Association between the Nursing Practice Environment and Safety Perception with Patient Safety Culture during COVID-19.

AIMS: In this study, we aimed to identify the relationship between nursing practice environments (NPEs) and safety perceptions with patient safety culture (PSC) during COVID-19. DESIGN: We conducted a quantitative, non-experimental, correlational, and cross-sectional study. We interviewed 211 nurses from Peru using two scales: PES-NWI and HSOPSC. We used the Shapiro-Wilk test and Spearman's coefficient and estimated two regression models. RESULTS: NPE was reported as favorable by 45.5% of the participants, and PSC was reported as neutral by 61.1%. Safety perception, the workplace, and NPE predict PSC. All NPE factors were correlated with PSC. However, safety perception, support of nurses subscale, the nurse manager's ability, and leadership were predictors of PSC. CONCLUSION: To promote a safe work culture, health institutions should foster leadership that prioritizes safety, strengthens managers' abilities, encourages interprofessional collaboration, and considers nurses' feedback for constant improvement.

Nurse job task analysis: a profile of medical and surgical nursing activities.

Objective We aim to examine the activities undertaken by medical and surgical ward nurses at a major health service in Victoria, Australia, to inform nursing and midwifery strategic workforce planning. Methods This descriptive, exploratory study was conducted on 17 wards from three acute care hospitals in one of Victoria's largest health services. The Work Observation Method by Activity Timing tool was used to enable participants to document the time spent in each of 10 nursing activity domains. Results Data from 70 respondents across all shifts showed nurses spent one-third of their time in direct care. Registered nurses spent a lower proportion of time than enrolled nurses in direct care and medications overall. Compared with enrolled nurses, registered nurses spent less time in direct care on morning shifts and documentation on afternoon shifts, and more time on ward-related activities on afternoon shifts. Conclusions Medical and surgical enrolled nurses and registered nurses spent comparable proportions of time engaged in specific activities. Further research is required to understand the influences on the time devoted to direct care and how time spent in direct care intersects with other activities, and the relationship with patient outcomes and quality of care indicators.

Caring Knowledge as a Strategy to Mitigate Violence against Nurses: A Discussion Paper.

Violence against nurses is a disturbing trend in healthcare that has reached epidemic proportions globally. These violent incidents can result in physical and psychological injury, exacerbating already elevated levels of stress and burnout among nurses, further contributing to absenteeism, turnover, and intent to leave the profession. To ensure the physical and mental well-being of nurses and patients, attention to the development of strategies to reduce violence against nurses must be a priority. Caring knowledge-rooted in the philosophy of care-is a potential strategy for mitigating violence against nurses in healthcare settings. We present what caring knowledge is, analyze its barriers to implementation at the health system and education levels and explore potential solutions to navigate those barriers. We conclude how the application of models of caring knowledge to the nurse-patient relationship has the potential to generate improved patient safety and increased satisfaction for both nurses and patients.

The relationship between nurse burnout, missed nursing care, and care quality following COVID-19 pandemic.

OBJECTIVES: To determine the relationship between nurse burnout, missed nursing care, and care quality following the COVID-19 pandemic. BACKGROUND: Quality of care and missed nursing care can be consequences of nurse burnout. Little is known about how these factors related to nurse burnout following the COVID-19 pandemic. DESIGN: This study used a cross-sectional correlational design and was conducted in 12 general hospitals across Thailand from August to October 2022. METHODS: 394 nurses providing direct nursing care to patients during the COVID-19 pandemic completed the survey. The Emotional Exhaustion (EE) subscale of the Maslach Burnout Inventory-Human Services Survey (MBI-HSS), MISSCARE survey, and quality of care reported by nurses were used to collect data. Descriptive statistics and logistic regression models were used to analyse the data. RESULTS: Approximately thirty-six percent of nurses had burnout following the COVID-19 pandemic. Missed nursing care was higher among nurses with burnout. Most participants reported illness/symptoms such as anxiety, fatigue, a lack of concentration, and sleeping problems. After adjusting for demographic characteristics, every additional unit of emotional exhaustion was associated with 1.61 times higher odds of missed nursing care, 3.37 times higher odds of poor quality of nurse care, and 2.62 times higher odds of poor quality of care for the overall unit. CONCLUSION: The study findings demonstrate that burnout is associated with missed nursing care and poor quality of care following the COVID-19 pandemic. RELEVANCE TO CLINICAL PRACTICE: Policymakers, hospital administrators, and nurse managers should invest in strategies to reduce nurse burnout, which can increase patient safety and quality of care.

