A mixed methods study of an organization's approach to the COVID-19 health care crisis

BackgroundHealthcare emergency can increase work-related stress and reduce nurses’ job satisfaction and quality of life. Managerial decisions and proactive interventions implemented to react to the emergency ensure the best patient outcomes.PurposeThe purpose of this study was to verify whether a proactive organizational approach can limit nurses’ work-related stress and help preserve their job satisfaction and quality of life during a health emergency.MethodsA longitudinal mixed methods study was conducted. Data were collected before and after the transformation into a SARS-CoV-2 Hospital and the implementation of organizational interventions. Focus groups were conducted to investigate quantitative data.FindingsAfter the implementation of interventions and as the pandemic progressed, work-related stress decreased and job satisfaction and quality of life increased.DiscussionThrough proactive organization, even during an emergency, nurses are prepared for working, and work-related stress due to changes is reduced. Nurses are motivated and satisfied with their organization and management, and quality of life increases.     

The role of job satisfaction,work engagement,self-efficacy and agentic capacities on nurses' turnover intention and patient satisfaction

BackgroundNurses' voluntary turnover is a worrying global phenomenon which affects service quality. Retaining nursing staff within a hospital is important to eliminate the negative influence of voluntary turnover on the quality of care and organisation costs.ObjectivesThis research helps explain nurses' voluntary turnover by analysing the role of self-efficacy, agentic capacities, job satisfaction, and work engagement on hospital turnover intention, and to study the relationships between these variables and patient satisfaction.Setting and participantsThis study gathered data from 194 nurses and 181 patients from 22 inpatient wards at two hospitals in southern Italy.ResultsCorrelation analysis revealed that job satisfaction, work engagement, self-efficacy and agentic capacities were positively interrelated and negatively correlated with turnover intention. Path analysis showed that self-efficacy, some agentic capacities (anticipation and self-regulation), job satisfaction, and work engagement had direct or indirect effects on nurses' turnover intention, and that job satisfaction exerted a stronger effect on turnover intention. Also, patient satisfaction was positively correlated with nurses' job satisfaction, work engagement, self-efficacy, self-regulation and anticipation and negatively correlated with nurses' turnover intention.ConclusionResults highlighted the importance of implementing actions (for example through feedforward methodology and the goal setting technique) to improve self-efficacy, self-regulation skill, work engagement and job satisfaction in order to reduce nurses' turnover intention and increase patient satisfaction with nursing care.     

Prevalence and predictors of compassion satisfaction,secondary traumatic stress,and burnout among Chinese hospice nurses: A cross-sectional study

AimTo explore the prevalence and predictors of compassion satisfaction, secondary traumatic stress, and burnout among Chinese hospice nurses.BackgroundBecause of prolonged and continual contact with suffering, deaths, and grief, hospice nurses may be vulnerable to emotional burdens and have difficulty maintaining their professional quality of life.MethodsA cross-sectional study was conducted. A total of 478 hospice nurses were selected from 24 medical institutions in Sichuan province. Demographic, work-related information and work-related trauma questionnaire, the Chinese version of the Interpersonal Reactivity Index, the Chinese version of the Emotion Regulation Questionnaire, and the Chinese version of the Professional Quality of Life Scale for Nurses were used for collecting data.ResultsThe mean scores of compassion satisfaction, secondary traumatic stress, and burnout were 34.89 ± 6.21, 26.35 ± 5.24, and 24.49 ± 5.01, respectively. Job satisfaction, perspective-taking, empathic concern, working in tertiary hospitals, and adopting cognitive reappraisal strategy were positively associated with compassion satisfaction, while personal distress was a negative factor, all variables explaining 50.7 % of the variance. Higher burnout was found among nurse who had higher personal distress, worked in secondary or primary hospitals, worked >8 h per day and caring for >10 dying patients last month. In addition, job satisfaction, social support, perspective-taking, empathic concern, and cognitive reappraisal were identified as significant protectors, explaining 50.1 % of the variance. We also found that lower job satisfaction, higher personal distress, higher expressive suppression, lack of social support, senior nurses, and cared for >10 dying patients last month, were positively related to secondary traumatic stress. However, cognitive reappraisal had negative associations. These seven factors explained 32.0 % of the variance.ConclusionsHospice care has specific characteristics and hospice nurses may suffer from more work-related stressors compared with other nurses. Our study may provide clues to help nursing administrators identify hospice nurses who are at higher risk of compassion fatigue and design targeted interventions focused on potential risk factors and protectors to improve hospice nurses' compassion satisfaction, while reducing compassion fatigue.     

