Characteristics of Medical Deserts and Approaches to Mitigate Their Health Workforce Issues: A Scoping Review of Empirical Studies in Western Countries

BACKGROUND

Medical deserts are considered a problematic issue for many Western countries which try to employ multitude of policies and initiatives to achieve a better distribution of their health workforce (HWF). The aim of this study was to systematically map research and provide an overview of definitions, characteristics, contributing factors and approaches to mitigate medical deserts within the European Union (EU)-funded project "ROUTE-HWF" (a Roadmap OUT of mEdical deserts into supportive Health WorkForce initiatives and policies).

METHODS

We performed a scoping review to identify knowledge clusters/research gaps in the field of medical deserts focusing on HWF issues. Six databases were searched till June 2021. Studies reporting primary research from Western countries on definitions, characteristics, contributing factors, and approaches were included. Two independent reviewers assessed studies for eligibility, extracted data and clustered studies according to the four defined outcomes.

RESULTS

Two-hundred and forty studies were included (n=116, 48% Australia/New Zealand; n=105, 44% North America; n=20, 8% Europe). All used observational designs except for five quasi-experimental studies. Studies provided definitions (n=171, 71%), characteristics (n=95, 40%), contributing factors (n=112, 47%), and approaches to mitigate medical deserts (n=87, 36%). Most medical deserts were defined by the density of the population in an area. Contributing factors to HWF issues in medical deserts consisted in work-related (n=55, 23%) and lifestyle-related factors (n=33, 14%) of the HWF as well as sociodemographic characteristics (n=79, 33%). Approaches to mitigate them focused on training adapted to the scope of rural practice (n=67, 28%), HWF distribution (n=3, 1%), support/infrastructure (n=8, 3%) and innovative models of care (n=7, 3%).

CONCLUSION

Our study provides the first scoping review that presents and categorizes definitions, characteristics, contributing factors, and approaches to mitigate HWF issues in medical deserts. We identified gaps such as the scarcity of longitudinal studies to investigate the impact of factors contributing to medical deserts, and interventional studies to evaluate the effectiveness of approaches to mitigate HWF issues.

Associations among leadership, resources, and nurses' work engagement: findings from the fifth korean Working Conditions Survey

BACKGROUND

Nurses' work engagement has received extensive attention due to its positive impacts on individual and organizational outcomes, including patient safety and quality care in healthcare organizations. Although nurse managers' leadership and a variety of resources have been identified as important factors of nurses' work engagement, these relationships have not been well understood in Korean nursing contexts. The purpose of this study was to examine the associations among nurse managers' leadership, resources, and work engagement among Korean nurses after controlling for nurses' demographic and work-related characteristics.

METHODS

This is a cross-sectional study using data from the fifth Korean Working Conditions Survey. Using a sample of 477 registered nurses, we employed hierarchical linear regression analyses. Nurse managers' leadership, job resources (organizational justice and support from peers), professional resources (employee involvement), and personal resources (meaning of work) were examined as potential predictors of nurses' work engagement.

RESULTS

We found that nurse managers' leadership (β = 0.26, 95% confidence interval [CI] = 0.17-0.41) was the strongest predictor of nurses' work engagement, followed by meaning of work (β = 0.20, 95% CI = 0.07-0.18), organizational justice (β = 0.19, 95% CI = 0.10-0.32), and support from peers (β = 0.14, 95% CI = 0.04-0.23). Employee involvement was not a statistically significant predictor of nurses' work engagement (β = -0.07, 95% CI = -0.11-0.01).

CONCLUSIONS

Our findings suggest that comprehensive approaches are required to promote nurses' work engagement. Considering that nurse managers' leadership was the strongest predictor of nurses' work engagement, nurse managers should demonstrate supportive leadership behaviors such as acknowledging and praising their unit nurses' work performance. Furthermore, both individual- and organizational-level strategies are necessary for nurses to be engaged at work.

Evaluation of the correlation between sleep quality and work engagement among nurses in Shanghai during the post-epidemic era

AIM

To examine the status quo and influencing factors of sleep quality and work engagement of nurses participating in COVID-19 during the post-epidemic era and to study the relationship between them.

DESIGN

We conducted a cross-sectional survey and correlational and predictive logic to determine the association between sleep quality and work engagement among nurses in Shanghai during the post-epidemic era.

METHODS

This design involved 1060 frontline nurses in Shanghai. The Pittsburgh Sleep Quality Index questionnaire and the Utrecht Work Engagement Scale-9 scales were used for data collection.

RESULTS

This study found that the sleep quality of frontline nurses was impaired and the nurses with poor sleep accounted for 48.20% during the post-epidemic era. The work engagement of frontline nurses was at the medium level. Factors affecting nurses' sleep quality were the number of nurse night shifts, family support and nurse health. The factors affecting the nurse work engagement were monthly income, profession title, family support and self-health status. There was a positive correlation between nurses' sleep quality and work engagement.

Does the economic crisis contribute to the burnout and engagement of Spanish nurses?

