Career trajectories of nurses leaving the hospital sector in Ontario, Canada (1993–2004)

Title.  Career trajectories of nurses leaving the hospital sector in Ontario, Canada (1993–2004).
Aim.  This paper is a report of an analysis of the career trajectories of nurses 1 year after leaving hospitals.
Background.  Although hospitals are traditionally the largest employers of nurses, technological advances and budgetary constraints have resulted in many countries in relative shrinkage of the hospital sector and a shift of care (and jobs) into home/community settings. It has been often assumed that nurses displaced from hospitals will move to work in the other workplaces, especially the community sector.
Method.  Employment patterns were tracked by examining a longitudinal database of all 201,463 nurses registered with the College of Nurses Ontario (Canada) between 1993 and 2004. Focusing on the employment categories Active (Working in nursing), Eligible-Seeking nursing employment or Dropout from the nursing labour market, year-to-year transition matrixes were generated by sector and sub-sector of employment, nurse type, age group and work status.
Findings.  For every nurse practising nursing in any non-hospital job or in the community a year after leaving hospitals, an average of 1·3 and four nurses, respectively, dropped out of Ontario's labour market. The proportion of nurses leaving hospitals transitioning to the Dropout category ranged from 63·3% (1994–95) to 38·6% (2001–02). The proportion dropping out of Ontario's market was higher for Registered Practical Nurses (compared to Registered Nurses), increased with age and decreased with degree of casualization in nurses' jobs.
Conclusion.  Downsizing hospitals without attention to the potentially negative impact on the nursing workforce can lead to retention difficulties and adversely affects the overall supply of nurses.     

Factors That Influence the Decisions of Men and Women Nurses to Leave Nursing

PROBLEM.  The health and long-term care systems in the United States rely heavily on the services of registered nurses, but concerns exist about the adequacy of the current and projected supply of registered nurses to meet the nation's needs. One way to increase the nursing supply is to increase the retention rates of nurses, especially men nurses who are much more likely to leave nursing than are women. The study hypothesizes that the different retention rates of men and women can be explained in part by their different gender roles and careers goals.
METHODS.  A secondary analysis was conducted of the registered nurses who left nursing for other occupations in the National Sample Survey of Registered Nurses, 2000.
FINDINGS.  Three reasons for leaving nursing were cited most often by the male and female nurses who left nursing: better salaries available in current type of position, hours more convenient in other position, and find current position more rewarding professionally. Results of a multivariate logistic regression analysis show that men were 2.5 times more likely than women to cite better salaries as a reason for leaving the nursing profession, but no more likely to cite more convenient hours or to state that the non-nursing position was more professionally more rewarding.
CONCLUSIONS.  Thus, the men differed from the women in their attitudes toward the financial aspects of nursing but not the professional aspects. Suggestions are provided to redress the dissatisfactions of men nurses.     

Influences of context, process and individual differences on nurses' readiness for change to Magnet status

Title.  Influences of context, process and individual differences on nurses' readiness for change to Magnet status.
Aim.  The aim of this study was to test hypotheses associated with a model which explains individuals' readiness in early stages of a change.
Background.  In an effort to improve the quality of nursing care, hospitals in the United States of America seek to obtain Magnet recognition. While it is commonly known that Magnet hospitals provide higher quality patient care, little is known about the variability in nurses' attitudes and behaviour within Magnet hospitals.
Method.  We collected data in 2006 from 310 Registered Nurses to investigate the factors that influence their willingness to embrace the changes necessary for the high levels of excellence accompanying Magnet status. Hierarchical linear modelling was used because the data were multi-level.
Results.  Both change-specific context, such as a culture of research exhibited by the manager, and formal education of the nurse moderated the positive influences of the organization's procedural justice actions. Specifically, procedural justice was stronger when the nurse manager demonstrated a culture of research, and negative effects of low justice were mitigated when nurses had a higher level of formal education.
Conclusion.  Preparing managers beforehand to appreciate and adopt new behaviours associated with a forthcoming organizational change should enhance the success of change practices as new changes are initiated. Moreover, education that exposes employees to the pending realities of their industry, such as nursing research, can play an important role in the development of positive beliefs about changes facing their organizations.     

