Association between ethical leadership, ethical climate and organizational citizenship behavior from nurses' perspective: a descriptive correlational study

A National Study of Travel and Nontravel Nurses' Perceptions of the Work Environment

OBJECTIVE

To determine differences between travel (TNs') and nontravel nurses' (non-TNs') perceptions of their work environment and ethical work climate.

BACKGROUND

In the wake of the global pandemic, TNs continue to be a part of the healthcare workforce, yet little is known about them or their workplace perceptions.

METHODS

A cross-sectional, descriptive study was conducted in spring 2024 with 2201 RNs comparing TNs (n = 615) and non-TNs (n = 1586) from 7 US healthcare organizations. Perceptions of the health and ethicality of the work environment were measured.

RESULTS

Researchers found no meaningful differences between groups in the overall perceptions of the work environment. The mean responses indicated that a healthy work environment was not present for either group. Moderate positive correlations were noted between ethical work climate questions and healthy work environment standards.

CONCLUSIONS

These findings supplement the limited literature on the work experience of TNs. Future research is needed on TNs to further understand their perceptions of the work environment and ethical work climate particularly in contrast to non-TNs to inform nurse leader practice.

The relationship between ethical leadership, moral sensitivity, and moral courage among head nurses

BACKGROUND

Moral courage is a key factor in accelerating the implementation of moral behavior. Effective ethical leadership can enhance head nurses' moral competence-particularly moral sensitivity, which serves as a cornerstone of the moral decision-making process. However, there is limited evidence on how ethical leadership influences moral courage. This study aimed to examine the mediating role of moral sensitivity in the relationship between ethical leadership and moral courage among head nurses in China.

METHODS

A cross-sectional study was conducted between April and May 2024. The study sample consisted of 202 head nurses who agreed to participate in the study. Data were collected using the Ethical Leadership Scale, the Moral Sensitivity Scale, and the Moral Courage Scale.

RESULTS

A total of 212 head nurses participated in this study. The total scores of ethical leadership, moral sensitivity and moral courage of Chinese head nurses were 92.66(16.34), 45.05(6.40) and 84.64(14.84), respectively. Ethical leadership was positively correlated with moral sensitivity (r = 0.16, P < 0.05), ethical leadership was positively correlated with moral courage (r = 0.32, P < 0.01), and moral sensitivity was positively correlated with moral courage (r = 0.31, P < 0.01). Process analysis showed that ethical leadership enhanced the moral courage of head nurses through moral sensitivity, which was a partial mediating effect model, and the total indirect effect accounted for 13.79%.

CONCLUSIONS

This study demonstrates that ethical leadership significantly enhances head nurses' moral sensitivity and courage, with moral sensitivity serving as a critical mediating factor. The study reveals a cascade effect: the moral quality of senior managers shapes the ethical standards of head nurses, and then affects the behavior of clinical nurses, and ultimately forms the ethical organizational culture.

CLINICAL TRIAL NUMBER

Not applicable.

Promoting Employee Organizational Citizenship Behavior (OCB) in Small- and Medium-Sized Enterprises: A Cognitive and Affective Perspective on Ethical Leadership

Compared to the formal rules and regulations of large companies, leadership behavior has a greater influence on employee behaviors in small and medium enterprises (SMEs). Unlike large enterprises, many SMEs have a weaker market position, and their survival and development depend on employees' willingness to make additional efforts beyond their formal job duties. Thus, this study focuses on SME employees to explore the effect of ethical leadership on subordinates' organizational citizenship behavior (OCB). This study proposes a multilevel mediating model, where ethical climate and ethical role modeling represent cognitive social learning perspectives at the team and individual levels, respectively, while affective well-being serves as an individual-level affective perspective. A total of 426 valid questionnaires from 71 teams were collected, and MPLUS was used to verify the study hypotheses. The results indicate that (1) ethical leadership has a significant positive impact on employee OCB; (2) ethical leadership also significantly affects team ethical climate, ethical role modeling, and affective well-being; and (3) the partial mediating effects of team ethical climate, ethical role modeling, and affective well-being are confirmed. This research provides empirical evidence for the mechanism between ethical leadership and employee OCB in SMEs.

Organizational citizenship behavior of clinical nurses: A systematic review and meta-analysis

BACKGROUND

Organizational citizenship behavior can improve work efficiency and employee participation. This study systematically evaluated the level of organizational citizenship behavior of clinical nurses and meta-analysis the factors that affect it in terms of personal characteristics. The conclusions provide valuable recommendations for nursing managers to focus on cultivating organizational citizenship behavior.

METHODS

Adhering to the preferred reporting items for Systematic Reviews and Meta-analyses guidelines, we searched PubMed, Cochrane Library, Web of Science, Embase, ScienceDirect, Wiley Online Library, Scopus, China National Knowledge Infrastructure, SinoMed, Wanfang and VIP 11 databases from the inception of the databases until November 2023. Subsequently, 2 researchers independently screened the literature, extracted data, and evaluated the risk of bias in the included studies. Meta-analysis was performed using Stata 15.0 and RevMan 5.4 software.

