Resources-tasks imbalance: Experiences of nurses from factors influencing workload to increase

Exploring nurses' experiences of recommended patient care: a descriptive phenomenological study

BACKGROUND

Caring for recommended patients creates work and emotional challenges for nurses. Nurses are obligated to provide care regardless of the patient's situation. Therefore, knowing the experiences of nurses in dealing with recommended patients in order to provide quality and effective care can be the basis for increasing patient satisfaction. The present study was conducted aimed to explain nurses' experiences of caring for recommended patients.

METHODS

This was a qualitative study with descriptive phenomenological approach. Participants were 12 nurses working in different wards of hospitals affiliated to Kermanshah University of Medical Sciences, selected by purposive sampling method with maximum diversity. The data collected using semi-structured interviews in face-to-face and audio-recorded methods. MAXQDA 2020 software was used for data management. The analysis of the data was done using the Colaizzi's 7-step method. In order to verify the trustworthiness of the data, Lincoln and Guba criteria were used.

RESULTS

After continuous data analysis, 110 initial codes were extracted. These codes emerged in 18 sub-themes and 6 main themes including: catastrophe, be in decline, be in progress, discrimination, work overload, and poor prognosis.

CONCLUSIONS

The results showed information about the presence of recommended patients in the hospital, which can have consequences for patients and nurses. Therefore, it is advised that nurses provide standard care and avoid any kind of discrimination against all patients regardless of whether the patient is recommended or not.

How do compulsory citizenship behaviors affect moral disengagement in organizations? Significance of anger toward the organization during the COVID-19 pandemic

Background

With the COVID-19 pandemic, healthcare professionals, especially nurses, are confronted with an intensified workload. The literature on compulsory citizenship behaviors and their consequences is still far from explaining the cognitive and emotional mechanisms that underlie this relationship.

Methods

Drawing on the resource depletion theory, we unpack the mechanism by which compulsory citizenship behaviors influence moral disengagement with the mediation effects of anger toward the organization. We are reporting a cross-sectional survey of nurses (n = 294) in private and public hospitals in Istanbul, Turkey. The data analysis involved structural equation modeling and Bayesian mediation.

Results

The study revealed that compulsory citizenship behaviors positively influenced anger toward the organization and moral disengagement. Further, anger toward the organization mediates the link between compulsory citizenship behaviors and moral disengagement. Likewise, the Bayesian mediation analysis indicated that the proportion mediated (PM), which ensures a prediction of the extent to which the pathway explains the total effect through the mediation effect, was 33.74%.

Conclusion

The findings show that exposure to compulsory citizenship behaviors lead to negative emotional (anger toward to organization) and cognitive (moral disengagement) consequences in nurses.

Practical implications

Hospital managers should not force nurses to display discretionary work tasks outside their job descriptions. Providing an organizational milieu where voluntarily extra-role behaviors are encouraged may help reduce nurses' moral disengagement and, in turn, ease their anger toward the organization.

Nurses' role in addressing social determinants of health

ABSTRACT

Nurses have a vital role in addressing social and health inequities to promote quality healthcare for all. This article discusses the tools to screen for social determinants of health (SDOH) and key considerations for nurses and nurse leaders to advance the integration of SDOH information into their workflows.

JOB ROTATION APPROACH AMONG NURSES: A COMPARATIVE STUDY

ABSTRACT Objectives: to compare the perceived levels of job rotation, job satisfaction, and job conflict between two groups of nurses in Jordan, and to explore the differences between them. Moreover, several demographic factors were examined to investigate their association with job rotation approach in nurses who previously had job rotation experience. Method: a cross-sectional design with a total of 244 nurses: 122 nurses had experienced job rotation while 122 nurses never had experienced job rotation. The study was examined between January and February in the year of 2020. Job rotation scale, job satisfaction scale, and job conflict scale were used to assess the three variables. Independent t-test and one-way analysis of variance test were used to analyze significant differences between both selected groups. Results: statistical analysis indicated that nurses who underwent job rotation had significantly higher perceived levels of job rotation, job satisfaction, and lower level of job conflict compared to other nurses who did not experience job rotation. Moreover, gender, experience, and educational level were significantly associated with the perceived level of job rotation among nurses who had job rotation experience in Jordan. Job rotation was not found to be associated with marital status. Conclusions: job rotation approach is necessary to improve job satisfaction and reduce job conflict. Nursing directors should cooperate to apply nurses’ rotation approach at hospitals in order to increase job satisfaction and decrease the level of job conflict.

