Impact of recurrent changes in the work environment on nurses' psychological well-being and sickness absence

AIM: This paper is a report of a study of how the occurrence and appraisal of recurrent changes in the work environment of hospital nurses affect psychological well-being (i.e. job satisfaction, eustress and distress) and absence through illness. BACKGROUND: Many researchers have demonstrated the impact of major organizational changes on employees' psychological well-being, but only a few have focused on the permanent consequences in work conditions. In a contemporary healthcare setting, an increased number of recurrent operational changes has become a normal characteristic of nurses' work environment. Specific work situations have frequently been associated with occupational stress, whereas employees' appraisal of recurrent changes as stressors and their relation to psychological well-being and health outcomes (i.e. sickness absence) have been dismissed. METHODS: A cross-sectional questionnaire survey was conducted in 2003 with 2094 Registered Nurses in 10 general hospitals. Logistic regressions were used to investigate the impact on psychological well-being and prospectively measured rates of sickness absence (frequency and duration). RESULTS: The occurrence of changes in the work environment (in the past 6 months) had had a negative impact on staff psychological well-being. Nurses who had been confronted with changes scored statistically significantly higher for distress. Changes appraised as threatening were negatively related to job satisfaction and eustress, and positively related to distress and sickness absence (frequency and duration). Changes appraised as challenging were positively related to job satisfaction and eustress but had no impact on distress and sickness absence. CONCLUSION: Future research should take into consideration the impact of the occurrence and appraisal of recurrent changes in the work environment of healthcare employees (i.e. Registered Nurses) on psychological well-being and sickness absence. This should also be considered by managers when dealing with these nursing workforce issues.     

The relationship of body mass index (BMI) to job performance,absenteeism and risk of eating disorder among hospital-based nurses

Obesity has been linked to job absenteeism and decreased job performance. Additionally, shift work may be related to abnormal eating in nurses. This study examines the relationship between body mass index, job performance, absenteeism, and eating disorder risk among nurses. Registered Nurses (n = 63) participated in a survey that included the Work Limitations Questionnaire and the Eating Attitudes Test. Most participants were either overweight or obese. Significant correlations were noted between body mass index and job performance, and body mass index and risk of eating disorders. An understanding of how increased body mass index can affect a nurse's job performance and wellness warrants continued attention from the nursing profession.     

心脏外科ICU护士道德困境、伦理决策、职业倦怠现状及其相关性分析

目的:探讨心脏外科重症监护室(ICU)护士道德困境、伦理决策、职业倦怠的现状并分析其相关性。方法:采用中文版护士道德困境量表、护士伦理决策量表和中文版护士职业倦怠量表对武汉市2所三级甲等医院的108名心脏外科ICU护士进行问卷调查。结果:心脏外科ICU护士道德困境总分为(66.46±35.81)分,伦理决策总分为(173.45±19.16)分,职业倦怠总分为(130.76±27.86)分。心脏外科ICU护士的道德困境与其职业倦怠呈正相关(r=0.312,P<0.05),护士伦理决策行动维度与其职业倦怠呈负相关(r=-0.258,P<0.05),且护士的伦理决策与其道德困境呈负相关(r=-0.232,P<0.05)。结论:心脏外科ICU护士的道德困境和伦理决策中的行动维度与其职业倦怠密切相关,且护士的伦理决策与其道德困境也存在明显相关性。护理管理者应该重视心脏外科ICU护士在工作中面临的各种道德困境问题,同时建议护理管理者从多个方面来培养和提高心脏外科ICU护士的伦理决策能力,从而减轻其职业倦怠。     

Nursing staff mix models and outcomes

BACKGROUND: Recently, restructuring of the nursing workforce has been undertaken in a number of countries in an effort to provide efficient and cost-effective services to users. This often takes the form of the introduction of unregulated workers to carry out support roles with registered nurses. However, these changes have not been evaluated for efficacy or impact on nurses, patients or the health care system. PURPOSE: The purpose of this study was to determine the relationship between staff mix models comprising regulated staff (Registered Nurses and Registered Practical Nurses) or regulated and unregulated staff (Registered Nurses and unregulated workers), and nursing and quality outcomes. METHODS: This comparative correlational study was conducted in a random sample of 30 adult, acute care patient units within eight hospitals located in Toronto, Canada. Registered Nurses employed on 30 randomly selected hospital units, grouped by the two staff mix models (15 units per group), were surveyed using previously validated instruments to measure role conflict, role ambiguity, job satisfaction, perceived effectiveness of care and perceived quality of care. RESULTS: Results indicated that Registered Nurses in this study experienced high levels of role conflict, regardless of the type of staff mix model within which they worked. Registered Nurses on units employing both Registered Nurses and unregulated workers reported higher levels of job satisfaction. On units employing both Registered Nurses and unregulated workers, Registered Nurses perceived that the quality of care was lower. CONCLUSIONS: Staff mix model was related to Registered Nurses' perceptions of the quality of patient care. It was also evident that other variables within the work environment might have more influence on the outcomes examined than the independent variable of staff mix.     

