Collegial Nurse-physician Relations Research Articles

New Nurse Turnover Intention and Related Factors in Japan and China: Focusing on Nursing Practice Environment and Burnout.

With rapidly declining birth rates and aging populations worldwide, the demand for nursing care has increased in recent years. High turnover, an important cause of nurse staffing shortages, directly affects the quality of nursing care. However, no comparison studies on turnover intention in East Asia have been published. The purpose of this study was to clarify the relationships among turnover intention, the work environment, and related factors among new nurses in Japan and China. A self-administered questionnaire survey was used to collect data from nurses employed for < 2 years. This questionnaire included participant characteristics, assessment of desire to become a nurse at the start of employment, current turnover intention, the Practice Environment Scale of the Nursing Work Index, and the Maslach Burnout Inventory-Human Services Survey. The relationship between current turnover intention and, respectively, number of hospital beds, strength of desire to become a nurse at the start of employment, level of participation in hospital affairs, emotional exhaustion (EE), personal achievement, and demographic variables was assessed. The number of nurses who intended to leave the hospital was higher in Japan (74.1%) than in China (42.4%). However, of those expressing intention to leave, 46.6% of the nurses in China and only 5.0% of those in Japan indicated intention to quit the nursing profession altogether. In Japan, collegial nurse-physician relations and EE were related to turnover intention, whereas in China, number of hospital beds, strength of desire to become a nurse at the start of employment, participation in hospital affairs, EE, and personal achievement were all related to turnover intention. To enhance retention and reduce turnover intention among nurses, the strength of desire to become a nurse in China and the nurse-physician relationship and EE in Japan should be taken into particular consideration when designing retention strategies and nurse education programs.

Digital health competencies and affecting factors among healthcare professionals: additional findings from a systematic review.

In recent decades, nurses' and healthcare professionals' digital health competencies have emerged as key factors in enabling the digital healthcare transformation. Therefore, this review aims to describe the level of digital health competencies among nurses and healthcare professionals and the factors affecting them. We performed an additional analysis of a database populated in our original systematic review by identifying the data set, evaluating its appropriateness to the research questions, and performing the data analysis. Four areas of digital health competencies among nurses and healthcare professionals emerged: 'self-rated competencies', 'psychological and emotional aspects toward the use of digital technologies', 'knowledge about digital technologies' and 'use of digital technologies'. Item scores and affecting factors have been extracted and classified into poor, moderate and good levels of digital health competencies; factors have been categorised and then summarised. 'Use of digital technologies' was the area with the highest prevalence of poor-level scores, whereas the 'knowledge about digital technologies' had a good level of competence. Across categories, most of the items' scores reflected a moderate level of competence. The main factors affecting digital health competencies in nursing were being younger, more educated, having positive collegial nurse-physician relationships and participating in hospital business. Digital health competence might be further improved. Educators, policymakers and nurse managers should develop educational nursing programmes and opportunities by acting on the modifiable factors to develop digital health competencies.

What influences newly graduated registered nurses’ intention to leave the nursing profession? An integrative review

BackgroundNewly graduated registered nurses leaving the nursing profession in the early stages of their career have enormous financial and time implications for nursing organizations and affect the quality of nursing care.ObjectiveTo identify the factors influencing newly graduated registered nurses’ intention to leave the nursing profession over the past 10 years.MethodsThe framework developed by Whittemore and Knafl was used to conduct this integrative review. An electronic search was conducted for English articles to identify research studies published between 2011-2022 using the following databases of PubMed, MEDLINE, CINAHL, PsycINFO, and Scopus. Eligible publications were critically reviewed and scored using the Critical Appraisal Skills Program Checklist and the Center for Evidence-Based Management appraisal.ResultsTwenty-one studies were analyzed. The main factors affecting newly graduated registered nurses’ intention to leave the nursing profession included demographic factors (age, educational level, year of experience, professional title, employment status, health status, shift, hospital location and size), supervisor and peer support, challenges in the workplace, cognitive and affective response to work, work environment (collegial nurse-physician relations, insufficient staffing level, person-work environment fit), gender stereotypes, autonomous motivation, role models, and resilience.ConclusionsThe factors affecting newly graduated registered nurses’ intention to leave the nursing profession are multifaceted and should receive continuous attention from nurse managers. The findings provide more comprehensive for nurse administrators to develop intervention strategies to mitigate newly graduated registered nurses’ turnover intention.

