Factors influencing retention among hospital nurses: systematic review

The growth of nursing professional values - A grounded theory

BACKGROUND

The formation of nursing professional values is crucial to the development of the nursing profession, but it is influenced by various factors. The process of shaping nursing professional values in different growth contexts has been overlooked. In order to establish professional values in the context of Chinese nursing, it is necessary to investigate the evolution of nursing professional values throughout history.

PURPOSE

To develop a theory of professional values growth from a nursing context. Design: This study adopted a grounded theory approach from Strauss and Corbin.

PARTICIPANTS

From November 2021 to March 2022, a total of 33 participants were included.

METHODS

Data were collected using a semi-structured interview over telephone or online or face to face and were analysed using open, axial, and selective coding, with the help of MAXQDA 2020.

ETHICAL CONSIDERATIONS

The research was approved by the Ethics Committee of the China Medical University. All participants signed the informed consent and agreed to be interviewed before the study.

FINDINGS

The study has developed a theoretical construct of nursing professional values growth that consists of five dimensions: key aspects, decisive opportunities, drivers, embodiment, and shaping outcomes. And key aspects include four subcategories (the initial stage, the consciousness stage, the core stage, and the action stage). Decisive opportunities come from organisations and individuals. Drivers consist of social culture and self-trait, and embodiment covers two subcategories (humanism and ethical emotions). The last dimension is shaping outcomes, which consists of three subcategories (maintaining the original intention, professionalism, and instilling professional values).

DISCUSSION

The theory demonstrates the individual development process of nursing professional values in different interactive contexts, the context of its interaction with social and personal values is revealed, and the dynamics and mechanisms of the formation of personal psychological qualities in professional values from a nursing context are discovered.

CONCLUSIONS

This theory reveals the mechanisms that shape nursing professional values and can provide guidance for the growth of nursing students' professional values.

Transformational Leadership and Nursing Retention: An Integrative Review

Aim

To establish current evidence on the relationship between transformational nursing leadership and turnover intention.

Background

The persistent nursing shortage in healthcare has led to heightened demands for addressing both current needs and the healthcare requirements of a growing population. Recognizing the pivotal role of nursing leadership in fostering retention, this review highlights the influence of positive leadership on nursing staff. Evaluation. An integrative review, guided by Whittemore and Knafl's (2005) framework, was conducted using articles sourced from four online databases deducing to an inclusion of sixteen quantitative articles, one systematic review, and one integrative review published between 1992 and 2022. Key Issues. The study reveals conflicting evidence regarding the sole impact of transformational leadership on the nursing staff's intention to remain. However, it highlights transformational leadership's ability to enhance job satisfaction and organizational commitment contributes significantly to retention.

Conclusion

Using transformational leadership can effectively bolster nursing staff retention along with promoting other favorable workplace outcomes. Implications for Nursing Management. This review underscores the importance of enhancing leadership skills within nursing management. This involves not only fostering transformational leadership but also cultivating positive work-related outcomes to optimize nursing staff retention.

A dimensional analysis of nursing unit culture

AIM(S)

Organizational culture has been studied for over four decades among nurses, across countries and contexts. However, wide variation exists in how the concept has been defined and at what level of the organization it is measured. The aim of this study was to use a dimensional analysis to conduct a conceptual synthesis of unit culture from a nursing perspective.

DESIGN

Dimensional analysis, rooted in grounded theory methodology, was used to describe unit culture from a nursing perspective.

METHODS

A literature search was conducted in April 2022. Inclusion criteria were (1) peer review publications, (2) used the term 'unit culture' or 'ward culture', (3) references nurses' role in unit culture, (4) published in the last 20 years and (5) written in English. One hundred fifteen articles met inclusion criteria, but dimensional saturation was researched after coding 24 articles.

RESULTS

Findings were synthesized into four core dimensions and 10 subdimensions. Dimensions of unit culture included customs (practice norms, communication and prioritization), shared beliefs (assumptions, values and attitudes), hierarchy (social and informational) and atmosphere (emotional climate and collaboration). Conditions that shape unit culture include individual nurse characteristics, working conditions, unit policies/procedures and leadership. Unit culture impacts nurse work experiences and decision-making processes, which can affect outcomes including nurse wellbeing, practice behaviours and adherence to unit policies.

CONCLUSIONS

Identifying the dimensions of unit culture helps to bring clarity to a concept that is not well defined in existing literature.

IMPACT

This model of unit culture can be used to guide development of new instruments to measure unit culture or guide researchers in utilizing existing measures. Developing measures specific to unit culture are warranted to strengthen researchers' ability to assess how changing conditions of a unit (e.g. leadership, workload) changes unit culture and its related outcomes.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

On the Association Between Demographic Structural Change and the Effectiveness of Nurse Staffing Policy for Inpatient Care: Evidence from Taiwan

Purpose

This study investigates the influence of demographic changes on the effectiveness of hospital nurse staffing policy, measured by the cumulative response of inpatient care quality to adjustments in hospital nurse staffing levels in Taiwan.

Methods

The research design utilized in this study aligns with the observational time-series methodology, and a total of 99 monthly time-series observations were collected from multiple databases administered by the Taiwan government over the period from January 2015 to March 2023. Specifically, the time-varying parameter vector autoregressive and autoregressive distributed lag models were employed to investigate the association between age distribution and nurse staffing policy effectiveness.

Results

The time-varying impulse responses of the unplanned 14-day readmission rate after discharge to changes in nurse staffing levels indicate a positive association between patient-to-nurse ratios and unplanned 14-day readmission rates across various types of hospitals. Nevertheless, the effectiveness of hospitals' nurse staffing policy is observed to diminish with population aging, particularly evident in medical centers and regional hospitals.

Conclusion

Policymakers should establish lower mandated patient-to-nurse ratios, grounded in practical nurse workforce planning, to address the needs of an aging society and enhance inpatient care quality through improved nurse staffing in hospitals.

Exploring nurses' experiences: Abandoning the profession and migrating for improved opportunities

AIM

This study explores nurses' experiences in migration for employment and professional abandonment in Barcelona (Spain).

METHODS

Employing a mixed-design approach comprising 1) a qualitative descriptive phenomenological study, followed by 2) a subsequent cross-sectional study, 20 and 225 nurses participated in each study, respectively. Qualitative data, gathered through 4 focus group discussions, underwent inductive thematic analysis, following the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines, while quantitative data were descriptively analyzed.

FINDINGS

Three qualitative themes emerged: 1) Migration motives, such as improved job opportunities, permanent contracts, continuous training, and professional recognition; 2) Reasons for leaving or contemplating leaving the profession, including excessive workload, lack of recognition, limited development, and exhaustion; 3) Nurses' needs, encompassing more staffing, improved remuneration, permanent contracts, flexible schedules, greater autonomy, and career growth. The cross-sectional study revealed a 13.5 % professional abandonment rate at some point across all demographics and seniority levels. Migration trends varied by professional experience, with younger nurses seeking better conditions and opportunities elsewhere.

