Impact of nursing unit turnover on patient outcomes in hospitals

Effects of Consensus on Leader-Member Exchange (LMX) Within Nursing Teams on the Relationship Between Abusive Supervision, Job Satisfaction, and Unit Turnover: A Multilevel Moderation Study

Aim: This study explores how consensus on leader-member exchange (LMX)-the degree of within-unit agreement regarding the LMX nurse leaders establish with each team member-moderates the effects of abusive supervision on job satisfaction and internal turnover intentions. Method: Involving a sample of 1357 nurses nested into 130 groups (led by as many nurse leaders), cross-level moderations were tested. Results: Results show that, on one hand, LMX consensus acts as a resource when it is stronger, dampening the effect of abusive supervision on job satisfaction. On the other hand, nurses with higher job satisfaction belonging to groups with higher LMX consensus report higher intentions to change wards than nurses in groups with lower LMX consensus. The discussion addresses the concept of "star employees," i.e., employees with better performance, visibility, and relevant social capital. Implications for Nursing Management: The discussion highlights the importance for nurse managers to consider both the quality of individual LMX and overall team consensus to enhance nurse well-being and reduce turnover intentions.

Applying the Human Factors Analysis and Classification System within root cause analysis to prevent medical errors and enhancing patient safety culture: insights from a medical center

INTRODUCTION

Enhancing patient safety and minimizing medical errors are crucial in healthcare. While root cause analysis (RCA) is commonly used to investigate adverse events, its lack of human factor integration limits its effectiveness. The Human Factors Analysis and Classification System (HFACS), adapted from aviation to healthcare, systematically identifies human and organizational factors. However, the integration of HFACS into RCA and the impact of HFACS-RCA implementation remain underexplored. Therefore, this study aims to provide a practical case of HFACS integration into RCA and explore the effects of HFACS-RCA implementation.

METHODS

This study integrates HFACS into the RCA process at a medical center in Taiwan, examining an incident involving unsterilized instruments distributed from the Central Sterile Supply Room (CSR) to the Intensive Care Unit (ICU). This study employed a before-and-after study design to examine the impact of the HFACS-RCA intervention. The primary outcome measures were the changes in scores across the eight dimensions of the Taiwan Patient Safety Culture Survey (TPSC) before and after the intervention.

RESULTS

A 1-year follow-up of the CSR case showed no similar incidents. HFACS-RCA significantly improved TPSC scores in unit safety climate (P = .05), feelings toward management (P = .05), and job satisfaction (P = 0.05), while the other dimensions showed no significant changes.

CONCLUSION

HFACS-RCA application offers a comprehensive framework for identifying and mitigating factors contributing to medical errors, improving patient safety, and setting a precedent for future healthcare safety management research and practice.

Association Between Nurse Turnover and Nurses' Perception of Patient Outcomes in Acute Care Hospitals in South Korea: A Cross-Sectional Study

BACKGROUND

High turnover rates among nurses are a global concern. Previous studies show the negative impact on quality of care.

PURPOSE

The purpose of this study was to examine the relationship between nurse turnover and nurse's perceptions of patient outcomes.

METHODS

A cross-sectional study design was used. Nurses working in 35 general hospitals in South Korea were invited to participate in a survey assessing their perceptions of patient outcomes, including quality of care, patient safety, and adverse events. Nurse turnover was measured for the prior 6 months.

RESULTS

Data from 159 nurses were analyzed. There was a significant positive relationship between turnover rates and perceptions of poor quality of care, after controlling for demographic and work-related characteristics. Nurse turnover was not significantly associated with perceptions of patient safety or adverse events.

CONCLUSIONS

The negative consequence of nurse turnover on patient outcomes is partially supported in this study.

The combined effect of bed-to-nurse ratio and nurse turnover rate on in-hospital mortality based on South Korean administrative data: a cross-sectional study

BACKGROUND AND AIM

Nurse staffing levels are associated with patient mortality, but little is known regarding the association between nurse turnover rate and patient mortality. This study investigated the combined effect of the bed-to-nurse ratio and the nurse turnover rate on in-hospital mortality in patients admitted to Korean acute care hospitals using national administrative data.

METHODS

This study analyzed data from the National Health Insurance Service (NHIS) on 459,113 admitted patients and 111,342 employed nurses in 403 hospitals in South Korea from January to December 2016. Differences in in-hospital mortality and nurse turnover among hospital characteristics, including the bed-to-nurse ratio, were explored using the chi-square test. Multilevel, multivariate GEE logistic regression analyses were used to examine the combined effect of the bed-to-nurse ratio and the nurse turnover rate on in-hospital mortality.

RESULTS

During the study period, 13,675 (3.0%) patients died during hospitalization, and 13,349 (12.0%) nurses left their jobs. The risk of death among patients admitted to hospitals with a bed-to-nurse ratio of < 2.5 and a nurse turnover rate of ≥ 12% was lower than among patients admitted to hospitals with a bed-to-nurse ratio of ≥ 4.5 and a nurse turnover rate of ≥ 12% (odds ratio [OR] = 0.63; 95% confidence interval [CI], 0.48-0.82). The risk of in-hospital mortality decreased further when the nurse turnover rate was < 12% (OR = 0.59; 95% CI, 0.44-0.79).

CONCLUSION

The bed-to-nurse ratio and nurse turnover rate were jointly associated with patient mortality. When hospitals with a low bed-to-nurse ratio also experienced high nurse turnover, the risk of in-hospital mortality was even greater. The finding of this study will help health policy makers to better understand the importance of both nursing staffing levels and nurse turnover rates. It is necessary to create a comprehensive improvement plan that integrates policies aiming to improve nurse staffing levels and reduce turnover rates into a single strategy.

Association between nurse turnover and missed nursing care in acute care hospitals in South Korea

Objectives

High nurse turnover during nursing shortages can contribute to missed nursing care. This study investigated the prevalence of missed nursing care and how nurse turnover affects missed nursing care.

Methods

A cross-sectional design was adopted to collect data from a convenience sample of nurses working in general hospitals in South Korea. Six-month turnover rates (0%, 1-14%, 15-22%, and 23-50%) and 24 missed nursing care activities were measured. A multivariate regression analysis was performed to examine the relationship between nurse turnover and missed nursing care, after controlling for nurse and work-related characteristics.

