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Cortés-Álvarez NY, Lara-Morales A, Bautista-Rodríguez E, Marmolejo-Murillo LG, Díaz Jiménez A, Vergara Hernández LA, Fernández Moya M, Vuelvas-Olmos CR. Job burnout, cognitive functioning, and Brain-derived neurotrophic factor expression among hospital Mexican nurses. PLoS One 2024; 19:e0304092. [PMID: 38787900 PMCID: PMC11125546 DOI: 10.1371/journal.pone.0304092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 05/06/2024] [Indexed: 05/26/2024] Open
Abstract
AIM To analyze the relationship between burnout syndrome, cognitive functions, and sBDNF (Serum Brain-derived Neurotrophic Factor) in Mexican nurses. METHOD A descriptive cross-sectional design was used. This study target staff nurses working in hospitals in Guanajuato, México. Demographic and working condition data were collected via questionnaire. The Maslach Burnout Inventory (MBI) was used to evaluate burnout. A blood sample were collected and processed by ELISA technique to measure sBDNF. Finally, the General Cognitive Assessment (CAB) of the Cognifit© neuropsychological battery was used to evaluated cognitive functions. RESULTS Findings showed that there are sociodemographic characteristics and working conditions associated with burnout syndrome among nurses. Furthermore, the data demonstrated a significant decrease in sBDNF levels in burnout nurses and a negative correlation between BDNF levels and burnout syndrome. Additionally, these burnout nurse also revealed significant cognitive impairment in reasoning, memory, and attention as well as total scores of CAB. Interestingly, we found a positive correlation between sBDNF levels and the cognitive deficits in burnout nurse. CONCLUSION Reduced BDNF levels could be a biological indicator or part of the pathological process of burnout, which could affect cognitive abilities. Reduced cognitive function in nurses has relevant implications and emphasizes the need for specialized preventive strategies because nurses make clinical decisions concerning their patients, whose situations are constantly changing.
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Affiliation(s)
- Nadia Yanet Cortés-Álvarez
- Department of Nursing and Midwifery, Division of Natural and Exact Sciences, University of Guanajuato, Guanajuato, Mexico
| | - Alfredo Lara-Morales
- Department of Nursing and Midwifery, Division of Natural and Exact Sciences, University of Guanajuato, Guanajuato, Mexico
| | - Elizabeth Bautista-Rodríguez
- Faculty of Biotechnology, Laboratory of Medical & Pharmaceutical Biotechnology, Universidad Popular Autónoma del Estado de Puebla (UPAEP), Puebla, Mexico
| | | | | | | | - Monserrat Fernández Moya
- Department of Nursing and Midwifery, Division of Life Sciences, University of Guanajuato, Guanajuato, Mexico
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Kim Y, Lee K, Jung M. Improvement in nurse staffing ratios according to policy changes: a prospective cohort study. BMC Nurs 2024; 23:335. [PMID: 38760767 PMCID: PMC11100228 DOI: 10.1186/s12912-024-01995-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/06/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Since 1999, reimbursements for nursing services for inpatients have been paid differentially according to the nurse staffing ratios in Korea. However, differentiated nursing fees are insufficient for nurse staffing; thus, steps have been taken to improve the policy. This study aimed to identify the impact of a policy that changed the method of calculating nurse staffing ratios from the nurse-to-bed ratio to the nurse-to-patient ratio on improving the nurse staffing ratio in medical institutions. METHODS Data were collected from 1,339 medical institutions that continuously provided medical services from 2017 to of 2021, and a prospective cohort was used for analysis. A generalized estimating equation for longitudinal ordered logistic regression was used to identify the impact of this policy change on the nurse staffing ratios in medical institutions. RESULTS During the cohort study, 59.8% of the first-applied group of medical institutions and 65.6% of the second-applied group of medical institutions improved their nurse staffing ratios. However, only 22.6% of the medical institutions to which the revised calculation method was not applied improved their nurse staffing ratios. A statistically significant difference was found in the improved nurse staffing ratio depending on whether and when the revised calculation method was applied (χ2 = 89.830, p < .001). The analysis of nurse staffing ratios of medical institutions from 2017 to 2021 showed that the likelihood of improving the nurse staffing ratio increased gradually after the revised calculation method was adopted. Also,the likelihood of the nurse staffing ratio improving in the first-applied group was 1.41 times higher (odds ratio = 1.41, 95% confidence interval = 1.04-1.92) than in the non-applied group. The odds ratio for the improvement of nurse staffing ratio in the second-applied group was 2.35 (95% confidence interval = 1.76-3.14). CONCLUSIONS Financial incentives inherent in the new policy can be regarded as the driving force behind improvements in nurse staffing ratios. The revised calculation method should be extended to all medical institutions nationwide, and the law should be revised to secure the minimum number of nurses.
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Affiliation(s)
- Yunmi Kim
- College of Nursing, Eulji University, Seongnam-Si, Republic of Korea
| | - Kyounga Lee
- College of Nursing, Gachon University, Incheon, Republic of Korea.
| | - Minho Jung
- Department of Nursing, Seoul National University Hospital, Seoul, Republic of Korea
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3
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Catania G, Zanini M, Cremona MA, Landa P, Musio ME, Watson R, Aleo G, Aiken LH, Sasso L, Bagnasco A. Nurses' intention to leave, nurse workload and in-hospital patient mortality in Italy: A descriptive and regression study. Health Policy 2024; 143:105032. [PMID: 38460274 DOI: 10.1016/j.healthpol.2024.105032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 02/19/2024] [Accepted: 02/26/2024] [Indexed: 03/11/2024]
Abstract
Higher nurse-to-patient ratios are associated with poor patient care and adverse nurse outcomes, including emotional exhaustion and intention to leave. We examined the effect of nurses' intention to leave and nurse-patient workload on in-hospital patient mortality in Italy. A multicentered descriptive and regression study using clinical data of patients aged 50 years or older with a hospital stay of at least two days admitted to surgical wards linked with nurse variables including workload and education levels, work environment, job satisfaction, intention to leave, nurses' perception of quality and safety of care, and emotional exhaustion. The final dataset included 15 hospitals, 1046 nurses, and 37,494 patients. A 10 % increase in intention to leave and an increase of one unit in nurse-patient workload increased likelihood of inpatient hospital mortality by 14 % (odds ratio 1.14; 1.02-1.27 95 % CI) and 3.4 % (odds ratio 1.03; 1.00-1.06 95 % CI), respectively. No other studies have reported a significant association between intention to leave and patient mortality. To improve patient outcomes, the healthcare system in Italy needs to implement policies on safe human resources policy stewardship, leadership, and governance to ensure nurse wellbeing, higher levels of safety, and quality nursing care.
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Affiliation(s)
- Gianluca Catania
- Department of Health Sciences, University of Genoa, Via A. Pastore 1 16132, Genoa, Italy
| | - Milko Zanini
- Department of Health Sciences, University of Genoa, Via A. Pastore 1 16132, Genoa, Italy.
| | - Marzia A Cremona
- Department of Operations and Decision Systems, Université Laval Research Center, CHU de Québec Quebec G1V 4G2, Canada
| | - Paolo Landa
- Department of Operations and Decision Systems, Université Laval Research Center, CHU de Québec Quebec G1V 4G2, Canada
| | - Maria Emma Musio
- Department of Health Sciences, University of Genoa, Via A. Pastore 1 16132, Genoa, Italy
| | - Roger Watson
- Academic Dean, Southwest Medical University, Luzhou, PR China
| | - Giuseppe Aleo
- Department of Health Sciences, University of Genoa, Via A. Pastore 1 16132, Genoa, Italy
| | - Linda H Aiken
- Center for Health Outcomes and Policy Research, University of Pennsylvania, 418 Curie Blvd, Philadelphia PA 19104, USA
| | - Loredana Sasso
- Department of Health Sciences, University of Genoa, Via A. Pastore 1 16132, Genoa, Italy
| | - Annamaria Bagnasco
- Department of Health Sciences, University of Genoa, Via A. Pastore 1 16132, Genoa, Italy
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Amberson T, Graves JM, Sears JM. Overview of Occupational Injuries Among Registered Nurses in Washington State, 2007 to 2019. Workplace Health Saf 2024; 72:187-195. [PMID: 38158830 DOI: 10.1177/21650799231214235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
BACKGROUND Registered nurses (RNs) represent the largest segment of the health care workforce and have unique job demands and occupational health considerations. The purpose of this study was to describe the incidence, cost, and causes of occupational injuries among RNs in Washington State and to quantify the cumulative cost and burden of each type of injury, relative to all injuries among RNs. METHODS Annual injury claims data covered under Washington State workers' compensation (WC) fund were analyzed over a 13-year period (2007-2019). Annual mean incidence and cost of injuries were calculated and stratified by nature, source, and event/exposure. Negative binomial regression models were used to examine trends in injury incidence over time, for injury incidence overall, and by the most common injury classifications. RESULTS Between 2007 and 2019, 10,839 WC claims were filed and accepted for Washington State RNs (annual M = 834), totaling more than US$65 million. No significant trend in overall injury incidence was observed (incidence rate ratio [IRR]: 0.99, 95% confidence interval [CI] = [0.94, 1.05]). The most common injury exposures were bodily reaction and exertion, contact with objects and equipment, falls, and assaults and violent acts. DISCUSSION To our knowledge, this is the first broad study of the incidence and costs of occupational injuries among RNs across all workplace settings. We identified high-cost, high-frequency incidence rates of musculoskeletal, sharp, and violence-related occupational injury claims, highlighting intervention targets. Implications for Occupational Health Practice: Policy makers, health systems, and occupational health nurse leaders can use this information to identify priority areas where evidence-based occupational health and prevention programs are most needed.
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Affiliation(s)
- Taryn Amberson
- Department of Health Systems and Population Health, University of Washington
| | - Janessa M Graves
- College of Nursing, Washington State University
- Harborview Injury Prevention & Research Center
| | - Jeanne M Sears
- Department of Health Systems and Population Health, University of Washington
- Harborview Injury Prevention & Research Center
- Department of Environmental & Occupational Health Sciences, University of Washington
- Institute for Work & Health
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Muir KJ, Porat-Dahlerbruch J, Nikpour J, Leep-Lazar K, Lasater KB. Top Factors in Nurses Ending Health Care Employment Between 2018 and 2021. JAMA Netw Open 2024; 7:e244121. [PMID: 38592723 PMCID: PMC11004833 DOI: 10.1001/jamanetworkopen.2024.4121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 01/25/2024] [Indexed: 04/10/2024] Open
Abstract
Importance The increase in new registered nurses is expected to outpace retirements, yet health care systems continue to struggle with recruiting and retaining nurses. Objective To examine the top contributing factors to nurses ending health care employment between 2018 and 2021 in New York and Illinois. Design, Setting, and Participants This cross-sectional study analyzed survey data (RN4CAST-NY/IL) from registered nurses in New York and Illinois from April 13 to June 22, 2021. Differences in contributing factors to ending health care employment are described by nurses' age, employment status, and prior setting of employment and through exemplar nurse quotes. Main Outcomes and Measures Nurses were asked to select all that apply from a list of contributing factors for ending health care employment, and the percentage of nurse respondents per contributing factor were reported. Results A total of 7887 nurses (mean [SD] age, 60.1 [12.9] years; 7372 [93%] female) who recently ended health care employment after a mean (SD) of 30.8 (15.1) years of experience were included in the study. Although planned retirement was the leading factor (3047 [39%]), nurses also cited burnout or emotional exhaustion (2039 [26%]), insufficient staffing (1687 [21%]), and family obligations (1456 [18%]) as other top contributing factors. Among retired nurses, 2022 (41%) ended health care employment for reasons other than planned retirement, including burnout or emotional exhaustion (1099 [22%]) and insufficient staffing (888 [18%]). The age distribution of nurses not employed in health care was similar to that of nurses currently employed in health care, suggesting that a demographically similar, already existing supply of nurses could be attracted back into health care employment. Conclusions and Relevance In this cross-sectional study, nurses primarily ended health care employment due to systemic features of their employer. Reducing and preventing burnout, improving nurse staffing levels, and supporting nurses' work-life balance (eg, childcare needs, weekday schedules, and shorter shift lengths) are within the scope of employers and may improve nurse retention.
