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Work environment issues and intention-to-leave in Portuguese nurses: A cross-sectional study

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Abstract

This study extends the Registered Nurses Forecasting (RN4CAST) study evidence base with newly collected data from Portuguese nurses working in acute care hospitals, in which the measurement of the quality of work environment, workload and its association with intention-to-leave emerge as of key importance. Data included surveys of 2235 nurses in 144 nursing units in 31 hospitals via stratified random sampling. Multilevel multivariate regression analysis shows that intention-to-leave is higher among nurses with a specialty degree, nurses aged 35-39, and in nursing units where nurses are less satisfied with opportunities for career advancement, staffing levels and participation in hospital affairs. Analysis with moderation effects showed the observed effect of age and of having a specialty degree on intention-to-leave during the regression analysis is reduced in nursing units where nurses are more satisfied with opportunities for career advancement. The most important finding from the study suggests that promoting retention strategies that increase satisfaction with opportunities for career advancement among Portuguese nurses has the potential to override individual characteristics associated with increased turnover intentions.

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... A intenção de turnover e a intenção de abandonar a profissão é impactada pela satisfação do enfermeiro, como também pela adaptação ao estresse do trabalho 20,24,25 . As baixas remunerações e benefícios dos enfermeiros são uma das explicações para as altas percentagens de enfermeiros que relataram intenção de turnover 26 . ...
... Só 85 dos enfermeiros entrevistados (33,6%), concordaram que é importante ter a oportunidade de continuar a sua formação em enfermagem, sem abandonar a profissão, mas 188 dos participantes (74,3%) relataram que as suas organizações não oferecem oportunidades adequadas de progressão profissional 19 . A presença de maiores competências profissionais está associada a uma mortalidade reduzida, a uma maior satisfação dos clientes e uma menor ocorrência de erro nos cuidados 20,26,33 . ...
... Desde 2009 até 2015 mais de 10.000 enfermeiros portugueses solicitaram uma declaração para poderem exercer enfermagem noutro país da União Europeia 26 . Este pedido não implica que o mesmo número de enfermeiros tenha realmente emigrado, mas expressa grande interesse ou intenção de fazê-lo 26 . ...
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Resumo O objetivo deste estudo é examinar a evidência científica acerca da Qualidade dos Cuidados no Ambiente de Prática de Enfermagem. É cada vez mais importante para a satisfação dos clientes, dos enfermeiros e para a eficiência das organizações, perceber a relação entre o ambiente de prática de enfermagem e a qualidade dos cuidados de enfermagem. Foi realizada uma revisão scoping, durante o mês de Novembro de 2020, em que foram incluídos estudos publicados entre 2015 e 2020 para fornecer uma visão geral sobre quais as características do ambiente de prática que tem influência sobre a qualidade dos cuidados de enfermagem. Dos 940 títulos e resumos identificados, 21 estudos foram incluídos, dos quais 10 estudos são estudos transversais e 7 são estudos descritivos. As evidências indicam que existe vários fatores que interferem na qualidade dos cuidados de enfermagem e no ambiente de prática de enfermagem. A satisfação profissional, o apoio e suporte do enfermeiro gerente, a progressão da carreira, os distúrbios do sono e os sistemas informáticos são características do ambiente de prática de enfermagem que interferem com a qualidade dos cuidados de enfermagem. Descritores: Qualidade dos Cuidados de Saúde; Ambiente de trabalho; Enfermagem; Ambiente de Instituições de Saúde; Revisão
... For this reason, companies need to organize and maintain their work environment because it will impact employee job satisfaction at work. Moreover, Leone et al. (2015) and Tzafrir et al. (2015) explained that the high turnover rate resulted from the increased desire of employees to leave the organization; an uncomfortable and unsupportive workplace caused it. Based on Herzberg's two factors of motivation theory, the physical working condition is considered the hygiene factor. ...
... The results indicate that the literature review accepts and supports the hypothesis since it provides the most significant coefficient value. One of the reasons employees intend to leave an organization is dissatisfaction with their uncomfortable and unsupportive work environment (Budie et al., 2019;Leone et al., 2015;Tzafrir et al., 2015). This discomfort can be caused by tangible factors such as workplace conditions, layout, and atmosphere, as well as intangible factors such as interpersonal relationships with co-workers (Bakker et al., 2021;Taheri, Miah, & Kamaruzzaman, 2020). ...
... The physical work conditions show the highest coefficient value. This means that employees strongly desire to leave the organization in the public sector because they feel dissatisfied with the uncomfortable work environment (Budie et al., 2019;Leone et al., 2015;Tzafrir et al., 2015). Although it is not the only factor, it can be evidence that organizations in the public sector need to pay attention to these factors. ...
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Purpose: This study aims to find the relationship between the most influencing employee satisfaction factor toward intention to leave and examine the curvilinear effect of tenure to intention to leave. Design/methodology/approach: This study is based on quantitative analysis using Structural Equation Modelling Partial Least Square (SEM-PLS), which aims to examine and identify the factors influencing the intention to leave. Findings: The result showed that physical work conditions, promotional opportunities, and pay are the highest significantly affect ITL in the public sector in Mongolia. However, supervision has no significant influence on ITL. Hence, to decrease the ITL in Mongolia’s public sector, physical work conditions, promotional opportunities, and may need to be enhanced and well designed to improve job satisfaction. Originality/value: The research findings contribute to a better understanding of intent to leave and job satisfaction for public employees and provide empirical evidence on the factors influencing the intention to leave.
... However, in Portugal, studies on these matters are scarce. A previous study carried out in the Portuguese context reported the influence of individual and structural variables on the intention to leave of nurses [24]. However, it did not analyze factors, such as the contractual relationships, or the context of care delivery in the specialty dimension. ...
... This study indicates a moderate rate of nurses' intention to leave the service (internal intention to leave: 34.50%). However, the nurses' intention to leave the hospitals analyzed in the present study is low (external intention to leave: 8.71%), compared to a previous study in Portuguese hospitals, for which the response rate was higher (42.5%) [24]. In the international context, the rate of the nurses' organizational turnover intention is also globally higher. ...
... Previous national and international studies also highlighted this relationship between the work environment and intention to leave. Consistently with the results obtained, adequate work environments, thus being favorable to practice, should minimize intention to leave [1,8,12,24,43] and, consequently, the time/cost associated with integration processes and the risk of loss in quality of care provided during the replacement periods. Thus, ensuring favorable work environments is crucial to mitigate intentions to leave and promote nurse retention. ...
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Intention to leave is influenced by the commitment and individual and structural factors. It is a critical dimension in health systems due to the shortage of professionals and the potential impact on the quality of care. The present paper: (i) characterizes organizational commitment and intention to leave; (ii) analyzes the relationship between structural factors (such as, work environment and nurse staffing), individual factors (age), and nurses’ organizational commitments and intention to leave; and (iii) analyzes the differences in the intention to leave and in the organizational commitment according to service specialty, nurses’ specialization, and contractual relationship in Portuguese public hospitals. A cross-sectional study was conducted with a sample of 850 nurses from 12 public hospitals units. The results show a high affective and continuance commitment of nurses with the hospital, and a reduced tendency of the intention to leave. A significant positive association was also found between the intent to leave and individual/structural factors. Organizational commitment and intention to leave levels are satisfactory, despite the influence of several factors, such as nurse staffing, work environment, or other opportunities for professional development. The results identify particularly sensitive areas that, through adequate health and management policies, can reduce nurses’ intentions to leave and promote the sustainability of the health system.
... A favorable NPE leads to better results for clients, as it is an essential factor to increase nurse satisfaction [5,10], and it is fundamental to ensure that teams have an appropriate number of nurses and other staff members [1,8]. A favorable NPE is characterized by adequate human resources and materials, active participation of nurses in the governance, quality of care and nursing care, and good relationships among distinct groups of health service practitioners [5,6]. ...
... In Portugal, the PES-NWI was translated and validated by Amaral et al. [19] and used in several studies in the hospital context [10,[20][21][22][23], but no such research has been performed in PHC. ...
... Other instruments measure the NPE, but the PES-NWI is the most frequently used because it enables the evaluation of different objectives owing to its diversity of items, its good psychometric properties, and the comparability of results between studies and countries [5,18,30]. The PES-NWI is one of the most widely used instruments to measure the quality of NPEs [16] and relates aspects of nursing stability to patient safety and the quality of nursing care [10]. This scale evaluates several dimensions of the NPE through nurses' opinions about the conditions in which they work, thereby providing a better understanding of possible challenges for human resource management and health governance [10]. ...
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Studies related to the work environment in primary health care are scarce in the literature. The present study aimed to validate the psychometric properties of the Practice Environment Scale of Nursing Work Index (PES-NWI) in primary health care (PHC) and to evaluate its construct validity through exploratory and confirmatory factor analyses in a sample of Portuguese nurses. A quantitative, cross-sectional, and validation study design was implemented. Methods: The sample consisted of 1059 nurses from the PHC units of all 55 health center groups (HCGs) in mainland Portugal, 15 health centers in the Autonomous Region of Madeira, and 6 health centers in the Autonomous Region of the Azores. The study tested different structural models using exploratory and confirmatory factor analysis techniques. The reliability of the scale was tested by determining Cronbach's alpha coefficient. Results: The internal consistency of the PES-NWI was 0.91. Exploratory and confirmatory factor analyses were performed on the PES-NWI model in PHC with five factors: NPOA, NFQC, NMALSN, SRA, and CNPR. The results show that the scale presents acceptable fit quality indexes in the final factorial solution and adequate convergent validity. Conclusion: The PES-NWI in PHC has an adequate, robust, and reliable five-factor structure. The scale is valid and can be used in clinical practice, nursing management, and PHC research.
... According to previous studies [14,15] the interplay between multi-level factors underpinning professionals' intention to emigrate needs further attention. Perhaps unsurprisingly, political interventions aimed at preventing healthcare workforce emigration and better integrate immigrant health professionals continue to show poor results [16]. ...
... skill development, escape from traumatic events, improvement of professional or personal living conditions), and thus lead to differences in the length of stay and conditions of integration in the destination countries [36]. Improved working and employment conditions, training opportunities, and career progression are part of the solutions that have been pursued either to prevent unintended emigration among health professionals or to improve the wellbeing of immigrant health professionals [15]. However, there has not been a precise understanding of how health professionals assess the array of factors in their decision to emigrate, and the extent to which these factors are common or specific among professional groups. ...
... Ramos and Alves [37] surveyed first-year general medical residents and found that men were more likely to consider working abroad mainly due to the income in the NHS. Several other studies in other European countries corroborate the importance of income as a driver for emigration regardless of differences of health professionals' remuneration among countries and the average wage level in the different countries [15,[38][39][40][41][42]. The missing link is what bounds the importance of household income between low educated (and less remunerated) and high educated (and more remunerated) health workers. ...
Article
This paper aims to contribute to the discussion on health workforce migration, notably by testing an analytical model of the individual drivers for a professional to decide to emigrate. A large database was obtained from all primary health care units on mainland Portugal. A professional satisfaction survey was conducted and information on social-economic, labour and job satisfaction characteristics, including burnout, was obtained. Results showed that healthcare professionals who reported intention to emigrate are mostly male, young, not married, and more educated; they consider their income insufficient for their needs, and show higher levels of burnout at work and professional dissatisfaction. This profile is slightly different for GPs and nurses. The results obtained contribute to the discussion on what motivates primary health care professionals, including GPs and nurses, to emigrate. They also provide insight into the design of policy measures that may mitigate the intention of these healthcare professionals in general to emigrate.
