Leadership, adequate staffing and material resources, and collegial nurse-physician relationships promote better patients, professionals and institutions outcomes

Factors influencing the formation of balanced care teams: the organisation, performance, and perception of nursing care teams and the link with patient outcomes: a systematic scoping review

BACKGROUND

The composition of care teams is crucial for delivering patient-centered healthcare, yet assembling a well-balanced team remains a challenge. This difficulty stems from the intricate dynamics of team capacity, culture, context, and the demands of the job. The current literature offers limited guidance for decision-makers on how to effectively navigate these dynamics to compose a balanced care team.

METHODS

We conducted a systematic scoping review of literature spanning from 2009 to 2022. The aim was to identify factors that significantly influence the work environment, team performance, nursing outcomes, and patient outcomes within healthcare settings. Our review focused on extracting and synthesizing evidence to uncover these influencing factors.

RESULTS

Our analysis identified 35 factors that play a significant role in shaping the work environment and influencing team performance, nursing outcomes, and patient outcomes. These factors were categorized into nine key domains: workload, leadership, team composition, stress and demands, professional relationships, safety, logistics and ergonomics, autonomy and responsibility, and transparency and task clearness.

CONCLUSIONS

To improve patient care and nursing job satisfaction, policymakers and decision-makers can consider these influencing factors in the design and management of care teams. The findings advocate for strategic adjustments in these domains to enhance a team's balance. Furthermore, our review underscores the need for further research to fill the identified gaps in knowledge, offering a directive for future studies into optimal care team composition. This systematic approach to team composition can significantly impact patient outcomes and nurse satisfaction, providing a roadmap for creating more effective and harmonious teams.

Nurses' collegiality: An evolutionary concept analysis

Collegiality is one of the fundamental values of the nursing profession. During the nursing history, collegiality has been described as part of a nurse's relationship with their peers and it influences the quality of care they provide and job satisfaction and commitment to their work. Despite earlier definitions, the concept of collegiality in nursing has remained unclear. The aim of this study was to clarify the concept of collegiality in the nursing profession, using Rodger's evolutionary concept analysis. We carried out electronic searches using the CINAHL, PubMed, Scopus, Web of Science, SocINDEX, PsycINFO and Eric databases and manual searches of the reference lists of the selected papers. The searches were limited to peer-reviewed papers published in English language from the inception of database to November 2022. This identified 25 papers. Based on our analysis, the attributes of the concept of collegiality were achieving mutual goals together with equality, reciprocity, trusted advocacy, powerful self-regulation and engaged belongingness. Antecedents of the concept included existing professional group, connection between professionals and professional self-esteem. The consequences were strengthening nurses' professional status, job satisfaction and their ability to provide the best possible patient care. We found that nurses' collegiality was a value-based concept, with a unique character based on professional connections. The concept brought together ethical and pragmatic strategies to achieve the best possible results for the nursing profession. Provided knowledge can be applied for further development of the concept and applying it in clinical research and practice. The concept of nurses' collegiality should also be studied in the future because both the profession and their working environment are constantly changing.

Hospital Unit Type and Professional Roles as a Predictor of Relational Coordination in an Army Medical Center

BACKGROUND AND OBJECTIVES

High-quality communication and relationships are associated with quality of care. Workflow differences across hospital units can impede communication and relationships among health care professionals. Relational coordination (RC) is a process of communication supported by shared goals, shared knowledge, and mutual respect and is associated with quality of care and better performance outcomes in civilian hospitals. However, RC has not been explored in military hospitals. The objective of our study was to determine whether RC differs between hospital units and professional roles. Specifically, we examined RC differences by unit type for nurses, resident physicians, and physicians working in an Army Medical Center.

METHODS

We conducted an exploratory analysis of a secondary question from a cross-sectional study using a convenience sample of active-duty and civilian licensed practical nurses (LPNs), registered nurses (RNs), physician residents, and physicians (n = 289). We received institutional review board approval from the study site. Data were collected from January 2020 to March 2020, and participants completed a 47-item survey regarding their experiences of RC in various hospital units. We used t tests and one-way analyses of variance to explore bivariate relationships between RC and other study variables, as well as multiple regression to explore whether RC varied by unit type. We controlled for education and experience by including them in the model because these variables may influence perceptions of nurse-physician RC and their interactions with each other.

