Examining the experiences of mid-career nurses in hospitals: a phenomenological study.

BACKGROUND: The turnover of new and mid-career nurses has been increasing, leading to challenges in recruiting and retaining nursing staff. OBJECTIVES: Securing and retaining mid-career nurses is crucial for ensuring high-quality care. However, little is known about mid-career nurses' experiences regarding turnover. This study aimed to understand the experiences of mid-career nurses and identify strategies to enable mid-career nurses to maintain long-term employment in health services. DESIGN: Colaizzi's phenomenological methodology was adopted to illuminate the subjective meaning derived from the work-related challenges of mid-career nurses, leading to turnover. Focus group interviews were conducted to delve into the work challenges faced by mid-career nurses. METHOD: The participants were 23 mid-career nurses working in one tertiary hospital and six secondary hospitals across three Korean cities, recruited using purposive and snowball sampling. The inclusion criteria entailed a minimum of three years of nursing experience and current employment within a designated department or clinical area within the hospital environment, commonly known as a nursing unit. Such units encompassed a range of clinical settings, including medical-surgical units, intensive care units, and emergency rooms. The interview data were transcribed verbatim, and significant statements were extracted from abstract sentences to derive themes through an analytical process. RESULTS: Analysis of the work experiences of 23 mid-career nurses in medical institutions yielded 15 themes and 4 theme clusters derived from 353 meaningful statements. These theme collections were identified as 'Difficulties endured as a mid-career nurse', 'Meaningless and regrettable new graduate nurses' education', 'An inexpressibly poor work environment', and 'Systems and policies needed to remain in the hospital'. CONCLUSIONS: Difficulties faced by mid-career nurses including the establishment of an education and career development system, provisions for guaranteed leave, a diverse and flexible work system, opportunities for effective communication, and engagement with the opinions of mid-career nurses should promptly be addressed.

Calculating the optimal number of nurses based on nursing intensity by patient classification groups in general units in South Korea: A cross-sectional study.

AIM: This study aimed to calculate the total daily nursing workload and the optimal number of nurses per general unit based on the nursing intensity. DESIGN: This study was conducted using a cross-sectional study. METHODS: Three units at one general hospital were investigated. Patient classification according to nursing needs was performed for over 10 days in each unit in September 2018. The direct and non-direct nursing time and nursing intensity scores were analysed using descriptive statistics. RESULTS: For the internal medicine unit, the average direct nursing time per patient was 1.0, 1.5, 2.2 and 2.9 h for Groups 1, 2, 3 and 4, respectively. For the surgical unit, the average direct nursing time per patient was 0.9, 1.4, 2.1 and 2.6 h for Groups 1, 2, 3 and 4, respectively. 5 and 9 additional nurses were needed in the internal medicine and surgical nursing units. PATIENT CONTRIBUTION: This study confirmed that the optimal number of nurses was not achieved and that the nursing intensity was very high. Long-term efforts, such as improving the nursing environment, should be made to ensure an optimal number of nurses in various nursing units.

Development of a patient classification system for critical care nursing based on nursing intensity.

AIM: This study aimed to develop a valid and reliable new intensive care unit nursing classification tool, including direct and indirect nursing activities, by measuring the nursing intensity provided to patients. BACKGROUND: Prior tools primarily examine patients' medical records or disease severity/interactions, systematically failing to reflect comorbidity risk factors. DESIGN: The Delphi technique was used to test the content validity of the Korean Patient Classification System on Nursing Intensity for Critical Care Nurses (KPCSNIC). METHODS: Data were collected from four hospitals in two provinces from 26 December 2017 to 30 January 2018. To verify construct validity, staff nurses classified 365 patients, comparing differences by medical department and type of stay. To verify interrater reliability, data collectors and the head nurses of three intensive care units classified 87 patients. RESULTS: The KPCSNIC had 8 categories, 44 nursing activities and 105 criteria. Reliability was high (r = .84). Construct validity was verified by revealing differences according to medical department and type of patient. Using total scores, four KPCSNIC groups were identified. CONCLUSION: The KPCSNIC developed in this study can support staffing for nursing intensity by providing more specific evaluation criteria. Moreover, it reflects nursing intensity, including direct and indirect nursing activities.

