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Change fatigue in nursing: An integrative review

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Lindsay Beaulieu
Lindsay Beaulieu
Lindsay Beaulieu
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Cydnee Seneviratne at University of Calgary
Cydnee Seneviratne
Lorelli S. Nowell at University of Calgary
Lorelli S. Nowell
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Aims To synthesize the empirical and theoretical literature on change fatigue in nursing, including how change fatigue affects nurses, the nursing profession and strategies to prevent and overcome it. Background Change fatigue refers to the overwhelming feelings of stress, exhaustion and burnout associated with rapid and continuous change across healthcare organizations. Change fatigue can affect nurses' wellbeing, yet there is a distinct lack of literature which synthesizes the relationship between cumulative organizational change and nurses' wellbeing. Design Integrative review following Toronto and Remington and Whittemore and Knafl methodology. Data Sources Searches were conducted in CINAHL, Embase, Medline, APA PsycInfo, Scopus, Business Source Complete and ProQuest Dissertations & Theses Global in January 2022. Review Methods A comprehensive search was conducted to identify literature on change fatigue in nursing. Included literature were critically appraised for methodological quality. Data from each article were abstracted and thematically analysed. Results Twenty‐six articles were included in this review, including 14 empirical studies, 10 theoretical papers and two literature reviews. Five main themes described in the literature included: definitions, preceding factors, associated behaviours, consequences and mitigation strategies for change fatigue. Conclusion This review highlights the impact of rapid and continuous change on nurses and nursing practice. Further research is needed to explore the relationship between change fatigue and burnout, understand how and why nurses withdraw or avoid change, and to develop a metric to measure change fatigue when considering new change initiatives. Impact Findings from this review generated an improved understanding of how change fatigue affects nurses, the nursing profession and strategies to prevent and overcome it. This paper provides practical recommendations for future research, direction for nursing educators and leaders, and encourages nurses to practice political agency with change management. Patient or Public Contribution This project was an integrative review of the literature therefore no patient or public contribution was necessary.
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454 
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  wileyonlinelibrary.com/journal/jan J Adv Nurs. 2023;79:454–470.© 2022 John Wiley & Sons Ltd.
Received: 25 May 2022 
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  Revised: 27 Octob er 2022 
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  Accepted: 9 December 2022
DOI: 10.1111/jan.15546
REVIEW ARTICLE
Change fatigue in nursing: An integrative review
Lindsay Beaulieu1,2  | Cydnee Seneviratne1 | Lorelli Nowell1
1Faculty of Nursing, Unive rsity of Calgary,
Calgary, Alberta, Canad a
2Depar tment of Clinic al Neurosciences,
Alber ta Health Ser vices, Calgary, Alberta,
Canada
Correspondence
Lindsay Beaulieu, Faculty of Nur sing,
University of C algar y, 2500 Un iversity
Drive NW, Calgar y T2N 1N4, AB , Canada.
Email: lindsay.beaulieu1@ucalgary.ca
Funding information
Alber ta Registered Nurses Educat ion
Trust; Universit y of Calg ary
Abstract
Aims: To synthesize the empirical and theoretical literature on change fatigue in nurs-
ing, including how change fatigue affects nurses, the nursing profession and strate-
gies to prevent and overcome it.
Background: Change fatigue refers to the overwhelming feelings of stress, exhaustion and
burnout associated with rapid and continuous change across healthcare organizations.
Change fatigue can affect nurses' wellbeing, yet there is a distinct lack of literature which syn-
thesizes the relationship between cumulative organizational change and nurses' wellbeing.
Design: Integrative review following Toronto and Remington and Whittemore and
Knafl methodology.
Data Sources: Searches were conducted in CINAHL, Embase, Medline, APA PsycInfo,
Scopus, Business Source Complete and ProQuest Dissertations & Theses Global in
January 2022.
Review Methods: A comprehensive search was conducted to identify literature on
change fatigue in nursing. Included literature were critically appraised for methodo-
logical quality. Data from each article were abstracted and thematically analysed.
Results: Twenty- six articles were included in this review, including 14 empirical stud-
ies, 10 theoretical papers and two literature reviews. Five main themes described in
the literature included: definitions, preceding factors, associated behaviours, conse-
quences and mitigation strategies for change fatigue.
Conclusion: This review highlights the impact of rapid and continuous change on nurses and
nursing practice. Further research is needed to explore the relationship between change
fatigue and burnout, understand how and why nurses withdraw or avoid change, and to
develop a metric to measure change fatigue when considering new change initiatives.