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Affiliation(s)
- K. Jane Muir
- Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia
- The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- National Clinician Scholars Program, University of Pennsylvania, Philadelphia
| | - Joshua Porat-Dahlerbruch
- Department of Acute and Tertiary Care, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jacqueline Nikpour
- Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia
- The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | | | - Karen B. Lasater
- Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia
- The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
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Kim Y, Lee K, Jung M. Effects of a disincentive policy on behavioral changes by South Korean medical institutions that do not submit official nursing grade data. Int Nurs Rev 2024. [PMID: 38477823 DOI: 10.1111/inr.12956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 02/25/2024] [Indexed: 03/14/2024]
Abstract
AIM This study aimed to determine whether the policy of imposing deductions on medical institutions in South Korea led to increased submission of nursing grade data. BACKGROUND In Korea, medical institutions are required to report data on their nursing workforce; however, many institutions did not comply with this regulation, making it difficult to gauge their level of nurse staffing. Therefore, in 2020, a nursing fee deduction policy was introduced that penalizes medical institutions financially for failing to submit nursing workforce data. METHODS We prospectively collected data on the characteristics, nursing grade, and data submission status of 1,200 hospitals in South Korea from 2015 to 2021. We analyzed the submission rate of data related to nursing grades according to the characteristics of the medical institutions and evaluated the effect of policy change on data submission status using multiple logistic regression. FINDINGS The submission rate of data increased from 50.2% in 2015 to 93.3% in 2021, and 39.3% of medical institutions that had not previously submitted data did so after the policy was introduced. The submission rate of medical institutions unaffected by the policy also increased after its introduction. Compared with 2015, the likelihood of medical institutions submitting data increased by 23.69 times in 2020 and 20.47 times in 2021. CONCLUSION The appropriate use of disincentive policies, such as financial deductions for medical institutions showing inappropriate behavior, was found to be effective in inducing desirable changes in the behavior of medical institutions. IMPLICATIONS FOR NURSING AND HEALTH POLICY Properly planned and implemented policies can contribute to improved quality of medical services and patient safety through effective administrative control.
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Affiliation(s)
- Yunmi Kim
- College of Nursing, Eulji University, Seongnam-si, Republic of Korea
| | - Kyounga Lee
- College of Nursing, Gachon University, Incheon, Republic of Korea
| | - Minho Jung
- Department of Nursing, Seoul National University Hospital, Seoul, Republic of Korea
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Bae SH. Assessing the impacts of nurse staffing and work schedules on nurse turnover: A systematic review. Int Nurs Rev 2024; 71:168-179. [PMID: 37216655 DOI: 10.1111/inr.12849] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 04/26/2023] [Indexed: 05/24/2023]
Abstract
AIM This study aimed to investigate and synthesize the impacts of nurse staffing and work schedules on nurse turnover in acute hospitals. BACKGROUND The retention of nurses during the COVID-19 pandemic was critical due to the increased demand for nurses. Among the multifaceted factors contributing to nurse turnover, it is worth examining nurse staffing and work schedules while considering policy intervention. METHODS The findings of this systematic literature review were reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Using eight databases, including CINAHL and PubMed, research articles published from January 2000 until June 2021 were reviewed. The inclusion criteria were original peer-reviewed research, nonexperimental studies published in English or Korean languages, and studies examining the impacts of nurse staffing and work schedules on nurses' actual turnover. RESULTS Fourteen articles were reviewed. Among them, 12 studies investigated the relationship between nurse staffing and turnover, and four examined the impact of work schedules on nurse turnover. Nurse staffing levels are strongly related to nurse turnover in the expected direction. However, few studies have found that work schedules are significantly related to nurse turnover. CONCLUSION Inadequate and unsafe nurse staffing leads to increased nurse turnover rates. More studies are needed to investigate the impacts of work schedules on nurse turnover. IMPLICATIONS FOR NURSING, HEALTH, AND SOCIAL POLICY Several states in the United States have adopted the nurse staffing policy during the COVID-19 pandemic. More hospitals and the government should adopt and implement policies to regulate nurse staffing, reduce nurse turnover, and increase retention. Policy intervention in nurse work schedules should also be considered to prevent nurse turnover.
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Affiliation(s)
- Sung-Heui Bae
- College of Nursing, Graduate Program in System Health Science and Engineering, Ewha Womans University, Seoul, Republic of Korea
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Letvak S, Apple B, Jenkins M. Factors Affecting Perioperative Nurse Adherence to Ergonomic Safety Measures. AORN J 2024; 119:210-221. [PMID: 38407344 DOI: 10.1002/aorn.14097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 09/06/2023] [Accepted: 09/06/2023] [Indexed: 02/27/2024]
Abstract
AORN has identified safety risks unique to the perioperative setting and has developed ergonomic safety measures to help prevent musculoskeletal injuries and disorders. Little is known about adherence to these safety measures or the perceived barriers and facilitators to adherence. This study used a cross-sectional survey to determine the prevalence of pain and occurrence of musculoskeletal injuries and disorders. We asked perioperative staff members about their perceived barriers and facilitators to adherence with safety measures. A total of 155 perioperative nurses in one health system completed the online survey (55% response rate). Most (93%) had experienced at least one musculoskeletal injury or disorder or related pain. Years worked as a perioperative nurse and having neck pain were associated with safety measure adherence. The most reported barrier to safety measure adherence was inadequate staffing. Study findings highlight the need for increased attention to the physical workload demands in the perioperative setting.
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Tait D, Davis D, Roche MA, Paterson C. Nurse/midwife-to-patient ratios: A scoping review. Contemp Nurse 2024:1-13. [PMID: 38408182 DOI: 10.1080/10376178.2024.2318361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 02/08/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND A significant body of work has linked high nurse or midwife workload to negative patient outcomes. Anecdotal reports suggest that mandated ratio models enhance patient care and improve nurse job satisfaction. However, there is limited focused research. OBJECTIVE To identify key outcomes, implementation processes, and research needs regarding nurse/midwife-to-patient ratios in the Australian healthcare context. DESIGN Scoping review. METHODS Data sources were CINAHL, Open Dissertations, Medline, and Scopus. 289 articles screened, and 53 full text documents independently assessed against criteria by two reviewers and conflicts resolved by a third reviewer, using Covidence™. Three studies were included in this review. RESULTS Studies focused on nurse (job satisfaction, burnout), patient (mortality, readmission, length of stay) and system (costs) outcomes with limited information on implementation processes and no midwifery research. CONCLUSIONS Ratios provide benefits for patients, nurses, and hospitals although there is limited research in Australia. Implementation was poorly reported..
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Affiliation(s)
- Darcy Tait
- Australian Catholic University, School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Watson, Australian Capital Territory, Australia
| | - Deborah Davis
- University of Canberra, School of Nursing, Midwifery and Public Health, Faculty of Health & ACT Government Health Directorate, Bruce, Australian Capital Territory, Australia
| | - Michael A Roche
- University of Canberra, School of Nursing, Midwifery and Public Health, Faculty of Health & ACT Government Health Directorate, Bruce, Australian Capital Territory, Australia
- University of Technology Sydney, School of Nursing and Midwifery, Faculty of Health, Ultimo, New South Wales, Australia
| | - Catherine Paterson
- University of Canberra, School of Nursing, Midwifery and Public Health, Faculty of Health & ACT Government Health Directorate, Bruce, Australian Capital Territory, Australia
- Robert Gordon University, School of Nursing, Midwifery & Paramedic Practice, Garthdee, UK
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Hooper V. 2024: Moving to a New Reimbursement Model for Nursing. J Perianesth Nurs 2024; 39:1-2. [PMID: 38307695 DOI: 10.1016/j.jopan.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 12/11/2023] [Indexed: 02/04/2024]
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Potts BK, Pelletier JH, Rawdon L, Forbes ML. Short stay unit led by pediatric hospital medicine advanced practice providers. J Hosp Med 2024; 19:83-91. [PMID: 38151792 DOI: 10.1002/jhm.13262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 12/06/2023] [Accepted: 12/10/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND In response to a critical pediatric bed shortage in 2022, an urgent process change was required to provide safe and timely medical care. We proposed a pilot for an advanced practice provider (APP)-run short stay unit (SSU) for select pediatric hospital medicine (PHM) patients. OBJECTIVE To compare length of stay (LOS) and cost before and after implementation of a PHM APP-led SSU pilot at a tertiary pediatric hospital. DESIGNS, SETTINGS, AND PARTICIPANTS Single-center prospective pilot observational cohort study with historical control. Observation encounters for patients with asthma, bronchiolitis, croup, and dehydration were included. INTERVENTION An independent-practice model SSU staffed by APPs on the PHM service. MAIN OUTCOME AND MEASURES SSU encounters (September 1, 2022-December 1, 2022) were compared against pre-SSU encounters (September 1, 2021-August 31, 2022). Cohorts were described with summary statistics. SSU encounters were matched against pre-SSU encounters based on demographics and diagnosis, and the average effect of treatment was calculated. LOS was abstracted from the enterprise data warehouse and standardized unit cost from the Pediatric Health Information Systems database. RESULTS There were 1110 encounters included, 155 in the SSU cohort and 955 in the pre-SSU cohort: 24.2% asthma, 30.8% bronchiolitis, 8.3% croup, and 36.7% dehydration. Median (interquartile range) unit LOS decreased from 21 (16-26) to 18 (10-22) h, p < .001. Cost decreased from $3593 ($3031-$4560) to $2958 ($2278-$3856), p < .001. After matching, the average treatment effect was reduction of 3.88 h (95% confidence interval [CI] 1.91-5.85) and $593 (95% CI $348-$839). There were no significant differences in 7-day ED revisit rates.
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Affiliation(s)
- Brittany K Potts
- Division of Hospital Medicine, Akron Children's Hospital, Akron, Ohio, USA
- Northeast Ohio Medical University, Rootstown, Ohio, USA
| | - Jonathan H Pelletier
- Northeast Ohio Medical University, Rootstown, Ohio, USA
- Division of Critical Care Medicine, Akron Children's Hospital, Akron, Ohio, USA
| | - Leah Rawdon
- Division of Hospital Medicine, Akron Children's Hospital, Akron, Ohio, USA
| | - Michael L Forbes
- Northeast Ohio Medical University, Rootstown, Ohio, USA
- Rebecca D. Considine Research Institute, Akron Children's Hospital, Akron, Ohio, USA
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Thompson E, Senek M, Ryan T. Analysis of a nursing survey: Reasons for compromised quality of care in inpatient mental health wards. Int J Ment Health Nurs 2024; 33:52-61. [PMID: 37654077 DOI: 10.1111/inm.13216] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 08/09/2023] [Accepted: 08/11/2023] [Indexed: 09/02/2023]
Abstract
Current evidence suggests understaffing is related to poor quality and missed care in a global context, but this relationship is complex. There is also a research gap for quality in mental health care in the United Kingdom that includes a wider set of patient outcomes. This paper aims to investigate RMN's perception of quality of care on their last shift, their self-reported reasons for compromised care and potential impact on patient outcomes. A mixed methods approach, we used descriptive statistics to create a framework within which to qualitatively analyse data from the 2017 Royal College of Nursing (RCN) employment survey to consider the complex relationship between understaffing and care quality. We established three themes: 'Understaffing', 'Professional Code Expectations and Moral Distress' and 'Management'. In line with the current evidence; lack of resources and understaffing were consistently present throughout. Nurses also felt pressure from the Nursing and Midwifery Council (NMC) code of conduct which in turn instilled shame and fear for their registration when they were unable to achieve the standards expected. This was further exacerbated by poor management and supervision; leading nurses to reflect on poor outcomes for patients which compromised not only legal rights but safety of patients and staff alike. We conclude that focusing on staffing numbers alone is unlikely to improve care quality.