CONCLUSIONS

Multifactorial causes underlie job migration and professional abandonment, necessitating comprehensive interventions to improve nurses' working and professional conditions.

An evaluation of optometric advanced skills within a UK tertiary based setting

INTRODUCTION

Hospital-based optometrists are undertaking extended roles across ophthalmology that may require them to perform advanced skills (AS). Moorfields Eye Hospital (MEH) is the largest UK employer of hospital-based optometrists, it was sought to investigate which AS are being performed at this centre and how they align to the four pillars of advanced clinical practice (ACP).

METHODS

An online survey was sent to MEH optometrists in May 2022 that asked about professional status, sub-specialties worked, qualifications, acquisition and validation of AS, research and leadership.

RESULTS

Ninety-six optometrists with mean post-qualification experience was 16.2 years (SD 10.4) responded to the survey. There were 84 AS that covered clinical, leadership and research, with respondents achieving a mean of 11.8 (SD 10.3). Those with independent prescribing (IP) qualifications (n = 52) had a higher number of AS compared to non-IP optometrists (p = 0.03). There were 68 clinical AS across the sub-specialties (23 clinical AS were common in ≥2 sub-specialties), 49 out of 120 clinical AS could be performed by at least 60% of staff. Twenty-six optometrists identified with leadership, 56 had undertaken research/audit, 27 had published within a peer-reviewed journal and half of the time spent in active research was funded.

CONCLUSION

AS are being performed by optometrists within a tertiary eye hospital that supports ACP. IP optometrists had higher self-reported AS but current educational frameworks don't accommodate for some AS. Targeted AS courses with competency-based sign-off may further support high-quality patient care. Further research is required on how advanced care practitioners can support workforce transformation.

Examining the Effect of Entrepreneurial Leadership on Nursing Team Creativity in New Hospitals: A Structural Equation Model

METHODS

This cross-sectional study sampled 833 nurses from 2 new hospitals in Guizhou Province, China. They completed a questionnaire on entrepreneurial leadership, nursing team creativity, innovation climate, creative self-efficacy, team psychological safety, and knowledge sharing. Data were analyzed using structural equation modeling.

RESULTS

Entrepreneurial leadership positively influenced nursing team creativity. Innovation climate, creative self-efficacy, team psychological safety, and knowledge sharing mediated the relationship between entrepreneurial leadership and nursing team creativity in new hospitals.

CONCLUSIONS

This study confirmed the significant role of innovation climate, creative self-efficacy, team psychological safety, and knowledge sharing in mediating the relationship between entrepreneurial leadership and nursing team creativity through empirical analysis.

Strategies to attract school-leavers to nurse education programmes: an integrative literature review

The shortfall of nurses in the UK has led to concerns that there are insufficient staff to ensure safe and high-quality care. To address this shortfall, one group to focus on for recruiting nursing students is school-leavers. This article reports on an integrative literature review that was conducted to explore the educational strategies used to attract school-leavers to undergraduate nurse education programmes. The review identified that a variety of educational strategies were used, and all of the included studies reported positive effects on school pupils' intention to undertake nursing studies. These strategies often included interactions with nursing staff and/or nursing students, as well as observing and practising clinical skills, for example via simulation. However, most participants likely had a pre-existing interest in healthcare or nursing, the interventions were delivered predominantly to young women, and the included studies lacked longer-term follow-up. This highlights a need to conduct further research to assess the longitudinal impact of recruitment strategies aimed at broader audiences.

Association between abusive supervision and nurses' withholding voice about patient safety: the roles of impression management motivation and speak up-related climate

BACKGROUND

Abusive supervision by the nurse manager significantly influences nurses' withholding voice about patient safety. The role of impression management motivation and speak up-related climate is crucial in understanding their connection. This study aimed to explore the relationship between abusive supervision, impression management motivation, speak up-related climate, and withholding voice about patient safety.

METHODS

This cross-sectional study employed a convenience sampling method to recruit 419 clinical nurses from Taizhou Hospital, Zhejiang Province, China, between 1 November 2022 and 31 January 2023. The study adhered to the STROBE checklist. Abusive supervision and impression management motivation were assessed using the Chinese versions of the Abusive Supervision Scale and the Impression Management Motivation Scale, respectively. Withholding voice about patient safety and speak up-related climate were identified using the Chinese version of the Speaking Up about Patient Safety Questionnaire.

RESULTS

Nurse leaders' abusive supervision (β=0.40, p<0.01) and nurses' impression management motivation (β=0.10, p<0.01) significantly and positively influenced nurses' withholding voice about patient safety. We introduced impression management motivation as a mediating variable, and the effect of abusive supervision on nurses' withholding voice decreased (β from 0.40 to 0.38, p< 0.01). Nurses' speak up-related climate played a moderating role between abusive supervision and impression management motivation (β= 0.24, p<0.05).

CONCLUSIONS

Abusive supervision by nursing leaders can result in nurses withholding voice about patient safety out of self-protective impression management motives. This phenomenon inhibits nurses' subjective initiative and undermines their proactive involvement in improving patient safety, and hinders the cultivation of a culture encouraging full participation in patient safety, which should warrant significant attention.

Trends and determinants of clinical staff retention in the English NHS: a double retrospective cohort study

OBJECTIVES

To investigate how demographic, contractual and organisational factors are related to the retention of hospital workers in the English NHS. The study will specifically examine the trends in age-retention profiles.

DESIGN

A double retrospective cross-cohort study using administrative data on senior and specialty doctors, nurses and midwives who were included in the 2009 and 2014 payrolls of all English NHS hospital Trusts. These individuals were tracked over time until 2019 to examine the associations between sociodemographic characteristics and the retention of hospital workers in each cohort. Logistic regressions were estimated at the individual worker level to analyse the data. Additionally, a multilevel panel regression was performed using linked payroll-survey data to investigate the association between hospital organisation characteristics and the retention of clinical staff.

SETTING

Secondary acute and mental healthcare NHS hospital Trusts in England.

PARTICIPANTS

70 777 senior doctors (specialty and specialist doctors and hospital consultants) aged 30-70, and a total of 448 568 between nurses and midwives of any grade aged 20-70, employed by English NHS Trusts.

PRIMARY OUTCOME MEASURES

Employee retention, measured through binary indicators for stayers and NHS leavers, at 1-year and 5-year horizons.

RESULTS

Minority doctors had lower 1-year retention rates in acute care than white doctors, while minority nurses and midwives saw higher retention. Part-time roles decreased retention for doctors but improved it for nurses. Fixed-term contracts negatively impacted both groups' retention. Trends diverged for nurses and doctors from 2009 to 2014-nurses' retention declined while doctors' 5-year retention slightly rose. Engagement boosted retention among clinical staff under 51 years of age in acute care. For nurses over 50, addressing their feedback was positively associated with retention.

CONCLUSIONS

Demographic and contractual factors appear to be stronger predictors of hospital staff retention than organisational characteristics.

