The threat of COVID‐19 and its influence on nursing staff burnout

Nurses Navigating Mental Health During Uncharted Times: Self, Others, Systems (S.O.S)!

STUDY BACKGROUND

The nursing profession is facing a multiplicity of stressors that have both predated and been exacerbated by the Covid-19 pandemic. The emotional and physical demands entailed in nursing predispose nurses to suboptimal mental health and burnout.

PURPOSE

This paper draws upon the narrative interviews of 53 Canadian nurses as part of a larger pan-Canadian, cross disciplinary study that examined the gendered experiences of mental health, leaves of absence, and return to work of 7 professions.

METHODS

Thorne's interpretive descriptive guided Iterative and thematic analysis which identified three predominant themes within the nursing dataset, this paper focuses on the substantive theme of 'Navigating it Alone,'.

RESULTS

Nurses expressed a profound sense of isolation at 3 particular levels: at home, at work, and in systems - while simultaneously balancing uniquely gendered familial responsibilities and workplace demands.

CONCLUSIONS

These results illuminate instrumental pathways for stakeholders to attenuate the personal and professional pressures that continue to be disproportionately carried by nurses as they navigate these particularly challenging times.

Depicting occupational trauma concepts impacting nurse well-being during the COVID-19 pandemic

PURPOSE

The purpose of this concept delineation was to differentiate similar concepts impacting nurse well-being during the COVID-19 pandemic, including: compassion fatigue, burnout, moral injury, secondary traumatic stress, and second victim.

METHODS

A total of 63 articles were reviewed for concept delineation. Morse's (1995) approach to concept delineation was utilized to analyse the articles.

RESULTS

Concepts were described interchangeably but were found to present themselves in a sequence. A nurse may experience moral injury, leading to a second victim experience, synonymous with secondary traumatic stress, then compassion fatigue and/or burnout that can be acute or chronic in nature. An Occupational Trauma Conceptual Model was created to depict how these concepts interact based on concept delineation findings.

CONCLUSION

Nurses are experiencing long-lasting occupational trauma and future intervention research should centre on optimizing nurse well-being to ensure the sustainability of nursing profession.

Implementation of Coaching to Address Burnout in Emergency Clinicians

BACKGROUND

Factors including sleep disturbances, shift work, secondary traumatization, and workplace violence make emergency nurses uniquely susceptible to burnout. A recent study cited nearly half of emergency registered nurses (49.3%) experienced moderate to severe burnout. There is an urgent need for evidence-based solutions to address burnout and turnover in emergency nurses. The objective of this quality improvement project was to determine the effectiveness of a wellness coaching program for reducing burnout and turnover in emergency nurses and advanced practice providers.

METHODS

Baseline assessments of burnout and turnover intention were measured at the beginning of the coaching program and measured again upon completion of the coaching program.

INTERVENTION

Eight registered nurses and 2 advanced practice providers from an emergency department in a west coast community hospital completed 6 to 8 weeks of wellness coaching led by a board-certified nurse coach. The wellness coaching program was an evidence-based, modular curriculum in which participants chose the number and length of sessions.

RESULTS

An average of 6 hours of individualized, 1-on-1 wellness coaching was completed over 7.5 weeks. The project resulted in a large reduction in emotional exhaustion and turnover intention, no effect on depersonalization, and a small reduction in lack of personal achievement (Cohen's d = 0.79, 1.53, -0.18, and -0.35). Ninety percent of clinicians agreed or strongly agreed that coaching helped improve their burnout and said they would consider it again in the future.

CONCLUSION

This quality improvement project demonstrates wellness coaching was an evidence-based solution for improving burnout and turnover in emergency nurses. More investigation is needed to determine duration of reduction of these outcomes.

Prevalence of Impostor Phenomenon Among Final-Semester Baccalaureate Nursing Students

BACKGROUND

Impostor phenomenon (IP) is characterized as an internal sense of intellectual fraudulence and the inability to internalize success. It was identified by Clance and Imes in 1978 in a study with high-achieving women and has since been found among other professionals. Studies regarding IP are limited in nursing and among nursing students.

PURPOSE

The purpose of the study was to evaluate the prevalence of IP among senior baccalaureate nursing (BSN) students at a public central Texas university immediately prior to graduation.

METHODS

Senior BSN students were given an anonymous survey utilizing the Clance Impostor Phenomenon Scale.

RESULTS

Of the 86 senior BSN students, 82.5% completed the anonymous survey. Among students, 45.1% experienced moderate IP, 46.5% experienced frequent IP, and 8.5% experienced intense IP.

CONCLUSIONS

The incidence of IP was higher than expected. This study has implications for the future of nursing, including academic retention and postgraduation performance.

The risk factors for burnout among nurses: An investigation study

The objective of this investigation study is to examine the levels of burnout and work engagement among nurses working on the front lines of the COVID-19 pandemic. Additionally, we aim to analyze the risk factors associated with nurse burnout. This investigation study included a sample of 1764 registered nurses from 6 tertiary comprehensive hospitals in Wuhan. A total of 1800 questionnaires were distributed via email between January 2021 and July 2021, and 1764 completed questionnaires were returned. Nurses who had been on the front lines of the COVID-19 fight for more than six months were included in the study. The Maslach Burnout Inventory-General Survey (MBI-GS) scale was utilized to assess burnout levels among all nurses. Work engagement was measured using the Utrecht Work Engagement Scale (UWES). The general health of the nurses was evaluated using the General Health Questionnaire-12 (GHQ-12) score. Demographic and clinical data, including age, sex, hospital, department, education, years of experience, daily overtime, weekly rest time, number of night shifts per month, smoking or drinking habits, marital status, etc, were also collected. Statistical analyses were performed using SPSS 25.0. The GHQ-12 scores in the FC group were significantly higher than those in the non-frontline COVID-19 (NFC) group. Compared to the average value of the 2 groups, we found that the dimension 2 average value of UWES in NFC group (3.52 ± 1.07) were remarkably higher than that in FC group (3.40 ± 1.08, P < .05). Furthermore, the dimension 1 (emotional exhaustion) average value and dimension 2 (depersonalization) average value of MBI-GS in NFC group were remarkably declined than that in FC group. Spearman rank correlation showed that negative correlation among the average value of each dimension and the overall average values between MBI-GS and UWES. Logistic regression analysis showed that daily Overtime, fight against COVID-19, GHQ-12 score and dimension 2 of UWES were the risk factors for nurse burnout. In summary, this study showed that the dimension 1 (emotional exhaustion) average value and dimension 2 (depersonalization) average value of MBI-GS in NFC group were remarkably declined than that in FC group. This study may provide some basis for addressing nurse burnout.

Analyzing the concept of toxic positivity for nursing: A dimensional analysis approach

AIM

To analyze toxic positivity and its relevance to nursing.

DESIGN

Concept analysis using Schatzman's dimensional analysis approach.

DATA SOURCES

Two searches were conducted using Google Scholar, JSTOR, ProQuest and CINAHL (1990-2023). Keywords included "toxic positivity" (Phase 1) and "emotional suppression," "unrealistic optimism"; "disingenuous happiness," "forced gratitude" and "logical fallacy" (Phase 2). Retained sources (1) were in English (Phases 1 and 2); (2) used 'toxic positivity' as a construct reflecting the purpose of analysis (Phase 1); and (3) demonstrated relevance towards analytical findings (Phase 2). Total analytic sources were 35.

METHODS

The analytic phase, identification, elucidated conceptual dimensions and contexts. The analytic phase, logistics, examined relationships among dimensions and contexts through an iterative process resulting in a dimensional matrix/conceptual model.

RESULTS

Salient dimension is Emotional Suppression with two sub-dimensions, Logical Fallacy and Forced Gratitude. Other dimensions include Unrealistic Optimism and Disingenuous Happiness. Contexts include intra- and post-paradigmatic societal shifts and intra- and post-traumatic experiences. Analysis reveals toxic positivity as an exchange between a giver and receiver with the receiver experiencing negative outcomes.

CONCLUSION

The concept appears consistent in its application and use across contexts and is emerging in nursing literature.

IMPLICATIONS FOR THE PROFESSION

Acknowledging toxic positivity in nursing may inform theoretical and future research related to improving nursing burnout, bolstering retention, and enhancing well-being. Nurses across work environments may encounter toxic positivity. Leaders should consider policy adoption and inclusion of trauma-informed practices.

