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

Does nurse use of a standardized flowsheet to document communication with advanced providers provide a mechanism to detect pulse oximetry failures? A retrospective study of electronic health record data

BACKGROUND

Pulse oximetry guides clinical decisions, yet does not uniformly identify hypoxemia. We hypothesized that nursing documentation of notifying providers, facilitated by a standardized flowsheet for documenting communication to providers (physicians, nurse practitioners, and physician assistants), may increase when hypoxemia is present, but undetected by the pulse oximeter, in events termed "occult hypoxemia."

OBJECTIVE

To compare nurse documentation of provider notification in the 4 h preceding cases of occult hypoxemia, normal oxygenation, and evident hypoxemia confirmed by an arterial blood gas reading.

METHODS

We conducted a retrospective study using electronic health record data from patients with COVID-19 at five hospitals in a healthcare system with paired SpO2 and SaO2 readings (measurements within 10 min of oxygen saturation levels in arterial blood, SaO2, and by pulse oximetry, SpO2). We applied multivariate logistic regression to assess if having any nursing documentation of provider notification in the 4 h prior to a paired reading confirming occult hypoxemia was more likely compared to a paired reading confirming normal oxygen status, adjusting for characteristics significantly associated with nursing documentation. We applied conditional logistic regression to assess if having any nursing documentation of provider notification was more likely in the 4-hour window preceding a paired reading compared to the 4-hour window 24 h earlier separately for occult hypoxemia, visible hypoxemia, and normal oxygenation.

RESULTS

There were data from 1910 patients hospitalized with COVID-19 who had 44,972 paired readings and an average of 26.5 (34.5) nursing documentation of provider notification events. The mean age was 63.4 (16.2). Almost half (866/1910, 45.3 %) were White, 701 (36.7 %) were Black, and 239 (12.5 %) were Hispanic. Having any nursing documentation of provider notification was 46 % more common in the 4 h before an occult hypoxemia paired reading compared to a normal oxygen status paired reading (OR 1.46, 95 % CI: 1.28-1.67). Comparing the 4 h immediately before the reading to the 4 h one day preceding the paired reading, there was a higher likelihood of having any nursing documentation of provider notification for both evident (OR 1.45, 95 % CI 1.24-1.68) and occult paired readings (OR 1.26, 95 % CI 1.04-1.53).

CONCLUSION

This study finds that nursing documentation of provider notification significantly increases prior to confirmed occult hypoxemia, which has potential in proactively identifying occult hypoxemia and other clinical issues. There is potential value to encouraging standardized documentation of nurse concern, including communication to providers, to facilitate its inclusion in clinical decision-making.

Measuring the PULSE of Nursing: Development of a Dashboard to Evaluate and Monitor Nursing Care Models

BACKGROUND

Critical nursing shortages have required many health care organizations to restructure nursing care delivery models. At a tertiary health care center, 150 registered practical nurses were integrated into acute inpatient care settings.

PROBLEM

A mechanism to continuously monitor the impact of this staffing change was not available.

APPROACH

Leveraging current literature and consultation with external peers, metrics were compiled and categorized according to Donabedian's Structure Process Outcome Framework. Consultation with internal subject matter experts determined the final metrics.

OUTCOMES

The Patient care, Utility, Logistics, Systemic Evaluation (PULSE) electronic dashboard was developed, capturing metrics from multiple internal databases and presenting real-time composites of validated indicators.

CONCLUSION

The PULSE dashboard is a practical means of enabling nursing leadership to evaluate the impact of change and to make evidence-informed decisions about nursing care delivery at our organization.

Processing of clinical notes for efficient diagnosis with feedback attention-based BiLSTM

Predicting a patient's future health state through the analysis of their clinical records is an emerging area in the field of intelligent medicine. It has the potential to assist healthcare professionals in prescribing treatments safely, making more accurate diagnoses, and improving patient care. However, clinical notes have been underutilized due to their complexity, high dimensionality, and sparsity. Nevertheless, these clinical records hold significant promise for enhancing clinical decision. To tackle these problems, a novel feedback attention-based bidirectional long short-term memory (FABiLSTM) model has been proposed for more effective diagnosis using clinical records. This model incorporates PubMedBERT for filtering irrelevant information, enhances global vector word embeddings for numerical representations and K-means clustering, and performs to explore term frequency and inverse document frequency intricacies. The proposed approach excels in capturing information, aiding accurate disease prediction. The predictive capability is further enhanced with the help of a billiards-inspired optimization algorithm. The effectiveness of the FABiLSTM method has been assessed with the MIMIC-III dataset, yielding impressive results in accuracy, precision, F1 score, and recall score of 98.52%, 98%, 98.2%, and 98.2% individually. These results reveal ways in which the proposed technique excels in comparison with current practices.

Evaluating the association between effort-reward imbalance and suboptimal health status among hospital nurses: a cross-sectional study

OBJECTIVES

Occupational stress is a common complaint in nurses, who perceived more sense of effort-reward imbalance (ERI). Suboptimal health status (SHS) is a state between health and disease. However, the correlation between ERI and SHS is unclear. Therefore, the aim of this study was to examine the prevalence of SHS and ERI and evaluate the relationship between ERI and SHS in clinical nurses by a cross-sectional study.

MATERIAL AND METHODS

The current cross-sectional study was conducted through an online survey at Dongping People's Hospital in China. A total of 633 completed surveys were received. Effort-reward imbalance was measured by subscales of the ERI questionnaire. SHS was measured by the Suboptimal Health Status Questionnaire - 25 (SHSQ-25). The relationship between ERI and SHS in nurses was subsequently assessed by Spearman's correlation coefficient and logistic regression model.

RESULTS

The mean age of the optimal health status (OHS) group (M±SD 26.3±7.3 years) was younger than the SHS group (M±SD 30.3±6.9 years). The prevalence of SHS was 54.5% (345/633). Female nurses aged ≥30 years, a junior college or university graduate educational level, smokers, and nurses without regular exercise were at a higher risk of SHS. In Spearman's correlation analysis, ERI reflected by the effort-reward ratio was correlated with SHSQ-25 score (r = 0.662, p < 0.001). In logistic regression, ERI was strongly associated with SHS after potential confounding factors adjusting (OR 27.924, 95% CI 22.845-34.132).

CONCLUSIONS

The prevalence of SHS was significantly high in clinical nurses. Administrators should pay more attention to health status of female nurses aged ≥30 years, with a junior college or bachelor's degree, smoking, and without regular exercise to reduce the SHS and ERI. Int J Occup Med Environ Health. 2024;37(2):166-75.

Improve the satisfaction of medical staff on the use of home nursing mobile APP by using a hybrid multi-standard decision model

OBJECTIVE

To identify critical satisfaction gaps in a home nursing mobile application (APP) using a systematic decision-making model.

METHODS

Initially, the decision-making trial and evaluation laboratory method was used to analyze the relationship structure and corresponding weights among the indicators. The Importance-Performance Analysis (IPA) method was used to identify the categories of all indicators and their corresponding strategic directions. Twenty-six home nursing specialists currently providing home nursing services were recruited for this study.

RESULTS

The IPA results revealed that "Assurance," "Reliability," and "Personal security protection" are critical satisfaction gaps. From the influence network and weight results, "information quality" and "system quality" were the critical quality factors in the home nursing mobile APP. The influence of the network relationship structure and weight demonstrated a 98.12% significance level, indicating good stability.

CONCLUSION

Continuous improvement in information and system quality is recommended to optimize the overall quality of the home nursing mobile APP. Additionally, user demands should be considered, and personal safety guarantee functions should be developed and integrated into the system to ensure the safety of home nursing workers.

Investigation of the relationship between nurses' perception of toxic leadership and their organizational trust levels and turnover intentions

AIM

This study aimed to investigate the relationship between nurses' perception of toxic leadership and their organizational trust levels and turnover intentions.

DESIGN

This cross-sectional study was conducted using an online survey of 168 nurses working in public and university hospitals.

METHODS

Data were collected between April and November 2022 with the Toxic Leadership Scale, Organizational Trust Scale and Turnover Intention Scale. Descriptive statistics, correlations, and regression analyses were used to analyse these data.

RESULTS

It was determined that almost half of the nurses (46.4%) were exposed to negative behaviours from their managers within the last year. Nurses' perception of toxic leadership, organizational trust level and turnover intention were moderate. It was found that nurses' perceptions of toxic leadership had a negative effect on organizational trust level (R2 = .691; β = -0.832; p < .05) and a positive significant effect on turnover intention (R2 = .267; β = 0.521; p < .05).

CONCLUSIONS

This study revealed that toxic leadership behaviours in health organizations should be struggled with to increase nurses' organizational trust and reduce their turnover. In this context, an organizational culture in which toxic behaviours are not tolerated should be established in health organizations.

IMPACT

What problem did the study address? In the literature, mostly positive leadership behaviours of nurse managers are emphasized and little is known about their negative behaviours such as toxic leadership. What were the main findings? It was determined that nurses who perceived more toxic behaviour from their managers had less trust in their organizations and higher turnover intention. On whom will the research have an impact? To provide a positive working environment and reduce turnover, it is necessary to create an organizational culture in which the toxic behaviours of nurse managers are not tolerated.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Submental Island Flaps for Lateral Reconstruction: Technical Refinements for Optimal Outcomes and Resource Efficiency

Objective

To describe our modifications to the submental island flap (SMIF) in a case series that demonstrates improved reproducibility, shortened length of stay (LOS), and reduced utilization of hospital resources.