RESULTS

Seventy percent of participants were civilian (n = 203), 75% RNs (n = 217), and 78% female (n = 216). The mean age of respondents was 40 years (SD = 11.7), and the mean experience level was 11.9 years (SD = 9.5). RC was not associated with unit type. Total RC and between-role RC were associated with professional role. Physicians reported higher RC (β = .45, P = .01), and LPNs reported lower RC (β = -.06, P = .01). Education and experience were associated with RC. Participants with less experience reported higher RC (β = -.01, P = .00), and participants with graduate degrees reported lower RC (β = -.62, P = .00).

CONCLUSIONS

We recommend hospital leaders consider interventions to build interprofessional relationships, including interdisciplinary meetings, huddles, and structured communication tools. Improving RC among health care professionals is a cost-effective and unique way to enhance communication and collaboration among health care professionals across hospital units.

A relational coordination training intervention to improve job satisfaction and intent to stay in the intensive care unit: A pilot study

BACKGROUND

Relational coordination (RC) explores the coordination of work between and among professionals in a workgroup. RC is associated with higher job satisfaction and retention; however, researchers have not tested RC training interventions to improve job satisfaction and retention.

PURPOSE

To explore changes in job satisfaction and intent to stay among health care professionals following a virtual RC training intervention.

METHODS

We conducted a pilot, parallel group randomized controlled trial in four intensive care units. Data collection occurred via survey. Difference-in-difference regression models were used to analyze the job satisfaction and intent to stay outcomes.

DISCUSSION

The RC training intervention did not influence job satisfaction or intent to stay. Participants with baccalaureate degrees and African American/Black participants reported lower intent to stay.

CONCLUSION

The results from this pilot study are a critical first step in testing the efficacy of an RC training intervention to improve staff outcomes in a larger powered study.

Nurse Managers' Leadership, Patient Safety, and Quality of Care: A Systematic Review

This review examined relationships between nurse unit managers' leadership and patient safety and quality of care outcomes in hospital settings. Employing four databases (CINAHL, Embase, PubMed, and Web of Science) and ancestry searches, we identified 14 English-language, peer-reviewed, primary studies that examined such relationships using quantitative analyses. The studies were published between 2012 and 2021, and most used a cross-sectional design. Each study's quality was assessed using the Mixed-Method Appraisal Tool. In synthesizing results by categorizing outcomes, we found a positive trend in associations between effective nurse unit manager leadership and better outcomes, including fewer patient adverse events, increased nurse error reporting, and higher patient satisfaction and care quality. However, the heterogeneity of leadership measurement approaches and outcomes limited integration of study findings. Future researchers should clearly define study concepts to support interpretation of their findings and should use a suitable theoretical framework to help determine appropriate units of analysis.

Designing an optimal infection prevention service: Part 2

Background

The importance of infection prevention and control (IPC) services to prevent threats from healthcare-associated infections and improve the quality of healthcare delivery is undeniable. However, IPC services across the UK and Ireland have substantial variability in terms of team structures and delivery models.

Aim

The aim of this study was to define an optimal IPC service in different contexts and settings within the United Kingdom and Ireland.

Methods

This mixed methods study adopted discussion huddles with IPC teams to explore various components of IPC programmes and services. A Nominal Group technique was then undertaken to achieve a group consensus of what an optimal infection prevention service should look like.

Results

Five discussion huddles were conducted which included 53 participants in total. Key themes arising were IPC Service Priorities, IPC Service Enablers for Success, and Necessary Skills and Expertise Required for Delivering an Effective IPC Service. For the nominal technique, 45 responses were identified which were determining the key priorities for an effective IPC service and 69 responses for establishing key enablers for success.

Discussion

These findings supported the development of a conceptual model for designing an optimal infection prevention service, which can be used to develop IPC services at an international, national, regional and local level. A focus is required around implementation of these highlighted enablers, so are effectively embedded into infection prevention and control services, and wider healthcare settings.

