The nursing shortage: a worldwide problem

A Technology-Supported Guidance Model to Increase the Flexibility, Quality, and Efficiency of Nursing Education in Clinical Practice in Norway: Development Study of the TOPP-N Application Prototype

BACKGROUND

The challenges of nursing shortage in the nursing profession and of limited nursing educational capacity in nursing education in clinical practice need to be addressed to ensure supply according to the demand of these professionals. In addition, communication problems among nursing students, nurse educators, and nurse preceptors; variations in the guidance competence of nurse preceptors; and limited overview from nurse educators on nursing students' clinical practice are common challenges reported in several research studies. These challenges affect the quality of nursing education in clinical practice, and even though these problems have been highlighted for several years, a recent study showed that these problems are increasing. Thus, an approach is required to ensure the quality of nursing education in clinical practice.

OBJECTIVE

We aimed to develop a guidance and assessment application to meet the challenges reported in clinical practice. The application intended to increase the flexibility, quality, and efficiency of nursing education in clinical practice. Furthermore, it intended to increase interactive communication that supports guidance and ensure structured evaluation of nursing students in clinical practice.

METHODS

This study employed a multidisciplinary user-participatory design. Overall, 23 stakeholders from the project team (ie, 5 researchers, 2 software developers, 1 pedagogical advisor, and 15 user representatives [4 educators, 6 preceptors, and 5 students]) participated in a user-centered development process that included workshops, intervention content development, and prototype testing.

RESULTS

This study resulted in the creation of the Technology-Optimized Practice Process in Nursing (TOPP-N) guidance and assessment application for use as a supportive tool for nursing students, nurse preceptors, and nurse educators in clinical practice. The development process included the application's name and logo, technical architecture, guidance and assessment module, and security and privacy.

CONCLUSIONS

This study offers insights into the development of an evidence-based technological tool to support nursing students, nurse preceptors, and nurse educators in clinical practice. Furthermore, the developed application has the potential to meet several challenges reported in nursing education in clinical practice. After a rigorous development process, we believe that the TOPP-N guidance and assessment application prototype is now ready to be tested in further intervention studies.

A cross-sectional study on sleep disturbances and associated factors among nurses

BACKGROUND

Many studies have measured sleep disturbances among nurses globally, but none have addressed this issue in Vietnam. Therefore, this study aimed to assess the prevalence of sleep disturbance and identify associated factors among staff nurses in Vietnam. To identify sleep disturbances and associated factors among staff nurses in Vietnam.

METHODS

A cross-sectional design was used in this study. Participant nurses (n = 420) completed a general information questionnaire, the Vietnamese version of the General Sleep Disturbance Scale (GSDS), the Perceived Stress Scale, and the Short Form 12. Data were collected between July and September 2019 from three public hospitals located in southwestern Vietnam. Data were analyzed using Chi-square, independent Student's t-test, and multivariate logistic regression analysis.

RESULTS

The average GSDS score was 41.10 (SD = 19.48), indicating sleep disturbances among 46.9% of nurses. Age, health condition, stress, and quality of life had an impact on sleep disturbance. Multivariate logistic regression analysis confirmed that nurses with high stress and poor physical health status were more likely to experience sleep disturbances.

CONCLUSION

Vietnamese nursing staff suffers from a high rate of sleep disturbances. Significant predictors included high stress and poor physical health status. Administrators of healthcare services should carefully consider how to conduct interventions to help the nurses handle their sleep disturbances such as stress management and physical health promotion.

Profiling resilience: A latent profile analysis of German nurses' coping and resilience

Introduction

Because of the shortage of nurses, it becomes crucial for organizations and health systems to keep nurses in their workforce. As individual resilience is positively associated with organizational commitment and negatively with mental disorders, it may reduce nurses' intention to leave the profession. Thus, individual resilience gained attention in research. Nevertheless, there is no common conceptualization of individual resilience in the literature. Rather, three prevalent understandings exist. Due to these multiple understandings, the role of coping in the context of resilience remains unclear. Against this background, the aim of this study is to analyze the relationship between nurses' resilience and coping based on a person-centered approach.