IMPACT

Nursing workforce issues require deeper examination of potential contributing factors. Findings suggest toxic positivity may be encountered in work environments impacting nursing at individual and system levels.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Characteristics and quality of reporting qualitative nursing research related to the COVID-19 pandemic: a systematic search and critical review

BACKGROUND

The COVID-19 (Coronavirus disease of 2019) pandemic caused major disruption to nursing research, especially qualitative research. Researchers had to overcome numerous challenges that potentially impacted the quality of the studies carried out.

OBJECTIVES

The aim of this study is to assess the characteristics and quality of reporting qualitative nursing articles on the COVID-19 pandemic.

METHODS

A systematic search and critical review using content analysis was conducted on published nurse-led articles using a qualitative approach related to the COVID-19 pandemic. A combination of the Consolidated Criteria for Reporting Qualitative Research (COREQ) and Standards for Reporting Qualitative Research (SRQR) checklists and additional items identified from the literature were used to assess the characteristics and overall quality of reporting of qualitative research.

RESULTS

Out of 63,494 articles screened, 444 met the inclusion criteria. Most studies were published in high-impact, Quartile 1 journals, with the majority originating from the USA. Common themes included workforce experiences and the impact of pandemic restrictions. Methodological quality varied, with a notable underuse of standardized reporting checklists. Despite pandemic-induced challenges in data collection, interviews remained the predominant method. However, the adoption of remote research methods and analysis software was limited.

DISCUSSION

The findings underscore the resilience and adaptability of nursing researchers during the pandemic. High-quality publications in top-tier journals indicate rigorous academic standards. However, the low utilization of reporting checklists suggests a need for greater emphasis on methodological transparency and adherence to established quality guidelines. This review highlights the importance of enhancing qualitative research practices to improve the rigor and reliability of studies, particularly in crisis contexts.

Support Needs of Labor and Delivery Nurses After Traumatic Experiences

OBJECTIVE

To examine the effect of psychological distress, overall distress, and institutional support following a traumatic workplace event on absenteeism, turnover intention, and resilience among labor and delivery nurses.

DESIGN

A quantitative cross-sectional survey.

SETTING

Online distribution from January 13, 2021, to February 2, 2021.

PARTICIPANTS

A nationwide convenience sample of labor and delivery nurses recruited from the Association of Women's Health, Obstetric and Neonatal Nurses (N = 171).

METHODS

Participants completed a survey that included the Second Victim Experience and Support Tool-Revised and the Second Victim Support Desirability survey. We compared available versus desired support options using descriptive analyses. We examined levels of psychological distress and lack of institutional support in relation to turnover intention, absenteeism, and resilience using multiple regression analyses.

RESULTS

Participants identified and described various traumatic experiences in the workplace, including neonatal and maternal death, complicated births, and workplace violence. Participants indicated that the available support services did not meet their needs. Psychological distress, overall distress, and lack of institutional support were associated with absenteeism and turnover, whereas only institutional support was associated with resilience.

CONCLUSION

Labor and delivery nurses encounter various traumatic events in the workplace, and the support services provided after an event do not meet their needs. Additional research is needed to understand the scope of the problem and investigate best practices to assist labor and delivery nurses following traumatic events.

Mitigating Job Burnout in Jordanian Public Healthcare: The Interplay between Ethical Leadership, Organizational Climate, and Role Overload

In today's dynamic organizational landscape, characterized by rapid technological advancements and evolving workplace dynamics, understanding the factors influencing employee well-being is paramount. This study investigates the interplay between ethical leadership, organizational climate, role overload, and job burnout in public healthcare organizations across northern Jordan. By focusing on ethical leadership, organizational climate, and role overload as determinants of job burnout, this research provides insights into strategies for enhancing employee well-being. Drawing on ethical leadership theory, social exchange theory, and the job demands-resources model, this study employs PLS-SEM to analyze data collected from 260 employees working in Jordanian government hospitals. The findings reveal negative associations between ethical leadership and job burnout, highlighting the importance of ethical leadership behaviors in mitigating employee burnout. Additionally, a positive organizational climate is associated with lower levels of burnout, underscoring the impact of the broader organizational context on employee well-being. The study also explores the mediating role of organizational climate and the moderating effect of role overload in the relationship between ethical leadership and job burnout, providing insights into the complex dynamics at play in healthcare organizations. These findings enrich our understanding of the factors influencing employee well-being in healthcare contexts and underscore the importance of fostering ethical leadership and supportive organizational climates to mitigate job burnout.

The COVID-19 Lived Experience Through the Eyes of Nursing and Social Work Students

Purpose: The purpose of this study was to explore the lived experiences of nursing and social work students who were taking courses during the COVID-19 pandemic. Focus group discussions gave students a chance to express the pandemic's effects on their education and life. Methods: A hermeneutic phenomenological approach using Van Manen's Four Lifeworld Existentials guided this study. Using an open-ended format, interviews were conducted in 6 small groups ranging from 2 to 9 individuals, in person or via Zoom. The study was conducted from May to August 2022 in a university setting with 23 participants. Results: Ten existential themes emerged: Being Behind, Groundhog Day, Trying to Keep Up, Loss of Community, Fear of COVID, Being Alone, What is Self-Care?, Is This Career Right for Me?, What is Healthy?, and Access to Counseling. Conclusions: Participants indicated that the COVID-19 pandemic negatively impacted educational delivery, limiting learning opportunities and increasing feelings of isolation, stress, and anxiety. Implications for Education and the Future Workforce: Projected health-care workforce shortages may be exacerbated by students departing from the health-care professions as a result of increased burnout. Resilience training while in school is necessary to help promote coping, self-care strategies, and retention in the health-care professions.

Differential effects of healthcare worker burnout on psychotropic medication use and misuse by occupational level

PURPOSE

Burnout has been well examined among physicians and other high-wage, high-autonomy healthcare positions. However, lower-wage healthcare workers with less workplace autonomy (e.g., medical assistants, nurses' aides) represent a substantial proportion of the workforce, but remain understudied. We aimed to examine the effects of burnout on psychotropic medication use and misuse and whether these effects differed by occupational level.

METHODS

In March 2022, we collected data from a diverse sample of US healthcare workers (N = 200) and examined the cross-sectional relationship between burnout and changes in prescribed psychotropic medication (i.e., starting, stopping, and/or having a change in the dose/frequency) during the COVID-19 pandemic. We also separately examined the relationship between burnout and psychotropic medication misuse (i.e., without a prescription, in greater amounts, more often, longer than prescribed, and/or for a reason other than prescribed). We stratified models by occupational level (prescribers/healthcare administrators vs. other healthcare workers).

RESULTS

Greater burnout was associated with higher odds of changes in prescribed psychotropic medication among prescribers/healthcare administrators (aOR = 1.23, 95% CI 1.01, 1.48), but not among other healthcare workers (aOR = 1.04, 95% CI 0.98, 1.10). Greater burnout was not associated with psychotropic medication misuse among prescribers/healthcare administrators (aOR = 0.96, 95% CI 0.82, 1.12) but was associated with increased odds of psychotropic medication misuse among other healthcare workers (aOR = 1.07, 95% CI 1.01, 1.14).

CONCLUSIONS

Potential disparities in help-seeking and healthcare access might manifest in non-medical use of prescription drugs among some healthcare workers, which has implications for worker safety and well-being.

The relationship between role ambiguity and anxiety in intensive care unit nurses: The mediating role of emotional intelligence

BACKGROUND

Role ambiguity is recognized as a significant psychological risk stressor in nursing practice, which undermines the psychological well-being of nurses. Since the well-being of nurses plays a crucial role in ensuring positive patient outcomes, it becomes imperative to identify strategies for improving nurses' psychological well-being.

OBJECTIVES

This study aimed to explore the effects of role ambiguity on anxiety in intensive care unit nurses and the mechanisms mediating emotional intelligence.

METHODS

In April-June 2023, a convenience sampling method was used to collect data from 360 intensive care unit nurses in a total of 7 hospitals in Shaanxi Province, Hunan Province, Beijing, and Jiangsu Province, China. A linear regression model was used to verify the mediating effect.

RESULTS

Role ambiguity was significantly and positively associated with anxiety in ICU nurses (p < 0.01). A mediating mechanism between role ambiguity and anxiety was established for emotional intelligence (p < 0.01).