RESULTS

Twenty cross-sectional studies were included. The sample comprised 8657 nurses. The results of the meta-analysis showed that marital status, employment types, participation in mental health-related training, professional titles, and years of work experience affected nurses' organizational citizenship behavior were the influencing factors of nurses' organizational citizenship behavior (P < .05).

CONCLUSION

The findings suggest that the level of organizational citizenship behavior among nurses is relatively high, but it still needs to be maintained. This result suggests that nursing managers should pay more attention to cultivating nurses' organizational citizenship behavior to improve organizational efficiency and further improve the quality of high-quality nursing services.

Unethical conduct as a multifaceted phenomenon in psychiatric care: Nurse leaders' perspectives

Background: Mental healthcare can be considered a unique practice due to its ethical characteristics, and an awareness of ethics is crucial when working in a mental health setting. Several ethical challenges exist, and professionals may not always recognize the ethical aspects of psychiatric care. Research on psychiatric care from nurse leaders' perspective is scarce but important, because nurse leaders can impact and cultivate workplace culture. Aim: To explore the phenomenon of unethical conduct in a psychiatric inpatient context from nurse leaders' perspectives. Research design: Qualitative exploratory design. In-depth semi-structured interviews. Participants and research context: Eight nurse leaders from two different healthcare organizations in Finland. Leadership experience ranged between 2 and 30 years. Ethical considerations: Research ethics permission was received from a Research Ethics Board where the researchers are domiciled. Guidelines on good scientific practice as delineated by the Finnish Advisory Board on Research Integrity TENK were followed. Findings: Six main categories were generated: Unethical conduct and violations against patients, Unethical conduct and violations against staff, Unethical conduct and violations by staff against other staff, Unethical conduct and violations against leaders, Reasons underlying unethical conduct, and Consequences of unethical conduct and the positive development of psychiatric care. Conclusions: Unethical conduct was seen to be a multifaceted phenomenon, and patients and staff alike can experience and engage in unethical conduct. Unethical conduct against patients was linked to power imbalance (nature of involuntary care, staff attitudes) and a focus on rules based in historical precedent (paternalistic, routine-focused, not patient-centered). Unethical conduct against staff was linked to the nature of involuntary care and patient ill-health. Unethical conduct by staff against other staff was linked to a lack of understanding for others' work, interpersonal chemistry, (length of) work experience, and staff character. Unethical conduct against leaders was linked to leaders being perceived as the organization.

Managerial ethical principles and behaviours for nurse managers: A Delphi method

BACKGROUND

Managerial ethical principles and behaviours guide the roles, duties, responsibilities, behaviours, and relationships of nurse managers in healthcare institutions.

RESEARCH OBJECTIVES

The aim of this study was to establish the managerial ethical principles and behaviours for nurse managers.

RESEARCH QUESTION

What are the managerial ethical principles and behaviours for nurse managers?

RESEARCH DESIGN

The Delphi method, one of the qualitative research methods, was used in this study. The Delphi process consisted of two rounds. Data were collected by e-Delphi technique.

PARTICIPATIONS

42 experts were included in the first Delphi round and 39 in the second Delphi round. These experts consisted of nurse managers, academicians studying in the field of ethics and nursing management.

ETHICAL CONSIDERATIONS

Participation in the study was voluntary and informed consent of the experts was obtained before the study. Approval was obtained from the ethics committee of the university at which the researcher worked (Approval date: 24.07.2020, Decision No: 2020/12-16).

FINDINGS

At the end of the Delphi rounds, eight managerial ethical principles and 29 ethical behaviours of these principles were identified. The distribution of these behaviours and principles were: justice (six behaviours), equality (two behaviours), honesty (two behaviours), fairness (two behaviours), responsibility (eight behaviours), confidentiality (two behaviours), clarity (two behaviours), and humanity (five behaviours).

CONCLUSION

These managerial ethical principles and behaviours are intended to guide nurse managers when providing nursing services but should be updated accordingly in line with changing conditions and developments.

Ethical leadership in health-care organizations - a scoping review

PURPOSE

The purpose of this study is to explore the impact of EL style on key variables in health-care settings. Very few studies investigate the impact and outcomes of EL on health-care organizations. Synthesis of evidence will assist health-care leaders in making informed decisions about the outcomes they can expect from practicing EL.

DESIGN/METHODOLOGY/APPROACH

Arksey and O'Malley's five-stage framework is used for conducting the scoping review. The databases include Scopus, Emerald Insight and Web of Science.

FINDINGS

A total of 22 studies were finally considered for scoping review. The data are presented in terms of years, sampling techniques, sample size, data collection methods, and the directional relationship of the variables with EL.

PRACTICAL IMPLICATIONS

Managers should be trained in EL style as it promotes the sustainability of the environment and organizations. Furthermore, EL should be promoted in health-care organizations as it improves employee resilience and voicing behavior and reduces instances of adverse events and medication errors, thus making the hospital a better and safer place.