Impact: Findings from this review generated an improved understanding of how
change fatigue affects nurses, the nursing profession and strategies to prevent and
overcome it. This paper provides practical recommendations for future research, di-
rection for nursing educators and leaders, and encourages nurses to practice political
agency with change management.
Patient or Public Contribution: This project was an integrative review of the literature
therefore no patient or public contribution was necessary.
KEYWORDS
burnout, change fatigue, healthcare, nurses, nursing, organizational change, political agency,
rapid and continuous change, resiliency, workplace change
... Change fatigue was assessed using the six-item Change Fatigue Measurement Scale (CFMS), 37 which has been validated and found reliable in nursing settings. 1,12 Each item is rated on a 7-point Likert scale (1 = strongly disagree to 7 = strongly agree), which higher total score indicate greater change fatigue. In this study, the Cronbach's α was .921. ...
... 45 However, the process of organizational change is inevitably accompanied by an upsurge in workload and an expansion in the scope of responsibilities, which may lead to work-related stress and fatigue among nurses. 1,7 Therefore, the finding imply that managers should allocate greater attention to the change fatigue experienced by nurses holding high professional titles. Furthermore, we also found that overtime hours positively predicted change fatigue, which is in line with previous studies. ...
... 2,50,51 The ongoing changes challenge nurses' adaptability and coping mechanisms, making them susceptible to change fatigue. 1,12,42,52 However, the effective support and communication can help alleviate this phenomenon, as evidenced in our study. Therefore, it is essential for managers to proactively establish a two-way communication mechanism during periods of change. ...
Change Fatigue Among Clinical Nurses and Related Factors: A Cross-sectional Study in Public Hospitals
Article
Full-text available
  • Mar 2025
Objectives To investigate the levels of change fatigue among clinical nurses in public hospitals and identify the potential contributing factors. Design A cross-sectional, multi-stage sampling study was conducted in accordance with the STROBE guideline. Methods This study surveyed 2,228 nurses in China from October to December 2023 using Wen Juan Xing ( www.wjx.cn ) and employed stepwise multiple linear regression analysis to assess factors associated with change fatigue. Results The average change fatigue score of nurses was found to be at a medium to high level. Factors such as female, professional title, average overtime hours, workflow changes, workload increase, work-content changes, work pressure increases, new technology implementation and the change frequency were all identified as exacerbating nurses’ experience of fatigue related to change. Contrary to this, the support of change resources, communication and transmission of change information, distributed leadership, inclusive climate, readiness for change, change efficacy and workforce agility were found to alleviate the change fatigue to some extent. Conclusions It is urgent and challenging for nursing managers to manage change fatigue. All of these identified predictors in study significantly contribute to the understanding of change fatigue among nurses and can provide valuable insights for health policies aimed at improving the effectiveness of nursing changes. Furthermore, they also offer a theoretical foundation for managers to develop targeted intervention programs for preventing and mitigating the negative impact of change fatigue on nurses and organizational outcomes.
View
... A nurse also reports concerns about organisational changes. Managers need to be attentive to these fears, as rapid change leads to fatigue among nurses (McMillan and Perron, 2020;Beaulieu, Seneviratne, and Nowell 2023). Organisational changes must be accompanied by an implementation strategy (Nielsen et al. 2024). ...
The Outcomes of Implementing Logistician Positions on NURSES' Job Satisfaction in Hospitals: A Mixed‐Method Study
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  • Feb 2025
  • J ADV NURS
Aim To investigate the outcomes of implementing logistician positions on nurses' job satisfaction in hospitals. Design A sequential explanatory mixed‐methods approach was employed. Method In the quantitative phase, the “Job Satisfaction Single Item” scale was utilised, and nurses' perceptions and intentions to leave were assessed. Subsequently, semi‐structured interviews were conducted with nurses who had or had not experienced the deployment of logisticians to deepen the quantitative findings. Content analysis was conducted and data triangulation was used with a co‐researcher. Results Questionnaires were completed by 602 nurses, followed by semi‐structured interviews with 10 nurses between July 2023 and September 2023. Job satisfaction was significantly higher among nurses who worked with a logistician in their department. This organisational change freed up nurses' time and added more meaning to their work. Logisticians alleviated the physical and mental workload of nurses. Furthermore, turnover intention is higher among nurses who do not work with a logistician. Additionally, nurses provided recommendations and suggestions for the deployment of these posts. Conclusion Logistician positions enable nurses to refocus on their core duties, thereby improving their job satisfaction. Logisticians also improve nurses' health. Enhancing nurses' job satisfaction can reduce turnover rates and help address the nursing shortage. Further studies could complement these results in order to provide arguments in favour of the deployment of logisticians in hospitals. Impact Given the global nursing shortage, implementing logistician posts could be important to prevent the closure of hospital beds and ensure the continuous provision of healthcare services to the population. Patient or Public Contribution No patient or public contribution.