Study Design

This retrospective case series with chart review included adult patients who underwent resection of malignant or benign tumors resulting in lateral facial, parotid, or temporal bone defects, which were reconstructed with SMIF.

Setting

A tertiary-care academic referral center.

Methods

Retrospective case series included all adult patients who underwent SMIF reconstruction between March 2020 and August 2021. Patient demographic and clinical data were collected. Primary outcomes were measures of hospital utilization including duration of surgery, LOS, and postoperative outcomes.

Results

Twenty-eight patients were included with a mean age of 71.7 years. Eighty percent were male. All patients underwent parotidectomy, and the mean operative time was 347 minutes. The median LOS was 2.5 days (range 0-16 days). Seventy-five percent of the flaps drained into the internal jugular vein, and 25% drained into the external jugular vein. No patients required reoperation or readmission. All flaps survived.

Conclusion

SMIFs are a safe and effective option for reconstruction of lateral facial, parotid, and temporal bone defects. Compared to free flap reconstruction, SMIFs offer reduced length of surgery, decreased use of health care resources, and lower rate of reoperation. As health care resource allocation is increasingly important, the SMIF offers an excellent alternative to free flap reconstruction of lateral defects.

Workforce Engagement for Compassionate Advocacy, Resilience, and Empowerment (WE CARE): An Evidence-Based Wellness Program

Poor well-being and burnout among the nursing workforce were heightened by the COVID-19 pandemic. The purpose of this study was to deliver, spread, and sustain an evidence-based wellness program, Workforce Engagement for Compassionate Advocacy, Resilience, and Empowerment (WE CARE), for nurse leaders, staff registered nurses (RNs), and patient care technicians (PCTs) to ameliorate or prevent burnout, promote resilience, and improve the work environment. The program included Community Resiliency Model (CRM) training provided by a certified 6-member wellness team. A baseline and 6-month follow-up survey included measures of well-being, moral distress, burnout, resilience, perceived organizational support (POS), job satisfaction, intent to leave (ITL), and work environment. A total of 4900 inpatient RNs, PCTs, and leaders of a 1207-bed academic medical center in the southeastern United States were analyzed. From baseline (n = 1533) to 6-month follow-up (n = 1457), well-being, moral distress, burnout, job satisfaction, and work environment improved; however, resilience, POS, and ITL did not. Although we have seen some improvements in well-being and mental health indicators, it is still early in the intervention period to have reached a critical mass with the training and other interventions. The mental health and work environment issues among nurses are so complex, no one-size-fits-all intervention can resolve.

Consistently Exploring Nurse Staffing and Neurocritical Care Unit Turnover

ABSTRACT

BACKGROUND: Staffing models within nursing units have long been a hot topic of discussion. The COVID-19 pandemic exacerbated this discussion by straining the national nursing environment and workforce. Before the pandemic, the neuroscience intensive care unit (NSICU) primarily used an acuity-adjusted staffing model and aimed for a nurse-to-patient ratio of 1:1.5. During and after the pandemic, the NSICU was forced to primarily use a centralized staffing model because of the increased turnover in the hospital at large and a rise in patient census. METHODS : Unit census data in an NSICU were tracked before, during, and after the pandemic alongside utilization of a centralized staffing model in the hospital at large. RESULTS : During this time, the NSICU saw a statistically significant increase in average nurse-to-patient ratio and incidences of both floating and tripled assignments. The NSICU simultaneously saw a 180% increase in nursing turnover. CONCLUSION : Although we cannot prove that a centralized staffing model is directly responsible for higher nursing turnover, its utilization led to greater incidence of poor staffing-reflected in deviation from the nurse-to-patient ratio goal of the unit. Nurse staffing concerns play a large role in nurse satisfaction in the workforce: staffing shortages have been described both as a precursor to and as a consequence of increased nursing turnover.

Emotional burnout, job satisfaction, and intention to leave among pre-hospital emergency healthcare workers during the COVID-19 pandemic

BACKGROUND

With the onset of the COVID-19 pandemic, pre-hospital emergency healthcare workers (PHEHW) assumed critical responsibilities in controlling and preventing the spread of the virus.

OBJECTIVE

This descriptive study aimed to explore the emotional burnout, job satisfaction, and intention to leave among PHEHW during the COVID-19 pandemic.

METHODS

The study was conducted with 401 emergency medical technicians and paramedics. The Sociodemographic Data Form, the Emotional Burnout Scale, the Job Satisfaction Scale, the Intention to Leave the Profession Scale were used to collect data. The findings were assessed with a significance level set at p <  0.05 and a 95% confidence interval.

RESULTS

The participants demonstrated moderate scores in emotional burnout, job satisfaction, and intention to leave the profession. The analysis revealed a negative correlation, indicating that as emotional burnout increased, job satisfaction decreased, and the intention to leave the profession heightened. Notably, the participants who had 6-9 years of service, lacked knowledge about COVID-19, had no COVID-19 training, underwent COVID-19 testing, and experienced the loss of a healthcare worker due to COVID-19 exhibited higher levels of burnout. Furthermore, those who had 6-9 years of service, lacked knowledge about COVID-19, had no COVID-19 training, and lost a healthcare worker due to COVID-19 reported lower levels of job satisfaction. Additionally, participants who had 6-9 years of service, lacked knowledge about COVID-19, had no COVID-19 training, and experienced the loss of a healthcare worker due to COVID-19 displayed a greater intention to leave the profession.

CONCLUSIONS

It is important to implement improvement initiatives that will increase the motivation and job satisfaction of PHEHW. These include the regulation of working hours and shifts, augmenting staff numbers, enhancing working conditions, improving salaries, and implementing strategies aimed at fostering motivation and job satisfaction.

Determinants of intention to leave among nurses and physicians in a hospital setting during the COVID-19 pandemic: A systematic review and meta-analysis

BACKGROUND

The global outbreak of COVID-19 has brought to light the profound impact that large-scale disease outbreaks can have on healthcare systems and the dedicated professionals who serve within them. It becomes increasingly important to explore strategies for retaining nurses and physicians within hospital settings during such challenging times. This paper aims to investigate the determinants of retention among nurses and physicians during the COVID-19 pandemic.

METHOD

A systematic review of other potential determinants impacting retention rates during the pandemic was carried out. Secondly, a meta-analysis on the prevalence of intention to leave for nurses and physicians during the COVID-19 pandemic.

FINDINGS

A comprehensive search was performed within four electronic databases on March 17 2023. Fifty-five papers were included in the systematic review, whereas thirty-three papers fulfilled the eligibility criteria for the meta-analysis. The systematic review resulted in six themes of determinants impacting intention to leave: personal characteristics, job demands, employment services, working conditions, work relationships, and organisational culture. The main determinants impacting the intention to leave are the fear of COVID-19, age, experience, burnout symptoms and support. Meta-analysis showed a prevalence of intent to leave the current job of 38% for nurses (95% CI: 26%-51%) and 29% for physicians (95% CI: 21%-39%), whereas intention to leave the profession for nurses 28% (95% CI: 21%-34%) and 24% for physicians (95% CI: 23%-25%).

CONCLUSION

The findings of this paper showed the critical need for hospital managers to address the concerning increase in nurses' and physicians' intentions to leave during the COVID-19 pandemic. This intention to leave is affected by a complex conjunction of multiple determinants, including the fear of COVID-19 and the confidence in and availability of personal protective equipment. Moreover, individual factors like age, experience, burnout symptoms, and support are maintained in this review. Understanding the influence of determinants on retention during the COVID-19 pandemic offers an opportunity to formulate prospective strategies for retaining nurses and physicians within hospital settings.

Work-related flow and its correlates among frontline nurses during the COVID-19 pandemic

BACKGROUND

Ample evidence across non-healthcare fields highlights the role of work-related flow in enhancing resilience against work stress and work engagement. Understanding flow and its factors can support staff development and management.

AIMS

This study aimed to investigate the level of work-related flow and its associated factors among frontline nurses during the COVID-19 pandemic.

METHODS

A cross-sectional multicenter study included 336 nurses caring for COVID-19 patients between March and April 2022. Cluster random sampling was used to select 9 nurse groups from 29 Taiwanese hospitals specialized in COVID-19 care. A web survey link was shared on the selected nurses' social media. Hierarchical regression analyses examined predictor-outcome relationships, following the STROBE checklist for reporting findings.

RESULTS

Among demographic characteristics, sex (β = -0.11; p = 0.016) and living arrangement (β = -0.12; p = 0.017) reached statistical significance in model 3. Social support from family, friends, and significant others, managerial position, and sufficiency of personal protective equipment showed significant associations with work-related flow (all β > 0.12; p < 0.05). The variables included in the final model accounted for 35% of the variance in work-related flow for COVID-19 patient care tasks.

CONCLUSIONS

Flow experience is influenced by factors associated with demographics, work conditions, and social support. Nurse administrators should consider these factors when evaluating nurses' flow at work.