ORIGINALITY/VALUE

This is one of the studies investigating the EL implications for health-care managers.

Relationship between hospital ethical climate, critical thinking disposition, and nursing task performance

BACKGROUND

As ethical conflicts increase in the ever-changing healthcare field, nursing task performance, which is the overall ability of a nurse's professional knowledge, attitude, and skills, is important for patient health and safety, the provision of quality nursing care, and the appropriate resolution of nursing ethical problems. This study aimed to evaluate the mediating effect of critical thinking disposition on the relationship between hospital ethical climate and nursing task performance.

METHODS

A cross-sectional study was conducted. A total of a convenience sample of 200 clinical nurses from two Korean cities were recruited between November and December 2021. Direct questionnaires and online surveys were used to collect the data. The study variables were analyzed using descriptive statistics, correlations, and a model tested using the Hayes PROCESS macro (Model 4) mediation model.

RESULTS

The mean scores for hospital ethical climate, critical thinking disposition, and nursing task performance were 91.86 ± 11.29, 97.74 ± 10.70, and 138.58 ± 14.95, respectively. Hospital ethical climate and critical thinking disposition were positively correlated with nursing task performance. In the mediation test model, hospital ethical climate was found to be positively and significantly associated with nursing task performance (ß = 0.46, p < .001) with the mediation of critical thinking disposition (ß = 0.70, p < .001).

CONCLUSIONS

Hospital ethical climate and critical thinking disposition may be important determinants of task performance among clinical nurses. Hospital administrators should make efforts to create a more positive ethical climate in hospitals and conduct education and campaigns on a positive hospital ethical climate for hospital staff to improve nurses' performance.

A systematic review of leadership styles in healthcare sector: Insights and future directions

In light of the ongoing global health crisis, the significance of leadership within the healthcare sector has intensified. Given this consideration, the significance of appropriate leadership styles cannot be overstated. The objective of this paper is to critically review published studies on leadership elements in the healthcare sector. Using Bibliometrix R package and VOS viewer, we conducted bibliometric and network analyses on publications retrieved from the Web of Science (WOS) database, with content analysis integrated throughout the paper to deepen understanding. Ultimately, 243 articles were identified as relevant. The findings revealed transformational leadership emerges as the most extensively discussed leadership style. 91% of the articles' theme focus on quantitative research methods. This study synthesizes the influencing factors of the three most frequently discussed leadership styles-transformational, authentic, and ethical leadership-emphasizing the importance of job satisfaction and organizational citizenship behavior. And provides direction for future research through thematic analysis.

Transformational Leadership, Psychological Empowerment, and Organizational Citizenship Behaviors among Nursing Workforce: A Single Mediation Analysis

Aim

To explore the mediating effect of psychological empowerment in the association between transformational leadership and organizational citizenship behaviors in nursing context.

Background

Healthcare organizations worldwide are facing unprecedented challenges, necessitating effective leadership strategies to ensure quality patient care and organizational success. Transformational leadership has emerged as a tool to promote positive workplace behaviors, including organizational citizenship behaviors, among nursing staff. However, the mediating role of psychological empowerment in this relationship remains underexplored.

Methods

A cross-sectional survey was conducted from March 2023 until August 2023 involving 305 registered nurses at King Khalid Hospital to investigate the relationship among transformational leadership, psychological empowerment, and organizational citizenship behaviors. Validated scales were used to assess these variables. A single mediation analysis was conducted through processing macro version 3.5 model 4.

Results

This study found a strong positive association between transformational leadership and both psychological empowerment (r = 0.507, p < 0.001) and organizational citizenship behaviors (r = 0.445, p < 0.001) among nursing staff. Additionally, psychological empowerment partially mediated the relationship between transformational leadership and organizational citizenship behaviors, with a significant indirect effect (B = 0.110, CI: 0.058-0.166).

Conclusions

Transformational leadership positively impacted nurses' feelings of empowerment, which then led to higher exhibition of organizational citizenship behaviors. Implications for Nursing Management. Leadership development programs should prioritize the cultivation of transformational leadership qualities and support the psychological empowerment of nursing staff. This approach can enhance organizational effectiveness, foster positive workplace environments, and improve patient outcomes.

Ethical leadership behaviors of senior managers perceived by the junior managers working in public hospitals in Hail, Saudi Arabia

Objective

To examine junior managers experiences of ethical leadership behaviors exhibited by their senior managers.

Methods

In this cross-sectional study, 263 junior health care managers working in public hospitals in Hail, Saudi Arabia were surveyed using a self-administered questionnaire between 20 November, 2022 and 15 February, 2023. Descriptive statistics and regression analysis were employed in the analysis. Statistical Package for Social Sciences (SPSS) version 25 (IBM, Armonk, NY, USA) was used to conduct statistical analyses.

Results

The sample consisted of 118 men (44.9%) and the majority (66.6%) of the respondents were below the age of 36 years. In case of working environment, nearly 84% of the participants were satisfied with the relationships that they have had with their supervisors. Regression analysis indicate that women were more likely than men to experience healthy ethical leadership behaviors of their seniors (β = -0.163, p < 0.05). Ethical leadership behaviors of senior health care managers would not influence by the age or work experience of their juniors.

