Trust, ethical climate and nurses' turnover intention

Unethical conduct as a multifaceted phenomenon in psychiatric care: Nurse leaders' perspectives

Background: Mental healthcare can be considered a unique practice due to its ethical characteristics, and an awareness of ethics is crucial when working in a mental health setting. Several ethical challenges exist, and professionals may not always recognize the ethical aspects of psychiatric care. Research on psychiatric care from nurse leaders' perspective is scarce but important, because nurse leaders can impact and cultivate workplace culture. Aim: To explore the phenomenon of unethical conduct in a psychiatric inpatient context from nurse leaders' perspectives. Research design: Qualitative exploratory design. In-depth semi-structured interviews. Participants and research context: Eight nurse leaders from two different healthcare organizations in Finland. Leadership experience ranged between 2 and 30 years. Ethical considerations: Research ethics permission was received from a Research Ethics Board where the researchers are domiciled. Guidelines on good scientific practice as delineated by the Finnish Advisory Board on Research Integrity TENK were followed. Findings: Six main categories were generated: Unethical conduct and violations against patients, Unethical conduct and violations against staff, Unethical conduct and violations by staff against other staff, Unethical conduct and violations against leaders, Reasons underlying unethical conduct, and Consequences of unethical conduct and the positive development of psychiatric care. Conclusions: Unethical conduct was seen to be a multifaceted phenomenon, and patients and staff alike can experience and engage in unethical conduct. Unethical conduct against patients was linked to power imbalance (nature of involuntary care, staff attitudes) and a focus on rules based in historical precedent (paternalistic, routine-focused, not patient-centered). Unethical conduct against staff was linked to the nature of involuntary care and patient ill-health. Unethical conduct by staff against other staff was linked to a lack of understanding for others' work, interpersonal chemistry, (length of) work experience, and staff character. Unethical conduct against leaders was linked to leaders being perceived as the organization.

Ethical climate and turnover intention among nurses: A scoping review

INTRODUCTION

Nursing shortages and turnover pose significant challenges for health organizations worldwide, driven by various organizational and individual factors. Ethical climate has emerged as a critical aspect influencing nurses' well-being and retention within healthcare settings, reflecting organizational practices with moral implications. Understanding the relationship between ethical climate and turnover intention among nurses is paramount for practitioners, managers, and policymakers.

AIM

This review aimed to examine evidence and synthesize findings from prior studies on the association between ethical climate and turnover intention among nurses and identify key variables influencing its dynamics.

METHODS

A scoping review methodology was employed, encompassing studies retrieved up to February 2024 from major scientific databases, including PUBMED/MEDLINE, WEB OF SCIENCE, SCOPUS, and SCIENCE DIRECT. This study was conducted following ethical considerations and sound scientific guidelines.

RESULTS

Sixteen articles meeting the inclusion criteria were identified. Overall, a significant association between ethical climate and turnover intention was observed, with theoretical underpinnings demonstrated. Key variables frequently linked to both ethical climate and turnover intention included organizational commitment, job satisfaction, and moral distress, while organizational commitment, organizational cynicism, and organizational trust emerged as mediators.

CONCLUSION

Despite demonstrating a clear association, results underscore the necessity for replication studies, qualitative and longitudinal approaches, and standardized measurement. Enhancing the ethical climate through regular assessments, education, and interprofessional collaboration can improve retention. Future research should focus on theory building, ethical management and leadership, associated factors analysis, and intervention studies to develop comprehensive models and effective strategies for improving the ethical climate and reducing nurse turnover.

The predictive role of resilience and the ethical climate of hospital in the fatigue of surgical technologists working in operating rooms

BACKGROUND

Fatigue in surgical technologists is of paramount importance and is known as a priority because it can be regarded as a threat to the nurse's health and patient's safety. The fatigue level of healthcare workers can be affected by some factors, while the role of part of these factors is less known. This study aimed to determine the predictive role of resilience and the hospital ethical climate in the fatigue of surgical technologists working in operating rooms (ORs).

METHODS

This is a cross-sectional study conducted on 217 surgical technologists working in ORs of hospitals affiliated with Shiraz University of Medical Sciences. Data were collected using Connor-Davidson's Resilience scale, Olson's Hospital Ethical Climate Survey, and the Multidimensional Fatigue Inventory, and then analyzed using Pearson's correlation coefficient and multiple regression analysis.

RESULTS

87.1% and 12.9% of surgical technologists reported low and high fatigue, respectively. All fatigue subscales had significant and negative relationships with resilience (p < 0.05). Moreover, the relationship between fatigue and ethical climate was significant (p = 0.02). The multiple linear regression model showed the predictive role of resilience in fatigue (β=-0.29, P < 0.001). According to the model, 10% of the change of fatigue was related to resilience and ethical climate.

CONCLUSION

The present study demonstrated the relationship between resilience and ethical climate with fatigue. Moreover, resilience was a predictor of the surgical technologists' fatigue, so that their fatigue decreased with increasing resilience. However, future studies are recommended to determine other factors influencing fatigue in surgical technologists.

Development of ethical conflict scale for nurses in extraordinary circumstances and psychometric testing

AIM

The aim of this study was to develop and psychometrically test the Ethical Conflict Scale for Nurses in Extraordinary Circumstances (ECSNEC).

DESIGN

This study is designed to develop and validate an instrument.

