Showing papers in "Journal of Nursing Management in 2020"

Work stress among Chinese nurses to support Wuhan in fighting against COVID-19 epidemic.

Abstract: AIMS: To investigate the work stress among Chinese nurses who are supporting Wuhan in fighting against Coronavirus Disease 2019 (COVID-19) infection and to explore the relevant influencing factors. BACKGROUND: The COVID-19 epidemic has posed a major threat to public health. Nurses have always played an important role in infection prevention, infection control, isolation, containment and public health. However, available data on the work stress among these nurses are limited. METHODS: A cross-sectional survey. An online questionnaire was completed by 180 anti-epidemic nurses from Guangxi. Data collection tools, including the Chinese version of the Stress Overload Scale (SOS) and the Self-rating Anxiety Scale (SAS), were used. Descriptive single factor correlation and multiple regression analyses were used in exploring the related influencing factors. RESULTS: The SOS (39.91 ± 12.92) and SAS (32.19 ± 7.56) scores of this nurse group were positively correlated (r = 0.676, p < .05). Multiple regression analysis showed that only children, working hours per week and anxiety were the main factors affecting nurse stress (p = .000, .048, .000, respectively). CONCLUSIONS: Nurses who fight against COVID-19 were generally under pressure. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse leaders should pay attention to the work stress and the influencing factors of the nurses who are fighting against COVID-19 infection, and offer solutions to retain mental health among these nurses.

COVID-19 anxiety among front-line nurses: Predictive role of organisational support, personal resilience and social support.

Abstract: AIM: This study examines the relative influence of personal resilience, social support and organisational support in reducing COVID-19 anxiety in front-line nurses. BACKGROUND: Anxiety related to the COVID-19 pandemic is prevalent in the nursing workforce, potentially affecting nurses' well-being and work performance. Identifying factors that could help maintain mental health and reduce coronavirus-related anxiety among front-line nurses is imperative. Currently, no studies have been conducted examining the influence of personal resilience, social support and organisational support in reducing COVID-19 anxiety among nurses. METHODS: This cross-sectional study involved 325 registered nurses from the Philippines using four standardized scales. RESULTS: Of the 325 nurses in the study, 123 (37.8%) were found to have dysfunctional levels of anxiety. Using multiple linear regression analyses, social support (s = -0.142, p = .011), personal resilience (s = -0.151, p = .008) and organisational support (s = -0.127, p = .023) predicted COVID-19 anxiety. Nurse characteristics were not associated with COVID-19 anxiety. CONCLUSIONS: Resilient nurses and those who perceived higher organisational and social support were more likely to report lower anxiety related to COVID-19. IMPLICATION FOR NURSING MANAGEMENT: COVID-19 anxiety may be addressed through organisational interventions, including increasing social support, assuring adequate organisational support, providing psychological and mental support services and providing resilience-promoting and stress management interventions.

Acute stress disorder, coping self-efficacy and subsequent psychological distress among nurses amid COVID-19.

Abstract: Purpose Health care professionals, particularly nurses, are considered a vulnerable group to experience acute stress disorder (ASD) and subsequent psychological distress amid COVID-19 pandemic. This study aims to establish the prevalence of acute stress disorder and predictors of psychological distress among Jordanian nurses. Methods A quantitative, cross-sectional, descriptive and comparative design was used. Data were collected using a Web-based survey. A total of 448 Jordanian nurses (73% females) completed and returned the study questionnaire. Results The majority of nurses (64%) are experiencing ASD due to the COVID-19 pandemic and thus are at risk for PTSD predisposition. More than one-third of nurses (41%) are also suffering significant psychological distress. Among our sample, age, ASD and coping self-efficacy significantly predicted psychological distress. More specifically, younger nurses are more prone to experience psychological distress than older ones. While higher scores on ASD showed more resultant psychological distress, coping self-efficacy was a protective factor. Conclusion Given that individuals who suffer from ASD are predisposed to PTSD, follow-up with nurses to screen for PTSD and referral to appropriate psychological services is pivotal. Coping self-efficacy is found to ameliorate the effect of psychological distress on nurses' traumatic experience. Such findings warrant intensive efforts from health care institutions to provide psychosocial support services for nurses and ongoing efforts to screen them for traumatic and psychological distress symptoms. Implications for nursing management Nursing leaders and managers are in the forefront of responding to the unique needs of their workforces during the COVID-19 crisis. They need to implement stress-reduction strategies for nurses through providing consecutive rest days, rotating allocations of complex patients, arranging support services and being accessible to staff. They also need to ensure nurses' personal safety through securing and providing personal safety measures and undertake briefings to ensure their staff's physical and mental well-being, as well as providing referrals to appropriate psychological services.

Experiences of clinical first-line nurses treating patients with COVID-19: A qualitative study.