Combination Relationship between Features of Person-Centered Care and Patient Safety Activities of Nurses Working in Small-Medium-Sized Hospitals: A Cross-Sectional Study

Perceived safety culture and nursing work environment are considered important prerequisites for a patient safety activity. Patient safety is also associated with person-centered care; however, few studies apply the person-centered care framework which includes staff attributes and care environment. This study aimed to examine the canonical correlations of person-centered care factors, including professional self-concept, patient safety culture, nursing work environment, and patient safety activities of nurses working in small-medium-sized hospitals. A cross-sectional survey was used. Participants included 171 nurses from seven small-medium-sized hospitals in Busan metropolitan city, in Korea. Data were analyzed using descriptive statistics, t-test, one-way analysis of variance (ANOVA), Pearson's correlation coefficients, and canonical correlations. Two significant canonical variates were found. First, better professional self-concept, a positive patient safety culture, and better nursing work environment were associated with better patient safety care activities. Second, a negative patient safety culture and healthy nursing work environment were associated with a lack of communication between medical staff. Person-centered framework factors such as staff attributes and care environment were positively associated with patient safety activities. Based on the results, nurses in small-medium-sized hospitals should be highly aware of their professional self-concept. Moreover, nurses should be equipped with psychological safety and a healthy work environment to enhance patient safety activities.

Nurse Educator Perceptions of Workplace Collegiality

BACKGROUND

The nursing faculty shortage challenges nursing educators, administrators, and staff to find innovative ways to understand and address faculty retention.

PURPOSE

The purpose of this study was to examine nurse educators' perceptions of workplace collegiality and the possible correlation to role satisfaction and role persistence.

METHODS

Participants (n = 177) were recruited nationally from a Commission on Collegiate Nursing Education accredited schools listing. Three survey instruments were utilized: Survey of Collegial Communication, Job Satisfaction Survey, and Michigan Organizational Assessment Questionnaire.

RESULTS

The study found a positive relationship between collegiality and job satisfaction in academia. The Pearson correlation results indicated there was a significant negative correlation between the intent to remain and collegiality.

CONCLUSION

The findings suggest nursing educators perceive collegiality as an important component of job satisfaction and intent to remain.

Bedside Nurses' Perceptions of Effective Nurse-Physician Communication in General Medical Units: A Qualitative Study

Background

There is a dearth of research on successful interventions to improve nurse-physician communication (NPC). An important step is identifying what matters to bedside nurses and their perceptions of effective NPC communications and actions.

Methods

We conducted three focus groups with a total of 19 medical unit nurses across two hospitals in one academic medical center in the United States. Using a convenience sampling strategy, five to eight nurses voluntarily participated in each focus group. The recording was transcribed verbatim and two independent coders performed coding and resolved any discrepancies in codes. Qualitative content analysis was pursued to identify themes and associated quotes.

Results

The presence of direct communication between physicians and nurses was identified as the first theme and perceived by nurses as very important. Additional themes related to physician communication and attributes emerged including collegiality and respect (e.g., engaging nurses as partners in patient care), attentiveness and responsiveness (e.g., listening carefully and addressing concerns), and directness and support (e.g., backing nurses up in difficult situations). Effective NPC is further facilitated by organizational structure, relationship development separate from patient care, and consistent/timely use of technology.

Conclusions

Hospital bedside nurses provided valuable insight into improved physician communication and what attributes contribute to more effective NPC. Most importantly, they emphasized the significance of physicians in supporting them with difficult patients.

Relational Coordination Among Military and Civilian Nurses and Physicians in an Army Hospital: Do Demographic Characteristics and Professional Roles Matter?

OBJECTIVE

The aim of this study was to explore whether demographic characteristics and professional roles are associated with relational coordination (RC) among nurses and physicians.

BACKGROUND

The increased race, age, and gender diversity in the nursing and medical workforce raises questions regarding how well nurses and physicians communicate and interact. Relational coordination is a unique framework to enhance teamwork and care coordination among healthcare professionals.

METHODS

An exploratory cross-sectional study was conducted in a military hospital. The study variables were examined using multiple regression.

RESULTS

Two-hundred eighty-nine participants completed the survey. Professional role, race, age, gender, and experience were not associated with RC. Rank and education were significantly associated with RC. Enlisted service members reported higher RC between roles, and participants with graduate degrees reported lower RC within roles.

CONCLUSION

Hospital leaders can implement RC to foster inclusivity and teamwork among healthcare professionals despite demographic characteristics and professional roles.

The influence of nursing leadership styles on the outcomes of patients, professionals and institutions: An integrative review

AIM

This review was conducted to map leadership styles that positively impact patients, professionals and institutions.

BACKGROUND

Leadership is a topic widely studied because it is a fundamental skill in establishing favourable work environments, in addition to enabling nurses to influence their team in the search for better results. Therefore, a synthesis of the various studies produced to date is essential for nurses, managers and researchers to understand the different styles of leadership that positively influence organizational results, so they can choose the style they deem most appropriate.

