The influence of empowerment and incivility on the mental health of new graduate nurses

Structural and psychological empowerment among newly graduated nurses and related factors: A mixed methods study

AIMS

To discuss the levels of structural empowerment (SE) and psychological empowerment (PE) and the factors that influence perceptions of empowerment among newly graduated nurses (NGNs).

DESIGN

Mixed methods study.

METHODS

The quantitative part of the study was conducted with 220 NGNs with <1 year of job experience. The study was conducted between February and May 2023. Focus group discussions were conducted with 30 NGNs. Data were collected by using the Conditions for Work Effectiveness Questionnaire (CWEQ-II), the Psychological Empowerment Scale (PES) and a Semi-Structured Interview Form. Quantitative data were analysed using stepwise regression analysis. Content analysis was used to analyse qualitative data.

RESULTS

CWEQ-II and PES were moderate. The regression analysis showed that NGNs' SE scores increased in association with the following factors, including an increase in the total score on the PES, being married/having a partner, working a day shift, having career planning, increased satisfaction with the orientation programmes of the institution and increased satisfaction with the employing institution. As a result of the descriptive analysis of the focus group interviews conducted to determine the empowerment perceptions of NGNs, we identified three contexts along with the associated themes and subthemes. These three contexts were the 'concept of power', 'professional impression' and 'empowerment process'.

CONCLUSION

The results of this study indicate that the SE and PE levels of NGNs are moderate, and their empowerment perceptions are influenced by many factors that can be individual, organizational and work environment relevant.

IMPACT

This study's findings will guide policymakers, educators, researchers and administrators in empowering NGNs essential to the healthcare workforce.

REPORTING METHOD

The paper adheres to the COREQ checklist.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Factors Influencing Frontline Screening Nurses' Depression as a Long-Term Impact of COVID-19

Frontline screening nurses experienced exhaustion and depressive symptoms as a long-term impact of COVID-19. This study aimed to explore fatigue, depression, and empowerment among frontline screening nurses and examine the factors influencing depression. This was a descriptive cross-sectional study. The study included 140 frontline screening nurses in South Korea recruited from February to March 2021. The measures included a fatigue scale, the Text of Items Measuring Empowerment (TIME), and the Center for Epidemiological Studies Depression Scale (CES-D). The STROBE checklist was used for reporting aspects of the cross-sectional design. Frontline screening nurses showed high fatigue scores (M = 3.47, SD = 0.55), and 55.7% (n = 78) of them were depressed and had low empowerment scores (M = 3.53, SD = 0.69). Empowerment and fatigue were predictors of depression. Increased empowerment and decreased fatigue were important in decreasing depression. Therefore, efforts to provide sufficient staffing, screening for depression, and listening to nurses' voices are necessary.

New Graduate Nurses’ Incivility Experiences: The Roles of Workplace Empowerment, Nursing Leadership and Areas of Worklife

Aims

To determine what extent are workplace empowerment, New Graduate Nurses’ (NGN) perceptions of nurse leaders, trust in management, and areas of worklife predict coworker incivility experiences?

Background

NGNs’ perceptions of nursing leaderships’ control over workload contribute to coworker incivility experiences were tested. The relationship between workplace empowerment, authentic leadership, and areas of work life (workload control and fair resource allocation) to coworker incivility experiences were examined.

Design

Secondary analysis of Starting Out, national survey, Time 1 dataset. Select factors of workplace empowerment, authentic leadership, areas of worklife, trust in management and NGNs’ co- worker incivility experiences were situated within an ecological approach. Multiple linear regression was used to test whether a negative relationship of workplace empowerment, areas of worklife and authentic leadership to NGNs co-worker incivility experiences and important new findings were discovered.

Results

First, NGNs’ perceptions of workplace empowerment predict coworker incivility experiences when controlling for authentic leadership and trust in management. Second, NGNs’ perceptions of areas of worklife predict coworker incivility experiences when controlling for authentic leadership, trust in management, and workplace empowerment. Third, NGNs’ perceptions of authentic leadership do not predict coworker incivility experiences when controlling for workplace empowerment and trust in management. Finally, NGNs’ perceptions of authentic leadership do predict coworker incivility experiences when trust in management and workplace empowerment are not controlled.