AMBIENTE DA PRÁTICA PROFISSIONAL DA ENFERMAGEM EM HOSPITAL UNIVERSITÁRIO FRENTE À COVID-19

ABSTRACT Objective: to assess the environment of nursing professional practice during the COVID-19 pandemic. Method: cross-sectional study addressing a sample comprising nursing workers from a university hospital. The Brazilian version of the Practice Environment Scale was used, with 24 items distributed into five subscales. The analyses were performed in Statistical Package for the Social Sciences, version 25; the statistical significance was set at 5% (p≤0.05), and the internal consistency was assessed with Cronbach’s alpha. Results: 243 workers participated in the study: 62.1% of nursing technicians and aides and 37.9% of nurses. The mean score on the Practice Environment Scale was 2.58 (standard deviation=0.69). Three of the five subscales were poorly assessed: “Nursing foundations for quality of care” (mean 2.58 and SD ± 0.73), “Nursing manager, ability, leadership, and support of nurses” (mean 2.74 and SD ± 0.82), and “Collegial nurse-physician relations” (mean 2.78 and SD ± 0.76). The perception of the professionals who received training to care for Covid-19 patients was more favorable than those who did not receive any training. Conclusion: The nursing work environment during the pandemic was considered mixed; therefore, improvements are required to make nursing working conditions as adequate as possible.

The Impact of Nurse-Physician Relationships on Emergency Nurses’ Moral Distress

IntroductionMoral distress affects registered nurses’ job dissatisfaction, and may ultimately be associated with higher rates of turnover. Nurse-physician relationships have been shown to affect moral distress in the intensive care unit setting, but no research has evaluated this impact on emergency nurses. The purpose of this study was to investigate the impact of nurse-physician relationships on the moral distress of emergency nurses. MethodsA quantitative correlational design was used to evaluate the study’s aim. Point-of-care nurses currently working in an emergency department were asked to complete the Measure of Moral Distress Scale for Healthcare Professionals and the collegial nurse-physician relations domain of the Practice Environment Scale of the Nursing Work Index. Univariate and multivariate analyses were conducted to determine the impact of nurse-physician relationships on moral distress, controlling for demographic characteristics. ResultsThirty-two participants completed the survey. Multivariate regression showed that nurse-physician relationships are associated with moral distress in emergency nurses. Years of experience and gender did not affect moral distress in univariate or multivariate analyses. DiscussionGiven current staffing shortages and the need to retain expert nurses in high-acuity settings, strategies to improve nurse-physician collaboration opportunities should be explored in ED settings.

Relationship of the nursing practice environment with the quality of care and patients’ safety in primary health care

BackgroundNursing practice environment has impact on the quality of nursing care and on patients’ and nurses’ outcomes, namely better performances of these healthcare workers. Improving the nursing practice environment is a low-cost organizational strategy to achieve better patients’ outcomes and retain qualified nurses, thus improving nursing care of units, healthcare organizations and healthcare system. This study aims to analyse the relationship between nursing practice environment and the nurses` perception of quality of care, patient safety, and safety culture in Primary Health Care in Portugal.MethodsWe conducted a descriptive, analytical, and cross-sectional study using data from RN4CAST Portugal. The sample was composed of 1059 nurses from 55 Health Center Groups of the mainland Portugal, 15 Health Centers of the Autonomous Region of Madeira and 6 Health Centers of the Autonomous Region of the Azores. Multivariate analysis and correlation analysis methods were used for data processing.ResultsNurses consider that, in the Portuguese Primary Health Care, there is a mixed and unfavourable nursing practice environment, with a perception of a good quality of care, and both acceptable patients’ safety and safety culture. The Collegial Nurse-Physician Relations and Nursing Foundations for Quality of Care dimensions to have the best ratings. The perception of Primary Health Care nurses on the dimension Nurse Participation in Organization Affairs was the one that showed the lowest score, followed by Staffing and Resource Adequacy and Nurse Manager Ability, Leadership, and Support of Nurses. Based on perception of nurses, the relationship between the nursing practice environment and the safety culture is higher, followed by the quality of care and patients’ safety.ConclusionsThe perception of Primary Health Care nurses is that there is an unfavourable and mixed nursing practice environment, with good quality of care, and acceptable patient safety and safety culture. The quality of the nursing practice environments is associated to better quality and safety of care. Thus, improving the nursing practice environments in healthcare organizations is a low-cost organizational strategy to achieve greater patients and nurses’ outcomes, improving the quality of nursing care to patients in the Primary Health Care units.