... A favorable nursing practice environment leads to enhanced patient outcomes, which is an important factor to develop nurses' satisfaction [6,9] as well as to retain nursing staff [2,3,5,7]. A favorable nursing practice environment is defined by the adequacy of 2 of 10 manpower and resources, the effective participation of nurses in the governance of organizations, the quality of care, the provision of nursing care, and good relations between the different professional teams of nursing services [1][2][3]6]. ...
... Nursing practice environment has an impact on patient and nurse outcomes and environments where nurses are autonomous [12]. Environmental control and positive interactions between the nurses and the medical team reduce burnout levels [13][14][15][16][17][18][19][20], increase job satisfaction [1,5,13,14,[21][22][23][24], lower intention to quit [5,7,9,10,13,17,18,21], and ensure better results for clients with regard to the quality of care [1,7,10,13,15,21,[25][26][27] and patient safety [1,7,13,16,17,19,21,25]. ...
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The use of instruments designed to assess the nursing practice environment is crucial to improve the quality of nursing care, to anticipate problems and difficulties that may arise in organizations, and allow nurse managers to implement changes and improvements in key areas. In this study, we aimed to evaluate the psychometric properties of the Nursing Work Index-Revised Portuguese version (NWI-R-PT) scale. A quantitative, observational, descriptive, and cross-sectional study was conducted. Methods: The sample consisted of 767 nurses from 4 public Portuguese hospitals. Exploratory and confirmatory factor analysis techniques were used to test the distinct structural models. The scale's accuracy was evaluated through internal consistency, using Cronbach's alpha. Results: NWI-R-PT internal consistency was 0.91. The NWI-R-PT model with six factors, namely "Management Support," "Professional Development," "Fundamentals of Nursing," "Nurse-Physician Relationship," "Endowments," and "Organization of Nursing Care," was supported by exploratory and confirmatory factor analysis. The NWI-R-PT scale presents adequate goodness-of-fit indices concerning the final factorial model and the convergent validity. Conclusions: The NWI-R-PT scale has a competent and reliable structure. The scale's validity is confirmed; therefore, it may be employed in all contexts in clinical practice, research, and nursing management. The NWI-R-PT is a useful and valid instrument to assess the nursing environment in hospitals, primary care, long-term care, and nursing homes. The scale has significance in improving the quality of nursing care and patient safety, the professional development of nurses, and organizational results.
... Similarly, Wang et al. (2019) found that participation in hospital affairs, nurse-physician relations, and staffing and resource adequacy had a significant positive effect, whereas nursing foundations for quality of care had a significant negative effect on CS of nurses. Although not directly associated with SCS, participation in hospital affairs and nurse manager ability were found to be positively correlated with nurses' intent to stay in the profession (Friese and Himes-Ferris, 2013), and negatively correlated with their ITL (Heinen et al., 2013;Leone et al., 2015). These results reveal that career progression opportunities, representative power of nurse managers, and participation in hospital affairs, including committee decisions, management policies, and administrative processes, have a positive effect on nurses' SCS. ...
... The present study found a statistically significant positive relationship between nurse staffing and resource adequacy and SCS. Leone et al. (2015) found a negative relationship between nurse staffing and resource adequacy and ITL. In their systematic and meta-analysis study of the relationship between nurse staffing and outcomes, Shin, Park, and Bae (2018) found that an increased nurse-to-patient ratio increased the burnout levels of nurses, where increasing workload by one patient per nurse increased job dissatisfaction by 8% and ITL by 5%. ...
Article
Purpose: This study aimed to test the hypothesis model showing the relationship between nurses' individual and working characteristics, nursing work environment, subjective career success, job satisfaction, intent to leave, and professional commitment. Design and methods: A cross-sectional and correlational design was utilized for the study. The study sample consisted of 604 nurses working in four hospitals in Istanbul, Turkey. Data were collected using the Nurse Information Form, Subjective Career Success Inventory, Practice Work Environment Scale of the Nursing Work Index, Job Satisfaction Global Item, Intent to Leave Subscale, and Professional Commitment Scale. Data were analyzed using descriptive and correlation analysis, and the hypothesis model was tested using structural equation modeling. Findings: The hypothesis model that was established to test the antecedents and outcomes of subjective career success in nurses was acceptable and had a good fit. Having a master's degree, work schedule with rotating shifts (negative), good individual income, participation in hospital affairs, staffing and resource adequacy, and nurse-physician relations were significantly associated with the subjective career success of nurses. Subjective career success had a positive effect on job satisfaction and professional commitment and a negative significant effect on intent to leave in nurses. Conclusions: This study revealed that human capital, objective career success, and some characteristics of the nursing work environment were significantly associated with nurses' subjective career success, and that increased subjective career success produced positive professional and organizational outcomes. Clinical relevance: The results of this study, which revealed the antecedents and outcomes of nurses' career success, should be taken into consideration by managers who wish to retain a qualified nursing workforce.
... There are studies on the reasons underpinning mobility patterns of nurses within the EU, 9 on nurses' intentions to leave their country, on turnover rates and on retention strategies. 10,11 However, less research has focused on the experiences of EU/EEA nurses in UK, compared with the experiences of overseas (non-EU/EEA) nurses and on the influence of the organizations that recruit and employ them. ...
... These findings are well aligned with the literature, which notes that career growth not only increases nurses' job satisfaction but also enhances their sense of commitment, loyalty and gratitude towards their employer, which can be manifested in greater engagement, better performance and longer retention rates. 11,[23][24][25] Interviews showed that recruitment practices driven only by nursing shortages, but neglecting nurses' professional aspirations, preferences of area of work, location of organizations or years of experience, led many nurses to move internally after a couple of months, to more technical areas of practice, a better paying job or to a reference hospital in a different region. This suggests that the placement in the destination organization should try to respond to migrant's preferred specialty, location and aspirations to grow professionally. ...
Article
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In UK, since 2010 shortages of nurses and policy changes led many health service providers to become more active in recruiting nurses from the European Union Member States. This article analyses the experience of Portuguese nurses working in the English NHS considering the individual and organizational factors that affect the quality and duration of nurses' migration experience, future career plans and expectations. Twenty-seven semi-structured interviews were conducted at the individual, organizational and policy levels in UK with Portuguese nurses and NHS healthcare staff in 2015-16. The results demonstrate that organizational settings, conditions, actors' attitudes and level of support influence nurses' level of commitment to their employer and their overall mobility experience. Professional achievements, professional and personal sources of support made these nurses evaluate their overall mobility experience as positive, even overcoming personal challenges such as homesickness. The results reveal that migration is accomplished through constant interaction between institutions and individual actors at different levels. Understanding the influencing factors as well as the complex and dynamic nature of a professional's decision-making can design more effective retention responses.
... A prática de cuidados de enfermagem é desenvolvida num ambiente de crescente complexidade e estresse para os profissionais (5) . A natureza estressante da enfermagem pode levar ao esgotamento, baixa produtividade, absenteísmo (6) e, no longo prazo, contribui para a falta de pessoal (4,7) , agravando ainda mais o problema (8) . ...
... Um APE favorável leva à melhoria dos resultados dos clientes, é um fator essencial para o aumento da satisfação dos enfermeiros (6)(7)9) , sendo fundamental para se manter equipes com dotações seguras e reter nelas os enfermeiros (8) . ...
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Objective: To examine the scientific evidence about the nursing practice environment in Primary Health Care. Methods: Three-step scoping review. 1) An initial research on CINAHL and MEDLINE. 2) A broader search using the same keywords and search terms in the remaining EBSCOHost platform databases. 3) Search the bibliographical references of the selected articles. The studies selected were from 2007 to 2018. Results: 19 articles were included, most reported findings of the nursing practice environment and results for clients, nurses, nurse managers and the efficiency of organizations, in Primary Health Care. Conclusion: Improving the environment of nursing practice has consequences on the quality of nursing care, with increased results for clients, nursing and Primary Health Care.
... The Portuguese hospital context has been characterized, in previous studies, by understaffing, particularly in nursing teams, and by unfavourable working conditions for health care delivery. This is further aggravated by inequality in geographical distribution within the country itself, with the greatest discrepancies between the central and northern regions, as well as by clear primacy of hospital care (Castilho et al., 2016;Jesus et al., 2015;Leone et al., 2015;Ministério da Saúde, 2017). Despite its association with health care quality, particularly in the safety dimension, it is not well studied in the Portuguese hospitals context. ...
... The results showed the influence of nurse Nurse managers' perceptions of the nursing staff inadequacy are consistent with that nurses' providing direct care. Previous studiesLeone et al., 2015) on direct care nurses' perceptions of nursing environments in Portuguese hospital settings found that the adequacy of human resources is a critical dimension of the quality nursing practice environments. Nurses' underlined the nursing shortage to perform the tasks and assure the delivery of high-quality care to patients, which is expected given the ratios of nurses per inhabitant in national context. ...
Article
Aim: To verify the association between the nurse staffing and the quality of nursing care, mediated by the care process, based on a hypothetical model, in Portuguese public hospitals. Background: Nurse staffing influences health outcomes. Understaffing is associated with an increased risk for adverse events (AEs) and a reduction in the quality of care. Method: A cross-sectional study was conducted using a sample of 55 Portuguese nurse managers. A path model was developed to analyze potential causal mediation effects on care quality. Results: Nurse staffing (number and competencies) and teamwork indirectly influence the quality of care. This process is mediated by the response capacity, the use of new techniques and work methods and patient's surveillance capacity. The AEs occurrence also has a mediating role, being negatively associated with the quality of care. Conclusions: Optimizing nursing care safety and quality requires an adequate nurse staffing level, both in terms of number and competencies, as well as teamwork. Process components seem to play a mediating role in these relations. Implications for nursing management: These results deserve the attention of nursing management for investment in the nursing staff and in the care process, to improve quality and create value in health care.
... The ''intent to stay'' is described as the stated probability of an individual nurse staying in their current position (Boyle et al., 1999). It is noteworthy that nurses' intent to leave can be a precursor to actual leaving (Lee, Chiang, & Kuo, 2019) and connected to cognitive and behavioral interaction processes determined by individual needs, work-related feedback, and work climate (Leone et al., 2015). However, it has also been questioned whether nurses who are leaving their current position leave the profession or the organization (Simon, Mu¨ller, & Hasselhorn, 2010). ...
... Taylor states that ''we are selves only in that certain issues matters for us' ' (1989, p. 34). Attributing imports to certain issues that matters for us differs from ''a sentiment or attitude possessed by a private individual'' (Benner, 1994, p. 141) or from a cognitive and behavioral interaction processes determined by individual needs, work-related feedback, and work climate (Leone et al., 2015). The difference is linked to the qualitative worth of desires or goods which are also embedded within horizons of identity and awareness of the impact of realizing different desires (Taylor, 1989(Taylor, , 1999a. ...
