Participation In Hospital Affairs Research Articles

Nursing categories’ perceptions of the practice environment and quality of care in North West Province: a cross-sectional survey design

BackgroundThere is a substantial amount of literature on the perception of the practice environment and quality of care as perceived by registered nurses and community services nurses in South Africa and worldwide, but there is little to no research that could be found regarding other categories of nurses, and how these perceptions differ between the different categories. Therefore, the aim of this study is to describe the different nursing categories’ perceptions of the practice environment and quality of care and the association between the variables.MethodsThis study applied a cross-sectional survey design. Data were collected in April 2021 in the public sector of the North West Province. Multiphase sampling was applied to all categories of nurses who worked in an in-patient unit in the selected hospital for at least 3 months (n = 236).ResultsAll nursing categories perceived the practice environment as negative, regarding nurse participation in hospital affairs; nurse manager ability, leadership, and support of nurses and staffing and resource adequacy. Perceived quality of care and patient safety items were perceived as neutral and good. However, in all instances, the perceptions of community service nurses and registered nurses were most negative, and enrolled nurse assistants most positive. Adverse events towards patients and nurses were perceived to only occur a few times a year. Overall, nurse perceptions of quality of care and patient safety were most correlated with the subscale of nurse foundations of quality of care and nurse manager ability, leadership, and support of nurses. Adverse events towards patients were most correlated with the collegial nurse-physician relationship subscale, while adverse events towards nurses were correlated with the foundations of quality of care subscale.ConclusionImproving the practice environment, especially regarding the subscale nurse foundations of quality of care and nurse manager ability, leadership, and support of nurses, is associated with improved quality of care. Nurses with higher qualifications, registered nurses and community service nurses rated quality of care lower than other categories of nurses, contributing to literature that higher qualified staff are more competent to assess the practice environment and quality of care.

Nurse perceptions of practice environment, quality of care and patient safety across four hospital levels within the public health sector of South Africa

Improving the practice environment, quality of care and patient safety are global health priorities. In South Africa, quality of care and patient safety are among the top goals of the National Department of Health; nevertheless, empirical data regarding the condition of the nursing practice environment, quality of care and patient safety in public hospitals is lacking.AimThis study examined nurses’ perceptions of the practice environment, quality of care and patient safety across four hospital levels (central, tertiary, provincial and district) within the public health sector of South Africa.MethodsThis was a cross-sectional survey design. We used multi-phase sampling to recruit all categories of nursing staff from central (n = 408), tertiary (n = 254), provincial (n = 401) and district (n = 244 [large n = 81; medium n = 83 and small n = 80]) public hospitals in all nine provinces of South Africa. After ethical approval, a self-reported questionnaire with subscales on the practice environment, quality of care and patient safety was administered. Data was collected from April 2021 to June 2022, with a response rate of 43.1%. ANOVA type Hierarchical Linear Modelling (HLM) was used to present the differences in nurses’ perceptions across four hospital levels.ResultsNurses rated the overall practice environment as poor (M = 2.46; SD = 0.65), especially with regard to the subscales of nurse participation in hospital affairs (M = 2.22; SD = 0.76), staffing and resource adequacy (M = 2.23; SD = 0.80), and nurse leadership, management, and support of nurses (M = 2.39; SD = 0.81). One-fifth (19.59%; n = 248) of nurses rated the overall grade of patient safety in their units as poor or failing, and more than one third (38.45%; n = 486) reported that the quality of care delivered to patient was fair or poor. Statistical and practical significant results indicated that central hospitals most often presented more positive perceptions of the practice environment, quality of care and patient safety, while small district hospitals often presented the most negative. The practice environment was most highly correlated with quality of care and patient safety outcomes.ConclusionThere is a need to strengthen compliance with existing policies that enhance quality of care and patient safety. This includes the need to create positive practice environments in all public hospitals, but with an increased focus on smaller hospital settings.

Moral Distress and Intention to Leave During COVID: A Cross-sectional Study on the Current Nursing Workforce to Guide Nurse Leaders for the Future.

