An Intervention to Enhance Recognition of Nursing Assistant Roles and Enhance Information-Sharing.

This column describes a quasi-experimental trial that examined the effects of an intervention in which both nurses and nursing assistants shared their perceptions of the nursing assistant role on the frequency of information-sharing behaviors. In the intervention group, the frequency of nurses' linguistic responses in the intervention group increased in the nursing assistants' evaluations. The frequency of nursing assistants' linguistic response and feedback in the intervention group increased in self-evaluation and nurses' evaluation, respectively.

Work-related communication mediates the relationship between perceived diversity climate and psychological empowerment among part-time nurses: A cross-sectional study.

AIM: This study investigates which work-related communication mediates the relationship between diversity climate and psychological empowerment among part-time nurses. BACKGROUND: Part-time nurses' high psychological empowerment is desirable because it may lead to high quality nursing practice. METHODS: Anonymous self-report questionnaires or web-based surveys were used to measure diversity climate (Climate for Inclusion Scale), psychological empowerment (Japanese version of the Psychological Empowerment Scale) and work-related communication (scale developed in this study). The respondents were part-time nurses from departments with shift work in six Japanese hospitals having over 200 beds. The surveys were conducted from September to October 2020. Multiple regression analyses and a significance test of indirect effects were then conducted. RESULTS: Among the work-related communication components, 'expressing thoughts about their work' fully mediated the relationship between diversity climate and psychological empowerment. CONCLUSIONS: It is important for part-time nurses to be actively 'expressing thoughts about their work' to enhance their psychological empowerment. Positive diversity climate is also important because it allows part-time nurses to express their thoughts regarding work. IMPLICATIONS FOR NURSING MANAGEMENT: Managers can enhance part-time nurses' psychological empowerment by encouraging them to express their work-related opinions based on the diversity climate.

Nursing assistants' desired roles, perceptions of nurses' expectations and effect on team participation: A cross-sectional study.

AIMS: To examine the gap between nursing assistants' desired roles and their perceptions of nurses' expectations, and the relationship between these perceptions and nursing assistants' nursing team participation. BACKGROUND: Nursing assistants' role perceptions may be related to their participation in nursing teams. METHODS: We performed a secondary analysis of questionnaire data from 1,316 nursing assistants in Japan. RESULTS: Participants rated their desired roles higher than their perceptions of nurses' expectations of them. Where perceptions of nurses' expectations were higher, higher desired role scores were associated with greater nursing team participation. Where perceptions of nurses' expectations were lower, the desired role score was not associated with team participation. CONCLUSIONS: Nursing assistants perceive their roles as higher and inclusive of more duties than what nurses have expected of them. When perceptions of nurse expectations were high, they performed at a higher level. When perceptions of nurse expectations were low, they performed at a lower level, despite their desire to do more. IMPLICATIONS FOR NURSING MANAGEMENT: It may be useful for nurses and nursing assistants to jointly reflect on and promote awareness of nursing assistants' functional roles in the ward. This would promote nursing assistant team participation and optimize their scope of practice.

Exploring nurses' clinical reasons for bed transfers in acute care wards: An observational study.

AIMS: To investigate the number of bed transfers (patient transfers within the same ward) and their reasons in acute care wards of mid-sized hospitals with multibed and private rooms. BACKGROUND: Bed transfers, even when necessary, are burdensome for patients; however, the reasons for bed transfers in various types of rooms remain unclear. METHODS: An observational study was conducted in seven wards in three hospitals in Japan. Nurses completed a questionnaire regarding each bed transfer, which elicited the reasons for the transfer. We classified transfer patterns based on the functions of the patients' rooms and the number of beds in each room and analysed scores. RESULTS: Overall, 560 responses were analysed. The average number of bed transfers per day was 2.7. In total, 43% of bed transfers were conducted for patients aged over 70. The most frequent bed transfer pattern was 'transfer between patient rooms with the same number of beds', and the most frequent reason was 'patient did not need that bed'. CONCLUSIONS: Unnecessary bed transfers could be reduced by ward designs that reflect nurses' clinical judgement. IMPLICATIONS FOR NURSING MANAGEMENT: Monitoring data for the reason regarding bed transfer contributes to hospital planning and decreases unnecessary bed transfers.

