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Exploring nurses’ experiences of value congruence and the perceived relationship with wellbeing and patient care and safety: a qualitative study

  • NIHR Yorkshire and Humber Patient Safety Translational Research Centre

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Background Values are of high importance to the nursing profession. Value congruence is the extent to which an individual’s values align with the values of their organisation. Value congruence has important implications for job satisfaction. Aim This study explored nurse values, value congruence and potential implications for individual nurses and organisations in terms of wellbeing and patient care and safety. Method Fifteen nurses who worked in acute hospital settings within the UK participated in semi-structured telephone interviews. Thematic analysis was utilised to analyse the data. Results Four themes were identified: organisational values incongruent with the work environment; personal and professional value alignment; nurse and supervisor values in conflict; nurses’ values at odds with the work environment. Perceived value incongruence was related to poorer wellbeing, increased burnout and poorer perceived patient care and safety. The barriers identified for nurses being able to work in line with their values are described. Conclusions Value congruence is important for nurse wellbeing and patient care and safety. Improving the alignment between the values that organisations state they hold, and the values implied by the work environment may help improve patient care and safety and support nurses in practice.
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Exploring nurses’ experiences of value congruence and the perceived relationship with wellbeing
and patient care and safety: a qualitative study
Background: Values are of high importance to the nursing profession. Value congruence is the extent
to which an individual’s values align with the values of their organisation. Value congruence has
important implications for job satisfaction.
Aim: This study explored nurse values, value congruence and potential implications for individual
nurses and organisations in terms of wellbeing and patient care and safety.
Method: Fifteen nurses who worked in acute hospital settings within the United Kingdom
participated in semi-structured telephone interviews. Thematic analysis was utilised to analyse the
Results: Four themes were identified: organisational values incongruent with the work environment;
personal and professional value alignment; nurse and supervisor values in conflict; nurses’ values at
odds with the work environment. Perceived value incongruence was related to poorer wellbeing,
increased burnout, and poorer perceived patient care and safety. The barriers identified for nurses
being able to work in line with their values are described.
Conclusions: Value congruence is important for nurse wellbeing and patient care and safety.
Improving the alignment between the values that organisations state they hold and the values
implied by the work environment may help improve patient care and safety and support nurses in
Key Words: Nurses, Values, Wellbeing, Patient care, Patient safety, Burnout, Qualitative, Interview
Values are recognised as important within nursing (Rassin, 2008), and recent policy initiatives to
recruit nursing staff based on their values underlines the centrality of values for the profession
(Department of Health, 2012). All Registered Nurses (RNs) possess values that will influence their
attitudes, behaviours and emotions. Being aware of values that motivate RNs supports them in
practice. RNs without self-awareness of their motivating values may struggle with their professional
role; whereas RNs with an understanding of their values often achieve personal satisfaction (Altun,
2002). Studies have revealed a relationship between RN values and concepts of wellbeing such as
levels of burnout (Saito, Igarashi, Noguchi‐Watanabe, Takai, Y., & Yamamoto‐Mitani (2018), and job
satisfaction, and performance outcomes (Atefi, Abdullah and Wong, 2014). Importantly, these
studies explored either personal values (Atefi, Abdullah and Wong, 2014) or professional values
(Ravari et al., 2013) and found both sets of values to influence RN job satisfaction and performance.
There is a growing awareness that healthcare staff wellbeing and work related wellbeing concepts
such as burnout may have implications for patient safety. Therefore, it is possible that associations
between RN values and wellbeing concepts may also be relevant in terms of patient care and safety.
For RNs who work in acute hospital settings, depressive symptoms have been found to be directly
associated with poorer perceptions of patient safety at an individual and organisational level
(Johnson et al., 2017). Furthermore, chronic stress has been negatively associated with perceptions
of safety and the ability to act as a safe practitioner (Louch et al., 2017). These findings are
concerning given that RNs perform a key role in ensuring patient safety as they monitor and
coordinate patient care (Kirwin et al., 2013) and therefore have opportunities to reduce adverse
events and prevent errors before they occur. RN staffing levels are a key issue in patient safety. A
crucial review and discussion paper identified a positive relationship between RN staffing levels and
patient outcomes including: lower death rates, reduced incidents of falls, shorter hospital stays, and
less missed care opportunities in acute hospital care settings (Griffiths et al., 2016). The relationship
between RN staffing levels and patient outcomes is of particular concern in the UK due to the
current shortfall, with more than 10% of nursing posts vacant in (Buchan et al., 2019). Furthermore,
research highlights that inadequate staffing impacts not only patient care and safety, but also
negatively affects RN wellbeing (Sizmur & Raleigh, 2018.).
Whilst professional and personal values have been studied simultaneously (Rassin, 2008), few
studies have explored the relationship between these sets of values, and their association with
organisational values. This is important, as the relationships between wellbeing, burnout and patient
care and safety are likely to be influenced by value congruence: the alignment of an individual
employee’s values with those of the organisation in which they work (Verplanken, 2004). Value
incongruence has been related to significant negative outcomes for RNs including low job
satisfaction (Kaya, Çelik & Dalgıç, 2020), higher burnout (Leiter et al., 2009), greater intention to
leave, decreased patient satisfaction (Grates & Mark 2012) and increased staff turnover (Shao et al.,
2018). One study found a significant inverse correlation between value congruence, job satisfaction
and quality of patient care (Kramer and Hafner, 1989). However, there have been some mixed
findings in this area, with one study concluding that value congruence was not related to job
satisfaction (Kalliath et al., 1999), which underlines the need for further research to explore these
Studies to date highlight the importance of values for RNs and suggest potential relationships
between value congruence, wellbeing and patient care and safety. However, these studies have
predominantly used quantitative methods and there has been no study to date that explores RNs
perceptions of these potential relationships.