CONCLUSIONS

Role ambiguity has a significant impact on the mental health of intensive care nurses, and emotional intelligence plays a mediating role in reducing role ambiguity and anxiety in nurses.

IMPLICATIONS FOR CLINICAL PRACTICE

This study highlights that role ambiguity in the intensive care unit setting increases nurses' anxiety, while emotional intelligence alleviates the anxiety associated with role ambiguity. Creating support systems and improving the environment is a top priority for nursing administrators. This includes, but is not limited to, clarifying the roles of nurses, conducting social-emotional training, and developing emotional intelligence to prevent and regulate nurses' anxiety and maintain mental health.

The evolution of professional identity in intensive care nurses during COVID-19 - An interpretive phenomenological study

OBJECTIVES

This study explored the meaning behind professional identity in intensive care nurses who cared for patients with COVID-19.

RESEARCH METHODOLOGY/DESIGN

The exploration was conducted using a qualitative interpretive phenomenological approach with guidance from hermeneutics.

SETTING

Semi-structured audiovisual interviews were conducted with intensive care unit nurses (n = 20) throughout the United States of America, spanning nurse experiences of caring for patients with COVID-19 between 2019 and 2022.

OUTCOME MEASURE

Outcome measures were codes and themes which emerged from data using Benner's interpretive phenomenology method for nursing and Heidegger's hermeneutic circle.

FINDINGS

Four critical findings of this study were the themes a) Keep Them Alive, b) We Are Survivors, c) I Am An Intensive Care Unit Nurse, and d) I Was Meant For This.

CONCLUSION

Findings suggest that professional identity is evolving for nurses as they care for patients in the intensive care and that evolution affects nursing professionals' quality of life.

IMPLICATIONS FOR CLINICAL PRACTICE

The findings of this study have important implications for nursing practice. These themes highlight intensive care nurses' deep commitment and strong professional identity, which can positively impact nurse retention and foster a sense of purpose and fulfillment. Understanding the meaning attached to nurses' experiences can allow nurse leaders and mentors to enhance their roles and aid in the preparation of future intensive care nurses, helping future nurses find focus and satisfaction in their professional identities. Recognizing and nurturing nurses' strong professional identity may positively impact nurse retention and fulfillment. To achieve this, nurse leaders must comprehend and support nurses' experiences, cultivating an environment that empowers these caregivers to thrive and make a lasting impact on patient care.

Examination of Burnout Levels and Social Support Resources of Healthcare Workers in Filiation Teams During COVID-19 Pandemic in Turkey

This study aims to examine the level of burnout and social support of healthcare workers in filiation teams during the period of COVID-19 in Turkey. A total of 1028 healthcare workers have been reached. The sociodemographic questionnaire, Maslach Burnout Inventory (MBI), and Multidimensional Scale of Perceived Social Support (MSPSS) have been used. SPSS was used to analyze the data. Descriptive statistics were created, and independent t-tests and Pearson correlation tests were performed. 69.5% of the participants were females. The participants consisted of midwives (21.2%), nurses (15.5%), doctors (14.1%), psychologists (10.8%), and dentists (10.7%). The MSPSS scale scores of the participants were 62.66 ± 16.96; family 22.87 ± 5.85, friends 21.14 ± 6.30, and significant other person 18.65 ± 7.95. MBI scale scores are 54.05 ± 10.77, emotional exhaustion 18.12 ± 8.36, depersonalization 4.53 ± 3.45, and personal achievement 31.40 ± 7.04. The study showed that females have higher levels of emotional exhaustion and, as education levels, the population of the region, daily working hours, patient burden, and death of coronavirus-infected colleagues increase, and burnout levels increase.

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.

The relationships between nurses' resilience, burnout, perceived organisational support and social support during the second wave of the COVID-19 pandemic: A quantitative cross-sectional survey

AIMS

To examine the level of resilience and burnout among British nurses during the second wave of the COVID-19 pandemic and the influence of personal, social and organisational factors on nurses' resilience and burnout.

BACKGROUND

Nurses experienced excessive workload and emotional demands over a prolonged period during the COVID-19 pandemic which may have led to exhaustion. Little research has examined the correlation between the pandemic variables, nurses' resilience and burnout during the second wave of the COVID-19 pandemic.

DESIGN

This study utilised a descriptive, cross-sectional research design.

METHODS

A cross-sectional and self-report survey involved 111 staff nurses, who completed a self-administrated questionnaire between January and April 2021. A STORBE checklist was used to report the study results.

FINDINGS

The study found that nurses experienced a high level of burnout and low to moderate levels of resilience. The study revealed significant negative relationships between the level of burnout and perceived organisational support and nurses' resilience. The impact of the COVID-19 pandemic on nurses' social roles and their worries about patient safety were positively correlated with burnout. The perceived organisational support, the impact of the COVID-19 pandemic on nurses' social roles and the level of resilience were significant factors for burnout.

CONCLUSIONS

Nurses experienced a high level of burnout during the second wave of the COVID-19 pandemic, which may be influenced by how they felt their organisations supported them. Nurses' feelings that the pandemic affected their social roles were associated with increasing their burnout.

RELEVANCE TO CLINICAL PRACTICE

Strategies should be developed to address staff burnout and resilience. Nurse managers and educators should play leadership roles in creating professional training to include competencies and psychological preparedness for disasters and to implement strategies to increase the organisational commitments to staff safety and well-being.

The Vitruvian nurse and burnout: New materialist approaches to impossible ideals

The Vitruvian Man is a metaphor for the "ideal man" by feminist posthuman philosopher Rosi Braidotti (2013) as a proxy for eurocentric humanist ideals. The first half of this paper extends Braidotti's concept by thinking about the metaphor of the "ideal nurse" (Vitruvian nurse) and how this metaphor contributes to racism, oppression, and burnout in nursing and might restrict the professionalization of nursing. The Vitruvian nurse is an idealized and perfected form of a nurse with self-sacrificial language (re)producing self-sacrificing expectations. The second half of this paper looks at how regulatory frameworks (using the example of UK's Nursing and Midwifery Council Code of Conduct) institutionalize the conditions of possibility through collective imaginations. The domineering expectations found within the Vitruvian nurse metaphor and further codified by regulatory frameworks give rise to boredom and burnout. The paper ends by suggesting possible ways to diffract regulatory frameworks to practice with affirmative ethics and reduce feelings of self-sacrifice and exhaustion among nurses.

Factors contributing to the burnout of the faculties of a medical university in Iran: A cross-sectional study

BACKGROUND AND AIMS

Faculty members confront a variety of obstacles over time, the most recent of which is the coronavirus disease 2019 pandemic, which may increase their vulnerability to burnout (BO). This study aims to examine BO in medical school faculties, as well as the factors that lead to BO and well-being in them.

METHODS

This cross-sectional study was conducted in 2021 using online questionnaires completed by 222 faculty members of a medical university in Iran. The Maslach Burnout Inventory-Human Services Survey (MBI-HSS) and the Well-being index (WBI) were used. Additionally, we gathered individual-level profiles (demographic, well-being) and occupational information (job profile, attitude toward work).

RESULTS

A total of 60 (27%) faculties reported having high BO, and 112 (50.5%) reported having low well-being. Being female (odds ratio, OR = 2.69), having time to spend with the family (OR = .26), the intent of turnover (OR = 8.65), job recommendation to the offspring (OR = .26), and experiencing violence last year (OR = 2.97) were some of the individual-level factors and job-related attitudes associated with a higher BO. In the neural network for BO, the most important variables were the intention of turnover, followed by adequate family time.

CONCLUSION

One third of the responding faculty reported severe BO, and BO was found to be significantly associated with lower well-being. The increased levels of BO and a decreased experience of well-being were both associated with a higher intention of turnover. According to the study, it is important to pay attention to both clinical and nonclinical field faculty members, female faculty members, those who have a high workload, and members who have experienced violence in the workplace. By acknowledging the unique challenges and experiences faced by these individuals, tailored measures can be developed to address their specific concerns and foster a supportive and inclusive environment.

Protective and risk factors associated with substance use coping among healthcare workers during the COVID-19 pandemic

Background

Healthcare workers (HCWs) experienced high levels of stress and mental health consequences associated with the COVID-19 pandemic, which may have contributed to unhealthy coping behaviors, such as substance use coping (SUC). This study aimed to understand the extent of and predictors of SUC.

