Attributes of nursing work environment as predictors of registered nurses’ job satisfaction and intention to leave

Aim To examine how front-line registered nurses’ perception of their work environment associates with and predicts nurse outcomes in terms of job satisfaction and turnover intention. Background Mounting evidence has pointed to an inseparable link between attributes of the nursing work environment and nurse outcomes. However, there is a paucity of research examining nurses’ perception of their work environment beyond the Western context. Methods This cross-sectional survey involved 1271 registered nurses working in 135 inpatient units in 10 public hospitals in Hong Kong. The instrument comprised items developed from in-depth interviews with front-line nurses that explored nurses’ perception of their work environment. Results Factor analysis identified five dimensions (professionalism, co-worker relationship, management, staffing and resources, and ward practice) of the nursing work environment. Logistic regression analysis further identified professionalism, management and ward practice as significant factors in predicting nurses’ turnover intention, and staffing and resources as an additional factor in predicting their job satisfaction. Conclusions Attributes of the nursing work environment have a significant bearing on nurses’ job satisfaction and intention to leave. Implications for nursing management Managerial effort should focus on improving nurses’ work conditions through detailed resource planning, effective management and removal of work constraints that affect nursing practice.     

The impact of surgical ward nurses practising respiratory assessment on positive patient outcomes.

OBJECTIVE: A literature review to examine the incorporation of respiratory assessment into everyday surgical nursing practice; possible barriers to this; and the relationship to patient outcomes. PRIMARY ARGUMENT: Escalating demands on intensive care beds have led to highly dependent patients being cared for in general surgical ward areas. This change in patient demographics has meant the knowledge and skills required of registered nurses in these areas has expanded exponentially. The literature supported the notion that postoperative monitoring of vital signs should include the fundamental assessment of respiratory rate; depth and rhythm; work of breathing; use of accessory muscles and symmetrical chest movement; as well as auscultation of lung fields using a stethoscope. Early intervention in response to changes in a patient's respiratory health status impacts positively on patient health outcomes. Substantial support exists for the contention that technologically adept nurses who also possess competent respiratory assessment skills make a difference to respiratory care. CONCLUSIONS: Sub-clinical respiratory problems have been demonstrated to contribute to adverse events. There is a paucity of research knowledge as to whether respiratory education programs and associated inservice make a difference to nursing clinical practice. Similarly, the implications for associated respiratory educational needs are not well documented, nor has a research base been sufficiently developed to guide nursing practice. Further research has the potential to influence the future role and function of the registered nurse by determining the importance of respiratory education programs on post-operative patient outcomes.     

Point of care ultrasound use by Registered Nurses and Nurse Practitioners in clinical practice: An integrative review

BackgroundNurses and nurse practitioners (NPs) are utilising point of care ultrasound (PoCUS) in practice. PoCUS is a useful tool to enhance clinical assessments and improve patient care. There have been no published literature reviews on this topic.AimsThe objective of this review is to examine the literature on PoCUS and draw conclusions to determine the implications of the use of PoCUS by registered nurses and nurse practitioners to inform nursing practice.DesignIntegrative review.MethodsData bases MEDLINE, EMBASE, CINAHL and Google scholar were searched for relevant articles between 2008 and 2018. The inclusion criteria were registered nurses and nurse practitioners using PoCUS in their clinical practice. Articles retrieved were in English and with full text. Articles were assessed for quality using TREND and a PRISMA flowchart is presented.FindingsSix eligible articles were examined identifying major findings of education in PoCUS, accuracy and mastery of a skill and clinical influence.DiscussionAn evaluation of the use of PoCUS by registered nurses and nurse practitioners provides evidence of its efficacy and potential to improve patient care and inform nursing practice.ConclusionSome registered nurses and nurse practitioners are expanding their scope of practice to include PoCUS to improve patient care. PoCUS requires investment in time and education.     

Gender-related influences in nursing education.

