Nursing Practice Environment Research Articles

Impact of authentic leadership on nurses' well-being and quality of care in the acute care settings.

Both nurses' well-being and quality of care are top priorities of the healthcare system. Yet, there is still a gap in understanding the extent and how authentic leadership influences them. This information is needed to inform the development of effective interventions, organizational practices, and policies. Thus, this study aimed to test the mechanism by which nurses' perception of their managers' authentic leadership impacts nurses' well-being and perception of quality of care, given the role of the nursing practice environment and nurses' psychological capital. A cross-sectional design was used. This study recruited a random sample of 680 nurses from six hospitals in Saudi Arabia. A final sample of 415 completed the surveys, with a response rate of 61%. Structural equation modeling was performed to test the hypothesized model. The study showed that nurses' perceptions of authentic leadership in their managers positively and directly affect their perceptions of quality of care but do not directly affect nurses' well-being. Both the nursing practice environment and psychological capital fully mediated the relationship between authentic leadership and nurses' well-being. However, the nursing practice environment partially mediated the relationship between authentic leadership and perceptions of quality of care. The findings contribute to understanding the crucial role of authentic leaders' style in nurses' well-being and quality of care through its positive impact on the nursing practice environment and psychological capital. Designing interventions and policies that specifically target nursing managers' authentic leadership style has implications for enhancing nurses' well-being and the quality of patient care. Institutional measures are needed to help leaders practice an authentic leadership style to create a positive nursing practice environment and cultivate nurses' psychological capital, both of which contribute to nurses' well-being and attaining a better quality of care. Further work is required to highlight the outcomes of implementing an authentic leadership style relevant to other leadership styles.

Strategies and Interventions to Support Quality Outcomes in the Home Care Setting: A Longitudinal Multilevel Study.

The relationship between the practice environment, empowerment, and outcomes such as quality of care, job satisfaction, and intent to stay has been extensively studied in healthcare settings, including hospitals and long-term care facilities. Research consistently demonstrates that a positive practice environment, characterized by supportive leadership, adequate resources, and opportunities for professional growth, are associated with better quality of care, increased job satisfaction, and higher intent to stay among healthcare professionals. Limited knowledge exists regarding the specific relationship between the practice environment, empowerment, and these outcomes within home care organizations. This study assesses the impact of strategies on nurse practice environment, social capital, decision latitude, workload, care quality, job satisfaction, and retention in a Belgian home healthcare organization. A longitudinal survey was conducted in a home healthcare organization, with data collected at 3 time points: baseline (T1) (2015), T2 (2018), and T3 (2021). In T3, respondents reported significantly higher scores for departmental and general management compared with T1. The interventions led to significant improvements in social capital and decision latitude. Self-reported quality of care at the department level showed a significant increase, whereas no significant change was observed for quality of care during the last round. The implementation of strategies and interventions as part of a broader healthcare transformation process had a positive impact. Improvements were observed in nurse-reported quality of care, job satisfaction, and intent to stay in nursing. These findings emphasize the effectiveness of the implemented measures in enhancing nursing practice and creating a positive work environment. Continuous efforts to implement and evaluate such strategies are essential for enhancing the satisfaction and retention of nursing teams within healthcare organizations.

Nurse Manager Practice Environment and Its Influencing Factors: A Multicenter Cross-Sectional Study

