The association between supervisor support and ethical dilemmas on Nurses' intention to leave: The mediating role of the meaning of work

Perception and needs: a qualitative study on sense of job security among nurses in central and western China

AIMS

To explore nurses' perceptions of sense of job security and their needs to improve it.

DESIGN

A descriptive qualitative study employed an in-depth, in-person interview from February to April in 2021. The data analysis software NVivo V.11.0 was used to assist with the data organisation, and content analysis methods were conducted to explore key concepts.

SETTING

Three tertiary hospitals in central and western China were selected by convenience sampling method.

PARTICIPANTS

A total of 20 nurses participated in this study.

RESULTS

Four categories and 13 subcategories were extracted. The four main categories included: (1) enrich connotation of sense of job security; 2) challenges to sense of job security; (3) consequences of a sense of insecurity; and (4) the need to improve nurses' sense of job security.

CONCLUSIONS

Nurses expressed a multidimensional perception of a sense of security about the nursing profession, and they highlighted the importance of communication skills training and supervisors' humanistic care and support. It is necessary to improve the training system for nurses' ability improvement, a harmonious work environment, policies and psychological health support to enhance their sense of job security.

What is a High-Quality Moral Case Deliberation?-Facilitators' Perspectives in the Euro-MCD Project

The evaluation of the European Moral Case Deliberation Outcomes project (Euro-MCD) has resulted in a revised evaluation instrument, knowledge about the content of MCD (moral case deliberation), and the perspectives of those involved. In this paper, we report on a perspective that has been overlooked, the facilitators'. We aim to describe facilitators' perceptions of high-quality moral case deliberation and their Euro-MCD sessions. The research took place in Norway, Sweden, and the Netherlands using a survey combined with interviews with 41 facilitators. Facilitators' perceived that attaining a high-quality MCD implies fostering a safe and respectful atmosphere, creating a wondering mode, being an attentive authority, developing moral reflective skills, reaching a common understanding, and ensuring organisational prerequisites for the MCD sessions. Our central conclusion is that efforts at three levels are required to attain a high-quality MCD: trained and virtuous facilitator; committed, respectful participants; and organizational space. Furthermore, managers have a responsibility to prepare MCD participants for what it means to take part in MCD.

What influences newly graduated registered nurses' intention to leave the nursing profession? An integrative review

BACKGROUND

Newly graduated registered nurses leaving the nursing profession in the early stages of their career have enormous financial and time implications for nursing organizations and affect the quality of nursing care.

OBJECTIVE

To identify the factors influencing newly graduated registered nurses' intention to leave the nursing profession over the past 10 years.

METHODS

The framework developed by Whittemore and Knafl was used to conduct this integrative review. An electronic search was conducted for English articles to identify research studies published between 2011-2022 using the following databases of PubMed, MEDLINE, CINAHL, PsycINFO, and Scopus. Eligible publications were critically reviewed and scored using the Critical Appraisal Skills Program Checklist and the Center for Evidence-Based Management appraisal.

RESULTS

Twenty-one studies were analyzed. The main factors affecting newly graduated registered nurses' intention to leave the nursing profession included demographic factors (age, educational level, year of experience, professional title, employment status, health status, shift, hospital location and size), supervisor and peer support, challenges in the workplace, cognitive and affective response to work, work environment (collegial nurse-physician relations, insufficient staffing level, person-work environment fit), gender stereotypes, autonomous motivation, role models, and resilience.

CONCLUSIONS

The factors affecting newly graduated registered nurses' intention to leave the nursing profession are multifaceted and should receive continuous attention from nurse managers. The findings provide more comprehensive for nurse administrators to develop intervention strategies to mitigate newly graduated registered nurses' turnover intention.

Understanding registered nurses' career choices in home care services: a qualitative study

BACKGROUND

The anticipated growth in number of older people with long-term health problems is associated with a greater need for registered nurses. Home care services needs enough nurses that can deliver high quality services in patients' homes. This article improves our understanding of nurses' career choices in home care services.

METHODS

A qualitative study using individual semi-structured interviews with 20 registered nurses working in home care services. The interviews were audio-recorded, transcribed and thematically analyzed.

