A ward without walls? District nurses’ perceptions of their workload management priorities and job satisfaction

Exploring the workplace and workforce intentions of early career physiotherapists in Australia

BACKGROUND

Previous research has indicated significant concerns regarding attrition of early career physiotherapists in Australia. Despite the importance of retaining skilled and experienced professionals within the profession, the workplace and workforce intentions of early career physiotherapists remain relatively unexplored.

PURPOSE

The aim of this study was to investigate and explore factors influencing the workplace and workforce intentions of early career physiotherapists in Australia.

METHODS

The Turnover Intention Theory was used to guide a whole-of-person qualitative exploration through semi-structured interviews with 14 participants. Transcribed interview data was subjected to reflexive thematic analysis.

RESULTS

Four themes were generated, constructed as questions to represent participants' temporary holding of intentions: 1) What drives me?; 2) Do my expectations align?; 3) Do my values align?; and 4) What does the future hold?

CONCLUSION

Early career physiotherapists' perspectives encompass diverse and varied experiences that reflect an alignment, or in some cases a misalignment, of the expectations, values and resulting practices of becoming and being a physiotherapist. Early career physiotherapists experience a range of challenges within their workplaces, including significant experiences of stress, yet they express an underlying commitment to the wider profession.

Referral criteria: perceptions and experiences of district nursing students in Northern Ireland

An ever-ageing population and widening health inequalities intensify the complexity of care that is now delivered within community settings by district nurses. Appropriate referral criteria are required to facilitate the enhancement of efficient and equitable district nursing service provision. This study aimed to explore district nursing students' perceptions and experiences of district nursing referral criteria in Northern Ireland. A qualitative phenomenological approach was adopted using a purposive convenience sample of 10 district nursing students. Data were collected during online focus group interviews and analysed using a thematic framework. Four themes emerged: referral criteria; insight and inconsistency; task versus patient-centred care; and misunderstanding the service and referral quality. The themes reflect a lack of consensus with respect to referral criteria, contributing to inappropriate and poor-quality referrals. Appropriate and quality referrals to district nursing services are key to assuring sustainable service provision. Suitable access to district nursing services may be enhanced by developing consensus referral criteria.

Exploring the feasibility of the Magnet Hospital concept within a European university nursing department: a mixed-methods study

BACKGROUND

Human resource management in hospitals has become increasingly challenging. Nursing staff are a major asset in achieving the quality and safety objectives of health care institutions. The concept of Magnet Hospitals seeks to promote a positive work environment. Despite knowledge of the Magnet Hospital concept, the reasons for the lack of applying the concept within Belgian nursing departments is matter for debate.

OBJECTIVES/ AIMS/ HYPOTHESES

: The aim was to explore whether Magnet Hospital principles and values were applicable to a nursing department within a Belgian University Hospital Centre.

DESIGN

A mixed methods approach involving both qualitative and quantitative methodology was adopted.

METHODS

Data were collected across two sites of a University Hospital. For the quantitative phase, a magnetism measurement questionnaire was administered to a convenience sample of nurses from both sites using email and the hospital intranet. For the qualitative phase, a convenience sample of head nurses from across the two sites were recruited by email and agreed to attend interviews.

RESULTS

For the quantitative phase, scores obtained show a limited magnetism among the nurses (n = 224). Out of the 18 sub-dimensions, seven appear to be underdeveloped (score <50) compared to two developed (score> 75). The qualitative phase showed nine facilitators, nine barriers, and seven neutral constructs among surveyed head nurses (n = 17). These demonstrate a marked interest in the concept, but constraints put forward imply that establishment of the concept would be premature or at least quite difficult within the institution.

CONCLUSIONS

Despite interest toward the concept, the implementation of Magnet Hospital within nursing departments currently seems difficult. However, these results shed light upon managerial, organisational, and scientific issues involved in using the concept of the Magnet Hospital within European hospitals.

IMPACT STATEMENT

Communication, unit management strategy and transition of human resource management, through a more human and less administrative approach, are essential for Magnet Hospital implementation.

