Work engagement supports nurse workforce stability and quality of care: nursing team-level analysis in psychiatric hospitals

Challenges and responsibilities in the medication management process in 24/7 group housing services for adults with intellectual disability: Interviews with nurses

Staff in 24/7 group housing services for adults with intellectual disability are responsible for ensuring safe medication management processes and supporting the residents in their health-related issues. Ten interviewed nurses reported several challenges in the medication management process emerging at the staff level, the level of the group home, and the level of the social and healthcare system, and were often related to issues in communication and responsibility. They reported a variety of complex tasks in the medication management process, for which they need a multiple skill set. They also act as healthcare advocates for residents, but healthcare services do not always match residents' needs. Training for social and healthcare professionals, access to healthcare services and the collaboration of social and healthcare services should be improved to provide the people with intellectual disability the best possible pharmacotherapy and healthcare.

Work engagement of psychiatric nurses: a scoping review

OBJECTIVES

Work engagement is an essential factor in improving employee performance. However, no reviews on the work engagement of psychiatric nurses have been conducted to date. This study aimed to examine the current status of research on the work engagement of psychiatric nurses and identify salient factors.

DESIGN

A scoping review.

METHODS

This review adhered to the established scoping review methodological guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews checklist. The inclusion criteria were based on nurses, work engagement and psychiatric settings without language or date restrictions. Regardless of the methodology or study design, research studies related to the work engagement of psychiatric nurses have been included. A systematic search was conducted in MEDLINE, CINAHL and PsycINFO from the inception of each database, with the search strategies being set by an information specialist. The deadline for the search was 15 February 2023.

RESULTS

The study included 12 studies. All studies have been published since 2013. The study designs included cross-sectional (n=10), longitudinal (n=1) and intervention (n=1) studies. The impacts of work engagement were classified into (1) attitudes towards patients, (2) attitudes towards work, (3) mental health and (4) quality of care. Factors influencing work engagement were classified into (1) demographics, (2) workplace factors, (3) individual factors and (4) patient factors.

CONCLUSION

Work engagement of psychiatric nurses has lately gained attention, although data are limited because most studies used a cross-sectional design. Psychiatric nurses with higher work engagement showed positive outcomes. Workplace and individual factors can potentially improve their work engagement. The findings can assist nursing managers in enhancing psychiatric nurses' work engagement and, consequently, their performance.

The impact of psychological capital on nurses' job performance: a chain mediation analysis of problem-focused coping and job engagement

BACKGROUND

Previous studies have explored the relationships of psychological capital with employees' job performance in the health sector. However, the possible indirect pathways, including a serial mediation of problem-focus coping and job engagement, have not been extensively examined. This article explores how psychological capital influences nurses' coping strategies focused on problem-solving, their level of engagement with their jobs, and how this, in turn, affects their job performance.

METHODS

The study involved 575 nurses from Cameroon's public health sector. It investigated how psychological capital, an intrinsic resource, triggers nurses' problem-focus coping liaison with job engagement to impact job performance. Analysis was conducted to assess the relationships among psychological capital, problem-focus coping, job engagement, and job performance with the use of SmartPLS 4.0 and PROCESS 4.2.

RESULTS

Findings revealed a significant effect of psychological capital on problem-focus coping, job engagement and job performance. Moreover, notable relationships were identified between psychological capital, problem-focus coping, job engagement, and performance, highlighting a chain mediation effect.

CONCLUSION

The research advocates for hospital managers to employ strategies fostering employees' psychological capital to better cope with organizational stressors to promote job engagement and enhance job performance. The study contributes fresh insights into healthcare organizational dynamics and human resource management, providing a foundation for future advancements in this field.

Work Engagement among Acute Care Nurses: A Qualitative Study

Aims

To understand how Omani nurses conceptualize work engagement, explore factors influencing engagement, and identify strategies to improve work engagement.

Design

A qualitative study design.

Methods

Semistructured interviews were conducted with twenty-one Omani nurses from four acute-care hospitals. Interview transcripts were examined using directed content analysis.

Results

Participants defined work engagement as a positive state where nurses are engaged physically, emotionally, and mentally with work. Mentally engaged nurses' minds are occupied with patients even when they are off duty. Organizational factors affecting work engagement were leadership, teamwork, autonomy, pay, and job demand. Individual factors affecting engagement included considering nursing a rewarding profession. A social factor was family commitments. Strategies suggested to improve engagement included improved pay and monetary incentives, working system flexibility, open-door policy, performance feedback, recognition, and resources.

Conclusion

Mentally engaged nurses are attached to work even when they are off duty. Nurses' gait and facial expressions can indicate high or low work engagement. Nurses with family obligations felt drained of energy, affecting their vigor and enthusiasm at work. Implications. Management skills and practices impact work engagement. Nurse's feedback can be used to improve practice and design interventions that promote nurses' engagement.

Work immersion and perceived stress among clinical nurses: a latent profile analysis and moderated mediation analysis

BACKGROUND

Exploration of the relationship between individual work immersion and perceived stress is critical for clinical nurses' effective psychological interventions and human resource management, as well as to alleviate nursing staff shortages. In order to further dissect the influencing factors of perceived stress among nursing staff, our study introduces the concepts of perfectionism and social connectedness to analyze the specific pathways that influence perceived stress in terms of an individual's intrinsic and external personality traits. This study provides relevant recommendations for the development of stress management measures for nursing staff.

METHODS

This was a cross-sectional survey. 993 registered clinical nurses were included from four hospitals in Guangzhou through a convenience sampling method. Clinical nurses' work immersion, perceived stress, perfectionism, and social connectedness were investigated using questionnaires based on latent profile analysis. The relationships between variables were analyzed using t-tests, analysis of variance, Pearson's correlation analysis, latent profile analysis, and moderated mediation analysis.

RESULTS

The results showed that (1) general influences on nurses' perceived stress included only child, labor relationship, labor allowance, and family support; (2) nurses' work immersion contained four subgroups: lowest (12.6%), medium-low (39.8%), medium-high (39.9%), and highest (7.7%); (3) positive and negative perfectionism played a mediating role between the association of work immersion and perceived stress; (4) social connectedness played a moderating role in the mediation model of perceived stress.

