Case management in primary healthcare for people with complex needs to improve integrated care: a large-scale implementation study protocol.

INTRODUCTION: Case management (CM) is among the most studied effective models of integrated care for people with complex needs. The goal of this study is to scale up and assess CM in primary healthcare for people with complex needs. METHODS AND ANALYSIS: The research questions are: (1) which mechanisms contribute to the successful scale-up of CM for people with complex needs in primary healthcare?; (2) how do contextual factors within primary healthcare organisations contribute to these mechanisms? and (3) what are the relationships between the actors, contextual factors, mechanisms and outcomes when scaling-up CM for people with complex needs in primary healthcare? We will conduct a mixed methods Canadian interprovincial project in Quebec, New-Brunswick and Nova Scotia. It will include a scale-up phase and an evaluation phase. At inception, a scale-up committee will be formed in each province to oversee the scale-up phase. We will assess scale-up using a realist evaluation guided by the RAMESES checklist to develop an initial programme theory on CM scale-up. Then we will test and refine the programme theory using a mixed-methods multiple case study with 10 cases, each case being the scalable unit of the intervention in a region. Each primary care clinic within the case will recruit 30 adult patients with complex needs who frequently use healthcare services. Qualitative data will be used to identify contexts, mechanisms and certain outcomes for developing context-mechanism-outcome configurations. Quantitative data will be used to describe patient characteristics and measure scale-up outcomes. ETHICS AND DISSEMINATION: Ethics approval was obtained. Engaging researchers, decision-makers, clinicians and patient partners on the study Steering Committee will foster knowledge mobilisation and impact. The dissemination plan will be developed with the Steering Committee with messages and dissemination methods targeted for each audience.

From Wasteland to Bloom: Exploring the Organizational Profiles of Occupational Health and Well-Being Strategies and Their Effects on Employees' Health and Well-Being.

Based on the signaling and conservation of resources theories, this study aims to identify different strategic organizational profiles related to occupational health and well-being (OHWB). Additionally, this study explores how these various organizational profiles impact employees' well-being, specifically in relation to absenteeism, emotional exhaustion, work overload, intention to quit, and job satisfaction. Data were collected from 59 organizations and 2828 employees. The first phase of this study presents the latent profile analysis carried out to identify OHWB organizational profiles. This analysis reveals four organizational profiles that are metaphorically named according to the growth stages of plants (i.e., wasteland, sprouting, budding, and blooming OHWB profiles). The second phase of this study investigates the associations between the latent profiles assigned to the organizations with absenteeism, intention to quit, emotional exhaustion, feelings of work overload, and job satisfaction among their employees using MANOVA. The results show that organizational profiles influence employees' health and well-being. Employees working in organizations with a low OHWB profile, known as the "wasteland profile", tend to report more days of absenteeism, higher levels of emotional exhaustion, greater work overload, and lower job satisfaction. Employees are also more likely to express a greater intention to quit their jobs than those working in organizations with a higher OHWB profile (a "blooming profile"). This study is useful for organizations and practitioners seeking to understand how investing in a health and well-being strategy can benefit their employees.

Measuring Team Functioning During the COVID-19 Pandemic: Perspectives of Cancer Care Team Members.

