Trauma-Informed Healthcare Leadership? Evidence and opportunities from interviews with leaders during COVID-19.

BACKGROUND: COVID-19 impacted the mental health of healthcare workers, who endured pressures as they provided care during a prolonged crisis. We aimed to explore whether and how a Trauma-Informed Care (TIC) approach was reflected in qualitative perspectives from healthcare leaders of their experience during COVID-19 (2020-2021). METHODS: Semi-structured interviews with healthcare leaders from four institutions were conducted. Data analysis consisted of four stages informed by interpretative phenomenological analysis: 1) deductive coding using TIC assumptions, 2) inductive thematic analysis of coded excerpts, 3) keyword-in-context coding of full transcripts for 6 TIC principles with integration into prior inductive themes, and 4) interpretation of themes through 6 TIC principles (safety; trustworthiness and transparency; peer support; collaboration and mutuality; empowerment, voice, and choice; and awareness of cultural, historical, and gender issues). RESULTS: The actions of leaders (n = 28) that were reported as successful and supportive responses to the COVID-19 pandemic or else missed opportunities reflected core principles of Trauma-Informed Care. To promote safety, leaders reported affirmative efforts to protect staff by providing appropriate physical protection, and enhanced psychological safety by providing channels for communication about emotional well-being. To promote trustworthiness and transparency, leaders listened to their staff, shared current COVID-19 information, and increased frequency of meetings to disseminate accurate information. To promote mutual support, strategies included wellness check-ins, sharing uplifting stories, affirming common goals, articulating fears, and leading by example. Examples of empowerment included: making time and adjusting modalities for flexible communication; naming challenges outside of the hospital; and functioning as a channel for complaints. Reported missed opportunities included needing more dedicated time and space for healthcare employees to process emotions, failures in leadership managing their own anxiety, and needing better support for middle managers. Awareness of the TIC principle of cultural, historical, and gender issues was largely absent. Results informed the nascent Trauma-Informed Healthcare Leadership (TIHL) framework. CONCLUSIONS: We propose the Trauma-Informed Healthcare Leadership framework as a useful schema for action and analysis. This approach yields recommendations for healthcare leaders including creating designated spaces for emotional processing, and establishing consistent check-ins that reference personal and professional well-being.

A Mixed Methods Examination of Decision-Making During Program Exploration and Implementation in Schools.

Schools are a critical setting to promote healthy youth development through the provision of evidence-based programs (EBPs), yet preventive EBPs in schools are underutilized. The Exploration, Preparation, Implementation, Sustainment (EPIS) framework highlights numerous factors that may influence program adoption during the Exploration phase and progress monitoring during the Implementation phase. However, no research has systematically and simultaneously identified the factors that influence school administrators' decision-making during these important processes. We conducted semi-structured interviews with 24 school administrators in the Midwestern region of the U.S. to understand how they weigh various considerations that inform their adoption and progress monitoring of prevention programs. Results indicated that school administrators consider five separate factors during the adoption decision, prioritized in the following order: need for the program, school community buy-in, contextual fit, resources, and program characteristics (including the evidence-base). Further, administrators consider five indicators to monitor program performance, prioritized as follows: intervention fidelity, quantitative and qualitative data that determine if the identified need was met, school community buy-in, resource consumption, and program characteristics. Implications for prevention scientists and suggestions for future research are discussed.

Comparison of the Achieved and Expected Competence Level of New Graduate Nurses: Two Cross-Sectional Studies.

