Impact of the Work Environment on Nurse Outcomes: A Mediation Analysis.

BACKGROUND: The nursing workforce remains in a vulnerable state post pandemic as working conditions are difficult and exacerbated by a global nursing shortage. Identifying factors leading to turnover intentions are thus critical for health care system recovery. PURPOSE: The purpose of this study was to examine the impact of nurses' work environment and the pandemic on missed nursing care, scope of practice, emotional exhaustion, and intent to leave. METHODS: This study was a cross-sectional, self-reporting online survey, sent to hospital-based nurses in a Canadian province (n = 419). Mediation analysis was used to examine both direct and indirect effects of work environment and COVID-19 impact on nurse outcomes (emotional exhaustion and intent to leave) through missed care and scope of practice. RESULTS: The results showed that 73% of nurses were considering leaving the profession. Several direct and indirect pathways predicted emotional exhaustion and intent to leave. A better work environment was related to both decreased emotional exhaustion and intent to leave. Nurses' scope of practice partially mediated the relationship between work environment and intent to leave. On the other hand, missed care did not mediate emotional exhaustion or intent to leave. CONCLUSIONS: While considering the global nursing shortage, it is imperative to implement strategies to promote nurses' well-being and their retention within the health care system.

Job Characteristics, Emotional Exhaustion, and Work-Family Conflict in Nurses.

The purpose of this study is to identify whether emotional exhaustion, a component of burnout, mediates the relationship between job demands, job resources, and work-family conflict (WFC). A cross-sectional design was used with survey data. A total of 1,202 nurses in eastern Canada participated in this study. Data were collected via an online survey and analyzed using mediation analysis. The results indicated that job demands and emotional exhaustion predicted WFC. Moreover, emotional exhaustion partially mediated the relationship between job demands, supervisor support, and WFC. This model also showed that younger nurses had increased WFC. Our study indicates that there are several direct and indirect pathways leading to WFC. Moreover, workplace resources can reduce emotional exhaustion, which, in turn, may help maintain work-family balance in nurses. These findings contribute to the existing knowledge on the precursors and consequences of burnout symptoms.

A critical incident study of ICU nurses during the COVID-19 pandemic.

BACKGROUND: Intensive care unit nurses are providing care to COVID-19 patients in a stressful environment. Understanding intensive care unit nurses' sources of distress is important when planning interventions to support them. PURPOSE: To describe Canadian intensive care unit nurse experiences providing care to COVID-19 patients during the second wave of the pandemic. DESIGN: Qualitative descriptive component within a larger mixed-methods study. PARTICIPANTS AND RESEARCH CONTEXT: Participants were invited to write down their experiences of a critical incident, which distressed them when providing nursing care. Thematic analysis was used to analyze the data. ETHICAL CONSIDERATIONS: The study was approved by the ethics committee at the researchers' university in eastern Canada. RESULTS: A total of 111 critical incidents were written by 108 nurses. Four themes were found: (1) managing the pandemic, (2) witness to families' grief, (3) our safety, and (4) futility of care. Many nurses' stories also focused on the organizational preparedness of their institutions and concerns over their own safety. DISCUSSION: Nurses experienced moral distress in relation to family and patient issues. Situations related to insufficient institutional support, patient, and family traumas, as well as safety issues have left nurses deeply distressed. CONCLUSION: Identifying situations that distress intensive care unit nurses can lead to targeted interventions mitigating their negative consequences by providing a safe work environment and improving nurses' well-being.

The long-term effects of psychological demands on chronic fatigue.

AIM: Investigate the impact of psychological job demands and resources on chronic fatigue. BACKGROUND: Nurse fatigue is a serious problem with negative consequences on patient safety and nurse well-being. Excessive job demands can exacerbate nurse fatigue, which may limit the ability of nurses to engage in professional practice. METHODS: This two-wave study was carried out with a self-report questionnaire administered to nurses in eastern Canada (n = 154). Cross-lagged analysis using structural equation modelling was conducted to examine the interactions between psychological job demands, resources and chronic fatigue over time. RESULTS: Results showed that psychological job demands predicted chronic fatigue a year later. Nonetheless, job resources (decision latitude, social support) did not buffer the relationship between psychological job demands and chronic fatigue 1 year later. CONCLUSIONS: Psychological demands have a long-term effect on chronic fatigue, thus interventions to mitigate fatigue are needed. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers should be aware of the cumulative effects of chronic fatigue and implement strategies to create a better balance between job demands and resources in the workplace.

The impact of long work hours and shift work on cognitive errors in nurses.