Nursing morale: predictive variables among a sample of registered nurses in Australia

Aim  This study investigates the determinants of morale among Registered Nurses in Queensland, Australia.
Background  In light of the public discussions on the issues facing the future of nursing, it is critical to understand the factors that influence morale.
Methods  A 160-question instrument sought information from Registered Nurses on their perceptions of 'self', work and morale. A response rate of 41% was achieved ( n  = 343) from a convenience sample of three acute hospitals.
Results  Following binary logistic regression modelling for organizational morale, significant relationships were found with patient care provision and team interaction. Binary logistic regression modelling for personal morale revealed positive relationships with team interaction, consultation, professional recognition and lower levels of patient abuse.
Conclusion  The results point to a number of organizational and professional issues that can be considered by health care administrators and policy makers to develop workplaces that have a positive impact on the morale of nurses.     

Shielding or caging? Healthcare staffs’ views on fall risk and protection in Stockholm

Aim.  To describe Registered Nurses' and enrolled nurses' views and reasoning on falls, fall risk, use of physical restraints and patients' safety and security in nursing homes.
Background.  Nursing home patients frequently suffer from diseases which require medication. Both Registered Nurses and enrolled nurses must make decisions about how to protect patients from falls and fall-related injuries. Physical restraints are frequently used. When patients are unable to understand or do not wish to limit their freedom of movement, staff must consider each decision carefully.
Method.  A qualitative approach was used. Data were analysed using a thematic content analysis method.
Findings.  Staff have sufficient knowledge about which pathologically related conditions lead to fall risk. An insufficient number of staff on duty jeopardizes patient safety. Wheelchairs with safety belts, and bed rails, are sometimes used. For Registered Nurses it was not an easy decision to use restraints. Enrolled nurses' actions were based on standard procedure, to protect and supervise patients.
Conclusion.  Staff often use restraints to protect their patients, even though this may mean compromising the patient's integrity.
Relevance to clinical practice.  Nurses, occupational therapists, physiotherapists and physicians should plan the care together. Restrictive measures should be adapted to each individual patient.     

Perceptions of internal marketing and organizational commitment by nurses

Title.  Perceptions of internal marketing and organizational commitment by nurses.
Aim.  This paper is a report of a study to determine whether a favourable perception of internal marketing is associated with increased organizational commitment.
Background.  The role of nurses in healthcare treatment is expanding, and becoming more important as time progresses. Therefore, the primary concern of business of health care is to use internal marketing strategies effectively to enhance and develop nurses' organizational commitment and reduce turnover to promote competitive advantages for the organization.
Methods.  A cross-sectional design was used. Questionnaires were distributed in 2006 to a convenience sample of 450 Registered Nurses in two teaching hospitals in Taiwan, and 318 questionnaires were returned. Eighteen were excluded because of incomplete answers, which left 300 usable questionnaires (response rate 66·7%). Validity and reliability testing of the questionnaire proved satisfactory and Structural Equation Modeling was used to analyse the data.
Results.  A favourable perception of internal marketing was associated with increased organizational commitment. Communication management had the greatest influence on organizational commitment and external activity had the smallest impact.
Conclusion.  Hospital managers need to recognize the importance of internal marketing for staff retention and the survival of their organizations as competitive pressure increases. As a great deal of time and costs are involved in educating nurses, the best way to retain outstanding nurses and reduce turnover costs and personnel problems is for employers to understand the needs and expectations of their nursing staff.     

Attitudes of nurse professionals and nursing students towards children with disabilities. Do nurses really overcome children's physical and mental handicaps?

Background:  Many health professionals and nurses, who are involved in the care of disabled children, do not exhibit the essential sensitivity and appropriate attitudes towards them, resulting in a poor quality of nursing care.
Aim:  The objective of this study was to investigate the attitudes of nurse professionals (paediatric nurses) and nursing students towards disabled children.
Patients and methods:  The present study is a comparative study. The sample consisted of 228 first-year nursing students, 90 post-diploma nurses attending MSc degree course and 123 nurse professionals who are employed in paediatric hospitals. After obtaining permission from the hospitals and the educational settings and informing about the subjects of the study, data were collected using the paediatric Attitude Towards Disabled Person Scale (ATDP).
Results:  Overall nurses' attitudes appeared to be poor (mean ATDP score 61.7 ± 14.2). However, the post-diploma nurses had significantly higher ATDP scores than first-year students and paediatric nurses ( P  < 0.001). In addition, first-year students had significantly higher scores than paediatric nurses ( P  = 0.047). Across the sample, females hold significantly more positive attitudes than males ( F  = 9.5, P  = 0.002), while age did not have any significant effect.
Conclusions:  Carefully designed curricula can influence the attitudes of nursing students towards children with disabilities. Special courses for treating disabled children should be integrated to the basic nursing studies. Moreover, continuing hospital education can change paediatric nurses' attitudes towards children with disabilities.     