The aim of this study was to investigate how the experience of caring for COVID-19 patients, nurses' moral distress, and the current practice environment impact nurses' intention to leave. Caring for COVID-19 patients has been associated with an increase in nurses' moral distress and an increase in nurses' turnover. To date, research has focused on nurses' moral distress, the practice environment, and intentions to leave during the pandemic's peak. The current workplace climate, including those who stayed in their positions, has not been adequately assessed. This cross-sectional correlational study was conducted in a Magnet® hospital. Moral distress related to team/system (B = 0.64, t = 3.86, P < 0.001), nurses' participation in hospital affairs (B = -2.21, t = -3.52, P < 0.001), and staffing (B = -1.91, t = -5.48, P < 0.001) are strongest predictors for nurses' intention to leave postpandemic. Nurses in practice still report experiencing COVID-related moral distress; however; issues related to resources and staffing have the most substantial impact on intention to leave among the current nursing workforce.

Relationship among the nursing practice environment, occupational career, and work engagement of Chinese nurses employed in Japan: A cross-sectional study

BackgroundWork engagement is a positive, fulfilling, work-related state of mind characterized by vigor, dedication, and absorption, and it affects the quality of care nurses give. Chinese nurses working in Japan experience differences in nursing practice and difficulties in career development. Therefore, the nursing practice environment and occupational career may affect their work engagement. However, little research has been completed on the factors affecting Chinese nurses' work engagement in Japan. ObjectiveTo clarify the relationship between the nursing practice environment, occupational career, and work engagement of Chinese nurses in Japan. DesignA cross-sectional study. Setting(s)Japanese hospitals (beds>19). Participants149 Chinese nurses employed in Japan. MethodsUsing a cross-sectional study design, we mailed 640 paper questionnaires, which included a QR code for online responses, to 58 Japanese hospitals that employed Chinese nurses. A survey request form and internet address were sent to the WeChat app, where Chinese nurses in Japan communicate. The contents included attribute-related questions, the Nursing Practice Environment Scale, the Occupational Career Scale, and the Utrecht Work Engagement Scale. A multivariate analysis was conducted with nine adjustment factors, such as gender, educational background, and work engagement, as the dependent variables. The significance level was set at p<.05. ResultsParticipants’ average age was 28.4 years, and the average years of nursing in Japan was 3.8. The work engagement score was 3.09, which is the low-medium level. The nursing practice environment was positively associated with work engagement (β=0.46, 95 %CI=1.02,1.99, p<.001), with nurse participation in hospital affairs among the subscales having the strongest effect on work engagement (β=0.41, 95 %CI=0.68,1.49, p<.001). The occupational career score was also positively associated with work engagement (β=0.42, 95 %CI= 0.51,1.08, p<.001), and among the subscales, forming and coordinating interpersonal relationships had the most influence on participants' work engagement (β=0.39, 95 %CI=0.42,0.94, p<.001). ConclusionsBased on the results, we suggest that the work engagement of Chinese nurses could be enhanced by providing them with the same opportunities to train and improve their skills as Japanese nurses, as well as by helping them form relationships with patients and colleagues.

Effect of the Nurse Work Environment on Older Hispanic Surgical Patient Readmissions.

Readmissions following hospitalization for common surgical procedures are prevalent among older adults and are disproportionally experienced by Hispanic patients. One potential explanation for these disparities is that Hispanic patients may receive care in hospitals with lower-quality nursing care. The objective of this study was to evaluate the relationship between the hospital-level work environment of nurses and hospital readmissions among older Hispanic patients. Using linked data sources from 2014 to 2016, we conducted a cross-sectional analysis of 522 hospitals and 732,035 general, orthopedic, and vascular surgical patients (80,978 Hispanic patients and 651,057 non-Hispanic White patients) in four states. Multivariable logistic regression models were employed to determine the relationship between the work environment and older Hispanic patient readmissions at multiple time periods (7, 30, and 90 days). In final adjusted models that included an interaction between work environment and ethnicity, an increase in the quality of the work environment resulted in a decrease in the odds of readmission that was greater for older Hispanic surgical patients at all time periods. Specifically, an increase in three of the five work environment subscales (Nurse Participation in Hospital Affairs, Nursing Foundations for Quality of Care, and Staffing and Resource Adequacy) was associated with a reduction in the odds of readmission that was greater for Hispanic patients than their non-Hispanic White counterparts. System-level investments in the work environment may reduce Hispanic patient readmission disparities. This study's findings may be used to inform the development of targeted interventions to prevent hospital readmissions for Hispanic patients.