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Previous theoretical and empirical models of nurses' remaining in everyday nursing practice are explained by elements such as intent to stay and desire to stay. This study provides a model that expands or expresses an increased understanding of the comprehensiveness of the issue by pointing to the qualitative worth of different desires. The aim of this study is to describe a comprehensive model of nurses' remaining in everyday nursing practice. This study was designed in three sequential stages: first, the empirical foundation of the model; second, the development of the model; and third, the description of the model. The described model is derived from a previous qualitative study's comprehensive understanding of empirical findings. That original study was based on a hermeneutical approach, the aim of which was to understand what is of significance for nurses to remain in everyday practice. The collected data consisted of qualitative interviews and qualitative follow-up interviews with 13 nurses. The research context was the primary and secondary somatic and psychiatric health service. The present comprehensive model is stated in a simple structure, which nonetheless provides a relevant framework for constituent elements of nurses' remaining in everyday practice. Horizons of identity and self-understanding have been identified as constituent elements or key concepts involved in remaining. By focusing on a deepened and broader understanding, the model highlights that remaining may be constituted through a process of identification and taking standpoints, which in turn has a potential to empower nurses to realize themselves.
... The nursing work environment is established by the organizational characteristics of a work situation that constrain or facilitate the professional practice of nurses [4]. A positive nursing work environment can lead the effectiveness of health organizations to improved patient outcomes, being an essential condition for increasing nurses' satisfaction [2,4,7], which is crucial to keep the teams with safe allocations and reduce the turnover of nurses [5,6]. A favorable nursing work environment has positive characteristics, such as the appropriate of human and material resources, the quality of care, the participation of nurses in the governance of organizations, good relations between different professional groups and provision of nursing care [2,4,5,8]. ...
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The Indicators of Quality Nursing Work Environment scale (IQN-WE) with 65 items, developed by Chiou-Fen Lin, Meei-Shiow Lu, and Hsiu-Ying Huang in 2016, aimed to create a set of quality indicators of the nursing work environment. The translation and validation for the Portuguese cultural context of the IQN-WE scale was performed in this study. Objectives: culturally and linguistically adapt the IQN-WE scale, originating from the Portuguese version, and evaluate its psychometric characteristics. Methods: it is a descriptive, cross-sectional, observational and quantitative study. The IQN-WE scale was validated in a sample of 542 nurses belonging to a hospital center in Portugal. The study obtained a response of 21.69%, of whom 78.0% were women and 22% men. The mean age of the sample was 39 years and a standard deviation of 8.1 years. All nurses who work have a bachelor's degree, and 13.5% have a master's degree. Results: the study obtained an instrument with a total explained variance of 52.67% and KMO = 0.843. It found a strong-to-moderate linear correlation matrix between the dimensions. The pre-test and the team of experts ensured the content validity. The determination of internal consistency guaranteed reliability, with 0.95. Confirmatory factor analysis validated the construct. The factorial model presented a goodness of fit index, with five factors. Conclusion: the study achieved an instrument with 50 items in five dimensions: Team Support and Professional Development; Team Organization and Management; Safe Nursing Work Environment; Information Systems and Risk Control; Salary and Welfare. The IQN-WE-PT scale proved to be an appropriate instrument to be applied in health organizations in Portugal.
... The lowest score in the study was found to be in the subdimension of "Staffing and Resource Adequacy". This sub-dimension, which influences work environments, has often been found to have the lowest score in other studies too (26,27,30,31). As the shortage of nurses is both a global and national problem, this may have led to the low scores for the "Staffing and Resource Adequacy" sub-dimension. ...
Article
Objective: Unfavorable work environments are among the factors that affect nurses’ intention to leave. This study was explored to examine the relationship between nurses’ work environments and their intention to leave. Methods: This cross-sectional and correlational design study was carried out with 547 nurses working in a university, a private hospital, and a teaching hospital between November 2016 and February 2017. The Practice Environment Scale of the Nursing Work Index and a question about intention to leave was used. Descriptive statistics, Pearson correlation and multiple linear regression analysis were used in the analysis of the data. Results: The mean total score of scale was found to be M= 2.30±0.56 and nurses' perceptions of work environments to be unfavorable. It was found that; 13.9% of the nurses did not intend to leave, 35.5% had a low, and 50.8% had a high intention to leave. It was determined that unfavorable work environments increases intention to leave (R= .370, R2= .137, p
... So, hypothesis fourth issupported. The studies conducted by Rizwan et al. (2014), Leone et al. (2015) and Haque et al. (2019)support the hypothesis four. violence.The results show that the frequency of violence experienced by SMEs is interactively influenced by the women employees. ...
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The purpose of this study is to determine which factors lead to intention to leave workplace due to workplace violence among women employees in the Bangladesh based SMEs. Workplace violence is a prevalent occurrence all around the world. Women have been disproportionately victimized by workplace violence in recent years. In order to achieve the study objectives, the researchers developed four hypotheses. The study results were obtained from a sample of 274 women employeesfollowing the stratified random sampling at various SMEs in Dhaka, Bangladesh. A positivist research approach was adopted, which allows deducing empirical knowledge from data-driven hypotheses. All items used to measure constructs were adopted from past studies.The data was analysed using SPSS v25. The researchers investigated whether there is a positive and significantconnection between employee conflict, workplace pressure, employee family conflict and managerial issue with intention to leave due to workplace violence. The study demonstrated that there is a positive and significant connection between employee conflict, workplace pressure, and managerial issue with intention to leave due to workplace violence. There is no established linkage between employee family conflictand intention to leave dueto workplace violence. This study explored that workplace violence is a major issue in Bangladesh in recent years. This study claims that gender parity is regarded as a critical objective to achieve, as well as a fundamental human right and an economic imperative of progress and social fairness. This study will assist policymakers and legislators in enacting legislation that promote a work-friendly environment for women in the Bangladesh based SMEs.
... In a Chinese study of registered nurses, 51.67% stated that limited career growth was the main reason for their leaving (Cao et al., 2013). Claudia et al. (2015) suggested that the nurses' perceptions of opportunities for professional advancement and growth could be the single most important factor related to turnover intention. ...
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Aims To explore nurses' experiences and perceptions of career growth and its influencing factors, as career growth is more closely associated with individual attitudes and behaviours in the new career era. Design A qualitative descriptive design was used. Methods Thirty‐one nurses from 10 secondary and 8 tertiary hospitals in Sichuan Province of China were purposively selected to participate in this study. The data were collected using individual semi‐structured face‐to‐face interviews. Two researchers independently reviewed the transcripts and emergent coding. The data were analysed using qualitative content analysis. Findings The nurses' perceptions of career growth fully described the nurses' experience and occurred in five dimensions: career promotion, career goal progress, professional ability and quality improvement, professional identity development and increase in personal prestige. The factors influencing career growth were identified at the organizational, individual and social levels. Career growth in nursing was complex, changed over time and showed several specific characteristics compared with other careers. The nurse‐specific symbol of career growth was professional identity development, which reflected career progression characteristics. Conclusions Career growth is a multi‐dimensional concept with varying influencing factors. The meaning of career growth for nurses is distinct from that for employees in other careers. Impact Nursing managers should guide nurses to comprehensively assess their career growth from multiple perspectives, and professional identity development deserves more attention. Both organizations and individuals should take responsibility for career management to pursue career growth.
... This finding may be explained by that in Bangladesh, higher education is less valued in positioning or promoting of the nurses. Several studies also reported that more professional and educational qualifications were significantly associated with high TI [15,[50][51][52]. In the government sector, nurses from tertiary level hospitals were more prone to turnover. ...
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During the COVID-19 pandemic, workplace violence was widespread against healthcare personnel. Workplace violence (WPV) against nurses exhilarates their turnover intention (TI). The objective of this study was to investigate the association between workplace violence and turnover intention and also identify other factors associated with TI among Ban-gladeshi female nurses. An exploratory cross-sectional study was carried out among 881 female nurses between April 26 and July 10, 2021. The TI of the female nurses was the outcome variable of this study. The primary exposure variable was WPV faced by the nurses. Workplace Violence Scale (WPVS) was used to measure the WPV, and Turnover Intention Scale-6 (TIS-6) was used to measure the TI of the nurses. Multiple linear regression model was fitted to find the adjusted association of TI with WPV and other study variables. A stratified analysis by type of job (government vs. private) was also performed. The majority of the nurses (74.46%) faced low to high levels of WPV. The overall mean score of TIS was found 16.33 (± 4.72). Multiple linear regression analysis revealed that compared to government jobholders, the mean score of TIS (15.81 vs. 17.20) was found significantly higher among the private jobholders (p < 0.001). Nurses exposed to the intermediate and high level of WPV had a significantly higher TI score (β = 4.35, 95% CI: 3.36, 5.34) than the non-exposures. The TI of private jobholders was found significantly higher (β = 2.04, 95% CI: 1.09, 3.00) than the government jobholders. Compared to diploma degree holders, significantly higher TI was observed among the B.Sc. degree holders (β = 0.86, 95% CI: 0.22, 1.55) and M.Sc. degree holders (β = 1.46, 95% CI: 0.58, 2.34). Besides, the nurses who did not get timely salaries scored higher TI (β = 1.17, 95% CI: 0.12, 2.22). Moreover, the nurses who did not receive any training against WPV scored significantly higher TI (β = 1.89, 95% CI:
... Heavy work burden and shortages of nursing staff appear to be associated with an increased risk of burnout, MSDs and dissatisfaction as well as medical/nursing errors (18,19). It also caused low job satisfaction, deterioration in the quality of life, increased stress, tendency to absenteeism, and a greater desire to change position or leave the profession (3,20,21). ...
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Introduction: Care delivery from nursing staff to patients in hospital environment may involve the exertion of considerable muscular force and, as a result, there is a consequent risk of developing musculoskeletal disorders (MSDs). The aim of this prospective study was to investigate the relationship between reported MSDs and perceived caring behaviors among nursing staff. Methods: A total of 250 questionnaires were completed in three Greek hospitals during February and March 2019. The Nordic Musculoskeletal Questionnaire for the evaluation of MSDs and the Caring Behaviors Inventory-24 (CBI-24) for the assessment of caring behaviors were used. Results: A total of 185 participants (74%) were found to have at least one MSD. Back (64.3%), neck (63.2%) and shoulder (58.4%) pain were the most commonly reported MSDs. The mean score on the CBI-24 scale was 5.06 (SD=0.51) and the mean “Connectedness” dimension was 4.59 (SD=0.74). Elbow MSDs were significantly associated with the lowest score in the “Knowledge and skills” dimension (p=0.024) and the lowest overall nursing score (p=0.048). Linear regression analysis showed that the lowest nursing care score was associated with left-handed nurses (p=0.008) of low hierarchical position (p=0.013), suffering from elbow MSDs (p=0.002), for which they did not seek treatment (p=0.023). Participants who continued to work on a regular basis despite MSDs showed a lower score on the dimensions of “Respectful” (p=0.05) and “Connectedness” (p=0.01). Conclusions: The nursing staff showed high percentage of MSDs that negatively affected their perceived dimensions of caring behaviors. These findings could be used to prevent and deal with work-related MSDs, reduce occupational hazards and improve hospital patient care.
... Problems in the working climate are the issues that should be dealt with by the management (Arslan Yürümezoğlu et al., 2019;Leone et al., 2015;Nantsupawat et al., 2017). These problems contribute to turnover intentions. ...
