Identifying Potentially Preventable Reasons Nurses Intend to Leave a Job.

OBJECTIVE: The aim of this study was to describe the relationships between intent to leave, reasons nurses intend to leave, and the nursing work environment in military hospitals. BACKGROUND: Intention to leave is a precursor of nurse turnover. The reasons nurses intend to leave may be influenced by leader interventions and potentially preventable. METHODS: This descriptive, correlational secondary analysis included 724 nurse survey responses from 23 US Army hospitals. Bivariate correlations and predictive modeling techniques were used. RESULTS: Forty-nine percent of nurses indicated they intended to leave, 44% for potentially preventable reasons. Dissatisfaction with management and the nursing work environment were the top potentially preventable reasons to leave. Nurses who intended to leave for potentially preventable reasons scored aspects of the nursing work environment significantly lower than those intending to leave for nonpreventable reasons. CONCLUSIONS: Identifying potentially preventable reasons in conjunction with intent to leave can provide leaders opportunities to intervene and influence turnover intention.

Access to post-acute care services reduces emergency department utilisation among individuals insured by Medicaid: An observational study.

AIMS AND OBJECTIVES: We examined whether access to post-acute care services differed between individuals insured by Medicaid and commercial insurers and whether those differences explained emergency department utilisation 30 days post-hospitalisation. BACKGROUND: Timely follow-up to community-based providers is a strategy to improve post-hospitalisation outcomes. However, little is known regarding the influence of post-acute care services on the likelihood of emergency department use post-hospitalisation for individuals insured by Medicaid. DESIGN: We conducted a retrospective observational study of electronic health record data from an academic medical centre in a large northeastern urban setting. The STROBE checklist was used in reporting this observational study. METHODS: Our analysis included adults insured by Medicaid or commercial insurers who were discharged from medical services between 1 August-31 October 2017 (n = 785). Logistic regression models were used to examine the effects of post-acute care services (primary care, home health, specialty care) on the odds of an emergency department visit. RESULTS: Post-hospitalisation, 12% (n = 59) of individuals insured by Medicaid experienced an emergency department visit compared to 4.2% (n = 13) of individuals commercially insured. Having Medicaid insurance was associated with higher odds of emergency department visits post-hospitalisation (OR = 3.24). Having a home care visit or specialty care visit within 30 days post-discharge were significant predictors of lower odds of emergency department visits. Specific to specialty care visits, Medicaid was no longer a significant predictor of emergency department visits with specialty care being more influential (OR = 0.01). CONCLUSIONS: Improving connections to appropriate post-acute care services, specifically specialty care, may improve outcomes among individuals insured by Medicaid. RELEVANCE TO CLINICAL PRACTICE: Hospital-based nurses, including those in direct care, case management and discharge planning, play an important role in facilitating referrals and scheduling appointments prior to discharge. Individuals insured by Medicaid may require additional support in accessing these services and nurses are well-positioned to facilitate care continuity.

Development and Testing of the Quality Improvement Self-efficacy Inventory.

Quality improvement is paramount for patient safety. Leading change for quality improvement requires nurses with knowledge and skills beyond the clinical management of patients. In this study, staff nurses working in hospitals throughout Alabama were asked via an online survey to rate their quality improvement knowledge and skills using the new 10-item Quality Improvement Self-Efficacy Inventory (QISEI) and their perceptions of the nursing work environment using the Practice Environment Scale of the Nursing Work Index. Nurses (N = 886) rated the basic quality improvement items higher than the more advanced items. Several nurse characteristics and the nursing work environment were associated with nurses' ratings of their quality improvement knowledge and skills. Educators and administrators in health care organizations can use QISEI to gauge their nurses' knowledge and skills and then develop continuous professional development opportunities aimed at improving quality and safety competencies.

Is Hospital Nurse Staffing Legislation in the Public's Interest?: An Observational Study in New York State.

BACKGROUND: The Safe Staffing for Quality Care Act under consideration in the New York (NY) state assembly would require hospitals to staff enough nurses to safely care for patients. The impact of regulated minimum patient-to-nurse staffing ratios in acute care hospitals in NY is unknown. OBJECTIVES: To examine variation in patient-to-nurse staffing in NY hospitals and its association with adverse outcomes (ie, mortality and avoidable costs). RESEARCH DESIGN: Cross-sectional data on nurse staffing in 116 acute care general hospitals in NY are linked with Medicare claims data. SUBJECTS: A total of 417,861 Medicare medical and surgical patients. MEASURES: Patient-to-nurse staffing is the primary predictor variable. Outcomes include in-hospital mortality, length of stay, 30-day readmission, and estimated costs using Medicare-specific cost-to-charge ratios. RESULTS: Hospital staffing ranged from 4.3 to 10.5 patients per nurse (P/N), and averaged 6.3 P/N. After adjusting for potential confounders each additional patient per nurse, for surgical and medical patients, respectively, was associated with higher odds of in-hospital mortality [odds ratio (OR)=1.13, P=0.0262; OR=1.13, P=0.0019], longer lengths of stay (incidence rate ratio=1.09, P=0.0008; incidence rate ratio=1.05, P=0.0023), and higher odds of 30-day readmission (OR=1.08, P=0.0002; OR=1.06, P=0.0003). Were hospitals staffed at the 4:1 P/N ratio proposed in the legislation, we conservatively estimated 4370 lives saved and $720 million saved over the 2-year study period in shorter lengths of stay and avoided readmissions. CONCLUSIONS: Patient-to-nurse staffing varies substantially across NY hospitals and higher ratios adversely affect patients. Our estimates of potential lives and costs saved substantially underestimate potential benefits of improved hospital nurse staffing.