Issues around gender identity, self-concept, professional education, and women's learning preferences shape the socialization of nurses and nursing education. How gender issues influence learners and nursing education in relation to nursing education for registered nurses are explored and recommendations are made for nursing educators in two broad categories: self-awareness and helping learners learn. The exploration leads to three conclusions: first, it is timely for nurses to continue such explorations for their own practice, and to share how to help other nurses cope with visible and invisible gender-related issues; second, nurses can share strategies to address the influence of gender issues in nursing education, and, third, the nursing profession benefits from drawing on available resources to discuss gender issues. Although reflections on these issues have been shaped by working with registered nurse learners, they are equally relevant to basic nursing students and practicing nurses.     

Professional identity in nursing: A mixed method research study

Professional identity is developed through a self-understanding as a nurse along with experience in clinical practice and understanding of their role. Personal and professional factors can influence its development. A recent integrative literature review synthesised factors that influenced registered nurse’s perceptions of their professional identity into three categories of the self, the role and the context of nursing practice. This review recommended that further research was needed into professional identity and how factors and perceptions changed over time. The aims of this study were to explore registered nurses’ understanding of professional identity and establish if it changed over time. A mixed-methods study using a two-stage design with an on-line survey and focus groups was implemented with registered nurses who were studying nursing at a postgraduate level in Australia or Scotland. The reported influences on professional identity related to the nurse, the nursing role, patient care, the environment, the health care team and the perceptions of nursing. Professional development and time working in the profession were drivers of changes in thinking about nursing, their role and working context and their professional identity. Additionally, participants sought validation of their professional identity from others external to the profession.     

Occupational changes in nursing: the situation of enrolled nurses

BACKGROUND: The move to one level of qualified nurse in the United Kingdom (UK) is, in part, a consequence of professionalizing strategies. Registered nurses now undertake technical work previously performed by doctors. The role of enrolled nurses, and their career intentions, have not been considered in light of these changes, despite the fact that many still work in the National Health Service. AIM: This paper considers the pursuit of professionalization by nurses, illustrating the argument with findings from an empirical study of conversion to registered nurse by enrolled nurses. METHODS: The paper is based on a secondary analysis of a large data set, originally used to explore ethnic inequalities in nursing. Data from 2968 respondents were analysed to answer a number of research questions relating to the characteristics of different groups of enrolled nurses and predictors of conversion to registered nurse. These included demographic characteristics, markers of career orientation, career progression and job satisfaction. STUDY LIMITATIONS: This study used secondary analysis of data and, therefore, exploration of issues was limited, not least because the data were 10 years old. Also, the design was cross-sectional and respondents' experiences related to different stages of the phenomenon under study and the same group was not studied over time. FINDINGS: Enrolled nurses who had converted to registered nurse were more likely than those who had no intention of converting to: be male, be younger, have been nursing longer, not be working on elderly care wards, have a high career orientation, not have taken a career break, and work full-time. Most of these factors predicted likelihood to convert. Although nurses who converted to registered nurse were more likely to anticipate career progression, they were less likely to be satisfied with their work. CONCLUSION: In attempts to define rewarding nursing work, the importance of ensuring that qualified nurses continue to retain basic nursing care skills should be acknowledged. This may offer an uncomfortable view to those seeking to further the professional status of nursing.     

Remediation: a necessary function for employers to correct incompetence regarding clinical professional registered nurse practice

Remediation for the professional licensed registered nurse is a topic sparsely written about in the nursing literature. The provision of remediation, however, is a common tool used to address registered nurse practice issues. This article seeks to describe the various stakeholders' roles in remediation and recommends that nurses in management roles should ensure the provision of remediation for registered nurses when warranted.     

Nursing leadership in an academic hospital in Gauteng

Aim This study was aimed at describing nursing leadership in an academic hospital in Gauteng, South Africa. Background Nurse managers’ leadership styles affect nurses’ attitudes, behaviour and work performance. However, little is known about how nurses experience nurse leadership and what leadership styles are found in academic hospitals in Gauteng. Methods The study was based on Maxwell’s framework of leadership (relationships, equipping, leadership and attitude). A qualitative design was used in order to describe the experiences of registered nurses and nurse managers. The population of the study was all registered nurses and nurse managers of the hospital in which the study was conducted. In phase one of the study, a discussion group with 35 registered nurses using the nominal group technique was held to respond to the following statement: ‘Please explain how you have experienced leadership by nurse managers in this hospital’. In phase two of the study, five nurse managers were interviewed individually, using a semi-structured interview guide. Results Some nurse managers were practising autocratic leadership in this hospital. Implications for nursing management The nurse managers need to be taught about contemporary leadership styles such as transformational leadership and visionary leadership and also about supervision, role modelling and caring.     