Conclusions

NGNs’ perceptions of authentic leadership would benefit from workplace empowerment of the nurse leader in workplace environments to mitigate coworker incivility experiences.

Nurse leadership in promoting and supporting civility in health care settings: A scoping review

AIM

This scoping review aimed to identify the existing evidence on how nurse leaders promote and maintain civility amongst nurses in health care settings.

BACKGROUND

Research on managing workplace incivility in nursing, a prevalent and concerning issue worldwide, recommends nurse leaders to command cultural change through strong leadership and civility interventions. However, there is very little empirical evidence summarizing and analysing how nurse leaders pragmatically achieve civility, and combat workplace incivility, in the health care setting.

EVALUATION

A scoping review was undertaken using the electronic databases CINAHL, Emerald Insight, MEDLINE, PsychINFO, PubMed and Scopus. Google Scholar was used to search for grey literature.

KEY ISSUES

The eight studies included in this review describe how nurse leaders promote and maintain civility under four key themes: (1) creating a shared vision, (2) educating self and others, (3) fostering accountability and (4) providing support.

CONCLUSION

The review provides an overview of commonly used strategies and actions that pragmatically promote and maintain civility in the health care setting by nurse leaders, while also highlighting areas of future research needed to strengthen the evidence base.

IMPLICATIONS FOR NURSING MANAGEMENT

It is important for nurse leaders to gain an understanding of evidence-based practices when addressing workplace incivility in order to address this prevailing problem for the future and safety of nurses moving forward.

Frequency and Outcomes of Workplace Incivility in Healthcare: A Scoping Review of the Literature

AIMS

To evaluate the frequency and outcomes of workplace incivility in healthcare for nursing management.

BACKGROUND

Incivility in the workplace is a significant problem that is important to nurse managers, as it goes directly against the fundamental values and ethics of providing high-quality care to patients. The Joint Commission (2021) and the American Nurses Credentialing Center have called on healthcare organizations to identify and intervene in the problem of workplace incivility.

EVALUATION

Studies included in this scoping review were those that measured and analyzed the frequency and outcomes of workplace incivility in healthcare. Four databases were searched, and 28 articles were reviewed. Evaluation was based on general quality, including study characteristics, instruments, and statistical analyses.

KEY ISSUES

Studies used a quasi-experimental design, and most focused on the Registered Nurse population. The Workplace Incivility Scale was the most commonly used instrument to measure workplace incivility frequency. The most frequently studied work-related outcomes were burnout, satisfaction, and turnover.

CONCLUSIONS

Although the frequency of workplace incivility in healthcare is not clear, its consequences are substantial. Multiple studies have revealed significant relationships between workplace incivility and work-related outcomes that are important to nurse managers. Research is needed on non-nursing healthcare professionals, and validation studies are needed on instruments used to measure workplace incivility frequency.

IMPLICATIONS FOR NURSING MANAGEMENT

The findings of this review can help nurse managers better understand the phenomenon, frequency, and impact of workplace incivility in the healthcare setting and move toward addressing the problem of workplace incivility among nurses and other healthcare professionals.

Empowerment Predicting Nurses' Work Motivation and Occupational Mental Health

Introduction

Empowering nurses is essential for improving work outcomes, and understanding the role of structural and psychological empowerment in supporting nurses' work motivation and occupational mental health are essential to stimulate nurses' productivity and preserve their mental health.

Objectives

To evaluate nurses' perspectives about the levels of structural and psychological empowerment in their working areas. Additionally, to evaluate nurses' motivation and occupational mental health, and to predict the nurses' motivation and occupational mental health through structural and psychological empowerment.

Methods

A descriptive correlational design and quota sampling were used. Two hundred registered nurses were recruited from two hospitals in Jordan. Data were collected using four valid and reliable self-report questionnaires.

Results

Nurses who participated in this study were young and have an average total experience in nursing of fewer than 10 years. Nurses in this study reported a moderate level of structure empowerment and a low level of psychological empowerment. Significant positive relationships were documented between both structural, psychological empowerment, and nurses' work motivation (r = 0.85), (r = 0.83) respectively. A significant negative relationship found between both structural, psychological empowerment, and nurses' occupational mental health (r = -0.31), (r = -0.29) respectively.

