Nurse Practice Environments and Outcomes: Implications for Oncology Nursing

Impact of Patient Safety Culture on Job Satisfaction and Intention to Leave Among Healthcare Workers: Evidence from Middle East Context

Background

The association between patient safety culture and staff outcomes remains unclear to date. This study aimed to identify the relationship between patient safety culture/job satisfaction and intention to leave among healthcare workers.

Methods

A cross-sectional study was conducted using an online survey. Multinomial logistic regression analysis was used to investigate the association between the safety culture dimensions and the outcomes in terms of job satisfaction and intention to leave.

Results

Majority were females (77.2%); age between (20-30) years were (66.1%). 1-5 years work experience was reported by (98.2%); nurses accounted for (75.7%). (62.1%) reported very good patient safety grade. (78.3%) of respondents had no intention to leave; (84.3%) reported they like their job, (70.5%) stated that working in this hospital is like being part of a large family. However, (38%) said the hospital is not a good place to work, and morale in their clinical area is low. The overall composite scores were highest for "teamwork within hospital units (81.4)", and "organizational learning (79.4)", while lowest for "communication openness (37)",staffing (26.5)", and "non-punitive response to error (22.1)". Females were two times more likely to leave their jobs compared to males (AOR: 2.36, 95% CI: 1.24-3.46); intention to leave was 3.35 (95% CI = 2.19-5.09). As for job satisfaction, ages between 31-40 years tend to like their job two times more than other age groups (AOR: 1.90, 95% CI = 1.02-3.55). The safety culture domains "staffing" and "hospital management support for patient safety" were linked to a higher odds ratio for job satisfaction.

Conclusion

Aside from gender and age, the dimensions of safety culture, including staffing, hospital management support, hospital handover, and transition, may have a signification impact on job satisfaction and intention to leave among healthcare workers.

Exploring non-physician care professionals' roles in cancer multidisciplinary team meetings: A qualitative study

The growing complexity of cancer care necessitates collaboration among different professionals. This interprofessional collaboration improves cancer care delivery and outcomes. Treatment decision-making within the context of a multidisciplinaire team meeting (MDTMs) may be seen as a particular form of interprofessional collaboration. Various studies on cancer MDTMs highlight a pattern of suboptimal information sharing between attendants. To overcome the lack of non-medical, patient-based information, it might be recommended that non-physician care professionals play a key patient advocacy role within cancer MDTMs. This study aims to explore non-physician care professionals' current and aspired role within cancer MDTMs. Additionally, the perceived hindering factors for these non-physician care professionals to fulfil their specific role are identified. The analysis focuses on nurses, specialist nurses, head nurses, psychologists, social workers, a head of social workers and data managers. The results show that non-physician care professionals play a limited role during case discussions in MDTMs. Neither do they actively participate in the decision-making process. Barriers perceived by non-physician care professionals are classified on two main levels: 1) team-related barriers (factors internally related to the team) and 2) external barriers (factors related to healthcare management and policy). A group of non-physician care professionals also belief that their information does not add value in the decision-making proces and as such, they underestimate their own role in MDTMs. To conclude, a change of culture is needed towards an interdisciplinary collaboration in which knowledge and expertise of different professions are equally assimilated into an integrated perspective to guarantee a true patient-centred approach for cancer MDTMs.

Clinicians Report Barriers and Facilitators to High-Quality Ambulatory Oncology Care

BACKGROUND

Ambulatory oncology practices treat thousands of Americans on a daily basis with high-risk and high-cost antineoplastic agents. However, we know relatively little about these diverse practices and the organizational structures influencing care delivery.

OBJECTIVE

The aim of this study was to examine clinician-reported factors within ambulatory oncology practices that affect care delivery processes and outcomes for patients and clinicians.

METHODS

Survey data were collected in 2017 from 298 clinicians (nurses, physicians, nurse practitioners, and physician assistants) across 29 ambulatory practices in Michigan. Clinicians provided written comments about favorable and unfavorable aspects of their work environments that affected their ability to deliver high-quality care. We conducted inductive content analysis and used the Systems Engineering Initiative for Patient Safety work system model to organize and explain our findings.

RESULTS

Clinicians reported factors within all 5 work-system components of the Systems Engineering Initiative for Patient Safety model that affected care delivery and outcomes. Common themes surfaced, such as unfavorable aspects including staffing inadequacy and high patient volume, limited physical space, electronic health record usability issues, and order entry. Frequent favorable aspects focused on the skills of colleagues, collaboration, and teamwork. Some clinicians explicitly reported how work system factors were relational and influenced patient, clinician, and organizational outcomes.

CONCLUSIONS

These findings show how work-system components are interactive and relational reflecting the complex nature of care delivery.

IMPLICATIONS FOR NURSING PRACTICE

Data obtained from frontline clinicians can support leaders in making organizational changes that are congruent with clinician observations of practices' strengths and opportunities for improvement.

The Effects of the Nursing Practice Environment and Self-leadership on Person-centered Care Provided by Oncology Nurses

Purpose

This study aimed to investigate the effects of the nursing practice environment and self-leadership on person-centered care provided by oncology nurses.

Methods

This cross-sectional study included 145 nurses who worked in oncology wards at eight university hospitals in Seoul, Daejeon, and Chungcheong Province with at least six months of experience. Data were collected using a self-administered survey and analyzed using descriptive statistics, Pearson correlation coefficients, the t-test, analysis of variance, and hierarchical multiple regression analysis in SPSS version 26.0.