Empowerment and its application in health promotion in acute care settings: nurses' perceptions

Title.  Empowerment and its application in health promotion in acute care settings: nurses' perceptions.
Background.  Empowerment has long been a central tenet of health promotion theory. Globally, governments have advocated the use of empowerment in their public health policies. Nurses are seen as essential in the delivery of this agenda using the empowerment model to engage patients in self-care and decision-making.
Method.  Six different vignettes requiring a health promotion intervention were shown to a convenience sample of 20 Registered Nurses in a United Kingdom acute care hospital. The nurses were asked to describe how they would meet the health promotion needs of the patients described in the vignettes. The data were collected between 2005 and 2006 and analysed using thematic analysis.
Findings.  Two types of practitioner were identified: Type I divergent nurse health promotion practitioner and Type II convergent nurse health promotion practitioner. The main factor distinguishing the two types was the way in which they conceptualized the verb 'to empower'.
Conclusion.  The theory of health promotion taught to participants does not seem to be applied in acute care settings. This raises the possibility that Registered Nurses acting as mentors and role models are convergent rather than divergent thinkers.     

Work-home interference among nurses: reciprocal relationships with job demands and health

Title.  Work-home interference among nurses: reciprocal relationships with job demands and health.
Aims.  This paper is a report of a study with three aims: (i) to investigate whether emotional, quantitative and physical demands have a causal, negative impact on nurses' health; (ii) to examine whether work-home interference can explain this effect, by playing a mediating role; and (iii) to test the so-called loss spiral hypothesis claiming that nurses' health problems lead to even higher job demands and more work-home interference over time.
Background.  While many scholars have thought in terms of the stressor→work-home interference→strain model, the validity of a model that includes opposite pathways needs to be tested.
Method.  A questionnaire was completed twice, with a 1-year time interval by 753 (63·4%) Registered Nurses working in hospitals, 183 (15·4%) working in nursing homes, and 251 (21·1%) working in home care institutions. The first measurement took place between October 2002 and June 2003.
Findings.  Our findings strongly support the idea of cross-lagged, reciprocal relationships between job demands and general health over time. The reciprocal model with work-home interference as an intervening variable (including reciprocal relationships between job demands, work-home interference and general health) showed a good fit to the data, and proved to be superior to both the causality and reversed causation models.
Conclusion.  The higher nurses' job demands, the higher is their level of work-home interference and the more likely is a general health deterioration over time, in turn giving rise to higher job demands and work-home interference, which may even aggravate the nurses' general health, and so on.     

Jordanian nurses' knowledge and practice of breast self-examination

Title.  Jordanian nurses' knowledge and practice of breast self-examination.
Aim.  This paper is a report of a study to evaluate the knowledge and practice of Jordanian nurses in relation to breast self-examination.
Background.  Studies have shown that women who have learned about breast self-examination have positive attitudes toward breast cancer and practise breast self-examination more frequently, and that nurses who teach their clients about methods of early detection and breast self-examination are more knowledgeable about breast cancer screening and breast self-examination techniques than those who do not. Therefore, it is important to understand nurses' knowledge about breast cancer and its early detection.
Methods.  A cross-sectional design was used, with a convenience sample of 347 Registered Nurses at three large cities in Jordan (response rate 95%). Data collection took place in 2005 using a self-administrated questionnaire with three parts and based on the American Cancer Society's guidelines: demographics, knowledge, and practice of breast self-examination.
Results.  Nurses reported high levels of knowledge of breast self-examination (M = 7·6, sd . 2·7). A high proportion of nurses reported doing breast self-examination in the past 12 months (85%), but only 17·7% reported doing so on a monthly basis. None of the demographic characteristics was found to be associated with the practice of breast self-examination.
Conclusion.  More health education about monthly breast self-examination and prevention strategies is needed for nurses and their women patients, especially for Arabic women.     

The leadership concept in Iranian nursing

Background:  Although greater emphasis has been placed on leadership skills in nursing management in the last decade, the concepts are often confused or used erroneously by Iranian nurses. At the same time we have observed that wide variations in nurses' clinical practice appeared to be related to the presence or absence of leadership skills among senior nurses.
Aim:  To begin to identify the concepts used for expressing leadership in nursing within the Iranian cultural context.
Methods:  A qualitative approach was adopted using content analysis of semi-structured interviews carried out with 10 nurse managers from hospitals in Teheran. The data were analysed using the constant comparative method.
Findings:  Fifty-five primary codes were identified from the respondents' experiences and from these three main themes were abstracted for describing the leadership concept. These were 'personality traits', 'being a model', and 'being a spiritual guide for the nursing profession'.
Conclusion:  Implementing the culture of patient safety and dignity needs leadership. From Iranian nurse managers' perspectives a leader as a spiritual guide should empower nurses spiritually; it means he/she has a vision for nursing; has clear and explicit objectives; and has a commitment to nursing. Nurses who are confident about the underlying concepts of leadership in their culture can help to adapt nursing to an ever-changing healthcare environment.     