View
... Health professionals are motivated to ensure patient safety and avoid harm, but incorporating multiple changes into clinical practice can lead to change fatigue. 32 To improve the integration of evidence into practice, it is necessary to support professionals' knowledge of and adherence to evidence-based guidelines and practice change. Local facilitators and project champions are essential for project success, given that professionals who perceive the benefits of change tend to view this process positively. ...
Implementation of the I-DECIDED tool for PIVC assessment and decision making: discussion paper
Article
Full-text available
  • Jan 2025
  • Br J Nurs
HIGHLIGHTS PIVCs often cause pain, irritation, or infection. Regular and careful catheter checks can decrease complications and improve patient outcomes. Implementation of the I-DECIDED® tool led to fewer idle catheters and complications. We present ideas for implementing the tool and how to overcome some common barriers. Introduction Peripheral intravenous catheter (PIVC) assessment and decision making should be evidence based to minimize risks and enhance patient care. Exploring implementation strategies from successful outcome studies can raise health care professionals' awareness, boost adherence to evidence-based protocols, and elevate PIVC care standards. Aim To describe the implementation of the I-DECIDED® device assessment and decision tool for PIVC management in the Australian and Brazilian contexts. Methods The Promoting Action on Research Implementation in Health Services (PARIHS) framework (evidence, context, facilitation) was used to prospectively plan the implementation of the tool in adult inpatient units in Australia and to retrospectively analyze the implementation of the tool in a pediatric inpatient unit in Brazil. Similarities and differences in the implementation studies were explored. Results Implementation of the tool in Australia and Brazil demonstrated that prevention and early detection of PIVC complications is achievable with standardized assessment and decision prompts. Both contexts witnessed a reduction in idle PIVCs, decreased insertion site complications, improved dressing quality, and significant improvements in documentation following implementation. Common implementation strategies included champions, education, badge cards, and posters. Enabling flexibility and context-specific education strategies was essential. Conclusion Standardization of PIVC assessment and decision making using the I-DECIDED® tool reduced the prevalence of idle catheters and complications in Australia and Brazil. Implementation of the tool in different contexts confirms its utility and relevance for PIVC management in diverse health care settings. Promotion and adoption of the tool as a PIVC management bundle could increase patient safety and reduce health care costs.
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... Thus, the issue of resistance to change can be a significant impediment to healthcare improvement. Studies indicate that nurse fatigue due to changes is common (Beaulieu et al., 2023;Camilleri et al., 2019). Therefore, the barriers mentioned by the Nurse Auditors in this study represent expected results. ...
Viewpoints of nurse auditors regarding the profession: a qualitative study
Article
  • Jan 2025
  • J Health Organisat Manag
Purpose This study aims to understand the experiences of Brazilian nurse auditors in the practice of their profession, exploring the importance, challenges, rewards and strategies related to the occupation. Design/methodology/approach This is a qualitative descriptive study conducted with 44 nurse auditors. An online, open-ended questionnaire was used. Thematic content analysis was performed. Findings Five themes were identified: (1) functions of a nurse auditor; (2) skills required for a nurse auditor; (3) learning to be a nurse auditor; (4) advantages of being a nurse auditor and (5) challenges faced by a nurse auditor. Also, a total of 16 subthemes were presented. Research limitations/implications The study critically examined essential aspects of auditing through the lens of nurse auditors, addressing a relevant topic. However, limitations must be acknowledged, including the use of self-report questionnaires, regional representation disparities, the scarcity of international articles on the topic and potential researcher bias. Practical implications The study underscores the importance of increasingly integrating nurse auditors into the workforce while emphasizing the need to enhance the capacitation of these professionals through theoretical and practical education. It highlights the significance of educating other multidisciplinary team members about the nurse auditor’s crucial role in fostering teamwork and ensuring the quality of healthcare services. Originality/value To the best of the author’s knowledge, this is the first study conducted with Brazilian nurse auditors, exploring crucial aspects of auditing from the perspective of these professionals. Understanding the critical role of nurse auditors in maintaining and improving healthcare quality can enhance public trust in healthcare systems.