The study aims:
To explore perceptions of values and value congruence with RNs employed in acute hospital
To understand how values and value congruence are perceived to be related to RN wellbeing,
patient care and safety.
The study adopted an exploratory qualitative approach (Sandelowski, 2000). An essentialist
approach was considered most appropriate as it reported the reality of the participant’s experiences
and related meaning (Braun and Clarke, 2006). To guide and enhance the transparency of study
reporting, the COREQ checklist was applied by one author (AD) (Tong, Sainsbury and Craig, 2007).
Semi-structured telephone interviews were conducted with RNs working in acute hospital settings.
Telephone interviews are a popular method with healthcare staff due to the flexibility of time and
place they offer participants who work shifts (Carr and Worth, 2001). Research suggests that there is
little difference in the responses yielded between telephone and face-to-face interviews (Carr and
Worth, 2001). The interviews lasted an average of 30 minutes.
The interview schedule was informed by relevant literature (Altun, 2002; Atefi, Abdullah and Wong,
2014; Grates & Mark, 2012; Rassin, 2008; Verplanken, 2004) with several areas of focus including:
important values for nurses, value congruence and the implications of value congruence. The semi-
structured interview style and schedule allowed for flexibility within the interview, which enabled
the pursuit of issues raised by the study participants. Pilot interviews, conducted with research and
community nurses (n=2), helped refine the topic guide. The interview schedule followed an iterative
approach in which earlier interviews with participants influenced subsequent interviews.
Participant selection and recruitment
Any UK based RN working in an acute hospital setting was eligible to participate. Nurses responded
to advertisements on social media platforms (Facebook and Twitter) to register their interest in
participating. Social media allowed for the recruitment of RNs from multiple organisations of
different sizes from varied geographic locations with a broad range of experiences. This was to
ensure the interviews included RNs perceptions from different organisational cultures. The study
assumed a hybrid sampling method (Barber, 2001), using a combination of opportunity and
purposive sampling. Opportunistic sampling was utilised in the first instance, an approach often used
to recruit nurses (Barnfield, Cross & McCauley (2018). Following this, purposive sampling was
embraced, which allowed a level of control over the cases sampled (Barber, 2001). The recruitment
strategy followed an iterative approach, whereby the researcher (AD) engaged in preliminary
analysis which shaped the subsequent sampled cases (Cohen and Crabtree, 2006). Subgroups not
represented within the sample were subsequently targeted e.g., different NHS bands and
Participants were recruited between May and November (2018). There were 26 responses to the
advertisements, and 15 nurses completed the interviews. The nurses who initially expressed an
interest in participating but did not complete an interview were not required to provide a reason for
non-participation. However, those who did provide a reason for not being able to complete an
interview cited differing work patterns or busy schedules. The participants were based across nine
different hospitals which varied in geographical location and size, in England and Scotland.. The
majority of participants were female (93.3%), White British (93.3%) and Band 5 (66.66%; see Table
Recruitment was ongoing until data saturation had been reached. Data saturation (Saunders et al.,
2017) was considered to be achieved when new interview participants were not expressing new
insights, thus leading to informational redundancy. One researcher (AD) listened to audio recordings
of completed interviews in order to establish when informational redundancy was being reached.
Ethical considerations
Ethical approval was granted by [removed for peer review] (Ethics Reference No: PSC-304;
26/03/2018). All participants consented to participating in the interview and being audio recorded.
Data analysis
The interviews were audio-recorded and transcribed verbatim. Reflexive thematic analysis was used:
this offers a flexible approach for data analysis to provide a rich and detailed account (Braun and
Clarke, 2006). This was appropriate for understanding RNs’ values and their experiences of value
congruence and its impact on wellbeing and patient care and safety. Data analysis involved six steps
(Braun and Clarke, 2006). In the first step, familiarisation with the data occurred through listening to
the audio recordings, reading and re-reading transcripts with initial observations being noted. In the
next stage, all transcripts were read and coded by one author (AD). Additionally, two authors
independently coded a third of the transcripts (GL and JJ). After discussion and consensus between
three authors (AD, GL and JJ), initial codes were generated, and applied to the full dataset. In stage
three, codes were gathered into potential themes. In the fourth stage, the themes were reviewed in
relation to the coded extracts and the entire data set. In stage five, with further analysis, these
themes were refined to generate clear definitions and names. Finally, meaningful extracts were
identified to represent the themes. Throughout the analysis stages, one author (AD) simultaneously
charted the data by creating tables with initial codes, pulling data from further transcripts into this
and then visually grouping these to form the final themes.
Four key themes were identified, which described the different aspects of value congruence
experienced by RNs: organisational values incongruent with the work environment; personal and
professional value alignment; nurse and supervisor values in conflict; and nurses’ values at odds with
the work environment.