Objective. This study aimed to evaluate the current status and related factors of practice environments of nurse managers in China. Background. Insufficient nurse staffing and poor working environment directly increase the burnout and turnover of nurse leaders. Nurse managers play a pivotal role in healthcare organizations, and their performance has been inextricably linked to achieving optimal patient, staff, and healthcare organizational outcomes. However, there are few studies exploring the influencing factors of nurse manager practice environment. Methods. A cross-sectional study was undertaken to examine a sample of 405 nursing managers who were selected from 10 hospitals located across three provinces in China. The general characteristics questionnaire, the Nurse Manager Practice Environment Scale, the Perceived Stress Scale, and the Career Growth Scale were used. Data were analyzed by descriptive statistics, univariate analysis, and multiple stepwise linear regression. Results. The total scores of the nurse manager practice environments were 236.71 ± 27.635 (with 270 being the highest possible score), which was at a generally high level. The three lowest scores were adequate budgeted resources, fair and manageable workload, and nurse manager-physician relationships. Nurse manager practice environment was predicted by hospital geographic location, having (or not) training experience in higher ranked hospitals, levels of perceived stress, and career growth scores. Conclusion. Chinese nursing managers reported a relatively favorable nursing practice environment. Policymakers should pay more attention to the practice environment of nursing managers in small city hospitals, and they could regularly evaluate, monitor, and promote practice environment determinants that are sensitive to disparities between different hospitals. In addition, hospital managers can take action by implementing diversity training programs, developing stress-reduction initiatives, and creating robust career development programs for nurse managers to support nurse managers better. Implications for nursing management: a better understanding of the current practice environment of nursing managers is beneficial for improving nursing managers’ work environment, which in turn will promote the quality of care delivered and nursing management work. For nurse managers, the characteristics of the management and work environment of the small city hospitals should be benchmarked and learned against the district capital hospitals. Also, hospital administrators were required to adopt strategies to foster psychological support of nurse managers and create pathways and opportunities for professional growth to create a supportive working environment.

Effects of the nursing practice environment, nurse staffing, patient surveillance and escalation of care on patient mortality: A multi-source quantitative study

BackgroundA favourable nursing practice environment and adequate nurse staffing have been linked to reduced patient mortality. However, the contribution of nursing care processes such as patient surveillance and escalation of care, on patient mortality is not well understood. ObjectiveThe aim of this study was to investigate the effect of the nursing practice environment, nurse staffing, missed care related to patient surveillance and escalation of care on 30-day inpatient mortality. DesignA multi-source quantitative study including a cross-sectional survey of nurses, and retrospective data extracted from an audit of medical and admission records. Setting(s)A large tertiary teaching hospital (600 beds) in metropolitan Sydney, Australia. MethodsData on the nursing practice environment, nurse staffing and missed care were obtained from the nursing survey. Patient deterioration data and patient outcome data were collected from the medical and admission records respectively. Logistic regression models were used to examine the association between the nursing practice environment, patient deterioration and 30-day inpatient mortality accounting for clustering of episodes within patients using generalised estimating equations. ResultsSurveys were completed by 304 nurses (84.5 % female, mean age 34.4 years, 93.4 % Registered Nurses) from 16 wards. Patient deterioration data was collected for 30,011 patient deterioration events and 63,847 admitted patient episodes of care. Each additional patient per nurse (OR = 1.22, 95 % CI = 1.04–1.43) and the presence of increased missed care for patient surveillance (OR = 1.13, 95 % CI = 1.03–1.23) were associated with higher risk of 30-day inpatient mortality. The use of a clinical emergency response system reduced the risk of mortality (OR = 0.82, 95 % CI = 0.76–0.89). A sub-group analysis excluding aged care units identified a 38 % increase in 30-day inpatient mortality for each additional patient per nurse (OR = 1.38, 95 % CI = 1.15–1.65). The nursing practice environment was also significantly associated with mortality (OR = 0.79, 95 % CI: 0.72–0.88) when aged care wards were excluded. ConclusionsPatient mortality can be reduced by increasing nurse staffing levels and improving the nursing practice environment. Nurses play a pivotal role in patient safety and improving nursing care processes to minimise missed care related to patient surveillance and ensuring timely clinical review for deteriorating patients reduces inpatient mortality. Tweetable abstractPatient mortality can be reduced by improving the nursing practice environment & increasing the number of nurses so that nurses have more time to monitor patients. Investing in nurses results in lower mortality and better outcomes. #PatientSafety #NurseStaffing #WorkEnvironment #Mortality.

The influence of psychological resilience and nursing practice environment on nurses' moral courage: A cross-sectional study.

To determine the relationship between psychological resilience, nursing practice environment, and moral courage of clinical nurses and also the factors influencing moral courage. Cross-sectional study. 586 nurses from a general hospital were selected by convenience sampling method in January 2023. The general information questionnaire, Nurses' Moral Courage Scale (NMCS), Resilience Scale, and Practice Environment Scale (PES) were measured. Hierarchical linear regression analysis was used to explore the influencing factors of clinical nurses' moral courage. Nurses' average moral courage score was 79.00 (69.00, 91.00). The nurses' moral courage was positively correlated with psychological resilience and nursing practice environment. Multivariate linear regression analysis showed that psychological resilience and nursing practice environment entered the regression equation, accounting for 23.4% of the total variation. Psychological resilience and nursing practice environment are the main factors affecting the moral courage of clinical nurses. Nursing managers should conduct moral courage training, develop a decent nursing practice environment, pay attention to the psychological emotions of nurses, and actively build a safe, open, and supportive atmosphere for moral behaviour.