AIM: To explore and compare the self-perceived competence level of new graduate nurses with the expected competence level that nurse managers believe new graduate nurses should have in general. DESIGN: Two cross-sectional empirical studies. METHODS: Two independent cross-sectional studies were carried out in 12 tertiary hospitals in September 2020 and November 2021, respectively. Participants were 1017 new graduate nurses with less than 2 years of work experience and 306 nurse managers who completed an online survey. RESULTS: The score of self-perceived nursing competence of new graduate nurses was 74.77 ± 14.35, and the expectation of nurse managers was 74.21 ± 15.04. The values of 18 items were significantly different between the two of them (p < 0.05), and there were only three items showed higher expectations of nurse managers than the self-rated values of new graduate nurses. Results of latent profile analysis revealed that this cohort of new graduate nurses could be divided into three subgroups, named risky competent (11.1%), medium competent (46.0%) and advanced competent (42.9%). When comparing, the nurse managers' expected competence level was between the value of 'medium competent' group and 'advanced competent' group. CONCLUSIONS: Our study adopted a dual perspective comparison of nurse managers and new graduate nurses, which broke through the limitations of the previous single perspective study of new graduate nurses' nursing competence. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: This study highlights the importance of the consistency in new graduate nurses' nursing competence from the perspectives of new graduate nurses and nurse managers. IMPACT: This study showed a generally good match of actual nursing competence level of new graduate nurses and the expected level from nurse managers. While there was significant individual heterogeneity in the competence score of new graduate nurses, three subgroups were identified through the individual-centred analysis of latent profile analysis. Therefore, Nurse managers need to systematically adjust the standardized training programs and teaching methods for new graduate nurses according to the population characteristics and take precise interventions to improve nursing competence of new graduate nurses. REPORTING METHOD: We adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution.

Leaders development program by 360 degree feedback: reflection on head nurses' leadership practices.

BACKGROUND: Leadership in nursing is crucial for delivering high-quality healthcare and ensuring positive outcomes for patients, staff, and institutions. Many nurses in leadership positions lack formal training, which can compromise their effectiveness. This study aims to evaluate the effect of a leadership development program utilizing 360-degree feedback on head nurses' leadership practices. METHODS: A true-experimental design was employed in three healthcare institutions. The study involved 80 head nurses (40 intervention, 40 control), 240 staff nurses, and 29 supervisors. The intervention group participated in a six-week leadership development program using 360-degree feedback. Data were collected pre- and post-intervention using the Leadership Development and 360-Degree Feedback Knowledge Questionnaire and the Leadership Practices Inventory (LPI). RESULTS: The intervention group showed significant improvements in leadership knowledge and practices across all dimensions. Knowledge scores increased from 25.1 ± 8.8 to 93.0 ± 5.1 post-intervention, maintaining at 83.2 ± 7.1 at follow-up. Self-assessed leadership scores improved from 88.1 ± 6.0 to 97.5 ± 2.7, and 98.5 ± 2.0 at follow-up. Supervisor and staff assessments also showed substantial increases. Multiple linear regression analyses confirmed the strong positive impact of the intervention on leadership outcomes. CONCLUSION: The leadership development program using 360-degree feedback significantly enhanced head nurses' leadership knowledge and practices. The results suggest that such programs can improve leadership capabilities in healthcare settings, leading to better patient care and organizational performance. Future research should address group homogeneity and explore long-term impacts on patient outcomes.

Relegated to the Sidelines: A Qualitative Inquiry of Gatekeepers' Perspectives and Values of Physical Education for Disabled Children.

Several institutional aspects within the U.S. public school system impede the delivery of adapted physical education (APE) services to disabled children, including a lack of understanding and prioritization of these services by the special education team and a lack of qualified APE professionals to deliver these services. Thus, we conducted a qualitative inquiry grounded in a critical-ableism perspective to explore special education gatekeepers' experiences and perspectives of APE. Gatekeepers included parents, physical educators, and school administrators. Using a reflexive thematic analysis, we developed four interrelated themes: (a) disregard, negative, and charity mindsets toward disability; (b) systemic challenges in valuing and prioritizing APE; (c) presence as inclusion: (un)intentional marginalization in physical education; and (d) physical education for my child was a nightmare. These findings illustrate the complexities around the provision of physical education and APE to disabled children.

Professional Standards for Specialist Medical Administrators: Over-the-top Downunder?