Methods

The sample consisted of 263 HCWs in North Central Florida. Univariable and multivariable logistic regression analyses investigated whether moral injury and other work risk factors, protective factors, and clinically relevant symptoms (i.e., work exhaustion, interpersonal disengagement, depression, anxiety, and/or PTSD) were associated with likelihood of SUC.

Results

Clinically relevant levels of interpersonal disengagement and anxiety increased the likelihood of SUC. Mediational analyses found that interpersonal disengagement and anxiety explained 54.3% of the relationship between Self Moral Injury and SUC and explained 80.4% of the relationship between professional fulfillment and SUC.

Conclusion

Healthcare supervisors should be aware that providers who are experiencing moral injury and less professional fulfillment may be experiencing significant interpersonal disengagement and anxiety, which could lead to SUC. Future studies should examine the effects of implementing targeted prevention and treatment interventions, along with longitudinal outcomes related to SUC behaviors.

Demystifying the experience of participating in a root cause analysis: A hermeneutic phenomenological study

AIM

This study aimed to explore registered nurses' experience participating in a root cause analysis (RCA) meeting because of their involvement in an adverse event.

BACKGROUND

An RCA is the most common strategy used by organizations for adverse event investigations. Nursing healthcare professionals directly involved in an adverse event may be asked to participate in the RCA. However, no studies were found in the literature on their experience.

METHODS

Semi-structured audio-taped interviews were held with 13 registered nurses who participated in an RCA. Ricoeur's hermeneutic phenomenology guided data analysis.

RESULTS

Two structural elements represented the world of the nurses: 1) Learning about an RCA, and 2) being on the other side of the RCA table. Three phenomenological themes emerged: 1) anticipatory and embodied fear, 2) to speak or not to speak, 3) the aftermath.

CONCLUSION

Nurses desire RCA education to assist in understanding and support from nurse leaders throughout the process. Healthcare organizations must create a safe and collaborative environment to empower nurses to speak up and have their voices heard during the RCA process.

IMPLICATIONS FOR NURSING LEADERS

Nurses want to participate in RCA meetings. However, leaders must demystify the RCA process for nurses through education and training.

Factors influencing the burnout dimensions among nurses: A cross-sectional study in South Korea

AIM

To investigate the factors influencing three dimensions of burnout among clinical nurses in South Korea.

DESIGN

Descriptive, correlational and cross-sectional study.

METHODS

We recruited 300 clinical nurses to participate in an online survey conducted in June 2021. Purposive sampling was used for the survey. Multiple linear regression was used for data analysis.

RESULTS

The regression models explained 55.8%, 45.8% and 34.3% variances in emotional exhaustion, depersonalization and personal accomplishment respectively. Emotional exhaustion was influenced by experience in the current department, working overtime, shift type, depression, job stress and emotional labour. Depersonalization was influenced by gender, hospital size, the associated department, overtime, coping strategies, depression and emotional labour. Personal accomplishment was influenced by clinical experience, shift type, resilience and the perceived threat of coronavirus disease 2019.

Mental health and work-related factors in healthcare workers in a pandemic - meta-analysis

Due to the SARS-CoV-2 pandemic, healthcare workers worldwide faced major challenges in the form of psychological stress. The aim of this systematic literature review and meta-analysis is to identify mental health consequences and associated work-related factors in healthcare workers during a pandemic and to quantify the influence of associated work-related factors on mental health consequences. A systematic literature search according to PRISMA was conducted on 5 August 2021 using the databases PubMed Central and APA PsychInfo. The included studies investigated the mental health consequences and associated work-related factors in healthcare workers in a pandemic. In addition, we performed a risk of bias analysis to assess the study quality of the included studies using the JBI checklists. Random-effect models and pooled effect estimators were used for the meta-analysis. The Chi2 and I2 statistics were used to identify the statistical heterogeneity. Additional sensitivity analysis was performed. From a total of 3,910 publications, 43 studies met the inclusion criteria. These studies provided 15 stress consequences and 20 stress factors. The most frequently reported stress factors were 'contact with COVID-19 patients', 'no education or training in handling infectious diseases' and 'insufficient protective equipment'. Anxiety, stress, and depression were the most common outcomes identified. Analyses showed an increase in anxiety scores among HCWs who cared for COVID-19 patients, as well as a rise in depressive symptoms due to inadequate or no personal protective equipment. In this review, various pandemic-associated stress factors and stress consequences of healthcare workers were observed. With the results, criteria for effective measures and interventions can be developed to minimize the risk of stress consequences.

Mobile Mindfulness for Psychological Distress and Burnout among Frontline COVID-19 Nurses: A Pilot Randomized Trial

Rationale: The coronavirus disease (COVID-19) pandemic exacerbated psychological distress and burnout in frontline healthcare workers. Interventions addressing psychological distress and burnout among these workers are lacking. Objectives: To determine the feasibility and explore the impact of mobile mindfulness to treat psychological distress and burnout among nurses in frontline COVID-19 units. Methods: We conducted a pilot randomized trial of 102 nurses working in COVID-19 units at a single hospital between May 2021 and January 2022. Participants were randomized to mobile mindfulness (intervention) or waiting list (control). The primary outcome was feasibility, assessed by comparing rates of randomization, retention, and intervention completion to predefined targets. Secondary outcomes were changes in psychological distress (Patient Health Questionnaire-9, General Anxiety Disorder-7, Perceived Stress Scale-4) and burnout symptoms (Maslach Burnout Inventory) after 1 month. Results: We randomized 102 of 113 consented individuals (90%, target 80%), and 88 completed follow-up (86%, target 80%). Among 69 intervention participants, 19 completed ⩾1 mindfulness session per week (28%, target 60%), and 13 completed ⩾75% of mindfulness sessions (19%, target 50%). Intervention participants had greater decreases in Patient Health Questionnaire-9 scores than control subjects (difference in differences, -2.21; 95% confidence interval, -3.99, -0.42; P = 0.016), but the Maslach Burnout Inventory depersonalization scores decreased more in the control arm than in the intervention arm (difference in differences, 1.60; 95% confidence interval, 0.18, 3.02; P = 0.027). There were no other changes in emotional distress or burnout symptoms. Conclusions: This trial of mobile mindfulness in frontline nurses met feasibility targets for randomization and retention, but participants had modest intervention use. Intervention participants had a reduction in depression symptoms, but not in burnout. Clinical trial registered with www.clinicaltrials.gov (NCT04816708).

Compassion Fatigue and Ethical Attitudes in Nursing Care in Intensive Care Nurses During the COVID-19 Pandemic: A Cross-sectional Study

BACKGROUND

Intensive care unit (ICU) nurses faced an increased risk of compassion fatigue and ethical concerns during the COVID-19 pandemic.

PURPOSE

To evaluate compassion fatigue of ICU nurses and their ethical attitudes in care during the COVID-19 pandemic and analyze contributing factors.

METHODS

An exploratory cross-sectional research design was used.

RESULTS

A total of 103 ICU nurses participated. The nurses' compassion fatigue and ethical attitude scores were high. Compassion fatigue was explained by the following variables: considering resigning, receiving support for ethical decisions, willingness to work in the ICU, duration of providing activities of daily living in a shift, and number of patients per nurse.

CONCLUSIONS

Compassion fatigue was high in nurses working in the ICU during COVID-19. The high level of ethical attitudes shows commitment to professional ethics and reflects the development of the nurses' professional identity. Implementation of interventions that help improve compassion fatigue among nurses is needed.

Were the unfinished nursing care occurrence, reasons, and consequences different between COVID-19 and non-COVID-19 patients? A systematic review

BACKGROUND

Unfinished Nursing Care (UNC) has been documented also during the Coronavirus (COVID-19) pandemic; however, while several secondary studies were conducted before this period to summarise occurrences, reasons, and consequences of UNC and provide a global picture of the phenomenon, no synthesis of the evidence produced during the pandemic has been documented to date. Therefore, the aim of this review is to identify differences, if any, in the UNC occurrence, reasons, and consequences perceived by nurses caring for COVID-19 and non-COVID-19 patients.

