Healthy work environment: A systematic review informing a nursing professional practice model in the US Military Health System

AIM

The aim of the study was to develop recommendations for creating a healthy work environment based on current literature for nurses working within the US Military Health System (MHS). However, our findings would likely benefit other nursing populations and environments as well.

DESIGN

Systematic literature review.

DATA SOURCES

We conducted a systematic literature search for articles published between January 2010 until January 2024 from five databases: PubMed, Joanna Briggs, Embase, CINAHL and Scopus.

METHODS

Articles were screened, selected and extracted using Covidence software. Article findings were synthesized to create recommendations for the development, implementation and measurement of healthy work environments.

RESULTS

Ultimately, a total of 110 articles met the criteria for inclusion in this review. The articles informed 13 recommendations for creating a healthy work environment. The recommendations included ensuring teamwork, mentorship, job satisfaction, supportive leadership, nurse recognition and adequate staffing and resources. Additionally, we identified strategies for implementing and measuring these recommendations.

CONCLUSIONS

This thorough systematic review created actionable recommendations for the creation of a healthy work environment. Based on available evidence, implementation of these recommendations could improve nursing work environments.

IMPACT

This study identifies methods for implementing and measuring aspects of a healthy work environment. Nurse leaders or others can implement the recommendations provided here to develop healthy work environments in their hospitals, clinics or other facilities where nurses practice.

REPORTING METHOD

PRISMA 2020 guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Survey Research: Do All RN Types Have the Same Perceptions Regarding Professional Nursing Governance?

OBJECTIVE

Researchers examined professional nursing governance perception differences by RN type (clinical, manager, and other RNs), and nurse-related outcome associations.

BACKGROUND

Shared governance is associated with improved nurse-related outcomes. Understanding differences in RN types regarding shared governance perceptions is important and not well studied.

METHODS

Mean Index of Professional Nursing Governance (IPNG) scores from 3 hospitals' 502 RNs were used to evaluate associations by RN type and unit-based nurse-related outcomes. Descriptive and inferential statistical methods were used.

RESULTS

Shared governance was the predominant finding (overall score and 4 of 6 subscale scores) with no significant differences by RN type. Traditional governance was scored for 1 subscale (control over personnel), which was not significant. There were no significant differences in the IPNG score associations with outcomes data by RN type.

CONCLUSIONS

Clinical nurses, managers, and other RN types perceived their governance as shared, without significant difference in the nurses' perceptions based on role.

A Survey of Interim Nurse Managers to Understand the Role and the Impact on Nurse and Patient Outcomes

OBJECTIVE

The aim of this study was to describe the current state of the interim manager (IM) role and the impact of the role on job performance.

BACKGROUND

Interim managers provide leadership during organizational change, yet little is known about the role and its impact on outcomes.

METHODS

An electronic survey was completed by 179 IMs working in acute care hospitals. Instruments included the Nurse Manager Practice Environment Scale, Decision Involvement Scale, Subjective Stress Scale, Maslach Burnout Inventory, and Brief Resilience Scale.

RESULTS

The average tenure for IMs was 10 months. Despite moderately high levels of stress and exhaustion, IMs were resilient, positively viewed their work environment, and perceived their job performance as positively impacting nurse and patient outcomes. Interim managers were generally satisfied in their roles and likely to pursue nursing leadership as a career.

CONCLUSION

Interim managers desire permanent leadership opportunities providing a pool for replacing exiting nurse managers. Support is needed to be successful.

Nurses' critical reflections of working in unit practice councils-A qualitative interview study

AIM

This study aimed to describe nurses' experiences of working as members of unit practice councils.

BACKGROUND

Health care organisations worldwide want personnel to participate in decision-making. Unit practice councils promote unit-level decision-making over unit-specific issues. Despite extensive research on shared decision-making, few studies have examined the experiences of nurses serving as members of these councils.

METHODS

A descriptive qualitative study design was used with semi-structured interviews of 16 nurses in two clinics of a Finnish university hospital. Interviews were analysed using thematic analysis.

RESULTS

The analysis revealed two themes describing nurses' experiences as members of unit practice councils: (i) inchoate unit practice councils with insufficient allocated working time and (ii) partial empowerment of nurses through the organisation's evolving Magnet project.

CONCLUSIONS

Unit practice councils in the studied organisations are inchoate and unable to effectively advance shared decision-making or support nurses' professional autonomy. In the future, the councils require constant support from all leadership levels of the organisation.

IMPLICATIONS FOR NURSING MANAGEMENT

Sharing decision-making power could be a win-win situation where nurse leaders relinquishing power over certain matters gain time to immerse in wider issues. While acknowledging different organisational roles, there is room for trusting each other's professionality and respecting autonomous work.

Nurse managers' perception of governance among Korean nurses

AIM

This study aims to ascertain nurse managers' perception of nurses' governance and explore their perception of facilitating and hindering factors of shared governance.

BACKGROUND

Shared governance has been introduced in nursing as a plan to improve nursing service quality. There is limited understanding about how governance is implemented.

METHODS

A mixed-methods design was used to elicit Korean nurse managers' views.