Assessment of Nursing Practice Environment in Primary Healthcare Centers in Saudi Arabia: A Cross-Sectional Study

A work environment that boosts nurses’ leadership skills, has adequate resources and staff and collegial nurse–physician relations, and allows nurses to participate in decision-making enhances patient care quality and nurses’ job satisfaction and performance. I used a cross-sectional design and the Practice Environment Scale of the Nursing Work Index among 519 nurses to assess the nursing practice environment in primary healthcare centers (PHCs) across the Kingdom of Saudi Arabia. Respondents’ views varied, and the general mean (2.45) showed that most nurses thought their work environment has a fair number of staff and resources. The general standard deviation (0.924) indicated that a significant variation exists between the composite score values, and there were no significant differences in the other factors. It was concluded that most PHCs have poor staff and resource adequacy, which shows the significant influence of nurses’ job satisfaction and performance on the quality of their work environment.

Effect of Nurses’ Professionalism, Work Environment, and Communication with Health Professionals on Patient Safety Culture (AHRQ 2.0.): A Cross-Sectional Multicenter Study

Aims. To identify nurses’ professionalism, work environment, and communication with healthcare professionals as factors influencing clinical nurses’ perception of patient safety culture. Background. Patient safety is a representative indicator of the quality of nursing care. A multidisciplinary approach, including individual and organizational components, is needed to improve patient safety culture. Methods. A cross-sectional study was conducted in January 2021 involving a total of 271 nurses in six tertiary hospitals. Data were collected from participants on nurse professionalism, work environment, communication, and patient safety culture. A multiple regression model was used to analyze variables influencing patient safety culture. Results. Factors affecting patient safety culture were nursing foundations for quality of care (β = 0.230, p &lt; 0.001 ), nurse manager ability, leadership, support of nurses (β = 0.294, p &lt; 0.001 ), and collegial nurse-physician relations (β = −0.138, p = 0.026 ) in the nursing work environment. Accuracy (β = 0.117, p = 0.007 ), shift communication (β = 0.128, p = 0.026 ), satisfaction (β = 0.283, p = 0.001 ), and timeliness (β = 0.239, p &lt; 0.001 ) of communication between healthcare professionals and nurses have a significant impact on patient safety culture. All these predictors accounted for 59% (R2) of patient safety culture awareness ( p &lt; 0.001 ). Conclusions. Enhancing patient safety culture requires a systematic and organizational approach that considers individual characteristics. Nurse managers play a crucial role in promoting patient safety by employing various communication channels and leading team education and training initiatives to foster collaboration among healthcare professionals. Implications for Nursing Management. The provision of patient safety education directly influences patient safety culture, and continuous education enables nurses to grow within the institution. To ensure effective communication in healthcare settings, nurse managers should prioritize shift communication, evaluate the accuracy of information exchange, and establish diverse communication channels, including social media platforms or business messengers, for internal hospital communication.

The Nursing Work Environment, Supervisory Support, Nurse Characteristics, and Burnout as Predictors of Intent to Stay among Hospital Nurses in the Republic of Korea: A Path Analysis.

This study aimed to examine the comprehensive impact of five aspects of the nursing work environment as well as supervisory support, nurse characteristics, and burnout on intent to stay (ITS) among Korean hospital nurses. A cross-sectional questionnaire was distributed in seven general hospitals from May to July of 2019. Data were collected from a sample of 631 Korean nurses. The hypothesized model was evaluated using the STATA program for path models. Findings demonstrated that burnout played a mediating role on the relationships between the nursing work environment, supervisory support, nurse characteristics, and ITS. Burnout was the most influential predictor of ITS (β = -0.36, p < 0.001). Nurse participation in hospital affairs (β = 0.10, p = 0.044) and collegial nurse-physician relationships (β = 0.08, p = 0.038) had a direct effect on ITS. Supervisory support had a significant direct effect on ITS (β = 0.19, p < 0.001). Therefore, to increase nurses' ITS, it is necessary to improve their participation in hospital affairs and collegial relationships, as well as strengthen support from supervisors and reduce burnout.