METHODS

This study is a systematic review (PROSPERO CRD42023410602). According to the Population, Exposure, Comparator, and Outcomes framework, primary comparative cross-sectional, longitudinal, and cohort studies, randomised/non-randomised controlled trials were included from Medline, CINAHL, and Scopus, collecting perceptions of nurses with tools measuring UNC between COVID-19 and non-COVID-19 patients and published in English, Italian, or Turkish. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline and Johanna Briggs Quality Appraisal Tool were used, and findings were summarised narratively.

RESULTS

Five hospital-based cross-sectional studies using the self-administered MISSCARE and UNC Survey comparing data collected (a) before the pandemic vs. in the first wave; (b) before, in the second and in the third wave; and (c) simultaneously among COVID-19 and non-COVID-19 patients in the second wave. Three main patterns emerged suggesting a higher UNC occurrence among COVID-19 patients in the first wave, less occurrence among them compared to non-COVID-19 patients in the second wave, and contrasting findings with some in favour and others in contrast to COVID-19 patients. Similar patterns emerged regarding UNC reasons while no studies investigated the UNC consequences.

CONCLUSIONS

In the first wave, COVID-19 patients were likely to be at increased risk of UNC, while in later waves non-COVID-19 patients were at increased risk of UNC. Reasons also were different across waves. Findings documented during the COVID-19 pandemic may help to prevent UNC in future disasters.

The experiences of nurses following seclusion or restraint use and immediate staff debriefing in inpatient mental health settings

AIM

The aim of this study is to explore nurses' experiences of seclusion or restraint use and their participation in immediate staff debriefing in inpatient mental health settings.

DESIGN

This research was conducted using a descriptive exploratory design and data were gathered through in-depth individual interviews.

METHODS

The experiences of nurses following seclusion or restraint use and their participation in immediate staff debriefing were explored via teleconference, using a semi-structured interview guide. Reflexive thematic analysis was used to identify prevalent themes from the data.

RESULTS

Interviews (n=10) were conducted with nurses from inpatient mental health wards in July 2020. Five themes emerged through the data analysis: (i) ensuring personal safety; (ii) grappling between the use of least-restrictive interventions and seclusion or restraint use; (iii) navigating ethical issues and personal reactions; (iv) seeking validation from colleagues and (v) attending staff debriefing based on previous experience. The themes were also analysed using Lazarus and Folkman's Transactional Model of Stress and Coping.

CONCLUSION

Staff debriefing is a vital resource for nurses to provide and/or receive emotion- and problem-focused coping strategies. Mental health institutions should strive to establish supportive working environments and develop interventions based on the unique needs of nurses and the stressors they experience following seclusion or restraint use.

PATIENT OR PUBLIC CONTRIBUTION

Nurses in both frontline and leadership roles were involved in the development and pilot test of the interview guide. The nurses who participated in the study were asked if they can be recontacted if clarification is needed during interview transcription or data analysis.

Embedding the A-EQUIP model of restorative supervision in a critical care unit by professional nurse advocates

The professional nurse advocate (PNA) programme was launched in March 2021, which was towards the end of the third wave of COVID-19 and the start of a critical point of recovery. COVID-19 placed exceptional challenges and pressure on healthcare staff, with many experiencing feelings of stress and burnout. The role of the PNA emerged as a response to the impact this had upon the nursing workforce. PNAs are trained to facilitate restorative clinical supervision and to advocate education for quality improvement, resulting in improvements to patient care and staff wellbeing. The programme started with 400 critical care nurses; since then it has been rolled out to all specialties, with the aim to have 5000 PNAs integrated into the national workforce by April 2022. Criteria for the level 7 PNA training programme requires a registered nurse to be working in a patient-facing role, at band 5 or above, hold a level 6 qualification and have approval from their line manager. The training programme is typically 10 to 12 days in length over a 12-week period. This article explores the implementation of the PNA role in a critical care unit.

How does the work-life balance impact stress on primary healthcare workers during the COVID-19 pandemic?

BACKGROUND

Most studies in advanced care settings reported that the increasing workload increases the work-life imbalance and harms the mental health of health workers. The COVID-19 Pandemic's tracing, testing, treatment, and mass vaccination also have multiplied the primary healthcare workers' workload. Nevertheless, studies on primary care workers are scarce. This study aimed to investigate how the COVID-19-related work-life balance impact stress on primary healthcare workers in the third years of the pandemic.

METHODS

The study was a cross-sectional, web-based survey conducted on primary healthcare workers in Kediri Regency, Indonesia, with the highest Omicron case surge worldwide. It was conducted right after the surge between July and August 2022, the third year of the COVID-19 pandemic hit Indonesia. Under coordination with the local government health officials, primary healthcare workers were invited to participate in an online survey. The respondents were asked to evaluate their sociodemography, work conditions, personal life, and perceived stress (using the Perceived Stress Scale) during the pandemic. Their work-life balance was evaluated using the Work/Non-work Interference and Enhancement Scale. We used several hierarchical linear regression models to determine which variables contribute to work stress among primary healthcare workers.

RESULTS

Sociodemographic characteristics, including gender, age, marital status, years of professional experience, and educational level, were not significantly associated with stress levels among our respondents. Separately, work conditions and personal life variables did not associate with stress levels. However, primary healthcare workers' work and personal lives interfere with each other during the pandemic and are associated with their higher stress.

CONCLUSION

During the pandemic, the work life of primary health workers interferes with their personal life more than the interference of personal life on their work life. At the same time, the work life's enhancement on the personal life and vice versa were lower than its interference. Those conditions are associated with higher perceived stress of primary health workers.

Improving Staff Workflow in Urology Procedure Clinic Using the Model for Improvement

OBJECTIVE

To maximize procedure volume and minimize workflow inefficiency in our urological procedure clinic, we hypothesized that for staff (nurses/medical assistants) and patient teams, team workflow duration (TWD) (the time required to complete team duties for a single appointment) could be reduced by 50% with a targeted workflow intervention developed using the Model for Improvement and Plan-Do-Study-Act cycles. Workflow inefficiency leads to wasted time and workplace dissatisfaction, resulting in lost revenue due to low procedure volume and high staff turnover.

METHODS

A baseline time study was performed to measure TWD for clinical teams, including the front desk, physician, staff, and patient teams. Implementation of previously identified interventions was also recorded. A workflow intervention was developed in which staff duties were split among two roles: staffer and triager. TWD and intervention implementation were remeasured over six Plan-Do-Study-Act cycles. Semistructured interviews were conducted as a balance measure to assess impact on staff workflow and wellness.

RESULTS

Our workflow intervention resulted in a 44% and 42% reduction in staff and patient TWD, saving nearly 17 minutes per appointment on average. Thematic analysis revealed that time saved could be best used to protect lunch breaks and allow time to complete nonclinical duties such as patient calls, which had previously been performed after-hours.

CONCLUSION

Introduction of staffer and triager roles to staff workflow increased clinic efficiency by reducing workflow and procedure appointment duration. Time saved was used to increase procedure volume while also supporting staff wellness.

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.

Spanish psychometric properties of the moral distress scale-revised: a study in healthcare professionals treating COVID-19 patients

BACKGROUND

Moral distress appears when a healthcare professional is not able to carry out actions in accordance with their professional ethical standards. The Moral Distress Scale-Revised is the most widely used to assess levels of moral distress, but it is not validated in Spanish. The aim of the study is to validate the Spanish version of the Moral Distress Scale - utilised within a sample of Spanish healthcare professionals treating COVID-19 patients.

METHODS

The original (english) and the portuguese and french versions of the scale were translated into spanish by native or bilingual researchers and reviewed by an academic expert in ethics and moral philosophy as well as by a clinical expert.

RESEARCH DESIGN

Descriptive cross-sectional study carried out using a self-reporting online survey. The data was collected between June- November 2020. A total of 661 professionals responded to the survey (N = 2873).

PARTICIPANTS

healthcare professionals with more than two weeks of experience treating COVID-19 patients at the end of their life and working in the public sector of the Balearic Islands Health Service (Spain). Analyses included descriptive statistics, competitive confirmatory factor analysis, evidence on criterion-related validity and estimates of reliability. The study was approved by the Research Ethics Committee at the University of Balearic Islands.