Development and Implementation of an Inpatient CAMEO© Staffing Algorithm to Inform Nurse- Patient Assignments in a Pediatric Cardiac Inpatient Unit

BACKGROUND

Nursing workload measurement systems are vital to determine nurse staffing for safe care. The Inpatient Complexity and Assessment and Monitoring to Ensure Optimal Outcomes (CAMEO©) acuity tool provides a standardized language to communicate the acuity and complexity of nursing care in the pediatric inpatient setting.

DESIGN AND METHODS

A process improvement project was implemented on a pediatric cardiac inpatient unit to utilize the Inpatient CAMEO© tool to inform nurse-patient assignments. Development of the Inpatient CAMEO© Staffing Algorithm utilized a modified Delphi methodology. Six Delphi rounds were performed for algorithm development, addressing potential implementation barriers, educating nursing staff, piloting feasibility, and final full implementation.

RESULTS

The cardiac inpatient unit's charge nurses' algorithm utilization was 86% (n = 12) during the feasibility pilot. The algorithm impacted and changed 28% (n = 4) of the shifts' assignments. One-year post algorithm implementation, CAMEO© documentation rates increased from 25 to 30% to >60%. A retrospective, two-week point-prevalence analysis one-year post-implementation described adherence to the Inpatient CAMEO© Staffing Algorithm for 87% (n = 375) of the nurses' patient assignments.

CONCLUSIONS

The Inpatient CAMEO© Staffing Algorithm was developed based upon the Inpatient CAMEO© tool and the Inpatient CAMEO© Complexity Classification System to inform nurse-patient assignments and allocate nursing resources. The Inpatient CAMEO© Staffing Algorithm was feasible and sustainable for over one year following implementation at a single center's pediatric cardiac inpatient unit.

Development of a conceptual framework for a Person-centred Nurse Residency Programme

Newly Qualified Professional Nurses (NQPNs) require support while transitioning from student to professional nurse. Nurse residency programmes guided by competent facilitators provide such support. We developed a conceptual framework for a Person-centred Nurse Residency Programme. This qualitative interpretive descriptive study was conducted in three phases. In phase 1, we assessed the support needs of purposively selected NQPNs as well as senior professional nurses. Data were collected using multiple methods and analysed during a consensus workshop held in Phase 2. In Phase 3, we developed a conceptual framework which was validated by six nurse education experts. The final framework comprised of four domains: learning outcomes, learning processes, learning environment, prerequisites of the facilitator, and was underpinned by the educational theories of constructivism and person-centeredness. Advocates of nurse residency programmes should recognise that these domains are interrelated and aim to achieve person-centred support for NQPNs.

Pragmatic Management of Drug-Resistant Tuberculosis: A Qualitative Analysis of Human Resource Constraints in a Resource-Limited Country context-Ethiopia

Objectives: Existing evidence suggests that drug-resistant tuberculosis (DR-TB) remains a huge public health threat in high-burden TB countries such as Ethiopia. The purpose of this qualitative study was to explore the challenges of healthcare workers (HCWs) involved in providing DR-TB care in Addis Ababa, Ethiopia.

Methods: We conducted in-depth interviews with 18 HCWs purposively selected from 10 healthcare facilities in Addis Ababa, Ethiopia. We then transcribed the audiotaped interviews, and thematically analysed the transcripts using Braun and Clark’s reflexive thematic analysis framework.

