The Effect of Work Stressors on RN Exhaustion: The Role of Perceived Organizational Support.

OBJECTIVE: This study examines the effect of work environment stressors on RNs' exhaustion through perceived organizational support (POS). BACKGROUND: Drawing on conservation of resources theory and POS theory, POS is theorized to act as a buffer or mediator between lack of COVID-related support and communication (LCSC), 3 role stressors (role overload, role ambiguity, nonparticipation), bullying, and exhaustion. METHODS: A cross-sectional survey design was used. A total of 169 questionnaires (16.6% response rate) were analyzed, performing Pearson correlation, mediation, moderation, and hierarchical robust regression tests. RESULTS: The 3 role stressors were strongly related to bullying. Support was found for an interactive relationship between LCSC and POS at different levels of bullying. Role overload, role ambiguity, and bullying had positive direct effects on exhaustion, whereas POS had negative direct and indirect effects. CONCLUSIONS: Cognitive skills training at individual level coupled with organizational-based stress interventions and leadership development programs could reduce exhaustion.

Leadership Implications Related to Bullying and Intent to Leave Among Licensed Practical Nurses.

OBJECTIVE: This study examines the relationship between bullying and intent to leave among a sample of LPNs as mediated by exhaustion, job satisfaction, and organizational commitment. BACKGROUND: Bullying incidents may negatively impact the well-being, commitment, and retention for LPNs. METHODS: A cross-sectional survey design was used. A total of 168 questionnaires (19.65% response rate) were analyzed, performing Pearson correlation, mediation, and hierarchical regression tests. RESULTS: LPNs reported a relatively high score on exhaustion and were somewhat committed to their organization. They were fairly satisfied with the job and unlikely to leave it. The model explained 72% of the variance in intent to leave, with commitment, exhaustion, and bullying being the strongest correlates. CONCLUSIONS: Nursing leadership needs to implement antibullying language in policies, institute communication and self-leadership trainings, model authentic leadership, and foster ethical climates to support the retention of LPNs.

Relationship of Direct-to-Consumer Advertising to Efficiency of Care, Quality of Care, and Health Outcomes.

BACKGROUND: Direct-to-consumer advertising (DTCA) is effective in promoting pharmaceutical products to consumers and may pose a challenge to providers in the delivery of care. This study examined advanced practice nurse prescriber (APNP) general views of DTCA and tested the effects of DTCA discussion between the patient and APNP in an office visit on efficiency of care, quality of care, and health outcomes. METHODS: A cross-sectional design was used to survey 1,163 APNPs in a single US Midwestern state. The final sample consisted of 316 participants (27.17%). Pearson's chi-squared and multinomial logistic regression analyses tested DTCA effects. RESULTS: Direct-to-consumer advertising disadvantages were increased costs of drugs (80%) and misled patients (75%). Direct-to-consumer advertising benefits included a balanced presentation of risks and benefits (60%) and patients getting treatments (51%). Direct-to-consumer advertising discussion was viewed as worsening time efficiency of visit (53%). Worsened efficiency was associated with worsened nurse-patient relationship. Direct-to-consumer advertising discussion had no effect on quality of care (86%) and health outcomes (89%). Worsened quality was related to inappropriate clinical requests and challenged prescriptive authority among other factors. The nurse doing what the patient wanted was related to worsened health outcomes. CONCLUSION: The findings suggest training initiatives to maximize DTCA benefits in health care delivery.

Direct-to-consumer advertising effects on nurse-patient relationship, authority, and prescribing appropriateness.