Results

The final sample was 264 nurses. The mean six-month turnover rate was 15.49%. Seven activities (turning patient every 2 h, attending interdisciplinary care conference, ambulation, patient bathing/skin care, emotional support, mouth care, full documentation) had a missed care prevalence of 30% or higher. Nurses in units with moderate turnover rates (15 and 22%) reported more missed nursing care than those in units with zero turnover.

Conclusion

Nurse turnover increases missed nursing care, highlighting the adverse effects of nurse turnover on care processes. Consequently, hospitals and governments should implement policy changes and strategies to prevent nurse turnover.

Mental health of midwives during the COVID-19 pandemic: A scoping review

AIM

A summary of studies focusing on the mental health of midwives during the COVID-19 pandemic has not yet been conducted. This review aims to comprehensively understand the current state of midwives' mental health in the context of the COVID-19 pandemic and to provide valuable insights to guide future research.

METHODS

This study was based on a framework for conducting scoping reviews. The protocol was registered before conducting this review and procedures were carried out according to that protocol. Article searches were conducted in four databases from December 2019 to December 2023. From 921 articles selected according to pre-registered protocol criteria, the analysis finally included 14 studies.

RESULTS

A total of 13 studies were cross-sectional and one was longitudinal, with pre-pandemic data. More than 80% of the studies began data collection within approximately 1 year after the pandemic was declared by the World Health Organization (by February 2021). Half of the studies were conducted in Asia. Burnout and turnover intentions were investigated in several studies but used different measures. Only two studies were aimed at positive aspects such as job satisfaction and well-being.

CONCLUSIONS

Most research on midwives' mental health during the COVID-19 pandemic has focused on negative aspects such as burnout and turnover intentions. However, most results were cross-sectional, with studies in the early stages of the pandemic, so continued follow-up is needed.

Measuring Nurses' Organizational Well-Being: A Systematic Review of Available Instruments

This systematic review aimed to identify and compare instruments measuring nurses' organizational well-being, summarise the dimensions measured by these instruments, the statistical analysis performed for validity evidence and identify an instrument that comprehensively investigates nurses' organizational well-being. The JBI Manual for Evidence Synthesis and the PRISMA checklist were used as guidelines. The search was conducted on Medline, CINAHL, Cochrane Library and Scopus. Critical appraisal and data extraction were drawn on the COSMIN checklist. Dimensions were conceptually synthesized by the measurement concepts' similarity. Twenty-two articles were retrieved and they included 21 instruments that measured nurses' organizational well-being. The instruments vary by dimension number (range 2-19), items (range 12-118) and concept elicitation. A plurality of methodologies has been used in instrument development and assessments of evidence for validity. Only four instruments reported a concurrent criterion validity or a measurement comparison with an already tested-for-validity instrument. Similar dimensions were leadership and support, relationships and communication, work-family balance, work demands, violence, control and autonomy, satisfaction and motivation, work environment and resources, careers, and organizational policy. This review underlines the core areas of the instruments that measure nursing organizational well-being. It allows administrators and researchers to choose the appropriate instruments for monitoring this multidimensional concept.

New insights on a recurring theme: A secondary analysis of nurse turnover using the National Sample Survey of Registered Nurses

BACKGROUND

Registered nurse (RN) turnover is a recurring phenomenon that accelerated during COVID-19 and heightened concerns about contributing factors.

PURPOSE

Provide baseline RN turnover data to which pandemic and future RN workforce turnover behaviors can be compared.

METHODS

A cross-sectional, secondary analysis of RN turnover using U.S. National Sample Survey of Registered Nurses 2018 data. Responses from 41,428 RNs (weighted N = 3,092,991) across the United States were analyzed. Sociodemographic, professional, employment, and economic data and weighting techniques were used to model prepandemic RN turnover behaviors.

DISCUSSION

About 17% of the sample reported a job turnover, with 6.2% reporting internal and 10.8% reporting external turnover. The factors common across both internal and external turnover experiences included education, employment settings, and years of nursing experience.

CONCLUSIONS

Baseline RN turnover data can help employers and policymakers understand new and recurring nursing workforce trends and develop targeted actions to reduce nurse turnover.

Mediating effects of workgroup processes on the relationship between nurse turnover and nurse outcomes in hospitals

Background

Nurse turnover is often considered to be an outcome, and few studies have investigated its consequences in nursing care. The underlying mechanism of the nurse turnover-nurse outcome relationship has not been empirically investigated. Therefore, this study examines workgroup processes and nurse outcomes as the consequences of nurse turnover and the mediating effect of workgroup processes on the nurse turnover-nurse outcomes relationship.

Methods

A cross-sectional design was adopted to investigate the data collected from 264 staff nurses. Furthermore, six-month turnover rates, workgroup processes (nurse-nurse collaboration, team cohesion), and nurse outcomes (job satisfaction, intent to leave) were utilized in the multivariate regression models.

Results

Overall, 53 (24.4%) nurses had worked in nursing units with a zero six-month turnover rate. The average mean six-month turnover rate was 15.5%. Nurse turnover adversely affected nurses' job satisfaction and several subscales of team cohesion including task cohesion and social cohesion. Team cohesion partially mediated the relationship between nurse turnover and job satisfaction.

Conclusion

Nurse turnover decreased job satisfaction and team cohesion, and team cohesion partially mediated the nurse turnover-nurse outcomes relationship. These findings provide evidence supporting the significant adverse effects of nurse turnover and suggest the potential role of workgroup processes in explaining the underlying mechanism of the relationship between nurse turnover and nurse outcomes.

Implications for nursing and health policy

Healthcare organizations must create a positive work environment to reduce nurse turnover. Further, states and countries should try to develop and establish nursing and health policies to prevent turnover.

Determining the Role of Employee Engagement in Nurse Retention along with the Mediation of Organizational Culture

In today's unpredictable environment, the rapid emergence of the COVID-19 pandemic has shaken the world and its healthcare infrastructure immensely. As nurses are the building blocks of the healthcare personnel labor market, organizations should develop tactics that aid in their retention. With a solid theoretical foundation in self-determination theory, this study aims to understand the role of employee engagement in keeping nurses in 51 hospitals in the Northern Indian region, along with the mediation of organizational culture through smart PLS. In a complementary mediation relationship with organizational culture, nurse retention is positively correlated with employee engagement.