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THE PLACE AND FUTURE OF ISLAMIC BANKING IN THE GERMAN BANKING SYSTEM
... In a similar study in 10 European countries, a significant relationship was found between the intention to leave work and gender (Heinen et al., 2013). Another study, which was conducted in 2015 with 2,235 pharmacists working in hospital settings, found that older workers had a lower turnover intention than that of younger workers (Leone et al., 2015). A study conducted by Lambert (2006) showed that gender and education level influenced participants' turnover intent. ...
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Background/Aim Pharmacists are one of the most essential healthcare professionals, with substantial clinical knowledge and skills in the use of medications. Pharmacists provide patient care services and contribute to the enhancement of health outcomes, which increases their workload. This study was conducted to determine the association between intention to leave work and quality of work life (QWL) of pharmacists in Saudi Arabia. Methods This cross-sectional study was conducted using a self-administered questionnaire provided as a paper-based survey using two scales (the Work-related Quality of Life [QoL] and Intention to Leave scales). In addition, this was combined with demographics to determine the relationship between intention to leave work and quality of work-life. Data were analyzed using descriptive and analytical statistical tests. Results A total of 284 (76.5%), out of the 371 surveys distributed, were completed and returned. The average age and annual income of the respondents were 33.4 ± 6.5 years and 196,401 ± 82,306.7 SAR, respectively and 61.2% and 38.9% were male and female, respectively, whereas 62.9% were married and 53.2% reported having children. The multiple linear regression analysis conducted showed a significant negative relationship between QWL and the intention to leave work (β = -0.131; 95% CI, -0.185 to -0.076). Conclusion We found a significant association between the QWL and intention to leave. This indicates that a greater intention to leave was associated with a low or lousy QWL among Saudi pharmacists.
... Studies have shown that higher positions tend to allow for greater room for development. Such positions are associated with a higher degree of freedom from authority, and various needs are easier to satisfy [47]. Senior nurses have more advanced qualifications, mature skills and rich experience, which enables them to cope with the pressures of their work more easily. ...
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Background: Nursing is a high-risk occupation that involves exposure to stress. The physical and mental health of nurses is directly related to the quality of medical services, so the quality of life of nurses cannot be ignored. This study is a Chinese nursing study that investigated occupational stress, job burnout, and quality of life of surgical nurses in Xinjiang, China. Methods: This study employed the cluster random sampling method and carried out a questionnaire survey among 488 surgical nurses from five hospitals from May 2019 to September 2019. The study analyzed the relationship between occupational stress, job burnout and quality of life. The Effort-Reward Imbalance questionnaire (ERI), Maslach Burnout Inventory General Survey (MBI-GS) and the 36-item Short Form Health Survey (SF-36) were used to evaluate occupational stress, job burnout and quality of life among surgical nurses. Results: A total of 550 questionnaires were distributed in this study, and 488 were retrieved, with an effective recovery rate of 88.73 %. The results revealed that the quality of life score among surgical nurses was not high, and differences were observed in the quality of life score of patients according to gender, age, title, and frequency of night shifts (P < 0.05). There was a positive correlation between occupational stress and job burnout. Higher levels of occupational stress and job burnout were associated with a poorer quality of life score. Occupational stress and job burnout were identified as risk factors for quality of life, and the interaction between high levels of stress and burnout seriously reduced quality of life. The structural equation model revealed that occupational stress and job burnout had a direct impact on quality of life, occupational stress had a direct impact on job burnout, and job burnout was identified as a mediating factor in the relationship between occupational stress and quality of life. Conclusions: Surgical nurses have a high level of occupational stress and burnout, and low quality of life score. Quality of life is correlated with occupational stress and job burnout. According to the individual characteristics and psychological state of nurses, managers can implement personalized intervention measures promptly and effectively to relieve their tension and burnout, and improve the quality of life of surgical nurses.
... Problems in the working climate are the issues that should be dealt with by the management (Arslan Yürümezoğlu et al., 2019;Leone et al., 2015;Nantsupawat et al., 2017). These problems contribute to turnover intentions. ...
... Thus, the perceptual indicator seems to capture with relative accuracy the dynamism associated with the nurse staffing. This may be a good indicator, considering the different nursing care needs at different times.Nurses' perception of the inadequacy of human resources to meet the needs is in line with previous studies conducted inPortuguese hospitals (Jesus et al., 2015;Leone et al., 2015). The latest recommendations of the International Council of Nurses (ICN) on staffing levels even encourage professionals to report unsafe nurse staffing situations(ICN, 2018). ...
Article
Aim To contribute to the knowledge of nurse staffing in hospital settings in central and northern Portugal. Background Nurse staffing is a critical factor for the quality and safety of healthcare, and is still an understudied topic in Portugal. Method A cross-sectional study was conducted with a sample of 850 nurses from 12 public hospitals in the central and northern regions of Portugal. Results Nurse staffing in these hospital units is insufficient, especially in internal medicine units and central hospitals. Nurses’ perceptions are in line with the objective data. Conclusions The shortage of nurses is a horizontal issue that is especially serious in internal medicine units and central hospitals and a potential threat to the quality of care. Implications for Nursing Management The results stress the need for an urgent intervention in nurse staffing levels in the hospitals analyzed in this study. Contextual knowledge about nurse staffing is essential for decision-making and supporting health and human resource management policies.
... There is a direct relation between nurses' workload and patient satisfaction [8], patient outcomes [9][10][11][12][13][14] and nurse reported quality of care and performance [15][16][17]. High workload is also a predictor for nurses' job dissatisfaction, stress, burnout [18][19][20] and absenteeism [21], and generally shows a negative effect on job outcomes [22] and nurses' intention to leave [23,24]. High turnover of nursing staff results in higher costs for training of new nurses, or hiring of temporary staff [11,25]. ...
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Aim Calculating a modelled workload based on objective measures. Exploring the relation between this modelled workload and workload as perceived by nurses, including the effects of specific job demands, job resources and personal resources on the relation. Design Academic hospital in the Netherlands. Six surgical wards, capacity 15–30 beds. Data collected over 15 consecutive day shifts. Methods Modelled workload is calculated as a ratio of required care time, based on patient characteristics, baseline care time and time for non-patient related activities, and allocated care time, based on the amount of available nurses. Both required and allocated care time are corrected for nurse proficiency. Five dimensions of perceived workload were determined by questionnaires. Both the modelled and the perceived workloads were measured on a daily basis. Linear mixed effects models study the longitudinal relation between this modelled and workload as perceived by nurses and the effects of personal resources, job resources and job demands. ANOVA and post-hoc tests were used to identify differences in modelled workload between wards. Results Modelled workload varies roughly between 70 and 170%. Significant differences in modelled workload between wards were found but confidence intervals were wide. Modelled workload is positively associated with all five perceived workload measures (work pace, amount of work, mental load, emotional load, physical load). In addition to modelled workload, the job resource support of colleagues and job demands time spent on direct patient care and time spent on registration had the biggest significant effects on perceived workload. Conclusions The modelled workload does not exactly predict perceived workload, however there is a correlation between the two. The modelled workload can be used to detect differences in workload between wards, which may be useful in distributing workload more evenly in order prevent issues of over- and understaffing and organizational justice. Extra effort to promote team work is likely to have a positive effect on perceived workload. Nurse management can stimulate team cohesion, especially when workload is high. Registered nurses perceive a higher workload than other nurses. When the proportion of direct patient care in a workday is higher, the perceived workload is also higher. Further research is recommended. The findings of this research can help nursing management in allocating resources and directing their attention to the most relevant factors for balancing workload.
... Based on these theories, misalignment resulting from comparing current employment policies with preferred employment policies can negatively influence an individual's intention to stay in a profession [24,25]. These preferences in policies on remuneration, practice structure, job, career advancements, and work schedules have been studied in healthcare professionals such as physicians [26] and nurses [27][28][29]. There is, however, very little midwifery-specific literature on these preferences, particularly as they relate to alignment of actual and preferred employment policies. ...
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Background This study examines whether alignment of actual and preferred employment policies, including compensation method, employment status, and work schedule, affect midwives’ intention to stay in the profession. The study further investigates the moderating effect of financial-rewards satisfaction and compares midwives’ policy preferences in urban/rural practices. Methods Cross-sectional survey data from 549 midwives across Canada were analysed through descriptive statistics, bivariate correlations, and hierarchical linear regressions. Further regression analysis separated data for urban/rural practicing midwives. Results Three-quarters of the respondents are paid through a billable-course-of-care, while only one-third prefer this model. Another one-third prefer a combination of salary and billable-course-of-care. More than three-quarters of the respondents are independent contractors, but half prefer other forms of employee status. Lastly, half prefer a part-time work schedule, while others prefer full-time. Alignment of actual and preferred employment policies significantly explains midwives’ intention to stay in the profession. Intentions to stay in the profession for urban midwives is significantly affected by the alignment of actual and preferred compensation methods, but not for rural ones. Both urban and rural midwives report similar preferences for employment status and work schedule policies. Furthermore, satisfaction with financial rewards is significantly associated with their intention to stay. Conclusion Policymakers can positively influence midwives’ intention to stay in the profession by facilitating alignment of their actual and preferred employment policies.
... The results corroborate previous evidence, highlighting the role of the structure component in the effectiveness of care, in terms of the quality of practices and patient safety (Aiken et al., 2011;Cho et al., 2016;Stalpers et al., 2015;Wei et al., 2018). However, the results are particularly worrying because studies conducted in Portuguese hospital settings have found that nurses perceive the work environment as unfavourable to nursing practice Leone et al., 2015). ...
Article
Aim To assess the impact of safe nurse staffing on the quality of care, based on the structure‐process‐outcome approach, in Portuguese hospitals. Background Safe nurse staffing is essential for the quality of care in hospital settings, together with work environment, organizational commitment, and nursing practices. However, there is little evidence of its analysis in the Portuguese context. Method A cross‐sectional survey study was conducted using a sample of 850 nurses from 12 public hospital units in the central and northern regions of Portugal. Results The proposed structural equation model for quality assessment has a good fit (χ2/df=2.37; CFI=0.88, PCFI=0.83; PGFI=0.77, RMSEA=0.04), showing the impact of safe nurse staffing, work environment, and affective and normative organizational commitment on the quality of care (mortality rate and adverse events). The mediating effect of nursing practices was also found. Conclusion Safe nurse staffing, which is compromised in 90% of the units, is a predictor of the quality of care through the mediating effect of nursing practices. Implications for Nursing Management The results not only highlight the need for urgent intervention but also support political decision‐making with a view to improving the access to quality care.
... Problems in the working climate are the issues that should be dealt with by the management (Arslan Yürümezoğlu et al., 2019;Leone et al., 2015;Nantsupawat et al., 2017). These problems contribute to turnover intentions. ...
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Nursing is a profession group with a high turnover rate. The high turnover rate affects the quality, quantity and cost of patient care. For this reason, the speed of job turnover in nurses and the reasons for their leave remain up-to-date as an issue that health and nurse managers should focus on and develop effective strategies. Some of the factors that affect the turnover and need to be taken precautions are limited career opportunities, poor support, lack of recognition and negative staff attitudes. Nurses should also be provided with educational opportunities, safe working environments, and social opportunities to maintain work-life balance so that they can recognize and develop themselves. Efforts should be made to increase the organizational commitment of the employee. The shortage of qualified nurses with the appropriate skills is a global problem. The nursing work environment is characterized by a mixture of inappropriate skill and inadequate patient-staff ratios. Low participation in decision-making processes and increasing patient demands make this process even more difficult. These problems affect heavy workloads and stress levels, making nurses feel worthless and powerless
... [16][17][18][19] This leaves migration flows heavily influenced by individual preferences, but also by market-based principles and responsive to external shocks. 8,20 This was clearly demonstrated in the past by a surge in East-West and South-North mobility following EU enlargement in 2004 and 2007 and the economic crisis in 2008-09, respectively. 8,9 Although we find a slight slowdown in the rate of increase in East-West and South-North EU mobility since 2016, potentially linked among other factors to the UK vote to leave the EU ('Brexit') and an economic recovery in many countries following the economic crisis, these mobility patterns have largely continued. ...