BACKGROUND:: Discussing direct-to-consumer advertising of prescription drugs during a visit could affect prescribing practices and provider-patient relationship. RESEARCH OBJECTIVES:: The study examines advanced practice nurse prescribers' perceptions of direct-to-consumer advertising and its effects on nurse-patient relationship, prescriptive authority, and appropriateness of patient clinical requests. RESEARCH DESIGN:: A cross-sectional survey design was implemented. PARTICIPANTS AND RESEARCH CONTEXT:: The random sample consisted of 316 nurses (27.17% response rate) in one of the Midwestern states in the United States. Pearson's chi-square analysis and multiple/multinomial logistic regression analyses were used. ETHICAL CONSIDERATIONS:: Permission to conduct the study was obtained from the university's Institutional Review Board. Participation was voluntary, and measures were taken to protect the anonymity and confidentiality of consenting participants. FINDINGS:: Most nurses (69%) believed that patients were "poor or very poor" at assessing the relevance of drug advertisements, 61% reported that the increase in drugs advertisements directed at patient was "a bad or a very bad thing," and only 16% thought the advertisements were accurate to "a very or to a great extent." Improved nurse-patient relationship was associated with factors such as the patient not bringing printed material, seeking nurse's opinion only, taking responsibility for their health, and not challenging nurse's prescriptive authority. DISCUSSION:: Advertising discussion during a visit could improve as well as pose a challenge to a nurse-patient relationship and nurse's prescriptive authority. CONCLUSION:: The positives of discussing advertising information can be maximized and the negatives minimized through enhanced interpersonal nurse-patient communication.

Countering Unprofessional Behaviors Among Nurses in the Workplace.

OBJECTIVE: This study investigates the association of authentic leadership (AL) and perceived organizational support to workplace bullying among a sample of licensed practical nurses (LPNs). BACKGROUND: Workplace bullying is a serious problem in the workplace that harms nurses' physical and psychological well-being. METHODS: A cross-sectional survey design was implemented. A simple random sample of 855 was drawn from a population of 4306 LPNs in a single US Midwestern state. A total of 168 usable questionnaires were returned (19.65% response rate). RESULTS: Forty-three percent of nurses experienced at least 2 negative behaviors on a weekly/daily basis; 12% self-identified as a victim. The moral component of AL was a major determinant of overall workplace bullying (ß = -.59), person-related bullying (ß = -.70), and physical intimidation (ß = -.58). Perceived support was a major determinant of work-related bullying (ß = -.40). CONCLUSIONS: Organizational support initiatives and AL training for nurse leaders should be considered to reduce bullying.

The prevalence of binge eating disorder and its relationship to work and classroom productivity and activity impairment.

OBJECTIVE: The study aimed to determine the prevalence of binge eating disorder on university campus, its associations with health risk factors, and its associations with work and classroom productivity and activity impairment, adjusted for health risk factors. PARTICIPANTS: The study was conducted at a public midwestern university in the United States and involved 1,165 students. METHODS: Data were collected online, using preestablished instruments. Descriptive, chi-square, correlation, and robust multiple regression tests were used. RESULTS: About 7.8% of the participants were assessed as having binge eating disorder. Binge eating disorder was more common among obese students than nonobese students. Associations were found between moderate binge eating disorder and classroom productivity and daily activity impairment; however, sleep duration and physical activity were the strongest predictors. CONCLUSIONS: University students are at risk of binge eating disorder. Interventions with this population should include education, screening, and clinical consultation when warranted.

Health Information Exchange Capabilities in Skilled Nursing Facilities.

The purpose of this study is to determine the levels at which health information exchange is used by skilled nursing facilities for clinical functions, the benefits and barriers associated with health information exchange and telehealth/telemonitoring capabilities, and the facility characteristics associated with health information exchange capabilities. A cross-sectional design was implemented. Data were collected from nursing home administrators, using a mail and online survey approach. A total of 156 usable questionnaires were returned of 397 distributed­a 39.30% response rate. The highest level of electronic exchange for clinical functions was within the facility than within corporation/affiliated organization or with nonaffiliated providers. It was also more prevalent in for-profit skilled nursing facilities than nonprofit skilled nursing facilities. More than half of the facilities reported no electronic exchange for functions, such as public health reporting, diagnostic test orders/results, medical orders/e-prescribing, advance directives, lab orders/results, and radiology orders/ results. Similarly, telehealth/telemonitoring was not in wide use by facilities in the state. The greatest barriers to electronic exchange of clinical functions were financial barriers, technological barriers, and connectivity barriers. Faster and accurate billing, improved care planning, and improved quality of documentation were reported as benefits of electronic information exchange of clinical data with affiliated and nonaffiliated providers.

