New Graduate Nurses' Incivility Experiences: The Roles of Workplace Empowerment, Nursing Leadership and Areas of Worklife.

AIMS: To determine what extent are workplace empowerment, New Graduate Nurses' (NGN) perceptions of nurse leaders, trust in management, and areas of worklife predict coworker incivility experiences? BACKGROUND: NGNs' perceptions of nursing leaderships' control over workload contribute to coworker incivility experiences were tested. The relationship between workplace empowerment, authentic leadership, and areas of work life (workload control and fair resource allocation) to coworker incivility experiences were examined. DESIGN: Secondary analysis of Starting Out, national survey, Time 1 dataset. Select factors of workplace empowerment, authentic leadership, areas of worklife, trust in management and NGNs' co- worker incivility experiences were situated within an ecological approach. Multiple linear regression was used to test whether a negative relationship of workplace empowerment, areas of worklife and authentic leadership to NGNs co-worker incivility experiences and important new findings were discovered. RESULTS: First, NGNs' perceptions of workplace empowerment predict coworker incivility experiences when controlling for authentic leadership and trust in management. Second, NGNs' perceptions of areas of worklife predict coworker incivility experiences when controlling for authentic leadership, trust in management, and workplace empowerment. Third, NGNs' perceptions of authentic leadership do not predict coworker incivility experiences when controlling for workplace empowerment and trust in management. Finally, NGNs' perceptions of authentic leadership do predict coworker incivility experiences when trust in management and workplace empowerment are not controlled. CONCLUSIONS: NGNs' perceptions of authentic leadership would benefit from workplace empowerment of the nurse leader in workplace environments to mitigate coworker incivility experiences.

A review: Developing an ecological model approach to co-worker incivility experiences of new graduate nurses.

AIM: To explore how an ecological approach be used to explore relationships among workplace empowerment, authentic leadership, trust in management, areas of work life and co-worker incivility experiences of new graduate nurses. DESIGN: Key concepts related to new graduate nurses' incivility experience informed the research question building on the findings of our first author's integrative review. Second, relevant theories and concepts were identified by conducting a literature review. Third, the themes build on prior theories and factors to propose a hypothetical model. DATA SOURCES: (2016-2019) CINAHL, OVID, PSYCINFO, PUBMED, EBSCO, ERIC, SCOPUS, Cochrane Library; PROQUEST and Google Scholar. REVIEW METHODS: (a) Constructs identified in an IR (Blackstock et al., 2018) guided a literature review on predictive variables linked to new graduate nurse's co-worker incivility experiences; (b) an ecological approach was explored; and (c) we demonstrate how multidimensional organizational factors related to incivility experiences of new graduate nurses can be situated in an ecological model. RESULTS: Structural and organizational factors, and nurse leaders influencing new graduate nurses' experiences are situated in an ecological model. Placing new graduate nurses' co-worker incivility experiences in the microsystem and close to the mesosystem (nurse supervisor) and exosystem (workplace empowerment) of our ecological model provides new insights into their incivility experiences and informs future research. CONCLUSION: The ecological approach and operational definition of incivility help to clarify incivility behaviours as not merely individual behaviours observed by others needing corrective cognitive behaviours, nor support in a graduate transition program, but rather a symptom of work environment factors contributing to multidimensional work environments of new graduate nurses' and influence incivility behaviours. IMPACT: New graduate nurse co-worker incivility research could measure change across time and across system domains informed by this ecological approach and can shape new ways of thinking about how to prevent and mitigate incivility.

Organisational antecedents, policy and horizontal violence among nurses: An integrative review.