Exercise as a falls prevention strategy in the care of older people

Older people who sustain a fall may experience a range of adverse outcomes, such as distress, injury and loss of independence. Falls increase the risk of frailty and frailty increases the risk of falls. Regular exercise is a pillar of falls prevention and can have extensive benefits for older people's health, well-being and ability to undertake activities they enjoy. As part of the multidisciplinary team, nurses have a pivotal role in implementing exercise-based falls prevention strategies for older people and in encouraging their patients to exercise. This article discusses exercise as a falls prevention strategy in hospital and in the community and supports nurses to develop their knowledge and confidence in promoting exercise in older people.

Undergraduate nursing students challenge misconceptions towards men in nursing: A mixed-method study

AIMS

To examine misconceptions towards men in nursing from the perspective of undergraduate nursing students. Specifically, this study sought to explore contributing factors of misconceptions and attributions of the success of men in nursing.

DESIGN

A convergent parallel mixed-method study.

METHODS

A national survey was conducted (July-September 2021). The quantitative data included demographics and responses to the Gender Misconceptions of Men in Nursing (GEMINI) scale. The qualitative data included responses to a provocative statement related to characteristics of men and their career in nursing. The GRAMMS guideline was used in reporting.

RESULTS

Undergraduate nursing students (n = 1245) from 16 Australian schools of nursing responded to the survey. Quantitative analysis demonstrated that most students (96%) did not have misconceptions about men in nursing. Those who did were more likely to be men, born overseas, not in health-related employment and did not have nursing as their first choice. Four broad overarching main themes were generated in response to the statement that suggested men do not have the right attributes for nursing: (1) 'This is a very misandristic viewpoint'; (2) 'Compassion and intelligence are distributed in men and women equally'; (3) 'Men bring a different quality to nursing' (4) 'Anyone can be whatever they want to be'.

CONCLUSION

Overall, nursing students did not have misconceptions about men in nursing, despite experiencing ongoing social stigma regarding archaic gender norms. The findings from this study indicate that the next-generation nurses were championing to challenge the gender stereotype and support the needs of a gender diverse society.

IMPACT

Attitudes and misconceptions that elicit gender inequalities must be addressed with comprehensive strategies and de-gendered language and imagery within the profession, schools, workplaces and the media. Shifting culture and attitudes towards inclusion, values the diversity in the workforce and supports healthy workplace environments.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

SHOULD I STAY OR SHOULD I GO-A rapid qualitative study of principal deteriorating factors experienced by nurses relating to their intentions to leave their current position in a medical hospital department

BACKGROUND

High nurse turnover in hospitals is a worldwide problem with dire consequences for patient care such as increased mortality and a decrease in patient safety. A specific effort to retain nurses is urgently needed due to the many vacant nursing positions, especially across the Medical hospital departments.

AIM

To identify the principal deteriorating factors experienced by nurses relating to their intentions to leave the medical department at a university hospital.

METHODS

A rapid qualitative research methodology was used. Participants comprised 22 registered nurses employed in five university hospital medical department units. The Rigorous and Accelerated Data Reduction (RADaR) technique was therefore used for data collection through qualitative semi-structured interviews and analysis. COREQ was used for reporting the study.

RESULTS

The RADaR analysis detected a downward spiral of five principal deteriorating factors influencing nurses' intentions to leave their position in the medical department. The factors were resignations from several nursing colleagues combined with too few and inexperienced nurses present during shifts, additional tasks assigned, a management refraining from improving the problematic issues, leading to decisive consequences for patient care and a declining feeling of professional care.

CONCLUSIONS

The lack of nurses in the department caused missed nursing care, which affected the nurses' job satisfaction and intentions to leave their positions. Future research initiatives must focus on evaluating successful interventions to maintain the nurses in the positions. Further knowledge, is also needed, to investigate how we can change the downward spiral to a story of retention success.

Evaluating a competency framework for rheumatology nurses

The Royal College of Nursing (RCN) competency framework for rheumatology nurses was developed in 2020. As part of the framework proposal, a service evaluation was planned following the framework's roll-out to determine its usefulness and acceptability. The aim of this evaluation was to explore rheumatology nurse specialists' answers to the research question: 'What was your experience of using the RCN's rheumatology competency framework?' A total of 14 rheumatology nurse specialists were interviewed and shared their opinions regarding the competency framework. Five themes were identified: personal usage; benefits to managers; inequalities and inequity in nursing; ideas for improvement; and general properties. The findings of this evaluation demonstrated the value of the framework, which enabled rheumatology nurse specialists to document the competency level they were working at and to identify their future training needs.

Status and related factors of professional growth among young nursing talents: a cross-sectional study in China

BACKGROUND

The shortage of nurses has been a global human resources problem. A good professional growth environment is essential to developing potential nursing students and attracting nurses to join, and it has great significance in reducing nurse turnover. However, nurses' comprehensive perceptions of professional growth have not yet been examined.

METHODS

A cluster sampling method was used to conduct a professional growth questionnaire survey on young nursing talents from a large Chinese public tertiary A hospital in March 2022.

RESULTS

The score of professional growth among 243 young nursing talents was 57.92 ± 9.607, with a scoring rate of 77.23%. The scores for dimensions of professional growth, from lowest to highest, were rehabilitation growth, promotion speed, professional goal progress, and professional ability development. Attitudes towards participating in training, service as the quality manager or clinical teacher, self-efficacy, professional title, work-family support, education, and organizational commitment of young nursing talents were significantly associated with professional growth.

CONCLUSION

The professional growth of young nursing talents was at a moderate level and needed to be strengthened. Nursing leaders and managers are expected to develop management practices to enhance young nursing talents' professional growth in combination with the related factors.

Relationship between shift assignments, organizational justice, and turnover intention: A cross-sectional survey of Japanese shift-work nurses in hospitals

AIM

Shift management and planning processes for shift-working nurses are important for their continued work. This study aimed to determine the association between shift assignments, organizational justice, and their interaction with turnover intention among shift-work nurses.

METHODS

This cross-sectional study used an online questionnaire administered to Japanese nurses between January and February 2020. Enquiries pertaining to their daily start and end times for each shift type, the shift assignments, organizational justice, and their turnover intention were made. To examine the association with turnover intention, logistic regression analysis was performed with shift assignments, organizational justice, and their interaction terms as independent variables.

RESULTS

A total of 386 nurses participated in the final analysis. Of these, 161 nurses (41.7%) had turnover intention. Unequal work assignments and procedural justice were significantly associated with turnover intention. However, the interaction between these factors was not significant.

CONCLUSION

The results suggest that procedural justice in the workplace and turnover intention are related, but in shift planning, even procedural justice cannot buffer unequal work from leading to turnover intention. This study provides valuable insights for nursing managers who manage the schedules of shift-working nurses.

Professional care workforce: a rapid review of evidence supporting methods of recruitment, retention, safety, and education

BACKGROUND

Across the care economy there are major shortages in the health and care workforce, as well as high rates of attrition and ill-defined career pathways. The aim of this study was to evaluate current evidence regarding methods to improve care worker recruitment, retention, safety, and education, for the professional care workforce.

