Implementation of an intravenous medication infusion pump system: implications for nursing

AIM: To assess perceptions of nurses regarding the implementation of intravenous medication infusion system technology and its impact on nursing care, reporting of medication errors and job satisfaction. BACKGROUND: Medication errors are placing patients at high risk and creating an economic burden for hospitals and health care providers. Infusion pumps are available to decrease errors and promote safety. METHODS: Survey of 1056 nurses in a tertiary care Magnet hospital, using the Infusion System Perception Scale. Response rate was 65.43%. RESULTS: Nurses perceived the system would enhance their ability to provide quality nursing care, reduce medication errors. Job satisfaction was related to higher ratings of the management team and nursing staff. Perceptions verified the pump was designed to promote safe nursing practices. CONCLUSIONS: It is important to consider relationships with job satisfaction, safe nursing practice and the importance of ratings of nursing staff and management teams when implementing infusion technology. IMPLICATIONS FOR NURSING MANAGEMENT: Infusion pumps are perceived by nurses to enhance safe nursing practice. Results stress the importance of management teams in sociotechnological transformations and their impact on job satisfaction among nurses.     

Effects of Case Management on the Nursing Context-Perceived Quality of Care, Work Satisfaction, and Control Over Practice

Purpose: To examine in 1995 the effects of case management on the context of nursing practice-perceived quality of care delivered, work satisfaction, and control over nursing practice-rather than the commonly studied effect on fiscal outcomes.
Design: Prospective quasi-experimental. Sampled were nurses on four units at one community hospital where patients with DRG 107 (Coronary Artery Bypass Graft, with no cardiac catheterization) were traditionally hospitalized.
Methods: Registered nurses on these units completed quality of care, satisfaction, and practice-control scales before and 1 year after implementation.
Findings: Significant positive differences were found in several aspects of perceived quality of care for both staff nurses and case managers, with specific increases found in nurses' perceived ability to develop relationships with patients, ability to be therapeutic, and support for good care from the institutional structure and administration. A significant decrease in nurses' satisfaction with their pay and other rewards as well as respect from colleagues was found. Case managers were found to have significantly increased perceptions of control over their practice.
Conclusions: Case management was found to have a primarily positive effect on nurses-staff and case managers alike. There were significant increases in several aspects of the nurses' perceptions of the quality of care delivered. Additionally, case managers were more satisfied with the administration, the respect they received, and their pay and rewards in the institution. Most strikingly, case managers perceived themselves to have more control over their practice. Some negative effects of the program were a decrease in satisfaction with the pay and rewards by the staff who were not case managers.     

Nurse staffing models as predictors of patient outcomes

BACKGROUND: Little research has been conducted that examined the intended effects of nursing care on clinical outcomes. OBJECTIVE: The objective of this study was to evaluate the impact of different nurse staffing models on the patient outcomes of functional status, pain control, and patient satisfaction with nursing care. RESEARCH DESIGN: A repeated-measures study was conducted in all 19 teaching hospitals in Ontario, Canada. SUBJECTS: The sample comprised hospitals and adult medical-surgical and obstetric inpatients within those hospitals. MEASURES: The patient's functional health outcomes were assessed with the Functional Independence Measure (FIM) and the Medical Outcome Study SF-36. Pain was assessed with the Brief Pain Inventory and patient perceptions of nursing care were measured with the nursing care quality subscale of the Patient Judgment of Hospital Quality Questionnaire. RESULTS: The proportion of regulated nursing staff on the unit was associated with better FIM scores and better social function scores at hospital discharge. In addition, a mix of staff that included RNs and unregulated workers was associated with better pain outcomes at discharge than a mix that involved RNs/RPNs and unregulated workers. Finally, patients were more satisfied with their obstetric nursing care on units where there was a higher proportion of regulated staff. CONCLUSIONS: The results of this study suggest that a higher proportion of RNs/RPNs on inpatient units in Ontario teaching hospitals is associated with better clinical outcomes at the time of hospital discharge.     

