Quality focus of the first line nurse manager and relationship to unit outcomes

The purpose of this article was to examine the relationship between the quality focus of the first line nurse manager and patient satisfaction, job satisfaction of the nursing personnel, unit effectiveness, staff perceptions of quality, and nursing personnel turnover. Of the unit outcomes that were tested, quality focus was found to be a significant predictor variable only for staff nurse job satisfaction (R2 = 0.218). Managers need to be aware of their vision for quality of patient care and how this translates into expectations for nursing care quality and overall quality of the organization.     

Nurse executive and staff nurse perceptions of the effects of reorganization in Veterans Health Administration hospitals

OBJECTIVE: To examine nurse executive perceptions of effects of service line reorganization on nurse executive roles, nursing staff and patient care, and compare nurse executive responses to staff nurse reports of job satisfaction and quality of care in the same types of Veterans Health Administration facilities. BACKGROUND: Although a growing body of research focuses on the association between nurse staffing structures, nurse satisfaction, and patient outcomes, relatively little attention has been paid to the effects of hospital restructuring on nursing management and nursing staff. METHODS: Data on hospital and nursing service organization and nurse executive perceptions were collected through structured interviews with 125 nurse executives conducted from December 2002 through May 2003. Staff nurse data were derived from a survey of Veterans Health Administration nursing staff conducted from February through June 2003 at the same facilities. RESULTS: Nurse executives in Veterans Health Administration described significant changes in the nurse executive role, and new challenges for managing nursing practice and achieving consistent quality of nursing care. Although nursing management perceived differences in the overall effects of restructuring on nursing staff depending on the type of reorganization, staff nurses reported significant differences in perceived quality of patient care across organization types.     

Mentoring: nurturing the critical care nurse

Mentoring is an active process that is currently receiving widespread attention in education, in the corporate world, and increasingly in health care. Job satisfaction of the critical care nurse may be related to the fulfillment of personal needs and goals. The attainment of these needs and goals ultimately will lead to increased job productivity, which in turn will promote cost-effectiveness, an outcome cherished by management. Therefore, recognizing the worth of job satisfaction to the institution and the possibility that mentoring may have an effect on it among the professional staff may be a key to the future of improved health care and cost reduction in an increasingly specialized and technologic health care environment. Certainly, the nursing shortage is no longer news to the lay public or those of us engaged in the practice of nursing. In critical care that shortage is acutely apparent. Attrition of qualified critical care nurses is increasing and various solutions to the shortage have been proposed, some being met with more enthusiasm than others. A more basic solution might be to answer the question, "How can we maintain a high quality of patient care while promoting job satisfaction and instilling a sense of self-worth within the critical care nurse?" Critical care nurses need to play a pivotal role in nurturing and developing other critical care nurses as a means to retain those individuals. How can they do that effectively? Mentoring is one answer.     

The relationship among leadership preferences, head nurse leader style, and job satisfaction of staff nurses.

A better understanding of the effects of the relationships between staff nurses and their leaders is needed if retention of vital resources is to occur in this age of increasing need and decreasing resources in the health care industry. This study investigated the interactions among leadership preferences of staff nurses, the perceived leader behavior of their nurse managers, and their job satisfaction. Although a "match" or "mismatch" relationship was not found, one surprising finding was the high positive relationship between structuring behavior of head nurses and job satisfaction of staff nurses. Implications and recommendations for training nurse managers are offered.     

The changing training needs of clinical nurse managers: exploring issues for continuing professional development