RESULTS

Quantitative data revealed the level of nurses' governance perceived by nurse managers as shared governance. However, among the subdomains, 'control over personnel' and 'participation in committee structures' indicate traditional governance. Analysis of qualitative data identified the factors that facilitate or hinder the subdomains: 'stifled atmosphere', 'nurse manager's encouragement', 'lack of opportunity and perception of the given authority' and 'flexible organisational structure'.

CONCLUSION

Findings from the study can be used to inform shared governance programmes for hospitals.

IMPLICATIONS FOR NURSING MANAGEMENT

Health care organisations, nurse managers and nurses must take action at each level to improve the current nurse governance situation. A flexible organisational culture with opinion windows for participation by nurses is important for shared governance. Supportive leadership of nurse managers and nurse-directed implementation could advance shared governance.

Staff Nurse Decisional Involvement in the United States and Turkey

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

Journey of Excellence: Implementing a Shared Decision-Making Model

Research has shown that nurses who participate in shared decision making (SDM) have more control over their practice and greater job satisfaction, and hospitals that have instituted SDM have lower rates of nurse turnover and better patient outcomes. The purpose of this article is to describe the implementation of an SDM structure at a pediatric hospital. The hospital's chief nurse officer charged a group of nurses with developing SDM guidelines to outline the purpose, structure, and function of unit councils. A targeted, multifaceted approach to the implementation of these guidelines led to the successful standardization of nine existing unit councils and the expansion of the SDM unit council structure to all other hospital units. Work continues with guideline refinement in response to the real-life circumstances nurses encounter on the units, and the original group of nurses continues to review literature on SDM best practices. In addition, professions other than nursing, including multidisciplinary teams in dialysis, cardiovascular surgery, respiratory therapy, and child life, have adopted the guidelines for use in their departments.

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

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

[Intervening conditions on governance of the nursing practice at an obstetrics centre]

Governance refers to all processes that grant nurses autonomy, control and authority over the nursing practice. The aim of this study was to identify intervening conditions on governance of nursing practice at an obstetrics centre. This is a qualitative study based on the grounded theory method. Data were collected between January and May 2013 by means of semi-structured interviews with 27 participants of a university hospital in southern Brazil, divided into four sampling groups. Data were analysed using open, axial and selective coding. Governance is reinforced by experience and professional autonomy, coordination of the care and management dimension, interpersonal communication, satisfaction and engagement with the profession. It is limited by difficulties with interpersonal relationships, work overload and precarious physical structure of the maternity units. This study provides arguments for the discussion on improvements in healthcare and the professional satisfaction of nurses and nursing teams.

Evaluating the effect of safety culture on error reporting: a comparison of managerial and staff perspectives

Although medical error reporting has been studied, underreporting remains pervasive. The study aims were to identify the organizational factors with the greatest perceived effect on error reporting and to determine whether associations differ for management and clinical staff. A total of 515 637 respondents from 1052 hospitals completed the Hospital Survey on Patient Safety Culture. Nine organizational factors were tested as predictors of error reporting using weighted least-squares multiple regression. Error feedback was perceived as the most significant predictor, while organizational learning was another significant factor. It also was found that although management support for patient safety was significantly related to error reporting among clinical staff, this association was not significant among management. This difference is relevant because managers may not be aware that their failure to demonstrate support for safety leads to underreporting by frontline clinical staff. Findings from this study can inform hospitals' efforts to increase error reporting.

Decisional Involvement Among Staff Nurses Based on Educational Level and Certification Status

Mechanisms to enhance the work environment are nurse decisional involvement (DI), obtainment of a baccalaureate or higher degree, and specialty certification. The purpose of this descriptive comparative study was to determine the difference between actual and preferred DI of staff nurses on the overall Decisional Involvement Scale (DIS), the differences based on its subscales, and those based on education level and certification. The sample included 163 staff nurses from a Midwestern health care organization. A statistically significant difference was found between actual and preferred DI, but no difference was found based on educational level and certification. There is a need to focus on nurses with a BSN/master’s degree or specialty certification and to conduct comprehensive studies to address the effects of education and certification on DI. An additional strategy that can be useful for organizations is to provide nurses with the empowerment structures, expectations, and mentoring/coaching to become involved in the process of decision making.

The nurse manager practice environment scale: development and psychometric testing

OBJECTIVES

The objectives of this study were to develop and test a scale designed to describe and assess nurse managers' practice environments.

BACKGROUND

Creating practice environments supporting workers at all levels is critical to achieving excellent patient, staff, and organizational outcomes. Scales are available to assess staff nurses' practice environment; however, no comparable scale for nurse managers exists.

METHODS

A cross-sectional design using an electronic survey was administered to nurse managers in 25 hospitals in 9 health systems from 6 states.

RESULTS

Exploratory factor analysis with a varimax rotation produced a final solution of 44 items loading in 8 domains. Cronbach's α's ranged from .72 to .97. Mean scores ranged from 3.92 to 4.99 on a 6-point Likert scale.

CONCLUSIONS

The scale demonstrated adequate psychometric properties and warrants further use and testing. Understanding the nurse manager practice environment may reveal insights to guide opportunities to improve organizational performance.