Nurse Burnout and Patient Safety, Satisfaction, and Quality of Care: A Systematic Review and Meta-Analysis.

Importance: Occupational burnout syndrome is characterized by emotional exhaustion, depersonalization, and a diminished sense of personal accomplishment and is prevalent among nurses. Although previous meta-analyses have explored the correlates of nurse burnout, none have estimated their association with health care quality and safety and patient morbidity and mortality. Objective: To evaluate the magnitude and moderators of the association between nurse burnout and patient safety, patient satisfaction, and quality of care. Data Source: The Web of Science, Scopus, MEDLINE, Embase, PsycINFO, CINAHL, and ProQuest databases were searched from January 1, 1994, to February 29, 2024. Study Selection: Two reviewers independently identified studies that reported a quantifiable association between nurse burnout and any of the outcomes of patient safety, patient satisfaction, or quality of health care. Data Extraction and Synthesis: The PRISMA 2020 guideline was followed. Two reviewers independently extracted the standardized mean difference (SMD) (Cohen d) estimates for a random-effects meta-analysis. Subgroup analyses and meta-regressions were conducted using prespecified variables. Main Outcomes and Measures: Any measure of patient safety, patient satisfaction, or quality of health care previously associated with nurse burnout. Results: A total of 85 studies (81 cross-sectional and 4 longitudinal) involving 288 581 nurses from 32 countries (mean [SD] age, 33.9 (2.1) years; 82.7% female; mean [SD] burnout prevalence rate with study-specific ascertainments, 30.7% [9.7%]) were included. Nurse burnout was associated with a lower safety climate or culture (SMD, -0.68; 95% CI, -0.83 to -0.54), lower safety grade (SMD, -0.53; 95% CI, -0.72 to -0.34), and more frequent nosocomial infections (SMD, -0.20; 95% CI, -0.36 to -0.04), patient falls (SMD, -0.12; 95% CI, -0.22 to -0.03), medication errors (SMD, -0.30; 95% CI, -0.48 to -0.11), adverse events or patient safety incidents (SMD, -0.42; 95% CI, -0.76 to -0.07), and missed care or care left undone (SMD, -0.58; 95% CI, -0.91 to -0.26) but not with the frequency of pressure ulcers. Nurse burnout was also associated with lower patient satisfaction ratings (SMD, -0.51; 95% CI, -0.86 to -0.17) but not with the frequencies of patient complaints or patient abuse. Finally, nurse burnout was associated with lower nurse-assessed quality of care (SMD, -0.44; 95% CI, -0.57 to -0.30) but not with standardized mortality rate. The associations were consistent across nurses' age, sex, work experience, and geography and persistent over time. For patient safety outcomes, the association was smaller for the low personal accomplishment subcomponent of burnout than for emotional exhaustion or depersonalization, as well as for nurses with a college education. Conclusions and Relevance: In this systematic review and meta-analysis, nurse burnout was found to be associated with lower health care quality and safety and lower patient satisfaction. This association was consistent across nurse and study characteristics.

Investigating the relationship between moral courage and caregiving behaviours among nurses working in COVID-19 wards in Iran.