Organisational values incongruent with the work environment
There was incongruence described by most RNs across all bands, between organisational values and
the work environments created in practice. The values that the RNs described as reported by their
organisations included honesty, compassion, care, respect and being patient centred. However, the
RNs perceived that organisations aimed to meet policy driven targets, and that managing limited
resources and funding had become the most valued aspects for the organisations. Service pressures
created barriers (e.g., staffing levels) which were perceived as preventing the nurses from being able
to work in line with their values, eroding value congruence between RNs and their organisation. This
incongruence was described by RNs from all bands (5-8), however the extent to which RNs viewed
these pressures within the wider context varied. Band 5 RNs, described this incongruence as being
created at the organisation level, whereas higher banded RNs (i.e., 7, 8) described the incongruence
as emerging due to external pressures from national policies or directives. Regardless of origin, this
incongruence impacted on RNs’ perceived levels of wellbeing and feelings of wanting to leave the
profession, across all bands. It also led to RNs feeling disenfranchised: RNs described their
organisations as either using values as ‘buzz words’ or trying to enforce these values without
creating an environment where it was possible for nurses to enact these to promote patient care
and safety. The result was that this incongruence created tensions between the RNs and their
“If I’m being totally honest I feel like they just tap these words out to like make them look
good, but they don’t create an environment in order to fulfil them. So they say this is what
we are striving for and this is what we are doing, but at the end of the day all it comes down
to is money in the budget and that’s the most important thing to them like the managers and
stuff. Like if I say, ‘well you know we want more staff so I can give person centred care', they
would just say ‘well you should be giving that anyway’ erm and they say ‘well we have to
look at the budget’ and that’s all they look at, is the numbers [sic]” ( P6 Female, Band 5)
Nurses hate tick boxes they are just meaningless but governments love them but that’s not
what patient care is all about […] I feel as though hands-on patient care is getting
compromised by some of these things [sic]” (P15 Female, band 7)
I think that hospitals that are under extreme pressure at the minute and I think that
sometimes causes the conflict between your values and you know your actions [sic]” (P4
Male, Band 8)
Personal and professional value alignment
There was a clear perceived relationship between personal and professional values. RNs described
these as being inseparable and that both were integral to their role. RNs highlighted a specific value
set required to be, and perform as, a nurse. The values most frequently described as important were
related to both personal and professional life, for example, compassion and respect for others,
integral to promoting patient experiences of care and safety. The interplay between personal and
professional values with those of the workplace was considered important for RN wellbeing. Any
value congruence or incongruence experienced by RNs within the workplace applied to their
personal values, as well as professional:
“I think what you bring to nursing is what you value, you know you can’t draw a line in the
sand between them both you know what is important to you outside of work is always going
to transfer to what you do inside of work and vice versa. [sic]” (P12 Female, Band 7)
I feel like to be considered a nurse you have to have values that match up with the
professional remit otherwise there are going to be issues. [sic] (P14 Female, Band 5)
Nurse and supervisor values in conflict
Some RNs described a lack of congruence between their own values and the values held by their
supervisors. There was a difference between the positions of supervision identified between the
different bands of RNs. Band 5 RNs mainly discussed their immediate leaders on their ward or unit
(e.g. matron, lead nurse); whereas RNs in higher bands (Band 7) more often referred to the
management tier of their organisation or of the NHS. RNs described some of their supervisors as
holding a different set of values to themselves, which could lead to supervisors asking or expecting
them to behave in a way that was not in line with their own values. For example, Band 5 RNs
reported the importance (to them) of providing good quality and safe patient care, whilst they
perceived their supervisor’s values were related more to efficiency or numbers. Many RNs described
their supervisors as prioritising the saving of money, conducting audits or managing the flow of
patients through the hospital. This perceived values conflict was viewed as having an impact on
patient safety, as nurses described being asked to act in a way that led to some potentially unsafe
behaviours. Furthermore, the perception of a different value set among senior nurses also impacted
upon levels of wellbeing or burnout. The quality of patient care that nurses felt they could provide
was considered to be closely linked with their wellbeing. Nurses who described experiencing a
conflict in values with those of their supervisors, felt they were unable to provide the care they
wanted to provide, and perceived this as being linked to poorer wellbeing:
The Matron
asked me to move this patient that was close to dying on to the corridor. I was
just like that is ridiculous obviously that goes against all your values but then so stuff like that
and when they have patients on corridors and stuff like that. That was really hard to see
patients on corridors, but not in bed areas. That goes against your values, like imagine
coming to see your relative in hospital and they’re on the corridor [sic]” (P8 Female, Band 5)
A Matron is the head of a nursing team. They carry out RN duties, but also look after a team of staff
(, 2020).
