Practicing Autonomously: A Comparison of Nurses

Forty-five subjects including community health nurses with baccalaureate nursing degrees, senior-level generic nursing students, and registered nurses in a baccalaureate nursing program were compared on age, years of employment in nursing, and three variables of professional autonomy: nurses' rights and responsibilities, the nurse-patient relationship, and nurses' role in health care delivery. It was predicted that nurses from baccalaureate programs and those practicing in community health nursing would perceive themselves as more autonomous and that age and years of employment in nursing would not appreciably alter perceptions of autonomy. An analysis of variance confirmed the initial prediction at the 0.01 level of significance or better for nurses' rights and responsibilities and their role in health care delivery. A significant negative correlation was obtained between age and nurses' rights and responsibilities for the community health nurses; a significant positive correlation was obtained between years of work experience and nurses' rights and responsibilities for only the registered nurses. This study is perceived as an initial step in a lengthy process aimed at identifying factors that influence nurses' perceptions about professional autonomy.     

How clinical nurses in South Korea perceive the status of the nursing profession: A Q‐methodological approach

Professional self‐image among nurses is shaped by subjective perceptions, feelings, and tacit views. A perceived positive status reflects and influences the nurse's self‐esteem, professional empowerment, and nursing performance. The aim of this study was to examine the perceived status of the nursing profession among clinical nurses in South Korea. Q‐methodology was used with data collected from September to December 2014. Forty‐four Q statements were selected and scored by the 31 participants on a 9‐point scale with normal distribution. The data were analyzed using the pc‐QUANL program. Thirty‐one nurses were classified into 3 factors based on the following viewpoints: as professional (I am proud of my nursing job), subprofessional (I am not proud of my nursing job), and developmental (advocating for change and improvement). The major finding of this study included clinical nurses' subjective perception toward the status of nursing profession. The results indicated that to raise the status of nursing profession, nurses need to understand the value of nursing and their contribution to patients and public.     

Nurse qualifications and perceptions of patient safety and quality of care in South Africa

A plethora of research links professional nurses' qualifications to patient outcomes. Also, research has shown that reports by nurses on the quality of care correspond with process or outcome measures of quality in a hospital. New to the debate is whether professional nurses' qualifications impact on their perceptions of patient safety and quality of care. This research aims to investigate professional nurses' perceptions of patient safety and quality of care in South Africa, and the relationship between these perceptions and professional nurses' qualifications. A cross‐sectional survey of 1117 professional nurses from medical and surgical units of 55 private and 7 public hospitals was conducted. Significant problems with regard to nurse‐perceived patient safety and quality of care were identified, while adverse incidents in patients and professional nurses were underreported. Qualifications had no correlation with perceptions of patient safety and quality of care, although perceptions may serve as a valid indicator of patient outcomes. Creating an organizational culture that is committed to patient safety and encourages the sharing of adverse incidents will contribute to patient safety and quality of care in hospitals.     

A critical review of knowledge on nurses with problematic substance use: The need to move from individual blame to awareness of structural factors

Problematic substance use (PSU) among nurses has wide‐ranging adverse implications. A critical integrative literature review was conducted with an emphasis on building knowledge regarding the influence of structural factors within nurses' professional environments on nurses with PSU. Five thematic categories emerged: (i) access, (ii) stress, and (iii) attitudes as contributory factors, (iv) treatment policies for nurses with PSU, and (v) the culture of the nursing profession. Conclusions were that an overemphasis on individual culpability and failing predominates in the literature and that crucial knowledge gaps exist regarding the influence of structural factors on driving and shaping nurses' substance use.     

The satisfaction with the quality of dementia care and the health,burnout and work ability of nurses: A longitudinal analysis of 50 German nursing homes

Background

The increasing prevalence of residents with dementia in Nursing Homes (NH) leads to a demanding work with high physical and psychological workloads. This study focuses on NH nurses and their satisfaction with quality of care for residents with dementia (SQCD) and its impact on nurses' general health, burnout and work ability.

Method

Two-wave (2007/2009) self-report questionnaire data of 305 nurses (RNs and nurses' aides) from 50 German NHs.