CONCLUSIONS

Work immersion, perfectionism, and social connectedness have an important impact on clinical nurses' perceived stress. Nursing managers or leaders should pay attention to the differences of individual work immersion status, adopt reasonable stress management strategies, accurately identify positive perfectionist groups and strengthen the relationship between groups, so as to ensure the quality of nursing care, and reduce nursing turnover and alleviate the problem of staff shortage.

Encountering suffering in digital care: a qualitative study of providers' experiences in telemental health care

BACKGROUND

Encountering patients who are suffering is common in health care, and particularly when providing mental health care. Telehealth technologies are increasingly used to provide mental health care, yet little is known about the experiences of providers when encountering patients who are suffering within remote care. The present study explored health care providers' lived experiences of encountering patient suffering during telemental health care.

METHODS

A qualitative phenomenological approach was used to uncover participants' experiences. In-depth interviews were conducted with a purposive sample of physicians, psychologists, and therapists who used telemental health in varied clinical practices in Sweden. Data were analyzed using descriptive phenomenology.

RESULTS

Telehealth care with patients who were suffering was experienced by providers as loose connections, both literally in compromised functioning of the technology and figuratively in a compromised ability connecting emotionally with patients. Providers' lived experiences were explicated into the following aspects: insecurity in digital practice, inaccessibility of the armamentarium, and conviction in the value of telehealth care. Interpersonal connection between patient and provider is necessary. Worry and guilt arose for providers with fears that technology would not work, patient status was deteriorated, or the care needed could not be delivered. Providers overcame barriers in telehealth encounters, and expressed they perceived that patients appreciated the care received, and through it found relief.

CONCLUSIONS

This study brings an understanding of experiences in providing telemental care for patients who are suffering. Providers experience challenges in connecting with patients, and in accessing tools needed to enable reaching the goals of the caring encounter. Efforts to ensure functioning of technology, comfort with its use, and accessibility of tools might be some accommodations to support providers for successful and rewarding telehealth care encounters.

Nurses' work engagement: The influences of ambidextrous leadership, clinical nurse leadership and workload

AIM

To test the relationships among staff nurses' work engagement, nurse managers' ambidextrous leadership and staff nurses' clinical leadership and workload.

DESIGN

A multicentre cross-sectional survey design was used.

METHODS

The study was conducted in eight medical centres from six representative provinces of China in October 2019. The participants completed electronic questionnaires that measured ambidextrous leadership, clinical nurse leadership, workload and work engagement. We used structural equation modelling to test a hypothetical model.

RESULTS

The hypothetical model had a good fit to the actual data. Ambidextrous leadership was positively associated with clinical nurse leadership and work engagement, and clinical nurse leadership had a significant positive relationship with work engagement, which partially mediated the path from ambidextrous leadership to work engagement. In addition, workload moderated the relationship between ambidextrous leadership and clinical nurse leadership.

CONCLUSION

This study makes a timely contribution to the nursing literature by demonstrating that nurse managers' ambidextrous leadership and clinical nurse leadership are important determinants of work engagement. Improving the level of ambidextrous leadership and clinical nurse leadership helps to enhance work engagement.

IMPACT

This study provides a new strategy to increase nurses' work engagement from a new perspective of nursing leadership. Enhancing nurse managers' ambidextrous leadership and clinical nurse leadership can increase work engagement. Nurse managers should value the role of ambidextrous leadership and clinical nurse leadership in promoting work engagement, especially when nurses perceive they have a low workload.

Work engagement status of registered nurses in pediatric units in Saudi Arabia: A cross-sectional study

BACKGROUND

This study aimed to evaluate the work engagement status of registered pediatric nurses and its relationship with personal- and work-related variables in selected hospitals. Personal- and work-related factors generally influence work engagement. However, data on work engagement in pediatric clinical practice are limited.

METHODS

This study employed a cross-sectional design, including 230 registered nurses working in pediatric units in Madinah, Saudi Arabia. A non-probability approach (convenience sampling) was adopted in recruiting the sample. Eight personal- and work-related variables were examined using the Utrecht Work Engagement Scale shortened 9-item version.

RESULTS

The overall mean scale score was 4.54 (standard deviation = 0.95). The dedication subscale showed the highest mean score (4.84), followed by the absorption (4.48) and vigor subscales (4.29). A higher work engagement score was associated with an older age (H = 17.892; p < 0.001), a non-Saudi nationality (Z = 5.724; p < 0.001), a higher educational level (Z = 3.178; p = 0.001), and a long duration of experience (>10 years) (H = 18.435; p < 0.001). No significant differences were observed between the total scale score according to marital status (p = 0.077), current working unit (p = 0.063), and current working hours (p = 0.067).

CONCLUSIONS

Among registered pediatric nurses, work engagement is relatively high but is average in terms of the vigor component. To our knowledge, this research is the first to explore how work environment affects work engagement among pediatric nurses in Madinah, Saudi Arabia.

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.

Predictive roles of organizational and personal factors in work engagement among nurses

Objective: To determine the work engagement levels of hospital nurses and the predictive roles that nurses’ personal and organizational characteristics play.

Methods: A cross-sectional design was employed in this study, which included 549 nurses working in the Central Philippines. Nurses were selected through purposive sampling, and a self-report questionnaire outlining personal and organizational characteristics was employed. The Utrecht Work Engagement Scale (UWES) was applied to gather data about nurse engagement.

Results: The dedication score was the highest among the three dimensions of engagement while the vigor score was the lowest. Overall, Filipino nurses experienced an average level of work engagement. We observed significant relationships between a nurse’s age, years of experience in nursing, years in their present unit, and their position at work and their levels of engagement, vigor, sense of dedication, and absorption. Hospital capacity was a negative predictor of vigor, dedication, absorption, and overall work engagement. Further, the type of nursing contract was a negative predictor of vigor and dedication. The type of hospital and the nurse’s position were positive predictors of vigor, dedication, and absorption.