RESULTS

The analysis resulted in three themes emphasizing the importance of multiple stakeholders and contextual factors, fit with nurses' private life, and meaning of work. The results offer important insights that can be used to improve organizational policy and HR practices to sustain a workforce of registered nurses in home care services.

CONCLUSION

The results illustrate the importance of having a whole life perspective to understand nurses' career choices, and how nurses' career preferences changes over time.

The Impact of the Working Hours Among Malaysian Nurses on Their Ill-Being, Intention to Leave, and the Perceived Quality of Care: A Cross-Sectional Study During the COVID-19 Pandemic

Purpose

This study explores the effect of working duration on nurses and their ill-being (ie, anxiety, depression, fatigue, and sleepiness), intention to leave, and the quality of nursing care.

Methods

A questionnaire survey was employed for a convenience sample of 400 nurses at Malacca General Hospital in Malaysia who voluntarily participated in this cross-sectional study. The Statistical Package for the Social Sciences (SPSS) was used to treat and analyze the data. Descriptive statistics were generated, and Post Hoc analyses and ANOVA tests were conducted.

Results

Findings indicated that working hours duration was significantly associated with nurses' anxiety (F (4, 394) = 10.362, p <0.001), depression (F (4, 395) = 23.041, p< 0.001), fatigue (F (4, 395) = 24.232, p< 0.001), sleepiness (F (4, 395) = 4.324, p < 0.002), quality of nursing care (F (4, 395) = 16.21, p <0.001) and intention leave their job, (F (4, 395) = 50.29, p <0.001). The results also revealed that working more than 14 hours was negatively associated with their perceived quality of nursing care and positively associated with their perceived ill-being and intention to leave.

Conclusion

Shift length is an important issue, and nursing managers must consider shift length as it can adversely correlate with the nurses' perceptions of work and life.

The Race to Retain Healthcare Workers: A Systematic Review on Factors that Impact Retention of Nurses and Physicians in Hospitals

The shortage of healthcare workers is a growing problem across the globe. Nurses and physicians, in particular, are vulnerable as a result of the COVID-19 pandemic. Understanding why they might leave is imperative for improving retention. This systematic review explores both the prevalence of nurses and physicians who are intent on leaving their position at hospitals in European countries and the main determinants influencing job retention among nurses and physicians of their respective position in a hospital setting in both European and non-European countries. A comprehensive search was fulfilled within 3 electronic databases on June 3rd 2021. In total 345 articles met the inclusion criteria. The determinants were categorized into 6 themes: personal characteristics, job demands, employment services, working conditions, work relationships, and organizational culture. The main determinants for job retention were job satisfaction, career development and work-life balance. European and non-European countries showed similarities and differences in determinants influencing retention. Identifying these factors supports the development of multifactorial interventions, which can aid the formulation of medical strategies and help to maximize retention.

Competence Development and Collaborative Climate as Antecedents of Job Performance, Job Commitment and Uncertainty: Validation of a Theoretical Model across Four Hospitals

Knowledge is lacking regarding how organizational factors are associated with uncertainty in patient treatment. Thus, the aim of the current study was to investigate how competence development and collaborative climate relates to job performance and job commitment, and further whether job performance and job commitment relate to uncertainty. Additionally, we examined whether these associations differed between four different hospitals. We applied data from 6445 hospital workers who provided care to patients. Basic statistics and structural equation modelling (SEM) were used to test the validity of the theoretical model developed in the study and the hypothesized associations. All hypothesized paths between the latent variables were significant and in accordance with the model across the four hospitals. The current study has implications for practical human resource management and indicates that competence development should be strengthened at the individual level and collaborative climate should be strengthened at the ward level. Strengthening competence development and collaborative climate can increase job performance and job commitment of individual workers and reduce uncertainty during care in hospital settings.

Hospital ethical climate survey - selected psychometric properties of the scale and results among polish nurses and midwives

BACKGROUND

The hospital ethical climate affects the quality of nursing care. A positive ethical climate is likely to reduce the proportion of those who consider leaving the profession, so it is necessary to develop tools which will enable assessment and analysis of the hospital ethical climate. The aim of this study was to examine selected psychometric properties of the Polish version of the Hospital Ethical Climate Survey, assess the hospital ethical climate perceived by nurses and midwives from Polish hospitals, and to determine its correlations with job-related variables.

