop, and Retain Nurse Leaders

In 2019, the National Academy of Science identified clinician burnout as a growing public health concern. The COVID-19 pandemic has only compounded this crisis and transformed it into an escalating fracture within the US health care system. Concurrently evolving with this emergency is a rise in the number of nurses who intend to leave the profession. Frontline nurse leaders are the lynchpin in ensuring health care systems function. These leaders have accountability over patient care and clinician well-being. Focused efforts must address clinician burnout. However, without addressing the well-being of frontline nurse leaders, the fault line in our health care system becomes a vast chasm. Recently, published literature began to emerge describing and addressing frontline clinician burnout. Unfortunately, only a few, if any, address issues related to leaders. The aim of this qualitative case study research was to explore and discover general themes in system chief nurse executive leadership practices that support, mentor, develop, and retain nurse leaders as a basis for future research. Three major themes were identified for future study and exploration: enhancing leadership development programs; improving leader work environments; and focusing on leader well-being and support. Further research is needed to evaluate the effectiveness of these themes.

Burnout status, occupational satisfaction, and intention to leave the profession of nurses during the COVID-19 pandemic period; The Case of Turkey

We examined the burnout status, professional satisfaction and intention to leave the profession of nurses who are actively working in Turkey during the COVID-19 pandemic period. We conducted the descriptive study with 371 nurses and collected using Copenhagen Burnout Scale (CBS), Occupational satisfaction scale (OSS) and Intention to leave the profession scale (ILPS). In this study, nurses showed a high level of exhaustion and intention to leave work, and a low level of occupational satisfaction. In the fight against COVID-19, the continuity of health services, at the same time, in order to provide adequate quality and safe health care, reducing working hours, bringing the shifts to an appropriate and reasonable time, improving the working environment and approaches that will increase their motivation and professional satisfaction are important to prevent nurses from experiencing burnout and to keep them in their professions and workplaces.

Turnover intention and its associated factors among nurses: a multi-center cross-sectional study

Aim

The purpose of our study was to assess the turnover intention of nurses in China and examine the associated factors.

Background

Since the world population ages, the demand for nurses has kept growing, and the shortage of nurses and high turnover rates are concerned with the quality of care. Thus, understanding nurses' turnover intention and the relevant factors could provide nurse managers with strategies to address the modifiable factors to decrease the turnover rate of nurses.

Methods

A multi-center cross-sectional study was conducted on a total of 1,854 nurses working in 15 hospitals in China. Data were collected using a self-designed demographic questionnaire, the Turnover Intention Scale, the Job Satisfaction Scale, the Pay Level Satisfaction Scale, the Interpersonal Conflict at Work Scale, and a single question on the sense of belonging to the hospital.

Results

Most nurses (n = 1286, 69.4%) had a high level of turnover intention. Multilevel logistic regression analysis demonstrated that nurses being single (OR = 1.366, p < 0.05), with a junior college or below (OR = 0.381, p < 0.01), being a clinical nurse (OR = 1.913, p < 0.01), having higher pay level (OR = 0.596, p < 0.001), having higher job satisfaction (OR = 0.406, p < 0.001), having conflicts with colleagues (OR = 1.400, p < 0.05), and having a higher sense of belonging to the hospital (OR = 0.532, p < 0.001) proved to affect nurses' turnover intention.

Conclusion

This study extended the knowledge about the factors associated with nurses' intention to leave, which led to the turnover of nurses, and is one of the main contributors to the current shortage of nurses.

Implications for nursing management

This study provided new approaches to decreasing the turnover rate of nurses. Effective management strategies may mitigate nurses' turnover intention.

Resilience Room Use and Its Effect on Distress Among Nurses and Allied Staff

ABSTRACT

BACKGROUND: Nationwide nursing shortages have spurred nursing research on burnout and resiliency to better understand the emotional health of nurses and allied staff to retain talent. Our institution implemented resilience rooms in the neuroscience units of our hospital. The goal of this study was to evaluate the effects of resilience room use on emotional distress among staff. METHODS: Resilience rooms opened to staff in the neuroscience tower in January 2021. Entrances were electronically captured via badge readers. Upon exit, staff completed a survey containing items on demographics, burnout, and emotional distress. RESULTS: Resilience rooms were used 1988 times, and 396 surveys were completed. Rooms were most used by intensive care unit nurses (40.1% of entrances), followed by nurse leaders (28.8%). Staff with >10 years of experience accounted for 50.8% of uses. One-third reported moderate burnout, and 15.9% reported heavy or extreme burnout. Overall, emotional distress decreased by 49.4% from entrance to exit. The greatest decreases in distress were recorded by those with the lowest levels of burnout (72.5% decrease). CONCLUSION: Resilience room use was associated with significant decreases in emotional distress. The greatest decreases occurred with the lowest levels of burnout, suggesting that early engagement with resilience rooms is most beneficial.

