Association of Nurse Engagement and Nurse Staffing on Patient Safety

Association between workplace psychological violence and work engagement among emergency nurses: The mediating effect of organizational climate

Background

Given that increasing attention is being given to the burdens on medical systems, researchers have concentrated their attention on nurses’ work engagement, especially in emergency departments.

Purpose

To investigate the current situation of work engagement of nurses in emergency department, and to find out the impact of psychological violence on work engagement and its impact path.

Basic procedures

The research is a cross-sectional study. Questionnaires were distributed to 243 nurses from the emergency departments of ten tertiary hospitals from September to October 2019. SPSS was used to conducted ANOVA. The AMOS was used to conduct structural equation model to test the mediating effect of organizational climate on the association between psychological violence and dimensions of work engagement.

Main findings

Psychological violence was negatively correlated with organizational climate, vitality, dedication, and focus, and organizational climate was positively correlated with dimensions of work engagement. A negative relationship was found between psychological violence and three dimensions of work engagement, which was mediated by organizational climate.

Conclusion

In order to curb workplace psychological violence and improve the work engagement level of emergency nurses, organizational climate can be used as an intervention measure. The support of leaders, the care of colleagues and the mutual understanding and communication between doctors and patients can alleviate the job burnout of nurses in the face of heavy work, so that nurses can face their daily work with a better mental outlook.

Work Engagement and Patient Quality of Care: A Meta-Analysis and Systematic Review

Past research has demonstrated that work engagement among health care professionals influences patient quality of care. There is, however, no estimate of the strength of this relationship, and existing reviews have not always explained conflicting findings. We conduct a meta-analysis and review of 25 articles, and find a small to medium mean effect size (r = .26, p < .01) for the positive association between engagement and quality of care. Moderator analyses on five factors (type, data source, level of analysis of the quality of care measure, profession, and work engagement measure) indicate that only data source is significant, providing preliminary evidence that the relationship is stronger if quality of care is measured via self-assessments. Although a more consistent conceptualization of quality of care is needed to better determine its association with work engagement, our findings suggest that work engagement is as important as burnout in predicting quality of care.

The Factors That Affect Turnover Intention According to Clinical Experience: A Focus on Organizational Justice and Nursing Core Competency

The purpose of this study was to investigate organizational justice and nursing core competency as factors that affect turnover intention among nurses. The participants comprised 153 nurses who worked at tertiary hospitals and general hospitals throughout South Korea. Turnover intention was measured using the Nurse Turnover Intention Scale. Organizational justice was measured using the Justice Scale, and nursing core competency was measured using the Korean Nursing Core Competency Scale. Data were collected via an online survey and analyzed using multiple regression. Among nurses with less than 3 years of clinical experience, a lower distributive justice score (β = −0.47, p < 0.001) was associated with high turnover intention. Among nurses with 3 to 6 years of clinical experience, a lower interactional justice score (β = −0.37, p = 0.042) and high nursing core competency (β = 0.31, p = 0.034) were associated with high turnover intention. The type of organizational justice that influenced turnover intention differed depending on clinical experience. These results highlight the need to understand the professional characteristics of nurses according to their clinical experience and to provide targeted organizational support and effective competency-based human resource management.

Effects of Mindfulness Meditation on Doctors' Mindfulness, Patient Safety Culture, Patient Safety Competency and Adverse Event

OBJECTIVE

This study investigated the effects of mindfulness meditation on doctors' mindfulness, patient safety culture, patient safety competency, and adverse events.

METHODS

We recruited 91 doctors from a hospital in China and randomized them to mindfulness meditation group (n = 46) and a waiting control group (n = 45). The mindfulness meditation group underwent an 8-week mindfulness meditation intervention, while the control group underwent no intervention. We measured four main variables (mindfulness, patient safety culture, patient safety competency, and adverse event) before and after the mindfulness meditation intervention.

RESULTS

In the experimental group, mindfulness, patient safety culture and patient safety competency were significantly higher compared with those of the control group. In the control group, there were no significant differences in any of the three variables between the pre-test and post-test. Adverse events in the experimental group were significantly lower than in the control group.

CONCLUSIONS

The intervention of mindfulness meditation significantly improved the level of mindfulness, patient safety culture and patient safety competency. During the mindfulness meditation intervention, the rate of adverse events in the meditation group was also significantly lower than in the control group. As a simple and effective intervention, mindfulness meditation plays a positive role in improving patient safety and has certain promotional value.

Personal Resources and Work Engagement: A Literature Review

The level of nurse work engagement affects retention, burnout, job satisfaction, patient satisfaction, and outcomes. However, there is a paucity of evidence identifying the specific personal resources that benefit nurse work engagement and mechanisms to develop personal resources. The purpose of this review was to examine which personal resources affect work engagement, reveal strategies to improve work engagement, and uncover implications for the nursing professional development practitioner. A total of 400 articles resulted from a review of the literature, with 14 studies meeting inclusion criteria. Personal resources varied. Interventions to promote the development of personal resources are described. [J Contin Educ Nurs. 2022;53(3):115-121.].