METHODS

A rapid review of comparative interventions designed to recruit, retain, educate and care for the professional workforce in the following sectors: disability, aged care, health, mental health, family and youth services, and early childhood education and care was conducted. Embase and MEDLINE databases were searched, and studies published between January 2015 and November 2022 were included. We used the Quality Assessment tool for Quantitative Studies and the PEDro tools to evaluate study quality.

RESULTS

5594 articles were initially screened and after applying the inclusion and exclusion criteria, 30 studies were included in the rapid review. Studies most frequently reported on the professional nursing, medical and allied health workforces. Some studies focused on the single domain of care worker education (n = 11) while most focused on multiple domains that combined education with recruitment strategies, retention strategies or a focus on worker safety. Study quality was comparatively low with a median PEDro score of 5/10, and 77% received a weak rating on the Quality Assessment tool for Quantitative Studies. Four new workforce strategies emerged; early career rural recruitment supports rural retention; workload management is essential for workforce well-being; learning must be contextually relevant; and there is a need to differentiate recruitment, retention, and education strategies for different professional health and care workforce categories as needs vary.

CONCLUSIONS

Given the critical importance of recruiting and retaining a strong health and care workforce, there is an immediate need to develop a cohesive strategy to address workforce shortfalls. This paper presents initial evidence on different interventions to address this need, and to inform care workforce recruitment and retention. Rapid Review registration PROSPERO 2022 CRD42022371721 Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022371721.

Flanders Nursing Home (FLANH) project: Protocol of a multicenter longitudinal observational study on staffing, work environment, rationing of care, and resident and care worker outcomes

BACKGROUND

While the demand for high quality of care in nursing homes is rising, it is becoming increasingly difficult to recruit and retain qualified care workers. To date, evidence regarding key organizational factors such as staffing, work environment, and rationing of care, and their relationship with resident and care worker outcomes in nursing homes is still scarce. Therefore, the Flanders Nursing Home (FLANH) project aims to comprehensively examine these relationships in order to contribute to the scientific knowledge base needed for optimal quality of care and workforce planning in nursing homes.

METHODS

FLANH is a multicenter longitudinal observational study in Flemish nursing homes based on survey and registry data that will be collected in 2023 and 2025. Nursing home characteristics and staffing variables will be collected through a management survey, while work environment variables, rationing of care, and care worker characteristics and outcomes will be collected through a care worker survey. Resident characteristics and outcomes will be retrieved from the Belgian Resident Assessment Instrument for long-Term Care Facilities (BelRAI LTCF) database. Multilevel regression analyses will be applied to examine the relationships between staffing variables, work environment variables, and rationing of care and resident and care worker outcomes.

CONCLUSION

This study will contribute to a comprehensive understanding of the nursing home context and the interrelated factors influencing residents and care workers. The findings will inform the decision-making of nursing home managers and policymakers, and evidence-based strategies to optimize quality of care and workforce planning in nursing homes.

Facilitating flexibility in postgraduate nursing education through entrustable professional activities to address nursing shortages and career prospects

AIM

To communicate how the Dutch postgraduate nursing education landscape was redesigned using entrustable professional activities (EPAs). The goal of this initiative was to reduce training time, enhance transfer across nursing specialities and contribute to a better-aligned continuum of initial education, postgraduate education and continuing professional development.

BACKGROUND

Nursing shortages continue to worsen worldwide. An approach to address this growing shortage is to create a more flexible postgraduate training structure, offering training in the just-in-time and just-as-needed models. EPAs can be used as building blocks for training and assessment. Experience with EPAs (i.e. units of professional practice that can be entrusted once a trainee has demonstrated the required competencies) in health professions education, including nursing, is rising rapidly. While EPAs are largely used to create training flexibility within a programme, they can also be used to create flexibility across programmes. In 2018-2022, training hospitals and education institutions in the Netherlands collaborated in the CZO Flex Level Project to redesign the postgraduate nursing education landscape using EPAs.

DISCUSSION

The implementation of a flexible postgraduate nursing education model nationwide will face several challenges. An overview of these challenges and suggestions for future research on the effects of the new structure on nursing competence, satisfaction and career development are provided.

CONCLUSION

EPAs can imbue flexibility within and across training programmes. Designing an EPA-based educational landscape requires nationally coordinated efforts.

IMPLICATIONS FOR NURSING POLICY

Redesigning educational structures to allow for more flexibility is critical to address major societal challenges in healthcare.

Career optimism and job-related well-being of Australian nurses during COVID-19: A cross-sectional study

BACKGROUND

Australia has been confronted with a severe nursing deficit, making it difficult to maintain a strong healthcare workforce capable of meeting the mounting demands of healthcare organizations.

AIMS

This study aimed to understand how personal and organizational resources influence career optimism and job-related affective well-being of Australian nurses during a pandemic using the Conservation of Resource Theory.

METHODS

A cross-sectional online survey was emailed to 123 Australian nurses from January to February 2021. The survey consisted of self-reported measures, including mindfulness, career optimism, job-related affective well-being, personal and job resources measures, and the Dirty Dozen scale. Correlations, independent sample t-test, and a series of hierarchical regressions were conducted on the cross-sectional data with SPSS Version 27. The STROBE checklist was used to report the results.

RESULTS

Findings suggested that mindfulness, perceived supervisor support, and job autonomy were significant predictors of job-related well-being, whereas mindfulness, perceived supervisor support, and opportunities for professional growth contributed more to career optimism of nurses during a health crisis. Male nurses in this study reported significantly higher mindfulness, career optimism, and job-related well-being levels than female nurses.

LINKING EVIDENCE TO ACTION

Developing mindfulness among nurses, allocating organizational resources to facilitate more supervisor support, and providing job autonomy may enhance career optimism and job-related well-being of nursing staff who work in disruptive and high-demand work environments such as those experienced during the COVID-19 health crisis. Supervisors should also facilitate and encourage nurses to reflect and be mindful of their behaviors with their peers and patients which can help to reduce exploitative or arrogant behaviors in the workplace.

How local, first-line nurse leaders can positively influence nurse intent to stay and retention: A realist review

AIMS AND OBJECTIVES

To explore evidence on how local nurse leaders can positively influence nurse retention.

BACKGROUND

Nurse turnover and retention is a wicked problem with multiple interrelated factors and no one solution. Local nurse leadership has the potential to positively influence nurse intent to stay directly or via various factors.

DESIGN

A realist review.

METHODS

Having designed a search strategy based on a tentive programme theory, 1386 initial hits in three databases were screened and reduced to 48 research articles published between 2010-2021. The articles' content were coded for findings that supported, refined or contradicted four ContextMechanismOutcome configurations.

