The changing face of nurses in Australian general practice.

OBJECTIVE: To describe the workforce characteristics and current responsibilities of nurses working in Australian general practice settings. DESIGN: Survey research combining qualitative and quantitative data collected through telephone interview. SUBJECTS: 222 enrolled (RN Division 2 in Victoria) and registered nurses (RN Division 1 in Victoria) working in general practice in rural and urban areas of Australia. RESULTS: General practice nurses in Australia are likely to be RNs (84.7%) who work on a part-time basis (75.3%) in a medium to large practice (93.7%). Often the nurse has worked less than five full time equivalent years (52.3%) in a general practice environment and is likely to work in a practice where at least one other nurse works (64.4%). The nurse is likely to have some post-basic formal education (65.9%), and to have participated in professional development in the past two years (94.9%). The nurse performs a diverse range of activities within the general practice. No substantial differences were found in the workforce characteristics or role of urban and rural general practice nurses. CONCLUSION: It appears that nurses working in general practice are no longer the 'handmaiden' to the doctor but are professionals who perform a vast range of clinical, administrative and organisational responsibilities within the general practice primary health care setting.     

Job control,work-family balance and nurses’ intention to leave their profession and organization: A comparative cross-sectional survey

BackgroundThe shortage of nurses is a problem in many countries. In Japan, the distribution of nurses across different care settings is uneven: the shortage of nurses in home healthcare and nursing homes is more serious than in hospitals. Earlier research has identified numerous factors affecting nurses’ intention to leave work (e.g., job control, family-related variables, work-family conflict); however, these factors’ levels and effect size may vary between nurses in hospitals, home healthcare, and nursing homes.ObjectivesThis study measured job control, family-related variables, and work-family conflict among nurses in hospitals, home healthcare, and nursing homes, and compared these variables’ levels and effect size on nurses’ intention to leave their organization or profession between these care settings.DesignThe research design was cross-sectional.MethodsParticipating nurses from hospitals, home healthcare facilities, and nursing homes self-administered an anonymous questionnaire survey; nurses were recruited from the Kyushu district of Japan. Nurses from nine hospitals, 86 home healthcare offices, and 107 nursing homes participated. We measured nurses’ intention to leave nursing or their organization, perceived job control, family variables and work-family conflict. We analyzed 1461 participants (response rate: 81.7%).ResultsThe level of job control, family variables, and work-family conflict affecting nurses varied between hospitals, home healthcare, and nursing homes; additionally, these variables’ effect on nurses’ intention to leave their organization or profession varied between these care settings. Work-family conflict, family variables, and job control most strongly predicted nurses’ intention to leave their organization or profession in hospitals, home healthcare, and nursing homes, respectively.ConclusionsInterventions aiming to increase nurse retention should distinguish between care settings. Regarding hospitals, reducing nurses’ work-family conflict will increase nurse retention. Regarding home healthcare, allowing nurses to fulfill family responsibilities will increase nurse retention. Regarding nursing home nurses, increasing nurses’ job control will increase nurse retention.     

The magnet process and the perceived work environment of nurses

BACKGROUND: Several studies have described the work environment of nurses from magnet and nonmagnet hospitals, but there have been no studies of nurses from hospitals in the magnet application process. OBJECTIVES: To compare the differences between characteristics of hospitals and nurses from three hospital types: magnet hospitals, hospitals in the process of applying for magnet certification, and nonmagnet hospitals, and how nurses from these hospitals perceive their work environment. METHODS: In a national, cross-sectional survey of critical care nurses, the Perceived Nursing Work Environment (PNWE) instrument was administered to measure nurses' perceptions of their work environment. RESULTS: Data were available from 2,092 nurse surveys. Over a third of the respondents were from in-process hospitals and almost half were from nonmagnet hospitals. The majority of nurses were female and from large hospitals in the Atlantic region. The mean age of nurses was 39.5 years and the mean years of work experience in the intensive care unit (ICU) was 10.2 years. Higher nurse scores were significantly associated with magnet certification on one subscale of the PNWE, nursing competence. DISCUSSION: Nurses from magnet hospitals had a positive perception of nursing competence in their work environment. Further research is necessary to examine the nurse work environment and to determine if the characteristics of magnet hospitals have changed.     

