Association of Nurse Engagement and Nurse Staffing on Patient Safety

Impact of a Structured Nurse Mentoring Program on Organizational Engagement

Nursing leadership identified a significant decrease in measured nursing engagement at the 3- to 5-year tenure. Mentoring was chosen as an effective intervention to increase engagement and promote professional development in this Proficient-Expert group of nurses. The benefits of the implemented structured mentoring program include increased organizational engagement, increased perception of well-being support, and increased mentor competency.

Analysis of the Current Situation and Influencing Factors of Nurses' Voice Behavior in Neonatal Intensive Care Units of Grade A Tertiary Hospitals in Sichuan Province: A Multicenter Cross-Sectional Study

Aims: Voice behavior refers to nurses' proactive actions in offering constructive suggestions, providing feedback, or raising concerns in the workplace, which are crucial for enhancing care quality and improving the work environment. This study aims to investigate the current status and influencing factors of voice behavior among nurses in neonatal intensive care units (NICUs) in tertiary hospitals in Sichuan Province, providing empirical evidence for improved nursing management and hospital administration. Design: A multicenter, crosssectional survey. Methods: From January to June 2023, 422 neonatal nurses from tertiary hospitals in Sichuan Province were selected through stratified random sampling. Data were collected through self-reported questionnaires, including a general information questionnaire and a voice behavior scale. The voice behavior scale consists of 10 items, divided into promotive and prohibitive behavior dimensions, using a five-point Likert scale (1 = "never" and 5 = "always"). The scale has been widely used among Chinese nurses and demonstrates good internal consistency (Cronbach's α = 0.951). Data analysis was conducted using SPSS Version 26.0. Structural validity was assessed through exploratory factor analysis (KMO > 0.8, Bartlett's test p < 0.05), followed by confirmatory factor analysis using AMOS. For group comparisons, independent t-tests and analysis of variance (ANOVA) were used, with Welch's test for unequal variances. Post hoc multiple comparisons were performed using Tamhane's T2 for unequal variances and LSD for equal variances. A p-value < 0.05 was considered statistically significant. Results: Age, marital status, and number of children significantly influenced voice behavior. Voice behavior increased with age up to 50 years, unmarried individuals exhibited less voice behavior than married or divorced ones, and more children correlated with more voice behavior. Job title, position, and years of experience in the neonatal department also significantly impacted voice behavior. Higher positions and more than 15 years of experience were associated with increased voice behavior. Senior titles correlated with higher prohibitive voice behavior. Conclusion: The voice behavior of NICU nurses is influenced by various factors, including age, marital status, number of children, job title, position, and years of experience in the neonatal department. As age increases, the number of children grows, work experience accumulates, and nurses' voice behavior tends to intensify. In particular, for senior nurses, managers should pay attention to their prohibitive voice behavior and encourage their active involvement in decision-making processes to enhance the quality of care. Nursing managers should tailor management strategies based on these individual characteristics, providing customized support for nurses at different experience levels. At the same time, emphasis should be placed on creating a psychologically safe work environment to stimulate nurses' initiative and creativity, thereby improving team communication and collaboration. This approach will contribute to ensure the quality of care and patient safety in NICUs. Implications for the Profession: Understanding the factors influencing voice behavior helps nursing managers to enhance nurse participation and care quality. Nursing managers can implement the following strategies: (1) create a psychologically safe environment: encourage open communication by ensuring nurses feel their opinions are valued, with clear channels for feedback and action, (2) address senior nurses' prohibitive voice behavior: provide leadership training to senior nurses to transform negative feedback into constructive suggestions, promoting collaboration and work improvement, (3) tailor strategies based on experience: offer support and mentorship to new nurses, while encouraging experienced nurses to take leadership roles and contribute to decision-making, (4) incentivize contributions: develop reward systems to recognize nurses' involvement in improving patient care, such as acknowledging innovative ideas and active participation.

Fostering an active daily life: An ethnographic study unravelling the mechanisms of Green Care Farms as innovative long-term care environment for people with dementia

OBJECTIVES

Green Care Farms (GCFs) are gaining attention as innovative dementia care environment. Compared with regular nursing homes, first studies suggested a more active daily life, more social interaction and a higher quality of life of GCF residents. Regular facilities aiming to redesign and implement GCF elements might be hindered to do so by a lack of space for meadows or regulations prohibiting animals. Therefore, this study explored the underlying mechanisms by which GCFs may generate the positive effects.

DESIGN

This study is an observational, explorative study using multiple methods.

SETTING

One GCF and one traditional nursing home aiming to implement GCF elements.

PARTICIPANTS

Residents, family members, staff, managers, and other involved individuals of the two nursing homes.

MEASUREMENTS

Ethnographic observations (n = 52 days), semi-structured interviews (n = 67) and a focus group with experts from various disciplines were conducted. Data was analyzed thematically and triangulated.

RESULTS

We identified six possible mechanisms of GCFs encouraging an active daily life. These are: 1) stimulating the senses, 2) promoting engagement in purposeful activities tailored to the individual, 3) creating a community, 4) promoting freedom and autonomy in a responsible way, 5) integrating the vision in all actions, and 6) continuously transforming to carry out the vision in practice.

CONCLUSIONS

Our results provide first insights into environmental working mechanisms, which are relatively generic and have the potential to be transferred to other settings. Hence, this study provides other care organizations with guidance on implementing the care vision of GCFs in their local context.

WHAT IS ALREADY KNOWN

WHAT THIS PAPER ADDS.

The Relationship Between Perceived Staffing and Quality of Care: The Mediating Roles of Job Satisfaction and Work Engagement

BACKGROUND

Although work engagement and job satisfaction are two important indicators associated with care quality, their mediating effects on the relationship between perceived staffing and quality of care have not been adequately clarified.

PURPOSE

This study was designed to determine the mechanism by which nurses' perceived staffing influences quality of care by clarifying the mediating roles of job satisfaction and work engagement.

METHODS

A cross-sectional questionnaire survey was implemented among 2,142 clinical nurses from 211 inpatient wards in 13 hospitals. Work engagement, job satisfaction, perceived staffing, and rated quality of care were measured.

RESULTS

Most (89.7%) of the respondents rated quality of care as good or better, and 56.1% perceived staffing in the wards as adequate. The two main findings of this study are as follows: (a) Perceived staffing influenced quality of care via one direct and three indirect pathways, with the indirect effect greater than the direct effect (β direct = 0.09, β total indirect = 0.25), and (b) work engagement and job satisfaction were important mediators of the impact of staffing on quality of care.

CONCLUSION

Quality of care may be enhanced by improving the work engagement and satisfaction of nurses in their current job, suggesting an effective approach to alleviating the current nursing shortage.

Factors Associated With Junior Nurses Ability to Recognise and Respond to Clinical Deterioration: A Cross-Sectional Study in Tertiary Hospitals in Malawi

RATIONALE

Recognising and responding swiftly to patient deterioration is critical for preventing adverse events. Junior nurses play a vital role in identifying the signs of clinical deterioration and initiating interventions. No prior studies have assessed junior nurses' abilities to manage clinical deterioration in Malawi.

OBJECTIVES

This study aimed to assess junior nurses' ability to recognise and respond to clinical deterioration in Malawian tertiary hospitals and identify associated factors.

METHODS

The institutional based cross-section study design was used which included 322 junior nurses across all departments of four tertiary hospitals in Malawi (November-December 2023). Data collection utilised a questionnaire for clinical deterioration recognition and response ability in junior nurses. Chi-square, Fisher's exact, and logistic regression tests were used for data analysis.

FINDINGS

Junior nurses achieved a median score of 71 with an interquartile range of 68-75 on the clinical deterioration questionnaire. According to the study, nurses with more work experience, those who worked in intensive care units, and those who participated in discussions about clinical deterioration had better scores. In contrast, nurses with less than 1 year of experience were 5.5 times more likely to struggle with recognising and responding to clinical deterioration than those with 5 years of experience (OR: 5.506, p = 007). Additionally, working in the paediatric department decreased junior nurses' ability to recognise and respond to clinical deterioration six times compared to working in the intensive care unit (OR: 6.068, p = 0.018). Furthermore, junior nurses who had never engaged in discussions related to clinical deterioration had a seven times higher likelihood of poor ability to recognise and respond to clinical deterioration (OR = 6.954, p = 0.005).

CONCLUSION

This study highlights the need for specialised training programmes related to clinical deterioration that incorporate active learning, such as clinical scenarios and practical applications, along with mentorship initiatives to enhance junior nurses' skills and confidence in recognising and responding to clinical deterioration.

Navigating 'deterioration in mental state' - from recognition to response in general hospitals to satisfy 'National Standards': a discussion paper

BACKGROUND

The Australian Commission on Safety and Quality in Health Care 'National Standards' require general hospitals to have systems for clinicians to recognise and respond to patients' deteriorating mental state. The lack of an evidence-based operational definition and clear guidance challenges this requirement.