Background: In a public health crisis such as COVID-19, cancer teams face significant challenges including acute work disruptions, rapid shifts in clinical practice, and burnout. Within this context, it is crucial to explore team functioning from the perspectives of multiple stakeholders. Objective: This quantitative pilot study aimed to 1) measure perceptions of multi-stakeholders on key indicators of team functioning (Team Effectiveness, TE, and Team Relational Coordination, TRC) during COVID-19 and its transition, and 2) document whether patient perceptions of TE/TRC are significantly associated with their cancer care experiences. Methods: A descriptive design with repeated measures was used. Through convenience sampling, participants were recruited from two outpatient cancer clinics at a large university-affiliated hospital, in Montréal, Qc, Canada. Sixty-six participants (ie, 13 healthcare professionals, 40 patients, 6 informal caregivers, and 7 volunteers) completed e-measures at T1 (years 2021-2022) and n = 44 at T2 (year 2023). Results: At T1, participants reported high perceptions of Team Effectiveness (scale 1 to 6) M = 4.47; SD = 0.7 (Mdn = 4.54; IQR: 4.06-5) and Relational Coordination (scale 1 to 5) M = 3.77; SD = 0.77 (Mdn = 3.81; IQR: 3.12-4.38) with no significant differences in perceptions across the four groups. At T2, no significant changes in TE/TRC perceptions were found. At both time points, patient perceptions of TE/TRC were significantly correlated with positive cancer care experiences (Spearman rank correlation rs ranging from 0.69 and 0.83; p < 0.01). Conclusion: To our knowledge, this is the first study documenting perceptions of cancer team functioning amidst the pandemic as reported by multiple stakeholders. Significant relationships between patient perceptions of TE/TRC and their cancer care experiences underscore the importance of including patients' views in team functioning processes. Future work should rely on larger sample sizes to further explore key elements of optimal team functioning.

From burnout to behavior: the dark side of emotional intelligence on optimal functioning across three managerial levels.

Introduction: Burnout has been typically addressed as an outcome and indicator of employee malfunctioning due to its profound effects on the organization, its members, and its profitability. Our study assesses its potential as a predictor, delving into how different sources of motivation-autonomous and controlled-act as mediational mechanisms in the association between burnout and behavioral dimensions of functioning (namely, organizational citizenship behaviors and work misbehaviors). Furthermore, the buffering effects of emotional intelligence across three different managerial levels were also examined. Methods: To this end, a total non-targeted sample of 840 Romanian managers (513 first-, 220 mid-, and 107 top-level managers) was obtained. Results: Burnout predicted motivation, which predicted work behaviors in a moderated-mediation framework. Contrary to our initial prediction, emotional intelligence augmented the negative association between burnout and motivation, exhibiting a dark side to this intelligence type. These findings are nuanced by the three managerial positions and shed light on the subtle differences across supervisory levels. Discussion: The current article suggests a relationship between multiple dimensions of optimal (mal)functioning and discusses valuable theoretical and practical insights, supporting future researchers and practitioners in designing burnout, motivation, and emotional intelligence interventions.

The cost of protecting resources: a cross-sectional study on the interaction between LMX and role ambiguity on work addiction and burnout among Canadian first-level healthcare managers.

Introduction: Using the conservation of resources (COR) theory, our study explores the interaction between role ambiguity and leader-member exchange (LMX) quality on burnout using work addiction as a mediator among Canadian first-level healthcare managers. Methods: Cross-sectional data was collected among 165 first-level managers working in healthcare with the support of interprofessional associations in Canada. Linear regression was used to test the presented hypotheses. Results: Work addiction fully mediated the positive relationship between role ambiguity and burnout among first-level managers. In addition, high LMX exacerbated both the direct and indirect effects of role ambiguity. Conclusion: Our study contributes by identifying role ambiguity as a context under which LMX can have adverse effects for first-level managers in healthcare. Moreover, work addiction acted as a mediator, theorized as a risky resource investment which depletes managers' resources. Having a good relationship with their team further entices managers to develop a pathological relationship with their work to protect its members, which in turn is related to higher levels of burnout.

Lessons learned from the pandemic: expanding the collaboration between clinical and logistics activities in a hospital.