An assessment of organizational well-being, organizational health, and work-related stress: A cross-sectional study of nurses involved with COVID-19 interventions.

BACKGROUND: Nurses have been affected by stress, developing many related consequences during the health emergency caused by the SARS-CoV-2 (COVID-19) pandemic. It is essential for healthcare organizations to protect their human resources because there is a strong correlation between the health status of healthcare workers and the quality of care provided. OBJECTIVE: The aim of the study was to measure the perception of the organizational health level of the workplace among COVID-19 nurses (i.e. nurses who directly dealt with COVID-19 countermeasures) as an influence on work quality and work-related stress. METHODS: A cross-sectional study was carried out by administering the Nursing Questionnaire on Organizational Health (QISO) to nurses in contact with COVID-19 patients. The search period ranged between August and September 2021 with nurses who work and/or worked in Lazio. RESULTS: 123 questionnaires were collected. The scores with a value below the recommended level (2,6) are: "Comfort of the working environment" (mean = 2.57; SD = 0.66); "Valorization of skills" (mean = 2.40; SD = 0.62); "Openness to innovation" (mean = 2.46; SD = 0.77); "Satisfaction with top management" (mean = 2.48; SD = 0.81); and the inverse scale "Fatigue" (mean = 2.94; SD = 0.55). CONCLUSION: Management of healthcare organizations should define action strategies to promote and increase organizational well-being and reduce work-related stress risk factors. Some action strategies that could be used include improving the elements of the work environment to make it more comfortable for workers; strengthening and improving communication; improving the relationship between nurses and senior management; and establishing a team of experts for psychological assistance.

Motivating nurses' coworker-directed helping behaviour during the COVID-19 pandemic: Role of managerial humour and nurses' power distance orientation.

AIMS: The aims of the research are to investigate (1) the influence of managerial humour on nurses' coworker-directed helping behaviour, (2) the mediating effect of nurses' feelings of energy between managerial humour and nurses' coworker-directed helping behaviour and (3) the moderating effect of nurses' power distance orientation. DESIGN: This is a quantitative study. A three-wave survey design was conducted to collect data from direct managers to nurse dyads. METHODS: The random sampling method was employed. Data were collected from the supervisor to subordinate dyad at three time points during the first half of 2021. A total of 235 paired data sets of nurses and their direct managers were collected from a large state-owned Chinese hospital. We used hierarchical regression analyses via SPSS 22.0 software to examine the hypotheses. RESULTS: (1) Managerial humour can foster nurses' coworker-directed helping behaviour via accumulating their feelings of energy. (2) Power distance orientation moderates the effect of managerial humour on feelings of energy as well as the indirect effect of managerial humour on nurses' coworker-directed helping behaviour via feelings of energy, in a way that these effects are stronger when nurses have higher (vs. lower) level of power distance orientation. CONCLUSION: Managerial humour can increase nurses' feelings of energy, which in turn, motivates them to help their coworkers. Nurses' power distance orientation is an important boundary condition that constrains managerial humour effectiveness. IMPACT: Hospital managers could use more humour during their interactions with nurses because managerial humour can promote nurses' feelings of energy and coworker-directed helping behaviour. Hospitals can take humour into account during managers' selection and training to improve management effectiveness. Managers in eastern countries should use more humour during their interactions with followers. PATIENT OR PUBLIC CONTRIBUTION: Nurses and their direct managers from a large state-owned Chinese hospital contributed to this study by completing the survey.

The association between nurse managers' transformational leadership and quality of patient care: A systematic review.