Conclusion

Ethical leadership behavior of senior health care managers was satisfactory. Longitudinal research is needed to investigate how cultural and environmental factors affect the ethical leadership behavior of healthcare managers in Saudi Arabia.

Reliability of Moral Distress Scale, Secondary Traumatic Stress Scale, and Jefferson Scale of Empathy Among Greek Nurses: A Pilot Study

Background and Purpose: Moral distress (MD), secondary traumatic stress (STS), and empathy are of particular interest to the nursing profession. The availability of validated tools for the assessment of these parameters is of high importance. The primary aim of this pilot study was to evaluate the reliability of the Greek version of the MD Scale or the revised version (MDS-R), the Jefferson Scale of Empathy for Health Professionals (JSE-HP), and the STS Scale (STSS) in Greek nurses working in open and psychiatric wards. Methods: To assess the reliability of scales, internal consistency (coefficient alphas) and test-retest (interclass correlation coefficients [ICCs]) were calculated. Results: A total of 38 nurses took part in the study. All scales and subscales presented excellent stability (.876 ≤ ICC ≤ .963, p < .0001) and acceptable to excellent internal consistency reliability (first measurement, .796 ≤ coefficient alpha ≤ .959; second measurement, .794 ≤ coefficient alpha ≤ .956). Conclusions: The Greek version of MDS-R, STSS, and JSE-HP may be proposed for the assessment of relevant variables in Greek nursing staff.

Ethical Leadership in LTC: From Caregivers' Customer Orientation to Senior's Satisfaction and Well-Being

Background

In response to the growth of the world's senior population, an investigation of ethical leadership on LTCs is needed, in particular in the impact it may have on customer orientation and on seniors' well-being.

Objective

We propose a model to identify the relationship between ethical leadership in LTCs and caregivers' customer orientation, and its influence on satisfaction with the service, satisfaction with life, and the quality of the interaction between caregivers and seniors.

Sampling

We present a matched sample of 277 caregivers and 277 elderly Brazilians, workers and seniors' in LTCs in Brazil. The minimum sample size was 222, determined using G-Power software version 3.1.9.2, based on the desired statistical power parameters and the number of predictors. Two structured questionnaires were developed, one for caregivers and the other for the elderly. 69 LTCs were contacted and 29 participated in the survey (10 nonprofit, 34.48%). Data were treated statistically using SEM modelling.

Results

We identified a positive influence of ethical leadership on caregivers' attitudes, favoring their orientation towards the seniors'. A positive relationship between customer-oriented caregivers and customer satisfaction, life satisfaction, and the quality of the senior's interaction. A customer-oriented caregiver exerts a mediating effect between ethical leadership and the seniors' related outcomes, making ethical leadership beneficial to seniors and their family members.

Conclusion

Ethical leadership favors successful management of LTCs, increasing customer orientation, and provides clues to establish a better causality and a chain of effects between leadership and senior-related outcomes. Therefore, LTCs may be the appropriate outlet for the role of ethics in leadership.

Practical Implications

This study provides managers with an understanding of the effects of ethical leadership in the context of LTCs, for both caregivers and seniors. The powerful effects of ethical leadership can be a stimulus to increase the role of ethics in LTCs, improving the quality of care, the well-being of the seniors, and, therefore, the human and financial performance of these institutions.

The associations between benevolent leadership, affective commitment, work engagement and helping behavior of nurses: a cross-sectional study

BACKGROUND

Benevolent leadership is common in organizations, including hospitals, and is known to have positive effects on employees. Yet, nursing literature lacks sufficient research on its relationships with nurses' behavior.

METHODS

In March to April 2022, a cross-sectional study was carried out involving 320 nurses employed across various hospitals in Sichuan Province, China. Benevolent leadership, affective commitment, work engagement, and helping behavior were evaluated using the Benevolent Leadership Scale, Affective Commitment Scale, Work Engagement Scale, and Helping Behavior Questionnaire, respectively. The study employed structural equation model and the bootstrap method to investigate the proposed relationships.

RESULTS

The SEM analysis results indicated a positive association between benevolent leadership and several outcomes among nurses. Specifically, benevolent leadership was found to be positively associated with nurses' affective commitment (β = 0.58, p < .001), work engagement (β = 0.02, p < .001), and helping behavior (β = 0.17, p = .001). Additionally, there was a significant indirect effect between benevolent leadership and nurses' work engagement through affective commitment (β = 0.08, p = .007) as well as between benevolent leadership and helping behavior through affective commitment (β = 0.16, p < .001).

CONCLUSIONS

This study's findings emphasize the crucial role of benevolent leadership in fostering nurses' positive attitudes and behaviors in the workplace. Hospital administrators could promote the benevolent leadership of head nurses to enhance nurses' affective commitment, work engagement, and helping behaviors.