Abstract: Aim To explore the work experience of clinical first-line nurses treating patients with coronavirus disease 2019 (COVID-19). Background COVID-19 has been listed as an international public health emergency. Clinical first-line nurses are at a high risk of infection, and they face a lack of experience and inadequate preparation for COVID-19, leading to physical and psychological disorders. Methods A qualitative study was conducted from January to February 2020 at a COVID-19-designated hospital in Wuhan, China. Thirty nurses were selected for the study using a purposive sampling method. Data were collected by semi-structured interviews and analysed using content analysis. Results Two main categories were defined in the study from the perspective of nurses: negative experiences during clinical first-line work and positive impacts of clinical first-line work. Under the first category, two subcategories were included: psychological experiences of clinical first-line work and difficulties faced during clinical first-line work. The analysis further yielded two subcategories for the second category: the needs of clinical first-line work and the impact of clinical first-line work on professional attitudes. Conclusions The results demonstrate that success depends upon strengthening emergency training and knowledge of infectious diseases for nurses, providing adequate protective equipment and improving the emergency response plans of hospitals for public health emergencies. Implications for nursing management It is believed that our findings will guide hospital managers to make improvements in personal, administrative and institutional areas and that they will provide a reference and inspiration for nurses with regard to public health emergencies in the future.

Factors associated with insomnia among Chinese front-line nurses fighting against COVID-19 in Wuhan: A cross-sectional survey.

Abstract: AIM: To investigate the prevalence of insomnia among front-line nurses fighting against COVID-19 in Wuhan, China, and analyse its influencing factors. BACKGROUND: Insomnia is an important factor that can affect the health and work quality of nurses. However, there is a lack of big-sample studies exploring factors that affect the insomnia of nurses fighting against COVID-19. METHOD: This cross-sectional study using the Ascension Insomnia Scale, Fatigue Scale-14 and Perceived Stress Scale took place in March 2020. Participants were 1,794 front-line nurses from four tertiary-level general hospitals. RESULTS: The prevalence of insomnia among participants was 52.8%. Insomnia was predicted by gender, working experience, chronic diseases, midday nap duration, direct participation in the rescue of patients with COVID-19, frequency of night shifts, professional psychological assistance during the pandemic, negative experiences (such as family, friends or colleagues being seriously ill or dying due to COVID-19), the degree of fear of COVID-19, fatigue and perceived stress. CONCLUSION: The level of insomnia among participants was higher than the normal level. Interventions based on influencing factors should be implemented to ensure nurses' sleep quality. IMPLICATIONS FOR NURSING MANAGEMENT: An in-depth understanding of the influencing factors of insomnia among front-line nurses can help nurse managers develop solutions to improve front-line nurses' sleep quality, which will enhance the physical and mental conditions of nurses and promote the quality of care.

The support needs of Australian primary health care nurses during the COVID-19 pandemic.

Abstract: Aim To identify Australian primary health care nurses' immediate support needs during the COVID-19 pandemic. Background COVID-19 has had widespread implications for primary health care nurses. Supporting these nurses' capacity to deliver quality care ensures that ongoing health needs can be met. Methods Primary health care nurses were recruited to an online survey via social media and professional organisations in April 2020. Results Six-hundred and thirty-seven responses were included in the analysis. Participants provided 1,213 statements about perceived supports required to provide quality clinical care. From these, seven key categories emerged, namely personal protective equipment, communication, funding, industrial issues, self-care, workplace factors and valuing nurses. Conclusion A number of key issues relating to personal health and safety, care quality and job security need to be addressed to support primary health care nurses during the COVID-19 pandemic. Addressing these support issues can assist in retaining nurses and optimizing the role of primary health care nurses during a pandemic. Implications for nursing management Responding to the needs of primary health care nurses has the potential to facilitate their role in providing community-based health care. This knowledge can guide the provision of support for primary health care nurses during the current pandemic, as well as informing planning for future health crises across the health service.

Influence of toxic and transformational leadership practices on nurses' job satisfaction, job stress, absenteeism and turnover intention: A cross-sectional study.

Abstract: Aim This study examined the influence of toxic and transformational leadership practices on nurses' job satisfaction, psychological distress, absenteeism and intent to leave the organisation or the nursing profession. Background Transformational leadership is attributed to favourable nurse consequences; however, the nursing literature is silent regarding the causal association between toxic leadership and nurses' job outcomes. Methods This is a cross-sectional study involving 770 registered nurses from 15 hospitals in Central Philippines. Data were collected using seven self-report scales during the months of December 2019 to February 2020. Results The composite scores for the transformational leadership scale and toxic leadership scale were 4.22 and 1.59, respectively. Toxic leadership predicted job satisfaction, absenteeism, psychological distress and intention to leave the profession. Transformational leadership predicted job satisfaction and intent to leave the profession. Conclusion Results suggest that nurses working with a transformational leader report higher job contentment and lower intent to leave the nursing profession. Nurses who work for a manager exhibiting toxic leadership behaviours demonstrated lower job contentment, higher stress levels, frequent absenteeism and higher intent to leave the nursing profession. Implication for nursing management Nurse retention strategies should include measures to foster transformational leadership and derail toxic leadership practices in nurse managers through evidence-based education, training and professional development.

