Nurse managers' professional networks, psychosocial resources and self-rated health

Lived experiences of Iranian nursing managers in organizing and confronting the COVID-19 pandemic

BACKGROUND

The prevalence of the new infectious disease is a global health issue and a threat to nurses and other health care workers. In addition to nurses who have been directly involved in the care of patients with coronavirus disease 2019 (COVID-19), nursing managers have also played a key role in the management and control of this disease. The present study aimed to investigate the lived experiences of nursing managers in organizing and confronting COVID-19 in Iran.

MATERIALS AND METHODS

This study was a qualitative research design conducted by descriptive phenomenology based on Husserl philosophy. Participants consisted of 32 nursing managers working in general public hospitals in East Guilan, north of Iran, selected using purposive sampling. In-depth and semi-structured interviews were used to collect data. Colaizzi's strategy was used to analyze the data. Coding was done with MAXQDA 2007 software. Lincoln and Guba trustworthiness criteria were used to achieve accuracy and reliability of the data.

RESULTS

Data analysis led to the emergence of a main theme called "Management in the COVID-19 Crisis" and three sub-themes: "Dealing with the unknown", "Managing deficiencies and assets" and "Structural challenges".

CONCLUSION

In this study the nursing managers experienced how to deal with the COVID-19 crisis. By examining the experiences of managers involved in the COVID-19 pandemic, a rich set of managerial experiences can be gathered that prepare them for other infectious diseases in the future.

Predictors of occupational stress and well-being in First-Line Nurse Managers: A cross-sectional survey study

BACKGROUND

First-line nurse managers have a pivotal role in the organization of health care but have to deal with significant job-related issues and problems in a changing and challenging health care environment. As their new roles are complex and often unclear, it might be expected that these professionals are at risk for occupational stress.

OBJECTIVES

The objective of this study is to analyze and describe relationships between job characteristics, and also interdisciplinary conflicts with physicians as potential predictors of occupational well-being (job satisfaction, psychosomatic distress, turnover intention, work engagement and burnout).

DESIGN

this study had a cross-sectional design and used a web-based survey.

METHODS

This study was conducted in 2015 in 11 Belgian (Flemish) hospitals. All First-line nurse managers were eligible (N=481) and 318 respondents (66.1%) agreed to take part in the survey. A hierarchical regression analyses was applied to analyze relationships between predictors and outcomes.

RESULTS

job demand and job control measures were predictive of all outcomes. Collaboration with doctors only predicted job satisfaction and turnover intention. Social support from management was predictive of turnover intention. Social support from colleague- first-line nurse managers was not predictive. Social support from the staff members (team) was however a strong predictor of all stress outcomes.

CONCLUSIONS

Job demands, job control and social support of the team and management were all important predictors of occupational well-being in first-line nurse managers. All of these variables can be influenced by hospital management to improve the work conditions of this professional group in order to retain their workforce.

Sense of community and job satisfaction among social and health care managers

Purpose

– The purpose of this paper is to identify how the factors associated with sense of community at work are connected with job satisfaction among the front-line managers and middle managers in social and health-care services in Finland.

Design/methodology/approach

– A questionnaire prepared for this study was sent to 241 social and health-care managers (front line and middle managers) in Finland. A total of 136 of managers responded to the survey (response rate was 56 per cent). Data were analyzed by using descriptive statistics, exploratory factor analysis and multiple linear regression analysis.

Findings

– Alongside job meaningfulness, open communication and good flow of information within the organization, sense of security provided by close relationships at work and managers’ own superiors’ appreciation of their leadership skills all are related to managers’ job satisfaction.

Originality/value

– The study adds to our understanding of factors which are connected to the job satisfaction among social and health-care managers’. The findings of this study can be used in the development of leadership to support managers in coping at work.

A systematic review of nurse-related social network analysis studies

BACKGROUND

Nurses frequently work as part of both uni- and multidisciplinary teams. Communication between team members is critical in the delivery of quality care. Social network analysis is increasingly being used to explore such communication.

AIM

To explore the use of social network analysis involving nurses either as subjects of the study or as researchers.

METHODS

Standard systematic review procedures were applied to identify nurse-related studies that utilize social network analysis. A comparative thematic approach to synthesis was used. Both published and grey literature written in English, Spanish and Portuguese between January 1965 and December 2013 were identified via a structured search of CINAHL, SciELO and PubMed. In addition, Google and Yahoo search engines were used to identify additional grey literature using the same search strategy.