Results

Person-centered care was significantly correlated with the nursing practice environment (r=0.27, P<0.001) and self-leadership (r=0.40, P<0.001), and the nursing practice environment was correlated with self-leadership (r=0.380, P<0.001). Hierarchical multiple regression analysis showed that the nursing practice environment was a significant predictor of person-centered care (β=0.31, P<0.001), after adjusting for covariates including monthly salary, total clinical career, and the position of oncology nurses. Self-leadership was a significant predictor of person-centered care (β=0.34, P<0.001) after controlling for the nursing practice environment, along with covariates. The final model explained 18.7% of the variance in person-centered care.

Conclusion

Our findings emphasize the importance of the nursing practice environment and nurses' self-leadership for providing person-centered care in oncology care units. Educational programs to reinforce nurses' self-leadership and administrative support for nursing practice are necessary to improve oncology nurses' capability to provide person-centered care.

The Relationship Between Work Environment Satisfaction and Retention Intention Among Nursing Administrators in Taiwan

BACKGROUND

Nursing administrators are essential to ensuring the quality of healthcare provided in hospitals. The nursing manpower shortage that has affected hospitals in Taiwan over the past decade has weighed particularly heavily on nursing administrators, who are expected to maintain high levels of nursing care quality in frequently understaffed healthcare settings.

PURPOSE

The objective of this study was to explore the relationship between work environment satisfaction and nursing administrator retention in Taiwan.

METHODS

This study used a cross-sectional, questionnaire-based survey to collect data from a sample population of nursing administrators. A set of indicators of quality nursing work environments was developed and included in the questionnaire. A total of 1,829 questionnaires were distributed, and the effective response rate was 95.57%.

RESULTS

The average overall rate of satisfaction with the current work environment across all domains was 3.59 (SD = 0.61). The highest level of satisfaction was found in the domain of safe practice environment (M = 3.83, SD = 0.70), and the lowest was found in the domain of informatics (M = 3.38, SD = 0.91). Length of administrative position tenure was significantly correlated with retention. Each of the eight domains significantly influenced retention. The domain of support and caring was the most significant predictor of nursing administrator retention.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

Length of administrator position tenure was significantly correlated with nursing administrator retention. Moreover, intention to stay among junior administrators was particularly affected by the support and caring domain. Therefore, it is recommended that nursing departments develop effective strategies to assist and encourage junior administrators to strengthen their career prospects and satisfaction.

The state of the science of nurse work environments in the United States: A systematic review

A healthy nurse work environment is a workplace that is safe, empowering, and satisfying. Many research studies were conducted on nurse work environments in the last decade; however, it lacks an overview of these research studies. The purpose of this review is to identify, evaluate, and summarize the major foci of studies about nurse work environments in the United States published between January 2005 and December 2017 and provide strategies to improve nurse work environments. Databases searched included MEDLINE via PubMed, CINAHL, PsycINFO, Nursing and Allied Health, and the Cochrane Library. The literature search followed the PRISMA guideline. Fifty-four articles were reviewed. Five major themes emerged: 1) Impacts of healthy work environments on nurses' outcomes such as psychological health, emotional strains, job satisfaction, and retention; 2) Associations between healthy work environments and nurse interpersonal relationships at workplaces, job performance, and productivity; 3) Effects of healthy work environments on patient care quality; 4) Influences of healthy work environments on hospital accidental safety; and 5) Relationships between nurse leadership and healthy work environments. This review shows that nurses, as frontline patient care providers, are the foundation for patient safety and care quality. Promoting nurse empowerment, engagement, and interpersonal relationships at work is rudimental to achieve a healthy work environment and quality patient care. Healthier work environments lead to more satisfied nurses who will result in better job performance and higher quality of patient care, which will subsequently improve healthcare organizations' financial viability. Fostering a healthy work environment is a continuous effort.

Leadership styles and outcome patterns for the nursing workforce and work environment: A systematic review

BACKGROUND

Leadership is critical in building quality work environments, implementing new models of care, and bringing health and wellbeing to a strained nursing workforce. However, the nature of leadership style, how leadership should be enacted, and its associated outcomes requires further research and understanding. We aimed to examine the relationships between various styles of leadership and outcomes for the nursing workforce and their work environments.

METHODS

The search strategy of this systematic review included 10 electronic databases. Published, quantitative studies that examined the correlations between leadership behaviours and nursing outcomes were included. Quality assessments, data extractions and analysis were completed on all included studies by independent reviewers.

RESULTS

A total of 50,941 titles and abstracts were screened resulting in 129 included studies. Using content analysis, 121 outcomes were grouped into six categories: 1) staff satisfaction with job factors, 2) staff relationships with work, 3) staff health & wellbeing, 4) relations among staff, 5) organizational environment factors and 6) productivity & effectiveness. Our analysis illuminated patterns between relational and task focused leadership styles and their outcomes for nurses and nursing work environments. For example, 52 studies reported that relational leadership styles were associated with higher nurse job satisfaction, whereas 16 studies found that task-focused leadership styles were associated with lower nurse job satisfaction. Similar trends were found for each category of outcomes.

CONCLUSIONS

The findings of this systematic review provide strong support for the employment of relational leadership styles to promote positive nursing workforce outcomes and related organizational outcomes. Leadership focused solely on task completion is insufficient to achieve optimum outcomes for the nursing workforce. Relational leadership practices need to be encouraged and supported by individuals and organizations to enhance nursing job satisfaction, retention, work environment factors and individual productivity within healthcare settings.

Association of nurse work environment and safety climate on patient mortality: A cross-sectional study

BACKGROUND

There are two largely distinct research literatures on the association of the nurse work environment and the safety climate on patient outcomes.

OBJECTIVE

To determine whether hospital safety climate and work environment make comparable or distinct contributions to patient mortality.

DESIGN

Cross-sectional secondary analysis of linked datasets of Registered Nurse survey responses, adult acute care discharge records, and hospital characteristics.