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WHO Member States adopted the Global Code of Practice on the International Recruitment of Health Personnel 10 years ago. This study assesses adherence with the Code's principles and its continuing relevance in the WHO Europe region with regards to international recruitment of health workers. Data from the joint OECD/EUROSTAT/WHO-Europe questionnaire from 2010 to 2018 are analyzed to determine trends in intra- and inter-regional mobility of foreign-trained doctors and nurses working in case study destination countries in Europe. In 2018, foreign-trained doctors and nurses comprised over a quarter of the physician workforce and 5% of the nursing workforce in five of eight and four of five case study countries, respectively. Since 2010, the proportion of foreign-trained nurses and doctors has risen faster than domestically trained professionals, with increased mobility driven by rising East-West and South-North intra-European migration, especially within the European Union. The number of nurses trained in developing countries but practising in case study countries declined by 26%. Although the number of doctors increased by 27%, this was driven by arrivals from countries experiencing conflict and volatility, suggesting countries generally are increasingly adhering to the Code's principles on ethical recruitment. To support ethical recruitment practices and sustainable workforce development in the region, data collection and monitoring on health worker mobility should be improved.
... Um aspecto salientado em vários estudos refere-se ao impacto da gestão e da liderança nos ambientes da prática profissional de enfermagem e, consequentemente, nos resultados dos profissionais e dos pacientes (9,(25)(26)31,34,38,(50)(51) . Não obstante a tendência decrescente da economia nos últimos anos, há intervenções de custo relativamente baixo que os gestores em enfermagem, podem mobilizar para melhorar a governança da força de trabalho, com consequentes ganhos para os enfermeiros, a profissão, as organizações de saúde e o sistema de saúde como um todo (32) . ...
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Objective: To identify the instruments used to evaluate the professional nursing practice environments in the hospital context. Method: An integrative review, whose research process was conducted independently by two researchers in the period from July to August 2019 in the CINHAL, PubMed and SciELO databases. Results: Based on the inclusion and exclusion criteria, 53 studies published between 2009 and 2019 were considered for analysis. Ten instruments and three thematic areas were identified: instruments for the assessment of the nursing professional practice environments; implications of the use of instruments for the assessment of nursing professional practice environments; limitations of the instruments for the assessment of nursing professional practice environments. Conclusion: Despite the relevance of the instruments identified, this integrative review provides contributions that support the need to use specific tools to assess the nursing practice environments that include the structure, process and outcome components.
... [20][21][22] Perhaps most worrying, the shortage is also underpinned by many nurses' decision to leave the profession, citing burnout, stress, understaffing, high workloads, minimal job satisfaction, emotional exhaustion and poor patient safety as reasons. [23][24][25][26][27][28] Many nurses talk about the disappointment and disillusionment of wanting to care for patients in an holistic way but being unable to do this in the systems in which they work. 29 Increasingly, and perhaps unsurprisingly, international research is identifying that what many nurses are required to prioritise is technical care over fundamental care, 30 which leads to missed care 30 31 or, worst case scenario, patient neglect or harm. ...
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Objective The International Learning Collaborative (ILC) is an organisation dedicated to understanding why fundamental care, the care required by all patients regardless of clinical condition, fails to be provided in healthcare systems globally. At its 11th annual meeting in 2019, nursing leaders from 11 countries, together with patient representatives, confirmed that patients’ fundamental care needs are still being ignored and nurses are still afraid to ‘speak up’ when these care failures occur. While the ILC’s efforts over the past decade have led to increased recognition of the importance of fundamental care, it is not enough. To generate practical, sustainable solutions, we need to substantially rethink fundamental care and its contribution to patient outcomes and experiences, staff well-being, safety and quality, and the economic viability of healthcare systems. Key arguments We present five propositions for radically transforming fundamental care delivery: Value: fundamental care must be foundational to all caring activities, systems and institutions Talk: fundamental care must be explicitly articulated in all caring activities, systems and institutions. Do: fundamental care must be explicitly actioned and evaluated in all caring activities, systems and institutions. Own: fundamental care must be owned by each individual who delivers care, works in a system that is responsible for care or works in an institution whose mission is to deliver care. Research: fundamental care must undergo systematic and high-quality investigations to generate the evidence needed to inform care practices and shape health systems and education curricula. Conclusion For radical transformation within health systems globally, we must move beyond nursing and ensure all members of the healthcare team—educators, students, consumers, clinicians, leaders, researchers, policy-makers and politicians—value, talk, do, own and research fundamental care. It is only through coordinated, collaborative effort that we will, and must, achieve real change.
... and competences in the workforce, which is essential in maintaining quality of care. Finally, workload has been shown to have an effect on nurses' intention to leave (Lacey et al., 2007;Leone et al., 2015) and on job outcomes (Van Bogaert, van Heusden, Timmermans, & Franck, 2014), both directly and as a mediating factor. High turnover of nursing staff results in higher costs for training of new nurses or using temporary staff (Twigg & Duffield, 2009;Unruh, 2008) and therefore needs to be minimized. ...
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Aim: Quantifying the relation between patient characteristics and care time and explaining differences in nursing time between wards. Design: Academic hospital in the Netherlands. Six surgical wards, capacity 15-30 beds, 2012-2014. Methods: Linear mixed effects model to study the relation between patient characteristics and care time. Estimated marginal means to estimate baseline care time and differences between wards. Results: Nine patient characteristics significantly related to care time. Most required between 18 and 35 min extra, except "two or more IV/drip/drain" (8) and "one-on-one care" (156). Care time for minimum patient profile: 44-57 min and for average patient profile: 75-88 min. Sources of variation: nurse proficiency, patients, day-to-day variation within patients. The set of characteristics is short, simple and useful for planning and comparing workload. Explained variance up to 36%. Calculating estimated means per ward has not been done before. Nurse proficiency is an important factor.
... Negative work climate is a management problem in the organization. [20] "In recent years, work climate has been considered by health care systems as a powerful factor among individuals and team levels which can affect the performance of an organization. [21] Reducing job stress and providing adequate staff will enhance job satisfaction which will encourage nurses to stay, and also improving work environments may delay this problem. ...
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Background: Because of the importance of staff shortage in health systems, considering the intention to leave the job and its related factors among nurses is very important. The aim of this study was to identify the association between the intention to leave the nursing profession and work climate and demographic characteristics. Materials and methods: A cross-sectional survey was conducted among 206 nurses, by random sampling method from six hospitals (response rate = 92%). A set of self-administered questionnaires were applied for the evaluation of intention to leave and work climate. Results: The high level of intention to leave the profession was expressed by 23.70% of the participants; 25.10% of the participants had the moderate intention. Data analysis revealed that work climate, type of employment, marital status, and overtime working were significant predictors of nurses' intention to leave after controlling other independent variables (R2 = 0.10, p < 0.001). Conclusions: It was found that work climate and some demographic characteristics can be seen as indicators for intention to leave among nurses; therefore, considering the so-called variables is required. Further studies are needed to identify other aspects of the issue.
... The emigration of Portuguese nurses only took on significant dimensions after 2010-2011; up to this point Portugal had principally been a receiving country, welcoming primarily Spanish nurses . Although recent, there are already studies on the departure of Portuguese nurses conducted in the sending country, Portugal (Gomes et al. 2014;Leal 2013;Leone et al. 2015;Reis 2016;Ribeiro et al. 2014), and some that complement this with the perspective of the receiving country Stoehr 2015). ...
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Portuguese emigration increased ever since its interruption by the 1974 revolution, especially since Portugal became a member of the then European Economic Community. This increase was underpinned by the regime of free movement of people within the European Union, which has helped transform Europe into the lead destination of Portuguese emigration. The effects of the 2008 financial crisis on this migratory dynamic have proven complex. In the first instance, the fact that this crisis was global prompted a downturn in emigration. However, in a second phase, there was new and very marked growth in the rate of Portuguese emigration coupled with changes to the hierarchy of destinations. The greatest of these alterations was the abrupt decline in the numbers departing for Spain, which was overtaken by the United Kingdom as the main destination for emigration. From a comparative perspective, the joint effects of the growth in emigration and the stagnation of immigration mean that Portugal is today among the least attractive countries in EU. As a consequence, international migratory patterns in Portugal today – as in the 1960s – are exacerbating rather than countering the population decline in the country with the lowest fertility rate in Europe.
... The emigration of Portuguese nurses only took on significant dimensions after 2010-2011; up to this point Portugal had principally been a receiving country, welcoming primarily Spanish nurses (Ribeiro et al. 2014). Although recent, there are already studies on the departure of Portuguese nurses conducted in the sending country, Portugal (Gomes et al. 2014;Leal 2013;Leone et al. 2015;Reis 2016;Ribeiro et al. 2014), and some that complement this with the perspective of the receiving country Pereira 2015;Stoehr 2015). ...
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Philippine and Indian nurses have been emigrating for many years, but Portuguese nurses and other South and East Europeans have recently started to replace them in the UK. This study focuses on the recent migration of Portuguese nurses – both as emigrants and immigrants – within the European area. The research mixes extensive and intensive methodologies. Health agencies started to recruit heavily among Portuguese nurses after 2008, which often led to their decision to leave the country with a guaranteed job abroad. In turn, this dynamic of emigration being motived by institutional and recruitment networks was caused by a structural factor: the barriers erected in 2010 by UK immigration policies against the contracting of nurses from outside the EU, which led the job agencies to search for nurses inside Europe. The chapter’s main finding is that although the push factor of economic recession and increased unemployment that hit the European periphery after the 2008 financial crisis played a role in the outflow of Portuguese nurses, it was the pull factor that was more significant. The second finding is that this new mass emigration of nurses is not just a Portuguese phenomenon but rather is in keeping with other Southern and East European peripheral countries.
... More qualifications or a higher professional category are associated with better mental health, contradicting the findings of other studies in which increased training and its consequent responsibilities seem to exacerbate mental health, 23 as these factors are connected with a greater intention to leave the profession. 24 Naturally, it is recognized that a higher degree of demand and stress are felt among professionals with a greater level of responsibility, although it often appears exclusively as a motivating factor and not as a cause of psychological difficulties. The results of the present study are in line with those of other studies that report more self-esteem among professionals with more training and, subsequently, more job satisfaction and a higher quality of care that they provide. ...
