Advanced Practice Nurses Globally: Responding to Health Challenges, Improving Outcomes

Burnout and work engagement in advanced practice cancer nurses: A scoping review

PURPOSE

To explore the job demands, resources and outcomes of burnout and work engagement in advanced practice cancer nurses.

METHODS

A scoping review guided by Arksey and O'Malley's methodological framework. Six databases, including CINAHL (EBSCO), Cochrane Library, MEDLINE (Ovid), PsycINFO (Ovid), Scopus, and ProQuest Dissertations and Theses database and grey literature were searched for studies published in English between January 2000 and January 2024. A descriptive analysis and qualitative content analysis were conducted to analyse the data.

RESULTS

A total of 2344 articles were screened for eligibility, and 28 were selected for inclusion. Four broad themes were identified: (i) job demands, (ii) job resources, (iii) negative outcomes and (iv) positive outcomes in relation to the advanced practice cancer nurses' work environment and practices. A total of 31 job demands, 22 job resources, 9 negative and 12 positive outcomes were identified. Three studies reported higher burnout among advanced practice cancer nurses, while no studies provided data on work engagement.

CONCLUSION

Higher job demands lead to negative outcomes, which could affect advanced practice cancer nurses' overall performance and well-being. The evidence for the relationship of job demands and resources with burnout and work engagement is inconclusive. Further research is needed to address the influence of job demands and resources on burnout and work engagement of advanced practice cancer nurses.

Trans-Atlantic collaboration to establish a nurse practitioner-program in Switzerland

AIMS

This study was conducted to design, develop and implement an adult gerontology nurse practitioner (AGNP)-track in a Master of Science in Nursing (MSN)- program at a Swiss university of applied science (Swiss UAS) with a minimum of 500 practice hours.

BACKGROUND

Healthcare delivery models integrating advanced practice nurses (APN) are increasingly important due to demographic needs, public health challenges, and shortage of healthcare professionals. In countries such as Switzerland, nursing has traditionally had a late integration of Bachelor of Science in Nursing (BSN), and MSN have been predominantly taught without practice hours. To meet the changing healthcare needs of the population, the curriculum of an MSN-program of a Swiss UAS was revised, an AGNP-track was designed and developed and international standards, adapted to the Swiss context, were integrated.

DESIGN

Curriculum development research was executed to revise the Swiss MSNprogram to integrate an AGNP-track, while incorporating international standards.

METHOD

Based on an extensive review of the current Swiss MSN-curriculum and the identification of needs of the Swiss, a blueprint for an AGNP-track was developed. We adapted and integrated educational practice standards from the United States of America, the United Kingdom, Ireland and New Zealand. For implementation, a working transnational transatlantic collaboration was established comprising regular meetings between the collaborating American universities. New curricular contents were developed collaboratively using the foundation of an American curricular model for AGNP, and adapting it to the Swiss context.

RESULTS

At the outset of this process, the Swiss UAS established a working relationship with a nurse consultant from American Universities with well-established nurse practitioner education. We developed an AGNP-program blueprint, and submitted it for review to national and international experts. Our team had trust and a collaborative spirit, which were essential for the success of the future AGNP-program. In addition, support from Swiss practice areas and political goodwill increased the momentum of the implementation of new AGNP MSN-track at a Swiss UAS.

CONCLUSION

The AGNP-track at a Swiss UAS used an American curriculum as a foundation. However, national and international standards were integrated to adapt it to the Swiss context and culture.

Lessons learned from Saudi nurse academic leaders about advanced practice nursing roles: a qualitative approach

BACKGROUND

Advanced Practice Nursing (APN) is evolving across the Middle East, including in Saudi Arabia. However, limited knowledge exists regarding the facilitators and barriers to APN programs and role implementation in the region. This study utilizes a descriptive exploratory qualitative approach to examine the perspectives of academic nurse leaders on APN in Saudi Arabia.

METHODS

This study used a descriptive qualitative design. Semi-structured interviews were conducted with 13 academic leaders from various academic institutions across Saudi Arabia over six months in 2022 and 2023 via Zoom. Audio recordings were transcribed using NVivo. Thematic analysis identified several key themes.