The national and European economic crisis has caused significant changes in the National Health System in Spain, among others a considerable deterioration in the working conditions of nursing professionals. The aim of this study was to analyse whether the economic crisis situation influenced the burnout and engagement of Spanish nursing professionals. The research design was a transversal study based on descriptive and inferential statistical analysis. Because the variable "economic crisis" is not susceptible to direct experimental manipulation, to explore its possible influence on the burnout and engagement of nursing staff, we use an indirect strategy of "priming". That is, we presented a group of participants with news about how the economic crisis was affecting healthcare personnel, in order to facilitate their cognitive accessibility, while another control group did not read any news. The participants were 66 nursing professionals from two public hospitals in the north of Spain completed various questionnaires that allowed information to be collected on the factors of interest in the study. The work experience of the participants contributes significantly to their burnout levels. The economic crisis situation helps to explain the burnout of Spanish nurses, but not their engagement levels.

The relationship between work practice environment and work engagement among nurses: The multiple mediation of basic psychological needs and organizational commitment a cross-sectional survey

Background

Previous researchers have demonstrated that the work practice environment influences nurses' engagement; however, few studies have explored the mechanisms that explain the links between them.

Objectives

To examine whether basic psychological needs and organizational commitment mediate the relationship between the work practice environment and work engagement.

Methods

A cross-sectional survey was conducted with a sample of 893 nurses from 14 cities in Sichuan Province of China between November 2021 and December 2021. Data were collected online using the Chinese version of the Practice Environment Scale of the Nursing Work Index, Basic Needs Satisfaction in General Scale, Organizational Commitment Scale, and Utrecht Work Engagement Scale. The Pearson correlation analysis and multiple mediation model were used to analyze the data.

Results

The Pearson correlation analysis showed that work practice environment, basic psychological needs, and organizational commitment were positively associated with work engagement. The positive relationship between work practice environment and work engagement was mediated by basic psychological needs and organizational commitment [B = 0.505, SE = 0.032, 95% CI (0.442, 0.566)].

Conclusions

The study substantially contributes to the existing knowledge by revealing the mechanisms of fostering work engagement among nurses and explaining why the work practice environment influences work engagement.

A Longitudinal Study of the Impact of Personal and Professional Resources on Nurses' Work Engagement: A Comparison of Early-Career and Mid-Later-Career Nurses

To predict and ensure a healthy and high-performing nursing workforce, it is necessary to identify the antecedents that promote work engagement, especially among early-career nurses. To date no study has focused on this. This longitudinal survey, administered to 1204 nurses working in seven general hospitals with 200 or more beds in four prefectures in Japan at two different times in 2019, aims to examine the causal relationship between the personal and professional resources for nurses to work vigorously (PPR-N) and work engagement among nurses in the early stages of their careers, considering time as a key mediating factor. The analysis of structural equation modeling using the cross-lagged effect model supported that PPR-N had significant and positive effects on work engagement after 3 months among early-career nurses with less than 10 years of nursing experience. The PPR-N is a reliable antecedent of work engagement, which is typical of early-career nurses. These results may be provided guidance for managers in overseeing the work environment to ensure a thriving sustainable nursing workforce.

The Impact of Generation on Nurse Manager Job Satisfaction

OBJECTIVE

The aim of this study was to determine the effects of generational membership on nurse managers' (NMs') perception of their practice environment and job satisfaction using the Nurse Manager Practice Environment Scale (NMPES).

BACKGROUND

Boomers, Generation Xers, and millennials make up the NM workforce. Each has specific perceptions and expectations for their practice environment and job satisfaction. Little is known about these differences.

METHODS

A secondary analysis of NM survey data was conducted using descriptive statistics and multiple regression to identify the impact of generation on NMs' perception of their practice environment and satisfaction.

RESULTS

Generational membership did not significantly impact NMPES or job satisfaction scores, but the practice environment was a strong predictor of these outcomes.

CONCLUSION

Generational membership did not impact NMs' satisfaction for this sample, but the practice environment did. Further research is needed to examine additional factors that influence NM satisfaction and retention.

Multi-level analysis of individual and work environment factors associated with nurses' perceived emotional exhaustion

BACKGROUND

Several factors at the individual- and work environment-level were suggested to correlate with emotional exhaustion development in nurses.

AIM

To explore nurses' perceived emotional exhaustion and associated factors by employing hierarchical modelling techniques.

METHODS

1539 nurses completed the cross-sectional survey. Generalized Linear Mixed Model was performed to identify predictors of emotional exhaustion.

RESULTS

At the individual level, female gender, high workload and emotional job demands increased the risk of emotional exhaustion; instead, higher education, satisfaction with the role of follower, perceiving nursing profession as meaningful, feeling independent at work, and group closeness were protective factors. At the work environment level, hospital ward type did not affect emotional exhaustion.

CONCLUSIONS

Emotional exhaustion is largely influenced by ward culture and organizational policies, and to a lower extent by socio-demographic variables. Moreover, it emerges as an intrinsic risk of the nursing profession rather than being associated with the clinical area profile.

Precursors and outcomes of work engagement among nursing professionals-a cross-sectional study

BACKGROUND

Health services organizations must understand how best to lower nursing professionals' turnover intentions, and increase their job satisfaction and the quality of care provided to patients. This study aims to examine whether work engagement (WE) is a significant predictor of the achievement of these preferred organizational goals. The study also aims to examine whether organizational culture and organizational climate can manage the WE of nursing professionals and indirectly contribute to the accomplishment of the preferred organizational goals.

