Work Environment: Training Nursing Managers to Change Operational Practice

Objective To explore the chief nurses' integrity leadership, the nurses' work environment, the current status of the new job nurses' adaptation level, and analyze the relevance, to provide a basis for targeted new nurse training. Methods The newly recruited nurses from totally 4 Class Ⅲ hospitals in Wenzhou were selected by convenient sampling and investigated with the general information questionnaire, Chief Nurses' Integrity Leadership Scale, Nurse Work Environment Scale and Chinese Work Adjustment Scale between June and September 2018. Totally 296 questionnaires were distributed, and 282 of them were collected, with a successful collection rate of 95.27%. Results The work adjustment, chief nurses' integrity leadership and work environment in the 282 newly recruited nurses totaled (61.36±8.95) , (40.09±9.53) and (100.50±12.35) , respectively. Chief nurses' integrity leadership behavior and work environmental scores were positively correlated with work adjustment scores (P<0.05) . Multivariate linear regression analysis showed that chief nurses' leadership behavior and nurses' work environment and educational background were the influencing factors to the work adjustment of the newly recruited nurses (P<0.01) . Conclusions The work adjustment scores of newly recruited nurses are at low levels. Chief nurses' leadership behavior and nurses' work environment and educational background were the influencing factors to the work adjustment of newly recruited nurses, indicating that clinical nursing managers should take measures to improve chief nurses' integrity leadership behavior as well as nurses' work environment in order to improve the work adjustment of newly recruited nurses and ensure the quality of clinical nursing service. Key words: Nurses; Newly recruited nurses; Integrity leadership; Work environment; Work adjustment

Starting Now: Implementing the Healthy Work Environment Standards Is More Important Than Ever

Introduction: The increasing emphasis on creating healthy work environments is driven by their impact on both nurse and patient outcomes. Previous evidence has established a link between supportive nursing leadership and work environments, but demographic characteristics have not been adequately explored. This study aims to investigate whether demographic variations among nurses influence their perceptions of supervisory support and work environment. Methods: Secondary data analysis of a cross-sectional quantitative survey was utilized to recruit registered nurses employed in a government-owned and corporate-controlled (GOCC) tertiary hospital in the Philippines from September 2022 and October 2022. The primary data were collected through a demographic questionnaire, the validated Supervisory Support Scale tool, and the American Association of Critical-Care Nurses’ Healthy Work Environment Assessment Tool. Inferential analyses were employed to examine differences between study variables. Data processing was performed using Microsoft Excel 2022 and the R program, with a significance level set at 0.05. Results: The original dataset with a sample of 519 registered nurses was predominantly composed of non-married female nurses with bachelor’s degrees and varying clinical experiences. The secondary data analysis revealed no significant differences in work environment and supervisory support perceptions in relation to nurses’ demographic characteristics. Conclusions: This study provides critical insights into the Philippine nursing workforce literature by demonstrating that nurses’ demographic variations alone do not significantly influence their supervisory support and work environment perceptions. These results suggest that shifting the focus to broader factors beyond demographic variations among nurses may play a more critical role in shaping nurses’ work environment and supervisory support perceptions. Future research should explore the potential intersection of systemic factors such as leadership competencies, psychological safety, and workplace policies in shaping the nursing workforce dynamics.

Background: The nursing work environment is complex with many variables affecting the nurses' perception and work satisfaction. The strongest predictor of nurse's job dissatisfac-tion and intent to leave a job is personal stress related to the practice environment. Negative work environments demoralize nurses and contribute to the development of unsafe working conditions, which are unhealthy and highly associated with nursing job dissatisfaction, low productivity, and high turnover. High nurse turnover in healthcare facilities can negatively affect the ability of hospitals to meet patient needs, provide quality care and increases both direct and indirect labor costs. Aim of Study: To explore the impact of nursing staff perception of work environment on turnover rate in hemodi-alysis unit. Subjects and Methods: A descriptive correlational design was utilized to collect data from A convince sample of nursing staff working in the selected unit (hemodialysis unit) during the time of data collection (from May to September 2017) at a governmental University hospital. Data was collected by using two tools: The Practice Environment Scale-Nursing Work Index (PES-NWI) questionnaire and turnover rate sheet. Results: There were no significant relation between nursing staff perception of work environment and educational level, there were a high positive relation between nurses perception of work environment and years of experience and there were dramatically increase of turnover rate over the years. Conclusion: Poor nurse work environment is the under-lying factor of nursing turnover. Recommendation: Improving nurse work environment should be emphasized through policy to retain nurses in the workforce; Further research is needed to investigate the tools, guidelines and interventions used by managers in the nursing field to create healthy and welcoming working conditions.