RESULTS

The Description of APN theme highlighted specialized clinical skills, autonomous practice, and varied roles. The Needs theme emphasized improving patient outcomes, supporting healthcare transformation, and increasing cost-efficiency. The Current Status theme noted APN's infancy and limited academic programs in Saudi Arabia. Differences in APN roles theme revealed specific functions and regional variations within the healthcare system. The Focus of APN Education theme emphasized the need for all specialties. Recommended admission requirements for the APN program included a bachelor's degree and two years of experience. The Challenges theme included organizational and regulatory factors, such as organizational access to resources, and regulatory facilitators included supportive laws. The APN Future theme revealed an optimistic yet challenging outlook.

CONCLUSIONS

Academic nurse leaders consider APN essential for improving patient outcomes, requiring supportive laws, collaboration, expert involvement, and resource allocation to establish robust APN programs, offering insights for similar global contexts. This study identified challenges and facilitators of implementing APN roles and highlighted actionable steps for various stakeholders to enhance the integration of APNs. The perspectives of academic nurse leaders provide actionable recommendations to highlight the requirements for APN roles, admission to the educational programs, challenges and facilitators to assist APNs in practicing at their full potential, ultimately improving patient health outcomes by shaping the future of nursing education, practice, and regulation adjustments.

CLINICAL TRIAL NUMBER

Not applicable.

Advanced Practice Nurses' Roles and Responsibilities in Advance Care Planning for Older Persons-A Mixed Methods Systematic Review

AIM

To systematically identify, evaluate and synthesise the research literature about (a) the roles and responsibilities of advanced practice nurses (APNs) in the context of advance care planning (ACP) for older persons, (b) the characteristics of APNs' ACP practices and (c) the facilitators and barriers influencing APNs' involvement in ACP.

DESIGN

Mixed-methods systematic review.

METHODS

Followed the mixed methods systematic review guidelines outlined by the Joanna Briggs Institute. Three researchers independently screened studies for eligibility using the Covidence Screening Application. The screening involved two stages: titles and abstracts, followed by full-text evaluation. The Mixed Methods Appraisal Tool was used for quality assessment. A convergent integrated synthesis combined quantitative and qualitative data by 'qualitising' quantitative findings into text, enabling integration and thematic analysis to synthesise the results.

DATA SOURCES

Medline, CINAHL and Embase were searched from 2012 to 2024 for original research in English, focusing on APNs involved in ACP for individuals aged 65 or older, using qualitative, quantitative or mixed method designs.

RESULTS

The review included 19 studies: seven qualitative, nine quantitative and three mixed method designs. Thematic analysis revealed that APNs play a key role in ACP, aligning care with patient preferences through discussions and documentation. Studies from the United States (12), United Kingdom (4), Canada (2) and Australia (1) show varying APN roles and responsibilities.

CONCLUSION

APNs are crucial to ACP, but barriers limit their impact. Overcoming these is key to improving outcomes.

IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE

APNs clinical expertise and close patient relationships are crucial for aligning care with patient preferences and needs in ACP. However, to fully maximise their contribution, it is essential to overcome barriers such as time constraints, lack of role recognition and insufficient training. Addressing these challenges will enhance the effectiveness of APNs in providing person-centred care.

REPORTING METHOD

This review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Barriers and facilitators to the application of nurse practitioners' training pilot programs in China: A CFIR-guided descriptive qualitative study

BACKGROUND

The Guidelines on Prescriptive Authority for Nurses released by the International Council of Nurses indicate that 44 countries or territories worldwide have enacted legislation granting prescriptive authority to nurses. In the US, 27 states, two territories, and Washington, D.C. have authorized certified nurse practitioners full practice authority, including prescriptive authority, and momentum is building. Currently, in mainland China, there is no national legal mandate for nurse practitioners to prescribe, although a few institutions have initiated pilot training programs for nurse practitioners. However, little is known about the factors influencing their prescribing. Research on the value of such pilot programs from the perspectives of nurse practitioners and stakeholders is required. Aim The purpose of this study is to identify, assess and synthesize the perceptions of nurse practitioners and stakeholders in two pilot training programs on the barriers and facilitators to the potential development and implementation of nurse prescribing in mainland China.

DESIGN

A descriptive qualitative research design.

SETTINGS

The study was conducted at two nurse practitioner pilot institutions in mainland China.

PARTICIPANTS

Five nurse practitioners, three collaborators, three policymakers and three trainers of nurse practitioners from two pilot institutions.

METHODS

Data were collected via semi-structured interviews. The Consolidated Framework for Implementation Research (CFIR) was used as a framework to orient the data analysis.