PURPOSE: The Covid-19 pandemic generated significant changes in the operating methods of hospital logistics departments. The objective of this research is to understand how these changes took place, what collaboration mechanisms were developed with clinical authorities and, to what extent, logistics and clinical care activities should be decoupled to maximize each area's contribution? DESIGN/METHODOLOGY/APPROACH: The case study is selected to investigate practices implemented during the COVID-19 pandemic in hospitals in Canada. The pandemic presented an opportunity to contrast practices implemented in response to this crisis with those historically used in this environment. FINDINGS: The strategy of decoupling logistical tasks of an operational nature from clinical activities is well-founded and helps free clinical staff from tasks for which they are not trained. However, the decoupling of operational tasks should be combined with an integration of the clinical information flow to the logistics hub players. With this clinical information, the logistics hub can generate its full potential enabling better inventory management decisions to be made. ORIGINALITY/VALUE: The concept of decoupling is studied to identify configurations that offer the best benefits for clinical staff.

Toward a new conceptualization of resilience at work as a meta-construct?

Organizations of all kinds are faced with multiple demands for adaptation of increasing frequency and amplitude due to such factors as reorganizations, climate change, pandemics, and labor shortages. This new reality requires our organizations to anticipate, adjust, and demonstrate resilience. The study of resilience at work relies on the comprehension of how organizational systems, as well as their work collectives and members, manage to overcome adversity without suffering from irreversible damage. However, the study of this phenomenon of interest contains grey areas concerning both its definition, its conceptualization, and the dynamic processes that underlie it. This theoretical paper addresses these different issues by providing first, a conceptual content analysis of the most frequently used definitions and second, a new conceptualization of resilience at work as a resource, either individual or collective. Moreover, we suggest a multilevel, dynamic, and virtuous conceptual approach to resilience at work, relying on both bottom-up and top-down flows. Accordingly, we formulate different theoretical propositions upon which future empirical research can draw to analyze the relationships between individual, team, and organizational resilience. Building on a conservation of resources lens, we offer a novel contribution to the resilience in the workplace literature, by providing an integrative and multilevel theory of resilience at work that highlights both the processual and interpersonal nature of its emergence, and the organizational levers that can foster it.

Effects of ethical climate in association with tenure on work addiction, quality of care and staff retention: a cross-sectional study.

OBJECTIVES: Work addiction is not contingent on personality alone; it is also impacted by social contextual factors. Work addiction influences the perceived quality of care and intention to remain in healthcare sector. The current study seeks to understand the role of ethical climate as a potential organisational lever to reduce such addiction, especially among newcomers. DESIGN: We contacted a sample of Canadian healthcare organisations to collect quantitative data using an online questionnaire from November 2021 to February 2022. All constructs (ethical climate, work addiction, perceived quality of care, intention to quit the profession) were measured using validated psychometric scales. 860 respondents provided complete questionnaires. We analysed the data using structural equation modelling and regression analysis. RESULTS: Work addiction mediated the indirect relationship between ethical climate and the intention to quit the profession (ß=-0.053; 95% CI (-0.083 to -0.029); p<0.001) and with quality of care (ß=0.049; 95% CI (0.028, 0.077); p<0.001). For each increase of 1 SD of ethical climate, the total effects regarding the variations in the outcomes were more important at low rather than high levels of tenure for work addiction (-11%, -2%), perceived quality of care (23%, 11%) and intention to quit the profession (-30%, -23%), respectively. CONCLUSION: Ethical climate in healthcare organisations has a significant and beneficial relationship with healthcare workers' (HCWs) work addiction behaviours. In turn, this relationship is related to greater perceived quality of care and higher intention to remain, especially for HCWs with lower tenure.

How do Informal Caregivers of Seniors' Tasks Lead to Presenteeism and Absenteeism Behaviors? A Canadian Quantitative Study.