Conclusions

The levels of nurses' work motivation and occupational mental health can be predicted through the levels of structural and psychological empowerment. The higher workplace empowerment was associated with increased work motivation, as well as reduced the feeling of occupational stress among nurses. Thus, administrators should invest in fostering structural and psychological empowerment in the work environment.

Cross-sectional Study of the Relationship between Experiences of Incivility from Staff Nurses and Undergraduate Nursing Students’ Sense of Belonging to the Nursing Profession

AIM

This study examined the frequency of incivility for undergraduate nursing students and the relationship between staff nurse incivility and nursing students' sense of belonging. Factors between program semester and students' body mass index (BMI) to staff nurse incivility and students' sense of belonging were assessed.

BACKGROUND

Sense of belonging enhances belonging development to the profession. However, no studies address the relationship between incivility and nursing students' sense of belonging.

METHODS

A cross-sectional design assessed the relationship between staff nurse incivility and undergraduate nursing students' sense of belonging to the nursing profession. An online survey was administered to 123 pre-licensure junior and senior undergraduate nursing students from February 1, 2021, to May 5, 2021. Correlation coefficient, descriptive statistics, Fisher r-to-z transformation, 95% confidence intervals were calculated.

RESULTS

Staff nurse incivility inversely correlated with undergraduate nursing students' sense of belonging (rs=-.358; p <.001). American Indian or Alaskan Native students reported the highest mean frequency of incivility (1.25 ± .421). There were no significant differences in correlations based on semester or BMI.

CONCLUSION

Staff nurse incivility is inversely associated with sense of belonging in students. Further research is needed to test interventions mitigating the effects of incivility on belonging.

Studying the relationships between authentic leadership, structural empowerment, and civility in the palliative care sector in Portugal

PURPOSE

This paper aims to propose a model studying the relationship of authentic leadership (AL), structural empowerment (SE) and civility in the palliative care sector. This model proposes SE as a mediator between AL and civility.

DESIGN/METHODOLOGY/APPROACH

Data was collected from 213 employees working in five major public palliative care hospitals in central Portugal. The study sample was predominantly female (80.3%) and the response rate was 42.6%. Variables were measured using the Authentic Leadership Inventory, Workplace Civility Scale and Conditions of Work Effectiveness Questionnaire II scales. Hayes' PROCESS macro for mediation analysis in SPSS was used to test the hypothesized model.

FINDINGS

Results suggest that AL has a significant positive direct relationship with both SE and civility. Furthermore, SE demonstrated to play a partial mediation effect between AL and civility.

PRACTICAL IMPLICATIONS

This study may be of use for healthcare administration encouraging the development of AL, suggesting that the more leaders are seen as authentic, the more employees will perceive they have access to workplace empowerment structures and a civil environment.

ORIGINALITY/VALUE

Considering the mainstream literature in healthcare management, to the best of the authors' knowledge, this is the first study to date to integrate the relation of AL, SE and civility in the palliative care sector. Further, the research model has not previously been introduced when considering the mediating role structural empowerment can play between AL and civility.

Registered Nurses' Experiences With Incivility During the Early Phase of COVID-19 Pandemic: Results of a Multi-State Survey

Background:

Incivility among workers in the health sector is recognized as an occupational hazard. The COVID-19 outbreak brought sudden and profound changes to many health care settings, many of which have been identified as antecedents to workplace incivility. The purpose of this retrospective study was to explore the experiences of registered nurses with workplace incivility, cyber-incivility, and incivility outside of work during the early phase of the COVID-19 pandemic.

Methods:

This mixed-methods study used convenience sampling. Data were collected from June to September 2020 via an online survey, which consisted of both closed- and open-ended questions. Participants were recruited from national nursing organizations and unions. Data were analyzed using descriptive statistics and thematic analysis for open-ended responses.