Quality of work life and work engagement among nurses with standardised training: The mediating role of burnout and career identity

AIM

To explore the impact of the quality of work life of nurses with standardised training on their work engagement and its impact path, that is, the intermediary role of career identity and job burnout.

BACKGROUND

Most countries currently face the serious problem of a shortage of nurses and this difficulty is likely to persist for a long time. In recent years, some hospitals in China have attempted to try out clinical standardised training for new nurses for a duration of at least two years. They need to cope with clinical work, training assessments, and low salaries. Ways to improve the work input of new nurses play a pivotal role in reducing the turnover rate of nurses.

DESIGN

The current research is a cross-sectional study.

METHODS

Valid questionnaires were received from 245 nurses from the tertiary hospitals between June and July 2021. AMOS was used to conduct a structural equation model to evaluate the mediating effect of burnout and career identity on the association between the quality of work life and work engagement. We describe the study in accordance with the STROBE statement.

RESULTS

The quality of the work life of nurses with standardised training is at a medium to high level (191.62 ± 27.18) and their work engagement is at a relatively high level (75.77 ± 19.60). Quality of work life was negatively correlated with burnout (r1 = -0.672, p < 0.001) and positively correlated with career identity (r2 = 0.810, p < 0.001) and work engagement (r2 = 0.642, p < 0.001). Moreover, a positive relationship was found between the quality of work life and work engagement (β1 =0.644), which was mediated by burnout and career identity (β2 =0.144, β3 =0.218).

CONCLUSIONS

Although the work engagement of nurses with standardised training is encouraging, that work engagement decreases with the increase in the age of nurses, still needs investigation. When nurse managers want to improve the work engagement of new nurses, they should not only pay attention to the quality of work life but take career identity and burnout into consideration.

Understanding nurses' perceptions of barriers and enablers to use of a new electronic medical record system in Australia: A qualitative study

BACKGROUND

Electronic medical record system implementations impact nurses, their work and workflows. The aim of this study was to understand nurses' perceptions of barriers and enablers to using a new electronic medical record in an acute hospital environment.

METHODS

Data were collected just prior to an organisation-wide new electronic medical record implementation at a large tertiary healthcare organization in Victoria, Australia. Sixty-three nurses from five hospital sites participated in 12 focus group interviews. Transcripts were transcribed and deductive content analysis used the 14-domain Theoretical Domains Framework to identify barriers and enablers.

RESULTS

Coded data mapped to 13 of the 14 domains. Nurse motivation emerged as a dominant theme among both barriers and enablers. Nurses' most common perceived barriers related to emotions (24.1%) and environmental context and resources (21.3%). Conversely, the most common enablers related to social influences (21%) and reinforcement (20.8%).

DISCUSSION

In addition to effecting changes in their work and workflows, the dominance of nurses' emotional responses reveals the potential for implementation of a new electronic medical record to negatively affect nurses' psychological well-being. Using data aligned to the Theoretical Domains Framework assisted identification of behavior change strategies to target the barriers and enablers perceived by nurses. Strategies aligned with nine behavioral intervention categories are recommended for successful implementation and optimization of an electronic medical record by nurses.

CONCLUSIONS

Multifaceted strategies targeting multiple behaviors are required to support adoption of the electronic medical record by nurses, and reduce the risk for nurse attrition in the workforce.

Implementing the Clinical Occurrence Reporting and Learning System: A Double-Loop Learning Incident Reporting System in Long-term Care

BACKGROUND

Most incident reporting systems have been questioned for their effectiveness in improving patient safety as they serve as an administrative reporting system.

LOCAL PROBLEM

The long-term-care sector faced unique challenges, such an aging population and resource constraints, and its current incident reporting systems lack contextualization to address its needs.

METHODS

This quality improvement project was conducted at a 624-bed nursing home in Singapore from January to September 2019, using the Plan-Do-Study-Act methodology.

INTERVENTION

The existing incident reporting system (known as Clinical Occurrence Reporting and Learning System-CORALS) was redesigned to facilitate double-loop learning and workplace improvement initiatives.

RESULTS

The results demonstrated significant improvement in nurses' postintervention knowledge and confidence in handling future adverse events and greater staff awareness and information dissemination on patient safety issues.

CONCLUSION

A double-looped system could improve nurses' patient safety awareness and their workplace practices, which would ultimately lead to better patient outcomes.

Mattering perception, work engagement and its relation to burnout amongst nurses during coronavirus outbreak

AIM

To assess the mattering perception, feelings of burnout and work engagement amongst nurses during coronavirus outbreak.

DESIGN

Cross-sectional research design.

METHODS

It conducted at Zagazig fever hospital and chest hospital on 280 nurses. A self-administered questionnaire containing four parts; characteristics, mattering at Work Scale, Burnout scale and Engagement scale.

RESULTS

The present study reported that more than half of studied nurses had moderate mattering level and more than one-quarter of them had low mattering. More than two-fifth of studied nurses had moderate level and slight less than one-third of them had low engagement. More than two-fifth of studied nurses had moderate level of burnout, whilst slight less than one-third of them had high burnout, and one-quarter of them had low burnout.