The Relationship Between Nursing Practice Environment and Innovative Behavior in the Al-Madinah Region, Saudi Arabia: A Descriptive Study.

Background and objective A positive and supportive practice environment is essential for inspiring innovation in nursing. Innovative behaviors (IBs) could motivate nurses to devise solutions in several domains, such as identifying and solving workplace problems, building new work methods, delivering their services efficiently and effectively, adopting new medical technology advancements, and leading the change process to face current challenges in healthcare. In this study, we aimed to investigate the relationship between the nursing practice environment (NPE) and IB in the Al-Madinah region of Saudi Arabia. Methods A quantitative, descriptive, cross-sectional correlational design was employed for the study. The convenience sample consisted of 330 bedside nurses working in five general hospitals in the Al-Madinah region who voluntarily completed a self-report questionnaire consisting of queries related to demographic and professional characteristics, the Practice Environment Scale of the Nursing Work Index (PES-NWI), and the Innovative Behavior Inventory (IBI). The collected data were analyzed using descriptive statistics and Pearson's correlation. Results Based on the study findings, the NPE was favorable. The overall PES-NWI mean score was 2.62 ± 0.50, and the mean scores of four of the five subscaleswere >2.50. The collegial nurse-physician relations subscale was perceived as the most favorable (2.87 ± 0.59), while staffing and resource adequacy was perceived as unfavorable (2.35 ± 0.65). The overallIBI mean score was 3.53 ± 0.56, indicating that nurses had a moderate level of agreement on IB. The highest mean score in IB was in the idea search domain (3.72 ± 0.77), while it was lowest in the implementation of starting activities domain (3.11 ± 0.86). Conclusions The correlation between the NPE and IB was positive and statistically significant. However, the correlation of the staffing and resources adequacy subscale in relation to subscales of idea search, overcoming obstacles, and innovation output did not reach statistical significance. Healthcare organizations should incorporate the principles of work innovation and healthy nursing work environments into their core values and enhance and nurture them through strategic management.

Nurses' well-being during the coronavirus (2019) pandemic: A longitudinal mixed-methods study.

To determine prevalence, predictors and change over time of nurses' and student nurses' mental health and well-being, and explore nurses' perceptions, barriers and enablers of well-being. Longitudinal mixed-methods survey. Forty-nine students and registered nurses participated from Victoria, Australia. Data were collected from December 2019 to July 2020. Validated psychometrics and free-text response questions were employed. Analysis used latent growth curve modelling, Pearson product-moment correlations and thematic analysis. A strong positive correlation was found between self-determination and work well-being, and a strong negative correlation between work well-being and flight risk. Several moderate relationships were found; a moderate positive correlation between work well-being and nurse manager ability, leadership and support, and a moderate negative correlation between burnout and staffing and resource adequacy. Collegial nurse-physician relationships deteriorated. Three themes, physical health, psychological well-being and social connection, were identified as important for nurses' well-being.

Factors Affecting the Resilience of New Nurses in Their Working Environment.

Resilience and working environment are variables that affect turnover. However, how these two variables impact each other is unclear. This study is a descriptive correlation study to identify the factors of the nursing working environment affecting the resilience of new nurses in general tertiary hospitals. This study was conducted by convenience sampling of 233 new nurses with less than 1 year of working experience. Data were collected through questionnaires from 20 to 27 October 2019, and analyzed using correlation analysis and stepwise multiple regression analysis. The results show that the work environment impacts the resilience of new nurses by 30.2%. Specifically, the following qualities of a work environment were found to affect new nurses’ resilience, including “nursing foundation for quality of care”, “nurse participation in hospital affairs”, “nurse manager ability, leadership, and support of nurses”, “collegial nurse–physician relations”, and “staffing and resource adequacy”. These findings imply that a satisfactory working environment improves new nurses’ resilience and reduces their intent to leave their workplace. Further studies are needed to elucidate this relationship, especially considering the ever-changing work environments.

