Socio-demographic analysis of free-lance nurses in a non-institutional employment regimen.

INTRODUCTION: The free-lance nurse, not bound to rigid organizational systems, can offer personalized assistance always respecting the rights of the person and of the profession. More recent graduates have decided to undertake the nursing profession by moving towards the free-lance nursing, considering it both as a career opening and as a professional opportunity, although this option never got much attention from the researchers in the Italian nursing scene. Free-lance nursing is now considered a valuable opportunity to develop a nursing career. This market is destined to grow for different reasons, such as an increasing chronicity of health conditions of more and more ageing population and the deficits of the National Health Service (Servizio Sanitario Nazionale - SSN) in community and home care. AIM: The aim of the study was to evaluate the correlation between the development of the free-lance nursing and the Italian socio-economic context. METHODS: The design of the study was descriptive - observational. Data collection and observation was carried out from January 2018 until April 2108. For the analysis a linear regression model was adopted to quantify a cause-effect relationship between one or more independent variables and the dependent variable which interprets the phenomenon investigated. The regression carried out was descriptive to analytically express the observed reality and represent it in a plausible way. The specification model was represented as: Free-lance nurses per capita = per capita income + Out of Pocket expense per capita + waiting lists in days + number of beds per inhabitants + NHS nurses per inhabitants. RESULTS: The estimate carried out had an R of 0.813, R-square equal to 0.6612, adjusted R-square 0.540 and standard error of the estimate 1.277, highlighting a correlation between the variables adopted in the model and a p = 0.005. From the analysis of the variables used, the average per capita income (p = 0.045) and the nurses working in the National Health Service /1,000 beds (p = 0.017) were statistically significant. CONCLUSIONS: It can be stated that the free-lance nursing profession is costly for patients and therefore develops more revenue where the average per capita income grows, but the research also seems to show that, where the National Health Service has too few nurses, the private demand increases in order to satisfy healthcare needs.

What personality types dominate among nurses and paramedics: A scoping review?

BACKGROUND: Certain personality traits captured by the Big Five framework have been shown to play an important role in predicting burnout in response to stressors, with evidence they reflect a relationship to psychological resilience. Understanding such distributions can subsequently serve to facilitate identification and implementation of more specifically targeted preventative strategies. METHODS: Arksey and O'Malley's five stage scoping was used to review the literature. The research question that guided this scoping was: Big Five personality factor predominance's among nurses and paramedics, and any relationships with constructs critical for wellbeing. Five electronic databases were searched during November 2018: PsycINFO, Embase, Medline, ProQuest and Scopus. RESULTS: Eighteen articles met inclusion criteria. Two broad themes emerged: those specifically about personality traits of nurses and/or paramedics, and those concerned with various associations between one or other construct and personality trait(s). Low Neuroticism and higher Extraversion are considered desirable traits in nurses and paramedics as they have each been found to have a negative correlation with burnout. CONCLUSIONS: Nurses and paramedics with higher Neuroticism and lower Extraversion suggest being less suited to their profession, particularly when exposed to critical incidents.

The systems and signs of political militants in/of Brazilian nursing.

OBJECTIVES: to analyze the systems and signs in the constitution of militant nurses. METHODS: a historical and qualitative research based on oral history carried out with 11 nurses who had been working in the professional field since 1980. Data collected from semi-structured interviews were organized into NVivo software 10, being analyzed through dialectical hermeneutics. RESULTS: systems and signs are systems that allow us to use senses, symbols or meaning to objectify and subjectivate the subject. The revealed senses were categorized and divided into improper, religious, heroic, communist, and socially involved. CONCLUSIONS: militancy signs are convergent with what is put in national and international literature. The difference found was in the heroic sense and implicated with the social. Militant is almost never associated with positive aspects. An individual who builds himself as a political being empowers himself as a social being, making knowledge of power, generating a break in traditional models.