Global prevalence of turnover intention among intensive care nurses: A meta-analysis

BACKGROUND

Nurse turnover is considered a major cause of nurse shortage, representing problems for health care systems in terms of both quality and cost of care for patients, and intention to leave is the strongest practical predictor variable of actual turnover.

AIM

This systematic review and meta-analysis aims at exploring the global prevalence of turnover intention in intensive care nurses.

DESIGN

This was a systematic literature review.

METHODS

A systematic review of empirical quantitative studies on turnover intention in nurses of intensive care units (ICUs), published in English till March 2021, was conducted. The databases PubMed, Embase, ISI Web of Knowledge, and CINAHL were searched. Eligible studies were observational or descriptive studies that reported the prevalence of turnover intention among nurses in all types of ICUs. The quality of studies was assessed using a modified Newcastle-Ottawa Scale. A random effect meta-analysis was conducted to estimate the pooled prevalence of turnover intention among ICU nurses.

RESULTS

We identified 18 cross-sectional studies investigating a total of 23 140 intensive care nurses from 23 countries. The intention to leave rate was ranged from 3.0% to 75.0%. The pooled prevalence of turnover intention was 27.7% (95% confidence interval: 21.6%-34.3%).

CONCLUSIONS

This meta-analysis showed that more than 27% of the intensive care nurses had the intention to leave worldwide. In the current context of nursing shortage, efforts should be made to improve conditions for this important group of care providers.

RELEVANCE TO CLINICAL PRACTICE

The prevalence of turnover intention is relatively high among intensive care nurses. Nurse managers should take this intention seriously, as the intention to leave may lead to an actual decision to leave the profession.

The mediating role of nurse-physician collaboration in the effect of organizational commitment on turnover intention

Despite extensive research having been carried out on nurse-physician collaboration, there remains a paucity of evidence on how collaboration interacts with organizational commitment and its effect on turnover intention. This study aims to determine the mediating role of nurse-physician collaboration on the effect of organizational commitment on turnover intention. We used a cross-sectional design based on voluntary paper surveys from the inpatient clinics of six public hospitals in the north of Turkey. Data including measures of nurse-physician collaboration, organizational commitment, and turnover intention were collected from a convenience sample of the nurses (n = 212) and physicians (n = 109). Pearson's correlation analysis was used to determine the relationships between variables, and the mediating effect was analyzed with PROCESS Macro "Model 4" for IBM SPSS. Statistical significance was specified at 95% confidence intervals and two-tailed P values of <0.05 for all tests. While most of the participants were nurses (66%), 34% were physicians. For both nurses and physicians, organizational commitment and nurse-physician collaboration negatively affected the turnover intention. However, the mediating role of nurse-physician collaboration was only significant for nurses (b = -0.025). The results demonstrate the importance of harmony, joint decision-making, and responsibility-sharing between nurses and physicians concerning dedication, engagement, and job satisfaction, especially for nurses.

Relational coordination and staff outcomes among healthcare professionals: a scoping review

Relational coordination (RC) is a process of coordinating work between professionals that can be used as a framework to enhance interprofessional collaborative practice (IPCP) in various healthcare settings. RC encompasses four communication dimensions (frequent, timely, accurate, problem-solving) and three relational dimensions (shared knowledge, shared goals, mutual respect). RC has been associated with better staff and patient outcomes; it has wide applicability, and it has been examined nationally and internationally in various healthcare settings. The aim of this scoping review is to identify and synthesize available evidence on RC and staff outcomes among healthcare professionals. Literature searches were conducted on articles published between May 2000 until February 2020. Sixteen abstracts were screened from four databases (PubMed, Psych Info, CINAHL, and Scopus). Eleven empirical studies fulfilled the inclusion criteria. Articles were excluded if they did not measure RC and staff outcomes. RC was reported as positively associated with higher job satisfaction, better work engagement, lower burnout, lower turnover, and reciprocal learning among healthcare professionals. Literature on this topic is scarce, despite RC being a promising framework for healthcare professionals in various disciplines to enhance IPCP and improve staff outcomes across healthcare settings.

Perceived Impact of Nurse Turnover on the Organization: A Delphi study on Managers of nursing

AIMS

To identify the aspects and items of nurse turnover impact on organizations as perceived by nursing management.

BACKGROUND

Turnover rate does not capture the extent to which an organization is affected by turnover. Another indicator is required to assess the control status of turnover impact.

METHODS

A Delphi study was conducted in 2021, where 2,670 managers of nursing at 712 hospitals were asked to complete three surveys. Factor analysis was conducted on these items for which a consensus was reached.

RESULTS

Overall, 232 managers who responded multiple times, including the third survey, were included in the analysis. Consensus was reached for 36 items affected by turnover and considered important for nursing management. Using exploratory factor analysis, the following six factors were extracted: quality of nursing care, physical and mental health of nursing staff, workload and working conditions of nursing staff, relationships among nursing staff members, sense of responsibility among nursing staff, and cost and benefit of hiring replacement personnel.

CONCLUSIONS

Six aspects consisting of 36 items were extracted. These aspects can be used to assess the impact of nurse turnover.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers can assess the status of the organization more appropriately by understanding these aspects.

A qualitative descriptive study of the COVID-19 pandemic: Impacts on nursing care delivery in the critical care work system

The COVID-19 pandemic drastically changed the delivery of nursing care in U.S. critical care settings. The purpose of this study was to describe nurses' perceptions of the critical care work system during the COVID-19 pandemic in the U.S. We conducted interviews with experienced critical care nurses who worked during the pandemic and analyzed these data using deductive content analysis framed by the Systems Engineering Initiative for Patient Safety (SEIPS) 2.0 model. Concepts include the critical care work system structures, nursing care processes, outcomes, and adaptations during the pandemic. Our findings revealed a description of the critical care work system framed by the SEIPS 2.0 model. We suggest how human factors engineers can utilize a human factors and engineering approach to maximize the adaptations critical care nurses made to their work system during the pandemic.

Noneconomic and economic impacts of nurse turnover in hospitals: A systematic review

AIM

To examine and synthesize the noneconomic and economic impacts of nurse turnover in acute hospitals.