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Affiliation(s)
- Elissa Thompson
- Division of Nursing and Midwifery, University of Sheffield, Sheffield, UK
| | - Michela Senek
- University of Sheffield, Sheffield University/Strategic Research Alliance, Sheffield, UK
| | - Tony Ryan
- University of Sheffield, Sheffield University/Strategic Research Alliance, Sheffield, UK
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Ulupınar F, Erden Y. Intention to leave among nurses during the COVID-19 outbreak: A rapid systematic review and Meta-Analysis. J Clin Nurs 2024; 33:393-403. [PMID: 36435976 DOI: 10.1111/jocn.16588] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 11/07/2022] [Indexed: 10/26/2023]
Abstract
AIMS AND OBJECTIVES The COVID-19 pandemic has caused an increase in the workload of nurses and changes in working conditions. Stress and the increase in workload during the COVID-19 pandemic had a negative effect on nurses' intention to leave. This study aimed to determine the current rate of intention to leave the job among nurses during the COVID-19 outbreak by conducting a rapid systematic review and meta-analysis. METHODOLOGY/METHODS The review procedure was conducted by the PRISMA criteria. The researchers searched PubMed and Web of Science databases for studies providing the rate of nurses' intent to leave, published until 31 December 2021. Heterogeneity was assessed using the I2 test, and publication bias was measured by Egger's test. RESULTS The estimated overall intent to leave the profession among nurses during the COVID-19 pandemic was 31.7% (95% CI: 25%-39%) with significant heterogeneity (Q test: 188.9; p = 0.0001; I2 : %95.2; Tau2 : 0.225). Additionally, Egger's regression test suggested no publication bias for estimating the pooled rate of nurses' intent to leave during the COVID-19 outbreak. NO PATIENT OR PUBLIC CONTRIBUTION Since the research is a meta-analysis study, a literature review model was used. Ethics committee approval was not obtained because the literature review did not directly affect humans and animals. CONCLUSION This study showed that approximately one-third of nurses working during the COVID-19 pandemic had thoughts about intending to leave their job. The findings indicate the need for strategies involving precautions and solutions to minimise the psychological impacts of COVID-19 among nurses. RELEVANCE TO CLINICAL PRACTICE In this period when the global nurse crisis exists, it is of great importance for institutions to retain their nurse workforce. There is an urgent need to prepare nurses to cope better with COVID-19 pandemic. Identification of risk factors for intention to leave could be a significant weapon giving nurses and healthcare systems the ability to response in a better way against the following COVID-19 waves in the near future.
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Affiliation(s)
- Fadime Ulupınar
- Faculty of Health Sciences, Nursing Department, Erzurum Teknik University, Erzurum, Turkey
| | - Yasemin Erden
- Faculty of Health Sciences, Nursing Department, Erzurum Teknik University, Erzurum, Turkey
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Rainbow JG, Dudding KM, Bethel C, Norton A, Platt C, Vyas PK, Slebodnik M. Work-Related Health Conditions Among American Nurses: A Scoping Review. SAGE Open Nurs 2024; 10:23779608241257026. [PMID: 38784646 PMCID: PMC11113033 DOI: 10.1177/23779608241257026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 04/16/2024] [Accepted: 05/08/2024] [Indexed: 05/25/2024] Open
Abstract
Background Working in the nursing profession is hazardous, and nurses report poor health. Risk factors associated with poor health outcomes have been documented. However, the extent of literature exploring the prevalence of health conditions among American nurses that may be attributable to their work has not been examined. Method A scoping review following the Joanna Briggs Institute recommendations was conducted of peer-reviewed quantitative studies to answer the question: What are health conditions experienced by American nurses that may be attributable to their work as nurses? Results Thirty articles met the inclusion criteria. Due to the methods used in many articles, studies of the prevalence of health conditions among the nursing population were lacking. Health conditions studied broke into six categories: (a) work-related injuries and hazards; (b) unhealthy lifestyles; (c) mental health conditions; (d) burnout; (e) fatigue, sleep, and migraines; and (f) reproductive health. The role of work in the health conditions studied varied from an immediate impact on health (e.g., a needlestick or injury) to a cumulative impact (e.g., scheduling or workplace demands). Within the work demands, the physical environment; physical, emotional, and cognitive demands of work; and shiftwork were all frequently identified as antecedents that could be further explored and addressed to improve nurse health. Conclusions Healthcare systems should seek to address the hazards and exposures that may be linked to health conditions in the nursing workforce. Understanding and mitigating the impact of the pandemic and nursing work on the workforce's health is crucial to the solvency of the workforce. Occupational health practitioners should assess for workplace hazards and exposures.
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Affiliation(s)
| | | | - Claire Bethel
- University of Pittsburgh Medical Center, Harrisburg, PA, USA
| | - Angie Norton
- University of Arizona College of Nursing, Tucson, AZ, USA
| | | | - Pankaj K. Vyas
- University of Arizona College of Nursing, Tucson, AZ, USA
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15
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Lei S, Sun J, Wang C, Zhang X, Han W, Wang X, Xie J. Nurse-to-patient ratios and readiness for hospital discharge: A moderated mediation model. Nurs Open 2024; 11:e2047. [PMID: 38268295 PMCID: PMC10697126 DOI: 10.1002/nop2.2047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 08/31/2023] [Accepted: 10/19/2023] [Indexed: 01/26/2024] Open
Abstract
AIM To explore whether and to what extent, nurse-patient assessment differences mediate the association between nurse-to-patient ratios and readiness for hospital discharge, and examine whether nurse-patient characteristics moderate the indirect and/or direct effect of mediation model. DESIGN A cross-sectional study was carried out from March 2021 to December 2022. METHODS A total of 523 pairs of gastrointestinal cancer patients with PICC and their nurses were recruited. All the participants were invited to complete the general information questionnaire and the Readiness for Hospital Discharge Scale. Outcome measure was patient-reported readiness for hospital discharge. This study was reported according to the STROBE checklist. RESULTS The patients reported a low level of readiness for hospital discharge. Nurse-patient assessment differences were positively associated with nurse-to-patient ratios but negatively associated with readiness for hospital discharge. Furthermore, nurse-patient assessment differences fully mediated the effect of nurse-to-patient ratios on readiness for hospital discharge, and age and gender of patients only moderated the indirect path of mediation model.
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Affiliation(s)
- Shuang‐yan Lei
- Department of RadiotherapyShaanxi Provincial Cancer HospitalXi'anShaanxiChina
| | - Jia‐ru Sun
- Department of NursingXi'an Jiaotong University Health Science CenterXi'anShaanxiChina
| | - Cai‐hua Wang
- Department of NursingXi'an Jiaotong University Health Science CenterXi'anShaanxiChina
| | - Xiao‐fang Zhang
- Department of RadiotherapyShaanxi Provincial Cancer HospitalXi'anShaanxiChina
| | - Wen‐jin Han
- Department of NursingXi'an Jiaotong University Health Science CenterXi'anShaanxiChina
| | - Xiao‐qin Wang
- Department of NursingXi'an Jiaotong University Health Science CenterXi'anShaanxiChina
| | - Juan Xie
- Department of NursingShaanxi Provincial Cancer HospitalXi'anShaanxiChina
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16
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Stuart WP. From the outside looking in: A nurse-family care experience in a hospital with nurse-to-patient mandated ratios. Nurs Manag (Harrow) 2024; 55:9-11. [PMID: 38170883 DOI: 10.1097/nmg.0000000000000089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Affiliation(s)
- Wilma Powell Stuart
- Wilma Powell Stuart is an associate professor and the coordinator for the Executive Nurse Administration DNP track at the University of South Alabama College of Nursing in Mobile, Ala. Dr. Stuart's healthcare career has focused in areas of leadership for over 4 decades. Her past roles in acute care facilities have included direct care nurse, house supervisor, nurse manager, CNO, chief operating officer, and CEO. Dr. Stuart's healthcare experience extends across four states and Saudi Arabia. She is a member of the American Nurses Association, Texas Nurses Association, American Organization for Nursing Leadership, Texas Organization for Nursing Leadership, Association for Leadership Science in Nursing, Southern Nursing Research Society, and Sigma Theta Tau International Honor Society of Nursing. The stated opinions in this article are personal opinions and do not reflect the opinions of her current or past employers or professional society affiliations. The limited information related to patient care was reviewed and approved by the patient
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17
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Galanis P, Moisoglou I, Malliarou M, Papathanasiou IV, Katsiroumpa A, Vraka I, Siskou O, Konstantakopoulou O, Kaitelidou D. Quiet Quitting among Nurses Increases Their Turnover Intention: Evidence from Greece in the Post-COVID-19 Era. Healthcare (Basel) 2023; 12:79. [PMID: 38200985 PMCID: PMC10779139 DOI: 10.3390/healthcare12010079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/16/2023] [Accepted: 12/26/2023] [Indexed: 01/12/2024] Open
Abstract
As turnover intention is a strong determinant of actual turnover behavior, scholars should identify the determinants of turnover intention. In this context, the aim of this study was to assess the effect of quiet quitting on nurses' turnover intentions. Additionally, this study examined the impact of several demographic and job characteristics on turnover intention. A cross-sectional study with 629 nurses in Greece was conducted. The data were collected in September 2023. Quiet quitting was measured with the "Quiet Quitting" scale. In this study, 60.9% of nurses were considered quiet quitters, while 40.9% experienced high levels of turnover intention. Multivariable regression analysis showed that higher levels of quiet quitting increased turnover intention. Moreover, this study found that turnover intention was higher among females, shift workers, nurses in the private sector, and those who considered their workplace understaffed. Also, clinical experience was associated positively with turnover intention. Since quiet quitting affects turnover intention, organizations, policymakers, and managers should address this issue to improve nurses' intentions to stay at their jobs.
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Affiliation(s)
- Petros Galanis
- Clinical Epidemiology Laboratory, Faculty of Nursing, National and Kapodistrian University of Athens, 11527 Athens, Greece; (P.G.); (A.K.)
| | - Ioannis Moisoglou
- Faculty of Nursing, University of Thessaly, 41500 Larisa, Greece; (I.M.); (I.V.P.)
| | - Maria Malliarou
- Faculty of Nursing, University of Thessaly, 41500 Larisa, Greece; (I.M.); (I.V.P.)
| | | | - Aglaia Katsiroumpa
- Clinical Epidemiology Laboratory, Faculty of Nursing, National and Kapodistrian University of Athens, 11527 Athens, Greece; (P.G.); (A.K.)
| | - Irene Vraka
- Department of Radiology, P. & A. Kyriakou Children’s Hospital, 11527 Athens, Greece;
| | - Olga Siskou
- Department of Tourism Studies, University of Piraeus, 18534 Piraeus, Greece;
| | - Olympia Konstantakopoulou
- Center for Health Services Management and Evaluation, Faculty of Nursing, National and Kapodistrian University of Athens, 11527 Athens, Greece; (O.K.); (D.K.)
| | - Daphne Kaitelidou
- Center for Health Services Management and Evaluation, Faculty of Nursing, National and Kapodistrian University of Athens, 11527 Athens, Greece; (O.K.); (D.K.)
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18
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Williams LM, Carpenter D, Mercier M, Reynolds E, Davis T. Healthy Work Environment Standards in Tele-Critical Care Nursing. AACN Adv Crit Care 2023; 34:350-358. [PMID: 38033213 DOI: 10.4037/aacnacc2023407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
The COVID-19 pandemic exacerbated staffing challenges in intensive care units, with increased burnout and moral distress cited as major problems. A healthy work environment is critical to nurses' success and wellbeing. During the pandemic, a survey by the American Association of Critical-Care Nurses revealed decreased composite scores in each of the 6 critical elements of a healthy work environment. Hospital units that improved even 1 critical element reported higher job satisfaction. The use of telehealth tools by expert nurses expanded care delivery during the pandemic by improving response to acutely and critically ill patients while supporting hospital-based nurses. All of the critical elements of a healthy work environment are relevant to the tele-critical care nurse's role and challenges. This article describes how tele-critical care nurses were affected by the pandemic and how healthy work environment strategies promoted successful nurse and patient outcomes.