Conclusions: Filipino nurses were satisfactorily engaged at work. A number of nurses’ personal and organizational characteristics play a predictive role in their work engagement. Thus, nursing administrators must support, develop, and implement activities and measures that engage nurses at work.

Work engagement of psychiatric nurses: a scoping review protocol

INTRODUCTION

Psychiatric nurses face various stressors related to nurse-patient relationships, workplace interpersonal relationships and organisational problems, and are required to perform excellent work under stressful situations. As work engagement (a counterconcept of burnout) is a key factor that improves the performance of nurses, clarifying how to improve work engagement is an essential topic among researchers. Although some knowledge has been accumulated on the subject, no reviews have been conducted on the work engagement of psychiatric nurses. To fill the gap, this scoping review will examine the status of research activity on the work engagement of psychiatric nurses and identify related factors, consequently mapping the available research in this area.

METHODS AND ANALYSIS

The review will be conducted according to established scoping review methodological guidelines. The inclusion criteria will be based on nurses (participants), work engagement (concept), and psychiatric settings (context) without language or date restrictions. Regardless of the methodology or study design, research related to the work engagement of psychiatric nurses will be included. A systematic search will be conducted for MEDLINE, CINAHL and PsycINFO, with the searches being arranged by an information specialist through discussion. The first author will screen all potentially relevant publications, and the second author will independently screen a random sample comprising 10% of the manuscripts. Any disagreement will be resolved by a review team. Data will be extracted using a standardised extraction form, subsequently summarised through quantitative (frequencies) and qualitative analyses (narrative synthesis), and reported in the results of the review.

ETHICS AND DISSEMINATION

As the data will be collected from existing literature, ethical approval is not required. The findings will be disseminated through conference presentations and publication in a peer-reviewed journal. They are expected to help researchers enhance psychiatric nurses' work engagement, consequently contributing to improving their performance.

Work Engagement and Patient Quality of Care: A Meta-Analysis and Systematic Review

Past research has demonstrated that work engagement among health care professionals influences patient quality of care. There is, however, no estimate of the strength of this relationship, and existing reviews have not always explained conflicting findings. We conduct a meta-analysis and review of 25 articles, and find a small to medium mean effect size (r = .26, p < .01) for the positive association between engagement and quality of care. Moderator analyses on five factors (type, data source, level of analysis of the quality of care measure, profession, and work engagement measure) indicate that only data source is significant, providing preliminary evidence that the relationship is stronger if quality of care is measured via self-assessments. Although a more consistent conceptualization of quality of care is needed to better determine its association with work engagement, our findings suggest that work engagement is as important as burnout in predicting quality of care.

The Whole Is Greater Than the Sum of Its Parts: Exploring Attributes of Team Work Engagement Climate

Despite growing interest in the concept of team work engagement (TWE), relatively little is known about the conditions that allow it to emerge. Based on the literature on work engagement and team climate, this study introduces the concept of TWE climate and examines its conceptual attributes. Based on a one-and-a-half-year qualitative investigation of eight Dutch self-steering project teams, we discovered that TWE climate comprises eight attributes, both (a) personal and (b) shared. Personal attributes include team members' commitment and drive toward the team and a personal feeling of being respected within the team. Shared attributes include a shared ability to overcome challenges and a shared sense of accomplishment, community, drive, and focus. Our findings indicate that personal and shared attributes are both critical elements of a team climate conducive to team work engagement. We conclude this paper by discussing what these findings mean for the concept of TWE climate in light of future research and practice.

Impact of Intrinsic and Extrinsic Motivation on Work Engagement: A Cross-Sectional Study of Nurses Working in Long-Term Care Facilities

Nurses’ work motivation impacts their job satisfaction and work engagement, affecting their quality of care. Work motivation, a personal resource, can be categorized into intrinsic and extrinsic motivation, each of which may function differently in the job demands–resources (JD–R) model. To study the effect of nurses’ intrinsic and extrinsic work motivation on work engagement in long-term care (LTC) facilities, we randomly selected 1200 facilities from 6055 LTC facilities in eastern Japan. Two nurses from each facility completed a self-report questionnaire—newly developed for this study for evaluating intrinsic and extrinsic work motivation—to assess their work engagement, job satisfaction, and work motivation. Multiple regression analysis of 561 valid questionnaires investigated the relationship between work motivation and work engagement, indicating that intrinsic work motivation, job satisfaction, and age had a significant positive effect on work engagement, while extrinsic work motivation had no significant effect. However, half the nurses chose to work because of extrinsic work motivation, explaining the high turnover rate of nursing staff in LTC facilities. Findings indicate the importance of measures to foster nurses’ intrinsic motivation to improve work engagement. Further research should investigate how to improve the intrinsic motivation of nurses working in LTC facilities.

Effect of Practice Environment on Nurse Reported Quality and Patient Safety: The Mediation Role of Person-Centeredness

This study aims to explore the potential mediation role of person-centeredness between the effects of the work environment and nurse reported quality and patient safety. A quantitative cross-sectional survey collected data from 1055 nurses, working in medical and surgical units, in twelve Malaysian private hospitals. The data collection used structured questionnaires. The Hayes macro explored the mediation effect of person-centeredness between the associations of work environment dimensions and care outcomes, controlling nurses’ demographics and practice characteristics. A total of 652 nurses responded completely to the survey (61.8% response rate). About 47.7% of nurses worked 7-h shifts, and 37.0% were assigned more than 15 patients. Higher workload was associated with unfavorable outcomes. Nurses working in 12-h shifts reported a lower work environment rating (3.46 ± 0.41, p < 0.01) and person-centered care (3.55 ± 0.35, p < 0.01). Nurses assigned to more than 15 patients were less likely to report a favorable practice environment (3.53 ± 0.41, p < 0.05), perceived lower person-centered care (3.61 ± 0.36, p < 0.01), and rated lower patient safety (3.54 ± 0.62, p < 0.05). Person-centeredness mediates the effect of nurse work environment dimensions on quality and patient safety. Medical and surgical nurses, working in a healthy environment, had a high level of person-centeredness, which, in turn, positively affected the reported outcomes. The function of person-centeredness was to complement the effects of the nurse work environment on care outcomes. Improving the nurse work environment (task-oriented) with a high level of person-centeredness (patient-oriented) was a mechanism through which future initiatives could improve nursing care and prevent patient harm.

