Developing a model for predicting safety performance of nurses based on psychosocial safety climate and role of job demands and resources, job satisfaction, and emotional exhaustion as mediators

Assessing the Impact of Burnout on Nurse Safety Behaviors and Patient Safety Competence: A Latent Profile Analysis Study

Aim: This study examines the association between burnout, nurse safety behaviors, and patient safety competency among nurses working in cancer hospitals using person-centered and variable-centered methodologies. Background: Burnout is prevalent among nurses worldwide, with cancer hospital nurses exhibiting high levels of burnout. Burnout correlates with a higher incidence of adverse events and diminished patient safety. Nurse safety behaviors and patient safety competency play protective roles in ensuring patient safety. Methods: This study used a cross-sectional online survey and included 2092 eligible nurses, with 95.0% being female. We invited nurses from cancer hospitals in 12 provinces in China to complete an online survey from April to June 2023. Through the online Questionnaire Star platform, invited nurses provided demographic information and completed the Maslach Burnout Inventory, the Nurse Safety Behaviors Scale, and the Patient Safety Competency Scale. Latent profile analysis was used to identify heterogeneous characteristics of nurse burnout. Results: From a person-centered perspective, nurse burnout was categorized into three latent profiles: "high achievement stable type" (70.3%), "high-efficiency contradictory type" (6.6%), and "high-pressure adaptive type" (23.1%). From a variable-centered perspective, patient safety competency partially mediated the relationship between burnout profiles and nurse safety behaviors. Conclusion: This study identified three heterogeneous latent profiles of burnout among cancer hospital nurses and highlighted the significant impact of excessive working hours and lack of safety training on burnout across different job titles and income levels. Additionally, it verified the mediation effect of patient safety competency between burnout profiles and nurse safety behaviors. Future treatments should focus on high-risk populations by offering improved safety training and suitable work schedules to reduce burnout. Furthermore, personalized measures to enhance nurses' safety competencies should be adopted to improve burnout and safety behaviors. This study integrates person-centered and variable-centered methods, offering new insights and underscoring the critical role of safety in mitigating burnout.

A highly effective mindfulness intervention for burnout prevention and resiliency building in nurses

Objectives

Healthcare workers, most notably nursing professionals, face high levels of recurrent stress that lead to symptoms of burnout and other negative mental health outcomes. This indicates the need for greater individual and organizational health system support, including implementation of effective, evidence-based interventions for burnout reduction in this population. Organizationally supported mindfulness-based interventions can be used to build individual resilience, buffering the detrimental effects of occupational stress and enhance professional well-being. Our aim was to evaluate the effect of an evidence-based mindfulness intervention on perceived stress, burnout, resilience, and work engagement in nursing professionals.

Methods

A non-randomized single arm, pre/post design was used for this study. Healthcare workers (n = 631), including Registered Nurses and Advanced Practice Nurses (n = 128), physicians (n = 105), social workers (n = 21), pharmacists (n = 8), chaplains (n = 30), physician and occupational therapists (n = 39), patient care assistants (n = 13), other clinical staff (n = 26), non-clinical staff (n = 229), and 32 others participated in Mindfulness in Motion, an 8-week evidence-based worksite mindfulness intervention. Validated self-report measures assessing burnout (Maslach Burnout Inventory), perceived stress (Perceived Stress Scale), resilience (Connor Davidson Resiliency Scale), and work engagement (Utrecht Work Engagement Score) were given pre and post program. Total burnout was determined by scores on the subscales of emotional exhaustion, depersonalization, and personal accomplishment of the Maslach Burnout Inventory: Emotional exhaustion >27 or depersonalization >13 or personal accomplishment <31.

Results

Significant reductions in burnout (p < 0.00001), perceived stress (p < 0.00001), with significant increases in resilience (p < 0.00001), and work engagement (p < 0.00001) were observed among Registered and Advanced Practice Nurses comparing pre-post measures. Notably, the number of nursing professionals who no longer qualified as burned out was 10% higher than the other participants.

Conclusion

Our results suggest that nursing professionals could greatly benefit from organizationally supported mindfulness-based interventions such as Mindfulness in Motion and may benefit them most compared to other health system employees.