The correlates of precarious working conditions in the Mexican nursing labour market from 2005 to 2018: A repeated cross-sectional study.

AIM: To analyse sociodemographic and labour correlates of labour precariousness among Mexican nurses from 2005 to 2018. BACKGROUND: The progressive loss of labour rights has led to a situation characterized by precarious working conditions among health workers globally. METHODS: A repeated cross-sectional and population-based study was carried out (N = 3,699,282). A generalized ordinal logistic regression model was estimated to assess correlates of precariousness. Precariousness was defined as a non-weighted score of the sum of five dichotomous variables: (a) non-written contract; (b) income lower than two times the minimum wage; (c) with a partial or an extended workday; (d) without social benefits; and (e) without social security. RESULTS: The labour precariousness level increased during the studied period, particularly among the younger and the older, the single ones and among those located in suburban and rural areas. Nurses with lower levels of training were more exposed to precarious conditions, as well as those with jobs in private health institutions or working outside the health sector. CONCLUSIONS: Precarious work is considered a combination of global and local labour factors, including the lack of protective labour policies in health institutions, which calls for the development of a public policy to protect jobs in the health sector. IMPLICATIONS FOR NURSING MANAGEMENT: Given that precarious work is considered a combination of global and local labour factors, including the lack of protective labour policies in health institutions, public health institutions should avoid nursing outsourcing employment as much as possible, and full-time contracts should respect the fundamental international and country-specific labour rights.

A validation study of the Job Crafting Scale among nurses in public hospitals in China.

PURPOSE: To verify the reliability and validity of the Job Crafting Scale among nurses in Chinese public hospitals. BACKGROUND: Job crafting is an important organisational variable for medical institutions. Although the Japanese and Spanish versions of the Job Crafting Scale are available, this scale has not been validated in Chinese nurses. METHODS: A convenience sample of 2,095 registered hospital nurses was recruited from 25 provinces in mainland China from June 2019 to July 2019. Descriptive analyses were performed. Reliability and correlation analyses, exploratory factor analyses and confirmatory factor analyses of data collected using the Chinese version of the Job Crafting Scale were also conducted. FINDINGS: The Chinese version of the Job Crafting Scale has good validity and reliability. The goodness-of-fit indices for confirmatory factor analysis were acceptable (CFI = 0.933, NFI = 0.927, TLI = 0.920, IFI = 0.933). The Cronbach α coefficient for the total scale was .920, and the coefficients for each dimension of this scale were between .804 and .894. CONCLUSION: The Chinese version of the Job Crafting Scale has good reliability and validity, which supports its use as an effective tool to measure the working level of job crafting among nurses in public hospitals in China. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers may use reliable and effective tools, including the Chinese version of the Job Crafting Scale, to determine the level of job crafting at their institutions and to develop effective interventions to improve it.

Relationship Between Nurse Certification and Clinical Patient Outcomes: A Systematic Literature Review.

BACKGROUND: Certification of nurses has been identified as a strategy to improve health care quality. However, the impact nursing certification has on clinical patient outcomes remains unclear. PURPOSE: The purpose was to examine the relationship between nursing certification and clinical outcomes. METHODS: A systematic review of the literature was conducted through the search of relevant bibliographic databases (CINAHL Plus, PubMed, Medline, and Cochrane Collaboration). RESULTS: Nursing certification was found to have a significant inverse relationship to patient falls and health care-associated infections. Significant correlations were not established in outcomes such as pressure injuries and mortality. CONCLUSIONS: The validation of knowledge through nursing certification has an impact on specific outcomes such as patients falls and health care-associated infections.

Perceived importance and performance of clinical leadership in practice: A cross-sectional study of nurses and midwives of all grades.