SETTING

Acute care hospitals in California, Florida, New Jersey, and Pennsylvania.

PARTICIPANTS

The sample included 600 hospitals linked to 27,009 nurse survey respondents and 852,974 surgical patients.

METHODS

Nurse survey data included assessments of the nurse work environment and hospital safety climate. The outcome of interest was in-hospital mortality. Data analyses included descriptive statistics and multivariate random intercept logistic regression.

RESULTS

In a fully adjusted model, a one standard deviation increase in work environment score was associated with an 8.1% decrease in the odds of mortality (OR 0.919, p<0.001). A one-standard deviation increase in safety climate score was similarly associated with a 7.7% decrease in the odds of mortality (OR 0.923, p<0.001). However, when work environment and safety climate were modeled together, the effect of the work environment remained significant, while safety climate became a non-significant predictor of mortality odds (OR 0.940, p=0.035 vs. OR 0.971, p=0.316).

CONCLUSIONS

We found that safety climate perception is not predictive of patient mortality beyond the effect of the nurse work environment. To advance hospital safety and quality and improve patient outcomes, organizational interventions should be directed toward improving nurse work environments.

Using Data to Strengthen Ambulatory Oncology Nursing Practice

BACKGROUND

Efforts to measure quality of care do not capture the unique aspects of ambulatory oncology settings. To retain nurses, ensure a safe practice environment, and encourage behaviors that support high-quality care, there is a need to identify factors associated with job satisfaction and turnover with measures that reflect the ambulatory setting.

OBJECTIVE

The objective of this study was to examine the patterns and correlates of the work environment for nurses and nurse practitioners working in a National Cancer Institute-designated Comprehensive Cancer Center.

METHODS

Web-based questionnaires were disseminated to employees with a registered nurse license in ambulatory settings and related support services and included 3 affiliated satellite locations. Participants completed the Practice Environment Scale of the Nursing Work Index, revised for ambulatory oncology settings, the Safety Organizing Scale, and items to assess job satisfaction, perceived quality of care, and intention to leave their current position. Logistic and linear regression models were used to examine factors associated with these outcomes.

RESULTS

From 403 individuals, 319 (79.2%) participated. The majority of respondents endorsed excellent quality of care (57.7%), job satisfaction (69.3%), and intention to stay in current position (77.4%). Endorsement of favorable collegial nurse-physician relationships was significantly associated with all 3 outcomes and increased performance of safety organizing behaviors. Nurses reported variations in practice environments and safety organizing behaviors across units.

CONCLUSIONS

Work environment assessments are useful to retain experienced nurses and support the delivery of high-quality patient care.

IMPLICATIONS FOR PRACTICE

Routine assessment of the work environment for registered nurses and advanced practice nurses is feasible and informative.

Evaluation and Improvement of the Nurse Satisfactory Status in a Tertiary Hospital using the Professional Practice Environment Scale

Background

The present study was performed to quantitatively examine nurse satisfaction, to investigate the associated factors influencing satisfaction, and to evaluate the effect of improvement measures based on these factors.

Material/Methods

A survey using the 38-item Chinese version of the Practice Environment Scale (CPPE-38) was performed in a university-affiliated tertiary hospital in Shanghai, China in 2013. Linear regression analysis was performed to screen for associated factors related to each CPPE-3 score and the total satisfaction score. Several improvement measures were established to improve nurse satisfaction, and the CPPE-38 survey was again performed in 2015 to evaluate the effect of these improvement measures.

Results

A total of 1,050 respondents were recruited in 2013, with a response rate of 87.6%. The total satisfaction score of the CPPE-38 was 2.99±0.64. The lowest score in a subscale of the CPPE-38 was 2.40±0.59 for interpersonal interaction and the highest score was 3.15±0.40 for internal work motivation. Work location was associated with scores for work motivation and total satisfaction, while the highest education degree was associated with scores for internal relationship and autonomy. The scores for internal work motivation, control over practice, interpersonal interaction, and internal relationship and autonomy were significantly improved in 2015 after two years of improvement efforts, while the total satisfaction score was not significantly different compared to the 2013 score.

Conclusions

Working location and education degree were two factors correlated with CPPE-38 scores in our hospital. Humanistic concerns, continuing education, and pay raise may improve the practice satisfaction of nurses.

Nurse-perceived quality of care in intensive care units and associations with work environment characteristics: a multicentre survey study

AIMS

To examine nurse-perceived quality of care, controlling for overall job satisfaction among critical care nurses and to explore associations with work environment characteristics.

BACKGROUND

Nurse-perceived quality of care and job satisfaction have been positively linked to quality outcomes for nurses and patients. Much evidence exists on factors contributing to job satisfaction. Understanding specific factors that affect nurse-perceived quality potentially enables for improvements of nursing care quality.

DESIGN

A multicentre survey study was conducted in three Dutch intensive care units.

METHODS

The Dutch version of the Essentials of Magnetism II questionnaire was used; including the single-item indicators: (i) nurse-perceived quality of care; (ii) overall job satisfaction; and (iii) 58 statements on work environments. Data were collected between October 2013 - June 2014.

RESULTS

The majority of 123 responding nurses (response rate 45%) were more than satisfied with quality of care (55%) and with their job (66%). No associations were found with nurse characteristics, besides differences in job satisfaction between the units. After controlling for job satisfaction, nurse-perceived quality was positively associated with the work environment characteristics: adequacy of staffing, patient-centeredness, competent peers and support for education. Patient-centeredness and autonomy were the most important predictors for overall job satisfaction.