An Examination of Factors That Predict the Perioperative Culture of Safety

The perioperative setting is an intricate, complicated work environment in which patients are vulnerable to adverse events. Using a convenience sample, we examined relationships between the length of perioperative nurse experience, perioperative nurse engagement, and an OR culture of safety. We explored differences in safety culture scores based on CNOR certification status. There was no significant relationship between the length of perioperative nurse experience and the level of OR culture of safety. However, perioperative nurse engagement had a significant relationship with an OR culture of safety (P < .001), and this factor was a significant predictor of an OR culture of safety (P < .001). Perioperative nurses who held CNOR certification had significantly higher culture of safety scores compared with those who did not (P = .004). Additional research on perioperative nurse engagement and factors relating to patient safety may help perioperative leaders develop and implement engagement strategies.

Electronic Health Record Usability: Associations With Nurse and Patient Outcomes in Hospitals

BACKGROUND

Electronic health record (EHR) usability issues represent an emerging threat to the wellbeing of nurses and patients; however, few large studies have examined these relationships.

OBJECTIVE

To examine associations between EHR usability and nurse job (burnout, job dissatisfaction, and intention to leave) and surgical patient (inpatient mortality and 30-day readmission) outcomes.

METHODS

A cross-sectional analysis of linked American Hospital Association, state patient discharge, and nurse survey data was conducted. The sample included 343 hospitals, 1,281,848 surgical patients, and 12,004 nurses. Logistic regression models were used to assess relationships between EHR usability and outcomes, before and after accounting for EHR adoption level (comprehensive vs. basic or less) and other confounders.

RESULTS

In fully adjusted models, nurses who worked in hospitals with poorer EHR usability had significantly higher odds of burnout [odds ratio (OR), 1.41; 95% confidence interval (CI), 1.21-1.64], job dissatisfaction (OR, 1.61; 95% CI, 1.37-1.90) and intention to leave (OR, 1.31; 95% CI, 1.09-1.58) compared with nurses working in hospitals with better usability. Surgical patients treated in hospitals with poorer EHR usability had significantly higher odds of inpatient mortality (OR, 1.21; 95% CI, 1.09-1.35) and 30-day readmission (OR, 1.06; 95% CI, 1.01-1.12) compared with patients in hospitals with better usability. Comprehensive EHR adoption was associated with higher odds of nurse burnout (OR, 1.14; 95% CI, 1.01-1.28).

CONCLUSION

Employing EHR systems with suboptimal usability was associated with higher odds of adverse nurse job outcomes and surgical patient mortality and readmission. EHR usability may be more important to nurse job and patient outcomes than comprehensive EHR adoption.

Nurse turnover: A longitudinal survival analysis of the Korea Nurses' Health Study

AIMS

To identify factors influencing turnover among Korean female nurses from a longitudinal perspective.

DESIGN

A national cohort study called the Korea Nurses' Health Study (2013-2020) was used.

METHODS

A national sample of female nurses from module 1 (N = 20,613, 2013-2014), module 5 (N = 11,527, 2016-2017), module 7 (N = 8,658, 2018-2019) and module 8 (N = 10,253, 2019-2020) was used. Based on a nurse turnover model, individual, health-related, social work environment and work organizational factors were considered explainable variables for nurse turnover. Kaplan-Meier survival analysis and multivariate Cox regression analysis were used to identify the factors influencing female nurse turnover in South Korea.

RESULTS

Female nurses who had less education, were unmarried, were pregnant, and had higher stress levels and an increased probability of experiencing turnover as they aged. Those who perceived moderate health rather than good/very good health, had depressive symptoms, had a higher salary, were charge nurses/unit managers/supervisors or advanced practice nurses, were advanced practice nurses rather than registered nurses, worked shifts, worked in special care units or outpatient wards/administration as opposed to general wards, and worked in larger hospitals had a decreased probability of experiencing turnover as they aged. A two-way interaction analysis revealed that those who had depressive symptoms and increased perceived stress were more likely to experience turnover as they aged.

CONCLUSION

Multiple factors influenced female nurse turnover, including individual, health-related, social work environment and work organizational factors. A multidimensional approach is needed to reduce nurse turnover.

IMPACT

Various factors predict nurse turnover as nurses age, implying that a multifaceted approach is needed to manage nurse turnover. The influence of depressive symptoms on turnover should be evaluated by considering the perceived stress level. Nursing managers and policy makers could use our results to develop programs/policies to reduce nurse turnover.

Inpatient Staffing Dashboard: A Nursing-Information Technology Collaborative Project

Inadequate staffing negatively impacts hospital operations, quality of patient care, and employee engagement. Traditional staffing approaches to address clinical staffing and scheduling are not as effective in a complex healthcare environment. Organizations must leverage innovative strategies and use of technology to improve clinical staffing. To address the staffing challenges, nursing staffing and information technology at Loma Linda University Medical Center developed an inpatient staffing dashboard. A staffing dashboard is a staffing tool comprised of several tabs and staffing measures, which include filled percentage as the key performance indicator. During the staffing dashboard development, evaluation took place to determine the staffing and scheduling system's extract-transform-load capacity. Data were analyzed, defined, and profiled. Tableau software was used to create an interactive staffing dashboard and integrated with EPIC Hyperspace for user accessibility. The interactive features and staffing measures available in this staffing tool empowered staffing and nursing leaders to utilize data visualization for day-to-day nursing operations, proactively plan for staffing demands, and use data to drive staffing decisions. Our collaborative experience proved that nursing and information technology collaborative projects produce innovative solutions and workflow efficiencies. Leaders must promote nursing-information technology collaborations in healthcare organizations.