Findings:

A total of 526 nurses’ responses were included in the analysis. More than one third experienced greater incivility at work during the COVID-19 outbreak than before the pandemic (37.4%), and almost half (45.7%) said they witnessed more incivility than before the pandemic. Cyber-incivility and incivility outside of work were also issues. Qualitative results indicated that respondents felt they were on edge during this period. Other themes included leadership failure, fractured co-worker relationships, heightened incivility from patients and families, and hostility and ostracism from the general public

Conclusion/Application to practice:

Occupational health nurses, nursing leaders, and staff nurses need to work to restore relations that were fractured by incivility during the pandemic. In the future, improved preparedness, including establishing clear channels of communication, may lessen incivility by decreasing role stress and organizational chaos.

Moderating Effects of Structural Empowerment and Resilience in the Relationship between Nurses' Workplace Bullying and Work Outcomes: A Cross-Sectional Correlational Study

This cross-sectional correlational study aimed to evaluate the moderating effects of structural empowerment and resilience in the relationship between workplace bullying and nursing work outcomes. Data were collected from 435 nurses and nurse managers working at a tertiary hospital in Seoul, South Korea. The moderating effects were examined using stepwise hierarchical multiple regression models. The bootstrapping method was utilized to verify the magnitude and significance of the moderating effects. Structural empowerment showed a moderating effect in the relationship between workplace bullying and nursing work outcomes: for the conditional values above the average level of structural empowerment, workplace bullying was significantly associated with nursing work outcomes, while work outcomes were low regardless of workplace bullying for the conditional values less than average. However, resilience had no moderating effect. To improve work outcomes, bullying must be reduced and structural empowerment and resilience increased.

Relationships among sex, empowerment, workplace bullying and job turnover intention of new graduate nurses

AIMS AND OBJECTIVES

The purpose of this study was twofold: examine the relationships among new graduate nurses' (NGNs) structural empowerment, experience of workplace bullying, and their job turnover intention and assess the relationships between sex, workplace bullying, and job turnover intention.

BACKGROUND

Nursing research has highlighted the issue of workplace bullying and its negative impacts. Despite increased awareness, male nurses and their responses to bullying have not been a significant focus of study.

DESIGN

A secondary analysis of data collected from a random sample of 1008 Canadian NGNs from the following: Starting Out: A time-lagged Study of New Graduate Nurses' Transition to Practice.

METHODS

All data were analysed using SPSS, and the study model was tested using the SPSS PROCESS macro, specifically Model 4 (for simple mediation). This paper is compliant with the STROBE reporting guideline for cross-sectional studies.

RESULTS

Structural empowerment significantly predicted workplace bullying and job turnover intention. Workplace bullying significantly predicted job turnover intention. Structural empowerment mediated job turnover intention through workplace bullying. Male new graduate nurses reported significantly higher workplace bullying than female NGNs yet lower job turnover intention.

CONCLUSIONS

The findings demonstrate the positive effects of structural empowerment on both decreasing workplace bullying and job turnover intention. Furthermore, findings showed the influence of sex on workplace bullying and job turnover intention. The findings contribute to literature on male NGNs and suggest that they experience significantly higher rates of workplace bullying than their female counterparts. The findings suggest differences exist in the workplace experience for male and female NGNs that future research may help reveal.

RELEVANCE TO CLINICAL PRACTICE

The findings suggest structural empowerment may be used to reduce bullying prevalence and reduce job turnover intention consequently. The findings also suggest that some measures are needed to address the higher frequency of bullying experienced by male NGNs.

Predictors and triggers of incivility within healthcare teams: a systematic review of the literature

OBJECTIVES

To explore predictors and triggers of incivility in medical teams, defined as behaviours that violate norms of respect but whose intent to harm is ambiguous.

DESIGN

Systematic literature review of quantitative and qualitative empirical studies.

DATA SOURCES

Database searches according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline in Medline, CINHAL, PsychInfo, Web of Science and Embase up to January 2020.

ELIGIBILITY CRITERIA

Original empirical quantitative and qualitative studies focusing on predictors and triggers of incivilities in hospital healthcare teams, excluding psychiatric care.