Missed nursing care: a concept analysis

Title.  Missed nursing care: a concept analysis.
Aim.  This paper is a report of the analysis of the concept of missed nursing care.
Background.  According to patient safety literature, missed nursing care is an error of omission. This concept has been conspicuously absent in quality and patient safety literature, with individual aspects of nursing care left undone given only occasional mention.
Method.  An 8-step method of concept analysis – select concept, determine purpose, identify uses, define attributes, identify model case, describe related and contrary cases, identify antecedents and consequences and define empirical referents – was used to examine the concept of missed nursing care. The sources for the analysis were identified by systematic searches of the World Wide Web, MEDLINE, CINAHL and reference lists of related journal articles with a timeline of 1970 to April 2008.
Findings.  Missed nursing care, conceptualized within the Missed Nursing Care Model, is defined as any aspect of required patient care that is omitted (either in part or in whole) or delayed. Various attribute categories reported by nurses in acute care settings contribute to missed nursing care: (1) antecedents that catalyse the need for a decision about priorities; (2) elements of the nursing process and (3) internal perceptions and values of the nurse. Multiple elements in the nursing environment and internal to nurses influence whether needed nursing care is provided.
Conclusion.  Missed care as conceptualized within the Missed Care Model is a universal phenomenon. The concept is expected to occur across all cultures and countries, thus being international in scope.     

The Management of Aggression and Violence Attitude Scale (MAVAS): a cross-national comparative study

Title.  The Management of Aggression and Violence Attitude Scale (MAVAS): a cross-national comparative study.
Aim.  This paper is a report of a study to determine the transferability of the Management of Aggression and Violence Attitude Scale to European mental health inpatient settings.
Background.  Incidents of patient aggression and violence are common in psychiatric in-patient facilities, and nurses' attitudes may play a part in how they are managed.
Methods.  Nursing staff from acute psychiatric in-patient units in Switzerland and the United Kingdom completed the Management of Aggression and Violence Attitude Scale. Data were collected in the UK in 2001 and Switzerland in 2003. The Swiss sample comprised 75 respondents: 45 female, mean age 36·24, mean experience 7·35 years, 60 Registered Nurses. The United Kingdom sample was 75 respondents: 58 female, mean age 32, mean experience 5·25 years, 48 Registered Nurses. T -tests identified differences between the groups in their responses to each Management of Aggression and Violence Attitude Scale statement.
Results.  There was 66% concordance of views between the groups. Swiss nurses were, however, more likely to regard factors internal to the patient as contributory to aggression while United Kingdom nurses perceived environmental factors to be more important. Both groups endorsed physical means of aggression management, Swiss nurses more so.
Conclusion.  There are both commonalities and differences between the attitudes of Swiss and United Kingdom nursing staff regarding patient aggression. Differences may relate to rates of aggression, variations in management approaches, training and policy. The Management of Aggression and Violence Attitude Scale is a potentially effective tool for making comparisons about perspectives on patient aggression.     

Estimating nurses' workload using the Diagnosis Procedure Combination in Japan

Aim:  To examine the methods used to estimate nurse staffing levels in acute care settings with Diagnosis Related Groups, which in Japan are called the Diagnosis Procedure Combination (DPC).
Methods:  For estimating staffing requirements, the study used four DPC groups: (1) acute or recurrent myocardial infarction (AMI) with stenting, (2) angina pectoris with coronary artery bypass grafting (CABG), (3) sub-arachnoid haemorrhage (SAH) with clipping surgery, and (4) cerebral infarction with carotid endarterectomy (CEA). Registered nurses with more than 3-year nursing experience in nine university hospitals in the Tokyo metropolitan area completed self-report questionnaires in order to obtain nursing care time and care intensity per each DPC. The concordance rate was measured by Kendall's coefficient of concordance. The relationship between the care time and the care intensity was examined by a time series graph per DPC. Care intensity consisted of professional judgement, mental effort for helping patients, professional skill, physical effort for providing activities of daily living support, and nurse stress, based on the Hsiao and colleagues' model of resource-based relative value scale.
Results:  Twenty-five nurses in nine university hospitals answered for a hypothetical typical patient with AMI and with CABG, and 28 nurses in nine university hospitals answered for a hypothetical typical patient with SAH and with CEA. Kendall's coefficient of concordance was 0.896 for AMI, 0.855 for CABG, 0.848 for SAH, 0.854 for CEA. The time series data of the care time and the care intensity items showed different patterns for each DPC.
Conclusion:  The DPC for cardiovascular and cerebral surgical procedures can be used for estimating nurses' workload.     