RESULTS

Within the five Consolidated Framework for Implementation Research domains, we identified 31 barriers and 50 facilitators influencing the potential implementation of nurse practitioner prescribing. Barriers mainly included insufficient urgency for change, lack of policy and legal support, inadequate education and training on prescribing, and low public awareness. Facilitators encompassed nurses' practical prescribing experience, their competence and confidence in role expansion, effective teamwork, and a strong demand orientation within healthcare settings.

CONCLUSION

Our findings suggest that China possesses significant potential to successfully carry out nurse practitioner prescribing initiatives. It is crucial to explore factors hindering or promoting the development of nurse practitioners to effectively support their implementation within healthcare systems while strategizing for future advancements in this area. In the case that the national policy has not yet been promulgated, the outcomes derived from our pilot work will carry substantial influence over national policies.

Transfer of internationally qualified nurses' specialty skills to developed countries after immigration: A multicentre policy review

BACKGROUND

Internationally qualified nurses are highly sought after as a labour source due to continued shortages in the nursing profession in most developed countries. However, the lack of clear policies and procedures for nurses in the host country to use specialty nursing skills can result in the underutilisation of their expertise.

OBJECTIVES

To review the registration processes of internationally qualified nurses in 20 developed countries, with a focus on the transferability of specialised skills gained overseas.

METHODS

A multicentre policy review design was used, using the STROBE reporting guidelines. The study sourced policy information from nurse registration bodies in developed countries and reviewed and removed redundant policies.

RESULTS

Out of 34 policies initially identified, 26 were used to show the registration process of nurses after immigration to developed countries. Only four of the 20 countries reviewed indicated the option of specialised nurse registration on their website for internationally qualified nurses, with a university qualification required before years of experience. All other countries indicated the general registration pathway only.

IMPLICATIONS FOR NURSING POLICY

More attention is needed to address the lack of well-defined policies that guide the utilisation of internationally qualified nurses' specialised skills. Transparent procedures are essential to fully benefit from their expertise in the host country's health workforce.

Academic training of nurses developing advanced practice roles

The nursing profession, without losing its essence, is in continuous evolution in order to face and respond to the ever-changing health challenges of the population. Advanced Practice Nursing is a clear example of this development. The performance of advanced practice roles entails greater responsibility, expansion and depth of nursing practice, which is only possible with additional education beyond the bachelor's degree - a master's or doctoral degree in nursing - and greater expertise in clinical practice in a particular area of specialization. Advanced practice nursing is intrinsically linked to the level of education since, further academic development of nursing promotes the advancement of autonomous practice. This article addresses the education of Advanced Practice Nurses, and focuses on its core aspects; providing detailed information on competencies, curricular structure, curriculum and key components of training programs. Finally, special mention is made of advanced role training in the critical care setting.

The development of advanced practice nurses in Singapore

The development of advanced practice nursing has evolved globally over the past decades and has become an important component in the contemporary healthcare system. The term 'advanced practice nurse' is used to refer to nurses practising at a higher level than traditional nurses and is defined as a registered nurse who has acquired the expert knowledge base, complex decision-making skills and clinical competencies for expanded practice. In 2003, Singapore embarked on the development of advanced practice nurses as an initiative to improve the nursing professional image, retain excellent clinical nurses and fill the gaps in the provision of healthcare services for the ageing population. This paper documents Singapore's journey of advanced practice nursing development and shares our unique learning experience in the aspects of education, certification, registration and scope of practice.

Intensive Primary Care Nursing: Exploring the Impact of a Nurse-Led Model for Medically and Social Complex Patients