Communication enhancement: nurse and patient satisfaction outcomes in a complex continuing care facility

AIMS: This paper presents an evaluation of a communication enhancement intervention on staff and patients in a complex continuing care facility. BACKGROUND: The importance of effective communication as a fundamental element of nursing has been emphasized and is regarded as integral to the provision of quality patient care. For people residing in complex continuing care (similar to long-term care facilities), opportunities for socialization occur primarily during interactions or communication with staff, and these interactions have been found to be limited. One way to improve nursing staff communication is through a communication enhancement intervention. METHODS: Twenty-one nursing staff members (Registered Nurses, Registered Practical Nurses and healthcare aides) working in a complex continuing care environment and 16 patients participated in this study, conducted in the summer of 2003. A repeated measures design was used to evaluate the effects of the communication enhancement intervention on outcomes. Data were collected from patients and nurses at baseline, 5 weeks into the intervention and at 10 weeks after the intervention. Nurse outcome variables included nurses' job satisfaction and their relationships with patients; patient outcome variables included two measures of patient satisfaction with care. RESULTS: Nursing staff felt closer to their patients (F(2,40) = 3.0, P = 0.045) following the intervention and reported higher levels of job satisfaction (F(2,40) = 4.1, P = 0.02). No changes were found in the level of patient satisfaction with care. CONCLUSIONS: Our results suggest that nursing staff can feel better about their job and about their patients as they enhance their communication skills. Understanding the barriers to finding time to talk with patients for a few minutes a day, outside of direct hands-on caregiving, requires further exploration.     

A shared care model vs. a patient allocation model of nursing care delivery: Comparing nursing staff satisfaction and stress outcomes

Tran DT, Johnson M, Fernandez R, Jones S. International Journal of Nursing Practice 2010; 16 : 148–158
A shared care model vs. a patient allocation model of nursing care delivery: Comparing nursing staff satisfaction and stress outcomes This study compared nurse outcomes between the shared care in nursing (SCN) and patient allocation (PA) models of care. A quasi‐experimental design was used. Job satisfaction, stress and aspects of role were measured at baseline and 6 months after the implementation of the SCN model using validated instruments. Nurses in the PA (n = 51) and SCN (n = 74) units were comparable at baseline. Nurses from both groups were satisfied with their job and experienced clarity in their role despite some levels of pressure. ‘Satisfaction with co‐workers’ in the SCN group decreased, emphasizing the challenges of supervising staff. Matched pair sample sizes at follow‐up were small. The SCN represents an innovative model of care delivery that is responsive to increasing proportions of enrolled nurses and assistants in nursing within wards. Both models have been found to be supportive of nursing staff. Although difficulties with follow‐up data were experienced, this study represents the first Australian quasi‐experimental research, comparing two models with validated measures. New tasks such as negotiating with co‐workers might create some new challenges for nurses. Hospital administrators should consider the repertoire of care delivery models available.     

Teaching and community hospital work environments

The Institute of Medicine report suggests that nursing work environments experience threats to patient safety related to organizational management and workforce deployment practices, work design, and organizational culture. Organizational factors contribute to nursing and potentially patient outcomes, yet few studies have examined the differences in practices perceived by nurses employed in different settings. Nurses from 16 medical and surgical units in eight randomly selected acute care hospitals representing teaching and community organizations participated in this project. Nurses working in teaching hospitals reported lower levels of role tension, yet their perceptions of the quality of work, the work environment, nursing unit leadership, quality of care, and levels of job stress and job satisfaction were higher than their colleagues in the community sites. This study highlights some important differences between teaching and community hospitals that can inform nurse executives and policy makers of the unique work-life issues for different groups of nurses.     

Antecedents and consequences of intra-group conflict among nurses

almost j., doran d.m., mcgillis hall l. & spence laschinger h.k. (2010) Journal of Nursing Management 18, 981–992
Antecedents and consequences of intra-group conflict among nurses Aim To test a theoretical model linking selected antecedent variables to intra-group conflict among nurses, and subsequently conflict management style, job stress and job satisfaction. Background A contributing factor to the nursing shortage is job dissatisfaction as a result of conflict among nurses. To develop strategies to reduce conflict, research is needed to understand the causes and outcomes of conflict in nursing work environments. Method A predictive, non-experimental design was used in a random sample of 277 acute care nurses. Structural equation modelling was used to analyse the hypothesised model. Results Nurses’ core self-evaluations, complexity of care and relationships with managers and nursing colleagues influenced their perceived level of conflict. Conflict management style partially mediated the relationship between conflict and job satisfaction. Job stress had a direct effect on job satisfaction and core self-evaluation had a direct effect on job stress. Conclusion Conflict and its associated outcomes is a complex process, affected by dispositional, contextual and interpersonal factors. How nurses manage conflict may not prevent the negative effects of conflict, however, learning to manage conflict using collaboration and accommodation may help nurses experience greater job satisfaction. Implications for nursing management Strategies to manage and reduce conflict include building interactional justice practices and positive interpersonal relationships.     