Behavior of nurses and nurse aides toward influenza vaccine: the impact of the perception of occupational working conditions

Although influenza vaccination of hospital healthcare workers (HCWs) has been associated with a reduction in patient mortality and morbidity, HCW vaccine coverage is low in France. Previous studies identified the role of perceptions of vaccine efficacy and safety as well as practical issues (e.g., limited time). We aimed to determine whether HCW behavior toward influenza vaccine was associated with occupation-related psycho-social issues and perceptions of management. Between February and August 2018, an anonymous online questionnaire explored the perceptions and behavior of nurses and nurse aides regarding the influenza vaccine, as well as the perceived quality of professional management, perceived psychological contract breach, perceived workload, and compassion fatigue using previously validated scales. Among the 791 respondents (mean age 36.9 ± 10 years, female 85.0%; nurses 76.4%), 28.6% had been vaccinated during the current year (i.e., the study year) and 13.0% during the previous year. Among those not vaccinated during the study year, their vaccination intention for the coming year on a 1-5 scale was 1/5 for 68.5% and 5/5 for 15.4%. Positive behavior/intention regarding the influenza vaccine (recent vaccination and/or high future intention) was positively correlated with perceptions of management and negatively correlated with feelings of a psychological contract breach and compassion fatigue. In multivariate analysis, this positive behavior/intention was correlated with management perception independently of the perceptions of vaccination itself. Among nurses and nurse aides, the propensity to be vaccinated appears to depend closely on the perceived working conditions. These factors should be addressed when promoting vaccination among these populations.

Recognition and assessment of dementia in primary care

The majority of patients are diagnosed within a memory assessment service or a neurology clinic. However, early detection of a possible dementia is often done in a primary care setting. Dementia diagnosis has been seen by some as a 'tick-box exercise' but there are significant benefits to patients and their families when screening or testing for dementia is carried out early, especially in supporting the patients management of other comorbid or long-term conditions. Community nurses have a key role in identifying patients who may have the signs and symptoms of dementia by enabling them to access a timely diagnosis.

Caseload management: a district nursing challenge

The district nurse is accountable for the standard of nursing care that is delivered by the team they lead. One of the key challenges in ensuring the provision of a high standard of care is effective caseload management, and caseload management is a core component of the district nursing role. This article highlights the strategic drivers behind community care, outlines the challenges that impact effective caseload management and discusses why effective caseload management is significant in the delivery of community care. It also explores the delegation of workload, triaging referrals, caseload analysis and clinical supervision as methods that the district nurse can use to overcome and manage the challenges that caseload management can present.

Job satisfaction and career intentions of registered nurses in primary health care: an integrative review

Background

There has been a significant growth of the international primary health care (PHC) nursing workforce in recent decades in response to health system reform. However, there has been limited attention paid to strategic workforce growth and evaluation of workforce issues in this setting. Understanding issues like job satisfaction and career intentions are essential to building capacity and skill mix within the workforce. This review sought to explore the literature around job satisfaction and career intentions of registered nurses working in PHC.

Methods

An integrative review was conducted. Electronic databases including: CINAHL, MEDLINE, Scopus and Web of Science, and reference lists of journal publications were searched for peer-reviewed literature published between 2000 and 2016 related to registered nurse job satisfaction and career intentions. Study quality was appraised, before thematic analysis was undertaken to synthesise the findings.

Results

Twenty papers were included in this review. Levels of job satisfaction reported were variable between studies. A range of factors impacted on job satisfaction. Whilst there was agreement on the impact of some factors, there was a lack of consistency between studies on other factors. Four of the six studies which reported career intentions identified that nearly half of their participants intended to leave their current position.

Conclusion

This review identifies gaps in our understanding of job satisfaction and career intentions in PHC nurses. With the growth of the PHC nursing workforce internationally, there is a need for robust, longitudinal workforce research to ensure that employment in this setting is satisfying and that skilled nurses are retained.

The work-based predictors of job engagement and job satisfaction experienced by community health professionals

BACKGROUND

Job engagement represents a critical resource for community-based health care agencies to achieve high levels of effectiveness. However, studies examining the organizational sources of job engagement among health care professionals have generally overlooked those workers based in community settings.