DATA EXTRACTION AND SYNTHESIS

Of the 1397 publications screened, 53 were included (44 quantitative and 9 qualitative studies); publication date ranged from 2002 to January 2020.

RESULTS

Based on the Medical Education Research Study Quality Instrument (MERSQI) scores, the quality of the quantitative studies were relatively low overall (mean MERSQI score of 9.93), but quality of studies increased with publication year (r=0.52; p<0.001). Initiators of incivility were consistently described as having a difficult personality, yet few studies investigated their other characteristics and motivations. Results were mostly inconsistent regarding individual characteristics of targets of incivilities (eg, age, gender, ethnicity), but less experienced healthcare professionals were more exposed to incivility. In most studies, participants reported experiencing incivilities mainly within their own professional discipline (eg, nurse to nurse) rather than across disciplines (eg, physician to nurse). Evidence of specific medical specialties particularly affected by incivility was poor, with surgery as one of the most cited uncivil specialties. Finally, situational and cultural predictors of higher incivility levels included high workload, communication or coordination issues, patient safety concerns, lack of support and poor leadership.

CONCLUSIONS

Although a wide range of predictors and triggers of incivilities are reported in the literature, identifying characteristics of initiators and the targets of incivilities yielded inconsistent results. The use of diverse and high-quality methods is needed to explore the dynamic nature of situational and cultural triggers of incivility.

Organisational empowerment and assertive communication behaviours: a survey of Jordanian newly qualified nurses

BACKGROUND

Newly qualified nurses (NQNs) face several challenges in their early years of practice. Being empowered and able to speak up against unsafe practice are two important pillars for practising nursing safely and competently. Little research has examined the potential correlation between those two dimensions in the context of NQNs in Jordan.

AIMS

To investigate the correlation between NQNs' perceived structural empowerment in their work setting and their willingness to challenge unsafe practice in some hypothetical clinical scenarios.

METHODS

A cross-sectional survey involved 233 NQNs, who completed a self-administered questionnaire between January and March 2016.

FINDINGS

Participants reported moderate levels of both perceived structural empowerment and willingness to speak up against unsafe practice. There was a statistically significant positive correlation between the total structural empowerment score and the mean score for speaking up against unsafe practice.

CONCLUSION

The findings highlight the impact of peer, managerial and overall organisational support on enabling NQNs to become more empowered and assertive. Concrete, collaborative and organisation-wide efforts must be considered to foster greater empowerment of NQNs, but also revisiting work priorities to include supporting and advocating assertive communication skills among the more vulnerable of the newly qualified cohort.

Impact of workplace incivility on compassion competence of Korean nurses: Moderating effect of psychological capital

AIM

This study aimed to examine the association between workplace incivility and compassion competence of Korean nurses, as well as the moderating effect of psychological capital.

BACKGROUND

Workplace incivility affects the quality of patient care and as such is worthy of critical examination regarding its impact on the compassion competence of nurses.

METHODS

In this descriptive cross-sectional study, data for 192 Korean hospital nurses were used to analyse the relationship between workplace incivility and compassion competence and the moderating effect of psychological capital.

RESULTS

Workplace incivility was negatively associated with compassion competence of nurses. Furthermore, psychological capital had a conditional moderating effect on the relationship between workplace incivility and nurses' compassion competence. The negative associations of workplace incivility with compassion competence were significant at low and medium levels of psychological capital but not at high psychological capital. Moreover, the association was stronger for those with low psychological capital.

CONCLUSION

Workplace incivility is negatively associated with compassion competence among nurses, and psychological capital has conditional moderating effects in its relationship.

IMPLICATIONS FOR NURSING MANAGEMENT

Management efforts to reduce workplace incivility and to improve nurses' psychological capital are needed to improve patient care quality.

Health consequences of bullying in the healthcare workplace: A systematic review

AIMS

To review both mental and physical health consequences of bullying for healthcare employees.

DESIGN

Systematic literature review.

DATA SOURCES

EMBASE, MEDLINE, PsycINFO, PUBMED and Web of Science Core Collection were searched for articles published between 2005 - January 2017.

REVIEW METHODS

This review was conducted using the framework described by Khan and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Two independent reviewers performed systematic data extraction and appraised the methodological quality of included articles. A pooled mean prevalence of bullying was estimated.