The aim of the present study was to determine whether there are differences in hospital characteristics, nursing unit characteristics, the nurse work environment, job satisfaction and turnover rates in rural and urban nursing units. Research in urban hospitals has found an association between the nurse work environment and job satisfaction and turnover rates, but this association has not been examined in rural hospitals. Rural and urban nursing units were compared in a national random sample of 97 United States hospitals (194 nursing units) with between 99 and 450 beds. Significant differences were found between hospital and nursing unit characteristics and the nurse work environment in rural and urban nursing units. Both nursing unit characteristics and the work environment were found to have a significant influence on nurse job satisfaction and turnover rates. Job satisfaction and turnover rates in rural and urban nursing units are associated with both nursing unit characteristics and the work environment. Both rural and urban hospitals can improve nurse job satisfaction and turnover rates by changing unit characteristics, such as creating better support services and a work environment that supports autonomous nursing practice. Rural hospitals can also improve the work environment by providing nurses with more educational opportunities.

Nurse burnout and low job satisfaction are main reasons that cause nurses to leave their current position. Improving the nursing work environment may reduce the severity of job burnout and of job dissatisfaction and thus decrease the turnover intention of nursing staff. The aim of this study was to explore the correlation between the nursing work environment and the outcome variables of burnout, job satisfaction, and turnover intention in the western region of Mainland China. This is a cross-sectional descriptive study. Survey data were collected between February and December 2012 from 1,112 clinical nurses working at 83 medical, surgical, and intensive care units in 20 hospitals across the western region of Mainland China. Multistage sampling was conducted on some of the participants. The research instruments that were used included the Practice Environment Scale of the Nursing Work Index, Maslach Burnout Inventory, Nurse Job Satisfaction Scale, and the self-developed basic information and turnover intention questionnaire. Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS) version 19.0. The level of statistical significance was set at p<.05. Among the five dimensions of the nursing work environment, collegial nurse-physician relations earned the most favorable mean scores (3.57±0.68; total=4 points), whereas adequacy of staffing and resources earned the lowest (3.21±0.82). Over half of the participants (58.4%) reported experiencing a high level of emotional exhaustion (EE) burnout, 45.2% reported experiencing a high level of depersonalization (DP) burnout, and 24.6% reported experiencing a high level of personal accomplishment (PA) burnout. About 59% of the participants were satisfied with their work and 3.8% reported intention to leave. Participants in self-reported "favorable" work environments were less likely to report high burnout, less likely to report intention to leave, and more likely to report job satisfaction than their peers in self-reported "poor" work environments. The odds ratio (OR) values were 0.64 (EE), 0.66 (DP), 0.57 (PA), 0.19, and 2.26. The results of the present study support that the nursing work environment affects nurse burnout, job satisfaction, and turnover intention. Therefore, nursing managers should work to improve nursing work environments in order to reduce the turnover intent among their nursing staff.

Objective: Assurance of patient safety to realize the quality of health services is the responsibility of all health workers, especially nurses. Improving patient safety can reduce the risk of nosocomial infections and prevent the negative effects of nursing actions. The application of patient safety is still low due to several aspects, namely communication errors (57.7%), safety and service quality (57.4%), open communication (54.4%), management support (53.8%), and the work environment. (28.4%). An unfavorable work environment for the professional practice of nursing harms the quality of nursing care and patient safety. Methods: Analyzed the relationship between the nurse's work environment and patient safety at Mitra Sejati General Hospital, Medan. Methods: This research is a correlational analytic descriptive study with a cross-sectional approach. The study population was all nurses in the inpatient room at Mitra Sejati General Hospital, Medan, totaling 200 nurses. The sampling technique used was total sampling, by setting inclusion criteria. The study wascarried out from March to July 2022. Data analysis was carried out univariate and bivariate using the chi-square test. Results: most of the respondents stated that patient safety was well implemented (56%) and the work environment was good (64.5%). There is a significant relationship between the nurse's work environment and patient safety, p-value = 0.005. Conclusion: A good working environment for nurses ensures the optimal implementation of patient safety. Therefore, the hospital management contributes to supporting a conducive working environment for nurses by involving nurses in decision-making related to the development of nursing services, improving the ability of nurses, fulfilling nurse resources according to the required expertise

Nurse engagement, empowerment and strong relationships among staff, residents and families, are essential to attract and retain a suitably qualified and skilled nursing workforce for safe, quality care. There is, however, limited research that explores engagement, empowerment and relational coordination in long-term care (LTC). Nurses from an older persons' mental health and dementia LTC unit in Australia participated in this study. Forty-one nurses completed a survey measuring psychological empowerment, work engagement and relational coordination. Twenty-nine nurses participated in individual interviews to further explore these concepts. Although nurses reported high psychological empowerment and work engagement, their relationships with key stakeholders varied. Our findings suggest that nurses in LTC require both supports and opportunities to contribute as active members of the multiprofessional care team that includes tailored education, professional development and positive interactions within the care team. Regular support is needed to enable nurses to feel empowered, foster relationships and communication, and facilitate work engagement. Based on these findings, we suggest that it is important to find ways to ensure that all who provide care perceive that they are part of the whole care team and able to contribute to the care and well-being of people in LTC.