An Examination of Factors That Predict the Perioperative Culture of Safety

The perioperative setting is an intricate, complicated work environment in which patients are vulnerable to adverse events. Using a convenience sample, we examined relationships between the length of perioperative nurse experience, perioperative nurse engagement, and an OR culture of safety. We explored differences in safety culture scores based on CNOR certification status. There was no significant relationship between the length of perioperative nurse experience and the level of OR culture of safety. However, perioperative nurse engagement had a significant relationship with an OR culture of safety (P < .001), and this factor was a significant predictor of an OR culture of safety (P < .001). Perioperative nurses who held CNOR certification had significantly higher culture of safety scores compared with those who did not (P = .004). Additional research on perioperative nurse engagement and factors relating to patient safety may help perioperative leaders develop and implement engagement strategies.

A multilevel analysis of the impact of group organisational citizenship behaviour on nurse-patient relationship: The mediating effect of work engagement and the moderating effect of emotional intelligence

AIM

To explore the cross-level relationships between group organisational citizenship behaviour, emotional intelligence, work engagement and nurse-patient relationship.

BACKGROUND

Group-level factors influencing nurse-patient relationship are seldom studied.

METHOD

A cross-sectional questionnaire survey was conducted among 1,246 nurses from 55 nursing groups in a 3A hospital in China, and the data were analysed by multilevel analysis.

RESULTS

Group organisational citizenship behaviour is positively related to nurse-patient relationship with work engagement as a mediator. Emotional intelligence moderates the relationship between group organisational citizenship behaviour and nurse-patient relationship. Specifically, high emotional intelligence reduces the positive impact of group organisational citizenship behaviour on nurse-patient relationship.

CONCLUSIONS

This study provides new insights into the influencing factors of nurse-patient relationship based on the social information processing theory. In groups with high group organisational citizenship, positive work engagement and emotional intelligence, nurses are more likely to deliver better performance in patient care, leading to better nurse-patient relationships.

IMPLICATIONS FOR NURSING MANAGEMENT

This study suggests that influencing factors at both group and individual levels should be considered while establishing nurse-patient relationships. A positive group climate and personal ability development significantly improve patient care quality.

The Relationship Among Organizational Identity, Psychological Resilience and Work Engagement of the First-Line Nurses in the Prevention and Control of COVID-19 Based on Structural Equation Model

Purpose

To explore how the organizational identity and psychological resilience affect work engagement of the front-line nurses in the prevention and control of coronavirus disease 2019 (COVID-19) and to establish the relationship model based on these factors.

Material and Methods

Convenience sampling was applied to collect questionnaire samples from 216 nurses (from 12 cities in 6 provinces). General information questionnaires, organizational identity scale (OIQ), psychological resilience scale (CD-RISC), and Utrecht Work Engagement Scale (UWES) were used as tools for data collection.

Results

Both organizational identification and psychological resilience had a positive impact on work engagement (r=0.457~0.669). The structural equation model indicated that psychological resilience had a significant partial mediating effect on the relationship between organizational identity and work engagement; the mediating effect value was 0.25, the overall effect value of work engagement was 0.73, and the mediating effect accounted for 34.2%.

Conclusion

Our results revealed that organizational identity could directly affect nursing. It can also indirectly affect nurses’ work engagement through the intermediary role of psychological resilience. In face of the COVID-19 epidemic, hospitals and nursing managers could improve the level of nurses’ job involvement by improving organizational identity, which in turn may have a positive effect on psychological resilience.

A quest for quality care: Exploration of a model of leadership relationships, work engagement, and patient outcomes

Aim

To explore the effects of resonant leadership, leader exchange relationships and perceived organizational support on work engagement and patient outcomes.

Design

A cross‐sectional survey design.

Methods

Data were collected in June and July 2016 from 252 nurses and clerical staff and institutional patient safety (falls rates) and patient satisfaction (Friends and Family Test) in New Zealand. Data were analysed with structural equation modelling (SEM).

Results

The final model was an excellent fit to the data (χ² (22, N = 252) = 39.048, p = 0.014). Resonant leadership was significantly and positively associated with relationships at work, perception of unit care quality (β = 0.28, p < 0.001), reduced falls rates (β = −0.14, p < 0.05) and better patient satisfaction (β = −0.41, p < 0.001). A direct effect of resonant leadership was demonstrated on patient satisfaction (β = 0.20, p < 0.01). Perceived organization support (β = 0.40, p < 0.001) and leader–member exchange (β = 0.46, p < 0.001) were confirmed antecedents of work engagement. Work engagement was confirmed as an antecedent of nurse perception of unit care quality (β = 0.21, p < 0.001). Where social exchanges exist, work engagement mediates these. Three further mediated paths bypassed work engagement altogether.

Conclusion

Existing literature investigating the drivers and impacts of work engagement predominantly focuses on staff outcomes rather than patient outcomes. The findings identify modifiable factors to improve staff experience, patient safety, and ultimately patient satisfaction. Resonant leadership, a relational style, is a core antecedent of quality care and positively associated with staff experience and patient outcomes.

Impact

This investigation into a real‐world problem for nurse leaders also confirmed that an organizational focus on work engagement is not always required. Resonant leadership improves staff work experience, patient safety, and patient satisfaction. Nurse leaders should measure, foster, and develop resonant leadership in practice.

Prevention of occupational injuries and accidents: A social capital perspective

Prior research has consistently established the pragmatic nature of literature regarding occupational injuries and accidental happenings faced by nursing professionals. However, current realities require a subjective approach to identify preventative measures that could influence occupational health and safety in healthcare sectors. A qualitative design followed a descriptive approach to assess unbiased opinions towards occupational obstructions that lead to accidental happenings. This study used the social capital framework in particular as a support resource to eliminate its detrimental effects on nurse's capacity to serve their patients. The findings extended the fundamental understanding of social capital from social ties to workplace and personal ties as potential mechanisms of support. Healthcare organizations need to redefine their control policies to provide the ultimate support to their care agents. A social capital model offers nursing practitioners and nursing managers an approach for building evidence-based policies with implications for nurse's safety, education and training.