RESULTS

Forty-five papers met inclusion criteria. Bullying prevalence ranged from 3.9% to 86.5%, with a pooled mean estimate of 26.3%. Perceived bullying was associated with mental health problems including psychological distress, depression and burnout, and physical health problems including insomnia and headache. Bullied staff took more sick leave.

CONCLUSION

Bullying occurs frequently amongst healthcare staff and is deleterious to health and occupational functionality.

Predictors of new graduate nurses' health over the first 4 years of practice

AIM

To examine predictors of Canadian new graduate nurses' health outcomes over 1 year.

DESIGN

A time-lagged mail survey was conducted.

METHOD

New graduate nurses across Canada (N = 406) responded to a mail survey at two time points: November 2012-March 2013 (Time 1) and May-July 2014 (Time 2). Multiple linear regression (mental and overall health) and logistic regression (post-traumatic stress disorder risk) analyses were conducted to assess the impact of Time 1 predictors on Time 2 health outcomes.

RESULTS

Both situational and personal factors were significantly related to mental and overall health and post-traumatic stress disorder risk. Regression analysis identified that cynicism was a significant predictor of all three health outcomes, while occupational coping self-efficacy explained unique variance in mental health and work-life interference explained unique variance in post-traumatic stress disorder risk.

When Team Conflicts Threaten Quality of Care: A Study of Health Care Professionals' Experiences and Perceptions

OBJECTIVES

To explore professionals' experiences and perceptions of whether, how, and what types of conflicts affected the quality of patient care.

PATIENTS AND METHODS

We conducted 82 semistructured interviews with randomly selected health care professionals in a Swiss teaching hospital (October 2014 and March 2016). Participants related stories of team conflicts (intra-/interprofessional, among protagonists at the same or different hierarchical levels) and the perceived consequences for patient care. We analyzed quality of care using the dimensions of care proposed by the Institute of Medicine Committee on Quality of Health Care in America (safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity).

RESULTS

Seventy-seven of 130 conflicts had no perceived consequences for patient care. Of the 53 conflicts (41%) with potential perceived consequences, the most common were care not provided in a timely manner to patients (delays, longer hospitalization), care not being patient-centered, and less efficient care. Intraprofessional conflicts were linked with less patient-centered care, whereas interprofessional conflicts were linked with less timely care. Conflicts among protagonists at the same hierarchical level were linked with less timely care and less patient-centered care. In some situations, perceived unsatisfactory quality of care generated team conflicts.

CONCLUSION

Based on participants' assessments, 4 of 10 conflict stories had potential consequences for the quality of patient care. The most common consequences were failure to provide timely, patient-centered, and efficient care. Management of hospitals should consider team conflicts as a potential threat to quality of care and support conflict management programs.

Impact of workplace incivility in hospitals on the work ability, career expectations and job performance of Chinese nurses: a cross-sectional survey

OBJECTIVES

The objectives of this study were to investigate new nurses' experiences of workplace incivility; verify the mediating role of work ability in the relationship between workplace incivility and job performance and examine the moderating role of career expectations in the relationship between workplace incivility and job performance.

DESIGN

This cross-sectional survey was conducted in China in May 2016.

SETTINGS

The research settings included 54 cities across 29 provinces of China.

PARTICIPANTS

Of the 903 participants recruited, 696 new nurses (<3 years of nursing experience) agreed to complete the online questionnaire of the study. The effective response rate was 77.1%. The inclusion criteria were voluntary participation, <3 years of nursing experience and recognition as a registered nurse. The exclusion criteria were refusal to participate, >3 years of nursing experience or not recognised as a registered nurse.

RESULTS

New nurses (60.7%) experienced some level of workplace incivility in the previous year, and it was more frequent among those with higher educational degrees. Work ability mediated the relationship between workplace incivility and job performance, and this relationship was moderated by career expectations.

CONCLUSION

Incivility towards new nurses was relatively common in the workplace. Workplace incivility impairs job performance by weakening the work ability of new nurses. Higher career expectations may buffer workplace incivility and contribute to the maintenance of job performance by buffering the detrimental effects of workplace incivility.