METHODS

In detail, a cross-sectional questionnaire survey study was conducted through a convenience sampling of a total of N = 164 nurses, from four Norwegian public hospitals. Structural equation modeling was employed in testing the hypothesis in the conceptual model, using Stata software. Furthermore, mediation analyses were achieved through use of the "medsem" package in the Stata software, in testing whether the proposed direct and indirect effects were statistically significant, and the type of mediation found.

RESULTS

The three key findings from this study are: i) WE of nursing professionals was found to be positively related to service quality of care (β = 0.551) and job satisfaction (β = 0.883). Job satisfaction fully mediates the relationship between WE and turnover intention and in itself explains almost 60% (R² = 0.59) of turnover intention; ii) nursing professionals' perception of organizational culture (β = 0.278) and collaboration climate (β = 0.331) were both directly related to their WE; and iii) WE fully mediates the relationship between organizational culture/climate and service quality of care and job satisfaction. Moreover, WE partially mediates the relationship between collaborative climate and job satisfaction.

CONCLUSIONS

The WE of nursing professionals is highly correlated to their job satisfaction. WE and turnover intentions are (fully) mediated by job satisfaction. Employers should therefore focus on improving the job satisfaction of nursing professionals. The WE of nursing professionals is a common key factor for such improvement. Consequently, leaders and managers should continuously manage nursing professionals' WE, focusing on such areas as organizational culture and climate, because WE is an effective means of enabling multiple desirable outcomes for hospital organizations.

Occupational stress and work engagement among military police officers

This paper investigates the levels of occupational stress and work engagement among military police officers. This cross-sectional, descriptive, and analytical study was conducted with 268 police officers from the 3rd Military Police Battalion of Paraná state. We observed significant levels of occupational stress in 125 (46.7%) police officers. The main stressors were lack of career growth prospects (3.7; ±1.3); inadequate training (3.4; ±1.2); discrimination/favoritism in the work environment (3.1; ±1.4); long working hours (3.0; ±1.4); distribution of tasks (2.7; ±1.1); control type (2.7; ±1.1); gaps in disclosing information about organizational decisions (2.7; ±1.2); low valuation (2.7; ±1.2). Levels of work engagement ranged from 3.8 [medium] to 4.1 [high]. The correlation between occupational stress and work engagement was low for the dimensions of Absorption (r: -.284; p<0.001) and Overall Score (r: -0.393; p<0.001) and moderate for the dimensions Vigor (r: -0.422; p<0.001) and Dedication (r: -0.414; p<0.001). We concluded that an important number of police officers had shown occupational stress. However, they displayed good levels of work engagement and are enthusiastic, inspired, and proud of their work.

Retention strategies and barriers for millennial nurses: a scoping review

OBJECTIVE

The objectives of this scoping review were to explore the existing literature related to millennial nurse-retention strategies and barriers, to examine and conceptually map the evidence, to extract any differences between Generation Y and Generation Z nurses, and to identify any gaps in the literature.

INTRODUCTION

The millennial generation has become the largest group of nurses in the workforce. As nursing leaders grow to understand this generation's tendency to change employers frequently, organizations need to identify and implement strategies and reduce barriers to retain this generation as employees.

INCLUSION CRITERIA

Studies and reports including registered nurses born between 1980 and 2000 with any level of education preparation and in any setting or geographical location were included. Studies and reports that examined nurse-retention barriers and strategies were considered for inclusion. This review considered experimental and quasi-experimental study designs, analytical observational studies, case-control studies, analytical cross-sectional studies, descriptive observational studies, systematic reviews and meta-analyses, qualitative studies, and text and opinion papers.

METHODS

The review was conducted in accordance with the JBI methodology for scoping reviews. Studies and reports written in English after 2010 were included. The databases searched included MEDLINE, CINAHL, Embase, Scopus, Ovid HealthStar, and PsycINFO. The search for unpublished studies and reports included MedNar and ProQuest Dissertations and Theses. Eligible studies and reports underwent data extraction by two independent reviewers using a tool created by the authors. Along with a narrative summary, results are presented in a diagrammatic format that aligns with the review objectives and questions.

RESULTS

Thirty-eight publications were included in the review. Strategies for millennial nurse retention were provided in 21 publications, barriers were provided in two publications, and 15 publications provided both strategies and barriers. No publications provided information on the differences between Generation Y and Generation Z. The findings from this scoping review were grouped into five concepts, with strategies and barriers for millennial retention identified for each of the concepts. Concepts identified included leadership, work environment, professional growth, professional fatigue, and self-actualization.

CONCLUSIONS

The current evidence base shows that barriers to and strategies for millennial nurse retention commonly focus on the work environment and the relationships between nursing leadership and the bedside nurse. A preliminary scan of the evidence indicates that creating a healthy work environment that is collaborative, fair, flexible, challenging, and provides opportunities for growth may keep millennial nurses engaged. Having nursing leadership that models these values and leads by example may help millennial nurses to feel safe and supported; however, due to the methodology employed in this review, further rigorous research is needed to confirm this.

The meaning of nursing practice for nurses who are retired yet continue to work in a rural or remote community

BACKGROUND

Although much research has focused on nurses' retirement intentions, little is known about nurses who formally retire yet continue to practice, particularly in rural and remote settings where mobilization of all nurses is needed to assure essential health services. To optimize practice and sustain the workforce stretched thin by the COVID-19 pandemic, it is necessary to understand what it means for retired registered nurses (RNs) and licensed practical nurses (LPNs) to work after retirement. This study explored what nursing practice means for RNs and LPNs who have formally retired but continue to practice in rural and remote communities.