The effects of job characteristics, organizational justice and work engagement on nursing care quality in China: A mediated effects analysis

AIM

To analyse the structural associations among job characteristics, organizational justice, work engagement and nursing care quality in Chinese nurses.

BACKGROUND

Nursing care quality helps ensure patient safety, which are core concerns. The explicit relationships among the study's variables from a management perspective can help hospital managers to implement effective strategies to improve nursing care quality.

METHODS

This cross-sectional study was conducted to investigate the relationships among the variables in 1,615 nurses in eight Chinese tertiary hospitals. Structural equation modelling was used to test a proposed model of these relationships.

RESULTS

The scores of job characteristics, organizational justice, work engagement and nursing care quality were 3.55 ± 0.41, 3.84 ± 0.77, 4.67 ± 1.30 and 3.42 ± 0.70. Job characteristics and organizational justice had direct effects on nursing care quality. Work engagement mediated the relationship of nursing care quality with job characteristics and organizational justice. The final model explained 24% of nursing care quality.

CONCLUSION

The results provide a better understanding of the associations between the study's variables. Perceived job characteristics and organizational justice can improve nursing care quality through work engagement.

IMPLICATIONS FOR NURSING MANAGEMENT

Reconfiguring work design to strengthen nurses' positive perceptions of job characteristics and organizational justice can enhance nursing care quality.

Is Commitment to One’s Profession Always a Good Thing? Exploring the Moderating Role of Occupational Commitment in the Association Between Work Events and Occupational Health

Using a 12-week experience sampling design, this study examined the interaction between negative and positive events in predicting work engagement and burnout in a sample of nurses. Additionally, this study explored the moderating effect of affective occupational commitment as a moderator of work events and work engagement/burnout relation. Results indicated that positive and negative events, as well as their interactive effects significantly predicted both work engagement and burnout. In addition, occupational commitment moderated the association between negative events and burnout. Specifically, the association between negative events and burnout was stronger for nurses who reported high occupational commitment. Positive events did not interact with occupational commitment to predict work engagement or burnout. Similarly, occupational commitment did not moderate the link between negative events and work engagement. Implications for research and practice are discussed.

Linking Self-efficacy to Quality of Working Life: The Role of Work Engagement

The aim of this study was to explore the effect of work engagement, as an intermediary variable, on the relationship between self-efficacy, and job satisfaction and affective organizational commitment as individual indicators of quality of working life (QWL). A cross-sectional correlational design was utilized assessing a convenience sample of 321 nursing staff. All participants were employed in public hospitals and had more than five months of professional experience in the same hospital. Mediation analysis was performed using path analysis and bootstrapping confidence intervals (percentile-corrected). Work engagement partially mediated the relation between self-efficacy and job satisfaction, and fully mediated the relation between self-efficacy and affective organizational commitment. Self-efficacy seems to be an important predictor of QWL in nursing staff, although its effect is partially mediated (e.g., job satisfaction) or fully mediated (e.g., affective commitment) by work engagement.

Interprofessional collaboration in hospitals: a critical, broad-based review of the literature

Interprofessional collaboration (IPC) is a common term applied in the healthcare literature, with suggestions it contributes to improved quality and safety of patient care across the globe. Despite worldwide implementation of models of IPC, past systematic or meta-reviews on this topic have concluded that the evidence is mixed. However, these reviews are yet to adequately consider the qualitative and mixed-methods literature on this topic. In this critical review, we synthesize the outcomes and key findings of IPC in hospitals, taking a broader approach by including diverse study designs. A total of 4,776 abstracts were screened from three major databases (Medline, CINAHL, Embase). Thirty-four studies fulfilled inclusion criteria. Although outcomes and key findings (e.g., staff turnover, error rates) were mostly positive, there were inconsistencies in the results. The included studies reflected a variety of study designs and different methodological approaches. Overall, our review revealed moderate evidence that IPC can positively influence patient, staff and organizational factors in hospitals, and that inconsistent findings may be due to variation in context (e.g., the cohort of patients). Recommendations from the review are to incorporate qualitative- and mixed-methods approaches to studying IPC in healthcare and tailor evaluations of IPC outcomes specific to the context.

Relationship between the nursing practice environment and the therapeutic relationship in acute mental health units: A cross-sectional study

The therapeutic relationship constitutes the central axis of mental health nursing. The clinical practice environment has been empirically related to the quality of care. However, the relationship between the two constructs is unknown in the setting of mental health units. We aimed to examine whether the practice environment and nurses' characteristics influence the therapeutic relationship in mental health units. Through a cross-sectional design, data were collected via an online form completed by nurses in 18 mental health units. Linear regression was used to examine the relationship between the clinical practice environment and the therapeutic relationship. Questionnaires were completed by 198 participants. The mean age was 33.8 (SD 9.1) years, 71.7% were women, and only 20.2% had a specialist qualification in mental health. The therapeutic relationship was better when there was a more favourable practice environment (B: 3.111; 95% CI: 1.46-4.75). The most influential environment-related factor was the nursing foundations for quality of care (B: 2.124; 95% CI: 0.17-4.07). The factors associated with a high-quality therapeutic relationship were a more favourable practice environment and the presence of more foundations for quality nursing care, coupled with higher academic attainment and longer nursing experience. Institutions should take into account the importance of the nursing practice environment in mental health units. Aspects related to the quality of nursing foundations, such as training, the use of nursing language and taxonomy, and the existence of a common nursing philosophy, are influential for a high-quality therapeutic relationship.

