Registered nurses' perceptions of factors influencing nursing care quality: A structural equation modeling study

Dissatisfaction with working conditions associated with lower vaccine confidence, commitment and behaviors among nurses: A large scale cross-sectional survey in France

BACKGROUND

Before, during, and after the COVID-19 pandemic, doctor shortages led many countries to expand nurses' role in their mass vaccination programs. Nonetheless, nurses often express marked vaccine hesitancy. Simultaneously, their working conditions have been deteriorating.

OBJECTIVES

To study 1) the association between nurses' perceptions of their working conditions and their vaccination-related behaviors (vaccination recommendations to their patients), and 2) the mediating role in this associations of their trust in health authorities, vaccine confidence, and vaccine proactive efficacy.

DESIGN

A cross-sectional survey.

SETTINGS

Salaried, community (self-employed) and mixed nurses in France.

PARTICIPANTS

18,888 nurses registered with the French national order of nurses (ONI, registration is mandatory) (N = 439,323).

METHODS

In February 2023, this cross-sectional study used an online questionnaire to survey the nurses mandatorily registered with the French national order of nurses. Seven items adapted from models of psychosocial risk factors at work assessed their satisfaction with their working conditions. The international short version of the Pro-VC-Be (health professionals, vaccine confidence and behaviors), a validated instrument measuring psychosocial determinants of health-care professionals' vaccine behaviors) evaluated their vaccine-related attitudes and behaviors. Multiple group mediation analysis with structural equation modeling measured the associations between satisfaction at work, trust in health authorities, vaccine confidence, proactive efficacy (commitment and self-efficacy) in vaccination, and vaccination recommendations (against seasonal influenza for those with a chronic disease and against COVID-19 among adults).

RESULTS

Among the 18,888 participants, satisfaction at work had generally deteriorated, and only 47 % considered vaccines safe. Among salaried nurses (61 %), satisfaction at work was statistically significantly associated (p < 10-3) with trust in health authorities (β = 0.26 [0.24; 0.28]), vaccine confidence (total effect: β = 0.35 [0.31; 0.38]), proactive efficacy (total effect: β = 0.18 [0.16; 0.21]), and, to a smaller extent, with seasonal influenza and Covid-19 vaccine recommendations (total effect: β = 0.13 [0.09; 0.16]). Trust in health authorities played a statistically significant role (p < 10-3) mediating the associations of satisfaction at work with vaccine confidence and proactive efficacy. These three dimensions in turn mediated the relation between satisfaction at work and frequency of vaccination recommendations. These relations were similar among community nurses.

CONCLUSIONS

Satisfaction at work appears to enhance nurses' vaccination attitudes and behaviors, which are likely to reinforce their capacity to promote their patients' vaccination. Significant improvement in their working conditions is needed to enable them to accomplish this role serenely.

Evaluation of nursing process competencies, nursing quality, and patient safety using virtual simulation with debriefing: A quasi-experimental study

Background

Investing in clinical education is important for adult urgent and emergency surgery and traumatology as it promotes registered nurses' competencies by providing professional development training to respond to urgent or emergency surgeries.

Objective

To examine registered nurses' self-assessment of the effects of virtual video simulation with an immediate debriefing approach on nursing process competencies, nursing care quality, incomplete care, and patient safety in surgical units.

Methods

This study used a quasi-experimental two-group pre- and post-test design. The study was conducted at two provincial hospitals in Cambodia. Participants included registered nurses employed in surgical units. The experimental group (n = 46) completed a virtual video simulation and immediate debriefing. The control group (n = 35) completed virtual training on the nursing process. Data were collected two months after a successful second-week follow-up using Competency of Nursing Process, Cambodian Nursing Care Quality, Care Left Undone, and Patient Safety scales. Wilcoxon signed-rank test and Mann-Whitney U test were used to evaluate the differences before and after the sessions. Generalized linear model was used to compare the differences between the two groups.

Results

The results showed statistically significant improvements in the experimental group on competency, nursing care quality, patient safety, and reducing care left undone after the intervention. However, the control group revealed statistically insignificant differences. In addition, the experimental group provided positive feedback, such as experiencing a real patient scenario, developing critical-thinking, improving communication skills, and having an opportunity to ask questions.

Conclusion

Our study showed that VVS and immediate debriefing have the potential to support in-service training of RNs from diverse backgrounds. Particularly, integrating virtual video simulation and immediate debriefing may to promote competency in the nursing process and improve care outcomes.

Translations of the Practice Environment Scale of the Nursing Work Index: A systematic review

Since 2002, the Practice Environment Scale of the Nursing Work Index has been used worldwide to evaluate nurse work environments. High quality translations in different languages can help advance science and inform practice globally. The study purposes were to conduct a systematic review of published translations of the instrument and to assess their linguistic equivalence and psychometric performance. We conducted a comprehensive search, a quality assessment and synthesis of linguistic equivalence, reliability, and validity data. Studies published through July 2021 were identified in the CINAHL, LILACS, EMCare, and Scopus databases. Thirty-eight publications were selected, comprising 46 translations into 24 languages and 15 language variants, and 35 countries. Translations are in predominantly European, Southeast Asian, and Middle Eastern languages. Two-thirds of the translations reflected medium to high fulfillment of translation quality criteria. The GRADE ratings, reflecting satisfactory fulfillment of cross-cultural equivalence and psychometric properties, were predominantly high (n = 23), then low (n = 15), then moderate (n = 8). The identified translations will support the advancement of global science and the improvement of nurses' work environments.