IMPLICATIONS FOR NURSING PRACTICE AND MANAGEMENT

Allocating care tasks to nurses based on their flow levels can be beneficial, particularly during healthcare crises. Ensuring a sufficient supply of personal protective equipment and offering social support to nurses are vital strategies for facilitating their flow experience in the workplace.

Job satisfaction among expatriate nurses during the COVID-19 pandemic: A cross-sectional study

AIM

To investigate the association between job resources, job satisfaction, and moderating effect of COVID-19 anxiety and practice setting among expatriate acute care nurses in Qatar.

BACKGROUND

Expatriate nurses are more vulnerable to reduced job satisfaction. Increased COVID-19 anxiety and reduced perceived job resources among acute care nurses impact their job satisfaction more than that of general ward nurses.

METHOD

An online survey was used to recruit 293 expatriate acute care nurses from four public hospitals in Qatar. Data were collected between June and October of 2021. Structural equation modeling was used for data analysis. We ensured to follow STROBE guidelines when doing this research.

RESULTS

Job resources were a significant predictor of job satisfaction among expatriate acute care nurses (β = 0.80, 95% CI: 0.73-0.85, p < 0.001). There was no significant moderating effect of COVID-19 anxiety (β = 0.055, 95% CI: -0.61 to 0.151, p = 0.329) or workplace setting on this relationship (χ2  = 0.077, df = 1, p = 0.781).

DISCUSSION

Our study found that the relationship between job resources and acute care nurses' job satisfaction is consistent across different workplace settings regardless of the level of COVID-19 anxiety. This is in line with previous studies that have highlighted the importance of job resources in determining nurses' job satisfaction.

CONCLUSION

The study emphasizes the need for sufficient job resources for improved job satisfaction among expatriate acute care nurses in Qatar, especially during the COVID-19 pandemic.

IMPLICATIONS FOR NURSING POLICY

Nursing leaders must prioritize adequate resources such as staffing, proper training, and policies that increase nurse autonomy to improve job satisfaction and reduce the negative effects of dissatisfaction.

Impact of the Work Environment on Nurse Outcomes: A Mediation Analysis

BACKGROUND

The nursing workforce remains in a vulnerable state post pandemic as working conditions are difficult and exacerbated by a global nursing shortage. Identifying factors leading to turnover intentions are thus critical for health care system recovery.

PURPOSE

The purpose of this study was to examine the impact of nurses' work environment and the pandemic on missed nursing care, scope of practice, emotional exhaustion, and intent to leave.

METHODS

This study was a cross-sectional, self-reporting online survey, sent to hospital-based nurses in a Canadian province (n = 419). Mediation analysis was used to examine both direct and indirect effects of work environment and COVID-19 impact on nurse outcomes (emotional exhaustion and intent to leave) through missed care and scope of practice.

RESULTS

The results showed that 73% of nurses were considering leaving the profession. Several direct and indirect pathways predicted emotional exhaustion and intent to leave. A better work environment was related to both decreased emotional exhaustion and intent to leave. Nurses' scope of practice partially mediated the relationship between work environment and intent to leave. On the other hand, missed care did not mediate emotional exhaustion or intent to leave.

CONCLUSIONS

While considering the global nursing shortage, it is imperative to implement strategies to promote nurses' well-being and their retention within the health care system.

Mediating effects of social support and presenteeism on turnover intention and post-traumatic stress disorder among Chinese nurses in the post-pandemic era: a cross-sectional study

Background

The shift in national policies for epidemic prevention and control in the post-pandemic era is undoubtedly a challenge for health care professionals. Nurses, as an important part of the health care professional population, have an even greater impact on their mental health and occupational safety. This may expose nurses to post-traumatic stress disorder (PTSD) and presenteeism, and ultimately lead to their turnover.

Objective

This study aimed to investigate the relationship between turnover intention and post-traumatic stress disorder among Chinese nurses during post-pandemic era, and the mediating role of social support and presenteeism.

Methods

In this study, a multicentre cross-sectional survey was conducted in April 2023 among nursing staff in several tertiary general hospitals in northern China, with online data collection using the Turnover intention Scale (PTSD), the Impact of Events Scale (IES), the Social Support Scale (SSS), and the Stanford presenteeism Scale (STAS) and the relationship between variables was analyzed using hierarchical multivariate regression, and Structural Equation Modeling (SEM) was used to analyze the relationship between post-traumatic stress disorder and the Turnover intention from the pathway between.

Results

Data were collected from 2,513 nurses who met the inclusion criteria, in which general information such as age, department, specific department, Professional title, history of alcohol consumption, form of employment, Years of working, and Average working hours per day were statistically significant with the difference in the turnover intention. The results of the study showed a 32% high turnover intention among nurses in the post-pandemic era, which was lower than the turnover intention during the pandemic. The results of hierarchical multiple regression analysis showed that post-traumatic stress disorder, social support, and presenteeism were significant predictors of turnover intention. The total effect of post-traumatic stress disorder on turnover intention to work was 0.472 [bias modified 95% confidence interval (0.415-0.483), p < 0.001]. Social support and attendance played a partially intermediate role in post-traumatic stress disorder and propensity to leave (an indirect effect of 26% of the total effect).

Conclusion

Turnover intention and post-traumatic stress disorder levels are high and social support plays an important role in the tendency to leave the job and post-traumatic stress disorder, healthcare institution can be achieved by strengthening social support for nurses in the post-epidemic era and preventing the occurrence of presenteeism.

Moral Distress and Intention to Leave During COVID: A Cross-sectional Study on the Current Nursing Workforce to Guide Nurse Leaders for the Future

OBJECTIVE

The aim of this study was to investigate how the experience of caring for COVID-19 patients, nurses' moral distress, and the current practice environment impact nurses' intention to leave.

BACKGROUND

Caring for COVID-19 patients has been associated with an increase in nurses' moral distress and an increase in nurses' turnover. To date, research has focused on nurses' moral distress, the practice environment, and intentions to leave during the pandemic's peak. The current workplace climate, including those who stayed in their positions, has not been adequately assessed.

METHODS

This cross-sectional correlational study was conducted in a Magnet® hospital.

RESULTS

Moral distress related to team/system (B = 0.64, t = 3.86, P < 0.001), nurses' participation in hospital affairs (B = -2.21, t = -3.52, P < 0.001), and staffing (B = -1.91, t = -5.48, P < 0.001) are strongest predictors for nurses' intention to leave postpandemic.

CONCLUSIONS

Nurses in practice still report experiencing COVID-related moral distress; however; issues related to resources and staffing have the most substantial impact on intention to leave among the current nursing workforce.

A Global Overview of Missed Nursing Care During the COVID-19 Pandemic: A Systematic Review

The coronavirus disease 2019 (COVID-19) pandemic has placed unparalleled pressure on many countries' healthcare systems, impacting the delivery of health and nursing care services. Despite the growing number of missed care studies during the pandemic, a broader perspective is essential when designing theory-driven strategies to improve nursing care delivery. This review aimed to synthesize evidence of missed nursing care during the COVID-19 pandemic in acute care settings through a systematic review and narrative synthesis. An electronic search of articles published since the emergence of the pandemic was conducted using 5 databases (Scopus, PubMed, Web of Science, CINAHL, and PsycINFO). A total of 470 articles were identified during the initial search, and 10 articles were included in the review. The sample sizes of the studies ranged from 37 to 536 nurses. Results of the content analysis were grouped into 5 categories: (1) prevalence of missed care, (2) frequency of missed care, (3) reasons for missed care, (4) nurses' and organizational variables contributing to missed care, and (5) work environment elements contributing to missed care. The review's findings revealed a shift in the nature of missed nursing care during the pandemic, with an emphasis on nursing care tasks vital for the recovery of patients with COVID-19. Despite the unique circumstances brought about by the pandemic, an inadequate nursing workforce continued to be identified as the primary reason for missed care, consistent with the pre-pandemic period.

Intention to leave, depersonalisation and job satisfaction in physicians and nurses: a cross-sectional study in Europe

The European healthcare sector faces a significant shortage of healthcare workers. Assessing the prevalence of this issue and understanding its direct and indirect determinants are essential for formulating effective recruitment programs and enhancing job retention strategies for physicians and nurses. A multicentric cross-sectional study was conducted, involving 381 physicians and 1351 nurses recruited from eight European hospitals in Belgium, the Netherlands, Italy, and Poland. The study focused on assessing turnover intentions among healthcare workers based on the Job Demands-Resources model, using an online questionnaire. Structural equation models were employed to test the data collection questionnaires' construct validity and internal consistency. The turnover intention was assessed by agreement with the intention to leave either the hospital or the profession. Among physicians, 17% expressed an intention to leave the hospital, while 9% intended to leave the profession. For nurses, the figures were 8.9% and 13.6%, respectively. The internal consistency of the questionnaires exceeded 0.90 for both categories of health workers. Depersonalization and job dissatisfaction were identified as direct determinants of turnover intention, with work engagement being particularly relevant for nurses. We found a higher intention to leave the hospital among physicians, while nurses were more prone to leave their profession. To mitigate turnover intentions, it is recommended to focus on improving job satisfaction, work engagement and fostering a positive working climate, thereby addressing depersonalisation and promoting job retention.