RESULTS

An unidimensional model in which a general factor of moral distress explained by 11 items of the Spanish version of the MDS-R scale was an adequate representation of the data: χ²(44) = 113.492 (p 0.001); Comparative Fit Index = 0.965; Root Mean Square Error of Approximation = 0.079[0.062,0.097]; and Standarized Root Mean-Square = 0.037. Evidence of reliability was excellent: Cronbach's alpha = 0.886 and McDonald's omega = 0.910. Moral distress was related to discipline, with nurses having statistically significant higher levels than physicians. Additionally, moral distress successfully predicted professional quality of life, with higher levels of moral distress being related to poorer quality of life.

CONCLUSIONS

The Spanish version of Moral Distress Scale-Revised can be used as a reliable and valid measurement tool for the evaluation of moral distress experienced by health professionals. This tool will be highly useful for managers and applicable to a variety of healthcare professionals and settings.

A Longitudinal Cohort Study of Factors Impacting Healthcare Worker Burnout in New York City During the COVID-19 Pandemic

OBJECTIVE

This study aimed to longitudinally examine the prevalence and correlates of burnout in frontline healthcare workers (FHCWs) during COVID-19 in New York City.

METHODS

A prospective cohort study of 786 FHCWs at Mount Sinai Hospital was conducted during the initial COVID surge in April to May 2020 (T1) and November 2020 to January 2021 (T2) to assess factors impacting burnout.

RESULTS

Burnout increased from 38.9% to 44.8% ( P = 0.002); 222 FHCWs (28.3%) had persistent burnout, 82 (10.5%) had early burnout, and 129 (16.5%) had delayed burnout. Relative to FHCWs with no burnout ( n = 350; 44.7%), those with persistent burnout reported more prepandemic burnout (relative risk [RR], 6.67), less value by supervisors (RR, 1.79), and lower optimism (RR, 0.82), whereas FHCWs with delayed burnout reported more prepandemic burnout (RR, 1.75) and caring for patients who died (RR, 3.12).

CONCLUSION

FHCW burnout may be mitigated through increasing their sense of value, support, and optimism; treating mental health symptoms; and counseling regarding workplace distress.

Exploration of California School Nurse perspectives on the impact of COVID-19

OBJECTIVE

To explore in a sample of school nurses (SN) in California the impact of the COVID-19 pandemic on school nurse health services, how school nurses mitigated the impact of COVID-19, and moral distress levels among school nurses.

DESIGN AND METHODS

Nineteen (N = 19) school nurses who work in K-12 schools in California, USA participated in a mixed-methods approach involving qualitative descriptive design, inductive content analysis, and descriptive statistics. Interviews were conducted in August and September 2021.

RESULTS

Five themes emerged: (1) role of the SN during the COVID-19 pandemic, (2) coordination with school administration, (3) COVID-19 related challenges and disruptions to care, (4) moral distress, and (5) coping during the pandemic.

CONCLUSION

The pandemic had a profound impact on school nurses. This study provides school nurse perspectives of the impact of COVID-19 on services they delivered, the unique skills of school nurses essential to mitigation strategies, and moral distress school nurses encountered during the pandemic. Understanding the important role school nurses had during the pandemic is paramount to fully contextualize the contributions they made within public health nursing practice and inform preparedness for future pandemics.

Rethinking Traditional Emergency Department Care Models in a Post-Coronavirus Disease-2019 World

As the nursing shortage in United States emergency departments has drastically worsened since the coronavirus disease-2019 (COVID-19) pandemic, emergency departments have experienced increased rates of inpatient onboarding, higher rates of patients leaving without being seen, and declining patient satisfaction scores. This paper reviews the impacts of the coronavirus disease-2019 pandemic on the current nursing shortage and considers how various medical personnel (emergency nurse-extenders) can ameliorate operational challenges by redesigning emergency department systems. During the height of the coronavirus disease-2019 pandemic, the psychological effects of increased demand for emergency nurses coupled with the fear of coronavirus infection exacerbated nursing turnover rates. Health care workers who can be trained to augment the existing emergency department workforce include paramedics, Emergency Medical Technicians, emergency department technicians, ancillary staff, scribes, and motivated health sciences students. Utilizing non-nurse providers to fulfill tasks traditionally assigned to emergency nurses can improve emergency department flow and care delivery in a post-coronavirus disease-2019 world.

Primary healthcare nurses' experiences of addressing intimate partner violence in supportive legal and health system contexts

AIM

To explore the experiences of primary healthcare (PHC) nurses caring for women experiencing intimate partner violence (IPV) in a context of institutional support for the management of this health issue.

DESIGN

Secondary qualitative analysis.

METHODS

A purposeful sample (n = 19) of registered nurses, working in a PHC setting, with experience providing care to women who had disclosed intimate partner violence completed an in-depth interview. Thematic analysis was used to code, categorize and synthesize the data.

RESULTS

Four themes were developed from the analysis of the interview transcripts. The first two themes address the characteristics of the type of violence most frequently encountered by participants, and how these characteristics shape the needs of women and the care nurses provide them. The third theme encompasses uncertainties and strategies developed to deal with the aggressor during the consultations as the woman's companion or as the patient himself. Finally, the fourth theme reflects the positive and negative consequences of caring for women exposed to intimate partner violence.

CONCLUSION

When there is a supportive legal framework and health system to address IPV, nurses are able to implement evidence-based best practices in caring for women experiencing intimate partner violence. The predominant type of violence experienced by women at the time they enter the healthcare system shapes their needs and the service/unit they reach. These varying needs should be considered in the development of training programmes for nurses and should be adapted for different healthcare services. Caring for women experiencing intimate partner violence implies an emotional burden even in an institutional supportive context. Therefore, actions to prevent nurses' burnout should be considered and implemented.

IMPACT

Lack of institutional support usually hinders the potential role nurses can play in the care provided to women who have experienced intimate partner violence. Findings from this study demonstrated that primary healthcare nurses are able to implement evidence-based best practices in the care for women experiencing intimate partner violence when there is a supportive legal framework and the health system context is openly favourable to addressing intimate partner violence. Findings from this study could inform the design and implementation of programmes and/or policies to improve nurses' responses to intimate partner violence in primary healthcare services.

COVID-19 Did Not Stop the Rising Tide: Trends in Case Volume Logged by Surgical Residents

INTRODUCTION

The coronavirus pandemic has profoundly impacted all facets of surgical care, including surgical residency training. The objective of this study was to assess the operative experience and overall case volume of surgery residents before and during the pandemic.

METHODS

Using data from the Accreditation Council for Graduate Medical Education annual operative log reports, operative volume for 2015 to 2021 graduates of Accreditation Council for Graduate Medical Education -accredited general, orthopedic, neuro- and plastic surgery residency programs was analyzed using nonparametric Kendall-tau correlation analysis. The period before the pandemic was defined as AY14-15 to AY18-19, and the pandemic period was defined as AY19-20 to AY20-21.

RESULTS

Operative data for 8556 general, 5113 orthopedic, 736 plastic, and 1278 neurosurgery residency graduates were included. Between 2015 and 2021, total case volume increased significantly for general surgery graduates (Kendall's tau-b: 0.905, p = 0.007), orthopedic surgery graduates (Kendall's tau-b: 1.000, p = 0.003), neurosurgery graduates (Kendall's tau-b: 0.905, p = 0.007), and plastic surgery graduates (Kendall's tau-b: 0.810, p = 0.016). Across all specialties, the mean total number of cases performed by residents graduating during the pandemic was higher than among residents graduating before the pandemic, though no formal significance testing was performed. Among general surgery residents, the number of cases performed as surgeon chief among residents graduating in AY19-20 decreased for the first time in 5 years, though the overall volume remained higher than the prior year, and returned to prepandemic trends in AY20-21.

CONCLUSIONS

Over the past 7 years, the case volume of surgical residents steadily increased. Surgical trainees who graduated during the coronavirus pandemic have equal or greater total operative experience compared to trainees who graduated prior to the pandemic.

Persevering in Nursing with Godly Purpose

ABSTRACT

COVID-19 impacted the psychological and spiritual wellness of healthcare providers, in addition to their physical health. Christian nurses must continue to look for reassurance of God's provision and control of circumstances as a means of coping through adversity in their work. Practical Scripture applications are provided to sustain nurses' resilience and encouragement.

New Graduate Nurses Navigating Entry to Practice in the Covid-19 Pandemic

BACKGROUND

The Covid-19 pandemic has significantly impacted organizational life for nurses, with known physical and psychological impacts. New graduate nurses are a subset of nurses with unique needs and challenges as they transition into their registered nurse roles. However, this subset of nurses has yet to be explored in the context of the Covid-19 pandemic.