Lack of access to primary care contributes to health inequities. Treatment settings that utilize the full experience and training of nurses, both registered nurses (RNs) and advanced practice registered nurses (APRNs), can expand in primary care and successfully address health inequities. This small study describes the implementation of a model of primary care called intensive primary care (IPC), which has eight elements that support the full utilization of a nurse's experience and training. This is a mixed method qualitative study, which reports the observations of the implementation and pre- and post-intervention measures. The IPC model was implemented at a free clinic, which targeted underserved population between 2020 and 2023. Participants were selected as a convenience sample. Participants were to have two or more chronic health problems The participants received primary care using the IPC model, which included setting self-management goals, and meeting with RN or APRN on a monthly basis (face to face, via phone or zoom) to monitor progress toward goals. Twenty-two people were approached, and 19 completed the intervention. Pre- and Post-intervention measures (Patient Assessment of Chronic Illness Care [PACIC]-20); Functional, Communicative, Critical Thinking Health Literacy; Perceived Stress; Patient Activation; Perceived Self Efficacy for Chronic Disease; EuroQo- 5 Dimension (EQ-5D); Trust in Provider; Emotional Support-Patient Reported Outcome Measure Information System (PROMIS); and Patient Health Questionnaire-9) were obtained and analyzed with paired T test (α < .05). Nurses involved meet weekly to share observations recorded in free form notes. These observations were summarized by two of the authors (MD and KF) at the end of the study. All patients had improved physical health outcomes, but more importantly, there were significant improvements in measures known to impact health and health outcomes, specifically, patient activation, self-efficacy for chronic illness, PACIC, and trust in provider. Time spent with patients, both duration and frequency of contact, was observed to have significant impacts.

Response and innovations of advanced practice nurses during the COVID-19 pandemic: A scoping review

AIM

Identify and map international evidence regarding innovations led by or involving advanced practice nurses in response to COVID-19.

BACKGROUND

COVID-19 necessitated unprecedented innovation in the organization and delivery of healthcare. Although advanced practice nurses have played a pivotal role during the pandemic, evidence of their contributions to innovations has not been synthesized. Evidence is needed to inform policies, practices, and research about the optimal use of advanced practice nurses.

METHODS

A scoping review was conducted and reported using the PRISMA-ScR checklist. Electronic databases were searched for peer-reviewed articles published between January 2020 and December 2021. Papers were included that focused on innovations emerging in response to COVID-19 and involved advanced practice nurses.

RESULTS

Fifty-one articles were included. Four themes were identified including telehealth, supporting and transforming care, multifaceted approaches, and provider education. Half of the articles used brief and mostly noncomparative approaches to evaluate innovations.

CONCLUSION

This is the first synthesis of international evidence examining the contributions of advanced practice nurses during the pandemic. Advanced practice nurses provided leadership for the innovation needed to rapidly respond to healthcare needs resulting from COVID-19. Innovations challenged legislative restrictions on practice, enabled implementation of telehealth and new models of care, and promoted evidence-informed and patient-centered care.

IMPLICATIONS FOR PRACTICE

Advanced practice nurses led, designed, implemented, and evaluated innovations in response to COVID-19. They facilitated the use of telehealth, supported or transformed models of care, and enabled health providers through education, mentorship, and mental health support.

IMPLICATION FOR POLICY

Advanced practice nurses are a critical resource for innovation and health system improvement. Permanent removal of legislative and regulatory barriers to their full scope of practice is needed.

[Practice and challenges of delegating medical tasks in the interprofessional everyday work of inpatient healthcare in Germany - An exploratory survey]

BACKGROUND

The delegation of medical tasks (DMT) plays a significant role in the everyday practice of inpatient care but also presents a potential challenge in interprofessional collaboration. Assessing the conditions of DMT in everyday work is crucial to identify areas for optimization.

METHODS

In a nationwide exploratory study, physicians, nursing and allied health professionals working for inpatient care facilities were surveyed regarding various aspects of DMT using a standardized online questionnaire.

RESULTS

The majority of the 757 participants (64.9% physicians), perceived DMT to be both economically and time-efficient (88.5% agreement) and in the best interest of patients (74%). For 78.7% of the respondents, DMT represents a potential conflict in their daily work, depending on the quality of interprofessional communication. Inadequate staffing was identified as a barrier to a broader implementation of DMT by 83.8% of participants. 63.2% of the participants considered their knowledge of legal aspects related to DMT to be at least good (participants with less than 5 years of professional experience: 52.6%). Physicians primarily acquire relevant knowledge through professional practice (71.3% vs. non-physicians 39.5%).

CONCLUSION

Across the different professional groups DMT was considered beneficial and serving the interests of patients. Targeted promotion of safe and cost-effective DMT should be incorporated into medical education. Achieving greater benefits from DMT requires explicit legal frameworks, effective communication within the team and, in particular, adequate staffing among the professional groups responsible for delegated tasks.

Stepping outside national borders: International active learning educational collaboration events

AIM

This paper discusses the benefits of international collaborations for advanced practice nursing education. It identifies new perspectives and innovative practices to enhance cultural competency.