AIM: Pilot study to examine the impact of long work hours and shift work on cognitive errors in nurses. BACKGROUND: Twelve-hour shifts are more commonly used in hospital settings and there is growing concern over the impact that extended and irregular work hours have on nurses' well-being and performance. METHOD: Twenty-eight nurses working different shifts (8-hr days and 12-hr rotation) participated in this study. Nurses were assessed at the beginning of four consecutive shifts using actigraphy, a sleep diary and an after work questionnaire. RESULTS: Nurses working 12-hr rotations had less total sleep time and less sleep efficiency than 8-hr day nurses. Twelve-hour rotation nurses also napped more than their counterparts. There were no differences between the two groups with respect to cognitive errors. CONCLUSIONS: Twelve-hour rotations have a negative effect on nurses' sleep patterns. There is no evidence indicating 12-hr rotations increased errors. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers can implement specific strategies, such as greater shift work flexibility and designated quiet time, to reduce the effects of disturbed sleep patterns in nurses.

Starting Out: qualitative perspectives of new graduate nurses and nurse leaders on transition to practice.

AIM: To describe new graduate nurses' transition experiences in Canadian healthcare settings by exploring the perspectives of new graduate nurses and nurse leaders in unit level roles. BACKGROUND: Supporting successful transition to practice is key to retaining new graduate nurses in the workforce and meeting future demand for healthcare services. METHOD: A descriptive qualitative study using inductive content analysis of focus group and interview data from 42 new graduate nurses and 28 nurse leaders from seven Canadian provinces. RESULTS: New graduate nurses and nurse leaders identified similar factors that facilitate the transition to practice including formal orientation programmes, unit cultures that encourage constructive feedback and supportive mentors. Impediments including unanticipated changes to orientation length, inadequate staffing, uncivil unit cultures and heavy workloads. CONCLUSIONS: The results show that new graduate nurses need access to transition support and resources and that nurse leaders often face organisational constraints in being able to support new graduate nurses. IMPLICATIONS FOR NURSING MANAGEMENT: Organisations should ensure that nurse leaders have the resources they need to support the positive transition of new graduate nurses including adequate staffing and realistic workloads for both experienced and new nurses. Nurse leaders should work to create unit cultures that foster learning by encouraging new graduate nurses to ask questions and seek feedback without fear of criticism or incivility.

The changing boundaries of nursing: a qualitative study of the transition to a new nursing care delivery model.

AIMS AND OBJECTIVES: To explore how nursing personnel have experienced the introduction of a new nursing care delivery model within their setting. BACKGROUND: New ways of nursing care are being implemented in many countries to contain rising health care costs and deal with ongoing nursing shortages. The adoption of new nursing care delivery models will have a substantial impact on the nature of nursing practice. DESIGN: A qualitative design was used for this study. Symbolic interactionism was used as a guiding framework. METHODS: Semi-structured interviews were held with 20 nurses (17 registered nurses and 3 ancillary nursing personnel) in two hospitals in eastern Canada following the introduction of a new nursing care nursing model. The constant comparative method was used to analyse interview data. RESULTS: Four themes emerged from the data: (1) the ownership of tasks, (2) managing the workers, (3) a different way of knowing the patient and (4) the struggle to change. CONCLUSIONS: Nursing boundaries were flexible, regardless of the implementation of a new nursing care delivery model. Nursing tasks shifted from one group of workers to another during the course of the day to meet patient needs. RELEVANCE TO CLINICAL PRACTICE: This study highlights the challenges in relation to the introduction of new nursing care delivery models within hospital settings.

Discrimination of differentially inhibited cysteine proteases by activity-based profiling using cystatin variants with tailored specificities.

Recent research has shown the possibility of tailoring the inhibitory specificity of plant cystatins toward cysteine (Cys) proteases by single mutations at positively selected amino acid sites. Here we devised a cystatin activity-based profiling approach to assess the impact of such mutations at the proteome scale using single variants of tomato cystatin SlCYS8 and digestive Cys proteases of the herbivorous insect, Colorado potato beetle, as a model. Biotinylated forms of SlCYS8 and SlCYS8 variants were used to capture susceptible Cys proteases in insect midgut protein extracts by biotin immobilization on avidin-embedded beads. A quantitative LC-MS/MS analysis of the captured proteins was performed to compare the inhibitory profile of different SlCYS8 variants. The approach confirmed the relevance of phylogenetic inferences categorizing the insect digestive Cys proteases into six functionally distinct families. It also revealed significant variation in protease family profiles captured with N-terminal variants of SlCYS8, in line with in silico structural models for Cys protease-SlCYS8 interactions suggesting a functional role for the N-terminal region. Our data confirm overall the usefulness of cystatin activity-based protease profiling for the monitoring of Cys protease-inhibitor interactions in complex biological systems. They also illustrate the potential of biotinylated cystatins to identify recombinant cystatin candidates for the inactivation of specific Cys protease targets.

Workplace experiences of new graduate nurses.

