Registered Staff Nurses Research Articles

Nurse Staffing and NICU Infection Rates

There are substantial shortfalls in nurse staffing in US neonatal intensive care units (NICUs) relative to national guidelines. These are associated with higher rates of nosocomial infections among infants with very low birth weights. To study the adequacy of NICU nurse staffing in the United States using national guidelines and analyze its association with infant outcomes. Retrospective cohort study. Data for 2008 were collected by web survey of staff nurses. Data for 2009 were collected for 4 shifts in 4 calendar quarters (3 in 2009 and 1 in 2010). Sixty-seven US NICUs from the Vermont Oxford Network, a national voluntary network of hospital NICUs. All inborn very low-birth-weight (VLBW) infants, with a NICU stay of at least 3 days, discharged from the NICUs in 2008 (n = 5771) and 2009 (n = 5630). All staff-registered nurses with infant assignments. We measured nurse understaffing relative to acuity-based guidelines using 2008 survey data (4046 nurses and 10 394 infant assignments) and data for 4 complete shifts (3645 nurses and 8804 infant assignments) in 2009-2010. An infection in blood or cerebrospinal fluid culture occurring more than 3 days after birth among VLBW inborn infants. The hypothesis was formulated prior to data collection. Hospitals understaffed 31% of their NICU infants and 68% of high-acuity infants relative to guidelines. To meet minimum staffing guidelines on average would require an additional 0.11 of a nurse per infant overall and 0.34 of a nurse per high-acuity infant. Very low-birth-weight infant infection rates were 16.4% in 2008 and 13.9% in 2009. A 1 standard deviation-higher understaffing level (SD, 0.11 in 2008 and 0.08 in 2009) was associated with adjusted odds ratios of 1.39 (95% CI, 1.19-1.62; P < .001) in 2008 and 1.40 (95% CI, 1.19-1.65; P < .001) in 2009. Substantial NICU nurse understaffing relative to national guidelines is widespread. Understaffing is associated with an increased risk for VLBW nosocomial infection. Hospital administrators and NICU managers should assess their staffing decisions to devote needed nursing care to critically ill infants.

Nasal Continuous Positive Airway Pressure

The purpose of this multisite study was to describe suctioning techniques of registered nurses (RNs) and respiratory therapists (RTs) caring for neonates requiring nasal continuous positive airway pressure (CPAP). The care practices investigated included suctioning frequency, assessment parameters, and techniques used to suction. A convenience sample of neonatal intensive care unit (NICU) RNs and practicing RTs at 8 Midwestern hospitals in the United States caring for neonates on nasal CPAP in a level II or III NICU were included. Eighty-five percent of respondents were RNs of which almost 89% (88.6%) were staff RNs, 63% were bachelor prepared, and 33% of the RNs had greater than 20 years of neonatal nursing experience. A cross-sectional descriptive comparative design was used for this study. An investigator-developed Web-based survey pertaining to current practice concerns was developed by the research team. The 31-item survey tool consisted of 4 sections. The first section addressed the frequency of suctioning. The second section addressed assessment parameters used to determine the need for suctioning. The third section addressed the technique used to suction, including gloving techniques, hyperoxygenation, and the use of catheters in nares and mouth and suctioning devices. Demographic data, including staff position, level of education, years of nursing, and NICU experience and certification, were collected in the fourth section. Descriptive statistics were used to characterize demographics and each item of the survey. Chi-square statistics (Pearson chi-square and Fisher Exact text) were used to compare RNs' and RTs' nasal CPAP suctioning practices. The results of this study indicated that decision making related to the need to suction was variable. In addition, the frequency of suctioning and nasopharyngeal and oropharyngeal suctioning techniques were highly variable for neonates requiring nasal CPAP. Despite the treatment of respiratory distress with nasal CPAP, there are no best practice guidelines for providing nasopharyngeal and oropharyngeal suctioning for maintenance of a patent airway. Future randomized controlled clinical trials are needed to develop best practices for nasal CPAP suctioning.

Essential Nursing SkillsEssential Nursing Skills

THIS IS a comprehensive little handbook aimed at nursing students, but would serve also as a reminder for those who mentor students, as well as newly registered staff nurses.