Factors associated with clinical nurses' preconception health behavior in Korea: a cross-sectional survey.

Nurses have been reported to be at an increased risk for miscarriage and preterm labor. However, there is limited knowledge regarding nurses' preconception health behaviors. Therefore, this study aimed to identify factors influencing these behaviors. One hundred sixty nurses, who were planning their first pregnancy within the upcoming year, participated in an online survey from August 11 to October 31, 2021. Data on preconception health behavior, perceived health status, pregnancy anxiety, nursing practice environment, and social support were analyzed using the t-test, Pearson correlation coefficients, and multiple regression analysis. Age (р=.024), educational level (р=.010), marital status (р=.003), work experience (р=.003), satisfaction with the work department (р<.001), smoking status (р=. 039), and previous health problems related to pregnancy outcomes (р=.004) were significantly associated with nurses' preconception health behaviors. Furthermore, perceived health status (р<.001), pregnancy anxiety (р=.011), nursing practice environment (р=.003), and social support (р<.001) showed significant correlations with preconception health behaviors. Social support (β=. 28, р=.001), satisfaction with the work department (β=.23, р=.032), marital status (β=.22, р=.002), and perceived health status (β=.23, р=.002) were confirmed as factors associated with preconception health behaviors. These factors explained 40.9% of the variance in preconception health behaviors (F=6.64, р<.001). Clinical nurses' preconception health behaviors were influenced by social support, perceived health status, satisfaction with the work department, and marital status. Interventions to improve clinical nurses' preconception health behaviors should target social support and perceived health status. A preconception health behavior education program considering clinical nurses' marital status and satisfaction with the workplace can also be implemented.

Predictors of Nursing Performance for Patient Safety among Nurses in Regional Hospitals: A Cross-sectional Study

Nursing performance for patient safety is crucial for improving patient safety outcomes and quality of care. This cross-sectional study aimed to explore nursing performance for patient safety and identify the predictability of patient safety knowledge, patient safety attitude, nurse practice environment, patient-to-nurse ratio, and nursing hours per patient day on nursing performance for patient safety. The participants included 234 nurses randomly selected from six regional hospitals across Thailand. The research instruments included a demographic data form, the Practice Environment Scale of the Nursing Work Index, the Patient Safety Principles and Knowledge Questionnaire, the Safety Attitudes Questionnaire, and the Nursing Performance for Patient Safety Scale, which yielded scale-level content validity indices ranging from .85 to .88. The Cronbach’s alpha coefficients ranged from .81 to .98. Descriptive statistics and stepwise multiple regression were utilized for the data analysis.The results revealed that the nurses perceived overall nursing performance for patient safety at a high level. Patient-to-nurse ratio was the strongest predictor of nursing performance for patient safety, followed by patient safety knowledge, patient safety attitude, nurse practice environment, and nursing hours per patient day. All predictors could predict nursing performance for patient safety, accounting for 56.00% of the variance. Nurse administrators and policymakers can use the results of this study to develop strategies for improving nursing performance for patient safety. We recommend longitudinal studies using different samples of Thailand nurses in diverse settings to confirm results across the country.

Individual Attributes and Environmental Conditions of Registered Nurses Working in Freestanding Emergency Departments in the United States: A Descriptive Exploratory Study