RESULTS

Sufficient evidence was found to support four guiding lights encouraging local nurse leaders to: (1) foster relational connectedness; (2) enable professional practice autonomy; (3) cultivate healthful workplace cultures; (4) support professional growth and development. Mutuality and reciprocity is also key if leaders themselves are to experience wellbeing and growth.

CONCLUSIONS

Person-centred, transformational and resonant local nurse leaders can positively influence nurse intent to stay within the workplace or organisation.

REPORTING METHOD

Conform JCN guideline 'What to cover in the main tekst by article type' for reviews.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

Retention and turnover among migrant nurses: A scoping review

AIM

To map and explore primary research about factors related to retention, turnover and turnover intention among migrant nurses.

BACKGROUND

Understanding retention and turnover among migrant nurses is essential, especially in the context of nursing shortage. There is a range of factors motivating nurses to emigrate; however, factors related to retention and turnover among migrant nurses in the host country are unclear.

METHODS

This review utilised Arksey and O'Malley's methodological framework for scoping reviews, and is reported with the PRISMA-ScR checklist. Four electronic databases were searched-CINAHL, PsycINFO, ProQuest and PubMed-to identify primary research published between January 2000 and May 2022. Titles and abstracts were reviewed against the inclusion and exclusion criteria, and then full-text versions were reviewed. Data extracted were summarised, and results synthesised.

RESULTS

Fifteen studies were included, with studies mainly from the Middle East, the United Kingdom and the United States. Personal, organisational, financial, political and environmental factors were found to influence retention and turnover among migrant nurses.

CONCLUSION

Retention and turnover rates among migrant nurses vary among host countries. The factors identified are related to each other; hence, retention and turnover among migrant nurses are best understood in the context of their source country, host country and individual circumstances. IMPLICATIONS FOR NURSING POLICY, SOCIAL POLICY, AND HEALTH POLICY: Host countries must promote strategies that foster retention, such as reviewing immigration policies to support long-term immigration and family unity. Organisations employing migrant nurses need to consider the presence of a social network to facilitate adaptation and integration. It is also recommended that source countries address the reasons for emigration and initiate policies encouraging return migration, including providing merit to overseas experience. International nursing organisations should call for an examination of the conditions of migrant nurses to ensure equality across all source countries.

Cross-Cultural Adaptation and Validation of the Perceptions of Empowerment in Midwifery Scale in the Spanish Context (PEMS-e)

Midwifery empowerment is an important topic. The most widely used instrument to measure the perceived empowerment of midwives is the Perceptions of Empowerment in Midwifery Scale (PEMS), which has not been validated in Spain. The aim of this study was to translate and adapt the PEMS to the Spanish context. This research was carried out in two phases; Phase 1: Methodological study; translation, backtranslation and cross-cultural adaptation of the PEMS and pilot study on the target population (10 midwives) for evaluation of face validity. Phase 2: Cross-sectional observational study to obtain a sample for construct validation by Exploratory Factor Analysis and measurement of PEMS-e reliability. Additionally, an inferential analysis was carried out to study the possible association between several collected variables and PEMS-e subscale-scores. A total of 410 midwives from 18 Spanish regions participated in the study through an online questionnaire. An initial Spanish version of the PEMS scale was produced, demonstrating adequate face validity. A final model was produced for the PEMS-e, which included 17 items classified into two subscales ("Organizational support" and "Own skills and teamwork") with fit indexes RMSEA = 0.062 (95%CI: 0.048-0.065) and AGFI = 0.985 (95%CI: 0.983-0.989) and Cronbach's alpha 0.922 for the total scale. Results showed that one in four midwives had considered abandoning the profession in the last 6 months (p ≤ 0.001). This research suggests that Spanish midwives perceive their empowerment level as low. The PEMS-e is a valid tool with solid psychometric properties that can be used in future research to identify factors that contribute to increased empowerment among Spanish midwives and inform strategies to improve job satisfaction and retention in the profession.

Hospital characteristics associated with nurse staffing during labor and birth: Inequities for the most vulnerable maternity patients

BACKGROUND

Evidence is limited on nurse staffing in maternity units.

PURPOSE

To estimate the relationship between hospital characteristics and adherence with Association of Women's Health, Obstetric and Neonatal Nurses nurse staffing guidelines.

METHODS

We enrolled 3,471 registered nurses in a cross-sectional survey and obtained hospital characteristics from the 2018 American Hospital Association Annual Survey. We used mixed-effects linear regression models to estimate associations between hospital characteristics and staffing guideline adherence.

FINDINGS

Overall, nurses reported strong adherence to AWHONN staffing guidelines (rated frequently or always met by ≥80% of respondents) in their hospitals. Higher birth volume, having a neonatal intensive care unit, teaching status, and higher percentage of births paid by Medicaid were all associated with lower mean guideline adherence scores.

DISCUSSION AND CONCLUSIONS

Important gaps in staffing were reported more frequently at hospitals serving patients more likely to have medical or obstetric complications, leaving the most vulnerable patients at risk.

A systematic review study on the factors affecting shortage of nursing workforce in the hospitals

AIM

This study aimed to determine factors that influence the nursing workforce shortage and their impact on nurses.

DESIGN

This study applied a systematic review design.

METHODS

Using Cochrane library guidelines, five electronic databases were systematically searched (Research 4life-PubMed/Medline, Scopus, Embase, CINAHL) from 2010-2021. The remaining articles with pertinent information were presented in a data extraction sheet for further thematic analysis. A Reporting Items for Systematic Reviews and Meta-Analysis Flow Diagram was adopted and used. The studies published from 2010-2021 and in English language were examined and included in the systematic review.

RESULTS

Four themes were identified as factors influencing the nursing workforce shortage, including Policy and planning barriers, Barriers to training and enrolment, Factors causing nursing staff turnover and Nurses' stress and burnout. Nursing workforce shortage is a global challenge that roots in multiple causes such as individual, educational, organizational and managerial and policy-making factors.

Factors contributing to nurse resignation during COVID-19: A qualitative descriptive study

AIMS

To explore and describe registered nurses' perceptions and experiences of work well-being extending from what inspired them to join the healthcare organization, what created a great day at work for them, through to what may have supported them to stay.

DESIGN

Qualitative descriptive study.

METHODS

Thirty-nine Australian nurses who resigned in 2021 from two metropolitan healthcare organizations in Victoria were interviewed in 2022, each for 30-60 min. The semi-structured interview transcripts were transcribed verbatim and analysed inductively and thematically.

RESULTS

Four themes were constructed for each of the key research questions. Inspiration to join the organizations transpired through organizational reputation, recruitment experiences, right position and right time, fit and feel. A great day at work was created through relationships with colleagues, experiences with managers, adequate resourcing and delivering quality care. Factors contributing to nurses resigning included COVID-19, uncertainty of role, workload and rostering, and finally, not feeling supported, respected and valued. Factors that may have supported the nurses to stay included flexible work patterns and opportunities, improved workplace relationships, workload management and support, and supportive systems and environments. Cutting across these themes were five threads: (1) relationships, (2) communication, (3) a desire to learn and develop, (4) work-life balance and (5) providing quality patient care.