BACKGROUND

Nurse turnover occurs when nurses leave their jobs or the profession and is a major concern for the healthcare industry. Many studies have investigated the determinants of nurse turnover.

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was utilized in the current review. Article search was conducted in June 2021. Research articles published since January 2000 were included. Eight databases (e.g., CINAHL, PubMed, PsycINFO, and Web of Science) were used. The following eligibility criteria were applied for inclusion: Articles that (1) were nonexperimental quantitative studies, (2) examined the impact of actual nurse turnover in acute hospitals, (3) were a peer-reviewed original research article, and (4) were written in English or Korean.

RESULTS

Among 9,041 searched articles, 16 were included in the review. Seven studies investigated the association of nurse turnover with processes and outcomes (workgroup processes, nurse staffing, nurse outcomes, and patient outcomes), and partially supported the negative impact of turnover. Nine studies found that nurse turnover is very costly.

CONCLUSION

Most studies investigated the turnover cost, which is costly. The negative noneconomic impact of nurse turnover was partially supported.

IMPLICATIONS FOR NURSING PRACTICE AND NURSING POLICY

To prevent the adverse noneconomic and economic impacts of nurse turnover and retain nurses, healthcare organizations, nurse managers, and hospital staff nurses need to develop and implement prevention strategies and policies to address nurse turnover. Efforts to address nurse turnover can increase hospital competency to improve the quality of nursing care services and patient safety.

Moral distress interventions: An integrative literature review

Moral distress has been well reviewed in the literature with established deleterious side effects for all healthcare professionals, including nurses, physicians, and others. Yet, little is known about the quality and effectiveness of interventions directed to address moral distress. The aim of this integrative review is to analyze published intervention studies to determine their efficacy and applicability across hospital settings. Of the initial 1373 articles discovered in October 2020, 18 were appraised as relevant, with 1 study added by hand search and 2 after a repeated search was completed in January and then in May of 2021, for a total of 22 reviewed articles. This review revealed data mostly from nurses, with some studies making efforts to include other healthcare professions who have experienced moral distress. Education-based interventions showed the most success, though many reported limited power and few revealed statistically lowered moral distress post intervention. This may point to the difficulty in adequately addressing moral distress in real time without adequate support systems. Ultimately, these studies suggest potential frameworks which, when bolstered by organization-wide support, may aid in moral distress interventions making a measurable impact.

Timely Communication Through Telehealth: Added Value for a Caregiver During COVID-19

Objective: This caregiver case study applies the lens of relational coordination theory (RC) to examine the value of telehealth as a medium of care coordination for a pediatric patient with hypermobile Ehlers-Danlos Syndrome (hEDS) during the COVID-19 pandemic.

Background: The COVID-19 pandemic has placed an unprecedented burden on the delivery of healthcare around the globe and has increased the reliance on telehealth services. Delivering telehealth requires a high level of communication and coordination within and across providers as well as between providers, patients and their families. However, it is less clear how telehealth impacts the coordination of care. In this paper, we provide insight into the quality of care coordination between providers and an informal caregiver following policy changes to the provider payment structure in Massachusetts.

Methods: This paper employs a single-case, autoethnographic study design where one of the authors uses their experiential insights, as mother of the patient, to inform a wider cultural and political understanding of the shift to remote caregiving for a pediatric patient with hEDS. Data was collected using reflective journaling, interactive interviews, and participant observation and analyzed using content analysis.

Results: Findings revealed four interrelating roles of the caregiver including, logistics support, boundary spanner, home health aide, and cultural translator. The adoption of telehealth was associated with improved timeliness and frequency of communication between the caregiver and providers. Findings about the impact of telehealth adoption on accuracy of communication were mixed. Mutual respect between the caregiver and providers remained unchanged during the study period.

Conclusions: This paper highlights areas where payer policy may be modified to incentivize timely communication and improve coordination of care through telehealth services. Additional insight from the perspective of an informal caregiver of a patient with a rare chronic disease provides an understudied vantage to the care coordination process. We contribute to relational coordination theory by observing the ways that caregivers function as boundary spanners, and how this process was facilitated by the adoption of telehealth. Insights from this research will inform the development of telehealth workflows to engage caregivers in a way that adds value and strengthens relational coordination in the management of chronic disease.

Redefinition and Measurement Dimensions of Sustainable Employability Based on the swAge-Model

Objectives: To solve the labour shortage, we clarify the definition and dimensions of sustainable employability, and make it possible to develop sustainable employability scales in the future and lay the foundation for subsequent quantitative research. Finally, people’s sustainable employability can be improved. Highly sustainable employability employees can continue to work in the labour market and their working lives can be prolonged. Labour market supply will increase and labour shortage will be partly solved. Methods: We discuss the concept of sustainable employability based on some previous studies. Our conclusion is that the existing definitions and measurement dimensions are problematic. The swAge-model, a tool that helps us understand how to make working life more sustainable and healthier for all ages, can be the basis of sustainable employability. Results: We develop a discussion paper concerning the definition and measurement dimensions of sustainable employability using the swAge-model with an added factor of intrinsic work value and the dynamic chain. Conclusions: Our definition of sustainable employability takes environmental factors into consideration and makes it clear that it is not a solely personal characteristic, but the result of an interaction between individuals and the environment, thus distinguishing employability from work ability. We use the swAge-model as a basis to make the composition of our definition more logical and informed. Our measurement dimensions are clearly described to facilitate the future development of a scale, and our concept may ultimately help to extend the working lives of older and retired workers and thus solve the future labour shortage problem.

The Impact of the COVID-19 Pandemic on Future Nursing Career Turnover Intention Among Nursing Students

Introduction

A shortage of nurses has been a major global concern, particularly during pandemics. Nursing students turning away from the nursing profession upon graduation may exacerbate nursing workforce shortfalls. The main objective of this study was to assess perceived occupational turnover intention among nursing students and associated factors (fear of COVID-19 and life satisfaction). Students were also asked to provide suggestions that could enhance their intention to join the nursing profession.

Methods

An online survey was sent to all registered undergraduate nursing students at Fujian Medical University, China. The partial least squares structural equation model (PLS-SEM) was used to investigate key factors influencing turnover intention.

