Effect of Nursing Care Delivery Models on Registered Nurse Outcomes

Measuring the PULSE of Nursing: Development of a Dashboard to Evaluate and Monitor Nursing Care Models

BACKGROUND

Critical nursing shortages have required many health care organizations to restructure nursing care delivery models. At a tertiary health care center, 150 registered practical nurses were integrated into acute inpatient care settings.

PROBLEM

A mechanism to continuously monitor the impact of this staffing change was not available.

APPROACH

Leveraging current literature and consultation with external peers, metrics were compiled and categorized according to Donabedian's Structure Process Outcome Framework. Consultation with internal subject matter experts determined the final metrics.

OUTCOMES

The Patient care, Utility, Logistics, Systemic Evaluation (PULSE) electronic dashboard was developed, capturing metrics from multiple internal databases and presenting real-time composites of validated indicators.

CONCLUSION

The PULSE dashboard is a practical means of enabling nursing leadership to evaluate the impact of change and to make evidence-informed decisions about nursing care delivery at our organization.

Development of a Professional Practice Nursing Model for a University Nursing School and Teaching Hospital: A nursing methodology research

AIM

The aim of the study was to describe the process of developing a Professional Practice Model by a Nursing School and Nursing Department of University Hospital.

DESIGN AND METHOD (S)

This is a descriptive nursing methodology research, developed along three stages: preliminary, empirical and validation. The empirical phase used qualitative and quantitative methodology. 28 teachers from the nursing school and nurses from the hospital participated. We defined the elements of the nursing meta-paradigm from narratives and focus group. Then, we extracted propositions regarding the nature of nursing from the relationship between the meta-paradigm elements, which concluded in the core elements.

RESULTS

The core elements of this nursing professional practice model are nursing seeks the well-being of the person, family or group; nursing is total and global, person-centred; nursing is compassionate; nursing entails up-to-date, quality scientific, technical and human competencies; nursing is delivered in a teaching hospital environment, with a Christian ethical perspective.

Investing in Canada’s nursing workforce post-pandemic: A call to action

Nurses represent the highest proportion of healthcare workers globally and have played a vital role during the COVID-19 pandemic. The pandemic has shed light on multiple vulnerabilities that have impacted the nursing workforce including critical levels of staffing shortages in Canada. A review sponsored by the Royal Society of Canada investigated the impact of the pandemic on the nursing workforce in Canada to inform planning and implementation of sustainable nursing workforce strategies. The review methods included a trend analysis of peer-reviewed articles, a jurisdictional scan of policies and strategies, analyses of published surveys and interviews of nurses in Canada, and a targeted case study from Nova Scotia and Saskatchewan. Findings from the review have identified longstanding and COVID-specific impacts, gaps, and opportunities to strengthen the nursing workforce. These findings were integrated with expert perspectives from national nursing leaders involved in guiding the review to arrive at recommendations and actions that are presented in this policy brief. The findings and recommendations from this policy brief are meant to inform a national and sustained focus on retention and recruitment efforts in Canada.

Nurses' Workplace Conditions Impacting Their Mental Health during COVID-19: A Cross-Sectional Survey Study

Among health workers, nurses are at the greatest risk of COVID-19 exposure and mortality due to their workplace conditions, including shortages of personal protective equipment (PPE), insufficient staffing, and inadequate safety precautions. The purpose of this study was to examine the impact of COVID-19 workplace conditions on nurses' mental health outcomes. A cross-sectional correlational design was used. An electronic survey was emailed to nurses in one Canadian province between June and July of 2020. A total of 3676 responses were included in this study. We found concerning prevalence rates for post-traumatic stress disorder (47%), anxiety (38%), depression (41%), and high emotional exhaustion (60%). Negative ratings of workplace relations, organizational support, organizational preparedness, workplace safety, and access to supplies and resources were associated with higher scores on all of the adverse mental health outcomes included in this study. Better workplace policies and practices are urgently required to prevent and mitigate nurses' suboptimal work conditions, given their concerning mental health self-reports during the COVID-19 pandemic.

The National Standard of Psychological Health and Safety in the Workplace: A Psychometric and Descriptive Study of the Nursing Workforce in British Columbia Hospitals

BACKGROUND

In 2013, the Mental Health Commission of Canada created a National Standard that includes 13 workplace factors associated with employee mental health.

PURPOSE

This study (a) examined the psychometric properties of Guarding Minds at Work (GMW), the instrument used to measure the Standard's 13 workplace factors and (b) assessed BC nurses' workplace risk factors.

METHODS

A province-wide survey study of 3,077 direct care nurses working in acute care settings was conducted.

RESULTS

Subscale internal consistencies were acceptable. For most items, the original alphas were greater than the alpha-if-item-deleted. All corrected item-subtotal correlations were moderate to high. The 13-factor structure showed an adequate model fit based on absolute fit indices (SRMR = 0.057 and RMSEA = 0.054) but the relative fit indices were lower than the recommended cutoff (CFI = 0.827 and TLI = 0.815). Nurses identified nine of the 13 GMW factors as serious or significant concern in their workplace.

CONCLUSIONS

The findings were consistent with a plethora of evidence pointing to shortcomings in nurses' work environments. This was the first study partially supporting the reliability and validity of the GMW. More work is required to refine the GMW and gain a better understanding of its psychometric properties.

The relationships between nurses' work environments and emotional exhaustion, job satisfaction, and intent to leave among nurses in Saudi Arabia

AIMS

To examine relationships between components of nurses' work environments and emotional exhaustion, job satisfaction and intent to leave among nurses in Saudi Arabia.

DESIGN

A descriptive correlational study with cross-sectional data.

METHODS

Data were collected in 2017 from 497 Registered Nurses working in a large tertiary hospital in Riyadh, Saudi Arabia. Participants completed an online survey like that used in RN4Cast studies to measure nurses' perceptions of their work environments and nurse outcomes. Hierarchical linear regression and logistic regression were conducted to examine the relationships between components of nurses' work environments and nurse outcomes after controlling for nurse and patient characteristics.

RESULTS

Nurse participation in hospital affairs was uniquely associated with all three nurse outcomes, whereas staffing and resource adequacy was associated with emotional exhaustion and job satisfaction, but not intent to leave. These two variables were also the components of the nursing practice environment that received the lowest ratings. Nurse manager ability, leadership and support of nurses, and nurse-physician relationships were associated with job satisfaction only. A nursing foundation for quality of care was not uniquely associated with any of the three outcomes. Finally, nurse emotional exhaustion and job satisfaction fully mediated the relationship between nurse participation in hospital affairs and intent to leave.

CONCLUSION

Magnet-like work environments in Saudi Arabia are critical to recruiting and retaining nurses in a country with critical nursing shortages.

IMPACT

This study addresses a gap in the literature regarding which components of the nurses' work environment are uniquely associated with emotional exhaustion, job satisfaction and intent to leave among nurses in Saudi Arabia. Study results will assist Saudi hospital administrators and nurse leaders to develop recruitment and retention strategies by focusing on those work environment components most associated with nurse outcomes: participation in hospital affairs and staffing and resource adequacy.