IntroductionFreestanding emergency departments (FSEDs) are emergency facilities not connected to inpatient services. The percentage of FSEDs of all EDs grew from 1% in 2001 to 12% in 2017, making FSEDs a substantial subset of US emergency care. The purpose of this study was to describe the individual attributes and environmental conditions of registered nurses working in FSEDs in the US. MethodsA quantitative descriptive exploratory design with cross-sectional survey methodology. ResultsA total of 364 emergency nurses responded to the survey. Most reported their FSED was open 24 hours/day (99.5%), with board-certified emergency physicians onsite (91.5%) and a mean of 3.6 RNs working per shift. Resources immediately available in more than 50% of FSEDs included laboratory and imaging services, and in fewer than 30% of FSEDs included behavioral health care, MRI, obstetric care, orthopedic care, neurologic care, and surgical consult care. Respiratory therapy was reported by 39.6% of respondents as being immediately available. A significant minority of respondents expressed concerns about adequacy of resources and training and the effect on patient care in both survey (30% of respondents) and open-ended questions (42.5% of respondents). DiscussionThe practice environment of emergency nurses in FSEDs was reported as having positive elements; however, a substantial subpopulation reported serious concerns. FSEDs adhere to some of the standards put forward by the American College of Emergency Physicians, with notable exceptions in the areas of staffing RNs, staffing ancillary staff, and availability of some resources.

The Effects of Laughter Yoga on Happiness and Stress in Nursing Students Going into Clinical Practice for the First Time.

Background: There are numerous difficulties that nursing students must overcome in the nursing practice environment. This circumstance mainly impacts the happiness and stress levels of nursing students who lack clinical practice. Aim: In this study aimed to examine the effect of laughter yoga (LY) on nursing students' happiness and stress levels attending to clinical practice for the first-time. Method: In this randomized controlled trial, a totally 50 nursing students were included from a nursing school in Turkey. Data were collected between December 2022-January 2023 via The Happiness Scale and the Perceived Stress Scale for Nursing Students. A total of eight LY lessons for 4 weeks were practiced to the laughter group (LG). Result: The Happiness Scale's means were compared between the groups before and after the intervention, and the results revealed a significant increase (p < 0.05). There was not a significant difference in the stress scale scores between both the groups following LG and clinical practice (t: -1.780; p = 0.081). However, the stress scores of the LG decreased significantly after the LY sessions were completed (b: 3.595; p = 0.001). Conclusion: LY can be an effective method to be used to help increase happiness and reduce the stress of nursing students for first-time entering clinical practice.

Assessment of Nursing Practice Environment and Its Influencing Factors: A Cross-Sectional Study at Shandong Province, Jinan.

To investigate the current nursing practice environment in Jinan, Shandong Province, and to identify the factors influencing the practice environment. This study is a cross-sectional study for nurses. From October to December 2022, using the clustering and stratified sampling methods, 2426 nurses from internal Medicine, Surgery, Obstetrics and Gynecology, Outpatient Department and Intensive Care Department of the Provincial Hospital of Shandong Medical University were selected and then investigated and analyzed using the revised Nurse Practice Environment Assessment Scale. The overall mean evaluation of the practice environment scored 75.13±19.87, with a minimum value of 59.74 and a maximum value of 95.82. The items with higher scores were "the hospital has systematic training for new nurses", "the work system is perfect", and "the hospital can provide continuing education for nurses in accordance with the needs of their positions". The items with lower scores were "nurses enjoy legal benefits", "nurses have the opportunity to participate in hospital management decisions", and "nurses have the opportunity to participate in hospital internal management". The results of the multiple linear regression analysis of the factors influencing nurses' practice environment showed that gender, education, position, and years of work were independent influences on nurses' practice environment scores (p < 0.05), and they explained 48.127% of the variation in the total scores of the nurses' practice environment scale. The estimated values (β) of sex, education, cheif nurse, nurses staff, work experience (year), and whether the only child variables were 3.141, 3.237, 2.713, 5.471, 2.074 and 0.732, respectively. The nurse practice environment still needs to be improved, mainly in terms of hospital management participation, human resource allocation and salary distribution system.

Characterization of nurses’ work methods: The analysis of a Portuguese hospital

Background &amp; Aim: Providing nursing care occurs through work methods that ensure the organization and implementation of care: the functional work method, the teamwork method, the individual work method, or the reference nurse work method. This study aims to identify work methods that nurses adopt in a Portuguese hospital.&#x0D; Methods &amp; Materials: A cross-sectional study was conducted in a hospital in northern Portugal. A non-probabilistic convenience sampling technique was used, and 627 nurses were enrolled. Data were collected between March and April 2023 using the “Nurses’ Work Methods Assessment Scale.” The Statistical Package for the Social Sciences was used to perform descriptive and inferential statistics, using the Mann-Whitney, Kruskal-Wallis, and Spearman’s correlation tests.&#x0D; Results: The individual method predominated, followed by the functional and teamwork methods. A lower adherence to the nurse reference method was observed. The variable “work context” was the most significant for the four working methods. In the individual method, the frequency of the variable “condition in which the profession is practiced” was higher in specialist nurses and, particularly, rehabilitation nursing specialists. The frequency of using the individual method is also higher when nurses have a master’s degree and training in nursing care organization methodology.&#x0D; Conclusion: The highest frequencies of the individual method are related to the level of training, suggesting the influence of training in adopting working methods in clinical practice. Although the reference nurse method points to better satisfaction of clients’ needs, nursing practice environments sometimes have inadequate conditions for its operationalization.