The influence of experiences of involvement in the COVID-19 rescue task on the professional identity among Chinese nurses: A qualitative study.

Abstract: Aims To explore the influence of experiences of involvement in the COVID-19 rescue task on professional identity among Chinese nurses from a qualitative method perspective. Background Professional identity of nurses is not static and easily affected by many factors. The COVID-19 epidemic brings the tremendous physical and psychological challenges for rescue nurses. At present, there are limited data on the influence of rescue experiences on the nurses' professional identity. Methods This study used a face-to-face interview with semi-structured questions to learn about the influence of rescue experiences on the professional identity of nurses. Purposeful sampling was used to collect participants (n = 14), and interview data were analysed following the Colaizzi's phenomenological analysis. Results The 'impression of exhaustion and fear', 'feeling the unfairness', 'perceiving incompetence in rescue task' and 'unexpected professional benefits' were the main factors affecting the professional identity of rescue nurses. Conclusion The present study showed that special attention and targeted support measures should be provided to improve the professional identity of rescue nurses. Implications for nursing management Nurse managers should make a post-epidemic recovery plan to help nurses to improve the professional identity. Designed education programmes and complete disaster response system should be developed to deal with infection disease in the future.

Positive spiritual climate supports transformational leadership as means to reduce nursing burnout and intent to leave.

Abstract: Aim To explore the relationship between spiritual climate and transformational leadership, and examine their impact on nurses perceived emotional exhaustion and intentions to quit. Background Transformational leadership is known to have a significant positive effect on work environment and job satisfaction. Additionally, promoting spiritual climate amongst staff can benefit workers by increasing self‐worth. The relationship between the two is unknown. Methods Nurse clinicians from 2 sites in the Jiangsu Province of China completed self‐report questionnaires based on spiritual climate, emotional exhaustion, clinical leadership and Turnover Intention Scales. Mediation analysis was applied to evaluate impact of spiritual climate. Results Perceived positive spirituality amongst nurse clinicians reinforces transformational leadership to reduce emotional exhaustion (indirect effect of −0.089, p < .01). Burnout and intention to leave showed significantly positive correlation with lower levels of perceived spirituality (r = .545, p < .01). Conclusion Transformational leadership in the workplace can reduce nurses' burnout, and a positive spiritual climate increases meaningfulness in their work. This may help in nurse retention. Implications for Nursing Management Health care leaders must look beyond transformational leadership to maintain a positive and supportive clinical climate, and this may involve acknowledgement of nurses' spiritual needs.

Improved work environments and staffing lead to less missed nursing care: A panel study

Abstract: Aim To document how changes in the hospital work environment and nurse staffing over time are associated with changes in missed nursing care. Background Missed nursing care is considered an indicator of poorer care quality and has been associated with worse patient care experiences and health outcomes. Several systematic reviews of cross-sectional studies report that nurses in hospitals with supportive work environments and higher staffing miss less care. Causal evidence demonstrating these relationships is needed. Methods This panel study utilized secondary data from 23,650 nurses surveyed in 2006 and 14,935 surveyed in 2016 in 458 hospitals from a four-state survey of random samples of licensed nurses. Results Over the 10-year period, most hospitals exhibited improved work environments, better nurse staffing and more missed care. In hospitals with improved work environments or nurse staffing, the prevalence and frequency of missed care decreased significantly. The effect on missed care of changes in the work environment was greater than that of nurse staffing. Conclusions Changes in the hospital work environment and staffing influence missed care. Implications for nursing management Modifications in the work environment and staffing are strategies to mitigate care compromise. Nurse managers should investigate work settings in order to identify weaknesses.

The association of nurse caring behaviours on missed nursing care, adverse patient events and perceived quality of care: A cross-sectional study.

Abstract: Aim This study evaluated the role of nurse caring in predicting missed nursing care, adverse patient events and the quality of nursing care. Background Missed nursing care is an issue essential in health care, as it is associated with adverse patient events. While studies have previously examined factors that result in missed nursing care activities and adverse events, the role of nurse caring itself in this context has not yet been explored. Methods A cross-sectional research design was adopted, employing a convenience sample of 549 registered nurses from six hospitals in the Philippines identified between October 2018 and January 2019. Four self-report scales were used in this study as follows: the caring behaviour inventory, the missed nursing care scale, the adverse patient events scale and a single-item scale to measure the quality of nursing care. Results Comforting or talking with patients and changing patients' positioning in bed were the most frequently missed care tasks, while patient/family complaints and patient/family verbal abuse were the most frequently reported adverse events. Nurse caring strongly predicted the quality of care, missed nursing care and patient adverse events. Conclusion Fostering caring behaviours among nurses has a profound effect on nurses' decision to omit or provide nursing care as well as on reducing adverse events and promoting quality nursing care. Implications for nursing management The adoption of strategies to improve caring behaviours among nurses is critically important to prevent or reduce the occurrence of errors and adverse events.