PURPOSE

This study drew on the demand-control model, in addition to stressors that are more specific to community health services (e.g., unrewarding management practices), to identify conditions that are closely associated with the engagement experienced by a community health workforce. Job satisfaction was also included as a way of assessing how the predictors of job engagement differ from those associated with other job attitudes.

METHODOLOGY/APPROACH

Health and allied health care professionals (n = 516) from two Australian community health services took part in the current investigation. Responses from the two organizations were pooled and analyzed using linear multiple regression.

FINDINGS

The analyses revealed that three working conditions were predictive of both job engagement and job satisfaction (i.e., job control, quantitative demands, and unrewarding management practices). There was some evidence of differential effects with cognitive demands being associated with job engagement, but not job satisfaction.

PRACTICE IMPLICATIONS

The results provide important insights into the working conditions that, if addressed, could play key roles in building a more engaged and satisfied community health workforce. Furthermore, working conditions like job control and management practices are amenable to change and thus represent important areas where community health services could enhance the energetic and motivational resources of their employees.

Relationships between followers' behaviors and job satisfaction in a sample of nurses

The study investigated two followership behaviors, followers’ active engagement and followers’ independent critical thinking, and their relationship with job satisfaction in a sample of nurses. In addition, the study also considered a number of control variables and classical job demands and job resources—workload and emotional dissonance for job demands, and meaningful work for job resources—which have an impact on well-being at work. A paper-and-pencil questionnaire was administered to 425 nurses in an Italian hospital, and a hierarchical multiple regression was used to test the hypotheses. In addition to the job demands and job resources considered, followers’ active engagement had a significant impact on job satisfaction. Moreover, it showed a significant linear and curvilinear relationship with the outcome variable. Followers’ independent critical thinking has a non significant relationship with job satisfaction, confirming the mixed results obtained in the past for this dimension. These findings bore out the importance of analyzing followers’ behaviors as potential resources that people can use on the job to increase their own well-being. Looking at followers not just as passive recipients but as active and proactive employees can also benefit the organization.

A cross-sectional study investigating patient-centred care, co-creation of care, well-being and job satisfaction among nurses

BACKGROUND

Developments in the community health nursing sector have resulted in many changes in the activities of these nurses. The concepts of patient-centred care and co-creation of care are gaining importance in the work of community health nurses. Whether patient-centred care also contributes positively to nurses' well-being and job satisfaction is not known.

METHOD

In 2015, a cross-sectional survey was conducted among 153 community health nurses employed by 11 health care organisations in the southern part of the Netherlands. Correlation and regression analyses were performed to identify relationships among patient-centred care, co-creation of care, background characteristics, job satisfaction and well-being of community health nurses.

RESULTS

Patient-centred care and co-creation of care were correlated positively with community health nurses' well-being and job satisfaction. Both variables were predictors of well-being, and patient-centred care was a predictor of job satisfaction. The length of time in the present position was related negatively to community health nurses' job satisfaction and well-being.

CONCLUSIONS

Investment in patient-centred care and co-creation of care is important for the well-being and job satisfaction of community health nurses.

IMPLICATIONS FOR NURSING MANAGEMENT

To safeguard or improve job satisfaction and well-being of community health nurses, organisations should pay attention to the co-creation of care and patient-centred care.

Burnout in the intensive care unit professionals: A systematic review

BACKGROUND

Burnout has been described as a prolonged response to chronic emotional and interpersonal stress on the job that is often the result of a period of expending excessive effort at work while having too little recovery time. Healthcare workers who work in a stressful medical environment, especially in an intensive care unit (ICU), may be particularly susceptible to burnout. In healthcare workers, burnout may affect their well-being and the quality of professional care they provide and can, therefore, be detrimental to patient safety. The objectives of this study were: to determine the prevalence of burnout in the ICU setting; and to identify factors associated with burnout in ICU professionals.

METHODS

The original articles for observational studies were retrieved from PubMed, MEDLINE, and Web of Science in June 2016 using the following MeSH terms: "burnout" and "intensive care unit". Articles that were published in English between January 1996 and June 2016 were eligible for inclusion. Two reviewers evaluated the abstracts identified using our search criteria prior to full text review. To be included in the final analysis, studies were required to have employed an observational study design and examined the associations between any risk factors and burnout in the ICU setting.

