Nurse staffing and patient outcomes in Belgian acute hospitals: cross-sectional analysis of administrative data

Background

Studies have linked nurse staffing levels (number and skill mix) to several nurse-sensitive patient outcomes. However, evidence from European countries has been limited.

Objectives

This study examines the association between nurse staffing levels (i.e. acuity-adjusted Nursing Hours per Patient Day, the proportion of registered nurses with a Bachelor's degree) and 10 different patient outcomes potentially sensitive to nursing care.

Design-setting-participants

Cross-sectional analyses of linked data from the Belgian Nursing Minimum Dataset (general acute care and intensive care nursing units: n = 1403) and Belgian Hospital Discharge Dataset (general, orthopedic and vascular surgery patients: n = 260,923) of the year 2003 from all acute hospitals (n = 115).

Methods

Logistic regression analyses, estimated by using a Generalized Estimation Equation Model, were used to study the association between nurse staffing and patient outcomes.

Results

The mean acuity-adjusted Nursing Hours per Patient Day in Belgian hospitals was 2.62 (S.D. = 0.29). The variability in patient outcome rates between hospitals is considerable. The inter-quartile ranges for the 10 patient outcomes go from 0.35 for Deep Venous Thrombosis to 3.77 for failure-to-rescue. No significant association was found between the acuity-adjusted Nursing Hours per Patient Day, proportion of registered nurses with a Bachelor's degree and the selected patient outcomes.

Conclusion

The absence of associations between hospital-level nurse staffing measures and patient outcomes should not be inferred as implying that nurse staffing does not have an impact on patient outcomes in Belgian hospitals. To better understand the dynamics of the nurse staffing and patient outcomes relationship in acute hospitals, further analyses (i.e. nursing unit level analyses) of these and other outcomes are recommended, in addition to inclusion of other study variables, including data about nursing practice environments in hospitals.     

The relationship between nurse practice environment,nurse work characteristics,burnout and job outcome and quality of nursing care: A cross-sectional survey

Aim

To explore the mechanisms through which nurse practice environment dimensions are associated with job outcomes and nurse-assessed quality of care. Mediating variables tested included nurse work characteristics of workload, social capital, decision latitude, as well as burnout dimensions of emotional exhaustion, depersonalization, and personal accomplishment.

Background

Acute care hospitals face daily challenges to their efforts to achieve nurse workforce stability, safety, and quality of care. A body of knowledge shows a favourably rated nurse practice environment as an important condition for better nurse and patient outcome variables; however, further research initiatives are imperative for a clear understanding to support and guide the practice community.

Design

Cross-sectional survey.

Method

Grounded on previous empirical findings, a structural equation model designed with valid measurement instruments was tested. The study population was registered acute care nurses (N = 1201) in two independent hospitals and one hospital group with six hospitals in Belgium.

Results

Nurse practice environment dimensions predicted job outcome variables and nurse ratings of quality of care. Analyses were consistent with features of nurses’ work characteristics including perceived workload, decision latitude, and social capital, as well as three dimension of burnout playing mediating roles between nurse practice environment and outcomes. A revised model adjusted using various fit measures explained 52% and 47% of job outcomes and nurse-assessed quality of care, respectively.

Conclusion

The study refines understanding of the relationship between aspects of nursing practice in order to achieve favourable nursing outcomes and offers important concepts for managers to track in their daily work. The findings of this study indicate that it is important for clinicians and leaders to consider how nurses are involved in decision-making about care processes and tracking outcomes of care and whether they are able to work with physicians, superiors, peers, and subordinates in a trusting environment based on shared values. The involvement of nurse managers at the unit level is especially critical because of associations with nurse work characteristics such as decision latitude and social capital and outcome variables. Further practice and research initiatives to support nurses’ involvement in decision-making process and interdisciplinary teamwork are recommended.     

Front-line management, staffing and nurse-doctor relationships as predictors of nurse and patient outcomes. a survey of Icelandic hospital nurses

Objective

To investigate aspects of nurses’ work environments linked with job outcomes and assessments of quality of care in an Icelandic hospital.

Background

Prior research suggests that poor working environments in hospitals significantly hinder retention of nurses and high quality patient care. On the other hand, hospitals with high retention rates (such as Magnet hospitals) show supportive management, professional autonomy, good inter-professional relations and nurse job satisfaction, reduced nurse burnout and improved quality of patient care.