In Australia, there are only two publicly reported disciplinary cases against specialist medical administrators. In the most recent decision of Medical Board of Australia v Gruner, the Victorian Civil and Administrative Tribunal confirmed that specialist medical administrators owe patients and the public the same professional obligations as medical practitioners with direct patient contact. More controversially, the Tribunal also held that medical administrators have a professional obligation only to accept roles with clear position descriptions that afford them sufficient time and resources to ensure the safe delivery of health services. We argue that this imposes unrealistic expectations on medical administrators engaged by rural, regional, or private health services that already struggle to attract and retain specialist medical expertise. This may exacerbate existing health inequalities by disincentivising specialist medical administrators from seeking fractional appointments that assist under-funded areas of workforce shortage.

The effect of nursing services management efficiency on nurses' professional commitment: A cross-sectional study.

AIM: To determine the effect of nurses' perceptions of the effectiveness of nursing services management on their professional commitment. BACKGROUND: Effective healthcare management is crucial for improving patient care quality. Understanding nurses' perspectives on nursing services management and their commitment provides valuable insights for management strategies, improving well-being and healthcare outcomes. METHODS: This descriptive, cross-sectional, and correlational study involved 265 state hospital nurses. Data were collected between November 2020 and June 2021 using descriptive characteristic form, Nursing Services Management Effectiveness Scale, and Nursing Professional Commitment Scale. This study adhered to the STROBE checklist. RESULTS: Nurses' views on the effectiveness of nursing services management and their professional commitment were found to be influenced by age, professional experience, and institutional positions. The average scores for nursing services management perception and professional commitment were 2.65 ± 0.72 and 66.63 ± 12.40, respectively. A statistically significant positive and low-level correlation was observed between nurses' nursing services management perception and professional commitment scores. Nurses' positive perception of nursing services management explains 17.1% of the variance in nurses' professional commitment levels. DISCUSSION AND CONCLUSION: This study outlines how nurses' views on effective nursing services management can enhance their professional commitment. Managers should contribute to increase nursing services management efficacy by eliminating deficiencies in management practices to make their institutions successful and to increase their employees' professional commitment level. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Assuming positive perceptions of nursing management increase nurses' professional commitment, developing policies to boost organizational support is vital. Managers should focus on improving nursing services management to increase organizational success, increase nurses' professional commitment, and achieve the best health outcomes by eliminating management deficiencies.

Nurse manager support of graduate nurse development of work readiness: An integrative review.

AIM: To systematically review relevant literature to identify how Nurse Managers support graduate nurse work readiness. BACKGROUND: Graduate nurses face many difficulties when transitioning from student to qualified nurse. Nurse managers establish workplace culture through leadership styles, yet little is known about how they can best support graduate nurses to transition to professional practice in the acute hospital environment. DESIGN: A five-step, systematic integrative review reported in accordance with the PRISMA 2020 Checklist. METHODS: The steps of the review method included (1) problem identification, (2) literature search, (3) data evaluation and quality appraisal, (4) data extraction and analysis and (5) presentation. Analysis used the Framework method and was guided by theory of graduate nurse work readiness and the Theoretical Domains Framework. DATA SOURCES: MEDLINE COMPLETE, Cumulative Index to Nursing and Allied Health (CINAHL) Complete, ERIC and PSYCINFO searched in December 2020. RESULTS: Studies eligible for inclusion (N = 40) represented research from 15 countries; most (67.5%, n = 27) used a qualitative design, 22.5% (n = 9) were quantitative and 10% (n = 4) used mixed methods. Three themes related to the social constructs and local area work environments influenced by nurse managers emerged: supporting people, supportive environment and supporting learning. CONCLUSION: The review identified a lack of robust evidence about the effectiveness of specific nurse manager-led strategies to support development of graduate work readiness. However, the findings provide a framework to guide nurse managers in supporting graduate nurses and provide a foundation for further research about nurse manager roles in developing graduate work readiness. IMPLICATIONS FOR THE PROFESSION OR PATIENT CARE: Previous research has described poor transition of graduate nurses as responsible for increased workplace errors, decreased job satisfaction and high rates of attrition. Exploring the role of nurse managers in graduate nurse transition is essential to ensure quality patient care and a sustainable workforce. IMPACT: What Problem Did the Study Address? Graduate nurses face many difficulties when transitioning from student to qualified nurse. Nurse managers establish workplace culture through leadership styles, yet little is known about how they can best support graduate nurses to transition to professional practice in the acute hospital environment. What Were the Main Findings? High rates of attrition are attributed to poor support during the initial transition phase of graduate nurses. Nurse managers can impact transition by providing a supportive environment, support learning and by providing a team of supportive people. Where and on whom will the research have an impact? The research will have an impact on graduate nurses and nurse managers. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution (integrative review exploring existing literature). This integrative review was registered with PROSPERO (CRD42021213142).