AIMS OF THE STUDY: To identify areas where clinical nurse managers perceived that they would benefit from further training and to make recommendations for planning future programmes to meet their needs. BACKGROUND: The effectiveness of the clinical nurse manager has traditionally been associated with maintaining standards of care. Continuing professional development (CPD) is essential to ensure this important group feel adequately prepared to perform their role and has been recognized as an important factor in maintaining job satisfaction and reducing wasteful staff turnover. A review of the literature indicated that since the 1980s the CPD needs of clinical nurse managers have tended to be overlooked despite increasing complexity of the tasks expected of them. Thus it appeared that a fresh study to address these needs would be justified and should take into account sources of work-related stress and variables relating to job satisfaction. METHODS: The study involved clinical nurse managers employed in all four acute hospital National Health Service (NHS) trusts where training needs were served by a major inner city educational consortium. Data collection proceeded in two stages. Initially interviews were undertaken with a random sample of 15 clinical nurse managers to provide in-depth, qualitative data. This information was used to develop a survey questionnaire distributed to the remaining 182 clinical nurse managers in each of the trusts. RESULTS: Data from the interviews indicated that clinical nurse managers appeared to feel clinically competent but generally experienced lack of confidence when dealing with a range of issues, in particular; human resources, managing budgets, deputizing for senior colleagues across the trust ('acting up') and using information technology in everyday practice. Response rate to the survey was good (65%). The results corroborated the interview findings, indicating a need for updating in the same wide range of topics. There were few differences in training needs across all four trusts. Clinical nurse managers who perceived that they had been well-prepared for their role demonstrated higher levels of job satisfaction. Perceived preparation for clinical leadership was the same irrespective of the employing trust, length of time in post and other sociodemographic variables. CONCLUSIONS: The study findings confirm that CPD remains a major issue for clinical nurse managers in the United Kingdom (UK) and that providing opportunities for such development may be an important factor in enhancing job satisfaction. The study findings should help those providing CPD to plan more effectively for this group and have implications for staff recruitment and retention.     

The USA's nurse managers and UK's ward sisters: critical roles for empowerment

• ? The nurse manager/ward sister^* role is becoming endangered as many of these nurses are being asked to take fiscal and personnel responsibility for multiple units/programmes and supervise more non-registered nursing staff.
• ? Loss of this important nurse manager/ward sister role could severely decrease nursing's voice in the development and implementation of policies that affect nurses arid the care they deliver.
• ? The authors review 20 years of literature from both the USA and the UK regarding supportive supervision and the role of the nurse manager/ward sister. Nurse managers/ward sisters were found to be key individuals within the entire health-care organization.
• ? Nurse managers/ward sisters can empower the nurses they surpervise to initiate changes that will improve patient care. Nurse managers/ward sisters can also improve the working conditions and thus increase the job satisfaction and retention of those they supervise.
• ? Strategies for being more supportive of these overworked and endangered nurse managers/ward sisters are suggested.

     

Staffing in acute hospital wards: part 2. Relationships between grade mix,staff stability and features of ward organizational environment

This paper explores relationships between grade mix, staff stability, care organization and nursing practice. The data were collected in the mid-1990s from a nationally representative sample of 100 acute hospital wards and 825 nurses. Analyses provides important insights for managers seeking to achieve the strategic aims set out in consecutive National Health Service (NHS) human resource management policies. Hypotheses about ward clinical grade mix were not well supported. Where there was rich grade mix, nurses reported better collaborative working with other disciplines and greater influence. However, it was expected that wards practising 'devolved' nursing would have a richer grade mix and that the latter would lead to more innovative practice and nurses experiencing greater job satisfaction. No evidence to support any of these hypotheses was found although the opposite scenario - a link between poor grade mix, unprogressive practice and perceived lower standards of care - was supported. Wards practising the 'devolved' system rely on adequate numbers of nurses rather than a rich grade mix, and do not necessarily provide a more stable, retentive work environment for nurses. By contrast, findings about staff stability were largely as expected. A strong link between staff stability and standards of professional nursing practice was found, indicating that staff stability is more important than a rich grade mix for achieving innovative, research-based practice. However, staff instability undermined cohesion with nurse colleagues, collaborative working with doctors, and nurses' ability to cope with the workload. Overall, both the papers demonstrate that staffing resources and prevailing ethos of care are more important predictors of care processes and job satisfaction than organizational systems. They identify the detrimental effects on nurses and their work of having few staff and a weak grade mix, and the importance of staff stability. Higher standards of nursing practice are achieved where stability is high, independently of staffing characteristics.     

Being a nurse today

This article was presented as a conference in Soria as part of the celebration of International Nursing Day 2000. The topic of this conference was the contribution Florence Nightingale made to the definition of the real essence of the nursing profession, and its evolution over the course of the century. The author included a discussion of these topics: What do nurses want? What do business managers want? What does society want and need? Finally, the author concluded that nursing is a lively profession which has tremendous desires to improve itself.     