Organizational characteristics of nursing practice environments related to registered nurses’ professional autonomy and job satisfaction in two Finnish Magnet-aspiring hospitals: structural equation modeling study

BackgroundNurses are leaving their profession because of poor personal job satisfaction, heavy workload, and unfavorable work environments with low professional autonomy. Professional autonomy involves the possibility to influence one’s work and have a sense of control – the ability to contribute to a workplace culture and influence how decisions are made. This study explores registered nurses’ perceptions of the nursing practice environment, using the Nursing Work Index-Revised (NWI-R), and its relationships with professional autonomy and job satisfaction.MethodsA cross-sectional study along with instrument re-validation was conducted using a web-based survey for nurses in two Magnet-aspiring hospitals in Finland in September 2021 (n = 586). Structural equation modeling was used to find out the relationships of the NWI-R components with professional autonomy and job satisfaction.ResultsPrincipal component analysis and confirmatory factor analysis supported seven components with 34 items. Collegial nurse–doctor relationships, organization’s quality standards, and nursing involvement and expertise sharing (means of 3.23, 2.96, and 2.66, respectively) demonstrated a favorable nursing practice environment; professional nursing standards, nurse management and leadership, staffing and resource adequacy, and professional advancement (means of 2.38, 2.18, 2.15, and 2.13, respectively) demonstrated an unfavorable nursing practice environment. The presented model (RMSEA 0.068, CFI 0.987, TLI 0.946) indicated that nursing involvement and expertise sharing, organization’s quality standards, nurse management and leadership, and collegial nurse–doctor relationships were related to professional autonomy. Nurse management and leadership, staffing and resource adequacy, and organization’s quality standards were related to job satisfaction. Moreover, professional autonomy was related to job satisfaction.ConclusionNurses’ professional autonomy is important due to its relationship with job satisfaction. When factors that increase professional autonomy are taken into account and attention is paid to the promotion of autonomy, it is possible to improve nurses’ job satisfaction. These issues cannot be solved at the unit level; investment is needed at the organizational and political levels. The results introduce nurses, managers, researchers, and stakeholders to improvements in the nursing practice environment toward an organizational culture where nurses may utilize their professional autonomy to its full potential.

The moderating role of just culture between nursing practice environment and oncology nurses' silent behaviors toward patient safety: A multicentered study

BackgroundPatient safety is a critical part of healthcare delivery that must be prioritized to guarantee optimal patient outcomes. Oncology nursing is a specialized area of nursing that demands great focus on patient safety because of the high-risk nature of this patient group. Nurses play an important role in ensuring that patients receive safe and effective care. However, the nursing practice environment can have a substantial impact on how nurses respond to patient safety problems. A just culture can promote open communication and identify potential safety issues, whereas a culture of silence can have a negative impact on patient outcomes. ObjectiveFirstly, assess the relationship between the nursing practice environment and oncology nurses' silent behavior towards patient safety. Secondly, the interaction effect of just culture as a moderator in this relationship. MethodA cross-sectional, correctional research design was employed. Data was collected from 303 nurses working at the oncology departments of five hospitals in Egypt using three questionnaires. Data was analyzed using SPSS-PROCESS Macro (v4.2). ResultsThere was a moderate, negative, and significant correlation between the nurse practice environment and silent behavior of nurses towards patient safety. The interaction effect of just culture with nurse practice environment strengthens this relationship, thus enhancing errors reporting. ConclusionsThis study emphasized on the importance of creating a just culture that facilitates open communication and eliminating the potential hazards result from nurses' silence. Thus, oncology nurses must be encouraged to report issues related to patient safety.