Article
Aim To understand Portuguese nurses' perceptions of their mental health. Background The impact of nurses' health and well‐being on the quality and safety of the care they provide is well known. In Portugal, there are no representative studies regarding nurses' mental health. Materials and Methods Transversal, analytical, and observational methods were used, with a quantitative approach. Participants answered questions through an online form. We collected data concerning social‐professional characterization, general health status, and mental health. The General Health Questionnaire‐28 (GHQ‐28) was used. Results A total of 1264 nurses participated in a nonrandomized sample. Two‐thirds revealed a negative perception of their mental health. Of these, 22.2% reported severe depression symptoms, 71.6% indicated significant somatic symptoms, 76% showed significant anxiety, and 94.1% presented some kind of social dysfunction. Conclusion Better mental health is associated with being part of a larger household, enjoying more hours of sleep, having more free weekends, being male, working as a specialist, and engaging in leisure activities. Worse mental health is associated with being older, having a longer career, working more hours, and practicing in the hospital context. Implications for nursing practice The professionals' living and working conditions must be addressed by their managers.
... transformational leadership) can improve job satisfaction (Morsiani, Bagnasco, & Sasso 2017) and mitigate intention to leave, leading to high quality care (Lavoie-Tremblay, et al. 2016). Another aspect related to the quality of the work environment that impacts on job satisfaction and increases the retention of nurses is the opportunity for career advancement and professional development (Leone et al., 2015). ...
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Aim Expand knowledge about the predictive factors of nurses’ intention to leave their job, and consequently to turnover. Background Nurse turnover is costly and negatively influences quality of care. Understanding the association between intention to leave and modifiable features of hospital organization may inform strategies to reduce turnover. Methods A cross‐sectional survey of 3667 medical and surgical nurses was conducted in Italy. Measures included intention to leave; work environment; burnout; job satisfaction and missed care using the RN4CAST instruments. Descriptive, logistic regression analysis was used. Results Due to job dissatisfaction, 35.5% of the nurses intended to leave their current job, and of these, 33.1% the nursing profession. Push factors included: understaffing, emotional exhaustion, poor patient safety, performing non‐nursing care, being male. Pull factors included: positive perception of quality and safety of care, performing core nursing activities. Conclusion The present study expands knowledge about the predictive factors of nurses’ intention to leave their job, and consequently to turnover, which is one of today's major issues contributing to the shortage of nurses. Implications for Nursing Management Nurses’ intention to leave their job is the consequence of a poor work environment, characterized by factors such as understaffing and performance of non‐nursing activities. This article is protected by copyright. All rights reserved.
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Background: Due to the nursing shortage, positive work environments are needed to retain (student) nurses. More and attractive internships for students need to be ensured. In order to provide more internship places learning departments were developed, which are characterized by a buddy system and supervisors who coaches at least two students during a shift. Gaining knowledge about career perspectives and job satisfaction is essential within the context of learning departments, as both will contribute to quality and safety of care and will support lifelong learning. The current study aimed to investigate how nurses and nursing students working and learning in learning departments experience preconditions for career opportunities. Methods: Using a generic qualitative approach, semi-structured interviews were conducted through videocalls between March and April 2021 in the Netherlands. Inductive qualitative analysis based on ‘The Data Analysis Spiral’ was used. Results: Career perspective is explored among six students and seven nurses. Five main themes were generated for both nurses and students; (1) personal goals; (2) skills and self-efficacy; (3) mentoring; (4) job satisfaction; and (5) career perspectives. Within the five main themes, subcategories were developed from 198 codes related to career opportunities. Results show career perspective is experienced differently. For students, the requirements to experience career perspective seem largely existing, as learning departments fits with personal goals, increases self-efficacy and provide coaching mentoring. Students felt learning departments contributed positively to becoming more skilled in working independently and collaborating with fellow students. This resulted in students feeling well prepared for the future. Nurses’ career perspectives varied from wanting more personal development to experiencing opportunities due to having great colleagues, a challenging patient category, satisfaction from sharing knowledge and a decreasing physical workload. Nurses who had affinity with coaching students experience more career perspective on learning departments. Conclusion: Interviews provided in-depth insights within five themes. Interviews gave in-depth insight into the elements of learning departments that contribute to career perspectives of (student)nurses. The results can be used by nursing supervisors, teachers and policymakers to optimize nurses’ work environment, to eliminate leave intentions and improve quality of patientcare. The results should be taken into consideration when coaching students, developing manuals and implementing or optimizing learning departments. Future research is recommended to investigate which tools/interventions are effective for nurses and other healthcare professionals to support career guidance.
Article
"Objectives: Health professions such as nursing are at high risk of work-related musculoskeletal disorders (WRMDs). This study aims to present the most common WRMSDs that occur in nursing personnel, investigate the risk factors associated with their occurrence, and identify preventive and therapeutic strategies. Material and Methods: A comprehensive literature search in PubMed, Scopus, and Google Scholar was performed using keywords, until May 2021, while the results reported by various authors were summarized. Results: Low back discomfort (30% to 60%), neck disorders (30% to 48%), and shoulder disorders (43 to 53%) are the most common WRMSDs in nursing personnel. The major risk factors are classified as demographics and job characteristics, physical, psychosocial, and workplace organizational factors, which often co-exist and act together. WRMSDs have serious consequences such as absenteeism, reduced productivity, increased morbidity, health costs as well as lower quality of life. To reduce the incidence of WRMSDs, it is crucial to implement prevention strategies, such as ergonomic measures and training programs in high-risk nursing departments as well as immediate therapeutic approaches, where required. Organizational interventions are also required to improve the working environment in terms of assigning tasks among nursing staff, setting working hours, keeping a positive attitude, and conducting medical examinations. Conclusion: Early identification of risk factors concerning WRMSDs among nursing personnel and immediate treatment is needed to maintain their productivity as well as to provide quality nursing care, followed by evidence-based ergonomic and organizational intervention strategies for their safety and health protection. "
Article
Retention of healthcare staff, and predictors on organizational and team level: a literature review Healthcare is under increasing pressure. The shortage of the health workforce is progressively rising. The high turnover of healthcare professionals has a negative impact on the quality and cost of healthcare services. Reducing staff turnover is for that reason a crucial objective. Mapping the facilitating and impeding factors is a first essential step. This literature study focuses on the psychosocial factors on which healthcare organisations can have an impact. PubMed, Web of Science and ScienceDirect were consulted between July 2021 and September 2021. The search terms were set on retention of healthcare workers combined with boolean operators, and was refined to recent European studies. The search yielded 23 articles. The predictors of retention were distinguished into 5 themes: individual factors, social capital, decision latitude, work demands and patient care. Four extensive factors span the different themes: recognition, shared values, leadership and communication. These extensional factors and themes are interrelated and influence each other. All of these factors stand on a (work) balance, in which there must be an equity in the caregivers’ efforts and their rewards. Improving the psychosocial aspects of the work environment, especially the staffs’ satisfaction at work, can help to retain the healthcare personnel and reduce the shortages.
Article
Purpose: The aim of this paper is to review research conducted on managing the ageing healthcare workforce and identify gaps for further research. Design/methodology/approach: A systematic literature search of studies in the English language was carried out in Scopus and Web of Science databases. Findings: The study consists of an analysis of 75 published articles. The majority of the papers were published in recent years, indicating a growing interest in the field. The authors specified the following inclusion criteria: all years, articles/reviews, English language and full text in the Web of Science and Scopus databases. The authors of the paper illustrated seven major categories with different topics that were suggested for future research. It included: challenges of labor market in the healthcare field, age-related changes and their influence on work ability, training opportunities and lifelong learning among ageing health workforce, motives of early retirement, ageing and its relationship to Occupational Health and Safety. Longitudinal studies and case study strategy with mixed-methods approaches were suggested for future research by the authors. Originality/value: The paper summarizes knowledge related to the management of ageing health workforce, describes topics researched and as a result, presents findings on and conclusions about the most important future implications of the ageing workforce for management in the healthcare field providing lines for further research. To the authors' knowledge, no holistic systematic literature reviews have been published in academic journals targeted specifically to ageing healthcare workers.
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Aim: The aim of this study is to examine the effects of nurses’ individual and professional characteristics and regret about their career decision on their turnover intention. Method: This cross-sectional and descriptive study was conducted with 415 nurses working in a university hospital, where 1324 nurses were employed and volunteered to participate. The data were collected with a questionnaire consisting of three parts. The questionnaire consisted of the nurse introductory information form, the Career Decision Regret Scale, and the Turnover Intention Scale. Descriptive statistics, correlation and multiple regression (stepwise) analyses were used in the data analysis. Results: The mean score of the nurses’ turnover intention scale was determined as 2.33 ± 1.10 and the total mean score of the career regret scale was 71.08 ± 24.43. In the regression analysis, the conclusion was that the turnover intention was affected by marital status and career decision regret (R2 =19.5%; p<,001). Conclusion: The results of the study show that nurses’ turnover intention is influenced by marital status and regret about the career decision. Policymakers should establish national strategies for organizing early intervention programs, such as informing students about career choices and career counseling services before choosing a university/occupation. Additionally, it is recommended by the institution managers to adopt organizational strategies to support nurse welfare, empathy, and professional development, and to improve the working environment, despite the possibility of nurses leaving the job due to professional decision regrets. Keywords: Nurse, turnover intention, career decision regret, individual characteristics, professional characteristics
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Introduction: The increasing complexity of care associated with a greater use of new technologies, drugs and other treatments, proves to be a challenge for health organizations, and is often the basis for the existence of adverse events. The administration of medication is considered a crucial activity with regard to patient safety. The occurrence of errors during the medication management process entails important costs for patients, professionals and the health service. In regard to Europe, the data indicate that 8 to 12% of patients admitted to a hospital experienced adverse events, such as medication errors, among others. The World Health Organization has defined harmless medication as the third Global Patient Safety Challenge. Objective: To examine scientific evidence in medication administration errors. Methods: Integrative literature review, based on database searches (CINAHL, Cochrane, Mediclatina, MEDLINE, CUIDEN) and bibliographic references of the articles included Limiters: articles published from 2015 to 2020; full text and Europe. Results: Eleven included articles that report a relationship between the occurrence of errors and organizational factors (interruptions, lack of human resources, accelerated work rhythms, workloads, and punitive culture); medication system factors (security systems) and individual factors (tiredness, lack of skills and negligence). Conclusion: Improve the nursing practice environment and ensure the existence of safety routines systems in the administration of medication, non-punitive organizational culture and sufficient human resources (trained and educated in the safe use of the medicine) have an impact on reducing the occurrence of medication errors and consequently, promoters of patient safety.
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The work context where nurses provide care plays an important role in the results for the client and for the nurses and their teams. The different characteristics of the Nursing Practice Environment are important in the construction of management strategies for the promotion of favorable work environment, which consequently contribute to the continuous improvement of the Quality of Nursing Care. Objectives: to examine the scientific evidence about the EPA in a hospital context. Methods: Integrative review, with 6 steps: 1) identification of the research question; 2) definition of keywords; 3) definition of the information to be extracted from the selected studies; 4) evaluation of the studies included in the review; 5) interpretation of results; 6) presentation of the review / synthesis of knowledge. The selected studies were in the period between 2015 and 2020. Results: 26 articles were included; the vast majority reported findings of the nursing practice environment and results for nurses, for nurse managers, for clients and for the effectiveness of organizations, in the hospital context. Conclusions: Improving the nursing practice environment has consequences for the quality of nursing care, with an increase in results for nursing, clients and the hospital context.