AIM: To explore the differences in perceived importance and actual performance of clinical leadership for all grades of nurses and midwives engaged in clinical practice. BACKGROUND: Clinical leadership is central to the provision of person-centred care. However, little is known about how nurses and midwives perceive this in practice. METHODS: Data were collected on a sample of nurses and midwives in the Republic of Ireland, using a cross-sectional study design (n = 324). The clinical leadership needs analysis instrument was used to measure perceived importance and performance of clinical leadership in practice. Grades of nurses/midwives included; staff, manager, advanced practitioner and senior manager. RESULTS: Senior managers were more likely to report significantly higher scores than staff grades for perceived importance of Technology & Care Initiatives (p < .01) and Financial & Service Management (p = .02). Performance of Staff & Care Delivery was significantly higher for senior managers than staff grades [F(5,309) = 6.06 p < .01]. CONCLUSION: There was a mismatch between the perceived importance and actual performance of clinical leadership in practice between different grades of staff. IMPLICATIONS FOR NURSING MANAGEMENT: Leadership training for all grades and mentoring of staff grades can promote the building of confidence and empower staff in leading clinical practice.

Effects of individual characteristics on insomnia severity trajectory among nurses: A prospective longitudinal study.

AIMS: To examine the longitudinal effects of individual characteristics on the change pattern of insomnia and the association of occupational stress with insomnia over time in newly graduated nurses. BACKGROUND: The association between individual factors and insomnia in nurses is inconclusive. Longitudinal research on insomnia in newly graduated nurses is limited. METHODS: This prospective longitudinal study included 200 participants generating 800 observations of insomnia severity during their first year of nursing. We employed growth mixture modelling for data analyses. Both time-varying covariate (occupational stress) and time-invariant covariates (nurses' characteristics) were entered into the model simultaneously. RESULTS: Nurses had a homogeneous insomnia trajectory during the whole year of survey. The educational level significantly predicted the growth rate of insomnia severity among nurses. Occupational stress at each time point was significantly associated with worse insomnia across time points (all p < .001). CONCLUSIONS: Nurses with a baccalaureate degree were more resilient to the development of severe insomnia. Additional studies have an opportunity to investigate the reason for the effects of the educational level on the pattern of insomnia. IMPLICATIONS FOR NURSING MANAGEMENT: Considering nurses' occupational stress and educational level would lead more effective management of stress and insomnia in newly graduated nurses.

What do we know about our agency nurse population? A scoping review.

BACKGROUND: Nurse staffing shortages are often managed by using temporary staff. This review discovers what is known about nurses who choose to work in this way. PROCEDURE: A literature search found eight international studies investigating the lived experience of agency nurses. RESULTS: Nurses actively choose agency nursing to work flexibly and avoid office politics or as a career stop-gap. However, respondents describe feeling isolated, working difficulties with permanent staff and fewer opportunities for training. CONCLUSIONS: Though participants described positive reasons for choosing agency nursing, there were significant downsides. The findings must be viewed in the context of the continued feminized nature of the nursing profession as care responsibilities were cited as a reason for choosing this study pattern. However, the lack of security and provision of adequate pensions and career advancement are considerable issues. The costs of using agency staff are high and consideration must be given to encouraging these nurses into substantive contracts. These individuals show considerable resilience, flexibility, and varied expertise. Such qualities are vital for health care in the 21st century and understanding why they opt out of permanent nursing will enable employers to adapt practices to harness this. Suggestions for practice and further research are presented.

Development and validation of Nurses' Moral Courage Scale.

