Hospital nurses' intention to report near misses, patient safety culture and professional seniority.

OBJECTIVES: To determine the extent nurses reported near miss events; to describe the relationship between patient safety culture, professional seniority and intention to report near misses; and to determine predictors of intention to report near miss events. DESIGN: This was a descriptive cross-sectional correlational study.The sampling method was cluster convenience sampling. Surveys were based on the Hospital Survey on Patient Safety (HSOPS). SETTING: Three general Hospitals (a small, large and a tertiary center) located in the north and center of Israel. PARTICIPANTS: ICU and inpatient ward nurses working in general hospitals. MAIN OUTCOME MEASURES: Patient safety culture, reporting medical errors and near miss events, intention to report near miss events, professional seniority. RESULTS: The sample included 227 nurses. Most nurses rated the patient safety culture components as moderately positive. Approximately 80% stated their intention to report a near miss, however 52.4% indicated that they did not report a near miss event in the past year. A positive correlation was found between all components of the patient safety culture and the intention to report a near miss event. Professional seniority was not related to any safety culture components or intention to report a near-miss event. Three variables predicted intention to report: team work, feedback and communication about errors, and the amount of near misses reported in the last year. CONCLUSIONS: There is a discrepancy between what nurses describe as their intent to report a near miss event and their actual reporting of an event. Components of safety culture, especially communication openness, teamwork and reported near misses in the last year are significant predictors of the intent to report. Therefore, reinforcement of these components should be encouraged at the policy level to enable nurses to report near misses and thus improve patient safety.

A Conflict of Values: Nurses' Willingness to Work Under Threatening Conditions.

PURPOSE: The purpose of this study was to determine the willingness of Israeli registered nurses to work under threatening conditions, their perceived level of threat, and perceptions of peer willingness to report to work. DESIGN: This descriptive study was based on a convenience sample of registered nurses working in four hospitals throughout Israel from internal medicine, surgical, emergency, and intensive care units. METHODS: A questionnaire designed by the investigators was administered to registered nurses while on duty. The questionnaire consisted of three sections: personal characteristics, perceived level of personal threat from five situations (caring for a patient with a dangerous infection, terror attack, war, radiation or chemical disaster, or natural disaster), and perceived personal and peer willingness to work under these threats. FINDINGS: A convenience sample of 249 registered nurses from four hospitals responded. The highest level of perceived threat was a natural disaster (earthquake; M = 2.15, SD = 0.9). Terror (M = 0.83, SD = 0.6) and war (M = 1.01, SD = 0.6) received the lowest mean perceived threat scores. Most respondents were not willing to work during a natural disaster but were willing to care for patients with dangerous infections and during times of war. Weak positive statistically significant correlations were found between the level of perceived threat and willingness to work for all of the threats, except for terror (Spearman rank correlation = .16-.35). CONCLUSIONS: Local culture, perceptions of the level of threat, and perceived peer responsiveness are associated with registered nurses' willingness to work under threat. CLINICAL RELEVANCE: When faced with a threat to personal safety or security, many registered nurses might not be willing to work as usual. What is perceived as threatening is influenced by the local culture and environment. Therefore, managers should be aware of potential cultural and peer influences on this possible conflict of values.

Factors Associated With Full Implementation of Scope of Practice.

PURPOSE: To describe whether nurses fully implement their scope of practice; nurses' perceptions of future practice implementation; and the association between scope of practice implementation with professional autonomy and self-efficacy. DESIGN: A descriptive correlational study was conducted using a convenience sample of 145 registered nurses with post-basic certification from two Israeli university hospitals, from May 2012 to September 2013. METHODS: Five questionnaires were distributed: (a) Demographic and Work Characteristics, (b) Implementation of Scope of Practice, (c) Attitudes Towards Future Practice, (d) Practice Behavior Scale, and (e) Practice Self-Efficacy. Descriptive statistics for all demographic and questionnaire data were analyzed. Two regression models were developed, where current and future implementations were the criterion variables and demographic and work characteristics, professional autonomy, and self-efficacy were the predictors. FINDINGS: High levels of professional autonomy, self-efficacy, and attitudes towards future practice were found in contrast to low or moderate levels of current implementation of the full extent of scope of practice. Primary reasons associated with low implementation were lack of relevance to practice and permission to perform the practice. Significant associations were found between professional autonomy, self-efficacy, and attitudes towards future practice, but not with current implementation. CONCLUSIONS: Nurses wanted to practice to the full extent of their scope of practice and felt able to do so but were hindered by administrative and not personal barriers. CLINICAL RELEVANCE: Even though staff nurses with post-basic certification had high levels of professional autonomy and self-efficacy, many were not implementing the full extent of their scope of practice. Similar to findings from around the world, external factors, such as administrative and policy barriers, were found to thwart the full implementation of nurses' full scope of practice. Therefore, practicing nurses should be aware of these barriers and work towards reducing them.