RESULTS

Overall, 203 full text articles were identified in the electronic databases after the exclusion of duplicate articles. After the initial review, 25 studies fulfilled the inclusion criteria. The prevalence of burnout in ICU professionals in the included studies ranged from 6% to 47%. The following factors were reported to be associated with burnout: age, sex, marital status, personality traits, work experience in an ICU, work environment, workload and shift work, ethical issues, and end-of-life decision-making.

CONCLUSIONS

The impact of the identified factors on burnout remains poorly understood. Nevertheless, this review presents important information, suggesting that ICU professionals may suffer from a high level of burnout, potentially threatening patient care. Future work should address the effective management of the factors negatively affecting ICU professionals.

Caseload management methods for use within district nursing teams: a literature review

Effective and efficient caseload management requires extensive skills to ensure that patients receive the right care by the right person at the right time. District nursing caseloads are continually increasing in size and complexity, which requires specialist district nursing knowledge and skills. This article reviews the literature related to caseload management with the aim of identifying the most effective method for district nursing teams. The findings from this review are that there are different styles and methods of caseload management. The literature review was unable to identify a single validated tool or method, but identified themes for implementing effective caseload management, specifically caseload analysis; workload measurement; work allocation; service and practice development and workforce planning. This review also identified some areas for further research.

Workplace health and safety issues among community nurses: a study regarding the impact on providing care to rural consumers

OBJECTIVES

The objective of the study was to investigate the types of workplace health and safety issues rural community nurses encounter and the impact these issues have on providing care to rural consumers.

METHODS

The study undertook a narrative inquiry underpinned by a phenomenological approach. Community nursing staff who worked exclusively in rural areas and employed in a permanent capacity were contacted among 13 of the 16 consenting healthcare services. All community nurses who expressed a desire to participate were interviewed. Data were collected using semistructured interviews with 15 community nurses in rural and remote communities. Thematic analysis was used to analyse interview data.

RESULTS

The role, function and structures of community nursing services varied greatly from site to site and were developed and centred on meeting the needs of individual communities. In addition, a number of workplace health and safety challenges were identified and were centred on the geographical, physical and organisational environment that community nurses work across. The workplace health and safety challenges within these environments included driving large distances between client's homes and their office which lead to working in isolation for long periods and without adequate communication. In addition, other issues included encountering, managing and developing strategies to deal with poor client and carer behaviour; working within and negotiating working environments such as the poor condition of patient homes and clients smoking; navigating animals in the workplace; vertical and horizontal violence; and issues around workload, burnout and work-related stress.

CONCLUSIONS

Many nurses achieved good outcomes to meet the needs of rural community health consumers. Managers were vital to ensure that service objectives were met. Despite the positive outcomes, many processes were considered unsafe by community nurses. It was identified that greater training and capacity building are required to meet the needs among all staff.

Analysing the role played by district and community nurses in bereavement support

This article explores bereavement support as one of the roles of the district nurse (DN) and community nurse (CN). Bereavement support is considered part of palliative care, which is a major role for all nurses. There is, however, a constant move to increase acute care in the home, questionably placing greater demand on DNs/CNs and primary care provision. Discussion in this article is framed around research into bereavement care in the community, existing guidelines, and policy drivers stressing its importance. Bereavement can result in depression, stress-related disorders, and high mortality; it is therefore imperative to understand the complexities, theoretical aspects, and implications of poor service provision. Palliative care is one of the primary roles of a DN, and it largely involves emotional support. It has been shown that DNs lack confidence and the skills to provide bereavement support to families and carers of palliative care patients. Education, training, and time management are the main determinants of effective bereavement support. The need is to develop a standard collaborative approach to bereavement support and incorporate it into the palliative care role of DNs.

Mobile working: positively engaging community nurses

Mobile working refers to a practitioner's ability to access information systems and applications while 'on the move'. This relatively new concept has yielded a number of benefits, including the ability to access patients' electronic records in real time and a reduction in travelling time for clinicians, thereby improving efficiency within community nursing practice. For a change in practice to be successful, it is necessary to ensure that the proposals are discussed with the staff group implementing them and that appropriate help and support are provided during the period of transition. Maintaining engagement with community nursing teams may be challenging due to increasing workloads and limited resources, potentially affecting health professionals' ability to attend workshops and associated events. Considering the specific needs of the workforce requires consideration and planning, including provision of additional support for members of staff who may lack confidence in working with mobile devices.