Results: We identified five major themes: 1) inadequate training and provision of information on DR-TB to HCWs assigned to work in DR-TB services, 2) fear of DR-TB infection, 3) risk of contracting DR-TB, 4) a heavy workload, and 5) resource limitations.

Conclusion: Our findings highlight major human resource constraints that current DR-TB care policies need to foresee and accommodate. New evidence and best practices on what works in DR-TB care in such resource-limited countries are needed in order to address implementation gaps and to meet global TB strategies.

Health care staff support for mothers in NICU: a focused ethnography study

BACKGROUND

Mothers of premature newborns in the neonatal intensive care unit (NICU) have complex needs and require a significant amount of support during the NICU admission. However, little is known about mothers' support needs in the NICU. This study aimed to explore health care staff and mothers' experiences of meeting the mothers support needs in the NICU. This study aimed to explore health care staff and mothers' experiences of meeting the mothers' support needs in the NICU.

METHODS

A focused ethnographic approach was adopted. Observations and interviews with 21 mothers, 18 nurses, and five physicians were undertaken over a seven months period. Qualitative data analysis was conducted using the Roper and Shapira (2000) five-step framework.

RESULT

Two main themes of "insufficient provision of the mothers' support needs" (subthemes: inadequate accompany of the mothers in care, assigning monitoring and care to the mothers, inadequate sharing of medical the information) and "supporting the mothers in certain circumstances" (subthemes: reassuring the mothers, supporting the mothers with reduced functional capacity, providing information) were obtained.

CONCLUSION

The mothers experienced a gap between expected and actual support provided by health care staff. Although, the health care staff believed that mothers' support was a necessity, it was not their main concerns, and they considered workload as a barrier for the mothers support in the NICU.

Exploring the relation between modelled and perceived workload of nurses and related job demands, job resources and personal resources; a longitudinal study

Aim

Calculating a modelled workload based on objective measures. Exploring the relation between this modelled workload and workload as perceived by nurses, including the effects of specific job demands, job resources and personal resources on the relation.

Design

Academic hospital in the Netherlands. Six surgical wards, capacity 15–30 beds. Data collected over 15 consecutive day shifts.

Methods

Modelled workload is calculated as a ratio of required care time, based on patient characteristics, baseline care time and time for non-patient related activities, and allocated care time, based on the amount of available nurses. Both required and allocated care time are corrected for nurse proficiency. Five dimensions of perceived workload were determined by questionnaires. Both the modelled and the perceived workloads were measured on a daily basis. Linear mixed effects models study the longitudinal relation between this modelled and workload as perceived by nurses and the effects of personal resources, job resources and job demands. ANOVA and post-hoc tests were used to identify differences in modelled workload between wards.

Results

Modelled workload varies roughly between 70 and 170%. Significant differences in modelled workload between wards were found but confidence intervals were wide. Modelled workload is positively associated with all five perceived workload measures (work pace, amount of work, mental load, emotional load, physical load). In addition to modelled workload, the job resource support of colleagues and job demands time spent on direct patient care and time spent on registration had the biggest significant effects on perceived workload.

Conclusions

The modelled workload does not exactly predict perceived workload, however there is a correlation between the two. The modelled workload can be used to detect differences in workload between wards, which may be useful in distributing workload more evenly in order prevent issues of over- and understaffing and organizational justice. Extra effort to promote team work is likely to have a positive effect on perceived workload. Nurse management can stimulate team cohesion, especially when workload is high. Registered nurses perceive a higher workload than other nurses. When the proportion of direct patient care in a workday is higher, the perceived workload is also higher. Further research is recommended. The findings of this research can help nursing management in allocating resources and directing their attention to the most relevant factors for balancing workload.

Understanding workforce experiences in the early career period of Australian midwives: insights into factors which strengthen job satisfaction

OBJECTIVE

The aim of this study was to explore the experiences of early career midwives in Australia and identify the organisational, work environment, personal factors and stressors that influence workforce participation.