Job engagement and satisfaction are associated with nurse caring behaviours: A cross-sectional study

BACKGROUND

There is a scarcity of literature assessing the impact of job engagement and satisfaction in the nurse's caring behaviours. This study aims to identify how these factors affect the caring behaviours of nurses.

METHODS

This study used a cross-sectional design and employed self-report questionnaires. A total of 549 nurses from private and government hospitals participated in the survey conducted in the year 2019. Descriptive and inferential statistics were utilized to analyse the data.

RESULTS

Results revealed that the nurses display high caring behaviours and job engagement and moderate sense of satisfaction. Remarkably, there are no profile variables significantly related to the nurse's caring behaviours. Findings suggest that job engagement and satisfaction are significantly associated with the nurses' caring behaviours.

CONCLUSION

Factors such as job engagement and satisfaction affect nurses' caring behaviours.

IMPLICATIONS TO NURSING MANAGEMENT

Health organisations must provide strategies to increase job engagement and satisfaction of nurses to yield high caring behaviours, which is vital to the achievement of patient safety.

Nurse staffing legislation: Empirical evidence and policy analysis

Unsafe nurse staffing conditions in hospitals have been shown to increase the risk of adverse patient events, including mortality. Consequently, United States and international professional nursing organizations often advocate for safer staffing conditions. There are a variety of factors to consider when staffing nurses for patient safety, such as the number of patients per nurse, nurse preparation, patient acuity, and nurse autonomy. The complex issue of staffing nurses often is compounded by cost issues and can become politicized. When nurse organizations' recommendations for safe staffing measures are disregarded by hospital administrations, nurse lobbyists and interest groups often pursue legislative action to protect patients and nurses from unsafe staffing conditions. This article presents a narrative review of safe nurse staffing factors and an analysis of nurse staffing legislation. Using a patient-centric lens, three state-level nurse staffing policies (mandated nurse-to-patient ratios, public reporting of staffing plans, and nurse staffing committees) were evaluated by empirical evidence, cost to hospitals and state governments, political feasibility, and potential to affect patient populations. Although nurse staffing policy analysis can be conducted in several ways, it is crucial that nurses consider empirical evidence related to staffing policies as well as evaluations of implemented policies and political influences.

Developing an internship program to support nursing student transition to clinical setting

BACKGROUND

The largest statewide hospital system collaborated with local nursing schools to provide a patient care internship program for nursing students. The goal was to create a pipeline of future nurses by equipping students for work in the clinical setting and promoting nurse retention.

PURPOSE

The purpose of this project was to determine the correlation between the student nurse internship program on the interns' NLCEX-RN pass rates, retention rates for the local hospitals, cost-savings, students' confidence, and program satisfaction.

METHOD

Nursing students (n = 25) were recruited from local nursing schools for unlicensed assistant personnel positions at the system hospitals. The program included a six-week intensive to educate nursing students as non-licensed staff members of hospital units, which continues as a mentored experience during the senior year of their baccalaureate program. Qualitative and quantitative data were collected and analyzed.

RESULTS

The program had a pass rate of 96% for NCLEX-RN on first attempt. Additionally, 82% of participants were retained at the hospitals. Hospitals saved $216,993. Students reported increased role satisfaction with the program.

CONCLUSIONS

Program results suggest benefits of supportive NCLEX-RN pass rates, nurse retention, and cost benefit. Findings can be used to support future program expansion and improve the experience of nursing students as they transition into professional practice.

Nurses' attitudes towards families in neonatal units

OBJECTIVE

To analyze nurses' attitudes towards families of newborns hospitalized in neonatal units.

METHOD

This is a survey carried out in ten municipal hospitals in São Paulo. Two questionnaires were applied, one from the sociodemographic profile and the other from the characterization of neonatal units, and the Importância das Famílias nos Cuidados de Enfermagem - Atitudes dos Enfermeiros scale. Parametric tests ANOVA, Pearson's correlation and Tukey's multiple comparison were applied.

RESULTS

The sample consisted of 145 nurses. Most participants had a mean age of 43.7 (± 9.4) years, were female, nursing assistants, have graduated for more than five years and worked at the unit for less than five years. The total score showed a good attitude towards families (77.7), with statistical significance for an 8-hour working day (p=0.004); supervisor position (p=0.027); participation in short-term courses (p=0.029); written protocols on family care (p=0.031).

CONCLUSION

Although nurses perceive themselves with positive attitudes towards families, it is necessary to invest in training and changes in structure and organizational processes aimed at including families in neonatal units.