BACKGROUND: Moral courage is required at all levels of nursing. However, there is a need for development of instruments to measure nurses' moral courage. OBJECTIVES: The objective of this study is to develop a scale to measure nurses' self-assessed moral courage, to evaluate the scale's psychometric properties, and to briefly describe the current level of nurses' self-assessed moral courage and associated socio-demographic factors. RESEARCH DESIGN: In this methodological study, non-experimental, cross-sectional exploratory design was applied. The data were collected using Nurses' Moral Courage Scale and analysed statistically. PARTICIPANTS AND RESEARCH CONTEXT: The data were collected from a convenience sample of 482 nurses from four different clinical fields in a major university hospital in Finland for the final testing of the scale. The pilot comprised a convenience sample of 129 nurses. ETHICAL CONSIDERATIONS: The study followed good scientific inquiry guidelines. Ethical approval was obtained from the university ethics committee and permission to conduct the study from the participating hospital. FINDINGS: Psychometric evaluation showed that the 4-sub-scale, 21-item Nurses' Moral Courage Scale demonstrates good reliability and validity at its current state of development showing a good level of internal consistency for a new scale, the internal consistency values ranging from 0.73 to 0.82 for sub-scales and 0.93 for the total scale, thus well exceeding the recommended Cronbach's alpha value of >0.7. Principal component analysis and confirmatory factor analysis supported the theoretical construct of Nurses' Moral Courage Scale. Face validity and expert panel assessments markedly contributed to the relevance of items in establishing content validity. DISCUSSION AND CONCLUSION: Nurses' Moral Courage Scale provides a new generic instrument intended for measuring nurses' self-assessed moral courage. Recognizing the importance of moral courage as a part of nurses' moral competence and its assessment offers possibilities to develop interventions and educational programs for enhancement of moral courage. Research should focus on further validation measures of Nurses' Moral Courage Scale in international contexts.

Projections of progress toward the 80% Bachelor of Science in Nursing recommendation and strategies to accelerate change.

BACKGROUND: In 2011, the Institute of Medicine recommended that 80% of RNs have a bachelor's degree or higher by 2020. Progress toward this recommendation has been slow. PURPOSE: This paper presents a model that projects whether the 80% recommendation can be met within a 10-year period and estimates the impact of education changes that might accelerate progress. METHODS: A projection model for 2016 to 2026 was created using a "stock-and-flow" approach. Secondary data were extracted from multiple sources for the projections. The model includes the option to enter alternative values of key parameters to estimate the impact of changes. DISCUSSION: Based on current patterns of entry-level and RN-to-BSN education, approximately 66% of RNs are projected to have BSN+ education by 2025. CONCLUSIONS: To reach the 80% goal by 2025, changes in the mix of entry-level education and/or an increase in the number of RN-to-BSN graduates will be required.

Enfermeras de cine: cómo son y qué hacen en la gran pantalla / Nurses in films: how they are and what they do in the big screen

El cine nos educa sentimental y emocionalmente sin que nos demos cuenta, porque utiliza los clichés y los estereotipos que forman parte del imaginario colectivo. Los profesionales de la Enfermería son objeto de estereotipos, es decir, de imágenes común y acríticamente aceptadas por la sociedad. En este texto se destacan seis estereotipos de enfermeras: religiosa, heroica, objeto sexual, secretaria obediente, diabólica y, finalmente, profesional; también se comenta cómo el cine muestra al enfermero. Para ello se han seleccionado algunos títulos de películas que ilustran las características de cada estereotipo. Se concluye que es esencial cuestionar y denunciar por parte de las asociaciones e instituciones profesionales el mal uso de la imagen de la enfermera, ya que el signo positivo o negativo de las imágenes tiene consecuencias no solo en la percepción de los pacientes y usuarios, sino también en la asignación de recursos y en las políticas sanitarias (AU)

Films will educate us sentimental and emotionally without our realizing it, because they use the clichés and stereotypes that are part of collective thinking. Nursing professionals are the object of stereotypes, that is to say, of images commonly and uncritically accepted by society. This text highlights six nurse stereotypes: religious, heroic, sexual object, obedient secretary, diabolic and, finally, professional. There is also a discussion about the way in which male nurses are shown in films. To this aim, there has been a selection of some films titles that illustrate the characteristics of each stereotype. The conclusion is that it is essential for professional associations and institutions to question and denounce the bad use of the nurse image, because the positive or negative use of the images will have consequences not only in the perception by patients and users but also in the assignment of resources and in healthcare policies (AU)

A Rasch Rating Scale Analysis of the Presence of Nursing Scale-RN.