Managerial style and well-being among psychiatric nurses: A prospective study

WHAT IS KNOWN ON THE SUBJECT?: Numerous studies have shown that organizational and managerial factors have significant effects on nurses' workplace well-being. There are few studies on the effects of nurses' perceptions of their supervisors' autonomy-supportive behaviours on their workplace well-being. There are few studies on the determinants of nurses' workplace well-being within a psychiatric context. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: This study examines the psychological processes underlying the relationship between nurses' perceptions of their supervisors' autonomy-supportive behaviours and their workplace well-being. Mental health nurses' perceptions of their supervisors' autonomy-supportive behaviours are indirectly and positively related to their workplace well-being through their positive effects on psychological need satisfaction. Autonomy and competence need satisfaction has stronger effects on workplace well-being than relatedness need satisfaction. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: When their supervisor gives nurses a meaningful rationale for tasks and acknowledges their feelings and views, they feel more autonomous, competent and related to others. It is important for nurses to feel autonomous and competent in order to experience well-being at work. Nurses' workplace well-being might be positively and negatively linked to quality of care and turnover intentions, respectively. Abstract Introduction There is growing interest in the relationships between work factors and nurses' workplace well-being. However, there has been very little research on the psychological processes underlying the relationships between nurses' perceptions of supervisors' autonomy-supportive managerial style and their workplace well-being. Aim/question Drawing on self-determination theory, we explored the mediating role of psychological need satisfaction (autonomy, competence and relatedness) in the relationships between nurses' perceptions of supervisors' autonomy-supportive managerial style and their workplace well-being, using a prospective design. Method A prospective questionnaire was given to nurses in eight French psychiatric units. Data were collected from a sample of 294 French nurses who completed measures of perceived supervisors' autonomy-supportive behaviours at Time 1 and of psychological need satisfaction, work engagement and job satisfaction at Time 2 one year later. Results Results revealed that nurses' perceptions of supervisors' autonomy-supportive managerial style were indirectly and positively related to their vigour, dedication, absorption and job satisfaction one year later through their positive effects on psychological need satisfaction. Discussion/implications for practice Overall, this paper sheds light on the indirect effect of nurses' perceptions of supervisors' autonomy-supportive behaviours on their workplace well-being. Theoretical contributions and future directions, as well as implications for practice, are discussed.

Time Together: A nursing intervention in psychiatric inpatient care: Feasibility and effects

The facilitation of quality time between patients and staff in psychiatric inpatient care is useful to promote recovery and reduce stress experienced by staff. However, interventions are reported to be complex to implement and are poorly described in the literature. This multisite study aimed to evaluate the feasibility and effects of the nursing intervention Time Together, using mixed methods. Data consisted of notes from participant observations and logs to evaluate feasibility, and questionnaires to evaluate effects. The primary outcome for patients was quality of interactions, and for staff, it was perceived stress. The secondary outcome for patients was anxiety and depression symptom levels, and for staff, it was stress of conscience. Data were analysed using visual analysis, percentage of nonoverlapping data, and qualitative content analysis. The results showed that Time Together was a feasible intervention, but measurements showed no effects on the two patient outcomes: quality of interactions and anxiety and depressive symptoms and, questionable effects on perceived stress and stress of conscience among staff. Shared responsibility, a friendly approach, and a predictable structure enabled Time Together, while a distant approach and an unpredictable structure hindered the intervention. In conclusion, the intervention proved to be feasible with potential to enable quality interactions between patients and staff using the enabling factors as supportive components. It also had some effects on perceived stress and stress of conscience among staff. Further evaluation is needed to build on the evidence for the intervention.

Relationships between leadership, structural empowerment, and engagement in nurses

AIM

The aim of this study was to analyse the relationships among structural empowerment, the leadership style of managers, and the engagement of nurses in a health organization of Spain.

BACKGROUND

Transformational leadership has an impact on patient security and satisfaction as well as the well-being and engagement of healthcare workers. Empowerment is a management practice that is fundamental for professional growth and positively affects the quality of patient care.

DESIGN

A cross-sectional study.

METHODS

Randomized sample of 131 nurses recruited from 11 health centres with different levels of care was surveyed to assess managers' leadership style, nurse empowerment, and work engagement. The data were analysed by descriptive and correlational statistics and hierarchical mediated regression.

RESULTS

The transformational leadership of the nurse manager directly and positively influences the structural empowerment of nurses. The structural empowerment of nurses directly and positively influences engagement. The transformational leadership of managers positively influences nurse engagement through the mediating effect of structural empowerment.

CONCLUSION

The structural empowerment of nurses acts as a mediator between the transformational leadership of nurse managers and nurse engagement.

PRACTICAL IMPLICATION

The transformational leadership of nurse managers at the unit level has a double impact on staff nurses: first, increasing empowerment and second, increasing the engagement of the nurse staff.

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.

Does 'Time Together' increase quality of interaction and decrease stress? A study protocol of a multisite nursing intervention in psychiatric inpatient care, using a mixed method approach

INTRODUCTION

Despite the long-known significance of the nurse-patient relationship, research in psychiatric inpatient care still reports unfulfilled expectations of, and difficulties in, interactions and relationships between patients and staff. Interventions that create structures to allow quality interactions between patients and staff are needed to solve these problems. The aim of this project is to test effects of the nursing intervention Time Together and to evaluate the intervention process.

METHODS AND ANALYSIS

This is a multisite study with a single-system experimental design using frequent measures. The primary outcomes are quality interactions for patients and perceived stress for staff. Secondary outcomes are levels of symptoms of anxiety and depression for patients and stress of conscience for staff. A process evaluation is performed to describe contextual factors and experiences. Data are collected using questionnaires, participant observations and semistructured interviews. For analysis of quantitative data, both visual and statistical methods will be used. Qualitative data will be analysed using qualitative content analysis.

ETHICS AND DISSEMINATION

Ethical approval was granted by the Ethical Review Board in the region (Dnr 2016/339-31). The findings will contribute to the development of nursing interventions in general, but more specifically to the development of the intervention. This is relevant both nationally and internationally as similar interventions are needed but sparse. The findings will be disseminated through conference presentations and peer-reviewed publications.

TRIAL REGISTRATION NUMBER

NCT02981563.