CONCLUSION

Factors that contribute to nurse-perceived quality of care in intensive care units, independent from the effects of overall job satisfaction, were identified. Hereby, offering opportunities to maximize high quality of care to critically ill patients. Research in a larger sample is needed to confirm our findings.

Jordanian Nursing Work Environments, Intent to Stay, and Job Satisfaction

PURPOSE

The purpose of this study was to examine associations among the nursing work environment, nurse job satisfaction, and intent to stay for nurses who practice in hospitals in Jordan.

DESIGN

A quantitative descriptive cross-sectional survey design was used.

METHODS

Data were collected through survey questionnaires distributed to 650 registered nurses (RNs) who worked in three hospitals in Jordan. The self-report questionnaire consisted of three instruments and demographic questions. The instruments were the Practice Environment Scale of the Nursing Work Index (PES-NWI), the McCain Intent to Stay scale, and Quinn and Shepard's (1974) Global Job Satisfaction survey. Descriptive statistics were calculated for discrete measures of demographic characteristics of the study participants. Multivariate linear regression models were used to explore relationships among the nursing work environment, job satisfaction, and intent to stay, adjusting for unit type.

FINDINGS

There was a positive association between nurses' job satisfaction and the nursing work environment (t = 6.42, p < .001). For each one-unit increase in the total score of the PES-NWI, nurses' average job satisfaction increased by 1.3 points, controlling for other factors. Overall, nurses employed in public hospitals were more satisfied than those working in teaching hospitals. The nursing work environment was positively associated with nurses' intent to stay (t = 4.83, p < .001). The Intent to Stay score increased by 3.6 points for every one-unit increase in the total PES-NWI score on average. The highest Intent to Stay scores were reported by nurses from public hospitals.

CONCLUSIONS

The work environment was positively associated with nurses' intent to stay and job satisfaction. More attention should be paid to create positive work environments to increase job satisfaction for nurses and increase their intent to stay.

CLINICAL RELEVANCE

Hospital and nurse managers and healthcare policymakers urgently need to create satisfactory work environments supporting nursing practice in order to increase nurses' job satisfaction and intent to stay.

Organizational climate and employee mental health outcomes: A systematic review of studies in health care organizations

BACKGROUND

In recent years, the high prevalence of mental health problems among health care workers has given rise to great concern. The academic literature suggests that employees' perceptions of their work environment can play a role in explaining mental health outcomes.

PURPOSES

We conducted a systematic review of the literature in order to answer the following two research questions: (1) how does organizational climate relate to mental health outcomes among employees working in health care organizations and (2) which organizational climate dimension is most strongly related to mental health outcomes among employees working in health care organizations?

METHODOLOGY/APPROACH

Four search strategies plus inclusion and quality assessment criteria were applied to identify and select eligible studies. As a result, 21 studies were included in the review. Data were extracted from the studies to create a findings database. The contents of the studies were analyzed and categorized according to common characteristics.

FINDINGS

Perceptions of a good organizational climate were significantly associated with positive employee mental health outcomes such as lower levels of burnout, depression, and anxiety. More specifically, our findings indicate that group relationships between coworkers are very important in explaining the mental health of health care workers. There is also evidence that aspects of leadership and supervision affect mental health outcomes. Relationships between communication, or participation, and mental health outcomes were less clear.

PRACTICAL IMPLICATIONS

If health care organizations want to address mental health issues among their staff, our findings suggest that organizations will benefit from incorporating organizational climate factors in their health and safety policies. Stimulating a supportive atmosphere among coworkers and developing relationship-oriented leadership styles would seem to be steps in the right direction.

Learning from disaster: patient safety and the role of oncology nurses

When the Oncology Nursing Society (ONS) was almost exactly half its present age, in November 1994, a Boston Globe health columnist named Betsy Lehman was admitted to the Dana-Farber Cancer Institute in Boston, Massachusetts, to receive an investigational regimen for breast cancer. Her treatment ended in disaster. In one of the most notorious patient safety failures of modern times, Lehman was given severe overdoses of cyclophosphamide during a four-day period. On each of those four days, nurses, physicians, and pharmacists at Dana-Farber failed to notice that Lehman was receiving doses four times greater than the intended amount (Aspden, Wolcott, Bootman, & Cronenwett, 2007). Lehman died of cyclophosphamide toxicity on December 3, 1994.
.

Pod nursing on a medical/surgical unit: implementation and outcomes evaluation

A medical/surgical unit at the University of Michigan Health System implemented a pod nursing model of care to improve efficiency and patient and staff satisfaction. One centralized station was replaced with 4 satellites and supplies were relocated next to patient rooms. Patients were assigned to 2 nurses who worked as partners. Three patient (satisfaction, call lights, and falls) and nurse (satisfaction and overtime) outcomes improved after implementation. Efforts should be focused on addressing patient acuity imbalances across assignments and strengthening communication among the healthcare team. Studies are needed to test the model in larger and more diverse settings.

Perceptions about using mindfulness therapy: a lung cancer focus group study

BACKGROUND

Patients with lung cancer are in need of effective strategies to modify symptom burden and improve health-related quality of life (HRQOL). One promising approach to symptom management is an 8-week mindfulness-based intervention, which incorporates meditation, breathing, and gentle yoga exercises. It requires few resources to implement, but has not been adequately tested with lung cancer patients.

OBJECTIVE

The purpose of this study was to obtain lung cancer patient perceptions of a mindfulness-based intervention.

METHODS

Eleven lung cancer patients participated in audio-taped focus group sessions led by the investigator. Discussion questions probed patient perceptions of mindfulness in terms of symptom management, including benefits and barriers to this therapy and ways the intervention may need to be adapted to accommodate them.