When it goes higher up it will always come down to money and that’s where you will kind of
lose your sense of values and because it’s not about the care anymore it’s about the business
when it gets to the top of the NHS I think that upset me quite a lot because I didn’t feel like it
was something that I could control [sic]” (P 13, Female, Band 7)
Nurse values at odds with work environment
RNs discussed that care they were able to deliver within the current system was not in line with their
own values. They valued providing high quality, compassionate patient-centred care. However,
service pressures and the demand on staff created a work environment which was incongruent with
RN values, as these staff were no longer able to dedicate time to provide patient care. Building upon
the previous theme, the discord within the work environment described by RNs was exacerbated by
incongruence with supervisors. However, the incongruence within the work environment was a
culmination of many factors. The challenges described within the work environment influenced the
quality and safety of care that RNs perceived they could deliver. This inability to deliver safe and
good quality patient care impacted on RNs’ impression of their wellbeing, and feelings of wanting to
leave the profession:
The ability to be able to deliver care that is in line with your values is a massive influence on
job satisfaction and being happy at work. So yeah absolutely, it is important for those
elements of staff wellbeing that they are able to deliver nursing... that they are able to feel
that they are delivering nursing that’s important to them. [sic](P 12 Female, Band 7)
Sometimes that can really upset you because you I wanna be a good nurse you know I
wanna show people that I wanna care for them and I don’t feel like I'm giving that to them
because I haven’t got the time and I think that’s when you are really tested because you’re
not thinking about your values you've not got enough time to give the kind of care that you
want to give so that’s when your most tested. [sic] (P 13 Female, Band 5)
This is the first study to explore the relationship between value congruence, wellbeing and patient
care and safety for RNs using in-depth, qualitative methods. The study found that there is alignment
of personal and professional values of RNs. However, there were several areas of incongruence that
RNs experienced between their values, and their supervisors and work environment, and between
the organisation’s values and work environment. This incongruence was perceived to negatively
impact upon the relationships between quality of patient care and safety, and RN wellbeing.
This study builds upon previous literature assessing RNs values by providing depth and
understanding of the association between personal and professional values (Riklikiene, Karosas and
Kaeliene, 2017). Personal and professional value alignment was reinforced: RNs believed there to be
very little difference between their own personal values and professional values, and that having an
inherent set of values was integral to the profession. This finding is supported by the literature
reporting on RNs personal (Horton, Tschudin and Forget, 2007) and professional values (Weis and
Schank, 1997). This alignment of the personal and professional values for nurses may lead to further
ramifications for personal wellbeing as the sources of value incongruence at work cannot be
separated from professional values.
Our findings contribute to the existing literature by describing the relationship between value
congruence, wellbeing and patient care and safety. This adds to existing knowledge that value
incongruence is linked with poorer staff wellbeing (Verplanken, 2004), and higher staff turnover
(Grates & Mark 2012) as it provides supporting accounts which show how these concepts are
connected. Previous qualitative research established the relationships between burnout and patient
care and safety for physicians as being potentially circular (Hall et al., 2017). This finding is supported
by the current study, and together it suggests that value incongruence may be one catalyst for this
negative cycle of high levels of burnout amongst nurses, and poorer perceptions of patient care and
Further, the service pressures RNs described in this study which eroded values-based practice (i.e.
staffing levels and external policy context) were also identified in a review which focussed on
contributory factors to patient safety incidents (Lawton et al., 2011). This finding supports the
relevance of value congruence in the context of the work environment and patient safety
implications. This study highlights the different contexts of pressures for nurses of different bands.
Nurses in higher bands seemed more able to view service pressures within the wider context of
external policies.
These findings raise important implications for supporting staff wellbeing within the current system.
It is important to consider how to support nurses’ personal and professional values due to their close
alignment: values-based recruitment and employment would support this endeavour. The
incongruence identified by RNs between an organisations values and their work environment was
considered to be related to poorer wellbeing and a poorer quality of care and safety for patients.
Currently nurses are being recruited on the basis they hold the values of the organisation, through
values-based recruitment (DoH, 2012), however, this study demonstrates if these values are not
upheld within the work environment there will be a negative impact upon wellbeing and patient
care and safety. This relationship is further supported by longitudinal qualitative research following
students to newly qualified nurses: newly qualified nurses experienced burnout, disillusionment and
planned to leave the profession because the work environment prevented them behaving in line
with their values (Maben and Macleod Clark, 2007). Our findings suggest that organisations must
support an environment that is aligned with the values of the nurses recruited. If they do not do this,
they risk making nurses vulnerable to this potential negative cycle of poor wellbeing and burnout
leading to poor patient care and safety (Hall et al., 2017) relating to value incongruence.
Strengths and limitations
A strength of this study was the diverse sample across different specialities of RNs, a range of
experience (i.e. Bands and job title), and geographically diverse trusts. Despite this diversity the
majority of RNs included within this study were white, female and band 5: there was not the
diversity in ethnicity and nationality that exists in the current nursing workforce. Although a
telephone interview method was adopted with the aim of being as accessible as possible, further
research should explore these findings with these harder to reach groups.
Future research should also explore the possibility of a values based intervention to support nurses,
as this study shows a relationship between value incongruence and wellbeing, patient care and
safety. So, this may be an effective tool for supporting wellbeing, and improving patient care and
In summary, the current study has created a greater understanding of the relationship between
perceived nurse wellbeing and patient care and safety, by demonstrating the influence of value
incongruence upon these concepts for RNs. RNs reported that despite personal and professional
value congruence, they often experienced incongruence between their own values and the values
they perceived their supervisors to have, and a mismatch between working in line with their values
within the work environment. Furthermore organisational values were perceived to be challenging
to uphold within the work environment, with several barriers described as preventing RNs ability to
work in line with their values. This finding is important for the practice of values-based recruitment
and the potential for values focussed interventions to support nurse wellbeing.
Key points
RNspersonal and professional values were closely aligned.
The values of hospital organisations were described as being incongruent with the RNs’ work
RNs experienced perceived value incongruence in different forms and described this as
having an impact upon wellbeing and patient care and safety.
As nurses are increasingly being employed through values-based recruitment, organisations
need to ensure that the work environment and the organisations values are aligned to
support RN wellbeing and patient care and safety
Future research should explore the use of a values based intervention to support wellbeing
and patient care and safety.