The role of occupational stress in the association between emotional labor and burnout in nurses: A cross-sectional study

AimTo test a model to evaluate the influence of emotional labor on burnout and the mediating role of work-related stress reported by nurses.BackgroundNurses are particularly exposed to work-related stress caused by their relationships with their patients. Even though their emotional involvement can cause work-related stress for professionals, nurses recognize this as a fundamental part of the caring relationship, and it has been proved to be therapeutic for patients. The effects of emotional labor contribute to stress, and prolonged exposure to it contributes to burnout syndrome, with repercussions on nurses' health and quality of life, and patients' quality of care.MethodsA multicentre correlational study was conducted on a sample of 207 nurses from different clinical areas in three hospitals in Italy. A self-report questionnaire was used to measure levels of emotional labor, burnout and work-related stress.ResultsHigh levels of emotional labor and work-related stress increase burnout syndrome in nurses. Work-related stress mediates the relationship between emotional labor and burnout. The Oncology ward is identified as the major clinical area exposing nurses to emotional labor.ConclusionsThe results of this study highlight the mediating role of work-related stress in the relationship between emotional labor and burnout, offering a new field for intervention to interrupt this process.     

Differences in employment,job characteristics,and work-related perceptions by sociodemographic factors among registered nurses of diverse race/ethnicity

BackgroundAvailable research on registered nurses (RNs) indicates that RNs with diverse race/ethnicity are more likely to work in disadvantaged workplaces.PurposeTo examine differences in employment, job characteristics and perceptions about work among RNs by sociodemographic characteristics.MethodsWe analyzed data from statewide random samples of California RNs (N=895).FindingsIncreased age was associated with increased likelihoods of working part-time, day-shift, and in non-hospital settings and having managerial positions. Asian and Black nurses were more likely to work in urban areas than White nurses. The levels of job demand, job control, job satisfaction, perceived organizational culture, and safety climate were significantly different by sociodemographic characteristics. Greater intention to leave the job was associated with younger age and working in non-hospital settings.DiscussionThe findings suggest that differences exist in nurses' employment, job characteristics, and perceptions about their work and work environment by sociodemographic characteristics among RNs of diverse race/ethnicity.     

Job satisfaction of nurses with multicultural backgrounds: a questionnaire survey in Kuwait

BackgroundNurses working in Ministry of Health hospitals in Kuwait come from 35 countries, and only 12% of them are Kuwaitis. This study explores factors that influence the job satisfaction of nurses of multicultural background working in five general hospitals in Kuwait.ObjectivesThis study aims to identify factors related to the job satisfaction of nurses and the effect of selected background characteristics (e.g., age, gender, nationality, educational qualification, marital status, monthly salary, experience in other countries, and years of experience) on the global satisfaction scale by using the McCloskey–Mueller Satisfaction Scale.MethodsA stratified random sample size of 500 subjects was selected, and a questionnaire was distributed among them. Four hundred thirty-six completed questionnaires were returned, resulting in a response rate of 87.2%.ResultsFactor analysis identified five factors: satisfaction with (a) professional opportunities; (b) praise and recognition; (c) scheduling of duty; (d) control and responsibility, and (e) extrinsic rewards. These together explained 59.5% of the total variance. Nurses were found to be dissatisfied with two of five factors: professional opportunities and extrinsic rewards. Nurses were satisfied with the remaining three factors, although levels of satisfaction were not very high. The relationship of job satisfaction with nationality and marital status was positive and significant. However, a higher level of educational qualification showed an inverse relationship with job satisfaction.ConclusionsTwo issues identified here concerned aspects of nurses' professional development and extrinsic rewards, which have to be addressed as prerequisites to any improvement in the quality of nursing care in Kuwait. Based on our findings, we recommend a concerted action in developing a strategy to improve various aspects of nurses' professional development and extrinsic rewards. This will have a positive impact on the quality of health care of the Kuwaiti population.     