Critical Thinking of Nurse Managers Related to Staff RNs’ Perceptions of the Practice Environment

BACKGROUND INFORMATION AND SIGNIFICANCE: Critical thinking (CT) skills and the inclination to engage in critical thinking are essential for nurse managers to function as transformational leaders capable of influencing staff to align with organizational goals. In an extensive literature review, numerous studies were found examining the concept of CT in students and no studies were found exploring CT in nurse managers. Identifying the attributes, such as CT, that lead to success in the nurse manager role is useful when preparing nurse managers to lead effectively in the current healthcare climate. Is there a difference between nurse managers' CT dispositions and their respective staff nurses' perceptions of the practice environment? A convenience sample of 12 nurse managers and a random sample of 132 of their respective staff registered nurses (RNs) participated in this descriptive study. CT in nurse managers was measured by the California Critical Thinking Disposition Inventory (CCTDI). Staff RNs' perceptions of the practice environment were measured by the Practice Environment Scale (PES). The research question was answered using a t test. Significant (p < .001) differences were found between specific nurse managers' CCTDI scores for open-mindedness, analyticity, and critical thinking confidence, and significant differences (p < .01) were found for systematicity when compared with their respective staff RNs' mean subscale and overall PES scores. Results of the study support the positive relationship between strength in critical thinking dispositions of nurse managers and their respective staff RNs' perceptions of the practice environment. Nurse managers with stronger CT dispositions may be better able to create positive practice environments that are conducive to job satisfaction and thus the retention of staff RNs. Inclusion of strategies to support the development and use of CT in nurse managers is recommended. CT and other leadership attributes and skills including emotional and social intelligence and management of change through an appreciative inquiry process may provide opportunities to improve leadership effectiveness in nurse managers. Enhancing critical thinking skills and dispositions of nurse managers may help to create positive work environments for staff RNs. Staff RNs who work in an environment perceived to be positive may be in a better position to deliver high quality, safe patient care.

Bullying of Staff Registered Nurses in the Workplace: A Preliminary Study for Developing Personal and Organizational Strategies for the Transformation of Hostile to Healthy Workplace Environments

The primary purpose of this study was to validate the perceptions of frequency and patterns of bullying behavior experienced by registered nurses (RNs) across the United States. This study was completed to develop relevant and sensitive tailored interventions for the future. A 30-item anonymous electronic survey was used to identify the frequency, type, perpetrators, and personal and professional consequences of bullying. Findings from the overall population of 303 RN respondents (mean age of 49 years) indicated that 70% of the bullying was reported by a predominant group of staff RNs (n = 212), and it is this group that is the focus of this report. Of this group, bullying occurred (a) most frequently in medical-surgical (23%), critical care (18%), emergency (12%), operating room/Post Anesthesia Care Unit (9%), and obstetrical (7%) areas of care and (b) within the 5 years or less of employment on a unit (57%). Perpetrators included senior nurses (24%), charge nurses (17%), nurse managers (14%), and physicians (8%) who publicly humiliated, isolated, excluded, or excessively criticized the staff nurses. Subsequent stress levels were reported as moderate or severe, with support found primarily with family, colleagues, and friends and not with an available workplace infrastructure of solution. Many left the workplace completely with or without jobs awaiting them. Bullying among U.S. nurses is a hidden problem with significant patient-directed quality performance and workforce implications. It is critical that innovative strategies be developed and implemented to address the root cause of this problem.

The State of Obesity Management for Women Giving Birth in Atlantic Canada

The purpose of this survey was to gain insight into the status of birthing facilities across Atlantic Canada regarding obesity management. Specifically, we were interested in learning about the reported number of obese women entering birthing facilities, if body mass index (BMI) was determined from weight and height, and whether this was used to diagnose maternal obesity or not. Clinical, delivery, or equipment-related challenges and the state of existing or planned policies or guidelines specific to this high-risk population were also sought. An online, cross-sectional survey (audit), distributed via email to key staff members at birthing facilities in Atlantic Canada, including nurse managers, nurse practitioners, registered staff nurses and obstetrician-gynecologists. Twenty-two responses were received from 38 invitees (57% response rate), representing half the birthing facilities in Atlantic Canada. Despite the fact that the majority of facilities recorded maternal height and pre-pregnancy weight upon admission, these measurements were not used to calculate and document maternal BMI, nor to make a diagnosis of maternal obesity. More troubling, no birthing facilities in our survey had guidelines or care plans in place to deal with this high-risk population, and two-thirds of those surveyed had no plans for their creation in the near future. While maternal obesity was considered a problem, a third of respondents reported no direct access to properly sized lifts or transfer devices in their units. This study provides a useful baseline for monitoring improvements in the care of obese women giving birth in Atlantic Canada.