Tensions and contradictions in nurses' perspectives of evidence-based practice

Aim  To explore nurses' understanding and interpretation of evidence-based practice (EBP).
Background  EBP has been welcomed into the nursing lexicon without a critical examination of its interpretation by practitioners. The literature suggests that there is a great deal of confusion and contradiction over the meaning and application of EBP. Although work has been conducted on how EBP might be implemented, the general issue of how nurses understand and use EBP is largely unexplored. This paper seeks to examine in depth the understandings of EBP, to enable managers, educationalists and policy makers to implement it more effectively.
Methods  All registered nurses, midwives and health visitors in one UK National Health Service (NHS) Trust were asked to complete a questionnaire in October 2006.
Results  Despite a disappointing response rate (8.9%, 218/2438), the survey revealed interesting tensions and contradictions in nurses' understanding of EBP. National and local guidelines, practitioners' own experience and patients' preferences were the main influences on nurses' practice. Published research had relatively little impact, particularly among nurses graded E, F and G and those who had not attended a study day on EBP.
Conclusions  The hierarchies of evidence propounded in local and national guidelines are not adopted by practising nurses, who use other sources of evidence, such as reflection on their own experiences, when making clinical decisions. However, subsuming published evidence to clinical judgement does not contradict the original tenets of EBP.
Implications for Nursing Management  Unless it is incorporated into national or local guidelines, research has relatively little impact on practice. To develop nursing practice and nursing knowledge, nurse leaders need to foster the synthesis of experiential knowledge and published research, in accordance with the founding principles of the EBP movement.     

Making research useful to the practising nurse*

This paper examines the problem of developing research in nursing and the challenge of establishing its relevance and usefulness to the practising nurse. It is accepted that considerable progress has been made worldwide in recent years in the development of nursing research but nurses remain generally remote from the intellectual challenge of an evolving research-based profession. The publication of research reports is examined in the light of the acknowledged need for dissemination of research findings and differences in their presentation are noted as evidence of an apparent discouragement of the practising nurse from sharing in the accumulated nursing knowledge through research. It is argued that learning about research should be brought into the centre of basic nursing education and the growth in clinical research should be encouraged as a means of demonstrating the usefulness of research to the practising nurse.     

The work of Accident and Emergency nurses: Part 2. A & E maxims: making A & E work unique and special

An ethnomethodological study was undertaken to explore the work of Accident and Emergency (A & E) nurses; the aim of which was to analyse the ordinary, taken for granted, everyday work of those practising A & E nursing. In this second paper on the work of A & E nurses, the specific rules or maxims of nursing work in A & E are introduced.From the analysis of materials gained: fieldwork notes, observations of nurses at work and conversations, a number of maxims of A & E nursing work were identified. Maxims direct, instruct and make nurses accountable for their work and the ways in which it gets done. That is, the presence of maxims underpinning A & E nursing work ensure that A & E nursing is seen and heard as a specific type of work with its own unique approach to talk and organization.Being aware of the maxims of A & E nursing work is not the concern of the nurse practising A & E nursing on a daily basis. Implicit and explicit reference to the maxims when talking about and doing the work provides nurses with impressions of who can do the job. Non-adherence by some nurses to the maxims of A & E nursing work often leads their colleagues to question their commitment to their choice of work setting.Maxims of A & E nursing account for the ways in which the work is seen, heard and talked about. Maxims direct the organization of work and its development within the A & E setting.     

Admitting hospital patients: a qualitative study of an everyday nursing task

In recent years new modes of nursing work have been introduced globally in response to radical changes in healthcare policies, technology and new ideologies of citizenship. These transformations have redefined orthodox nurse-patient relationships and further complicated the division of labour within health-care. One distinctive feature of the work of registered nurses has been their initial assessment of patients being admitted to hospital, and it is of interest that this area of nursing practice remains central to the registered nurse's role at a time where other areas of practice have been relinquished to other occupational groups. This qualitative study, drawing on conversation analysis and ethnographic techniques, explores this area of everyday nursing work. Initial nursing assessments have attracted considerable interest in the nursing literature, where it is clearly stated that assessments should be patient centred and seen as the important first step on the road to a therapeutic nurse-patient relationship. Results from this study lead to the conclusion that the actual nursing practice of patient assessment on admission to hospital is at odds with the recommendations of the literature and that a more routinised, bureaucratic form of work is devised by nurses as a means of expediting the process of admission.     