Exploring Nurses' Perceptions of Safety: A Phenomenological Study

The purpose of the study is to explore the lived experiences of nurses with regard to their personal safety and to identify the fundamental structures underlying nurse safety. A qualitative descriptive phenomenological design, using the data analysis method proposed by Colaizzi, was used. Eleven nurses participated in the study between March and July 2019. The research findings indicated the fundamental structure of nurse safety encompasses 3 categories: "nurses' personal protection systems," "safety support systems," and "risk factors." The fundamental structure identified in this study can contribute to better understanding and insight regarding the safety of nurses.

Evaluating a symptom-triggered gastric residual volume policy in a surgical trauma intensive care unit: Simple and safe

BACKGROUND

Routine checking of gastric residual volumes (GRVs) during enteral feeding within surgical trauma intensive care units (STICUs) is a common practice. However, data on the necessity of this practice and its impact on nutrient delivery are limited. We aim to study the association between the replacement of a routine GRV (rGRV) policy with a triggered GRV (tGRV) policy and the safe achievement of daily nutrition goals.

METHODS

We prospectively collected data on patients after we instituted a tGRV policy and compared them with a historical cohort of patients who had rGRV assessments in our STICU at a level 1 trauma center. The primary end point was achieving 80% of prescribed nutrient goals. Secondary end points included aspiration pneumonia, witnessed emesis, and glycemic control.

RESULTS

A total of 145 patients accounting for 1405 STICU days were treated under the tGRV policy, and 156 patients accounting for 1694 STICU days were treated under the rGRV policy. There were no statistically significant differences between the tGRV and rGRV groups with regard to the proportion of days meeting or exceeding protein (56.7% vs 56.2%) or calorie (56.4% vs 56.0%) goals. After adjusting for in-hospital deaths, injury severity score, complications, and STICU time, the predictive margins for meeting caloric and protein goals were higher among the tGRV patients (57% vs 56%), but these differences were not statistically significant.

CONCLUSION

A tGRV policy did not change protein or calorie delivery among patients or increase the risk of emesis compared with traditional monitoring methods.

Exploring Normalization of Deviance among Perioperative Registered Nurses in the Operating Room

Normalization of deviance is a phenomenon in which individuals and teams deviate from what is known to be an acceptable performance standard until the adopted way of practice becomes normalized. In health care, this phenomenon erodes the safety culture, and it can be particularly concerning in high-risk work environments, such as the operating room (OR). The purposes of this study were to: (a) Explore the concept of normalization of deviance in the OR; (b) Identify reasons for normalization of deviance; and (c) Identify factors that protect against normalization of deviance.This focused ethnographic study included a sample of 10 perioperative nurses who were interviewed. Our findings demonstrated that normalization exists in the OR. Reasons for normalization of deviance included productivity pressures, generalized complacency, complacency related to length of experience, social pressures, and negative acculturation. Factors that protect against normalization of deviance included nurse engagement and having supportive managerial relationships.

Nurse Motivation, Engagement and Well-Being before an Electronic Medical Record System Implementation: A Mixed Methods Study

Implementation of an electronic medical record (EMR) is a significant workplace event for nurses in hospitals. Understanding nurses' key concerns can inform EMR implementation and ongoing optimisation strategies to increase the likelihood of nurses remaining in the nursing workforce. This concurrent mixed-methods study included surveys from 540 nurses (response rate 15.5%), and interviews with 63 nurses to examine their perceptions of using a new EMR prior to implementation at a single healthcare organisation. Survey findings revealed 32.2% (n = 174) of nurses reported low well-being scores and 28.7% (n = 155) were experiencing burnout symptoms. In contrast, 40.3% (n = 216) of nurses reported high work satisfaction, 62.3% (n = 334) had high intentions of staying in their role, and 34.3% (n = 185) were engaged in their work. Nearly half (n = 250, 46.3%) reported intrinsic motivation towards EMR use. Thematic analysis of focus group interviews revealed two themes, each with three subthemes: (1) Us and Them, detailed the juxtaposition between nurses' professional role and anticipated changes imposed on them and their work with the EMR implementation; and (2) Stuck in the middle, revealed nurses' expectations and anticipations about how the EMR may affect the quality of nurse-patient relationships. In conclusion, anticipation of the EMR implementation emerged as a stressor for nursing staff, with some groups of nurses particularly vulnerable to negative consequences to their well-being.

Quality of care in Hunan Province nursing homes: relationship to staffing and organizational climate

Our objective was to examine the quality of care perceived by nursing staff and its relationship with the staffing and organizational climate in nursing homes. The participants in this cross-sectional study included 358 nursing staff from 26 nursing homes in Hunan Province, China. This study found that the interaction effect between nursing staff to resident ratio and physician to resident ratio exerted a significant effect on quality of care (p < 0.05). Higher scores on the relationships and communication scale (OR = 4.771, p = 0.002) and lower scores on the work stress scale (OR = 0.980, p = 0.050) were also associated with better quality of care. More work experience was related to lower quality of care (OR = 0.944, p = 0.048), and work experience was associated with relationships and communication (Beta = 0.172, p = 0.002) and work stress (Beta= = 0.259, p = 0.000). Staffing level, work experience, work stress, relationships and communication are key factors in providing higher quality of care in nursing homes.