Factor Structure of the Geriatric Care Environment Scale

Older adults comprise approximately 60% of all adult, nonobstetric hospital admissions. Nurses Improving Care for Health System Elders (NICHE) is a national program aimed at system improvement to achieve patient-centered care for older adults. The NICHE hospitals use the Geriatric Institutional Assessment Profile (GIAP) to assess their institutional readiness to provide quality care to older adults and to document improvement in geriatric care delivery. To explore the factorial structure of the 28-item Geriatric Care Environment Scale (GCES) of the GIAP, test its validity with a sample of staff registered nurses (RNs), and evaluate its invariance across 4 groups of RNs who worked at 4 different types of hospitals. Staff RNs (N = 9,400) at 71 acute hospitals, who responded to the GIAP from 1999 to 2004, were split randomly into 2 groups for cross-validation. A 3-step data analysis was completed. The a priori factor structure was developed using exploratory factor analysis. The obtained factor model was validated, and its invariance by types of hospitals was examined by confirmatory factor analyses. The GCES is internally consistent (Cronbach's alpha = .93) and accounts for approximately 55% of the total variance. The 4 factors extracted from the exploratory factor analysis are Aging-Sensitive Care Delivery, Resource Availability, Institutional Values Regarding Older Adults and Staff, and Capacity for Collaboration. The 4-factor structured model is validated in a half-randomly selected sample (normed fit index [NFI] = .931, nonnormed fit index [NNFI] = .933, comparative fit index [CFI] = .939, root-mean-square error of approximation [RMSEA] = .058) and does not vary significantly across the 4 groups of RNs who worked at the 4 different types of hospitals (NFI = .969, NNFI = .975, CFI = .976, RMSEA = .027). The GCES is a reliable measure of RN perception of how care provided to older adults reflects age-sensitive principles and the organizational practice environment that supports or hinders care delivery.

Turnover factors revisited: A longitudinal study of Taiwan-based staff nurses

Background The relationship between employees’ intent to stay/leave a position and the actual turnover of employees merits further investigation. Most previous studies of this relationship have utilized cross-sectional designs to examine nurse turnover from a fixed point in time. Research using a longitudinal design could increase the ability to predict who will leave, and to identify factors that cause turnover behavior. Objectives To investigate whether the same mechanisms and factors that affect employee's turnover intentions can be applied to actual turnover in a longitudinal way in an effort to expose causal relationships. Design After a review of existing literature, we collected baseline data on turnover determinants as well as two intervening variables: job satisfaction and intent to stay. Three years later, hospital personnel records were used to identify the actual turnover of nurses who responded in the first wave. Settings With its 600 beds and metropolitan site, the target hospital located in Taichung, Taiwan is representative of Taiwan's general hospitals. Methods The 412 registered staff nurses (managers excluded) at work in this hospital were reached by a mail questionnaire in the first wave. Three years later, the turnover data collected in wave two had divided the wave one's 308 respondents (74.8%) into 132 leavers (42.9%, coded as “1”) and 176 stayers (57.1%, coded as “0”). The data were then processed by descriptive statistics, exploratory factor analysis, multiple regression, and logistic regression. Results As in previous studies of this type, distributive justice, workload, resource inadequacy, supervisory support, kinship support, and job satisfaction were again proven to be highly associated with intent to stay/leave. Nevertheless, with the exception of workload, these indicators worked poorly when predicting the actual turnover. Conclusions The study confirms earlier findings on the relationships among turnover determinants, job satisfaction, and intent to stay, and suggests a more comprehensive selection of turnover factors must be taken into account when attempting to explain variations in actual turnover.

Predicting registered nurse job satisfaction and intent to leave.