METHODS

There are four basic steps in the development process of ECSNEC: (1) establishment of the conceptual framework, (2) creation of the item pool, (3) preliminary evaluation and (4) psychometric evaluation. The data were gathered from 519 nurses who worked in two different hospitals operating in Istanbul between June 2022 and October 2022.

RESULTS

The scale had good content validity. The exploratory factor analysis revealed a three-factor construct which explained 47.31% of the total variance in the measured variable. The corresponding construct was confirmed by the confirmatory factor analysis. The Cronbach's alpha coefficients were greater than .60 for all dimensions. The test-retest reliability coefficient value of the scale was 0.90.

CONCLUSION

ECSNEC is a valid and reliable tool to determine the ethical conflict experienced by nurses in extraordinary circumstances.

IMPACT

The established scale allows the identification of factors influencing the ethical challenges nurses face in extraordinary circumstances. Thus, policies can be developed to prevent such ethical conflicts.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Effects of ethical climate in association with tenure on work addiction, quality of care and staff retention: a cross-sectional study

OBJECTIVES

Work addiction is not contingent on personality alone; it is also impacted by social contextual factors. Work addiction influences the perceived quality of care and intention to remain in healthcare sector. The current study seeks to understand the role of ethical climate as a potential organisational lever to reduce such addiction, especially among newcomers.

DESIGN

We contacted a sample of Canadian healthcare organisations to collect quantitative data using an online questionnaire from November 2021 to February 2022. All constructs (ethical climate, work addiction, perceived quality of care, intention to quit the profession) were measured using validated psychometric scales. 860 respondents provided complete questionnaires. We analysed the data using structural equation modelling and regression analysis.

RESULTS

Work addiction mediated the indirect relationship between ethical climate and the intention to quit the profession (β=-0.053; 95% CI (-0.083 to -0.029); p<0.001) and with quality of care (β=0.049; 95% CI (0.028, 0.077); p<0.001). For each increase of 1 SD of ethical climate, the total effects regarding the variations in the outcomes were more important at low rather than high levels of tenure for work addiction (-11%, -2%), perceived quality of care (23%, 11%) and intention to quit the profession (-30%, -23%), respectively.

CONCLUSION

Ethical climate in healthcare organisations has a significant and beneficial relationship with healthcare workers' (HCWs) work addiction behaviours. In turn, this relationship is related to greater perceived quality of care and higher intention to remain, especially for HCWs with lower tenure.

Impact of ethical climate, moral distress, and moral sensitivity on turnover intention among haemodialysis nurses: a cross-sectional study

BACKGROUND

While several studies have been performed on turnover intention among nurses, limited studies have considered the ethical perspectives on turnover intention among haemodialysis nurses. The purpose of this study was to clarify the impact of ethical factors, namely ethical climate, moral distress, and moral sensitivity on turnover intention among haemodialysis nurses.

METHODS

This cross-sectional research was conducted between July and August 2017. A total of 148 haemodialysis nurses were invited to participate in the study by convenience sampling from 11 general and university hospitals in South Korea. Data were analysed using SPSS for t-test, one-way analysis of variance, Pearson's correlation coefficients, and multiple regression analysis.

RESULTS

In the final regression model, the adjusted R-squared significantly explained 34.6% of the variance in turnover intention (F = 22.534, p < .001) when moral distress related to physician practice (β = 0.310, p = .001) and ethical climate related to the hospital climate (β = - 0.253, p = .003) and manager (β = - 0.191, p = .024) were included. Following the stepwise multiple regression process, all subdomains related to moral sensitivity were excluded due to no statistical significance in the final regression model.

CONCLUSION

To reduce turnover intention among haemodialysis nurses, hospitals and managers should pay attention to haemodialysis nurses' moral distress originating from physicians' practice and improve their ethical climate. Additionally, it is required that the impact of moral sensitivity on turnover among nurses working in diverse care settings be examined further.

Nurses' perception about Human Resource Management system and prosocial organisational behaviour: Mediating role of job efficacy

AIMS

To examine the relationship between nurses' perception about human resource management system and prosocial organisational behaviour through job efficacy.

BACKGROUND

Literature suggests that non-profit organisations are often confronted with financial constraints on one side and the expectation of delivering high-quality services on the other. Employees voluntarily engaging in service-oriented behaviours help to bridge this gap to some extent, and human resource management system plays a significant role in eliciting the requisite behaviours. In this article, the case of nurses from non-profit hospitals has been undertaken to examine the aspects of human resource management system that needs focus while promoting prosocial organisational behaviours among the nurses for ensuring better service delivery.

METHOD

Cross-sectional design was employed. Data were collected from 387 nurses working in non-profit hospitals in India through questionnaires and were analysed with the help of structural equation modelling.

FINDINGS

In the absence of sophisticated human resource system in non-profit hospitals, the study found that nurses' perception about human resource management system is positively related to prosocial organisational behaviours, and job efficacy partially mediates the relationship.

CONCLUSION

Positive perceptions such as involvement with the job and communication as well as supervisors' support are essential human resource practices for fostering self-efficacy and, thus, improving prosocial organisational behaviour of nurses working in non-profit hospitals.

IMPLICATION FOR NURSING MANAGEMENT

Non-profit hospitals should focus on nurses' participation and supervisory support, which would provide a better human touch approach to patient care and also improve service quality. The findings shed light on the nursing management of non-profit hospitals in terms of human resource management that has to be given much attention for institutionalizing prosocial organisational behaviour.