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Affiliation(s)
- Lisa-Mae Williams
- Lisa-Mae Williams is Operations Director, Tele-Critical Care and Virtual Sepsis Unit, Baptist Health South Florida, 6855 Red Rd, Coral Gables, FL 33143
| | - Dawn Carpenter
- Dawn Carpenter is Nurse Practitioner, Guthrie Healthcare System, Sayre, Pennsylvania, and Associate Professor, University of Massachusetts, Worcester, Massachusetts
| | - Marie Mercier
- Marie Mercier is Nurse Manager, Virtual Critical Care, Atrium Health, Mint Hill, North Carolina
| | - Erin Reynolds
- Erin Reynolds is Medical-Surgical ICU Clinical Director, Inova Fairfax Medical Campus, Falls Church, Virginia
| | - Theresa Davis
- Theresa Davis is Assistant Vice President of Nursing, High Reliability Center, Inova Health System, Falls Church, Virginia, and current AACN president
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19
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Chang YH, Hsu CH, Tseng YC, Hsiung CA. Country-Level Factors Associated With Nurse Salaries: Empirical Evidence From Organisation for Economic Co-operation and Development Countries and Taiwan. J Nurs Res 2023; 31:e303. [PMID: 37988058 DOI: 10.1097/jnr.0000000000000585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Salary impacts nurse retention rates and thus is a factor affecting the nursing shortage both in Taiwan and around the world. Nurses in Taiwan earn a low salary compared with other health professionals and may be undervalued compared with their international counterparts. PURPOSE This study was designed to analyze the factors associated with nurse salary (NS) in Organisation for Economic Co-operation and Development (OECD) countries and to compare NS in Taiwan with those in OECD member states. METHODS Data were extracted from the OECD statistics database and official statistics for Taiwan. For the 28 OECD member countries considered in this study and Taiwan, 21 indicators characterizing healthcare systems, including demographics, socioeconomic status, health behaviors and risks, healthcare resources, health financing, healthcare utilization, health outcomes, and economic inequality, were examined for the period of 2009-2018. A random-effects model (REM) and a fixed-effects model (FEM) were used to investigate the associations between these indicators and annual NS levels. The expected annual NS for Taiwan was estimated and compared with the actual NS for Taiwan using the REM. RESULTS In the REM, higher NS in OECD countries was shown to be positively associated with gross domestic product per capita (0.49, 95% confidence interval [CI] [0.41, 0.56]), proportion of population aged 65 years and over (2.72, 95% CI [2.17, 3.26]), crude birth rate (1.02, 95% CI [0.56, 1.49]), number of computerized tomography scanners per million population (0.26, 95% CI [0.17, 0.35]), alcohol consumption per person (0.94, 95% CI [0.26, 1.61]), and prevalence of obesity (0.64, 95% CI [0.40, 0.89]) and to be in inversely associated with infant mortality rate (-3.13, 95% CI [-3.94, -2.32]), bed density (-0.99, 95% CI [-1.72, -0.25]), number of hospital discharges (-0.08, 95% CI [-0.11, -0.05]), household out-of-pocket expenditure as a percentage of health expenditure (-0.34, 95% CI [-0.56, -0.11]), and the Gini coefficient (-0.25, 95% CI [-0.50, -0.01]). The FEM results were similar to those of the REM. The predicted annual NS for Taiwan based on the REM rose from 29,390 U.S. dollars (corrected for purchasing power parity; 95% CI [22,532, 36,247]) in 2009 to 49,891 U.S. dollars (95% CI [42,344, 57,438]) in 2018. The actual annual NS in Taiwan in 2018 was approximately 12% lower than the model-predicted value. CONCLUSIONS/IMPLICATIONS FOR PRACTICE Taiwan has a lower NS compared with its OECD counterparts. These findings may help policymakers, healthcare managers, and nurse organizations develop effective strategies to improve the remuneration system for nurses in Taiwan.
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Affiliation(s)
| | - Chia Hui Hsu
- MS, Research Assistant, Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli County, Taiwan
| | - Yu-Chun Tseng
- MS, Research Assistant, Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli County, Taiwan
| | - Chao A Hsiung
- PhD, Honorary Investigator, Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli County, Taiwan
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20
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Bahlman-van Ooijen W, Malfait S, Huisman-de Waal G, Hafsteinsdóttir TB. Nurses' motivations to leave the nursing profession: A qualitative meta-aggregation. J Adv Nurs 2023; 79:4455-4471. [PMID: 37209086 DOI: 10.1111/jan.15696] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 03/20/2023] [Accepted: 04/16/2023] [Indexed: 05/22/2023]
Abstract
AIM To systematically provide an overview of the qualitative evidence available on the motivations for nurses to leave the nursing profession. DESIGN A qualitative systematic review using the meta-aggregation design of the Joanna Briggs Institute. DATA SOURCES Qualitative studies in English, dating from 2010 until January 2023, were obtained from CINAHL, PsycINFO and PubMed. REVIEW METHODS Studies were selected using predetermined inclusion and exclusion criteria. Quality assessment was done using the Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research. The assessment of confidence in the review findings was done according to the ConQual approach. RESULTS Nine papers that investigated nurses' motivations to leave the profession were included. We developed four synthesized findings from 11 synthesized categories and 31 categories to reflect nurses' motivations to leave the profession, including (1) challenging work environment, (2) emotional distress, (3) disappointment about nursing reality, and (4) culture of hierarchy and discrimination. CONCLUSION This review provides an in-depth and meaningful understanding of motivations for nurses to leave the profession. Among others, poor working conditions, a lack of opportunities for career development, a lack of support from managers, work-related stress, a discrepancy between nursing education and practice and bullying behaviour were motivations to leave the profession, which calls for targeted action to retain nurses in the profession. IMPACT Findings of this study shine a light on reasons why nurses leave the profession, providing evidence to support nurse managers and policymakers to develop retention strategies to move out of current crisis into recovery of sustainable global healthcare. PATIENT OR PUBLIC CONTRIBUTION There was no direct patient or caregiver contribution to this study because this study originated from the process of a Master study. However, two of the authors are still involved in clinical nursing practice and provided the necessary link between research and practice.
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Affiliation(s)
- Wilmieke Bahlman-van Ooijen
- Nursing Science, Program in Clinical Health Sciences, University Medical Center, Utrecht, The Netherlands
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Simon Malfait
- Nursing Department, Ghent University Hospital, Ghent, Belgium
- Faculty of Medicine, Ghent University, Ghent, Belgium
| | - Getty Huisman-de Waal
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
- Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Thóra B Hafsteinsdóttir
- Nursing Science, Program in Clinical Health Sciences, University Medical Center, Utrecht, The Netherlands
- Nursing Science Department, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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21
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Min A, Baek W, Choi S. What are the key factors influencing newly graduated nurses' preference for choosing their workplace? A best-worst scaling approach. J Nurs Scholarsh 2023; 55:1204-1214. [PMID: 37291734 DOI: 10.1111/jnu.12920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 05/10/2023] [Accepted: 05/25/2023] [Indexed: 06/10/2023]
Abstract
INTRODUCTION The literature cites many factors that influence a nurse's decision when choosing their workplace. However, it is unclear which attributes matter the most to newly graduated nurses. The study aimed to identify the relative importance of workplace preference attributes among newly graduated nurses. DESIGN A cross-sectional study. METHODS We conducted an online survey and data were collected in June 2022. A total of 1111 newly graduated nurses in South Korea participated. The study employed best-worst scaling to quantify the relative importance of nine workplace preferences and also included questions about participants' willingness to pay for each workplace preferences. The relationships between the relative importance of the workplace attribute and the willingness to pay were determined using a quadrant analysis. RESULTS The order according to the relative importance of workplace preferences is as follows: salary, working conditions, organizational climate, welfare program, hospital location, hospital level, hospital reputation, professional development, and the chance of promotion. The most important factor, salary, was 16.67 times more important than the least important factor, the chance of promotion, in terms of choosing workplace. In addition, working conditions and organizational climate were recognized as high economic value indicators. CONCLUSION Newly graduated nurses nominated better salaries, working conditions, and organizational climate as having a more important role in choosing their workplace. CLINICAL RELEVANCE The findings of this study have important implications for institutions and administrators in recruiting and retaining newly graduated nurses.
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Affiliation(s)
- Ari Min
- Department of Nursing, Chung-Ang University, Seoul, Republic of Korea
| | - Wonhee Baek
- College of Nursing, Gyeongsang National University, Jinju, Republic of Korea
| | - Sungkyoung Choi
- Department of Nursing, Catholic Kwandong University, Gangneung, Republic of Korea
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22
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Vázquez-Calatayud M, Eseverri-Azcoiti MC. Retention of newly graduated registered nurses in the hospital setting: A systematic review. J Clin Nurs 2023; 32:6849-6862. [PMID: 37283198 DOI: 10.1111/jocn.16778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 04/28/2023] [Accepted: 05/19/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND There is a gap in the literature on identifying and describing effective interventions for the retention of newly graduated registered nurses in hospital settings. To the best of our knowledge, no systematic review has been conducted on this issue. AIM To identify effective interventions that promote the retention of newly graduated registered nurses in the hospital setting and their components. DESIGN A systematic review was conducted according to PRISMA 2020 Statement. METHODS Information derived from the PubMed, CINAHL, Scopus, PsycINFO and Cochrane Library databases was reviewed, for the period January 2012-October 2022. Screening, data extraction and quality appraisal were conducted independently by two reviewers. The Joanna Briggs Institute Critical Appraisal tools were used for descriptive, quasi-experimental and cohort studies. Disagreements between the two reviewers were resolved through discussion. RESULTS Following the critical appraisal, nine studies were included. The evidence reveals the heterogeneity of programmes developed in the hospital context to promote the retention of newly graduated registered nurses, clarifies the three competencies to be addressed (core, cross-cutting and specific), their components (programme development framework, duration, content and support components), and shows significant improvements after their implementation. CONCLUSIONS This systematic review identifies that either nurse residency or individualised mentoring programmes, lasting 1 year, and multi-component, addressing core and specific competencies and including preceptor or mentor components seem to be the most comprehensive and effective in promoting the retention of new nurses in the hospital setting. RELEVANCE TO CLINICAL PRACTICE The knowledge provided by this review will contribute to developing and implementing more effective and context-specific strategies directed at retaining newly graduated registered nurses and subsequently enhancing patient safety and healthcare costs. NO PATIENT OR PUBLIC CONTRIBUTION Given the study design and focus.
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Affiliation(s)
- Mónica Vázquez-Calatayud
- Clínica Universidad de Navarra, Pamplona, Spain
- University of Navarra, Innovation for a Person-Centred Care Research Group (ICCP-UNAV), Pamplona, Spain
- Navarra's Health Research Institute (IdiSNA), Pamplona, Spain
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23
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Vogt KS, Simms-Ellis R, Grange A, Griffiths ME, Coleman R, Harrison R, Shearman N, Horsfield C, Budworth L, Marran J, Johnson J. Critical care nursing workforce in crisis: A discussion paper examining contributing factors, the impact of the COVID-19 pandemic and potential solutions. J Clin Nurs 2023; 32:7125-7134. [PMID: 36823696 DOI: 10.1111/jocn.16642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 01/12/2023] [Accepted: 01/20/2023] [Indexed: 02/25/2023]
Abstract
AIMS AND OBJECTIVES The critical care nursing workforce is in crisis, with one-third of critical care nurses worldwide intending to leave their roles. This paper aimed to examine the problem from a wellbeing perspective, offering implications for research, and potential solutions for organisations. DESIGN Discursive/Position paper. METHOD The discussion is based on the nursing and wellbeing literature. It is guided by the authors' collaborative expertise as both clinicians and researchers. Data were drawn from nursing and wellbeing peer-reviewed literature, such as reviews and empirical studies, national surveys and government and thinktank publications/reports. RESULTS Critical care nurses have been disproportionately affected by the COVID-19 pandemic with studies consistently showing critical care nurses to have the worst psychological outcomes on wellbeing measures, including depression, burnout and post-traumatic stress disorder (PTSD). These findings are not only concerning for the mental wellbeing of critical care nurses, they also raise significant issues for healthcare systems/organisations: poor wellbeing, increased burnout and PTSD are directly linked with critical care nurses intending to leave the profession. Thus, the wellbeing of critical care nurses must urgently be supported. Resilience has been identified as a protective mechanism against the development of PTSD and burnout, thus offering evidence-based interventions that address resilience and turnover have much to offer in tackling the workforce crisis. However, turnover data must be collected by studies evaluating resilience interventions, to further support their evidence base. Organisations cannot solely rely on the efficacy of these interventions to address their workforce crisis but must concomitantly engage in organisational change. CONCLUSIONS We conclude that critical care nurses are in urgent need of preventative, evidence-based wellbeing interventions, and make suggestions for research and practice.