Nurse job dissatisfaction has been the primary predictor of intent to leave; however, although many predictors of job satisfaction have been identified, little is known about the influence of variable nurse attitudes, such as psychological empowerment and hardiness, on job satisfaction. The purpose of this study was to investigate the relative influence of nurse attitudes, context of care, and structure of care on job satisfaction and intent to leave. A nonexperimental, predictive design evaluated these relationships in a nonrandom sample of 90 registered staff nurses using instruments with known psychometric properties. The major predictor of intent to leave was job dissatisfaction, and the major predictor of job satisfaction was psychological empowerment. Predictors of psychological empowerment were hardiness, transformational leadership style, nurse/physician collaboration, and group cohesion. Results supported the influence of nurse attitude on job satisfaction relative to other contributing factors.

Nutrition Risk Classification: A Reproducible and Valid Tool for Nurses

Incorporating the nursing staff to assist with the screening process on admission will allow patients who are at nutritional risk to be assessed by registered dietitians earlier in their hospital stay. The goal of this study was to develop an objective, valid, reproducible nutrition screen for use by registered nurses (RNs) to allow for nutrition classifications of hospitalized patients. The current nursing admission assessment form was modified to contain questions on weight loss history, percentage of ideal body weight, and alterations in dietary intake and gastrointestinal function. Assessments were completed within 48 hours of admission. On the basis of the answers to these questions, patients were classified as "at nutritional risk" or "low nutritional risk." In phase 1, to assess reproducibility of the form, a prospective study between staff RNs and a nutritionist was undertaken on 186 consecutive adult admissions. Nutrition screening and classification was done independently by both practitioners. In phase 2 of the study, prospective validation of the form contrasting prealbumin (PAB) levels with RN nutritional risk classification (n = 56) was investigated. Interobserver agreement of nutrition classification between RN and nutritionist was 97.3% (p = .95). Twenty-nine patients were classified at low nutritional risk (27 normal PAB and 2 low PAB); 27 patients were classified as at nutritional risk (16 normal PAB and 11 low PAB) (chi 2 = 8.9, p < .003, power 0.8). The sensitivity of the tool was 84.6%. To our knowledge, this is the first nutrition screening tool designed for staff RNs that has been tested for both validity and reproducibility.

Reliability of Aggregated Organizational Data: An Evaluation of Five Empirical Indices

Nursing systems research has included many levels of measurement such as individuals, work groups, organizations, and systems of organizations. Variables important to organizational survival often are measured at the individual level, with inferences made to the work group or the organization. This study demonstrated a process for determining the reliability of individual level data aggregated to the work group and organization levels. Data were analyzed on four variables: job enjoyment; manager's leadership style in terms of structuring expectations and consideration; and control over nursing practice. Job enjoyment was assessed over time. Registered staff nurses (n = 632), representing 54 nursing units from 4 large acute care hospitals, comprised the sample. The results indicated the assessment of reliability and validity is important at the level of inference and at each time interval. Aggregated data were deemed reliable when the following criteria were met: Cronbach's alpha > .60; intraclass correlation (1,k) > .60; and a significant F ratio. The interpretation of omega 2 as an indicator of effect size suggested that the validity of inference at the aggregated level is in question when effect size is negligible or small.

HEALTH CARE ADMINISTRATION DIVISION.

Academy of Management Annual Meeting Proceedings includes abstracts of all papers and symposia presented at the annual conference, plus 6-page abridged versions of the “Best Papers” accepted for inclusion in the program (approximately 10%). Papers published in the Proceedings are abridged because presenting papers at their full length could preclude subsequent journal publication. Please contact the author(s) directly for the full papers. ArticlesHEALTH CARE ADMINISTRATION DIVISION.Published Online:13 Dec 2017https://doi.org/10.5465/ambpp.1993.10322305AboutSectionsPDF/EPUB ToolsDownload CitationsAdd to favoritesTrack Citations ShareShare onFacebookTwitterLinkedInRedditEmail AbstractThe article provides summaries for paper that focus on health care administration. In the paper "Evaluating Reasons for Nurse Turnover: A comparison of Attitude Surveys and Exit Interviews," high turnover rates among hospital nurses demand rigorous and valid processes of research to determine the reasons motivating such attrition. This paper examines the relative effectiveness of exit interviews and an employee attitude survey in generating data which are useful in managing nurse retention. The paper "Hospitals Compete: The Question Is Not "If", But "How"," presents an alterative conceptualization of competition in the hospital industry. It argues that competition is possible among hospitals in spite of their departure from conventional definitions of competitive behavior. It presents a unifying model capable of addressing a full variety of competitive interactions faced by hospitals. The paper "Impact of Hospital Policies on Absenteeism Among Staff Registered Nurses," demonstrates the effectiveness of organizational policies in reducing absenteeism.FiguresReferencesRelatedDetails Vol. 1993, No. 1 Permissions Metrics Downloaded 0 times in the past 12 months History Published online 13 December 2017 Published in print 1 August 1993 InformationCopyright of Academy of Management Journal is the property of Academy of Management and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder’s express written permission. However, users may print, download, or email articles for individual use.KeywordsHEALTH services administrationNURSES -- AttitudesEXIT interviewingLABOR turnoverHOSPITALSCOMPETITIONABSENTEEISM (Labor)PDF download