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... First, in this study, we examined the effect of nurses' change fatigue on their professional identification. To the best of our knowledge, limited studies (Beaulieu et al., 2022) have focused on the effect of nurses' change fatigue on identification. Therefore, we aimed to expand the related literature by focusing on the results of the possible effects of change fatigue on nurses' identification. ...
The Roles of Job Stress and Collegial Support in the Effect of Nurses' Change Fatigue Level on Occupational Identification Hemşirelerin Değişim Yorgunluğu Düzeyinin Mesleki Özdeşleşmeye Etkisinde İş Stresi ve Meslektaş Desteğinin Rolü Öz
Article
Full-text available
  • Dec 2024
This study was conducted to determine the mediating role of job stress and the moderating role of colleague support in the effect of change fatigue levels of nurses on professional identification. The study was designed in descriptive-cross-sectional type. The population of the study consists of 389 people selected by the simple random sampling method among 2,482 employees working in a training and research hospital in Erzincan province. The data were collected from nurses and nurse assistants working in a university education and research hospital through a questionnaire. According to the results of the study, there were negative relationships between change fatigue levels and professional identification, positive relationships between change fatigue and job stress, negative relationships between change fatigue and collegial support, negative relationships between job stress and collegial support, negative relationships between job stress and professional identification and positive relationships between collegial support and professional identification. In addition, it was found that job stress has a mediating role in the effect of change fatigue on professional identification. Finally, it was also found that colleague support has a moderating role in the indirect effect of change fatigue on professional identification (through job stress).
View
... Health professionals are motivated to ensure patient safety and avoid harm, but incorporating multiple changes into clinical practice can lead to change fatigue. 32 To improve the integration of evidence into practice, it is necessary to support professionals' knowledge of and adherence to evidence-based guidelines and practice change. Local facilitators and project champions are essential for project success, given that professionals who perceive the benefits of change tend to view this process positively. ...
Implementation of the I-DECIDED® Tool for PIVC Assessment and Decision Making: Discussion Paper
Article
Full-text available
  • Dec 2024
  • J Assoc Vasc Access
Introduction Peripheral intravenous catheter (PIVC) assessment and decision making should be evidence based to minimize risks and enhance patient care. Exploring implementation strategies from successful outcome studies can raise health care professionals’ awareness, boost adherence to evidence-based protocols, and elevate PIVC care standards. Aim To describe the implementation of the I-DECIDED® device assessment and decision tool for PIVC management in the Australian and Brazilian contexts. Methods The Promoting Action on Research Implementation in Health Services (PARIHS) framework (evidence, context, facilitation) was used to prospectively plan the implementation of the tool in adult inpatient units in Australia and to retrospectively analyze the implementation of the tool in a pediatric inpatient unit in Brazil. Similarities and differences in the implementation studies were explored. Results Implementation of the tool in Australia and Brazil demonstrated that prevention and early detection of PIVC complications is achievable with standardized assessment and decision prompts. Both contexts witnessed a reduction in idle PIVCs, decreased insertion site complications, improved dressing quality, and significant improvements in documentation following implementation. Common implementation strategies included champions, education, badge cards, and posters. Enabling flexibility and context-specific education strategies was essential. Conclusion Standardization of PIVC assessment and decision making using the I-DECIDED® tool reduced the prevalence of idle catheters and complications in Australia and Brazil. Implementation of the tool in different contexts confirms its utility and relevance for PIVC management in diverse health care settings. Promotion and adoption of the tool as a PIVC management bundle could increase patient safety and reduce health care costs.
View
Lead Yourself through Change: How Self-Leadership Buffers the Impact of Change Fatigue on Employee Outcomes
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  • Feb 2025
In this study, we shed light on the underlying psychological mechanism of the negative impact of change fatigue on employees’ extra-role performance, which represents a positive change outcome. Drawing from self-determination theory in combination with job demands–resources theory, we assume that the negative impact of change fatigue on extra-role performance is mediated by psychological need satisfaction. Furthermore, by considering the buffer hypothesis in job demands–resources theory, we hypothesize that self-leadership represents a sufficient personal resource to compensate for the negative effects of change fatigue. To test our hypotheses, we investigated a two-wave sample from a German insurance company. The results partially confirm our theoretical predictions. For organizational practitioners, the results imply that self-leadership represents a valuable personal resource for employees to mitigate the psychological consequences of fatigue caused by organizational change. Thus, especially organizations that are undergoing change may provide training for employees to learn to apply self-leadership strategies.