RESULTS

Forty-three primary studies were identified with literature from North America dominating the published work. So far it would appear that no author or group of authors have developed a programme of research in the nursing field using the social network analysis approach although several authors may be in the process of doing so.

LIMITATIONS

The dominance of literature from North America may be viewed as problematic as the underlying structures and themes may be an artefact of cultural communication norms from this region.

CONCLUSIONS

The use of social network analysis in relation to nursing and by nurse researchers has increased rapidly over the past two decades. The lack of longitudinal studies and the absence of replication across multiple sites should be seen as an opportunity for further research.

IMPLICATION FOR NURSING AND HEALTH POLICY

This analytical approach is relatively new in the field of nursing but does show considerable promise in offering insights into the way information flows between individuals, teams, institutions and other structures. An understanding of these structures provides a means of improving communication.

Social networks of professionals in health care organizations: a review

In this article, we provide an overview of social network research in health care, with a focus on social interactions between professionals in organizations. We begin by introducing key concepts defining the social network approach, including network density, centrality, and brokerage. We then review past and current research on the antecedents of health care professionals' social networks-including demographic attributes, professional groups, and organizational arrangements-and their consequences-including satisfaction at work, leadership, behaviors, knowledge transfer, diffusion of innovation, and performance. Finally, we examine future directions for social network research in health care, focusing on micro-macro linkages and network dynamics.

Psychosocial and organizational work environment of nurse managers and self-reported depressive symptoms: cross-sectional analysis from a cohort of nurse managers

OBJECTIVES

The association between depressive symptoms and psycho-organisational work environment has been established in the literature. Some studies have evaluated depressive symptoms in healthcare workers, but little research has been carried out among nurse managers. The aim of the study is to evaluate the depressive symptoms prevalence among nurse managers' population and work environment factors.

MATERIAL AND METHODS

A descriptive correlational research design was used. Data were collected from 296 nurse managers in five hospitals in the eastern area of France between 2007 and 2008. Health outcomes were evaluated by measuring depressive symptoms (CES-D scale), the exposure data by assessing psycho-organisational work environment with effort-reward imbalance-model of Siegrist. Multiple logistic regressions were used to describe the strength of the association between depressive symptoms and effort-reward imbalance adjusted for personal and occupational characteristics of the nurse managers.

RESULTS

Among the nurse managers, a third had depressive symptoms, and 18% presented an effort-reward imbalance (ratio: ≥ 1). A significant association was found between depressive symptoms and effort-reward imbalance (OR = 10.81, 95% CI: 5.1-23, p < 10(-3)), and with esteem as a reward (OR = 3.21, 95% CI: 1.6-6.3, p < 10(-2)).

CONCLUSION

In view of the hierarchical situation of nurse managers and their primary roles in hospitals, it is necessary to take prevention measures to improve their work environment and health.

Predictors and outcomes of nurse leader job stress experienced by AWHONN members

OBJECTIVE

To measure the relationships among stressors (personal factors, job/role factors, hospital factors), job stress, and outcomes experienced by nurse leaders and examine moderation of autonomy and leadership style on outcomes of job stress.

DESIGN

A cross-sectional, quantitative design.

SETTING

Acute and nonacute care settings throughout North America.

PARTICIPANTS

A nonprobability convenience sample of 392 was drawn from a population of nurse leaders across the United States and Canada who were members of the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN).

METHODS

A mailing list was obtained from AWHONN, and a total of 3,986 recruitment and follow-up postcards were sent to nurse leaders. Participants were asked to complete the survey online or request a hard copy to return by mail. Study variables were measured using previously published scales with demonstrated psychometric properties.

RESULTS

Nurse leaders reported stress averages above the midpoint of the scales. Personal factors did not significantly predict stress, but role overload, organizational constraints, and role ambiguity were found to be the best predictors of stress. Job satisfaction, intent to quit, and mental health symptoms were the most significant outcomes of stress. Autonomy moderated relationships between perceptions of stress and outcomes with low autonomy showing greater negative outcomes when levels of stress are higher.

CONCLUSION

Nurse leaders experience significant job stress that may suggest a need to design and implement evidence-based interventions to reduce stress among this group.

Health professional networks as a vector for improving healthcare quality and safety: a systematic review

BACKGROUND

While there is a considerable corpus of theoretical and empirical literature on networks within and outside of the health sector, multiple research questions are yet to be answered.