Workplace empowerment and magnet hospital characteristics: making the link

OBJECTIVE: To test a theoretical model linking nurses' perceptions of workplace empowerment, magnet hospital characteristics, and job satisfaction in 3 independent studies of nurses in different work settings. BACKGROUND: Strategies proposed in Kanter's structural empowerment theory have the potential to result in work environments that are described in terms of magnet hospital characteristics. Identifying factors that contribute to work conditions that attract and retain highly qualified committed nurses, such as those found in magnet hospitals, that can be put in place by nursing administrators is extremely important for work redesign to promote professional nursing practice. METHODS: Secondary analyses of data from 3 studies were conducted--2 of staff nurses and 1 with acute care nurse practitioners working in Ontario, Canada. The Conditions of Work Effectiveness Questionnaire-II, the NWI-R, and measures of job satisfaction were used to measure the major study variables.RESULTS The results of all 3 studies support the hypothesized relationships between structural empowerment and the magnet hospital characteristics of autonomy, control over practice environment, and positive nurse-physician relationships. The combination of access to empowering work conditions and magnet hospital characteristics was significantly predictive of nurses' satisfaction with their jobs. CONCLUSIONS/IMPLICATIONS: These findings suggest that nursing leaders' efforts to create empowering work environments can influence nurses' ability to practice in a professional manner, ensuring excellent patient care quality and positive organizational outcomes.     

护士结构授权与心理授权的关系

目的调查护士结构授权和心理授权水平,分析两者之间的关系,为护理管理者改善护士工作环境、提高管理效率提供依据。方法采用问卷调查法,对上海市2所综合医院的206名护士的工作效能与心理授权情况进行调查。结果护士结构授权总分为(17.42±3.059)分,处于中等水平;心理授权总分为(3.49±0.583)分,处于中等偏上水平;结构与心理授权呈显著正相关(P<0.01);结构授权中的正式权力、信息和非正式权力是护士心理授权的预测变量(P<0.01)。结论我国护士结构和心理授权水平还有待于进一步提升;本研究建立的心理授权多元线性回归模型基本反映了其与结构授权之间的相互关系;提示护理管理者需注重创造结构性授权环境,注重信息传达与提高护士正式与非正式权力,从而提高护士心理授权水平,稳定护士队伍,提高护士工作效率和护理质量。     

Leader empowering behaviours, staff nurse empowerment and work engagement/burnout

Efforts to improve nursing working conditions are critical to retaining nurses currently in the system and attracting newcomers to the profession (Laschinger et al. 2003b). The nurse leader's empowering behaviours can be pivotal in the way nurses react to their work environment. The purpose of this study was to test a model examining the relationship between nurse leaders' empowerment behaviours, perceptions of staff empowerment, areas of work life and work engagement using Kanter's theory of structural power in organizations. A cross-sectional correlational survey design tested the model in a random sample of 322 staff nurses in acute care hospitals across Ontario. Overall, staff nurses perceived their leaders' behaviours to be somewhat empowering and their work environment to be moderately empowering. Fifty-three percent reported severe levels of burnout. Leader empowering behaviour had an indirect effect on emotional exhaustion (burnout) through structural empowerment and overall fit in the six areas of work life. The final model statistics revealed a good fit (chi(2)=30.4, chi=3, chi=0.96, chi=0.95, chi=0.95). These findings suggest that the Leader's empowering behaviours can enhance person-job fit and prevent burnout. These findings have important implications in the current nursing shortage.     

Hospital nurses' perceptions of respect and organizational justice

OBJECTIVE: To test an exploratory model of the antecedents and consequences of nurses' perceptions of respect in hospitals. BACKGROUND: Although nurses in hospital settings often state that they do not receive the respect they deserve for their contribution to patient care, there is little empirical research on this phenomenon. Interactional organizational justice theory framed the analysis. METHODS: A random sample of 285 staff nurses from Ontario teaching hospitals completed measures of interactional justice, structural empowerment, perceived respect, work pressures, emotional exhaustion, and work effectiveness. RESULTS: More than half of the nurses felt that managers did not show concern or deal with them in a sensitive and truthful manner regarding decisions affecting their jobs. The strongest predictors of perceptions of respect were interactional organizational justice, followed by structural empowerment and job stress resulting from lack of recognition, poor interpersonal relationships and heavy workload. Consequences of nurses' feelings of respect included greater job satisfaction, trust in management, and lower emotional exhaustion, as well as higher nurse ratings of quality of care and perceived staffing adequacy. CONCLUSIONS: A positive organizational environment increases nurses' perceptions of respect, resulting in positive outcomes for both the nurse and the organization.     

The importance of work environment: evidence-based strategies for enhancing nurse retention

As the nation faces a growing nursing shortage, it is imperative that home care leaders implement evidence-based strategies to improve nurse recruitment and retention. Previous research indicates that characteristics of the work environment that support nursing practice enhance nurses' job satisfaction and reduce turnover. Yet, there is little evidence to assist in prioritizing initiatives to improve the work environment of nurses. In this nationwide survey, home care nurses were asked to rate the importance of specific agency work environment traits, as listed on the Nursing Work Index-Revised, in supporting their home care practice. The 10 agency traits rated as most important are presented, and evidence-based recommendations for creating a culture of nurse retention are discussed.     

