Does unit culture matter? The association between unit culture and the use of evidence-based practice among hospital nurses

Evidence Based Practice Attributes Across Nursing Roles in A Children's Hospital

BACKGROUND

Evidence-based practice (EBP) attributes are associated with improved patient care outcomes. There is a paucity of knowledge on pediatric nurses' attributes based on their clinical sub-specialties.

AIM

To investigate the relationships between pediatric nurses' EBP attributes and background variables, including their academic degree, years of experience, and clinical specialty.

METHODS

A convenience sample of 185 nurses participated in this descriptive, cross-sectional study. The electronic surveys included 11 background questions and the short-versions of the EBP Beliefs Scale, Organizational Culture and Readiness Scale, and EBP Implementation Scale.

RESULTS

EBP belief scores were notably higher in pediatric nurses in neonatology, critical care, and among nurse leaders. No statistically significant difference was found in EBP organizational culture among nurse leaders, clinical nurses, and advanced practice nurses. EBP implementation was favorable in neonatology, acute care, and nurse leaders. No significant results were found in EBP attribute scores related to nurses' age, academic nursing degree, or years of experience.

LINKING EVIDENCE TO ACTION

This study confirmed findings from prior studies acknowledging the impact nurse leaders have on creating and sustaining a favorable EBP culture and implementation science. Organizational attributes such as Magnet status, a shared governance structure, support for specialty certification, and EBP mentorship also reinforce nursing EBP attributes. Further research should investigate unit-level strategies and measure the impact on pediatric patient care outcomes.

Geriatric evaluation and management inpatients spend little time participating in physically, cognitively or socially meaningful activity: a time-motion analysis

BACKGROUND

Geriatric Evaluation and Management (GEM) services provide subacute care for older adults with complex conditions. Meaningful activities are important for preventing functional decline in hospitalised older adults; however, no studies have evaluated GEM inpatients' participation in such activities.

OBJECTIVE

To determine the proportion of time GEM inpatients spend performing meaningful activities during the day and investigate whether ward environments and day of the week are associated with activity levels.

METHOD

This observational study used behavioural mapping to audit inpatients across three GEM wards. Observations were made at 10-minute intervals over 12 consecutive hours on weekdays and 10.5 hours on weekend days. Activities were categorised as physical, cognitive or social. Logistic mixed models were used to analyse factors associated with engagement in meaningful activities.

RESULTS

In total, 60 030 minutes were observed among 70 inpatients. Overall, GEM inpatients spent 16%, 6% and 18% of observed time in physically, cognitively and socially meaningful activities, respectively. Weekend days were associated with higher odds of cognitive engagement (OR 4.79, 95% CI 1.71-13.41, P = .003) but lower odds of social engagement (OR 0.57, 95% CI 0.38-0.85, P = .006). Time spent outside patients' rooms was positively associated with all types of meaningful activities. The odds of physically meaningful activity were not found to vary between weekends and weekdays.

CONCLUSIONS

GEM inpatients demonstrate lower engagement in meaningful activities compared to rehabilitation contexts. The positive association between activity levels and time spent outside patients' rooms emphasises the importance of accessible communal areas. Interventions to promote active participation are needed in inpatient GEM settings.

A dimensional analysis of nursing unit culture

AIM(S)

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

DESIGN

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

IMPACT

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

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

Emergency Nursing Workforce, Burnout, and Job Turnover in the United States: A National Sample Survey Analysis

INTRODUCTION

Few studies have examined emergency nurses who have left their job to better understand the reason behind job turnover. It also remains unclear whether emergency nurses differ from other nurses regarding burnout and job turnover reasons. Our study aimed to test differences in reasons for turnover or not currently working between emergency nurses and other nurses; and ascertain factors associated with burnout as a reason for turnover among emergency nurses.

METHODS

We conducted a secondary analysis of 2018 National Sample Survey for Registered Nurses data (weighted N = 3,004,589) from Health Resources and Services Administration. Data were analyzed using descriptive statistics, chi-square and t-test, and unadjusted and adjusted logistic regression applying design sampling weights.

RESULTS

There were no significant differences in burnout comparing emergency nurses with other nurses. Seven job turnover reasons were endorsed by emergency nurses and were significantly higher than other nurses: insufficient staffing (11.1%, 95% confidence interval [CI] 8.6-14.2, P = .01), physical demands (5.1%, 95% CI 3.4-7.6, P = .44), patient population (4.3%, 95% CI 2.9-6.3, P < .001), better pay elsewhere (11.5%, 95% CI 9-14.7, P < .001), career advancement/promotion (9.6%, 95% CI 7.0-13.2, P = .01), length of commute (5.1%, 95% CI 3.4-7.5, P = .01), and relocation (5%, 95% CI 3.6-7.0, P = .01). Increasing age and increased years since nursing licensure was associated with decreased odds of burnout.

DISCUSSION

Several modifiable factors appear associated with job turnover. Interventions and future research should account for unit-specific factors that may precipitate nursing job turnover.