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Affiliation(s)
- Katharina Sophie Vogt
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
- School of Psychology, University of Leeds, Leeds, UK
| | - Ruth Simms-Ellis
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
- School of Psychology, University of Leeds, Leeds, UK
| | - Angela Grange
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
| | | | - Rebecca Coleman
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
- School of Psychology, University of Leeds, Leeds, UK
| | - Reema Harrison
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | | | | | - Luke Budworth
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
- School of Medicine, University of Leeds, Leeds, UK
| | - Jayne Marran
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
| | - Judith Johnson
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
- School of Psychology, University of Leeds, Leeds, UK
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
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24
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Li W, Honggui W, Hong P, Hong L. Factors that affect career success of nurses who practice in assisted reproductive technology. Rev Lat Am Enfermagem 2023; 31:e3926. [PMID: 37194896 PMCID: PMC10202227 DOI: 10.1590/1518-8345.6388.3926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 02/10/2023] [Indexed: 05/18/2023] Open
Abstract
to examine the relationship between career success and work environment of nurses who practice in assisted reproductive technology and to identify factors that affect career success. a cross-sectional study conducted in 53 fertility centres in 26 provinces in mainland China. Data were collected using a demographic data questionnaire, a specialised nursing competence questionnaire, the Career-Success Scale, and the Nursing Work Environment Scale. Descriptive and inferential statistics were applied. 597 assisted reproductive technology nurses participated in our survey, and 555 valid questionnaires were collected. Theoverall mean scores for career success and work environment were 3.75 [standard deviation (SD) = 1.01] and 3.42 (SD = 0.77) respectively. There was a strong positive correlation between career success and work environment (r = 0.742, p < 0.01). Multiple regression showed that attending academic conferences, psychological care, professional development, support and care, salary, and welfare were significant factors that influence career success. attending academic conferences, psychological care, and work environment are positively related to career success. Administrators should consider ways to address these factors.
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Affiliation(s)
- Wang Li
- Women and Children's Hospital of Chongqing Medical University, Center for Reproductive Medicine, Chongqing, Chongqing, China
- Chongqing Health Center for Women and Children, Center for Reproductive Medicine, Chongqing, Chongqing, China
| | - Wen Honggui
- Women and Children's Hospital of Chongqing Medical University, Center for Reproductive Medicine, Chongqing, Chongqing, China
- Chongqing Health Center for Women and Children, Center for Reproductive Medicine, Chongqing, Chongqing, China
| | - Peng Hong
- Women and Children's Hospital of Chongqing Medical University, Center for Reproductive Medicine, Chongqing, Chongqing, China
- Chongqing Health Center for Women and Children, Center for Reproductive Medicine, Chongqing, Chongqing, China
| | - Luo Hong
- Women and Children's Hospital of Chongqing Medical University, Center for Reproductive Medicine, Chongqing, Chongqing, China
- Chongqing Health Center for Women and Children, Center for Reproductive Medicine, Chongqing, Chongqing, China
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25
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Zyoud RN. Psychometric properties of Nursing Time Management Scale (NTMS), Arabic version. BMC Nurs 2023; 22:153. [PMID: 37147627 PMCID: PMC10161497 DOI: 10.1186/s12912-023-01316-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 04/23/2023] [Indexed: 05/07/2023] Open
Abstract
Despite the presence of numerous generic time management instruments, relatively few research articles have assessed the validity and reliability of time management skills specific for the nursing profession. This study aimed at developing and validating a time management scale for nurses.Method A self-administered questionnaire was administered to 715 nurses working in hospitals and clinics in the northern region of the West Bank, Palestine. The scale was examined through exploratory factor analysis, reliability measures, and correlations with other scales.Results The scale revealed a 3-factor structure 1) organization of nursing work 2) planning and goal setting and 3) coordination of nursing work. The scale demonstrated excellent psychometric properties.Conclusions The Nursing Time Management Scale (NTMS) is a valid and reliable measure that can be used in assessing time management skills of nurses and in evaluating interventions and training modules aiming at developing nurses' time management skills.
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Affiliation(s)
- Raj'a Nayef Zyoud
- Arab American University- Palestine, 13 Zababdeh, P.O Box 240, Jenin, Palestine.
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Peutere L, Terho K, Pentti J, Ropponen A, Kivimäki M, Härmä M, Krutova O, Ervasti J, Koskinen A, Virtanen M. Nurse Staffing Level, Length of Work Experience, and Risk of Health Care-Associated Infections Among Hospital Patients: A Prospective Record Linkage Study. Med Care 2023; 61:279-287. [PMID: 36939226 PMCID: PMC10079297 DOI: 10.1097/mlr.0000000000001843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
BACKGROUND Nurse understaffing may have several adverse consequences for patients in hospitals, such as health care-associated infections (HAIs), but there is little longitudinal evidence available on staffing levels and HAIs with consideration of incubation times to confirm this. Using daily longitudinal data, we analyzed temporal associations between nurse understaffing and limited work experience, and the risk of HAIs. METHODS The study was based on administrative data of 40 units and 261,067 inpatient periods for a hospital district in Finland in 2013-2019. Survival analyses with moving time windows were used to examine the association of nurse understaffing and limited work experience with the risk of an HAI 2 days after exposure, adjusting for individual risk factors. We reported hazard ratios (HRs) with 95% CIs. RESULTS Neither nurse understaffing nor limited work experience were associated with the overall risk of HAIs. The results were inconsistent across staffing measures and types of HAIs, and many of the associations were weak. Regarding specific HAI types, 1-day exposure to low proportion of nurses with >3 years of in-hospital experience and low proportion of nurses more than 25 years old were associated with increased risk of bloodstream infections (HR=1.30; 95% CI: 1.04-1.62 and HR=1.40; 95% CI: 1.07-1.83). Two-day exposure to low nursing hours relative to target hours was associated with an increased risk of surgical-site infections (HR=2.64, 95% CI: 1.66-4.20). CONCLUSIONS Data from time-varying analyses suggest that nursing staff shortages and limited work experience do not always increase the risk of HAI among patients.
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Affiliation(s)
- Laura Peutere
- School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu
- Finnish Institute of Occupational Health, Helsinki
| | - Kirsi Terho
- Department of Hospital Hygiene and Infection Control, Turku University Hospital Turku
| | - Jaana Pentti
- Department of Public Health, University of Turku, Turku Finland
| | - Annina Ropponen
- Finnish Institute of Occupational Health, Helsinki
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Mika Kivimäki
- Finnish Institute of Occupational Health, Helsinki
- Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Mikko Härmä
- Finnish Institute of Occupational Health, Helsinki
| | | | | | - Aki Koskinen
- Finnish Institute of Occupational Health, Helsinki
| | - Marianna Virtanen
- School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
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Polancich S, Miltner R, Montgomery A, Dick T, Poe T, Brown D, Patrician PA. Quality Matters: Examining the Impact of Nurse Staffing Challenges on Clinical Outcomes. J Healthc Manag 2023; 68:174-186. [PMID: 37159016 DOI: 10.1097/jhm-d-22-00170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
GOAL The purpose of this study was to examine nurse staffing while describing the relationships that exist in staffing and quality associated with nursing care during the COVID-19 pandemic, a significantly challenging time for nurse staffing. We examined the relationship between permanent registered nurse (RN) and travel RN staffing during the pandemic and the nursing-sensitive outcomes of catheter-associated urinary tract infections (CAUTIs), central line-associated bloodstream infections (CLABSIs), falls, and hospital-acquired pressure injuries (HAPIs) and length of stay and compared the cost of CAUTIs, CLABSIs, falls, and HAPIs in fiscal years 2021 and 2022. METHODS We used a descriptive, observational design to retrospectively examine permanent nurse staffing volume and CAUTI, CLABSI, HAPI, and fall counts from October 1, 2019, to February 28, 2022, and travel nurse volume for the most current 12 months, April 1, 2021, to March 31, 2022. Descriptive statistics, Pearson correlation, and statistical process control analyses were completed. PRINCIPAL FINDINGS Pearson correlation showed a statistically significant, moderately strong negative correlation (r = -0.568, p = .001) between the active registered nurse full-time equivalents (RN FTEs) and average length of stay (ALOS), and a moderately strong positive correlation (r = 0.688, p = .013) between the travel RN FTEs and ALOS. Pearson correlations were not statistically significant, with low to moderate negative correlations for CAUTIs (r = -0.052, p = .786), CLABSIs (r = -0.207, p = .273), and falls (r = -0.056, p = .769). Pearson correlation for active RN and HAPI showed a moderately strong, statistically significant positive correlation (r = 0.499, p = .003). We observed common cause variation in CAUTIs and CLABSIs, with HAPIs and falls showing special cause variation via statistical process control. PRACTICAL APPLICATIONS Despite the challenges associated with the lack of available nurse staffing accompanied by increasing responsibilities including unlicensed tasks, positive clinical outcomes can be maintained by staff adherence to evidence-based quality improvement.
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Affiliation(s)
- Shea Polancich
- University of Alabama at Birmingham School of Nursing and University of Alabama at Birmingham Hospital, Birmingham, Alabama
| | | | | | - Tracey Dick
- University of Alabama at Birmingham School of Nursing
| | - Terri Poe
- University of Alabama at Birmingham Hospital
| | - Daran Brown
- University of Alabama at Birmingham Hospital
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Cho H, Sagherian K, Steege LM. Hospital staff nurse perceptions of resources and resource needs during the COVID-19 pandemic. Nurs Outlook 2023; 71:101984. [PMID: 37126868 PMCID: PMC10086098 DOI: 10.1016/j.outlook.2023.101984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 03/28/2023] [Accepted: 04/04/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND There is a knowledge gap related to the resource needs of hospital nurses working during the Coronavirus disease 2019 (COVID-19) pandemic. PURPOSE To investigate nurses' perceptions of organizational resources and support needs approximately 18 months after the COVID-19 pandemic began. METHOD Cross-sectional survey of a convenience sample of 2,124 U.S. hospital nurses from July to September 2021 FINDINGS: There were some misalignments between what resources were provided to nurses and what was perceived as helpful to them. Nurses reported increased staffing, compensation, and management and leadership support most frequently as resources that could help them continue to provide safe and quality care during and after the pandemic. These were also the resources nurses most frequently reported that they wanted to be provided by their hospitals during the pandemic but were not. DISCUSSION The findings offer valuable insights into how organizations can prepare to ensure workforce resilience during future crises.
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Affiliation(s)
- Hyeonmi Cho
- College of Nursing, Chung-Ang University, Seoul, South Korea
| | - Knar Sagherian
- College of Nursing, The University of Tennessee Knoxville, Knoxville, TN
| | - Linsey M Steege
- School of Nursing, University of Wisconsin-Madison, Madison, WI.