Relationships between job burnout, ethical climate and organizational citizenship behaviour among registered nurses: A cross-sectional study

AIM

This study aimed to investigate the levels of nurses' organizational citizenship behaviour and the associations between job burnout and ethical climate with organizational citizenship behaviour.

BACKGROUND

Organizational citizenship behaviour improves adverse outcomes led by nursing shortage. However, the associations between three dimensions of job burnout and organizational citizenship behaviour are inconsistent, and little is known about whether ethical climate is related to organizational citizenship behaviour in nurses.

METHODS

In this cross-sectional study, 1157 nurses were selected using convenience sampling from April to October 2019. Self-report surveys assessed nurses' organizational citizenship behaviour, emotional exhaustion, depersonalization, personal accomplishment and perceptions of ethical climate.

RESULTS

Mean organizational citizenship behaviour was high among nurses. The regression model showed that job burnout and ethical climate explained an additional 38.6% of the variance in organizational citizenship behaviour over and above sociodemographic factors, with 44.9% of the total variance.

CONCLUSION

Nurses' organizational citizenship behaviour was at a relatively high level. Depersonalization was negatively associated with organizational citizenship behaviour while personal accomplishment and ethical climate were positively related to organizational citizenship behaviour. Therefore, nurse leaders are encouraged to take measures to help nurses reduce job burnout and create a favourable ethical climate for increasing nurses' organizational citizenship behaviour.

First, Be a Good Citizen: Organizational Citizenship Behaviors, Well-Being at Work and the Moderating Role of Leadership Styles

The study investigates the effect of organizational citizenship behavior (OCB) on well-being at work. The study further examines the moderating role of people and task-focused leadership styles between OCB on well-being at work. Individual-directed organizational citizenship behaviors (OCBI) and organizational-directed organizational citizenship behaviors (OCBO) will also be analyzed. A quantitative study was conducted and convenient sampling was adopted in selecting respondent workers (n = 200) in different Portuguese organizations. The results show that OCBs positively and significantly influence well-being at work. The strength of individual-directed organizational citizenship behaviors (OCBI) on well-being at work is stronger than that of organization-directed organizational citizenship behaviors (OCBO). Contrary to expectations, the relationship between leadership styles and well-being was not statistically significant, offering possibilities for discussion regarding the central importance usually attributed to leadership in the organizational context. However, leadership styles have a moderating effect between OCB and well-being at work, except when the employee adopts OCBO and the leadership style is people-oriented. The present study is innovative because it positions OCB as an antecedent in the relationship with well-being at work and investigates the moderating role of leadership styles in the relationship between organizational citizenship behavior and well-being.

Ethical climate in healthcare: A systematic review and meta-analysis

BACKGROUND

Ethical climate refers to the shared perception of ethical norms and sets the scope for what is ethical and acceptable behaviour within teams.

AIM

This paper sought to explore perceptions of ethical climate amongst healthcare workers as measured by the Ethical Climate Questionnaire (ECQ), the Hospital Ethical Climate Survey (HECS) and the Ethics Environment Questionnaire (EEQ).

METHODS

A systematic review and meta-analysis was utilised. PSYCINFO, CINAHL, WEB OF SCIENCE, MEDLINE and EMBASE were searched, and papers were included if they sampled healthcare workers and used the ECQ, HECS or EEQ.

ETHICAL CONSIDERATION

Ethical approval was not required.

RESULTS

The search returned 1020 results. After screening, 61 papers were included (n = 43 HECS, n = 15 ECQ, n = 3 EEQ). The overall sample size was over 17,000. The pooled mean score for the HECS was 3.60. Mean scores of individual studies ranged from 2.97 to 4.5. For the HECS studies, meta-regression was carried out. No relationship was found between the country of the studies, the study setting (ICU v non-ICU settings) or the mean years of experience that the sample had. For the ECQ, sub-scales had mean scores ranging from 3.41 (instrumental) to 4.34 (law) and were all observed to have significant and substantial heterogeneity. Three studies utilised the EEQ so further analysis was not carried out.

CONCLUSIONS

The above results provide insight into the variability of scores as measured by the HECS, ECQ and EEQ. To some extent, this variability is not surprising with studies carried out across 21 countries and in a range of healthcare systems. Results also suggest that it may be that more local and context specific factors are more important when it comes to predicting ethical climate.

Technical Readiness and Stereotypes in Hospital Nursing-A Question of Gender and Age?

(1) Background: The nursing profession is associated with various stereotypes. These social images or prejudices against specific groups can inhibit the personal growth of individuals, e.g., sociodemographic characteristics influence the social image of nurses. Based on the forward-looking topic digitization, we examined and discussed the influences of sociodemographic characteristics and motives of hospital nurses on technical readiness to gain insights into the digitization process in hospital nursing. (2) Methods: As part of an online survey on technical readiness among German hospital nurses, we particularly examined sociodemographic influences on technical readiness and the relationship between sociodemographic characteristics and professional motives. Furthermore, we included a qualitative analysis of optional comment fields. (3) Results: The analysis included 295 responses. Age and gender had a significant influence on technical readiness. Furthermore, the importance of motives differed between gender and age. The analysis of the comments produced three categories specifying our results: beneficial experiences, obstructive experiences and further conditions. (4) Conclusions: In general, the nurses showed high technical readiness. In order to gain high motivation for digitization and promote personal growth, special targeting and cooperation between gender and age groups can be beneficial. However, there are more sites at system level, such as funding, cooperation and consistence.