METHODS

A pan-Canadian cross-sectional survey conducted in 2014-2015 of nurses in rural and remote Canada provided data for analysis. Textual responses from 82 RNs and 19 LPNs who indicated they had retired but were occasionally employed in nursing were interpreted hermeneutically.

RESULTS

Retired nurses who continued to practice took on new challenges as well as sought opportunities to continue to learn, grow, and give back. Worklife flexibility was important, including having control over working hours. Nurses' everyday practice was inextricably tied up with their lives in rural and remote communities, with RNs emphasizing serving their communities and LPNs appreciating community recognition and the family-like character of their work settings.

CONCLUSIONS

Retired nurses who continue to work in nursing see retirement as the next phase in their profession and a vital way of engaging with their rural and remote communities. This study counters the conventional view of retaining retired nurses only to combat nursing shortages and alleviate a knowledge drain from the workplace. Rural and remote nurses who retire and continue working contribute to their workplaces and communities in important and innovative ways. They can be characterized as dedicated, independent, and resilient. Transitioning to retirement in rural and remote practice can be re-imagined in ways that involve both the community and the workplace. Supporting work flexibility for retired nurses while facilitating their practice, technological acumen, and professional development, can allow retired nurses to contribute their joy of being a nurse along with their extensive knowledge and in-depth experience of nursing and the community.

Relational coordination and staff outcomes among healthcare professionals: a scoping review

Relational coordination (RC) is a process of coordinating work between professionals that can be used as a framework to enhance interprofessional collaborative practice (IPCP) in various healthcare settings. RC encompasses four communication dimensions (frequent, timely, accurate, problem-solving) and three relational dimensions (shared knowledge, shared goals, mutual respect). RC has been associated with better staff and patient outcomes; it has wide applicability, and it has been examined nationally and internationally in various healthcare settings. The aim of this scoping review is to identify and synthesize available evidence on RC and staff outcomes among healthcare professionals. Literature searches were conducted on articles published between May 2000 until February 2020. Sixteen abstracts were screened from four databases (PubMed, Psych Info, CINAHL, and Scopus). Eleven empirical studies fulfilled the inclusion criteria. Articles were excluded if they did not measure RC and staff outcomes. RC was reported as positively associated with higher job satisfaction, better work engagement, lower burnout, lower turnover, and reciprocal learning among healthcare professionals. Literature on this topic is scarce, despite RC being a promising framework for healthcare professionals in various disciplines to enhance IPCP and improve staff outcomes across healthcare settings.

Nurses Working in Nursing Homes: A Mediation Model for Work Engagement Based on Job Demands-Resources Theory

This study examined the impact that the attractiveness of working in nursing homes and autonomous clinical judgment have on affective occupational commitment, and whether work engagement mediates these relationships. This analysis was based on the job demands-resources theory. The study setting was 1200 nursing homes (including long-term care welfare facilities and long-term care health facilities) in eastern Japan. An anonymous, self-report questionnaire survey was administered to two nurses from each facility, resulting in a prospective sample of 2400 participants. Overall, 552 questionnaires were analyzed, in which structural equation modeling and mediation analysis using the bootstrap method were performed. The results showed that the attractiveness of working in nursing homes does not directly affect affective occupational commitment; work engagement fully mediates the impact of attractiveness of working in nursing homes on affective occupational commitment. Additionally, autonomous clinical judgment showed a direct impact on both work engagement and affective occupational commitment, indicating that work engagement partially mediates the impact on affective occupational commitment. To increase the affective occupational commitment of nurses working in nursing homes, managers should help nurses recognize the attractiveness of working in nursing homes, and then provide appropriate support to help such nurses work in a motivated manner.

Measuring work engagement in a multigenerational nursing workforce

AIM

To examine the level of work engagement among Veteran-aged, Baby Boomer, Generation X, (Gen X) and Millennial registered nurses.

BACKGROUND

Workforce engagement plays a critical role in health care organisations. Organisations with a highly engaged nursing workforce outperform those organisations that have disengaged or non-engaged employees.

METHOD

Quantitative non-experimental causal comparative study measured multigenerational nurses' level of work engagement.

RESULTS

Veteran-aged nurses were the most engaged, followed by Baby Boomer, Gen X and Millennial. The sample scored highest on dedication and lowest on vigour. Veterans and Baby Boomer nurses were statistically different than Gen X and Millennial nurses in their level of engagement. There were no statistical differences between Veteran and Baby Boomers and between Gen X and Millennials in their level of engagement.

CONCLUSIONS

Gen X and Millennial RNs scored lowest on level of engagement and are statistically similar in their level of disengagement.

IMPLICATION FOR NURSING MANAGEMENT

Nurse managers must prioritize engagement strategies as a core function of their leadership role. It is essential that leaders cultivate an employee engagement culture across a multigenerational workforce. Nurse leaders should take full advantage of the experience of the retiring generations to mentor and transfer critical knowledge to the Gen X and Millennial nurses.