Shared values: impact on staff nurse job satisfaction and perceived productivity

A nationwide study on the impact of shared values on staff nurse job satisfaction and perceived productivity was done in 24 hospitals under different auspices, some of which were also Magnet Hospitals. Data were obtained from a 25% random sample of the staff nurse population (N = 2,336), 58% of the head nurse group, 65% of the clinical experts, and 66% of the top management. Staff nurses and clinical experts had more value congruence than did staff nurses and head nurses. A significant inverse correlation was found between value congruence and nurse job satisfaction and quality care. Explanations of the finding center on recent role changes for both staff nurses and head nurses, power differential, and evolving clarity of the staff nurse role. A serendipitious finding was that staff nurses reported fewer factors as important to their job satisfaction and perceived environment conducive to quality patient care than did other members of the nursing department. However, factors important to staff nurses were very important.     

Role perceptions and reported actual role content of hospital nurses in Mainland China

Aim. The study aimed to explore nurses’ views and experiences regarding their working roles in Mainland China. Background. Ministry of Health guidance relating to the hospital nurse's role has been widely used in Mainland China since 1982 but it does not adequately cover the development of new roles arising from recent health care system reforms. This has led to increasing concerns about the potential of role conflict and role ambiguity for nurses especially where role expectations are not reflected in actual role content leading to job dissatisfaction and higher turnover. Methods. A cross‐sectional survey design using postal questionnaires comprising demographic questions and four scales measuring role perception and actual role content, job satisfaction, occupational stress, role conflict and role ambiguity was used. Five hundred and twelve hospital nurses in Beijing participated representing a response rate of 81%. Results. Most respondents reported that staff nurses should undertake most of the roles described in the domain of patients’ physical care, psychosocial and communication and professional aspects of patient care and patient care management and there was overall consensus regarding the roles of other health care personnel. Further, they reported that nurses always or sometimes carried out these roles. Different role perceptions were reported across educational groups. Additionally, nurses’ ratings of role perception and actual role content were related to their ratings of job satisfaction, occupational stress, role conflict and role ambiguity (p < 0·05). Conclusions. There was relative consensus regarding role perceptions but the role boundary between nursing and non‐nursing work lacked clarity. The importance of role expectations is highlighted regarding job satisfaction and other components of working lives. Relevance to clinical practice. Acknowledgement of a potential gap between expectations and actual role of nurses provides the basis for developing strategies to reduce resulting occupational stress, role conflict and role ambiguity and increase job satisfaction. Additionally the findings provide a basis for international comparison of actual nurse role content and the potential support needs of nurses from Mainland China who move to work in other health care systems.     

Influence of stress and nursing leadership on job satisfaction of pediatric intensive care unit nurses.

BACKGROUND: High levels of stress and the challenges of meeting the complex needs of critically ill children and their families can threaten job satisfaction and cause turnover in nurses. OBJECTIVE: To explore the influences of nurses' attributes, unit characteristics, and elements of the work environment on the job satisfaction of nurses in pediatric critical care units and to determine stressors that are unique to nurses working in pediatric critical care. METHOD: A cross-sectional survey design was used. The sample consisted of 1973 staff nurses in pediatric critical care units in 65 institutions in the United States and Canada. The following variables were measured: nurses' perceptions of group cohesion, job stress, nurse-physician collaboration, nursing leadership, professional job satisfaction, and organizational work satisfaction. RESULTS: Significant associations (r = -0.37 to r = -0.56) were found between job stress and group cohesion, professional job satisfaction, nurse-physician collaboration, nursing leadership behaviors, and organizational work satisfaction. Organizational work satisfaction was positively correlated (r = 0.35 to r = 0.56) with group cohesion, professional job satisfaction, nurse-physician collaboration, and nursing leadership behaviors. Job stress, group cohesion, job satisfaction, nurse-physician collaboration, and nursing leadership behaviors explained 52% of the variance in organizational work satisfaction. Dealing with patients' families was the most frequently cited job stressor. CONCLUSIONS: Job stress and nursing leadership are the most influential variables in the explanation of job satisfaction. Retention efforts targeted toward management strategies that empower staff to provide quality care along with focal interventions related to the diminishment of stress caused by nurse-family interactions are warranted.     

Nurses' perceptions of hospital work environments

AIM: To examine factors within the nursing work environment that may affect nurse outcomes. BACKGROUND: Primary data were acquired from unit managers and staff nurses on the study units. Secondary data were collected from health records administrative databases. The sample included adult medical and surgical units within all 19 teaching hospitals in Ontario, Canada. METHODS: A cross-sectional study design was employed in this study. A random sampling process was used to recruit the number of nurses (n = 1,116) required to provide a statistically adequate sample for the survey. RESULTS: Perceptions of the quality of care at the unit level were found to have a statistically significant positive influence on nurses' job satisfaction, and a statistically significant negative influence on nurses' job pressure and job threat. CONCLUSIONS: The results of this study underscore the importance of examining the environment in which nurses' work as a potential factor that influences outcomes experienced by patients and nurses.     