EVALUATION

An integrative literature review retrieved articles from five databases, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The level of evidence and its quality were assessed using the criteria of the Joanna Briggs Institute.

KEY ISSUES

Thirty-five studies were included, 18 of which reported the influence of leadership styles on patients (safety), nine on professionals (burnout) and eight on institutions (turnover and absenteeism).

CONCLUSION

Transformational leadership had positive results for patients, professionals, and institutions alike.

IMPLICATIONS FOR NURSING MANAGEMENT

The results showed the need for nurses to improve their leadership skills, especially in the transformational style, to achieve positive results.

LIDERANÇA COACHING DOS ENFERMEIROS RELACIONADA COM AMBIENTE DA PRÁTICA PROFISSIONAL NA ATENÇÃO PRIMÁRIA À SAÚDE

RESUMO Objetivo: correlacionar autopercepção dos enfermeiros e percepção dos auxiliares de enfermagem sobre liderança coaching dos enfermeiros com o ambiente da prática profissional na Atenção Primária à Saúde. Método: estudo transversal e correlacional com 150 profissionais de enfermagem, sendo: 75 enfermeiros e 75 auxiliares de enfermagem de 13 Unidades Básicas de Saúde localizadas na Zona Sul de São Paulo, SP, Brasil. Foram aplicados Practice Environment Scale - versão brasileira, Questionário de Autopercepção do Enfermeiro no Exercício da Liderança e Questionário de Percepção de Técnicos e Auxiliares de Enfermagem no Exercício da Liderança, no período de janeiro a maio de 2019. Foram utilizados Análise de Variância Univariada e Multivariada, Teste de Correlação de Pearson (p<0,05) e tamanho do efeito de Rosenthal. Resultados: entre os enfermeiros, duas correlações significantes entre os domínios dos instrumentos foram observadas: comunicação e fundamentos de enfermagem voltados para a qualidade do cuidado (r=0,265; p=0,022) e comunicação com relações colegiais entre enfermeiros e médicos (r=0,263; p=0,023). Nos auxiliares de enfermagem, destacam-se comunicação e fundamentos de enfermagem voltados para a qualidade do cuidado (r=0,416) e valor total do Questionário de Percepção de Técnicos e Auxiliares de Enfermagem no Exercício da Liderança e relações colegiais entre médicos e enfermeiros (r=0,409). Conclusão: para os enfermeiros, a comunicação contribuiu para melhor percepção da qualidade do cuidado e boas relações com médicos. Nos auxiliares, todos os domínios da liderança coaching colaboraram para percepções positivas do ambiente. A liderança coaching parece contribuir para que ambientes mais favoráveis à prática profissional sejam estabelecidos na atenção primária à saúde.

NURSES’ COACHING LEADERSHIP RELATED TO PRACTICE ENVIRONMENT WITHIN PRIMARY HEALTH CARE

ABSTRACT Objective: to correlate the nurses’ self-perception and the perception of nursing aides regarding coaching leadership and the practice environment within Primary Health Care. Method: cross-sectional and correlational study addressing 150 nursing workers: 75 nurses and 75 nursing aides of 13 Basic Health Units located in the south of São Paulo, SP, Brazil. The Brazilian version of the Practice Environment Scale, Questionário de Autopercepção do Enfermeiro no Exercício da Liderança [Questionnaire on Self-Perception of Nurses of Exercise of Leadership], and Questionário de Percepção de Técnicos e Auxiliares de Enfermagem no Exercício da Liderança [Questionnaire on Perception of Nurse Technicians and LPNs of Exercise of Leadership] were applied between January and May 2019. Univariate and Multivariate Analyses, and the Pearson’s Correlation test (p<0.05) were used, besides Rosenthal effect size. Results: two significant correlations were found among the nurses between the instruments’ domains: communication and nursing foundations for quality care (r=0.265; p=0.022) and communication and collegial nurse-physician relationships (r=0.263; p=0.023). The following stand out among the nursing aides: communication and nursing foundations for quality care (r=0.416) and the total score obtained in the Questionnaire on Perception of Nurse Technicians and LPNs of Exercise of Leadership and collegial nurse-physician relationships (r=0.409). Conclusion: for the nurses, communication contributed to a better perception of quality care and good relationships with physicians. For the nursing aides, all the domains of coaching leadership collaborate for environments that favor their practice within PHC.