OBJECTIVE

To review governance mechanisms and assessment processes for deteriorating mental state in a metropolitan general hospital and propose an organisational framework.

METHODS

A qualitative document analysis using the READ approach systematically reviewed hospital committee reports, health district policies, and training programs to identify and synthesise key assessment points and processes.

FINDINGS

The study mapped assessment points for recognising and responding to deteriorating mental state across patient journey stages. An organisational systems infographic provides a blueprint for meeting National Standards accreditation criteria.

CONCLUSIONS

Hospitals should establish comprehensive systems to observe, monitor, assess, and refer individuals with deteriorating mental state, involving multiple governance processes and frameworks.

Work engagement, resilience and turnover intentions among nurses: a mediation analysis

INTRODUCTION

Healthcare organizations experience difficult challenges as a result of nursing staff turnover. This is because it not only interrupts continuity of service but also its financial implications.

AIM

The purpose of the study was to find out the effects of work engagement on nurses' intentions to leave their jobs while considering resilience as a mediating factor.

METHODS

The study used a descriptive-analytical design using a survey questionnaire on nurses working in different healthcare settings. The Utrecht Work Engagement Scale, the Brief Resilience Scale, and the Turnover Intention Scale were among the validated scales that were employed. The hypothesized relations were tested using descriptive and mediation analyses at a significance of <0.05.

RESULTS

Though the turnover intention (n = 3.83 ± 1.42) and the level of work engagement (n = 4.03 ± 1.32) among nurses were high, their level of resilience of nurses was average (n = 2.48, SD: 0.63). Resilience had a negative association with turnover intention (β =  - 0.5699, p < .0001), and there was also a significant negative association between work engagement and turnover intentions among nurses with resilience mediating the relationship (β = -0.0367, p < .05).

CONCLUSION

Disengaged nurses are more likely to leave their jobs. Moreover, resilience acts as a mechanism through which work engagement influences turnover intentions. The study emphasizes the need to encourage work engagement among nurses to lessen intentions to leave the profession. Among factors that can improve work engagement and resilience to reduce turnover include conducting regular engagement assessments, fostering positive workplace cultures, employing flexible scheduling practices, and offering resources for personal and professional development.

Understanding the Concept of Patient Safety Culture: Constitutive and Operational Definitions for Health Care Organizations

BACKGROUND

Patient safety culture is crucial for improving health care quality, however, there is no consensus on its definition.

PURPOSE

This study aimed to clarify and update the concept of patient safety culture.

METHODS

We employed Norris' 6-step concept clarification method. The content was organized through a scoping review of 4 databases. Twelve health professionals participated in focus groups and 10 experts participated in content validation. The content validity coefficient (CVC) was calculated for agreement between experts.

RESULTS

Three patient safety culture domains were identified: organizational, professional, and patient and family participation. The experts rated the definitions favorably, with high CVC scores (>0.87), indicating good agreement. The operational definitions were reduced from 76 to 54 items after expert evaluation.

CONCLUSION

An updated definition of patient safety culture is provided, which can inform development of assessment instruments by managers and health care professionals.

Satisfaction Levels of Ambulatory Patients with the Quality of Nursing Care: Validation and Application of the Patient Satisfaction with Nursing Care Quality Questionnaire in Albania

BACKGROUND

In the last decades, there has been a growing demand for outpatient services; understanding the factors influencing patient satisfaction is critical for improving healthcare quality.

OBJECTIVES

This study evaluates patient satisfaction with nursing care and examines how satisfaction varies based on socio-demographic factors in ambulatory settings across five healthcare centers in the municipality of Vlora, Albania.

METHODS

In this cross-sectional study, a total of 246 patients were surveyed using the Patient Satisfaction with Nursing Care Quality Questionnaire (PSNCQQ), adapted for outpatient contexts, after assessing its validity and reliability. The mean age of the sample was 63.9 ± 13.1 years old with a range of 21 to 94 years, and 47.2% were aged between 50 and 69 years.

RESULTS

The results indicate that the overall satisfaction level was fair, with a mean PSNCQQ score of 2.55 on a five-point scale. Socio-demographic factors, such as age, gender, education, and socio-economic status, significantly impacted patient satisfaction. Younger patients (aged 20-49), females, and those with a higher education and socio-economic status reported higher satisfaction. Medical history also played a role, with patients attending general check-ups showing greater satisfaction compared to those with chronic conditions. Older patients tend to report a lower level of satisfaction with the care provided compared to younger patients.

CONCLUSIONS

Communication and nurse-patient interactions emerged as key areas for improvement, particularly in outpatient settings where care is episodic. These findings suggest that personalized care, improved communication, and greater attention to socio-demographic and medical factors can enhance patient satisfaction in ambulatory care settings.

The nursing practice environment and hospital sociotechnical complexity: a mixed-methods study

OBJECTIVES

to analyze the relationship between the nursing practice environment and hospital sociotechnical complexity as perceived by nurses.

METHODS

a sequential explanatory mixed-methods study was conducted in a hospital in southern Brazil. The Brazilian version of the Practice Environment Scale-Nursing Work Index and the Complexity Characterization Questionnaire were administered to 132 nurses. Subsequently, semi-structured interviews were conducted with 18 participants, and the data were subjected to thematic analysis. Data integration was achieved through a connection approach.

RESULTS

the nursing practice environment was found to be favorable, except in the subscale concerning Staffing and Resource Adequacy, where complexity was present in the activities. The three emerging categories explained human and technical aspects related to complexity in the practice environment, quality of care, and patient safety. Unexpected variability was inversely correlated with the practice environment.

CONCLUSIONS

the study results indicate a relationship between these constructs, with implications for the quality and the safety of care.

The relationship between organizational trust and voice behavior among neonatal intensive care unit nurses in tertiary A hospitals in Sichuan Province: the mediating role of career resilience

Background

Neonatal intensive care unit (NICU) nurses face immense pressure, yet research on their voice behavior and the motivational mechanisms behind it is limited. Specifically, the impact of organizational trust and career resilience on this behavior has not been thoroughly explored.

Aim

This study aims to examine the relationship between organizational trust and voice behavior in NICU nurses, with career resilience acting as a mediating factor, providing empirical evidence for nursing management.

Methods

A multicenter cross-sectional survey was conducted from January to June 2023, involving 422 neonatal nurses from tertiary hospitals in Sichuan Province, China. Data were collected using a self-designed questionnaire, a voice behavior scale, an organizational trust scale, and a career resilience scale. Hierarchical regression and structural equation modeling (SEM) were employed to analyze the relationships among the variables.

Results

Hierarchical regression analysis revealed that organizational trust (β = 0.28, p < 0.001) and career resilience (β = 0.45, p < 0.001) significantly predicted voice behavior. Mediation analysis using structural equation modeling confirmed that career resilience mediated the relationship between organizational trust and voice behavior, with a mediation effect of 0.340, accounting for 44.8% of the total effect. The structural model demonstrated good fit indices (CFI = 0.962, RMSEA = 0.045), indicating the robustness of the proposed model.

Conclusion

Organizational trust significantly influences NICU nurses' voice behavior, with career resilience playing a critical mediating role. Enhancing organizational trust and fostering career resilience among NICU nurses can improve their willingness to engage in voice behavior, ultimately leading to better healthcare outcomes.

Implications for nursing management

Nursing managers should foster a trusting and supportive work environment to improve nurses' job satisfaction and organizational commitment. This can be achieved by enhancing psychological empowerment and promoting positive interactions between nurses, the organization, and leadership. Such an environment helps reduce burnout and strengthens career resilience. Increased resilience enables nurses to better manage clinical pressures and challenges, elevating their career expectations and enhancing their willingness to engage in work. This, in turn, promotes innovation, active participation, and improved voice behavior, ultimately contributing to organizational success.

Assessment of patient safety culture among healthcare providers in tertiary hospitals in Malaysia-A cross-sectional study

Background and Aim

Patient safety culture is crucial for every health care institution, as a lack of it may harm patients seeking treatment. The current study aimed to identify the level of safety culture and assess the knowledge, attitude, and perception of patient safety culture among healthcare providers (HCPs') in tertiary hospital settings.

Methods

A cross-sectional study was conducted among HCPs from two private tertiary hospitals in Johor and Selangor. A structured validated questionnaire, including the Hospital Survey on Patient Safety Culture, was used to assess the level of patient safety culture in these hospitals.