Workplace incivility, lateral violence and bullying among nurses. A review about their prevalence and related factors

BACKGROUND

Negative interactions among nurses are well recognized and reported in scientific literature, even because the issues may have major consequences on professional and private lives of the victims. The aim of this paper is to detect specifically the prevalence of workplace incivility (WI), lateral violence (LV) and bullying among nurses. Furthermore, it addresses the potential related factors and their impact on the psychological and professional spheres of the victims.

METHODS

A review of the literature was performed through the research of papers on three databases: Medline, CINAHL, and Embase.

RESULTS

Seventy-nine original papers were included. WI has a range between 67.5% and 90.4% (if WI among peers, above 75%). LV has a prevalence ranging from 1% to 87.4%, while bullying prevalence varies between 2.4% and 81%. Physical and mental sequelae can affect up to 75% of the victims. The 10% of bullied nurses develop Post-Traumatic Stress Disorder Symptoms. Bullying is a predictive factor for burnout (β=0.37 p<0.001) and shows a negative correlation with job efficiency (r=-0 322, p<0.01). Victims of bullying recorded absenteeism 1.5 times higher in comparison to non-victimized peers (95% CI: 1.3-1.7). 78.5% of bullied nurses with length of service lower than 5 years has resigned to move to other jobs.

CONCLUSIONS

There is lack of evidence about policies and programmes to eradicate workplace incivility, lateral violence and bullying among nurses. Prevention of these matters should start from spreading information inside continue educational settings and university nursing courses.

Ethical tensions: A qualitative systematic review of new graduate perceptions

Background:

New graduate transition into the workforce is challenging and can involve managing ethical tensions. Ethical tensions cause new graduates to doubt their capabilities due to their lack of experience. To support new graduates, we need to know what these ethical tensions are.

Objectives:

To explore the ethical tensions perceived to occur in practice for new graduate health professionals.

Research design:

This qualitative systematic review involved a search of five databases (Medline, EMBASE, AMED, CINAHL and Scopus) which resulted in the retrieval of 3554 papers. After the two-phased screening process, eight studies were identified that met the inclusion criteria and had rich data on the review question. Articles were read several times, critically appraised and analysed through thematic analysis.

Ethical considerations:

No ethical approval was required for the systematic review. The review was conducted following well-established reporting guidelines enabling transparency and rigour.

Findings:

Studies originated from Australia, United States, Iran and China. One study included speech pathologists and seven were with nurses. Four themes included the following: (1) enduring an unknown workplace culture that generates uncertainty without support for new graduates; (2) being vulnerable because of distress from bullying, exclusion and being a scapegoat; (3) constraining systems and institutional restrictions that cause dilemmas; and (4) experiencing disillusionment from lost ideals about ethical practice.

Discussion:

This review has brought to light the vulnerability of new graduates to negative workplace culture and collegial incivility. In addition, new graduates are subjected to ethical tensions created by institutional constraints which can create dilemmas and uncertainties through practice that does not align with what they anticipated.

Conclusion:

Understanding ethical tensions experienced by new graduates enables provision of informed support. There needs to be considerable cultural change for orientation and socialisation of new graduates to enable them to learn and manage ethical tensions.

Promoting the legitimacy and agency of new graduate nurses' participation in nursing research

AIM

This paper explores the legitimacy and agency of new graduate mental health nurses to participate in research activities as a regular part of their professional nursing role.

BACKGROUND

There is a wealth of literature describing personal and organisational factors that act as barriers to nurses' engagement in research and overcoming these barriers remains a challenge for health organisations. Some new graduate nurses are well positioned to contribute to research and yet the literature has given little attention to this specific cohort.

RESULTS

This paper will show how facilitating new graduates' participation in research benefits the new graduate and the health service.

CONCLUSION

New graduates learn research skills from experienced researchers and this ensures a sustainable future workforce of researchers. Employers who support staff to pursue professional challenges such as research are more likely to generate organisational commitment and loyalty amongst staff.