AIM: To examine the correlation between moral courage and caregiving behaviour among nurses who are employed in the COVID-19 ward in Iran. DESIGN: This study is a descriptive-correlational and cross-sectional research conducted in 2021 in the city of Tehran, Iran. METHODS: A total of 270 nurses employed in COVID-19 wards, who had been working in these wards for at least 1 month, were recruited from XXX hospitals and XXX Hospital. Data collection was conducted from September to November 2021. The data collection tools included a demographic information form, the Caring Dimension Inventory (CDI-25), and the Professional Moral Courage Scale (PMC). The designed questionnaire links were provided to the participants virtually through the Persian platform 'Pars Line' and via WhatsApp. Descriptive statistics and inferential statistics were used to examine the relationship between moral courage and care behaviour. RESULTS: There was a significant difference in the mean of caring behaviour between the age groups (<30 and >40 years old), and the work experience groups (<5 years and >15 years) (p < 0.05). Ethical values also varied significantly between certain age and experience groups (p < 0.05), but no significant differences were found in ethical behaviour across most ages (30-40 years) and work experience categories (>10 years) (p > 0.05). The level of moral courage among the nurses was higher than the median score of the instrument (87.31 ± 10.37). Among the dimensions of moral courage, the highest score was related to the dimension of ethical factors (17.64 ± 2.64), and the lowest score was related to the dimension of multiple values (17.26 ± 2.78). The level of caring behaviours among the nurses was lower than the median score of the instrument (46.11 ± 10.84). Among the dimensions of caring behaviours, the highest score was related to physical-technical behaviours (19.22 ± 5.27), and the lowest score was related to professional behaviours (1.35 ± 0.67). Based on the analysis, moral courage had a weak and inverse correlation with caring behaviours among nurses. The higher moral courage does not necessarily result in improved caregiving behaviours, emphasizing the need for further research to explore and address this relationship. PATIENT: No Patient or Public Contribution.

The prevalence, risk factors and coping strategies of low back pain among nurses in public hospitals in Kota Kinabalu, Sabah: A cross-sectional study.

INTRODUCTION: Healthcare workers are recognised to have a high prevalence of musculoskeletal disorders and nursing profession are well known with high prevalence of low back pain (LBP). There is a widespread consensus that low back discomfort is a major contributor to both inabilities to work and illness. Absenteeism is frequently employed as a proxy for the presence of a handicap. AIM: The purpose of this study was to determine the prevalence of LBP among nurses in six different wards in three general hospitals in Kota Kinabalu, Sabah as well as the associated workplace risk factors and coping strategies implemented by nurses in ward. MATERIALS AND METHODS: A cross-sectional study involved 420 nurses from three public hospitals in Kota Kinabalu, Sabah, was carried out. The respondents were carefully selected by proportionate stratified random sampling method. Nurses sociodemographic and occupational details, occupational health in nursing practice, seventeen work risk variables and nine coping techniques were collected via a selfadministered questionnaire. RESULTS: Among the 420 participants, 57 did not report any discomfort. In the previous 12 months, 44.5% (95.0% CI: 39.74,49.25) of nurses experienced low back discomfort lasting longer than three days. The results of a simple logistic regression analysis revealed that gender and years of working experience were significantly associated with LBP. The department of intensive care unit nurses had the highest OR value of 2.4 (p = 0.03). There were no statistically significant association with age, marital status and body mass index (p > 0.05). Adjusting plinth or bed height (68.4%) was the top coping mechanism cited by respondents in the clinical context to reduce the risk of LBP, and working with perplexed or agitated patients posed the greatest occupational risk. CONCLUSION: LBP is still a major work-related issue among nurses, with a high prevalence rate. To mitigate these impacts, multidisciplinary efforts are required. The outcomes of this study may help policy makers to allocate resources to reduce LBP among nurses.

Workplace Violence against Nurses Working at Private Teaching Hospitals of Kathmandu: A Descriptive Cross-sectional Study.

INTRODUCTION: Workplace violence in hospitals is a global concern and is considered as a major occupational hazard for all health care providers including the nurses. The aim of this study was to assess the status of workplace violence against nurses at hospitals in Kathmandu and determine the actions taken to investigate its cause. METHODS: A descriptive cross-sectional study was conducted among a convenient sample of 100 registered nurses employed in Nepal Medical College and Teaching Hospital, and Kathmandu Medical College and Teaching Hospital. All eligible nurses who were willing to participate irrespective of their academic fulfilment, from all different shifts and of age below 45 years were included. Data were collected using a structured questionnaire and analysed using SPSS software. Ethical approval was taken from the Institutional Review Committee (IRC) of Nepal Medical College and Kathmandu Medical College. RESULTS: Among 100 participants, the prevalence of workplace violence was 72 (72%) (62.13-80.52, 95% Confidence Interval). Verbal abuse accounted to 50 (69.44%), followed by physical violence accounting 17 (23.61%). Action was taken to investigate the causes of both physical violence 5 (29.41%) and verbal abuse 2 (4%) by the hospital administration 3 (60%) in physical violence and 2 (100%) in verbal abuse and police 2 (40%) in physical violence. CONCLUSIONS: The study reveals a troubling reality, as the vast majority of nurses reported experiencing various forms of violence in their workplace. So, addressing this issue immediately could protect nurses' well-being and ensure quality care which benefits both healthcare professionals and patients.