[The Moderating Effect of Organizational Justice on the Relationship between Self-Efficacy and Nursing Performance in Clinical Nurses].

PURPOSE: This study aimed to examine the moderating effect of organizational justice on the relationship between self-efficacy and nursing performance among clinical nurses. METHODS: In January 2021, a cross-sectional survey was conducted with 224 clinical nurses recruited from a university-affiliated hospital in Suwon, South Korea. Participants completed online-based, self-report structured questionnaires. Collected data were analyzed using multiple regression and a simple model of PROCESS macro with a 95% bias-corrected bootstrap confidence interval. RESULTS: Self-efficacy and organizational justice were found to be significant predictors of nursing performance. These two predictors explained the additional 34.8% variance of nursing performance in the hierarchical regression model, after adjusting the other covariates. In addition, organizational justice moderated the relationship between self-efficacy and nursing performance among the clinical nurses. In particular, at low self-efficacy level, participants with high organizational justice had higher nursing performance compared to those with low organizational justice. CONCLUSION: Enhancing organizational justice can be used as an organizational strategy for improving the organizational culture in terms of distribution, procedure, and interaction. Ultimately, these efforts will contribute to the improvement of nursing performance through a synergistic effect on organizational justice beyond nurses' individual competency and self-efficacy.

Developing and testing a Korean patient classification system for general wards based on nursing intensity.

AIM: To develop a new general wards patient classification tool based on the nursing intensity level that reflects patients' clinical characteristics and indirect nursing activities. DESIGN: A cross-sectional design was adopted. This methodological study developed a patient classification system to sort general ward patients based on the intensity of their nursing needs and verified the validity and reliability of this classification system. METHODS: Thirteen experts verified the tools' content validity. Data collectors and head nurses classified 150 patients from two hospitals with four general wards and various nurse staffing levels. Inter-rater reliability was analysed. Staff nurses classified 846 patients following the Korean patient classification system on nursing intensity scores that reflected patients' clinical status. Content validity was verified based on the classification results. Using K-group cluster analysis, score ranges for four groups were identified. RESULTS: The developed tool includes 8 domains, (symptom management, infection control, nutrition and medication, personal hygiene and secretion, activity, sleep and rest, guidance in nursing/emotional support, nursing activity planning and coordination, indirect activity), 24 subdomains, 66 nursing activities and 124 criteria. Inter-rater reliability showed high agreement.

Integrative literature review of patient classification tools for nursing intensity evaluation: Focusing on comparison of South Korean and international tools.

AIM: This study aimed to review the literature on patient classification tools (PCTs) for assessing nursing strength and to compare South Korean and international tools. DESIGN: Integrative literature review. METHODS: We searched the relevant literature published from 2000-2017 in PubMed and two electronic databases in Korea in March 2017. Twenty-five published studies were reviewed. RESULTS: In most Korean studies, patients were classified by PCT, which were tested to ensure validity and reliability, followed by measurement of nursing time and development of the conversion index. In international studies, PCTs used were simpler than those in Korean studies; the results of estimation for optimum nurse staffing were reported. Most studies insufficiently reflected indirect nursing needs and patients' non-clinical factors. The current PCTs used in Korean studies inadequately reflect the reality of nursing field. Therefore, development of new PCTs reflecting nursing intensity based on direct and indirect nursing activities is necessary.

Effects of nursing power and organizational trust on nurse's responsiveness and orientation to patient needs.

Aim: To assess the relationship among perceived nursing group power, organizational trust and patient orientation and identify patient orientation predictors. Background: Nurses and nursing organizations should use all resources to give care. Methods: Survey data were collected from 193 nurses at six acute care hospitals in South Korea. Characteristics of hospitals and nurses were analysed using t tests, one-way ANOVAs and regression models. Results: The means for perceived nursing group power, organizational trust and patient orientation were 3.71 (SD± 0.58), 3.22 (SD± 0.83) and 3.94 (SD± 0.53), respectively. Multiple regression analysis revealed that 40% of the variance in patient orientation was explained by perceived nursing group power, organizational trust and work experience. Conclusion: Hospitals should increase nursing group power and improve organizational trust to enhance patient orientation. Hospital executives and nurse managers should work to enhance nursing group power and positive perceptions of organizational trust, which could contribute to patient orientation.