BACKGROUND

Competent, well-trained advanced practice nurses (APNs) are necessary to provide high-quality and safe patient care, improve access to care, and address health disparities that are no longer geographically bound. In 2021, an international network of advanced practice educators established an active learning program to teach students their role in global citizenship and increase awareness of health disparities. APN students from Scotland, Wales, Minnesota, Houston, and Rotterdam participated in presentations, online discussions, and in-country scholarships.

SOURCES OF EVIDENCE

Growing health disparities have created the need for efficient international collaboration to develop new concepts, approaches, and bidirectional exchange of experiences, culture, and knowledge. Integrating global health into curricula engages students' curiosity and integrates education, research, practice, and leadership while improving cultural competency.

DISCUSSION

Forty-two students participated in the international presentations. The students strongly believed in the benefit of international collaboration and the need for a universal role for the advanced practice nurse. They responded positively to sharing cultural and clinical experiences.

CONCLUSION

The recent global health challenge supported the development of innovative methods to deliver education and created an opportunity for advanced practice students to develop cultural competence and critical thinking. Collaborative solutions are essential to education and healthcare as we move forward in the 21st century.

IMPLICATIONS FOR NURSING PRACTICE

Robust international collaborations have enabled the development of cultural competence and critical thinking. These are crucial elements for advanced practice roles.

Models of care with advanced practice nurses in the emergency department: A scoping review

INTRODUCTION

Emergency departments play a critical role in healthcare systems internationally. Visits for emergency care continue to increase, related to poor access to primary care, the COVID-19 pandemic, and health human resource issues. International literature shows similar stressors in the emergency department. Extended wait times to see health providers lead to poor outcomes, and innovative models of care are needed to address emergency department overcrowding and to meet the needs of patients. Advanced practice nurses have the expertise and scope of practice to optimize and address primary and acute care needs and could be further integrated into the emergency healthcare systems. It is unclear what and how advanced practice nurses are functioning in emergency departments to improve patient and organization outcomes.

METHODS

This scoping review was a comprehensive search of MEDLINE, EMCARE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, and gray literature. Authors developed inclusion and exclusion criteria, performed title and abstract screening, and full text screening using review software. Data about models of care with advanced practice nurses were extracted and organized to understand patient, provider, and organizational outcomes. We also extracted information about the development and implementation of roles.

RESULTS

Of the 6780 records identified, 76 met inclusion criteria. Emergency department models of care, mainly using nurse practitioners, include fast-track, generalized emergency, minor injury, orthopedics, pediatrics, geriatrics, specific populations, and triage. Reported patient outcomes include improvement in key metrics specific to emergency departments, such as total length of stay, wait times to be seen by a provider, left without being seen rates, treatment for pain, costs, and resource use. When comparing nurse practitioners to other providers, outcomes were similar or better for patient and organizational outcomes.

DISCUSSION

Various models of care utilizing advanced practice nurses in emergency departments are present internationally and information about how they are developed, integrated, and utilized provides practical information to support and sustain new roles. There is an opportunity to expand the use of these roles into emergency departments as the nurse practitioner scope of practice grows. Given the current crisis across healthcare systems, there is need for innovation, and improving delivery of emergency services with these advanced practice nursing models of care can help to address important health policy priorities in Canada and other countries.

TWEETABLE ABSTRACT

Advanced Practice Nurse models of care in emergency - Improved outcomes for patients and organizations - A review of the literature. @SamanthaH_RN.

Advancement of research on nurse practitioners: Setting a research agenda

BACKGROUND

Primary care delivered by nurse practitioners (NPs) helps to meet the United States' growing demand for care and improves patient outcomes. Yet, barriers impede NP practice. Knowledge of these barriers is limited, hindering opportunities to eliminate them.

PURPOSE

We convened a 1.5-day conference to develop a research agenda to advance evidence on the primary care NP workforce.

METHODS

Thirty experts gathered in New York City for a conference in 2022. The conference included plenary sessions, small group discussions, and a prioritization process to identify areas for future research and research questions.

DISCUSSION

The research agenda includes top-ranked research questions within five categories: (a) policy regulations and implications for care, quality, and access; (b) systems affecting NP practice; (c) health equity and the NP workforce; (d) NP education and workforce dynamics, and (e) international perspectives.

CONCLUSION

The agenda can advance evidence on the NP workforce to guide policy and practice.