Results

A total of 1020 complete responses were received (response rate: 86.2%). Nearly half (49.1%) reported that they would choose not to be on a nursing course if given a choice, 45.4% often think of not going into the nursing profession in the future, and 23.7% would consider entering a healthcare industry that has zero contact with patients. The total turnover intention score range was 3 to 15, and the mean ± standard deviation (SD) was 9.2 (SD ± 2.5). PLS-SEM path analysis revealed that fear of COVID-19 (β = 0.226, p < 0.001) had a positive effect on turnover intention. Satisfaction with life (β = −0.212, p < 0.001) had a negative effect on turnover intention. Analysis of open-ended survey data on students’ perspectives on how to encourage nursing students to enter the nursing workforce revealed five central themes: 1) professional role, respect, and recognition; 2) higher wages; 3) reduce workload; 4) enhance occupational health and safety; and 5) career advancement opportunities.

Conclusion

Factors influencing turnover intention and suggestions to reduce students’ apprehension towards joining the nursing profession found in this study should be seriously taken into consideration in initiatives to address the nurse shortages.

An Examination of Nurses' Empowerment and Speaking Up During Postanesthesia Clinical Hand Overs

Hierarchical relationships can negatively affect nurses' psychological empowerment and interprofessional hand overs. We explored nurses' perceptions of their psychological empowerment, teamwork, and work engagement; relationships between these concepts during interprofessional clinical hand overs; and observed interactive communication behaviors during hand overs. We used surveys and observations of interprofessional clinical hand overs to collect data from 39 nurses in a postanesthesia care unit in Australia. Nurses reported high scores for psychological empowerment and work engagement. Relationships between empowerment and teamwork (r = 0.41, P = .01) and empowerment and work engagement (r = 0.65, P < .001) were positive and significant. Relationships between nurses' observed communication behaviors and perceptions of empowerment, teamwork, and work engagement were nonsignificant. Additional research is needed to better understand how empowerment, teamwork, and work engagement affect nurses' interactive communication behaviors during interprofessional clinical hand overs in the postanesthesia care unit.

Relational interventions for organizational learning: An experience report

INTRODUCTION

Quality improvement and implementation science practitioners identify relational issues as important obstacles to success. Relational interventions may be important for successful performance improvement and fostering Learning Health Systems.

METHODS

This case report describes the experience and lessons learned from implementing a relational approach to organizational change, informed by Relational Coordination Theory, in a health system. Structured interviews were used to obtain qualitative participant feedback. Relational Coordination was measured serially using a validated seven-item survey.

RESULTS

An initial, relational intervention on one unit promoted increased participant engagement, self-efficacy, and motivation that led to the spontaneous, emergent dissemination of relational change, and learning into other parts of the health system. Staff involved in the intervention reported increased systems thinking, enhanced focus on communication and relationships as key drivers for improvement and learning, and greater awareness of organizational change as something co-created by staff and executives.

CONCLUSIONS

This experience supports the hypothesis that relational interventions are important for fostering the development of Learning Health Systems.

Characteristics of Pediatric Extracorporeal Membrane Oxygenation Programs in the United States and Canada

The aim of this study was to evaluate the current infrastructure and practice characteristics of pediatric extracorporeal membrane oxygenation (ECMO) programs. A 40-question survey of center-specific demographics, practice structure, program experience, and support network utilized to cannulate and maintain a pediatric patient on ECMO was designed via a web-based survey tool. The survey was distributed to pediatric ECMO programs in the United States and Canada. Of the 101 centers that were identified to participate, 41 completed the survey. The majority of responding centers are university affiliated (73%) and have an intensive care unit (ICU) with 15-25 beds (58%). Extracorporeal membrane oxygenation has been offered for >10 years in 85% of the centers. The median number of total cannulations per center in 2017 was 15 (interquartile range [IQR] = 5-30), with the majority occurring in the cardiovascular intensive care unit (median = 13, IQR = 5-25). Fifty-seven percent of responding centers offer ECPR, with a median number of four cases per year (IQR = 2-7). Most centers cannulate in an operating room or ICU; 11 centers can cannulate in the pediatric ED. Sixty-three percent of centers have standardized protocols for postcannulation management. The majority of protocols guide anticoagulation, sedation, or ventilator management; left ventricle decompression and reperfusion catheter placement are the least standardized procedures. The majority of pediatric ECMO centers have adopted the infrastructure recommendations from the Extracorporeal Life Support Organization. However, there remains broad variability of practice characteristics and organizational infrastructure for pediatric ECMO centers across the United States and Canada.

Cultural Diversity in Nursing Teams: Triggers, Team Process and Contingencies / Kulturelle Vielfalt in Pflegeteams: Triggers, Teamprozesse und Kontext

Introduction

The study explored cultural diversity in nursing teams and the internal and external conditions under which cultural differences represent an asset or a liability for these teams.

Methods

A qualitative design with content analysis was employed. In total, 18 interviews were conducted with nurses and assistant nurses with experience of working in culturally diverse teams in three distinct clinical settings.

Results

Three domains emerged in the study analysis: triggers, team process and contingencies. Each one encompassed a number of themes related to culturally diverse nursing team processes, triggers of team processes and context-specific contingencies, which represent the complexity of culturally diverse nursing team functioning.

Discussion/implications

The study suggests how cultural differences in nursing teams can be managed and further explored from within the team and by individuals leading those teams, taking into account the disablers and enablers of their functioning.

Transition of newly graduated nurses in China: An evaluation study

The work adaptation of newly graduated nurses exerts a vital impact on their career developments. It is of great significance to guide newly graduated nurses to get acclimatized to the student-to-nurse transition. This study aimed to investigate the work adaptability disorder from the perspective of the organizational socialization and explore the potential factors of work adaptability disorder of newly graduated nurses. A cross-sectional study was performed. Convenience sampling was adopted to recruit 206 newly graduated nurses at four tertiary hospitals in China. The Work Adaptability Disorder Scale, the Transition Shock of Newly Graduated Nurses Scale, and the Organizational Socialization Questionnaire were utilized to measure the work adaptability disorder. The results showed the level of work adaptability disorder was mediocre among newly graduated nurses in China. The variables of gender, education, only child, family residence, transition shock, and organizational socialization could serve as predictors of work adaptability. Our research showed countermeasure of improving organizational socialization and relieving transition shock should be added to the training program of newly graduated nurses with purpose of promoting their adaptation.