Turnover Rates and Factors Influencing Turnover of Korean Acute Care Hospital Nurses: A Retrospective Study Based on Survival Analysis.

PURPOSE: This study aimed to explore turnover rates for Korean acute care hospital nurses and identify factors influencing their turnover. METHODS: The study was retrospective in nature. Nurse cohort data were obtained from hospital status data from Korea's Health Insurance Review Assessment Service. The observation period was from January 1, 2012 to December 31, 2016, and data for 96,158 nurses were analyzed. Independent variables included nurses' age and sex and hospital setting, type, ownership, and nurse staffing level. Kaplan-Meier analysis was performed to estimate survival curves, and factors influencing turnover were analyzed using Cox's proportional hazard regression. RESULTS: The cumulative turnover probability for all nurses was .17, .29, .38, .45, and .50 for the first, second, third, fourth, and fifth years, respectively. The results showed that the longer the career duration, the lower the turnover rates. According to the factors influencing nurse turnover, both nurses' (i.e., sex and career duration) and hospitals' (i.e., hospital setting, type, ownership, and nurse staffing level) characteristics were statistically significant. CONCLUSION: It should be noted that the turnover rate of nurses with less than three year of career duration and of those with less than one year has been shown to be quite high. Therefore, target populations for acute care hospital nurse turnover should be expanded from new graduate nurses to experienced nurses with less than 3 years of career. Further studies are required to examine the causes of high turnover rates in hospitals that are small and/or have low nurse staffing levels.

Association of Working Hours and Patient Safety Competencies with Adverse Nurse Outcomes: A Cross-Sectional Study.

The environment of health organizations can determine healthcare quality and patient safety. Longer working hours can be associated with nurses' health status and care quality, as well as work-related hazards. However, little is known about the association of hospital nurses' working hours and patient safety competencies with adverse nurse outcomes. In this cross-sectional descriptive study, convenience sampling was employed to recruit 380 nurses from three tertiary care hospitals in South Korea. Data were collected using structured questionnaires from May to June 2016. Hierarchical linear regression analysis was used to identify the association of working hours and patient competencies with adverse nurse outcomes among 364 participants selected for analysis. Most nurses worked over 40 h/week. Working hours (ß = 0.202, p < 0.001) had the strongest association with adverse nurse outcomes. Low perceived patient safety competencies (ß = -0.179, p = 0.001) and frequently reporting patient safety accidents (ß = 0.146, p = 0.018) were also correlated with adverse nurse outcomes. Nursing leaders should encourage work cultures where working overtime is discouraged and patient safety competencies are prioritized. Further, healthcare managers must formulate policies that secure nurses' rights. The potential association of overtime with nurse and patient outcomes needs further exploration.

Core nursing competency assessment tool for graduates of outcome-based nursing education in South Korea: A validation study.

AIM: To develop a competency assessment instrument for nurses who have completed an outcome-based educational program based on national standards and to assess the content-, construct-, and criterion-related validity of that instrument. METHODS: In the development stage, the competencies of nurses with 1-3 years' clinical experience after the completion of nursing education and training programs, based on national standards, were identified. A systematic literature review was conducted to derive the competencies in addition to the 12 national standard competencies. In the evaluation stage, the content-, construct-, and criterion-related validity of the developed tool were verified. For verification of the content validity at each stage, the participants were 10 nurse managers of general hospitals and 10 nurse professors. A factor analysis was conducted to assess the construct validity and the Cronbach's alpha coefficients and item-total correlation were used to assess the reliability of the developed scale. For the factor analysis, the participants were 141 nurses with 1-3 years' clinical experience who were recruited from four general hospitals. In order to evaluate the construct- and criterion-related validity, the correlations between a nursing performance measurement scale, a self-leadership tool, and the developed scale were examined. RESULTS: A competency assessment instrument, consisting of 19 items on a 4-point scale, was developed and validated for assessing the competencies among nurses with 1-3 years' experience. CONCLUSIONS: Nursing research, policy awareness, and leadership competencies were required by the Korean Accreditation Board of Nursing Education for nursing college graduates, but were removed due to poor content validity, indicating a need for nursing professionals to bridge the gap between educational standards in nursing colleges and clinical settings.