OBJECTIVE

To conduct a systematic review of studies of professionals' network structures, identifying factors associated with network effectiveness and sustainability, particularly in relation to quality of care and patient safety.

METHODS

The authors searched MEDLINE, CINAHL, EMBASE, Web of Science and Business Source Premier from January 1995 to December 2009.

RESULTS

A majority of the 26 unique studies identified used social network analysis to examine structural relationships in networks: structural relationships within and between networks, health professionals and their social context, health collaboratives and partnerships, and knowledge sharing networks. Key aspects of networks explored were administrative and clinical exchanges, network performance, integration, stability and influences on the quality of healthcare. More recent studies show that cohesive and collaborative health professional networks can facilitate the coordination of care and contribute to improving quality and safety of care. Structural network vulnerabilities include cliques, professional and gender homophily, and over-reliance on central agencies or individuals.

CONCLUSIONS

Effective professional networks employ natural structural network features (eg, bridges, brokers, density, centrality, degrees of separation, social capital, trust) in producing collaboratively oriented healthcare. This requires efficient transmission of information and social and professional interaction within and across networks. For those using networks to improve care, recurring success factors are understanding your network's characteristics, attending to its functioning and investing time in facilitating its improvement. Despite this, there is no guarantee that time spent on networks will necessarily improve patient care.

Role stress among first-line nurse managers and registered nurses - a comparative study

BACKGROUND

Studies show that first-line nurse managers (F-LNMs) experience high psychological job demands and inadequate managerial guidance. The purpose of this study was to investigate whether F-LNMs have higher stress levels and show more signs of stress-related ill health than registered nurses (RNs).

AIM

The aim of this study was to examine possible differences in self-rated health between F-LNMs and RNs on various psychosocial factors (e.g. job demand, job control and managerial support).

METHODS

Data were collected at a university hospital in Sweden. Sixty-four F-LNMs and 908 RNs filled in a web-based questionnaire.

RESULTS

Both F-LNMs and RNs reported having good health. Approximately 10-15% of the F-LNMs and RNs showed signs of being at risk for stress-related ill health. Statistically significant differences (Mann-Whitney U-test) were found in the distribution between the F-LNMs and the RNs on three indices of job control, job demand and managerial support.

CONCLUSION

Our findings suggest that F-LNMs were able to cope with high-demand job situations because of relatively high control over work.

IMPLICATION FOR NURSING MANAGEMENT

The implication for nursing management shows the needs for a work environment for both F-LNMs and RNs that includes high job control and good managerial support.

Trends in self-rated health among nurses: a 4-year longitudinal study on the transition from nursing education to working life

For nurses, the transition from higher education to working life involves several types of changes and seems to be a major contributing cause of distress and, consequently, ill health on a longer term basis. The aim of this study was to longitudinally monitor the development of self-rated health (SRH) in nurses, starting from the last semester at the university with subsequent follow-ups when the nurses had entered working life. The Longitudinal Analyses of Nurses' Education and working life is an ongoing nationwide longitudinal project focusing on mapping health and career development in nurses in Sweden. SRH is one of the most widely used single-item measures of perceived health status with a well-established predictive ability on future health outcomes, including morbidity and mortality. This study found a small but significant and continuous decline in SRH among nurses during 3 years of follow-ups, starting from their last semester of nursing education and continuing 3 years into their working life. The most pronounced decline in SRH seems to occur in the transition between student life and working life and is most explicit among the youngest nurses. However, the long-term effect on SRH when entering into working life seems to be more pronounced among the older nurses.

Building social capital in healthcare organizations: thinking ecologically for safer care

Research on patient safety and health human resources, 2 critical issues for 21st century healthcare, converges on similar findings. Specifically, it is apparent that along with the patients, families, and communities we serve, nurses and other healthcare professionals navigate a volatile health care system where persistent restructuring, market pressures, and workforce instability present ongoing threats to the delivery of safer care. Drawing from the fields of nursing, healthcare ethics, health systems management, and ecological restoration, we outline the role of social capital for organizational integrity, healthy workplace cultures, sustainable resource management, improved nurse retention, effective knowledge translation, and safer patient care. Nursing leaders can use ecological thinking to build the vital resource of social capital by taking concrete steps to commit the necessary human and material resources to: (1) forge relations to foster bonding, bridging and linking social capital; (2) build solidarity and trust; (3) foster collective action and cooperation; (4) strengthen communication and knowledge exchange; and (5) create capacity for social cohesion and inclusion.