Nursing scope of practice: descriptions and challenges

The nursing workforce is faced with shortages of near crisis proportions, yet little is understood about the optimal utilization of various categories of nurses - Licensed Practical Nurses (LPNs), Registered Nurses (RNs) and Registered Psychiatric Nurses (RPNs). The primary purpose in this study was to elicit the perceptions of nurses (RNs, LPNs, and RPNs) of what "working to full scope of practice" meant to them. Participants included acute care nurses in three health regions in western Canada. A key finding from the study was the fact that nurses most often discussed scope of practice by reference to the tasks they perform, rather than the roles they play in healthcare delivery. Assessment and coordination of care were two components of nursing work that most differentiated the three nursing roles. Nonetheless, insufficient role differentiation among nurses and between nurses and other healthcare professionals leaves some nurses feeling devalued and not respected for their contribution to healthcare delivery.     

Nursing workforce utilization: an examination of facilitators and barriers on scope of practice

Several reports have highlighted the need to address underutilization of health human resources, but barriers to and facilitators of role optimization for nurses are poorly understood. The purpose in this study was to understand the perceptions of nurses - Licensed Practical Nurses (LPNs), Registered Nurses (RNs) and Registered Psychiatric Nurses (RPNs) - of the extent to which they can work to full scope of practice and identify barriers and facilitators in optimizing their roles. As part of a mixed-methods study, semi-structured interviews were conducted with 167 acute care nurses (RNs, LPNs, RPNs and nurse managers) in three western Canadian health regions. Approximately 48% of all nurses interviewed felt they were working to full scope, at least some of the time. Barriers to working to full scope included heavy workload, high patient acuity, lack of time, poor communication and ineffective teamwork. Identified facilitators were working as a team, management and leadership support and support for continuing education. Barriers need to be addressed in light of nursing shortages, as these are closely related to job satisfaction and directly affect the retention and recruitment of all groups of nurses. Policies and strategies based on these findings must be developed to ensure that nurses can work to their full scope of practice.     

Depression in a pediatric intensive care unit nursing staff

This study compared the depressive symptoms of 36 ICU nurses to 23 non-ICU nurses. The study was conducted in a pediatric setting where critically ill children may present unique demands. The ICU nursing staff had a significantly higher frequency (28%) of symptoms consistent with a depressive disorder than either the age group norm (12%) or the non-ICU nurses (13%). This finding suggests a continued need for investigation into the stresses associated with the delivery of critical care.     

Reviewing nursing stress according to a proposed coping-adaption framework

Is stress a common problem for nurses who work in intensive care units (ICUs)? Stress-coping theory is useful in analyzing ineffective coping and its outcome, burnout. This article compares stress among nurses in ICUs to stress in non-ICU nurses. Effects of stresses, such as nursing dissatisfaction and the loss of nurses to the profession, will be discussed. Research and commentaries regarding stress in ICU nurses v non-ICU nurses will be reviewed. Areas for future research will be presented.     

Career trajectories of nurses leaving the hospital sector in Ontario, Canada (1993–2004)