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.     

Resilience as a mediator between compassion fatigue,nurses' work outcomes,and quality of care during the COVID-19 pandemic

BackgroundNurses in the frontline of the battle against COVID-19 are highly vulnerable to compassion fatigue (CF), which may affect their mental health, work effectiveness, and patient safety outcomes. However, no studies have investigated nurses' CF in relation to job outcomes and care quality during the pandemic.AimsThis study aims to examine the mediating role of resilience in the relationship between CF and frontline nurses' job outcomes (job satisfaction and turnover intention) and care quality.DesignAn online, cross-sectional survey containing five self-report scales was used to collect data from 270 frontline nurses in selected hospitals in the Philippines.ResultsOverall, 38.5% of frontline nurses experienced medium to high CF during the second wave of the pandemic. Increased CF was associated with poorer nurse-reported quality of care (β = −0.145, p = 0.019), lower job satisfaction (β = −0.317, p = 0.001), and higher organizational turnover intention (β = 0.301, p = 0.001). Moreover, resilience fully mediated the relationship between CF and quality of care (β = −0.088, p = 0.169), and partially mediated the relationship between CF and job satisfaction (β = −0.259, p = 0.001), and CF fatigue and organizational turnover intention (β = 0.272, p = 0.001).ConclusionFrontline nurses are at risk of developing CF during the pandemic. Psychological resilience reduces the negative impact of CF on frontline nurses' job satisfaction, turnover intention, and the quality of care in their assigned unit. Proactive measures to reduce CF should be prioritized by nursing administrators. Resilience-promoting interventions could foster job satisfaction and retention in nurses and, hence, the quality of care delivered in their units.     

Teamwork and social cohesion are key: Nurses' perceptions and experiences of working in a new decentralised intensive care unit

BackgroundDecentralised nursing stations (DCNs) have gained popularity in new hospital designs owing to their positive impact on patient safety. However, the impact on the nurses' working environment and on continuity and quality of patient care is limited.ObjectivesThe objective of this study was to describe nurses' perceptions and experiences of the working environment and of patient care in a decentralised intensive care unit (ICU).MethodsTwelve months after the establishment of the new decentralised ICU in a tertiary teaching hospital in Sydney, Australia, a prospective cross-sectional survey of registered nurses working in the unit was undertaken. Nurses' perceptions and experiences of the working environment and patient care were evaluated using a 56-item questionnaire comprising nine domains and optional open-ended comments. Quantitative data were analysed using SPSS, version 25. Qualitative data were used to enhance the quantitative data.ResultsA total of 128 nurses responded to the questionnaire. The mean scores for overall job satisfaction, nursing teamwork, social cohesion, continuity of patient care, and quality of patient care were 3.02 (±0.91), 2.78 (±1.05), 2.68 (1.02), 2.60 (±1.01), and 3.48 (±0.88), respectively, for a maximum obtainable score of 5. Overall mean scores for teamwork, social cohesion, and continuity of patient care were explained by nurses to be a direct result of the physical layout of the new DCN ICU. Nurses believed this influenced their ability to interact with other staff and impacted teamwork and social cohesion and in turn reflected in their current job satisfaction.ConclusionsImplementation of a new model of nursing care, whereby staff members are rostered together in a pod for a period of time, along with team-building exercises, is recommended to improve the social cohesion and teamwork within the DCN ICU. Further research on nurses' experiences within a DCN ICU is required to produce robust evidence and generalisability.     