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Ziarat HM, Seyedfatemi N, Mardani-Hamooleh M, Farahani MA, Vedadhir A. Nursing in oncology ward with intertwined roles: a focused ethnography. BMC Nurs 2023; 22:83. [PMID: 36964551 PMCID: PMC10036964 DOI: 10.1186/s12912-023-01250-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 03/15/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND Characteristics of nursing care in the oncology ward depend on this ward's specific context. This study aimed to investigate the nursing care in the oncology ward regarding the culture of this ward. METHODS This qualitative study was conducted in an oncology ward using a focused ethnographic approach. The whole nursing team of the selected ward (N = 16) participated in the study through purposeful sampling. Three methods of observation, interview, and field documents were used for data collection. Data were analyzed by Spradley's (1980) ethnographic method. RESULTS 'Nursing in the oncology ward with intertwined roles' emerged as the main theme. This theme included the following subthemes: 'Robin Hood nurse,' 'a secretive nurse,' 'a negligent nurse,' 'a snitching nurse,' 'a complaining nurse,' 'an apathetic senior nurse,' 'a stigmatized training nurse,' 'a brazen-bodied nurse,' 'a compassionate nurse,' 'a moonlighting nurse,' and 'a drug bartender.' CONCLUSION This study provided a deep cultural insight into nursing care in the oncology ward, considering the particular culture of this ward and emphasizing the nurses' intertwined roles. These roles are on a spectrum, with positive roles, such as compassion, on one side and negative roles, such as negligence, on the other. The results of this study can be provided to nursing managers; therefore, by being aware of nurses' roles considering the specific subculture of the oncology ward, they can provide psychological interventions to improve the mental health of reluctant and complaining nurses and ethics-based training for secretive, negligent, and snitching nurses to provide quality care to the patient.
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Affiliation(s)
- Hadiseh Monadi Ziarat
- Department of Nursing, Nursing and Midwifery Care Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Naima Seyedfatemi
- Department of Nursing, Nursing and Midwifery Care Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Marjan Mardani-Hamooleh
- Department of Nursing, Nursing and Midwifery Care Research Center, Iran University of Medical Sciences, Tehran, Iran.
- Department of Psychiatric Nursing, Iran University of Medical Sciences, Zafar Str, Vanak Sq, PO Box 1419733171, Tehran, Iran.
| | - Mansoureh Ashghali Farahani
- Department of Nursing, Nursing and Midwifery Care Research Center, Iran University of Medical Sciences, Tehran, Iran
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Lin PY, Kaplan W, Lin CH, Lee YH. Taiwan's National Health Insurance at the Emergency Department following the COVID-19 outbreak. Public Health Nurs 2023. [PMID: 36882994 DOI: 10.1111/phn.13186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/26/2023] [Accepted: 02/24/2023] [Indexed: 03/09/2023]
Abstract
Taiwan's National Health Insurance (NHI) is a widely acclaimed universal healthcare system. In the past few years, particularly following the COVID-19 outbreak, challenges related to maintaining the NHI system have surfaced. Since 2020, NHI has faced a series of challenges, including excessive patient visits to the hospital emergency department, a lack of an effective primary care and referral system, and a high turnover rate of healthcare workers. We review major problems related to Taiwan's NHI, emphasizing input from frontline healthcare workers. We provide recommendations for potential policies addressing the concerns around NHI, for example, strengthening the role of primary care services under the NHI administration, reducing the high turnover rate of healthcare workers, and increase the premium and copayments. We hope that this policy analysis may allow policymakers and scholars to understand both the merits and critical problems related to NHI from the clinical perspective.
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Affiliation(s)
- Pei-Ying Lin
- Taipei Veterans General Hospital, Taipei City, Taiwan.,National Yang Ming Chiao Tung University, Taipei City, Taiwan
| | | | - Chia-Hung Lin
- Taipei Veterans General Hospital, Taipei City, Taiwan.,National Taiwan University, Taipei City, Taiwan
| | - Yen-Han Lee
- University of Central Florida, Orlando, Florida
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31
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Bae SH. Comprehensive assessment of factors contributing to the actual turnover of newly licensed registered nurses working in acute care hospitals: a systematic review. BMC Nurs 2023; 22:31. [PMID: 36739408 PMCID: PMC9899133 DOI: 10.1186/s12912-023-01190-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 01/24/2023] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND During the COVID-19 pandemic, the demand for nursing care increased, making the retention of nurses even more important. Among staff nurses, it is reported that the turnover rate of newly licensed registered nurses is higher. However, no systematic reviews have focused on the factors that influence newly licensed registered nurses' turnover. Additionally, because newly licensed registered nurses are a major source of the supply of nurses, it is critical to retain them to meet patient needs. Therefore, this study aimed to systematically synthesize the factors contributing to the actual turnover of newly licensed registered nurses working in acute care hospitals. METHODS CINAHL, Cochrane Library, DBpia, EBSCO, PubMed, PsycINFO, RISS, and Web of Science were searched for studies published between January 2000 and June 2021. This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS Ten articles from 9029 were included in this review. All studies used a longitudinal design. The annual turnover rates of newly licensed registered nurses ranged from 12 to 25%. Health status, including sleep and healthy lifestyles, were significant factors affecting turnover. Most studies focused on work environment factors, and emotional exhaustion, job satisfaction, peer support, and intent to leave, were significantly associated with newly licensed registered nurses' turnover. Small hospitals located in nonmetropolitan areas were at risk of high turnover of newly licensed registered nurses. CONCLUSIONS Turnover is inevitable in the process of employment, but high turnover can be prevented. Through reviewing ten articles, significant contributing factors for newly licensed registered nurses' turnover included personal factors of health status; work environment factors of physical exhaustion, emotional exhaustion, depersonalization, occupational injuries, income, intent to stay, job satisfaction, and peer support; and hospital factors of hospital size, location, and unionization. Most existing studies focus on work environment factors, which reflects the significance of fostering healthy work conditions to prevent high turnover. These findings can be used to develop strategies and policies for work environment to reduce high turnover of newly licensed registered nurses, and support high-risk groups, such as small hospitals located in nonmetropolitan areas with high levels of nurses' turnover.
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Affiliation(s)
- Sung-Heui Bae
- grid.255649.90000 0001 2171 7754College of Nursing, Graduate Program in System Health Science and Engineering, Ewha Womans University, Helen Hall #204, 52, Ewhayeodae-gil, Seodaemun-gu, Seoul, 03760 Republic of Korea
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Van den Heede K, Balcaen K, Bouckaert N, Bruyneel L, Cornelis J, Sermeus W, Van de Voorde C. Improving hospital nurse staffing during the pandemic: Implementation of the 2019 Fund for Health Care Staff in Belgium. Health Policy 2023; 128:69-74. [PMID: 36462953 PMCID: PMC9701585 DOI: 10.1016/j.healthpol.2022.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 10/08/2022] [Accepted: 11/25/2022] [Indexed: 11/29/2022]
Abstract
Chronic hospital nurse understaffing is a pre-existing condition of the COVID-19 pandemic. With nurses on the frontline against the pandemic, safe nurse staffing in hospitals is high on the political agenda of the responsible ministers of Health. This paper presents a recent Belgian policy reform to improve nurse staffing levels. Although the reform was initiated before the pandemic, its roll-out took place from 2020 onwards. Through a substantial increase of the hospital budget, policy makers envisaged to improve patient-to-nurse ratios. Yet, this ambition was considerably toned down during the implementation. Due to a shortage of nurses in the labour market, hospital associations successfully lobbied to allocate part of the budget to hire non-nursing staff. Moreover, other healthcare settings claimed their share of the pie. Elements of international best-practice examples such as ward managers supernumerary to the team and increasing the transparency on staffing decisions were adopted. Other measures, such as mandated patient-to-nurse ratios, nurse staffing committees, or the monitoring or public reporting of ratios, were not retained. Additional measures were taken to safeguard that bedside staffing levels would improve, such as the requirement to demonstrate a net increase in staff to obtain additional budget, staffing plan's approval by local work councils and recommendation to base staff allocation on patient acuity measures. This policy process makes clear that the engagement of budgets is only a first step towards safe staffing levels, which needs to be embedded in a comprehensive policy plan. Future evaluation of bedside nurse staffing levels and nurse wellbeing is needed to conclude about the effectiveness of these measures and the intended and unintended effects they provoked.
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Affiliation(s)
- Koen Van den Heede
- Belgian Healthcare Knowledge Centre (KCE), Kruidtuinlaan 55, 1000 Brussels, Belgium,Leuven Institute for Healthcare Policy ... Katholieke Universiteit Leuven, Kapucijnenvoer 35, 3000 Leuven, Belgium,Corresponding author at: KCE Belgian Health Care Knowledge Centre: Federaal Kenniscentrum voor de Gezondheidszorg, Kruidtuinlaan 55 doorbuilding 9th… 1000 Brussels, Belgium
| | - Koen Balcaen
- University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Nicolas Bouckaert
- Belgian Healthcare Knowledge Centre (KCE), Kruidtuinlaan 55, 1000 Brussels, Belgium
| | - Luk Bruyneel
- Leuven Institute for Healthcare Policy ... Katholieke Universiteit Leuven, Kapucijnenvoer 35, 3000 Leuven, Belgium
| | - Justien Cornelis
- Belgian Healthcare Knowledge Centre (KCE), Kruidtuinlaan 55, 1000 Brussels, Belgium
| | - Walter Sermeus
- Leuven Institute for Healthcare Policy ... Katholieke Universiteit Leuven, Kapucijnenvoer 35, 3000 Leuven, Belgium
| | - Carine Van de Voorde
- Belgian Healthcare Knowledge Centre (KCE), Kruidtuinlaan 55, 1000 Brussels, Belgium
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Nurse Performance Metrics: A Scoping Review. J Nurs Adm 2023; 53:110-115. [PMID: 36693001 DOI: 10.1097/nna.0000000000001251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE The purposes of this scoping review are: 1) to identify instances in the literature that describe measuring individual nurse performance and 2) characterize those metrics. BACKGROUND The impact of nurses on patient outcomes has been demonstrated at the unit or hospital level, with nurses measured in aggregate. There is an opportunity to evaluate individual nurse performance by creating metrics that capture it. METHODS A scoping review based on the framework published by the Joanna Briggs Institute was performed. RESULTS Researchers identified 12 articles. Three themes were trended: the emerging nature of these metrics in the literature, variability in their applications, and performance implications. CONCLUSIONS Individual nurse performance metrics is an emerging body of research with variability in the types of metrics developed. There is an opportunity for future researchers to work with nurse leaders and staff nurses to optimize these metrics and to use them to support nursing practice and patient care.
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Kells M, Jennings Mathis K. Influence of COVID-19 on the next generation of nurses in the United States. J Clin Nurs 2023; 32:359-367. [PMID: 35043488 DOI: 10.1111/jocn.16202] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 11/27/2021] [Accepted: 12/10/2021] [Indexed: 01/17/2023]
Abstract
AIMS/OBJECTIVES Examine the affective state (anxiety, depression), life satisfaction, stress and worry, media consumption and perceptions of pursuing a career in nursing amidst the COVID-19 pandemic. BACKGROUND Nursing students worldwide have reported increased stress, fear and anxiety amidst challenges and risks associated with COVID-19. It remains unclear what impact COVID-19 will have on nursing students in the United States (US) as they prepare to enter the workforce. DESIGN Cross-sectional study of undergraduate nursing students at one university in the Northeastern United States. METHODS Students (N = 161) completed an online survey (July 2020) about health and life satisfaction, affective state (depression, anxiety), stress and interest in pursuing nursing. Descriptive statistical analysis described sample and quantitative data. Linear regression was used to examine whether media consumption, stress, affective states predicted interest in pursuing a nursing career. Qualitative thematic analysis was applied to the open-ended question, 'How has COVID-19 influenced your interest in pursuing a nursing career?'. The Standards for Reporting Qualitative Research (SRQR) checklist was used to evaluate methodological quality. RESULTS Mean stress score was 56.6 (range 0-100), 55.6% of respondents felt unsettled about the future, and 68.2% reported feeling overwhelmed. 18.7% of students reported moderate to severe anxiety, 19.8% reported moderate to severe depression and 54.4% reported that COVID-19 influenced their interest in nursing. Six themes emerged from qualitative analysis: no change, reaffirming/confirmatory, importance of nursing, reality check, positive influence and negative influence. CONCLUSIONS Universities/colleges and nursing faculty should prioritise universal mental health assessment for nursing students and enhance mental health services to support and monitor this population. RELEVANCE TO CLINICAL PRACTICE Mental health services to support nursing students are warranted in the wake of the COVID-19 pandemic. Reduction in nursing workforce may have significant impacts on staffing ratios, patient outcomes, nurse burn-out and other aspects of clinical care.