Job satisfaction of Malaysian registered nurses: a qualitative study

BACKGROUND

Job satisfaction is an important factor in health care settings. Strong empirical evidence supports a causal relationship between job satisfaction, patient safety and quality of care. However, there have not been any studies exploring the job satisfaction of Malaysian nurses.

AIM

The main purpose of this qualitative descriptive study was to explore the factors related to feelings of job satisfaction as well as job dissatisfaction experienced by registered nurses in Malaysia.

METHOD

A convenient sample of 46 Malaysian nurses recruited from a large hospital (number of beds = 895) participated in the study. A total of seven focus group discussions were conducted with nurses from surgical, medical and critical care wards. A semi-structured interview guide was used to facilitate the interviews, which were audio-recorded, transcribed verbatim and checked. The transcripts were used as data and were analysed using a thematic approach.

FINDING

The study identified three main themes that influenced job satisfaction: (1) nurses' personal values and beliefs; (2) work environment factors and (3) motivation factors. Concerning the nurses' personal values and beliefs, the ability to help people made the nurses felt honoured and happy, which indirectly contributed to job satisfaction. For work environment factors, team cohesion, benefit and reward, working conditions play an important role in the nurses' job satisfaction. Motivation factors, namely, professional development and clinical autonomy contributed to job satisfaction.

CONCLUSION

It is important for nurse leaders to provide more rewards, comfortable work environments and to understand issues that affect nurses' job satisfaction.

RELEVANCE TO CLINICAL PRACTICE

Our findings highlight the importance of factors that can improve nurses' job satisfaction. The study provides basic information for hospital administrators in planning effective and efficient policies to improve nursing job satisfaction in order to increase the quality of patient care and decrease nursing turnover.

Factors influencing registered nurses perception of their overall job satisfaction: a qualitative study

AIM

The purpose of this qualitative descriptive study was to explore factors related to critical care and medical-surgical nurses' job satisfaction as well as dissatisfaction in Iran.

BACKGROUND

Job satisfaction is an important factor in healthcare settings. Strong empirical evidence supports a causal relationship between job satisfaction, patient safety and quality of care.

METHOD

A convenient sample of 85 nurses from surgical, medical and critical care wards of a large hospital was recruited. Ten focus group discussions using a semi-structured interview guide were conducted. Interviews were audio-recorded, transcribed verbatim and analysed using a thematic approach.

FINDINGS

The study identified three main themes that influenced nurses' job satisfaction and dissatisfaction: (1) spiritual feeling, (2) work environment factors, and (3) motivation. Helping and involvement in patient care contributed to the spiritual feeling reported to influence nurses' job satisfaction. For work environment factors, team cohesion, benefit and rewards, working conditions, lack of medical resources, unclear nurses' responsibilities, patient and doctor perceptions, poor leadership skills and discrimination at work played an important role in nurses' job dissatisfaction. For motivation factors, task requirement, professional development and lack of clinical autonomy contributed to nurses' job satisfaction.

CONCLUSION AND IMPLICATIONS FOR NURSING AND HEALTH POLICY

Nurse managers should ensure a flexible practice environment with adequate staffing and resources with opportunities for nurses to participate in hospital's policies and governance. Policy makers should consider nurses' professional development needs, and implement initiatives to improve nurses' rewards and other benefits as they influence job satisfaction.

Need for Preparedness

Home health care faces challenges that could affect job satisfaction and quality of care. The aim of the study was to describe nurses’ experiences of competence in home health care. The study sample comprised of interviews with six nurses and was analyzed using manifest qualitative content analysis. The category “Being prepared” and subcategories “Importance of leadership strategies,” “Training promotes safety and independence,” and “Co-operation for professional development” were identified. Organizing and planning continuous learning activities at a managerial level, such as collaborations with a focus on supervision and sense of coherence (SOC) training, could develop patient safety within home health care. The results demonstrate that professionally competent nurses working in home health care environments contribute to safe working practices to meet quality care outcomes.