Methods

Cross-sectional survey of 695 nurses at Landspitali University Hospital, Reykjavík. Nurses’ work environments were measured using the nursing work index—revised (NWI—R) and examined as predictors of job satisfaction, the Maslach burnout inventory (MBI) and nurse-assessed quality of patient care using linear and logistic regression approaches.

Results

An Icelandic adaptation of the NWI—R showed a five-factor structure similar to that of Lake (2002). After controlling for nurses’ personal characteristics, job satisfaction, emotional exhaustion and nurse rated quality of care were found to be independently associated with perceptions of support from unit-level managers, staffing adequacy, and nurse-doctor relations.

Conclusions

The NWI—R measures elements of hospital nurses’ work environments that predict job outcomes and nurses’ ratings of the quality of patient care in Iceland. Efforts to improve and maintain nurses’ relations with nurse managers and doctors, as well as their perceptions of staffing adequacy, will likely improve nurse job satisfaction and employee retention, and may improve the quality of patient care.     

The relationship between inpatient cardiac surgery mortality and nurse numbers and educational level: Analysis of administrative data

Background

In most multicenter studies that examine the relationship between nurse staffing and patient safety, nurse-staffing levels are measured per hospital. This can obscure relationships between staffing and outcomes at the unit level and lead to invalid inferences.

Objective

In the present study, we examined the association between nurse-staffing levels in nursing units that treat postoperative cardiac surgery patients and the in-hospital mortality of these patients.

Design-setting-participants

We illustrated our approach by using administrative databases (Year 2003) representing all Belgian cardiac centers (n = 28), which included data from 58 intensive care and 75 general nursing units and 9054 patients.

Methods

We used multilevel logistic regression models and controlled for differences in patient characteristics, nursing care intensity, and cardiac procedural volume.

Results

Increased nurse staffing in postoperative general nursing units was significantly associated with decreased mortality. Nurse staffing in postoperative intensive care units was not significantly associated with in-hospital mortality possibly due to lack of variation in ICU staffing across hospitals.

Conclusion

This study, together with the international body of evidence, suggests that nurse staffing is one of several variables influencing patient safety. These findings further suggest the need to study the impact of nurse-staffing levels on in-hospital mortality using nursing-unit-level specific data.     

Nursing unit teams matter: Impact of unit-level nurse practice environment,nurse work characteristics,and burnout on nurse reported job outcomes,and quality of care,and patient adverse events—A cross-sectional survey

Aim

To investigate the impact of nurse practice environment factors, nurse work characteristics, and burnout on nurse reported job outcomes, quality of care, and patient adverse events variables at the nursing unit level.

Background

Nurse practice environment studies show growing insights and knowledge about determining factors for nurse workforce stability, quality of care, and patient safety. Until now, international studies have primarily focused on variability at the hospital level; however, insights at the nursing unit level can reveal key factors in the nurse practice environment.

Design

A cross-sectional design with a survey.

Method

In a cross-sectional survey, a sample of 1108 nurses assigned to 96 nursing units completed a structured questionnaire composed of various validated instruments measuring nurse practice environment factors, nurse work characteristics, burnout, nurse reported job outcomes, quality of care, and patient adverse events. Associations between the variables were examined using multilevel modelling techniques.

Results

Various unit-level associations (simple models) were identified between nurse practice environment factors, nurse work characteristics, burnout dimensions, and nurse reported outcome variables. Multiple multilevel models showed various independent variables such as nursing management at the unit level, social capital, emotional exhaustion, and depersonalization as important predictors of nurse reported outcome variables such job satisfaction, turnover intentions, quality of care (at the unit, the last shift, and in the hospital within the last year), patient and family complaints, patient and family verbal abuse, patient falls, nosocomial infections, and medications errors.

Conclusion

Results suggested a stable nurse work force, with the capability to achieve superior quality and patient safety outcomes, is associated with unit-level favourable perceptions of nurse work environment factors, workload, decision latitude, and social capital, as well low levels of burnout. Nurses, physicians, nursing leaders, and executives share responsibility to create an environment supportive of interdisciplinary team development.     