Major educational factors associated with nursing adverse events by nursing students undergoing clinical practice: A descriptive study

BACKGROUND

As the main group of healthcare providers in hospitals, nurses have more frequent contacts than any other clinician and thus are in a better position to improve patient safety. With the purpose of cultivating competent nurses, nursing educators have the responsibility to promote patient safety. A better understanding of educational factors affecting nursing adverse events by nursing students undergoing clinical practice can help nursing educators find appropriate ways to fulfil their duty.

OBJECTIVE

To examine the status quo of nursing adverse events and to discuss the major educational factors concerned in different regions of China.

DESIGN

A descriptive study design was undertaken in 2018.

PARTICIPANTS AND SETTING

A convenience sample of 1173 nursing students undergoing clinical practice was recruited from 22 hospitals in different regions of China.

METHODS

The Chinese version of the Medical Student Safety Attitudes and Professionalism Survey (MSSAPS) was administered to and demographic and professional data were collected from clinical nursing students after obtaining informed consent.

RESULTS

The incidence of nursing adverse events in clinical student nurses was 17.8%. Approximately 87.01% of nursing adverse events were near miss. The positive response rate of safety attitudes and professionalism by clinical nursing students ranged from 57.5% to 96.9%. Logistic analysis indicated that gender, educational level, hospital regions, safety culture and professional behavior experience dimensions were the major factors influencing nursing adverse events.

CONCLUSION

Attention should be paid to the situation in which clinical nursing students are prone to nursing adverse events. Cooperation between nursing colleges and hospitals should be strengthened to promote patient safety in clinical nursing students. We suggest that nursing educators implement patient safety education in both theoretical and practical teaching and use multiple forms, especially simulation-based training, to strengthen safe nursing behavior to reduce the incidence of nursing adverse events.

Effects of self-rated workload and nurse staffing on work engagement among nurses: A cross-sectional survey

AIM

To analyse net effects of self-rated workload and nurse staffing (nurse-to-patient ratio and staff skill mix) on work engagement among clinical nurses.

BACKGROUND

Improving nurses' engagement is necessary to enhance patient outcomes, so factors that influence engagement should be explored.

METHODS

A cross-sectional study was conducted in 1,428 registered nurses from 145 units of 11 hospitals. A hierarchical linear model was used to analyse the data.

RESULTS

Self-rated workload had a negative effect on engagement (β = -0.353, p < .001, effect size (f² ) = 14.20%), while only one index of skill mix (percentage of nurses with ≤ 5 work years) had a significant effect on engagement, which was positive (β = 0.258, p < .05, f²  = 8.50%). These two variables explained 22.7% of the variance of engagement at the unit level (R² _between  = 22.7%, p < .05). No significant effect of staffing on self-rated workload was found.

CONCLUSIONS

Self-rated workload had more effect on engagement than did staffing, and factors that influence self-rated workload need to be explored.

IMPLICATIONS FOR NURSING MANAGEMENT

Balancing the mix of experience levels in nursing teams may improve work engagement. Managers should pay attention to multiple strategies to motivate nurses to engage in work in clinical practice.

System-Level Improvements in Work Environments Lead to Lower Nurse Burnout and Higher Patient Satisfaction

BACKGROUND

Burnout among nurses is associated with lower patient satisfaction, yet few system-level solutions have been identified to improve outcomes.

PURPOSE

The purpose of this study was to examine the relationship between nurse burnout and patient satisfaction and determine whether work environments are associated with these outcomes.

METHODS

This study was a cross-sectional analysis of 463 hospitals in 4 states. Burnout was defined using the Maslach Burnout Inventory. Patient satisfaction was obtained from the Hospital Consumer Assessment of Healthcare Providers and Systems survey.

RESULTS

Fifty percent of hospitals where burnout is high have poor work environments, which is strongly related to lower patient satisfaction.

CONCLUSIONS

High levels of nurse burnout are associated with lower patient satisfaction. Our findings demonstrate that hospitals can improve outcomes through investments in work environments.

Case for hospital nurse-to-patient ratio legislation in Queensland, Australia, hospitals: an observational study

OBJECTIVES

To determine whether there was variation in nurse staffing across hospitals in Queensland prior to implementation of nurse-to-patient ratio legislation targeting medical-surgical wards, and if so, the extent to which nurse staffing variation was associated with poor outcomes for patients and nurses.

DESIGN

Analysis of cross-sectional data derived from nurse surveys linked with admitted patient outcomes data.

SETTING

Public hospitals in Queensland.

PARTICIPANTS

4372 medical-surgical nurses and 146 456 patients in 68 public hospitals.

MAIN OUTCOME MEASURES

30-day mortality, quality and safety indicators, nurse outcomes including emotional exhaustion and job dissatisfaction.