Managing work-related stress in the district nursing workplace

This article aims to highlight the issue of work-related stress within the district nursing workplace. It will acknowledge how the management of work-related stress has previously been discussed within nursing literature and will consider the emerging relationship between staff working conditions, staff wellbeing and quality of patient care. It will reintroduce the Health and Safety Executive's (HSE's) Management Standards approach to tackling work-related stress, which provides management support to reduce environmental work stressors and encourage enabling work environments and a positive workplace culture.

District nurses' experiences with the free-choice system in Swedish primary care

This article aims to describe the experiences of district nurses regarding their work situation after the free-choice system in primary care in Sweden was implemented. The study comprised a total of 17 semi-structured narratives with district nurses. The narratives were analysed using manifest qualitative content analysis. One category,'being an underused resource', and three subcategories, 'being financially aware','being flexible' and 'being appealing', were identified. A focus on economic benefit can limit the cooperation and exchange of experiences within and between different care units, which could have a negative impact on the quality of care due to competition between different care providers. Underused resources and restrictions in terms of improvement skills have an impact on job satisfaction and the working environment, and affect the quality of care as a result.

The relationship between nurse practice environment, nurse work characteristics, burnout and job outcome and quality of nursing care: a cross-sectional survey

AIM

To explore the mechanisms through which nurse practice environment dimensions are associated with job outcomes and nurse-assessed quality of care. Mediating variables tested included nurse work characteristics of workload, social capital, decision latitude, as well as burnout dimensions of emotional exhaustion, depersonalization, and personal accomplishment.

BACKGROUND

Acute care hospitals face daily challenges to their efforts to achieve nurse workforce stability, safety, and quality of care. A body of knowledge shows a favourably rated nurse practice environment as an important condition for better nurse and patient outcome variables; however, further research initiatives are imperative for a clear understanding to support and guide the practice community.

DESIGN

Cross-sectional survey.

METHOD

Grounded on previous empirical findings, a structural equation model designed with valid measurement instruments was tested. The study population was registered acute care nurses (N=1201) in two independent hospitals and one hospital group with six hospitals in Belgium.

RESULTS

Nurse practice environment dimensions predicted job outcome variables and nurse ratings of quality of care. Analyses were consistent with features of nurses' work characteristics including perceived workload, decision latitude, and social capital, as well as three dimension of burnout playing mediating roles between nurse practice environment and outcomes. A revised model adjusted using various fit measures explained 52% and 47% of job outcomes and nurse-assessed quality of care, respectively.

CONCLUSION

The study refines understanding of the relationship between aspects of nursing practice in order to achieve favourable nursing outcomes and offers important concepts for managers to track in their daily work. The findings of this study indicate that it is important for clinicians and leaders to consider how nurses are involved in decision-making about care processes and tracking outcomes of care and whether they are able to work with physicians, superiors, peers, and subordinates in a trusting environment based on shared values. The involvement of nurse managers at the unit level is especially critical because of associations with nurse work characteristics such as decision latitude and social capital and outcome variables. Further practice and research initiatives to support nurses' involvement in decision-making process and interdisciplinary teamwork are recommended.

Factors influencing home care nurse intention to remain employed

AIM

To identify factors affecting Canadian home care nurse intention to remain employed (ITR).

BACKGROUND

In developed nations, healthcare continues to shift into community settings. Although considerable research exists on examining nurse ITR in hospitals, similar research related to nurses employed in home care is limited. In the face of a global nursing shortage, it is important to understand the factors influencing nurse ITR across healthcare sectors.

METHODS

A qualitative exploratory descriptive design was used. Focus groups were conducted with home care nurses. Data were analysed using qualitative content analysis.

RESULTS

Six categories of influencing factors were identified by home care nurses as affecting ITR: job characteristics; work structures; relationships/communication; work environment; nurse responses to work; and employment conditions.

CONCLUSION

Findings suggest the following factors influence home care nurse ITR: having autonomy; flexible scheduling; reasonable and varied workloads; supportive work relationships; and receiving adequate pay and benefits. Home care nurses did not identify job satisfaction as a single concept influencing ITR.