Ethical leadership and decision authority effects on nurses' engagement, exhaustion, and turnover intention

AIM

The aim of the present study was to investigate emotional exhaustion, work engagement, and turnover intention in the nursing profession by exploring the antecedent effects of ethical leadership and job components such as decision authority.

BACKGROUND

Emotional exhaustion, low work engagement, and high turnover intention are prevalent issues in the nursing profession. The experience of feeling overworked has led to feelings of burnout and low morale among nurses in Ireland, which has prompted the authors to identify potential variables that reduce these outcomes-in this case, ethical leadership and decision authority.

DESIGN

A descriptive, cross-sectional survey design was used across three hospital sites.

METHODS

A cross-sectional sample of 89 nurses was recruited from three Irish hospitals to capture the experience of nurses between December 2017 - February 2018. Hypotheses were tested using path model analysis.

RESULTS

Ethical leadership positively predicted decision authority among nurses. Ethical leadership also had an indirect effect on all three outcome variables (work engagement, exhaustion, and turnover intention). Further effects were noted in relation to the mediators in relation to the three outcome variables. Decision authority had a positive effect on work engagement and related to lower turnover intention.

CONCLUSIONS

The present study demonstrated the role of ethical leadership as a mechanism to positively affect job control and work experience outcomes for nurses at work. Ethical leadership style in hospitals and providing nurses with the authority to make decisions can improve their work experience and help to engage, support, and retain nurses.

IMPACT

The study found support for the positive role of ethical leadership in relation to decision authority and as a positive predictor of work engagement, negative predictor of emotional exhaustion, and turnover intention among nurses.

Instruments for assessing professional nursing practice environments: An integrative review

ABSTRACT Objective: To identify the instruments used to evaluate the professional nursing practice environments in the hospital context. Method: An integrative review, whose research process was conducted independently by two researchers in the period from July to August 2019 in the CINHAL, PubMed and SciELO databases. Results: Based on the inclusion and exclusion criteria, 53 studies published between 2009 and 2019 were considered for analysis. Ten instruments and three thematic areas were identified: instruments for the assessment of the nursing professional practice environments; implications of the use of instruments for the assessment of nursing professional practice environments; limitations of the instruments for the assessment of nursing professional practice environments. Conclusion: Despite the relevance of the instruments identified, this integrative review provides contributions that support the need to use specific tools to assess the nursing practice environments that include the structure, process and outcome components.

Relationship between sense of coherence, health and work engagement among nurses

AIM

To examine the sense of coherence among registered nurses and its relationship with health and work engagement.

BACKGROUND

Sense of coherence is a global orientation to view life as structured, manageable and meaningful and have the capacity to cope with stressful situations. A high sense of coherence score indicates that an individual can understand, manage and attribute meaning to events in his or her life as well as in the work environment. Registered nurses face many workplace stressors that may be easier to manage with a strong sense of coherence; however, the effect of this score on their self-reported health status and work engagement remains unknown.

METHODS

In a cross-sectional study, 109 registered nurses working in a long-term care setting responded to a self-administered questionnaire. Social support, work-related family conflicts, sense of coherence, self-reported health status and work engagement variables were analysed using multiple linear regression models.

RESULTS

Nurses with a high sense of coherence score reported no work-related family conflicts (mean difference -6.91; 95% CI -10.65 to -3.18; p = .000), better health (r = .408) and greater work engagement (r = .223), compared to their peers with lower sense of coherence. The association between sense of coherence and self-reported health was confirmed by linear regression modelling (β = .276, p = .003).

CONCLUSIONS

Nurses with a higher sense of coherence had better health and greater work engagement. The work engagement variable showing the highest association with sense of coherence was dedication.

IMPLICATIONS FOR NURSING MANAGEMENT

Implementing interventions that increase sense of coherence among nurses can increase commitment to their work, to the institution and to building more engaged teams.

Attitudes about work engagement of different generations-A cross-sectional study with nurses and supervisors

AIM

This study investigated whether generation Y nurses (1981-1995) adopt a different attitude about work than generation X caregivers (1966-1980) and baby boomers (1956-1965).

BACKGROUND

Employees' positive attitude to work engagement is a competitive factor for clinics. In age-diverse team structures, possible different attitudes can lead to conflicts.

METHODS

As part of a quantitative, descriptive, cross-sectional study with the survey instrument AVEM-44, health and nursing staff, as well as nursing directors and ward administrators, were interviewed.

RESULTS

A total of N = 992 individuals (n = 312 nursing directors, n = 259 ward administrators and n = 421 nurses) were included in the study. Nurses and executives viewed generation Y as being less willing to give oneself out and as attaching less importance to work than generation X and the baby boomers. On the other hand, professional ambition was more important to generation Y than the older generations.

CONCLUSIONS

Transformational leadership behaviour represents an approach to guide employees of different generations individually and to harmonize different attitudes.

IMPLICATIONS FOR NURSE MANAGEMENT

To lead employees transformationally, it is necessary to know generation-specific differences concerning attitudes towards work.

Rural Hospital Nursing Skill Mix and Work Environment Associated With Frequency of Adverse Events

Introduction:

Although rural hospitals serve about one fifth of the United States, few studies have investigated relationships among nursing resources and rural hospital adverse events.