Results

In this study, the calculated sample size was 320, and all 550 eligible participants from both hospitals were approached to participate. However, only 158 responded, resulting in a response rate of 49.38%. The majority of the HCPs (n = 110; 69%) rated their hospital as very good or excellent in maintaining an overall patient safety culture. The study revealed that communication about the errors (PRR = 80) and organizational learning and continuous improvement (PRR = 74) were good in their hospital settings. However, staffing and work pace (PRR = 28), response to errors (PRR = 40), reporting patient safety events (PRR = 48), and handoffs and information exchange (PRR = 39) were inadequate. These findings indicate the negative attitudes among HCPs and the need for further improvement to maintain a culture of patient safety.

Conclusion

HCPs in the study settings had optimal knowledge but negative attitudes towards the culture of patient safety in their organization. Inadequate staffing, work pace, and a lack of response to mistakes were commonly observed, which may increase the chances of errors and pose health threats to patients that need to be addressed immediately. Every healthcare organization is urged to address the issue of patient safety culture as a matter of urgency.

Enhancing Nursing Excellence: Exploring the Relationship between Nurse Deployment and Performance

Proper nurse placement is crucial for enhancing the performance and quality of health services. This study aims to explore in-depth the relationship between nurse placement and performance in order to promote nursing excellence. A quantitative analysis was conducted using a descriptive correlational methodology. The population in this study consisted of 214 executive nurses at Medan Government Hospital, with a sample size of 139. The study's findings revealed that nurses performed exceptionally well in providing nursing care, scoring 94.2%, with those well-placed scoring 90.6%. The results from the Spearman rho correlation test showed that nursing qualifications, experience, work environments, and team dynamics have significant relationships with nurse performance. Meanwhile, the nurse's rho factor towards patients and the policy or regulation component showed low significance and relationship. The novelty of this study lies in its indication that nursing performance can be enhanced by aligning the placement of nurses with their abilities and experience, and fostering a work environment and positive team dynamics that encourage collaboration and efficiency. These findings provide vital insights for nursing staff management in order to enhance nursing care quality and patient health outcomes. This study highlights the need for suitable placement and professional development for nurses in order to attain maximum performance.

Nurses' perceptions of patient safety culture and adverse events in Hail City, Saudi Arabia: a cross-sectional approach to improving healthcare safety

OBJECTIVE

This study aimed to assess nurses' perceptions of patient safety culture (PSC) and its relationship with adverse events in Hail City, Saudi Arabia.

DESIGN

A cross-sectional study was conducted between 1 August 2023 and the end of November 2023 at 4 governmental hospitals and 28 primary healthcare centres.

SETTING

Hail City, Saudi Arabia.

PARTICIPANTS

Data were collected from 336 nurses using 3 instruments: demographic and work-related questions, PSC and adverse events.

RESULTS

Nurses had positive responses in the dimensions of 'teamwork within units' (76.86%) and 'frequency of events reported' (77.87%) but negative responses in the dimensions of 'handoffs and transitions' (18.75%), 'staffing' (20.90%), 'non-punitive response to errors' (31.83%), 'teamwork across units' (34.15%), 'supervisor/manager expectations' (43.22%) and 'overall perception of patient safety' (43.23%). Significant associations were found between nationality, experience, current position and total safety culture, with p values of 0.015, 0.046 and 0.027, respectively. Nurses with high-ranking perceptions of PSC in 'handoffs and transitions,' 'staffing' and 'teamwork across hospital units' reported a lower incidence of adverse events than those with low-ranking perceptions, particularly in reporting pressure ulcers (OR 0.86, 95% CI 0.78 to 0.94, OR 0.82, 95% CI 0.71 to 0.94 and OR 0.83, 95% CI 0.70 to 0.99, respectively) (p<0.05). Nurses with high-ranking perceptions of PSC in UK 'handoffs and transitions' reported a lower incidence of patient falls. Similarly, those with high-ranking perceptions in both 'handoffs and transitions' and 'overall perception of patient safety reported a lower incidence of adverse events compared with those with low-ranking perceptions, especially in reporting adverse drug events (OR 0.83, 95% CI 0.76 to 0.91 and OR 0.75, 95% CI 0.61 to 0.92, respectively) (p<0.05).

CONCLUSION

From a nursing perspective, hospital PSCs have both strengths and weaknesses. Examples include low trust in leadership, staffing, error-reporting and handoffs. Therefore, to improve staffing, communication, handoffs, teamwork, and leadership, interventions should focus on weak areas of low confidence and high rates of adverse events.

The influencing factors of nurses' job engagement in tertiary, A grade hospitals in East China: A cross-sectional study

AIM

To explore the effects of demographic characteristics, mental workload, and Adversity quotient (AQ) on the job engagement of nurses in East China.

DESIGN

A quantitative and cross-sectional study.

METHOD

The survey collected questionnaire data on mental workload, adversity quotient, and job engagement from 473 nurses selected working in 12 Grade-A tertiary hospitals based on informed consent in East China between July 2020 and March 2021.

RESULTS

The total score of mental workload was 78.24 ± 11.65, the adversity quotient score was 128.26 ± 15.84, job engagement score was 42.32 ± 7.79. Job engagement has a remarkable positive correlation with adversity quotient (r = 0.613, p<0.001), and a negative correlation with mental workload (r = -0.499, p<0.001). Mental workload has an apparent negative correlation with adversity quotient (r = -0.291, p<0.001). Labor-management relationship with current organization, department, study to get a degree or diploma in spare time, attitude towards a career in Nursing, attitude towards the current career position, satisfaction with marriage, social support, load feelings, self-assessment, control, and endurance could predict 70.9% of job engagement of nurses.

CONCLUSIONS

The mental workload of nurses was higher, the AQ was at a medium level, and the job engagement of nurses was also slightly higher. Labor-management relationship with current organization, department, study to get a degree or diploma in spare time, attitude towards a career in Nursing, attitude towards the current career position, satisfaction with marriage, social support, load feelings, self-assessment, control, and endurance had predictive effects on nurses' job engagement. It is necessary to take a variety of measures according to the social-demographic characteristics, improve the adversity quotient, and evaluate the mental workload correctly, to improve the job engagement of nurses.

IMPACT

The epidemic situation and other emergencies make the work pressure of nurses in Grade-A tertiary hospitals increase suddenly. It should pay attention to the influence of different demographic factors, and pay attention to the correct guidance of work demand-mental workload, as well as the cultivation, and improvement of job resource-AQ, which can improve the job engagement of nurses to some extent.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

The Clinical Nurse Specialist: A Valuable Asset to a High-Reliability Healthcare Organization

High-reliability organizations aim to achieve zero harm. The clinical nurse specialist (CNS) is an advanced practice RN who adds value to the leadership team. The CNS is proficient in influencing care delivery across the continuum and the master of developing collaborative relationships that aid in the discovery of deficiencies in care and generation of innovative ideas to minimize deficiencies. This column provides some examples of the impact and role of the CNS.

Improving Patient Safety and Care Quality Through a "Speaking-Up" Climate: The Mediating Role of Situation Monitoring

Purpose

In healthcare settings, a climate that encourages speaking up among staff is believed to enhance patient safety and quality of care. However, the specific mechanisms of this relationship remain underexplored. Particularly, there is a need to understand how components of teamwork, such as situation monitoring, can be linked to the impact of a speaking-up climate on relevant outcomes. This study aimed to investigate the direct and indirect effects of a speaking-up climate on patient safety and quality of care using situation monitoring as a potential mediator.

Patients and Methods

This cross-sectional study used survey data from 380 staff nurses who provided direct patient care at three Korean hospitals. Structural equation modeling was utilized to test a hypothesized mediation model using Mplus 7.0.

Results

Our data analysis confirmed the partial mediation model. As hypothesized, a speaking-up climate directly improved patient safety (β = 0.384, p < 0.001) and quality of care (β = 0.393, p < 0.001). Also, we found that indirect effects of a speaking-up climate on patient safety (β = 0.224, p < 0.001) and quality of care (β = 0.186, p = 0.005) through situation monitoring were significant. These results indicate that situation monitoring was found to significantly mediate the relationship between a speaking-up climate, patient safety, and quality of care.

Conclusion

Our study demonstrates that the positive impact of a speaking-up climate extends beyond improving nurses' speaking up. Further, fostering a speaking-up climate can significantly improve patient safety and quality of care, and situation monitoring has a critical role in this relationship. These findings contribute to understanding how encouraging a speaking-up climate could benefit patient safety and care quality in healthcare organizations.

The role of psychological factors on improving work engagement among nurses

Background

Work engagement is affected by many psychological variables including emotional intelligence, psychological empowerment, and resilience that are not well-studied among nurses.

Purpose

This study aims to examine the impact of emotional intelligence on the work engagement of critical care nurses, and the mediating role of resilience and psychological empowerment.

Methods

A descriptive cross-sectional design was adopted in this study among 150 critical care nurses at one university hospital in Saudi Arabia. Independent t-test and correlational analysis were used to assess relationships between study variables. A multi-step regression model was used to assess the mediatory effect.