Gender dynamics in nursing profession: impact on professional practice and development in Tanzania.

BACKGROUND: Gender disparity has long been noted in nursing, a predominantly female-dominated profession. However, recently the increase in the number of male nurses disproves the existing belief that nursing is exclusively a female profession. Even though the studies have reported changing gender trends in nursing, the information is not sufficient and the effects of the changing trend on professional practice and professional development have not been explored. Therefore this study aims to assess the influence of gender in nursing on professional practice and development in Tanzania. METHODS: This was an analytical Hospital-Based Cross-sectional Study Design, conducted at four hospitals in Dar es Salaam, with 580 nurses between 20th May and 20th June 2024. Proportionate sampling was used to determine the required number of participants from each of the four facilities. Moreover, systematic random sampling was used to recruit participants from each facility. The validated questionnaire was used to obtain data, which were analyzed through descriptive and inferential statistics. RESULTS: Among seventy items that measured professional practices, sixty three items indicated good professional practices among female nurses compared with their male counterparts male. On the association of gender in nursing to professional practice and development, the findings revealed no significant association between gender in nursing and professional practice (χ2 = 1.384; P = 0.239). Moreover, the item analysis revealed that male nurses have professional development in three items similar to female nurse who had shown professional development on other three items. Through binary logistic regression, male nurses were 0.528 (OR) times less likely to have good professional development than their female counterpart (P < 0.001; 95% CI: 0.379, 0.737). Several social demographic factors were found to be associated with professional practice and development. CONCLUSION: It was found that professional practice does not depend on gender in nursing, because the practice was optimal across both genders. Nurse's self-image of nursing, facility factors, and professional development influence their professional practice. Moreover, gender in nursing is associated with professional development, indicating the existence of gender stereotypes in the distribution of opportunities between male and female nurses. The study recommends extending this cross-sectional study to nonclinical settings such as training institutions.

Self-compassion and work engagement among Chinese nurses: exploring mediating effects of depression, anxiety, and stress.

Objective: Work engagement significantly influences both the quality of nursing care and nurses' job performance. In this study, we aimed to explore the mediating effects of negative emotions on the relationship between self-compassion and work engagement among Chinese nurses. Method: A cross-sectional study was performed on nurses in a tertiary A hospital located in Henan province from September, 2023 to December, 2023. Custom-designed digital surveys were disseminated to gather pertinent data. Structural Equation Modelling (SEM) were utilised to analyse the data and determine relationships among self-compassion, negative emotions and work engagement. Results: A total of 1,201 nurses were included. According to the statistical model, self-compassion (ß = 0.116, CI: -0.036 to -0.008, p < 0.001) and negative emotions (ß = -0.372, CI: -0.053 to -0.033, p < 0.001) were correlated with work engagement. Furthermore, our analysis revealed that negative emotions partially mediated the relationship between self-compassion and work engagement (ß = 0.174, CI: -0.066 to -0.020, p < 0.01). Conclusion: These findings indicate that incorporating self-compassion and negative emotion regulation in interventions targeting work engagement may enhance the overall level of work engagement among nurses, thereby improving job satisfaction and the quality of patient care.

Missed nursing care and associated factors among nurses at University of Gondar Comprehensive Specialized Hospital, Ethiopia, 2022.