Professional values and nursing care quality: A descriptive study.

Professional values are important in promoting healthy work environments, patient satisfaction, and quality of care. Magnet® hospitals are recognized for excellence in nursing care and as such, understanding the relationship between nurses' values and Magnet status is essential as healthcare organizations seek to improve patient outcomes. The research question is: are there differences in individual values, professional values, and nursing care quality for nurses and nurse managers practicing in Magnet, Magnet journey, and non-Magnet direct patient care settings? This descriptive cross-sectional study is guided and informed by the conceptual framework of the Professional Values Model including individual values, professional values, and nursing care quality. Convenience sampling of registered nurses and nurse managers, responsible for direct patient care, was utilized in a non-profit healthcare system in the Midwest region of the United States. Institutional review board approval was obtained. Participants were informed about the right to self-determine participation and assurance of anonymity. 827 (n = 827) nurses and nurse managers responded to the survey. Significant differences were identified in individual values sub-scale: self-enhancement (p = 0.38), professional values (p = 0.037), practice environment: participation in hospital affairs (p = 0.00), foundations for quality care (p = 0.016), and resources adequacy (p = 0.012) and in nurse sensitive HCAHPS questions: nurses explained things understandably (p = 0.00), got help as soon as wanted (p = 0.00), and treated with courtesy and respect (p = 0.00). Findings indicate that fostering individual and professional values may impact nursing practice, regardless of Magnet designation. Promoting professional values may contribute to improved work environments, enhancing patient satisfaction. Study results offer valuable insights for organizations striving to enhance nursing values, impacting quality of care provided to patients. Cross-Sectional Studies, Respect, Ethics Committees, Patient Satisfaction, Nurse Administrators, and Personal Satisfaction.

Workplace violence against cardiovascular nurses during Covid-19 pandemic

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): The National Federation of Orders for Nursing Professions (FNOPI - Italia) Background Workplace violence (WPV) impacts negatively both healthcare workers and healthcare organizations. Nurses are the most exposed healthcare workers to vertical WPV, also during the COVID-19 pandemic. Purpose Describing the WPV against nurses and its predictive factors in cardiovascular settings during COVID-19 pandemic in Italy. Methods This is a secondary analysis conducted in cardiovascular hospital settings from a larger national study between January and April 2021. Data were collected through the Practice Environment Scale of the Nursing Work Index (PES-NWI; Likert scale 1 to 4) and the adapted version of the Violence in Emergency Nursing and Triage (VENT) Questionnaire. Descriptive and logistic regression analyses were conducted. Results The analysis was conducted on 360 cardiovascular nurses (76.7% female; mean age 42.6 years, SD 10.8). Thirty per cent (n=108) of them reported WPV in last year and/or last week and 14.2% (n=51) only in last week. The number of patients was higher for nurses with WPV (mean difference [MD] +1.9; p = .030). The work environment was significantly worse for nurses with WPV: mean PES-NWI composite score (MD -0.2; p&amp;lt;.001); PES-NWI subscales: staffing and resource adequacy (MD -0.3; p&amp;lt;.001); nursing foundations for quality of care (MD -0.2; p = .005); nurse participation in hospital affairs (MD -0.3; p&amp;lt;.001); physician-nurse relationship (MD -0.2; p = .004). Multiple linear regression demonstrated that the risk of WPV increases when a clear nursing philosophy was not completely implemented in cardiovascular setting (odds ratio [OR] 5.29; 95% confidence interval [CI], 1.07-26.05; p = .040) and the nurses restrain patients (OR 2.49; 95% CI, 1.04-5.97, p = .041). The risk of WPV decreases when protectives glasses were present (OR 0.36; 95% CI 0.19-0.70, p = .003). Conclusion Public healthcare services should reduce WPV by investing in improving the nurse work environment. Integrated and multimodal programs of prevention and management of WPV are useful to address it.

