Work environment, resilience, burnout, intent to leave during COVID pandemic among nurse leaders: A cross-sectional study

Leading through the COVID-19 pandemic: Experiences of UK Executive Nurse Directors

AIM

To explore the challenges experienced by Executive Nurse Directors during the COVID-19 pandemic, and to inform future nursing leadership strategies.

DESIGN

A qualitative research project involving interviews with 21 Executive Nurse Directors from England and Wales.

METHODS

Participants were purposively sampled and recruited through Chief Nursing Officers and nursing leadership networks. Semi-structured interviews were conducted and recorded online via Teams. Braun and Clarke's approach to thematic reflexive analysis was applied to data analysis.

RESULTS

Executive Nurse Directors played a critical role during the COVID-19 pandemic. Six themes are explored: tensions, and adaptive response to personal leadership styles; uncertainty and support at the board level; responding to national political decision-making; the personal and emotional impact of the role and the sources of effective support; the voice and public profile of nursing; lessons learnt and strategies for future leadership development. Enablers of decision-making included effective multidisciplinary working, freedom from normal organizational constraints, support for innovation, and the development of stronger bonds with colleagues. Barriers to decision-making included limited knowledge of the virus and its impact and lack of guidance, particularly at a national level. Priorities, strategies and actions for recovery include recognizing the emotional impact of being in a high-level decision-making role, protecting staff from burnout and understanding the long-term implications of pandemic work for nurse leaders.

CONCLUSION

Future strategies for nursing leadership during public health, national and global emergencies are recommended.

IMPACT

This study contributes to the literature exploring the Executive Nurse Director role and their experiences of leading through the COVID-19 pandemic, and identifies priorities, strategies and actions for recovery and learning for the future of senior leadership.

REPORTING METHOD

The study adhered to the Consolidated Criteria for Reporting Qualitative Research.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Relationships among perceived social support, mindful self-care, and resilience among a sample of nurses in three provinces in China: a cross-sectional study

Objective

In this study, we aimed to determine the relationships among perceived social support, mindful self-care, and resilience in a sample of nurses in three provinces of China.

Methods

A cross-sectional study was conducted in seven hospitals in Guangdong, Guizhou, and Henan provinces between August and October, 2023; the provinces are located in south, southwest, and central China. A total of 389 nurses were surveyed using a self-designed sociodemographic characteristics questionnaire and the Chinese versions of Multidimensional Scale of the Perceived Social Support, Brief-Mindful Self-Care Scale and the 10-item Connor-Davidson Resilience Scale (CD-RISC-10).

Results

Of the 389 nurses, the majority were women (n = 365; 93.8%), aged 26-35 years (n = 244; 62.7%) and had bachelor's degrees (n = 337; 86.6%), had worked for 10-20 years (n = 136; 35%), with junior professional titles (n = 331; 85.1%), and had a monthly income in the range 3,001-6,000 yuan in CNY (n = 239; 61.4%). Nurses' resilience was measured using the CD-RISC-10, which ranges from 10 to 40 points. And average score of nurses' resilience was (23.94 ± 6.95). Multiple linear regression showed that scores for resilience were higher among nurses who had higher educational attainment (95% confidence interval: 0.568-3.024, p < 0.01), professional titles (95% confidence interval: 0.009-1.693, p < 0.05), scores of mindful self-care (95% confidence interval: 0.086-0.155, p < 0.01), and scores of perceived social support (95% confidence interval: 0.242-0.328, p < 0.01).

Conclusion

Nurses with higher educational attainment and professional titles exhibited higher levels of resilience. Perceived social support and mindfulness self-care are significantly positively correlated with resilience of nurses. The findings of this study are beneficial to further our understanding of nurses' resilience. The identification of associated factors is conducive to providing more support for nurses who tend to have lower resilience earlier, and can provide useful information for research targeted intervention and support plans aimed at improving nurses' resilience in the future.

Factors influencing nurse manager retention, intent to stay or leave and turnover: A systematic review update

AIMS

To understand factors influencing nurse manager retention or intention to leave, develop a preliminary theoretical model and identify strategies and interventions for workforce planning.

DESIGN

Systematic review update of literature with integrated design of mixed research synthesis.

METHODS

We included peer-reviewed articles examining factors influencing retention or intention to leave for front-line, middle or patient care nurse managers. Authors independently screened articles for inclusion and assessed included articles for quality. We adhered to a convergent synthesis approach.

DATA SOURCES

Nine databases included MEDLINE, EMBASE, PsychINFO, CINAHL Plus with Full Text, ERIC, Health Source Nursing/Academic Edition, Scopus, ProQuest Dissertations and Theses and LILACS in January 2023.

RESULTS

Thirty-five studies published between 1990 and 2022, 22 quantitative and 13 qualitative or mixed methods, were included. 155 factors influencing nurse manager retention, intention to stay, or turnover were reported. Job satisfaction was most frequently examined (n = 7), followed by factors such as empowerment (n = 3), decision-making (n = 3) and resilience (n = 2). We developed a preliminary theoretical model demonstrating staff relations and leadership, organizational and job characteristics, socio-demographics, personal characteristics, well-being and nurse manager relationship with work influence managers' intention to stay or to leave.