Factors influencing the satisfaction of rural physician assistants: a cross-sectional study.

The purpose of the study was to determine factors that attract physician assistants (PAs) to rural settings, and what they found satisfying about their practice and community. A cross-sectional survey design was used. All PAs who were practicing in both nonmetropolitan counties and rural communities in metropolitan counties, in a single midwestern US state, served as the population for the study. A total of 414 usable questionnaires were returned of the 1,072 distributed, a 39% response rate. Factor analysis, descriptive statistics, Pearson's correlation analysis, and robust regression analyses were used. Statistical models were tested to identify antecedents of four job satisfaction factors (satisfaction with professional respect, satisfaction with supervising physician, satisfaction with authority/ autonomy, and satisfaction with workload/salary). The strongest predictor of all four job satisfaction factors was community satisfaction, followed by importance of job practice. Additionally, the four job satisfaction factors had some significant associations with importance of socialization, community importance, practice attributes (years of practice, years in current location, specialty, and facility type), job responsibilities (percentage of patient load not discussed with physician, weekly hours as PA, inpatient visits), and demographics (marital status, race, age, education).

Electronic health records use and barriers and benefits to use in skilled nursing facilities.

The purpose of this study was to determine the levels of automation for 21 clinical functions and the benefits and barriers to electronic health records use in skilled nursing facilities in one of the Midwestern states in the US. A cross-sectional design was implemented. Data were collected from nursing home administrators using a mail and online survey approach. A total of 156 usable questionnaires of 397 distributed were returned, for a 39.30% response rate. While many facilities reported fully automated Minimum Data Set assessments, licensed nurse clinical notes, and care plans, there remained a predominant reliance on paper for functions, such as diagnostic tests and consults. Although many facilities had advanced toward using automation to produce quality reports, they were lagging behind in the use of automated clinical decision support and summary reports. The top two barriers included the amount of capital needed and the cost for hardware and infrastructure. Facilities with paper records were more likely to identify those barriers for functions, such as clinical notes and assessments. The top three benefits were quality patient care monitoring, management control of performance, and anywhere/anytime easier access to clinical data. The study concludes with recommendations to nursing home leaders and other stakeholders.

Ethical climates in for-profit, nonprofit, and government skilled nursing facilities: managerial implications for partnerships.

This study investigates ethical climates in government, nonprofit, and for-profit nursing homes and determines their similarities and differences. Surveys were collected from 656 (21.4%) licensed nurses who worked in 100 skilled nursing facilities in one Midwestern state. Shared law and code and caring ethical climates were identified across the 3 sector nursing homes. Those climates were also polarized. Important implications were drawn for consideration of ethical perceptions of each sector during negotiations and contract management.

Licensed nurses' perceptions of ethical climates in skilled nursing facilities.

This study examines the presence of ethical climates in skilled nursing facilities and identifies their antecedents (work group, job position, tenure). A cross-sectional survey design was implemented. A total of 359 facilities were selected in the Midwestern United States. Responses were received from nurses representing 100 of those facilities (28%). A total of 656 usable questionnaires were returned of the 3060 distributed (21.4% response rate). Descriptive statistics, confirmatory factor analysis, and multivariate and univariate analyses of variance were used. The results confirmed the presence of five ethical climates. Significant differences between registered and licensed practical nurses with regard to egoistic and independence ethical climates were found. Furthermore, nurses in management and non-management positions differed significantly in their perceptions of caring and egoistic climates. The results suggest incongruence in value perceptions and imply that researchers and practitioners have to direct efforts towards preventing and identifying reasons behind this.