Resilience of the health team in caring for people with mental disorders in a psychiatric hospital

OBJECTIVE

Evaluating and understanding the resilience process of the health team in caring for people with mental disorders in a psychiatric hospital.

METHOD

A mixed-method study with concomitant triangulation of data from a cross-sectional study, with health professionals, and Grounded Theory in the data. Quantitative data were collected using the Resilience Scale and analyzed using descriptive and inferential statistics. Qualitative data were obtained from interviews and analyzed using initial and focused coding.

RESULTS

40 health professionals participated in the study. Mean responses of the participants in the resilience scale were 99.80 ± 12.86 points, with a minimum of 35 and a maximum of 114 points. From the qualitative data, we can highlight the professionals' commitment in developing competencies in caring for people with mental disorders; valorization of teamwork and positive impact on work for the re-signification of the meaning of life.

CONCLUSION

Understanding this process of resilience enables developing strategies to improve the quality of life of workers in psychiatric hospitals.

OBJETIVO

Avaliar e compreender o processo de resiliência da equipe de saúde no cuidado a pessoas com transtornos mentais em um hospital psiquiátrico.

MÉTODO

Estudo de método misto com triangulação concomitante de dados de um estudo transversal, com profissionais de saúde, e uma Teoria Fundamentada nos Dados. Os dados quantitativos foram coletados a partir da Escala de Resiliência e analisados por meio de estatística descritiva e inferencial. Os dados qualitativos foram obtidos a partir de entrevistas e analisados mediante codificação inicial e focalizada.

Resultados:

Participaram da pesquisa 40 profissionais de saúde. Na escala de resiliência, a média das respostas dos participantes foi 99,80±12,86 pontos, o mínimo foi de 35 e o máximo de 114 pontos. Nos dados qualitativos, destacaram-se o empenho dos profissionais para o desenvolvimento de competências para o cuidado de pessoas com transtornos mentais, a valorização do trabalho em equipe e o impacto positivo no trabalho para a ressignificação do sentido da vida. Conclusão: O entendimento desse processo de resiliência possibilita o desenvolvimento de estratégias para a melhoria da qualidade de vida dos trabalhadores que atuam em hospitais psiquiátricos.

Work engagement, social support, and job satisfaction in Portuguese nursing staff: A winning combination

BACKGROUND

Job Demands-Resources model assumes the mediator role of work engagement between social support (job resource) and job satisfaction (organizational result). However, recent studies suggest that social support can be considered as a moderator variable in the relationship between engagement and job satisfaction in nursing staff.

AIM

The aim of this study is to analyze the moderator role of social support, from supervisor and from co-workers, in the relationship between work engagement and job satisfaction in a Portuguese nursing sample.

METHOD

We conducted a cross-sectional and correlational study assessing a final sample of 215 participants (55.56% response rate, 77.21% women). Moderation analyses were carried out using multiple and hierarchical linear regression models.

RESULTS

Job satisfaction was significantly predicted by work engagement and social support from supervisor and from co-workers. The significant interaction in predicting job satisfaction showed that social support from co-workers enhances the effects of work engagement on nurses' satisfaction.

CONCLUSION

A climate of social support among co-workers and higher levels of work engagement have a positive effect on job satisfaction, improving quality care and reducing turnover intention in nursing staff.

Experiencing violence in a psychiatric setting: Generalized hypervigilance and the influence of caring in the fear experienced

BACKGROUND

Exposure to violence in the mental health sector both affects employees and has implications for the quality of care provided.

OBJECTIVE

This phenomenological study aims to describe and understand the ways in which acts of aggression from a patient might affect workers in a psychiatric institute, their relationships with the patients and the services offered.

METHODS

Two semi-structured interviews were conducted with each of the 15 participants from various professions within a psychiatric hospital.

RESULTS

Our analysis reveals four themes: hypervigilance, caring, specific fear toward the aggressor and generalized fear of all patients. A state of hypervigilance is found among all participants. An emphasis on caring is present among the majority and unfolds as a continuum, ranging from being highly caring to showing little or no caring. A feeling of fear is expressed and is influenced by the participant's place on the caring continuum. Caring workers developed a specific fear of their aggressor, whereas those showing little or no caring developed a generalized fear of all patients. Following a violent event, caring participants maintained this outlook, whereas those demonstrating little to no caring were more inclined to disinvest from all patients.

CONCLUSIONS

Hypervigilance and fear caused by experiences of violence impact the quality of care provided. Considerable interest should thus be paid to caring, which can influence fear and its effects.

Can Completing a Mental Health Nursing Course Change Students' Attitudes?

Nursing program graduates rarely choose mental health nursing as a career. A quasi-experimental study was conducted to examine attitudes of 310 nursing students towards persons with mental illness. Students completed surveys on the first and last days of their program's psychiatric mental health nursing course. The pre- and post-test survey analysis indicated that students improved their attitude, knowledge and preparedness to care for persons with mental illness. However, students maintained little interest in working as a mental health nurse. Modifications in mental health nursing courses could be made to improve students' interest in choosing a career in mental health nursing.

The Productive Ward Program™

Aim

To investigate the impact of the quality improvement program “Productive Ward – Releasing Time to Care™” using nurses’ and midwives’ reports of practice environment, burnout, quality of care, job outcomes, as well as workload, decision latitude, social capital, and engagement.

Background

Despite the requirement for health systems to improve quality and the proliferation of quality improvement programs designed for healthcare, the empirical evidence supporting large-scale quality improvement programs impacting patient satisfaction, staff engagement, and quality care remains sparse.

Method

A longitudinal study was performed in a large 600-bed acute care university hospital at two measurement intervals for nurse practice environment, burnout, and quality of care and job outcomes and three measurement intervals for workload, decision latitude, social capital, and engagement between June 2011 and November 2014.

Results

Positive results were identified in practice environment, decision latitude, and social capital. Less favorable results were identified in relation to perceived workload, emotional exhaustion. and vigor. Moreover, measures of quality of care and job satisfaction were reported less favorably.