Psychometric Properties of Grief Traits and State Scale for Nurses to Measure Levels of Grief.

Frequent exposure to patient deaths prompts nurses to experience grief. Unresolved grief leads to harmful consequences of nurses' mental health and quality of nursing care. A cross-sectional study using an online survey was conducted to determine the psychometric properties of the Grief traits and State Scale for Nurses. Exploratory factor analysis revealed two factors measuring the level of nurses' grief traits (Cronbach's alpha: 0.84) and two factors in grief state (Cronbach's alpha: 0.86). Nurses' feelings of unable to provide good care were associated with a higher risk of grief (odds ratio (OR): 4.30, 95% confidence interval (CI): 1.45-12.75), uncomfortable feeling toward deaths (OR: 11.29, 95%CI: 1.48-85.91), and emotional exhaustion (OR: 7.12, 95%CI: 1.63-30.99). Results indicated that the scale was reliable in determining the levels of their grief. Nurse managers can use the scale to identify their nurses' levels of grief, creating opportunities to influence the resolution of the grief experiences.

Early Childhood Administrator Perspectives About Preschool Inclusion: A Qualitative Interview Study.

This qualitative phenomenological study utilized structured interviews with 23 preschool administrators to explore their beliefs about preschool inclusion and needed resources for providing high-quality preschool inclusion. Themes emerged regarding administrators' beliefs about inclusion, including divergent understandings of inclusion as something that is either for all or for some children. Administrators placed a high value on families' preferences regarding preschool inclusion and at times focused their descriptions of inclusion on logistical aspects of placements and funding. Administrators said they needed additional money and personnel resources to provide high-quality preschool inclusion. Study findings are discussed in the context of the paucity of research on administrator perspectives regarding inclusion and implications for supporting administrators who play a key role in implementing preschool inclusion. Supplementary Information: The online version contains supplementary material available at 10.1007/s10643-023-01448-0.

Perceptions of Hospital-at-Home Among Stakeholders: a Meta-synthesis.

BACKGROUND: Hospital-at-home (HaH) provides acute healthcare in patients' homes as an alternative to traditional hospital inpatient care. HaH has been shown to improve clinical outcomes, increase patient satisfaction, and reduce hospitalization costs. Despite its effectiveness, the uptake of HaH remains slow and little is known about factors that impact the quality and transferability of HaH. This review aimed to qualitatively synthesize existing literature to examine the perspectives of stakeholders to identify areas of improvement in this model of care. METHODOLOGY: Six electronic databases (Cumulative Index of Nursing and Allied Health Literature, PubMed, Embase, PsychINFO, Scopus, and Mednar) were searched from inception date until 3 February 2021. The included studies were assessed for quality using the Critical Appraisal Skills Program tool. This review was registered on the International Prospective Register of Systematic Reviews. The meta-synthesis was completed according to Sandelowski and Barroso's guidelines. RESULTS: Sixteen articles met the inclusion criteria. The overarching synthesized theme was "the intricacies of developing HaH," and the four main themes were (1) factors influencing patient selection, (2) advantages of HaH, (3) challenges of HaH, and (4) enablers for HaH development. CONCLUSION: Overall, high levels of satisfaction were expressed by various stakeholders. Continuity of care remains an important factor for patient-centeredness in HaH. Caregivers should be involved in the decision-making process and supported throughout the HaH duration to prevent caregiver burnout. Collaboration and coordination among healthcare professionals are vital and can be strengthened through training and technological advancements of remote patient monitoring. Institutional and organizational support for stakeholders may make HaH a viable solution to modern healthcare challenges.