The Working Experiences of Male Nurses in China: Implications for Male Nurse Recruitment and Retention

Abstract: Aims To understand the working experiences and career trajectories of male nurses in China. Background Compared with developed countries, men were far more under-represented in the nursing profession in China. Little is known about the working experiences of Chinese male nurses and the contextual factors that contribute to their low participation rate in the nursing profession. Methods In-depth interviews with twenty-five male nurses and two hospital administrators were conducted. All interviews were analysed using thematic analysis. Results Chinese male nurses had better career prospects and promotion chances compared with female nurses. The extremely low participation rate of men in nursing was related to the prejudice among the general public as well as the low professional status and salary. Two unique contextual factors influenced the career trajectories of male nurses in China: (1) the major assignment mechanism in the college entrance examination and (2) the implementation of the two-child policy. Conclusion Although Chinese male nurses enjoyed many advantages compared with female nurses, they also encountered many difficulties related to working in a female-dominated profession. Implications for nursing management Appropriate measures should be taken to shift public attitudes towards male nurses, improve the professionalization of nursing and promote gender diversity and equity.

Transition shock and newly graduated nurses' job outcomes and select patient outcomes: A cross-sectional study

Abstract: AIM This study examined transition shock experiences in newly graduated nurses as well as its relative influence on job outcomes (job satisfaction, stress and burnout, and intent to leave their organisation) and select patient outcomes (missed care, adverse events and perceived quality of care). BACKGROUND Transition shock is a reality common among newly graduated nurses and has been considered an issue relevant to nursing administrators. To date, the mechanism by which transition shock perception is linked with nurse and patient outcomes remains unexplored. METHODS A descriptive, cross-sectional design was used. One hundred seventy-six newly graduated nurses (nurses with <1 year of work experience) were included in the study. Data were collected using seven standardized scales. RESULTS Hospital classification (e.g., being employed in a government-owned hospital) (β = 0.255; p = .001) predicted transition shock. Overall, newly graduated nurses reported greatest challenges with regard to their expectations of the actual work environment (mean = 2.60, standard deviation = 0.42) and in balancing their professional and personal lives (mean = 2.51, standard deviation = 0.35). Higher levels of reality shock were associated with adverse patient events (β = 0.821; p = .001). CONCLUSION New graduates experience great challenges in balancing their professional and personal lives. Ensuring work-life balance and work readiness in newly graduated nurses may potentially reduce the occurrence of missed nursing care and adverse events. IMPLICATIONS FOR NURSING MANAGEMENT Nurse managers can adequately support newly graduated nurses' transition through the implementation of empirically based transition programmes. By providing flexible work arrangement, reasonable workload, adequate nurse staffing, limited mandatory overtime and self-scheduling, nurse managers can effectively assist newly graduated nurses in attaining work-life balance.

Effects of bullying on job insecurity and deviant behaviors in nurses: Roles of resilience and support

Abstract: Aim The present study tested a moderated mediation model in the Hospital industry of Pakistan. Extending the Conservation of Resources theory, we conducted a joint investigation of the mediating role of (a) Job Insecurity in linking Workplace Bullying with victim's deviant work behaviors and (b) the moderating roles of Resilience and Perceived Supervisor Support in influencing the mediation. Background Although the direct effects of bullying on deviant work were well established, the mechanisms and the boundary conditions through which bullying triggers deviant behaviors are still unknown. Method Utilizing temporally segregated field data from a sample of nurses and their fellow colleagues (n = 251 dyads), a quantitative study was conducted in Pakistani hospitals. Results Results were consistent with our hypothesized moderated mediation (mod-med) framework in which workplace bullying led to deviant work behaviors in nurses via job insecurity. Moreover, this indirect effect was salient under nurses' low resilience and perceptions of supervisor support. Conclusion Based on these findings, the relationship between workplace bullying and deviant work behaviors appears to be more complex than what is commonly believed. Implications for nursing management The findings of the present study emphasize how and why bullying at workplace (particularly nurses) generates deviant work behavior.

Exploring job satisfaction and workplace engagement in millennial nurses.