Validation of an instrument for measuring psychosocial and organisational work constraints detrimental to health among hospital workers: the NWI-EO questionnaire

Background

Quality of care, job satisfaction and the health of registered nurses (RNs) are associated with their exposure to psychosocial and organisational work factors (POWFs).

Objectives

To develop and validate an extended version of the Revised Nursing Work Index (NWI-R), the NWI-EO (Extended Organisation) tool specifically designed for occupational physicians and those involved in prevention programmes in healthcare institutions to assess the perception of POWFs, and then to determine priorities for preventive action to improve work organisation at the hospital staff level.

Methods

The tool was validated in the ORSOSA study, a multicentre French cohort of RNs and NAs (n = 4085) recruited in 214 work units of 7 French university hospitals. A total of 34 items (19 candidate items developed by a focus group and 15 items from the NWI-R) were analysed using principal component analysis (PCA) based on a randomised split-half of the data. In addition, construct validity, test-retest reliability, internal consistency and concurrent validity were assessed.

Results

Response rate was 91%. Twenty-two items were selected (9 of the 15 NWI-R items and 13 of the 19 candidate items) by PCA, resulting in an 8-factor solution that explained 53% of the common variance. The stability of the factorial structure of this 22-item NWI-EO questionnaire was confirmed by PCA on the other half-sample as well as by PCA on subgroups (age, gender, occupational group, specialty area, hospital). Reliability, assessed by internal consistency and test-retest, was satisfactory. Concurrent validity with two external measurements of organisational characteristics of work units was also observed.

Conclusion

The NWI-EO was found to have good psychometric properties. Several POWFs accessible to prevention programmes can be evaluated with this tool: poor communication in the work unit, lack of support from senior nurses, inadequate staffing to perform duties, poor relationships between workers, frequency of interruptions during tasks, low level of shared values within the team with regard to work, lack of support from the administration, and changes in planned vacations and time off. We believe the NWI-EO is a useful tool for assessing POWFs among RNs and NAs in order to determine priorities for preventive action to improve work organisation at the unit level.     

The relationship between nurse staffing and patient outcomes: a case study

Background

Research has shown a direct relationship between staffing levels and patient outcomes for specific nurse-sensitive indicators, with lower patient to nurse ratios (i.e. less patients per nurse) associated with better outcomes.

Objectives

To explore the relationship between nurse staffing characteristics (the nursing hours worked by permanent and temporary staff and nurse hours per patient day) and patient outcomes: pressure sores, patient falls, upper gastrointestinal bleed, pneumonia, sepsis, shock and deep vein thrombosis.

Design

A case study using retrospective hospital data, at ward level.

Setting

A tertiary cardio-respiratory NHS Trust in England, comprising two hospitals.

Participants

All patients, including day cases, who were admitted to either hospital as an in-patient over 12 months.

Methods

Data were extracted from corporate hospital systems. The clinical areas were categorised as lower dependency, i.e. wards, or critical care which included ICU and high dependency units. The relationship between nurse staffing characteristics and patient outcomes was assessed using either a Poisson or negative binomial regression model as appropriate. We sought to establish whether the outcomes were affected by the nurse hours per patient day, the permanent nurse hours worked as a percentage of the total hours, and the permanent nurse hours worked as a percentage of the permanent and bank hours combined.

Results

In the lower dependency category wards there was only a weak association demonstrated between nurse staffing and the majority of the outcomes. The results from the high dependency critical care areas showed few significant results with only the rate of sepsis being significantly reduced as the ratio of permanent staff hours increased.

Conclusions

The study demonstrated the possibility of using existing hospital data to examine the relationship between nurse staffing and patient outcomes, however the associations found were weak and did not replicate reliably the findings from previous work.     

Revisiting the impact of job satisfaction and organizational commitment on nurse turnover intention: an individual differences analysis

Background

Nurse turnover is an important contributing factor to the worldwide nursing shortage. Many studies have examined the antecedents of nurse turnover to gain a better understanding of the problem and help hospitals reduce their turnover rates. However, an important shortcoming of this research stream is its exclusive focus on explaining turnover behavior of the “average nurse”, thereby disregarding individual differences between nurses and groups of nurses.

Objectives

To examine individual differences in the relationships between two crucial turnover antecedents – job satisfaction and organizational commitment – and nurse turnover intention.