Professional identity, job satisfaction, and turnover intention among Chinese novice nurses: A cross-sectional study

The world is faced with challenges due to a growing aging population and the increasing burden of chronic disease. The acute shortage of nurses and high turnover rates, particularly among novice nurses, are of great concern in many countries. Several studies have shown that turnover intention among nurses is influenced by professional identity and job satisfaction. However, to the best of our knowledge, no studies have examined this issue in the context of novice nurses. Thus, the present study aimed to explore the relationship between professional identity, job satisfaction, and turnover intention among novice nurses in China. From March 18 to April 23, 2022, a cross-sectional survey was carried out involving 532 novice nurses recruited from four public hospitals in Sichuan Province, China. Among the sample, 526 questionnaires were retrieved, with an effective response rate of 98.87%. The mean scores for turnover intention, professional identity, and job satisfaction were 13.02 ± 3.94, 36.17 ± 7.98, and 111.02 ± 21.46, respectively. High turnover intention was observed among novice nurses, of whom 54.37% (286/526) had high or very high turnover intention. Professional identity and job satisfaction among novice nurses were moderate. In terms of demographic characteristics, "Whether living with relatives" and "Monthly income" had a statistically significant impact on the turnover intention of novice nurses (P < .05). Both professional identity (r = -0.459) and job satisfaction (r = -0.517) were significantly and moderately negatively correlated with turnover intention (P < .01). The results of the multivariate linear regression analysis revealed that variables including "Whether living with relatives," "Professional identity," "Control and responsibility for work," and "Benefits" jointly accounted for 29.9% of the variance related to turnover intention among novice nurses. "Whether living with relatives," "Professional identity," "Control and responsibility for work," and "Benefits" were highly predictive of turnover intention levels among novice nurses. Hence, potential predictors of turnover intention should be considered, and intervention research should be conducted to reduce the level of turnover intention among novice nurses.

The impact of COVID-19 on nurses' job satisfaction: a systematic review and meta-analysis

Background

The global healthcare landscape was profoundly impacted by the COVID-19 pandemic placing nurses squarely at the heart of this emergency. This review aimed to identify the factors correlated with nurses' job satisfaction, the impact of their job satisfaction on both themselves and their patients, and to explore strategies that might have counteracted their job dissatisfaction during the COVID-19 pandemic.

Methods

The Joanna Briggs Institute (JBI) methodology for systematic reviews of prevalence and incidence was used in this review. The electronic databases of CINAHL, MEDLINE, SCOPUS, PsycINFO and Academic Search Complete were searched between January 2020 to February 2023.

Results

The literature review identified 23 studies from 20 countries on nurses' job satisfaction during the COVID-19 pandemic. A pooled prevalence of 69.6% of nurses were satisfied with personal, environmental, and psychological factors influencing their job satisfaction. Job satisfaction improved psychological wellbeing and quality of life, while dissatisfaction was linked to turnover and mental health issues.

Conclusion

This systematic review elucidates key factors impacting nurses' job satisfaction during the COVID-19 pandemic, its effects on healthcare provision, and the potential countermeasures for job dissatisfaction. Core influences include working conditions, staff relationships, and career opportunities. High job satisfaction correlates with improved patient care, reduced burnout, and greater staff retention.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023405947, the review title has been registered in PROSPERO and the registration number is CRD42023405947.

Psychological distress as a mediator between workplace violence and turnover intention with caring for patients with COVID-19

The Coronavirus Disease 2019 (COVID-19) outbreak exacerbated workplace violence and turnover intention among nurses, particularly affecting greater levels of psychological distress. This study aimed to examine psychological distress as a mediator of the relationship between workplace violence and turnover intention among clinical nurses, and to investigate whether caring for patients with COVID-19 moderates this relationship through the lens of the affective events theory. We conducted an online survey of 325 Korean registered nurses (mean age = 30.75; female = 92.6%) who work in clinical settings between August and October 2021 using the convenience sampling method. Psychological distress was measured using the 21-item Depression Anxiety Stress Scale and workplace violence using one dichotomous item adopted from the Workplace violence questionnaire. We measured turnover intention using the six-item Anticipated Turnover Scale. Caring for patients with COVID-19 was determined using one dichotomous item. The research hypotheses assume that the relationship between workplace violence and turnover intention could be mediated by psychological distress and moderated by caring for patients with COVID-19 among Korean nurses. We performed a moderated mediation analysis with workplace violence as the independent variable, turnover intention as the dependent variable, psychological distress as a potential mediator, and caring for patients with COVID-19 as a potential moderator. The analysis revealed that nurses' psychological distress among 308 nurses had a statistically significant mediating effect on the relationship between workplace violence and turnover intention. Furthermore, caring for patients with COVID-19 had a significant further moderating effect on this relationship. These findings highlight the need for psychological support services for clinical nurses at institutional and organizational levels amidst the ongoing COVID-19 pandemic. It is hoped that these findings can contribute to the development of tailored interventions for nurses caring for patients with COVID-19 to attenuate their psychological distress in a timely and effective manner.

The impact of COVID-19 on nurse alcohol consumption: A qualitative exploration

AIMS AND OBJECTIVES

To explore the long-term impact of the COVID-19 pandemic on nurse alcohol consumption.

BACKGROUND

The COVID-19 pandemic has caused immense disruption to healthcare services worldwide, and nurses have not been immune, experiencing burnout, declining mental health and ultimately, attrition from the profession. Increases in alcohol consumption have been reported across subsections of society, including those with pre-existing mental ill health and experiencing high stress, and exploring this phenomenon in nurses is essential for workforce well-being and sustainability.

DESIGN

Qualitative descriptive study design.

METHODS

Secondary analysis of individual, semi-structured interviews with nurses (N = 42) from diverse settings across Australia, including community, primary and hospital settings, conducted in July and August 2021. Data were analysed using structural coding and reported in accordance with the CORE-Q guidelines.

FINDINGS

Two key themes were found after analysis of the data: (1) factors influencing alcohol consumption (subthemes: workplace factors and external factors), and (2) the pandemic's influence on alcohol consumption (subthemes: increased consumption, moderation of consumption and alcohol as a reward).

CONCLUSIONS

Several participants described increased alcohol consumption because of the COVID-19 pandemic, particularly due to the stress of working in an environment where resources were scarce. Workplace factors such as overtime, missed breaks and heightened workload were all described as driving stress, and in turn increased alcohol consumption.

RELEVANCE TO CLINICAL PRACTICE

Increased alcohol consumption has been associated with burnout, absenteeism and intention to leave. The nursing profession is currently undergoing significant continuing stress providing care and management to patients with the SARS-CoV-2 virus, and increased alcohol consumption is a significant threat to personal and workforce well-being, workforce sustainability and quality nursing care.

Career decisions and aspirations of early-career nurses: Insights from a qualitative interpretative description study

AIM

To explore the career decisions and aspirations of early-career registered nurses in New Brunswick, Canada.

DESIGN

A qualitative study using an interpretive description approach was conducted.

METHODS

Semi-structured one-on-one interviews were conducted with a purposive sample of nurses (n = 22) currently working in New Brunswick, Canada, with up to 5 years of experience from February to April 2022.

RESULTS

Participants described diverse career paths and aspirations. Personal factors affecting these included the desire for meaningful work, career satisfaction, work-life balance, spending time with family, working in a preferred location, and finances. Professionally, working conditions were the dominant factor influencing early-career nurses' career decisions and aspirations. Participants described how short staffing, safety, support, and scheduling influenced their day-to-day work, mental and physical health, job and career satisfaction, and intent to leave.

CONCLUSION

The findings highlighted the abundant and diverse career opportunities available to nurses early in their careers. Early-career nurses are interested in finding nursing positions with a high degree of person-job fit and value opportunities for ongoing professional education and growth.

IMPACT

This study in New Brunswick, Canada, explores early-career nurses' career decisions and aspirations during nursing shortages and the pandemic, emphasizing the importance of person-job fit. Recommendations include improving working conditions and career pathways to enhance the sustainability of the nursing profession.

REPORTING METHOD

Standards for Reporting Qualitative Research (SRQR).

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Effect of mode of healthcare delivery on job satisfaction and intention to quit among nurses in Canada during the COVID-19 pandemic

The COVID-19 pandemic resulted in a major shift in the delivery of healthcare services with the adoption of care modalities to address the diverse needs of patients. Besides, nurses, the largest profession in the healthcare sector, were imposed with challenges caused by the pandemic that influenced their intention to leave their profession. The aim of the study was to examine the influence of mode of healthcare delivery on nurses' intention to quit job due to lack of satisfaction during the pandemic in Canada. This cross-sectional study utilized data from the Health Care Workers' Experiences During the Pandemic (SHCWEP) survey, conducted by Statistics Canada, that targeted healthcare workers aged 18 and over who resided in the ten provinces of Canada during the COVID-19 pandemic. The main outcome of the study was nurses' intention to quit within two years due to lack of job satisfaction. The mode of healthcare delivery was categorized into; in-person, online, or blended. Multivariable logistic regression was performed to examine the association between mode of healthcare delivery and intention to quit job after adjusting for sociodemographic, job-, and health-related factors. Analysis for the present study was restricted to 3,430 nurses, weighted to represent 353,980 Canadian nurses. Intention to quit job, within the next two years, due to lack of satisfaction was reported by 16.4% of the nurses. Results showed that when compared to participants who provided in-person healthcare services, those who delivered online or blended healthcare services were at decreased odds of intention to quit their job due to lack of job satisfaction (OR = 0.47, 95% CI: 0.43-0.50 and OR = 0.64, 95% CI: 0.61-0.67, respectively). Findings from this study can inform interventions and policy reforms to address nurses' needs and provide organizational support to enhance their retention and improve patient care during times of crisis.