Nurse middle manager ethical dilemmas and moral distress.

BACKGROUND: Nurse managers are placed in a unique position within the healthcare system where they greatly impact upon the nursing work environment. Ethical dilemmas and moral distress have been reported for staff nurses but not for nurse middle managers. OBJECTIVE: To describe ethical dilemmas and moral distress among nurse middle managers arising from situations of ethical conflict. METHODS: The Ethical Dilemmas in Nursing-Middle Manager Questionnaire and a personal characteristics questionnaire were administered to a convenience sample of middle managers from four hospitals in Israel. RESULTS: Middle managers report low to moderate levels of frequency and intensity of ethical dilemmas and moral distress. Highest scores were for administrative dilemmas. CONCLUSION: Middle managers experience lower levels of ethical dilemmas and moral distress than staff nurses, which are irrespective of their personal characteristics. Interventions should be developed, studied, and then incorporated into institutional frameworks in order to improve this situation.

Preferences of Israeli nursing students in choosing their future workplace.

AIM: To examine the decision-making process and factors influencing nursing students when choosing a workplace. BACKGROUND: In view of the global nursing shortage, nurse recruitment strategies should address multicultural factors and students' expectations, which may influence their workplace preference. METHODS: A combined study involving qualitative (focus groups) and quantitative (questionnaire survey) methods, was carried out in a University School of Nursing in Israel. RESULTS: Focus groups revealed that students focused on various aspects of job security and salary benefits. The perceived 'ideal' hospital is one with close proximity to home, offers good employment conditions and has a positive social atmosphere. Differences were found in the quantitative survey between female and male students as well as between students in the academic vs. non-academic track. CONCLUSIONS: IT is important to periodically review the considerations and motives of nursing students when choosing a workplace and responsively implement various strategies to recruit new nurses. IMPLICATIONS FOR NURSING MANAGEMENT: The hospital's image as a quality and friendly workplace should be strengthened and nursing students should be offered opportunities for professional and academic development.

Improving Patient Safety in General Hospitals Using Structured Handoffs: Outcomes From a National Project.

Background: Promoting quality and patient safety is one of the health policy pillars of Israel's Ministry of Health. Communication among healthcare professionals is of utmost importance and can be improved using a standardized, well-known handoff tool such as the Introduction, Situation, Background, Assessment, and Recommendations (ISBAR). This study aims to present implementation process and participants' satisfaction of a national project that used a standardized tool for team communication. Methods: This national intervention project included process implementation teams from 17 Israeli general hospitals evaluating the ISBAR implementation process for transferring patients from intensive care units to medical/surgical wards. The project, conducted between January 2017 and March 2018, used Fischer's test and logistic regression. The project evaluation was based on the participants' assessment of and satisfaction with the handoff process. Results: Eighty-seven process implementers completed the questionnaire. A statistically significant increase in satisfaction scores in terms of four variables (p < 0.001) was observed following the implementation of the project. Nurses reported higher satisfaction at the end of the process (0.036). Participants who perceived less missing information during handoffs were more satisfied with the process of information flow between wards (84.9%) than those who perceived more missing information (15.6%). Participants who responded that there was no need to improve information flow were more satisfied with the project information flow (95.6%) compared to the group which responded that it was necessary to improve information flow (58.2%). Three out of four variables predicted satisfaction with the process. Being a nurse also predicted satisfaction with information flow with a point estimate of 2.4. The C value of the total model was 0.87. Conclusions: Implementation of a safety project at a national level requires careful planning and the close involvement of the participating teams. A standardized instrument, a well-defined process, and external controls to monitor and manage the project are essential for success. Disparities found in the responses of nurses vs. physicians suggest the need for a different approach for each profession in planning and executing a similar project in the future.