RESULTS

Three primary themes from the qualitative analysis include (1) awareness and interest, (2) perceived barriers and benefits, and (3) recommended adaptations. Specific perceptions included the importance of targeting key symptoms such as dyspnea, worry, and insomnia, whereas recommendations pointed out the need for a shorter duration than the standard 8-week protocol and a home-based approach for greater accessibility.

CONCLUSIONS

The design of mindfulness-based intervention protocols must consider unique characteristics of this vulnerable group, such as targeting specific symptoms, reducing the 8-week protocol, and a home-based offering.

IMPLICATIONS FOR PRACTICE

Nurses are integral to optimizing HRQOL and independent functioning for lung cancer patients. As lung cancer survivorship is extended, it becomes increasingly imperative that a range of supportive resources is available for patients to manage symptoms and improve HRQOL.

Nursing practice environment and outcomes for oncology nursing

BACKGROUND

It is commonly assumed that oncology nurses experience high job-related burnout and high turnover because their work involves inherent stressors such as caring for patients with serious and often life-threatening illness.

OBJECTIVES

The objectives of this study were to examine the differences in outcomes such as job dissatisfaction and burnout between oncology nurses and medical-surgical nurses, and to identify factors that affect oncology nurse outcomes.

METHODS

A secondary analysis of nurse survey data collected in 2006 including 4047 nurses from 282 hospitals in 3 states was performed; t test and χ2 test compared differences between oncology nurses and medical-surgical nurses in nurse outcomes and their assessments of nurse practice environment, as measured by the Practice Environment Scale of the Nursing Work Index. Logistic regression models estimated the effect of nurse practice environment on 4 nurse-reported outcomes: burnout, job dissatisfaction, intention to leave the current position, and perceived quality of care.

RESULTS

Oncology nurses reported favorable practice environments and better outcomes than did medical-surgical nurses. All 4 subscales of the Practice Environment Scale of the Nursing Work Index studied were significantly associated with outcomes. Specifically, nurses who reported favorable nursing foundations for quality of care (eg, active in-service or preceptorship programs) were less likely to report burnout and leave their current position.

CONCLUSIONS

Better practice environments, including nurse foundations for quality care, can help to achieve optimal nurse outcomes.

IMPLICATIONS FOR PRACTICE

Improving hospital practice environments holds significant potential to improve nurse well-being, retention, and quality of care. Specifically, hospitals should consider preceptor programs and continuing education and increase nurses' participation in hospital decision making.

Magnet Hospitals: Higher Rates of Patient Satisfaction

Patient satisfaction with care is an important indicator of quality of care. As of 2013-2014, 30% of the Value-Based Purchasing score Medicare is using to determine hospital reimbursement is based on patient reports of care. This study determined whether significant relationships exists between Magnet (N = 160), Magnet-in-progress (N = 99), and non-Magnet hospital (N = 1,742) status and the highest ratings on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey questions related to patient satisfaction with care. This study was a secondary analysis of data collected and compiled from three sources (the American Hospital Association, American Nurses Credentialing Center, and HCAHPS databases). Analysis revealed that Magnet and Magnet-in-progress hospitals have significantly (p < .007) higher scores than non-Magnet hospitals on six of the seven questions regarding patient-reported satisfaction with care. The implications of these results for nursing are discussed.

The context of oncology nursing practice: an integrative review

BACKGROUND

In oncology, where the number of patients is increasing, there is a need to sustain a quality oncology nursing workforce. Knowledge of the context of oncology nursing can provide information about how to create practice environments that will attract and retain specialized oncology nurses.

OBJECTIVE

The aims of this review were to determine the extent and quality of the literature about the context of oncology nursing, explicate how "context" has been described as the environment where oncology nursing takes place, and delineate forces that shape the oncology practice environment.

METHODS

The integrative review involved identifying the problem, conducting a structured literature search, appraising the quality of data, extracting and analyzing data, and synthesizing and presenting the findings.

RESULTS

Themes identified from 29 articles reflected the surroundings or background (structural environment, world of cancer care), and the conditions and circumstances (organizational climate, nature of oncology nurses' work, and interactions and relationships) of oncology nursing practice settings.

CONCLUSIONS

The context of oncology nursing was similar yet different from other nursing contexts. The uniqueness was attributed to the dynamic and complex world of cancer control and the personal growth that is gained from the intense therapeutic relationships established with cancer patients and their families.

IMPLICATIONS FOR PRACTICE

The context of healthcare practice has been linked with patient, professional, or system outcomes. To achieve quality cancer care, decision makers need to understand the contextual features and forces that can be modified to improve the oncology work environment for nurses, other providers, and patients.

Patterns and correlates of missed nursing care in inpatient oncology units

BACKGROUND

Missed nursing care influences the quality of hospital care, yet this problem has not been explored in the oncology setting, nor are the correlates of missed nursing care in inpatient oncology settings understood.

OBJECTIVE

We examined the frequency of missed care in oncology units, differences in missed care between oncology and non-oncology units, and the relationship between unit staffing and missed care.

METHODS

We performed secondary analysis of survey data collected in 2008 to 2009 across 9 hospitals. The MISSCARE Survey was administered to nurses and medical assistants employed in 62 units (n = 2318). Descriptive statistics and linear regression were used to examine the frequency of missed care, differences between oncology (n = 12) and non-oncology units (n=50), and the relationship between unit staffing and missed care.

RESULTS

Oncology nursing unit personnel reported ambulation, care conference attendance, and mouth care as most frequently missed. Oncology units had significantly lower missed care than did non-oncology units (P < .05). Higher patient assignments were associated with an increase in reported missed care (P < .05).