The issue of missed nursing care is a problem that affects the overall quality of nursing care in hospitals around the world. However, there is limited research about it in Ethiopia. This study assessed missed nursing care and factors among nurses. An institutional-based cross-sectional study was conducted among 485 nurses at the University of Gondar Specialized Hospital. The data were collected from May 15 to June 15, 2022 using a self-administered questionnaire. A simple random sampling technique was used to select study participants. The data was entered to EPI DATA version 4.6 and exported to SPSS version 23 for analysis. Descriptive statistics were computed, and a summative score of missed nursing care was calculated. Then, multiple linear regression analysis was used to identify the factors. A P-value of 0.05 was used to declare significant level. In this study, missed nursing care was 62.5% (95% CI 60.98-64.02). Documentation, vital signs assessment, intravenous care, and assessment as per hospital policy and patient education were the most frequently missed nursing care. Being single in marital status (B = -4.609, P = 0.004), adequacy of nursing staff (B = -2.458, P = 0.003), satisfaction with income (B = -8.753, P = 0.007), working in medical unit (B = -5.708, P = 0.002) and working in both day and night shift (B = 1.731, P = 0.027) were statistically associated factors. More than half of the participants missed basic nursing care. Most of the identified factors correlated with missed nursing care negatively. Efforts should be done to enhance communication between health team members, assign a manageable number of patients per nurse, and adjust shifts and units.

Assessing the Nursing Workload in the Cardiothoracic Intensive Care Unit: Comparative Study.

AIMS: This study aimed to assess nursing workload in Cardiac Intensive Care Unit (CICU) after three cardiothoracic surgery procedures during first four postoperative days using Nursing Activities Score (NAS) and Nine Equivalents of Nursing Manpower Use Score (NEMS) systems, to compare their performance for that purpose and to investigate association between nursing workload and type of surgery. DESIGN: A comparative study. METHODS: The research environment includes CICU of the University Hospital for Cardiovascular Diseases in Serbia. A total of 808 patients who underwent coronary, valvular, or combined surgery, resulting in 2282 filled NAS and NEMS pairs chart. Statistical analysis was performed using SPSS-19. The correlation between NAS and NEMS was tested by Spearman's correlation coefficient. Differences were considered statistically significant at p < 0.05. RESULTS: The lowest median of cumulative NAS 176 (175-257) and NEMS 76 (64-91) had coronary surgery patients, the highest NAS 224.5 (178-334.5) and NEMS 83 (69-121) had those with combined surgery; this difference was statistically significant (p < 0.001). The median of both scores decreased after surgery, with the following values from the first to the fourth postoperative day: NAS from 104 (102-105) to 81 (74-85) and NEMS from 46 (42-46) to 30 (30-37). The difference in mean values of both scores between the first and the fourth postoperative day was statistically significant (p < 0.001). NAS and NEMS were in a positive, strong correlation (r = 0.913; p < 0.005). CONCLUSION: Both scores can be used to measure nursing workload, identify the required number of nurses in CICU, and support task allocation. NAS may have an advantage because it better describes extensive postoperative monitoring and care needed for cardiac surgery patients. Nursing workload is associated with type of surgery, with the highest workload measured in patients who underwent combined surgery procedure and on the first postoperative day.

Humanistic care ability and its influencing factors among Chinese surgical nurses.

AIM: This paper aims to investigate the humanistic care ability among surgical nurses in China and identify its statistically significant influencing factors. DESIGN: A cross-sectional, descriptive and correlational design was used. METHODS: A total of 210 surgical nurses were recruited from a tertiary public hospital in Wuhu, Anhui Province. Four with incomplete responses were excluded, leaving 206 participants for data analysis. Variables were measured using the general questionnaire, caring ability inventory (CAI), and General Self-Efficacy Scale (GSES). Multivariate linear regression analyses were performed to identify the statistically significant influencing factors of participants' humanistic caring ability. RESULTS: The overall average score of the CAI was 190.14 (SD = 19.24), and the average scores for the three dimensions of cognitive, courage, and patience were 70.46 (SD = 7.77), 62.12 (SD = 8.47) and 57.56 (SD = 6.02), respectively. The overall average score of the GSES was 26.05 (SD = 5.77). Professional attitude, perceived care from the department head nurse, perceived care from colleagues and self-efficacy were the statistically significant factors influencing the humanistic care ability of surgical nurses (R2 = 0.45, adjusted R2 = 0.44, F = 40.64, p < 0.001).