Title.  Career trajectories of nurses leaving the hospital sector in Ontario, Canada (1993–2004).
Aim.  This paper is a report of an analysis of the career trajectories of nurses 1 year after leaving hospitals.
Background.  Although hospitals are traditionally the largest employers of nurses, technological advances and budgetary constraints have resulted in many countries in relative shrinkage of the hospital sector and a shift of care (and jobs) into home/community settings. It has been often assumed that nurses displaced from hospitals will move to work in the other workplaces, especially the community sector.
Method.  Employment patterns were tracked by examining a longitudinal database of all 201,463 nurses registered with the College of Nurses Ontario (Canada) between 1993 and 2004. Focusing on the employment categories Active (Working in nursing), Eligible-Seeking nursing employment or Dropout from the nursing labour market, year-to-year transition matrixes were generated by sector and sub-sector of employment, nurse type, age group and work status.
Findings.  For every nurse practising nursing in any non-hospital job or in the community a year after leaving hospitals, an average of 1·3 and four nurses, respectively, dropped out of Ontario's labour market. The proportion of nurses leaving hospitals transitioning to the Dropout category ranged from 63·3% (1994–95) to 38·6% (2001–02). The proportion dropping out of Ontario's market was higher for Registered Practical Nurses (compared to Registered Nurses), increased with age and decreased with degree of casualization in nurses' jobs.
Conclusion.  Downsizing hospitals without attention to the potentially negative impact on the nursing workforce can lead to retention difficulties and adversely affects the overall supply of nurses.     

The relationship between supervisor support and registered nurse outcomes in nursing care units

Workplace social support is a major characteristic related to the Job Demand-Control model of job stress. Organizational and managerial support have an effect on nurse satisfaction and burnout. The relationships between perceived supervisor support and measures of nurse occupation-related outcomes were investigated in 3 nursing units within an academic medical center. Nurses with greater levels of perceived supervisor support experienced more positive job outcomes and less negative outcomes, including less occupational stress, than nurses with less perceived supervisor support. Implications for refocusing the role of the nurse supervisor and its effect on multiple nursing occupation-related outcomes are discussed.     

合作单元式责任制护理方式对护士工作满意度的影响

目的:探讨合作单元式责任制护理方式对护士工作满意度各维度的影响及其影响程度,为提高护士工作满意度,稳步推进优质护理服务提供依据。方法:采用护士工作满意度量表对该院8个优质护理服务示范病房117名护士在开展合作单元式责任制护理之前和之后4个月分别进行问卷调查。结果:8个优质护理示范病房护士工作满意度总分由原来的(2.85±0.44)分上升至(3.02±0.44)分,满意率由30.8%上升至49.6%(P<0.01),其中护士对排班制度、同事关系、社会和专业交流机会、工作被称赞或认可、工作的控制与决策5个维度的满意度得分均有所提高,差异有统计学意义(P<0.05)。护士工作满意度影响回归系数:排班制度为0.446,社会和专业交流机会为0.323,工作被称赞或认可为0.236,工作控制与决策为0.199,同事关系为0.120。结论:通过改变护理工作模式,实施合作单元式责任制护理可以提高护士工作满意度。     

Communication enhancement: nurse and patient satisfaction outcomes in a complex continuing care facility

AIMS: This paper presents an evaluation of a communication enhancement intervention on staff and patients in a complex continuing care facility. BACKGROUND: The importance of effective communication as a fundamental element of nursing has been emphasized and is regarded as integral to the provision of quality patient care. For people residing in complex continuing care (similar to long-term care facilities), opportunities for socialization occur primarily during interactions or communication with staff, and these interactions have been found to be limited. One way to improve nursing staff communication is through a communication enhancement intervention. METHODS: Twenty-one nursing staff members (Registered Nurses, Registered Practical Nurses and healthcare aides) working in a complex continuing care environment and 16 patients participated in this study, conducted in the summer of 2003. A repeated measures design was used to evaluate the effects of the communication enhancement intervention on outcomes. Data were collected from patients and nurses at baseline, 5 weeks into the intervention and at 10 weeks after the intervention. Nurse outcome variables included nurses' job satisfaction and their relationships with patients; patient outcome variables included two measures of patient satisfaction with care. RESULTS: Nursing staff felt closer to their patients (F(2,40) = 3.0, P = 0.045) following the intervention and reported higher levels of job satisfaction (F(2,40) = 4.1, P = 0.02). No changes were found in the level of patient satisfaction with care. CONCLUSIONS: Our results suggest that nursing staff can feel better about their job and about their patients as they enhance their communication skills. Understanding the barriers to finding time to talk with patients for a few minutes a day, outside of direct hands-on caregiving, requires further exploration.     

The Basic Knowledge Assessment Tool: Is It Useful?

