A comparative analysis of contemporary nurses' discontents

Factors predicting Registered Nurses' intentions to leave their organization and profession: A job demands-resources framework

AIMS

To develop a comprehensive model of nursing turnover intention by examining the effects of job demands, job resources, personal demands and personal resources on burnout and work engagement and subsequently on the intention to leave the organization and profession.

BACKGROUND

The ageing population and a growing prevalence of multimorbidity are placing increasing strain on an ageing nursing workforce. Solutions that address the anticipated nursing shortage should focus on reducing burnout and enhancing the engagement of Registered Nurses (RNs) to improve retention.

DESIGN

A cross-sectional survey design.

METHOD

Data were collected in 2014-2015 via an e-survey from 2,876 RNs working in New Zealand. Data were analysed with structural equation modelling.

RESULTS

Higher engagement results in lower intention to leave the organization and profession. Burnout has significant effects on intentions to leave through lower engagement. While most of the demands and resources' variables (except professional development) have effects on intentions to leave, greater workload and greater work-life interference result in higher burnout and are the strongest predictors of intentions to leave. Greater emotional demands (challenges) and greater self-efficacy also have strong effects in lowering intentions to leave through higher engagement.

CONCLUSIONS

Employee burnout and work engagement play an important role in transmitting the impacts of job demands, job resources, personal demands and personal resources into RN intention to leave the organization and profession. Work-life interference and high workloads are major threats to nursing retention while challenge demands and higher levels of self-efficacy support better retention.

Nurses' perceptions of conflict as constructive or destructive

AIMS

The aim of this study was to examine nurses' perceptions of constructive and destructive conflicts and their management among nurses.

BACKGROUND

Conflict among nurses is common and has been associated with lack of collaboration, lack of communication and disruptive behaviour, with the potential to have negative impact teamwork. However, unlike the broader social science literature, positive views of conflict are scarce in the nursing literature. Given the various functions of conflict and the high stakes of ineffective conflict management in nursing, it is necessary to examine how nurses understand both sides of conflict: constructive and destructive.

DESIGN

A qualitative descriptive design.

METHODS

Data were collected from 34 full time nurses as part of a conflict skills training course offered over 6 months beginning in October 2009. Each participant was asked to write a weekly journal about conflicts in his/her work place.

RESULT

Data yielded 163 entries (82 classified as constructive and 81 as destructive). Results showed that quality patient care and cooperative communication contributed to the perception that conflict is constructive in nature. The central underlying themes in nurses' perceptions of destructive conflict were time constraints, role conflict and power differences that are not managed through communication.

CONCLUSION

This article helps to identify nursing perceptions of constructive and destructive conflict and to understand complexities nurses face during their interactions with other nurses, physicians and patients. The insight that constructive views are related to constructive processes provides an excellent opportunity for an educational intervention, so that we can educate nurses to analyse problems and learn how to manage conflict with effective collaborative processes.

Emergency department nurses' perceptions and experiences of providing care for older people

Emergency department nurses are challenged to provide safe, quality care to older people; however, nurses' perceptions of their role and experiences are seldom investigated. This focus-group study investigated emergency department nurses' perceptions and experiences of caring for older people, using four focus groups of nurses with a minimum three months' experience in the emergency department and a demographic survey. Data were thematically analyzed. Two themes emerged. The first was the clash of expectations between nurses and family/carers related to safety and quality of nursing care. Older people were perceived to be vulnerable in the emergency department, and nurses were frustrated that competing priorities decreased their ability to ensure them safe and quality care. Nurses felt family/carers were disappointed with care provided, and might not empathize with or understand their predicament. The second theme concerned nurses' perception that family/carers could provide a safety net for the older person in the emergency department in times of high workload. Nurses need support to care for older people in the emergency department to ensure safe and optimal care, and a shared understanding of care provision between nurses and family needs development.

Exploring the key predictors of retention in emergency nurses

AIM

To explore the factors that predict the retention of nurses working in emergency departments.