Objectives:

The purpose was to determine relationships among nursing skill mix (proportion of registered nurses [RNs] to all nursing staff), the work environment, and adverse events (medication errors, patient falls with injury, pressure ulcers, and urinary tract infections) in rural hospitals.

Methods:

Using a cross-sectional design, nurse survey data from a large study examining nurse organizational factors, patient safety, and quality from four U.S. states were linked to the 2006 American Hospital Association data. The work environment was measured using the Practice Environment Scale of the Nursing Work Index (PES-NWI). Nurses reported adverse event frequency. Data analyses were descriptive and inferential.

Results:

On average, 72% of nursing staff were RNs (range = 45%–100%). Adverse event frequency ranged from 0% to 67%, across 76 hospitals. In regression models, a 10-point increase in the proportion of RNs among all nursing staff and a one standard deviation increase in the PES-NWI score were significantly associated with decreased odds of frequent adverse events.

Conclusion

Rural hospitals that increase the nursing skill mix and improve the work environment may achieve reduced adverse event frequency.

Practice Environment Scale of the Nursing Work Index: A Reliability Generalization Meta-Analysis

A healthy work environment is a critical factor in nurse satisfaction, retention, and patient outcomes. The Practice Environment Scale of the Nursing Work Index (PES-NWI) is the most commonly used instrument to measure the nursing practice environment. This study uses meta-analysis to examine the reliability generalization of the PES-NWI. A meta-analysis of 51 studies representing a total of 80,563 subjects was conducted. The mean score reliability for the PES-NWI based on 38 studies ( n = 68,278) was .922 ( p < .05). The Mean Weighted Effect Size was stronger for studies conducted in the United States versus non-U.S. (.946 vs. .907). For studies rated high and moderate quality, the mean score reliability was .911 and .946, respectively. Scores on the PES-NWI are reliable for measuring the nursing practice environment across samples in the United States and non-U.S. countries.

Emergency department leaders and levels of engagement among their nursing staff

AIM

Researchers have begun to examine work engagement in nursing, but there is little research specific to work engagement in emergency department (ED) nurses. The erratic nature and increased requirements of EDs adds to the burden on leaders to meet patient demands while keeping staff engaged. The aim of this pilot study was to describe and explore the relationship between levels of ED registered clinical nurses' (RNs) work engagement and age, years of experience and shift worked to determine if there are differences between ED nurses and those working in other areas and whether this information could help ED leaders in their approach to staff engagement.

METHOD

A descriptive pilot study was used with RNs from a Midwestern urban level 1 trauma ED in the US. Participants completed an electronic survey that included demographics and the Utrecht Work Engagement Scale (UWES).

FINDINGS

Participants had a Bachelor of Science in nursing or higher and 62% had five years' or less nursing experience. UWES scores compared to national benchmark scores were average and Cronbach alpha coefficients were 0.90. Reliability for each subscale differed. Analysis found no significant difference in relation to age.

CONCLUSION

Participants scored high in total engagement with absorption ranking highest. Evidence reinforces the need for leaders to develop positive relationships with novice nurses to foster engagement and increase tenure.

Work engagement among participants of residency and professional development programs in nursing

OBJECTIVE

to assess the levels of engagement at work of nurses enrolled in multi-professional residency and professional development programs in health care of a Brazilian public institution.

METHOD

a cross-sectional study with 36 professionals. The data were collected in September 2013, with use of the Utrecht Work Engagement Scale (UWES), composed of seventeen self-evaluation items with the dimensions vigor, dedication and absorption, as well as an overall score.

RESULTS

the levels of engagement ranged from 3.8 to 4.3, and the standard deviations, between 1.1 and 1.3. Nurses showed average levels on vigor (3.8) and absorption (3.9) dimensions, and high levels on dedication (4,3) and engagement (4.0).

CONCLUSION

the professionals presented good levels of energy, resilience, enthusiasm and involvement with the work. They are satisfied with the activity and are dedicated to it, which promotes the acquisition of skills and competences along the in-service training, ensuring a future professional practice of quality.

Registered nurses' preferences for rural and urban jobs: A discrete choice experiment

BACKGROUND

Recruitment and retention of nurses is an ongoing challenge for employers in rural areas worldwide. There is limited information available regarding influences on nurses' job choice in the U.S. and little understanding of how nurses make trade-offs between desired and less desirable job characteristics when choosing between jobs.

OBJECTIVES

The purpose of this research was to examine the hospital job preferences of registered nurses in the U.S. The specific objectives of the study were: 1) To identify the relative importance of key job attributes on registered nurse job choice, and 2) To predict the impact of changes in the levels of attributes on the probability of registered nurses choosing one job over another.

DESIGN AND SETTING

A discrete choice experiment was developed and applied in the U.S. using California as a study site.

PARTICIPANTS

190 registered nurses currently working in nursing or intending to return to work in nursing from urban, large-, small- and isolated-rural communities.

METHODS

The survey instrument was developed through a literature review and semi-structured interviews with nurse experts, utilizing a hypothetical job in a hospital medical / surgical unit. Experimental design principles were applied to create a discrete choice experiment which was pilot tested with urban and rural nurses. The survey was mailed to a random sample of 1000 licensed registered nurses in California. A mixed logit model was used to estimate nurses' preferences for different levels of the job attributes. Willingness to pay estimates and simulations of job uptake rates were calculated.