Results

58.6% (2007) and 64.9% (2009) of the respondents reported satisfaction with the quality of care of the dementia residents. However, when dissatisfied, this was perceived as substantial work stressor and was adversely associated with nurses' individual resource outcomes. Those nurses who between 2007 and 2009 had become dissatisfied or were dissatisfied at both measurements showed the most adverse scorings for burnout, general health and work ability.

Discussion

The findings imply that in NHs, SQCD may be a relevant work factor with substantial impact on nurses' core resources.     

An exploratory study about meaningful work in acute care nursing

OBJECTIVE. To develop deeper understandings about nurses' perceptions of meaningful work and the contextual factors that impact finding meaning in work. BACKGROUND. Much has been written about nurses' job satisfaction and the impact on quality of health care. However, scant qualitative evidence exists regarding nurses' perceptions of meaningful work and how factors in the work environment influence their perceptions. The literature reveals links among work satisfaction, retention, quality of care, and meaningfulness in work. METHODS. Using a narrative design, researchers interviewed 13 public health nurses and 13 acute care nurses. Categorical‐content analysis with Atlas.ti data management software was conducted separately for each group of nurses. This article reports results for acute care nurses. RESULTS. Twenty‐four stories of meaningful moments were analyzed and categorized. Three primary themes of meaningful work emerged: connections, contributions, and recognition. Participants described learning‐focused environment, teamwork, constructive management, and time with patients as facilitators of meaningfulness and task‐focused environment, stressful relationships, and divisive management as barriers. Meaningful nursing roles were advocate, catalyst and guide, and caring presence. CONCLUSIONS. Nurse administrators are the key to improving quality of care by nurturing opportunities for nurses to find meaning and satisfaction in their work. Study findings provide nurse leaders with new avenues for improving work environments and job satisfaction to potentially enhance healthcare outcomes.     

The importance of practice-based evidence

Objectives — To describe professional advice- and information-seeking at primary health care (PHC) centres.

Design — Prospective cross-sectional data collection using semi-structured interviews. Statistical analysis of association between team-based and centralized organization, profession and pattern of advice-seeking.

Setting — 4 urban PHC centres in Östergötland County, Sweden.

Participants — 199 PHC centre staff members (25 doctors, 70 nurses, 49 nurses' aides, 12 medical laboratory technologists, 24 secretaries, 19 physiotherapists). Nine (4%) staff members did not participate in the study (4 doctors, 3 nurses, 1 nurses' aide, and 1 secretary).

Main outcome measures — Number of staff using an advice source.

Results — For organizational advice, PHC centre managers were consulted at the centrally organized PHC centres, while staff at centres using team organization more often consulted outside sources. Having no one to ask for advice on patient communcation was more common in the centralized organization. Regarding medical advice, only nurses' aides differed by consulting their own profession rather than doctors. For patient communication problems, the professions shared an intra-professional advice pattern.

Conclusions — The PHC centre staff maintain parallel overlapping networks of professional advice-seeking. The observed networks can also be seen to answer simultaneous demands from patients, the local health care administration, social services and professional authorities. Straightforward ways to develop the professional communication at PHC centres would be to visualize these multiple dependencies and to support their optimal function in the organization.     

Conflict and professionalism: perceptions among nurses in Saudi Arabia

ZAKARI N.M., AL KHAMIS N.I. & HAMADI H.Y. (2010) Conflict and professionalism: perceptions among nurses in Saudi Arabia. International Nursing Review 57 , 297–304 Aim: To examine the relationship between nurses' perceptions of conflict and professionalism. Background: In Saudi Arabia, health‐care sectors are constantly undergoing major changes because of social, consumer‐related, governmental, technological and economic pressures. These changes will influence the nature of health‐care organizations, such as hospitals' work environment. The ability of nurses to practise in a professional manner may be influenced by their work environment and conflict level. Methods: A cross‐sectional design was conducted in this study. A simple random selection of three health‐care sectors in Saudi Arabia was performed and 346 nurse managers, as well as bedside nurses participated to provide information about conflict levels and professionalism. The Perceived Conflict Scale was used to assess the level of conflict, and the Valiga Concept of Nursing Scale was used to assess the professionalism perception among nurses. Results: The intragroup/other department type of conflict had a statistically significant correlation with the perception of professionalism. In addition, the findings point to a low perception among the participating nurses regarding their professionalism. Conclusion: A number of factors might explain the low level of perception of professionalism. These relate to the workplace itself, as well as to the personal background of the nurses, which includes the personal interest in the nursing profession, as well as the family's, society's and the consumers' views of the profession. Given the findings of this study, nurse managers are encouraged to create a work environment that supports professionalism and minimizes conflict.     

