Mental preparedness for prolonged periods of high workload - what did we learn from the covid-19 pandemic?

Factors influencing nurse manager retention, intent to stay or leave and turnover: A systematic review update

AIMS

To understand factors influencing nurse manager retention or intention to leave, develop a preliminary theoretical model and identify strategies and interventions for workforce planning.

DESIGN

Systematic review update of literature with integrated design of mixed research synthesis.

METHODS

We included peer-reviewed articles examining factors influencing retention or intention to leave for front-line, middle or patient care nurse managers. Authors independently screened articles for inclusion and assessed included articles for quality. We adhered to a convergent synthesis approach.

DATA SOURCES

Nine databases included MEDLINE, EMBASE, PsychINFO, CINAHL Plus with Full Text, ERIC, Health Source Nursing/Academic Edition, Scopus, ProQuest Dissertations and Theses and LILACS in January 2023.

RESULTS

Thirty-five studies published between 1990 and 2022, 22 quantitative and 13 qualitative or mixed methods, were included. 155 factors influencing nurse manager retention, intention to stay, or turnover were reported. Job satisfaction was most frequently examined (n = 7), followed by factors such as empowerment (n = 3), decision-making (n = 3) and resilience (n = 2). We developed a preliminary theoretical model demonstrating staff relations and leadership, organizational and job characteristics, socio-demographics, personal characteristics, well-being and nurse manager relationship with work influence managers' intention to stay or to leave.

CONCLUSIONS

Nurse managers who were empowered, satisfied with their work, received constructive feedback and found meaning in their roles showed greater intent to stay.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Nurse administrators can ensure managers are provided with authority to make decisions that promote autonomy. Work cultures that allow for regular meaningful constructive feedback from staff and leaders may contribute to nurse managers feeling valued.

IMPACT

Understanding factors that influence job retention or intention to leave may help nurse managers and their supervisors identify areas for strategy and intervention design to ensure sustainability of this workforce.

REPORTING METHOD

PRISMA 2020 Guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Risk and protection factors of mental stress among medical staff in the third year of the COVID-19 pandemic

Background

The COVID-19 pandemic placed an extraordinary burden on health care workers (HCW), who are reported to suffer from great mental stress. The current study investigates the mental health of HCW in the later phases of the pandemic.

Methods

HCW completed the following questionnaires online (06/2021-02/2022, N=159): demographics (age, gender, profession, ward), Impact of Event Scale (IES-R, posttraumatic stress), State Trait Anxiety Inventory (STAI-S, state anxiety), stress-coping questionnaire (SVF-78), and bespoke corona-specific stress and protective-factor questions (5 items each). We used factor analysis to test scale properties and regression-type methods (t-tests, ANOVA, multiple regression) for hypothesis tests and effect-size estimation.

Results/discussion

Mental stress in HCW is influenced by similar factors as described for earlier phases. However, differences to earlier phases were found in ward affiliation which is no longer a variable of concern for explaining differences in mental health of HCW. Further, even if nurses are the occupational group with the highest mental stress as in prior research, detailed analysis shows that medical specialists with close proximity to patients with a high-level of responsibility are the most burdened sub-group. Unlike nurses, they suffer from high levels of anxiety in addition to high levels of post-traumatic and COVID-specific stress. Analyses showed further that COVID-specific stress is the strongest predictor of mental stress, wherein COVID-specific stress factors remain the same as reported in literature on the early pandemic phases. HCW showed to use still more positive than negative coping strategies. Negative strategies increased as expected mental stress, whereas positive strategies alleviated only anxiety. Additionally, we found that doctors benefited from many protective factors while nurses had access to fewer protective factors like earlier waves.

Conclusion

Data show that HCW still suffer from mental stress in the third year of the pandemic. HCW of all hospital wards may be affected by mental stress and need attention and protective measures. Medical specialists are the most burdened subgroup. Detailed analyses show that properties other than occupation, gender, or ward affiliation are more appropriate to evaluate mental stress of HCW. The findings have implications for developing specialized protection strategies for the post-pandemic phase and future pandemics.

What Are the Factors That Influence Job Satisfaction of Nurses Working in the Intensive Care Unit? A Multicenter Qualitative Study

Aim

To explore and describe the factors that influence the job satisfaction of nurses working in the intensive care unit (ICU).

Background

High turnover and dropout rates of nurses currently put pressure on the accessibility and quality of ICU care. Job satisfaction is an important predictor for turnover. However, there is little knowledge about the factors that enhance or frustrate the job satisfaction of ICU nurses.

Methods

A qualitative descriptive study was conducted from March to July 2022. Semistructured interviews were held with 23 registered nurses who were purposively sampled from the ICU in four hospitals in the Netherlands. Interview transcripts were analyzed by using a thematic content analysis approach.

Results

Six themes emerged: (1) being part of a solid team; (2) professional autonomy; (3) competence development; (4) appreciation of work by others; (5) work content; and (6) human resource management. Interviewees described the importance of being part of a team, having professional autonomy and opportunities to develop and remain challenged as a professional. In practice, these needs are often not met. Interviewees expressed their own role in meeting these needs by taking charge in situations, being eager to learn, and actively looking for ways to keep work attractive. Recognition and appreciation for their work are important catalysts for staying motivated. Monotonous work, poor leadership, and bureaucracy reduced their job satisfaction.