Professional engagement: Connecting self-efficacy to actual turnover among hospital nurses

AIMS

To examine how nurses' self-efficacy impacts professional engagement (professional opportunities exploration and workplace improvement participation), nurses' turnover intention and further on actual turnover.

BACKGROUND

The problem of nursing shortage has become a common global issue. Nurses' self-efficacy could reduce nurses' turnover intention. However, whether professional engagement could connect nurses' self-efficacy and their actual turnover remains unknown.

DESIGN

This study adopts a three-wave follow-up design.

METHODS

This study uses proportionate random sampling to survey nurses in a large medical centre in Taiwan. Totally, 417 participants were enrolled from December 2021 to January 2022 (first wave) and followed up from February 2022 to March 2022 (second wave). The data of nurses' actual turnover (or not) were traced in May 2022 (third wave). STROBE statement was chosen as the EQUATOR checklist.

RESULTS

Self-efficacy was positively linked to outcome expectation, which is positively linked to professional opportunities exploration. Self-efficacy was positively linked to career interest and workplace improvement participation. Professional engagement was negatively linked to nurses' intention to leave the target hospital, which was positively linked to actual turnover.

CONCLUSION

This study uniquely finds that professional engagement is the key to the mechanism underlying the influence of nurse' self-efficacy on their actual turnover.

IMPACT

Our findings impact nursing management that professional engagement is as well important as nurses' self-efficacy, with an aim to maintain the professional nursing workforce.

PATIENT OR PUBLIC CONTRIBUTION

Nurses complete the questionnaires, return them to the investigators and permit investigators to check their personnel data.

A divided community: A descriptive qualitative study of the impact of the COVID-19 pandemic on nurses and their relationships

AIMS

To identify the personal and professional impact of the COVID-19 pandemic on clinical nurses with regard to personal and workplace safety, personal and professional relationships and perceptions of their team, organization and community, and to understand lessons learned to inform future responses to pandemics or global emergencies.

DESIGN

Qualitative, descriptive free-text surveys, informed by appreciative inquiry.

METHODS

Nurses working in adult COVID- and non-COVID cohort medical-surgical and intensive care units, outpatient cancer and general surgery centres were invited to participate. Data were collected between April and October 2021 and analysed using summative content analysis.

RESULTS

In total, 77 participants completed free-text surveys. Five themes were identified: (1) Constraints on nursing: barriers in communication and diminished patient safety and quality of care; (2) Navigating uncertainty: the emotional toll of the pandemic; (3) Team solidarity, renewed appreciation and reaffirming purpose in nursing work; (4) Enhanced trust versus feeling expendable; and (5) Increased isolation and polarization within communities. Nurses described a perceived negative impact on a number of their relationships, including with patients, employer and community. They described a huge emotional toll that included feelings of isolation and polarization. While some nurses described feeling supported by their team and employer, others described feeling expendable.

CONCLUSION

Nurses' responses provided insights into negative emotional experiences during the pandemic due to heightened uncertainty and fear, and also the importance of support received from peers, colleagues and their employer. Nurses experienced feelings of isolation and polarization within their communities. The varied responses reflect the importance of societal solidarity when faced with global emergencies, and the need for nurses to feel valued by their patients and employer.

IMPACT

Effective responses to public health emergencies require individuals and communities to work together to achieve collective goals. Efforts to retain nurses are critical during global emergencies.

PATIENT OR PUBLIC CONTRIBUTION

No patient and public involvement.

An explorative and confirmative factor analysis of the Leadership and Management Inventory-II among staff working in elderly care

PURPOSE

The Purpose of the study was to investigate the construct validity and internal consistency of the LaMI among staff in the context of elderly care in Sweden.

DESIGN/METHODOLOGY/APPROACH

Questionnaire data from a longitudinal study of staff working in elderly care were used. Data were collected using the Leadership and Management Inventory. First data collection was for explorative factor analysis (n = 1,149), and the second collection, one year later, was for confirmatory factor analysis (n = 1,061).

FINDINGS

The explorative factor analysis resulted in a two-factor solution that explained 70.2% of the total variance. Different models were tested in the confirmatory factor analysis. The final model, a two-factor solution where three items were omitted, showed acceptable results.

ORIGINALITY/VALUE

The instrument measures both leadership and management performance and can be used to continually measure managers' performances as perceived by staff to identify areas for development.

Nurses' Experiences and Perspectives of the Telehealth Working Environment and Educational Needs

BACKGROUND

The continuing evolution of health care and the nursing profession includes the exponential growth of telehealth platforms. The goal of this study was to describe nurses' experiences with and perspectives on their practice with and future need for telehealth.

METHOD

A cross-sectional descriptive mixed methods study was conducted with nursing graduates from a single university. Completed survey questions focused on demographics, current work status, plans for employment participation, and telehealth experience. Descriptive analysis was conducted with statistical software, with directed content analysis for narrative responses.

RESULTS

A total of 305 of 5,080 participants completed the survey (6% response rate). Nurses described perceived benefits and barriers to working in a telehealth environment. Nurses identified continuing education needs that could form the basis for a telehealth continuing education program to increase confidence in telehealth delivery.

CONCLUSION

The identified telehealth educational needs will positively influence the formation of continuing education opportunities for practicing nurses. [J Contin Educ Nurs. 2023;54(11):501-508.].

Evaluation of the impact of redeployment during the COVID-19 pandemic: results from a multi-centre survey

Background

The COVID-19 pandemic brought unprecedented upheaval for healthcare systems globally. Rapid changes in the way nurses were asked to work brought about many challenges, especially with the requirement for nurses to move into intensive care and high dependency areas to deliver care for the increasing number of critically ill patients.

Aim

The purpose of this evaluation was to assess the impact of these changes on nurses who were redeployed during the first acute phase of the pandemic and explore factors associated with burnout.

Methods

A redeployment survey, containing 42 items in four domains (preparation for redeployment, safety and support, perceived competence, reflections and emotional impact) was administered online to nurses who had been redeployed in two hospitals in England, one urban and one rural. Bivariate correlations and a multiple linear regression model were conducted to explore associations between perceptions of leadership, training, communication and feeling valued with levels of emotional exhaustion.

Results

Valid responses were received from 240/618 (39%) nurses. The majority of respondents felt it was their duty to work where they were asked (79%), were prepared to work where needed (72%) and were consulted on changes to their working hours (55%). However, nurses were nervous about the new role (75%) and felt they had a lack of choice regarding redeployment (66%) and the way it was implemented (50%). Multiple regression analysis showed that lack of training (β = 0.18) and feeling undervalued (β = 0.48) was positively associated with emotional exhaustion, which accounted for 38% of the variance among redeployed nurses.

Conclusions

To mitigate the risk of nurses developing burnout as a result of redeployment, there is a need for training to upskill them so they feel competent in doing the changed role. Additionally, nursing leadership needs to support nurses feeling valued as individuals in their role.

Canadian respiratory therapists who considered leaving their clinical position experienced elevated moral distress and adverse psychological and functional outcomes during the COVID-19 pandemic

INTRODUCTION

Respiratory therapists (RTs) faced morally distressing situations throughout the COVID-19 pandemic, including working with limited resources and facilitating video calls for families of dying patients. Moral distress is associated with a host of adverse psychological and functional outcomes (e.g. depression, anxiety, symptoms of posttraumatic stress disorder [PTSD] and functional impairment) and consideration of position departure. The purpose of this study was to understand the impact of moral distress and its associated psychological and functional outcomes on consideration to leave a clinical position among Canadian RTs during the COVID-19 pandemic.

METHODS

Canadian RTs (N = 213) completed an online survey between February and June 2021. Basic demographic information (e.g. age, sex, gender) and psychometrically validated measures of moral distress, depression, anxiety, stress, PTSD, dissociation, functional impairment, resilience and adverse childhood experiences were collected.

RESULTS

One in four RTs reported considering leaving their position. RTs considering leaving reported elevated levels of moral distress and adverse psychological and functional outcomes compared to RTs not considering leaving. Over half (54.5%) of those considering leaving scored above the cut-off for potential diagnosis of PTSD. Previous consideration to leave a position and having left a position in the past each significantly increased the odds of currently considering leaving, along with system-related moral distress and symptoms of PTSD, but the contribution of these latter factors was small.

CONCLUSIONS

Canadian RTs considering leaving their position reported elevated levels of distress and adverse psychological and functional outcomes, yet these individual-level factors appear unlikely to be the primary factors underlying RTs' consideration to leave, because their effects were small. Further research is required to identify broader, organizational factors that may contribute to consideration of position departure among Canadian RTs.