Analysis of organizational culture factors that influence the performance of health care professionals: A literature review

Hospitals in today’s healthcare system are under pressure to boost their competitiveness. A number of studies have shown the disconnect between corporate culture and the enhancement of healthcare professionals’ performance. While it is well accepted that an organization’s culture has a substantial impact on the performance of its health care professionals in clinical practice, the mechanisms by which culture might enhance health care professionals’ performance remain unclear. This paper draws on 22 literature reviews and database searches using keyword syntax from Sciencedirect, Pubmed, Google Schoolar, and other relevant publications published between 2011 and 2021. Research in the field demonstrates that a company’s culture may influence the efficiency and effectiveness of its healthcare employees. This overarching issue was dissected into the following themes: nurse performance mediated by discipline; the existence of cultural groups; a central focus on health care professional management; and individual, organizational, and psychological aspects. The optimal performance of nurses and the outcomes of patient care are contingent on management in the health care business knowing the cultural factors that exist in the workplace.

Mitigating primary care provider burnout with interdisciplinary dyads and shared care delivery

RATIONALE, AIMS AND OBJECTIVES

Increased incidence of chronic illnesses coupled with physician shortages have yielded strain on primary care provider (PCP) to meet care demands. Interdisciplinary providers have increasingly been embedded into primary care teams to alleviate some workload demand. Little evidence exists about the impact of interdisciplinary PCP care delivery models on provider strain in primary care. To determine the impact of interdisciplinary PCP care delivery on burnout, job satisfaction and intention to leave current position.

METHODS

We conducted a cross-sectional mail survey using Dillman methodology of primary care practices (e.g., internal medicine) across New York State. A random sample of interdisciplinary PCPs (physicians, nurse practitioners, and physician assistants) (n = 333) responded. The Provider Comanagement Index (α = 0.85) was used to measure how well interdisciplinary dyads comanagement care delivery attributes (effective communication; mutual respect and trust; shared philosophy of care). Provider outcomes were measured with validated Agency for Healthcare Research and Quality and Health Resources and Services Administration items for burnout, job satisfaction and intention to leave position. Descriptive statistics, logistic regression models, crude and adjusted odds ratios were calculated, controlling for participant and practice characteristics.

RESULTS

Almost 30% of participants reported burnout with three times the odds of intending to leave their current position within 1 year. With each unit increase in effective comanagement between interdisciplinary dyads there was 15% less burnout and 10% less odds of intention to leave position.

CONCLUSION

Incorporating interdisciplinary specialties in primary care appears promising to alleviate some adverse provider outcomes. Organizations contemplating delivery models to promote well-being and retention may consider comanagement. Cost effectiveness research is needed to determine financial sustainability of interdisciplinary care delivery.

The powder keg: Lessons learned about clinical staff preparedness during the early phase of the COVID-19 pandemic

BACKGROUND

Little is known about clinical staff's perspectives on preparedness for a pandemic. The purpose of this study was to obtain various clinical staff perspectives about preparedness to meet the demands for care during the early phase of the SARS-CoV-2 (COVID-19) pandemic.

METHODS

We conducted a qualitative study using semistructured in-person interviews from March 2020 to April 2020 at a large tertiary academic urban hospital center. Interview guides were informed by the Resilience Framework for Public Health Emergency Preparedness and analyzed using a directed content analysis approach.

RESULTS

Fifty-five clinical staff participated in the study. Three themes emerged from the data (1) Risk assessment and planning: "The powder keg," (2) Innovative evolution of roles and responsibilities, and (3) Pandemic response and capacity. In the early phases of the pandemic, participants reported varying levels of risks for dying. However, most participants adapted to practice changes and became innovative in their roles over time. Hierarchies were less relevant during care delivery, whereas team collaboration became crucial in managing workforce capacity.

DISCUSSION

As the pandemic progressed, staff preparedness evolved through a trial-and-error approach.

CONCLUSIONS

The pandemic is evolving as is clinical staff preparedness to meet the demands of a pandemic. In order to get a grasp on the crisis, clinical staff relied on each other and resorted to new workarounds.

An Examination of the Factors Associated With Implementation of Evidence-Based Management Practices for Improving Nurse Work Environments

BACKGROUND

Evidence-based management practices (EBMPs) that improve nurses' work environments have been linked to improvements in patient outcomes such as patient satisfaction and mortality. Yet, the extent to which nurse managers implement these EBMP or the factors associated with their implementation is not known.

AIMS

Guided by the Promoting Action on Research Implementation in Health Services (PARIHS) Framework, we examined individual, evidence, and organizational characteristics associated with nurse managers' implementation of the five EBMPs.

METHODS

A cross-sectional, correlational, survey design was used. Nurse managers from 10 public hospitals in New York City were recruited. Evidence and contextual variables were measured with the Organizational Readiness for Change Assessment instrument. EBMPs were measured with a modified version of the Practice Environment Scale of the Nursing Work Index. All multi-item scales were validated with confirmatory factors analysis in the studied sample. Additionally, the scales had Cronbach's alpha reliability greater than .8. A multivariate linear regression analysis with robust standard error correction was used to analyze the data and to adjust for clustering of managers in hospitals.

RESULTS

A total of 331 nurse managers responded for a 47.4% response rate. Bachelor's degree, number of staff supervised, managers' personal experience with evidence for EBMPs, staff culture, and organizational resources were significant predictors of nurse managers' implementation of EBMPs for NWE improvement (p < .05).

LINKING EVIDENCE TO ACTION

Staff culture was positively associated with implementation of all five EBMPs for improving nurses' work environments. Managers should prioritize nursing unit culture that encourages staff to innovate and change in order to improve care.