Conclusion

Our findings provide deeper insight into a range of factors that influence the job satisfaction of ICU nurses and may also apply to nurses in other settings. Practical recommendations are given for keeping the nursing profession attractive for the current and future generation. Implications for Nursing Management. Findings emphasize the importance of optimizing nurses' work conditions by investing in their social embeddedness, professional autonomy, opportunities for competence development, and appreciation of work.

Mental well-being of intensive care unit nurses after the second surge of the COVID-19 pandemic: A cross-sectional and longitudinal study

OBJECTIVES

To determine the impact of the second surge of the COVID-19 pandemic (October 2020 to June 2021) on mental well-being of intensive care unit nurses and factors associated with mental health outcomes.

METHODS

An online survey was available for Dutch intensive care unit nurses in October 2021, measuring mental health symptoms; anxiety, depression (Hospital Anxiety and Depression Scale), and post-traumatic stress disorder (Impact of Event Scale-6). Additionally, work-related fatigue was measured using the Need For Recovery-11 questionnaire. Previous data from the first surge (March until June 2020) were used to study mental well-being longitudinally in a subgroup of intensive care unit nurses. Logistic regression analyses were performed to determine factors associated with mental health symptoms.

RESULTS

In total, 589 nurses (mean age 44.8 [SD, 11.9], 430 [73.8 %] females) participated, of whom 164 also completed the questionnaire in 2020. After the second surge, 225/589 (38.2 %) nurses experienced one or more mental health symptoms and 294/589 (49.9 %) experienced work-related fatigue. Compared to the first measurement, the occurrence of mental health symptoms remained high (55/164 [33.5 %] vs 63/164 [38.4 %], p = 0.36) and work-related fatigue was significantly higher (66/164 [40.2 %] vs 83/164 [50.6 %], p = 0.02). Granted holidays as requested (aOR, 0.54; 95 % CI, 0.37-0.79), being more confident about the future (aOR, 0.59; 95 % CI, 0.37-0.93) and a better perceived work-life balance (aOR, 0.42; 95 % CI, 0.27-0.65) were significantly associated with less symptoms.

CONCLUSION

The second surge of the COVID-19 pandemic further drained the mental reserves of intensive care unit nurses, resulting in more work-related fatigue.

A systematic review and meta analysis on burnout in physicians during the COVID-19 pandemic: A hidden healthcare crisis

Objective

This systematic review and meta-analysis aims to explore overall prevalence of burnout among physicians during early and late COVID-19 pandemic and geographical differences in burnout.

Methods

This review was registered prospectively with PROSPERO (CRD42022327959). A comprehensive search of several databases, including Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily, Ovid Embase, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, PsycINFO, and Scopus, spanning from December 2019 to May 2022 was conducted. Eligible studies included physicians or medical professionals including physicians that worked directly or indirectly with COVID-19 patients, whilst reporting burnout outcomes using a validated scale. Literature that did not include physicians or did not occur in a hospital setting were excluded. Literature including medical students were also excluded.

Results

Forty-five observational studies were included, all of which were cross-sectional studies. The pooled estimate of overall prevalence of burnout was 54.60% (95% CI: 46.7, 62.2). Mean emotional exhaustion, depersonalization, and personal accomplishment was found to be 22.06% (95% CI: 18.19, 25.94), 8.72 (95% CI: 6.48, 10.95) and 31.18 (95% CI: 27.33, 35.03) respectively. Frontline workers displayed higher rates of burnout than second-line healthcare workers (HCW) (OR: 1.64, 95% CI: 1.13, 2.37). Studies from the early pandemic period reported burnout prevalence of 60.7% (95% CI: 48.2, 72) compared to a prevalence of 49.3% (95% CI: 37.7, 60.9) from the late pandemic period. Geographically, burnout was highest amongst Middle East and North Africa (MENA) studies (66.6%, 95% CI: 54.7, 78.5), followed by Europe (48.8%, 95% CI: 40.3, 57.3) and then South America (42%, 95% CI: -0.4, 84.4). Lastly, burnout prevalence overall (OR = 0.77, 95% CI: 0.36, 1.67) emotional exhaustion (MD = -0.36, 95% CI: -4.64, 3.91), depersonalization (MD = -0.31, 95% CI: -1.80, 1.18), and personal accomplishment (MD = 0.55, 95% CI: -0.73, 1.83) were found comparable between physicians and nurses.

Conclusion

COVID-19 has had significant consequences on HCW burnout. Further research is needed to examine early signs of burnout and to develop effective coping strategies.

Fundamental drivers of nurses' experiences of ICU surging during the coronavirus disease 2019 (COVID-19) pandemic

PURPOSE OF REVIEW

Nurses working in intensive care units have been heavily impacted by the coronavirus disease 2019 (COVID-19) pandemic. This review summarizes the current state of the evidence regarding intensive care nurses experience of the pandemic.

RECENT FINDINGS

The pandemic has had an impact on: nursing workload, the organization of nurse staffing, experiences of staff redeployed into ICU, nurses' perceptions of the safety and quality of patient care, and staff health. In the few comparative studies, mental health was worse for nurses than other healthcare workers in intensive care. Despite some of this evidence being published early in the pandemic, no studies were found to evaluate interventions to improve nurses' experiences.

SUMMARY IMPLICATIONS FOR PRACTICE OR RESEARCH

Many of the adverse impacts of the pandemic are interdependent; for example, reducing nurses' workload is likely to have benefits for mental health indicators.Adverse mental health outcomes are likely to have an impact on future recruitment and retention for intensive care nursing.More studies are needed to understand the longer term impact of the pandemic on intensive care nurses.