Article
Aim: To analyse the moderating effect of role clarity on the relationship between social support (supervisor and colleagues) and job satisfaction. Background: The social support of supervisors and co-workers and the clarity of roles are important antecedents of job satisfaction. According to the Conservation of Resources theory, the interaction of the instrumental nature of role clarity and social support would result in higher levels of job satisfaction in nursing. Methods: Through a convenience sample, a final sample of 191 participants (64.92% registered nurses, 35.08% nursing assistants) was obtained from a private hospital complex in Portugal. Hierarchical linear regression models were carried out to check the moderating function of role clarity. Results: Regression models showed the moderating effect of role clarity. Nursing staff with high social support from their supervisors and peers showed higher scores in job satisfaction when role clarity was high. Conclusion: An adequate description of roles, through clear and detailed information regarding expected functions, responsibilities and behaviour, allows the effect of social support from supervisors and co-workers on job satisfaction to be stronger. Implications for nursing practice: Strategies such as defining responsibilities, setting clear expectations and role analysis allow a reduction in sources of uncertainty in jobs. Training in communication and feedback skills would improve the social support given by supervisors and colleagues. Implications for nursing policy: Hospital boards and nurse managers should be aware of the importance of clarifying roles, responsibilities, and functions of each professional category and hierarchical level for the provision of adequate quality of care.
Article
Aims and objectives: To assess the nursing practice environments and nurse job-related outcomes in two types of hospitals in Saudi Arabia. Background: The nursing shortage is a challenging problem in Saudi hospitals. Studies have shown that poor practice environments and high patient-to-nurse ratios are associated with poor nurse job outcomes (i.e. job dissatisfaction, burnout and intention to leave) and that can lead to nurse turnover and compound the nursing shortage. However, little research has been conducted on this topic in Saudi Arabia. Design: A cross-sectional design. A model that links the nursing practice environment and patient-to-nurse ratio to nurse job outcomes was tested through a path analysis of survey data. Methods: A sample of 404 nurses from public and military hospitals in Saudi Arabia completed a survey that included the Practice Environment Scale of the Nursing Work Index, the Maslach Burnout Inventory and questions related to job dissatisfaction and intention to leave the job. A model of nurse turnover was used to test the relationships among study variables. This study was carried out in accordance with the STROBE checklist for cross-sectional studies. Results: The nursing practice environment and nurse job outcomes were better in military hospital compared with public hospital. Overall, 53% of participants had high burnout, 39% were dissatisfied, and 26% intended to leave their jobs. The path analysis showed that the nursing practice environment and patient-to-nurse ratio were predictors of burnout and job dissatisfaction, which in turn lead to intention to leave. The tested model had good fit and explained the direct and indirect effects of study variables. Conclusion: Poor nursing practice environments and high patient-to-nurse ratios contribute to poor nurse job outcomes in Saudi hospitals. Relevance to clinical practice: Nurse leaders can focus on enhancing practice environments and reducing patient-to-nurse ratios as retention strategies to improve nurse job outcomes.
Article
Purpose: This study illustrates the huge untapped potential of quantifying the impact of culture in making meaningful comparisons across groups. Our focus is on cross-national differences in nurses' reports of their relations with physicians, and how the measurement of this complex construct and the evaluation of true differences are related to dimensions of national culture. Design: We examine across 14 European countries the association between indices of national culture from the seminal work of Hofstede and 39,435 nurses' ratings of their relations with physicians. Multilevel confirmatory factor analysis was used to evaluate strong factorial invariance across countries and to examine the influence of power distance and masculinity. Findings: There was wide variation across countries in nurses' reports of their relations with physicians. Strong factorial invariance was shown for a one-factor model, which confirmed that across countries the seven survey items measure a common factor of physician-nurse relations. This model showed no country bias for any of the seven survey items, which suggests that differences across countries reflect true differences. These true differences were significantly associated with variation in country values of power distance, which showed a significant negative correlation with physician-nurse relations. Conclusions: Continuously pursuing a better understanding of characteristics that impact the studied indicators, such as national culture, is elementary to better understand the construct under study. In this application, country values of power distance negatively impacted nurse-reported relations with physicians, which strongly varied across countries. Clinical relevance: Better nurse-reported relations between nurses and physicians link to higher nurse job satisfaction, lower emotional exhaustion, better nurse-perceived quality of care, and lower patient mortality. The Practice Environment Scale of the Nursing Work Index is an excellent instrument to characterize variation in working relations between nurses and physicians as well as physicians' professional posture towards nurses.
Article
This study examines the relationships between of nurses’ perception of their authentic leadership, intention to quit, and employee performance. The implementation part of the study was conducted with nurses working in a public hospital in the city of Yozgat, Turkey. The data were collected in December 2017 from 189 participants. The results of the analyses showed that relationships between authentic leadership dimensions and intention to quit were not significant. While the all dimensions of authentic leadership explained 6.8% of the variance for the employee performance; explained 3.7% of the variance for the intention to quit. According to these results, improving authentic leadership perception of nurses will improve nurse performance.
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Work engagement of nurses has a great effect on their productivity, patient outcomes, and organizational performance. It is important to explore what can be done to facilitate nurse engagement. In this study, we surveyed a total of 1,065 nurses chosen from seven hospitals in China by random cluster sampling to explore the state of nurse engagement and its associations with organizational justice and job characteristics. The mean score for nurse engagement was 3.5 (SD = 1.5) on a 0–6 scale, and in hierarchical multiple regression analyses we found that nurse engagement had statistically significant relationships with the two organizational justice dimensions of distributive justice (β = 0.13, p < .01) and informational justice (β = 0.17, p < .05); and the three job characteristic dimensions of task significance (β = 0.15, p < .01), job feedback (β = 0.10, p < .01), and skill variety (β = .08, p < .05). Hence, work engagement of nurses was not at a high level, and nursing leaders should consider enhancing their engagement through creating motivational job characteristics and improving nurses’ perception of organizational justice.
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The WHO Global Code of Practice on the International Recruitment of Health Personnel is a landmark in the health workforce migration debate. Yet its principles apply only partly within the European Union (EU) where freedom of movement prevails. The purpose of this article is to explore whether free mobility of health professionals contributes to "equitably strengthen health systems" in the EU. The article proposes an analytical tool (matrix), which looks at the effects of health professional mobility in terms of efficiency and equity implications at three levels: for the EU, for destination countries and for source countries. The findings show that destinations as well as sources experience positive and negative effects, and that the effects of mobility are complex because they change, overlap and are hard to pin down. The analysis suggests that there is a risk that free health workforce mobility disproportionally benefits wealthier Member States at the expense of less advantaged EU Member States, and that mobility may feed disparities as flows redistribute resources from poorer to wealthier EU countries. The article argues that the principles put forward by the WHO Code appear to be as relevant within the EU as they are globally. Copyright © 2015. Published by Elsevier Ireland Ltd.
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This study integrates previously isolated findings of nursing outcomes research into an explanatory framework in which care left undone and nurse education levels are of key importance. A moderated mediation analysis of survey data from 11,549 patients and 10,733 nurses in 217 hospitals in eight European countries shows that patient care experience is better in hospitals with better nurse staffing and a more favorable work environment in which less clinical care is left undone. Clinical care left undone is a mediator in this relationship. Clinical care is left undone less frequently in hospitals with better nurse staffing and more favorable nurse work environments, and in which nurses work less overtime and are more experienced. Higher proportions of nurses with a bachelor's degree reduce the effect of worse nurse staffing on more clinical care left undone. © The Author(s) 2015.
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Background: Recent methodological advancements should catalyze the evaluation of measurement invariance across groups, which is required for conducting meaningful cross-group comparisons. Objective: The aim of this study was to apply a state-of-the-art statistical method for comparing latent mean scores and evaluating measurement invariance across managers' and frontline workers' ratings of the organization of hospital care. Methods: On the 87 nursing units in a single institution, French-speaking and Dutch-speaking nursing unit managers' and staff nurses' ratings of their work environment were measured using the multidimensional 32-item practice environment scale of the nursing work index (PES-NWI). Measurement invariance and latent mean scores were evaluated in the form of a Bayesian 2-level multiple indicators multiple causes model with covariates at the individual nurse and nursing unit level. Role (manager, staff nurse) and language (French, Dutch) are of primary interest. Results: Language group membership accounted for 7 of 11 PES-NWI items showing measurement noninvariance. Cross-group comparisons also showed that covariates at both within-level and between-level had significant effects on PES-NWI latent mean scores. Most notably, nursing unit managers, when compared with staff nurses, hold more positive views of several PES-NWI dimensions. Conclusions: Using a widely used instrument for measuring nurses' work environment, this study shows that precautions for the potential threat of measurement noninvariance are necessary in all stages of a study that relies on survey data to compare groups, particularly in multilingual settings. A Bayesian multilevel multiple indicators multiple causes approach can accommodate for detecting all possible instances of noninvariance for multiple covariates of interest at the within-level and between-level jointly.
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A new Irish government came to power in March 2011 with the most radical proposals for health system reform in the history of the state, including improving access to healthcare, free GP care for all by 2015 and the introduction of Universal Health Insurance after 2016. All this was to be achieved amidst the most severe economic crisis experienced by Ireland since the 1930s. The authors assess how well the system coped with a downsizing of resources by an analysis of coverage and health system activity indicators. These show a health system that managed ‘to do more with less’ from 2008- 2012. They also demonstrate a system that was ‘doing more with less’ by transferring the cost of care onto people and by significant resource cuts. From 2013, the indicators show a system that has no choice but ‘to do less with less’ with diminishing returns from crude cuts. This is evident in declining numbers with free care, of hospital cases and home care hours, alongside increased wait-times and expensive agency staffing. The results suggest a limited window of benefit from austerity beyond which cuts and rationing prevail which is costly, in both human and financial terms.
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Background: Austerity measures and health-system redesign to minimise hospital expenditures risk adversely affecting patient outcomes. The RN4CAST study was designed to inform decision making about nursing, one of the largest components of hospital operating expenses. We aimed to assess whether differences in patient to nurse ratios and nurses' educational qualifications in nine of the 12 RN4CAST countries with similar patient discharge data were associated with variation in hospital mortality after common surgical procedures. Methods: For this observational study, we obtained discharge data for 422,730 patients aged 50 years or older who underwent common surgeries in 300 hospitals in nine European countries. Administrative data were coded with a standard protocol (variants of the ninth or tenth versions of the International Classification of Diseases) to estimate 30 day in-hospital mortality by use of risk adjustment measures including age, sex, admission type, 43 dummy variables suggesting surgery type, and 17 dummy variables suggesting comorbidities present at admission. Surveys of 26,516 nurses practising in study hospitals were used to measure nurse staffing and nurse education. We used generalised estimating equations to assess the effects of nursing factors on the likelihood of surgical patients dying within 30 days of admission, before and after adjusting for other hospital and patient characteristics. Findings: An increase in a nurses' workload by one patient increased the likelihood of an inpatient dying within 30 days of admission by 7% (odds ratio 1·068, 95% CI 1·031-1·106), and every 10% increase in bachelor's degree nurses was associated with a decrease in this likelihood by 7% (0·929, 0·886-0·973). These associations imply that patients in hospitals in which 60% of nurses had bachelor's degrees and nurses cared for an average of six patients would have almost 30% lower mortality than patients in hospitals in which only 30% of nurses had bachelor's degrees and nurses cared for an average of eight patients. Interpretation: Nurse staffing cuts to save money might adversely affect patient outcomes. An increased emphasis on bachelor's education for nurses could reduce preventable hospital deaths. Funding: European Union's Seventh Framework Programme, National Institute of Nursing Research, National Institutes of Health, the Norwegian Nurses Organisation and the Norwegian Knowledge Centre for the Health Services, Swedish Association of Health Professionals, the regional agreement on medical training and clinical research between Stockholm County Council and Karolinska Institutet, Committee for Health and Caring Sciences and Strategic Research Program in Care Sciences at Karolinska Institutet, Spanish Ministry of Science and Innovation.