AIM: To examine and summarize the reported association of nurse managers' transformational leadership and quality of patient care based on the perceptions of registered nurses. BACKGROUND: Transformational leadership behaviors of nurse managers result in staff nurses' satisfaction and retention and patient satisfaction. Patient safety and quality of care are vital to high-performing healthcare organizations. Perceptions of registered nurses are important because nurses are frontline healthcare providers fundamental to patient safety and quality of care and are considered the final line of defense in preventing adverse events and errors and improving the safety of patients. MATERIALS AND METHODS: We  searched the CINAHL, ProQuest, PubMed, Science Direct, and Web of Science databases for evidence published between 2018 and 2022 in the English language. We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in carrying out this meta-analysis. RESULTS: Nine quantitative studies were appraised using the Joanna Briggs Institute checklists and were included in the final review that involved a total sample of 3633 registered nurses. The included studies were reported across Asian, Middle East, and European countries within the past five years. The association between the transformational leadership behaviors of nurse managers and the quality of patient care was found in varying degrees (i.e., insignificant, weak, indirect, and strong direct association) based on the perceptions of registered nurses. CONCLUSIONS: There is a direct and indirect association between the transformational leadership behaviors of nurse managers and the quality of patient care internationally. This association is influenced by confounding and mediating factors, including gender, organizational culture, structural empowerment, and job satisfaction. IMPLICATIONS FOR NURSING AND HEALTH POLICIES: Healthcare organizations need to support nursing leaders to have a stronger transformational leadership style by considering several factors that influence their leadership to improve the quality of patient care their staff nurses provide at the bedside.

Factors associated with professional identity among ICU nurses during COVID-19: A cross-sectional study.

AIM: To determine the associated factors of professional identity among intensive care unit (ICU) nurses during the COVID-19 pandemic in China. DESIGN: Multicentre cross-sectional study. METHODS: This study invited 348 ICU nurses in five hospitals in China from May to July 2020. Online self-report questionnaires were adopted to collect their demographic and occupational characteristics, perceived professional benefits and professional identity. Based on univariate and multiple linear regression analysis, a path analysis was performed to determine the associated factors' effects on professional identity. RESULTS: The mean score of professional identity was 102.38 ± 16.46. Perceived professional benefits, doctor recognition level and family support level were associated with ICU nurses' professional identity. The path analysis revealed that perceived professional benefits and doctor recognition level had direct effects on professional identity. In addition, doctor recognition level and family support level had indirect effects on professional identity through the mediation of perceived professional benefits.

Three Missed Critical Nursing Care Processes on Labor and Delivery Units During the COVID-19 Pandemic.

OBJECTIVE: To examine the relationships of three missed critical nursing care processes on labor and delivery units with reduced nursing time at the bedside and adequacy of unit staffing during the COVID-19 pandemic in the United States. DESIGN: A cross-sectional survey. SETTING: Online distribution from January 14 to February 26, 2021. PARTICIPANTS: A national convenience sample (N = 836) of registered nurses employed on labor and delivery units. METHODS: We conducted descriptive analyses on respondent characteristics and critical missed care items adapted from the Perinatal Missed Care Survey. We conducted robust logistic regression analyses to assess the relationships of three missed critical nursing care processes (surveillance of fetal well-being, excessive uterine activity, and development of new maternal complications) with reduced nursing time at the bedside and adequacy of unit staffing during the COVID-19 pandemic. RESULTS: Less nursing time at the bedside was associated with greater odds of missing any of the critical aspects of care, adjusted odds ratio = 1.77, 95% confidence interval [1.12, 2.80]. Adequate staffing greater than or equal to 75% of the time was associated with lower odds of missing any of the critical aspects of care compared to adequate staffing less than or equal to 50% of the time, adjusted odds ratio = 0.54, 95% confidence interval [0.36, 0.79]. CONCLUSION: Perinatal outcomes are dependent on the timely recognition of and response to abnormal maternal and fetal conditions during childbirth. In times of unexpected complexity in care and resource constraints, a focus on three critical aspects of perinatal nursing care is needed to maintain patient safety. Strategies that enable bedside presence of nurses, including maintaining adequate unit staffing, may help to mitigate missed care.