The influence of learning circumstances and on-the-job opportunities for professional growth on perceived person-environment fit among hospital nurses: A longitudinal study.

AIMS: The study aimed to determine the influence of learning circumstances (learning inside and outside hospitals, and communication about the nursing practice with colleagues) and on-the-job opportunities for professional growth on each dimension of person-environment fit (needs-supplies, demands-abilities, person-organisation and person-group fit) among nurses. BACKGROUND: It is desirable for each dimension of person-environment fit to be high, as it links to many work-related outcomes. METHODS: A longitudinal survey using a questionnaire was conducted in February 2019 (Time 1) and October 2019 (Time 2). A simple linear regression analysis and a multiple linear regression analysis were conducted, using data from 324 nurses. RESULTS: The results of the simple regression analysis showed that three variables related to learning circumstances at Time 1 were positively related to each dimension of person-environment fit at Time 2. The multiple regression analysis showed on-the-job opportunities for professional growth at Time 1 related to person-environment fit at Time 2. CONCLUSIONS: To achieve high person-environment fit, nurses should be aware of on-the-job opportunities for professional growth. IMPLICATIONS FOR NURSING MANAGEMENT: To achieve high person-environment fit, nurse managers should evaluate nurses' abilities and assign them jobs that would help improve their nursing skills.

Relationship between nurses' perceptions of nursing assistant roles and information-sharing behaviors: A cross-sectional study.

Information-sharing between nurses and nursing assistants is necessary for appropriate inpatient care. Nurses who perceive nursing assistant roles highly may display positive behaviors related to information-sharing with nursing assistants. This study aims to examine the relationship between nurses' perceptions of nursing assistant roles and the frequency of their sharing information with nursing assistants. Using a self-administered, cross-sectional survey questionnaire, data from 2,642 nurses in 182 hospitals were collected. Nurses' perceptions of nursing assistant roles were measured with a scale containing four factors: (i) improving patients' abilities through daily care; (ii) caring for various patients using broad perspectives; (iii) facilitating co-ordination and co-operation among team members; and (iv) increasing the amount of information on patients among team members. Information-sharing behaviors included "expressing," "asking," "linguistic response," and "feedback." Multiple regression analyses for each nurse's information-sharing behaviors were conducted. Nurses' perceptions of nursing assistant roles were positively correlated with the frequency of sharing information with nursing assistants. The degree of the correlations differed, depending on the type of information-sharing behavior. Therefore, improving nurses' understanding of nursing assistant roles might increase their information-sharing behaviors.

Quality of work among part-time nurses and its relationship to job satisfaction and work values: A cross-sectional study.

This study compared the quality of work between part-time and full-time nurses and investigated the relationship between quality of work and satisfaction with the work itself among part-time nurses. Quality of work was measured by specific work content and job characteristics. It was hypothesized that work content would affect satisfaction mediated by job characteristics. Furthermore, the moderating effects of intrinsic work values on the relationship between job characteristics and satisfaction were examined. A cross-sectional survey was conducted with 444 part-time and 795 full-time nurses working in Japanese hospital wards in 2017. The Mann-Whitney U test, χ2 test, and hierarchical multiple regressions were used. Work content differed between part-time and full-time nurses; however, job characteristics and satisfaction showed little difference. Work content was not associated with satisfaction mediated by job characteristics. Within the job characteristics, autonomy and feedback had positive effects on the satisfaction of part-time nurses, whereas interaction with work values was insignificant. When assigning work, it is important to allow part-time nurses to experience higher levels of autonomy and feedback regardless of their intrinsic work values.