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Exploring Nurses' Personal and Professional Values and Care Quality: A Convergent Mixed-Methods Analysis
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  • Dec 2024
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Background Professional standards and the Codes of Ethics from the International Council of Nurses and American Nurses Association are frameworks driving professional practice and are linked to positive patient and nursing outcomes. Objective To describe qualitative themes extracted from narrative responses on how nurses’ personal values influence nursing care and converge with quantitative results assessing personal values, professional values, and the practice environment, a key component of nurse satisfaction and subsequent care quality. Methods A convenience sample of nurses across 19 sites within a large nonprofit healthcare system was surveyed. Quantitative measures included the Short Schwartz’s Value Survey for personal values, the Nurses Professional Values Scale-3 for professional values, and the Practice Environment Scale of the Nursing Work Index, assessing practice settings. Concurrently, nurses were asked, “How do your values influence the care you provide?” Responses were examined using a descriptive qualitative method for thematic analysis. Results The sample included qualitative (n = 408) and quantitative (n = 671) responses. Six qualitative themes emerged: patient-centered care, professionalism/integrity of practice, advocacy, dissonance, golden rule/ethics of reciprocity (religiosity), and perseverance. Themes converged with the mean personal values of achievement, self-direction, universalism, benevolence, tradition, and conformity, and diverged with hedonism, security, and stimulation. All professional values factor means and work environment subscale means converged. Conclusions Findings highlight convergence and divergence between qualitative and quantitative responses from nurses, offering new insights into the themes of dissonance, perseverance, and religiosity. The findings present valuable opportunities to enhance recruitment and retention strategies.
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The Relationship Between Perceived Nursing Workload and Occupational Fatigue in Clinical Nurses: The Moderating Role of Nursing Teamwork
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Aim: This study investigated the association between perceived nursing workload and occupational fatigue in clinical nurses. We specifically focused on how nursing teamwork moderates this relationship. Background: Hospital nurses often face heavy workloads, leading to significant fatigue. Understanding the link between work-load, fatigue and teamwork is crucial to addressing nurse burnout. Methods: A cross-sectional study was conducted among 356 clinical nurses from five educational-therapeutic hospitals in Ardabil, Iran. Data were collected using validated instruments, including the Occupational Fatigue Exhaustion Recovery-15 (OFER) scale, the Quantitative Workload Inventory (QWI) and the Nursing Teamwork Survey (NTS). Hierarchical linear regression analysis assessed the relationships between perceived workload, occupational fatigue and nursing teamwork. Results: The study's findings show that increased nursing workloads were significantly linked to higher levels of both acute (B = 5.70 to 6.76, p < 0.001) and chronic fatigue (B = 6.71 to 7.16, p < 0.001). Additionally, effective nursing teamwork, comprising trust, team orientation, support, shared mental models and team leadership was associated with reduced fatigue levels. Conclusion: Our study shows high workloads are linked to increased fatigue among nursing professionals. Teamwork can help lessen the adverse effects of workload on fatigue. Healthcare organisations should focus on optimising workload distribution and strengthening teamwork. Further research is needed to understand these dynamics and develop targeted interventions to support nursing staff in high-demand environments. Implications for Nursing and Health Policy: The study emphasises the need for healthcare organisations to prioritise work-load management and enhance teamwork among nursing staff. Implementing structured workload assessments and fostering a collaborative work environment, along with policies promoting work-life balance, can improve patient care quality, benefit nursing professionals and contribute to a more resilient healthcare system.