CONCLUSIONS

Novel ways of working and supporting individuals, teams and organizations are needed to maintain and sustain nurses. The nurses' inspiration, what created a great day at work, and support needed to stay highlighted the importance of workplace initiatives to build nursing career pathways, provide equitable opportunities for professional development, workload and roster flexibility and implement professional relationship-enhancing actions to foster authentic civility.

IMPACT

This study contributes an in-depth exploration of the perceptions and experiences of nurses who resigned from two healthcare organizations and provides a description of (1) what inspired these nurses to initially join the organization, (2) what they perceived created a great day at work for them, (3) the factors contributing to their resignation and (4) what may have supported them to stay. The reasons nurses resign from an organization were identified as complex and multi-factorial, with opportunities for promoting nursing career pathways, addressing equity in opportunities and implementing professional relationship-enhancing actions. These contributions add both context and opportunity to strengthen organizational initiatives to attract, sustain and retain nurses.

Abusive supervision and employee well-being of nursing staff: Mediating role of occupational stress

AIM

The study examined whether occupational stress mediated the relationship between abusive supervision and well-being of nursing staff.

DESIGN

A cross-sectional questionnaire survey was administered.

METHODS

Data were collected at three-time points between July 2020 and January 2021. A total of 313 valid responses were obtained from nurses working in a general hospital in Taiwan. The data were analysed using descriptive statistics, Pearson's correlation analysis and the bootstrap method.

RESULTS

Abusive supervision was positively associated with occupational stress (β = 0.288, SE = 0.069, 95% CI [0.152, 0.423]) and negatively associated with employee well-being, including psychological (β = -0.350, SE = 0.084, 95% CI [-0.515, -0.186]), physical (β = -0.301, SE = 0.080, 95% CI [-0.459, -0.143]) and social well-being (β = -0.422, SE = 0.121, 95% CI [-0.661, -0.183]). Occupational stress was negatively related to employee well-being. A mediation analysis with bootstrapping revealed that occupational stress mediated the relationship between abusive supervision and employee well-being, which included psychological (95% bootstrap CI [-0.183, -0.046]), physical (95% bootstrap CI [-0.212, -0.062]) and social well-being (95% bootstrap CI [-0.178, -0.040]).

CONCLUSION

Abusive supervision influences employee well-being. Occupational stress mediates the relationship between abusive supervision and employee well-being. To improve employee well-being, hospital administrators should develop policies for effectively managing nursing supervisors' abusive behaviour and subordinates' stress management.

IMPACT

Abusive supervision increased the occupational stress of employees and influenced their well-being. Thus, educational courses should be implemented to train supervisors to practice positive leadership and treat employees fairly. Promoting stress management among nursing staff may lead to the prompt reporting of abusive events and improved employee well-being.

NO PATIENT OR PUBLIC CONTRIBUTION

This study investigated the relationship between the abusive supervision and employee well-being of nursing employees. No patient or public contribution is involved in this study.

A conflicted tribe under pressure: A qualitative study of negative workplace behaviour in nursing

AIM

This study explored workplace interactions of Australian nurses in regional acute care hospitals through an examination of nurses' experiences and perceptions of workplace behaviour.

DESIGN

This research is informed by Social Worlds Theory and is the qualitative component of an overarching mixed methods sequential explanatory study.

METHODS

Between January and March 2019, data were collected from 13 nursing informants from different occupational levels and roles, who engaged in semi-structured, in-depth, face-to-face interviews. Data analysis was guided by Straussian grounded theory to identify the core category and subcategories.

RESULTS

Theoretical saturation occurred after 13 interviews. The core category identified is A conflicted tribe under pressure, which is comprised of five interrelated subcategories: Belonging to the tribe; 'It's a living hell'; Zero tolerance-'it's a joke'; Conflicted priorities; Shifting the cultural norm.

CONCLUSION

This study provides valuable insight into the nursing social world and the organizational constraints in which nurses work. Although the inclination for an individual to exhibit negative behaviours cannot be dismissed, this behaviour can either be facilitated or impeded by organizational influences.

IMPACT

By considering the nurses' experiences of negative workplace behaviour and identifying the symptoms of a struggling system, nurse leaders can work to find and implement strategies to mitigate negative behaviour and create respectful workplace behaviours.

PATIENT OR PUBLIC CONTRIBUTION

This study involved registered nurse participants and there was no patient or public contribution.

CLINICAL TRIAL REGISTRATION

Study registration Australian New Zealand Clinical Trials Registry (Registration No. ACTRN12618002007213; December 14, 2018).

Exploring the relationship between midwives' work environment, women's safety culture, and intent to stay

BACKGROUND

The shortage of midwives is a concern for healthcare systems as it compromises the quality maternity care. Various studies argue that a favorable work environment increases nurses' job satisfaction and intention to continue working at their current workplace.

AIM

To analyze the work environment and its relationship with women's clinical safety culture and midwives' intention to stay in their current job and the midwifery profession.

METHODS

A cross-sectional, correlational study was performed on N = 218 midwives working in Spain. Standardized instruments were used, including The Practice Environment Scale of the Nursing Work Index (PES-NWI) and the Hospital Survey on Patient Safety Culture (HSOPSC). Descriptive and bivariable statistics were used. The study followed the STROBE guidelines.

RESULTS

The work environment in the labor wards was mixed, according to the PES-NWI classification. The mean total score of the PES-NWI significantly and positively correlated with the mean total score of the HSOPSC (rs = 0.498, p < 0.001), indicating that as the quality of midwives' work environment increased, women's clinical safety increased. Significant correlations were observed between the midwives' intent to stay in the hospital where they work and features of women's safety culture.

CONCLUSION

The results of this study showed significant relationships between the work environment, women's safety culture, and midwives' intentions to leave their job/profession. Creating a favorable working environment could be a potentially effective strategy that encourages improvement in the women's safety culture in healthcare organizations and greater intention of midwives to stay at their current job.

Attentes du personnel infirmier de la relève envers l’employeur pour favoriser l’engagement professionnel : un premier jalon pour la conception d’interventions organisationnelles au Québec (Canada)

Introduction: Poor work conditions jeopardize the quality of nursing jobs and increase turnover and attrition rates, especially for early career nurses and licensed practical nurses. Understanding perspectives of the nursing staff on work engagement is essential to develop innovative and responsive organizational interventions. Objectives: 1- Define the expectations of early career nursing staff with respect to their workplace in order to support work engagement 2- Identify priority actions to support work engagement at organizational level. Methods: A mixed-methods research design based on a conceptual mapping approach was used. Early career nurses and licensed practical nurses (N=14) working in a semi-urban integrated health and social services center in Quebec (Canada) were asked the following question: “What can the workplace do to promote work engagement?” Multidimensional scaling and cluster analysis were used to organize the 49 statements provided by the nursing staff. At the same time, participants prioritized actions by rating the “importance” and “probability of a successful implementation” of each statement. Results: Nursing staffs’ expectations toward their workplace in order to support work engagement were: attractive working conditions, positive leadership, safe working conditions, professional development opportunities, and personalized career path. More specifically, the priority actions identified were: showing respect, providing a healthy environment and avoiding transfer to unwanted departments. Discussion and conclusion: The results suggest several actions to promote work engagement of early career nursing staff working in semi-urban settings in Quebec, including providing human and material resources, implementing a positive organizational culture, and exercising benevolent leadership.