Professional quality of life profiles and its associations with turnover intention and life satisfaction among nurses: a prospective longitudinal study.

BACKGROUND: Nursing shortage is a global issue. Turnover intention and life satisfaction are significant predictors of turnover. The specific nature of nursing and stressful work schedules lead to impaired professional quality of life (ProQOL), and existing studies have confirmed the effect of a dimension of ProQOL (such as secondary trauma stress, burnout and compassion satisfaction) on turnover intention and life satisfaction. Yet the heterogeneity of ProQOL across individuals is not known. A lack of research on the relationship between potential ProQOL subgroups and turnover intention and life satisfaction, and the mechanisms underlying this relationship remain understudied. The study aimed to determine different ProQOL profiles, and their cross-sectional and longitudinal effects on turnover intention and life satisfaction, while exploring the mediating roles of job satisfaction and work engagement within the relationship. METHODS: Data were collected at a tertiary hospital in a northeastern province of China. An online questionnaire was administered twice over the course of six months. 1832 and 900 participates provided cross-sectional and longitudinal data respectively. We used latent profile analysis (LPA) and K-means clustering to identify ProQOL profiles, and used the PROCESS macro program to conduct mediation analysis. RESULTS: The LPA results supported a 4-profile solution, including balanced protection, good quality, traumatic satisfaction and burnout problem. ProQOL profiles directly predicted nurses' current and subsequent turnover intention and life satisfaction. In addition, job satisfaction and work engagement mediated the effects of ProQOL profiles on turnover intention and life satisfaction in cross-sectional sample, and mediated the effects of ProQOL profiles on turnover intention in longitudinal sample. CONCLUSION: The findings suggest that nurses' ProQOL has distinct categorical characteristics and is strongly associated with turnover intention and life satisfaction. Hospital administrators should implement individualized, join management and interventions according to each profile. Furthermore, more attentions should focus on improving nurses' job satisfaction and work engagement levels to promote good work and life outcomes.

[Should I Stay or Should I go? Resilience, Intention to Quit and Job Satisfaction among Nurses in Intensive Care Units]. / Soll ich bleiben oder soll ich gehen? Resilienz, Kündigungsabsicht und Arbeitszufriedenheit von Krankenpflegefachkräften auf Intensivstationen.

AIM: Addressing the global nursing shortage is crucial to both national and international public health efforts. This paper aims to highlight the importance of resilience and its impact on primary care nurses' job satisfaction and intentions to quit, especially in the face of current challenges. METHODS: The study utilized a mixed methods design involving nurses in intensive care units of a university hospital in Austria. In the first phase of data collection, qualitative focus group interviews were conducted to gather insights on the current challenges and stressors faced by nursing professionals. Building on relevant literature, a quantitative survey was then administered to all nurses, using scales measuring resilience, intention to quit, and job satisfaction in order to examine the relationships between these variables. In addition, a data structuring of the resilience scale by factors was achieved with the help of confirmatory factor analysis. Subsequently, the correlations of the resilience factors with the other variables were examined by means of an additional correlation, regression and mediation analysis. RESULTS: The results showed negative correlations with regard to resilience and intention to quit as well as with regard to job satisfaction and intention to quit. In contrast, job satisfaction and resilience correlated significantly positively with each other. The negative correlation between resilience and the intention to quit was confirmed, but only for the factors "goal focus" and "pride and commitment". A closer examination of the two factors and their associated items revealed a connection to both professional identity and organizational identity. CONCLUSION: This study provides valuable insights for health care leaders and health care decision makers to effectively lead, develop, and thereby retain primary care nurses. The authors argue that improving resilience and strengthening organizational identity are important influencing factors in increasing job satisfaction and reducing nurses' intention to quit.

Perceptions on Medication Administration Errors (MAEs) among nurses at a tertiary government hospital.