Methods

This study presents a latent profile analysis based on a survey of 210 German nurses. The profiles were generated based on the Brief Resilience Scale and Brief COPE. The Perceived Workload of Nurses' Scale and sociodemographic data were considered as explanatory factors using nominal logistic regression. Further, the relation with possible consequences was tested by χ²-test using the Irritation Scale and KUT Commitment Measure.

Results

The study identifies four different profiles of coping and resilience. The profiles "resistant" and "social-active" show rather low irritations and high organizational commitment. The "passive" profile has lower irritation scores than the "solitary" profile does, but the "passive" profile is associated with more irritation than the "resistant" or the "social-active" profile. Whereas the other profiles include characteristics of resilience, the "solitary" profile has a vulnerable nature. The analysis shows that more coordination and information problems, higher age, and not being in a leadership role are associated with a higher probability of belonging to the "solitary" profile. The chance of belonging to the "solitary" profile is significantly higher for women than for men, whereas women have a significantly lower chance of belonging to the "resistant" profile, compared to men.

Conclusion

The analysis shows that the three prevalent understandings of resilience are appropriate but it also indicates that future scientific debate requires more precision in defining individual resilience. The study contributes to sharpening the definition of resilience as well as to understanding the link between coping and resilience.

Effectiveness of the educational interventions on improvement of the performance of burning ward nurses

Introduction — Burning is one of the most accidents with a higher rate of morbidity and mortality. The aim of this study was to investigate the status of nursing cares in the burning ward to improve the quality of nursing service following the education. Methods — An after-before intervention-educational audit study was conducted on burning ward nurses in Iran. The data were collected using a researcher-made checklist based on the Ministry of Health standards with “Yes/No” questions. The data were analyzed using SPSS software version.16 through descriptive statistics and Mc-Nemar nonparametric metric test. Results — The population consisted of 20 nurses working in the burning ward of the Sina Hospital in Tabriz/Iran. Presentation of nursing services was good in terms of the primary care (80.5%) and during hospitalization (83.4%); and it was weak in terms of the secondary care (42.5%). A significant improvement was observed following the educational intervention according to the results of the Mc-Nemar test performed before and after intervention (P<0.001). Conclusion — Audit education improved the nursing secondary cares and follow- up care after patients discharge. It is necessary to hold educational workshops for improving the nurses̓ performance in the other fields.

Predictors of nursing workers' intention to leave the work unit, health institution and profession

OBJECTIVE

to identify the factors related to the nursing workers' intention to leave the work unit, health institution and profession.

METHOD

cross-sectional study with quantitative approach was carried out with 267 nursing workers from seven emergency units in Brazil. For data collection, we used the Questionnaire of socio-demographic, life style and work and health aspects as well as the Work Ability Index, Workplace violence questionnaire, questions about intention to leave and the Turnover Intention Scale. The predictors of intentions to leave were evaluated through Poisson regression models.

RESULTS

workplace violence increased and better satisfaction with current job decreased the probability of greater intention to leave the unit, institution and profession. Better work ability decreased the probability of greater intention to leave the unit and profession. The more qualified workers and those who had been working in the institution longer was more likely to greater intention to leave the profession.

CONCLUSION

promoting job satisfaction, work ability and a violence-free environment is possible to decrease the workers' intention to leave the job or profession, but nursing managers need to understand the three phenomena of intention to quit individually for retention strategies.

A supportive climate and low strain promote well-being and sustainable working life in the operation theatre

BACKGROUND

Shortage of health-care workers e.g. in operating theatres is a global problem. A shortage of staff negatively affects patient outcomes, making it important to keep the employees from quitting. The aim of this survey was to study if well-being, zest for work, and thoughts about leaving work in an operating theatre can be related to the psychosocial work environment, as described by the job demand-control-support (JDCS) model.

METHODS

A questionnaire was provided to personnel in operating theatres of seven Swedish hospitals (n = 1405, with a response rate of 68%) that included the JDCS model, personal factors, work ability, well-being, zest for work, and thoughts about leaving their position. Ordinal scale regression was used for analyses.