The impact of perceived workload on nurse satisfaction with work-life balance and intention to leave the occupation

Background and aimIn the drive to make the health sector more economically efficient and effective, what is potentially being lost is the need to look after the well-being of those who work within this profession. Nurses are the largest group in the health sector workforce and the frontline of patient care. Workload perceptions are known to be impacting nurses' well-being and are becoming a critical concern for the retention of this workforce. In response, this study aims to examine the relationships among perceived workload, satisfaction with work-life balance (an indicator of well-being), and intention to leave the occupation. Additionally, high involvement work practices (HIWPs) are examined as a form of organisational support that may buffer the negative impact of perceived workload on nurses' well-being and intention to leave the occupation.MethodA 2016 online survey of the nursing profession in Australia yielded 2984 responses. We assessed the impact of perceived workload on nurses' well-being and intention to leave the occupation, and the role of HIWPs in ameliorating the negative impact of perceived workload.Results and conclusionOur results show that perceived workload is associated with increasing intention to leave the occupation and is mediated by nurses' satisfaction with work-life balance. Where organisational support is provided through HIWPs, this can mitigate such intentions. These aspects are within the control of those who manage this workforce and should be central to human resource management strategies in the health care sector.     

Newly qualified doctors’ perceptions of informal learning from nurses: implications for interprofessional education and practice

Abstract

Newly qualified doctors spend much of their time with nurses, but little research has considered informal learning during that formative contact. This article reports findings from a multiple case study that explored what newly qualified doctors felt they learned from nurses in the workplace. Analysis of interviews conducted with UK doctors in their first year of practice identified four overarching themes: attitudes towards working with nurses, learning about roles, professional hierarchies and learning skills. Informal learning was found to contribute to the newly qualified doctors’ knowledge of their own and others’ roles. A dynamic hierarchy was identified: one in which a “pragmatic hierarchy” recognising nurses’ expertise was superseded by a “normative structural hierarchy” that reinforced the notion of medical dominance. Alongside the implicit learning of roles, nurses contributed to the explicit learning of skills and captured doctors’ errors, with implications for patient safety. The findings are discussed in relation to professional socialisation. Issues of power between the professions are also considered. It is concluded that increasing both medical and nursing professions’ awareness of informal workplace learning may improve the efficiency of education in restricted working hours. A culture in which informal learning is embedded may also have benefits for patient safety.     

护士同情心疲乏、结构授权对其职业认同影响的研究

目的 了解护士的职业认同现况,探讨护士同情心疲乏及结构授权对其职业认同的影响。 方法 选取南京市某家三级甲等综合性医院1005名护士,采用一般资料调查问卷、同情心疲乏量表、结构授权量表、职业认同量表进行问卷调查,了解护士职业认同现状,并探讨三者之间的关系。 结果 职业认同总分为（104.49±19.54）分。年龄、护龄、工作职务、婚姻状况、职称、夜班次数、健康状况及收入对职业认同得分差异有影响（P＜0.05）。结构授权各维度与职业认同成正相关,同情心疲乏中职业倦怠及继发性创伤应激反应与职业认同成负相关。多元回归结果显示职业倦怠、继发性创伤应激反应、正式授权、非正式授权、资源、机会可预测职业认同水平的66.5%。 结论 护士职业认同处于中度水平,护理管理者应重视护士自身的发展,关心其身心健康水平,减少夜班次数和人均日常护理工作量,鼓励护士提高自我情绪调控能力,完善护理组织结构,提供相应的机会,建立资源信息共享系统,鼓励护士参与更多的决策,进而增强护士职业认同感。     