This study extends our knowledge on the role of informal caregivers of seniors and the impact of this role on presenteeism and absenteeism at work. Based on the conservation of resources theory, this article seeks to gain insights into the mechanisms and antecedents of presenteeism and absenteeism among employees who are also informal caregivers of seniors. Specifically, this article argues that family-work conflict and emotional exhaustion mediate the relationship between the informal caregiver's role, presenteeism, and absenteeism. Quantitative data (questionnaire) from this cross-sectional study were collected from 915 informal caregivers of seniors from 8 Canadian organizations. Structural equation modelling (SEM) was undertaken using IBM SPSS AMOS 28.0 to test all hypotheses. Informal caregivers of seniors who need to coordinate and organize healthcare are at a higher risk of experiencing family-work conflict. Family-work conflict experienced by informal caregivers subsequently leads to emotional exhaustion, presenteeism, and absenteeism. Because informal caregiving of seniors is likely to increase in coming years for many workers, organizations must be aware of the possible consequences of this role on work productivity. This study shows that not all tasks of informal caregivers of older adults lead to presenteeism and absenteeism through family-work conflict and emotional exhaustion. This study is innovative because, to our knowledge, no study of informal caregivers of older adults has examined the effect of different tasks in this role on presenteeism and absenteeism.

Sustainable employment depends on quality relationships between supervisors and their employees on the autism spectrum.

PURPOSE: Employment outcomes for individuals on the autism spectrum may be contingent upon employers' knowledge of autism and provision of appropriate workplace supports. We aimed to understand the organizational factors that influenced the organizational socialization of autistic employees. MATERIALS AND METHODS: We wrote nine case histories based on interviews from managers, autistic employees, and job coaches. Intra-case analysis, then cross-case analysis, provided an understanding of organizational factors that lead to sustained employment of autistic employees. RESULTS: The quality of the relationship between managers and autistic employees was consistently seen as the key facilitator of organizational socialization and positive employment outcomes of autistic employees. These relationships, however, relied on the skilled facilitation of the job coach during each stage of the employment cycle (hiring, on-boarding, training, performance management), as they had an important role in building a mutual understanding between supervisors and employees. As such, our study draws upon and contributes to leader-member exchange theory. CONCLUSIONS: Consistent with prior research, our study shows the importance of high-quality relationships between supervisors and supervisees for positive employment outcomes of autistic employees in organization but adds skilled communication facilitation as a novel antecedent to leader-member exchange, as a potentially key factor for autistic employees. Implications for rehabilitationThe relationship between the a manager and their employee is an important factor in effective organizational socialization and workplace outcomes for autistic employees.Job coaches can play a crucial role in building mutual understanding and high-quality relationships between managers and employees.Job coaches can support the inclusion of autistic employees by illustrating the multi-faceted socioemotional performance benefits over the longer term.

What Is on Your Gig Radar? Toward a Hierarchical Structure of Coping.

Digitalized independent workers, known as gig workers, have been shown to work under high-pressure, with a lack of autonomy, a lack of feedback and perceived competence, and a high level of isolation. We conducted a literature review to investigate how gig workers cope with these sources of stress. We identified primary sources of psychological stress in gig work and the main strategies used by workers for coping with them. We show that focusing solely on identifying coping strategies depicts a fragmented literature, making it impossible to compare, link, or aggregate findings. We suggest a radar classification of coping based on the motivational action theory of coping and self-determination theory that defines coping as a process to adapt to the environment and maintain well-being. We argue that this framework is both relevant and necessary for developing research on gig-worker coping.

Investigating a Participatory Intervention in Multidisciplinary Cancer Care Teams Using an Integrative Organizational Model: A Study Protocol.