LIDERANÇA COACHING DOS ENFERMEIROS RELACIONADA COM AMBIENTE DA PRÁTICA PROFISSIONAL NA ATENÇÃO PRIMÁRIA À SAÚDE

ABSTRACT Objective: to correlate the nurses’ self-perception and the perception of nursing aides regarding coaching leadership and the practice environment within Primary Health Care. Method: cross-sectional and correlational study addressing 150 nursing workers: 75 nurses and 75 nursing aides of 13 Basic Health Units located in the south of São Paulo, SP, Brazil. The Brazilian version of the Practice Environment Scale, Questionário de Autopercepção do Enfermeiro no Exercício da Liderança [Questionnaire on Self-Perception of Nurses of Exercise of Leadership], and Questionário de Percepção de Técnicos e Auxiliares de Enfermagem no Exercício da Liderança [Questionnaire on Perception of Nurse Technicians and LPNs of Exercise of Leadership] were applied between January and May 2019. Univariate and Multivariate Analyses, and the Pearson’s Correlation test (p&lt;0.05) were used, besides Rosenthal effect size. Results: two significant correlations were found among the nurses between the instruments’ domains: communication and nursing foundations for quality care (r=0.265; p=0.022) and communication and collegial nurse-physician relationships (r=0.263; p=0.023). The following stand out among the nursing aides: communication and nursing foundations for quality care (r=0.416) and the total score obtained in the Questionnaire on Perception of Nurse Technicians and LPNs of Exercise of Leadership and collegial nurse-physician relationships (r=0.409). Conclusion: for the nurses, communication contributed to a better perception of quality care and good relationships with physicians. For the nursing aides, all the domains of coaching leadership collaborate for environments that favor their practice within PHC.

Nurses' ehealth literacy and associations with the nursing practice environment.

To report on ehealth literacy levels in nurses and to explore its associations with the nursing practice environment. Nurses increasingly use the Internet and associated technologies to seek health-relevant information and manage their health. High ehealth literacy is a predictor of better health outcomes in diverse populations but its levels and work-related determinants have not been adequately explored in direct-care nurses. The sample for this cross-sectional study consisted of 200 staff nurses and nursing assistants in Greece. Participants reported during February-March 2019 their sociodemographic and work-related characteristics on a self-administered questionnaire which included the "electronic Health Literacy Scale"-eHEALS, and the "Practice Environment Scale of the Nursing Work Index"-PES-NWI. Crude and adjusted logistic regressions were performed. In adjusted models, participants that scored higher on the "Collegial nurse-physician relationships" and "Nurse participation in hospital affairs" dimensions of the clinical environment had higher odds of reporting better ehealth literacy. The lowest item score in eHEALS was related to not being able to make health decisions using Internet information. Nurses' ehealth literacy was positively associated with some dimensions of the hospital practice environment. Nurses reported higher ehealth literacy scores in comparison to other studies; however, they were not confident in distinguishing reliable health information from Internet sources. This is quite alarming because it can directly impair the ability of nurses to provide relevant and up-to-date evidence-based care. This is the first study to report internationally on the positive associations of a good working environment with nurses' ehealth literacy levels. Nursing policy should address the ehealth literary of nurses and integrate it into continuing professional education initiatives. Special focus should be put on nurses' ambiguity in distinguishing which ehealth information is reliable and can guide nursing practice. This should be combined with efforts to improve the nursing clinical environment and increase nurses' participation in hospital decisions.

Predictors of physical restraint use on critical care units: An observational structural equation modeling approach