Exploring the relationships among training needs,willingness to participate and job satisfaction in disaster nursing: The mediating effect of achievement motivation

ObjectivesDisaster nursing competencies and their willingness to participate are essential for the success of disaster relief nurses. This study investigates the correlations among emergency room and intensive care unit nurses' training needs, willingness to participate, achievement motivation and job satisfaction as well as their mutual influences on disaster relief efforts.MethodsA convenience sampling cross-sectional study was conducted, where 488 emergency room and intensive care unit nurses from five hospitals in Taiwan participated (response rate: 84.4%). The relationships among the variables were verified using structural equation modelling.ResultsTraining needs in disaster nursing were found to be positively correlated with willingness to participate and job satisfaction. Moreover, willingness to participate was found to be positively correlated with achievement motivation and job satisfaction. Achievement motivation was found to be positively correlated with job satisfaction. Furthermore, willingness to participate in disaster relief was found to indirectly mediate job satisfaction through achievement motivation.ConclusionsThe fulfilment of training needs for disaster nursing and willingness to participate may have an impact on nurses' job satisfaction through the mediating effect of achievement motivation. Nurses' learning needs should be the foremost consideration in disaster nursing training to alleviate human resource shortages and improve disaster responses. These findings can serve as a reference for increasing preparedness training for nurses in disaster management.Relevance to clinical practiceNurses substantially contribute to the progression of disaster relief and postdisaster reconstruction. Successful and effective disaster management relies on sufficient nurse responses and training preparedness. Nurses' willingness to participate and achievement motivation in disaster nursing can have an impact on their job satisfaction and alleviate distress for both themselves and patients for the purpose of disaster relief.     

Nurses work motivation caring for an immigrant population: A qualitative historical analysis

AimQualitative Phenomenological analysis of nurses' experience working with immigrants, exploring the dimension of work motivation.BackgroundNurses' professional motivation and job satisfaction affects quality of care, work performance, burnout and resilience. The challenge of maintaining professional motivation is reinforced when providing care to refugees and new immigrants. In recent years, a large number of refugees sought sanctuary in Europe, resulting in the formation of refugee camps and asylum centers. Medical staff - including nurses - are involved in patient-caregiver encounter treating multicultural immigrant/refugee population.Design and methodologyA qualitative Phenomenological Methodology was employed. In-depth semi structured interviews and archival research were both used.ResultsStudy population – 93 certified nurses working between the years 1934–2014. Thematic and text analysis was employed. Four main motivation themes emerged from the interviews: duty, mission, perception of devotion and the general responsibility to bridge the cultural gap for the immigrant patients.ConclusionThe findings emphasize the importance of understanding nurses' motivations in working with immigrants.     

Workplace violence against nurses,job satisfaction,burnout, and patient safety in Chinese hospitals

BackgroundMost nurses have experienced some form of workplace violence, which could lead to physical or psychological harm and reduced job performance. Previous studies have examined the effects of workplace violence on nurses' job satisfaction and patient safety, but there have been very few examinations of whether workplace violence affects patient safety through nurse job satisfaction and burnout.PurposeTo investigate the relationships among workplace violence, nurse outcomes and patient safety. To explore whether nurse burnout and job satisfaction play mediating roles in the association of workplace violence and patient safety.MethodsA cross-sectional survey was conducted in 23 hospitals in Guangdong province in China to collect data from 1502 nurses. A structural equation model design was tested with validated measurement instruments.FindingsNurse-reported workplace violence was found to be associated directly with higher incidences of burnout, less job satisfaction, lower patient safety and more adverse events. Nurse burnout was associated directly with lower patient safety and more adverse events. Higher nurse job satisfaction was associated directly with higher patient safety. Nurse burnout and job satisfaction played mediating roles in workplace violence and patient safety. The model explained 19.8% and 35.0% of nurse-reported patient safety and adverse events, respectively.DiscussionIt is important for administrators to consider how to protect nurses from workplace violence, to improve their wellbeing at work, and to deliver safe patient care. When nurses experience workplace violence, it is necessary to pay attention to their emotional reactions and job attitudes, and to provide them with support in order to avoid adverse impacts on patient safety. Further practices and research initiatives to support nurses' safety at work are recommended.     