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Implementation of a patient centred medical home (PCMH) initiative in general practices in New South Wales, Australia
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Background With an ageing population and an increase in chronic disease burden in Australia, Patient Centred Medical Home (PCMH) models of care have been identified as potential options for primary care reform and improving health care outcomes. Adoption of PCMH models are not well described outside of North America. We examined the experiences of seven general practices in an Australian setting that implemented projects aligned with PCMH values and goals supported by their local Primary Health Network (PHN). Method Qualitative and quantitative data were collected over a twelve month period, including semi-structured interviews, participant observation, and practice data to present a detailed examination of a subject of study; the implementation of PCMH projects in seven general practices. We conducted 49 interviews (24 pre and 25 post) with general practitioners, practice managers, practice nurses and PHN staff. Framework analysis deploying the domains of a logic model was used to synthesis and analyse the data. Results Facilitators in implementing successful, sustainable change included the capacity and willingness of practices to undertake change; whole of practice engagement with a shared vision towards PCMH change; engaged leadership; training and support; and structures and processes required to provide team-based, data driven care. Barriers to implementation included change fatigue, challenges of continued engaged leadership and insufficient time to implement PCMH change. Conclusions Our study examined the experiences of implementing PCMH initiatives in an Australian general practice setting, describing facilitators and barriers to PCMH change. Our findings provide guidance for PHNs and practices within Australia, as well as general practice settings internationally, that are interested in undertaking similar quality improvement projects.
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Repetitive reorganizations cause change fatigue, which creates employee resistance to further organizational change. This paper investigates how such fatigue arises. The results show that uncertainty and workload are mediating factors. The effect of change fatigue is not moderated by the perceived success of the prior reorganization, participation in that process, or leadership characteristics. It is only slightly moderated by the satisfaction of employees about the communication during the prior organizational reorganization.
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The PRISMA 2020 statement: An updated guideline for reporting systematic reviews
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The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement, published in 2009, was designed to help systematic reviewers transparently report why the review was done, what the authors did, and what they found. Over the past decade, advances in systematic review methodology and terminology have necessitated an update to the guideline. The PRISMA 2020 statement replaces the 2009 statement and includes new reporting guidance that reflects advances in methods to identify, select, appraise, and synthesise studies. The structure and presentation of the items have been modified to facilitate implementation. In this article, we present the PRISMA 2020 27-item checklist, an expanded checklist that details reporting recommendations for each item, the PRISMA 2020 abstract checklist, and the revised flow diagrams for original and updated reviews.
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Change Resistance as Practicing Moral Authenticity: A Qualitative Study
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Background and purpose Organizational changes are increasingly rapid and continuous in health care as organizations strive to meet multiple external pressures. Much change in health care fails and nurse resistance is commonly blamed for such failure. Nurse resistance to organizational change is often described as overt behaviours and are deemed destructive to the change process. Much of the literature describing organizational change comes from the perspectives of administrators, there is little known about nurses’ experiences of organizational change. The purpose of this inquiry was to explore the nature of frontline nurses’ experiences of rapid and continuous change. Methods A qualitative critical hermeneutic design was applied. 14 Registered Nurses participated in face-to-face interviews. Openended questions were used. The setting was an urban pediatric teaching hospital located in Canada. Research ethics board approval was obtained as required. Member reflections ensured accurate portrayals of participant’s experiences. Results The findings from this study suggest that acts of resistance to change are not overt, but rather covert behaviors in micro-ethical moments. Nurses engaged in resistance as means to provide morally authentic care at the bedside. These acts were utilized to take back power over their practice amidst feelings of powerlessness, however, paradoxically, when participants described the concept of power, they understood it solely in the context of feeling powerless within the planning, implementation and evaluation of organizational change initiatives. Nurses engagement with resistant behaviours in the context of organizational change demonstrated ethical action and political agency that enabled morally authentic nursing practice. Implications for practice The findings from this study offer new understandings of a well-established concept in nursing and can be used when considering the ethical dimensions of nursing work amidst rapidly changing health care institutions.
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Nurses’ Workplace Conditions Impacting Their Mental Health during COVID-19: A Cross-Sectional Survey Study
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Among health workers, nurses are at the greatest risk of COVID-19 exposure and mortality due to their workplace conditions, including shortages of personal protective equipment (PPE), insufficient staffing, and inadequate safety precautions. The purpose of this study was to examine the impact of COVID-19 workplace conditions on nurses’ mental health outcomes. A cross-sectional correlational design was used. An electronic survey was emailed to nurses in one Canadian province between June and July of 2020. A total of 3676 responses were included in this study. We found concerning prevalence rates for post-traumatic stress disorder (47%), anxiety (38%), depression (41%), and high emotional exhaustion (60%). Negative ratings of workplace relations, organizational support, organizational preparedness, workplace safety, and access to supplies and resources were associated with higher scores on all of the adverse mental health outcomes included in this study. Better workplace policies and practices are urgently required to prevent and mitigate nurses’ suboptimal work conditions, given their concerning mental health self-reports during the COVID-19 pandemic.