The effect of work environment on burnout among nursing directors: A cross-sectional study.

AIM: Identifying the relationship between burnout status and hospital size and workplace environment among hospital nursing directors. BACKGROUND: Although the demands on nursing staff and managers are increasing, nursing directors' burnout is an under-researched topic. METHODS: An anonymous survey was conducted with 205 nursing directors across all 654 hospitals in Tokyo, Japan. The survey instruments were the Japanese version of the Burnout Scale, the Organizational Justice Questionnaire, the Nursing Work Empowerment Scale and the Workplace Support Scale. RESULTS: Nursing directors who were close to burnout were from smaller rather than large hospitals. Correlations were found between emotional exhaustion and interactional justice, age, resources, moral support from hospital executives, and self-reflection support from subordinates. Regarding depersonalization, correlations were found with interactional justice, age and work support from subordinates. Regarding participants' personal accomplishment, correlations were found with procedural justice, interactional justice and opportunities. CONCLUSIONS: Nursing directors of smaller hospitals tend to experience greater burnout. The impact of work environment on burnout is greater than that of facility and individual characteristics. IMPLICATIONS FOR NURSING MANAGEMENT: To mitigate burnout, hospitals should ensure high organizational justice, provide access to resources and opportunities, and encourage moral support from executives and work support from subordinates.

Frontline nurse managers' visions for their units: A qualitative study.

AIMS: To elucidate frontline nurse managers' visions of their units. BACKGROUND: Managers have the opportunity to imagine and share their visions for effective unit management. METHODS: Semi-structured interviews were conducted with 12 frontline nurse managers working at inpatient units in two hospitals between 2016 and 2017. Data were qualitatively analysed using an inductive approach, focusing on participants' intents. RESULTS: Although participants showed four types of difficulties in verbalizing visions, five categories and 18 subcategories were extracted through analysis of their descriptions about actual cases reflecting their visions. The categories were (a) provide excellent care to ensure patient recovery based on reliable knowledge and skills, (b) make efforts to broaden patients' futures, (c) create a climate for pursuing better practice, (d) all staff continuously pursue professional development and (e) provide nursing care that responds to external changes. All categories were common to all participants' images of the future and linked together to form each manager's vision. CONCLUSION: Frontline managers experienced difficulty in articulating their visions. However, through episodes, they represented images of visions. The managers' visions comprised five categories reflecting various perspectives. IMPLICATIONS FOR NURSING MANAGEMENT: Using a conceptualized vision framework, and identifying difficulties in verbalizing their images, can help managers articulate their visions.

Relationship between Unit-Level Nurses' Expectations from Nursing Assistant Roles and Individual Nursing Assistants' Information-Sharing Behaviors: A Multilevel Mediation Analysis.

PURPOSE: This study aimed to investigate the relationship between the expectations of unit-level nurses from nursing assistants (NAs), frequency of individual NAs' information-sharing behaviors with nurses, and the effect of NAs' self-perceived roles on this relationship. NAs provide patient care along with nurses, and their information-sharing behaviors with nurses may be influenced by the expectations of the nurses. METHODS: Nurses and NAs from 104 integrated community care (sub- and postacute) units were included in this Japanese cross-sectional study conducted from July to September 2018. Nurses' expectations from NAs and the NAs' self-perceived roles and information-sharing frequency were measured. Multilevel mediation analysis was performed for NAs' information-sharing behaviors, such as expressing, asking, providing linguistic responses, and providing feedback. RESULTS: Unit-level nurses' expectations from NAs were associated with the frequency of NAs' asking and responding behaviors with nurses (p < .05), mediated by the NAs' self-perceived roles. The frequency of NAs' expressing behaviors and feedback were also associated with their self-perceived roles (p < .001). CONCLUSIONS: High expectations of unit-level nurses from NAs led to better perception by NAs of their roles and led to better information-sharing behaviors. Educating nurses on NAs' roles may improve information-sharing between nurses and NAs that leads to safe and appropriate care to patients.