Participants

A sample of 287 nurses working for a variety of Belgian hospitals participated in the study.

Methods

A survey method was used to collect quantitative data, which were analyzed through standard multiple linear regression, mixture regression models and t-tests.

Results

In the total sample of hospital nurses, both job satisfaction and organizational commitment significantly predicted nurse turnover intention. However, subsequent individual differences analyses revealed the existence of two subgroups of nurses. In the satisfaction focused group, only job satisfaction was found to predict nurse turnover intention, whereas in the satisfaction and commitment focused group both job satisfaction and organizational commitment were related to turnover intention. Furthermore, nurses in the latter group displayed stronger turnover intention, were significantly younger and had less job tenure and organizational tenure than nurses in the satisfaction focused group.

Conclusions

The debate on the antecedents of nurse turnover still continues, as the existing models fail to fully grasp nurse turnover. The present study identifies individual differences in nurse turnover antecedents among groups of nurses as a possible reason for the absence of one comprehensive turnover model that holds for the general nursing population. Further studies are needed in order to capture the total impact of the underlying individual differences in nurse turnover antecedents.     

The impact of an intervention for nurse prescribers on consultations to promote patient medicine-taking in diabetes: A mixed methods study

Background

Nurse prescribers are in a key position to promote medicine-taking in diabetes. Although patients’ beliefs about medicines are important predictors of medicine-taking, evidence suggests nurses do not routinely explore these.

Objectives

To evaluate a theory-based intervention designed to increase nurse prescribers’ exploration of medicines’ beliefs with people with diabetes.

Design

Mixed methods concurrent triangulation design.

Settings

Nurse prescribers were recruited from 7 Trusts in England.

Participants

A purposive sample of 14 nurse prescribers attended four 1 day workshops.

Methods

Audio-recordings of each nurse prescribers’ consultations with diabetes patients were collected at baseline, 1 week, 3 months and 6 months after the intervention. Nurse prescribers were interviewed at 1 month and 6 months post-intervention. Changes in medicines’ discussion and participation in consultations were analysed using MEDICODE. Interview data were analysed using Framework Analysis.

Results

MEDICODE themes of ‘attitudes towards medication’ showed a significant rise at 1 week (p < 0.01) and 3 months (p < 0.05). ‘Asks patient opinion about medication’ significantly increased at 1 week (p < 0.01). Discussion on ‘concerns about medication’ rose significantly at 1 week (p < 0.001) and 6 months (p < 0.01). Discussion on ‘expected effects of medication’, ‘action of medication’ and ‘reasons for medication’ showed no change. There were no significant changes in Dialogue Ratio. However, the Preponderance of Initiative moved towards more patient initiative at 1 week (p < 0.0001), 3 months (p < 0.0001), and 6 months (p < 0.0001). In interviews, nurses reported increased attention to patients’ medication beliefs and adoption of patient-centred skills. Contextual factors that positively influenced ability to explore medicines beliefs in practice settings were: support of colleagues and practicing new skills. Inhibiting factors included: patients’ perceived lack of receptivity, time constraints, and concerns about opening a ‘can of worms’. Six months interviews revealed using skills in practice enhanced nurses’ confidence and sustainability of skills requires a nurse-patient relationship. Method triangulation illuminated how the intervention was implemented in practice contexts.

Conclusions

The intervention was effective at changing some key dimensions of prescribing consultations. The use of a self-efficacy framework in the intervention, to promote nurses’ confidence in working in a different way, may have been instrumental in effecting the changes found. Contextual factors influencing beliefs exploration in medicine-taking consultations were identified.     

Measuring free-living physical activity in adults with and without neurologic dysfunction with a triaxial accelerometer

Hale LA, Pal J, Becker I. Measuring free-living physical activity in adults with and without neurologic dysfunction with a triaxial accelerometer.

Objective

To investigate the reliability, validity, and utility of a triaxial accelerometer to measure physical activity in the free-living environment in adults with and without neurologic dysfunction.

Design

Repeated-measures design.

Setting

General community.

Participants

Volunteer sample of 17 men and 30 women (age range, 28−91y) living in the community with stroke of greater than 6 months in duration (n=20), Parkinson disease (n=7), or multiple sclerosis (n=11), and healthy but sedentary controls (n=9).