The Nurse Work Environment and Turnover in Perinatal Hospices (S759)

SUMMARY Objective: One of the major reasons for the increase in nurse turnover rate in hospitals is the nurses’ negative work environment. The negativity of the work environment reduces nurses’ performance and adversely affects the quality of patient care and patient and health care workers safety. This present study was conducted to determine nurses' assessment of the work environments. Method : In this cross-sectional study, the study sample comprised 174 nurses who worked in Cumhuriyet University Hospital between October - November 2014, agreed to participate in the study and filled in the data collection forms completely. Data were collected with the sociodemographic characteristics questionnaire and the Nursing Work Index- the Practice Environment Scale”. Results : The mean age of the participating nurses was 32.09 ± 7:09. Of them, 86.8% were women, 64.9% were married, 74.7% had a graduate degree, 84.5% were permanently employed, 32.2% had a working experience in the profession less than 5 years and 79.9% were the members of a union or association. The total mean score obtained from the scale was X = 2.16 ± 0.49. Of the participants in the study, those who were male, contractual employees and/or members of a professional organization and whose length of service was under 5 years perceived their work environment more positively (p 0.05). Conclusions : It was found that the participating nurses assessed the work environment as moderately whereas they perceived the adequacy of manpower and other resources subscale negatively. Keywords : nursing, nursing work environment, patient & healthcare workers safety OZET Amac: Hastanelerde hemsire devir hizinin artmasinin onemli nedenlerinden birisi hemsirelerin calisma ortamlarinin olumsuz olmasidir. Calisma ortamlarinin olumsuzlugu ise hemsirelerin performansini azaltmakta, hasta bakim kalitesini ve hasta ve calisan guvenligini olumsuz etkilemektedir. Bu arastirma, hemsirelerin calisma ortamina iliskin degerlendirmelerini belirlemek amaciyla yapilmistir. Yontem: Kesitsel olarak yapilan bu calismanin orneklemini Ekim-Kasim 2014 tarihleri arasinda Cumhuriyet Universitesi Hastanesinde gorev yapan, calismaya katilmayi kabul eden ve veri toplama formlarini eksiksiz dolduran 174 hemsire olusturmustur. Veriler kisisel bilgi formu ve “Hemsirelik Is Indeksi-Hemsirelik Calisma Ortamini Degerlendirme Olcegi” kullanilarak toplanmistir. Bulgular: Hemsirelerin yas ortalamasi 32.09±7.09 olup, %86.8’i kadin, % 64.9 evli % 74.7’i lisans mezunu, %84.5’si kadrolu, % 32,2 sinin meslekteki calisma deneyimi 5 yil ve altindadir. Hemsirelerin % 79,9 bir sendika veya dernege uyedir. Olcekten alinan toplam puan ortalamasi X=2,16±0,49 olarak saptanmistir. Calismada erkeklerin, sozlesmeli calisanlarin, bir dernege veya sendikaya uye olanlarin ve calisma yili 5 yilin altinda olanlarin hemsirelik calisma ortamina yonelik tutumlarinin daha olumlu oldugu belirlenmistir (p 0.005) Sonuc: Hemsirelerin calisma ortamini genel olarak orta duzeyde degerlendirdigi ancak “insan gucu ve diger kaynaklarin yeterliligi” alt boyutunu olumsuz degerlendirdikleri saptanmistir. Anahtar Sozcukler: Hemsirelik, hemsirelik calisma ortami, hasta ve saglik calisani guvenligi

To test whether communication mediated relationships among nurses' work environments and nurse outcomes of job satisfaction and intent to stay. This study used a cross-sectional, quantitative survey design to query 650 nurses who worked in three hospitals in Jordan. We used Arabic versions of valid, reliable instruments measuring the nursing work environment, nurse perceptions of communication with physicians, intent to stay, and job satisfaction. Mediation analysis was used to test hypotheses. A total of 582 questionnaires were returned (89.5% response rate). Nurse perceptions of communication with physicians mediated the relationship between the nursing work environment and job satisfaction in medical, surgical, and critical care units. Nurse perceptions of communication with physicians mediated the relationship between the nursing work environment and intent to stay in all but maternity and "other" units. Depending on the nurse outcome, communication was a significant mediator for various unit types. These results may be related to the type of work that is done in each unit and the influence of patient care. Communication is one of many mechanisms that can specify how a positive nursing work environment can contribute to nurses' job satisfaction and intent to stay. A potential solution to the nursing shortage in Jordan emerges by identifying communication with physicians as a mediator in the relationship between the work environment and selected nurse outcomes.