Workplace Violence in the Hospital: Strategies for Meaningful Change.

BACKGROUND: Workplace violence is not a unique problem to organizations. Evidence-based toolkits and strategies are available to help provide a guiding framework for the reduction of workplace violence events. As times and stressors (both personal and environmental) change, hospitals must keep constant attention on how to address and implement initiatives to keep staff safe. This manuscript addresses steps taken at 1 hospital to meet this challenge. PROCESS: Although a workplace violence committee had been in place for some time, it was identified that not all of the key players were included. Membership was evaluated, and executive-level support was provided. A review of literature was conducted and identified top priorities upon which to focus efforts. Subcommittees were formed to be responsible for these categories of work and to report back to the committee. EVALUATION: Data points and a dashboard were created to monitor trends and effectiveness, especially regarding combating the culture of underreporting. Processes and resources were formalized and made easily accessible to staff. Case studies and direct feedback from staff have been impactful and helped identify additional barriers. Evaluation will continue to occur using process-improvement methodology along with technological assistance. CONCLUSIONS: Workplace violence is not part of the job. Ongoing work is needed to continue to move the needle and make hospitals a safer place to work. Engagement from all levels of the organization is necessary to have a successful program.

Integration of Interprofessional Learning Into an Accredited Nurse Residency Program.

The American Nurses Credentialing Center (ANCC) Practice Transition Accreditation Program® (PTAP) annually awards the Program Director of the Year at the ANCC Transition to Practice (TPP) Symposium. This year the Commission on Accreditation in Practice Transition Programs (COA-PTP) and ANCC PTAP/APPFA team is ecstatic to announce Dr. Simmy King, from Children's National Hospital, as the awardee. Dr. King's dedication to nurses in transition and quality improvement is impressive. Learn about the Children's National Hospital's ANCC PTAP journey and how they integrated interprofessional learning into their nurse residency. [J Contin Educ Nurs. 2023;54(5):197-200.].

Factors associated with recognition at work among nurses and the impact of recognition at work on health-related quality of life, job satisfaction and psychological health: a single-centre, cross-sectional study in Morocco.

OBJECTIVES: To describe the sociodemographic, occupational and health factors that influence nurses' recognition at work and to examine a recognition pathway model to assess the relationship between recognition at work and health-related quality of life (HRQOL), job satisfaction, anxiety and depression. DESIGN: This is a cross-sectional observational study with prospective data collection based on a self-report questionnaire. SETTING: University hospital centre in Morocco. PARTICIPANTS: The study included 223 nurses with at least 1 year of practice at the bedside in care units. MEASURES: We included the sociodemographic, occupational and health characteristics of each participant. The Fall Amar instrument was used to measure job recognition. HRQOL was measured using the Medical Outcome Study Short Form 12. The Hospital Anxiety and Depression Scale was used to assess anxiety and depression. Job satisfaction was measured using a rating scale (ranging from 0 to 10). Path analysis was used to examine the nurse recognition pathway model to assess the relationship between nurse recognition at work and key variables. RESULTS: The participation rate in this study was 79.3%. Institutional recognition was significantly correlated with gender, midwifery specialty and normal work schedule: ß=-5.10 (-8.06, -2.14), ß=-5.13 (-8.66, -1.60) and ß=-4.28 (-6.85, -1.71), respectively. Significant correlations were found between recognition from superiors and gender, mental health specialisation and normal work schedule: ß=-5.71 (-9.39, -2.03), ß=-5.96 (-11.17, -0.75) and ß=-4.04(-7.23, -0.85), respectively. Recognition from coworkers was significantly associated with mental health specialisation: ß=-5.09 (-9.16, -1.01). The trajectory analysis model found that supervisor recognition had the best impact on anxiety, job satisfaction and HRQOL. CONCLUSIONS: Recognition from superiors is important in maintaining nurses' psychological health, HRQOL and job satisfaction. Therefore, managers in hospitals should address the issue of recognition at work as a potential personal, professional and organisational lever.