Interventions

Not applicable.

Main Outcome Measures

Physical activity measured with the TriTrac RT3 accelerometer, 7-day recall questionnaire, and activity diary.

Results

The accelerometer reliably measured free-living physical activity (intraclass correlation coefficient, .85; 95% confidence interval, .74−.91; P=.000). The standard error of measurement indicated that a second test would differ from a baseline test by ±23%. Mean daily RT3 data collected in the first 3 days differed significantly from that of the mean daily RT3 data collected over 7 days. The RT3 appeared to distinguish level of mobility better than the 7-day recall questionnaire, and participants found the RT3 to be a user-friendly and acceptable measure of physical activity.

Conclusions

The triaxial accelerometer provided a stable measure of free-living physical activity, was found to distinguish between people with varying levels of mobility, and was well tolerated by participants. The results indicate that collecting data for 3 days was not reflective of data collected over 7 days.     

Bed-to-nurse ratios, provision of basic nursing care, and in-hospital and 30-day mortality among acute stroke patients admitted to an intensive care unit: Cross-sectional analysis of survey and administrative data

Background

The literature reports inconsistent evidence of the effects of nurse staffing on mortality despite continuing examination of this association.

Objective

To examine differences in provision of basic nursing care and in-hospital and 30-day mortality by nurse staffing of ICUs and general wards among acute stroke patients admitted to ICUs during hospitalization.

Design

A cross-sectional design that included survey and administrative data.

Settings and participants

The study included 6957 patients with hemorrhagic and ischemic stroke who were admitted to ICUs of 185 Korean hospitals.

Methods

Nurse staffing of ICUs and general wards was graded based on the bed-to-nurse ratios of each hospital. Provision of basic care was measured by whether five activities, such as bathing and feeding assistance, were fully provided by ICU nursing staff without delegation to patient families. Hospitals were categorized into low, middle, and high mortality groups for in-hospital and 30-day mortality based on z-scores that indicated standardized difference between observed and expected mortality after controlling for patient characteristics.

Results

In 83.8% of hospitals, basic care was provided fully by ICU nursing staff. The overall in-hospital and 30-day mortality rates were 21.9 and 25.4%, respectively. Hospitals with higher ICU staffing were more likely to fully provide basic care. Better ICU and general staffing tended to be associated with lower in-hospital and 30-day mortality. Compared with in-hospital mortality, 30-day mortality had a more distinct increase as nurse staffing became worse.

Conclusion

The findings provide evidence that nurse staffing may impact provision of basic care and patient mortality and suggest the need for policies for providing adequate nurse staffing.     

Effect of a 12-Week Yoga Intervention on Fear of Falling and Balance in Older Adults: A Pilot Study

Schmid AA, Van Puymbroeck M, Koceja DM. Effect of a 12-week yoga intervention on fear of falling and balance in older adults: a pilot study.

Objective

To determine whether fear of falling (FoF) and balance improved after a 12-week yoga intervention among older adults.

Design

A 12-week yoga intervention single-armed pilot study.

Setting

A retirement community in a medium-sized university town in the Midwest.

Participants

A convenience sample of adults (N=14) over the age of 65 years who all endorsed an FoF.

Intervention

Each participant took part in a biweekly 12-week yoga intervention. The yoga sessions included both physical postures and breathing exercises. Postures were completed in sitting and standing positions.

Main Outcome Measures

We measured FoF with the Illinois FoF Measure and balance with the Berg Balance Scale. Upper- and lower-body flexibility were measured with the back scratch test and chair sit and reach test, respectively.

Results

FoF decreased by 6%, static balance increased by 4% (P=.045), and lower-body flexibility increased by 34%.

Conclusions

The results indicate that yoga may be a promising intervention to manage FoF and improve balance, thereby reducing fall risk for older adults. Rehabilitation therapists may wish to explore yoga as a modality for balance and falls programming; however, future research is needed to confirm the use of yoga in such programming.     

Effects of 8 weeks sustained follow-up after a nurse consultation on hypertension: A randomised trial

Background

The prevalence of hypertension is high, but the overall control rate is low. Poor control of, hypertension is associated with a number of diseases, such as stroke, heart and renal failure, and high, mortality rates. Studies have shown the separate effects of nurse clinics and telephone follow-up on, blood pressure control, but the incremental effect of combining the two interventions is unknown.