Results

The results showed that a statistically significant positive association exists between each of the study variables (p < 0.01). The regression model showed that higher resilience (p < 0.001) and psychological empowerment (p < 0.001) predicted higher work engagement. The model predicted 33.3% of the changes in work engagement scores among critical care nurses.

Conclusion

To enhance work performance and quality of care rendered at critical care units, higher emphasis should be placed on emotional intelligence and other significant psychological variables.

Relationship between work-related psychosocial factors and self-leadership in advanced nurse practitioners: A cross-sectional study

AIM

The aim of this study was to investigate the relationship between advanced nurse practitioners' self-leadership and commitment to the workplace, work engagement and influence at work.

BACKGROUND

The concept of self-leadership is particularly suited to ANPs, who are required to take responsibility for their work roles. An optimum balance between the ANPs' psychosocial work environment and self-leadership may positively impact work ability in this group and can be compromised by interactions between and among these variables.

DESIGN

A cross-sectional correlational study was conducted from July 2020 to August 2020 on 153 ANPs across a national health service.

METHODS

The survey was distributed to respondents online. The revised self-leadership questionnaire was used to measure self-leadership, and three scales from the Copenhagen Psychosocial Questionnaire were used to measure commitment to the workplace, work engagement and influence at work. Multiple linear regression was used to examine the association between self-leadership and the psychosocial variables.

RESULTS

ANPs with high levels of self-leadership reported high levels of work engagement and commitment to the workplace. No relationship was found between self-leadership and influence at work.

CONCLUSION

Improving self-leadership among ANPs by involving them in strategic leadership activities at an organizational level could be an effective strategy for optimizing the role and facilitating ANPs to contribute at an organizational level beyond the clinical interface. However, organizational support is required to ensure that ANPs practise to the full potential of their training and capability.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

IMPACT

This study provided new evidence of a relationship between ANPs' self-leadership and psychosocial factors. This study found that ANPs with high levels of self-leadership reported high levels of work engagement and commitment to the workplace. Policymakers and organizational leaders can optimize the ANP role and facilitate ANPs to contribute strategically to improve care systems. This study identifies a relationship between ANPs' self-leadership and specific psychosocial variables.

The challenges of nursing care for patients with lumbar discectomy: A qualitative study

AIM

Patients with lumbar disc surgery experience many different problems during their hospital stay. Nurses also face different challenges in providing care to them. Nonetheless, no study has yet specifically addressed these challenges to the best of our knowledge. This study aimed at exploring the challenges of nursing care for patients with lumbar discectomy.

DESIGN

This qualitative study was conducted in 2022 using content analysis.

METHODS

Eight nurses, three patients with lumbar discectomy, and one physician were purposively selected from the neurosurgery wards of the hospitals affiliated to Golestan University of Medical Sciences, Gorgan, Iran. Semi-structured interviews were conducted for data analysis and the content analysis method recommended by Elo and Kyngas was used for data analysis. The main phases of this method are open coding, grouping, categorization, and abstraction. The MAXQDA 10 software was employed to facilitate data management. Data collection continued to reach data saturation.

RESULTS

The challenges of nursing care for patients with lumbar discectomy were categorized into eleven subcategories and three main categories, namely dominant routine-based practice in the healthcare system, futile attempt for team-based care, and shortages as a major barrier to quality care. There are different personal, professional, financial, structural, and organizational challenges in nursing care for patients with lumbar discectomy which can negatively affect postoperative patient recovery.

Factors in the Perioperative Nurses' Work Environment That Predict Work Engagement

Perioperative nurse engagement and certification are associated with a culture of safety, which is crucial in perioperative environments. Therefore, examining relationships between engagement, the practice environment, and certification is warranted. The purposes of this study were to examine the relationships between the perioperative practice environment and reported nurse engagement, determine differences in engagement based on certification, and identify facilitators and barriers to attaining and sustaining certification. In this multiphase mixed-methods study, we used a convenience sample of perioperative nurses (N = 379) to examine relationships between engagement, the practice environment, and certification. Qualitative interviews were conducted (n = 15) to supplement the quantitative findings. Leadership support (β = 0.23, P = .001) and nursing foundations for quality care (β = 0.21, P = .01) were significant predictors of engagement. Certified nurses did not have significantly higher mean engagement scores when compared with noncertified peers. Qualitative interviews corroborated the findings.

The association between team job crafting and work engagement among nurses: a prospective cohort study

BACKGROUND

Team-level job crafting has been put forward as a method to promote nurses' mental health. However, a longitudinal association is unclear. Therefore, the objective of this study was to investigate the association between team job crafting at baseline and work engagement, work performance, psychological distress, and intention to leave at three-month and six-month follow-ups among Japanese hospital nurses. Also, whether an increase in the team job crafting during 3 or 6 months was associated with an increase in the work engagement during 3 or 6 months of individual nurses was examined.

METHODS

A multilevel prospective cohort study was conducted. Data were collected from nurses of five hospitals in Japan at baseline (T1) and follow-ups at 3-months (T2) and 6-months (T3). A total of 2,478 nurses were included. The team job crafting scale for nurses and its three subscales were measured for the independent variables. Ward-means were used as ward-level variables. The dependent variables were work engagement, work performance, psychological distress, and intention to leave. Hierarchical Linear Modeling (HLM) was used to examine the multilevel association. The study protocol was registered at the UMIN Clinical Trials Registry (ID = UMIN000047810) (May 22, 2022).

RESULTS

A total of 460 nurses completed the T1 survey (response rate = 18.6%), and data from 391 nurses nested in 30 wards were included in the analyses. The intraclass correlation coefficients (ICCs) at T1 were 0.02 for work engagement and 0.07 for team job crafting. The HLM revealed that ward-level team job crafting at T1 was not significantly associated with work engagement, work performance, psychological distress, and intention to leave at T2 or T3. The ward-level change (T3-T1) of "crafting for the task considering the team's growth" (subscale for team job crafting) was significantly and positively associated with the change (T3-T1) in work engagement.

CONCLUSIONS

Ward-level team job crafting at baseline did not predict nurses' work engagement, work performance, psychological distress, or intention to leave at a three-month or six-month follow-up. The impact of ward-level team job crafting may attenuate over several months.

Original Research: A Real 'Voice' or 'Lip Service'? Experiences of Staff Nurses Who Have Served on Staffing Committees

BACKGROUND

Nurse staffing committees offer a means for improving nurse staffing and nursing work environments in hospital settings by giving direct care nurses opportunities to contribute to staffing decision-making. These committees may be mandated by state law, as is the case currently in nine U.S. states, yet little is known about the experiences of staff nurses who have served on them.

PURPOSE AND DESIGN

This qualitative descriptive study was conducted to explore the experiences of direct care nurses who have served on nurse staffing committees, and to better understand how such committees operate.

METHODS

Participants were recruited by sharing information about the study through online nursing organization platforms, hospital nurse leadership, state chapters of national nursing organizations, social media, and nonconfidential nursing email lists. A total of 14 nurses from five U.S. states that have had nurse staffing committee legislation in place for at least three years were interviewed between April and October 2022.

RESULTS

Four themes were identified from the data-a "well-valued" committee versus one with "locked away" potential: committee value; "who benefits": staffing committee beneficiaries; "not just the numbers": defining adequate staffing; and "constantly pushing": committee members' persistence.

CONCLUSIONS

The results of this study highlight the importance of actualizing staff nurse autonomy within nurse staffing committees-and invite further exploration into how staff nurses' perspectives can be better valued by nursing and nonnursing hospital leadership. Nurse staffing committees generally recommend staffing-related policies and practices that address the needs of patients and nurses, and work to find areas of compromise between nursing and hospital entities. But to be effective, the state laws that govern nurse staffing committees should be enforceable and evaluable, while committee practices should contribute to positive patient, nurse, and organizational outcomes; otherwise, they're just another form of paying lip service to change.

The relationship between nursing home staffing and resident safety outcomes: A systematic review of reviews

BACKGROUND

Resident safety is an important topic for nursing home practice with up to 33 % of residents subjected to an adverse event. In spite of a large evidence base examining the relationship between nursing home staffing and resident outcomes, the findings of several systematic reviews remain inconclusive and contradicting, possibly due to methodological shortcomings.

OBJECTIVE

The main aim of this review was to provide a comprehensive overview of the literature on nursing home staffing and its relationship with resident safety outcomes.

DESIGN

We undertook a systematic review of reviews. We searched Medline, CINAHL and Embase by the end of November 2022. Reviews were included if they assessed the relationship between nursing home staffing and resident safety outcomes using objective measures and data at resident level. Quality appraisal was conducted using the SIGN-checklist, but we did not exclude any reviews based on quality assessment. We used a narrative approach, tables and figures to summarize the findings.