Effects of individual, institutional and nursing work environment variables on nurses’ quality of work life

ABSTRACT The nurses’ quality of work life (QWL) is critical for a sustainable nursing workforce and effective healthcare delivery. As nurses make up the majority of the healthcare workforce, their QWL is an important issue for both nurses and nurse managers. Therefore, nurse managers need to assess, monitor, and improve the QWL of their nurses. This study aimed to determine the impact of the nursing work environment on nurses’ QWL. This descriptive and cross-sectional study was conducted among 330 nurses working in a private university hospital. A healthy nursing work environment and individual and institutional factors positively influence nurses’ QWL. This study showed that nurses’ participation in hospital affairs, satisfaction with the institution, satisfaction with the social facilities, ability to meet the institution's career goals, work unit, and perceived salary were all factors that influenced nurses’ QWL. This study contributes to the understanding of the impact of nurses’ work environment and individual and institutional variables on their QWL. Healthcare administration and nurse managers can help improve the quality of nurses’ working lives by developing strategies to create healthy work environments.

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.

Analyzing and Validating a Structure for Measuring the Nurse Practice Environment

Nurse shortages pose a challenge in many countries and retaining existing nursing staff is crucial to addressing these shortages. To inform possible interventions aimed at retaining nurses, managers need a comprehensive understanding of the nature of the nurse practice environment. The scales from two of the main instruments used to assess nurses' practice environments are tested. A survey of an online panel obtained responses from 459 Australian nurses. Analyses determined a combination of items with good construct validity and improved predictive utility for outcomes of interest for individual nurses. By essentially combining the best items from each instrument, a more comprehensive representation of the nurse work environment is obtained with improved predictive utility. The resulting combined set of scales is recommended for analyses of the nurse working environment and uses a combined set of scales from each of the two source instruments, namely: nurse participation in hospital affairs, recognition, nursing process, peer work standards, nursing competence, orientation, managers, resources, nurse-physician collaboration, and positive scheduling climate. Future research can then build on that strong set of items with a validated structure and predictive utility to inform management and interventions.

Working Condition and Job Satisfaction of Nurses as Predicting Factors of the Prevalence of Health care-associated Infections among Elderly Inpatients.

Health care-Associated Infections (HCAIs) are among the most common adverse events (AEs) that can negatively affect both patients and health systems. The elderly is among patients at high risk for infections. Some controllable risk factors have received less attention in research. Therefore, this study aims to investigate the relationship between prevalence of HCAIs among elderly inpatients, job satisfaction of nurses, and working condition. This cross-sectional study was conducted on 211 nurses working in hospitals affiliated with Iran University of Medical Sciences, Tehran, in 2021. The data were collected from HCAIs reports by the Nosocomial Infection Control Committee, a demographic questionnaire, the Practice Environment Scale of the Nursing Work Index (PES-NWI), and the Minnesota Satisfaction Questionnaire (MSQ). The data were statistically analyzed using Pearson correlation coefficient, ANOVA, t-test, and multiple linear regression (MLR) in SPSS 26. The results showed that there was a significant relationship between the PES-NWI and MSQ (r = 0.68, p < 0.00). The MLR results indicated that staffing and resource adequacy, nurse participation in hospital affairs, job satisfaction, nursing manager's leadership, and nursing foundations for quality of care are predictive factors that these could explain 78% of the changes in the prevalence of HCAIs and the goodness of fit of the regression model was acceptable [F6.210 = 129.47, p < 0.001]. Since job satisfaction and the work condition could predict HCAIs among the elderly patients, healthcare administers are recommended to consider these two variables in the development of HCAIs prevention and control programs.

A Cross-sectional Study Evaluating the Association Between the Nursing Practice Environment and Missed Nursing Care in Medical and Surgical Wards in Jordan.

Missed nursing care can jeopardize the safety of patients. The practice environment contains various elements that may impact nursing staff's capability to provide appropriate care. To examine the association between the practice environment and missed nursing care in Jordanian hospitals. A cross-sectional design, including the MISSCARE survey and the Practice Environment Scale of the Nursing Work Index, was used for this study. Data were gathered from 672 nurses working in 10 hospitals between March and July 2021. Findings revealed significant negative correlations between nurses' participation in hospital affairs ( r = -0.077, P = .046), nursing foundations for quality of care ( r = -0.139, P < .001), and missed nursing care. Information from this study can help nursing leaders modify practice environment elements that impact missed nursing care occurrences, which will help improve the quality of care provided to patients.