Support from Work and Intent to Stay Among Nurses During COVID-19: An Academic-Practice Collaboration

The COVID-19 pandemic created stressful working conditions for nurses and challenges for leaders. A survey was conducted among 399 acute and ambulatory care nurses measuring availability of calming and safety resources, perceptions of support from work, and intent to stay. Most nurses reported intent to stay with their employer, despite inadequate safety and calming resources. High levels of support from work were significantly influenced nurses' intent to stay. Leadership actions at the study site to provide support are described, providing context for results. Nurse leaders can positively influence intent to stay through consistent implementation of supportive measures.

Factors Influencing Nurse Intent to Leave Acute Care Hospitals: A Systematic Literature Review

Professional nurses are leaving their current positions in acute care hospitals and, in some cases, the profession in greater numbers than ever. Nurse leaders must understand factors surrounding nurses' intent to leave to develop strategies to mitigate this phenomenon and retain nurses. This review of the literature seeks to synthesize studies on nurses' intent to leave. Themes include job satisfaction, resources and staffing impacting workloads, leadership, and burnout.

Registered nurses' experiences of caring for patients in hospitals transitioning from curative to palliative care: A qualitative study

The aim of this study was twofold: to illuminate registered nurses' experiences of palliative care and of caring for patients transitioning from curative to palliative care in hospitals. A qualitative descriptive design was used. Group interviews were conducted with 11 registered nurses in three different hospital settings. Content analysis was performed. The results are presented in four themes: "Understanding palliative care in a hospital setting"; "Involving, supporting, and caring for patients and families"; "Striving for consensus and common goals of care"; and "Struggling with the hospital environment." The registered nurses described struggling with the interpretation of palliative care and with how to transfer it into clinical practice in their specific care settings. Teamwork and collaboration were challenging and goals of care incongruent within the team. Further implementation of a palliative care approach, with core components symptom relief, teamwork, communication and relationship, and family support, is crucial to improve both patient care and the conditions enabling registered nurses to provide good care for the patients and their families in hospital settings.

Development and evaluation of competency-based curriculum for continuing professional development among military nurses: a mixed methods study

BACKGROUND

Continuing professional development (CPD) is essential for career progression and maintaining military nursing competency. A well-designed CPD programme can improve the effectiveness of transforming knowledge and skills in healthcare organisations. This study aimed to develop a competency-based CPD curriculum for military nurses in China and evaluate its effectiveness from a developmental pilot study.

METHODS

In phase one, a two-round Delphi was conducted to design a competency-based curriculum of CPD based on a clinical ladder model among military nurses. In phase two, the curriculum of one CPD programme was redesigned, and a pilot quasi-experiment was conducted to evaluate the effectiveness of this programme.

RESULTS

A competency-based curriculum was developed for primary, intermediate, and senior titles, respectively. The trainees' overall satisfaction with the redesigned CPD programme was 100%. The four themes in the qualitative data were: 1) learning motivation and learning barriers; 2) professional growth; 3) role model promoted career planning; 4) learning environment mattered.

CONCLUSION

This study developed a competency-based curriculum for continuing professional development among military nurses that can be used in designing CPD programmes. Competency-based curriculum can be utilised in the CPD activities to facilitate the improvement of nursing competency.

The Impact of Quality of Work Organization on Distress and Absenteeism among Healthcare Workers

The quality of work organization may be responsible not only for reduced productivity but also for an increased risk of mental and physical disorders. This study was aimed at testing this hypothesis. Workers of a local health unit in Italy were asked to fill out the Work Organization Assessment Questionnaire (WOAQ) during their periodic medical examinations in the second half of 2018. On the same occasion, they also completed the Demand/Control/Support (DCS) measure of job strain, the Effort/Reward Imbalance (ERI) questionnaire, and the General Health Questionnaire (GHQ12) to assess psychological health. A total of 345 workers (85.8%) completed the survey. Linear regression analysis showed that the quality of work organization was inversely proportional to psychological health problems (p < 0.001). Occupational stress, measured both by job strain and ERI, was a moderating factor in this relationship. The relationship between the WOAQ and psychological health, moderated by job strain or ERI, remained highly significant even after adjustment for sex, age, social support, and overcommitment. Regression models explained over 40% of the shared variance of the association between quality of work organization and psychological health. The quality of work organization significantly predicted the risk of sickness absence for musculoskeletal disorders (OR = 0.984, CI95% 0.972-0.996) and for other health problems (OR = 0.977, CI95% 0.967-0.988). A continuous improvement of work organization must consider not only the clients' or production needs but also the well-being of workers.

Social jetlag and depression in female rotating-shift nurses: A secondary analysis

PURPOSE

This study aimed to identify the predictors of depression among female rotating-shift nurses.

DESIGN AND METHODS

This secondary data analysis used data of 190 Korean female rotating-shift nurses from the parent study conducted in 2018. A multiple logistic regression analysis was performed to identify the predictors of depression.

FINDINGS

Young age, poor sleep quality, and greater morning-shift social jetlag predicted depression among female nurses working a three-shift schedule.

PRACTICE IMPLICATIONS

Nursing management should consider scheduling shifts to minimize nurses' social jetlag and develop interventions for improving sleep quality to prevent depression among female rotating-shift nurses.

Registered nurses' perceptions of their career - an interview study

AIM

To explore registered nurses' perceptions of their career.

BACKGROUND

Career development options have been found to increase attraction to nursing and support nurses' engagement with their organisation and profession.

METHODS

Qualitative individual interviews with 23 registered nurses; data analysed with thematic analysis and reported according to the COREQ criteria.

RESULTS

Three themes emerged: career choices, career engagement, and career development. Participants had chosen a nursing career because they perceived it as humane, people-oriented, meaningful, diverse and secure work. Participants' engagement in their career was connected to the content of the work, in which direct patient care was central. Nurses connected career development with high competency, independence, influence and meaningful working life experience. However, they perceived career development opportunities as minute within direct patient care.

CONCLUSIONS

Career development opportunities for nurses in direct patient care are needed to foster their career engagement and the attractiveness of the nursing profession. Further research is needed on the career planning and development of nurses working in patient care.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers must play a central role in engaging nurses in their careers and promoting their competency and career planning and development in organizations.

Parental experiences of caring for children who have learning disabilities and procedural anxiety in hospital: An interpretive phenomenological study

BACKGROUND

Children with learning disabilities (LD) are more likely to have health conditions that require hospital attendance than children without LD. Like all children, they can experience fear and distress related to procedural anxiety. Parents play a key role in managing procedural anxiety in children with LD. No previous published qualitative studies have explored parental experiences of caring for a child with LD and procedural anxiety in hospital.

