Workplace resilience and emotional labour of Australian mental health nurses: Results of a national survey

Emotional labour is a form of adversity faced by mental health nurses in the context of their workplace interactions. Frequent exposure to emotional adversity can negatively impact mental health nurses’ biopsychosocial well‐being, workplace relationships, and performance. Workplace resilience is a dynamic interactive process within and between the person and their environment that promotes positive adaptation to adverse events and restores well‐being. Workplace resilience could be a protective process that helps mental health nurses positively adapt to workplace emotional adversity. This study aimed to investigate Australian mental health nurses’ workplace resilience and emotional labour and explore the relationship between them. A national cross‐sectional online survey comprising the Resilience at Work and Emotional Labour scales was completed by registered nurses (n = 482) working in a mental health role or setting across Australia. There was a strong negative relationship between resilience and the emotional labour strategy of surface acting. A positive association between resilience, frequency of emotional labour, and clinical supervision was also found. These findings point to a potential link between mental health nurses’ skills of cognitive reframing, and emotional and behavioural regulation needed to effectively manage their emotions and remain therapeutic in interpersonal interactions. Clinical supervision may be a key strategy in supporting mental health nurses’ resilience. Further investigation of workplace individuals’ internal and external resources, and organizational resources, supports, and strategies that can promote and strengthen mental health nurses’ well‐being is needed.     

Dynamics of nurses’ authority in the inpatient care of adolescent consumers with anorexia nervosa: A qualitative study of nursing perspectives

Nurses caring for adolescent consumers with anorexia nervosa in the inpatient setting are challenged in a unique way, in that they are caring for people with whom they do not have a mutually held concept of well‐being. Their efforts to ensure weight gain are frequently against the wishes of the consumer. This dissonance results in challenging interactions, where nursing care and authority may be undermined. This study investigated the dynamics of nurses’ authority within this context. Interviews with nurses (n = 10) were conducted and analysed through thematic analysis. Nurses reported that consumers, compelled by the psychopathology of anorexia nervosa, often sought to challenge or undermine their authority. Some nurses experienced the opposition and conflict as demoralizing, whereas others were able to maintain confidence in the therapeutic merit of their care. Younger, inexperienced nurses in this study were particularly vulnerable to interactions that mitigated their authority, due to their tendency to engage in friend‐like relationships. Nurses caring for adolescents with anorexia nervosa should be prepared to be confronted by interactions that overtly and surreptitiously undermine their capacity to exercise professional authority. It is important that nurses recognize the importance of maintaining their authority, and how it can be threatened in subtle and unexpected ways.     

Empathic processes during nurse–consumer conflict situations in psychiatric inpatient units: A qualitative study

Empathy is a central component of nurse–consumer relationships. In the present study, we investigated how empathy is developed and maintained when there is conflict between nurses and consumers, and the ways in which empathy can be used to achieve positive outcomes. Through semistructured interviews, mental health nurses (n = 13) and consumers in recovery (n = 7) reflected on a specific conflict situation where they had experienced empathy, as well as how empathy contributed more generally to working with nurses/consumers. Thematic analysis was used to analyse the data, utilizing a framework that conceptualizes empathy experiences as involving antecedents, processes, and outcomes. The central theme identified was ‘my role as a nurse – the role of my nurse’. Within this theme, nurses focussed on how their role in managing risk and safety determined empathy experienced towards consumers; consumers saw the importance of nurse empathy both in conflict situations and for their general hospitalization experience. Empathy involved nurses trying to understand the consumer's perspective and feeling for the consumer, and was perceived by consumers to involve nurses ‘being there’. Empathic relationships built on trust and rapport could withstand a conflict situation, with empathy a core component in consumer satisfaction regarding conflict resolution and care. Empathy allows the maintenance of therapeutic relationships during conflict, and influences the satisfaction of nurses and consumers, even in problematic situations. Nurse education and mentoring should focus on nurse self‐reflection and building empathy skills in managing conflict.     