Ethical Permissions
Ethical approval was granted by [removed for peer review] (Ethics Reference No: PSC-304;
Altun, I. (2002). Burnout and nurses’ personal and professional values. Nursing ethics, 9(3), 269-278.
Atefi, N., Abdullah, K. L., Wong, L. P., and Mazlom, R. (2014). Factors influencing registered nurses
perception of their overall job satisfaction: a qualitative study. International nursing review, 61(3),
Barbour, R. S. (2001). Checklists for improving rigour in qualitative research: a case of the tail
wagging the dog?. Bmj, 322(7294), 1115-1117.
Barnfield, J., Cross, W., & McCauley, K. (2018). Therapeutic optimism and attitudes among medical
and surgical nurses towards attempted suicide. International journal of mental health nursing, 27(6),
Braun, V., and Clarke, V. (2006). Using thematic analysis in psychology. Qualitative research in
psychology, 3(2), 77-101.
Buchan, J., Charlesworth, A., Gershlick, B., and Seccombe, I. (2019). A critical moment: NHS staffing
trends, retention and attrition. Health Foundation.
Carr, E. C., and Worth, A. (2001). The use of the telephone interview for research. NT research, 6(1),
Cohen, D., & Crabtree, B. (2006). Qualitative research guidelines project.
England, N. H. S. (2012). Compassion in Practice: Nursing, Midwifery and Care Staff Our Vision and
Strategy. DH/NHS Commissioning Board, London.
Gates, M. G., & Mark, B. A. (2012). Demographic diversity, value congruence, and workplace
outcomes in acute care. Research in nursing & health, 35(3), 265-276.
Griffiths, P., Ball, J., Drennan, J., Dall’Ora, C., Jones, J., Maruotti, A., Pope, C., Saucedo, A.R. and
Simon, M., 2016. Nurse staffing and patient outcomes: Strengths and limitations of the evidence to
inform policy and practice. A review and discussion paper based on evidence reviewed for the
National Institute for Health and Care Excellence Safe Staffing guideline development. International
Journal of Nursing Studies, 63, pp.213-225.
Hall, L. H., Johnson, J., Watt, I., Tsipa, A., and O’Connor, D. B. (2016). Healthcare staff wellbeing,
burnout, and patient safety: a systematic review. PloS one, 11(7).
Horton, K., Tschudin, V., and Forget, A. (2007). The value of nursing: a literature review. Nursing
ethics, 14(6), 716-740.
Johnson, J., Louch, G., Dunning, A., Johnson, O., Grange, A., Reynolds, C., Hall, L. and O'Hara, J., 2017.
Burnout mediates the association between depression and patient safety perceptions: A cross‐
sectional study in hospital nurses. Journal of advanced nursing, 73(7), pp.1667-1680.
Kalliath, T. J., Bluedorn, A. C., and Strube, M. J. (1999). A test of value congruence effects. Journal of
Organizational Behavior, 20(7), 1175-1198.
Kaya, A., Çelik, D., & Dalgıç, A. İ. (2020). Professional Values and Job Satisfaction Levels of Pediatric
Nurses and Influencing Factors: A Crosssectional Study. The Journal of Pediatric Research, 7(1), 58-
Kirwan, M., Matthews, A., and Scott, P. A. (2013). The impact of the work environment of nurses on
patient safety outcomes: a multi-level modelling approach. International journal of nursing
studies, 50(2), 253-263.
Kramer, M., and Hafner, L. P. (1989). Shared values: Impact on staff nurse job satisfaction and
perceived productivity. Nursing research.
Lawton, R., McEachan, R. R., Giles, S. J., Sirriyeh, R., Watt, I. S., and Wright, J. (2012). Development of
an evidence-based framework of factors contributing to patient safety incidents in hospital settings:
a systematic review. BMJ Qual Saf, 21(5), 369-380.
Leiter, M. P., Jackson, N. J., and Shaughnessy, K. (2009). Contrasting burnout, turnover intention,
control, value congruence and knowledge sharing between Baby Boomers and Generation X. Journal
of nursing management, 17(1), 100-109.
Louch, G., O’Hara, J., Gardner, P., and O’Connor, D. B. (2017). A daily diary approach to the
examination of chronic stress, daily hassles and safety perceptions in hospital nursing. International
journal of behavioral medicine, 24(6), 946-956.
Maben, J., Latter, S., and Clark, J. M. (2007). The sustainability of ideals, values and the nursing
mandate: evidence from a longitudinal qualitative study. Nursing Inquiry, 14(2), 99-113.
Rassin, M. (2008). Nurses' professional and personal values. Nursing ethics, 15(5), 614-630.
Ravari, A., Bazargan-Hejazi, S., Ebadi, A., Mirzaei, T., & Oshvandi, K. (2013). Work values and job
satisfaction: A qualitative study of Iranian nurses. Nursing Ethics, 20(4), 448-458.
Riklikiene, O., Karosas, L., and Kaseliene, S. (2018). General and professional values of student nurses
and nurse educators. Journal of advanced nursing, 74(3), 666-676.
Saito, Y., Igarashi, A., Noguchi‐Watanabe, M., Takai, Y., & Yamamoto‐Mitani, N. (2018). Work values
and their association with burnout/work engagement among nurses in long‐term care
hospitals. Journal of Nursing Management, 26(4), 393-402.
Sandelowski, M. (2000). Whatever happened to qualitative description?. Research in nursing and
health, 23(4), 334-340.