Starting Out: qualitative perspectives of new graduate nurses and nurse leaders on transition to practice

AIM

To describe new graduate nurses' transition experiences in Canadian healthcare settings by exploring the perspectives of new graduate nurses and nurse leaders in unit level roles.

BACKGROUND

Supporting successful transition to practice is key to retaining new graduate nurses in the workforce and meeting future demand for healthcare services.

METHOD

A descriptive qualitative study using inductive content analysis of focus group and interview data from 42 new graduate nurses and 28 nurse leaders from seven Canadian provinces.

RESULTS

New graduate nurses and nurse leaders identified similar factors that facilitate the transition to practice including formal orientation programmes, unit cultures that encourage constructive feedback and supportive mentors. Impediments including unanticipated changes to orientation length, inadequate staffing, uncivil unit cultures and heavy workloads.

CONCLUSIONS

The results show that new graduate nurses need access to transition support and resources and that nurse leaders often face organisational constraints in being able to support new graduate nurses.

IMPLICATIONS FOR NURSING MANAGEMENT

Organisations should ensure that nurse leaders have the resources they need to support the positive transition of new graduate nurses including adequate staffing and realistic workloads for both experienced and new nurses. Nurse leaders should work to create unit cultures that foster learning by encouraging new graduate nurses to ask questions and seek feedback without fear of criticism or incivility.

Individual, interpersonal, and organisational factors of healthcare conflict: A scoping review

Unresolved conflicts among healthcare professionals can lead to difficult patient care consequences. This scoping review examines the current healthcare literature that reported sources and consequences of conflict associated with individual, interpersonal, and organisational factors. We identified 99 articles published between 2001 and 2015 from PubMed, Cumulative Index to Nursing and Allied Health Literature, and Excerpta Medical Database. Most reviewed studies relied on healthcare professionals' perceptions and beliefs associated with conflict sources and consequences, with few studies reporting behavioural or organisational change outcomes. Individual conflict sources included personal traits, such as self-focus, self-esteem, or worldview, as well as individuals' conflict management styles. These conflicts posed threats to one's physical, mental, and emotional health and to one's ability to perform at work. Interpersonal dynamics were hampered by colleagues' uncivil behaviours, such as low degree of support, to more destructive behaviours including bullying or humiliation. Perceptions of disrespectful working environment and weakened team collaboration were the main interpersonal conflict consequences. Organisational conflict sources included ambiguity in professional roles, scope of practice, reporting structure, or workflows, negatively affecting healthcare professionals' job satisfactions and intent to stay. Future inquiries into healthcare conflict research may target the following: shifting from research involving single professions to multiple professions; dissemination of studies via journals that promote interprofessional research; inquiries into the roles of unconscious or implicit bias, or psychological capital (i.e., resilience) in healthcare conflict; and diversification of data sources to include hospital or clinic data with implications for conflict sources.

Graduate nurses' experiences of mental health services in their first year of practice: An integrative review

New graduate nurses have reported negative experiences in mental health settings, particularly during the transitional period of practice. Previous research has focused on addressing the undergraduate preparation of nurses for practice instead of the experiences and outcomes of the transitional period. Recently, there has been growing interest in exploring the experiences of graduate nurses in transition and the implementation of promising interventions to facilitate new graduates' assimilation to practice. Despite these initiatives, the overall shortage of mental health nurses continues to rise, and graduates still report negative experiences in the mental health setting. The purpose of this study was to identify and explore the experiences of new graduate nurses in mental health services in their first year of clinical practice. An integrative review was conducted with 22 studies sourced from the CINAHL, PubMed, Scopus, and PsychINFO electronic databases, as well as through hand-searching the literature. Literature review findings have highlighted negative clinical experiences and increased attrition from mental health services for graduate nurses. These experiences were closely linked with the changes in the training of mental health nurses, role ambiguity, inadequate clinical preceptorship, encountering the reality of mental health services, and the role of health services in transitioning graduate nurses into clinical practice. Established research into organizational cultures demonstrates that negative organizational outcomes result from negative workplace experiences. Therefore, further research into new graduate nurses' experiences of mental health nursing and its culture might clarify the reasons why they might not be attracted to the discipline and/or are leaving early in their career.