Relationship Between Teams' Leader-Member Exchange Characteristics and Psychological Outcomes for Nurses and Nurse Managers: A Cross-Sectional Study in Japan.

INTRODUCTION: The Leader-Member Exchange (LMX) theory, based on the social exchange theory, relates to positive psychological states among nurses. However, the influence of various LMX qualities coexisting within a team on nurses or nurse managers is still uncleared. OBJECTIVE: This study examines the relationship of nurses and nurse managers' psychological states with the average LMX and LMX dispersion among nurses in their units. METHODS: The study was conducted at two university hospitals in March 2017 using anonymous questionnaires. Nurses completed the LMX-7 scale and the subscales of job satisfaction, achievement, and growth from the Checklist on Commitments Related to Work. Nurse managers completed the subscales of management satisfaction, effectiveness, and extracting extra effort from the Multifactor Leadership Questionnaire. Both nurses and managers completed the Intention to Continue Working scale. The nurses' data were analyzed using a multilevel analysis to clarify associations between nurses' psychological states and LMX, average LMX, and LMX dispersion. Hierarchical multiple regression analysis tested to test the correlations of the psychological states of nurse managers with average LMX and LMX dispersion. RESULTS: Data from 586 nurses and 28 managers were analyzed. The LMX and average LMX of nurses were positively related to positive psychological states. Nurse managers displayed significant associations between high LMX dispersion and good psychological states. When average LMX was low, management effectiveness increased as LMX dispersion increased; when average LMX was high, management effectiveness was almost constant. CONCLUSION: The unit's LMX characteristics appear to be related to the psychological states of both nurses and nurse managers. Increasing the LMX of each nurse may lead to positive psychological states for not only that nurse but all nurses in the unit. When LMX with subordinates is low, increasing LMX with a portion of nurse managers should be a priority to improve their psychological states.

The relationship between work engagement and psychological distress of hospital nurses and the perceived communication behaviors of their nurse managers: A cross-sectional survey.

BACKGROUND: Communication between nurse managers and nurses is important for mental health of hospital nurses. OBJECTIVE: The aim of the present study was to investigate the relationship between managers' communication behaviors toward nurses, and work engagement and psychological distress among hospital nurses using a multilevel model. DESIGN: The present study was a cross-sectional questionnaire survey. SETTINGS: The participants were nurses working at three hospitals in Japan. PARTICIPANTS: A total of 906 nurses from 38 units participated in the present study. The units with small staff sizes and participants with missing entries in the questionnaire were excluded. The data for 789 nurses from 36 questionnaire survey units were analyzed. METHOD: A survey using a self-administered questionnaire was conducted. The questionnaire asked staff nurses about communication behaviors of their immediate manager and their own levels of work engagement, psychological distress, and other covariates. Three types of manager communication behaviors (i.e., direction-giving, empathetic, and meaning-making language) were assessed using the Motivating Language scale; and the scores of the respondents were averaged for each unit to calculate unit-level scores. Work engagement and psychological distress were measured using the Utrecht Work Engagement Scale and the K6 scale, respectively. The association of communication behaviors by unit-level managers with work engagement and psychological distress among nurses was analyzed using two-level hierarchical linear modeling. RESULTS: The unit-level scores for all three of the manager communication behaviors were significantly and positively associated with work engagement among nurses (p<0.05). This association was smaller and non-significant after adjusting for the psychosocial work environment. The individual levels of all three of the manager communication behaviors were also significantly and positively associated with work engagement (p<0.05). None of the three manager communication behaviors was significantly associated with psychological distress (p>0.05). CONCLUSION: Motivating language by unit-level managers might be positively associated with work engagement among hospital nurses, which is mediated through the better psychosocial work environment of the unit.