RESULTS

Medical-surgical nurse-to-patient ratios before implementation of ratio legislation varied significantly across hospitals (mean 5.52 patients per nurse; SD=2.03). After accounting for patient characteristics and hospital size, each additional patient per nurse was associated with 12% higher odds of 30-day mortality (OR=1.12; 95% CI 1.01 to 1.26). Each additional patient per nurse was associated with poorer outcomes for nurses including 15% higher odds of emotional exhaustion (OR=1.15; 95% CI 1.07 to 1.23) and 14% higher odds of job dissatisfaction (OR=1.14; 95% CI 1.02 to 1.28), as well as higher odds of concerns about quality of care (OR=1.12; 95% CI 1.01 to 1.25) and patient safety (OR=1.32; 95% CI 1.11 to 1.57).

CONCLUSIONS

Before ratios were implemented, nurse staffing varied considerably across Queensland hospital medical-surgical wards and higher nurse workloads were associated with patient mortality, low quality of care, nurse emotional exhaustion and job dissatisfaction. The considerable variation across hospitals and the link with outcomes suggests that taking action to improve staffing levels was prudent.

Self-assessed competence and need for further training among registered nurses in somatic hospital wards in Sweden: a cross-sectional survey

BACKGROUND

Professional competence and continuous professional development is essential for ensuring high quality and safe nursing care, and it might be important for motivating nurses to stay in the profession. Thus, there is a need to identify the developmental process of nursing competency. Assessment of competence and need for further training helps to identify areas for quality improvement, and to design interventions in order to facilitate continuous competence development in different work contexts. The current study aimed to 1) describe registered nurses' self-assessment of clinical competence as well as the need for further training, and 2) explore possible differences between registered nurses with varying lengths of professional experience as a nurse (≤ 0,5 year, > 0,5-5 years, and ≥ 6 years).

METHODS

A cross-sectional survey design was applied, using the Professional Nurse Self-Assessment Scale of clinical core competencies II. Registered nurses (n = 266) working in medical and surgical contexts in hospitals in Sweden responded (response rate 51%). Independent student t-test and analysis of variance were carried out.

RESULTS

Registered nurses assessed their competence highest in statements related to cooperation with other health professionals; taking full responsibility for own activities; and acting ethically when caring for patients. They assessed their need for further training most for statements related to assessing patients' health needs by telephone; giving health promotion advice and recommendations to patients by telephone; as well as improving a creative learning environment for staff at the workplace. For self-assessed competence and need for further training, differences between the groups for 35 and 46 items respectively, out of 50 were statistically significant.

CONCLUSIONS

Although the registered nurses assessed their competence high for important competence components expected of professionals such as cooperation with other healthcare professionals, it is problematic that knowledge of interactions and side-effects of different types of medication were reported as having the highest need of training. Longitudinal follow up of newly graduated nurses regarding their continuous development of competence as well as further training is needed.

Workplace verbal abuse, nurse-reported quality of care and patient safety outcomes among early-career hospital nurses

AIMS

To examine the differences in early-career nurses' verbal abuse experiences based on their sociodemographic characteristics, and to investigate the associations of verbal abuse experiences with nurse-reported care quality and patient safety outcomes.

BACKGROUND

Few studies have examined the relationships between early-career nurses' verbal abuse experiences and nurse-reported patient care quality and safety outcomes.

METHODS

Cross-sectional survey data from 799 early-career hospital nurses in the United States were analysed. Items assessed verbal abuse experiences from patients or their families, physicians and other employees. Associations between verbal abuse experiences and nurse-reported care quality and patient safety outcomes were examined using multiple logistic regression analyses.

RESULTS

There were significant differences in verbal abuse experiences by age, gender and work unit. Nurses who experienced verbal abuse, regardless of the perpetrator, were less likely to report high-quality care and a favourable safety grade. Nurses who experienced verbal abuse specifically from physicians or other employees were also less likely to feel comfortable reporting safety problems.

CONCLUSION

Managing verbal abuse may be important for improving patient care quality and safety. Future intervention study is needed to reduce verbal abuse.

IMPLICATIONS FOR NURSING MANAGEMENT

To optimize patient safety, managers should thoroughly monitor verbal abuse and organisations' need to establish clear expectations and ramifications for when verbal abuse occurs.

Safety and Quality of Pediatric Care in Freestanding Children's and General Hospitals

OBJECTIVES

The purpose of this study was to evaluate quality and safety of care in acute pediatric settings from the perspectives of nurses working at the bedside and to investigate hospital-level factors associated with more favorable quality and safety.

METHODS

Using data from a large survey of registered nurses in 330 acute care hospitals, we described nurses' assessments of safety and quality of care in inpatient pediatric settings, including freestanding children's hospitals (FCHs) (n = 21) and general hospitals with pediatric units (n = 309). Multivariate logistic regression models were used to estimate the effects of being a FCH on favorable reports on safety and quality before and after adjusting for hospital-level and nurse characteristics and Magnet status.

RESULTS

Nurses in FCHs were more likely to report favorably on quality and safety after we accounted for hospital-level and individual nurse characteristics; however, adjusting for a hospital's Magnet status rendered associations between FCHs and quality and safety insignificant. Nurses in Magnet hospitals were more likely to report favorably on quality and safety.