Nursing students' perceptions of the importance of caring behaviors

Title. Nursing students’ perceptions of the importance of caring behaviours Aim. This paper is a report of a study to determine the nursing students’ perceptions of the importance of caring behaviours. Background. Caring has been considered as the essence of nursing. It is believed that caring enhances patients’ health and well‐being and facilitates health promotion. Nursing education has an important role in educating the nurses with adequate caring abilities. Method. Ninety nursing students (response rate 75%) responded to a questionnaire consisting of 55 caring behaviours adapted from items on Caring Assessment Questionnaire (Care‐Q). Behaviours were ranked on a 5‐point Likert‐type scale. The caring behaviours were categorized in seven subscales: ‘accessibles’, ‘monitors and follows through’, ‘explains and facilitates’, ‘comforts’, ‘anticipates’, ‘trusting relationship’ and ‘spiritual care’. Data were collected in Iran in 2003. Findings. The students perceived ‘monitors and follows through’ (mean = 4·33, SD = 0·60) as the most and ‘trusting relationship’ (mean = 3·70, SD = 0·62) as the least important subscales. ‘To give patient’s treatments and medications on time’ and ‘to do voluntarily little things…’ were the most and least important caring behaviours, respectively. ‘Explains and facilitates’ statistically and significantly correlated with age (r = 0·31, P = 0·003) and programme year (r = 0·28, P = 0·025). Gender had no statistically significant influence on students’ perceptions of caring behaviours. Conclusion. Further research is needed, using longitudinal designs, to explore nursing students’ perceptions of caring behaviours in different cultures, as well as evaluation studies of innovations in curriculum and teaching methods to improve learning in relation to cultural competence and caring concepts.     

Does workplace violence,empathy, and communication influence occupational stress among mental health nurses?

Workplace violence is a major cause of occupational stress among mental health nurses, particularly those working in acute care. This study investigated the occurrence of occupational stress among mental health nurses in psychiatric hospitals and explored whether workplace violence, empathy, and communication skills influenced occupational stress levels in this population. A socio‐demographic questionnaire and the Chinese Nursing Work Stress Scale, Workplace Violence Scale, Jefferson Scale of Empathy – Health Professions version, and Nurses’ Clinic Communication Competence Scale were administered to 539 mental health nurses from three top‐grade tertiary research hospitals in the Beijing–Tianjin–Hebei region. The analysis revealed a high level of job stress (3.06 ± 0.69) and a moderate prevalence of workplace violence (6.21 ± 2.94) existed among participants when compared with among other nurses. Meanwhile, participants’ empathy (114.78 ± 15.99) and communication (4.31 ± 0.60) abilities were similar to or higher than those of other nursing populations. Mental health nurses with varying years of practice experience distinct levels of job stress. A linear regression analysis revealed that, while practice years (β = 0.104; P < 0.05) and workplace violence (β = 0.264; P < 0.01) aggravated occupational stress levels, empathy (β = ?0.147; P < 0.01) facilitated reductions in stress. Results suggest that reducing workplace violence and improving empathy in therapeutic relationships can limit the pervasiveness of occupational stress among mental health nurses. Having both psychological support and organizational support after a violent incident is essential, and the importance of professional education should be stressed.     

Grace under pressure: Mental health nurses' stories of resilience in practice

Mental health nurses experience both organizational and practice-related stressors in their work. Resilience is an interactive process of positive adaptation following stress and adversity. There is limited evidence on how personal resilience is applied to mental health nursing practice. The aim of this interpretive narrative study was to explore mental health nurses' stories of resilience in their practice for the purpose of gaining an understanding of resilience resources they draw on when dealing with challenging workplace situations. A storytelling approach was used in semistructured phone interviews with 12 mental health nurses who measured high on resilience (Workplace Resilience Inventory) and caring behaviours (Caring Behaviours Inventory). Within and across case narrative analysis produced stories of resilient practice within four themes: proactively managing the professional self; sustaining oneself through supportive relationships; engaging actively in practice, learning and self-care; and seeking positive solutions and outcomes. Nurses displayed poise in stressful situations and grace under pressure in demanding and emotionally challenging interactions, holding dignity and respect for self and others, with the aim of achieving positive outcomes for both. Resilient practice is the responsibility of organizations as well as individuals. To develop practice and support staff retention, we recommend organizations use tailored professional development to cultivate a growth mindset in new and experienced staff, develop organizational strategies to build positive team cultures, and prioritize strategies to reduce workplace stressors and strengthen staff psychological safety and well-being. The use of narrative techniques in reflective practice and clinical supervision may help build nurses' resilience and practice.     

Work-related stress, education and work ability among hospital nurses

Title. Work‐related stress, education and work ability among hospital nurses. Aim. This paper is a report of a study conducted to determine which occupational stressors are present in nurses’ working environment; to describe and compare occupational stress between two educational groups of nurses; to estimate which stressors and to what extent predict nurses’ work ability; and to determine if educational level predicts nurses’ work ability. Background. Nurses’ occupational stress adversely affects their health and nursing quality. Higher educational level has been shown to have positive effects on the preservation of good work ability. Method. A cross‐sectional study was conducted in 2006–2007. Questionnaires were distributed to a convenience sample of 1392 (59%) nurses employed at four university hospitals in Croatia (n = 2364). The response rate was 78% (n = 1086). Data were collected using the Occupational Stress Assessment Questionnaire and Work Ability Index Questionnaire. Findings. We identified six major groups of occupational stressors: ‘Organization of work and financial issues’, ‘public criticism’, ‘hazards at workplace’, ‘interpersonal conflicts at workplace’, ‘shift work’ and ‘professional and intellectual demands’. Nurses with secondary school qualifications perceived Hazards at workplace and Shift work as statistically significantly more stressful than nurses a with college degree. Predictors statistically significantly related with low work ability were: Organization of work and financial issues (odds ratio = 1·69, 95% confidence interval 1·22–2·36), lower educational level (odds ratio = 1·69, 95% confidence interval 1·22–2·36) and older age (odds ratio = 1·07, 95% confidence interval 1·05–1·09). Conclusion. Hospital managers should develop strategies to address and improve the quality of working conditions for nurses in Croatian hospitals. Providing educational and career prospects can contribute to decreasing nurses’ occupational stress levels, thus maintaining their work ability.     