Abstract: Aim To examine job satisfaction and workplace engagement of millennial nurses. Background Millennial nurses are a rapidly growing segment of the workforce. They are significantly less satisfied in their jobs compared with nurses of other generations and are more likely to have perceptions that may negatively impact job satisfaction and engagement. It is important for nurse leaders to understand and value the perspective of these nurses to improve job satisfaction and engagement. Method Exploratory-descriptive qualitative approach with 33 millennial nurses interviewed in nine focus groups. Results Five themes revealed areas that both enhance and hinder job satisfaction and engagement. Themes include the following: (1) professional relationships; (2) rewards; (3) communication; (4) professional development; and (5) workload/staffing. Conclusion Concerns identified by millennial nurses provide direction for nurse leaders who are charged with fostering a workplace setting that nurtures empathy and respect for nurses of all generations. Implications for nursing management Strategies to address preferences of millennials include employee rounding to ask about their needs, offer assistance and provide positive feedback. Ongoing mentoring regarding opportunities to support millennials' professional development includes offering participation in activities to advance evidence-based practice, preceptor training, financial assistance with national certification examinations and tuition reimbursement.

Linking the work environment to missed nursing care in labour and delivery

Abstract: Aim To measure the association between the nurse work environment (NWE) and missed nursing care on labour and delivery (L&D) units. Background L&D units provide a sizable fraction of acute hospital services to a unique population that is a national and global priority. L&D nurses are the frontline providers during labour. Maternal morbidity and mortality may be influenced by the NWE and missed care. Methods This cross-sectional study utilized secondary data from 1,313 L&D staff nurses in 247 hospitals from a four-state nurse survey collected in 2005-2008. Results Half of nurses missed care (range: zero to 100% across hospitals). Nurses on average missed 1.25 of 10 activities. The most commonly missed activities were comforting/talking with patients and teaching/counselling. In better as compared to poor NWEs, the odds and frequency of missed care were significantly lower. Conclusions L&D nurses routinely miss necessary nursing activities. Labouring women's psychosocial, comfort and educational needs are compromised most often, likely impacting quality and outcomes. Nurse communication with colleagues and managers about missed care is warranted. Implications for nursing management The L&D NWE is modifiable and appears to influence missed care. Managers should discuss missed care with staff and measure their NWE to identify actionable weaknesses.

A systematic review on the structured handover interventions between nurses in improving patient safety outcomes

Abstract: Aim This review aimed to elucidate the effectiveness of structured handovers in improving patient outcomes in the wards. Background Studies have reported that the lack of quality handovers is one of the main causes of adverse effects. Evaluation A search over six electronic databases: MEDLINE; CINAHL; Web of Science; EMBASE; Scopus; and CENTRAL via Ovid concluded nine studies and synthesized by two independent reviewers based on the Cochrane Handbook for Systematic Reviews of Interventions. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement was used to guide the undertaking of this review and meta-analysis. All studies published up to February 2019 were considered in this review. Key issues This review has demonstrated that structured handovers reduced the incidences of patient complications, medication errors and general adverse events. However, the results were not statistically significant. Conclusion Current structured handover formats were effective in reducing problematic handovers such as omission of information, inaccurate information and documentation errors. Implications for nursing management Although there is limited high-quality and rigorous research conducted to gain a clearer understanding of the impacts on patient-related outcomes in nursing care, structured handovers remained effective in reducing the number of mistakes in information transfer.

Factors associated with nurses' willingness to participate in care of patients with COVID-19: A survey in China.

Abstract: Aim The research aims to assess nurses' willingness to participate in care of patients with coronavirus disease 2019 (COVID-19) in China and to identify its associated factors. Background Along with the increasing number of infections, the world has paid widespread attention to COVID-19. Methods This cross-sectional study used a convenience sampling method that included a demographics questionnaire and the Nurses' Perceived Professional Benefits Questionnaire. The survey was distributed to 1,787 nurses from 36 hospitals in China. Results In total, 1,176 questionnaires were usable for this research. 92.79% of nurses were willing to participate in care of patients with COVID-19. Intensive care unit (ICU) nurses were less willing to participate, while surgical nurses were more willing to participate. In addition, nurses with high positive professional perception scores were more willing to participate than those with low scores. Conclusion The vast majority of nurses were willing to participate in care of patients with COVID-19 in China. Surgical nurses and nurses with positive professional perceptions are more likely to be willing to participate in treatment. Implications for nursing management To increase nurses' willingness to participate in care of patients with COVID-19, improving the sense of perceived professional benefits, offering salary and offering paid sick leave for nursing staff are effective ways. In addition, raising the awareness of infectious diseases and increased pre-disaster training during infectious diseases is critical.

The effect of mindfulness-based training on stress, anxiety, depression and job satisfaction among ward nurses: A randomized control trial.