The Perceptions of Ontario Radiation Therapists and Their Managers Regarding Continuing Professional Development

Continuing professional development (CPD) is essential to maintaining a knowledgeable health care work force. Studies of many health care professionals link CPD to competence, motivation, and job satisfaction. There is little information about CPD in the field of radiation therapy. In addition, staff views on CPD have been well researched, but there is a lack of literature looking at the opinions of managers. This study examined the following questions: (1) Is there a disparity between the views of radiation therapists and their managers concerning support for continuing professional development? (2) Where does the responsibility for continuing professional development lie? (3) Are radiation therapists aware of the availability of support within their department? and (4) Is there a difference between the academic (university affiliated) versus nonacademic centres? A self-administered electronic questionnaire was sent to 14 Ontario cancer centres. Of the 700 radiation therapists surveyed, there were 161 completed e-mail replies, giving a total response rate of approximately 23%. The final number of respondents in the management category was 25. Results showed that although more radiation therapists than managers felt that the organization should be responsible for providing opportunities for CPD, more managers than radiation therapists felt that the organization did indeed provide time off to support CPD. An additional discovery in the area of organizational responsibility is that, although the nonmanagement staff results were similar in both the academic and nonacademic settings, the management results differed significantly. Conclusions and recommendations indicate the need to expand the definition of CPD, implement more transparent CPD policies and application processes, increase communication between managers and staff, and investigate the need for radiation therapist-specific research on clinical competence.     

Developing a self‐checklist of staff development behavior for associate nurse unit managers using the Delphi method

The most significant influence on nurses' professional growth is through work under direct guidance in clinical settings. Associate nurse unit managers perform direct patient care with the staff, as well as assist management work of nurse unit managers. They can be excellent role models for the staff. We examined their behaviors that help promote staff development, aimed to identify effective behaviors, and created a self‐checklist to evaluate them. We created 53 items to assess staff development behaviors, which were evaluated via a Delphi survey with 252 experts and a questionnaire survey with 124 associate nurse unit managers in Japan to evaluate whether the created item was appropriate. The results of the Delphi survey showed an agreement rate of over 90%, and associate nurse unit managers showed an acceptance rate of 82.6–99.2% for 40 of 53 items. Consequently, we created 40‐item self‐checklist of staff development behaviors for associate nurse unit managers with adequate validity. This checklist would be helpful for them to promote staff development while working in clinical settings and would contribute to enhancing the quality of nursing.     

Managing a multicultural nurse staff in a multicultural environment

In many health care facilities, multicultural/ethnically diverse professional and ancillary staff members care for an equally diverse patient population. Often this diversity is compounded by the recruitment of foreign nurse graduates. The authors describe how nurse managers at a southern California community medical center worked together to better understand and deal with the problems generated by such cultural diversity in their organization.     

Fostering the coexistence of caring philosophy and economics in today's health care system

For the past decade, several health care systems are undergoing continuous administrative restructuring, whose main objective is cost reduction. These changes often result in the patients' needs not being met because nurses are continuously affected by widespread budget cuts and staff downsizing. Have we reached a point, where we are setting aside our prime directive of patient well-being for the sake of finances? If so, are we at risk of forsaking our professional identity as nurses? The authors believe that caring management and economical constraints can coexist while promoting quality patient care. The purpose of this article is to show how nurse managers and administrators can facilitate caring practices while maintaining their financial responsibilities within the health care organization. This article suggests several strategies for assisting nurse managers in promoting caring in the health care environment.     

护理管理者变革型领导行为与护理人员工作满意度的相关性研究

目的调查目前护理管理者变革型领导水平及护理人员工作满意度的现状,分析变革型领导对工作满意度的影响,并探索两者的相关性。方法采用问卷调查法对哈尔滨市一所三级甲等医院中的238名护理人员进行调查。结果护理管理者的变革型领导和护士的工作满意度都处于中等水平,两者之间呈正相关（P〈0.01）。结论通过提高护理管理人员变革型领导的知识和技能,可以提高护理人员的工作满意度。     

Views of job satisfaction and dissatisfaction in Australian long-term care

The existing job satisfaction literature has tended towards an overemphasis on job satisfaction instruments. In the study reported here the views of 27 nurses and assistants-in-nursing, collected through focus group interviews, were examined to determine the factors that contribute to workplace satisfaction and dissatisfaction in long-term care of older people. Content analysis of focus group interview data revealed that job satisfaction was related to workplace flexibility, residents, working within a team environment and dedication to the service of optimal resident care. Dissatisfaction was linked to working with unskilled or inappropriately trained staff, laborious tasks such as documentation, staffing levels, tensions within role expectations and the increasing need to be available for overtime. In spite of different role expectations, long-term nursing home care is reported to be a very satisfying area in which to work. However, care managers need to put in place strategies for building improved job satisfaction and workplace incentives to encourage graduates to consider long-term care opportunities. Limitations of the study include the small number of participants, bias towards one organization and lack of generalizability of the results. However, the findings confirm many earlier job satisfaction studies and further support the need to consider these issues in relation to recruitment and retention in long-term care.     

