How to keep registered nurses working in New Zealand even as economic conditions improve

Perioperative care to patients living with HIV by theatre nurses at a South African tertiary hospital

Background

Human Immunodeficiency Virus (HIV) is one of the leading health challenges worldwide that influences the provision of quality patient care. Stigma and discrimination around this condition and the health care needs affect the health care provision. This study aimed to gain an in-depth understanding of theatre nurses' experiences in providing perioperative care to patients living with HIV at a tertiary hospital in South Africa.

Methods

This study was conducted at a tertiary hospital in Tshwane district, South Africa. The study was underpinned by an interpretative phenomenological analysis design. Data were collected from 10 criterion purposively selected theatre nurses using in-depth individual interviews. Data were thematically analyzed and guided by an interpretive phenomenological analysis framework for data analysis.

Results

The study revealed that theatre nurses work in an under-resourced environment. The resources highlighted are human, materials, including personal protective equipment and life support. The situation negatively affects the perioperative care of HIV-positive patients, who are always prone to perioperative complications, such as profuse bleeding, and even death. The situation increases the occupational risk to the nurses.

Conclusions

The researchers proposed several recommendations targeted at improving the resources needed by theatre nurses when caring for people living with HIV perioperatively at South African tertiary hospitals. Findings will add to the body of knowledge of the Nursing profession about offering perioperative care to persons living with HIV.

Health workforce governance and professions: a re-analysis of New Zealand's primary care workforce policy actors

BACKGROUND

This article contributes to the health workforce planning literature by exploring the dynamics of health professions in New Zealand's Primary Care sector and deriving broad lessons for an international audience. Professions tend influence health policy and governance decisions and practices to retain their place, status and influence. Therefore, understanding their power dynamics and the positions that they have on workforce policies and issues assists workforce governance or health system reform plans.

METHODS

Using the infrequently reported health workforce policy tool, actor analysis, a reanalysis of previously collected data is undertaken using an actor-based framework for the study of professionalism. Two models were developed, (1) the framework's original four-actor model and (2) a five-actor model for the comparison of the Medical and Nurse professions. Existing workforce actor data were reclassified, formatted, and entered into actor analysis software to reveal the professions' relative power, inter-relationships and strategic workforce issue positions.

RESULTS

In the four-actor model, the Organised user actor is found to be most influential, while the others are found to be dependent. In the five-actor model, the Medical and Nurse professions are individually more influential than their combined position in the four-actor model. Practicing professionals and Organised user actors have strong converging inter-relationships over workforce issues in both models, though in the five-actor model, the Nurse profession has weaker coherency than the Medical profession. The Medical and Nurse professions are found to be in opposition over the workforce issues labelled divisive.

CONCLUSIONS

These results reflect the professions' potential to influence New Zealand's Primary Care sector, indicating their power and influence over a range of policy and reform measures. As such, the four lessons that are derived from the case indicate to policy makers that they should be aware of situational contexts and actor power, take care when encountering divisive issues and try to achieve broad-based support for proposed policies.

Work-Related Burnout, Compassion Fatigue, and Nurse Intention to Leave the Profession During COVID-19

The purpose of this mixed-method study was to understand the relationships between work-related burnout (WRB), compassion fatigue (CF), and intention to leave the nursing profession. The Job Demands-Resources model was used to predict intention to leave as a function of WRB, CF, and caring for COVID-19 patients in a sample of 1299 US nurses. Greater WRB and CF scores were associated with intention to leave the profession. Contrary to prior research, working with COVID-19 patients was associated with greater intention to stay in nursing. Personal finances may represent the rationale for nurses to choose to stay nurses despite burnout.

A transition programme to enhance ICU new graduate nurses' professional identity and intention to remain employed: A pre- and postevaluation

AIMS

To investigate the effect of a transition programme including cognitive-behaviour-based preceptorship intervention on ICU new graduate nurses' (NGNs)' professional identity and their intention to remain employed.

DESIGN

One-arm pre- and post-test design followed the TREND Statement.

METHODS

NGNs' professional identity and intention to remain employed were measured at baseline (T1), postintervention (1 month, T2) and 6-month follow-up (T3).

RESULTS

Fifty-three NGNs completed the programme, and their professional identity score significantly increased postintervention [from 111.5 (SD = 16.72) at T1 to 114.2 (SD = 9.12) at T2, p < 0.05], but decreased at T3 [105.8 (SD = 9.44) compared with T1 and T2, p < 0.05]. There was no significant difference in ICU NGNs' intention of remain employed outcomes at three time points (p > 0.05). The transition programme was effective to improve ICU NGNs' professional identity immediately after the intervention, but the increment did not maintain at the 6-month follow-up.