[Health care safety: The discrepancies between experience and degree of satisfaction of hospitalized patients observed in interviews performed by user representatives]

INTRODUCTION

The purpose of this article is to present the results of a qualitative survey conducted by user representatives (URs) focusing on the health care safety experience of hospitalized patients. The authors wished to identify factors associated with safety of care and, more specifically, with the possibly ominous medical events reported by patients.

METHODS

After being trained with these objectives in mind, eight URs conducted semi-directive interviews with fourteen patients hospitalized in eleven separate hospital units in nine different hospitals.

RESULTS

Eight types of factors consisting in 30 contributing factors liable to be reported by patients were identified: 1) factors related to patients' basic needs; 2) personalization of care; 3) professional factors; 4) organizational factors; 5) communication factors; 6) caregiver responsiveness; 7) infectious risks; 8) continuity of care. Patients' overall feelings about their hospitalization remained excellent notwithstanding more tempered, even negative experiences.

CONCLUSION

This paradoxical result shows that the patients' actual experience is far more instructive than their degree of satisfaction. In light of this study, the acceptability of this type of research (i.e. research conducted by URs) is excellent and it also appears highly feasible, whatever the limitations imposed by organizational considerations.

Service line structure and decision-maker attention in three health systems: Implications for patient-centered care

BACKGROUND

Scholars have noted a disconnect between the level at which structure is typically examined (the organization) and the level at which the relevant coordination takes place (service delivery). Accordingly, our understanding of the role structure plays in care coordination is limited.

PURPOSE

In this article, we explore service line structure, with an aim of advancing our understanding of the role service line structure plays in producing coordinated, patient-centered care. We do so by giving special attention to the cognitive roots of patient-centeredness.

METHODOLOGY/APPROACH

Our exploratory study relied on comparative case studies of the breast cancer service lines in three health systems. Nonprobability discriminative snowball sampling was used to identify the final sample of key informants. We employed a grounded approach to analyzing and interpreting the data.

RESULTS

We found substantial variation across the three service lines in terms of their structure. We also found corresponding variation across the three case sites in terms of where informant attention was primarily focused in the process of coordinating care. Drawing on the attention-based view of the firm, our results draw a clear connection between structural characteristics and the dominant focus of attention (operational tactics, provider roles and relationships, or patient needs and engagement) in health care service lines.

CONCLUSION

Our exploratory results suggest that service line structures influence attention in two ways: (a) by regulating the type and intensity of the problems facing service line participants and (b) by encouraging (or discouraging) a shared purpose around patient needs.

PRACTICE IMPLICATIONS

Patient-centered attention-a precursor to coordinated, patient-centered care-depends on the internal choices organizations make around service line structure. Moreover, a key task for organizational and service line leaders is to structure service lines to create a context that minimizes distractions and enables care providers to focus their attention on the needs of their patients.

New Graduate Nurse Transition Into the Intensive Care Unit: Qualitative Insights From a Longitudinal Study-Part 1

BACKGROUND AND PURPOSE

Patients admitted to intensive care units (ICUs) are critically ill and suffer from life-threatening sickness of injury. To work in ICU, registered nurses require additional knowledge and skills. While practices regarding the hire of new graduate nurses (NGNs) into settings such as the ICU vary, it is common that NGNs are being hired. However, NGNs in general, are at a higher risk for turnover within the profession as compared to their more experienced colleagues. NGNs in ICU settings may be at higher risk of turnover due to the complexity of the care context. It is of particular importance that the experiences of NGNs in ICU be explored with the intent of identifying what these nurses experience but also to consider how they can be best supported during a period of transition. This manuscript reports the findings from a mixed design study that sought to understand the transition of a cohort of NGNs over a period of 2 years.

METHODS

This study used both a purposive and convenience sample of NGNs. The qualitative component incorporated Thorne's (2016) interpretive description. Face-to-faceinterviews were completed.

RESULTS

Five themes were identified: an emotional transition, a social transition, a transitioning mindset, transitioning through firsts, and transitioning with confidence. Within each theme, there is a distinct difference and elements of transition were evident. Findings demonstrate that the NGNs appeared to be more confident in their skills and in their nursing practice over time. Findings from this study provide important insight into the experiences of NGNs in ICUs.

Predicting Sustainable Employability in Swedish Healthcare: The Complexity of Social Job Resources

Achieving sustainable employability (SE), i.e., when employees are able to continue working in a productive, satisfactory, and healthy manner, is a timely challenge for healthcare. Because healthcare is a female-dominated sector, our paper investigated the role of social job resources in promoting SE. To better illustrate the complexity of the organizational environment, we incorporated resources that operate at different levels (individual, group) and in different planes (horizontal, vertical): trust (individual-vertical), teamwork (group-horizontal), and transformational leadership (group-vertical). Based on the job demands-resources model, we predicted that these resources initiate the motivational process and thus promote SE. To test these predictions, we conducted a 3-wave study in 42 units of a healthcare organization in Sweden. The final study sample consisted of 269 professionals. The results of the multilevel analyses demonstrated that, at the individual level, vertical trust was positively related to all three facets of SE. Next, at the group level, teamwork had a positive link with employee health and productivity, while transformational leadership was negatively related to productivity. These findings underline the importance of acknowledging the levels and planes at which social job resources operate to more accurately capture the complexity of organizational phenomena and to design interventions that target the right level of the environment.

Hospital staff shortages: Environmental and organizational determinants and implications for patient satisfaction

Recent discussions and previous research often indicate that German hospitals are affected by a shortage of healthcare personnel on the labor market. However, until now, research has provided only limited insights into how environmental and organizational factors explain variations in staff shortages, how staff shortage measures relate to staffing ratios, and what relevance staff shortages have for patients. Regression analyses based on survey data of 104 German hospitals from 2015 to 2016, combined with labor market and patient satisfaction data, show that several environmental and organizational factors are significantly related to hospital staff shortages, measured by self-reports, vacancies, and turnover. These three measures of staff shortage do not correlate to the same degree for physicians and nurses, and none of the three significantly relate to nursing ratios, which indicates that the latter is a distinct concept rather than a direct consequence of staff shortage. The analyses further show that hospital staff shortages relate significantly to patient satisfaction with physician and nursing care. The findings suggest that hospitals are, to a certain extent, able to influence the degree to which they are affected by staff shortages and that hospitals' decisions about staffing levels depend on more than staff availability.