This study examined the effect of registered nurse (RN) staffing level, work environment, and education on adverse events experienced by residents in nursing homes. A cross-sectional study was conducted with 216 RNs working in nursing homes who were selected using random stratified sampling by location and bed size. Self-reported questionnaires regarding staffing level, work environment, education level, adverse events, and nurse characteristics were administered. Data from the National Health Insurance Service were used to describe nursing home characteristics. Both multiple and multinomial logistic regressions were used to control for the characteristics of nurses and nursing homes, and investigate the effects of nursing staffing level (number of older adults assigned to a nurse), work environment (Practice Environment Scale of the Nursing Working Index), and level of nursing education on the adverse events experienced by residents. An increase of one resident per RN was significantly associated with a higher incidence of pressure ulcers (OR= 1.019, 95% CI=1.004-1.035). Poor work environment increased the incidence of adverse events such as pressure ulcers (OR= 3.732, 95% CI=1.155-12.056) and sepsis (OR=3.871, 95%CI=1.086-13.800). Compared to RNs with a baccalaureate or higher, RNs with diplomas reported increased incidence rates of pressure ulcers (OR=2.772, 95%CI= 1.173-6.549). RN staffing, work environment, and education level affect the incidence of pressure ulcers, and the work environment affects the incidence of sepsis among residents in nursing homes. Policy-wise, improving the level of nurse staffing, nursing work environment, and nursing education will improve health outcomes of residents.

Purpose: This study investigated whether the work environment affects nurses' turnover intention with career motivation and job satisfaction acting as mediating factors.Methods: Data were collected from January 6-25, 2022, using a cross-sectional design.The participants were 205 nurses who had worked for more than six months at four small-to-medium-sized general hospitals in South Korea.Data analysis consisted of descriptive statistics, Pearson's correlation coefficients, independent t-tests, one-way ANOVAs, Scheffe test, and mediation analysis using Hayes' PROCESS Macro Model 6. Results: The nursing work environment had a significant positive association with career motivation and job satisfaction and negative effects on nurses' turnover intention.The single mediating effect of job satisfaction and the serial mediation effects of career motivation and job satisfaction on the relationship between the nursing work environment and turnover intention were significant.Thus, nurses' positive perceptions of the work environment strengthened career motivation, which in turn increased job satisfaction and reduced turnover intention.Conclusion: Providing a healthy work environment to nurses can help reduce their turnover intention.Therefore, the government and hospitals should implement human resource strategies to improve nursing work environments and take steps to enhance career motivation and job satisfaction to strengthen nurse retention.

Transition to Practice: Onboarding Components for Establishing and Sustaining Healthy Work Environments.

Many people residing in nursing or residential care homes (also called long-term care facilities) live with physical or cognitive difficulties. Staff working in these environments often help residents (particularly those with more advanced dementia) with their personal care needs, including maintaining mouth care and health. Poor oral health is associated with many difficulties, including increased risk of respiratory problems, pain and discomfort. Yet, concerns have been raised that staff may not have the knowledge and skills to effectively support residents with oral care and health. There is therefore an important gap between what is known about the importance of maintaining oral health (scientific evidence) and daily practice in long-term care environments. To work with care home staff: (1) to create a learning culture to address how to promote mouth care for residents, particularly when a resident resists support with this aspect of care; and (2) to effect mouth care practice changes (if required) using participatory and inclusive research cycles. We conducted a participatory research project to address this important area of care. Four participatory research 'cycles' were conducted. Cycle one explored existing literature to develop accessible guidance on strategies that staff could use to support residents to maintain and improve oral care, particularly when a resident may resist such care. Cycle two built on this review to determine knowledge levels within the care team. This highlighted deficiencies in staff knowledge, skills and competence for providing mouth care and their need for training to address this. Cycle three identified evidence-based strategies to develop staff understanding and knowledge. Cycle four brought together experts from nursing, dentistry, behaviour change, systematic reviews and care homes research to develop a grant application to progress this work further. This paper provides an example of the processes undertaken in a participatory research project, bringing together science and practice to improve an essential area of care. Using participatory research approaches in this setting can allow the effective translation of uncertainties in care and practice into questions that can be addressed by research, leading to meaningful outcomes for those living and working in care homes.