PURPOSE

To explore the experiences of new graduate nurses entering the profession in Ontario, Canada, during the Covid-19 pandemic approximately one year after entering the profession.

METHODS

Thorne's interpretive description method was utilized.

FINDINGS

All participants identified as completing second entry nursing programs, offering a unique perspective on new graduate nurse transition. Four themes emerged in the data: 'Virtual Didn't Cut It,' 'Go Where You Know,' 'Picking Up the Pieces,' and 'Learning When to Say No and Let Go.' Participants felt ill prepared to enter the profession and were cognizant of the various challenges facing the nursing profession, and how these pre-existing challenges were exacerbated by the pandemic. They acknowledged the need to protect themselves against burnout and poor mental health, and as such, made calculated early career decisions - demonstrating strong socio-political knowing. Half of the participants had already left their first nursing job; citing unmet orientation, mental health, and wellbeing needs. However, all participants were steadfast in remaining in the nursing profession.

CONCLUSIONS

Second entry new graduate nurses remain a unique subset of nurses that require more scholarly attention as their transition experiences may differ from the traditional trajectory of new graduate nurses.

Challenge, threat, coping potential: How primary and secondary appraisals of job demands predict nurses' affective states during the COVID-19 pandemic

AIM

The COVID-19 pandemic has led to a rapid raise of work-related stress among nurses, affecting their emotional well-being. This study examined how nurses appraise job demands (i.e. time pressure, emotional demands and physical demands) during the pandemic, and how primary (i.e. challenge and threat) and secondary appraisals (i.e. coping potential) of job demands predict nurses' affective states (i.e. positive affect, anger and anxiety).

DESIGN

A cross-sectional online survey.

METHODS

419 nurses completed self-report measures of job demands and related appraisals. Data analyses comprised correlation analysis, factor analysis, hierarchical linear regression analysis and dominance analysis.

RESULTS

Emotional and physical demands correlated exclusively with threat appraisal, while time pressure correlated with challenge and threat appraisal. Time pressure, emotional demands and threat appraisals of job demands predicted negative affective states, while challenge appraisals of emotional and physical demands predicted positive affect. Coping potential was identified as the most important predictor variable of nurses' affective states.

PUBLIC CONTRIBUTION

The current study identified statistically significant risk and protective factors in view of nurses' affective states experienced during the COVID-19 pandemic.

A conflicted tribe under pressure: A qualitative study of negative workplace behaviour in nursing

AIM

This study explored workplace interactions of Australian nurses in regional acute care hospitals through an examination of nurses' experiences and perceptions of workplace behaviour.

DESIGN

This research is informed by Social Worlds Theory and is the qualitative component of an overarching mixed methods sequential explanatory study.

METHODS

Between January and March 2019, data were collected from 13 nursing informants from different occupational levels and roles, who engaged in semi-structured, in-depth, face-to-face interviews. Data analysis was guided by Straussian grounded theory to identify the core category and subcategories.

RESULTS

Theoretical saturation occurred after 13 interviews. The core category identified is A conflicted tribe under pressure, which is comprised of five interrelated subcategories: Belonging to the tribe; 'It's a living hell'; Zero tolerance-'it's a joke'; Conflicted priorities; Shifting the cultural norm.

CONCLUSION

This study provides valuable insight into the nursing social world and the organizational constraints in which nurses work. Although the inclination for an individual to exhibit negative behaviours cannot be dismissed, this behaviour can either be facilitated or impeded by organizational influences.

IMPACT

By considering the nurses' experiences of negative workplace behaviour and identifying the symptoms of a struggling system, nurse leaders can work to find and implement strategies to mitigate negative behaviour and create respectful workplace behaviours.

PATIENT OR PUBLIC CONTRIBUTION

This study involved registered nurse participants and there was no patient or public contribution.

CLINICAL TRIAL REGISTRATION

Study registration Australian New Zealand Clinical Trials Registry (Registration No. ACTRN12618002007213; December 14, 2018).

Austerity Measures and Underfunding of the Spanish Health System during the COVID-19 Pandemic-Perception of Healthcare Staff in Spain

Insufficient pandemic preparedness and underfunding of human and economic resources have conditioned the response to COVID-19 in Spain. This underfunding has continued since the austerity measures introduced during the 2008 financial crisis. This study aims to understand the perceptions of healthcare staff in Spain on the relationship between the funding of the health system and its capacity to respond to the COVID-19 pandemic. To this end, we carried out a thematic content analysis, based on 79 online semi-structured interviews with healthcare staff across the regions most affected by the COVID-19 first wave. Participants reported a lack of material resources, which had compromised the capacity of the health system before the pandemic. The lack of human resources was to be addressed by staff reorganisation, such as reinforcing hospital units to the detriment of primary health care. Staff shortages continued straining the COVID-19 response, even after material scarcities were later partially alleviated. Personnel shortages need to be adequately addressed in order to adequately respond to future health crises.

Burnout and quality of life in nursing staff during the COVID-19 pandemic

OBJECTIVE

To investigate the association between burnout and quality of life among nursing staff at intensive care units during the new coronavirus pandemic and identify the influence of sociodemographic variables.

METHODS

A cross-sectional study was conducted with 109 nursing staff members at intensive care units of a public hospital in Brazil. Data collection involved the administration of a sociodemographic questionnaire as well as the WHOQOL-Bref and Oldenburg Burnout Inventory.

RESULTS

The participants presented a high state of burnout and a low score in the physical domain of the quality-of-life instrument. Men (p = 0.037), income (p = 0.011) and burnout (p < 0.001) independently influenced quality-of-life (p < 0.01). Age, being a nursing technician and working at two hospitals exerted an influence on burnout status (p < 0.05). A negative association was found between quality of life and burnout (p < 0.01).

CONCLUSION

Our findings showed that burnout due to occupational circumstances affected negatively the quality of life perceptions of nursing staff working at intensive care units during the COVID-19 pandemic.

Effect of COVID-19 Frontline Nurses' Profession Perception on Their Intention to Stay: The Mediating Role of Job Satisfaction

Introduction

Understanding the factors affecting the intention of frontline nurses during the coronavirus disease (COVID-19) pandemic to stay in the nursing profession is essential for developing strategies to overcome the challenges associated with the pandemic.

Objectives

This study aimed to examine the mediating effect of nurses' job satisfaction on the relationship between their sense of calling, job-esteem, and the intention to stay in their profession.

Methods

The study used a previously collected dataset, sourced from a dedicated COVID-19 hospital in Seoul City, South Korea. Original data were collected from June to July 2021. The study sample consisted of 134 nurses who provided direct care to patients. The intention to stay was measured with the following question: "Are you willing to work during this COVID-19 pandemic?". The Job Satisfaction Scale from the Korean Labor and Income Panel Study, Korean version of a Multidimensional Calling Measure, and Job-Esteem Scale for Hospital Nurses were utilized. Associations between the study variables were estimated using bivariate correlation analyses and bootstrapping mediation analyses.

Results

In the bivariate correlation analysis, nurses' sense of calling (r = .36, p < .001), job-esteem (r = .32, p < .001), and job satisfaction (r = .39, p < .001) were significantly associated with the intention to stay. In the mediation analysis, job satisfaction partially mediated the relationship between the sense of calling and the intention to stay (total effect; B = 0.410, p < .001) and fully mediated the relationship between job-esteem and the intention to stay (total effect; B = 0.549, p < .001).

Conclusion

Enhancing nurses' job satisfaction is crucial for fostering the retention of the nursing workforce amid the pandemic. Consequently, it is imperative to closely examine the job satisfaction and work environment of frontline nurses to identify areas in need of improvement. Addressing the factors that impede nurses' job satisfaction is essential to unlock the positive effects of a sense of calling and job-esteem.

'Caring for the helpers': factors associated with professional quality of life among Hong Kong nurses during the fifth wave of the COVID-19 pandemic

BACKGROUND

Western studies have found that nurses are likely to experience both positive and negative emotions in their job, as a helping profession [professional quality of life (ProQoL)] during the coronavirus disease 2019 (COVID-19) pandemic, and that psychosocial and work-related variables (e.g. pandemic-related stressors, interpersonal and organizational support, coping strategies) are associated with such outcomes. However, relevant studies on nurses in the Asian context are limited.