Registered nurse incentives to return to practice in the United States

This US study uniquely listened to registered nurses with current licenses who do not work as nurses or are unemployed. An electronic survey was advertised in 13 Boards of Nursing newsletters. Investigated was why nurses left nursing, what would entice them to return to nursing, and what skill review is essential to competent and confident return to nursing practice. Herzberg's theory was used to study factors affecting registered nurses' decision to practise nursing. Data were analysed using SPSS and manifest content analysis. Nurses ( n  = 127) identified various work conditions as the primary reasons for leaving nursing. Work condition improvement, recognition of one's work, opportunities for professional growth and family needs consideration were identified as key enticing factors for returning to nursing. Many respondents identified needing review of medicines, intravenous skills, new technologies and a refresher course. Acting on their voiced concerns will enhance nurse recruitment and retention.     

The relationship between nursing leadership and nurses' job satisfaction in Canadian oncology work environments

Background  Current Canadian oncology work environments are challenged by the same workforce statistics as other nursing specialties: nurses are among the most overworked, stressed and sick workers, and more than 8% of the nursing workforce is absent each week due to illness.
Aim  To develop and estimate a theoretical model of work environment factors affecting oncology nurses' job satisfaction.
Methods  The sample consisted of 515 registered nurses working in oncology settings across Canada. The theoretical model was tested as a structural equation model using LISREL 8.54.
Results  The final model fitted the data acceptably ( χ ² = 58.0, d.f. = 44, P  =   0.08). Relational leadership and physician/nurse relationships significantly influenced opportunities for staff development, RN staffing adequacy, nurse autonomy, participation in policy decisions, support for innovative ideas and supervisor support in managing conflict, which in turn increased nurses' job satisfaction.
Conclusions  These findings suggest that relational leadership and positive relationships among nurses, managers and physicians play an important role in quality oncology nursing environments and nurses' job satisfaction.
Implications for nursing management  Oncology nursing work environments can be improved by focusing on modifiable factors such as leadership, staff development and staffing resources, leading to better job satisfaction and hopefully retention of nurses.     

Professionalism: the major factor influencing job satisfaction among Korean and Chinese nurses

Background:  The nursing shortage has become an internationally important issue. Nurses' professionalism and job satisfaction have been recognized as strong factors influencing their turnover. As international interchanges in nursing education are growing between Korea and China, understanding the commonalities and differences in factors associated with job satisfaction is critical to improving nurses' job retention.
Aim:  To compare the factors influencing job satisfaction among Korean and Chinese nurses.
Method:  A cross-sectional survey was conducted. The participants were comprised of 693 nurses at three general hospitals in Jinan, People's Republic of China and 593 nurses at two general hospitals in Seoul, Korea. A questionnaire was designed to measure the nurses' professionalism and job satisfaction. Stepwise multiple regression analysis was performed to identify factors related to job satisfaction.
Results:  Professionalism was the common factor influencing job satisfaction in Korean and Chinese nurses. Professionalism was positively related to job satisfaction in both groups. Additional factors associated with job satisfaction were demographics and job characteristics such as age, job position and department of work, which were significant only in Korean nurses.
Conclusions:  Professionalism was the most important factor influencing job satisfaction in both Korean and Chinese nurses. Enhancing nursing professionalism is recommended as a common strategy to improve nurses' job retention across different healthcare systems.     

Foot health in older people and the nurses' role in foot health care–a review of literature

Scand J Caring Sci; 2010; 24; 194–201
Foot health in older people and the nurses' role in foot health care–a review of literature
Aims:  To describe foot health in older people and the role of nurses in foot health care. There is value in developing preventive measures in foot health care in older people, in creating educational programmes for nurses of foot care and in developing foot health evaluation instrument for nurses.
Methods:  The literature was retrieved from the Medline and CINAHL databases between 1980 and January 2008. Altogether 35 articles were reviewed.
Findings:  Based on the review, older people have a variety of foot health problems. Nurses have a theoretical knowledge of foot care, but they do not consider their clinical skills adequate.
Conclusions:  Future research should focus on evaluating in which areas of foot care nurses' knowledge is strongest and how effective their foot caring activities are. Nurses work closely with older people and are in a position to identify and prevent their foot health problems.