A research regarding the relationship among intensive care nurses' self-esteem,job satisfaction and subjective well-being

ObjectiveThe paper aims to explore the status of intensive care unit (ICU) nurses' self-esteem, job satisfaction, and subjective well-being and to investigate the relationship among the three elements.MethodsA cross-sectional survey of 224 nurses from five teaching hospitals in Tianjin, China, was conducted. Self-esteem scale, job satisfaction scale, and subjective well-being scale were used to explore the status of ICU nurses' self-esteem, job satisfaction, and subjective well-being. Correlation among the three elements was calculated by SPSS 17.0.ResultsThe scores of three scales (i.e., ICU nurses' self-esteem, job satisfaction, and subjective well-being) were 27.67 ± 3.41, 43.57 ± 9.04, and 69.73 ± 11.60, respectively. The subjective well-being was significantly positively correlated with self-esteem and job satisfaction (r = 0.454, P < 0.01; r = 0.584, P < 0.01, respectively).ConclusionThe study shows that the prevalence of subjective well-being and self-esteem with ICU nurses are at a low level, and job satisfaction is at the median level. Associations among self-esteem, job satisfaction, and subjective well-being in ICUs have been confirmed. Self-esteem and job satisfaction positively correlated with nurse subjective well-being. The higher the self-esteem and job satisfaction levels are, the stronger the subjective well-being is. The working pressure in ICUs cannot be alleviated temporarily; hence, to promote a high subjective well-being, managers and ICU nurses increase their self-esteem and job satisfaction through taking strategies that strengthen psychological construction.     

Stigmatization and dehumanization perceptions towards psychiatric patients among nurses: A path-analysis approach

BackgroundPeople with mental illness are stigmatized and dehumanized, which contributes to disorders' maintenance. Dehumanization is associated with abuse/neglect and should thus be evaluated among healthcare workers. We compared nurses' stigmatizing/dehumanizing perceptions of people with psychiatric versus non-psychiatric disorders. We also investigated the impact of social contact's quality/frequency and identified the determinants of dehumanization.MethodsFrench-speaking hospitals and nurses' associations were contacted to disseminate the survey among their employees or members. Three hundred thirty-six nurses reported their perceptions of one among three clinical populations (people with severe alcohol use disorder, schizophrenia, or cardiovascular disease). Nurses' perception of patients was evaluated through stigmatization, dehumanization, quality of contacts, structural discrimination, and evaluation of patients' life, pain, consent, and diagnostic overshadowing. Nurses' well-being was evaluated through their own perception of being dehumanized by superiors and their burnout, depression, anxiety, and stress levels.ResultsNurses stigmatized and dehumanized people with a psychiatric disorder more than people without a psychiatric disorder. Nurses dehumanized patients more if they felt dehumanized by their hierarchical superiors and less if they had qualitative contacts with patients.ConclusionsStigmatization and dehumanization are widespread among nurses in psychiatry, which advocates for less stigmatizing practices in healthcare settings. We propose concrete perspectives to reduce stigma/dehumanization among nurses.     

The moderating role of work-to-family spillover in the association between nurses' work values and work engagement: A cross-sectional study

Aim

Although researchers have emphasized the importance of enhancing work engagement in nurses to ensure work-related well-being, the underlying mechanisms of the influencing factors of work engagement remain unclear. This study aimed to elucidate whether work-to-family spillover moderates the relationship between nurses' work values and work engagement.

Methods

In total, 2600 nurses from 52 hospitals in the Tohoku region of Japan were recruited, and 1587 nurses participated. The questionnaire included items on demographic characteristics, the Nurses' Work Values Scale, the Japanese version of the Work-life Balance Scale, and the Work Engagement Scale. Data were analyzed using hierarchical multiple regression.

Results

The interaction terms of negative work-to-family spillover with extrinsic work values and prestige work values were significantly associated with work engagement. The interaction terms of nurses' work values and positive work-to-family spillovers did not show a significant association.

Conclusions

Nurses who emphasized extrinsic work values and those who did not emphasize prestige work values had the lowest work engagement in settings with high negative work-to-family spillover. To ensure nurses' work-related well-being and engagement, nursing managers could provide support for nurses in tackling work-related negative events, so that these do not carry over to family settings.