CONCLUSIONS

Quality and safety of pediatric care remain uneven; however, the organizational attributes of Magnet hospitals explain, in large part, more favorable quality and safety in FCHs compared with pediatric units in general acute care hospitals. Modifiable features of the nurse work environment common to Magnet hospitals hold promise for improving quality and safety of care. Transforming nurse work environments to keep patients safe, as recommended by the National Academy of Medicine 20 years ago, remains an unfinished agenda in pediatric inpatient settings.

Nursing Care Time for Newborns during Hospitalization in a Mixed Hospital Ward with an Obstetrics Department

PURPOSE

This study aimed to better understand the nursing care time spent with healthy term newborns from birth to discharge, giving insight into neonatal nursing staff management.

METHOD

In total, 30 healthy term newborns in a mixed hospital ward with an Obstetrics Department participated in this study. To measure care time, they had a wireless beacon attached to their cots. This measured how much time the nurses stayed in front of the cot from the time of birth until discharge, 24 hours/day. Collected data were tabulated every 24 hours after birth.

RESULTS

Seventeen newborns had their data analyzed. The average length of hospital stay for the newborns was 8231.3 minutes. The average nursing care time for the newborns was 533.8 minutes. Nurses provided the highest care time during the first 24 hours after birth (157.6 minutes/24hr). After the first 24, the average nursing care time gradually decreased. The average nursing care time during the first 24 hours after birth was longer than the nursing care time for any other 24-hour periods, with a significant difference (p = 0.001 to 0.046).

CONCLUSION

The nursing care time for healthy newborns gradually decreased with the passage of time after birth. Healthy newborns should be treated as individuals, and the number of nursing staff should be adjusted according to the number of newborns in the ward to ensure nursing care quality and to prevent life-threatening events during the first 24 hours after birth.

Nurses' experiences with newly acquired knowledge about medication management: A qualitative study

OBJECTIVE

To investigate nurses' experiences with implementation of knowledge gained through an obligatory medication management programme (MMP).

BACKGROUND

Lack of knowledge among nurses is an important contributor to medication management errors. Therefore, training programmes such as the MMP were established to help nurses acquire and refine their practice skills.

METHOD

This was a qualitative study using semistructured interviews and thematically analysed data.

RESULTS

The nurses felt that medication management was a major responsibility, but following the MMP, they experienced a greater awareness of their own knowledge and became more confident. Time pressures and poorly established procedures and organisational planning were experienced as barriers to ensuring sound medication management practice and made it difficult to implement the knowledge gained from the MMP.

CONCLUSION

Nurses reported that the MMP gave them greater awareness of their knowledge and new knowledge. They also stated that management choices were significantly affected by organisational factors, stress and their own lack of confidence.

IMPLICATIONS FOR NURSING MANAGEMENT

Ensuring a secure knowledge base, positive working environment and nursing staffing that matches the workload will further improve nurses' professional skills and knowledge.

Exploring the Professional Responsibility Concern Process: An Alberta Perspective

BACKGROUND

Registered nurses are pivotal in the analysis, recognition, and reporting of patient safety issues before harm occurs to patients. Little has been written about the relationship between the professional responsibility of reporting safety concerns and the processes that exist.

PROBLEM

More needs to be known about how nurses can best report factors in work environments that impact patient safety. Learning more about processes that exist amidst literature that illuminates the issues related to reporting and patient safety culture is needed. Also, best practice or key exemplars depicting how professional responsibility has been implemented are needed. Limited has been written exploring professional responsibility concern processes in Canada and internationally.

APPROACH

We completed a case study exploration comprising a public facing Web site scan of information about professional responsibility-like processes across Canada, as well as an extensive literature search exploring factors that are linked with nurse reporting of patient safety concerns.

CONCLUSION

Themes from related literature identify patient safety culture, leadership qualities, communication, positive nurse factors, speaking up, and whistle-blowing as important aspects that facilitate, or are related to, the ability for nurses to express professional responsibility concerns. Alberta has a well-developed system of reporting such concerns; however, the lack of research and literature on these topics requires additional focus in nursing internationally.

Patient safety competency and the new nursing care delivery model

AIM

To identify the factors affecting nurses' patient safety competency under the new nursing care delivery model.

BACKGROUND

In Korea, a new model was introduced in 2013 to ensure that nursing personnel provided inpatients with care without relying on guardians. After the launch of this service, there continue to be nurse-related patient safety incidents.

METHODS

This is a descriptive study. Data from 132 general hospital nurses were collected during 15-24 February 2017 and analysed using hierarchical multiple regression.

RESULTS

Participants' mean patient safety competency score was 3.82 (range 1-5). Clinical career (Pratt index = 47.3%), critical thinking disposition (30.4%), teamwork (24.1%) and critical thinking training experience (7.3%) were found to affect nurses' patient safety competency.

CONCLUSION

Under the new model, new nurses showed a low level of patient safety competency. Clinical career most influenced patient safety competency. Enhanced critical thinking and teamwork training are needed to improve patient safety competency among nurses.

IMPLICATIONS FOR NURSING MANAGEMENT

Nursing leaders must consider qualitative staffing mix involving appropriate placement of experienced nurses as well as quantitative staffing level to provide patients with high-quality, safe care and to implement the new model successfully. Regular training on critical thinking and teamwork should be carried out.