The Impact of the Early COVID-19 Pandemic on Registered Nurses' Intent to Stay in Nursing.

The COVID-19 pandemic has been difficult for registered nurses. Media reports, most of them anecdotal, have reported upticks in nurse resignations, and plans to resign and/or leave nursing due to COVID-19. This article reports findings from an online anonymous 95-item survey completed by about 1,600 nurses from a New York City metropolitan area health system's (HS) four hospitals and ambulatory care centers about their COVID-19 experience in the spring of 2020, their intent to stay at the HS, and their intent to stay working as a nurse. Conducted early in the pandemic, this survey addresses a major gap in the literature, as there was no timely evaluation of nurses' intent to leave during the "Great Attrition" wave or to stay during the "Great Attraction" trend. Among those nurses completing the survey, 85.7% reported that they planned to work as a nurse one year later and 77.9% reported that they planned to work at the HS one year later. Those nurses who obtained a master's or doctoral degree as their first professional degree in nursing, or had a high level of mastery, were less likely to report an intent to stay at the HS. Those with no children, those who thought the HS was more supportive, and those who thought that registered nurse-medical doctor relations were higher were more likely to intend to stay at the HS. Those nurses who reported worse communication with their nurse manager were less likely to report an intent to stay in nursing. Those who reported lower stress, who were unmarried and had no children were more likely to intend to work as nurses. Our findings on nurses' intent to leave their organization and their intent to leave nursing are much lower than reports in the popular press. Our data were collected early in the pandemic and it may not reflect the accumulated stress nurses experienced from witnessing the death of so many patients.

The State of Rest Break Practices Among 12-Hour Shift Hospital Nurses in the United States.

OBJECTIVE: This cross-sectional study aimed to explore the characteristics, content, and context of rest breaks taken by hospital nurses. BACKGROUND: Nurses often miss, skip, or take interrupted breaks. To improve the quality of breaks and promote within-shift recovery, it is important to understand current rest break practices including break activities and contextual challenges around them. METHODS: Survey data from 806 nurses were collected between October and November 2021. RESULTS: Most nurses did not take regular breaks. Rest breaks were often interrupted, spent being worried about work, and rarely resulted in a relaxed state. Common break activities were having a meal or a snack, and browsing the Internet. Regardless of workload, nurses considered patient acuity, staffing, and unfinished nursing tasks when deciding to take breaks. CONCLUSION: Rest break practices are of poor quality. Nurses mainly consider workload-related factors when taking breaks, which warrants the attention of nursing administration.

Psychological capital, grit and organizational justice as positive strengths and resources among registered nurses: A path analysis.

AIM: To examine registered nurses' individual strengths (psychological capital and grit) and an organizational resource (organizational justice) as well as associated work-related outcomes. In a time of a global nursing shortage, there is an urgent need to identify strengths and resources that can have a positive impact on the health, well-being and retention of registered nurses. DESIGN: A cross-sectional survey. METHODS: A nationwide convenience sample of 514 registered nurses responded to a survey. Data were collected using a self-reported questionnaire between March and May 2018. Data were analysed using descriptive statistics and multivariate path analysis. RESULTS: Participants rated their psychological capital and grit moderately high. Grit and organizational justice were found to have significant direct effects on psychological capital. Furthermore, psychological capital had positive direct effects on engagement and the perception of well-conducted everyday nursing as well as negative direct effects on burnout, the stress of conscience and the intent to leave the profession. CONCLUSION: The results suggest that nurse leaders and managers could consider improving registered nurses' well-being with two complementary approaches. It might be useful to reinforce positive, individual strengths, such as psychological capital, and at the same time create more favourable nursing work environments, for example by strengthening organizational justice. IMPLICATIONS FOR THE PROFESSION: Psychological capital and grit are emerging concepts in nursing workforce research. Identifying registered nurses' positive strengths and resources is important for inventing interventions that enhance nurses' engagement and well-being as well as reduce turnover intentions. IMPACT: Nurse leaders and managers play crucial roles in managing and developing registered nurses' individual strengths and organizational resources. This has gained even more importance now as the COVID-19 pandemic could have a long-term negative impact on nurses' well-being. REPORTING METHOD: The study is reported following STROBE guidelines. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Utility of a "Lavender Lounge" to Reduce Stress Among Critical Care Registered Nurses: A Cross-Sectional Study.