Registered Nurses (RN's) caring for the critically ill, require a wide range of specialised skills and knowledge. Assessing knowledge of RN's within Intensive Care Units (ICU's) is imperative if we are to ensure that patients are afforded quality care. The aim of this study was to evaluate existing knowledge of the RN's working in the ICU of a major teaching hospital using the Basic Knowledge Assessment Tool (BKAT).Overall mean test scores of 78% were encouraging. Knowledge gaps were evident in gastrointestinal and endocrine disorders. Significantly higher scores were obtained by RN's trained in the hospital based system (p=0.02) and those possessing ICU qualifications (p=0.01). There were no differences in scores according to age and length of ICU experience. Registered nurses scored badly in a number of questions, which highlighted some problems in the terminology used in the BKAT.     

综合医院重症监护病室护士工作满意度的调查

目的了解重症监护病房护士的工作满意度情况，提出医院护理管理对策。方法采用深度访谈法搜集9例个案资料，访谈结束后及时将录音资料转化为文字资料，并将资料组织为对研究现象有意义、个体化的解释；提出医院对所士加强管理的对策和措施。结果重症监护病房护士认为工作满意度主要受以下3方面影响：（1）工作量大，护士们感觉身心疲惫；（2）工作压力大；（3）特殊工作环境的影响。提出加强管理的措施：（1）医院管理者在制定政策上给予关注；（2）根据重症监护室提高护士福利待遇，护理工作的特点进行任务的分配和工作内容的设计；（3）减轻工作负担；（4）完善重症监护室护士的选拔制度，增加专业护士的培训；（5）重视护士职业生涯的规划；（6）增加护士与患者及管理层的沟通。结论工作量大、压力大及特珠工作环境是影响重症监护病房护士工作满意度的主要因素，管理者应关注这个特殊职业群体，采用科学的人力资源管理策略稳定并发展护士队伍。     

快速评分派班法在ICU护理人力资源管理中的应用

目的：探讨重危评分法在重症监护病房护理人力资源管理中应用的方法和意义。方法：通过自制评价量表（分为成人量表和儿童量表）,对某三级甲等教学医院ICU的600名危重病人进行评价,根据得分情况,按级别安排不同比例的看护护士,再统计病人满意度、ICU滞留时间、护士满意度,与以往对比。结果：评价结果中中度病人居多,占49．3％,其次为轻度,占45％;病人满意率由2008年7-9月份的94％提升到10～12月份的99％。病人ICU滞留时间由4．2±3．6天缩减到3．7±2．4天。在对该科室25名护士的工作满意度调查中,认为工作时过于疲劳者由40％减少到8％。结论：本研究可实现合理排班、合理使用人力资源,保证护理质量,缩短病人ICU滞留时间。     

Registered Nurses' perceptions of geriatric rehabilitation nursing in three Scandinavian countries

This study describes Registered Nurses' perceptions of geriatric rehabilitation nursing as well as their experiences of working in the rehabilitation of older patients in Denmark, Finland and Norway. The aim was to gain deeper insights into how Registered Nurses think about geriatric rehabilitation nursing and how their perceptions differ in these countries. The data were collected among 600 Registered Nurses using a structured questionnaire with five background items and 88 geriatric rehabilitation nursing items. The response rate was 65%. Data analysis was with SPSS statistical software. Geriatric rehabilitation nursing was experienced as something that required knowledge and experience, patience and creativity, as well as professional skills. The nurses talked with their patients about their rehabilitation goals, but not all nurses were aware of those goals. Progress in the rehabilitation process was evaluated on a daily basis and results were noted in the patients' records. The nurses motivated patients by giving them positive feedback, by preventing pain, by pausing to share with the patients their joy about progress, and by giving the patients the opportunity to cope with daily activities. The Registered Nurses in Denmark were more team oriented and they set out the goals in the patient's records more often than their colleagues did in Finland and Norway.     

成都地区三所三级甲等综合医院ICU与非ICU护士对机械通气病人照护行为意向的研究

目的对成都地区三所三级甲等综合医院ICU与非ICU护士对机械通气病人照护行为意向进行比较,为相关的护士培训提供依据。方法应用《护士对照护机械通气病人的行为态度、主观行为规范和行为意向》量表的中文修订版,对近三个月内照护过机械通气病人的ICU与非ICU护士进行测评,比较两组护士照护机械通气病人的行为态度、主观行为规范和行为意向间的差异。结论ICU与非ICU护士照护机械通气病人的行为态度(P>0.05)和主观行为规范(P>0.05)差异无显著性意义,行为意向(P<0.05)差异有显著性意义,ICU护士的行为意向优于非ICU护士。