The Impact of Person-Organization Fit on Nurse Job Satisfaction and Patient Care Quality

PurposeIn the current healthcare context, large health care organizations may increasingly emphasize profit, biomedicine, efficiency, and customer service in the delivery of care. This orientation toward nursing work by large organizations may be perceived by nurses as incompatible with professional caring.MethodsOrdinary Least Squares regression was used to explore the impact of person-organization fit (i.e., value congruence between self and employing organization) on nurses’ general job satisfaction and quality of patient care (n = 753).ResultsNurses’ perceived person-organization fit is a significant predictor of general job satisfaction and quality of patient care.ConclusionThe implications of our findings are discussed and recommendations for nursing leaders and future research are made.     

Patients perception of care under primary and team nursing

The relationship between the structure of nursing care and patient satisfaction is examined after equalizing the quantity and quality of nursing staff. An all-registered-nurse model of primary nursing is compared to team nursing. The nursing competency scores of registered nurses (as measured by the Slater scale) on two patient care units were equalized through 6 months of continuing education and staff development programs. A patient checklist was used to determine satisfaction with care and perceived omissions in care. No significant differences in satisfaction with care were found between the two units. The unit with primary nursing was perceived as having significantly higher omissions in care in three categories: dietary needs, reaction to therapy, and contact with nurses. The results suggest that the effect of nursing care structures on patient perception of care may be contingent upon the efficiency of the support systems and the competency of the nursing staff.     

Registered Nurses' views on their professional role

Aim The aim is to study Registered Nurses’ opinions and reflections about their work tasks, competence and organization in acute hospital care. Background The definition of the role of nurses has changed over time and it is often discussed whether Registered Nurses have a professional status or not. Method A qualitative research design was used. Data were derived from written reflections on diaries and from focus group interviews. Results All respondents had difficulties in identifying the essence of their work. It can be argued that being ‘a spider in the web’ is an important aspect of the nursing profession. Conclusion Registered Nurses tend to regard their professional role as vague. Managers must be considered key persons in defining the professional role of Registered Nurses. Implications for nursing management This study contributes to an understanding of the managers’ and the importance of nursing education in Registered Nurses professional development.     

Impact and determinants of nurse turnover: a pan-Canadian study

o’brien-pallas l., murphy g.t., shamian j., li x. & hayes l.j. (2010) Journal of Nursing Management 18, 1073–1086
Impact and determinants of nurse turnover: a pan-Canadian study Aim As part of a large study of nursing turnover in Canadian hospitals, the present study focuses on the impact and key determinants of nurse turnover and implications for management strategies in nursing units. Background Nursing turnover is an issue of ever-increasing priority as work-related stress and job dissatisfaction are influencing nurses’ intention to leave their positions. Methods Data sources included the nurse survey, unit managers, medical records and human resources databases. A broad sample of hospitals was represented with nine different types of nursing units included. Results Nurses turnover is a major problem in Canadian hospitals with a mean turnover rate of 19.9%. Higher levels of role ambiguity and role conflict were associated with higher turnover rates. Increased role conflict and higher turnover rates were associated with deteriorated mental health. Higher turnover rates were associated with lower job satisfaction. Higher turnover rate and higher level of role ambiguity were associated with an increased likelihood of medical error. Conclusion Managing turnover within nursing units is critical to high-quality patient care. A supportive practice setting in which role responsibilities are understood by all members of the caregiver team would promote nurse retention. Implications for nursing management Stable nurse staffing and adequate managerial support are essential to promote job satisfaction and high-quality patient care.     

重庆市万州区护士工作家庭冲突现状及其与结果变量关系的研究

目的 了解重庆市万州区护士工作家庭冲突的现状及其与工作压力感、压力症状、工作满意度、工作倦怠、工作绩效等结果变量的关系.方法 采用工作家庭冲突量表、工作压力感量表、压力症状量表、工作满意度量表、工作倦怠量表、工作绩效量表对重庆市万州区的1094名执业护士进行分层抽样问卷调查.结果 重庆市万州区护士面临较高的工作家庭冲突.工作家庭冲突显著影响护士的个人健康(工作压力感、压力症状、工作满意度、工作倦怠),对工作绩效没有显著影响.结论 重视护士群体的工作家庭冲突并采取平衡策略降低冲突水平,对保障护士的个人身心健康有着非常重要的意义.