Developmental stages associated with organizational learning in hospitals: An instrument development study.

AIM: To develop and test the Organizational Learning Instrument: Development Stages instrument, a measure of hospital units' readiness to engage in organizational learning. DESIGN: Cognitive interviewing, expert review and a quantitative, cross-sectional survey. METHODS: Item development was informed by previous research on organizational learning. Content validity was assessed and strengthened using cycles of cognitive interviewing and expert review. The resulting instrument was distributed by email to all nurses providing direct patient care in inpatient units in 11 Magnet® hospitals. Data were collected in 2018. Intraclass correlations, using hospital unit as the grouping variable, indicated the need to use multilevel methods to analyse the survey data. Thus, coefficient omega and multilevel confirmatory factor analysis were used to estimate the instrument's reliability and construct validity, respectively. RESULTS: The Organizational Learning Instrument: Development Stages is a 35-item survey comprised of four scales: Identity & Ownership, Team & Respect, Accountability & Support and Reliability & Sustainability. The expert review yielded scale-level content validity scores from 0.90 to 1.0 and item-level content validity scores from 0.86 to 1.0. Survey participants were 1212 nurses, working in 99 inpatient units, across 11 Magnet® hospitals. Intraclass correlations ranged from 0.113 to 0.158. Coefficient omega reliability for the four scales was 0.981-0.993. Standardized factor loadings for the 35 items were 0.699-0.961, with acceptable model fit statistics (comparative fit index = 0.980, Tucker-Lewis Fit Index = 0.979, and root mean squared error of approximation = 0.060). CONCLUSIONS: These results indicate the instrument meets or exceeds generally accepted criteria for content validity, reliability and construct validity instrument, and is suitable for further use and testing. IMPACT: Nurse administrators, managers and researchers now have a valid, reliable instrument to better foster and study organizational learning in hospital units. Advances in organizational learning are expected to improve a variety of patient, staff and organizational outcomes in hospital units.

Occupational health intervention for work-life balance and burnout management among teachers in rural communities.

This study examined the efficacy of the occupational health model of rational emotive behavioral on work-life balance (WLB) and burnout management (BOM) among public school teachers. The study was a pretest-posttest randomized control group design. The participants were 141 teachers in rural communities in Enugu state Nigeria drawn with emphasis on inclusion criteria. Two instruments were used for the data. Data were analyzed using repeated measure analysis of variance. The result showed that rational emotive occupational health coaching (REOHC) led to a significant increase in the management of WLB and burnout among teachers compared to their counterparts in the control group. At the follow-up stage, REOHC proved to be effective over a period of 3 months. REOHC is a therapeutic intervention strategy that is valid and reliable over time in the management of WLB and BOM among teachers. The researchers are optimistic that the extension of REOHC to other related social and psychological-based self-defeating belief by social workers, psychologists, counselors, and employers of labors can enhance their productivity and emotionality in the home and workplace.

Perceived importance of competencies by nurse managers at all levels: A cross-sectional study.

AIM: To explore nurse managers' perceived importance of competencies for their current job at different levels and the associated factors. BACKGROUND: Little work to date has explored the perceived importance of competencies in nursing leadership and management or considered the related factors in the Taiwan healthcare context. METHODS: Data collected from a previous large study comprising a cross-sectional web-based survey were analysed. Kruskal-Wallis test, two-sided Fisher exact test and multiple linear regression models were used for statistics analysis. RESULTS: The mix of three skills in Katz's model indicated that human skills were equally important in all three managerial levels. Of the 23 competencies, effective communication and political astuteness were rated by nurse managers at all levels as the highest-scored (M = 4.88, SD = 0.34) and lowest-scored competency (M = 3.92, SD = 0.78), respectively. Managerial level was a significant predictor of the perceived importance of competency. CONCLUSIONS: Relationship-based competencies were prominent in the perceived importance of competencies among nurse managers at different levels. Managerial hierarchy influences the relative importance of the different managerial competencies. IMPLICATIONS FOR NURSING MANAGEMENT: This study's results provide the talent strategy framework required for improving the competencies of nurse managers at all levels.