RESULTS

A majority reported moderate to high zest for work (76%). A minority (30%) had sometimes thought during at least one month in the last year of leaving their position. Lower social support scores and high demands together with low control (high-strain) scores were related to lower well-being, lower zest for work, and more thoughts about leaving the position. Anaesthetists scored in the low-strain field, nurse anaesthetists and assistant nurses in the passive field, and operating nurses in the active field, in comparison to all personnel.

CONCLUSION

According to the JDCS model, both lower social support and high strain were related to lower well-being and negative thoughts about the position. Social support scores were about the same for different occupational groups in the operating theatre, and no occupation scored on average in the high-strain field.

Job Embeddedness Scoring: Measurement Equivalence Between Rural and Urban Nurses

This study examined the measurement equivalency (ME) of the job embeddedness (JE) instrument for rural and urban registered nurses (RNs) using a secondary analysis of a cross-sectional mailed survey. JE represents the sum of reasons an employee remains at the present job. RNs from both rural and urban areas returned a 40-item JE instrument designed to assess their level of embeddedness. Analysis was performed using a multi-group confirmatory factor analysis for JE ratings of rural and urban RNs. The findings indicated that the original 40-item JE instrument needed to be respecified to achieve adequate fit for the sample of rural and urban RNs. This 32-item respecified instrument demonstrated that rural and urban RNs use the same metric when giving ratings for JE items. The findings of ME across rural and urban RNs facilitate comparisons between the two groups. The implications of these findings are that differences in ratings between rural and urban RNs may be attributed to real differences and not merely measurement artifact. Examination of these differences may lead to real strategies to retain nurses, thus mitigating the impact of the global nursing shortage.

Work-related stress, education and work ability among hospital nurses

AIM

This paper is a report of a study conducted to determine which occupational stressors are present in nurses' working environment; to describe and compare occupational stress between two educational groups of nurses; to estimate which stressors and to what extent predict nurses' work ability; and to determine if educational level predicts nurses' work ability.

BACKGROUND

Nurses' occupational stress adversely affects their health and nursing quality. Higher educational level has been shown to have positive effects on the preservation of good work ability.

METHOD

A cross-sectional study was conducted in 2006-2007. Questionnaires were distributed to a convenience sample of 1392 (59%) nurses employed at four university hospitals in Croatia (n = 2364). The response rate was 78% (n = 1086). Data were collected using the Occupational Stress Assessment Questionnaire and Work Ability Index Questionnaire.

FINDINGS

We identified six major groups of occupational stressors: 'Organization of work and financial issues', 'public criticism', 'hazards at workplace', 'interpersonal conflicts at workplace', 'shift work' and 'professional and intellectual demands'. Nurses with secondary school qualifications perceived Hazards at workplace and Shift work as statistically significantly more stressful than nurses a with college degree. Predictors statistically significantly related with low work ability were: Organization of work and financial issues (odds ratio = 1.69, 95% confidence interval 122-236), lower educational level (odds ratio = 1.69, 95% confidence interval 122-236) and older age (odds ratio = 1.07, 95% confidence interval 1.05-1.09).

CONCLUSION

Hospital managers should develop strategies to address and improve the quality of working conditions for nurses in Croatian hospitals. Providing educational and career prospects can contribute to decreasing nurses' occupational stress levels, thus maintaining their work ability.

Occupational stress among hospital nurses: cross-sectional survey

AIM

This paper is a report of a study conducted to explore factors associated with occupational stress among female hospital nurses in China.

BACKGROUND

Nursing is a highly stressful occupation, and high levels of occupational stress are believed to affect the physical and mental health of nurses. Occupational stress among nurses is the result of exposure to a combination of working environment and personal factors.

METHOD

A cross-sectional study was conducted in 2008. The study population consisted of 2613 female nurses from 20 hospitals in the Liaoning province of China. Occupational stress was measured by questionnaires that included the Chinese version of Personal Strain Questionnaire, and data were collected on respondents' demographics, working situations, occupational roles, and personal resources. Of the nurses solicited for enrolment in the study, 79.2% returned the completed questionnaire. A general linear regression model was applied to analyse the factors associated with occupational stress.