CONCLUSIONS

Nurse managers who were empowered, satisfied with their work, received constructive feedback and found meaning in their roles showed greater intent to stay.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Nurse administrators can ensure managers are provided with authority to make decisions that promote autonomy. Work cultures that allow for regular meaningful constructive feedback from staff and leaders may contribute to nurse managers feeling valued.

IMPACT

Understanding factors that influence job retention or intention to leave may help nurse managers and their supervisors identify areas for strategy and intervention design to ensure sustainability of this workforce.

REPORTING METHOD

PRISMA 2020 Guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Effectively and Efficiently Reengineering the Nursing Work Environment by Applying a Conceptual Framework for Nurse Retention

The nursing shortage that is upon us is the result of a confluence of factors, some simple and some complex. Legacy solutions are not working. Recovery from the current situation involves examining and reshaping the nursing work environment. Creative and innovative solutions are being developed and tested. The call for addressing the work environment is surfacing in the literature, yet methods for doing so in an orderly, progressive manner have been elusive. To solve complex problems, structure helps lead to clear thinking. This work presents a conceptual framework for nurse retention derived from concept analysis of initiatives with empirical outcomes for intent to stay, intent to leave, turnover, and retention. It layers in 2 simple theorists and presents an intuitive, understandable model to guide strategic planning and decision making. The Framework has been used for several applications, one of which is a unit-based action planning method that is systematic, cyclic, and uses data relevant to specific unit culture. Improvements occurred in retention and engagement metrics, work effectiveness scores, and cost. Nurse managers extol the process's simplicity and ease of use, and the role the Framework plays in shaping the way they think about nurse retention.

Nurse Managers' Professional Quality of Life During the COVID-19 Pandemic

BACKGROUND

Health systems cannot effectively support nurse managers without understanding psychosocial effects of the COVID-19 pandemic.

OBJECTIVE

The objective of this study was to describe the professional quality of life of frontline nursing management during the COVID-19 pandemic.

METHODS

A cross-sectional online survey of 54 nurses in management positions at a large Midwest academic medical center during 2022 was conducted. Participants completed an electronic survey including demographics, Professional Quality of Life Measure Version 5, and items assessing past consideration of and future intent to leave their position, organization, or profession.

RESULTS

Most participants had previously considered changing roles (80%) or leaving the organization during the pandemic (76%). Fewer respondents reported that changing role (24%) or organization (20%) was likely during the upcoming 6-12 months. Most participants scored in moderate ranges of Compassion Satisfaction, Burnout, and Secondary Traumatic Stress scales (85%, 89%, and 74%, respectively). Higher Compassion Satisfaction was associated with extreme unlikelihood of leaving for an internal non-management role. Higher Burnout scores were associated with more time working and past consideration or future likelihood of leaving for an external non-nursing position. Secondary Traumatic Stress scores were higher for nurse managers and house operation managers than assistant nurse managers and associated with past consideration of moving to an internal non-management role or external non-nursing position and future likelihood of moving to an external non-nursing position.

CONCLUSIONS

Nurse management occupies a demanding position between frontline staff needs and administrative requirements, profoundly impacted by COVID-19. Health care researchers, administration, and policymakers must learn how to support, retain, and sustain nursing management in a post-pandemic world.

Classification and citation analysis of the 100 top-cited articles on nurse resilience using chord diagrams: A bibliometric analysis

BACKGROUND

Studies of most-cited articles have been frequently conducted on various topics and in various medical fields. To date, no study has examined the characteristics of articles associated with theme classifications and research achievements of article entities related to nursing resilience. This study aims to graphically depict the characteristics of the 100 top-cited articles addressing nurse resilience (T100NurseR), diagram the relationship between articles and author collaborations according to themes extracted from article keywords, and examine whether article keywords are correlated with article citations.

METHODS

T100NurseR publications were retrieved from the Web of Science (WoS) core collection on October 13, 2022. Themes associated with articles were explored using coword analysis in WoS keywords plus. The document category, journal ranking based on impact factor, authorship, and L-index and Y-index were used to analyze the dominant entities. To report the themes of T100NurseR and their research achievements in comparison to article entities and verify the hypothesis that keyword mean citation can be used to predict article citations, 5 visualizations were applied, including network diagrams, chord diagrams, dot plots, Kano diagrams, and radar plots.

RESULTS

Citations per article averaged 61.96 (range, 25-514). There were 5 themes identified in T100NurseR, including Parses theory, nurse resilience, conflict management, nursing identity, and emotional intelligence. For countries, institutes, departments, and authors in comparison of category, journal impact factor, authorship, and L-index scores, Australia (129.80), the University of Western Sydney (23.12), Nursing (87.17), and Kim Foster (23.76) are the dominant entities. The weighted number of citations according to Keywords Plus in WoS is significantly correlated with article citations (Pearson R = 0.94; P = .001).

CONCLUSION

We present diagrams to guide evidence-based clinical decision-making in nurse resilience based on the characteristics of the T100NurseR articles. Article citations can be predicted using weighted keywords. Future bibliographical studies may apply the 5 visualizations to relevant studies, not being solely restricted to T100NurseR.