The Relationship Between Clinician Turnover and Client Outcomes in Community Behavioral Health Settings

OBJECTIVE

High clinician turnover in community behavioral health settings can lead to increased costs and can have a negative impact on care quality. Few studies have examined the implications of clinician turnover for client outcomes. This study investigated changes in client outcomes associated with clinician turnover.

METHODS

The study used prospective observational data collected as part of a larger randomized controlled trial. Clients (N=328) from two community behavioral health centers identified the clinician (N=121) whom they saw most often. Clients completed measures of depression, anxiety, mental and physical health functioning, and patient activation at baseline, 6 months, and 12 months. Clinician turnover during the 12-month study was obtained from agency records. Latent growth curve modeling was used to analyze the data.

RESULTS

Of the 328 clients, 24% experienced clinician turnover. For all outcomes except depression, the association with turnover was moderated by baseline status on the outcome measure. Turnover tended to be associated with clinical decline for clients who at baseline had low to moderate anxiety, high patient activation, or high physical health functioning. Surprisingly, turnover was associated with increased mental health functioning for clients who at baseline had very low mental health functioning. For physical health functioning, the association with turnover was also moderated by age. Turnover was associated with a sharper decline in functioning for older clients.

CONCLUSIONS

Results suggest that clinician turnover was associated most strongly with decline for higher functioning or older clients, but it was not uniformly associated with worsening clinical outcomes.

Improving Retention of Home Health Nurses: Fostering Outcome Sustainability Through an Innovative Orientation and Mentorship Program

Home healthcare plays an increasingly vital role in contemporary postacute healthcare. Staffing instability and lack of perceived organizational support is a stimulus for nursing attrition from the organization with far-reaching impact on staff morale, patient care, agency budgets, and relationships with other healthcare settings. The purpose of this article is to describe a redesign of an agency's nursing orientation and the development of a mentorship program for newly hired home healthcare nurses within a large Midwestern integrated health system. During this time frame, 154 nurses completed the newly designed orientation program and, of those, 91 participated in the mentorship program. In this article, we evaluate 1-year new-hire nursing retention rates over a 4-year period, examine new-hire job satisfaction and perceptions of preceptors and mentors during their first year, and discuss issues of outcome sustainability. Agency-wide turnover rates for all home healthcare nurses decreased from 15.4% in 2016 to 10.1% in 2018, demonstrating the associated impact of these initiatives on staffing stabilization.

Specialty cardiac nurses' work satisfaction is influenced by the type of coronary care unit: A mixed methods study

Background

Many dedicated Coronary Care Units (CCUs) in Victoria, Australia, have been decommissioned and replaced with larger combined generic medical/cardiac precincts called hybrid units. Hybrid units are staffed with a low proportion of specialist critical care nurses. These changes may pose risks to nurse satisfaction and retention, and quality of patient care. The aims of this study were to explore specialist cardiac nurses’ perceived work satisfaction across four CCUs, and differences in satisfaction between dedicated and hybrid CCUs.

Methods

This concurrent mixed methods study comprised two Phases in four Victorian CCUs (2 dedicated, 2 hybrid). In Phase 1, 74 specialist cardiac nurses completed the Professional Practice Environment (PPE) Scale. In Phase 2, 17 specialist cardiac nurses were interviewed to further explore elements of the PPE subscales. Descriptive, inferential (Phase 1), and content analyses (Phase 2) were performed.

Results

Survey participants’ median age was 38 years (IQR 30, 45). The median PPE Scale score was 3.10 (IQR 2.90, 3.10) indicating high levels of satisfaction with their workplaces. Specialist cardiac nurses in one hybrid unit were significantly less satisfied compared with each of the other three units (p < 0.05). There were no significant differences in overall satisfaction or in any subscale of the PPE Scale between dedicated and hybrid units. Qualitative data revealed nurses in hybrid units felt they had less control over practice, lacked autonomy, had poor relationships with physicians, and experienced inadequate nurse leadership.

Conclusions

Specialist cardiac nurses’ workplace satisfaction overall is high, with no significant differences between dedicated and hybrid CCUs. However, the structure of specialist cardiac units and NUM leadership skill level can impact nurses’ satisfaction with their workplace and collegial relationships. Strong nursing leadership that is respectful of nursing expertise and places patient safety foremost positively impacts nurses’ satisfaction. Further studies should assess the impact of the types of CCUs and NUM leadership on workforce factors such as nurse retention rates and patient outcomes such as adverse events.

Why newly graduated nurses in South Korea leave their first job in a short time? A survival analysis

BACKGROUND

South Korea is one of the countries with a very low percentage of active nurses among the Organization for Economic Cooperation and Development (OECD) countries. Although the number of nurses has increased steadily, the number of active nurses has not increased more than expected due to continued turnover.

METHODS

This study used data of a longitudinal panel of Graduates Occupational Mobility Survey (GOMS) and performed survival analysis to determine the turnover rate of nurses and the average time of turnover.

RESULTS

The turnover rate was the highest at 25% within first year and 50% of nurses left their first job during the study period. The hospital size and salary levels were major factors that affected the turnover rate, with small-scale hospitals and extremely low salary levels having the highest turnover. Dissatisfaction with the organization and dissatisfaction with the profession also directly impacted job turnover. Turnover rate of male nurses was higher than that of female nurses.

CONCLUSION

Turnover of newly graduated nurses is highly inefficient personnel management. A strategy for reducing the turnover is needed.

Perceived needs and coping resources of newly hired nurses

Objective:

Newly hired nurses who do not transition well often leave their first nursing position or nursing prematurely, at great cost to themselves, the profession, hiring organizations and patients. The purpose of this secondary analysis study was to better understand the transition experience of new graduate nurses and experienced nurses as they moved to a new setting in nursing, and the preceptor’s role in that transition.