Factors that affect career success of nurses who practice in assisted reproductive technology

to examine the relationship between career success and work environment of nurses who practice in assisted reproductive technology and to identify factors that affect career success. a cross-sectional study conducted in 53 fertility centres in 26 provinces in mainland China. Data were collected using a demographic data questionnaire, a specialised nursing competence questionnaire, the Career-Success Scale, and the Nursing Work Environment Scale. Descriptive and inferential statistics were applied. 597 assisted reproductive technology nurses participated in our survey, and 555 valid questionnaires were collected. Theoverall mean scores for career success and work environment were 3.75 [standard deviation (SD) = 1.01] and 3.42 (SD = 0.77) respectively. There was a strong positive correlation between career success and work environment (r = 0.742, p < 0.01). Multiple regression showed that attending academic conferences, psychological care, professional development, support and care, salary, and welfare were significant factors that influence career success. attending academic conferences, psychological care, and work environment are positively related to career success. Administrators should consider ways to address these factors.

Individual perspectives and mental maps of working conditions and intention to stay of physicians in academic medicine

Introduction

Job satisfaction has a strong impact on the intention to stay which is an important aspect to counter skills shortage in academic medicine. The purpose of the three studies reported here is to find out what specific factors are relevant for the intention to stay and turnover intention of physicians in academic medicine -and what measures might have a positive impact on employee retention.

Methods

In an interview study combining qualitative and quantitative methods, we investigated how the individual mental representation of working conditions influences job satisfaction and its impact on the intention to stay. In total, 178 physicians from German university hospitals, residents, and physicians, in 15 departments of anesthesiology were interviewed and surveyed. In a first study, chief physicians participated in interviews about job satisfaction in academic hospitals. Answers were segmented into statements, ordered by topics, and rated according to their valence. In a second study, assistant physicians during and after their training period talked about strengths, weaknesses, and potential improvements of working conditions. Answers were segmented, ordered, rated, and used to develop a "satisfaction scale." In a third study, physicians participated in a computer-led repertory grid procedure composing 'mental maps' of job satisfaction factors, filled in the job satisfaction scale and rated if they would recommend work and training in their clinic as well as their intention to stay.

Results

Comparing the interview results with recommendation rates and intention to stay show that high workload and poor career perspectives are linked to a negative attitude. A positive attitude towards work environment and high intention to stay is based on sufficient personnel and technical capacities, reliable duty scheduling and fair salaries. The third study using repertory grids showed that the perception of current teamwork and future developments concerning work environment were the main aspects to improve job satisfaction and the intention to stay.

Discussion

The results of the interview studies were used to develop an array of adaptive improvement measure. The results support prior findings that job dissatisfaction is mostly based on generally known "hygiene factors" and whereas job satisfaction is due to individual aspects.

Professional satisfaction in nursing during the COVID-19 pandemic

Objective:

to assess the job satisfaction of nursing professionals who worked in care and management during the COVID-19 pandemic.

Method:

cross-sectional epidemiological study, with the participation of 334 nursing professionals of a teaching hospital. Absolute and relative frequencies of qualitative variables and means of numerical variables were calculated. The mean scores of the domains of the Job Satisfaction Survey were compared with sociodemographic-labor variables. Student’s t-test, Mann-Whitney test, and ANOVA test were applied and followed by Tukey, Kruskal-Wallis, or Dunn’s post-test to verify the statistical significance of the results with a critical level of 0.05.

Results:

90 professionals were satisfied with their work, three professionals were dissatisfied and 241 professionals were ambivalent.

Conclusion:

ambivalence was evidenced among nursing workers regarding their job satisfaction during the period of the COVID-19 pandemic. The findings indicate a path for managers and health policymakers to invest in career plans and work environments that improve the working conditions of nursing workers.

Factors that affect career success of nurses who practice in assisted reproductive technology

to examine the relationship between career success and work environment of nurses who practice in assisted reproductive technology and to identify factors that affect career success. a cross-sectional study conducted in 53 fertility centres in 26 provinces in mainland China. Data were collected using a demographic data questionnaire, a specialised nursing competence questionnaire, the Career-Success Scale, and the Nursing Work Environment Scale. Descriptive and inferential statistics were applied. 597 assisted reproductive technology nurses participated in our survey, and 555 valid questionnaires were collected. Theoverall mean scores for career success and work environment were 3.75 [standard deviation (SD) = 1.01] and 3.42 (SD = 0.77) respectively. There was a strong positive correlation between career success and work environment (r = 0.742, p < 0.01). Multiple regression showed that attending academic conferences, psychological care, professional development, support and care, salary, and welfare were significant factors that influence career success. attending academic conferences, psychological care, and work environment are positively related to career success. Administrators should consider ways to address these factors.

Registered nurses' perceptions of their roles in medical-surgical units: A qualitative study

AIM

The aim of this study was to gain insight into the perception of nurses about their roles in medical-surgical units.