A multi-level study on whether ethical climate influences the affective well-being of millennial employees

Millennial employees are increasingly paying more attention to well-being in the workplace and it has become an important issue for managers. Given that millennial employees are more sensitive to ethical issues, this study began by analyzing an ethical element in the organization—the ethical climate—and explored whether millennial employees have higher affective well-being in organizations with a good ethical climate. We verified our hypotheses based on 288 valid questionnaires collected from 40 teams. The results showed that: (1) ethical climate was a positive predictor of millennial employees’ organizational citizenship behavior (OCB) and affective well-being, (2) employees’ OCB partially mediated the relationship between ethical climate and affective well-being, and (3) an employee’s moral identity effectively moderated the relationship between ethical climate and affective well-being, although it did not play a significant moderating role between ethical climate and OCB. These findings provide empirical support for applying situational strength and social information processing theories and emphasize the importance of cultivating an ethical climate in organizations.

Digitization in Everyday Nursing Care: A Vignette Study in German Hospitals

(1) Background: Digitization in hospital nursing promises to transform the organization of care processes and, therefore, provide relief to nurse staffing shortages. While technological solutions are advanced and application fields numerous, comprehensive implementation remains challenging. Nursing leadership is crucial to digital change processes. This vignette study examined the effects of the motives and values on nurses' motivation to use innovative technologies. (2) Methods: We asked hospital nurses in an online vignette study to assess a fictitious situation about the introduction of digital technology. We varied the devices on the degree of novelty (tablet/smart glasses), addressed motives (intrinsic/extrinsic), and values (efficiency/patient orientation). (3) Results: The analysis included 299 responses. The tablet vignettes caused more motivation than those of the smart glasses (Z = -6.653, p < 0.001). The dataset did not show significant differences between intrinsic and extrinsic motives. The nursing leader was more motivating when emphasizing efficiency rather than patient orientation (Z = -2.995, p = 0.003). (4) Conclusions: The results suggest efficiency as a motive for using known digital technologies. The nursing staff's willingness to use digital technology is generally high. Management actions can provide a structural framework and training so that nursing leaders can ensure their staff's engagement in using also unknown devices.

Factors influencing public health nurses' ethical sensitivity during the pandemic

BACKGROUND

Ethical sensitivity is a prerequisite for ethical nursing practices. Efforts to improve nurses' ethical sensitivity are required to correctly recognise ethical conflicts and for sound decision-making. Because an emerging infectious disease response involves complex ethical issues, it is important to understand the factors that influence public health nurses' ethical sensitivity while caring for patients with COVID-19, an emerging infectious disease.

OBJECTIVES

This study aims to identify the relationship between nursing professionalism, the organisation's ethical climate, and the ethical sensitivity of nurses who care for emerging infectious disease patients in Korean public health centres. Further, it sought to identify factors influencing ethical sensitivity and the mediating effect of the organisational ethical climate to inform guidelines and improve ethical sensitivity.

RESEARCH DESIGN

This was a cross-sectional descriptive study.

PARTICIPANTS AND RESEARCH CONTEXT

Data were collected from February 3 to 8 March 2021. Participants included 167 nurses caring for patients with COVID-19 in public health centres in South Korea.

ETHICAL CONSIDERATION

This study was approved by the Institutional Review Board of the Chung-Ang University and followed the principles of research ethics.

RESULTS

The factors influencing ethical sensitivity were working at a COVID-19 disease direct response department, nursing professionalism, and organisation's ethical climate. The organisation's ethical climate showed a partial mediating effect on the influence of nursing professionalism on ethical sensitivity.

CONCLUSION

Our findings show that nurses' ethical sensitivity can be improved by refining the organisation's ethical climate and nursing professionalism.

Moral distress and moral resilience of nurse managers

BACKGROUND

Moral distress is a phenomenon that can lead to an imbalance of the mind and body. There are many coping strategies to overcome the obstacles that lead the subject to this condition. Some coping strategies are capable of being achieved through the cultivation of moral resilience.

AIM

The aim is to identify the strategies of moral resilience in the nursing management of University Hospitals in Brazil.

RESEARCH DESIGN

The research design is the qualitative study with discursive textual analysis.

PARTICIPANTS AND RESEARCH CONTEXT

: 44 nurse managers and nurses in leadership positions participated in a total of 30 University Hospitals in Brazil. Data were collected online, using a questionnaire with open questions.

ETHICAL CONSIDERATIONS

The Ethics Committee approved the study. Participants received information about the research, agreed to respond to the questionnaire, and were guaranteed anonymity.