Many new graduate nurses find the first year of work stressful and, because of this, consider leaving their employer early in their career. The purpose of this study is to describe new graduate nurses' experiences during their first year of practice and to explore factors that may lead them to consider leaving their employer. We held semi-structured interviews with 23 new graduate nurses in New Brunswick. Five themes emerged from the data: surviving the first months; induction into the hospital culture; struggling to maintain a balance; being a nurse: assuming a professional role; and strategic choices: looking at the future. The findings suggest that the first year at work continues to be difficult for new graduates. Several participants changed jobs during their first year, and several others were seriously considering leaving. This study provides a more comprehensive understanding of the reasons new graduate nurses decide to leave and describes strategies that may assist in retaining this important group of healthcare providers.

Understanding intention to leave amongst new graduate Canadian nurses: a repeated cross sectional survey.

BACKGROUND: Previous studies indicate that new graduate nurses' first year of work is both stressful and difficult. The turnover rate of this group is particularly high. There is a need to increase our understanding of why new graduate nurses intend to leave their current employer. OBJECTIVES: The purpose of this study is to examine what proportion of new graduate nurses intends to leave their current position and to examine the relationship between transition programs, empowerment, work environment and intent to leave. DESIGN: Survey data was collected with new graduate nurses over a 5-year period, beginning in 2004 and ending in 2008. A total of 348 new graduate nurses were surveyed in eastern Canada. RESULTS: The results showed that 49.6% of the new graduate nurses did not intend to leave their current employer, whereas 4.9% were definitely planning to leave and 45.5% expressed different levels of uncertainty. Regression analysis indicated that a component of the work environment, foundations for quality nursing care, and a component of psychological empowerment, goal internalization explained, 24% of the variance of intent to leave. CONCLUSION: This study provides a more comprehensive understanding of factors that influence intent to leave. It also supports the importance of a good working environment for the retention of new graduate nurses.

Nurse migration to Canada: pathways and pitfalls of workforce integration.

Many internationally educated nurses (IENs) find it difficult to reinstate themselves in their profession after migration. This article explores factors contributing to the success and failure of IENs to reestablish professional careers. The article discusses a study involving 39 IENs in 5 focus groups and 10 interviews. In all, 29 interviews are held with other stakeholders. IENs encounter obstacles at each stage of the migration process. New strategies are required to assist IENs to reenter the workforce. Given the consistent predictions of an extreme nurse shortage, it is important that the brain waste of immigrant nurses be minimized.

The impact of health care restructuring and baccalaureate entry to practice on nurses in New Brunswick.

Health care restructuring during the 1990s resulted in major changes in the way nurses' work is defined and implemented. The adoption of the baccalaureate degree as basic preparation for entry into nursing has further complicated the lives of nurses. The purpose of this qualitative study is to explore the impact of health care reforms and changing educational requirements on nurses in New Brunswick, Canada. Sixty-three nurses representing different practice settings were interviewed and three focus groups were held with the nurses that were interviewed. Study findings indicate that nurses' practice has changed as a result of the reforms. Nurses give less direct care to patients and have taken on a greater administrative role. The requirement of a baccalaureate degree for entry to practice has placed a strain on working relationships between older and younger nurses, accentuating differences in working knowledge and work ethic among these groups.

Establishing consensus about the baccalaureate entry-to-practice policy.

This article is based on the results of a qualitative study examining educational reforms in New Brunswick, Canada, during the 1980s. Using the province of New Brunswick as a case study, three issues related to the baccalaureate entry-to-practice policy are examined. First, the process of upgrading nursing education to a baccalaureate degree and the conflict this change created between the Nurses Association of New Brunswick and the New Brunswick Nursing Union are described. Second, the reasons leaders of the professional nursing organization desired to upgrade nursing education are examined, and third, the issues underlying the conflict over nursing education are discussed.

The changing division of labour between nurses and nursing assistants in New Brunswick.

BACKGROUND: In 1989, the professional nursing organization that represents nurses in New Brunswick adopted baccalaureate entry to practice in nursing. This decision coincided with a major restructuring of provincial health care. Consequently, there has been a reorganization of health care worker roles which affects nurses and nursing assistants. AIM: This paper explores the changing division of labour between nurses and nursing assistants in the province of New Brunswick, Canada. METHODS: The study used archival material, from the period 1978-1990, of three nursing organizations that played a significant role in initiating baccalaureate entry to practice. Interviews with 19 key people involved in the decision to upgrade nurse education were conducted. Data from the archival material and interviews were analysed jointly. FINDINGS: There are ongoing tensions between nurses and nursing assistants. Although nurses would like a support worker, they remain ambiguous about the role of nursing assistants in health care and which tasks should be delegated to this group. Nursing leaders are concerned about the ease with which some patient-related tasks are moved to nursing assistants. In the past, these concerns have led nursing leaders to attempt to limit nursing assistant responsibilities through both legislative means and ways of organizing nursing labour (primary nursing). As a result of health care reforms and baccalaureate entry to practice for nurses, nursing assistant responsibilities are currently expanding. CONCLUSION: Upgrading nurse education, which came into effect in 1996 with the closure of diploma schools in New Brunswick, is likely to entrench the role of nursing assistants in health care because of the economic value of their work during a period of restructuring and rationalization of health care.