Objectives

This study examines whether there is an incremental effect on blood pressure control when using a nurse clinic combined with telephone follow-up.

Methods

This was a randomised controlled trial. The primary outcome measure was blood pressure reading. The secondary outcome measures included adherence to home blood pressure monitoring, exercise, diet, medication, and satisfaction with care.

Results

There were no significant differences in the baseline measures between the control and study groups. Significant differences were found at 8 weeks after intervention was initiated between groups in, systolic blood pressure (control −7.97 vs study −19.03, t = 2.35, p = 0.022, CI 1.66-20.47) and diastolic, blood pressure (control −3.72 vs study −11.68, t = 3.02, p = 0.004, CI 2.68-13.24). Other variables with a significant between-group differences (p < 0.05) were blood pressure control rate, adherence, to home blood pressure monitoring, exercise and satisfaction with care. Further analysis using, regression showed that home blood pressure monitoring is the most significant predictor for improved, systolic blood pressure.

Conclusions

This study showed that nurse clinics have positive effects on blood pressure control and adherence to healthy lifestyle, but telephone follow-up after such clinics augments the effects of the clinic consultation. This combined mode of services is worth considering for other chronic disease, management programmes.     

Leadership styles and outcome patterns for the nursing workforce and work environment: A systematic review

Context

Numerous policy and research reports call for leadership to build quality work environments, implement new models of care, and bring health and wellbeing to an exhausted and stretched nursing workforce. Rarely do they indicate how leadership should be enacted, or examine whether some forms of leadership may lead to negative outcomes. We aimed to examine the relationships between various styles of leadership and outcomes for the nursing workforce and their work environments.

Methods

The search strategy of this multidisciplinary systematic review included 10 electronic databases. Published, quantitative studies that examined leadership behaviours and outcomes for nurses and organizations were included. Quality assessments, data extractions and analysis were completed on all included studies.

Findings

34,664 titles and abstracts were screened resulting in 53 included studies. Using content analysis, 64 outcomes were grouped into five categories: staffsatisfaction with work, role and pay, staff relationships with work, staff health and wellbeing, work environment factors, and productivity and effectiveness. Distinctive patterns between relational and task focused leadership styles and their outcomes for nurses and their work environments emerged from our analysis. For example, 24 studies reported that leadership styles focused on people and relationships (transformational, resonant, supportive, and consideration) were associated with higher nurse job satisfaction, whereas 10 studies found that leadership styles focused on tasks (dissonant, instrumental and management by exception) were associated with lower nurse job satisfaction. Similar trends were found for each category of outcomes.

Conclusion

Our results document evidence of various forms of leadership and their differential effects on the nursing workforce and work environments. Leadership focused on task completion alone is not sufficient to achieve optimum outcomes for the nursing workforce. Efforts by organizations and individuals to encourage and develop transformational and relational leadership are needed to enhance nurse satisfaction, recruitment, retention, and healthy work environments, particularly in this current and worsening nursing shortage.     

Consultations between nurse prescribers and patients with diabetes in primary care: A qualitative study of patient views

Background

There is a drive to improve the quality of service provision for patients with diabetes and to enable better self-management of this condition. The adoption of prescribing by nurses is increasing worldwide and can potentially enhance service provision. Evidence suggests that patients prefer services where their lifestyle factors and opinions are considered by healthcare professionals within a partnership approach. Few studies have explored patients’ views about their consultations with a nurse prescriber.

Objective

To explore the views patients with diabetes have about their consultations with nurse prescribers and any impact this may have on their medications management.

Design

A qualitative study involving semi-structured interviews and thematic analysis.

Setting

Six primary care sites in which nurses prescribed medications for patients with diabetes in England. Data was collected in 2009.

Participants

Interviews took place with 41 patients with diabetes from the case loads of 7 nurse prescribers.