BackgroundModifiable unit characteristics, including nurse work environment, education, certification, and staffing have been shown to impact patient safety. Physical restraints are an important patient safety issue, however the relationships between these modifiable unit characteristics and physical restraint use on critical care units has not been explored. ObjectivesOur objective was to determine the role of nursing work environment, nurse education and certification, and nurse staffing on physical restraint use. DesignThe study was a secondary analysis of 2017–2018 unit-level restraint rates from the National Database of Nursing Quality Indicators linked to Registered Nurse survey and hospital characteristics data. MethodsWork environment was examined at the unit-level using total Practice Environment Scale of the Nursing Work Index and subscale scores. Unit-level nurse expertise included the percent of nurses with at least a Bachelor of Science in Nursing degree and percent with certification. Nurse staffing was the unit-level Registered Nurse hours per patient day and skill mix. Analyses included descriptive statistics, bivariate correlations, and Structural Equation Modeling. We used a first order model to estimate predicted restraint use from the five subscales of the Practice Environment Scale of the Nursing Work Index. A higher order model predicted restraint use from a total work environment factor score. ResultsThe sample included 408 critical care units from 226 hospitals. Mean restraint rate was 15% (SD 12, range 0–53%). In the first-order model, the Collegial Nurse-Physician Relations subscale had a positive relationship with restraint use (β = 0.167, 95% confidence interval 0.010–0.333). In the higher order model, the total work environment score had a negative relationship with restraint use (β = −0.088, 95% confidence −0.178– −0.014). Registered Nurse hours per patient day had a negative relationship to restraint use in both the first order (β = −0.114, 95% confidence interval −0.222–−0.025) and higher order models (β = −0.117, 95% confidence interval −0.223– −0.012). ConclusionWe found that better nurse-physician relationships were associated with higher restraint use. This finding is supported by previous literature and may reflect physician trust in nursing judgement when using restraints. However, a better work environment overall was associated with lower restraint rates. Further, Registered Nurse hours per patient day, but not skill mix, was associated with lower restraint rates. We conclude that improving the overall nurse work environment and nurse staffing, as well as using interprofessional interventions, may be successful in decreasing restraint use on critical care units.

Nurses’ perceptions of the practice environment in small rural hospitals

BackgroundNurses are essential to hospitals in rural areas, however little is known about the small rural hospital practice environment. Insight into this unique environment is important in attracting and retaining nurses in this setting. AimTo examine nurses’ perceptions of the practice environment in Australian small rural hospitals. DesignA descriptive cross-sectional survey. MethodsData were collected via an online survey of nurses working in Australian small rural hospitals. The Nursing Work Index-Revised: Australian was used to measure nurses’ perceptions of the practice environment and the relationships with demographics and hospital characteristics were examined. Descriptive, inferential statistics and multiple linear regression were applied to analyse the data. FindingsA total of 383 responses were included. The findings suggested an overall favourable practice environment. The collegial nurse-physician relations subscale was rated highest, which was supported by responses to free text comments. There were significant differences in nurses’ perceptions of the practice environment based on some demographic and hospital characteristics with those born overseas and those without 24-hour emergency departments having higher scores. The State/Territory where the hospital were located was a predictor of nurses’ perceptions of the practice environment. ConclusionTo positively influence the small rural hospital practice environment and improve staff satisfaction and retention, nurse leaders and managers can increase nurses’ involvement in organisational decision making and equip the workplace to better support rural nurses to work autonomously and with limited backup.

Leadership, adequate staffing and material resources, and collegial nurse-physician relationships promote better patients, professionals and institutions outcomes.

To test a theoretical model aiming to understand which characteristics of the professional nursing practice environment most affect patients, professionals and institution outcomes. A cross-sectional and correlational study, using a structural equation model. One thousand seven hundred and seventy-three staff nurses were recruited using convenience sampling in five Brazilian hospitals from November 2017 to July 2018. Structural equation modelling was used to assess the relationship between the characteristics of the nursing work environment and patients (climate of safety and quality of care), nursing professionals (job satisfaction and emotional exhaustion) and institutions (intention to leave the job) outcomes. The model was tested using the partial least squares method, considering the bootstrapping technique to estimate the results. The path coefficients and their respective 95% confidence intervals were calculated. The quality of fit of the structural model was assessed by calculating the coefficient of determination (R2 ), the predictive validity coefficient (Q2 ) and the effect size (f2 ). The characteristics that most affected the outcomes for patients were Nurse manager ability, leadership and support of nurses (λ=0.27), and Staffing and resource adequacy (λ=0.26); for nursing professionals, Staffing and resource adequacy (λ=-0.19), and Collegial nurse-physician relations (λ=0.19); and for institutions, Nurse manager ability, leadership and support of nurses (λ=-0.10), and Collegial nurse-physician relations (λ=-0.10). The characteristics of the professional nursing practice environment that most contribute to achieving better outcomes include nurse manager ability, leadership and support of nurses, staffing and resource adequacy, and collegial nurse-physician relations. This study allowed us to assess which strategies should be prioritized in the professional nursing practice environment to achieve better results. Thus, investment in the training of leadership, in the adequacy of resources, and in physician-nurse relations will bring better results for patients, nursing professionals, and institutions.