AIM: To identify the nurses' perceptions on the occurrence of Medication Administration Errors (MAEs) and barriers to reporting using the MAE Reporting Survey. BACKGROUND: MAEs is a serious public health threat that causes patient injury, death, and results to expensive health care. METHODS: Descriptive statistical analysis. RESULTS: The most frequent reasons for MAEs according to the nurses were physicians' medication orders are not legible (4.67 ± 1.21) and unit staffing levels are inadequate (4.63 ± 1.45). The most frequent reason for unreported MAEs were when med errors occur, nursing administration focuses on the individual rather than looking at the systems as a potential cause of the error (4.95 ± 4.33) and nurses could be blamed if something happens to the patient as a result of the medication error (4.29 ± 1.48). The highest prevalent non-IV related MAEs included wrong time of administration (M = 3.02 ± 2.37) and medication administered after the order to discontinue has been written (M = 2.60 ± 2.11), both with 0-20 % of reported non-IV MAEs. The highest prevalent IV related MAEs included wrong time of administration (M = 2.76 ± 2.29) and medication administered after the order to discontinue has been written (M = 2.45 ± 2.01). More than half (n = 95, % = 54.29) of the respondents stated that 0-20 % of all types of medication errors, including IV and non-IV medication errors are reported. CONCLUSIONS: The findings supported the notion that nurses perceive low percentages of MAEs reporting.

The effect of an educational intervention on perioperative registered nurse's knowledge, attitudes, and behaviors towards pressure injury prevention in surgical patients.

BACKGROUND: Pressure injuries continue to be a significant problem in perioperative patients. Surgical patients are particularly at risk due to lack of mobility and sensation during surgery and the early recovery period. The AORN (2024) recommends that healthcare organizations develop a comprehensive prevention program that includes risk assessment, prevention, and education. OBJECTIVES: To measure the effect of an educational intervention on perioperative nurses' knowledge, attitudes, and behaviors towards pressure injury prevention after one week and again after six months. METHODS: Nurse's knowledge, attitudes, and behaviors were measured at three different time periods using quantitative nonexperimental pretest posttest longitudinal design. Three hundred fifty-four perioperative registered nurses from 11 acute care hospitals participated. RESULTS: Nurses' knowledge scores were in the moderate range. Statistically significant differences were found between pre-test and posttest 1 scores, indicating that knowledge improved after nurses completed the education intervention and information was retained six months after. Nurses' attitudes were neither positive nor negative towards pressure injury prevention. Regarding behavior, the majority of nurses reported carrying out pressure injury prevention strategies, however only half reported carrying out daily risk assessment strategies. CONCLUSIONS: To prevent pressure injury in perioperative patients, it is imperative that guidelines for the prevention of perioperative pressure injury (AORN, 2024) are integrated into nursing practice.

A prospective longitudinal cohort study of the association between nurses' subjective and objective workload.

Critical care nurses have high workloads due to the severity of the disease and the complexity of the treatment and care. Understanding the factors that influence subjective workload as well as the association between subjective and objective workload could lead to new insights to reduce critical care nurses' workload. (1) To describe critical care nurses' subjective and objective workload per shift in a university-affiliated interdisciplinary adult intensive care unit in Switzerland and (2) to explore the association between objective and subjective workload. The study used a prospective longitudinal cohort design. Critical care nurses completed the adapted Questionnaire on the Experience and Evaluation of Work 2.0 (QEEW2.0) to assess the subjective workload after every shift for four weeks (0 = never loaded, 100 = always loaded). The objective workload was assessed with the Therapeutic Intervention Scoring System-28 (TISS-28), Nine Equivalents of Nursing Manpower Use Score (NEMS), Swiss Society for Intensive Care Medicine (SGI)-patients' categories and Patient-to-Nurse Ratio (PNR). Data was analysed using multilevel mixed models. The workload of 60 critical care nurses with a total of 765 shifts were analysed. The critical care nurses experienced a subjective high mental load (66 ± 26), moderate pace and amount of work (30 ± 25) and physical load (33 ± 25), and low emotional-moral load (26 ± 22). The one-time baseline subjective workload values were higher than the day-to-day values. The mean objective shift load using the TISS-28 was 43 ± 16 points, the NEMS 36 ± 14 points, the SGI-category 1.1 ± 0.5 nurses needed per patient and the PNR 1.2 ± 0.4. We found positive associations between day-to-day objective variables with subjective pace and amount of work, with physical and mental load but not with emotional-moral load and performance. Measured objective workload is associated with only certain subjective workload domains. To promote and retain critical care nurses in the profession, nursing management should give a high priority to understanding subjective workload and strategies for reducing it.