RESULTS

We included 13 systematic reviews published between 2006 and 2022 building on primary evidence from 1977 to 2022. Twelve reviews investigated the relationship between nurse staffing and resident safety outcomes (187 unique primary studies), and one review focused on allied health professionals (28 primary studies). Five reviews originated as work to inform governmental recommendations on staffing. We found diverse approaches used to investigate the staffing-outcome relationship with regard to design, timeframe, operationalization, data-source and theoretical rationales guiding the studies. The most prominently reported resident safety outcomes were pressure ulcers and urinary tract infections. Commonly reported staffing measures included number and level of education of nursing home staff. Based on narrative summaries, staffing seems to have a favorable relationship with resident safety outcomes, but logic models explaining the mechanisms of this relationship were sparsely reported.

CONCLUSIONS

The existing literature shows methodological limitations that demand a change in research on the staffing-outcome relationship in the nursing home setting. Our work highlights the need for carefully designed primary studies that address the pertinent shortcomings by design, timeframe, operationalization, data-source and theoretical rationales. These future studies will allow to carefully examine the causal relationship between selected staffing measures and resident safety outcomes in further detail and serve as legitimate evidence bases to inform action plans for clinical practice and to evaluate staffing policies.

Job Resources and Core Self-Evaluation as Predictors of Nurse Engagement and Patient-Safety Outcomes: A Longitudinal Study

Background

Work engagement and patient-safety outcomes in nursing practice are critically significant. However, most previous studies evaluating antecedents of work engagement and patient-safety outcomes have used cross-sectional designs.

Aims

To investigate the effects of job resources (organizational support and leader empowerment) and core self-evaluation on nurses' work engagement and patient-safety outcomes.

Methods

This longitudinal study surveyed 2,618 registered nurses from 17 public hospitals in XuZhou, China. Participants completed self-report questionnaires on organizational support, leader empowerment, and core self-evaluation at baseline. Work engagement and patient-safety outcomes were collected 18 months after the baseline. The mixed linear regression and Johnson-Neyman statistical analysis were used to analyze data.

Results

Organizational support was an outsize predictor of nurses' work engagement, followed by core self-evaluation and leader empowerment. Organizational support and core self-evaluation were equally crucial for predicting patient-safety outcomes. Moreover, the positive impact of leader empowerment on patient-safety outcomes became significant when the core self-evaluation score was below 51.

Conclusions

This study demonstrated that organizational support, leader empowerment, and core self-evaluation are important determinants of nurses' work engagement and patient-safety outcomes. Implications for Nursing Management. Hospital managers and nurse leaders should consider providing multiple supports to motivate staff nurses to engage in work. When nurses' core self-evaluation is low, empowering training for nurse leaders should be essential to reduce adverse patient events.

The Relationship between Clinical Environment and Adverse Events Reporting: Evidence from Lithuania

BACKGROUND

The clinical environment plays a crucial role in patient safety, as it encompasses the physical, organizational, and cultural aspects of healthcare delivery. Adverse events, such as active errors, can often be attributed to systemic issues within the clinical environment. Addressing and improving environmental factors is essential for minimizing adverse events and enhancing overall patient care quality.

METHODS

A descriptive, cross-sectional design was applied. The study utilized two questionnaires: the Reporting of Clinical Adverse Events Scale (RoCAES) and the Revised Professional Practice Environment (RPPE) scale. A total of 1388 questionnaires were fully filled out, with a response rate of 71 percent.

RESULTS

Nurses who expressed higher levels of satisfaction with various aspects of the clinical environment were more inclined to indicate their intention to report adverse events in the future. These positive relationships suggest that a contented clinical environment fosters a greater willingness among nurses to report adverse event occurrences.

CONCLUSION

The findings of our study support the evidence that demonstrated that the clinical environment plays a significant role in influencing the reporting of adverse events in healthcare settings. It significantly influences nurses' attitudes, quality of care, and adverse event reporting rate.

Work Engagement, Burnout, and Well-being in Nursing Professional Development Practitioners

Work engagement, burnout, and well-being in nursing professional development practitioners during the second year of COVID-19 were explored. Increased levels of work engagement were associated with decreased burnout and higher levels of well-being. Significant differences were noted in work engagement and burnout among those with more than 1 year of nursing professional development experience. Examining the health of the specialty highlights current concerns and provides insight into developing interventions to address the consequences of the pandemic.

Addressing nursing shortages and patient safety using Maslow's hierarchy of needs

ABSTRACT

Healthcare staffing shortages in the US were exacerbated by the COVID-19 pandemic. This article explores the multifaceted challenges and their impact on healthcare organizations, and proposes a framework rooted in Maslow's, hierarchy of needs to guide healthcare organizations in mitigating these shortages and improving patient safety and quality of care.

Specialized nurses' role in ensuring patient safety within the context of telehealth in home care: A scoping review

Objectives

Specialized nurses are uniquely positioned to implement innovative telehealth solutions to improve the quality and safety of home care, and this has become a focal point of contemporary healthcare research. This review aimed to identify the nature and scope of specialized nurses' roles in ensuring patient safety within the context of telehealth in home care.

Methods

A scoping review of the international literature was carried out from January 1, 2013, to August 29, 2024. The review employed Levac et al.'s framework to delineate the research phenomenon and consolidate existing empirical research findings. Through a comparative analysis, the review integrated findings from selected studies, highlighting both similarities and differences related to this phenomenon, which led to the development of distinct categories.

Results

The search yielded 1127 articles, from which 23 studies met the inclusion criteria for research synthesis and subsequent reporting of results. These studies spanned specialized nurses' roles in telehealth and various fields in which specialized nurses utilized telehealth to deliver high-quality and safe home care. The findings highlighted key outcomes linked to the improvement of patient safety in home care encompassing continuity of care, confidence in care, monitoring and early intervention, medication safety, engagement and adherence, and healthcare costs.

Conclusions

The review revealed the crucial role played by specialized nurses in harnessing telehealth in healthcare to meet the highest care standards, creating an environment that prioritizes the well-being and patient safety in home care.

Exploring influential factors on patient safety culture in delirium nursing care within long-term care facilities: a cross-sectional survey

BACKGROUND

Elderly residents with physical and cognitive impairments in long-term care facilities are vulnerable to safety risks.

PURPOSE

This study investigated factors that influence patient safety cultures in delirium nursing care in long-term care facilities.

METHODS

A cross-sectional survey was conducted among 214 nurses working in 12 long-term care facilities using a structured questionnaire from February 15, 2022, to March 14, 2022. Data analysis was performed using Pearson's correlation coefficients and hierarchical analysis with SPSS/WIN 25.0 software.

RESULTS

Significant factors associated with patient safety culture were identified. Organizational factors included the availability of delirium care manuals, nursing education and experience in delirium care, and the perceived necessity of delirium education. Individual factors included nurse-to-patient ratios, and nurses marital status.

CONCLUSION

To foster a strong patient safety culture, attention should be given to the availability of delirium care resources, the promotion of specialized and ongoing education and experience, and adequate staffing levels.

Nurses' experience with presenteeism and the potential consequences on patient safety: a qualitative study among nurses at out-of-hours emergency primary care facilities

OBJECTIVES

This study aimed to gain new insight and knowledge on out-of-hours emergency primary care nurses' experience of presenteeism in their workplace and their outlook on the impact they recognised the phenomenon to have on patient safety when caring for acute patients.

DESIGN

An explorative qualitative study.

SETTING

The study was conducted at three out-of-hours primary care facilities in southwest Norway.

PARTICIPANTS

A total of 10 female nurses were recruited as interviewees. Nurses providing direct patient care were included in the study.

RESULTS

The analysis resulted in four major themes: strong work ethics influence the decision to attend work unwell; work environment factors have a negative impact on nurses' health; nurses' awareness of consequences on the quality of care and patient safety and nurses make use of coping strategies when engaging in presenteeism.

CONCLUSION

Presenteeism is a common experience among nurses at out-of-hours emergency primary care clinics, with work-related stress being a significant contributing factor. Despite recognising a decrease in performance while engaging in presenteeism, nurses displayed adaptive behaviour. They were confident that their suboptimal health issues did not significantly impact patient safety while caring for acute patients. However, the true impact of presenteeism on patient safety in an out-of-hours emergency care setting remains uncertain due to the reliance on subjective reporting systems as quality indicators. More research is needed to understand the phenomenon and its implications on patient safety fully.

Relationship of the nursing practice environment with the quality of care and patients' safety in primary health care

BACKGROUND

Nursing practice environment has impact on the quality of nursing care and on patients' and nurses' outcomes, namely better performances of these healthcare workers. Improving the nursing practice environment is a low-cost organizational strategy to achieve better patients' outcomes and retain qualified nurses, thus improving nursing care of units, healthcare organizations and healthcare system. This study aims to analyse the relationship between nursing practice environment and the nurses` perception of quality of care, patient safety, and safety culture in Primary Health Care in Portugal.