OBJECTIVES

To explore how parents experienced caring for their child with LD and procedural anxiety in hospital.

METHODS

A purposive sample of six participants were recruited through a Facebook group for parents of children with LD. Remote semi-structured interviews were conducted via telephone, Microsoft Teams or Whatsapp. Interviews were transcribed verbatim and analysed using interpretative phenomenological analysis.

RESULTS

Five key themes were generated: (1) Emotional toll: parents characterized their experiences as highly emotional; reporting feeling stressed, anxious and worried. (2) Restraint and holding: parents spoke of their experiences of restraint which was largely viewed as negative and sometimes inappropriate. (3) Advocacy: parents articulated their responsibility as advocates for their children. (4) Going it alone: parents were extremely proactive in managing their child's anxieties but some also felt highly-pressurized and isolated. (5) Inconsistency and uncertainty: parents experienced inconsistency and uncertainty in their children's care from healthcare professionals which led to anxiety and frustration.

CONCLUSION

Parents of children with both LD and procedural anxiety experienced many challenges. Parents' expertise must be utilized by clinicians when caring for children with LD and procedural anxiety whilst ensuring appropriate support for parents. Nurses require specific training in psychosocial interventions to enhance care for children with LD and procedural anxiety. Further research identifying effective nursing strategies to enhance parental experiences would be beneficial to improve care to this patient group.

Self-rostering, work-life balance and job satisfaction in UK nursing: a literature review

Nursing vacancies are high across the UK, with some nurses considering leaving the profession. Evidence suggests that employers, including the NHS, need to be more flexible about working times to support employees' work-life balance and job satisfaction. Self-rostering is one approach that has the potential to enhance nurses' work-life balance and job satisfaction, enabling scope for greater autonomy. This could in turn lead to fewer nurses leaving the profession and contribute to making nursing more attractive as a career. This literature review focused on nurses in the NHS and found that self-rostering had a positive effect on their work-life balance and job satisfaction. However, a move to self-rostering can pose challenges and it should be assessed for suitability before implementation. Given the nursing vacancy crisis in the UK and many nurses' intentions to leave the profession, the potential benefits of self-rostering for nurses cannot be overlooked.

Giving nurses a voice through 'listening to staff' conversations to inform nurse retention and reduce turnover

Health and social care employers in the UK cannot afford to lose nurses given the current nursing workforce crisis. A variety of staff engagement initiatives aim to improve employee retention. This article describes how Listening to Staff (L2S) events were used as part of a service review to inform nurse retention strategies in one acute hospital trust. Over a 3-year period, 576 nurses took part in L2S events that examined nurses' perspectives of teamworking and support as well as career plans in areas with high nurse turnover rates. Comparative content analysis was used to analyse narrative data, which informed managers' retention plans. Examination of retention data before and after L2S events showed nursing turnover decreased, suggesting a variety of strategies to retain staff may have improved nurse retention. Findings imply capturing nurses' perceptions through staff engagement events may offer solutions for nurse retention.

Clinicians' attitudes towards escalation and management of deteriorating patients: A cross-sectional study

BACKGROUND

Internationally, rapid response systems have been implemented to recognise and categorise hospital patients at risk of deterioration. Whilst rapid response systems have been implemented with a varying amount of success, there remains ongoing concern about the lack of improvement in the escalation, and management of the deteriorating patient. It also remains unclear why some clinicians fail to escalate concerns for the deteriorating patient.

OBJECTIVE

The objective of this study was to explore clinicians' attitudes towards the escalation, and management of the deteriorating patient.

METHODS

A cross-sectional online survey of conveniently sampled clinicians from the acute care sector in a regional health district in Australia was conducted. The Clinicians' Attitudes towards Responding and Escalating care of Deteriorating patients scale, was used to explore attitudes towards the escalation and management of the deteriorating patient.

RESULTS

Survey responses were received from medical officers (n = 43), nurses (n = 677), allied health clinicians (n = 60), and students (n = 57). Years of experience was significantly associated with more confidence responding to deteriorating patients (p < .001) and significantly less fears about escalating care (p < .001). Nurses (M = 4.16, SD = .57) and students (M = 4.11, SD = .55) in general had significantly greater positive beliefs that the rapid response system would support them to respond to the deteriorating patient than allied health (M = 3.67, SD = .64) and medical (M = 3.87, SD = .54) clinicians, whilst nurses and medical clinicians had significantly less fear about escalating care and greater confidence in responding to deteriorating patients than allied health clinicians and healthcare students (p < .001).

CONCLUSION

Nurses and medical officers have less fear to escalate care and greater confidence responding to the deteriorating patient than allied health clinicians and students. Whilst the majority of participants had positive perceptions towards the rapid response system, those with less experience lacked the confidence to escalate care and respond to the deteriorating patient.

Co-worker relationships and their impact on nurses in Irish public healthcare settings

This article presents the findings of a secondary analysis of data arising from a quantitative study of 3769 nurses on co-worker relationships and their impact on nurses working in public healthcare settings in Ireland. The overall findings from this analysis suggest moderate to high levels of satisfaction with co-worker relationships, with an average scale mean of 77%. Statistically significant lower scale means were identified in respect of nurses whose basic nursing qualification was awarded in a country outside the EU, among students and among those working in the west of Ireland. Respondents intending to leave the healthcare workforce reported significantly lower scores (74%) on this index compared with those intending to stay (79%). Significant positive correlations between co-worker relationships and workplace engagement (0.233), job satisfaction (0.225), organisational commitment (0.221) and perception of managers (0.259) were identified. These findings have implications for the retention of nurses working in Irish public healthcare services.

Nurses' clinical leadership in the hospital setting: a systematic review

Aim

This study aims to identify the most effective interventions to facilitate nurses' clinical leadership in the hospital setting.

Background

There is a gap in the literature on the identification and measurement of effective interventions for leadership skill development among clinical nurses in hospitals. To the best of our knowledge, no systematic review has been performed on this issue.

Evaluation

A systematic review was conducted. The PubMed, CINAHL, PsycINFO and Cochrane databases were reviewed. Data extraction, quality appraisal and narrative synthesis were conducted in line with Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines.

Key issues

The evidence reveals that interventions designed to promote nurses' clinical leadership are complex, requiring that cognitive, interpersonal and intrinsic competencies as well as psychological empowerment, emotional intelligence and critical reflexivity skills be addressed.

Conclusions

The development of multicomponent, theory‐based and mixed‐format programmes may be more suitable to facilitate nurses' clinical leadership in the hospital setting.

Implications for Nursing Management

Strategies to facilitate nurses' clinical leadership in the hospital setting should address simultaneously the knowledge and ability of bedsides nurses to solve the practical problem collaboratively with a sense of control, competency and autonomy. Hence, it would promote high quality care, satisfaction and retention of bedside nurses.