Measuring workplace bullying in a U.S. nursing population with the Short Negative Acts Questionnaire.

Efforts to decrease nurse-reported workplace bullying (WPB) is an interest among researchers, nursing leaders, and healthcare organizations. Varying conceptual definitions and measurement approaches of WPB, however, have created barriers for researchers to provide reliable and consistent information regarding WPB. In this paper, the authors aim to (1) evaluate the reliability and construct validity of the Short Negative Acts Questionnaire (SNAQ) in a sample of U.S. nurses working in hospitals located throughout Alabama, (2) determine targets and non-targets of WPB, and (3) evaluate the criterion validity of the SNAQ based on WPB classification. The internal consistency reliability and construct validity of the SNAQ in 943 Alabama registered nurses was evaluated using Cronbach's α and confirmatory factor analysis. An exploratory factor analysis was conducted to explore the underlying structure of the SNAQ. Targets and non-targets of WPB were identified using latent class analysis of the SNAQ and by the self-labeling item. Agreement between the two methods was evaluated with Cohen's κ. Using both methods, the association between WPB classification and outcomes empirically associated with nurse-reported WPB was evaluated with random effects multiple logistic regression to determine criterion validity. The results indicate that the SNAQ is a reliable and valid instrument to explore WPB in a sample of U.S. registered nurses working in hospitals throughout Alabama.

How does workplace bullying influence nurses' abilities to provide patient care? A nurse perspective.

AIMS AND OBJECTIVES: To explore how workplace bullying influences nurses' abilities to provide patient care. BACKGROUND: Nurses' experiences of workplace bullying undermine nursing work environments and potentially threaten patient care. Although there is a link between nurses' experiences of workplace bullying and poor patient care, additional exploration is necessary as current evidence remains underdeveloped and inconclusive. DESIGN: Qualitative descriptive study. METHODS: Fifteen inpatient staff nurses who have experienced workplace bullying while working in one hospital located in the southern region of the USA participated in individual, semi-structured interviews. Inductive thematic analysis was used to analyse interview transcripts in NVivo 12 software. The COREQ checklist for qualitative studies has been used in reporting this study. RESULTS: Three themes, and respective subthemes, were generated from data analysis: (a) workplace bullying as part of the nursing work environment, (b) workplace bullying's influence on nurses and (c) workplace bullying's influence on patient care. Workplace bullying was perceived to be inherent in the nursing work environment; nurses felt that they were targets of workplace bullying because (a) they were new nurses, (b) there was an abuse of power, or (c) the nature of the work occasioned it. Nurses were mentally and emotionally influenced by the bullying. Some nurses perceived that workplace bullying did influence their ability to provide patient care; however, others did not. CONCLUSIONS: Organisations must support new nurses and manage relational attributes of the nursing work environment to reduce workplace bullying. Nursing leaders should receive education on fostering and sustaining favourable nursing work environments and be held accountable for behavioural expectations of the organisation. RELEVANCE TO CLINICAL PRACTICE: Understanding how nurses perceive the work environment to influence their experiences of workplace bullying informs the development of organisational interventions to reduce the behaviour. Furthermore, exploring how nurses' experiences of workplace bullying influences their abilities to provide patient care increases our understanding of workplace bullying implications.

Variables associated with missed nursing care in Alabama: A cross-sectional analysis.

AIM: To discover the extent of and factors associated with missed nursing care in Alabama. BACKGROUND: Missed nursing care is a well-documented phenomenon. However, it has not been studied in U.S. southern states that consistently rank poorly in health outcomes, such as Alabama. METHODS: The Perceived Implicit Rationing of Nursing Care Instrument was administered as part of the Alabama Hospital Staff Nurse Study. Analyses were run on 950 surveys completed by inpatient registered nurses. RESULTS: Overall missed nursing care scores vary significantly by gender, unit type, job satisfaction and quality of nursing care. Overall missed nursing care scores are correlated with the work environment and number of patients assigned to each nurse. Unit type, quality of nursing care and the work environment are important factors associated with missed nursing care. CONCLUSION: The results of this study advance nursing science by adding to the growing body of knowledge surrounding missed nursing care. The results reveal opportunities where nurses may need support in their bedside practice. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing management must monitor the nursing work environment, periodically measure missed nursing care to assess for improvement opportunities, and watch for interventions that could decrease missed nursing care.

Workplace Bullying and Newly Licensed Registered Nurses: An Evolutionary Concept Analysis.

Workplace bullying (WPB) among nurses, especially newly licensed registered nurses (NLRNs), negatively affects nurse, patient, and organizational outcomes. Despite empirical evidence addressing the prevalence and impact of WPB, the behavior continues to persist within nursing work environments. Increased conceptual clarity of WPB is needed for interventions to be developed, executed, and evaluated. The purposes of this concept analysis, in which we used Rodgers' evolutionary method, were to obtain a clearer understanding of WPB, to differentiate the concept from other forms of workplace violence, and to describe a definition of WPB consistently used in the literature. Three attributes specific to WPB included negative behaviors directed toward an individual who perceives themselves to be a target, a time frame of experiencing these negative behaviors (e.g., daily or weekly) for a prolonged period (e.g., several weeks), and the inclusion of a power gradient or hierarchy between the bully and target. Antecedents identified for WPB included a scarcity of resources and poor leadership and management. Consequences associated with WPB included adverse nurse, patient, and health care organizational outcomes. WPB was conceptually defined as any negative behavior, exhibited by a nurse of either perceived or actual power, that was repeatedly (i.e., daily or weekly) and persistently directed toward NLRNs who have difficulty defending themselves against the behavior. Implications for researchers, health care organizations, nurse leaders, and nurses are included.