The impact of economic recessions on health workers: a systematic review and best-fit framework synthesis of the evidence from the last 50 years

Economic crises carry a substantial impact on population health and health systems, but little is known on how these transmit to health workers (HWs). Addressing such a gap is timely as HWs are pivotal resources, particularly during pandemics or the ensuing recessions. Drawing from the empirical literature, we aimed to provide a framework for understanding the impact of recessions on HWs and their reactions. We use a systematic review and best-fit framework synthesis approach to identify the relevant qualitative, quantitative and mixed-methods evidence, and refine an a priori, theory-based conceptual framework. Eight relevant databases were searched, and four reviewers employed to independently review full texts, extract data and appraise the quality of the evidence retrieved. A total of 57 peer-reviewed publications were included, referring to six economic recessions. The 2010-15 Great Recession in Europe was the subject of most (52%) of the papers. Our consolidated framework suggests that recessions transmit to HWs through three channels: (1) an increase in the demand for services; (2) the impacts of austerity measures; and (3) changes in the health labour market. Some of the evidence appeared specific to the context of crises; demand for health services and employment increased during economic recessions in North America and Oceania, but stagnated or declined in Europe in connection with the austerity measures adopted. Burn-out, lay-offs, migration and multiple jobholding were the reactions observed in Europe, but job opportunities never dwindled for physicians during recessions in North America, with nurses re-entering labour markets during such crises. Loss of motivation, absenteeism and abuse of health systems were documented during recessions in low-income countries. Although the impacts of recessions may vary across economic events, health systems, labour markets and policy responses, our review and framework provide an evidence base for policies to mitigate the effects on HWs.

Mental workload of frontline nurses aiding in the COVID-19 pandemic: A latent profile analysis

Aims

To investigate the mental workload level of nurses aiding the most affected area during the Coronavirus disease 2019 (COVID‐19) pandemic and explore the subtypes of nurses regarding their mental workload.

Design

Cross‐sectional study.

Methods

A sample of 446 frontline nurses participated from March 8 to 19, 2020. A latent profile analysis was performed to identify clusters based on the six subscales of the Chinese version of the National Aeronautics and Space Administration Task Load Index. The differences among the classes and the variables including sociodemographic characteristics, psychological capital and coping style were explored.

Results

The level of mental workload indicates that the nurses had high self‐evaluations of their performance while under extremely intensive task loads. The following three latent subtypes were identified: ‘low workload & low self‐evaluation’ (8.6%); ‘medium workload & medium self‐evaluation’ (35.3%) and ‘high workload & high self‐evaluation’ (56.1%) (Classes 1, 2, and 3, respectively). Nurses with shared accommodations, fewer years of practice, junior professional titles, lower incomes, nonmanagement working positions, lower psychological capital levels and negative coping styles had a higher likelihood of belonging to Class 1. In contrast, senior nurses with higher psychological capital and positive coping styles were more likely to belong to Classes 2 and 3.

Conclusion

The characteristics of the ‘low workload & low self‐evaluation’ subtype suggest that attention should be paid to the work pressure and psychological well‐being of junior nurses. Further research on regular training program of public health emergency especially for novices is needed. Personnel management during public health events should be focused on the allocation between novice and senior frontline nurses.

Impact

This study addresses the level of mental workload of frontline nurses who aid in the most severe area of the COVID‐19 pandemic in China and delineates the characteristics of the subtypes of these nurses.

An Integrative Review of How Healthcare Organizations Can Support Hospital Nurses to Thrive at Work

Background: Solutions that address the anticipated nursing shortage should focus on thriving at work: a positive psychological state characterized by a sense of vitality and learning, resulting in higher levels of work engagement, commitment, and wellbeing. Purpose: To synthesize international evidence on organizational factors that support hospital nurse wellbeing and to identify how the Social Embeddedness of Thriving at Work Model can support health managers to develop management approaches that enable nurses to thrive. Method: Conduct an integrative review of literature published between 2005–2019. Results: Thematic analysis identified five key themes: (1) Empowerment; (2) Mood of the organization; (3) An enabling environment; (4) Togetherness with colleagues; and (5) Leaders’ connectivity. Conclusions: The Social Embeddedness of Thriving at Work Model supports managers to develop management approaches that enable their nurses to thrive. Health managers should consider strategies to support nurses to thrive at work to improve nurse work engagement and wellbeing.