METHODS

We conducted a descriptive, analytical, and cross-sectional study using data from RN4CAST Portugal. The sample was composed of 1059 nurses from 55 Health Center Groups of the mainland Portugal, 15 Health Centers of the Autonomous Region of Madeira and 6 Health Centers of the Autonomous Region of the Azores. Multivariate analysis and correlation analysis methods were used for data processing.

RESULTS

Nurses consider that, in the Portuguese Primary Health Care, there is a mixed and unfavourable nursing practice environment, with a perception of a good quality of care, and both acceptable patients' safety and safety culture. The Collegial Nurse-Physician Relations and Nursing Foundations for Quality of Care dimensions to have the best ratings. The perception of Primary Health Care nurses on the dimension Nurse Participation in Organization Affairs was the one that showed the lowest score, followed by Staffing and Resource Adequacy and Nurse Manager Ability, Leadership, and Support of Nurses. Based on perception of nurses, the relationship between the nursing practice environment and the safety culture is higher, followed by the quality of care and patients' safety.

CONCLUSIONS

The perception of Primary Health Care nurses is that there is an unfavourable and mixed nursing practice environment, with good quality of care, and acceptable patient safety and safety culture. The quality of the nursing practice environments is associated to better quality and safety of care. Thus, improving the nursing practice environments in healthcare organizations is a low-cost organizational strategy to achieve greater patients and nurses' outcomes, improving the quality of nursing care to patients in the Primary Health Care units.

Factors determining safety culture in hospitals: a scoping review

OBJECTIVE

To evaluate and synthesise the factors determining patient safety culture in hospitals.

METHODS

The scoping review protocol was based on the criteria of the Joanna Briggs Institute. Eligibility criteria were as follows: (1) empirical study published in a peer-reviewed journal; (2) used methods or tools to assess, study or measure safety culture or climate; (3) data collected in the hospital setting and (4) studies published in English. Relevant literature was located using PubMed, CINAHL, Web of Science and PsycINFO databases. Quantitative and qualitative analyses were performed using RStudio and the R interface for multidimensional analysis of texts and questionnaires (IRaMuTeQ).

RESULTS

A total of 248 primary studies were included. The most used instruments for assessing safety culture were the Hospital Survey on Patient Safety Culture (n=104) and the Safety Attitudes Questionnaire (n=63). The Maslach Burnout Inventory (n=13) and Culture Assessment Scales based on patient perception (n=9) were used in association with cultural instruments. Sixty-six articles were included in the qualitative analysis. In word cloud and similarity analyses, the words 'communication' and 'leadership' were most prominent. Regarding the descending hierarchical classification analysis, the content was categorised into two main classes, one of which was subdivided into five subclasses: class 1a: job satisfaction and leadership (15.56%), class 1b: error response (22.22%), class 1c: psychological and empowerment nurses (20.00%), class 1d: trust culture (22.22%) and class 2: innovation worker (20.00%).

CONCLUSION

The instruments presented elements that remained indispensable for assessing the safety culture, such as leadership commitment, open communication and learning from mistakes. There was also a tendency for research to assess patient and family engagement, psychological safety, nurses' engagement in decision-making and innovation.

Development and psychometric validation of the Sickness Presenteeism Scale-Nurse

AIM

This study's aim is to develop and psychometrically assess the Sickness Presenteeism Scale-Nurse.

BACKGROUND

Evaluation of the effects of sickness presenteeism on nurses' performance and productivity is important for healthcare quality.

DESIGN

This was an instrument development and validation study.

METHODS

Scale items were created based on literature review and qualitative research. Data were collected from 619 nurses between October and December 2021. The factor structure of the scale was determined by explanatory and confirmatory factor analysis performed with different sample groups. Convergent and discriminant validity were investigated, and reliability was evaluated with Cronbach's α values, adjusted item-total correlation, composite-reliability and split-half reliability.

RESULTS

Explanatory factor analysis showed that Sickness Presenteeism Scale-Nurse consisted of four sub-dimensions and 21 items and explained 57.9% of the total variance. This factor structure was confirmed by confirmatory factor analysis. The convergent and discriminant validity was confirmed. The total Cronbach's α value of the scale was calculated as 0.928, with Cronbach's α values of the sub-dimensions calculated as 0.815-0.903; composite reliability values were calculated as 0.804-0.903.

CONCLUSIONS

The Sickness Presenteeism Scale-Nurse is a valid and reliable measurement instrument that can be used to evaluate the effect of nurses' sickness presenteeism behaviour on job performance.

[Influence of work engagement and self-efficacy of nurses on clinical practice ability in burn intensive care unit]

Objective: To analyze the influence of work engagement and self-efficacy of nurses on clinical practice ability in burn intensive care unit (BICU), and to explore its potential pathways of action. Methods: A cross-sectional survey was conducted. From May to October 2020, a total of 30 hospitals with BICU in China were selected by stratified sampling method. Among BICU nurses who met the inclusion criteria, their clinical practice ability, work engagement, and self-efficacy were evaluated by self-evaluation scale of oriented problem-solving behavior in nursing practice (OPSN), Utrecht work engagement scale (UWES), and general self-efficacy scale (GSES), respectively. The total scale scores of each index and the average item scores were recorded. The self-designed general data questionnaire was used to investigate the nurses' gender, age, marital status, education background, working years, professional title, and the economic region of the hospital that they belonged to. The total scale scores of the above-mentioned three evaluation indexes were compared after the classification of nurses according to general data, and the data were statistically analyzed with independent sample t test or one-way analysis of variance. Pearson correlation analysis was used to analyze the correlation between the total scale scores of the three evaluation indexes. Based on the total scale scores of the above-mentioned three evaluation indexes, a structural equation model was established, the mediation analysis of the relationship among the three evaluation indexes and the pathway analysis of the structural model were conducted, and the Bootstrap method was used to verify the pathways of action. Results: A total of 401 questionnaires were distributed, and 337 valid questionnaires were returned, with a valid return rate of 84.04%. The total scale scores of clinical practice ability, work engagement, and self-efficacy of 337 nurses were 98.2±11.7, 67.7±18.6, and 26.6±5.6, respectively, and the average item scores were 3.9±0.5, 4.5±1.2, and 2.7±0.6, respectively. Among the 337 nurses, the majority were female, aged 40 or below, married, and had a bachelor's degree with work experience of ≤10 years; both nurses with professional nurse title and nurses from the Southeast region accounted for about 50%. There were statistically significant differences in the total scale score of clinical practice ability among nurses with different ages, education backgrounds, working years, and professional titles (with F values of 3.26, 4.36, 3.12, and 2.80, respectively, P<0.05). There was statistically significant difference in the total scale score of work engagement among nurses with different working years (F=4.50, P<0.05). There were statistically significant differences in the total scale score of self-efficacy among nurses with different ages, working years, and professional titles (with F values of 4.91, 4.50, and 2.91, respectively, P<0.05). The total scale score of nurses' work engagement was significantly positively correlated with the total scale score of clinical practice ability and the total scale score of self-efficacy (with r values of 0.30 and 0.51, respectively, P<0.05). The total scale score of nurses' self-efficacy was significantly positively correlated with the total scale score of clinical practice ability (r=0.37, P<0.05). The model had good adaptability, and the intermediary model was established. Nurses' work engagement had a significantly positive effect on both self-efficacy and clinical practice ability (with β values of 0.54 and 0.16, respectively, P<0.05), and nurses' self-efficacy had a significantly positive effect on clinical practice ability (β=0.29, P<0.05). Work engagement had a direct effect on self-efficacy and clinical practice ability, and self-efficacy had a direct effect on clinical practice ability and played a mediating role between work engagement and clinical practice ability. Bootstrap validation showed that self-efficacy played a significantly mediating role in the influence of work engagement on clinical practice ability (with effect size of 0.16, with 95% confidence interval of 0.08-0.24, P<0.05), accounting for half of the total effect of work engagement on clinical practice ability (with effect size of 0.32). Conclusions: BICU nurses have an above-average level of clinical practice ability, a medium level of self-efficacy, and a high level of work engagement. Work engagement and self-efficacy are positively correlated with clinical practice ability. Work engagement can directly affect clinical practice ability or indirectly affect clinical practice ability through the mediating role of self-efficacy.

Original Research: Exploring Frontline Nurses' Self-Perceived Levels of QI Engagement and QI Competence

BACKGROUND AND PURPOSE

Nurse engagement in quality improvement (QI) is critical in the delivery of safe high-quality care, yet few studies have evaluated frontline nurses in this area. The purpose of this study was to identify and compare levels of self-reported QI engagement and QI competence among frontline nurses and nurse leaders.