Implementing Brief Mindfulness-Based Interventions to Reduce Compassion Fatigue

BACKGROUND

Nurses in surgical-trauma units are susceptible to compassion fatigue due to work-related stressors. Mitigating and preventing compassion fatigue are critical to supporting the health and well-being of surgical-trauma nurses.

LOCAL PROBLEM

During the COVID-19 pandemic, a surgical-trauma unit was converted to a designated COVID-19 unit. Nurses verbalized feelings of burnout and stress during the pandemic and did not have a mechanism to cope with work-related stress. This project evaluated the impact of brief mindfulness-based interventions on compassion fatigue.

METHODS

From February 2021 to March 2022, mindfulness champions led 5 minutes of mindfulness-based interventions, including meditation, deep breathing, and self-compassion exercises, during shift huddles. The Professional Quality of Life, version 5, questionnaire was used to evaluate preintervention and postintervention burnout, secondary traumatic stress, and compassion satisfaction. Paired-sample t tests were used to evaluate the results.

RESULTS

Twenty-nine of 34 nurses responded (85% response rate) with matched preintervention and postintervention questionnaires. All subscale scores showed significant improvement after intervention. The mean burnout subscale score decreased by 9.35% (P = .003), mean secondary traumatic stress subscale score decreased by 11.89% (P = .005), and mean compassion satisfaction subscale score increased by 6.44% (P = .03) after intervention.

DISCUSSION

After implementing brief mindfulness-based interventions in shift huddles, nurses reported reductions in elements of compassion fatigue (burnout and secondary traumatic stress). Nurses reported that adding brief mindfulness-based interventions to shift huddles helped them cope with work-related stress.

CONCLUSIONS

Brief mindfulness-based interventions can improve nurses' compassion satisfaction while reducing compassion fatigue measurements.

Being a Hospice Nurse in Times of the COVID-19 Pandemic: A Phenomenological Study of Providing End-of-Life Care

End-of-life care changed during the COVID-19 pandemic, and the previous prevailing hospice philosophy and essential values of hospice care were suddenly under pressure. The aim was to explore hospice nurses' lived experience of providing end-of-life care to patients admitted in an out-hospital hospice setting during the COVID-19 pandemic. Data consist of 10 individual in-depth interviews of hospice nurses. A purposive sampling strategy was used, and the data collection and analysis was guided by a descriptive phenomenology. Providing end-of-life care was described through an existential dimension and a practical-related dimension. The pandemic and the ensuing constraints created an unfamiliar gap, triggering insecurity and unfamiliarity within nursing. Findings are elaborated in the following constituents: being a hospice nurse and providing end-of-life care. The latter constituent was further elucidated in additional perspectives: a new job position and bending the rules. Providing end-of-life care during the COVID-19 regime was a highly challenging and distressing experience due to the coercion of maintaining rules and restrictions as well as providing care. An experience of having to reinvent and work within a new agenda was present. Furthermore, the nurses experienced significant loss of job satisfaction and may be morally injured as well as highly exposed to secondary traumatization.

Nursing students' perceived stress, social support, self-efficacy, resilience, mindfulness and psychological well-being: A structural equation model

Nursing students' stress, protective factors (e.g. resilience, social support, mindfulness and self-efficacy) and psychological well-being (PWB) have been well reported in the literature. However, the interactions of these variables were scarcely examined in the latter part of the COVID-19 pandemic and in the context of a developing country. This cross-sectional correlational study complying with STROBE guidelines tested a hypothetical model of the interrelationships of nursing students' stress, protective factors and PWB using structural equation modelling (SEM). Nursing students (n = 776) from five nursing schools in the Philippines were conveniently recruited from September 2022 to January 2023. Six validated self-report scales (Perceived Stress Scale, Multi-dimensional Scale of Perceived Social Support, Generalized Self-Efficacy Scale, Connor-Davidson Resilience Scale, Mindful Attention Awareness Scale, and Psychological Wellbeing Scale) were used to collect data. SEM, mediation analyses and path analyses were used for data analysis. The emerging model demonstrated acceptable model fit parameters. Stress negatively impacted protective factors, while all the protective factors positively influenced PWB. Social support mediated the influence of stress on resilience, mindfulness and PWB. Resilience is a significant mediator of stress, self-efficacy, social support and PWB. Mindfulness mediated the influence of stress, social support and self-efficacy on PWB. Finally, self-efficacy had a mediating role between resilience and mindfulness. Nursing institutions and nurse educators can use the proposed model as their basis for empirical and theoretical evidence in creating programmes that will strengthen nursing students' protective factors, thus reducing stress while improving PWB and learning outcomes.

Were the unfinished nursing care occurrence, reasons, and consequences different between COVID-19 and non-COVID-19 patients? A systematic review

BACKGROUND

Unfinished Nursing Care (UNC) has been documented also during the Coronavirus (COVID-19) pandemic; however, while several secondary studies were conducted before this period to summarise occurrences, reasons, and consequences of UNC and provide a global picture of the phenomenon, no synthesis of the evidence produced during the pandemic has been documented to date. Therefore, the aim of this review is to identify differences, if any, in the UNC occurrence, reasons, and consequences perceived by nurses caring for COVID-19 and non-COVID-19 patients.

METHODS

This study is a systematic review (PROSPERO CRD42023410602). According to the Population, Exposure, Comparator, and Outcomes framework, primary comparative cross-sectional, longitudinal, and cohort studies, randomised/non-randomised controlled trials were included from Medline, CINAHL, and Scopus, collecting perceptions of nurses with tools measuring UNC between COVID-19 and non-COVID-19 patients and published in English, Italian, or Turkish. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline and Johanna Briggs Quality Appraisal Tool were used, and findings were summarised narratively.

RESULTS

Five hospital-based cross-sectional studies using the self-administered MISSCARE and UNC Survey comparing data collected (a) before the pandemic vs. in the first wave; (b) before, in the second and in the third wave; and (c) simultaneously among COVID-19 and non-COVID-19 patients in the second wave. Three main patterns emerged suggesting a higher UNC occurrence among COVID-19 patients in the first wave, less occurrence among them compared to non-COVID-19 patients in the second wave, and contrasting findings with some in favour and others in contrast to COVID-19 patients. Similar patterns emerged regarding UNC reasons while no studies investigated the UNC consequences.

CONCLUSIONS

In the first wave, COVID-19 patients were likely to be at increased risk of UNC, while in later waves non-COVID-19 patients were at increased risk of UNC. Reasons also were different across waves. Findings documented during the COVID-19 pandemic may help to prevent UNC in future disasters.

The role of ethical leadership and social networks in the promotion of workplace happiness and quality of care: A cross-sectional study

This study examines the sequential effects of perceived ethical leaders and the strength of social networks among healthcare professionals on the perceived workplace happiness of healthcare professionals and its impacts on the quality of provided care. We conduct a partial least squares (PLS) analysis to estimate the relationship between the variables. Data comes from a survey conducted to 321 healthcare professionals with primary/direct contact with patients working at Portuguese hospitals. We use previously validated scales in the literature for measuring the variables; ethical leadership, social network in the context of the workplace; satisfaction, engagement, and commitment as proxies of workplace happiness, and, quality of care provided to patients (the outcome of the research model). Results show that ethical leadership positively influences social networks, workplace happiness, and quality of provided care. Social networks also have a positive relationship with workplace happiness and quality of provided care. Additionally, the workplace happiness of healthcare professionals positively influences the quality of provided care to patients. Our work addresses a diverse research gap regarding hospitals' ethical and social environment and hospital performance. Specifically, the empirical operationalisation of ethical leadership fights a literature gap in healthcare management. Moreover, we report evidence on the influence of antecedents, but also the performance consequences, of workplace happiness in healthcare environments. Our findings contribute to the literature while providing managerial implications for healthcare settings.

Effects of eHealth interventions on stress reduction and mental health promotion in healthcare professionals: A systematic review

AIMS

To evaluate the effectiveness of eHealth interventions to reduce stress and promote mental health in healthcare professionals, and to compare the efficacy of different types of programs (guided vs. self-guided; 'third-wave' psychotherapies vs. other types).

BACKGROUND

Healthcare workers present high levels of stress, which constitutes a risk factor for developing mental health problems such as depression and anxiety. eHealth interventions have been designed to reduce these professional's stress considering that the characteristics of this delivery method make it a cost-effective and very appealing alternative because of its fast and easy access.

DESIGN

A systematic review of quantitative studies.

METHODS

A comprehensive database search for quantitative studies was conducted in PubMed, EMBASE and Cochrane (until 1 April 2022). The systematic review was conducted in accordance with the PRISMA and SWiM reporting guidelines. The quality of the studies was assessed using the National Heart, Lung and Blood Institute tools.

RESULTS

The abstracts of 6349 articles were assessed and 60 underwent in-depth review, with 27 fulfilling the inclusion criteria. The interventions were classified according to their format (self-guided vs. guided) and contents ('third-wave' psychotherapies vs. others). Twenty-two interventions emerged, 13 of which produced significant posttreatment reductions in stress levels of health professionals (9 self-guided, 8 'third wave' psychotherapies). Significant effects in improving depressive symptomatology, anxiety, burnout, resilience and mindfulness, amongst others, were also found.