Going the Extra Mile (or Not): A Moderated Mediation Analysis of Job Resources, Abusive Leadership, Autonomous Motivation, and Extra-Role Performance

Abusive leadership is particularly prevalent in nursing and it can have multiple adverse effects on performance at work. However, little research has examined whether and under what conditions abusive leadership may be detrimental to nurses’ extra-role performance. This cross-sectional study explores whether abusive leadership intensifies the effects of emotional job resources on autonomous motivation, a psychological mechanism that could be responsible for extra-role performance. Data were collected from dyads of registered French-Canadian nurses and their immediate supervisors (n = 99 dyads). The models were tested with path analysis using Mplus. Our results show that extra-role performance is positively associated with nurses’ job emotional resources and autonomous motivation, but negatively associated with abusive leadership. Nurses’ cynicism is also negatively associated with autonomous motivation. Importantly, the indirect relation between emotional resources and extra-role performance through autonomous motivation is moderated by abusive leadership, providing support for a moderated mediation effect. These results add to those supporting a similar moderated mediation mechanism to explain employee attitudes and demonstrate the relevance of self-determination theory in a work context. These findings reinforce the need to focus on the quality of leadership practices as well as interventions aimed at promoting the performance of nurses at work.

Relationship Between Self-Acceptance and Intention to Stay at Work Among Clinical Nurses in China: A Cross-Sectional Online Survey

BACKGROUND

During the pandemic and with the growing shortage of nurses, the problem of how to retain existing nurses was of paramount importance. However, there is limited evidence on the relationship between nurses' self-acceptance and intention to stay.

OBJECTIVES

This study aimed to investigate the factors influencing nurses' intention to stay at work, and explore the relationship between self-acceptance and their intention to stay.

METHODS

Convenience sampling was conducted to select nurses who worked in a clinical environment during June 2020, in hospitals in Shandong Province, China. Self-designed basic information and two questionnaires, namely, the "self-acceptance questionnaire" and "intention to stay" were adopted. Mean, median, related analysis, and regression analysis were adopted to describe the relationship of self-acceptance and intention to stay on part of Chinese nurses.

RESULTS

A total of 1,015 clinical nurses participated in the survey. The mean score of intention to stay among participants was 22.00. The multiple regression analysis revealed various factors, such as age, family support the work, interest in work, job suitability, type of employment, professional level, weekly working hours, working department and self-acceptance influenced the nurse's intention to stay (β range from -1.506 to 2.249).

CONCLUSION

Our findings identified several factors that are significantly related to and impact the level of intention to stay among clinical nurses.

Work hours and overtime of nurses working in Cambodian hospitals

Aim

To examine the nature and prevalence of Cambodian nurses’ work hours and overtime and related factors

Background

The chronic shortage of nursing workforce is a major cause of overtime among nurses.

Introduction

Nursing shortage and working overtime among nurses negatively affect nurse and patient outcomes, but nurses’ work hours and overtime in Cambodia have not been comprehensively examined.

Methods

A multicenter cross‐sectional study was conducted in four Cambodian hospitals. Data were collected from 253 nurses providing direct nursing care using a questionnaire. The STROBE checklist was used for reporting this study.

Results

More than a fifth of staff nurses worked more than 48 h, which is the legal work hour limit in Cambodia. Two major reasons for working mandatory or voluntary overtime, on‐call or 24‐h on‐call were (a) not wanting to let down colleagues and (b) able to get all work done. The number of patients cared for was related to whether or not nurses worked 48 h or more.

Conclusion

Overtime work and adverse nurse scheduling are common in Cambodia.

Implications for nursing and health policy

Nurse managers and healthcare institutes in Cambodia need to monitor Cambodian nurses’ work hours, which are often beyond the legal work hour limit. Moreover, it is important to understand why nurses work overtime and develop health policies, strategies, and programs that can help promote patient and nurse safety and retain qualified nursing staff. The 24‐h on‐call practice needs to be regulated according to the labor policy in healthcare institutes to prevent adverse nurse and patient outcomes.

Comparison of 12 and 24-hours shift impacts on ICU nursing care, efficiency, safety, and work-life quality

BACKGROUND

Nursing care quality is a central concern of health policy, and nurses' shift schedules affect the quality of care and their work-life status internationally. A lack of reliable information on the differences between 24- and 12-h shifts on care quality, nursing care quality, patient safety, and adverse and missed events warranted investigation in Cambodia.

AIM

We aimed to examine the impacts of 12-h shifts compared with 24-h shifts. The purpose was to find evidence to support the use of maximum 12-h shifts by registered nurses working in ICU contexts.

METHOD

A convergent mixed-method approach was chosen to highlight the issues around the long hours of shift work. We designed a 12-week coaching course during the implementation of 12-h shifts and assigned 30 nurses each to an experimental group and a control group. Data from quantitative surveying of 58 participants were combined with focus group discussions of 20 participants to gather qualitative insights. Pre- and post-test analysis involved descriptive statistics and the Wilcoxon sign rank test for quantitative analysis and then merged with qualitative findings from content analysis. Reporting of this study was steered by the STROBE and COREQ guidelines for quantitative and qualitative findings, respectively.

RESULTS

Quantitative results showed the increased quality of nursing work-life, nursing care quality, and patient satisfaction; decreased missed care and adverse events were significantly associated with the 12-h shift. Qualitative data supported nurses preferring 12-h rather than 24-h shift options.

DISCUSSION AND CONCLUSIONS

Changing rosters to 12-h shifts in the intervention caused increases in the study variables' scores. Results indicate the benefits of 12-h shifts on the quality of nursing work-life, nursing care quality, missed care, adverse events, and patient safety.

IMPLICATIONS FOR NURSING AND NURSING POLICY

We found that 24-h shifts had deleterious impacts on care quality and safety and nurse satisfaction with work. Health and nursing policymakers are urged to provide resources and strategize to implement 12 h shifts as soon as possible since the current 24-h shifts of nurses affect the patient quality of care and their health and safety and that of the nurses.