Teaching strategies of clinical reasoning in advanced nursing clinical practice: A scoping review

AIM/OBJECTIVE

To report and synthesize the main strategies for teaching clinical reasoning described in the literature in the context of advanced clinical practice and promote new areas of research to improve the pedagogical approach to clinical reasoning in Advanced Practice Nursing.

BACKGROUND

Clinical reasoning and clinical thinking are essential elements in the advanced nursing clinical practice decision-making process. The quality improvement of care is related to the development of those skills. Therefore, it is crucial to optimize teaching strategies that can enhance the role of clinical reasoning in advanced clinical practice.

DESIGN

A scoping review was conducted using the framework developed by Arksey and O'Malley as a research strategy. Consistent with the nature of scoping reviews, a study protocol has been established.

METHODS

The studies included and analyzed in this scoping review cover from January 2016 to June 2022. Primary studies and secondary revision studies, published in biomedical databases, were selected, including qualitative ones. Electronic databases used were: CINAHL, PubMed, Cochrane Library, Scopus, and OVID. Three authors independently evaluated the articles for titles, abstracts, and full text.

RESULTS

1433 articles were examined, applying the eligibility and exclusion criteria 73 studies were assessed for eligibility, and 27 were included in the scoping review. The results that emerged from the review were interpreted and grouped into three macro strategies (simulations-based education, art and visual thinking, and other learning approaches) and nineteen educational interventions.

CONCLUSIONS

Among the different strategies, the simulations are the most used. Despite this, our scoping review reveals that is necessary to use different teaching strategies to stimulate critical thinking, improve diagnostic reasoning, refine clinical judgment, and strengthen decision-making. However, it is not possible to demonstrate which methodology is more effective in obtaining the learning outcomes necessary to acquire an adequate level of judgment and critical thinking. Therefore, it will be necessary to relate teaching methodologies with the skills developed.

Relationships between self-efficacy, coping-style and quality of work-life among nursing managers in China: A cross-sectional study

AIM

To investigate the quality of work-life among nursing managers in China and analyze the relationships between self-efficacy, coping-style, and quality of work-life.

BACKGROUND

Self-efficacy, coping-style, and quality of work-life play significant roles in the stability of nursing teams, the quality of clinical care, and patient safety. Although some factors influencing quality of work-life have been identified, there is no large-scale study of the relationships among self-efficacy, coping-style, and quality of work-life of nursing managers. Strategies to strengthen the quality of work-life of nursing managers should be developed by exploring the relationships between the three variables.

METHODS

A nationwide cross-sectional study was conducted. A total of 1498 nursing managers from 51 tertiary general hospitals in 20 provinces in China were selected for the study using multistage stratified proportional sampling. Registered full-time nursing managers with more than one year of management experience were eligible for the study. The participants completed online questionnaires to assess their self-efficacy, coping-style, and work-related quality of life. The data were analyzed using descriptive analysis, Pearson's correlation, hierarchical multiple linear regression, and structural equation modelling to verify the relationships between variables.

RESULTS

The quality of work-life score for the nursing managers surveyed was 3.74 ± 0.56 out of a possible five. Self-efficacy was positively correlated with quality of work-life (β = 0.484, P < 0.01) over all demographic variables. Positive coping was also positively associated with quality of work-life (β = 0.404, P < 0.01). Self-efficacy and positive coping explained 22.7% and 14.2% of the variance in the quality of work-life, respectively. Structural equation modelling indicated that self-efficacy positively and directly predicted the quality of work-life (β = 0.395, P < 0.001), and indirectly affected quality of work-life via positive coping (β = 0.186, P < 0.001), but not via negative coping (β = 0.005, P > 0.05). The final model could explain 44% of the variance in the quality of work-life.

CONCLUSION

Self-efficacy was positively correlated with quality of work-life among Chinese nursing managers, and positive coping partially mediated this relationship. The results suggest that self-efficacy and positive coping are pivotal facilitators for improving the quality of work-life and need to be taken into account in measures to improve the quality of work-life of nursing managers.

IMPLICATIONS FOR NURSING MANAGEMENT

Hospital administrators should recognize the importance of nursing managers' work-life quality to promote both the stability of nursing teams and the quality of clinical care and safety provided. They should help nursing managers foster self-efficacy and active coping abilities through incentive measures and provide positive coping training courses to enhance their quality of work-life.