BACKGROUND: Work-related stressors are present in almost every profession, but many believe nurses caring for critically ill patients experience additional and unique stresses. Results of previous studies have demonstrated the potential benefits of various interventions to reduce stress among intensive care nurses. However, the practicality of nurses taking time out from a busy unit to meet their own needs remains in question. OBJECTIVES: To assess intensive care nurses' perceptions of the usability of a lounge designed to support them in refreshing and renewing themselves after stressful clinical situations. METHODS: This study used a descriptive, cross-sectional design and survey methodology with a convenience sample of registered nurses from a medical intensive care unit. RESULTS: Of 250 registered nurses eligible for participation, 54 (21.6%) completed surveys, and of those, 31 (57%) reported having used the lounge within the past month. Nurses reported having coverage provided by colleagues, visiting during their lunch break, and having low unit acuity were facilitators of lounge use. Barriers included high unit acuity, high unit census, and high patient care demands with no one available to cover patient assignments. CONCLUSIONS: The variables that lead to stress and burnout among medical intensive care unit nurses also prevent nurses from using a "relaxation room." A more effective approach may be organizational change that supports reduction of workload through increased staffing, prearranged breaks during shifts, and increased recovery time between shifts by limiting work to no more than 40 hours per week.

Determining the effect of selected mental factors on turnover intention through two modulators - stress and resilience over COVID-19 period.

INTRODUCTION: Turnover intention among nurses has risen in an alarming rate since the onset of the pandemic. There are various underlying factors to turnover intention. The present study aims to determine the effect of a number of mental factors on nurses' professional-turnover intention through two modulators of stress and resilience over COVID-19 period. METHODS: The current cross-sectional study was conducted at three hospitals in Khuzestan Province, southern Iran, during the winter of 2021. To collect the data, given the restrictions in place during COVID-19 period, the web link of electronic self-reported questionnaires (including general health, mental workload, work-family conflict, resilience, job stress, corona fear, and turnover intention) were sent to 350 nurses through e-mail and other social media (WhatsApp and Telegram). Accordingly, they were asked to complete the questionnaire during rest periods within two weeks. Totally, 300 people (85% participation) filled out the questionnaires. Finally, a model was constructed in the Amos software. RESULTS: The results showed that the four independent parameters of decreasing general health, increasing mental workload, increasing WFCs and fear of COVID-19 can indirectly increase nurses' turnover intention by increasing job stress. Among these variables, the highest indirect effect coefficient on turnover intention was related to the general health parameter (-0.141). The results also demonstrated a negative correlation between job stress and resilience, with lower resilience raising job stress and, consequently, increasing intention to quit the job. CONCLUSION: Mental factors affecting turnover intension were identified in this study through path analysis. Therefore, it is recommended that the required resilience-enhancing measures to be taken by hospitals and nursing administrations to reduce psychological pressures caused by mentioned variables with the aim of minimizing job-related stress and fostering nurse retention.

Nurses' self-efficacy and well-being at work amid the COVID-19 pandemic: A mixed-methods study.

AIMS: To explore the factors associated with the nurses' well-being at work. DESIGN: A sequential explanatory mixed-methods design. METHODS: The quantitative part of the study included a conveniently sampled 271 nurses employed in healthcare facilities in the Riyadh region of Saudi Arabia. A purposive sample of 21 nurses were interviewed in the qualitative part of the study. Data collection was performed from May to August 2021. This article followed the STROBE checklist. RESULTS: Nurses working in private hospitals reported higher level of self-efficacy than nurses in public hospitals. Being a Filipino, working in private hospital, and having higher self-efficacy were associated with better well-being at work among nurses during the pandemic. The thematic analysis revealed four important themes in understanding their well-being at work: safe work environment, ensuring staff nurses' health, leadership support, and solidarity in the workplace.