RESULTS

Mean Personal Strain Questionnaire score was 86.9, and this score was correlated, in descending order of standardized estimate, with role boundary, role insufficiency, responsibility, social support, self-care, nurse-patient relationship, chronic disease, role overload, rational coping and night shift.

CONCLUSION

Role boundary and role insufficiency were the factors that had the highest association with occupational stress. Occupational health education and occupational training programmes may be necessary to improve the knowledge and ability of nurses to cope with job demands and reduce occupational stress.

Work-related stress and work ability among Croatian university hospital midwives

OBJECTIVE

to explore the sources and levels of stress at work and work ability among Croatian midwives.

BACKGROUND

midwives are subjected to multiple stressors. Among health-care professionals, psychological distress for a prolonged period of time has negative effects on the worker's health, work ability and quality of patient care. 'Work ability' is a term describing a worker's resources related to physical, mental and social demands at work. As a measure of work ability in midwifery, the Work Ability Index (WAI) is considered to be a very predictive instrument; midwives with a poor WAI score usually leave their current job within five years.

SETTING

university hospitals in Zagreb, Croatia.

DESIGN

cross-sectional design survey.

PARTICIPANTS

300 health-care workers (105 qualified midwives and 195 paediatric nurses) were invited to complete the questionnaire. The total response rate was 53% (158/300). The sample included 14.7% of all hospital-based midwives in Zagreb hospitals.

METHODS

the Occupational Stress Assessment Questionnaire (OSAQ) for health-care workers and the WAI questionnaire.

FINDINGS

over three-quarters of the midwives (46/60, 76.7%) believed that their job was stressful, and considered that insufficient work resources caused the most stress. More than half of the midwives associated an insufficient number of coworkers, unexpected situations, inadequate income, night work, incurable patients and poor organisation at work with a high level of stress. The perceived specific stressors differed between midwives and paediatric nurses in the same hospital. Insufficient work resources and poor organisation at work were more common stressors among midwives than paediatric nurses (p<0.05). Midwives and nurses differed significantly with respect to age (p=0.002). Midwives were younger and had spent fewer years working in their current workplace compared with paediatric nurses (p<0.001). Also, midwives had a lower level of education than paediatric nurses (p=0.044). The mean WAI score for midwives was 40.0 [95% confidence interval (CI) 38.4-41.4], compared with 37.5 (95% CI 36.4-38.8) for paediatric nurses, both indicating good work ability. After adjusting for age, the difference in WAI score between the groups of workers was not significant.

CONCLUSIONS

Croatian midwives experienced work-related stress due to: insufficient work resources, insufficient number of coworkers, poor organisation at work, communication with superiors and emotional work. Midwives' work ability in relation to the demands of their job was good. These results confirmed that the WAI score decreases significantly with age.

IMPLICATIONS FOR PRACTICE

hospital management needs to improve organisational factors and resources, as well as midwives' education and position in the health-care system.

Diversity within nursing: effects on nurse-nurse interaction, job satisfaction, and turnover

Little research has focused on understanding interpersonal dynamics within a diverse nursing staff. This study investigated the impact of diversity on the interaction level among staff nurses, job satisfaction, nursing turnover, and the multicultural sensitivity of a diverse nursing staff in metropolitan Washington, DC. Data were collected from 194 registered nurses with 2 standardized instruments--the Workforce Diversity Questionnaire-II by Larkey and the Multicultural Sensitivity Scale Questionnaire by Jibaja-Rusth and others. One-way analyses of variance and correlation coefficient were used for data analysis. The findings showed that nurses who were satisfied with their current job were more likely to value differences and build trusting relationships. Nurses with higher educational levels appeared to be more open and involved with other cultural groups and were more likely to build more trusting relationships with other cultural groups. Multicultural sensitivity was related to cultural group inclusion/exclusion, valuing differences, and adaptation; however, multicultural sensitivity and trust were not related. Delivery of cost-effective, quality nursing care in the 21st century demands that the positive potential of cultural diversity in the nursing workforce be more fully understood through research such as this. More research on diversity is needed during these challenging times for the nursing profession.