Saunders, B., Sim, J., Kingstone, T., Baker, S., Waterfield, J., Bartlam, B., Burroughs, H. and Jinks, C.,
2018. Saturation in qualitative research: exploring its conceptualization and
operationalization. Quality & quantity, 52(4), pp.1893-1907.
Shao, J., Tang, L., Wang, X., Qiu, R., Zhang, Y., Jia, Y., ... & Ye, Z. (2018). Nursing work environment,
value congruence and their relationships with nurses’ work outcomes. Journal of Nursing
management, 26(8), 1091-1099.
Sizmur, S. and Raleigh, V., 2018. The risks to care quality and staff wellbeing of an NHS system under
pressure. The King's Fund: Oxford.
Tong, A., Sainsbury, P., and Craig, J. (2007). Consolidated criteria for reporting qualitative research
(COREQ): a 32-item checklist for interviews and focus groups. International journal for quality in
health care, 19(6), 349-357.
Verplanken, B. (2004). Value congruence and job satisfaction among nurses: a human relations
perspective. International journal of nursing studies, 41(6), 599-605.
Weis, D., and Schank, M. J. (1997). Toward building an international consensus in professional
values. Nurse education today, 17(5), 366-369. (2020). Nursing Salary & NHS Pay Band Calculator - [online]
Available at:
Table 1: Participant characteristics within the sample.
age (%)
NHS pay band
(www.nurses., 2020)
... Extra effort describes a leader's ability to drive followers to do more or work harder; effectiveness indicates a leader's ability to lead a group and meet goals; and satisfaction with leadership indicates the follower's satisfaction with their leader. Given what is known about leadership in nursing and the implications on professional nursing practice, it is important to consider nursing-specific outcomes such as the alignment of professional values with their leader (Dunning et al., 2021). Therefore, two additional outcomes-nurse manager ability, leadership and support of nurses and value alignment-were added to an adapted FRLM for the purposes of this study. ...
Aims: To describe primary care nurses' perceptions of their formal leaders' leadership behaviors and outcomes and explore differences based upon nurses' individual and work setting characteristics. Background: Formal nursing leadership is positively associated with patient, nurse workforce, and organizational outcomes, yet no studies have examined primary care nurses' perception of formal leadership behaviors and outcomes in the United States. Methods: Cross-sectional survey data from 335 primary care nurses were analyzed to assess perceived leadership behaviors associated with transformational, transactional, and passive-avoidant leadership styles, perceived leadership outcomes, and individual and work setting characteristics. Results: Positive leadership behaviors (transformational) were lower than those reported for other settings. There were significant differences in nurses' perceptions of their leaders' leadership behaviors and outcomes based upon individual and work setting characteristics. Conclusion: This study confirmed differences in perception of leadership and that individual and work setting characteristics influence nurses' perception of their leaders in primary care. Implications for nursing management: Leaders must be versatile and consider the unique needs of each staff member and the influence of clinic characteristics.
... For example, nursing work is viewed as caring (Freshwater and Cahill, 2010), it is predominantly undertaken by women (Goodman, 2016), and much of the work goes unnoticed. Dunning (2021) argues for the importance of values to nursing, but how clearly articulated are they? Understanding and creating cultures embedding the values associated with professional identity in nursing and lived through 'nursing work' is vital if, as the largest global single health and care profession (HCP), we are to respond to population need and position nursing where it should be: closer to communities and where people live (de Blok, 2015). ...
... Qualitative research suggests self-awareness, coping, feeling spiritually enriched and setting boundaries underpin a sense of balance and emotional wellbeing for palliative care nurses (Rose & Glass, 2009, 2010. For nurses in acute hospital settings, the nurses perceptions of organisational values congruence with their own values was perceived to be key for their wellbeing, patient care, and safety (Dunning, Louch, Grange, Spilsbury, & Johnson, 2021). For nurses in their first ...
Background The wellbeing of individuals influences organisational outcomes. Insight into nurses’ wellbeing is crucial to a sustaining a high-quality workforce. Aim To describe nurses’ perceptions and experiences of wellbeing, work wellbeing, and mental health. Method Using a qualitative descriptive design, semi-structured interviews were conducted, transcribed verbatim, analysed inductively and thematically, and reported per consolidated criteria for reporting qualitative research. Findings Nine Australian nurses were interviewed in 2020, each for 60 to 90 minutes. These nurses had a broad range of clinical roles and years of experience in metropolitan healthcare organisations. Six themes, each related to nurse wellbeing, depicted: 1) value and sense of purpose from nursing, yet also negative consequences of losing sight of oneself within the nursing role; 2) work nurses did to disengage from their job and create a balance within their life; 3) significance of the team and senior team as a source of both strength and opportunity for wellbeing; 4) a range of wellbeing initiatives with a perception these were often developed, and for use, in response to crisis as opposed to preventative or proactive measures; 5) value of additional nurse wellbeing education and promotion of available support; and 6) novel challenges and ways to wellbeing during times where resources were stretched and usual support systems impacted. Discussion Identified positive and negative consequences of nursing must be addressed when developing targeted wellbeing interventions. Conclusion New ways of working and supporting individual, team and organisational wellbeing are needed for flourishing working environments. Potential strategies to either leverage or mitigate the positive and negative consequences of nursing are offered.