Hospital nurses' work environment, quality of care provided and career plans

HINNO S., PARTANEN P. & VEHVILÄINEN‐JULKUNEN K. (2011) Hospital nurses' work environment, quality of care provided and career plans. International Nursing Review 58 , 255–262 Background: In several European countries, the availability of qualified nurses is insufficient to meet current healthcare requirements. Nurses are highly dissatisfied with the rising demands of the healthcare environment and increasingly considering leaving their jobs. Aim: The study aims to investigate the relationships between the characteristics of hospital nurses' work environment and the quality of care provided, and furthermore to examine Dutch nurses' career plans. Methods: A cross‐sectional, questionnaire survey of registered nurses (n = 334) working in the academic and district hospitals was conducted in 2005/2006. Previously validated questionnaires translated into the participants' language were used. Factor and regression analysis were used for data analysis. Results: Overall, nurses rated their work environment rather favourably. Five work environment characteristics were identified: support for professional development, adequate staffing, nursing competence, supportive management and teamwork. Significant relationships were found between nurses' perceptions of their work environment characteristics and quality of care provided and nurses' career plans. When work environment characteristics were evaluated to be better, nurse‐assessed quality of care also increased and intentions to leave current job decreased linearly. Conclusions: Study findings suggest that nurses' perceptions of their work environment are important for nurse outcomes in hospital settings. Further research is needed to explore the predictive ability of the work environment for nurse, patient and organizational outcomes in hospitals.     

Rural nurses. Part II, Surviving the nurse shortage

Cost containment and the nurse shortage have impacted rural hospitals and their nursing staffs. This impact did not appreciably affect burnout levels among the rural nurses, but did evidence itself in the reports of the directors of nursing and their nurses. Cost containment brought with it layoffs of colleagues in the work setting who were neighbors or relatives. This occurred while the rural areas were already filled with the unemployed and underemployed. Unfamiliar recordkeeping increased two- and three-fold, and the 23-hour admit caused unequal work flow. Downsizing, elimination of some services and reports of rural hospital closings were threatening to the nurses, who were often the sole support of their families. The rural nurse shortage was seen to be different from the national nurse shortage in significant ways. Except for the few study hospitals that were close to population centers, nurses could not be recruited from outside the geographic area. Suggestions from the Secretary's Commission on Nursing are not all appropriate for the rural hospital nurse shortage. Rural hospitals changed in the face of cost containment, and nursing personnel also worked to contain costs. However the nurses have worked within cost and salary constraints for so long that they predict loyalty to their community hospitals can be coming to an end. The nurse shortage is being approached by minor alterations in staffing and mode of care delivery. Federal support is desperately needed by the rural hospitals to permit equitable salaries, and to support financial aid to permanent residents of the rural areas for entrance into or advancement in nursing education.(ABSTRACT TRUNCATED AT 250 WORDS)     

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.     

Job satisfaction of nurses employed in rural and urban long-term care facilities

Previous investigators have identified residential differences in the job satisfaction of hospital nurses. However, the degree to which the greater job satisfaction of rural nurses can be generalized beyond hospitals to other work settings, including nursing homes, is unknown. The purpose of this research was to examine the job satisfaction of nurses (registered and licensed practical) employed in both rural and urban nursing homes. A total of 281 nurses from 26 participating nursing homes completed a mailed questionnaire that measured the personal and job-specific characteristics of the nurses and the contextual properties of the facilities in which they worked. The data indicated no statistically significant differences in the overall job satisfaction, or on any of the five subscales of the instrument, between rural and urban nurses. However, a pooled multivariate model identified five factors that predicted the job satisfaction of nurses employed in long-term care facilities: the employees' race and personal income; the employees' perception that their supervisor was interested in their career aspirations; the length of time that the nurses had intended to stay at the time of their hiring; and their current intent to leave. ©1995 John Wiley & Sons, Inc.     

The impact of staff nurse empowerment on person-job fit and work engagement/burnout

Workplace empowerment is an important strategy for creating positive nursing work environments in a time of a severe nursing shortage. The purpose of this study was to test a model linking staff nurse perceptions of empowerment to their perceived fit with 6 areas of work life and work engagement/burnout using Kanter's work empowerment theory. We tested the model in a cross-sectional correlational survey design with a random sample of 322 staff nurses in acute care hospitals across Ontario. Overall, staff nurses perceived their work environment to be only somewhat empowering. Fifty-three percent reported severe levels of burnout. Overall empowerment had an indirect effect on emotional exhaustion (burnout) through nurses' perceived fit in 6 areas of work life. The final model fit statistics revealed a good fit (chi2 = 32.4, df = 13, GFI = 0.97, IFI = 0.97, CFI = 0.97, RMSEA = 0.07). These findings have important implications in the current nursing shortage.     