IMPLICATIONS FOR NURSING MANAGEMENT

Home care nursing management should support nurse autonomy, allow flexible scheduling, promote reasonable workloads and create opportunities for team building that strengthen supportive relationships among home care nurses and other health team members.

Barriers to information exchange during older patients' transfer: nurses' experiences

AIMS AND OBJECTIVES

To describe nurses' experiences of barriers that influence their information exchange during the transfer of older patients between hospital and home care.

BACKGROUND

The successful transfer of an older patient across health organisations requires good communication and coordination between providers. Despite an increased focus on the need for cooperation among providers across healthcare organisations, researchers still report problems in the exchange of information between the hospitals and the healthcare systems in the municipalities.

DESIGN

A qualitative study using focus group methodology.

METHODS

Three focus group interviews using topic guides were conducted and interpreted. The study included registered nurses (n = 14) from hospital and home care. The data were analysed through content analysis.

RESULTS

Three main themes were identified: barriers associated with the nurse, barriers associated with interpersonal processes and barriers associated with the organisation. These themes included several subthemes.

CONCLUSIONS

The findings highlight the challenges that nurses encounter in ensuring a successful information exchange during older patients' transfer through the healthcare system. The barriers negatively influence the nurses' information exchange and may put the patients in a vulnerable and exposed situation. In order for nurses to conduct a successful exchange of information, it is critical that hospital and home care systems facilitate this through adequate resources, clear missions and responsibilities, and understandable policies.

RELEVANCE TO CLINICAL PRACTICE

Recognition of the barriers that affect nurses' exchange of information is important to ensure patient safety and successful transitions. The barriers described here should help both nurses in practice and their leaders to be more attentive to the prerequisites needed to achieve a satisfactory nursing information exchange and enhance informational continuity.

Shifting the balance of care? A qualitative study of policy implementation in community nursing

AIM

This qualitative study examined the interaction between policy implementation and service organisation and delivery for community nursing services.

BACKGROUND

Leadership in nursing is at the fore front of the policy agenda for shifting the balance of care from hospitals to the community setting and for improving the quality of healthcare services. Yet, little is known about the implementation of policy within the community setting.

METHOD

A qualitative, interpretive analysis including semi-structured interviews with nurse leaders (n = 12) and community nurses (n = 27) and three focus groups (n = 13) with community nurses (Total N = 39) in three Health Boards in Scotland.

RESULTS

Policy implementation is not adequately integrated between primary and secondary care service at the point of care delivery. The 'top down approach' to policy implementation for shifting the balance of care is currently at odds with the grass roots service organisation and delivery in the community setting.

CONCLUSIONS

The aspirations of integrated, collaborative health and social care require more clinicians working at the frontline in both primary and secondary care to value more the work of colleagues in the different sectors.

IMPLICATION FOR NURSING MANAGEMENT

The current 'top down approach' to policy implementation encourages resistance in the frontline community nurses rather than commitment. A more 'bottom up' integrated approach to policy implementation is therefore required.

Work engagement and occupational stress in nurses and other healthcare workers: the role of organisational and personal factors

AIMS AND OBJECTIVES

The aims of this study were to: (1) identify the role of organisational and personal factors in predicting work engagement in healthcare workers and (2) compare work engagement and occupational stress perceptions of healthcare professional categories.

BACKGROUND

Healthcare professionals, with particular regard to nurses, are exposed to several job stressors that can adversely affect both their mental and physical health and also decrease work engagement. Work engagement can be considered as the positive opposite of burnout, and it is characterised by energy, involvement and professional efficacy.

DESIGN

A cross-sectional survey research was conducted with self-report questionnaires.

METHODS

The Maslach Burnout Inventory-General Survey, the Areas of Worklife Scale and four scales from the Occupational Stress Indicator were administered to a sample of 198 hospital staff (registered nurses, nurse aides, physicians and physiotherapists), of which 110 participated in the study.

RESULTS

The most significant predictors of energy were workload, mental health and job satisfaction; the best predictors of involvement were community, workload, mental health and job satisfaction; professional efficacy was best predicted by values and job satisfaction. In relation to the second aim, physiotherapists had the highest levels of occupational stress and disengagement from their work, while nurse aides were the most work-engaged and job-satisfied professional category, with positive perceptions of the work environment.