Results

Findings are reported under three themes; the nurse consultation style, benefits of the nurse prescriber consultation and views on involvement and decision-making. Key aspects of the nurse consultation style were a non-hurried approach, care and rapport, approachability, continuity, and providing clear information based on specialist knowledge. Many benefits were described, including improved access to appropriate advice and medication, greater understanding and ability to self-manage, ability to address problems and improved confidence, trust and wellbeing. While patients were happy with the amount of information received and involvement they had decisions about their treatment, there was some controversy over the consistency of information provided on side-effects of treatment.

Conclusions

The study provides new knowledge about what patients with diabetes value and benefit from in respect to care provided by nurse prescribers. Continuity of relationship, flexibility over consultation length, nurses’ interpersonal skills and specialist diabetes knowledge were identified as crucial to good quality care. Patients require that nurse prescribers are skilled in providing a person-centred approach and have access to specialist training. The level of information and involvement offered to patients should reflect patients’ requirements.     

Magnet Hospital attributes in European hospitals: A multilevel model of job satisfaction

Background

The Magnet Recognition Program in the USA has been based on 14 hospital characteristics that were common in hospitals that were “magnets” for professional nurses. While the program has expanded to other countries, no research has explored how the concept translates to other cultures and healthcare systems, nor have multilevel approaches been used.

Objective

The primary aim of this study was to explore the presence of Magnet Hospital attributes in hospitals in two European countries. In addition, the relationship between Magnet Hospital attributes and nurses’ job satisfaction was examined at both the nurse and the hospital level.

Design

A secondary data analysis with cross-sectional design was conducted. A multilevel approach was taken to account for the hospital effect due to the nested nature of the data.

Settings

Nurses practicing in acute care hospitals in Germany (16) and Belgium (15) were examined. Hospitals that had less than five respondents were excluded.

Participants

Survey responses from 2303 registered nurses (RNs) from Belgium and 2646 RNs from Germany were included. Non-RN providers, RNs with administrative positions, and those working in non-inpatient areas were excluded. The final sample was 3182 staff nurses working in acute care hospitals.

Methods

Magnet Hospital attributes that might be represented in NEXT survey items were reviewed by an expert panel before psychometric testing. Only six Magnet Forces could be measured. Latent constructs of these forces and job satisfaction were established. The measurement models and structural regression models were estimated using multilevel modeling in Mplus 4.21.

Results

Six Magnet Forces were validated by two-level confirmatory factor analyses, with good fit to the data as demonstrated by the fit indices. All six Magnet Forces significantly predicted job satisfaction at the nurse level, with personnel policies having the strongest effect (b = 0.96). At the hospital level, management style had the strongest effect (b = 0.84) in predicting job satisfaction, followed by professional development, interdisciplinary relationship, and autonomy.

Conclusions

Magnet Hospital attributes are evident in hospitals in two European countries and were found to be associated with job satisfaction. Further multilevel research should explore these attributes particularly at the nursing unit-level where work environment is experienced.     

Generational differences in factors influencing job turnover among Japanese nurses: an exploratory comparative design

Background

Although nurse turnover is a serious problem, the fact that each nurse has different work-related needs/values, and leaves their job for different reasons makes it difficult for organisations to develop effective countermeasures against it. Understanding nurses’ needs and the reasons for job turnover by the generation in which they were born may provide some feasible solutions.

Objectives

The purpose of the study was to identify specific work-related needs and values of nurses in three generations (born in 1946-1959, 1960-1974, 1975-present). The study also aimed to explore generation-specific reasons that might make nurses consider leaving the jobs.

Settings

The study was conducted in three public hospitals in Japan.

Participants

A convenience sample of 315 registered nurses participated in the study.

Methods

A survey method was used to collect quantitative and qualitative data. Quantitative data were analysed by ANOVA, and qualitative data were analysed by content analysis.

Results

Nurses born between 1960 and 1974 embraced high needs and values in professional privileges such as autonomy and recognition, while those born after 1975 expressed low needs and values in the opportunities for clinical challenge. For nurses born between 1960 and 1974, the imbalance between their jobs and personal life made them consider leaving their jobs. For those born after 1975, losing the confidence to care made them consider turning over. Nurses born after 1960 tended to value economic return and job security more highly compared to those born between 1946 and 1959.

Conclusions

Nurses in different generations have different sets of needs/values and reasons for job turnover. Understanding generation-specific needs and values of nurses may enable organisations and Nurse Managers to develop feasible and effective countermeasures to reduce nurse turnover.