METHODS

A cross-sectional study among 558 nurses and midwives working in hospitals in Poland.

RESULTS

The 21-item model showed acceptable model fitness between the hypothetical model of ethical climate and the data in the study. Five items with low factor loadings were removed from the study. The internal consistency was satisfactory (0.93). The mean score for the overall hospital ethical climate was 3.62. The highest mean score of hospital ethical climate in the present study was found in the "peers" subscale and the lowest in the "physicians" subscale. A positive correlation was found between overall hospital ethical climate and respondents' satisfaction with work, salary, and working time. The hospital ethical climate was associated with problems found in nurses and midwives' work, such as: limited time for direct face-to-face care, the lack of equipment and resources to provide high-quality health care, strained relations with hospital managers and other health care professionals, limitations to one's own competences or those of other medical professionals, moral dilemmas related to patient care, the low prestige of nurses'/midwives' work, physical and mental burden, and the risk of making a mistake.

CONCLUSION

The Polish 21-item version of the Hospital Ethical Climate Survey is a reliable tool. Correlations revealed that relationships with managers and physicians, and working conditions should be improved in order for the hospital ethical climate to improve.

Linking meaningful work and nurse turnover intention: a multilevel modeling

Purpose

This study aims to examine the moderating role of perceived supervisor support at the team level on the relationships between meaningful work, job embeddedness, and turnover intention at the individual level.

Design/methodology/approach

A cross-sectional study was performed in 52 work-units from private general hospitals in Thailand. A total of 719 nurses completed a self-reported questionnaire. The hypotheses were tested through a multilevel approach.

Findings

The results indicate that job embeddedness mediates the relationship between meaningful work and intention to quit, and that perceived supervisor support at the team level reduces turnover intention by reinforcing the impact of meaningful work on job embeddedness.

Research limitations/implications

Despite a possible absence of common method variance, social desirability bias may exist due to a single-source survey data. The generalizability of the findings may be limited due to the nature of the sample, which involved only one industry.

Practical implications

Coaching supervisors on management and communication styles and providing team members with a say in concerns and expectations potentially improve how supervisors can be more supportive toward their respective team members.

Originality/value

The novelty of this study lies in its inclusion of meaningful work and a supportive constituent from team supervisors in the mediational pathway of job embeddedness-turnover model by considering a cross-level perspective.

Professional values and ethical sensitivities of nurses in COVID-19 pandemic

BACKGROUND

Nurses are facing several ethical problems like the safety of the nurses, patients, co-workers, and families, allocation of scarce resources, and the changing nature of the relationships of nurses with patients and families during the COVID-19 pandemic. These have caused nurses to have feelings such as stigmatization, fear, anger, anxiety, uncertainty, work-related strain, and burnout. Identifying nurses' ethical sensitivities and professional values are highly important to ensure that nurses are placed in the right decision-making position. This descriptive correlational study was carried out to evaluate the professional values and ethical sensitivities of nurses during the COVID-19 pandemic.

METHODS

A quantitative descriptive and correlational study was performed with 245 nurses in Turkey. The "personal information form," the "nurses professional values scale-revised (NPVS-R)," and the "moral sensitivity questionnaire (MSQ)" were employed for data collection.

RESULTS

The nurses' 52.7% reported facing an ethical dilemma. Also, 40.3% of the nurses who had an ethical dilemma during the pandemic failed to solve it. The mean NPVS-R scores of the nurses had statistically significant negative correlations with mean scores of the overall MSQ and its autonomy, benefit, integrative approach, and orientation subscales (p < .05). The nursing staff had high levels of professional values and moral sensitivities.

CONCLUSION

Professional value perceptions were enhanced, and moral sensitivities were improved. Age and professional experience were identified as factors that affected the professional value perceptions and moral sensitivities of the nurses. The results will form the basis for future studies and contribute to the resolution of ethical dilemmas experienced by nurses.

Do broken promises matter? The effects of psychological contract breach on job embeddedness and nurses' work attitudes

Purpose

This research investigates the effects of psychological contract breach on the fit, links and sacrifice dimensions of job embeddedness as well as the mediating roles of these three subcomponents in the relationships between psychological contract breach and nurses' work attitudes.