Staff nurse retention. Laying the groundwork by listening

In response to critical staff shortages, the nursing leadership of a five-hospital system implemented a research program to create a health promoting organization that would support nurse retention. Since a health promoting organization supports each individual's participation in the decision-making process through communication and consensus-building, listening to the concerns of current nurse managers (Parsons & Stonestreet, 2003) and staff nurses was crucial for developing innovative retention strategies. This qualitative study utilized open-ended, data-generating questions in focus groups to elicit the issues staff nurses considered crucial to their continued employment. Consistent with findings in the literature, the quality of administrative management systems and relationships with physicians, nurse managers, peers, and administrators were essential factors for nurse retention in this system.     

Factors contributing to nurse job satisfaction in the acute hospital setting: a review of recent literature

hayes b, bonner a & pryor j (2010) Journal of Nursing Management 18, 804–814
Factors contributing to nurse job satisfaction in the acute hospital setting: a review of recent literature Aim To explore and discuss from recent literature the common factors contributing to nurse job satisfaction in the acute hospital setting. Background Nursing dissatisfaction is linked to high rates of nurses leaving the profession, poor morale, poor patient outcomes and increased financial expenditure. Understanding factors that contribute to job satisfaction could increase nurse retention. Evaluation A literature search from January 2004 to March 2009 was conducted using the keywords nursing, (dis)satisfaction, job (dis)satisfaction to identify factors contributing to satisfaction for nurses working in acute hospital settings. Key issues This review identified 44 factors in three clusters (intra-, inter- and extra-personal). Job satisfaction for nurses in acute hospitals can be influenced by a combination of any or all of these factors. Important factors included coping strategies, autonomy, co-worker interaction, direct patient care, organizational policies, resource adequacy and educational opportunities. Conclusions Research suggests that job satisfaction is a complex and multifactorial phenomenon. Collaboration between individual nurses, their managers and others is crucial to increase nursing satisfaction with their job. Implications for nursing management Recognition and regular reviewing by nurse managers of factors that contribute to job satisfaction for nurses working in acute care areas is pivotal to the retention of valued staff.     

Managing respiratory care: where is the science?

Managing a respiratory care department is challenging. Health care is one of the few businesses in which the fees for services are dictated by the payers. Recent changes in focus and expectations in the overall health care industry have strongly affected the job of the respiratory care manager. There is now stronger emphasis on improving the management of human resources. Good human-resources management requires understanding the work force, minimizing staff turnover, and finding ways to do more work with fewer employees. Respiratory care managers must: marshal strong evidence and compelling reasoning to compete for funding; make evidence-based (or at least carefully researched) purchasing decisions; implement protocols to optimize patient and clinical outcomes (including work efficiency); implement patient-safety initiatives such as "care bundles," to avoid preventable complications; and vigorously pursue initiatives that optimize the work flow and advance the professional status of respiratory therapists, such as rapid-response teams.     

Predictors of nurse absenteeism in hospitals: a systematic review

Aim  This study aimed to identify and examine predictors of short-term absences of staff nurses working in hospital settings reported in the research literature.
Background  Front-line staff nurse absenteeism contributes to discontinuity of patient care, decreased staff morale and is costly to healthcare.
Evaluation  A systematic review of studies from 1986 to 2006, obtained through electronic searches of 10 online databases led to inclusion of 16 peer-reviewed research articles. Seventy potential predictors of absenteeism were examined and analysed using content analysis.
Key issue  Our findings showed that individual 'nurses' prior attendance records', 'work attitudes' (job satisfaction, organizational commitment and work/job involvement) and 'retention factors' reduced nurse absenteeism, whereas 'burnout' and 'job stress' increased absenteeism. Remaining factors examined in the literature did not significantly predict nurse absenteeism.
Conclusions  Reasons underlying absenteeism among staff nurses are still poorly understood. Lack of robust theory about nursing absenteeism may underlie the inconsistent results found in this review. Further theory development and research is required to explore the determinants of short-term absenteeism of nurses in acute care hospitals.
Implications for nursing management  Work environment factors that increase nurses' job satisfaction, and reduce burnout and job stress need to be considered in managing staff nurse absenteeism.