Abstract: AIM To assess the effect of a 4-week mindfulness-based training intervention on improving stress, anxiety, depression and job satisfaction among ward nurses. BACKGROUND Previous literature showed that mindfulness-based training is useful for helping nurses cope with stress. METHOD Nurses who have mild to moderate levels of stress, anxiety and depression identified from a teaching hospital were invited to a randomized control trial. The intervention group had a 2-hr Mindfulness-Based Training workshop, followed by 4 weeks of guided self-practice Mindfulness-Based Training website. Both the intervention group (n = 118) and the control group (n = 106) were evaluated pre- and post-intervention, and 8 weeks later (follow-up) using the Depression, Anxiety, and Stress Scale-21, Job Satisfaction Scale and Mindful Attention Awareness Scale. RESULTS There was a significant effect over time on stress, anxiety, depression and mindfulness level (p < .05). Regarding the difference between the groups and interaction between time and group, there was a significant effect for anxiety (p = .037 p = .008) and job satisfaction (p < .001, p = .40), respectively, with moderate effect size for anxiety reduction (.465) and small for job satisfaction increment (.221). CONCLUSION Mindfulness-Based Training is effective in improving anxiety and job satisfaction among nurses. CLINICAL IMPLICATIONS FOR NURSING MANAGEMENT Mindfulness-Based Training can be included as hospital policy to reduce anxiety and increase job satisfaction among nurses.

Associations between work environment and implicit rationing of nursing care: A systematic review.

Abstract: Aim To systematically evaluate the effect of working environment on implicit rationing of nursing care. Background Research has established direct and indirect associations between work environment and adverse patient outcomes. However, the causal nature of this relationship is uncertain, and implicit rationing has been proposed as a mediating factor between the work environment and patient outcomes. Method Eight databases were searched for articles published between May 2000 and May 2019. Results The reviewed articles provided evidence for the negative correlation between working environment and implicit rationing in 15 studies, and one of the studies showed that the correlation was not strong. There were differences in the levels of implicit rationing in different hospitals, units and shifts. Conclusion The degree of influence of various factors in the working environment on implicit rationing is different. In addition, the working environment is only one of the factors that affects implicit rationing. Implications for nursing management Nursing managers initiatives to improve nurses' work environments should include improve nurses' perception of the adequacy of staffing and resources and improving teamwork to decrease nursing care left undone, so as to improve nurse outcomes and quality of care.

Missed, rationed or unfinished nursing care: A scoping review of patient outcomes

Abstract: Aims To collate evidence about patient outcomes resulting from the phenomenon of incomplete nursing care described in the literature variously as missed, rationed, or unfinished nursing care. Background Nursing care which is not completed is known to have a negative impact on patients. However, to date, there has been no thorough exploration of the extent and potential seriousness of patient outcomes. Methods The search was performed in four scientific databases; 44 studies were included in the final content analysis. Results Missed, rationed and unfinished care negatively influence the patient outcomes in the context of patient safety and quality of nursing care. Despite the differences among concepts, the negative association with patient outcomes was significant and common for all concepts. Conclusion Awareness of potential harm of the phenomena to patient outcomes may help the management to develop preventive strategies to reduce or eliminate its actual occurrence. Implications for nursing management Hospital management should consider the phenomenon as an indicator of the quality of nursing care as well as establish the routine monitoring of the phenomena in the assessment of patient safety in healthcare facilities.

High resilience leads to better work performance in nurses: Evidence from South Asia.

Abstract: AIM To find out how resilience level is related to work performance of nurses. BACKGROUND Resilience is a developable and teachable skill which helps to recover from adversities and continue functioning above the norm. Though combating negative effects at work such as burnout is widely researched, harnessing positive organisational effects such as work performance through resilience is yet to be well-established. METHODS Cross-sectional study enrolled 230 nurses from Sri Lanka. The level of resilience at work and performance were assessed using culturally adapted and validated tools. How each resilience subscale predicted the nursing performance was assessed using bivariate correlation and linear regression analysis using ordinary least squares method. RESULTS The total resilience scale score demonstrated significant and strong positive correlations with all subdomains of nursing performance, as well as with overall performance (p < .05). In linear regression model, six out of seven subscales in resilience scale predicted 70.5% of variance of work performance. CONCLUSION Higher resilience level at work is associated with better working performance among nurses. IMPLICATIONS FOR NURSING MANAGEMENT Nursing profession is well-known to be of highly stressful and fostering resilience would be extremely useful as an investment to combat such negative effects, while yielding positive organisational benefits such as better work performance.

New graduate registered nurses' experiences with psychological safety.

Abstract: Aim The purpose of this study was to gain insight into new graduate registered nurses' experiences with psychological safety. Background Organizational learning allows acute care hospitals to consistently provide high-quality patient care. Psychological safety is critical for organizational learning. New graduate nurses in particular need to feel psychologically safe as they transition into professional nursing practice. Understanding new graduate registered nurses' experiences of psychological safety can guide leaders and others to create work environments that foster psychological safety and organizational learning. Method Semi-structured interviews were conducted with 13 newly graduated registered nurses working in inpatient hospital settings. Interviews were analyzed using thematic analysis. Results Four primary themes featured prominently in the new graduate nurses' experiences of psychological safety: building credibility, making personal connections, feeling supported and seeking safety. Conclusion Understanding these themes will help nursing education programmes, nurse managers, nurse colleagues and new graduate registered nurses foster psychological safety and create environments conducive to organisational learning. Implications for nursing management All members of the health care team involved in the new graduate registered nurses' transition to practice have a role in fostering psychological safety. Additional research is needed to better understand psychological safety and how to foster it.