"A wealth of knowledge": A survey of the employment experiences of older nurses and midwives in the NHS

BACKGROUND

The United Kingdom's National Health Service workforce is ageing, and the specific needs of this sector of its workforce need to be addressed. Nursing and midwifery shortage is a worldwide issue, and with increasing demands for care the retention of older nurses and midwives is crucial.

OBJECTIVES

To report on the employment experiences of nurses and midwives with a particular focus on issues relating to age, ethnicity, ill-health and disability.

DESIGN

The postal survey was developed following a literature review and analysis of National Health Service and Government policy documents.

SETTINGS

This was a UK-wide survey of nurses and midwives working in National Health Service Trusts and Primary Care Trusts.

PARTICIPANTS/METHODS

A postal survey of nurses and midwives was undertaken between May and December 2005. National Health Service Trusts and Primary Care Trusts (n=44) identified as having policies relevant to the study were contacted regarding the procedure for seeking research governance approval. Thirteen National Health Service Trusts and Primary Care Trusts participated, with 2610 surveys distributed; 510 surveys were returned (20% response rate).

RESULTS

Nurses and midwives aged 50 years and over had undertaken fewer Continuing Professional Development activities than nurses and midwives under 50. Whilst not related to age, the study also found that 20% of the survey sample reported experiencing some form of discrimination. Nurses and midwives did not differ on either quality of life or psychological health using standard instruments. Having a disability did not lead to greater psychological morbidity but did have a negative effect on quality of life. Having a work-related illness had a negative impact on both quality of life and psychological morbidity. In relation to ethnicity, black nurses and midwives reported lower psychological morbidity than other ethnic groups; that is, they enjoyed a higher level of mental well-being.

CONCLUSION

The nursing and midwifery workforce is ageing worldwide with a significant proportion now approaching, or having already reached, potential retirement age. With the recent introduction of the age legislation the working lives of older nurses and midwives in the National Health Service have never been more relevant. Whilst access to Continuing Professional Development is pertinent to the retention of nurses and midwives of all ages, in this study, older nurses reported less access than younger nurses.

Does self-care agency change between hospital admission and discharge? An Orem-based investigation

AIMS

To assess whether nursing care improved patients' self-care agency between admission to hospital care and discharge.

METHODS

A pre-test-post-test comparative research design with random subject selection was used. One hundred and sixty patients and 52 nurses rated identical self-care agency assessment forms, based on Orem's framework, both at admission and discharge. Patient satisfaction with nursing care and nurse satisfaction with working conditions were also assessed. Repeated measures ancova as well as paired and independent t-tests were used to test differences at both time points. Level of significance was set at 0.05 in this study.

RESULTS

Patients in general reported high self-care agency pre- and post-test. Compared with a reference group of elderly residents, the study sample showed significantly lower levels of self-care agency. We found no difference between patient and nurse assessments of self-care agency on admission and discharge. Better patient-nurse relationships were associated with greater self-care agency reported by patients.

CONCLUSIONS

Authors found no change in patient self-care agency between hospital admission and discharge. Outcomes may have been due to the inappropriate choice of the conceptual framework applied for acute care settings or to the insufficient length of the study. A longitudinal approach to observe long-term improvement of self-care capabilities is recommended.

Workplace and personal factors associated with physical and mental health in hospital nurses in China

Limited research exists on the workplace and personal factors that might be associated with the physical and mental health of nurses working in China. Therefore, the purposes of this study were to examine, in Chinese hospital nurses, the most frequently occurring workplace stressor, the most often used coping strategy, and the relationships that exist among workplace stressors, coping strategies, psychological hardiness, demographic characteristics, and physical and mental health. Four-hundred-and-eighty hospital nurses from five hospitals in three major Chinese cities were administered five self-report questionnaires. The findings indicated the most frequently cited workplace stressor was workload, while the most commonly used coping strategy was positive reappraisal. Numerous positive and negative correlations were found, suggesting the importance that workplace stress, coping strategies, psychological hardiness, and demographic characteristics play in relationship to each other, as well as to both the physical and mental health of Chinese nurses.