Creating a vision for nursing practice in a tertiary medical organization in Israel.

Rapid changes in the healthcare system obligate Israeli nursing leaders to reassess current nursing roles and to identify new paradigms that are in line with the demanding needs of acute care settings. The challenge of engaging nurses to achieve the desired changes in nursing role performance and perception can be accomplished by defining a comprehensive organizational vision. The authors present a process creating and implementing a nursing vision intended to empower the nurse's role in a large acute general hospital.

Using Telemedicine During the COVID-19 Pandemic: Attitudes of Adult Health Care Consumers in Israel.

Introduction: The COVID-19 pandemic has affected health care services worldwide due to lockdowns, prevention measures, and social distancing. During this period, patients, including older adults and those with chronic conditions, need ways to obtain medical attention other than going physically to the clinic, such as telemedicine services. The purpose of the present study was to evaluate attitudes toward telemedicine during the COVID-19 lockdown in Israel, assess willingness to use such services in the future, and evaluate the extent to which consumers have changed their minds regarding these services. Method: A cross-sectional, descriptive, correlational study was conducted among adults (age 20-90) using social media networks (N = 693). Data were collected using an online questionnaire explicitly designed to measure attitudes toward telemedicine. Results: Most of the participants had to use telemedicine during the lockdown and were satisfied therewith. The majority also stated that they would continue using telemedicine in the future. However, only a third stated that they had changed their minds regarding telemedicine. The main predictors of willingness to use telemedicine in the future were the necessity of using such services during lockdown, preference for going to a clinic, and satisfaction with telemedicine, alongside gender and having a chronic illness. Importantly, we found that a preference for visiting the clinic was negatively correlated with willingness to use telemedicine in the future. Education and being single were predictors of the change of mind regarding telemedicine. Participants with chronic conditions are more likely to use these services, and specific attention should be directed to their needs. A small portion of the study sample prefers live appointments with a physician. Conclusions: Telemedicine use is rapidly changing. It is vital for health care providers to identify non-telemedicine users and their common characteristics. Monitoring patients' attitudes regarding telemedicine is essential in the future after the pandemic ends. Targeted outreach plans should be formulated. These plans should be directed at identifying barriers to using telemedicine, and they should generate specific, focused plans.

Food allergy safety: a descriptive report of changing policy in a single large medical center.

BACKGROUND: Food allergy can result in life-threatening anaphylaxis and is considered an increasing public health burden. Hospitalized patients are dependent on the hospital menu to meet their nutritional needs; thus, errors in the meals provided can have a substantial impact on patients' health outcomes. In Israel, no specific policy protocol exists to ensure food allergy safety in the setting of a hospital foodservice system. OBJECTIVES: This paper has two aims: 1) to provide an in-depth review of food allergy as a major public health concern and 2) to report actions taken in a single large medical center, as an ongoing project that aimed to ensure patients' safety, and which ended in developing policy on this matter. RESULTS: During the years 2017-2019, we initiated several interventions with the goal of achieving food allergy safety and ensuring quality of care for patients with food allergies at Hadassah Hebrew University Medical Center. These included integrating food management safety into the computerized foodservice system, highlighting labels on patients' food trays, introducing safety checks into the process of food delivery to hospitalized patients; and ensuring the nutritional requirements of patients with allergy restrictions. Moreover, changes were made in specialized menus for patients with various types of food allergy, and specific procedures were implemented regarding enteral feeding, to prevent accidental allergen exposure. All the procedures were incorporated into a written protocol that applies to all hospital employees, and the staff received the relevant training. CONCLUSIONS: Our experience suggests that methods for food allergy safety should be promoted, and that an established policy and suitable set of guidelines on this matter is required. This clearly mandates collaboration between the various sectors of the hospital, including management and the computer department; and the medical, nursing, dietetics and kitchen staffs. Furthermore, routine ongoing knowledge training programs for medical teams and kitchen staff are crucial for such implementational changes. In a technological world, computerized systems delivering food to hospitalized patients must be adapted such as to create a uniformly safe food environment of healthcare systems, and developing a suitable policy should be prioritized accordingly by hospitals across Israel, with collaboration and synergy between institutions management and the departments of nutrition and patient safety and risk management.