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Aim:The aim of this cross-sectional study was to investigate the perceptions of professional values and job satisfaction levels of pediatric nurses and their influencing factors.Materials and Methods:This study was conducted with 134 nurses working in the pediatric clinics of three hospitals in Turkey. Nurses’ Professional Values scale and Minnesota Job Satisfaction Questionnaire were used to collect the data.Results:It was found that the pediatric nurses had high professional values and that job satisfaction scores were moderate. It was further noted that pediatric nurses who were single, received their education in a nursing high school, had professional experience of 11-15 years in pediatric clinics, were working as clinical responsible nurse, and were working during the day shift regularly had higher scores of professional values. It was found that the job satisfaction of the pediatric nurses who were married, received their education in a nursing high school, had professional experience of 11-15 years in pediatric clinics, were working as clinical responsible nurse, and were working at day shift regularly, was significantly higher than the others. The results also indicated a positive and high correlation between pediatric nurses’ perception of professional values and job satisfaction levelsConclusion:It was concluded that promoting professional values among nurses would eventually result in increasing levels of job satisfaction. We believe this study provides substantial data in this particular field in Turkey and it is hoped that it may be used to guide nursing managers to design well-established and unbiased programs for pediatric nurses.
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Saturation has attained widespread acceptance as a methodological principle in qualitative research. It is commonly taken to indicate that, on the basis of the data that have been collected or analysed hitherto, further data collection and/or analysis are unnecessary. However, there appears to be uncertainty as to how saturation should be conceptualized, and inconsistencies in its use. In this paper, we look to clarify the nature, purposes and uses of saturation, and in doing so add to theoretical debate on the role of saturation across different methodologies. We identify four distinct approaches to saturation, which differ in terms of the extent to which an inductive or a deductive logic is adopted, and the relative emphasis on data collection, data analysis, and theorizing. We explore the purposes saturation might serve in relation to these different approaches, and the implications for how and when saturation will be sought. In examining these issues, we highlight the uncertain logic underlying saturation—as essentially a predictive statement about the unobserved based on the observed, a judgement that, we argue, results in equivocation, and may in part explain the confusion surrounding its use. We conclude that saturation should be operationalized in a way that is consistent with the research question(s), and the theoretical position and analytic framework adopted, but also that there should be some limit to its scope, so as not to risk saturation losing its coherence and potency if its conceptualization and uses are stretched too widely.
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Abstract Background There is growing interest in the relationships between depressive symptoms and burnout in healthcare staff and the safety of patient care. Depressive symptoms are higher in healthcare staff than the general population and overlap conceptually with burnout. However, minimal research has investigated these variables in nurses. Given the conceptual overlap between depressive symptoms and burnout, there is also a need for an explanatory model outlining the relative contributions of these factors to patient safety. Aims To investigate the relationships between depressive symptoms, burnout and perceptions of patient safety. A mediation model was proposed whereby the association between symptoms of depression and patient safety perceptions was mediated by burnout. Design A cross-sectional questionnaire was distributed at three acute NHS Trusts. Method Three-hundred and twenty-three hospital nursing staff completed measures of depressive symptoms, burnout and patient safety perceptions (including measures at the level of the individual and the work area/unit) between December 2015 - February 2016. Results When tested in separate analyses, depressive symptoms and burnout facets were each associated with both patient safety measures. Furthermore, the proposed mediation model was supported, with associations between depressive symptoms and patient safety perceptions fully mediated by burnout. Conclusion These results suggest that symptoms of depression and burnout in hospital nurses may have implications for patient safety. However, interventions to improve patient safety may be best targeted at improving burnout in particular, with burnout interventions known to be most effective when focused at both the individual and the organisational level.
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Objective: To determine whether there is an association between healthcare professionals' wellbeing and burnout, with patient safety. Design: Systematic research review. Data sources: PsychInfo (1806 to July 2015), Medline (1946 to July 2015), Embase (1947 to July 2015) and Scopus (1823 to July 2015) were searched, along with reference lists of eligible articles. Eligibility criteria for selecting studies: Quantitative, empirical studies that included i) either a measure of wellbeing or burnout, and ii) patient safety, in healthcare staff populations. Results: Forty-six studies were identified. Sixteen out of the 27 studies that measured wellbeing found a significant correlation between poor wellbeing and worse patient safety, with six additional studies finding an association with some but not all scales used, and one study finding a significant association but in the opposite direction to the majority of studies. Twenty-one out of the 30 studies that measured burnout found a significant association between burnout and patient safety, whilst a further four studies found an association between one or more (but not all) subscales of the burnout measures employed, and patient safety. Conclusions: Poor wellbeing and moderate to high levels of burnout are associated, in the majority of studies reviewed, with poor patient safety outcomes such as medical errors, however the lack of prospective studies reduces the ability to determine causality. Further prospective studies, research in primary care, conducted within the UK, and a clearer definition of healthcare staff wellbeing are needed. Implications: This review illustrates the need for healthcare organisations to consider improving employees' mental health as well as creating safer work environments when planning interventions to improve patient safety. Systematic review registration: PROSPERO registration number: CRD42015023340.