Fatores associados à depressão relacionada ao trabalho de enfermagem

A depressão, problema enfrentado pelos profissionais de enfermagem, pode acarretar absenteísmo no trabalho. Este estudo teve por objetivo identificar evidências científicas sobre a ocorrência de depressão relacionada ao trabalho de enfermagem e caracterizar fatores desencadeantes e estratégias utilizadas para a prevenção da doença. Revisamos a literatura por meio de levantamento das pesquisas publicadas entre 1995-2005, em revistas indexadas nas bases nacionais e internacionais. Constatou-se que a saúde mental desses profissionais pode ser influenciada por fatores internos e externos ao trabalho. As estratégias propostas enfatizam o suporte administrativo, o relacionamento interpessoal e a divisão adequada do trabalho entre um número suficiente de profissionais. Estas estratégias devem estar apoiadas no gerenciamento da depressão, na redução do estresse laboral e na implantação de programas de atenção a Saúde do Trabalhador. Os resultados obtidos contribuem para com o avanço do conhecimento científico e como incentivo para a realização de novas pesquisas.

United States operating room nurses: work environment perceptions

Concerns about pending retirement of nurses working in the operating room (OR) are undeniable. The nurses' work environment and level of perceived support is part of the equation of why a nurse may choose to retire or stay in the workforce. This study compares nurses' perceptions of the work environment between OR nurses and nurses who work in other type units; and compares the work environment perceptions of OR nurses between institutions of two sizes (<300 beds and >300 beds). Findings include: OR nurses have better perceptions of their work environment than nurses in other type units and OR nurses in smaller hospitals are more satisfied with their work environment, workload and perceptions of organisational support. Implications for OR work environments are discussed.

Occupational stress, job satisfaction, and working environment among Icelandic nurses: a cross-sectional questionnaire survey

BACKGROUND

Nurses' occupational stress decreases job satisfaction, increases turnover rate, and reduces nursing quality. At different workplaces nurses are confronted with different work tasks, working conditions and hence different sources of stress.

OBJECTIVES

The purpose of this study was to explore what factors contribute to work-related stress among Icelandic nurses working within and outside the hospital environment.

DESIGN

The study used a cross-sectional survey design.

SETTINGS AND PARTICIPANTS

The study population was composed of all working nurses registered at the Icelandic Nurses' Association (INA). Approximately 95% (N=2,234) of Icelandic nurses are members of the INA. Questionnaires were posted to 522 (23.4%) randomly selected participants. The response rate was 42% (N=219), representing 9.8% of the population. Data was analyzed from 206 nurses; 35% worked outside the hospital setting and 65% were hospital based.

METHODS

Data was gathered on demographic information and indicators of working conditions, occupational stress, workload, and job satisfaction. A stepwise, multiple linear regression model was employed to calculate significant predictors of occupational stress.

RESULTS

The findings suggest that the strenuous conditions of Icelandic nurses are felt more severely among hospital nurses than among nurses working outside hospital settings. The study identified which sources of occupational stress are specific to each of the two groups.

CONCLUSIONS

The study found several factors that contribute to work-related stress. These findings can be used to guide preventive measures to diminish occupational stress among Icelandic nurses.

Cross-cultural comparison of workplace stressors, ways of coping and demographic characteristics as predictors of physical and mental health among hospital nurses in Japan, Thailand, South Korea and the USA (Hawaii)

In an attempt to cross-culturally compare factors that may contribute to the nursing shortage within countries that have produced a limited number of research findings on role stress in nurses, this research examined work stressors, ways of coping and demographic characteristics as predictors of physical and mental health among hospital nurses from Japan, South Korea, Thailand and the USA (Hawaii). Subjects (n = 1554 hospital-based nurses) were administered four self-report questionnaires: Demographic Questionnaire, "Nursing Stress Scale", "Ways of Coping Questionnaire" and "SF-36 Health Survey". Findings suggested that nurses indicated similar workplace stressors, ways of coping, and levels of physical and mental health. While subjects, across countries, demonstrated a variety of predictors of physical and mental health, several predictors were found to be the same. Cross-culturally the role of nurses may vary; however, certain factors are predictive of the status of hospital nurses' physical health and mental health.