Nurses' ethical leadership and related outcome variables: Systematic review and meta-analysis.

AIM: To investigate the outcomes and the effect sizes of ethical leadership in nursing practice. BACKGROUND: Many meta-analysis of ethical leadership have been conducted in other fields, but there are none for the effects of ethical leadership of nurse leaders and should be investigated. EVALUATION: For a systematic literature review, we searched PubMed, EMBASE, the Cochrane Library, CINAHL, OVID, Web of Science and Korean databases for studies published in Korean or English. We used Comprehensive Meta-Analysis (CMA) 2.0 and R 3.6.2 for the meta-analysis. KEY ISSUES: We divided the outcomes of ethical leadership into three categories and investigated the effect sizes: subordinates' perceptions of their leaders (ES = 0.65), subordinates' ethical behaviours (ES = 0.04) and job or organisational outcomes (ES = 0.45). In addition, we identified 14 outcome variables, and transformational leadership showed the greatest effect size (ES = 0.77) among them. CONCLUSION: This study confirmed the positive effects of ethical nursing leadership on individual nurses' perceptions about their leaders, their jobs and organisations. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing organisations and nurse administrators should make efforts to highlight ethical leadership of nurse leaders to improve outcomes of organisational performance including individual nurses' perceptions about their leaders, their jobs and organisations.

The association between hospital nursing resource profiles and nurse and patient outcomes.

AIMS: To identify and describe profiles of nursing resources and compare nurse and patient outcomes among the identified nursing resource profiles. BACKGROUND: Research linking nurse education, staffing, and the work environment treats these nursing resources as separate variables. Individual hospitals exhibit distinct profiles of these resources. METHODS: This cross-sectional secondary analysis used 2006 data from 692 hospitals in four states. Latent class mixture modelling was used to identify resource profiles. Regression models estimated the associations among the profiles and outcomes. RESULTS: Three profiles were identified (better, mixed and poor) according to their nursing resource levels. Hospitals with poor profiles were disproportionately mid-sized, for-profit, and had lower technology capability. Nurse job outcomes, patient mortality and care experiences were significantly improved in hospitals with better resource profiles. CONCLUSIONS: Hospitals exhibit distinct profiles of nursing resources that reflect investments into nursing. Nurse and patient outcomes and patients' experiences are improved in hospitals with better nursing resource profiles. This finding is consistent with the literature that has examined these resources independently. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers can identify their nursing resource profile and the associated outcomes. Our results show the advantages of improving one's hospital nursing resource profile, motivating managers to make an informed decision regarding investments in nursing resources.

Perspectives of nursing directors on emergency nurse deployment during the pandemic of COVID-19: A nationwide cross-sectional survey in mainland China.

AIMS: The aim of this study is to investigate the situation and perceptions of nursing directors about emergency nursing staff deployment in designated hospitals during the pandemic of COVID-19 in mainland China. BACKGROUND: The pandemic of COVID-19 has significantly depleted health care resources, leading to increased burden of nursing care and staffing and exacerbating the crisis in health care facilities. Currently, how to effectively plan and schedule nursing staffing in the pandemic still remains unknown. METHODS: From 14 July 2020 to 8 September 2020, 62 nursing directors of designated hospitals in mainland China were invited to participate in a cross-sectional online survey for their perceptions of nursing human-resource allocation during the pandemic of COVID-19. RESULTS: A total of 55 valid questionnaires were collected, showing that 96.36% of the hospitals had emergency nursing organizations and management systems during the pandemic, 96.36% had well-established scheduling principles for nursing human resources and 54.55% of hospitals had human-resource scheduling platforms. All the hospitals had trained emergency nursing staff in infection control (55, 100%), work process (51, 92.73%) and emergency skills (50, 90.91%). Most of the participants were satisfied with the nursing staffing deployments at their institutions (52, 94.55%). However, more than two thirds of them believed that their human-resource deployment plans need further improvements (39, 70.91%). CONCLUSIONS: Most of the designated hospitals investigated had established emergency nursing organizations, and management systems, and related regulations for the epidemic. However, the contents mentioned above still need to be further standardized. IMPLICATIONS FOR NURSING MANAGEMENT: The surge of patients in the epidemic was considerable challenge for the emergency capacity of hospitals. In the future, we should pay more attention to the following aspects: building emergency nursing staffing platforms, increasing emergency human-resource reserves, establishing reliable communication channels for emergency response teams, improving the rules and regulations of emergency human-resource management, offering more training and drills for emergency-related knowledge and skills and giving more focus on bio-psycho-social wellbeing of nurses.