METHODS

This study used a cross-sectional descriptive design. A convenience sample of frontline nurses (bedside RNs and advanced practice nurses) and nurse leaders from acute and ambulatory care sites completed the Nursing Quality Improvement in Practice (NQuIP) tool, which measures engagement and competence (knowledge, skills, and attitudes) in QI.

RESULTS

Data from 6,351 surveys completed by frontline nurses and nurse leaders representing 66 sites nationwide were analyzed. Only 52.5% of all respondents reported participating in QI. Knowledge scores were relatively high, while skills scores-especially those related to using QI tools-were low. Overall attitudes toward QI were positive. Nurse leaders scored significantly higher in engagement and competence than the frontline nurses they supervise.

CONCLUSIONS

The study findings indicate that nurse engagement in QI is limited. Although nurses' knowledge levels appear to be high, their limited competency in QI-related skills may contribute to low QI engagement. Leaders must make efforts to increase nurse engagement in order to attain high-quality outcomes. Using the NQuIP tool will allow leaders to evaluate nurses' self-perceived QI competence and engagement, which will aid in identifying target areas and developing effective strategies for improvement.

A Cross-sectional Study Evaluating the Association Between the Nursing Practice Environment and Missed Nursing Care in Medical and Surgical Wards in Jordan

BACKGROUND

Missed nursing care can jeopardize the safety of patients. The practice environment contains various elements that may impact nursing staff's capability to provide appropriate care.

PURPOSE

To examine the association between the practice environment and missed nursing care in Jordanian hospitals.

METHODS

A cross-sectional design, including the MISSCARE survey and the Practice Environment Scale of the Nursing Work Index, was used for this study.

RESULTS

Data were gathered from 672 nurses working in 10 hospitals between March and July 2021. Findings revealed significant negative correlations between nurses' participation in hospital affairs ( r = -0.077, P = .046), nursing foundations for quality of care ( r = -0.139, P < .001), and missed nursing care.

CONCLUSION

Information from this study can help nursing leaders modify practice environment elements that impact missed nursing care occurrences, which will help improve the quality of care provided to patients.

Supervisors' Work Engagement Is Associated With Interactivity and Carefulness in Supporting Subordinates: A Cross-sectional Study Using Text Mining in Japan

OBJECTIVE

This study aimed to structure supervisory support and clarify the relationship between supervisors' work engagement and support for their subordinates.

METHODS

We conducted a cross-sectional study in a manufacturing company using a questionnaire survey. Supervisors provided open-ended responses regarding the provision of support for their subordinates. Using text mining, we structured these descriptions into multiple categories, assigned words to them, and analyzed frequently mentioned categories by the level of work engagement.

RESULTS

We obtained responses from 729 participants that included 13,968 words. We structured supervisory support by three categories (contents, direction, and attitude toward support) and 11 subcategories. As supervisors' work engagement increased, the rates of mentioning information retrieval, information transmission, and carefulness increased.

CONCLUSIONS

Supervisors with work engagement could communicate with each other and be careful in providing support to their subordinates.

Associations among leadership, resources, and nurses' work engagement: findings from the fifth korean Working Conditions Survey

BACKGROUND

Nurses' work engagement has received extensive attention due to its positive impacts on individual and organizational outcomes, including patient safety and quality care in healthcare organizations. Although nurse managers' leadership and a variety of resources have been identified as important factors of nurses' work engagement, these relationships have not been well understood in Korean nursing contexts. The purpose of this study was to examine the associations among nurse managers' leadership, resources, and work engagement among Korean nurses after controlling for nurses' demographic and work-related characteristics.

METHODS

This is a cross-sectional study using data from the fifth Korean Working Conditions Survey. Using a sample of 477 registered nurses, we employed hierarchical linear regression analyses. Nurse managers' leadership, job resources (organizational justice and support from peers), professional resources (employee involvement), and personal resources (meaning of work) were examined as potential predictors of nurses' work engagement.

RESULTS

We found that nurse managers' leadership (β = 0.26, 95% confidence interval [CI] = 0.17-0.41) was the strongest predictor of nurses' work engagement, followed by meaning of work (β = 0.20, 95% CI = 0.07-0.18), organizational justice (β = 0.19, 95% CI = 0.10-0.32), and support from peers (β = 0.14, 95% CI = 0.04-0.23). Employee involvement was not a statistically significant predictor of nurses' work engagement (β = -0.07, 95% CI = -0.11-0.01).

CONCLUSIONS

Our findings suggest that comprehensive approaches are required to promote nurses' work engagement. Considering that nurse managers' leadership was the strongest predictor of nurses' work engagement, nurse managers should demonstrate supportive leadership behaviors such as acknowledging and praising their unit nurses' work performance. Furthermore, both individual- and organizational-level strategies are necessary for nurses to be engaged at work.

Nurses' assessed self-efficacy levels to medical asepsis and their relation to structural empowerment, work engagement and work-related stress

BACKGROUND

Nurses' working conditions are important for their well-being at work and for their ability to provide patients with safe care. Self-efficacy can influence employees' behaviour at work. Therefore, it is valuable to study self-efficacy levels to medical asepsis in relation to working conditions.

OBJECTIVE

To investigate the relationship between nurses' assessed self-efficacy levels to medical asepsis in care situations and structural empowerment, work engagement and work-related stress.

METHODS

A cross-sectional study with a correlational design was conducted. A total of 417 registered nurses and licensed practical nurses at surgical and orthopaedic units responded to a questionnaire containing: the Infection Prevention Appraisal Scale, the Conditions of Work Effectiveness Questionnaire-II, the Utrecht Work Engagement Scale-9 and the Health & Safety Executive Management Standards Indicator Tool. Correlational analyses and group comparisons were performed.

RESULTS

The nurses rated high levels of self-efficacy to medical asepsis in care situations. The correlational analyses revealed that correlation coefficients between structural empowerment, work engagement, work-related stress and self-efficacy to medical asepsis were 0.254-0.268. Significant differences in self-efficacy were found in the grouped working conditions.

CONCLUSIONS

This study revealed that nurses rated high self-efficacy levels to medical asepsis and, to some extent, this seemed related to structural empowerment, work engagement and work-related stress. This valuable knowledge could enable improvements at the managerial and organisational levels, benefiting both nurses and patients in the long run.

Predictive roles of organizational and personal factors in work engagement among nurses

Objective: To determine the work engagement levels of hospital nurses and the predictive roles that nurses’ personal and organizational characteristics play.

Methods: A cross-sectional design was employed in this study, which included 549 nurses working in the Central Philippines. Nurses were selected through purposive sampling, and a self-report questionnaire outlining personal and organizational characteristics was employed. The Utrecht Work Engagement Scale (UWES) was applied to gather data about nurse engagement.

Results: The dedication score was the highest among the three dimensions of engagement while the vigor score was the lowest. Overall, Filipino nurses experienced an average level of work engagement. We observed significant relationships between a nurse’s age, years of experience in nursing, years in their present unit, and their position at work and their levels of engagement, vigor, sense of dedication, and absorption. Hospital capacity was a negative predictor of vigor, dedication, absorption, and overall work engagement. Further, the type of nursing contract was a negative predictor of vigor and dedication. The type of hospital and the nurse’s position were positive predictors of vigor, dedication, and absorption.

Conclusions: Filipino nurses were satisfactorily engaged at work. A number of nurses’ personal and organizational characteristics play a predictive role in their work engagement. Thus, nursing administrators must support, develop, and implement activities and measures that engage nurses at work.

The transcultural adaptation and validation of the Chinese version of the Attitudes Toward Recognizing Early and Noticeable Deterioration scale

Background

In China, clinical deterioration events present a real problem for every clinical nurse. Patient deterioration is determined in part by nurses' attitudes toward early recognition of clinical deterioration. However, research on attitudes toward the early identification of clinical deterioration is still in its infancy, and even less research has been done on ward nurses' attitudes toward the early identification of clinical deterioration. To drive behavioral change and improve the care of deteriorating patients, nurses need comprehensive, valid, and reliable tools to assess their attitudes toward early identification of deterioration.

Objective

In this study, we aimed to translate the Attitudes Toward Recognizing Early and Noticeable Deterioration (ATREND) scale into Chinese and to assess its validity and reliability tests.

Methods

From March 2022 to July 2022, the ATREND scale was translated, back-translated, and cross-culturally adapted into the Chinese version using a modified Brislin translation model. Then, 460 ward nurses were recruited from tertiary Grade A general hospitals in two cities: Shenyang and Jinzhou in Liaoning Province, China. Reliability analyses were conducted using internal consistency, split-half, and test-retest reliability. We convened a committee of experts to determine the validity of the content. Tests of the structural validity of the scale were conducted using exploratory and validation factor analyses.