Nurses’ continuing professional development: A systematic literature review

Nurses' continuing professional development (CPD) improves the quality of nursing care, patients' safety, nurses' satisfaction and healthcare costs. However, evidence has shown that nurses do not always participate in their CPD and that CPD does not always address nurses' real needs. To examine this issue, a systematic review of the literature on nurses' experiences regarding their CPD in the clinical context was carried out. The studies selected for this review (n = 9) were analyzed thematically, through which three themes were identified: The relevance of CPD to nurses; the intrinsic and extrinsic motivations of nurses to participate in CPD; and the specific needs of nurses to participate in CPD. The findings of this review highlight that nurses' experiences regarding their CPD is a key issue that has not been deeply studied. For nurses, their CPD continues throughout their professional career, and keeping their knowledge and skills up to date is important. The goals, motivations and needs that nurses may have to lead and participate in their CPD may vary according to their age and position. Organizations should consider nurses' specific professional situation as well as their actual needs to boost their CPD through different approaches and enhance nurses’ retention at hospitals.     

“I feel broken”: Chronicling burnout,mental health,and the limits of individual resilience in nursing

Healthcare systems and health professionals are facing a litany of stressors that have been compounded by the pandemic, and consequently, this has further perpetuated suboptimal mental health and burnout in nursing. The purpose of this paper is to report select findings from a larger, national study exploring gendered experiences of mental health, leave of absence (LOA), and return to work from the perspectives of nurses and key stakeholders. Given the breadth of the data, this paper will focus exclusively on the qualitative results from 53 frontline Canadian nurses who were purposively recruited for their workplace insight. This paper focuses on the substantive theme of “Breaking Point,” in which nurses articulated a multiplicity of stress points at the individual, organizational, and societal levels that amplified burnout and accelerated mental health LOA from the workplace. These findings exemplify the complexities that underlie nurses' mental health and burnout and highlight the urgent need for multipronged individual, organizational, and structural interventions. Robust and timely interventions are needed to restore the health of the nursing profession and sustain its future.     

Effects of unit empowerment and perceived support for professional nursing practice on unit effectiveness and individual nurse well-being: A time-lagged study

BackgroundRecruitment and retention strategies have emphasized the importance of positive work environments that support professional nursing practice for sustaining the nursing workforce. Unit leadership that creates empowering workplace conditions plays a key role in establishing supportive practice environments that increase work effectiveness, and, ultimately, improves job satisfaction.ObjectivesTo test a multi-level model examining the effect of both contextual and individual factors on individual nurse job satisfaction. At the unit level, structural empowerment and support for professional nursing practice (organizational resources) were hypothesized to be predictors of unit level effectiveness. At the individual level, core self-evaluation, and psychological empowerment (intrapersonal resources) were modeled as predictors of nurse job satisfaction one year later. Cross-level unit effects on individual nurses’ job satisfaction were also examined.DesignThis study employed a longitudinal survey design with 545 staff nurses from 49 hospital units in Ontario, Canada. Participants completed a survey at two points in time (response rate of 40%) with standardized measures of the major study variables in the hypothesized model. Multilevel structural equation modeling was used to test the model.ResultsNurses shared perceptions of structural empowerment on their units indirectly influenced their shared perceptions of unit effectiveness (Level 2) through perceived unit support for professional nursing practice, which in turn, had a significant positive direct effect on unit effectiveness (Level 2). Unit effectiveness was also strongly related to individual nurse job satisfaction one year later. At Level 1, higher core self-evaluation had a direct and indirect effect on job satisfaction through increased psychological empowerment.ConclusionsThe results suggest that nurses’ job satisfaction is influenced by a combination of individual and contextual factors demonstrating utility in considering both sources of nurses’ satisfaction with their work in creating effective nursing work environments.     

ICU护士职业延迟满足对工作满意度影响的研究

目的调查ICU护士职业延迟满足以及工作满意度现况,分析二者之间的相关性及影响工作满意度的因素。方法采用职业延迟满足量表和护士工作满意度量表对280名ICU护士进行调查。结果 ICU护士的职业延迟满足总分为(21.32±3.58)分;工作满意度总分为(124.49±22.08)分;ICU护士职业延迟满足与工作满意度呈正相关(P0.01);职称和职业延迟满足为ICU护士工作满意度的主要影响因素(P0.01)。结论 ICU护理管理者应关注护士的职业延迟满足感,以提高其工作满意度。