A causal model of thriving at work in Chinese nurses.

AIM: To develop and test the first causal model of thriving at work in Chinese nurses. BACKGROUND: Nurses' ability to thrive at their work is critical to retain qualified nurses and meet the needs of a constantly changing health environment. However, this is a poorly researched area. INTRODUCTION: Thriving at work refers to the feeling of vitality and learning at work, which are evidenced to be solidly associated with nurses' development. Only a few factors have been explored regarding the effects of thriving at work. METHODS: A cross-sectional study was undertaken using stratified random sampling. This involved 565 nurses from five general hospitals in Dali city, Yunnan Province, People's Republic of China. Data were collected from April to September 2019 using seven instruments. The model was constructed and tested using the Analysis of Moment Structure program and reported using the STROBE checklist. RESULTS: All model variables provided direct and indirect effects to the outcome. The final model fitted the empirical data with acceptable indices. DISCUSSION: Predicting variables of workplace mindfulness, authentic leadership, workplace violence, organizational justice and years of experience were found to affect thriving at work directly and indirectly. Psychological capital and perceived organizational support mediated the effects between predicting variables to the outcome. CONCLUSION AND IMPLICATIONS FOR NURSING AND HEALTH POLICY: Recommendations for nursing and health leaders are provided to improve nurses' thriving at work by building fair, supportive, and safe working environments, improving head nurses' authentic leadership and cultivating nurses' mindfulness. Policies need to be promulgated to improve and regulate the nurse-patient ratio and to eliminate violence against Chinese nurses.

Nurses' extended work hours: Patient, nurse and organizational outcomes.

BACKGROUND: Nursing shortages have been associated with increased nurse workloads that may result in work errors, thus impacting patient, nurse and organizational outcomes. AIM: To examine for the first time in Thailand nurses' extended work hours (working more than 40 h per week) and its relationship to patient, nurse and organizational outcomes. METHODS: Using multistage sampling, 1524 registered nurses working in 90 hospitals across Thailand completed demographic forms: the Nurses' Extended Work Hours Form; the Patient, Nurse, Organizational Outcomes Form; the Organizational Productivity Questionnaire and the Maslach Burnout Inventory. The data were analysed using descriptive statistics, Spearman's rank correlation and logistic regression. RESULTS: The average extended work hour of respondents was 18.82 h per week. About 80% worked two consecutive shifts. The extended work hours had a positive correlation with patient outcomes, such as patient identification errors, pressure ulcers, communication errors and patient complaints and with nurse outcomes of emotional exhaustion and depersonalization. Furthermore, we found a negative correlation between extended work hours and job satisfaction as a whole, intent to stay and organizational productivity. Nurses who had extended work hours of >16 h per week were significantly more likely to perceive all four adverse patient outcomes than participants working an extended ≤8 h per week. LIMITATIONS: Patient outcomes were measured by respondents' self-reports. This may not always reflect the real occurrence of adverse events. CONCLUSIONS: Associations between extended work hours and outcomes for patients, nurses and the organization were found. The findings demonstrate that working two shifts (16 h) more than the regular work hours lead to negative outcomes for patients, nurses and the organization. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Our findings add to increasing international evidence that nurses' poor working conditions result in negative outcomes for professionals, patients and health systems. Policymakers need to be aware of the issues regarding nurses' extended work hours, which has been found to contribute to burnout. Urgently, nurse and health administrators need to develop and implement appropriate nursing overtime policies and strategies to help reduce this phenomenon, including measures to overcome the nursing shortage.