Design/methodology/approach

Data were collected from 591 nurses from private general hospitals in northern Thailand. The hypotheses were tested and analyzed by means of a confirmatory factor analysis, structural equation modeling and a bootstrapping procedure.

Findings

The results indicate that psychological contract breach was negatively associated with the three dimensions of job embeddedness, signifying that the fit, links and sacrifice dimensions are distinct constructs. Also, these three subcomponents mediated the relationship between psychological contract breach and loyal boosterism. Only the links and sacrifice dimensions were found to have mediating effects on turnover intention.

Research limitations/implications

Future research may consider longitudinal data to avoid potential method biases and draw causal inferences among study variables. Employing cross-cultural research in future studies would also be beneficial.

Practical implications

If possible, health care organizations should not make any promises that they cannot keep or fulfill. Fine-tuning expectation and managing communication in a timely manner may signal commitments to fulfill the contracts and minimize any potential inducement-outcome discrepancies.

Originality/value

This study adds to the literature by furthering understanding of the employee-organization relationship through the lens of psychological contract and job embeddedness theories.

The Second Side of the Coin-Resilience, Meaningfulness and Joyful Moments in Home Health Care Workers during the COVID-19 Pandemic

Nursing literature predominantly focuses on job demands but is scarce for resources related to nurses' work. In the face of the COVID-19 pandemic, resources that can buffer the health-impairing effects of increased demands gain importance. The aim of this study is to explore resilience, meaning of work and joyful moments in home health care workers in South Germany during the pandemic. Resilience and meaning of work were measured quantitatively; moments of joy were investigated qualitatively by audio diaries and analyzed with qualitative content analysis. In all, 115 home health care workers (mean age = 47.83 ± 11.72; 81.75% female) filled in the questionnaires and 237 diary entries were made by 23 persons (mean age = 46.70 ± 10.40; 91.30% female). The mean scores of resilience (5.52 ± 1.04; 1-7) and meaning of work (4.10 ± 0.92; 1-5) showed high levels, with significantly higher values in females. Home care workers experienced joyful moments 334 times in 60 different types in the categories of social relationships, work content, work organization, work environment and self-care. A deeper understanding of resilience, meaning of work and joyful moments provides a basis for the development of worksite health promotion programs that address both demands and resources in home health care workers.

The Impact of Business Leaders' Formal Health and Safety Training on the Establishment of Robust Occupational Safety and Health Management Systems: Three Studies Based on Data from Labour Inspections

The impact of occupational safety and health (OSH) training is a neglected topic in safety research. In Norway, such training is mandatory for all business leaders. Hence, the Norwegian working life forms a particularly interesting case for studying the impact of OSH training. On the basis of data from labour inspections performed by the Norwegian Labour Inspection Authority (NLIA), this article examines the impact of business leaders’ mandatory OSH training on the establishment of robust OSH systems. Three separate studies have been conducted. In study 1, cross-sectional data from inspections of 29,224 companies are analysed. In study 2 and 3, longitudinal data from inspections of 1119 and 189 companies, respectively, are analysed. The analyses reveal that mandatory OSH training of business leaders is positively associated with compliance with legal requirements related to the minimum content of OSH systems. This means that mandatory OSH training is important for the establishment of robust occupational safety and health management systems.

Influence of sleep fragmentation and fatigue on turnover of female nurses working rotating shifts

AIMS AND OBJECTIVES

To investigate whether the sleep quality and fatigue of female nurses working rotating shifts could be used to predict future turnover status.

BACKGROUND

Female nurses working rotating shifts often suffer from sleep problems and fatigue, and the turnover rates of nurses are generally higher than those of other hospital personnel.

DESIGN

A prospective study.

METHODS

We recruited a total of 198 female nurses working rotating shifts from December 2017 to March 2019. The nurses completed the Checklist Individual Strength (CIS) scale and wore an actigraph for seven consecutive days in order to collect their sleep parameters. Their turnover status was tracked until 31 May 2021 at which time 55 participants (27.8%) had resigned. The Cox proportional hazard model was used to analyse the factors influencing turnover. In addition, the study adhered to the STROBE checklist.