DESIGN AND SETTING

A qualitative study, using in-depth semi-structured interviews, was undertaken with midwives 6 - 7 years post-qualification. Qualitative content analysis identified key themes and sub-themes.

PARTICIPANTS

Twenty-eight midwives from one Australian university (graduating years 2007 and 2008) were included. Their pre-registration education was via either a Bachelor of Midwifery (direct-entry) or a Gradate Diploma of Midwifery (post-nursing degree).

FINDINGS

Three themes were generated: (i) 'sinking and swimming'; (ii) 'needing a supportive helping hand'; and (iii) 'being a midwife … but'. The initial transition into midwifery was overwhelming for most participants, particularly when providing intrapartum care. Job satisfaction was strongly related to having a well-developed midwife-woman relationship in clinical care and being able to work to their full scope of practice. Dissatisfaction stemmed from remuneration concerns, inflexibility of rostering, high workloads, and poor managerial approaches. Experiences of bullying were ubiquitous. Factors inducing midwives to stay in their profession were not the absence of those that caused dissatisfaction. The midwife-woman relationship sustained their practice despite those factors that caused dissatisfaction.

KEY CONCLUSIONS

Building strategies that strengthen job satisfaction in midwives is vital. Strategies that provide relational aspects of midwifery practice, ongoing support, rostering flexibility, induce psychological wellbeing, and address workplace bullying, may assist in the early career transition. Access to continuity of midwifery care models as new graduates is warranted.

IMPLICATIONS FOR PRACTICE

Continued professional development and career progression strategies are needed for midwives to cultivate their midwifery skills and work to their potential.

Satisfação no trabalho do pessoal de enfermagem na rede pública de saúde em uma capital brasileira

Resumo Evidências confirmam que a satisfação no trabalho percebida pelo pessoal da enfermagem está associada a indicadores de bem-estar dos profissionais e qualidade dos serviços prestados. O objetivo do estudo transversal foi investigar fatores associados com o relato de satisfação no trabalho. A satisfação no trabalho foi avaliada com base na pergunta já validada: “Você está satisfeito com o seu trabalho?”. A amostragem aleatória estratificada e proporcional incluiu enfermeiros, auxiliares e técnicos de enfermagem da rede municipal. O modelo multivariado foi baseado na técnica de regressão de Poisson com variâncias robustas para a estimação dos fatores independentemente associados com a satisfação no trabalho. Participaram 290 sujeitos: 73,8% relataram satisfação com o trabalho. Idade, contar com forte apoio social e melhores condições de trabalho foram positivamente associadas com satisfação. A triagem positiva para transtornos mentais comuns foi negativamente associada com satisfação. O destaque para o ambiente de trabalho e tipo de gestão indica a relevância desses fatores para o fortalecimento dos recursos humanos em saúde.

Influence of new hire transition workload on insomnia in nurses

AIMS

In this study, we investigated the relationship of the prevalence and incidence of insomnia with the new hire transition workload in nurses.

METHODS

This retrospective study used the clinical diagnosis data of the entire nursing population in Taiwan for 2005 to 2008, drawn from the National Health Insurance Research Database. Adjusted logistic regression and Cox regression models were used to separately analyse factors related to the prevalence and incidence of insomnia.

RESULTS

During this period, the prevalence of insomnia increased, whereas its incidence remained stable. After adjustment for demographic variables in the logistic regression models, the higher prevalence of insomnia was associated with a longer employment duration and a higher new hire ratio. In the Cox regression models, a higher incidence of insomnia was associated with a shorter employment duration and a higher new hire ratio. Nurses with a longer employment duration had a higher prevalence, but lower incidence, of insomnia. A higher new hire ratio was associated with a higher prevalence and incidence of insomnia.

CONCLUSION

To mitigate the risk of insomnia, we suggest that additional support should be provided to non-new nurses to assist them in the new hire transition.