Applying an ethical decision-making tool to a nurse management dilemma.

This article considers ethical dilemmas that nurse managers may confront and suggests an ethical decision-making model that could be used as a tool for resolving such dilemmas. The focus of the article is on the question: Can nurse managers choose the ethically right solution in conflicting situations when nurses' rights collide with patients' rights to quality care in a world of cost-effective and economic constraint? Managers' responsibility is to ensure and facilitate a safe and ethical working environment in which nurses are able to give quality care to their patients. In nursing it is frequently declared that managers' main obligations are to patients' needs and their rights to receive quality care. However, managers' ethical responsibilities are not only to patients but also to the nurses working in their institution. This article describes a real (but disguised) situation from an Israeli health care context to illustrate the dilemmas that may arise. The question is posed of whether nurse managers can maintain patients' and nurses' rights and, at the same time, fulfill their obligation to the conflicting demands of the organization. The article also offers a way to solve conflict by using an ethical decision-making model.

The oncology nurse coordinator: role perceptions of staff members and nurse coordinators.

BACKGROUND: There is extensive evidence that the role of nurse coordinators is beneficial for patients. Nurse coordinators are more available to patients compared to general registered nurses, know better to control symptoms and work as team players with multiple care providers. Despite its significance, there is a dearth of literature on the subject in Israel and a lack of clarity regarding the definitions of the role in terms of responsibilities and authorities. The aim of the study is to: To examine how the role of nurse oncology coordinator is implemented in various fields of oncology and to describe the actual performance of different kinds of oncology nurse coordinators and staff perceptions regarding this role in one tertiary hospital in Jerusalem. METHODS: A phenomenological approach was used to explore the participants' experiences and views of nurse coordinators' performance. We conducted a qualitative study using in-depth semi-structured interviews. Interviewees included 30 employees from different levels of the hospitals, and leading figures associated with oncology medicine outside of the hospital: Nurses and physicians of the Sharett Oncology Institute of Hadassah Ein Kerem Hospital in Jerusalem, the administrative staff of Hadassah Ein Kerem Hospital, head nurses of the Israel Cancer Association, the chairperson of the Non-Profit Organization of Oncology Nurses, nurse directors at the Ministry of Health Nursing Division, and seven nurse coordinators at Hadassah Ein Kerem Hospital in diverse fields of oncology. RESULTS: The nurse coordinator is perceived as an important staff member providing care to cancer patients. Several key elements were found to be common features in the work of all nurse coordinators: emotional support, guidance to patients, and coordination of patients' care. CONCLUSIONS: The nurse coordinator plays a noteworthy role in the health care system. In view of the variety of roles that the nurse coordinator assumes in different units, performance standards must be adapted to the performance areas for each unit, as well as nurses' professional development requirements. Changes in a service organization and careful attention to the continuum of care highlight the need to develop and to strengthen the role of a nurse who coordinates treatment over the entire continuum of care, both in the hospital and in the community.

What do discharged patients know about their medication?

Patient's knowledge is a necessity for empowering patients to perform self-care, especially when dealing with new, ill-defined and unknown situations. The aim of this paper is to assess patients' reported as opposed to correct knowledge about medication therapy after discharge from hospital and to identify factors that increase correct knowledge. Three hundred and forty-one patients were interviewed 7-14 days after discharge from six internal wards in a large medical facility in Israel. Most patients (73%) were aware of the course and purpose of their medication. They were, however, unaware of side effects, needed lifestyle changes, and correct medication schedules. A large difference was found between levels of reported and correct knowledge about various issues regarding medication treatment. No significant correlation was found between correct knowledge about medication therapy at discharge, and gender, age, education, patient satisfaction and wish for more counseling. The only factor which significantly affected levels of correct knowledge was whether the patient had received medication counseling during hospitalization. The findings illuminate the gap between patients' perception of knowledge and actual knowledge. The study indicates the need for patient counseling during hospitalization, with respect to medication therapy.