Psychological empowerment and job satisfaction between Baby Boomer and Generation X nurses

sparks a.m. (2012) Journal of Nursing Management  20, 451–460 Psychological empowerment and job satisfaction between Baby Boomer and Generation X nurses Aim This paper is a report of a study of differences in nurses’ generational psychological empowerment and job satisfaction. Background Generations differ in work styles such as autonomy, work ethics, involvement, views on leadership, and primary views on what constitutes innovation, quality, and service. Method A secondary analysis was conducted from two data sets resulting in a sample of 451 registered nurses employed at five hospitals in West Virginia. One data set was gathered from a convenience sample and one from a randomly selected sample. Data were collected from 2000 to 2004. Results Baby Boomer nurses reported higher mean total psychological empowerment scores than Generation X nurses. There were no differences in total job satisfaction scores between the generations. Conclusion There were significant differences among the generations’ psychological empowerment scores. Generational differences related to psychological empowerment could provide insight into inconsistent findings related to nurse job satisfaction. Implications for nursing management Nurse administrators may consider this evidence when working on strategic plans to motivate and entice Generation X nurses and retain Baby Boomers. Although implications based on this study are tentative, the results indicate the need for administrators to consider the differences between Baby Boomer and Generation X nurses.     

Rural Nurse Managers’ Perspectives into Better Communication Practices

The aim of this qualitative study was to describe the communication perceptions of nurse managers in rural areas. Prior research in tertiary settings was the impetus for studying viewpoints in other settings. Grounded theory methods were used to collect and analyze interview data with nine managers from regional, critical access hospitals, and home health settings in central Pennsylvania. Nurse Managers associated successful communication with job satisfaction, work efficiency, and employee retention. Circumstances influencing communication involved discussion tones, techniques, resources, and environmental factors. Recommended techniques included regular conversations, diverse messaging, and conferencing huddles to improve information dissemination and workflow in rural settings.     

Examining the language–place–healthcare intersection in the context of Canadian homecare nursing

Currently, much of the western world is experiencing a shift in the places where care is provided, namely from institutional settings like hospitals to diverse community settings such as the home. However, little is known about how language and the physical and social aspects of place interact to influence how health‐care is delivered and experienced in the home environment. Drawing on ethnographic participant observations of homecare nursing visits and semi‐structured interviews with Canadian family caregivers, care recipients and nurses, the intersection of language, place and health‐care was explored in this secondary analysis. Our findings reveal four themes: homecare nurses view themselves as ‘guests’; home environments facilitate the development of nurse–client relationships; nurses adapt healthcare language to each home environment; and storytelling and illness narratives largely prevail during medical interactions in the home. These findings demonstrate the spatiality of language and how the home environment informs decisions regarding language use. Furthermore, these findings exemplify how language and place mutually influence the experiences and delivery of home health‐care. We conclude by discussing the importance of considering the language–place–healthcare intersection in order to gain a better understanding of medical exchanges in places and the associated implications for optimizing best nursing practice.     

The gate still swings both ways in rural Texas

Aims  To give nurse managers a perspective of what it is like to practice in a frontier or rural setting without the resources of the metropolitan centres.
Background  I grew up in rural Texas and more recently had the opportunity to work with rural hospitals seeking to be designated as Nurse Friendly by the Texas Nurses Association. This renewed my interest in and great respect for nurses on the frontier and other rural areas.
Key issues  This article summarizes some characteristics of rural nursing in relation to their practices that address patient safety and quality of care, nurse satisfaction and balanced life style, community service, and teamwork/relationships.
Conclusions  I conclude that there are many advantages and satisfactions in rural nursing that are different from but equally as meaningful and challenging as metro nursing practice.
Implications for nursing management  This article is important because there is a shortage of nurses everywhere; however, direct care nurses and nurse managers in rural areas may have greater challenges in meeting their patient's needs while balancing their personal lives.     

A comparative study of organisational characteristics, work characteristics and nurses' psychological work reactions in a hospital and nursing home setting

OBJECTIVES: The aim of the current study was twofold. First, we explored whether there were any differences concerning organisational characteristics, work characteristics and psychological work reactions in two types of health care setting, hospitals and nursing homes. Second, it was investigated and validated whether relationships between organisational characteristics, work characteristics and psychological work reactions found in research on hospital nursing are also present in nursing homes. METHODS: The variables were assessed by questionnaires that were distributed among nurses and caregivers in 15 randomly selected general hospitals and 14 nursing homes in the Netherlands. Manova and hierarchical regression analyses were carried out to explore differences in the variables and in relationships between the variables. RESULTS AND CONCLUSION: Results show that the major difference in hospital-based and nursing home practice is in the work organisation as assessed by the organisational characteristics "environmental uncertainty" and "decision authority". Relations found between variables are in majority in line with the JDC-model and confirm the applicability of this theory in different types of health care settings.