Missed nursing care and related factors in Iranian hospitals: A cross-sectional survey.

Abstract: Aim: To determine the prevalence of, and reasons for, missed care by nurses and the factors associated with it in Iranian hospitals. Background: Despite providing high-quality patient care in hospitals, nurses often fail to deliver optimum care, which jeopardizes the safety of patients and increases health care costs. Therefore, identifying missed nursing care is essential if the quality of health services is to be improved. Methods: A cross-sectional study was conducted among 215 nurses working in the medical�surgical wards of eight public and private hospitals in Tabriz, Iran. The �MISSCARE� survey tool was used to collect data in relation to the extent of missed care and the related reasons. Logistic regression models were used to assess the association between factors and missed nursing care. Results: Results showed that the mean score of overall missed nursing care was 2.57 and 72.1 of the nurses reported that they missed at least one nursing care item on their last shift. �Patient discharge planning and teaching�, �emotional support to patient and/or family� and �attend interdisciplinary care conferences whenever held� were the most common missed items by nurses in Iran. In a 5-point Likert scale, the most important reasons identified by nurses for missed care were �human resources�, 3.11 (95 CI: 3.03�3.19); �material resources�, 2.7 (95 CI: 2.6�2.8); and �communication�, 2.4 (95 CI: 2.3�2.5), respectively. Missed nursing care was associated with sex (OR for males = 2.83, 95 CI: 1.01�7.89), age (OR = 1.16, 95 CI: 1.01�1.33) and the number of patients under care (OR = 1.11, 95 CI 1.01�1.22). A reverse association was found with the number of patients discharged (OR = 0.89, 95 CI: 0.82�0.96) and satisfaction with teamwork (OR = 0.60, 95 CI: 0.41�0.89). Conclusions: There is a need to identify the factors contributing to the incidence of missed nursing care in hospitals and to develop strategies to address these. Implications for Nursing Management: The results of this study highlighted the importance of addressing missed nursing care in Iranian public and private hospitals. Nursing management should consider improving communication between team members and units. Changes are required regarding task division and payments to the nursing staff. Further research is required to understand the reasons behind missed nursing care, and the development of appropriate policies to address better nursing care in hospitals is recommended. © 2020 John Wiley & Sons Ltd

Relationship between the implementation of primary nursing model and the reduction of missed nursing care.

Abstract: Aims To evaluate and predict the relationship between the implementation of the primary nursing model and the reduction of missed nursing care. Background Primary nursing can provide hospital leaders and nursing staff with guidance in implementing safe, patient-centred care, with responsibility and accountability during the nursing process. The implementation can be measured in terms of missed nursing care. Methods A predictive correlational study was used. The study was conducted in four inpatient units at the University Hospital, Northeast, Brazil. Data were collected from 96 nursing professionals, using the MISSCARE instrument at four and seven months after the implementation of the primary nursing model. Results Missed nursing care was reduced by 78.5%. Job title and staff satisfaction showed significant associations with decreased missed care (p Conclusion The predictive effect between efficacy in reducing missed nursing care and reasons and efficiency in the management of nursing care, using the primary nursing model, was verified. Implications for nursing management Nursing staff and managers should consider adopting a Primary Nursing Model of care to reduce missed nursing care.

Transformational leadership, knowledge sharing and reflection, and work teams' performance: A structural equation modelling analysis.

Abstract: AIM The aim was to determine whether there are relationships among transformational leadership, safe team climate, knowledge sharing and reflection, and team performance in nursing and social work teams. BACKGROUND Based on organisational learning theory, we hypothesized that transformational leadership could create a safe team climate that fosters knowledge sharing and reflection in teams and thus influences the performance of teams. METHODS We conducted a cross-sectional study using questionnaires and validated scales to measure transformational leadership, safe team climate, knowledge sharing and reflection, and performance. The sample consisted of 32 teams (N = 32 teams, n = 183 team members). RESULTS We conducted structural equation modelling. The results indicate that reflection positively relates with team performance, transformational leadership has a direct positive relationship with safe team climate, and safe team climate has positive relationships with knowledge sharing and reflection. CONCLUSION Our findings regarding transformational leadership's positive influence on teams in nursing and social work fill an important gap in the literature. The study's limitations are the use of self-reports and a small sample size. IMPLICATIONS FOR NURSING MANAGEMENT Our results indicate that transformational leadership can foster a safe climate in work teams and hereby team learning and performance.