Development of the Nursing Career Preference Inventory

The Nursing Career Preference Inventory (NCPI) was developed to assist nurses in determining which of the four primary nursing practice areas--clinical, administration, research, or education--are most reflective of their personal work activity interests or preferences, and which of 14 customary hospital nursing role positions most often encompass the preferred work activity patterns. This report describes NCPI development and the reliability and validity of the instrument for VA and non-VA hospital nurse reference groups. Correlations between work activity responses of VA and non-VA nurses in the same positions ranged from .71 to .96, and alpha reliability coefficients for the four practice and activity item subsets ranged from .86 to .93 for the two nurse populations. Although additional work is needed to explore item consistency over time, the NCPI can be a useful tool in career development programs that are designed to assist nurses toward selecting nursing role positions and building career plans that reflect their own personal talents and interests.     

Reflection-on-practice: enhancing student learning

The writing of a reflective diary is viewed as an effective tool for promoting reflection and learning in students, and for self-assessment and evaluation of a clinical learning experience This work is a study of 30 undergraduate nurses and then- use of reflective diaries during a period of community health care practice The theoretical basis of the study is based on Schon's work on reflection-in-action The research tool, developed for the study of nursing practice by Powell, is based on Mezirow's levels of reflectivity The findings are that, in the sample used, students do reflect on their practice according to Mezirow's levels of reflectivity, but that the highest number of reflections occur at the lower levels of reflectivity (94% of the total number of scores) However, although only 6% of the total number of scores were found at the higher levels of reflectivity, some 22 of the sample of 30 students did attain conceptual and theoretical reflectivity, the highest levels of reflectivity     

开展心脏康复护理的动力因素分析

目的通过对临床医院在循环内科工作过的护士的调查,分析了护理人员开展心脏康复护理的动力因素,以探讨临床护理人员实施心脏康复护理的可行性。方法以Pender的健康促进模式为理论框架,自行设计问卷,并对曾在循环内科工作过的注册护士进行问卷调查。结果总动力因素均数为高水平,动力因素的子因素均数水平按降序排列依次为:自身工作的成就感;对新知识的渴望;乐于同其他医务人员合作;可获得更高评价及医院行政部门要求。结论为了调动护理人员开展心脏康复的积极性,在护理实践、护理行政管理、及护理教育方面应制定相应措施。     

Extended immersive simulation to develop nontechnical skills: Content analysis of students' views

BackgroundThe purpose of undergraduate nursing education is the preparation of graduates for clinical practice. Despite this focus, graduates are often unprepared for independent practice, particularly in the use of skills such as time management, delegation and critical thinking in clinical situations. This paper reports on students’ views of using extended, immersive simulation to consolidate the use of both technical and nontechnical skills in preparing them for independent nursing practice.AimTo investigate students’ views on the value of extended, immersive simulation in preparing them for independent practice as registered nurses.MethodsCross-sectional research involving content analysis of open-ended survey questions. The study involved comments from 287 final year nursing students conducted at a university in Western Australia.FindingsThemes related to critical thinking, the role of the registered nurse, communication, time management, teamwork and leadership were identified through the content analysis. Students believed exposure to extended simulation facilitated development of the essential skills required to practise independently and helped them prepare for the role of a registered nurse. Many expressed the wish for this type of simulation to be included throughout all years of the nursing curriculum.DiscussionStudents need experience in clinical situations where they are challenged to use multiple skills simultaneously to develop the expertise required of registered nurses. The ability to practise independently, and take responsibility for decisions made in complex ward conditions, is not currently required of students on clinical placements. Simulation is a way to fill this void in nursing education to enable students to experience the full role of a registered nurse.ConclusionBased on our findings nursing students believed that extended, immersive simulation was an effective method of supporting students as they undertake the full responsibilities of registered nurses to enable them to be safe and effective practitioners on commencement of the registered nurse role.