CONCLUSIONS

Missed care is a problem shared by inpatient oncology and non-oncology units. Missed ambulation and mouth care are worrisome, given their importance to oncology patients. Suboptimal staffing increases missed care.

IMPLICATIONS FOR PRACTICE

These data motivate quality improvement and evidence-based management. Clinicians can strategize to ensure patients receive adequate ambulation and mouth care. Managers can use our findings to support the importance of stable nurse staffing to reduce untoward patient outcomes.

Healthy work environments and staff nurse retention: the relationship between communication, collaboration, and leadership in the pediatric intensive care unit

BACKGROUND

A healthy work environment can improve patient outcomes and registered nurse (RN) turnover. Creating cultures of retention and fostering healthy work environments are 2 major challenges facing nurse leaders today.

SPECIFIC AIMS

Examine the effects of the healthy work environment (communication, collaboration, and leadership) on RN turnover from data collected from a research study.

METHODS

Descriptive, cross-sectional, correlational design. Pediatric critical care RNs from 10 pediatric intensive care units (PICU) completed the Practice Environment Scale of the Nursing Work Index Revised and a subscale of the Intensive Care Unit Nurse-Physician Communication Questionnaire. These staff nurses were asked whether they intend to leave their current job in the next 6 months. Statistical analysis included correlations, multiple linear regression, t tests (2-tailed), and 1-way analysis of variance.

RESULTS

A total of 415 RNs completed the survey. There was a statistically significant relationship between leadership and the intent to leave (P < .05). There was also an inverse relationship between years of experience and intent to leave. None of the communication variables between RNs and among RNs and MDs or collaboration were significantly associated with PICU nurses' intention to leave.

CONCLUSION

Effective leadership in the PICU is important to PICU RNs and significantly influences their decisions about staying in their current job.

Communication and the healthy work environment: nurse managers' perceptions

OBJECTIVE

A qualitative design was used to decipher the viewpoints of nurse managers about communication trends associated with their leadership roles and unit subcultures.

BACKGROUND

Disruptive behaviors such as poor communication and inadequate teamwork have been associated with patient harm and deficient workplace cultures. However, few studies have focused on nurse managers' perceptions of communication and a healthy workplace.

METHODS

A descriptive qualitative study was conducted using 12 in-depth interviews of 6 nurse managers to better understand communication patterns of managers. Analysis identified 5 themes and 13 subthemes.

RESULTS

Workplace processes were identified that either promoted or hindered managers' abilities to set a positive tone and to stay connected to their staff, ensuring effective communication while meeting multiple unit and institutional challenges.

CONCLUSIONS

Findings can be used to strengthen communication practices, obviate communication disconnects, and ensure a healthy workplace.

Nursing practice environments and job outcomes in ambulatory oncology settings

OBJECTIVE

The aim of this study was to investigate job satisfaction and intent to stay for ambulatory oncology nurses.

BACKGROUND

An oncology provider shortage suggests that retention is a high priority, and factors associated with job outcomes are unknown in this setting.

METHOD

Data were derived from a cross-sectional survey completed by 402 oncology nurses employed in ambulatory settings. Logistic regression models estimated the likelihood of job satisfaction or intent to stay for at least 1 year.

RESULTS

Most nurses (80.9%) were satisfied and 87.4% indicated their intent to stay. Significant variables for job satisfaction were university/hospital ownership, staffing and resource adequacy, nurse manager ability and leadership, and workloads. Variables significant for intent to stay were staffing and resource adequacy, participation in practice affairs, and years of experience.

CONCLUSIONS

Favorable practice environments are key to effective nurse retention. Staffing, leadership, and resource allocation influence retention in ambulatory settings.

Systematic review on the relationship between the nursing shortage and job satisfaction, stress and burnout levels among nurses in oncology/haematology settings

AIM

To establish the best available evidence regarding the relationship between the nursing shortage and nurses' job satisfaction, stress and burnout levels in oncology/haematology settings.

METHODS

Electronic databases (CINAHL, Medline, Scopus, ScienceDirect, PsycInfo, PsycArticles, Web of Science, The Cochrane Library, Proquest and Mednar) were searched using a three-step strategy in order to identify published and unpublished studies conducted between 1990 and 2010. Grey literature was excluded in the review. The identified studies were evaluated using standardised critical appraisal instruments from the Joanna Briggs Institute-Meta Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI). A total of seven descriptive and descriptive-correlational studies published in English were included and data were presented in a narrative summary.

RESULTS

Findings revealed a positive bidirectional relationship between the nursing shortage and oncology registered nurses' (RNs') job dissatisfaction, stress and burnout. The extent of the job dissatisfaction, stress and burnout experienced by the oncology RNs and their perception of staffing inadequacy differed according to their demography and work settings. Particularly, nurses who had higher qualifications and positions, who worked full-time and who worked in inpatient settings and non-Magnet hospitals were more likely to attribute staffing inadequacy as one of the main contributing factors for their job dissatisfaction, stress and burnout. This led to a rise in the number of oncology RNs leaving the speciality.

CONCLUSION

Within the constraints of the study and the few quality papers available, it appears that oncology RNs who worked in substandard staffing units often express job dissatisfaction, stress and burnout, which prompt them to seek new employment out of the oncology specialty. This entails a pressing need for organisations to ensure sufficient staffing in oncology/haematology settings, in order to ensure that quality patient care is provided. Limited studies that examine the relationship between the nursing shortage and oncology RNs' stress and burnout have been conducted. Also, no studies in the Asian context have previously been conducted.

IMPLICATIONS FOR PRACTICE

Organizations need to customize their strategies for the recruitment and retention of oncology nurses. The strategies should take into consideration the specific demographic characteristics of oncology nurses or those of work settings that are experiencing staffing inadequacy and negative nursing outcomes. The strategies should also aim to replicate features of other institutions that are attractive to oncology nurses, and also include training that help oncology nurses better manage their emotions.