CONCLUSIONS

Both organisational and personal factors were found to be significantly associated with work engagement. In this study, physiotherapists were the category with the highest risk of work-related psychological problems, whereas nurse aides had the lowest risk.

RELEVANCE TO CLINICAL PRACTICE

Interventions aimed at improving clinical practice and psychological health of nurses and hospital staff should focus on workload, workers' personal expectations and job satisfaction.

Nurses' information exchange during older patient transfer: prevalence and associations with patient and transfer characteristics

Introduction

To ensure continuity of care, it is important to effectively communicate the health status of older patients who are transferred between health care organizations. The objectives of this study were to: (1) evaluate the prevalence of nursing transfer documents, and (2) identify patient and transfer characteristics associated with the presence of nursing transfer documents for older patients transferred from home care to hospital and back to home care again after hospitalization.

Methods

Nursing documents were reviewed from a total of 102 records of older inpatients admitted from home care to medical wards at a local hospital in central Norway and later discharged home. Frequencies were used to describe patient and transfer characteristics, and the prevalence of transfer documents. Pearson’s χ² test and logistic regression were used to identify possible associations between patient and transfer characteristics and the presence of nursing transfer documents.

Results

While nursing admission notes were present in 1% of the patient transfers from home care to the hospital, 69% of patient discharges from the hospital to home care were accompanied by nursing discharge notes. Patient and transfer characteristics associated with the presence of a nursing discharge note were age, gender, medical department facility, and length of hospital stay.

Conclusions

The low prevalence of nursing transfer documents constitutes a challenge to the continuity of care for hospitalized home care patients. Patient and transfer characteristics may impact the nurses’ propensity to exchange patient information. These findings emphasize the need for nurses and managers to improve the exchange of written information. While nurses must strive to transfer accurate patient information at the right place and at the right time, the managers must facilitate this by providing appropriate guidelines and standards, as well as adequate personnel and resources.

Job satisfaction among public health nurses: a national survey

BACKGROUND

Despite increasing interest in nurses' job satisfaction relatively few studies have investigated job satisfaction among public health nurses.

AIM

To establish current level of job satisfaction among public health nurses and identify the main contributing variables/factors to job satisfaction among this population.

DESIGN

Quantitative descriptive design. A simple random sample of 1000 public health nurses was conducted yielding a response rate of 35.1% (n = 351). Data was collected using the Index of Work Satisfaction Questionnaire. Descriptive and inferential statistics were deployed.

RESULTS

Low levels of job satisfaction among public health nurses emerged. Professional status, interaction and autonomy contributed most to job satisfaction while pay and task-related activities contributed least. Age and tenure were the only biographic factors that correlated significantly with job satisfaction.

CONCLUSION

Public health nurse managers/leaders need to find creative ways of improving the factors that contribute to job satisfaction and address robustly those factors that result in low job satisfaction.

IMPLICATIONS FOR NURSING MANAGEMENT

The critical issue for public health nurse managers is to determine how job satisfaction can be improved. Greater collaboration and consultation between managers and public health nurses can be regarded as a useful way to begin this process, especially if contemporary nursing is to embrace a responsive approach within the profession.

Inovação tecnológica e cargas de trabalho dos profissionais de saúde: uma relação ambígua

Trata-se de uma revisão integrativa com objetivo de rastrear a produção científica acerca da influência da inovação tecnológica nas cargas de trabalho dos profissionais de saúde. Selecionou-se 57 publicações nas bases de interesse de 2004 a 2009. Predominaram as pesquisas de campo com abordagem qualitativa, realizadas em hospitais. Nenhum estudo teve por objetivo relacionar inovação tecnológica e cargas de trabalho. Nos estudos sobre inovação tecnológica destacaram-se publicações sobre tecnologias de informação e comunicação e novas formas de organização do trabalho; no tema cargas de trabalho predominaram estudos sobre condições promotoras de estresse e Burnout. Os achados mostraram que as inovações influenciam as cargas de trabalho de modo ambíguo, podendo aumentá-las ou diminuí-las.