Multidisciplinary teams encounter many challenges that can lead to higher levels of distress and burnout. This trend is acutely prevalent among multidisciplinary cancer care teams who frequently contend with increased task complexity and numbers of patients. Resilience is emerging as a critical resource that may optimize team members' psychological health and wellbeing, work efficiency, and organizational agility, while reducing burnout. Accordingly, the proposed study aims to implement and evaluate a promising participatory interventional approach that fosters team resilience. Specifically, the effects of the intervention on participating team members will be compared to a control group of non-participating team members. This intervention's core components include skills training, patient-centered meetings, talking spaces, and an agile problem-solving approach. The proposed study also seeks to determine whether enhanced resilience improves team mental health status and organizational outcomes. A participatory interventional approach will be implemented and assessed at three-time intervals [i.e., pre-intervention deployment (N = 375), 12 months post-deployment (N = 236), and 24 months post-deployment (N = 146)] across five cancer care teams in three Quebec healthcare institutions. A mixed methods design will be used that includes observations, semi-structured interviews, focus groups, and self-report questionnaires. Direct observation will document team functioning and structural resources (e.g., meetings, conflict management, and leadership). Semi-structured interviews will explore participants' experience with activities related to the participatory interventional approach, its perceived benefits and potential challenges. Focus groups will explore participants' perceptions of their team's resilience and the effectiveness of the intervention. Questionnaires will assess support, recognition, empowerment, organizational justice, individual resilience, psychological safety, work climate, team resilience, workplace burnout, engagement, quality of work life, wellbeing, and organizational citizenship behaviors, and sociodemographic variables. Moreover, objective measures including absenteeism and staff turnover will be obtained via human resource records. Structural equation modeling will be used to test the study's hypotheses. The proposed protocol and related findings will provide stakeholders with quantitative and qualitative data concerning a participatory interventional approach to optimize team effectiveness. It will also identify critical factors implicated in favorable organizational outcomes in connection with multidisciplinary cancer care teams. Expected results and future directions are also presented herein.

Reducing burnout among nurses: The role of high-involvement work practices and colleague support.

BACKGROUND: The impact of human resource practices on nurses' well-being, the underlying mechanisms involved, and the contextual factors that enhance or impede their success are not fully clear. PURPOSE: The aim of this article was to examine a moderated mediation model whereby high-involvement work practices are purported to reduce nurses' burnout via psychological empowerment, and colleague support is expected to moderate the mediating role of psychological empowerment in the high-involvement work practices-burnout link. METHODOLOGY/APPROACH: Structural equation modeling was employed on cross-sectional survey data collected from a large sample of nurses in Canada (N = 2,174). RESULTS: The findings revealed that psychological empowerment partially mediated the association between high-involvement work practices and burnout, whereas colleague support was directly associated with lower burnout rather than exerting a moderating effect. CONCLUSION: The study identifies the universality of high-involvement work practices in alleviating nurses' burnout and highlights the important role of psychological empowerment as an explanatory variable. In addition, colleague support is an important yet independent predictor of nurses' burnout. PRACTICAL IMPLICATIONS: This study identifies a strategy that can be adopted by hospital managers to help protect against nurse burnout while offering insights into the underlying process involved.

The determinants of burnout and professional turnover intentions among Canadian physicians: application of the job demands-resources model.

BACKGROUND: Burnout among physicians is growing at an exponential rate and many are leaving the profession. Nevertheless, the specific antecedents and intermediary stages involved in predicting their professional turnover intentions are not fully clear. PURPOSE: We apply the Job Demands-Resources model and investigate an innovative model which predicts physician burnout and its ultimate consequences on professional turnover intentions. METHODOLOGY/APPROACH: Structural equation modeling was used on cross-sectional survey data from a sample of 407 Canadian physicians. RESULTS/CONCLUSIONS: Job demands (work stress, work overload, and work-family conflict) and job resources (patient recognition and meaning at work) influence intention to leave the profession through a two stage health-impairment and motivational process related to health problems and professional commitment, respectively. PRACTICAL IMPLICATIONS: This study identifies key job resources and job demands which predict physician burnout and professional turnover intentions thereby pinpointing which levers managers can use improve their health and retain them in the profession.

Changes in Alcohol Habits Among Workers During the Confinement of COVID-19: Results of a Canadian Cross-Sectional Survey.