AIM: To explore the organisational antecedents related to horizontal violence among nurses and the extent to which policy initiatives reduce its incidence. BACKGROUND: Organisational re-engineering initiatives affect registered nurse roles, adding complexity to organisational antecedents related to horizontal violence and policy. No previous systematic review has examined the role of organisational policies in reducing horizontal violence among nurses. METHODS: An integrative review was undertaken, beginning with a search through 18 electronic databases and reference lists of key articles. The studies included were quality appraised. RESULTS: 1,423 abstracts were screened, resulting in 22 studies being included. Emergent themes were the influence of working conditions, relational aspects of teams and leadership, organisational culture, climate and role of structural processes, leadership role and decision-making authority, and the relationship of organisational structures to anti-horizontal violence policy. CONCLUSION: Further research exploring historical health care organisational hierarchies that inadvertently propagate oppressive nursing work conditions is needed. IMPLICATIONS FOR NURSING MANAGEMENT: If nurse managers understand the impacts of organisational antecedents and climate on registered nurse roles, they can advocate for the breakdown of hierarchies and power inequalities that keep registered nurses in oppressed positions. This awareness and advocacy could facilitate a new understanding of horizontal violence inclusive of organisational roles and the creation of effective anti-horizontal violence policies.

The impact of organisational factors on horizontal bullying and turnover intentions in the nursing workplace.

AIM: To examine the impact of organisational factors on bullying among peers (i.e. horizontal) and its effect on turnover intentions among Canadian registered nurses (RNs). BACKGROUND: Bullying among nurses is an international problem. Few studies have examined factors specific to nursing work environments that may increase exposure to bullying. METHODS: An Australian model of nurse bullying was tested among Canadian registered nurse coworkers using a web-based survey (n = 103). Three factors - misuse of organisational processes/procedures, organisational tolerance and reward of bullying, and informal organisational alliances - were examined as predictors of horizontal bullying, which in turn was examined as a predictor of turnover intentions. The construct validity of model measures was explored. RESULTS: Informal organisational alliances and misuse of organisational processes/procedures predicted increased horizontal bullying that, in turn, predicted increased turnover intentions. Construct validity of model measures was supported. CONCLUSION: Negative informal alliances and misuse of organisational processes are antecedents to bullying, which adversely affects employment relationship stability. IMPLICATIONS FOR NURSING MANAGEMENT: The results suggest that reforming flawed organisational processes that contribute to registered nurses' bullying experiences may help to reduce chronically high turnover. Nurse leaders and managers need to create workplace processes that foster positive networks, fairness and respect through more transparent and accountable practices.

Simulated patient scenario development: A methodological review of validity and reliability reporting.

INTRODUCTION: Some healthcare scholars (educators and researchers) develop their own simulated patient scenarios to address specific learning objectives. Clear processes of validity and reliability are needed in the development of simulated scenarios for the purpose of replication and the transfer of findings to other contexts. METHODS: This paper reports a methodological review of CINAHL to determine how valid and reliable simulated patient scenarios are developed. We reviewed 375 abstracts based on specific inclusion and exclusion criteria to yield 17 qualifying records. Data about the discipline, population, type of simulation, and validity and reliability processes were extracted. RESULTS: Selected records were from nursing, medicine, and paramedicine. While some studies used high-fidelity simulations, some used low-fidelity or a combination of high- and low-fidelity simulations. Scholars validated scenarios by using personal experience, consulting experts, or requesting participant feedback. They also examined different types of validity (face, content, construct). Most studies did not address how reliability of scenarios was determined. To ensure consistency in scenario delivery, some studies piloted scenarios with participants, or examined performance through video-tapes or virtual patients. CONCLUSIONS: This review shows that scholars use inconsistent processes to develop valid and reliable simulated patient scenarios, often overlooking evidence-based approaches to determining validity and reliability. Future practices pertaining to scenario development should use systematic processes in determining validity and reliability so simulation exercises can be replicated in other contexts.

Evolution of Quality Review Programs for Medicare: Quality Assurance to Quality Improvement.

This article outlines the development, successes, and future directions of the Medicare Peer Review Organization (PRO) program. As established by the Tax Equity and Fiscal Responsibility Act of 1982, the purpose of the PRO program is to promote the quality, medical necessity, and appropriateness of services reimbursed through Medicare. We describe the evolution of the PRO program from a retrospective quality review approach, focused on individual events, to a proactive, quality improvement approach. Priorities for future development are described, including the identification of additional clinical areas for attention, improvements in program infrastructure, and broadening the scope of projects to new provider settings.