Aims To explore the relationships between work environment, value congruence and nurses’ work outcomes; as well as to test the moderating effects of value congruence. Background A poor nursing work environment in most of mainland China has negatively influenced nurses’ job satisfaction, burnout and turnover intention. New insights such as improving nurses’ value congruence should be proposed to better foster nurses. Methods Cross‐sectional data were selected from the Chinese Nurses’ Environment of Work Status study. In total, 19149 valid samples were collected. Hierarchical regression analyses and simple slope analyses were performed. Results The correlation coefficients of the variables were all significant (p < .01) and in the expected direction. Value congruence moderated the relationship between nursing work environment and burnout (emotional exhaustion: β = 0.106, p < .01; depersonalization: β = 0.111, p < .01). Conclusions Nursing work environment and value congruence were positively related to job satisfaction, and negatively related to burnout and turnover intention. The adverse impact of poor work environment on nurses’ burnout can be buffered if nurses’ value congruence is compatible with that of the organisation. Implications for Nursing Management Except for improving the organisational characteristics, value congruence is a useful concept that managers can leverage to improve positive outcomes for both the organisation and its nurses.
Identification of the attitudes to consumers admitted to hospital following a suicide attempt and the therapeutic optimism of nurses caring for this cohort is vital to ascertain the level of nursing care provided. A convenience sample of 72 Registered and enrolled nurses from a large metropolitan health service in South Eastern Melbourne, Australia, completed a demographic questionnaire, the Elsom Therapeutic Optimism Scale (ETOS), and the Attitudes to Attempted Suicide‐Questionnaire (ATAS‐Q). Data were analysed using SPSS (version 25). Whilst the ETOS & ATAS‐Q correlate positively, themes of shame, blame, misunderstandings, and myths about suicide influence nurses’ perspectives when providing suicide attempt aftercare. This may potentially lead to care that is tokenistic and task focused. To develop their professional skill set when providing suicide attempt aftercare, nurses need both formal and informal education and opportunities to reflect on their practice.
Aims To examine burnout and work engagement among nurses in Japanese long‐term care hospitals and their relation to nurses’ and organisational work values, and nurse‐organisation congruence of such values. Background Nursing managers must help improve nurses’ well‐being; however, no research has considered strategies to improve staff outcomes in long‐term care hospitals. We propose that individual nurse's work values and the congruence of these values with those of their organisations may influence burnout and work engagement. Methods We conducted a cross‐sectional survey of nurses in long‐term care hospitals. Multiple regression analyses were conducted to examine the effects of nurses’ work values and nurse‐organisation congruence in these values on burnout and work engagement. Results Higher individual intrinsic and altruistic work values were associated with improvements in nurses’ burnout and work engagement. Nurse‐organisation non‐congruence in altruistic values was associated with lower work engagement, whereas that of intrinsic work values was not associated with either outcome variable. Conclusion Promoting intrinsic and altruistic work values among nurses could be effective for improving both burnout and work engagement. Implications for Nursing Management Opportunities such as case conferences could foster intrinsic and altruistic work values through the review of good care practices and communication between managers/colleagues about feelings and thoughts.
Aim: To explore and compare the self-reported general and professional values in undergraduate student nurses and nurse educators in Lithuania. Background: Contemporary nursing requires strong moral motivation and clear values as nurses confront many ethical dilemas in their practice. Students acquire essential values of the nursing profession through the appropriate role modeling of their educators. Nursing students seek to become capable in providing ethical and professional patient care while their educators attempt to model desired behaviors. Design: A national cross-sectional comparative study was carried out in March 2011. Four-hundred eight respondents participated: 316 undergraduate nursing students and 92 nurse educators. Methods: A 57-item questionnaire was delivered to nursing programs at three universities and six colleges. Permission to conduct the study was granted by The Center on Bioethics. Results: Student nurses and their educators rated the general value of altruism equally. Educators, in comparison with students, ranked honesty and intellectualism significantly higher and more often admired truth-telling in any circumstance. Students were more likely to avoid intellectual challenges in reading and placed lower importance on academic qualifications for career advancement. The professional nursing values of honesty, intellectualism and authority were ranked significantly higher by nurse educators than student nurses. Conclusions: The study revealed differences in self-reported general and professional values in undergraduate student nurses and nurse educators. The values of nurse educators were not always stronger than those of students. Positive relationships between particular general and professional values in both students and educators confirmed the link between professional and personal values. This article is protected by copyright. All rights reserved.
Purpose: Stress is a significant concern for individuals and organisations. Few studies have explored stress, burnout and patient safety in hospital nursing on a daily basis at the individual level. This study aimed to examine the effects of chronic stress and daily hassles on safety perceptions, the effect of chronic stress on daily hassles experienced and chronic stress as a potential moderator. Method: Utilising a daily diary design, 83 UK hospital nurses completed three end-of-shift diaries, yielding 324 person days. Hassles, safety perceptions and workplace cognitive failure were measured daily, and a baseline questionnaire included a measure of chronic stress. Hierarchical multivariate linear modelling was used to analyse the data. Results: Higher chronic stress was associated with more daily hassles, poorer perceptions of safety and being less able to practise safely, but not more workplace cognitive failure. Reporting more daily hassles was associated with poorer perceptions of safety, being less able to practise safely and more workplace cognitive failure. Chronic stress did not moderate daily associations. The hassles reported illustrate the wide-ranging hassles nurses experienced. Conclusion: The findings demonstrate, in addition to chronic stress, the importance of daily hassles for nurses' perceptions of safety and the hassles experienced by hospital nurses on a daily basis. Nurses perceive chronic stress and daily hassles to contribute to their perceptions of safety. Measuring the number of daily hassles experienced could proactively highlight when patient safety threats may arise, and as a result, interventions could usefully focus on the management of daily hassles.