Structural Equation Modeling of Associations Between Nursing Practice Environment And Missed Nursing Care: A Cross-sectional Study.

Missed nursing care (MNC) negatively impacts the quality of patient care. There may be a relationship between the nursing practice environment (NPE) and MNC; however, this relationship has not been examined in developing countries during the COVID-19 pandemic. To determine the relationship between the NPE and MNC during the COVID-19 pandemic. A cross-sectional study of 300 participants was conducted in 4 teaching hospitals in Iran. Data were collected using a demographic and clinical form, the Nursing Professional Practice Environment Questionnaire, and MISSCARE survey and analyzed using structural equation modeling. The hypothesized model was well fit, showing that 1 unit improvement of the NPE domains of patient-centered care , effective leadership , and policy transparency decreased MNC by 0.18, 0.12, and 0.05, respectively. The model confirmed the association between the dimensions of the NPE and MNC. These findings can assist health policymakers and nursing managers in improving the NPE.

Highlighting the Benefits of the Clinical Education Resource Nurse for New Graduate Nurses.

Nurse residency programs provide a valuable transition to practice environment for graduate nurses. The Clinical Education Resource Nurse (CERN) role offers continued clinical assistance to graduate nurses who have completed orientation with a preceptor during the 1st year of practice including education and continued clinical oversight when needed. This column defines the role of CERN and provides a description of the clinical application and support provided.

How nursing practice environments limit implicit rationing of care and nurse-assessed adverse events: the role of flow at work

BackgroundThe nursing practice environment is beneficial in curbing implicit rationing of nursing care and adverse patient events. However, the underlying mechanisms of these relationships remain unexplored.AimTo test whether flow at work mediates the relationship between the nursing practice environment, implicit rationing of nursing care, and nurse-assessed adverse patient events.MethodsThis cross-sectional study involved 231 nurses from five hospitals in Port Said, Egypt. The participants completed Arabic-translated versions of the Practice Environment Scale of the Nursing Work Index, the Work-Related Flow Inventory, the Perceived Implicit Rationing of Nursing Care instrument, and the Adverse Patient Events scale. Structural equation modeling was used to test the hypothetical model.ResultsThe favorable nursing practice environment positively predicted nurses’ flow at work (β = 0.64, p < 0.001), while inversely predicting implicit rationing of nursing care (β = -0.23, p = 0.014) and adverse patient events (β = -0.35, p < 0.001). Nurses’ flow at work inversely predicted implicit rationing of nursing care (β = -0.30, p = 0.002) and adverse patient events (β = -0.29, p = 0.002). Moreover, nurses’ flow at work acted as a mediator, linking the nursing practice environment to the rationing of nursing care and adverse patient events, with 500 bootstrap results for the indirect effects (β = -0.24, p = 0.001, 95% CI: -0.43 to -0.09; and β = -0.44, p = 0.003, 95% CI: -0.79 to -0.16, respectively).ConclusionNurses working in a favorable nursing practice environment are more likely to experience flow at work, limiting implicit rationing of nursing care and adverse patient events.Implications for nursing managementNursing administrators should strive to create a healthy nursing practice environment to foster nurses’ flow and thereby reduce the frequency of implicit rationing of nursing care and adverse patient events.

Intent to stay, moral distress, and nurse practice environment among long-term care nurses: A cross-sectional questionnaire survey study.

Many long-term care facilities in the United States face significant problems with nurse retention and turnover. These challenges are attributed, at least in part, to moral distress and a negative nurse practice environment. The purpose of the study was divided into two parts: first, to investigate the relationships among nurse practice environment, moral distress, and intent to stay; second, to explore the potential mediating effect of the nurse practice environment on the intent to stay among those with high levels of moral distress. This study was a descriptive, cross-sectional survey using targeted sampling. A total of 215 participants completed the surveys. Participants were nationally representative of long-term care nurses by age, years of experience, employment status, and type of health setting. This study was an online national survey of long-term care nurses' perceptions of their intent to stay, moral distress level (Moral Distress Questionnaire), and nurse practice environment (Direct Care Staff Survey). Structural equation modeling analysis explored intent to stay, moral distress, and the nurse practice environment among long-term care nurses. The mean moral distress score was low, while the mean nurse practice environment and intent to stay scores were high. Moral distress had a significant, moderately negative association with the nurse practice environment (β = -0.41), while the nurse practice environment had a significant, moderately positive association with intent to stay (β = 0.46). The moral distress had a significant, moderately negative association with intent to stay (β = -0.20). The computed structural equation modeling suggested a partially mediated model (indirect effect = -0.19, p = 0.001). Since the nurse practice environment partially mediates the relationship between moral distress and intent to stay, interventions to improve the nurse practice environment are crucial to alleviating moral distress and enhancing nurses' intent to stay in their jobs, organizations, and the nursing profession. Our study demonstrated that the nurse practice environment mediates moral distress and intent to stay. Interventions to improve the nurse practice environment are crucial to alleviating moral distress and enhancing nurses' intent to stay in their jobs, organizations, and the nursing profession.