BACKGROUND

As a result of ever-changing work environments, medical-surgical nurses find it difficult to know and practice according to the full scope of their roles.

DESIGN

A qualitative descriptive study.

METHODS

Semi-structured individual interviews were conducted with 21 nurses on three campuses of a large tertiary care hospital located in Quebec, Canada. Thematic analysis was used to construe meaning from the interviews. This research adheres to the Standards for Reporting Qualitative Research guidelines and checklist.

RESULTS

The data analysis resulted in three main themes: (i) confusion in nurses' roles and scope of practice; (ii) challenges in the continuity of care and (iii) factors affecting the roles of nurses in medical-surgical units.

CONCLUSION

Attention must be paid to the care continuum as it represents a critical element for surgical patients' quality and safety of care.

RELEVANCE TO CLINICAL PRACTICE

Medical-surgical nurses should understand their roles and the factors that limit their full scope of practice in order to provide and manage complex care situations. Additionally, an interdisciplinary approach is a strategy that may better respond to patients' clinical needs across the surgical journey.

A systematic review study on the factors affecting shortage of nursing workforce in the hospitals

AIM

This study aimed to determine factors that influence the nursing workforce shortage and their impact on nurses.

DESIGN

This study applied a systematic review design.

METHODS

Using Cochrane library guidelines, five electronic databases were systematically searched (Research 4life-PubMed/Medline, Scopus, Embase, CINAHL) from 2010-2021. The remaining articles with pertinent information were presented in a data extraction sheet for further thematic analysis. A Reporting Items for Systematic Reviews and Meta-Analysis Flow Diagram was adopted and used. The studies published from 2010-2021 and in English language were examined and included in the systematic review.

RESULTS

Four themes were identified as factors influencing the nursing workforce shortage, including Policy and planning barriers, Barriers to training and enrolment, Factors causing nursing staff turnover and Nurses' stress and burnout. Nursing workforce shortage is a global challenge that roots in multiple causes such as individual, educational, organizational and managerial and policy-making factors.

What if delivery riders quit? Challenges to last-mile logistics during the Covid-19 pandemic

Notoriously precarious, hazardous, and stressful, delivery jobs became even more onerous and dangerous during the pandemic. In this study, set in Ho Chi Minh City, Vietnam, we applied Structural Equation Modelling to a large sample of primary data to measure delivery riders' intention to quit their jobs at the height of the pandemic. We found that job burnout was the key trigger to the intention to quit whereas the risk of Covid-19 infection did not directly affect this behavioral intention. Female riders, migrants, persons living with chronic diseases, and those who had seen their income decimated during the pandemic were more likely to want to quit their job. But if a mass of delivery drivers or riders had failed to show up for work, the last-mile delivery sector would have become paralysed, leaving individuals in various states of lockdown or isolation without food and supplies. As the sector is poised to retain its importance in the post-pandemic period, we recommend a number of approaches for both private companies and public policy makers to persuade riders to stay in their jobs. First and foremost, strategies to prevent and mitigate job burnout should be formulated.

Applying a multi-criteria decision-making approach to identify key satisfaction gaps in hospital nurses’ work environment

Aim

A decision analysis model was constructed to explore the key factors affecting the job satisfaction of hospital nurses and to analyze the key satisfaction gaps in the case hospital.

Background

In China, medical institutions are facing greater pressure and challenges in the normalization of epidemic prevention and control. Nurses play a critical role in the delivery of medical care services. Past studies have shown that improving job satisfaction among hospital nurses is important for both reducing nurse turnover and improving the quality of care.

Methods

McCloskey/Mueller satisfaction scale (MMSS-31) was used to survey 25 nursing specialists in a case hospital in Zhejiang. Then, the Consistent Fuzzy Preference Relation (CFPR) method was used to analyze the degree of importance of dimensions and corresponding sub-criteria. Finally, the importance-performance analysis method was applied to identify critical satisfaction gaps for the case hospital.

Results

In terms of local weight for dimensions, "Control/Responsibility (C ₈)" ≻ "Praise/Recognition (C ₇)" ≻ "Extrinsic Rewards (C ₁)" are the top three key factors for nurses' work environment satisfaction in the case of a hospital. In addition, the sub-criteria "Salary (C ₁₁)", "Benefits (C ₁₃)", "Child care (C ₃₃)", "Recognition-peers (C ₇₃)", "Encouragement/feedback (C ₇₄)", and "Decision making (C ₈₅)" are the key factors for improving clinical nursing satisfaction in the case hospital.

Conclusion

The issues that nurses care about but for which they have not attained expectations mainly involved extrinsic rewards, recognition/encouragement and control over their working process. The findings of this study could offer an academic reference for management and remind them to consider the above factors in exploring future reform, further improving nurses' job satisfaction and motivating them to provide better nursing services.