The Impact of eHealth and mHealth on doctor behavior and patient involvement: an Israeli and Portuguese comparative approach.

Based on the experience of a Short Term Scientific Mission (STSM) promoted by COST Net and developed in CIES/ISCTE-IUL (Portugal), this paper presents a reflection about the implementation of Information & Communication Technologies (ICT) in the healthcare sector in Israel and Portugal. Specifically, we focus on the impacts of ICT or eHealth on patient empowerment, as perceived by doctors and managers in order to better comprehend the role of national policy and explore the options for building a national strategy regarding ICT in healthcare. The experience of the Portuguese healthcare system was selected and compared to the results found in a similar research in Israel. Methodologically, in-depth interviews with the Ministry of Health, the private sector, patients associations and researches were used to collect data. Purposeful sampling was used to select respondents, and secondary sources were used for triangulation. The findings of the research work show that the increased deployment of ICT has furthered patient empowerment (1). From the doctors' perspective, while ICT has provided more information in the long-run, changes of these magnitudes were not easy in the beginning. These findings were similar in both countries. The work concludes that ICT tools were successfully implemented and the general perception is that they have been beneficial. The work provides information in order to understand and improve ICT services. Additionally, the results suggest alternatives for future investments in these technologies.

Health information technology implementation - impacts and policy considerations: a comparison between Israel and Portugal.

The use of Information and Communications Technology (ICT) in health systems is increasing worldwide. While it is assumed that ICT holds great potential to make health services more efficient and grant patients more empowerment, research on these trends is at an early stage. Building on a study of the impact of ICT on physicians and patients in Israel, a Short Term Scientific Mission (STSM) sponsored by COST Net in conjunction with CIES/ISCTE IUL (Portugal) facilitated a comparison of ICT in health in Israel and Portugal. The comparison focused on patient empowerment, physician behavior and the role of government in implementing ICT. The research in both countries was qualitative in nature. In-depth interviews with the Ministry of Health (MOH), the private sector, patients associations, health plans and researchers were used to collect data. Purposeful sampling was used to select respondents, and secondary sources were used for triangulation. The findings indicate that respondents in both countries feel that patient empowerment has indeed been furthered by introduction of ICT. Regarding physicians, in both countries ICT is seen as providing more information that can be used in medical decision making. Increased access of patients to web-based medical information can strengthen the role of patients in decision making and improve the physician-patient relationship, but also shift the latter in ways that may require adjustments in physician orientation. Physician uptake of ICT in both countries involves overcoming certain barriers, such as resistance to change. At the national level, important differences were found between the two countries. While in Israel, ICT was promoted and adopted by the meso level of the health system, in particular the health plans and government intervention can be found in a later stage, in Portugal the government was the main developer and national strategies were built from the beginning. These two approaches present different advantages and disadvantages. Government involvement in earlier stages could provide benefit in terms of interoperability of systems between different healthcare organizations. However, innovation could be slowed down due to government bureaucracy or lack of leadership. The work provides information in order to understand and improve ICT services. Additionally, it provides input regarding impact of ICT on the physician/patient relationship and national policies in the area.

[The expected shortage of registered nurses in Israel].

In the last several years, many countries have experienced a shortage of registered nurses. This phenomenon is expected to escalate in the future. Recent studies have established significant relationships between the proportion of registered nurses and the quality of care, preventing health complications and achieving desired clinical outcomes. Thus, the shortage of nurses has a direct effect on the overall population's health. Israel, like other countries, will experience a nursing shortage in the near future. Many reasons are associated with this problem, some of which are attributed to the policy of the Ministry of Health, which did not invest sufficient resources in maintaining workers in the nursing profession. Furthermore, existing educational programs were closed and insufficient efforts were invested in the development of alternative educational programs. Until recently, new immigrants were a significant source of candidates to become nurses in Israel. Due to the decrease in the number of new immigrants to Israel, the nursing profession may be affected and the positive trend of nursing employment might be hampered. Other reasons for the nursing shortage can be related to the improvement in the economical situation in Israel, the increasing demand for registered nurses due to medical complexity and new sophisticated technologies in hospitals and in the community. This intimidating problem must be resolved immediately including broad creative strategies focusing on both short and long-term solutions.