RESULTS

The results revealed significant differences between the nurses in the still-working group and the resigned group in terms of the sleep quality parameters sleep efficiency (SE) and wake after sleep onset (WASO) as well as CIS scores. WASO was significantly correlated with intensity of fatigue, and fatigue was common among all of the nurses working rotating shifts. As time progressed, the sleep quality parameter WASO and CIS scores could be used to predict turnover status after 2.4 years.

CONCLUSION

The results of this study indicated more sleep fragmentation and poor sleep efficiency in the resigned group. Sleep fragmentation was highly correlated with fatigue, and sleep fragmentation and fatigue could be used to predict turnover status.

RELEVANCE TO CLINICAL PRACTICE

We suggest that relevant hospital management pay more attention to the sleep conditions and fatigue of female nurses working rotating shifts when arranging personnel and schedules and offer them more understanding.

What relationships can be found between nurses' working life and turnover? A mixed-methods approach

AIM

This study aimed to describe why registered nurses decide to leave their work and to investigate relationships between registered nurses' working life and turnover (leaving the unit vs. leaving the profession).

BACKGROUND

Much research has explored nurses' intention to leave, whereas less research has looked at turnover and especially leaving the profession.

METHODS

Data were collected using questionnaires and interviews.

RESULTS

The three most common reasons for both groups (leaving the profession, n = 40; leaving unit but not profession, n = 256) were high workload, low salary and applied for and got a new job. Multivariate logistic regression analysis revealed statistically significant relationships between turnover and empowering structures, such as access to resources and informal power as well as the factor learning in thriving.

CONCLUSIONS

Structural empowerment, such as good access to resources and informal power, is important to keeping nurses in the profession, whereas learning seems to increase the risk of leaving the profession when variables such as vitality, resources, informal power and age are held constant.

IMPLICATIONS FOR NURSING MANAGEMENT

To counteract nurses leaving the profession, managers must provide nurses with good access to resources and informal power, such as networks within and outside the organisation, and focus on nurses' vitality.

Influence of caring for COVID-19 patients on nurse's turnover, work satisfaction and quality of care

Aim

This study aims to examine, through the lens of the Job Demands‐Resources model, the influence of caring for COVID‐19 patients on nurse's perception of chronic fatigue, quality of care, satisfaction at work and intention to leave their organisation and the profession.

Background

Studies have examined how fear of COVID‐19 contributes to the mental, physical and work adjustment among nurses. To date, few studies have been conducted examining how caring for patients with COVID‐19 contributes to work outcomes among nurses.

Methods

This is a cross‐sectional survey involving 1705 frontline nurses and licensed practical nurses in Quebec, Canada. From these, 782 reported caring for COVID‐19 patients.

Results

High chronic fatigue, poor quality of care, lower work satisfaction and higher intention to leave their organisation were found for nurses caring for COVID‐19 patients. Poorly prepared and overwhelmed nurses showed higher turnover intention than those well prepared and in control.

Conclusions

There is an urgent need to provide support to nurses during the pandemic, with a long‐term strategy to increase their retention.

Implications for Nursing Management

Nurse administrators play an important role in supporting their nurses during a pandemic in the form of education, training and policy development to positively impact quality of care and retention.

Mediating Effects of Work Eudemonic Well-being for the Association Between Psychosocial Work Environment and Overall Eudemonic Well-being Among Japanese Workers: A Cross-sectional Study

OBJECTIVE

This study aimed to investigate the mediating effects of eudemonic well-being (EWB) at work for the associations between psychosocial work environment and overall EWB among Japanese workers.

METHODS

We conducted a cross-sectional study using data from a 2018 survey. psychosocial work environment measures included: job demands, job control, and supervisor and coworker support. Path analysis using structural equation modeling and mediation analysis were applied to examine the mediating effects of work EWB.

RESULTS

A total of 834 workers were analyzed. Work EWB completely mediated the associations of job control (β = 0.288, P < 0.001) and coworker support with overall EWB (β = 0.178, P < 0.001).

CONCLUSIONS

The effects of job control and coworker support associated with overall EWB were fully mediated by work EWB.