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Examining the cultural impacts of an emergency department move using ethnography
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Objective The purpose of this ethnographic study was to evaluate the cultural impacts of an emergency department (ED) move from an old to new physical space. Method Fieldwork was conducted over 14 months at an academic medical center ED in the United States. Primary data sources included participant observations and semistructured interviews. Results Over 720 h of participant observation and semi-structured interviews (n = 39) with emergency nurse, non-nurse clinicians, and unit administrators were collected and analyzed. One cross-cutting theme, “decisional power,” and three supporting themes “inadequate move preparation,” “change fatigue,” and “lack of change standardization” were identified. “Decisional power” was the perceived influence certain ED groups had making move-related decisions over others. “Change fatigue” described the impact of frequent change implementation on participants’ work processes, well-being, and job satisfaction. “Lack of change standardization” described power differentials between nurses striving to standardize new move-related processes and physicians implementing work styles discordant with such processes. Conclusion Findings can inform recommendations for health care policy and organizational operations such as: 1) including frontline stakeholder perspectives in move-related decisions; 2) allocating adequate time for clinician/employee training/education in the pre-move period; 3) assessing clinician/employee well-being throughout move implementation; 4) increasing unit administrator sensitivity to clinician change fatigue.
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The PRISMA 2020 statement: An updated guideline for reporting systematic reviews
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  • Int J Surg
The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement, published in 2009, was designed to help systematic reviewers transparently report why the review was done, what the authors did, and what they found. Over the past decade, advances in systematic review methodology and terminology have necessitated an update to the guideline. The PRISMA 2020 statement replaces the 2009 statement and includes new reporting guidance that reflects advances in methods to identify, select, appraise, and synthesise studies. The structure and presentation of the items have been modified to facilitate implementation. In this article, we present the PRISMA 2020 27-item checklist, an expanded checklist that details reporting recommendations for each item, the PRISMA 2020 abstract checklist, and the revised flow diagrams for original and updated reviews.
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Antecedents and outcome of employee change fatigue and change cynicism
Article
  • Dec 2020
  • J ORGAN CHANGE MANAG
Purpose Organisations implement changes either to address real business imperatives or to follow trends in their industries. But frequent changes in an organisation often lead to employee change fatigue and change cynicism. The purpose of this study is to investigate the impact of the change logic of appropriateness and the logic of consequences on change fatigue and change cynicism and the impact of change fatigue and change cynicism on change success. Design/methodology/approach To carry out this study, the authors collected data on a sample of 320 participants from diverse organisations, and they used structural equation modelling (SEM) techniques to test our hypotheses depicted in the research model. Findings The authors found that the change logic of consequences reduces both change fatigue and change cynicism, whereas the change logic of appropriateness increases change fatigue. The authors also found that change fatigue does not have any direct effect on change success, although it maintains an indirect negative effect on change success through change cynicism. Practical implications Along with other practical implications, the authors recommend that change managers help employees understand any logic of consequences that sustain their change initiatives. Additionally, change managers should work to prevent change fatigue from turning into change cynicism, which is the real precursor of reduced change success. Originality/value This study is among the first to show that employees experience change fatigue and change cynicism differently, depending on the reason underlying the change. It is also among the first to show that change fatigue does not affect change success directly but does so through the interplay of change cynicism.
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Ideological tensions amidst rapid and continuous organizational change in healthcare
Article
  • Oct 2020
  • J ORGAN CHANGE MANAG
Purpose The aim of this study was to explore the nature of frontline nurses' experiences of living with rapid and continuous organizational change. Design/methodology/approach A critical hermeneutic approach was utilized. This was a qualitative inquiry theoretically guided by critical management studies. Findings Participants recognized that many change initiatives reflected an ideological shift in healthcare that supported a culture of service, whilst sacrificing a culture of care. A culture of service prioritized cost-savings and efficiency, which saw nurses lose the time and resources required to provide quality, safe care. Practical implications Nurses felt morally responsible to uphold a culture of care, which proved challenging and at times unobtainable. The inability to provide quality, safe care in light of organizational changes resulted in a multitude of negative emotional repercussions, which fostered moral distress. Originality/value The findings from this study bring to light ideological tensions that negatively impact nurses. This study supports the conclusion that the planning, implementation and evaluation of organizational change initiatives must reflect a culture of care in order to alleviate the many negative experiences of organizational change noted in this study.
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