Surveys conducted pre- and post-implementation of a synergy tool: Giving voice to emergency teams.

AIM: To investigate the impact of a patients' needs assessment (synergy tool) on emergency department nurses' perceptions of quality, safe care delivery and morale. BACKGROUND: The synergy tool provides real-time data on types of patients, their arrival, management and discharge. This tool was introduced to two urban emergency departments in response to government priorities to reduce emergency department wait times and improve patient flow. METHOD: This survey, a component of participatory action research, measures perceptions of 158 nurses pre-introduction and 91 nurses post-introduction of the synergy tool. RESULT: Responses were consistent regarding intent to leave, workload/staffing, spirit at work and quality/safety. One question describing staff as working in 'crisis mode' indicated a significant improvement. CONCLUSION: Critical patient care may be missed during periods of overload, placing patients and staff at risk, leading to an increase in intent to leave. The synergy tool provides an objective means in real time for staff to identify their patients' care needs, assisting management with staffing decisions. Ongoing staff and management communication using tools such as the synergy tool may reduce perceptions of working in 'crisis mode'. IMPLICATIONS FOR NURSING MANAGEMENT: This research suggests that when managers employ a collaborative process and use evidence-based tools and approaches to addressing nurses' workload concerns, nurses' perceptions of working in 'crisis mode' diminish.

Nurse perspectives in the emergency department: The synergy tool in workload management and work engagement.

AIM: To explore emergency nurses' perceptions of how a nurse-driven patient needs assessment tool, the synergy tool, influenced their workload management. BACKGROUND: Quadruple Aim, particularly the fourth aim of improved staff work experiences, served as the conceptual framework to engage nurses in a participatory action research project. This project took place between 2017 and 2020 in two tertiary care emergency departments in one large Canadian city. METHOD: This study employed a qualitative descriptive component, focus group interviews and nurse comments on two open-ended survey questions. RESULTS: Use of the synergy tool heightened nurses' awareness of patients' holistic care needs. Nurses also stated how patient needs assessment data helped them identify unsafe workloads. CONCLUSIONS: The synergy tool, adapted for emergency department use by nurses, was a means to engage and empower nurses. Patient needs assessment data from the tool identified staffing gaps, resulting in additional nursing staff for both emergency departments. IMPLICATIONS FOR NURSING MANAGEMENT: A focus on patient needs assessment can be an effective way to address nurses' workload concerns.

Health Care Providers' Spirit at Work Within a Restructured Workplace.

Spirit at work (SAW) research emerged as a response to care provider determination to maintain a healthy and productive health care work environment, despite restructuring. The aim of this descriptive mixed-methods research is to present the care provider's perceptions of SAW. SAW is a holistic measure of care provider workplace outcomes, defined as the unique experience of individuals who are passionate about and energized by their work. A mixed group of licensed and unlicensed care providers in a continuing care workplace were surveyed. Eighteen Likert-type scale survey questions were further informed by two open-ended questions. Results indicated that unlicensed continuing care providers' perceptions of SAW are lower than licensed care providers. Responses suggest that open discussion between managers and team members, combined with structured workplace interventions, will lead to enhanced SAW and improved patient care. Further research on SAW within the continuing care workplace is required.

Spirit at work and hope among the ruins: registered nurses' covenant of care.

AIM: To explore registered nurses' (RNs) perspectives about the health care system, management/leadership, patients and spirit at work (SAW). BACKGROUND: Researchers investigating RNs experiences of reduced job satisfaction and diminishing organisational commitment are looking carefully at spirit at work as a means to foster healthier workplaces. METHODS: A descriptive, cross-sectional mixed methods design was used to measure and explore the relationships between spirit at work, job satisfaction and organisational commitment. A 2012 postal survey sent by the provincial licensing body to a random sample of 217 surgical and 158 home care registered nurses' in western Canada returned 179 surveys. Seventy-five respondents answered the open-ended survey question. Their responses warrant further content analysis and serve as the foundation of this article. RESULTS: Participants noted that organisational structures and policies, combined with unsupportive leadership, were associated with a reduced sense of community, lack of trust and diminished accountability. CONCLUSION: Spirit at work was described as sustaining registered nurses' and providing them with hope as they fulfilled their covenant of care with patients. IMPLICATIONS FOR NURSING MANAGEMENT: Leadership attention to the advancement of SAW may support the covenant of care between the registered nurses and patient while fostering healthier workplaces.