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Affiliation(s)
- Meredith Kells
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago Medicine and Biological Sciences, Chicago, Illinois, USA
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Schneider-Matyka D, Świątoniowska-Lonc N, Polański J, Szkup M, Grochans E, Jankowska-Polańska B. Assessment of The Effect of Stress, Sociodemographic Variables and Work-Related Factors on Rationing of Nursing Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2414. [PMID: 36767779 PMCID: PMC9915080 DOI: 10.3390/ijerph20032414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 01/25/2023] [Accepted: 01/27/2023] [Indexed: 06/18/2023]
Abstract
(1) Rationing of nursing care is withholding, limiting or not fulfilling the necessary nursing activities for patients. It may have a negative effect on patient safety and the quality of care. The aim of the present paper is the assessment of the effect of stress on the rationing of nursing care. (2) The current research has a cross-sectional, observational design. The study sample comprised 567 nurses. The following questionnaires were used in the study PIRNCA and PSS-10. (3) It was demonstrated that nurses with a high level of perceived stress rationed nursing care to a greater extent and showed lower assessment of nursing care and lower job satisfaction in comparison with nurses with average and low levels of perceived stress. (4) 1. Stress in nurses has a negative effect on rationing of nursing care and job satisfaction. It is recommended that actions aimed at developing effective stress coping skills be implemented as early as at the stage of training to become a nurse. 2. Factors such as marital status, sex, form of employment, place of employment and the level of professional burnout syndrome may have an influence on the level of experienced stress. In turn, the level of experienced stress, marital status, education, place of work as well as the place of residence may have an effect on rationing of nursing care and, consequently, affect the quality of care.
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Affiliation(s)
- Daria Schneider-Matyka
- Department of Nursing, Pomeranian Medical University in Szczecin, Żołnierska 48, 71-210 Szczecin, Poland
| | | | - Jacek Polański
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 213 Borowska Street, 50-556 Wrocław, Poland
| | - Małgorzata Szkup
- Department of Nursing, Pomeranian Medical University in Szczecin, Żołnierska 48, 71-210 Szczecin, Poland
| | - Elżbieta Grochans
- Department of Nursing, Pomeranian Medical University in Szczecin, Żołnierska 48, 71-210 Szczecin, Poland
| | - Beata Jankowska-Polańska
- Center for Research and Innovation, 4th Military Hospital, 5 Weigla Street, 50-981 Wrocław, Poland
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Oliveira L, Gehri B, Simon M. The deployment of temporary nurses and its association with permanently-employed nurses' outcomes in psychiatric hospitals: a secondary analysis. PeerJ 2023; 11:e15300. [PMID: 37138818 PMCID: PMC10150716 DOI: 10.7717/peerj.15300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 04/05/2023] [Indexed: 05/05/2023] Open
Abstract
Aims This study's objective was to investigate possible associations between the frequency of temporary nurse deployments and permanently-employed nurses' outcomes including staffing levels in Swiss psychiatric hospitals. Background Faced with widespread nursing shortages, some nursing managers frequently deploy temporary nurses to meet their staffing needs. While various studies have investigated the relationships between temporary nurses' deployment and permanently-employed nurse outcomes, few anywhere, and none in Switzerland, have explored such deployments' relationships with permanently-employed nurses' job satisfaction, burnout, or intent to leave their organization or profession. Furthermore, especially in psychiatric hospitals, research on temporary nurse deployments and their association with permanently-employed nurses' outcomes remains scarce. Methods This secondary analysis is based on the MatchRN Psychiatry study, which included 79 psychiatric units and 651 nurses. Using descriptive analyses and linear mixed modeling, we assessed the frequency of temporary nurses' deployment and its association with four permanently-employed nurse outcomes: staffing levels, job satisfaction, burnout, and intention to leave their organization or profession. Results Roughly one-quarter of the studied units reported frequently deploying temporary nurses. Nonetheless, no differences in nurse staffing levels were found. Regarding permanently-employed nurses' outcomes, we identified slightly higher levels of intention to leave the profession (beta = 0.18; 95% CI [0.03-0.33]) and burnout (beta = 0.19; 95% CI [0.4-0.33]) on units where temporary nurses were frequently deployed. Conclusion Deploying temporary nurses appears to help units maintain adequate staffing levels. However, additional research will be necessary to better understand whether working conditions are the common cause of temporary nurses' deployment and permanently-employed nurse outcomes. Until more information is available, unit managers should consider alternatives to deploying temporary nurses.
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Affiliation(s)
- Leonel Oliveira
- Institute of Nursing Science, Department of Public Health, University of Basel, Basel, Switzerland
| | - Beatrice Gehri
- Institute of Nursing Science, Department of Public Health, University of Basel, Basel, Switzerland
- University Psychiatric Clinics, Basel, Switzerland
| | - Michael Simon
- Institute of Nursing Science, Department of Public Health, University of Basel, Basel, Switzerland
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Renewing the care team model: Leveraging the LPN role in the acute care setting. Nurs Manag (Harrow) 2023; 54:24-31. [PMID: 36607185 DOI: 10.1097/01.numa.0000905032.53383.4e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Church CD, Schalles R, Wise T. The newly-licensed registered nurse workforce: Looking back to move forward. Nurs Outlook 2023; 71:101904. [PMID: 36588045 DOI: 10.1016/j.outlook.2022.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 11/15/2022] [Accepted: 11/30/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Newly licensed registered nurses (NLRNs) are a vital health human resource necessary for the sustainability of the nursing workforce. There are challenges associated with the transition of NLRNs into practice; yet, new nurses continue to leave their positions within the first year. To compound the situation, a global pandemic hit in 2020. To leverage a sustainable future for our nursing workforce we must examine workforce data of NLRNs. PURPOSE The purpose of this descriptive study was to review the most recent national source of workforce data to determine if the data reveals insight to help renew the focus on the NLRN workforce. METHODS This descriptive study was a secondary analysis of demographic, education, employment, and work environment variables from the 2018 National Sample Survey of Registered Nurses. FINDINGS The NLRN workforce is slightly more diverse, seeking a BSN as the first degree, and funding their initial education with federal loans. NLRNs cite inadequate staffing, stressful work environments, burnout, and salary as the reasons for leaving the first job. NLRNs cite a balanced schedule, experience in the job, and a sense of community with peers as reasons why they stay. DISCUSSION This study joins the decades of literature that points to a small group of problems that account for the overwhelming majority or nursing turnover and attrition. After analyzing the data, the authors pose several questions to readers for consideration about the NLRN workforce. The authors' hope is to garner renewed attention to the issues facing NLRNs.
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Affiliation(s)
- Cory D Church
- Texas Tech University Health Sciences Center School of Nursing, Mansfield, TX.
| | - Ryan Schalles
- Texas Tech University Health Sciences Center School of Nursing, Mansfield, TX
| | - Tiffani Wise
- Texas Tech University Health Sciences Center School of Nursing, Mansfield, TX
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Ageel M, Shbeer A. Assessment of the Critical Care Work Environment of Intensive Care Unit Nurses in Saudi Arabia. Risk Manag Healthc Policy 2022; 15:2413-2420. [PMID: 36582743 PMCID: PMC9793786 DOI: 10.2147/rmhp.s391698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
Background Nurses play a major role in the delivery of complex and challenging critical care in intensive care units (ICUs). Assessment of work environment is essential indicators of hospital management and can be applied to workforce planning and identifying nursing profession needs. The American Association of Critical-Care Nurses (AACN) recognized six standards for a healthy work environment and developed the Healthy Work Environment Assessment Tool (HWEAT). The aim of this study was to assess the work environment of ICU nurses in Jazan, Saudi Arabia. Methods This cross-sectional study was conducted at public and private hospitals. Data were collected using a self-administered questionnaire that included the sociodemographic characteristics and the AACN HWEAT. Data were analyzed to obtain descriptive and inferential statistics. The Mann-Whitney U and Kruskal-Wallis tests were employed to compare demographic data, on the basis of the overall mean HWEAT score. Results The study participants were 238 ICU nurses, who were predominantly female (83%). The mean overall HWEAT score was 3.55±1.03, which is within the "good" range, and was higher for male nurses (3.66), nurses aged ≥41 years (3.76), and nurses with postgraduate education (4.04), work experiences of >10 years (3.63), and alternate work shifts (3.6). Nurses in private hospitals had significantly higher overall scores than nurses in public hospitals (3.83 vs 3.19, P<0.001). All HWEAT standards ("effective decision-making", "authentic leadership", "appropriate staffing", "true collaboration", "skilled communication", and "meaningful recognition") were rated as good (mean range, 3.43-3.63). Conclusion The study results could assist hospitals in prioritizing the adoption of AACN HWE standards. A target benchmark of "good" was established for both the overall score and each standard, which indicates a good work environment as perceived by ICU nurses. In Addition, interpersonal differences should be considered when developing improvement initiatives.
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Affiliation(s)
- Mohammed Ageel
- College of Medicine, Jazan University, Jazan, Saudi Arabia,Correspondence: Mohammed Ageel, College of Medicine, Jazan University, Jazan, Saudi Arabia, Tel +966505769570, Email
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Ageel M, Shbeer A. Exploring Occupational Stress Among Intensive Care Units Nurses in Saudi Arabia Using the Health and Safety Executive Management Standards Indicator Tool. NURSING: RESEARCH AND REVIEWS 2022. [DOI: 10.2147/nrr.s386670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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Wang X, Shen J, Chen Q. Examining the Needs-Based Time Use of Chinese Nursing Assistants: A Time-Motion Study. J Nurs Res 2022; 30:e246. [PMID: 36201605 DOI: 10.1097/jnr.0000000000000525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND In light of the worldwide shortage of nurses and to maximize the effectiveness of the nursing care available, it is important to investigate the components of the care regularly provided by nursing assistants (NAs) to older adults. Well-organized allocation of NA care activities is directly linked to the quality of care provided to nursing home (NH) residents and their quality of life. However, relevant knowledge about the actual time allocation of NAs in this context is lacking, as previous related studies have focused only on the duration necessary for NAs to complete nursing activities. PURPOSE This study was designed to investigate the time allocation of NAs in completing job tasks necessary to meet the needs of residents in nursing care units at an NH in China. METHODS A time-motion method and nonparticipatory observations were used to collect data. Two postgraduate students observed 15 NAs' time expenditure and nursing content simultaneously during day shifts for 3 weeks as the NAs provided care to residents in four different nursing care levels. Data on nursing time and activity frequency were collected using a worklist based on the Zuluaga-Raysmith model. RESULTS The 119.6 hours of observation included 8,907 discrete observed activities. In terms of the care provided to meet the needs of residents, the most time-consuming activities were physical health care (26.8%) and communication care (18.3%), followed by mental, emotional, social, and spiritual health care (14.1%) and protection and security care (12.6%). The higher the level of care, the higher the proportion of somatic nursing time and nursing activity frequency. However, the time and frequency of psychological and spiritual care showed an opposite trend. CONCLUSIONS Because of their lack of formal nursing training and skills, NAs pay more attention to meeting the physiological needs of residents while ignoring their mental needs. Moreover, their effectiveness in providing spiritual care tends to be quite low. Furthermore, the NA nursing activity classification system based on the Zuluaga-Raysmith model developed in this study is applicable for designing nursing work tasks, organizing NH units, and improving the quality of life of residents, as this model accurately reflects the essence of NA work.