FINDINGS

Personal adaptive strategies (intrapersonal and interpersonal) and organizational collaborative strategies (intrinsic and transformational management) emerged from this process. The intrapersonal strategies involved elements of rationality, flexibility, rebalancing practices, moral courage, and detachment. The interpersonal strategies addressed support networks, team involvement, and dialog. Organizational strategies dealt with actions which reorient ethical infrastructure, ethical education, and psychological protection, as well as fostering dialogical relationships, empowerment, and cooperation.

CONCLUSION

From the perspective of social historical construction, it is understood that developing personal and organizational strategies is essential to cultivating moral resilience.

Hospital Ethical Climate and Job Satisfaction among Nurses: A Scoping Review

The aim of this study was to map and summarize the published research findings on hospital ethical climate and its relationship with nursing staff job satisfaction as well as strategies proposed in the literature for the improvement of hospital ethical climate and job satisfaction through the actions of nursing staff in leadership positions. A scoping review has been performed in accordance with the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension scoping reviews statement (PRISMA-ScR). Three electronic bibliographic databases were searched: the SCOPUS, Medline, and CINHAL Complete using a combination of keywords with the range of years 1994-2021. A total of 15 papers out of 235 records identified were eligible for the analysis. The literature review confirmed a significant relationship between ethical climate and job satisfaction of nurses. Furthermore, the interdependence of ethical climate and job satisfaction of nursing staff affects many different aspects including patients, co-workers, an organization and research. Identifying factors that influence ethical climate and job satisfaction as well as the relationship between these variables may help to reduce the dropout concerning a change of profession among nursing staff.

The relationship among factors of organizational justice, organizational citizenship behavior, job satisfaction, and ease of work among Japanese nurses

AIM

This work is aimed to create a strategy to improve the nurses' working environment.

BACKGROUND

As the working-age population is expected to decline in Japan, the maintenance of the nurse workforce is important. In order to create a strategy to improve the nurses' working environment, we studied the relationship among factors of organizational justice (procedural, distributive, and interactional justices), organizational citizenship behavior, job satisfaction, and ease of work.

METHODS

A cross-sectional, self-administered questionnaire was distributed to 969 nurses and 322 effective responses were analyzed (effective response rate 33.2%). The questionnaire contained demographic information, ease of work, and three scales for organizational justice, organizational citizenship behavior, and job satisfaction. The factor structure of the scales was studied using exploratory and confirmatory factor analysis. Structural equation modeling was used to investigate the relationship among measurements. The protocol was approved by the ethical committee of the author's university.

RESULTS

The final model showed a fair fit to the data (χ² = 1803.15, df = 1014, p < 0.001, comparative fit index = 0.907, root mean square error of approximation = 0.049). Interactional justice showed the most significant correlation to job satisfaction (r = 0.590). Job satisfaction and ease of work also showed a significant positive correlation (r = 0.696). Distributive justice had a slight negative indirect effect on job satisfaction, whereas procedural justice had no significant effect.

CONCLUSION

In order to enhance job satisfaction/ease of work among Japanese nurses, improvement of interactional justice may be the best strategy.

Improving Millennial Employees' OCB: A Multilevel Mediated and Moderated Model of Ethical Leadership

In the field of organizational behavior, the influence of leadership in organizations and the organizational citizenship behavior (OCB) of employees have always been two hot topics studied by scholars. However, previous studies have mainly examined the OCB of baby boomers and Generation Xers. With millennials now entering the workforce, they will highly likely not take the initiative to engage in OCB due to their different values. Scholars have found that millennials respond well to ethical leadership. Although this statement has a theoretical basis, empirical research regarding this topic is still insufficient. Thus, this study explores whether ethical leadership can effectively promote millennials' OCB. Moreover, the mediating effect of group-level ethical climate and individual-level affective well-being, and the moderating effect of individual-level moral identity, were examined. The study hypotheses were verified based on 384 valid questionnaires collected from 61 teams using Mplus 8.3. The results showed that (1) ethical leadership was a positive predictor of millennials' OCB; (2) ethical climate and affective well-being partially mediated the relationship between ethical leadership and OCB; and (3) moral identity moderated the relationship between ethical leadership and affective well-being and the indirect impact of ethical leadership on OCB. These findings provide empirical support for applying social learning theory, social information processing theory, and conservation of resources (COR)theory. This research also provides several managerial implications through which managers can more effectively improve the OCB of millennial employees.

Ethical Leadership and Organizational Citizenship Behavior: Mediation of Trust and Psychological Well-Being

PURPOSE

Nurses' behaviors are largely influenced by their managers' leadership style. The relationships between ethical leadership, trust, psychological well-being, and organizational citizenship behaviors have rarely been investigated in nursing studies. The current study attempted to examine the relationships between perceived ethical leadership, trust, psychological health, and nurses' organizational citizenship behaviors towards their patients in the context of Chinese hospitals.

METHODS

This research adopted a cross-sectional research design. Participants were 495 nurses solicited from six hospitals in China. Hayes's PROCESS and SPSS 22 were employed to analyze the data.