Spirit at Work (SAW): fostering a healthy RN workplace.

A cross-sectional mixed-method survey explored and measured relationships between spirit at work (SAW) concepts, experience, education, practice context, job satisfaction, and organizational commitment using LISREL 8.80 and 2012 survey data from a random sample of 217 surgical and 158 home care registered nurses (RNs) in western Canada. Qualitative data underwent content analysis using a priori coding categories based on established theory. Final model indices fit the observed data. SAW concepts of engaging work and mystical experience accounted for moderate to large amounts of model variance for both home care and surgical nurses, while significant positive relationships between SAW concepts, job satisfaction, and organizational commitment were also reported. Researchers concluded that SAW contributes to improved job satisfaction and organizational commitment while being sensitive to RN experiences across clinical contexts. As an holistic measure of RN workplace perceptions, SAW contributes essential information directed at creating optimal environments for both health care providers and recipients.

Workplace model for physical therapists and occupational therapists.

PURPOSE: The purpose of this paper is to test a model linking physical therapy (PT) and occupational therapy (OT) practitioners' perceptions of resonant leadership, structural empowerment and psychological empowerment to their experiences of spirit at work (SAW), job satisfaction and organizational commitment within the Canadian workplace. DESIGN/METHODOLOGY/APPROACH: The authors tested the model using LISREL 8.80 and survey data from 101 OTs and 169 PTs, randomly selected by the Alberta professional licensing associations. Content analysis of responses to the open-ended comments section provided additional depth and insight. FINDINGS: Analysis of results culminated in minor modifications to the original theoretical model, creating separate PT and OT models. Both models revealed a good fit with the observed data. Several SAW concepts accounted for moderate to large amounts of variance in both PT and OT models, indicating that SAW is a comprehensive workplace outcome. RESEARCH LIMITATIONS/IMPLICATIONS: Theory was derived from business and nursing research literature due to limited rehabilitation research literature. Discussion of OT results must consider the small sample size. This study is initial exploratory research. PRACTICAL IMPLICATIONS: Each discipline-specific model provides professionals, health care leaders and policy makers with a rich body of information upon which to base beneficial workplace decisions. SAW will guide leaders in the holistic development and enrichment of the work environment. ORIGINALITY/VALUE: This research contributes to the substantive knowledge of the OT and PT disciplines, particularly in the areas of leadership, workplace structural organization and indicators of healthy work environments such as SAW, empowerment, job satisfaction and organizational commitment.

Resonant leadership, workplace empowerment, and "spirit at work": impact on RN job satisfaction and organizational commitment.

Canadian researchers have developed the Spirit At Work (SAW) tool for identifying the experiences of individuals who are passionate about and energized by their work. This article describes (a) what registered nurses perceive as contributing to their personal SAW; and (b) the relationships among resonant leadership, structural empowerment concepts, psychological empowerment concepts, SAW concepts, job satisfaction, organizational commitment, and the demographic variables of experience, education, and rank in the RN workplace. The theoretical model was tested using LISREL 8.80 and survey data from 147 randomly selected RNs. Engaging work was found to account for 63% of the explained variance in the model's endogenous variables. Spiritual connection had a causal effect on organizational commitment, while resonant leadership and individual empowerment had significant causal influence on SAW, job satisfaction, and organizational commitment. These results strengthen those of previous studies reporting workplace structures/processes/contributions leading to superior care environments. Future studies will clarify the role of SAW in the workplace.

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.