Israeli nurse practice environment characteristics, retention, and job satisfaction.

BACKGROUND: There is an international nursing shortage. Improving the practice environment has been shown to be a successful strategy against this phenomenon, as the practice environment is associated with retention and job satisfaction. The Israeli nurse practice environment has not been measured. The purpose of this study was to measure practice environment characteristics, retention and job satisfaction and to evaluate the association between these variables. METHODS: A demographic questionnaire, the Practice Environment Scale, and a Job Satisfaction Questionnaire were administered to Israeli acute and intensive care nurses working in 7 hospitals across the country. Retention was measured by intent to leave the organization and work experience. A convenience sample of registered nurses was obtained using a bi-phasic, stratified, cluster design. Data were collected based on the preferences of each unit, either distribution during various shifts or at staff meetings; or via staff mailboxes. Descriptive statistics were used to describe the sample and results of the questionnaires. Pearson Product Moment Correlations were used to determine significant associations among the variables. A multiple regression model was designed where the criterion variable was the practice environment. Analyses of variance determined differences between groups on nurse practice environment characteristics. RESULTS: 610 nurses reported moderate levels of practice environment characteristics, where the lowest scoring characteristic was 'appropriate staffing and resources'. Approximately 9% of the sample reported their intention to leave and the level of job satisfaction was high. A statistically significant, negative, weak correlation was found between intention to leave and practice environment characteristics, with a moderate correlation between job satisfaction and practice environment characteristics. 'Appropriate staffing and resources' was the only characteristic found to be statistically different based on hospital size and geographic region. CONCLUSIONS: This study supports the international nature of the vicious cycle that includes a poor quality practice environment, decreased job satisfaction and low nurse retention. Despite the extreme nursing shortage in Israel, perceptions of the practice environment were similar to other countries. Policy makers and hospital managers should address the practice environment, in order to improve job satisfaction and increase retention.

Examining professional boundaries between nurses and physicians in neonatal intensive care units.

BACKGROUND: Medical and technological developments, financial constraints and a shortage of physicians have made it necessary to re-examine professional boundaries between physicians and nurses. Israel's manpower shortage in Neonatal Intensive Care Units (NICUs) has changed the responsibility and authority of nurses. However, these changes have not evolved into a uniform policy defining the division of responsibility between physicians and nurses. This study was designed to examine the work processes and actual division of labor between NICU physicians and nurses; the attitude of physicians and nurses to greater empowerment of the nursing role; and to suggest a model to regulate work processes and develop the role of neonatal nurse specialists in NICUs. METHODS: Open interviews with NICU physician-directors and head nurses and a cross-sectional survey of some 50% of the physicians and nurses at 22 hospital NICUs (N = 430). RESULTS: Main problems of NICUs: physician shortage, deficient infrastructures, fragmented work processes. Nurses do not perform many practices allowed to them due to the need for organizational approval and their own unawareness. Conversely, they sometimes conduct procedures and make decisions outside of their authority. Most physicians agree that nurse graduates of Post-Basic Education training (PBE) should be authorized to independently perform such activities as resuscitation and medication balancing while reserving invasive procedures for physicians. It is widely agreed that broadening the authority of nurses would improve the quality of NICU care even though it would increase the nursing workload. CONCLUSIONS: The study provides important input into decisions about authorizing nurses over complete practice areas rather than isolated activities; the need to remove institutional restrictions on tasks currently permitted to nurses; introducing teamwork from within the NICUs, and expanding nursing decision-making. The study reveals that there is a basis on which to to build the role of the neonatal nurse,since most NICU nurses have the suitable academic and clinical training.

Registered nurses in Israel - workforce employment characteristics and projected supply.