IMPLICATIONS FOR RESEARCH

Future research needs to examine the relationship between the nursing shortage and oncology nurses' job satisfaction, stress and burnout in bone marrow transplant units, paediatric oncology settings and Asian oncology settings. The characteristics of oncology nurses or workplaces that are more likely to experience negative nursing outcomes due the nursing shortage should also be identified.

Missed nursing care: Magnet versus non-Magnet hospitals

BACKGROUND

The objective of this study was to examine whether the amount, type, and reasons of missed nursing care differ between Magnet and non-Magnet hospitals.

METHOD

Data were collected from 124 medical-surgical, intermediate, intensive care, and rehabilitation units in 11 hospitals located in the Midwest and Western regions of the United States. A cross-sectional, descriptive study was conducted. The MISSCARE Survey was utilized to collect data on the level of perceived missed nursing care, and nursing staffing data was collected for each study unit.

FINDINGS

Missed nursing care showed significant differences according to Magnet status. Separate analysis showed no staffing-level difference between Magnet and non-Magnet hospitals.

CONCLUSIONS

The authors concluded that efficiencies in operations, work environment, and culture characterized by Magnet hospitals should be promoted.

Practice environments of nurses in ambulatory oncology settings: a thematic analysis

BACKGROUND

: The practice environments of nurses have been studied extensively in inpatient settings, but rarely in the ambulatory context. As the majority of cancer care is delivered in ambulatory settings, a better understanding of the nursing practice environment may contribute to quality improvement efforts.

OBJECTIVE

: We sought to examine the features of nursing practice environments that contribute to quality patient care and nursing job satisfaction.

METHODS

: In 2009-2010, we conducted focus groups with nurses who cared for adults with cancer outside inpatient units. A semistructured moderator guide explored practice environment features that promoted safe, high-quality care and high job satisfaction. We also asked nurses to identify practice environment features that hindered quality care and reduced job satisfaction. We conducted thematic analysis to report themes and to construct a conceptual framework.

RESULTS

: From 2 focus groups, composed of 13 participants, nurses reported that variability in workloads, support from managers and medical assistants, and the practice's physical resources could facilitate or hinder high-quality care and job satisfaction. High-quality communication across team members improved patient safety and satisfaction.

CONCLUSIONS

: Consistent with research findings from inpatient settings, nurses identified staffing and resource adequacy, management support, and collegiality as important inputs to high-quality care.

IMPLICATIONS FOR PRACTICE

: These findings can inform quality improvement initiatives in ambulatory oncology practices. Strengthening nurse-medical assistant relationships, smoothing patient workload variability, and implementing strategies to strengthen communication may contribute to quality cancer care. Studies to test our proposed conceptual framework would bridge existing knowledge gaps in ambulatory settings.

Influence of unit-level staffing on medication errors and falls in military hospitals

This study examined unit-level associations of nurse staffing and workload, and the effect of the practice environment on adverse patient events. A secondary analysis was conducted of a longitudinal data set of 23 Army inpatient units from the Military Nursing Outcomes Database. Generalized Linear Mixed Modeling accommodated nested, nonparametric data. Staff category was found to be a significant predictor of medication errors and patient falls, but the relationship varied by unit type. Patient census had no effect on either outcome; however, a higher patient acuity was associated with an increase in both adverse events. The nursing practice environment mediated medication errors but not falls, in all unit types. Skill mix is important; however, additional components of staffing need consideration in producing positive patient outcomes.

Healthcare team members' perception of staffing adequacy in a comprehensive cancer center

PURPOSE/OBJECTIVES

to describe the perceptions of staffing adequacy of healthcare team members working together on units in a comprehensive cancer center.

RESEARCH APPROACH

a descriptive, phenomenologic design was used. Semistructured interviews were conducted with participants.

SETTING

an urban, Magnet-designated comprehensive cancer center in the southwestern United States.

PARTICIPANTS

a purposive sample of 10 RNs, 5 nursing assistants, and 5 associate directors.

METHODOLOGIC APPROACH

data analysis was guided by Streubert's procedural interpretation of the phenomenologic method.

FINDINGS

themes emerged, including alterations to care; challenges to an already challenging shift; the right mix; effects on patients, safety, and quality; mitigating factors; and the aftermath.

CONCLUSIONS

perceived inadequate staffing affects healthcare staff both personally and professionally, triggering responses that influence approaches to patient care, unit operations, and relationships.

INTERPRETATION

the unique and sometimes varied perspectives and experiences of frontline staff are critical to understanding factors that influence and affect willingness to work and remain in hospital settings, and may serve as a basis for shaping interventions and strategies to ensure adequate numbers of caregivers at the bedside.

Compassion fatigue and burnout: prevalence among oncology nurses

This descriptive, cross-sectional survey was conducted in inpatient nursing units and outpatient clinics in a cancer center in the midwestern United States. The sample of 153 healthcare providers included RNs, medical assistants, and radiology technicians. The fourth revision of the 30-item Professional Quality of Life (ProQOL R-IV) scale was used for measuring compassion fatigue, compassion satisfaction, and burnout. A series of cross tab analyses examined the relationship between participant demographics and three ProQOL R-IV subscales. The study sample scored similarly on compassion satisfaction and burnout when compared with participants who used the ProQOL R-IV in previous studies. Value exists in analyzing the prevalence of burnout and compassion fatigue among oncology healthcare providers. Understanding the needs of distinct demographic groups offers valuable direction for intervention program development. Applying internal evidence in the design of a relevant stress-reduction program will better equip healthcare providers to recognize and manage compassion fatigue and burnout.