RESULTS

Eight factors were identified as important to job choice: earnings, nursing voice in management, tuition reimbursement, scheduling, patient care team, leadership, location and nursing sensitive patient care outcomes. Respondents valued a cohesive patient care team (coefficient 1.95, [SE 0.23]) and a strong nursing voice in management (coefficient 1.56, [SE 0.22]) highest. A job in a large urban inland location was negatively valued (coefficient -0.69, [SE 0.25]). Around 72% of respondents chose to stay in their current job when this choice was offered. While earnings were important, nurses were willing to sacrifice earnings to secure other valued job characteristics when choosing between jobs.

CONCLUSIONS

Study findings provide information on how job characteristics are valued by nurses in California. Findings suggest job seekers may be 65-75 percent more likely to choose a job when valued job characteristics are present. Our findings are particularly relevant to rural hospitals with limited financial resources.

Work engagement and its predictors in registered nurses: A cross-sectional design

Nurses are key staff members of health-care organizations. Nurse engagement directly influences quality of care and organizational performance. The purpose of the present study was to understand the state of work engagement and explore its predictors among registered nurses in China by using a descriptive, cross-sectional survey design (n = 1065). Work engagement was measured with the Chinese version of the Utrecht Work Engagement Scale. The results showed that the average work engagement of Chinese nurses was 3.54 (standard deviation = 1.49), and that nurses' age (β = .16, t = 5.32), job characteristics (β = .33, t = 9.43), and practice environment (β = .23, t = 6.59) were significant predictors of work engagement. Thus, nurse leaders should be encouraged to shape motivational job characteristics and create supportive practice environment so as to increase nurses' work engagement.

Effects of work environment and job characteristics on the turnover intention of experienced nurses: The mediating role of work engagement

AIM

To assess turnover intention among experienced nurses and explore the effects of work environment, job characteristics and work engagement on turnover intention.

BACKGROUND

The nursing shortage is an urgent concern in China. A high turnover rate of experienced nurses could have serious effects on the quality of care, costs and the efficiency of hospitals. It is crucial to explore the predictors of turnover intention and develop strategies tailored to experienced nurses.

DESIGN

A descriptive, cross-sectional survey design.

METHODS

A total of 778 experienced nurses from seven hospitals was surveyed on their work engagement, job characteristics, work environment and turnover intention in March-May 2017. Structural equation modelling was used to test a theoretical model and the hypotheses.

RESULTS

The results showed that 35.9% of experienced nurses had high-level turnover intention. The final model explained 50% of the variance in experienced nurses' turnover intention and demonstrated that: (1) work environment was positively associated with higher work engagement and lower turnover intention and work engagement partially mediated the relationship between work environment and turnover intention; and (2) job characteristics were positively related to higher work engagement and lower turnover intention and work engagement fully mediated the relationship between job characteristics and turnover intention.

CONCLUSIONS

The study confirms the intrinsic and extrinsic motivators on work engagement posited by job demands-resources model. Theory-driven strategies to improve work environment, enhance job characteristics and promote wok engagement are needed to address the nursing shortage and high turnover intention among experienced nurses.

Loss of Magnet® Designation and Changes in RN Work Engagement: A Report on How 1 Hospital's Culture Changed Over Time

OBJECTIVE

The aim of this study was to examine the loss of Magnet® designation and how RNs' work engagement changed at 1 community hospital.

BACKGROUND

The importance of RN work engagement to promote quality and safety is widely recognized in healthcare. Ongoing consistent research is critical to determine what organizational structures are needed to support RN work engagement.

METHODS

This was a comparative, descriptive, correlational study of RN cohorts at 2 time points: time 1 (T1), in 2011 during Magnet designation (n = 119), and time 2 (T2), in 2016, approximately 2 years after the loss of Magnet designation (n = 140).

RESULTS

The cohort of RNs at T2 reported significantly lower work engagement in the time period after the loss of Magnet designation when compared with the RN cohort at T1 during Magnet designation (P ≤ .0002).

CONCLUSION

These results provide insights for clinical leaders striving to support a culture of RN work engagement and quality care.

Global Nursing-a literature review in the field of education and practice

Aim

To describe key findings of Global Nursing in empirical nursing studies.

Design

A literature review using descriptive data synthesis of peer‐reviewed articles in the field of nursing education and practice.

Methods

This review of Cinahl Complete, PubMed, PsycINFO and Scopus was undertaken using the search strategy “global nursing”. Independent title/abstract and full‐text screening was undertaken, identifying original articles written in English.

Results

A total of 472 titles and 170 abstracts were read through. Seventy‐three articles were included for full‐text review. Twenty published studies of Global Nursing with multiple research methodologies fulfilled the inclusion criteria. Findings were described with five categories. Global Nursing Arena, Global Nursing Working Environments, Global Nursing Workforce Management, Global Nursing Competencies and Global Nursing Networking were shown to be crucial when Global Nursing was addressed in the literature.

Staff Nurse Decisional Involvement in the United States and Turkey

The purpose of this descriptive comparative study is to compare the levels of decisional involvement of staff nurses between one Midwestern health care system in the United States with a nongovernmental University hospital in Turkey. The Decisional Involvement Scale was used for data collection. U.S. ( n = 163) and Turkey ( n = 50) staff nurses were included in the study. Both samples preferred more decisional involvement than they currently experienced. However, Turkish nurses experienced and preferred lower levels of decisional involvement than the U.S. sample. Shared governance structures may be a strategy used to enhance staff nurse decisional involvement.