The Relationships Among Perceived Patients' Safety Culture, Intention to Report Errors, and Leader Coaching Behavior of Nurses in Korea: A Pilot Study.

OBJECTIVES: This study was undertaken to explore the correlations among nurses' perceptions of patient safety culture, their intention to report errors, and leader coaching behaviors. METHODS: The participants (N = 289) were nurses from 5 Korean hospitals with approximately 300 to 500 beds each. Sociodemographic variables, patient safety culture, intention to report errors, and coaching behavior were measured using self-report instruments. Data were analyzed using descriptive statistics, Pearson correlation coefficient, the t test, and the Mann-Whitney U test. RESULTS: Nurses' perceptions of patient safety culture and their intention to report errors showed significant differences between groups of nurses who rated their leaders as high-performing or low-performing coaches. Perceived coaching behavior showed a significant, positive correlation with patient safety culture and intention to report errors, i.e., as nurses' perceptions of coaching behaviors increased, so did their ratings of patient safety culture and error reporting. CONCLUSIONS: There is a need in health care settings for coaching by nurse managers to provide quality nursing care and thus improve patient safety. Programs that are systematically developed and implemented to enhance the coaching behaviors of nurse managers are crucial to the improvement of patient safety and nursing care. Moreover, a systematic analysis of the causes of malpractice, as opposed to a focus on the punitive consequences of errors, could increase error reporting and therefore promote a culture in which a higher level of patient safety can thrive.

Hospital preferences of nursing students in Korea: a discrete choice experiment approach.

BACKGROUND: DCE was applied to investigate nursing students' preferred hospital choice criteria and to investigate the trends in the trade-offs by calculating the marginal rate of substitution between these criteria. This study identified the properties of the hospitals primarily selected by nursing students, and aims to estimate the monetary value of each attribute. METHODS: Based on discussions and in-depth interviews with nursing students' focus groups and a literature review, we created a discrete choice experiment (DCE) that assessed how students' stated preference for a certain hospital choice was influenced by various job attributes: higher salary, location, hospital type, salary per year, provision of a dormitory, etc. We applied this DCE to nursing students in South Korea using a brief structured questionnaire, and we used conditional logit models to estimate the utility of each job's attributes. Willingness to pay (WTP) was estimated as the ratio of the value of the coefficient of interest to the negative of the cost attribute. RESULTS: Complete data for the DCE analysis were available for 702 nursing students. In the main effect mixed logit model, the welfare system and organizational culture were most strongly associated with job preference. Location, hospital type, and opportunity to upgrade qualifications had a negative influence on hospital choice. The WTP threshold was 7,043,000 KRW for the welfare system and 9,928,000 KRW for the organizational culture (relation-oriented). CONCLUSIONS: Better nursing working conditions, such as a positive organizational culture and the provision of a welfare system, can improve the motivation and applications for hospitals in rural areas.

Mental Health and Coping Strategies among Medical Students.

PURPOSE: Recently, concern of the college students' mental health has increased due to their continuous psychologic problems such as suicidal attempt. This study aimed to examine the correlation among depression, stress, self-esteem, and coping strategies of the medical students and also according to the academic year. METHODS: The subject was 384 medical students of K medical school in Korea. Self-rating depression scale, stress scale, self-esteem scale was used for the survey, and academic stress and coping strategies of the students were asked. Frequency analysis, one-way ANOVA, t-test, correlation analysis was carried out. RESULTS: Third year students were under most stress (F=5.67, p=0.000) and had the most students who were moderately (22.9%) and mildly depressed (6.3%). Stress form academic studies and grade was also the highest in third year students. For English fluency, freshmen students scored the top. Academic career stress and school culture stress were higher for year 3, 4, 5, 6 than year 1, 2 students. Differences of the coping strategies by academic year was significant in emotional display. Students who showed high level of depression and stress, also students with low self-esteem used emotional display as their major coping strategy. CONCLUSION: Depending on their academic year medical students' level of depression and stress was different, and they did not use a variety of coping strategies. Therefore, a program which can give a diverse access to variety of coping strategies to relieve students' stress should be developed taking their characteristics of academic year into consideration.