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Affiliation(s)
- Xinxia Wang
- MN, RN, MSN, School of Nursing, Chongqing Medical University, Chongqing, PRC
| | - Jun Shen
- MSN, RN, Professor, School of Nursing, Chongqing Medical University, Chongqing, PRC
| | - Qiu Chen
- MN, RN, MSN, School of Nursing, Chongqing Medical University, Chongqing, PRC
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Adynski GI, Sherwood G, Ikharo E, Tran A, Jones CB. Outpatient nurse staffing relationship with organizational, nurse and patient outcomes: A scoping review. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2022; 4:100064. [PMID: 38745630 PMCID: PMC11080568 DOI: 10.1016/j.ijnsa.2022.100064] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/20/2022] [Accepted: 01/23/2022] [Indexed: 01/17/2023] Open
Abstract
Background Nurses are an integral part of outpatient healthcare settings and are needed to provide effective patient care. Ample research and reviews have been done on nurse staffing in inpatient settings relationship with a variety of organizational, nurse and patient outcomes, however there is no review of outpatient nurse staffing relationship with organizational, nurse and patient outcomes. Objectives The purpose of this paper is to present a scoping review that evaluates the state of the literature on relationships among nurse staffing and organizational, nurse and patient outcomes in the outpatient setting. Methods The review used PRISMA guidelines for scoping reviews. The search focused on nurse staffing and organizational outcome in outpatient settings and synonyms for those terms. PubMed, Ebscohost CINAHL, and Ebscohost Global Health were searched. Articles were included if they measured nurse staffing relationship with any organizational, nurse and patient outcome in an outpatient setting. Extraction was completed in a matrix first then charted into synthesis tables. Results Thirty-seven studies were included in the review. Nurse staffing was measured in the literature by perceived staffing adequacy, types of healthcare workers staffed, full-time equivalents, nurse vacancies, proportion of nurses to total staff, agency or float nurse use, presence of nurse on the healthcare team and nurse to patient ratios. Nurse staffing of a variety of measures was associated with better patient outcomes, lower costs, and lower nurse turnover. Only one study of the 37 included did not show a positive outcome of better nurse staffing, which showed that increased nurse staffing was associated with less patient engagement in psychotherapy. Conclusions Outpatient care setting stakeholders and policy makers should consider improving nurse staffing, as stronger nurse staffing is associated with better patient outcomes lower costs and less nurse turnover. In addition, better staffing helps improve nurses' attitudes towards their job and increase job satisfaction. Most of the studies included in this review only focused on the staffing measure of perceived staffing adequacy. While perceived staffing adequacy is a useful measure of nurse staffing able to capture nurses' perception, it should not be used in isolation and more researchers should focus on gaps in outpatient nurse staffing with more objective measures such as fulltime equivalents. Tweetable abstract A 37 article scoping review on nurse staffing in outpatient care found that stronger staffing was linked with better patient outcomes, lower costs, and less turnover.
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Affiliation(s)
| | | | - Ebahi Ikharo
- University of North Carolina School of Nursing 100 Medical Drive, Chapel Hill, NC 27599, USA
| | | | - Cheryl B. Jones
- University of North Carolina School of Nursing 100 Medical Drive, Chapel Hill, NC 27599, USA
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Zhang J, Cao Y, Su M, Cheng J, Yao N. The experiences of clinical nurses coping with patient death in the context of rising hospital deaths in China: a qualitative study. BMC Palliat Care 2022; 21:163. [PMID: 36138401 PMCID: PMC9494800 DOI: 10.1186/s12904-022-01054-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 09/14/2022] [Indexed: 11/23/2022] Open
Abstract
Background Chinese clinical nurses are increasingly confronting patient death, as the proportion of hospital deaths is growing. Witnessing patient suffering and death is stressful, and failure to cope with this challenge may result in decreased well-being of nurses and impediment of the provision of “good death” care for patients and their families. To our knowledge, few studies have specifically explored clinical nurses’ experiences coping with patient death in mainland China. Objective We aimed to explore nurses’ experiences coping with patient death in China in order to support frontline clinical nurses effectively and guide the government in improving hospice care policy. Methods Clinical nurses were recruited using purposive and snowball sampling between June 2020 and August 2020. We gathered experiences of clinical nurses who have coped with patient death using face-to-face, semi-structured, in-depth interviews. Audio recordings were transcribed verbatim and analyzed using thematic analysis. Results Three thematic categories were generated from data analysis. The first was “negative emotions from contextual challenges.” This category involved grief over deaths of younger persons, pity for deaths without family, and dread related to coping with patient death on night duty. The second category was “awareness of mortality on its own.” Subthemes included the ideas that death means that everything stops being and good living is important because we all die and disappear. The third category was “coping style.” This category included focusing on treating dying patients, recording the signs and symptoms, and responding to changes in the patient’s condition. It also involved subthemes such as avoiding talk about death due to the grief associated with dying and death, and seeking help from colleagues. Conclusions Clinical nurses’ emotional experiences are shaped by intense Chinese filial love, charity, and cultural attitudes towards death. Reasonable nurse scheduling to ensure patient and staff safety is a major priority. “Good death” decisions based on Chinese ethical and moral beliefs must be embedded throughout hospital care. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-022-01054-8.
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Affiliation(s)
- Jinxin Zhang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.,NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China.,School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yingjuan Cao
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China.,Department of Nursing, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Mingzhu Su
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.,NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Joyce Cheng
- Johns Hopkins University School of Medicine, Baltimore, United States
| | - Nengliang Yao
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China. .,NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China.
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van der Mark CJEM, Kraan J, Hendriks PHJ, Vermeulen H, Oostveen CJV. Defining adequacy of staffing in general hospital wards: a Delphi study. BMJ Open 2022; 12:e058403. [PMID: 35918122 PMCID: PMC9351332 DOI: 10.1136/bmjopen-2021-058403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To gain consensus on the items that determine adequacy of shift staffing. DESIGN This was a three-round Delphi study to establish consensus on what defines adequacy of shift staffing in a general hospital ward. A literature review, focus group and five semistructured expert interviews were used to generate items for the Delphi study. SETTING Multicentre study in The Netherlands. PARTICIPANTS Nurses, head nurses, nursing managers, and capacity consultants and managers working for Dutch hospitals. RESULTS Twenty-six items were included in the Delphi study. One hundred and sixty-eight, 123 and 93 participants were included in the first, second and third round, respectively. After three rounds, six items were included (mostly related to direct patient care) and nine items were excluded. No consensus was reached on 12 items, including one item that was added after the first round. CONCLUSIONS This is the first study to specify items that determine adequacy of staffing. These items can be used to measure adequacy of staffing, which is crucial for enhancing nurse staffing methods. Further research is needed to refine the items of staffing adequacy and to further develop and psychometrically test an instrument for measuring staffing adequacy.
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Affiliation(s)
- Carmen J E M van der Mark
- Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), Radboudumc, Nijmegen, The Netherlands
- Department of Capacity Management, Rijnstate Hospital, Arnhem, The Netherlands
| | - Jocelynn Kraan
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Paul H J Hendriks
- Institute for Management Research, Radboud University, Nijmegen, The Netherlands
| | - Hester Vermeulen
- Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), Radboudumc, Nijmegen, The Netherlands
- Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Catharina J van Oostveen
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Spaarne Gasthuis Academy, Spaarne Gasthuis Hospital, Hoofddorp and Haarlem, The Netherlands
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Standards for Professional Registered Nurse Staffing for Perinatal Units. Nurs Womens Health 2022; 26:e1-e94. [PMID: 35750618 DOI: 10.1016/j.nwh.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Woodward KF, Willgerodt M. A systematic review of registered nurse turnover and retention in the United States. Nurs Outlook 2022; 70:664-678. [PMID: 35798584 DOI: 10.1016/j.outlook.2022.04.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 04/13/2022] [Accepted: 04/30/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND The pandemic has highlighted the struggles of nurses and risks of workforce shortages. Analysis of nurses' job decisions is necessary to mitigate these risks. PURPOSE The purpose of this systematic review was to understand factors associated with registered nurse (RN) work outcomes in the United States, and to examine the inclusion of equity and wellness concepts in this body of literature. METHODS This review utilized the Preferred Reporting Items for Systematic reviews and Meta-Analyses protocol. Studies from PubMed and CINAHL were included if they focused on RNs in the United States in the past 10 years. A total of 34 studies are included in the review. FINDINGS RN work outcomes are impacted by individual, unit level, and organizational factors. Few studies address equity, and many only address RN health in terms of burnout. DISCUSSION Future work needs to draw samples from broader practice settings, focus on interventions that promote positive outcomes, and focus on equity and the wellbeing of RNs.
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Standards for Professional Registered Nurse Staffing for Perinatal Units. J Obstet Gynecol Neonatal Nurs 2022; 51:e5-e98. [PMID: 35738987 DOI: 10.1016/j.jogn.2022.02.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Tuominen OA, Rantalainen T, Löyttyniemi E, Rehnbäck K, Lundgrén-Laine H, Salanterä S. Investigation of the causes and effects of stress in nurses working 'floating shifts'. Nurs Manag (Harrow) 2022; 29:e2044. [PMID: 35708997 DOI: 10.7748/nm.2022.e2044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Nurses working in hospitals may occasionally be reassigned to other wards for various reasons, for example to cover sudden absences or to support heavier-than-usual workloads. This practice is known as 'floating shifts'. AIM To assess how nurses are affected by the stress of working floating shifts, to understand what causes and alleviates this stress and to identify strategies that can be used to reduce stress. METHOD A cross-sectional research study which used an online survey. RESULTS Data were collected from 1,334 nurses in nine Finnish hospitals. Of these respondents, 63% (n=846) had worked floating shifts. Data analysis showed that having worked floating shifts in the past 12 months was not associated with increased reports of ongoing stress. However, respondents identified factors that they found stressful during floating shifts, such as the lack of a work partner. CONCLUSION Nurse managers should consider how floating shifts are administered so that nurses feel supported when working on a different ward or unit. Nurse managers can greatly influence nurses' ability to manage floating shifts.
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Grinspun D, Perry L, Abu-Qamar MZ, Stannard D, Porritt K. Nursing crisis: Challenges and opportunities for our profession after COVID-19. Int J Nurs Pract 2022; 28:e13075. [PMID: 35713391 PMCID: PMC9349996 DOI: 10.1111/ijn.13075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Thomas-Hawkins C, Flynn L, Zha P, Ando S. The effects of race and workplace racism on nurses' intent to leave the job: The mediating roles of job dissatisfaction and emotional distress. Nurs Outlook 2022; 70:590-600. [PMID: 35523600 DOI: 10.1016/j.outlook.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 03/01/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND There is scant evidence of quantifiable effects of workplace racism on nurses' job-related outcomes. PURPOSE The study aimed to examine associations among race, workplace racism, emotional distress, job dissatisfaction, and intent to leave among hospital-based nurses. METHODS This study used a correlational design with six measures in a statewide sample of 788 hospital-based nurses. FINDINGS Non-White nurses intended to leave the job at a higher rate than White nurses. Non-White nurses reported negative racial climates, multiple racial microaggression experiences, and high job dissatisfaction and emotional distress. Non-white race and workplace racism had significant individual effects on intent to leave. Job dissatisfaction and emotional distress significantly mediated indirect effects of non-White race, negative racial climates, and racial microaggressions on nurses' intent to leave. DISCUSSION In efforts to retain nurses of color in hospitals, there is an urgent need to mitigate workplace racism in these settings.
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Affiliation(s)
| | - Linda Flynn
- Division of Nursing Science, Rutgers University School of Nursing, Newark, NJ
| | - Peijia Zha
- Division of Nursing Science, Rutgers University School of Nursing, Newark, NJ
| | - Sakura Ando
- Rutgers University School of Nursing, Newark, NJ
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