RESULTS

This study demonstrated ethical leadership perceived by nurses is positively associated with trust in management and psychological well-being. Trust in management is also positively associated with nurses' organizational citizenship behaviors. The indirect effects of perceived ethical leadership on organizational citizenship behaviors through trust in management and psychological well-being were statically significant.

CONCLUSION

This study adds value to the literature by revealing ethical leadership boosts nurses' trust in leadership and their psychological well-being, resulting in more organizational citizenship behaviors towards patients in the context of the Chinese hospitals. It is suggested that the hospital management creates an environment in which all members are treated fairly to boost nurses' psychological health and improve their service quality toward patients' satisfaction.

Nursing Scheduling Mode and Experience from the Medical Teams in Aiding Hubei Province During the COVID-19 Outbreak: A Systematic Scoping Review of 17 Studies

INTRODUCTION

Due to COVID-19 outbreak, since January 24, 2020, national medical teams from across the country and the armed forces have been dispatched to aid Hubei. The present review was designed to timely summarize the existing frontline information about nursing scheduling mode with special focus on the length of shifts with the aim to contribute to improve the nurses' job satisfaction and the quality of nursing services.

METHODS

Articles from Jan 2020 to October 2020 were retrieved from China National Knowledge Infrastructure, Wanfang Data and Weipu Information, with the terms "COVID-19", "designated hospital", "Hubei-assisted", "makeshift hospital", "nursing", "nursing shift", "whole-system takeover" and variations of these, in the title and abstract fields and the Boolean combinations of these words as the retrieval strategy.

RESULTS

Seventeen journal articles have been included in the target field, from the nurses in aiding Hubei Province, four kinds of shift length, 2-hour (h), 3-h, 4-h and 6-h shift have been considered, the main nursing scheduling mode adopted in designated hospitals for COVID-19 patients was dynamic scheduling based on workload, flexible scheduling based on working hours, workload and the number of critically ill patients admitted, humanized scheduling based on the daily reported health status of the nurses, and professional-integrated scheduling according to the professional distribution of nurses on the basis of four-hour shift length, and in makeshift hospitals for mild patients, the scheduling mode was 6-h based correspondingly.

CONCLUSION

The descriptive results of the present systematic review shed light on the challenges and practical solutions of nursing scheduling mode in the context of cross-regional medical assistance. Additionally, the present systematic review could provide the academic community of nurses, nurse managers and administrators with baseline information and scientific productions from the content's points of view in the target field.

The obstacles to nurses being present with patients

AIM

The aim of the present research was to investigate the obstacles, which prevent nurses being present with patients.

BACKGROUND

It is vital for nurses to be able to spend time with patients for an accurate assessment of patients' needs to take place and to allow patients to express their concerns. The factors, which prevent nurses spending time with patients, are still unclear.

METHOD

Data were collected using semi-structured interviews with thirty-five participants, including the nurses and physicians from educational hospitals of Tehran. The analysis was performed through the conventional content analysis. To achieve accuracy and trustworthiness of the data, the Lincoln and Guba criteria were used.

RESULT

The results of the study can be summarized as: "conflict between human considerations and bureaucratic structure," "failure to meet basic needs," "the personal and interpersonal aspects of caring" and "safety in caring context."

CONCLUSION

To ensure high-quality care, it is important to understand more fully the factors that prevent nurses spending time with patients. Interventions are needed to allow nurses to spend more time with the patients.

IMPLICATION FOR NURSING MANAGEMENT

Health service managers should consider that the intrinsic motivation of nurses is to care for patients. They can increase the presence of nurses at patients' bedside and improve care quality by creating an attractive working environment, appreciating nurses' values, paying attention to their opinions and establishing professional communication based on mutual respect.

Ethical Leadership, Flourishing, and Extra-Role Behavior Among Nurses

Introduction

The nursing literature is silent about the relationship between ethical leadership, nurses’ flourishing, and extra-role behavior. This study was carried out to contribute to the relevant field research.

Objective

The aim of the present study was to investigate the relationship between nurses’ perceptions of their nursing managers’ ethical leadership behavior, nurses’ flourishing, and their extra-role behavior.

Methods

This was a cross-sectional study involving 302 nurses from six hospitals in Damietta City, Egypt. Data were collected using the following three self-report scales: Ethical Leadership at Work questionnaire, Flourishing Scale, and extra-role behavior scale. The data were analyzed using descriptive statistical, Pearson correlation, regression analysis and the structure equation model.

Results

There was a significant positive relationship between nursing managers’ ethical leadership, nurses’ flourishing, and extra-role behavior. The regression analysis showed that the ethical leadership of nursing managers and nurses’ flourishing predict extra-role behavior.

Conclusion

Nurses with a high level of flourishing and who work with a manager exhibiting ethical leadership behavior are more likely to activate extra-role behavior. Hence, it is recommended that nursing managers embrace an ethical approach in their leadership practices and promote flourishing among nurses to encourage them to go the extra the mile in their jobs.