The work engagement of nurses in multiple hospital sectors in Saudi Arabia: a comparative study

AIM

To examine the differences in work engagement among nurses in Saudi Arabia and its relationship with personal characteristics across different hospital affiliations.

BACKGROUND

Quality care requires an adequate supply of engaged nurses who are dedicated, energised and absorbed in their work. In the nursing profession, work engagement is of considerable importance, owing to the shortage of nurses and the continuing reduction in healthcare costs.

METHOD

An analytic comparative cross-sectional design was used. Eight hospitals from three provinces and different affiliation types participated in the study. The Utrecht work engagement scale (UWES) was used to measure 980 nurses' work engagement.

RESULTS

The findings indicate that nurses' total engagement scores were closer to the higher end of the Likert scale. The findings indicate generally high levels of work engagement, particularly regarding the element of dedication. Furthermore, the study shows significant differences in nurses' engagement among the various work settings and in nurses' age and experience.

CONCLUSIONS

A number of nurses' personal characteristics have independent influences on their work engagement.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse leaders should acknowledge that a statement of professional nursing scope of practice is a necessity to encourage and fulfil engagement.

Nurse managers' perceptions and experiences regarding staff nurse empowerment: a qualitative study

Aim: To study nurse managers' perceptions and experiences of staff nurse structural empowerment and its impact on the nurse manager leadership role and style.

Background: Nurse managers' leadership roles may be viewed as challenging given the complex needs of patients and staff nurses' involvement in both clinical and organizational decision-making processes in interdisciplinary care settings.

Design: Qualitative phenomenological study.

Methods: Individual semi-structured interviews were conducted with 8 medical or surgical nurse managers in a 600-bed Belgian university hospital between December 2013 and June 2014. This hospital was undergoing conversion from a classical hierarchical, departmental structure to a flat, interdisciplinary model.

Results: Nurse managers were found to be familiar with the structural empowerment of clinical nurses in the hospital and to hold positive attitudes toward it. They confirmed the positive impact of empowerment on their staff nurses, as evidenced by increased responsibility, autonomy, critical reflection and enhanced communication skills that in turn improved the quality and safety of patient care. Structural empowerment was being supported by several change initiatives at both the unit and hospital levels. Nurse managers' experiences with these initiatives were mixed, however, because of the changing demands with regard to their manager role and leadership style. In addition, pressure was being experienced by both staff nurses and nurse managers as a result of direct patient care priorities, tightly scheduled projects and miscommunication.

Conclusion: Nurse managers reported that structural empowerment was having a favorable impact on staff nurses' professional attitudes and the safety and quality of care in their units. However, they also reported that the empowerment process had led to changes in the managers' roles as well as daily practice dilemmas related to the leadership styles needed. Clear organizational goals and dedicated support for both clinical nurses and nursing unit managers are imperative to maintaining an empowering practice environment which can ensure the best care and healthy, engaged staff.

Factorial Validity of the Decisional Involvement Scale as a Measure of Content and Context of Nursing Practice

Decisional involvement is widely recognized as an essential component of a professional nursing practice environment. In recent years, researchers have added to the conceptualization of nurses' role in decision-making to differentiate between the content and context of nursing practice. Yet, instruments that clearly distinguish between these two dimensions of practice are lacking. The purpose of this study was to examine the factorial validity of the Decisional Involvement Scale (DIS) as a measure of both the content and context of nursing practice. This secondary analysis was conducted using data from a longitudinal action research project to improve the quality of nursing practice and patient care in six hospitals (N = 1,034) in medically underserved counties of Pennsylvania. A cross-sectional analysis of baseline data from the parent study was used to compare the factor structure of two models (one nested within the other) using confirmatory factor analysis. Although a comparison of the two models indicated that the addition of second-order factors for the content and context of nursing practice improved model fit, neither model provided optimal fit to the data. Additional model-generating research is needed to develop the DIS as a valid measure of decisional involvement for both the content and context of nursing practice.

Engaging new nurses: the role of psychological capital and workplace empowerment

The purpose of this study was to test a hypothesised model linking perceptions of workplace empowerment and psychological capital (PsyCap) to new graduate nurses’ work engagement by integrating theories of empowerment, PsyCap and work engagement. In response to the nursing shortage, efforts are needed to retain nurses by creating empowering work environments that leverage employee PsyCap to foster work engagement. A secondary analysis of data ( n = 205) from a study by Laschinger et al. (2012) was conducted to test the hypothesised model. Hierarchical multiple linear regression analysis was used to test the influence of empowerment and psychological capital on new graduate nurses’ work engagement. Measures of structural empowerment (Conditions of Work Effectiveness Questionnaire-II), PsyCap (Psychological Capital Questionnaire) and work engagement (Utrecht Work Engagement Scale) were used. The hypothesised model was supported. The combined effect of workplace empowerment and PsyCap explained 38% of the variance in new nurses’ work engagement. Workplace empowerment and PsyCap were significant independent predictors of work engagement ( β = 0.45 and 0.36, p < 0.05, respectively). The results suggest that the combination of personal and organisational resources is related to greater work engagement among new graduate nurses.