Conclusion

This study highlights the need to further understand how to implement large-scale quality improvement programs so that they integrate with daily practices and promote “quality improvement” as “business as usual.”

From ideals to resignation - interprofessional teams perspectives on everyday life processes in psychiatric inpatient care

WHAT IS KNOWN ON THE SUBJECT?: Psychiatric inpatient care has been described by both ward staff and patients as being demanding and disorganized, lacking opportunities for quality interactions in everyday life through joint activities. Qualitative research on interprofessional teams' perspectives on everyday life processes in psychiatric inpatient care is lacking. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Staff have ideals about care and collaboration, but the obstacles they face in everyday life, such as a poor environment, power asymmetry, lacking structure and the demands of managing chaos, mean that they appear to resign and shift focus from the patients' best interests to self-survival. Different professions in general describe the same obstacles in everyday life on the wards but there are also profession-specific perspectives on distancing and feelings of abandonment. To our knowledge, these findings have not been reported in the international evidence. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Given these findings we suggest interventions such as Protected Engagement Time as well as reflective dialogues within interprofessional teams. This would help staff to resume their caring role in everyday life in psychiatric inpatient care and put their ideals into practice.

ABSTRACT

Introduction Patients and ward staff describe psychiatric inpatient care as demanding, characterized by unpredictable events, yet research on interprofessional teams perspectives of everyday life processes in psychiatric inpatient care lacks. Aim This study aims to explore everyday life processes in psychiatric inpatient care, as reported by staff in interprofessional teams. Method A grounded theory design was used and 36 participants were interviewed. Results The analysis resulted in a process-oriented core category From ideals to resignation. Related to this core category were three further categories: Knowing where to go, Walking a path of obstacles and Shifting focus from the patient's best interests to self-survival. The staff had ideals about care and collaboration, but a poor environment, power asymmetry, lacking structure and demands of managing chaos meant that they appeared to resign from putting their ideals into practice. Discussion Different professions in general describe the same obstacles in everyday life on the wards but there are also profession-specific perspectives on distancing and feelings of abandonment. To our knowledge similar findings have not been reported in the international evidence. Implications In order to support interprofessional teams to work according to their ideals, interventions such as Protected Engagement Time and reflective dialogues within the teams are suggested.

Relationship between job demand and burnout in nurses: does it depend on work engagement?

AIM

The present study aimed to deepen the understanding of the relationships among job demands, control, social support, burnout and engagement in nurses.

BACKGROUND

Burnout is a prevalent phenomenon among nurses because of the interaction between high demands and low resources, according to the job demands-resources model.

METHODS

A descriptive, correlational design was used in a stratified random sample of 100 nurses recruited from two Spanish hospitals. Job demand, social support, control, engagement, and burnout were measured. Data were analysed by hierarchical regression analysis.

RESULTS

Social support is a significant predictor of nurses' engagement and demands is a predictor of nurses' burnout. Work engagement moderates the relationship between job demands and burnout.

CONCLUSIONS

The process that leads to burnout and the process that leads to engagement are not isolated processes; engagement acts as a moderator of burnout.

IMPLICATIONS FOR NURSING MANAGEMENT

The prevailing paradigm in combating burnout in nursing can be changed and could be based on the enhancement of nurses' strengths through increasing engagement.

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.

Exposure of mental health nurses to violence associated with job stress, life satisfaction, staff resilience, and post-traumatic growth

Workplace violence towards health workers in hospitals and in mental health units in particular is increasing. The aim of the present study was to explore the effects of exposure to violence, job stress, staff resilience, and post-traumatic growth (PTG) on the life satisfaction of mental health nurses. A descriptive, cross-sectional design was used. The sample consisted of mental health nurses (n = 118) working in a large mental health centre in Israel. Verbal violence by patients was reported by 88.1% of the nurses, and 58.4% experienced physical violence in the past year. Physical and verbal violence towards nurses was correlated with job stress, and life satisfaction was correlated with PTG and staff resilience. Linear regression analyses indicated that life satisfaction was mainly affected by PTG, staff resilience, and job stress, and less by exposure to verbal and physical violence. The present study is the first to show that, although mental health nurses are frequently exposed to violence, their life satisfaction is affected more by staff resilience, PTG, and job stress than by workplace violence. Therefore, it is recommended that intervention programmes that contribute to PTG and staff resilience, as well as those that reduce job stress among mental health nurses, be explored and implemented.

Autonomous home-care nursing staff are more engaged in their work and less likely to consider leaving the healthcare sector: a questionnaire survey

BACKGROUND

The need for home care is rising in many Western European countries, due to the ageing population and governmental policies to substitute institutional care with home care. At the same time, a general shortage of qualified home-care staff exists or is expected in many countries. It is important to retain existing nursing staff in the healthcare sector to ensure a stable home-care workforce for the future. However, to date there has been little research about the job factors in home care that affect whether staff are considering leaving the healthcare sector.

OBJECTIVE

The main purpose of the study was to examine how home-care nursing staff's self-perceived autonomy relates to whether they have considered leaving the healthcare sector and to assess the possible mediating effect of work engagement.

DESIGN, SETTING AND PARTICIPANTS

The questionnaire-based, cross-sectional study involved 262 registered nurses and certified nursing assistants employed in Dutch home-care organisations (mean age of 51; 97% female). The respondents were members of the Dutch Nursing Staff Panel, a nationwide group of nursing staff members in various healthcare settings (67% response rate).

METHODS

The questionnaire included validated scales concerning self-perceived autonomy and work engagement and a measure for considering pursuing an occupation outside the healthcare sector. Logistic regression and mediation analyses were conducted to test associations between self-perceived autonomy, work engagement and considering leaving the healthcare sector.

RESULTS

Nursing staff members in home care who perceive more autonomy are more engaged in their work and less likely to have considered leaving the healthcare sector. The positive association between self-perceived autonomy and considering leaving, found among nursing staff members regardless of their level of education, is mediated by work engagement.

CONCLUSION

In developing strategies for retaining nursing staff in home care, employers and policy makers should target their efforts at enhancing nursing staff's autonomy, thereby improving their work engagement.