Work Stress, Hardiness, and Burnout Among Hospital Staff Nurses

The question of whether personality hardiness moderates the impact of job stressors on burnout was studied in 107 registered staff nurses from an urban, community hospital who responded to a self-administered questionnaire. Consistent with previous research, burnout was significantly associated with higher levels of perceived job stress and lower levels of personality hardiness. Hierarchical multiple regression analyses further indicated that work stressors (particularly stress due to workload) and hardiness were significant additive rather than interactive predictors of burnout. That is, hardiness had beneficial main effects in reducing burnout, but did not appear to prevent high levels of job stress from leading to high levels of burnout.

Job Involvement and Organizational Commitment as Interactive Predictors of Tardiness and Absenteeism

This study examined job involvement and organizational commitment as interactive predictors of absenteeism and tardiness behaviors. Personnel records and questionnaires were used to collect tardiness and absence data for a subsample of 82 registered staff nurses out of a total sample of 228 nurses from a large Midwestern hospital. Results showed supportfor the hypothesis that individuals showing higher levels of job involvement and organizational commitment would exhibit less unexcused tardiness and absenteeism than those with lower levels of job involvement and organizational commitment. The implications and limitations of these findings are discussed.

Relationship of field dependence-independence to documentation of nursing-process components by registered nurses in a clinical setting.

Scores on the Group Embedded Figures Test of 56 registered staff nurses were correlated with percentage of components of nursing process documented on care plans and progress notes. Education, age, and work experience were control variables. The mean embedded figures scores for associate degree, diploma, and baccalaureate nurses were 11.47, 9.47, and 12.83, respectively. Baccalaureate nurses had the most success in documenting components and diploma nurses had the least. A significant correlation was observed between test scores and percentage of nursing process chains completed by diploma nurses. For associate-degree nurses, a significant inverse correlation was observed between test scores and percentage of components used and percentage of chains with a nursing diagnosis.

Role conflict and ambiguity: an empirical investigation of nursing personnel.

A review of the nursing literature provides a number of hypotheses regarding levels among nurses of role ambiguity (uncertainty regarding others' expectations) and role conflict (incompatible demands from various role senders or from multiple roles held simultaneously). Questionnaire data collected from 504 registered staff nurses, licensed practical nurses, nurses aides and head nurses/supervisors in five hospitals failed to provide much support for these hypotheses. Although levels of role conflict and ambiguity were low for most nurses, they were significantly related to job stress, organizational commitment, job satisfaction, and intentions to quit.

Perceived Dimensions of Job Satisfaction for Staff Registered Nurses

To measure the importance of dimensions of job satisfaction 144 females registered staff nurses in four East Coast metropolitan hospitals were given an 18-item Likert-type instrument. Results indicated that the traditional intrinsic/extrinsic dichotomy, which exists in elements of job satisfaction, did not apply. The nurses perceived their job satisfaction in a more complex fashion, in that four statistically independent dimensions emerged with "relationship orientations" accounting for almost 24 percent of the total variance. The study implies that previous considerations in job satisfaction for the professional may need to be reexamined in terms beyond the traditional in trinsic/extrinsic dichotomy.

595. Effect of Leadership Turnover in Nursing Upon Job Satisfaction and Cohesion of Head Nurses and Registered Staff Nurses. College Park, Md., University of Maryland, 1970

595. Effect of Leadership Turnover in Nursing Upon Job Satisfaction and Cohesion of Head Nurses and Registered Staff Nurses. College Park, Md., University of Maryland, 1970