Nurse understaffing associated with adverse outcomes for surgical admissions.

BACKGROUND: Nurses play a crucial role in maintaining the safety of surgical patients. Few nurse staffing studies have looked specifically at surgical patients to examine the impact of exposure to low staffing on patient outcomes. METHODS: A longitudinal patient analysis was conducted in four organizations in England using routine data from 213 910 admissions to all surgical specialties. Patients' staffing exposures were modelled as counts of understaffed registered nurse and nurse assistant days in the first 5 inpatient days. Understaffing was identified when staffing per patient-day was below the mean for the ward. Cox models were used to examine mortality within 30 days of admission and readmission within 30 days of discharge. Generalized linear models were used to investigate duration of hospital stay and occurrence of hospital-acquired conditions. RESULTS: Increased exposure to registered nurse understaffing was associated with longer hospital stay and increased risk of deep vein thrombosis, pneumonia, and pressure ulcers. This was also true for nurse assistant understaffing, but the effect sizes tended to be smaller. In the Cox models, there were similarly increased hazards of death for registered nurse understaffing (HR 1.09, 95% c.i. 1.07 to 1.12) and nurse assistant understaffing (HR 1.10, 1.08 to 1.13), whereas the effect size of registered nurse understaffing for readmission (HR 1.02, 1.02 to 1.03) was greater than that seen with nurse assistants (HR 1.01, 1.01 to 1.02). CONCLUSION: Understaffing by both registered nurses and nursing assistants is associated with increased risks of a range of adverse events, and generally larger effects are seen with registered nurse understaffing.

COVID-19 Mortality Disparities Among Socially Vulnerable Medicare Beneficiaries Associated With the Quality of Nurse Work Environments in U.S. Hospitals.

COVID-19 mortality disparities for socially vulnerable patients, including individuals facing higher levels of poverty, housing insecurity, and limited transportation, have been linked to the quality of hospitals where they received care. Few studies have examined the specific aspects of hospitals, such as nursing care quality, that may underlie disparate outcomes. Recent studies suggest that nursing resources in the pre-pandemic period were associated with mortality during the COVID-19 public health emergency. In this study, we examined the association between social vulnerability, the nurse work environment, and inpatient mortality among Medicare beneficiaries hospitalized with COVID-19. A cross-sectional analysis was conducted of linked survey data collected from nurses working in New York and Illinois, Medicare claims, American Hospital Association Annual Survey data, and the Social Vulnerability Index (SVI). Higher mortality rates were observed among patients in the highest quartile of social vulnerability compared to the lowest (6870 [25.8%] vs 5019 [19.1%]; P < .001). Using multivariable regression modeling, a statistically significant interaction was found between the highest SVI quartile and the nurse work environment (OR, 0.86; 95% CI, 0.76-0.98; P < .05), implying that the effect of a higher quality nurse work environment on mortality was decidedly greater for patients in the highest quartile (odds ratio = 0.86 × 0.94 = 0.80) compared to patients in the lowest quartile (OR, 0.94). Post-hoc analyses demonstrated that hundreds of COVID-19 related deaths among the most socially vulnerable patients may have been avoided if all hospitals had a high-quality nurse work environment. Strengthening the quality of nurse work environments may help to reduce health disparities and should be considered in public health emergency planning, specifically in hospitals serving socially vulnerable communities.

Relevant factors affecting nurse staffing: a qualitative study from the perspective of nursing managers.