Inclusive leadership and employee workplace well-being: the role of vigor and supervisor developmental feedback

PURPOSE

Employees within organizations actively pursue and maintain their workplace well-being. Although there are current studies that have examined the linking inclusive leadership to employee workplace well-being, the underlying intrinsic link between the two remains unclear. On the basis of self-determination theory, this research examined the relationship between inclusive leadership, vigor, supervisor developmental feedback, and workplace well-being.

PATIENTS AND METHODS

Data were collected from 61 teams that totaled 342 full-time employees through a 3-stage questionnaire. Multilevel Structural Equation Modeling and Monte Carlo simulations were conducted on data for hypothesis testing.

RESULTS

Inclusive leadership positively correlated with employee workplace well-being. Employee vigor mediates the link between inclusive leadership and employee workplace well-being. Supervisor developmental feedback moderated the relationship between inclusive leadership and employee vigor.

CONCLUSIONS

Inclusive leadership can improve employees' workplace well-being by stimulating their vigor. Therefore, managers need to be able to effectively meet employees' basic needs to stimulate their vigor. Based on meeting employees' basic needs, managers can also provide targeted developmental feedback to meet employees' growth needs, which can more effectively promote employees' vigor and workplace well-being.

Safeguarding nurses' mental health: The critical role of psychosocial safety climate in mitigating relational stressors and exhaustion

Burnout among nurses is a pervasive concern in healthcare, with profound implications for patient care and nurse well-being. While research has highlighted the detrimental effects of burnout on many aspects of nursing, including patient safety and quality of care, the underlying mechanisms driving burnout warrant further investigation. In this cross-sectional study, we surveyed 196 nurses from diverse Italian hospitals using an online questionnaire via Qualtrics. Our findings revealed significant negative correlations between psychological safety climate and both relational stressors and emotional exhaustion. Conversely, relational stressors positively correlated with emotional exhaustion, and a significant negative indirect effect of psychological safety climate was found for emotional exhaustion through relational stressors, emphasizing the pivotal role of psychological safety climate in mitigating nurse burnout. Our study underscores the potential effectiveness of interventions targeting psychological safety climate and relational stressors in alleviating emotional exhaustion and burnout among nurses. Theoretical implications underscore the importance of deepening the role of psychological safety climate in mitigating emotional exhaustion, while practical implications emphasize the need for fostering a positive psychological safety climate and implementing targeted interventions to support nurses' well-being.

How does psychosocial safety climate cross-level influence work engagement and job burnout: the roles of organization-based self-esteem and psychological detachment

BACKGROUND

Existing researches on nurses' work engagement and job burnout have mostly stayed at the individual level, and limited researches test the cross-level effects of psychosocial safety climate (PSC). The study aimed to explore the cross-level mediating effect of organization-based self-esteem (OBSE) and the moderating effect of psychological detachment between the relationship of PSC and work engagement and job burnout in nurses.

METHODS

The cross-sectional study was conducted during November to December 2022 at a tertiary hospital in a northeastern province of China. Data was collected from 1832 nurses through an online questionnaire. Correlation analyses and hierarchical linear modeling were used to test study hypotheses.

RESULTS

The results showed that PSC was positively associated with work engagement, and negatively associated with job burnout. OBSE mediated the effect of PSC on work engagement, as well as job burnout. Additionally, psychological detachment played a moderating role between PSC and work engagement, but no moderating effect was found between PSC and job burnout.

CONCLUSIONS

PSC at the organizational level increases work engagement and reduces job burnout by stimulating nurses' high levels of OBSE. Psychological detachment, as a situational factor, enhances the positive influence of PSC on work engagement. The implementation of measures to improve the PSC levels of the organization, and the levels of OBSE and psychological detachment among nurses could help to promote their good work performance.