Pathways among the nursing practice environment, job burnout, and job satisfaction to intention to leave: a cross-sectional study conducted in Taiwan.

The purpose of this study was to explore the pathways among the practice environment, job burnout, and job satisfaction and their relationships with the intention to leave among clinical nurses. A cross-sectional survey was administered to 310 nursing staff members working in regional teaching hospitals in southern Taiwan. The instruments used included the practice environment, job satisfaction, job burnout, and sociodemographic characteristics questionnaires. Structural equation modeling indicated that job satisfaction (β = -0.167) and job burnout (β = 0.361) were significantly and directly associated with the intention to leave, whereas the practice environment was significantly and directly associated with job satisfaction (β = 0.447). The practice environment (βindirect = -0.075) and job burnout (βindirect = 0.060) were significantly and indirectly associated with the intention to leave through job satisfaction. Job burnout and job satisfaction are directly associated with the intention to leave. Therefore, improving the practice environment and subsequent job burnout could be strategies to improve job satisfaction and decrease the intention to leave.

Upward Bullying as Experienced by Chinese Nurse Managers: A Qualitative Study

Aim. To understand the current situation of upward bullying in the Chinese nursing field and explore the manifestations, reasons, and outcomes of upward bullying experienced by Chinese nurse managers. Background. Workplace bullying, a serious social problem, is characterised by recurring incidents of intimidating, aggressive, and hostile behaviour. Bullying in the nursing profession exhibits all or some of the above traits. The evidence of upward bullying by subordinate nurses against nurses in positions of authority or power is limited in China. Methods. This qualitative study was conducted with semistructured, in‐depth interviews involving 12 hospital nurse managers in Wuhan, Hubei Province, between June and August 2023. The data were analysed using the Colaizzi seven‐step analysis method with Nvivo 12.0 software as a support. Results. We grouped our findings into three main categories: manifestations of upward bullying; reasons for upward bullying; and outcomes of upward bullying. Conclusions. Nurse managers in China are exposed to upward bullying in many forms and for complex reasons. More emphasis needs to be given to creating a positive work environment for them to facilitate their managerial role. Implications for Nursing Management. This study probes the realities of upward bullying against Chinese nurse managers and highlights the need for managers to develop the skills needed to identify, manage, and prevent bullying from subordinates. By contributing to the development of interventions and strategies that address workplace bullying, this study shows promise for enhancing managerial effectiveness and improving the nursing practice environment.

Reporting the adverse events and healthcare-associated infections in relation to the work environment

Abstract Aim. The aim of this multicenter study was to analyze the reporting of the adverse events and health care-associated infections (HAIs) in relation to work environment. Material and methods. This cross-sectional multicenter study was conducted in 14 acute care hospitals throughout the Czech Republic. A total of 105 acute care hospital wards were included in the study. The Practice Environment Scale of the Nursing Work Index was used to assess the practice environment. The questionnaire to assess the practice environment were completed by 805 nurses. The data on adverse events and HAIs were weekly reported. Results. The overall mean number of adverse events including healthcare-associated infections was 27.7 (±36.10) per 100 patients, the most frequent being pressure ulcers and falls. The most frequent healthcare-associated infections were urinary tract, gastrointestinal tract and surgical site infections. Analysis of all adverse events and HAIs failed to confirm a statistically significant relationship between the nursing practice environment and occurrence of adverse events or healthcare-associated infections. Conclusions. Adverse events and healthcare-associated infections are important indicators of quality of care in hospitalized patients. No type of the nursing practice environment aff ected the reporting of adverse events and HAIs.