BACKGROUND: The restrictions implemented around the world to contain the spread of the coronavirus disease 2019 (COVID-19) impact workers. Emotional distress and maladaptive behaviors such as alcohol misuse are expected, particularly in vulnerable groups such as front-line health workers. In the present study, we examined if alcohol consumption behaviors in Quebec workers changed during confinement of the COVID-19 pandemic, and whether healthcare workers reported specific patterns of changes. METHODS: Data were obtained from an anonymous online survey conducted among adult workers aged ⩾18 years in the province of Quebec, Canada, between May 25, 2020 and June 26, 2020. Participants provided self-reported data regarding sociodemographic including field of work, as well as mental health disorders, alcohol use, alcohol craving, and type of alcohol consumed. Changes in alcohol behaviors were assessed using Wilcoxon signed rank test for categorial variables and paired-t tests for continuous variables. RESULTS: The survey was completed by 847 participants (77.8% women), with 42.5% healthcare workers. Participants reported increased daily alcohol use (Z = -10.60; P < .001, r = -.372) and alcohol craving (P < .001, d = 0.485) during the confinement. Only the type of alcohol consumed during the confinement differed between health care workers and other workers (OR = 0.45, P = .003). Health care workers used less high alcohol products during the confinement. CONCLUSION: Our results show a significant increase in daily alcohol consumption and in alcohol craving during the confinement in the Quebec working population.

Psychological Distress and Tobacco Use Among Hospital Workers During COVID-19.

Background and Aims: This work aims to assess the impact of the COVID-19 pandemic on hospital workers' psychological parameters and attitudes toward substance use, before and during the French COVID-19 lockdown. Methods: An online survey was proposed to the staff of the University Hospital of Nice and Sainte-Marie psychiatric hospital in France from May 18 to June 6, 2020 assessing changes in daily habits, psychological distress and changes in substance use, including smoking. Results: A total of 702 respondents (80.3% female) filled out the survey. Overall, most of the workers reported increased stress, irritability, sadness, decreased motivation, and a worse quality of sleep after the beginning of the COVID-19 lockdown. Additionally, hospital workers who were more likely to use tobacco during the COVID-19 lockdown reported increased sadness (OR = 1.23, p < 0.001), loss of motivation (OR = 0.86, p < 0.05), alcohol consumption (OR = 3.12, p < 0.001), lower incomes (OR = 1.69, p < 0.05), living alone (OR = 1.77, p < 0.001) and doing less physical activity (OR = 0.36, p < 0.001). Conclusion: During the first lockdown, significant psychological changes (sadness, distress, irritability) associated with changes in tobacco use and physical activity were reported. Such results should encourage hospital leaders to implement dedicated policies to better accompany hospital workers' psychological distress.

The Participatory Approach: A Specific French Organizational Model at the Department Level to Serve the Quality of Work Life of Healthcare Providers and the Quality of Care in Pediatric Oncology.

BACKGROUND: Care providers 'psychological health at work is an important issue because it directly affects the quality of patient care. So far, few studies have studied the psychological health at work of care providers in paediatric oncology. The participatory approach (PA) is an innovative organizational model of department specific to France and previously associated with quality of work life (QWL) and job performance. The aim of the present study was to explore the relationships between the participatory approach, care providers' QWL and quality of care of children in pediatric oncology departments in France. METHODS: A multicentre survey was carried out in pediatric cancer units in France. Care providers completed a questionnaire assessing PA, QWL, consequences of QWL, and their perception of quality of care. The children or their parents completed a questionnaire assessing their perception of quality of care. RESULTS: Five hundred and ten healthcare professionals working in French pediatric oncology centres (more than 40% of the healthcare staff in paediatric oncology in France), 142 children and 298 parents responded to the survey. PA was associated with the care providers' QWL (ß = 0.274; p <0.001), work engagement (ß = 0.167; p<0.001), job satisfaction (ß = 0.166; p<0.001) and perception of quality of care (ß = 0.236; p<0.001). PA was also related to patients' perception of quality of care notably regarding quality of communication (ß = 0.161; p<0.001) and information (ß = 0.226; p<0.001). CONCLUSION: PA is an innovative organizational model that appears to play a role in all aspects of healthcare providers' QWL, and in the quality of care perceived by both care providers and patients.