Objective: To understand the current situation of nursing manpower allocation, explore the factors affecting nurse staffing, improve nurse staffing level, and provide reference for better formulation of nursing human resources staffing standards. Methods: A descriptive research method was used to conduct semi-structured interviews with 14 nursing managers. The data were analyzed and refined by content analysis. The sample size was subject to content saturation. Results: Nine themes and twenty sub-themes of influencing factors for nursing staffing were identified across four levels: hospital level, department level, patient level, and nurse level. Conclusion: Hospital and department managers need to comprehensively consider the factors of affecting nurse staffing. Adopting multidimensional optimization measures, improving relevant systems, optimizing nurse structure, and establishing flexible and mobile nurse database to cope with public emergencies, so as to effectively improve nurse staffing and nursing service quality.

Moderating role of relationships between workloads, job burnout, turnover intention, and healthcare quality among nurses.

BACKGROUND: In Jordan, nurses consider a primary providers of direct patient care, and play a multifaceted role in ensuring healthcare quality. The study aimed to examines the moderating effect of job satisfaction in the relationship between workload and healthcare quality, job burnout and healthcare quality, and turnover intention and healthcare quality. METHODS: A cross-sectional research approach was adopted among 311 from Registered Nurses (RN) across Jordanian hospitals. Job satisfaction, workload scale and job burnout scale were shared between March and April 2023. RESULTS: The overall findings indicate that workload, job burnout, and turnover intention are negatively and significantly related to healthcare quality, and that job satisfaction moderates the relationship between workload and healthcare quality, job burnout and healthcare quality, and turnover intention and healthcare quality. These findings have broad implications for healthcare organizations, emphasizing the pivotal role of job satisfaction in mitigating the negative effects of workload, burnout, and turnover intentions among nurses. CONSULSION: Strategies to enhance job satisfaction, such as reducing work-related stress and fostering supportive work environments, should be prioritized by healthcare policymakers and institutions to ensure the delivery of high-quality patient care.

Workplace violence and turnover intention among Chinese nurses: the mediating role of compassion fatigue and the moderating role of psychological resilience.

BACKGROUND: Workplace violence is a global public health issue and a major occupational hazard cross borders and environments. Nurses are the primary victims of workplace violence due to their frontline roles and continuous interactions. OBJECTIVE: The present study aimed to investigate the status of workplace violence, turnover intention, compassion fatigue, and psychological resilience among Chinese nurses, and explore the mediating role of compassion fatigue and the moderating role of psychological resilience on relationship between workplace violence and turnover intention among Chinese nurses. METHOD: A cross-sectional study was conducted among a convenience sample of clinical registered nurses from public hospitals in Changsha, Hunan, China. Data was collected through an online questionnaire, which included a demographic information form, the Workplace Violence Scale (WVS), the Turnover Intention Questionnaire (TIQ), the Compassion Fatigue Scale (CF-CN), and the Connor-Davidson Resilience Scale (CD-RISC). Descriptive statistics and correlation analysis were employed to examine the relationships among the main variables. A moderated mediation analysis was further conducted using the PROCESS macro for SPSS (Model 4 and Model 8) to examine the mediating role of compassion fatigue and the moderating role of psychological resilience. RESULT: The present survey recruited a convenience sample of 1,141 clinical registered nurses, who reported experiencing multiple types of workplace violence during the past year. Correlation analysis revealed significant positive correlations between workplace violence and turnover intention (r = 0.466, P < 0.01) as well as compassion fatigue (r = 0.452, P < 0.01), while negative correlation between workplace violence and psychological resilience (r=-0.414, P < 0.01). Moderated mediation analysis revealed that compassion fatigue mediated, while psychological resilience moderated, the positive relationship between workplace violence and turnover intention (all P < 0.05). CONCLUSION: This study underscores the mediating effect of compassion fatigue and the moderating role of psychological resilience in the relationship between workplace violence and turnover intention among Chinese nurses. Future efforts should be undertaken to develop effective preventive measures and intervention strategies at individual, organizational, and national levels to mitigate workplace violence and foster supportive work environment. CLINICAL TRIAL NUMBER: Not applicable.