Burnout, job dissatisfaction and missed care among maternity nurses

Abstract: Aim This study examined the prevalence of job dissatisfaction and burnout among maternity nurses and the association of job dissatisfaction and burnout with missed care. Background Nurse burnout and job dissatisfaction affect the quality and safety of care and are amenable to intervention. Little is known about job dissatisfaction and burnout among maternity nurses or how these factors are associated with missed care in maternity units. Methods This was a cross-sectional secondary analysis of the 2015 RN4CAST survey data and the American Hospital Association's 2015 Annual Survey. Robust logistic regression models at the nurse level examined the association of job dissatisfaction and burnout with missed care. Results One-quarter of nurses screened positive for burnout, and almost one-fifth reported job dissatisfaction. While 56.4% of nurses in the total sample reported any missed care, 72.6% of nurses with job dissatisfaction and 84.5% of nurses with burnout reported any missed care (p Conclusions The association of job dissatisfaction and burnout, which are modifiable states, with increased rates of missed maternity care suggests that addressing job dissatisfaction and burnout may improve care quality. Implications for nursing management Job dissatisfaction, burnout and missed care may decrease with an improved work environment.

Unfinished nursing care in four central European countries.

Abstract: Aim The main aim of the research was to describe and compare unfinished nursing care in selected European countries. Background The high prevalence of unfinished nursing care reported in recently published studies, as well as its connection to negative effects on nurse and patient outcomes, has made unfinished care an important phenomenon and a quality indicator for nursing activities. Methods A cross-sectional descriptive study was undertaken. Unfinished nursing care was measured using the Perceived Implicit Rationing of Nursing Care questionnaire (PIRNCA). The sample included 1,353 nurses from four European countries (Croatia, the Czech Republic, Poland and Slovakia). Results The percentage of nurses leaving one or more nursing activities unfinished ranged from 95.2% (Slovakia) to 97.8% (Czech Republic). Mean item scores on the 31 items of the PIRNCA in the total sample ranged from 1.13 to 1.92. Unfinished care was significantly associated with the type of hospital and quality of care. Conclusion The research results confirmed the prevalence of unfinished nursing care in the countries surveyed. Implications for nursing management The results are a useful tool for enabling nurse managers to look deeper into nurse staffing and other organizational issues that may influence patient safety and quality of care.

A cross-sectional survey on nurses’ second victim experience and quality of support resources in Singapore

Abstract: Aim The study aimed to investigate nurses' second victim experience and quality of support resources in Singapore. Background The second victim phenomenon, broadly described as the suffering of providers including nurses in the face of a clinical error, is often overlooked. Methods A cross-sectional questionnaire survey was adopted. A total of 1,163 nurses from an acute public hospital in Singapore took part in the study. The Second Victim Experience and Support Tool (SVEST) was employed to assess experience of second victims and the quality of support resources. Results The study results showed that nurses experienced second victim-related physical, psychological and professional distress. About 31.8% of the participants had turnover intentions, while 9.3% had absenteeism following an error. Nurses who are younger and less experienced were more likely to experience greater second victim response. Among the support options, peer support was rated as the most desirable. Conclusion Nurses, being at the forefront of care delivery, are especially susceptible to being a casualty of the second victim phenomenon. Implications for nursing management Acknowledging the second victim phenomenon, together with a strong organizational support, is essential in alleviating the trauma and assisting nurses with reconciliation in the aftermath of an unanticipated error.

The relationship between burnout, job satisfaction and the rationing of nursing care-A cross-sectional study.

Abstract: AIMS To assess the impacts of burnout and job satisfaction on the rationing of care in the professional group of nurses. BACKGROUND The shortage of nursing staff is currently one of the most significant health care problems. It is not clear how burnout and job satisfaction affect the rationing of nursing care. METHODS We included 594 nurses, and we used the Basel Extent of Rationing of Nursing Care-R (BERNCA-R), the Maslach Burnout Inventory (MBI) and the Job Satisfaction Scale (JSS). RESULTS The average scores were 1.72 ± 0.87 points for the BERNCA-R, 36.08 ± 21.25 for the MBI and 19.74 ± 5.57 for the JSS. A statistically significant positive correlation between the BERNCA-R and the MBI (p < .05) and a negative correlation between the BERNCA-R and the JSS (p < .05) were observed. Independent predictors of the BERNCA-R were the result of emotional exhaustion of the MBI and the assessment of the impact of independence on job satisfaction (p < .05). CONCLUSION Occupational burnout can decrease job satisfaction in nursing staff and result in adverse outcomes of rationing care. Nursing managers should pay more attention to individual differences in nursing-care workers linked with nursing burnout, job satisfaction and the rationing of care. IMPLICATIONS FOR NURSING MANAGEMENT Interventions aimed at counteracting burnout are the key to improving job satisfaction in nurses.