Social Comparisons, Self-Conceptions, and Attributions: Assessing the Self-Related Contingencies in Leader-Member Exchange Relationships.

Research on leader-member exchange (LMX) has demonstrated that, in addition to the value of LMX as an indicator of quality relationships with leaders, employees also evaluate how their relationship with the leader compares to other employees' relationship with the leader. This finding led to the emergence of LMX social comparison (LMXSC). This study examines how LMX vs. LMXSC relates to work outcomes and considers the employee and perceived supervisor self-concept levels as moderators. We posit that LMX predicts work performance through increased organizational commitment. We further suggest that the relational and collective levels of the self-concept act as contingencies of the relationships among LMX, LMXSC, commitment, and performance. A sample of 250 employee-supervisor dyads was used to test the hypotheses. LMX predicted commitment and, indirectly, performance. The employee and perceived supervisor relational self-concepts acted as moderators of LMXSC, and the perceived supervisor collective self-concept acted as a moderator of LMX and LMXSC. However, not all moderation hypotheses were supported. Unexpected moderating effects involving the employee and perceived supervisor individual self-concepts, as well as main effects, were also uncovered. This study helps differentiate LMX from LMXSC and understand the role of self-conceptions, including self-conceptions attributed by employees to the leader, in leader-member relationships.

Relationships Between Managerial and Organizational Practices, Psychological Health at Work, and Quality of Care in Pediatric Oncology.

PURPOSE: Psychological health at work for care providers is an important issue, because they are directly involved in quality of patient care. Managerial and organizational determinants have been found to be indicators of psychological health at work. The main objective of this study was to explore the relationships between the psychological health at work of pediatric oncology care workers with managerial and organizational determinants and with quality of care. MATERIALS AND METHODS: We performed regression analysis between psychological health at work (quality of work life [QWL], job satisfaction, and so on), managerial determinants (transformational leadership, perceived autonomy support), organizational determinants (organizational support, organizational justice, and participatory approach), and perceived quality of care. RESULTS: Participants were 510 health care professionals working in French pediatric oncology centers. No significant differences in the psychological health at work of the participants were found based on age, sex, length of employment, or professional discipline. In simple regression, significant associations were found between psychological health at work with all managerial and organizational determinants. In multiple regression, a significant link was found between QWL and perceived organizational support (ß = .21; P < .001), organizational justice (ß = .20, P < .001), and overall participatory approach (ß = .10; P < .02). Job satisfaction was also related to perceived organizational support (ß = .16; P < .01). Finally, perceived quality of care was linked to QWL (ß = .15; P < .01) and job satisfaction (ß = .30; P < .001). CONCLUSION: These results emphasize the importance of the role of managers and the organization in psychological health at work of health care providers and also in the quality of patient care.

New Graduate Nurses' Professional Commitment: Antecedents and Outcomes.

PURPOSE: This study examines the factors that increase new graduate nurses' professional commitment and how this professional commitment in turn affects professional turnover intentions, anxiety, and physical health symptoms. DESIGN: The study was carried out in association with the nursing undergraduate's affiliation of Quebec, Canada. A three-wave longitudinal design was employed among nursing students. Nurses were surveyed before they entered the labor market, and then twice after they started working. METHODS: Participants were contacted by post at their home address. The hypotheses were tested using structural equation modeling. FINDINGS AND CONCLUSION: Professional commitment explains why good work characteristics and the provision of organizational resources related to patient care reduce nurses' anxiety and physical symptoms, and increase their professional turnover intentions. Pre-entry professional perceptions moderate the effects of work characteristics on professional commitment such that when participants hold positive pre-entry perceptions about the profession, the propensity to develop professional commitment is higher. CLINICAL RELEVANCE: There is a worldwide shortage of nurses. From a nurse training perspective, it is important to create realistic perceptions of the nursing role. In hospitals, providing a good work environment and resources conducive to their professional ethos is critical for ensuring nurses do not leave the profession early on in their careers.