BACKGROUND

The escalating shortage of nurses is one of the most critical issues facing specialty areas, such as the emergency department. Therefore, it is important to identify the key influencing and intermediary factors that affect emergency department nurses' intention to leave.

METHODS

As part of a larger study, a cross-sectional survey was completed by 261 registered nurses working in the 12 designated emergency departments within rural, urban community and tertiary hospitals in Manitoba, Canada.

RESULTS

Twenty-six per cent of the respondents will probably/definitely leave their current emergency department jobs within the next year. Engagement was the key predictor of intention to leave (P < 0.001). Engagement was also associated with job satisfaction, compassion satisfaction, compassion fatigue, and burnout (P < 0.05). In an ordinal least-squares model (R(2) = 0.44), nursing management, professional practice, collaboration with physicians, staffing resources and shift work emerged as significant influencing factors for engagement.

CONCLUSIONS

Engagement plays a central role in emergency department nurses intention to leave. Addressing the factors that influence engagement may reduce emergency department nurses' intention to leave.

IMPLICATIONS FOR NURSING MANAGEMENT

This study highlights the value of research-based evidence as the foundation for developing innovative strategies for the retention of emergency department nurses.

A holistic framework for nursing time: implications for theory, practice, and research

TOPIC

Nursing time has relevance for those who produce it, those who receive it, and those who must pay for it. Although the term nursing time may be commonly used, a common understanding of the concept within the fields of nursing and healthcare administration is lacking.

PURPOSE

The purposes of this paper are to explore the concept of nursing time and to identify implications for theory development, clinical and administrative practice, and research.

DISCUSSION

Both physical and psychological forms of time are viewed as fundamental to our experience of time as social beings. Nursing time has significant intrinsic and instrumental value in nursing and health care. A holistic approach incorporating the physical, psychological, and sociological aspects and dimensions of nursing time is advocated.

CONCLUSIONS

Multiple strategies to enhance the patient experience of nursing time are warranted and should address how much time nurses spend with patients as well as how they spend that time. Patterns of overlapping and competing time structures for nurses should be identified and evaluated for their effect on physical time available for patient care and the psychological experiences of time by nurses and patients.

The meaning of good and bad care in the community care: older people's lived experiences

In spite of a considerable body of research in the past decades on what does or does not constitute good care for older people, there are still few studies addressing this question in which older people narrate their experiences of being dependent on community care. This study was therefore carried out aiming to explore older people's lived experiences of what good and bad care meant to them, when it was offered by community care services. Nineteen older persons in three Swedish communities participated in the study, which used a phenomenological-hermeneutic approach. Data were collected through unstructured interviews and Colaizzi's framework was utilized in the analysis of the data. The key theme arising from the analysis was that of being encountered as a human being by caregivers who, through the provision of safe and secure care, provide opportunities for living life as usual. When any of these circumstances are lacking, bad care will be the consequence. As the general intention in society is to ensure good quality of care to older people as well as others, the findings in our study should have important implications for providers of community care for older people.

A sense of security for cancer patients at home: the role of community nurses

The present paper reports on a qualitative research project designed to expose the presently unrecognised minutiae of community nurses' work with cancer patients at home, and to identify the ways in which these, combined to form comprehensive care episodes, contribute to physical and psychosocial well-being. The project was conducted in two locations in New South Wales, Australia, one metropolitan and one rural. The research model focused on particular nurse-patient encounters, and involved pre- and post-encounter interviews with nurses, post-encounter interviews with patients and carers, and observation of the encounters themselves. Participants included generalist community nurses, cancer patients being cared for at home, and their primary carers where appropriate. This research demonstrates that regular contact with generalist community nurses is associated with a strong sense of security about the immediate situation for home-based cancer patients and their primary carers. This sense of security is a significant component of patient and carer physical and psychosocial well-being, and may have implications for health services utilisation. In the present paper, the authors outline the factors underpinning this sense of security, and argue that these findings contribute important new knowledge that is vital for contemporary debates about role responsibilities and continuity of care for cancer patients.