The phenomenon of nursing presence encompasses the emotional connection between nurse and patient, and technical skills performed by the nurse. The Presence of Nursing Scale-RN version (PONS-RN) was developed to measure nurses' perceptions of their ability to be present to their patients. This study summarizes the process of re-evaluation of the psychometric properties of the PONS-RN instrument. A sample of 76 registered nurses providing direct patient care responded to the 31-item questionnaire. The Rasch rating scale model was used for assessing construct validity of PONS-RN data. A principal component analysis (PCA) of residuals supported appropriateness of the subscales defined by a 2-dimensional structure. The results of item and person fit analysis, rating scale functioning analysis and reliability analysis have demonstrated that the thirty-one item Presence of Nursing Scale-RN instrument yielded measures with high validity and reliability as two sub-scales.

Competency Skills Assessment: Successes and Areas for Improvement Identified During Collaboration Between Informaticists and a National Organization.

The Association of periOperative Registered Nurses (AORN) approached the Nursing Informatics Research Team (NIRT) with a request to collaborate and conduct a competency assessment for their organization. An online tool was developed to determine current technology in perioperative settings. This presentation shares the process used to conduct research that led to a method for assessing perioperative nurses' competencies skills in their practice as well as identified gaps in curricula that faculty could address. Both successes and areas for improvement are detailed. The outcome of the process demonstrated a need to understand what skills are being assessed as AORN did not know what technology existed or how existing equipment was being used.

Interpersonal relations and nurses' job satisfaction through knowledge and usage of relational skills.

BACKGROUND/RATIONALE: Many interpersonal labor disputes stem from the lack of communication skills and the relational problems in the interactions between health professionals. AIMS/METHODS: A qualitative study was conducted in a Spanish hospital in order to get to know how the communicative interaction between hospital nurses is like in relation to the nurses' interpersonal interaction and communication skills developed in their working relationships. Twenty-one hospital nurses between 29 and 55 years old, working in different wards, were interviewed. Open-ended interview discourses were transcribed verbatim and analyzed using qualitative content analysis. RESULTS: The following four key themes were analyzed: communication and sender; communication and awareness of who has the problem; non-verbal communication; communication and recipient. CONCLUSION: The results of this study highlight the need to broaden nurses' relational-communication skills in order to increase job satisfaction.

Hospital Nursing Workforce Costs, Wages, Occupational Mix,and Resource Utilization.

BACKGROUND: The objective of the study was to better understand how hospitals use different types of RNs, LPNs, and nurse aides in proprietary (for-profit), nonprofit, and government-owned hospitals and to estimate the wages, cost, and intensity of nursing care using a national data set. METHOD: This is a cross-sectional observational study of 3,129 acute care hospitals in all 50 states and District of Columbia using data from the 2008 Occupational Mix Survey administered by the Centers for Medicare &Medicaid Services (CMS). Nursing skill mix, hours, and labor costs were combined with other CMS hospital descriptive data, including type of hospital ownership, urban or rural location, hospital beds, and case-mix index. RESULTS: RN labor costs make up 25.5% of all hospital expenditures annually, and all nursing labor costs represent 30.1%, which is nearly a quarter trillion dollars ($216.7 billion) per year for inpatient nursing care. On average, proprietary hospitals employ 1.3 RNs per bed and 1.9 nursing personnel per bed in urban hospitals compared with 1.7 RNs per bed and 2.3 nursing personnel per bed for nonprofit and government-owned hospitals (P G .05). States with higher ratios of RN compared with LPN licenses used fewer LPNs in the inpatient setting. CONCLUSION: The findings from this study can be helpful in comparing nursing care across different types of hospitals, ownership, and geographic locations and used as a benchmark for future nursing workforce needs and costs.