BACKGROUND: Surveys of nursing supplies around the world have furnished a better understanding of the structure of the workforce, helped identify shortages, and plan professional training. This study aimed to examine the employment and workforce characteristics of registered nurses and the projected supply in Israel as a tool for planning. METHODS: 1. A survey of a national sample of 10% of the RNs of working age (3,200 nurses). 2. Analysis of administrative data from the Ministry of Health' Nursing Division and the Central Bureau of Statistics. RESULTS: Most registered nurses are employed (89%) - 67% work full time. The workforce is mature (45% are above 45), trained (55% qualified beyond the basic course, 48% hold a BA, 18% hold an MA or PhD), and stable: few quit the profession altogether. The likelihood of "survival" in the profession after 10 years is 93%; after 20 years - 88%. 23% have made some transition in the last 10 years (most - a single transition). Most of the transitions are from hospital to community work. Supply projections show a decrease in the total number of RNs in the nursing workforce from 28,500 in 2008 to 21,201 in 2028 - i.e., of 25% by the end of the period. As for the ratio per 1,000 population, the drop is from 4 registered nurses/1,000 in 2008 to 2/1,000 in 2028. CONCLUSIONS: The study findings provide more rigorous projections of supply than in the past on the declining rates of the nursing workforce in the coming decades, and contribute to decision making about the scope of training and recruitment. The study also points to the implications for policy decisions regarding the findings that the young nursing workforce is less stable, that there are advantages to recruiting a more mature workforce, and that post-basic education is connected with workforce stability.

Turnover of registered nurses in Israel: characteristics and predictors.

BACKGROUND: In an era of global and local nursing shortages, nursing turnover has negative consequences in terms of diminished quality of care, increased costs and economic losses and decreased job satisfaction. OBJECTIVE: To examine the turnover rate of registered nurses in Israel by assessing the varying degree of turnover between economic sectors, between hospital and community facilities, and/or between types of hospitals; and by examining potential predicting factors of turnover among registered nurses. METHODS: A national phone survey was undertaken in Israel consisting of a random sampling of registered nurses of working age (up to age 60). The subjects comprised 10% of a national database of 32,000 registered nurses. RESULTS: The turnover rate among working nurses in Israel currently stands at 23%. In addition, 13% of employed nurses have taken a temporary leave of absence for a period greater than 6 months in the past 10 years, most up to 1 year. While job satisfaction rates were relatively high (72%), Professional satisfaction rates were 60% with no significant difference between hospital and community nurses. The turnover rate of registered nurses from a hospital setting to the community was significantly higher (p<.01) than that of community registered nurses to hospitals. Predicting factors of turnover were found to be: young age, part-time work, lack of advanced professional education, academic education and low satisfaction with the nursing profession. CONCLUSIONS: The shift of nursing workforce is mainly from hospitals to community health settings. There is a need to monitor and understand the characteristics of job and professional satisfaction among hospital nurses in order to implement crucial organizational interventions and retain hospital nursing staffs. Since young nurses, nurses working part time and nurses with no advanced professional and academic education, tend to move more than others, efforts should be targeted at these specific groups.

The difference between professional image and job satisfaction of nurses who studied in a post-basic education program and nurses with generic education: a questionnaire survey.

To compare nurses' perceptions of the contribution of post-basic education (PBE) programs to nurses' professional image, job satisfaction, and clinical practice between two groups, nurses who had participated in PBE programs and nurses who had not. This is a cross-sectional study. A study conducted with 419 nurses employed in two major hospitals in Israel. Data were collected using structured questionnaires containing perception on professional self-image and clinical image, job satisfaction, and PBE contributions to nursing practice. Nurses who had completed a PBE in comparison to those who had not completed such a program rated higher the contribution of the program to independent decision making (40% and 50%, respectively, P < .001) as well as to specialized skills and proficiencies (38% and 55%, respectively, P < .01). Significant differences between the two groups were also found regarding professional image. Professional self-image and image of the clinical area were positively associated with professionalization. No differences regarding job satisfaction were found between the two groups. The study indicated that the model of PBE applied allows nurses to acquire greater self-confidence and improves professional self-image when making decisions. The model likewise helped nurses acquire greater authority to decide and intervene in clinical practice.