CONCLUSION

The evidence gathered in this review highlights the heterogeneity of the eHealth interventions that have been studied; self-guided and 'third-wave' psychotherapy programs are the most common, often with promising results, although the methodological shortcomings of most studies hinder the extraction of sound conclusions.

PROTOCOL REGISTRATION

PROSPERO CRD42022310199. No Patient or Public Contribution.

Influence of Sociodemographic, Organizational, and Social Factors on Turnover Consideration Among Eldercare Workers: A Quantitative Survey

Staff turnover in long-term care (LTC) is considered one of the main causes of staff shortages and a key problem for LTC systems in the developed world. Factors affecting staff turnover in LTC facilities are poorly understood due to a fragmented approach. The aim of this study was to use multivariate analysis to identify the factors at the macro-, meso-, and micro-level that influence LTC workers' turnover in Slovenia, a typical Central and Eastern European country. A correlational cross-sectional survey design with a self-reported online questionnaire was used among Slovenian LTC workers (N = 452). The results show that more than half of LTC workers intend to quit their jobs and leave the LTC sector. LTC workers who intend to leave are generally younger, have worked in the LTC sector for a shorter period, are mainly employed in the public sector, especially in nursing homes, and earn less. The connection between the intention to leave and the factors at the macro-, meso-, and micro-level is very high. Over 75% of the variance of intention to leave was explained by the linear influence of sociodemographic characteristics, social recognition, and work environment. Urgent measures for improving the work environment are needed.

Job satisfaction and moral distress of nurses working as physician assistants: focusing on moderating role of moral distress in effects of professional identity and work environment on job satisfaction

BACKGROUND

Physician assistant was created in response to a shortage of physicians. However, this profession is not officially recognized in Korea. Many nurses are working as physician assistants. Their job satisfaction was low due to role conflict. Job satisfaction plays a major role in providing high quality nursing. This study aimed to investigate effects of work environment and professional identity on job satisfaction and identify the mediating role of moral distress in such effects.

METHODS

Participants were 112 nurses working as physician assistants. They were recruited from three General Hospitals. A questionnaire scale was used to collect data. Data were analyzed using frequency, descriptive statistics, independent t-test, one-way ANOVA, Pearson correlation, and Macro Model 4 with SPSS Statistics.

RESULTS

Job satisfaction of nurses working as physician assistants had a score of 3.08 out of 5. It showed significant associations with work environment and professional identity. Moral distress had a partial mediating role in relationships of job satisfaction with work environment and professional identity.

CONCLUSION

Many nurses are working as physician assistants, although physician assistant as a profession is not officially recognized in Korea. Nurses working as physician assistants experience confusion about their professional identity and moral distress. For better nursing outcomes, physician assistant policy should be improved, and various strategies should be provided to improve their job satisfaction.

Burnout status, occupational satisfaction, and intention to leave the profession of nurses during the COVID-19 pandemic period; The Case of Turkey

We examined the burnout status, professional satisfaction and intention to leave the profession of nurses who are actively working in Turkey during the COVID-19 pandemic period. We conducted the descriptive study with 371 nurses and collected using Copenhagen Burnout Scale (CBS), Occupational satisfaction scale (OSS) and Intention to leave the profession scale (ILPS). In this study, nurses showed a high level of exhaustion and intention to leave work, and a low level of occupational satisfaction. In the fight against COVID-19, the continuity of health services, at the same time, in order to provide adequate quality and safe health care, reducing working hours, bringing the shifts to an appropriate and reasonable time, improving the working environment and approaches that will increase their motivation and professional satisfaction are important to prevent nurses from experiencing burnout and to keep them in their professions and workplaces.

Associations of health care staff burnout with negative health and organizational outcomes in the U.S. military health system

RATIONALE

Burnout is a personal and occupational phenomenon that has been associated with negative physical and psychological outcomes in medical staff. Additionally, there are implications for healthcare organizations, as those staff who are burned out are more likely to have lower productivity or leave the organization. As with the Covid-19 pandemic, future national emergencies and potentially large-scale conflicts will require similar and likely even larger scale responses from the U.S. Military Health System, thus it is important to understand burnout in this population so that the readiness of the staff and the military can remain at a high level.

OBJECTIVE

This assessment was designed to examine levels of burnout among United States Military Health System (MHS) staff working at Army installations and the factors that influence the development of burnout.

METHODS

Anonymous data was collected from 13,558 active-duty U.S. Soldiers and civilian MHS employees. Burnout was measured using the Copenhagen Burnout Inventory and the Mini-Z.

RESULTS

Results showed nearly half of staff who responded (48%) reported being burned out, an increase since last measured in 2019 (31%). Factors related to increased burnout included concerns about work/life balance and workload, low job satisfaction and feeling disconnected from others. Burnout was associated with increases in adverse physical and behavioral health (BH) outcomes.

CONCLUSIONS

Results indicate that burnout is a common problem across MHS Army staff and is related to significant adverse health consequences for the individual and reduced retention of staff for the organization. These findings highlight the need to address burnout through policies that standardize health care delivery policies and practices, providing support to leadership to promote a healthy workplace, and individual support to those who experience burnout.

Anxiety, depression, and insomnia among nurses during the full liberalization of COVID-19: a multicenter cross-sectional analysis of the high-income region in China

Introduction

Frontline nurses fighting against the epidemic were under great psychological stress. However, there is a lack of studies assessing the prevalence rates of anxiety, depression, and insomnia among frontline nurses after the full liberalization of COVID-19 in China. This study demonstrates the impact of the full liberalization of COVID-19 on the psychological issues and the prevalence rate and associated factors of depressive symptoms, anxiety, and insomnia among frontline nurses.

Methods

A total of 1766 frontline nurses completed a self-reported online questionnaire by convenience sampling. The survey included six main sections: the 9-item Patient Health Questionnaire (PHQ-9), the 7-item Generalized Anxiety Disorder (GAD-7), the 7-item Insomnia Severity Index (ISI), the 10-item Perceived Stress Scale (PSS-10), sociodemographic information, and work information. Multiple logistic regression analyses were applied to identify the potential significantly associated factors for psychological issues. The study methods were compliant with the STROBE checklist.

Results

90.83% of frontline nurses were infected with COVID-19, and 33.64% had to work while infected COVID-19. The overall prevalence of depressive symptoms, anxiety and insomnia among frontline nurses was 69.20%, 62.51%, and 76.78%, respectively. Multiple logistic analyses revealed that job satisfaction, attitude toward the current pandemic management, and perceived stress were associated with depressive symptoms, anxiety, and insomnia.

Conclusions

This study highlighted that frontline nurses were suffering from varying degrees of depressive symptoms, anxiety, and insomnia during full liberalization of COVID-19. Early detection of mental health issues and preventive and promotive interventions should be implemented according to the associated factors to prevent a more serious psychological impact on frontline nurses.

Gender and intention to leave healthcare during the COVID-19 pandemic among U.S. healthcare workers: A cross sectional analysis of the HERO registry

IMPORTANCE

The COVID-19 pandemic stressed the healthcare field, resulting in a worker exodus at the onset and throughout the pandemic and straining healthcare systems. Female healthcare workers face unique challenges that may impact job satisfaction and retention. It is important to understand factors related to healthcare workers' intent to leave their current field.

OBJECTIVE

To test the hypothesis that female healthcare workers were more likely than male counterparts to report intention to leave.

DESIGN

Observational study of healthcare workers enrolled in the Healthcare Worker Exposure Response and Outcomes (HERO) registry. After baseline enrollment, two HERO 'hot topic' survey waves, in May 2021 and December 2021, ascertained intent to leave. Unique participants were included if they responded to at least one of these survey waves.

SETTING

HERO registry, a large national registry that captures healthcare worker and community member experiences during the COVID-19 pandemic.

PARTICIPANTS

Registry participants self-enrolled online and represent a convenience sample predominantly composed of adult healthcare workers.

EXPOSURE(S)

Self-reported gender (male, female).

MAIN OUTCOME

Primary outcome was intention to leave (ITL), defined as having already left, actively making plans, or considering leaving healthcare or changing current healthcare field but with no active plans. Multivariable logistic regression models were performed to examine the odds of intention to leave with adjustment for key covariates.

RESULTS

Among 4165 responses to either May or December surveys, female gender was associated with increased odds of ITL (42.2% males versus 51.4% females reported intent to leave; aOR 1.36 [1.13, 1.63]). Nurses had 74% higher odds of ITL compared to most other health professionals. Among those who expressed ITL, three quarters reported job-related burnout as a contributor, and one third reported experience of moral injury.

CONCLUSIONS AND RELEVANCE

Female healthcare workers had higher odds of intent to leave their healthcare field than males. Additional research is needed to examine the role of family-related stressors.

TRIAL REGISTRATION

ClinicalTrials.gov identifier NCT04342806.