The relationship between structural empowerment and psychological empowerment for nurses: a systematic review

wagner j.i.j., cummings g., smith d.l., olson j., anderson l. & warren s. (2010) Journal of Nursing Management 18 , 448–462
The relationship between structural empowerment and psychological empowerment for nurses: a systematic review Aim To describe the findings of a systematic review examining the relationship between structural empowerment and psychological empowerment for registered nurses (RNs). Background Workplace empowerment research reveals a link between empowerment and positive work behaviours and attitudes. Research demonstrating the essential relationship between structural empowerment and psychological empowerment will provide direction for future interventions aimed at the development of a strong and effective health care sector. Methods Published research articles examining structural empowerment and psychological empowerment for nurses were selected from computerized databases and selected websites. Data extraction and methodological quality assessment were completed for the included research articles. Results Ten papers representing six studies reveal significant associations between structural empowerment and psychological empowerment for RNs. Implications for nursing management Creation of an environment that provides structural empowerment is an important organizational strategy that contributes to RNs’ psychological empowerment and ultimately leads to positive work behaviours and attitudes. Critical structural components of an empowered workplace can contribute to a healthy, productive and innovative RN workforce with increased job satisfaction and retention.     

Development and psychometric evaluation of workplace psychologically violent behaviours instrument

Aim. To develop an instrument to determine nurses’ perceptions of psychologically violent behaviours that they are exposed to in the workplace. Background. According to Leymann, psychological terror or mobbing in work life involves hostile and unethical communication, which is directed in a systematic way towards one individual who, due to mobbing, is pushed into a helpless and defenceless position, and being held there by means of continuing mobbing activities. Design. Survey. Methods. Because nurses who work in hospitals are generally the principle victims of physical, emotional and verbal violence due to the nature of their work environment, the research sample comprised 476 hospital nurses. Data were collected via self‐administered questionnaires. Results. The instrument to determine the perception of workplace psychologically violent behaviours contains 33 items and four factors (individual’s isolation from work, attack on professional status, attack on personality and direct attack). All items have shown statistically significant correlation (p < 0·01); the instrument’s total Cronbach’s α internal consistency coefficient was found to be 0·93. Conclusions. The findings show that the instrument’s validity and reliability are within the limits of an acceptable level and that it is an instrument that will encourage more studies on this subject. Relevance to practice. Defining the psychological pressure that nurses are exposed to in the workplace and determining its negative effects on the victim of workplace psychological pressure and on the institution will make it possible to protect individuals and the institution from psychological violence with both individual and institutional practices.     

Effects of workplace incivility and empowerment on newly-graduated nurses' organizational commitment

smith l.m., andrusyszyn m.a. & laschinger h . (2010) Journal of Nursing Management 18, 1004–1015
Effects of workplace incivility and empowerment on newly-graduated nurses’ organizational commitment Aim The purpose of the present study was to test an expanded model of Kanter’s theory by examining the influence of structural empowerment, psychological empowerment and workplace incivility on the organizational commitment of newly-graduated nurses. Background The early years of practice represent a significant confidence-building phase for newly-graduated nurses, yet many new nurses are exposed to disempowering experiences and incivility in the workplace. Method A predictive non-experimental design was used to examine the impact of structural empowerment, psychological empowerment and workplace incivility on the affective commitment of newly-graduated nurses (n = 117) working in acute care hospitals. Results Controlling for age, 23.1% of the variance in affective commitment was explained by structural empowerment, psychological empowerment and workplace incivility [R² = 0.231, F_5,107 = 6.43, P = 0.000]. Access to opportunity was the most empowering factor, with access to support and formal power perceived as least empowering. Perceived co-worker incivility was greater than perceived supervisor incivility. Conclusion Results offer significant support for the use of Kanter’s theory in the newly-graduated nurse population. Implications for Nursing Management Without specific strategies in place to combat incivility and disempowerment in the workplace, attempts to prevent further organizational attrition of new members may be futile.