Methods:

Schlossberg’s Transition Theory provided the framework for the secondary analysis of a large qualitative data set that were collected from 118 newly hired nurses who were predominantly female and Caucasian with the majority being under the age of 30 years and having less than 1-year experience. The data available for secondary analysis included all transcripts from the original study.

Results:

Two main themes were identified: Institutional Support and Sense of Self.

Discussion:

Preceptors are critical early in the transition and the newly hired nurse continues to look for support beyond the first year of the transition. Hospitals should consider implementing transition to practice programs that support the newly hired nurse, to include those with prior experience, throughout the first year of transition and should also consider a mentorship program of support after the first year.

HRM and the health of hospitals

While there is a plethora of research on people management and high-commitment management, most are focused on commercial enterprises. Even the high-commitment management literature on commercial organisations argues that we need to move beyond the confines of financial performance. There are relatively few studies of high-commitment management which focus on hospitals. This is despite the fact that human resources are a major cost and source of performance leverage in hospitals.

Safety culture: perception of health professionals in a mental hospital

OBJECTIVE

To evaluate the culture of patient safety in a mental health service.

METHOD

Cross-sectional study conducted with health professionals in a mental hospital, by applying the Safety Attitudes Questionnaire (SAQ). Descriptive and inferential analyses were performed.

RESULTS

One-hundred and three professionals participated in the study, with female predominance (64.1%) and time of performance equal to or greater than 21 years (32.4%). The nursing professionals of technical level and with statutory work regime were the most participative, 54.4% and 52% respectively. The total score was 69 points. The domain that reached the highest score was Job satisfaction (80 points) and the lowest was Working conditions (57 points). The statutory professionals and those with longer professional experience obtained better scores in the perception of safety culture.

CONCLUSION

The result of safety culture was below the recommended, indicating the need for strengthening this construct in mental health hospitals.

Responding to disruptive behaviors in nursing: A longitudinal, quasi-experimental investigation of training for nursing students

OBJECTIVES

The objective of this study was to determine the impact of a cognitive rehearsal intervention on nursing students' self-efficacy to respond effectively to disruptive behaviors.

DESIGN

This quantitative study was part of a longitudinal, quasi-experimental program of research.

SETTING

Interventions were conducted on site at facilities provided by participating pre-licensure nursing programs.

PARTICIPANTS

A total of 129 nursing students enrolled in their final academic year in three traditional format, pre-licensure nursing programs in the Midwestern United States were recruited to participate in this study.

METHODS

A cognitive rehearsal intervention was delivered to increase self-efficacy to respond to disruptive behaviors in the nursing workplace. Data were collected in writing immediately prior to and following the intervention. Three months later, data were collected in electronic format through a link sent by text message to their mobile phones. Study data were collected on the Self-efficacy to Respond to Disruptive Behaviors Survey, a 10-point Likert scale measuring self-efficacy and its dimensions: knowledge, previous behavioral engagement, affect, and motivation toward responding effectively to disruptive behaviors.

RESULTS

129 students completed the surveys at pre and post-test; 109 completed the survey three months later. Measures of overall self-efficacy and knowledge (p < 0.000), and both measures of situational self-efficacy (p = 0.002; p = 0.020) remained significantly increased three months after the intervention, compared to pre-test. Past behaviors increased on post-test but returned to baseline at the three-month follow-up. The intervention did not significantly impact affect scores. Changes in motivation toward effective responses were mixed between measurements immediately following the intervention and three months later.

CONCLUSION

Cognitive rehearsal interventions can increase self-efficacy to respond to disruptive behaviors with sustained effects up to three months later. Further research is needed to determine the effects of self-efficacy to respond once participants have entered the nursing workplace.

The worksite heart health improvement project's impact on behavioral risk factors for cardiovascular disease in long-term care: A randomized control trial

BACKGROUND

Long-term care workers are at high risk for cardiovascular disease, in part because of their poor health habits.

OBJECTIVE

The purpose of this study is to test the impact of the Worksite Heart Health Improvement Project (WHHIP) on subjective behavioral cardiovascular risk factors over time among long-term care staff.

DESIGN

The WHHIP was a 12-month cluster randomized control trial conducted in four long-term care facilities. The exercise, nutrition, and stress management intervention lasted 9-months and was implemented during paid work time.

SETTING AND PARTICIPANTS

Ninety-eight long-term care workers consented to participate in the study.

METHODS

Survey data included: mood, dietary salt intake, dietary fat intake, sleep quality, and sleep duration.

RESULTS

A significant positive short-term intervention effect at 9-month (p = .037) and long-term effect at 12-month for mood (p = .039) was found, signifying reduction in mood symptoms in the treatment group over time. The intervention group also showed longer sleep time (p = .016) and better sleep quality (p = .046) at 12-months. The intervention group had less dietary sodium intake at 9-months (p = .036); yet, this was not maintained over time.

CONCLUSION

The WHHIP demonstrated the ability to improve participants' mood, sleep and sodium intake over time. Lessons learned particularly the challenges faced implementing the WHHIP and the solutions recommended provide critical insights to strengthen future programs with this population.

Exploring the Influence of Nursing Work Environment and Patient Safety Culture on Missed Nursing Care in Korea

PURPOSE

This study aimed to explore the influence of nurse work environment and patient safety culture in hospital on instances of missed nursing care in South Korea.

METHODS

A cross-sectional design was used, in which a structured questionnaire was administered to 186 nurses working at a tertiary university hospital. Data were analyzed using descriptive statistics, t-test or ANOVA, Pearson correlation and multiple regression analysis.

RESULTS

Missed nursing care was found to be correlated with clinical career, nursing work environment and patient safety culture. The regression model explained approximately 30.3 % of missed nursing care. Meanwhile, staffing and resource adequacy (β = -.31, p = .001), nurse manager ability, leadership and support of nurses (β = -.26, p = .004), clinical career (β = -.21, p = .004), and perception on patient safety culture within unit (β = -.19, p = .041) were determined to be influencing factors on missed nursing care.

CONCLUSION

This study has significance as it suggested that missed nursing care is affected by work environment factors within unit. This means that missed nursing care is a unit outcome affected by nurse work environment factors and patient safety culture. Therefore, missed nursing care can be managed through the implementation of interventions that promote a positive nursing work environment and patient safety culture.