The Impact of a Psychoeducational Group Program on the Mental Well-Being of Unit-Based Nurse Leaders: A Randomized Controlled Trial

This randomized controlled trial examined the impact of a psychoeducational group program on the mental well-being of unit-based nurse leaders, specifically nurse managers and assistant nurse managers. The program was developed around the themes of resilience, insight, self-compassion, and empowerment to fight burnout and enhance purposeful adaptive coping to reduce distress and improve mental wellbeing. The sample included 77 unit-based nurse leaders. Outcomes included post-traumatic growth, resilience, insight, self-compassion, empowerment, perceived stress, burnout, and job satisfaction. Paired samples t-tests and repeated measures ANOVA tests were conducted to compare outcomes at baseline to the follow-up timepoints of endpoint, one-month follow-up, three-month follow-up, and six-month follow-up. The intervention group participants showed significant improvement in post-traumatic growth between baseline and all follow-up timepoints compared to the waitlist control group. Among intervention group participants, there were also significant improvements in self-reflection and insight, self-compassion, psychological empowerment, and compassion satisfaction, as well as significant reductions in perceived stress, burnout, and secondary traumatic stress. This study extends existing evidence that this psychoeducational group program can be an effective intervention for improving and protecting mental wellbeing. Among nurse leaders, it can reduce stress and burnout and improve post-traumatic growth, self-reflection and insight, self-compassion, psychological empowerment, and compassion satisfaction.

Staff quality of working life and turnover intentions in municipal nursing care and social welfare: a cross-sectional study

BACKGROUND

Nurses and social workers are two common professions with a university degree working within municipal nursing care and social welfare. Both groups have high turnover intention rates, and there is a need to better understand their quality of working life and turnover intentions in general and more specifically during the Covid-19 pandemic. This study investigated associations between working life, coping strategies and turnover intentions of staff with a university degree working within municipal care and social welfare during the Covid-19 pandemic.

METHODS

A cross-sectional design; 207 staff completed questionnaires and data were analyzed using multiple linear regression analyses.

RESULTS

Turnover intentions were common. For registered nurses 23% thought of leaving the workplace and 14% the profession 'rather often' and 'very often/always'. The corresponding figures for social workers were 22% (workplace) and 22% (profession). Working life variables explained 34-36% of the variance in turnover intentions. Significant variables in the multiple linear regression models were work-related stress, home-work interface and job-career satisfaction (both for the outcome turnover intentions profession and workplace) and Covid-19 exposure/patients (turnover intentions profession). For the chosen coping strategies, 'exercise', 'recreation and relaxation' and 'improving skills', the results (associations with turnover) were non-significant. However, comparing the groups social workers reported that they used 'recreation and relaxation' more often than were reported by registered nurses.

CONCLUSIONS

More work-related stress, worse home-work interface and less job-career satisfaction together with Covid-19 exposure/patients (Covid-19 only for turnover profession) increase turnover intentions. Recommendations are that managers should strive for better home-work interface and job-career satisfaction, monitor and counteract work-related stress to prevent turnover intentions.

How nursing students' risk perception affected their professional commitment during the COVID-19 pandemic: the mediating effects of negative emotions and moderating effects of psychological capital

Nurses play a pivotal role in the delivery of medical services. Professional commitment is crucial for nursing professionals' long-term, healthy, and sustainable development. However, nursing students' professional commitment levels are currently unsatisfactory in China, especially given that the COVID-19 pandemic has posed unprecedented challenges to the profession. Therefore, studies investigating the professional commitment levels of nursing students and the underlying influencing factors are urgently required. This study explored how nursing students' risk perceptions, negative emotions, and psychological capital affected their professional commitment during the COVID-19 pandemic. A cross-sectional study was conducted among nursing students using risk perception, professional commitment, negative emotions, and psychological capital scales. An analysis of 1142 Chinese nursing students suggested that nursing students' risk perception positively impacted professional commitment and that negative emotions mediated this association. Importantly, psychological capital moderates the mediating effect of negative emotions and can buffer the negative emotions caused by risk perception. This study demonstrated that effective intervention strategies should be implemented in multiple dimensions such as education, individual, public and society to improve the professional commitment of nursing students.

Psychological capital, grit and organizational justice as positive strengths and resources among registered nurses: A path analysis

AIM

To examine registered nurses' individual strengths (psychological capital and grit) and an organizational resource (organizational justice) as well as associated work-related outcomes. In a time of a global nursing shortage, there is an urgent need to identify strengths and resources that can have a positive impact on the health, well-being and retention of registered nurses.

DESIGN

A cross-sectional survey.

METHODS

A nationwide convenience sample of 514 registered nurses responded to a survey. Data were collected using a self-reported questionnaire between March and May 2018. Data were analysed using descriptive statistics and multivariate path analysis.

RESULTS

Participants rated their psychological capital and grit moderately high. Grit and organizational justice were found to have significant direct effects on psychological capital. Furthermore, psychological capital had positive direct effects on engagement and the perception of well-conducted everyday nursing as well as negative direct effects on burnout, the stress of conscience and the intent to leave the profession.

CONCLUSION

The results suggest that nurse leaders and managers could consider improving registered nurses' well-being with two complementary approaches. It might be useful to reinforce positive, individual strengths, such as psychological capital, and at the same time create more favourable nursing work environments, for example by strengthening organizational justice.

IMPLICATIONS FOR THE PROFESSION

Psychological capital and grit are emerging concepts in nursing workforce research. Identifying registered nurses' positive strengths and resources is important for inventing interventions that enhance nurses' engagement and well-being as well as reduce turnover intentions.

IMPACT

Nurse leaders and managers play crucial roles in managing and developing registered nurses' individual strengths and organizational resources. This has gained even more importance now as the COVID-19 pandemic could have a long-term negative impact on nurses' well-being.

REPORTING METHOD

The study is reported following STROBE guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

COVID-19 pandemic increases the occurrence of nursing burnout syndrome: an interrupted time-series analysis of preliminary data from 38 countries

AIM

To evaluate the trends in nursing burnout rates before and during the coronavirus 2019 restrictions.

METHOD

Meta-analysis was used to extract the data on global nursing burnout from 1 Jan. 2010-15 Dec. 2022. An interrupted time-series analysis using segmented ordinary least squares (OLS) regression models was used to explore if the nursing burnout were affected by the epidemic. Newey-West standard error was used to adjust for autocorrelation and heteroskedasticity.

RESULTS

Before the epidemic (April 2020), the nursing burnout rate rose with 0.0007497 (95% CI: 0.0000316, 0.0014677, t = 2.07, P = 0.041) per month. The trend of nursing burnout rate has increased by 0.0231042 (95 CI%:0.0086818, 0.0375266, t = 3.18, P = 0.002). The increasing trend of nursing burnout rate after the COVID-19 restrictions is 0.0007497 + 0.0231042 = 0.0238539 per month.

CONCLUSION

The study indicated that the Covid-19 restrictions had an impact on nursing burnout, increasing the occurrence of nursing burnout syndrome.

The Motivation of Medical Staff and the Work Interestedness in the Context of the COVID-19 Pandemic, in a Tertiary Hospital in Romania

The purpose of this study was to evaluate the impact of the COVID-19 pandemic on the motivation and work interestedness of employees in a tertiary hospital located in the northwest of Romania. In the study, 2230 employee satisfaction questionnaires distributed during 2019–2021 in the Oradea Emergency County Clinical Hospital (CCEHO) were analyzed. The percentage of those who declare themselves motivated at the hospital level remains relatively constant, at around 75%. There were differences between staff categories. The percentage of those who evaluate work interestedness with the qualifier “high” decreased from 45.45% for the year 2019 to 41.78% for the year 2021. The degree of motivation and work interestedness showed a significant increase for TESA staff during the pandemic period compared to the year 2019. A non-significant statistical increase in the percentage of motivated staff was observed among physicians, auxiliary staff and the radiology department staff. The motivation of nurses and laboratory staff decreased, but statistically insignificantly. The COVID-19 pandemic brought statistically significant changes at the level of motivation of the hospital staff only for the administrative staff, and the work interestedness for physicians and nurses decreased statistically significantly, especially in the second year of the pandemic. Older staff with an average level of education are more likely to be unmotivated, as shown by the regression model.

Uncovering the Experience: Return to Work of Nurses After Parental Leave

INTRODUCTION

To understand the experiences of emergency nurses who have returned to work after parental leave, specifically relating to the return to work transition, work-life balance, work engagement, and opportunities to continue human milk expression.

METHODS

Nurses (N = 19) were recruited from 5 emergency departments within 1 hospital system in the United States Midwest. Nurses (n = 11) were eligible to participate in a one-on-one interview if they had returned from parental leave within 6 months of the interview date. Nurses (n = 8) were eligible to participate in a focus group if they had returned from parental leave within 2 years of the interview date. Interviews were structured and data collection concluded when researchers believed data saturation was reached. Interviews were audio recorded and transcribed verbatim. Data were analyzed using Braun and Clarke's qualitative thematic analysis 6-phase framework.

RESULTS

Three major themes from the data were identified: (1) work engagement, (2) lactation, and (3) childcare. Work engagement was broken down into the subthemes: lack of communication, perceived engagement expectations, and actual engagement. Lactation was broken down into the subthemes: the act of pumping, lactation breaks, and lactation rooms. The coronavirus disease 2019 pandemic impact on return-to-work is described under each major theme.

DISCUSSION

Our findings provide insight into the unique challenges and experiences of nurses navigating parental leave and return-to-work in the emergency department. Strategies such as provision of managerial check-ins, return to work reorientation, lactation break coverage, enhanced supplementary lactation support, and leadership-provided accommodation may lighten the burden of these challenges and improve the returning nurse's job satisfaction.