Psychosocial factors associated with career success among nurses: A latent profile analysis.

In this study, a person-centred approach was used to analyse career success profiles and explore the associated psychosocial factors among nurses. A cross-sectional study was conducted from 15 April to 15 October 2019. A total of 1155 registered Chinese nurses were recruited from two general hospitals using convenience sampling. Participants completed a printed questionnaire, including the Maslach Burnout Inventory, Stress of Conscience Questionnaire, Practice Environment Scale, and Career Success Scale. Latent profile analysis and multinomial logistic regression were performed. The data were analysed with Mplus 8.3 and SPSS version 26.0. Three latent profiles of career success were identified: high, moderate and low. Nurses with lower educational levels, more years of work experience, lower emotional exhaustion, higher personal achievement, lower stress of conscience and higher participation in hospital affairs were more likely to have higher career success than the other profiles. Burnout, stress of conscience, practice environment, educational level and years of work experience were associated with career success among nurses. Targeting interventions may help enhance nurses' career success. Future research should combine subjective and objective indicators (salary, title and so on) to assess career success and explore other determinants for formulating interventions to enhance nurses' career success. The heterogeneity and psychosocial factors associated with nurses' career success provide valuable evidence for the formulation of individualized interventions. Nursing managers should understand the importance of career success, develop interventions to reduce nurses' burnout and stress of conscience, and improve the practice environment to enhance their career success. This study was designed to examine the psychosocial factors associated with nurses' career success. The study was not conducted using suggestions from the patient groups or the public.

Exploring the relationship between nursing work environment and medical error reporting among Jordanian nurses: a cross-sectional study

Abstract Objectives This study was conducted to explore the relationship between the nursing work environment and medical error reporting practices among Jordanian nurses. Methods This study was a cross-sectional survey of 334 participants who were conveniently selected from three types of hospitals (private, teaching and public) in Amman city, Jordan. The data were collected using a standardized questionnaire which was adopted from previous studies and consisted of three main sections including demographics, nursing work environment (The Practice Environment Scale-Nursing Work Index) and medical error reporting practices (incident reporting practice scale). SPSS version 26 was used for data analysis. Key findings The study findings detected a strong positive relationship between the nursing work environment and medical error reporting practices. ‘Nurse’s participation in hospital affairs’ showed the highest impact on medical error reporting practices among nurses. Based on the regression model, the nursing work environment explained 65.1% of variations in nurses’ medical error reporting practices. It was found that medical error reporting practices were statistically different across marital status and hospital type. Conclusions Based on data analysis findings, the nursing work environment was statistically strongly correlated to medical error reporting practices. To improve medical error reporting practices among nurses, decision-makers and hospital administrators should redesign their nursing work environment to create a more positive and favourable work environment.

How do intensive work environments affect nurses' absenteeism and turnover intent?

BackgroundIntensive hospital work environments can affect staff, patient, and organizational outcomes. Purpose(1) To assess quantitatively the relationship between critical care registered nurses' perceptions of their workplace, their absenteeism, and their turnover intent; and (2) to analyze nurses' recommendations for improvements for critical patient care. MethodsFollowing STROBE guidelines, a cross-sectional survey sampled registered nurses (n = 302), across the Canadian province of Alberta, in October 2018. We assessed nurses' perceptions of their work environment relative to their absenteeism and turnover intent utilizing regression modelling and the Practice Environment Scale of the Nursing Work Index. FindingsA negative binomial analysis indicated that RNs' positive perceptions about their workplace had significant associations with lower rates of absenteeism. Additionally, participants who scored their work environment higher were found to have decreased intentions of leaving the workplace. RNs ranked their “participation in hospital affairs” lowest when comparing practice environment domains and recommended optimizing staffing as the most important improvement for their work environment and patient care. DiscussionConsidering the demands associated with critical care patient settings, stakeholders can consider these findings that significant associations exist between nursing staffs' perceptions of the workplace relative to their absenteeism and their turnover intent. Implications for Policy: Value-based solutions are needed in optimizing these key factors, and staffs' participation in hospital affairs appears vital for organizational success.