OBJECTIVE

This study examined the psychosocial correlates of three indicators of ProQoL, i.e. compassion satisfaction, secondary traumatic stress (STS), and burnout, among nurses during the fifth wave of the COVID-19 pandemic in Hong Kong.

METHOD

Nurses in Hong Kong (N = 220) working in hospitals and community settings during the COVID-19 pandemic were recruited between 24 May and 27 June 2022 through nursing associations to complete an online survey measuring the aforementioned psychosocial variables.

RESULTS

Hierarchical regression results found that stressors from clinical work environments, insufficient emotional support, and less positive reframing were associated with poorer ProQoL (i.e. lower compassion satisfaction; higher STS and burnout) (β from 0.16, p > .05, to 0.44, p > .001). In addition, COVID-19-related worries/uncertainties and emotional processing were associated with higher STS (β from 0.21 to 0.23, p < .01), whereas insufficient organizational support for communication with the healthcare system was associated with higher burnout (β = 0.12, p < .05).

CONCLUSIONS

Our findings identified the important psychosocial determinants in ProQoL among nurses in Hong Kong and provide recommendations for services supporting the mental health of these nurses. Providing workshops for nurses to train their skills in coping with COVID-19-related uncertainties, worries, and stressors from the clinical work environment, in using adaptive coping strategies (e.g. positive reframing), and in soliciting emotional support from important others could facilitate their ProQoL. Moreover, the provision of organizational support through timely and transparent communication with the healthcare system could reduce STS in nurses.

The Effect of Coronovirus Perceptions and Attitudes of Pediatric Nurses on Quality of Life

Purpose: This cross-sectional study aims to explore the effect of pediatric nurses' perceptions and attitudes of coronavirus on their quality of life. Methods: It was carried out between the dates of June-August, 2021. The sample of the study consisted of 80 pediatric nurses working in the pediatric clinics of a university hospital. “Perceptions and Attitudes Evaluation Scale towards the COVID-19 Pandemic” and "WHOQOL-BREF-TR Scale" were used to collect data which were collected by online survey method. Results: It was determined that the mean score of the spiritual and social domains of the quality of life of the pediatric nurses was at a moderate level, while the mean scores of the physical and environmental domains were found to be below the medium level. According to the results of the regression analysis, the nurses' coronavirus perception and attitude sub-dimensions of dangerousness, macro, cognitive avoidance, common area avoidance and personal contact avoidance scores explained 30% of spiritual domain scores, and macro and common area avoidance sub-dimension scores explained 25% of social domain scores, macro and complo sub-dimensions scores explained 22% of environmental domain scores. Conlusion: As a result, it was determined that pediatric nurses' perceptions and attitudes towards coronavirus effect their quality of life. In order to increase the quality of life of pediatric nurses, attempts should be made to help nurses in the conditions of the COVID-19 pandemic and to provide necessary protection conditions to minimize the physical, spiritual, social, and environmental effects of the pandemic.

Veränderungen in anhaltenden Extremsituationen

Background

The Covid-19 virus caused increased challenges for nursing professionals.

Objectives

This study aims to explore psychosocial stress in the work environment of nursing staff resulting from the pandemic within an Austrian hospital. In addition, differences in the experience between nurses and nursing assistants, in leadership and management positions, as well as between wards with (suspected) Covid-19 positive patients and wards without Covid-19 patients will be recorded.

Design and Methods

In a mixed-method study, a web-based survey was conducted using the Copenhagen Psychosocial Questionnaire (COPSOQ). The qualitative data was collected with four open questions. The results were analysed descriptively and inferentially with a one-way analysis of variance and the Mann-Whitney-U test. The qualitative data were analysed using content analysis.

Results

A total of 104 participants completed the survey. The results show that there is a burden on nursing professionals (p = 0.03) within the area of emotional and quantitative demands (p < 0.01), but no differences between the individual nursing groups emerged. Leadership and management positions report less stress than the rest of the nursing staff (p ≤ 0.05). When distinguishing between Covid-19 (suspected) wards and non-Covid-19 wards, two scales (demands for hiding emotions % possibilities for development) were statistically significant (p ≤ 0.04).

Conclusion

The results of this study illustrate the psychosocial burden of the Covid-19 pandemic on nurses with different characteristics and are in line with current research. Further studies should address the impact of the burden on nursing practice.

Impact of COVID-19 pandemic on nurses' burnout and related factors: A rapid systematic review

AIM

This study aimed to investigate the effect of COVID-19 pandemic on nurses' burnout and related factors.

BACKGROUND

Nurses at the frontlines in every field of the health system and composed most of the health service industry closely experience all negative events during the pandemic.

METHODS

This study is a rapid systematic review.

RESULTS

A total of 751 studies were selected, of which 13 studies were compatible with the inclusion criteria. The sample size ranged from 107 to 12.596. The studies determined that nurses' burnout levels were generally moderate level and above during the COVID-19 pandemic. Sociodemographic, occupational, psychological, and COVID-19-related factors affected this burnout.

CONCLUSION

The results of this review may use to make implications that would ease the effect of the pandemic on nurses and develop strategies to protect nurses from burnout in similar possible situations. The protocol information is included here for blind peer review.

PROSPERO REGISTRATION NUMBER (ID)

CRD42021244849.

REGISTRATION AND PROTOCOL

Prior to undertaking the review, we registered the protocol in the International Prospective Register of Systematic Reviews (PROSPERO). The registration number is CRD42021244849. Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021244849. The changes made during the review process were registered in PROSPERO with an update.

Canadian critical care nurses experiences on the front lines of the COVID-19 pandemic: a qualitative descriptive study

BACKGROUND

Recent pandemics have provided important lessons to inform planning for public health emergencies. Despite these lessons, gaps in implementation during the COVID-19 pandemic are evident. Additionally, research to inform interventions to support the needs of front-line nurses during a prolonged pandemic are lacking. We aimed to gain an understanding of critical care nurses' perspectives of the ongoing pandemic, including their opinions of their organization and governments response to the pandemic, to inform interventions to improve the response to the current and future pandemics.

METHODS

This sub-study is part of a cross-sectional online survey distributed to Canadian critical care nurses at two time points during the pandemic (March-May 2020; April-May 2021). We employed a qualitative descriptive design comprised of three open-ended questions to provide an opportunity for participants to share perspectives not specifically addressed in the main survey. Responses were analyzed using conventional content analysis.

RESULTS

One hundred nine of the 168 (64.9%) participants in the second survey responded to the open-ended questions. While perspectives about effectiveness of both their organization's and the government's responses to the pandemic were mixed, most noted that inconsistent and unclear communication made it difficult to trust the information provided. Several participants who had worked during previous pandemics noted that their organization's COVID-19 response failed to incorporate lessons from these past experiences. Many respondents reported high levels of burnout and moral distress that negatively affected both their professional and personal lives. Despite these experiences, several respondents noted that support from co-workers had helped them to cope with the stress and challenges.

CONCLUSION

One year into the pandemic, critical care nurses' lived experiences continue to reflect previously identified challenges and opportunities for improvement in pandemic preparedness and response. These findings suggest that lessons from the current and prior pandemics have been inadequately considered in the COVID-19 response. Incorporation of these perspectives into interventions to improve the health system response, and support the needs of critical care nurses is essential to fostering a resilient health workforce. Research to understand the experience of other front-line workers and to learn from more and less successful interventions, and leaders, is needed.

Workplace Exposures and Prescription Drug Misuse Among Nurses

OBJECTIVE

This study examined the association between workplace exposure and prescription drug misuse in nurses.

BACKGROUND

Studies have found RNs and other health providers have higher rates of prescription misuse than the general population and have suggested that workplace exposures along with excessive job demands create circumstances fostering misuse.

METHODS

Survey data from 1170 RNs on workplace exposures (availability, frequency of administration, knowledge of substances, and workplace controls) were described by workplace, position, and specialty. Exposures were then related to prescription drug misuse using logistic regression.

RESULTS

Each workplace exposure was associated with past year prescription drug misuse. An index combining all exposures was significantly related to misuse ( P = 0.001), and odds of misuse increased by 38% for each point increase in the exposure index.

CONCLUSIONS

Consideration of the health and well-being of nurses at higher odds of exposure to prescription drugs with misuse potential is warranted. Workplace support to help nurses maintain and restore their health should be a priority.