Stress, interpersonal and inter-role conflicts, and psychological health conditions among nurses: vicious and virtuous circles within and beyond the wards

BACKGROUND

The increasing costs of nurses' occupational-stress, conflicts, and violence within healthcare services have raised international interest. Yet, research/interventions should consider that perceived stress and conflicts- but also potential resources- within the wards can crossover the healthcare settings, impacting nurses' private lives and viceversa, potentially creating vicious circles exacerbating stress, conflicts/violence or, conversely, virtuous circles of psychological/relational wellbeing. Based on the Demands-Resources-and-Individual-Effects (DRIVE) Nurses Model, and responding to the need to go in-depth into this complex dynamic, this study aims to explore potential vicious circles featured by the negative effects of the interplay (main/mediating effects) between perceived stressors in nursing linked to interpersonal conflicts (Conflicts-with-Physicians, Peers, Supervisors, Patients/their families), work-family inter-role conflicts (Work-Family/Family-Work-Conflicts), and work-related stress (Effort-Reward-Imbalance) on nurses' psychological/relational health (Anxiety, Depression, Somatization, Interpersonal-Sensitivity, Hostility). The potential moderating role of work-resources (Job-Control, Social-Support, Job-Satisfaction) in breaking vicious circles/promoting virtuous circles was also explored.

METHOD

The STROBE Checklist was used to report this cross-sectional multi-centre study. Overall, 265 nurses completed self-report questionnaires. Main/mediating/moderating hypotheses were tested by using Correlational-Analyses and Hayes-PROCESS-tool.

RESULTS

Data confirmed the hypothesized detrimental vicious circles (main/mediating effects), impairing nurses' psychological health conditions at individual level (Anxiety, Depression, Somatization), but also at relational level (Hostility and Interpersonal-Sensitivity). The moderating role of all work resources was fully supported.

CONCLUSION

Findings could be used to implement interventions/practices to effectively prevent the maintenance/exacerbation of vicious circles and promote psychological/relational wellbeing in healthcare settings and beyond.

Evidence for a Negative Loss Spiral between Co-Worker Social Support and Burnout: Can Psychosocial Safety Climate Break the Cycle?

Previous research suggests that co-worker social support predicts burnout, but this relationship may be far more complex, with the potential for a reciprocal cycle of loss. Leading research on loss spirals has explicitly called for more research on interindividual factors such as social support and, by extension, how interventions that operate on these interpersonal resources could play a role in primary and secondary prevention (i.e., intervening in cycles of loss). In this study, we explore the reciprocal relationship between burnout and co-worker social support, with psychosocial safety climate (PSC) as an upstream predictor and moderator of this relationship. Using hierarchical linear modelling (N = 380 frontline healthcare workers, nested within N = 63 teams) on longitudinal data, we found a reciprocal relationship between burnout and co-worker support, which was both triggered and moderated by PSC. These findings provide initial evidence for a social support-burnout loss spiral, wherein individuals with poor co-worker support are more likely to become burnt-out, and in this depleted state they are subsequently less likely to reach out for those social supports when available, which would, in turn, lead to further burnout. This social support-burnout loss spiral is exacerbated when working in a low-PSC context, as the environment does not send positive safety signals about resource scarcity and replenishment. Therefore, PSC may be a potential target for intervention both in primary prevention (i.e., stopping the loss spiral in the first instance) and in secondary intervention, as high PSC signals to workers already in the burnout-support loss cycle when it is safe to reinvest resources or engage in recovery behavior.

Examining the mediating effect of job satisfaction on the relationship between leader-member exchange and safety behavior among Algerian healthcare workers

PURPOSE

This study aims to examine the long-term impact of leader-member exchange (LMX) on employee safety behavior. It proposes a conceptual model that includes the mediating role of job satisfaction (JS) in the relationship between LMX and safety behaviors, regarding safety compliance behavior (SCB) and safety participation behavior (SPB).

DESIGN/METHODOLOGY/APPROACH

Data were collected from 325 health-care workers across public hospitals in Algeria at three waves. Data were analyzed with partial least square structural equation modeling.

FINDINGS

The findings revealed that LMX positively influenced employees' job satisfaction. However, the relationship between LMX and SCB was found to be mediated by job satisfaction. LMX was not directly related to both dimensions of safety behavior, whereas JS was positively associated with safety compliance and safety participation.

ORIGINALITY/VALUE

This is the first paper, to the best of the authors' knowledge, to report on the significant mediating role of JS on the reciprocal process used to exchange resources between leaders and subordinates and safety behaviors among health-care workers, thereby filling an important research gap in existing literature.