The changes in the nursing practice environment brought by COVID-19 and improvement recommendations from the nurses’ perspective: a cross-sectional study

BackgroundThe COVID-19 pandemic has brought an opportunity to increase investment in the nursing practice environment, which has greatly impacted patients, nurses, and organizations. However, there were limited studies concerning the changes in the practice environment since the COVID-19 pandemic and the way to improve it from nurses’ perspectives.MethodsA cross-sectional study was conducted among 460 nurses from seven hospitals in Sichuan, China. Both the quantitative and qualitative data were collected from an online questionnaire. The quantitative data were collected using the Chinese version of the Practice Environment Scale-Nursing Work Index and compared with available norms in 2010. The qualitative data were collected through an open question following the scale and analyzed by content analysis.ResultsThe mean of the score of the practice environment scale was 3.44 (SD = 0.56) out of 4.00. The score of the total scale and the dimensions were significantly higher than the norms, apart from nurse-physician relations and nurse participation in hospital affairs. The qualitative findings revealed positive changes in nursing foundations for quality of care, nurse participation in hospital affairs and nurse-physician relations, and poor staffing and resource adequacy. The improvement in the working model and ward environment is the primary concern of nurses.ConclusionsThe COVID-19 pandemic brought some positive changes in the nursing practice environment, but more efforts are needed to solve those nagging and important problems, such as staff shortages and low participation. Nursing managers and hospital leaders were encouraged to listen to nurses’ concerns and value this suitable opportunity for changing and improving to achieve better health services and coping ability to deal with emergency events going forward. Improving the ward environment and taking a professional model instead of sticking to the tedious process might be worthwhile.

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.

The Impact of Working Environment on Nurses' Caring Behavior in Sabah, Malaysia.

AimsThis study aims to investigate 5 types of work environment influencing nurses' caring behavior, namely (i) participation in hospital affairs, (ii) foundations for quality of care, (iii) manager ability, leadership, and support of nurses, (iv) staffing and resource adequacy, and (v) nurse-physician relations.DesignThis research is a cross-sectional study using the survey method.MethodsData were collected from 3,532 nurses working in public hospitals and health clinics within Sabah, Malaysia in 2015. The hypothesized model was evaluated using partial least squares method.ResultsThe findings reveal that all forms of work environment have a positive effect on nurses' caring behavior except for staffing and resource adequacy which shows a negative effect on caring behavior.ConclusionOverall, this study has added to theoretical contributions in the academic and research fields as well as in practical implications in the field of nursing practice by addressing the influence of work environments on caring behavior.Implications for Nursing ManagementThe present research has provided convergent evidence on the role of the working environment in influencing the behavior of nurses working in hospitals and health clinics in Sabah, Malaysia.

The relationship between practice environment, job satisfaction and intention to leave in critical care nurses.

Recent studies in the Kingdom of Saudi Arabia (KSA) have shown that the increasing nursing turnover in the health care industry has become a great source of concern. The overdependence on the supply of expatriate nurses (74%) and coronavirus disease 2019 (COVID-19) travel restrictions have exacerbated this staffing issue. To examine the relationship between perception of nursing practice environment (NPE), job satisfaction and intention to leave (ITL) among critical care nurses working in the state of Ha'il in KSA. Cross-sectional correlational (observational) design. Data were collected via electronic online survey distributed to registered critical care nurses working in King Khalid Hospital (KKH), Ha'il, KSA, between July and August 2020. Participant demographics and key variables data related to NPE, job satisfaction and ITL respectively were collected from the participants using existing and validated questionnaires. Descriptive statistics and correlational analysis and multivariable analyses were conducted. A response rate of 98% was achieved (152/160) for the study. Findings showed that the NPE was largely favourable (M=2.89, SD=0.44); however, nurse participation in hospital affairs (M=2.83, SD=0.47) and staffing and resource adequacy (M=2.88, SD=0.47) scored lowest. NPE was found to be significantly correlated with job satisfaction (rs=.287, P < .01). A significant negative relationship was found between NPE and ITL (rs=-0.277**, P < .01). However, job satisfaction was associated with ITL (rs=-.007, P=.930). Maintaining a healthy work environment and job satisfaction levels in critical care units is key to improving, recruitment and retention of nursing staff. Critical care and hospital leaders should implement programs that enhance the quality of the practice environment. This will improve nurse participation in unit and hospital affairs, job satisfaction and intention to stay.

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.