Working conditions, psychosocial resources and work stress in nurses and physicians in chief managers' positions

The study investigated whether psychosocial work conditions, professional network, job support, social network and support, sick leave and salary were associated with work stress in nurses in chief manager' positions above ward level and physicians in clinical director positions. A sample consisting of 205 nurses and 274 physicians in chief managers' positions at higher structural level answered a questionnaire. Odds ratios were used for estimating the bivariate association between work stress and psychosocial resources. The result showed that both nurse managers (OR 6.8; 95% CI: 3.5-13.5) and clinical directors (OR 6.7; 95% CI: 3.6-12.5) exposed to high job demands had a significantly higher probability of high level of work stress. The results also indicated that the available psychosocial resources taken together inside and outside work did not balance the experienced work stress in nurse managers and the clinical directors who were exposed to high work demands. No relation was found between work stress and sick leave and salary.

Self-rated health, work characteristics and health related behaviours among nurses in Greece: a cross sectional study

Background

Previous studies on self-rated health among nurses have indicated an association of low job satisfaction and stress in relation to poor self-rated health. The relationship between self rated health and the specific work characteristics and health related behaviours of nurses to our knowledge have not been adequately studied.

Objective

To investigate the health profile of nurses working in hospitals in North West Greece and to examine the associations between self rated health (SRH) and health related behaviours and work characteristics in this group of hospital employees.

Methods

A self-administered questionnaire was distributed to a random sample of 443 nurses working in all the hospitals in North West Greece. Regression analysis was used to examine the relationship of health related behaviours and work characteristics with self rated health among the nurses.

Results

A total of 353 responded to the questionnaire (response rate 80%) of which 311 (88%) were female and 42 (12%) male. The mean age (standard deviation) of the respondents was 36 years (5.6) and their mean years of working as nurses were 13.5 years (5.9). Almost half of the nurses' smoked, and about one third were overweight or obese. About 58% (206) of the nurses reported having poor health while 42% (147) reported having good health. Self-rated health was independently associated with gender, effort to avoid fatty foods and physical activity, according to multiple logistic regression analysis.

Conclusion

The population studied presented a relatively poor health profile, and a high proportion of poor SRH. Though female gender and effort to avoid fatty foods were associated with poor SRH, and exercise and white meat consumption with good SRH, specific work characteristics were not associated with SRH.

Good self-rated health is related to psychosocial resources and a strong cortisol response to acute stress: the LiVicordia study of middle-aged men

Self-rated health (SRH) is a strong predictor for disease and death. The relations among SRH, psychosocial factors, and cortisol dynamics were tested using pooled data from the LiVicordia study of 50-year-old men in Lithuania (n = 94) and Sweden (n = 89), controlling for effect of residence. SRH was assessed by "How would you assess your own health?" A standardized laboratory stress test included measures of cortisol in serum and saliva. Good SRH related to high scale scores of decision latitude, social support at work, coping, self-esteem, and sense of coherence; to low scores of overcommitment (all p < .01) and vital exhaustion (r = -0.40, p < 0.001); to low concentrations of saliva baseline cortisol (r = -.26, p = .001); and to a strong cortisol response to stress (r = .27, p = .001). Findings that good SRH related to favorable psychosocial characteristics and to a dynamic cortisol stress response indicate a possible explanation for observed lower risk for disease and death in this state.

Relaxation training methods for nurse managers in Hong Kong: a controlled study

Nurse managers are under increased stress because of excessive workloads and hospitals' restructuring which is affecting their work tasks. High levels of stress could affect their mental health. Yet, few stress management training programmes are provided for this population. The purpose of this study was to apply stretch-release relaxation and cognitive relaxation training to enhance the mental health for nurse managers. A total of 65 nurse managers in Hong Kong were randomly assigned to stretch-release relaxation (n = 17), cognitive relaxation (n = 18), and a test control group (n = 35). Mental health status was assessed using the Chinese version of State-Trait Anxiety Inventory and the Chinese version of the General Health Questionnaire. Participants were assessed at the pretreatment session, the fourth posttreatment session, and at the 1-month follow-up session. The results revealed both the stretch-release and cognitive relaxation training enhanced mental health in nurse managers in Hong Kong. The application of relaxation training in enhancing mental health status for nurses and health professionals is discussed.