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Background Little is known of the extent to which nursing-care tasks are left undone as an international phenomenon. Aim The aim of this study is to describe the prevalence and patterns of nursing care left undone across European hospitals and explore its associations with nurse-related organisational factors. Methods Data were collected from 33 659 nurses in 488 hospitals across 12 European countries for a large multicountry cross-sectional study. Results Across European hospitals, the most frequent nursing care activities left undone included ‘Comfort/talk with patients’ (53%), ‘Developing or updating nursing care plans/care pathways’ (42%) and ‘Educating patients and families’ (41%). In hospitals with more favourable work environments (B=−2.19; p<0.0001), lower patient to nurse ratios (B=0.09; p<0.0001), and lower proportions of nurses carrying out non-nursing tasks frequently (B=2.18; p<0.0001), fewer nurses reported leaving nursing care undone. Conclusions Nursing care left undone was prevalent across all European countries and was associated with nurse-related organisational factors. We discovered similar patterns of nursing care left undone across a cross-section of European hospitals, suggesting that nurses develop informal task hierarchies to facilitate important patient-care decisions. Further research on the impact of nursing care left undone for patient outcomes and nurse well-being is required.
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Few researchers have examined how the components of the Practice Environment Scale of the Nursing Work Index (PES-NWI) relate to nurses' well-being at multiple organizational levels. The objective of the study was to perform a multilevel assessment of the relationships of the PES-NWI subscales with three nurse outcomes: job satisfaction, emotional exhaustion, and turnover intentions. Additionally, we tested the multilevel factor structure of the PES-NWI. In a sample of 699 full-time registered nurses in 79 units and 9 branches of a hospital system, relationships of the NWI with nurse outcomes were fairly consistent across levels of analysis. However, subscales contributed differently to the three outcomes, demonstrating the complexity of environmental influences on nurses' work experience. © 2013 Wiley Periodicals, Inc. Res Nurs Health.
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There is strong evidence to show that lower nurse staffing levels in hospitals are associated with worse patient outcomes. One hypothesised mechanism is the omission of necessary nursing care caused by time pressure-'missed care'. To examine the nature and prevalence of care left undone by nurses in English National Health Service hospitals and to assess whether the number of missed care episodes is associated with nurse staffing levels and nurse ratings of the quality of nursing care and patient safety environment. Cross-sectional survey of 2917 registered nurses working in 401 general medical/surgical wards in 46 general acute National Health Service hospitals in England. Most nurses (86%) reported that one or more care activity had been left undone due to lack of time on their last shift. Most frequently left undone were: comforting or talking with patients (66%), educating patients (52%) and developing/updating nursing care plans (47%). The number of patients per registered nurse was significantly associated with the incidence of 'missed care' (p<0.001). A mean of 7.8 activities per shift were left undone on wards that are rated as 'failing' on patient safety, compared with 2.4 where patient safety was rated as 'excellent' (p <0. 001). Nurses working in English hospitals report that care is frequently left undone. Care not being delivered may be the reason low nurse staffing levels adversely affects quality and safety. Hospitals could use a nurse-rated assessment of 'missed care' as an early warning measure to identify wards with inadequate nurse staffing.
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Retaining valuable employees is a major issue for organizations, especially for professions characterized by shortage (e.g., nursing). It is thus important for organizations to determine factors predicting personnel satisfaction and intent to leave at various levels (i.e., organization, group, and individual). Yet, few studies of satisfaction in nursing have analyzed a comprehensive set of factors taking into account multiple organizational levels using appropriate statistical analysis techniques. We conducted a study with 1,547 nurses working in 17 hospitals in Switzerland. Results from multilevel analyses suggest that job satisfaction is predicted by both individual-level (burnout and work-family conflict) and group-level (group cohesion and unit effectiveness) factors, while organizational-level factors (e.g., autonomy) have less impact. Moreover, intent to leave the job is predicted by job satisfaction, but the relationship is moderated by perceived differences in priorities between nurses and their employer. Organizational administrators should consider both individual-level and group-level factors when developing strategies to satisfy and retain key personnel, but also how to align priorities and how to best communicate what they have done.
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chan z.c.y., tam w.s., lung m.k.y., wong w.y. & chau c.w. (2013) Journal of Nursing Management 21, 605–613 A systematic literature review of nurse shortage and the intention to leave Aim To present the findings of a literature review regarding nurses’ intention to leave their employment or the profession. Background The nursing shortage is a problem that is being experienced worldwide. It is a problem that, left unresolved, could have a serious impact on the provision of quality health care. Understanding the reasons why nurses leave their employment or the profession is imperative if efforts to increase retention are to be successful. Evaluation Electronic databases were systematically searched to identify English research reports about nurses’ intention to leave their employment or the profession. Key results concerning the issue were extracted and synthesized. Key issues The diversified measurement instruments, samples and levels of intention to leave caused difficulties in the attempt to compare or synthesize findings. The factors influencing nurses’ intention to leave were identified and categorized into organizational and individual factors. Conclusions The reasons that trigger nurses’ intention to leave are complex and are influenced by organizational and individual factors. Further studies should be conducted to investigate how external factors such as job opportunities correlate with nurses’ intention to leave. Implications for nursing management The review provides insight that can be useful in designing and implementing strategies to maintain a sustainable workforce in nursing.
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Given the extensive research on the topic of voluntary employee turnover in the past decade as well as new managerial approaches to employee retention, labor market dynamism, and evolution in research methodology and technology, it is important that researchers evaluate the current state of the field. In this chapter, we critically review prior research to provide a solid foundation and clear perspective to guide future research. Some of the major trends of the past decade include: (1) new individual difference predictions of turnover (e.g., personality, motivating forces); (2) increased emphasis on contextual variables with an emphasis on interpersonal relationships (e.g., leader–member exchange, interpersonal citizenship behaviors); (3) enhanced focus on factors looking specifically at staying (e.g., organizational commitment and job embeddedness); and (4) dynamic modeling of turnover processes with the consideration of time (e.g., changes in job satisfaction). We believe these trends point to a number of important issues to consider in the next decade, including the influence of social networks, differences across cultures, temporal aspects (e.g., early vs. late turnover), consequences of turnover, multi‐level investigations of turnover and other types of withdrawal (e.g., retirement).
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Aim Assess nurse retention challenges and strategies as perceived by nursing directors in Lebanese hospitals. Background The Kampala Health Workforce Declaration stressed the importance of retaining an effective, responsive and equitably distributed health workforce, particularly nurses. Little is known about nurse retention challenges and strategies in Lebanon. Methods Nursing directors of 76 hospitals participated and were sent a two-page survey on perceived retention challenges and hospital-based retention strategies. Results Retention challenges included unsatisfactory salary, unsuitable shifts and working hours, as well as better opportunities in other areas within or outside Lebanon. Retention strategies included implementing financial rewards and benefits, a salary scale, staff development, praise and improving work environment. Nursing directors did not address all perceived challenges in their strategies. Implications for nursing management To better manage the nursing workforce, nursing directors should regularly measure and monitor nurse turnover rates and also their causes and predictors. Nursing directors should develop, implement and evaluate retention strategies. More information is needed on the management and leadership capacities of nursing directors in addition to their span of control. Conclusion Nursing directors are facing challenges in retaining their nurses. If these problems are not addressed, Lebanon will continue to lose competent and skilled nurses.
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To determine whether hospitals with a good organisation of care (such as improved nurse staffing and work environments) can affect patient care and nurse workforce stability in European countries. Cross sectional surveys of patients and nurses. Nurses were surveyed in general acute care hospitals (488 in 12 European countries; 617 in the United States); patients were surveyed in 210 European hospitals and 430 US hospitals. 33 659 nurses and 11 318 patients in Europe; 27 509 nurses and more than 120 000 patients in the US. Nurse outcomes (hospital staffing, work environments, burnout, dissatisfaction, intention to leave job in the next year, patient safety, quality of care), patient outcomes (satisfaction overall and with nursing care, willingness to recommend hospitals). The percentage of nurses reporting poor or fair quality of patient care varied substantially by country (from 11% (Ireland) to 47% (Greece)), as did rates for nurses who gave their hospital a poor or failing safety grade (4% (Switzerland) to 18% (Poland)). We found high rates of nurse burnout (10% (Netherlands) to 78% (Greece)), job dissatisfaction (11% (Netherlands) to 56% (Greece)), and intention to leave (14% (US) to 49% (Finland, Greece)). Patients' high ratings of their hospitals also varied considerably (35% (Spain) to 61% (Finland, Ireland)), as did rates of patients willing to recommend their hospital (53% (Greece) to 78% (Switzerland)). Improved work environments and reduced ratios of patients to nurses were associated with increased care quality and patient satisfaction. In European hospitals, after adjusting for hospital and nurse characteristics, nurses with better work environments were half as likely to report poor or fair care quality (adjusted odds ratio 0.56, 95% confidence interval 0.51 to 0.61) and give their hospitals poor or failing grades on patient safety (0.50, 0.44 to 0.56). Each additional patient per nurse increased the odds of nurses reporting poor or fair quality care (1.11, 1.07 to 1.15) and poor or failing safety grades (1.10, 1.05 to 1.16). Patients in hospitals with better work environments were more likely to rate their hospital highly (1.16, 1.03 to 1.32) and recommend their hospitals (1.20, 1.05 to 1.37), whereas those with higher ratios of patients to nurses were less likely to rate them highly (0.94, 0.91 to 0.97) or recommend them (0.95, 0.91 to 0.98). Results were similar in the US. Nurses and patients agreed on which hospitals provided good care and could be recommended. Deficits in hospital care quality were common in all countries. Improvement of hospital work environments might be a relatively low cost strategy to improve safety and quality in hospital care and to increase patient satisfaction.
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The Portuguese population enjoys good health and increasing life expectancy, though at lower levels than other western European countries. All residents in Portugal have access to health care provided by the National Health Service (NHS), financed mainly through taxation. Co-payments have been increasing over time, and the level of cost-sharing is highest for pharmaceutical products. Approximately one-fifth to a quarter of the population enjoys a second (or more) layer of health insurance coverage through health subsystems and voluntary health insurance (VHI). Health care delivery is based on both public and private providers. Public provision is predominant in primary care and hospital care, with a gatekeeping system in place for the former. Pharmaceutical products, diagnostic technologies and private practice by physicians constitute the bulk of private health care provision. The Portuguese health system has not undergone any major changes on the financing side since the early 1990s, despite the steady growth of public health expenditure. On the other hand, many measures have been adopted to improve the performance of the health system, including public private partnerships (PPPs) for new hospitals, a change in NHS hospital management structures, pharmaceutical reforms, the reorganization of primary care and the creation of long-term care networks. Some of these measures have faced opposition from the (local) population, namely those related to the closure of health care facilities. There is an overall awareness, and concern, about the rise in health care expenditure in Portugal. Most of the reforms that have come into effect have done so too recently to measure any effects at present (January 2011).
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