Global use of the Practice Environment Scale of the Nursing Work Index

BACKGROUND

Although the Practice Environment Scale of the Nursing Work Index has been endorsed as a gauge of the quality of the nursing practice environment by several organizations in the United States promoting healthcare quality, there is no literature describing its use in different practice settings and countries.

OBJECTIVE

The purpose of this study was to inform research by describing the modifications and use of the scale in a variety of practice settings and countries.

METHODS

The Cumulative Index to Nursing and Allied Health Literature and the PubMed databases were searched for the years 2002-2010 to identify 37 research reports published since 2002 describing use, modification, and scoring variations in different practice settings and countries.

RESULTS

The scale was modified for 10 practice settings in five countries and translated into three languages. Composite scores ranged from 2.48 to 3.17 (on a 1-4 scale). The Staffing and Resource Adequacy subscale most often scored lowest. A new Nursing Information Technology subscale has been developed. New scoring methods to identify the favorability of practice environments are described. Over time, the nature of the research conducted using the measure has changed. Overall, most publications report significant associations between scale scores and multiple nurse, patient, and organizational outcomes.

DISCUSSION

Scale use is growing across different clinical settings and countries. Recommendations for future research use include reducing scale length, using consistent scoring methods, considering the impact of various modifications on the basis of cultural and clinical setting nuances, and using the measure in longitudinal and intervention research designs.

Improving the work environment through the use of research instruments: an example

Over the past several years, although the quality of the work environment has improved for registered nurses, there is much that still needs to be done. However, much of the published research conducted in relation to the quality of work environments has focused on the more traditional components of the work environment. To assess the nontraditional components of a work environment, it is critical that reliable and valid instruments be utilized in order to ensure that the data gathered is accurate and truly reflective of what exists within the work environment. This article will describe one instrument, the Sieloff-King Assessment of Group Outcome Attainment within Organizations, that has demonstrated reliability and validity. The application of this instrument in the improvement of the health care environment will be discussed.

A systematic review on the relationship between the nursing shortage and nurses' job satisfaction, stress and burnout levels in oncology/haematology settings

BACKGROUND

Nursing shortage is a global issue that which affects oncology nursing. Oncology nurses are more prone to experience job dissatisfaction, stress and burnout when they work in units with poor staffing. There is thus a need for greater understanding of the relationship between the nursing shortage and nursing outcomes in oncology/haematology settings.

OBJECTIVES

This review aimed to establish the best available evidence concerning the relationship between the nursing shortage and nurses' job satisfaction, stress and burnout levels in oncology/haematology settings; and to make recommendations for practice and future research.

INCLUSION CRITERIA

Types of participants: This review considered studies that included oncology registered nurses (RNs) who were more than 18 years of age and worked in either inpatient or outpatient oncology/haematology wards or units for the adult or paediatric patients.Types of intervention: This review considered studies that evaluated the relationship between the nursing shortage and nurses' job satisfaction, stress and burnout levels in oncology/haematology settings.Types of outcomes: This review included studies that measured job satisfaction, stress and burnout levels using different outcomes measures. Job satisfaction was determined by the Measure of Job Satisfaction scale, the Misener Nurse Practitioner Job Satisfaction Scale and the Likert scale, stress by the Pediatric Oncology Nurse Stressor Questionnaire and burnout by the Maslash Burnout Inventory scale.Types of studies: This review included descriptive/descriptive-correlational studies which were published in English.

SEARCH STRATEGY

The search strategy sought to identify published and unpublished studies conducted between 1990 and 2010. Using a three-step search strategy, the following databases were accessed: CINAHL, Medline, Scopus, ScienceDirect, PsycInfo, PsycArticles, Web of Science, The Cochrane Library, Proquest and Mednar.

ASSESSMENT OF METHODOLOGICAL QUALITY

Two independent reviewers assessed each paper for methodological validity prior to inclusion in the review using standardised critical appraisal instruments from the Joanna Briggs Institute-Meta Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI). Disagreements were resolved through discussion, or with a third reviewer.

DATA COLLECTION/EXTRACTION

Data were extracted using standardised data extraction tool adapted from the JBI-MAStARI. Data synthesisDue to the heterogeneous nature of the included papers, a meta-analysis was not possible. Hence, a narrative summary was presented for the studies.

RESULTS

This review encompassed seven descriptive/descriptive-correlational studies. Findings revealed a positive bidirectional relationship between the nursing shortage and oncology nurses' job dissatisfaction, stress and burnout. In addition, the extent of oncology nurses' job dissatisfaction, stress and burnout, and their perception of staffing inadequacy also differed according to nurses' demography and work settings.

CONCLUSIONS

The nursing shortage, coupled with an increasing number of patients diagnosed with cancer, entail a pressing need for organisations to ensure sufficient staffing in oncology/haematology settings, in order to provide quality patient care. This then requires interventions that target both the recruitment and retention of nurses.

IMPLICATIONS FOR PRACTICE

Organisations need to customise their strategies for the recruitment and retention of oncology nurses. The strategies should take into considerations the specific demographic characteristics of oncology nurses or characteristics of work settings that are experiencing staffing inadequacy and negative nursing outcomes. The strategies should also aim to replicate features of other institutions that are attractive to oncology nurses; and also include training that help oncology nurses better manage their emotions.

IMPLICATIONS FOR RESEARCH

Future research need to examine the relationship between the nursing shortage and oncology nurses' job satisfaction, stress and burnout in bone marrow transplant units, paediatric oncology settings and also Asian oncology settings. Characteristics of oncology nurses or workplaces that are more likely to experience negative nursing outcomes due the nursing shortage should also be identified.