Nurse work environment and its impact on reasons for missed care, safety climate, and job satisfaction: A cross-sectional study.

To describe the nurse work environment and its relation to reasons for missed nursing care, safety climate, and job satisfaction. This was a cross-sectional study. Two hundred and nineteen nursing professionals by a convenience sample from two teaching hospitals between April 2017 and October 2017. The variables nurse work environment, reasons for missed nursing care, safety climate, and job satisfaction were collected by measuring instruments, and a descriptive, correlation, and comparative analyses were performed. The nurse work environment was classified as mixed, with three subscales of the instrument resulting in scores that represented a better nurse work environment, namely: nursing foundations for quality care; collegial nurse-physician relations; and nurse manager ability, leadership, and support. The most frequent reasons for missed care were related to labour and material resources. A better work environment was associated with a high level of work satisfaction, better perception of the safety climate, and fewer reasons for missed care. Better nurse work environments can contribute to improving nurses' perception of job satisfaction and the safety climate, and to reducing reasons for missed care. Authentic leadership in the nurse work environment has implications in terms of reducing the reasons for missed nursing care, improving the perception of the safety climate, and job satisfaction. Nurse managers should evaluate the nurse work environment and missed nursing care as an important predictors of the quality of patient care.

Association of work environment and resilience with transition shock in newly licensed nurses: A cross-sectional study.

To examine transition shock in newly licensed nurses and the association of work environment and resilience with nurses' transition shock. Although work environment is related to transition shock in newly licensed nurses, little is known about the factors of nursing work environment associated with transition shock. Furthermore, resilience is known to help nurses positively face workplace challenges; however, there is little evidence on the associations between resilience and transition shock in new nurses. A cross-sectional, descriptive study. Data from 163 new nurses with <12months of work experience in the current hospital since graduation were analysed. Participants' characteristics, work environment, nurse resilience and transition shock were self-reported. Multivariable linear regressions were performed in three steps (following the STROBE checklist). The highest mean score of transition shock was obtained for the item 'I perceive the limitations of my professional knowledge in nursing care'. In the regression analysis adjusted for all variables, two factors of work environment-'nurse staffing and resource adequacy' and 'collegial nurse-physician relationships'-were associated with transition shock. Meanwhile, resilience was not related to transition shock. The gap between newly licensed nurses' theoretical and practical knowledge continues to exist. Adequate nurse staffing and a positive relationship with physicians, rather than nurse resilience, were more likely to associate with new nurses' transition shock. Hospitals need to provide ward-based simulations and case-based learning methods to enhance nurses' transition to professional practice. For nurses' transition, hospitals should make efforts to provide adequate nurse staffing and resources. Furthermore, hospitals should provide communication opportunities to build a positive collaborative culture between nurses and physicians. Unit nurse managers need to assess newly licensed nurses' perception of nurse-physician professional relationship and create an atmosphere of respect and understanding for each other.

Patient Safety in Selected Healthcare Facilities in Caraga Region: An Aiken Model Approach

This study aimed to determine the nursing organizational factors and patient safety in selected healthcare facilities in the Philippines. It utilized quantitative approach of research specifically descriptive correlational research design. The inclusion criteria of the entire population were composed mainly of 455 nurses employed among the five selected healthcare facilities in Caraga Region, Philippines within a period of 1 year and above offering inpatient and outpatient healthcare services. Results revealed that there was a positive response on organizational factors such as nursing foundations for quality care, nurse participation in hospital affairs, nurse manager leadership, ability and support and collegial nurse-physician relationships. Patient Safety with regards to supervisor/manager, wok area/unit, frequency of events reported, and communications, patient safety grade, hospital and number of events reported were positively performed and practiced. The patient safety practices were directly affected by the organizational factors being tested.