Results

The Cronbach's α value of the Chinese version of the ATREND scale was 0.804, and the Cronbach's α value of the dimensions ranged from 0.782 to 0.863. The split-half reliability and test-retest reliability were 0.846 and 0.711, respectively. Furthermore, the scale has an index of content validity of 0.922, indicating a high level of content validity. In exploratory factor analysis, eigenvalues, total variance explained, and scree plot supported a three-factor structure. The three-factor model supported by this study was confirmed by confirmatory factor analysis (CFA). Moreover, the model fitting indexes (e.g., χ ²/DF = 1.498, GFI = 0.954, RMSEA = 0.047) were all within acceptable limits based on the CFA.

Conclusion

The Chinese version of the scale is reliable and valid among ward nurses. Nursing educators and clinicians will be able to develop targeted educational programs to enhance the competence and behaviors of Chinese ward nurses in recognizing clinical deterioration. It will be based on the developed scale to assess Chinese nurses' attitudes and practices regarding early recognition of clinical deterioration. As a result, it is necessary to consider the Chinese scale's three-factor structure. The developed three-factor structured scale will assess Chinese ward nurses' attitudes and practices toward patient observation and vital sign-monitoring empowerment, enlightening them on the importance of patient observation, encouraging ward nurses to use a wider range of patient assessment techniques to capture early signs of clinical deterioration, and helping ward nurses to develop clinical confidence to monitor clinical deterioration.

Mediating roles of patient safety knowledge and motivation in the relationship between safety climate and nurses' patient safety behaviors: a structural equation modeling analysis

BACKGROUND

Few studies have examined the relationship between patient safety climate and two forms of patient safety behavior (i.e., safety compliance and safety participation) among nurses. Better understanding of factors contributing to nurses' safety behaviors could enhance patient safety. Therefore, this study aimed to examine the effect of patient safety climate on nurses' patient safety behavior and to explore whether patient safety knowledge and motivation mediate this relationship.

METHODS

This correlational, cross-sectional study used survey data from 1,053 staff nurses working at a general hospital located in a metropolitan area of South Korea. Structural equation modeling was employed to test a hypothesized multiple mediation model that was guided by Griffin and Neal's model of safety performance.

RESULTS

The results indicated that patient safety climate was directly related to both patient safety compliance behavior (β = 0.27, p < 0.001) and patient safety participation behavior (β = 0.25, p < 0.001). Concerning indirect effects, patient safety climate was associated with patient safety compliance behavior through both patient safety knowledge (β = 0.26, p < 0.001) and patient safety motivation (β = 0.04, p = 0.038), whereas patient safety climate was related to patient safety participation behavior only through patient safety knowledge (β = 0.27, p < 0.001) and not through patient safety motivation (β = 0.00, p = 0.985).

CONCLUSION

Based on this study's findings, building an organizational climate focused on patient safety is vital for improving nurses' patient safety behavior. Improving an organization's patient safety climate could promote both safety knowledge and motivation in nurses and thereby potentially enhance their patient safety behavior. Hence, healthcare organizations should implement practical interventions to improve their patient safety climate. Also, nursing management interventions designed to transfer patient safety knowledge to nurses would be particularly effective in improving their safety behavior.

Creating a culture of support for nursing surveillance

BACKGROUND

An estimated 98,000 deaths annually result from medical errors. Preventing these deaths must be a US healthcare goal. Surveillance decreases adverse events. Surveillance is essential for patient safety. Creating a unit culture that supports surveillance requires attention to its antecedents (nurse education, nurse expertise, nurse staffing, as well as organizational culture).

METHOD

The current literature on topics salient to creating a culture of nursing surveillance including its antecedents and its attributes were reviewed. The findings are summarized and presented.

DISCUSSION

Suggestions and tools enhancing a culture of safety allow the transition from one set of behaviors to another. An organizational culture that strives for excellence promotes surveillance which results in improved patient outcomes and better qualified nurses.

CONCLUSION

Unit change resulting in support for surveillance can minimize failure to rescue and promote interruption of adverse events. The patient outcomes include decreased morbidity and mortality.

Rebuilding trust in just culture

Even before RaDonda Vaught was found guilty of criminally negligent homicide, nurses were fearful of being held individually accountable for systemic errors. Leaders are now faced with repairing the loss of faith in just culture. This article provides an understanding of the erosion of just culture and interventions needed to improve trust.

Original Research: 'It Would Be Nice to Think We Could Have a Voice': Exploring RN Involvement in Hospital Staffing Policymaking

BACKGROUND

Hospitalized patient and nursing outcomes improve when nurses are involved in decision-making practices through shared governance structures. Yet there has been little research investigating how staff nurses are involved in hospital staffing policymaking and how they perceive this process.

PURPOSE

The study's primary aims were to increase understanding of staff nurses' perceptions of factors that hinder or support nurse involvement in hospital nurse staffing policymaking and to learn more about how nurses are, or would like to be, so involved. We also collected nurses' work environment and demographic information to further inform our understanding.

METHODS

This study used a qualitative descriptive approach. Using QuestionPro software, we solicited open-ended responses to semistructured questions to explore the topics of interest. The online form was distributed via social media. Results were analyzed using conventional content analysis. Multiple-choice questions related to demographics and nurse work environments were also included, and these results were analyzed using descriptive statistics.

RESULTS

Thirty-two staff nurses completed the online form between April 5 and May 24, 2021. Identified themes include "We aren't asked": structural barriers to staff nurse involvement; "No one cares": workplace culture barriers to staff nurse involvement; and "'They' versus 'we'": lack of power sharing for staffing decision-making. Participants described feeling powerless with regard to, and having little to no involvement in, hospital staffing policymaking. Yet they also expressed their desire to be engaged in this process and offered suggestions for how nurse involvement in such policymaking could be improved.

CONCLUSION

Our findings provide crucial insight into how organizations can address existing structural barriers to nurse involvement, offer more equitable opportunities for nurse involvement, foster more inclusive workplace cultures, and recognize the value of nurse input and autonomy regarding staffing decisions.

Undergraduate nursing students' experiences of becoming a professional nurse: a longitudinal study

Background

During education it is essential for nursing students to develop professionalism in nursing. Nurses are placed in situations based on trust, and it is crucial that their patients have confidence in them to provide professional and safe care. A key period in nursing students’ development of a professionalism occurs during training when students gain knowledge and skills that separate nurses as professional healthcare workers from laypeople. The purpose of this study was to investigate nursing students’ experiences of professional competence development during education.

Methods

A longitudinal study was carried out using qualitative content analysis with a manifest inductive approach. Thirty-four students enrolled in a Swedish three-year nursing program, from August 2015 to January 2017 were interviewed on four occasions.

Results

The results revealed that students’ professional role developed gradually. The students’ started their education with dreams and a naive understanding of the profession, but their understanding of the complexity of the nursing profession gradually evolved. Students became theoretically equipped at the university and developed clinical skills through practice. Students’ focus went from mastering medical technology to a more holistic approach. Before graduating, students felt ready but not fully trained.

Conclusions

Our findings indicate a discrepancy between the content of the theoretical education and the clinical settings since students identified a lack of evidence-based practice. A solid theoretical education before entering clinical training offered students possibilities for reflecting on evidence-based practice and the clinical settings. The realization that there is always potential for professional improvement can be interpreted as an emerging awareness, and development of professionalism. It is clear that students could benefit from increased collaborative work between clinical supervisors and faculty staff at the university.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-022-01002-0.

Nursing Work Environment Staffing Councils: An Alternative to Mandatory Regulated Staffing Ratios

OBJECTIVE

The aim of this study was to examine the self-reported perceptions of the healthy work environment (HWE) of nurses who are members of Nursing Workplace Environment and Staffing Councils (NWESCs).

BACKGROUND

In a statewide initiative, NWESCs were established at hospitals throughout the state of New Jersey as an alternative to nurse staffing ratio laws and to provide clinical nurses a voice in determining resources needed for patient care and support an HWE.

METHODS

This quantitative descriptive study presents the results of the Healthy Workplace Environment Assessment Tool (HWEAT) and open-ended questions about NWESCs among a sample of 352 nurses.

RESULTS

Three years after NWESC implementation, all HWEAT standard mean scores increased and were rated higher than the American Association of Critical-Care Nurses benchmark. There were statistically significant differences in clinical nurses' perceptions of an HWE compared with nurse leaders. Respondents also shared their NWESC's best practices and challenges. Responses to questions identified NWESC best practices and challenges.

CONCLUSION

This study offers insight into the improvement in nurses' perceptions of the HWE after the introduction of a statewide NWESCs. Structures such as the NWESCs may provide an alternative to mandated staffing ratios.

A systematic review of registered nurse turnover and retention in the United States

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.