Does empowerment enhance nurses' organizational commitment?

AIM: We examined whether psychological empowerment was significantly associated with the organizational commitment of licensed practical nurses. BACKGROUND: Healthcare organizations face unprecedented staffing challenges. This study provides insight into potential ways to ameliorate these issues. METHODS: In early 2010, we distributed a 45-item questionnaire, based on established measures of psychological empowerment and organizational commitment, to the entire population of active, full-time licensed practical nurses throughout a Midwestern US state. Our sample consisted of 1165 respondents. RESULTS: The results of our data analysis suggest that even after controlling for a range of potentially confounding variables, three subscales (meaning, self-determination and impact) were positively and associated with organizational commitment. However, one subscale (competence) was negatively related to the outcome. CONCLUSIONS: The psychological empowerment dimensions of impact, meaning and self-determination are associated with increased organizational commitment among licensed practical nurses. IMPLICATIONS FOR NURSING MANAGEMENT: Considering the profound staffing challenges facing the nursing profession-exacerbated by the current global pandemic and retirements-our findings provide nurse administrators with critical information to use in stemming the wave of nurses leaving the profession.

The effectiveness of the Ethics Quarter intervention on the ethical activity profile of nurse managers: A randomized controlled trial.

AIM: To test the effectiveness of a new ethics educational e-learning intervention, Ethics Quarter, in supporting nurse managers' ethical activity profile. BACKGROUND: Health care organisations need evidence-based ethics interventions to support nurse managers' ethical activity profile. METHODS: A parallel-group, individually randomized controlled trial was conducted in 2020. Finnish nurse managers nationwide [members of the Union of Health and Social Care Professionals in Finland (Tehy) trade union] were randomly allocated to intervention (n = 169) or control group (n = 172). The intervention group participated in the Ethics Quarter comprising twelve 15-min evidence-based educational 'quarters' spread over 6 weeks. The control group had standard organisational ethics structures. The primary and secondary outcomes were ethical activity profile and ethics knowledge, respectively. The Consolidated Standards of Reporting Trials (CONSORT) statement for study design and reporting was adopted. RESULTS: Ethical activity profile showed statistically significant differences in mean changes between the groups from baseline to 10 weeks: all five dimensions were statistically significantly higher in the intervention group compared with the control group (p = <.0001). CONCLUSION: The Ethics Quarter was effective in increasing nurse managers' ethical activity profile. IMPLICATIONS FOR NURSING MANAGEMENT: Applying this ethics educational e-learning intervention would benefit nursing management education and health care organisations. TRIAL REGISTRATION: clinicaltrials.gov: NCT04234503.

Emergency Nurse Consensus on Most Effective and Accessible Support Strategies During COVID-19: A Delphi Study.

INTRODUCTION: Emergency nurses face significant risk for stress-related complications while working during the COVID-19 pandemic. However, there is limited empirical evidence on the effectiveness and accessibility of support strategies for nurses in this novel situation. Expert consensus may help fill this knowledge gap. Therefore, the study objective was to gain expert consensus from emergency nurses on the most effective and accessible strategies during the COVID-19 pandemic. METHODS: This 2-round Delphi study recruited an online expert panel from emergency nurses practicing during the COVID-19 pandemic within a single Mountain West health system spanning 9 urban and rural emergency departments. Over 10 weeks in the summer of 2021, participants completed 2 sequential surveys to rate and rank employee-led and employer-led support strategies collated from a literature review. RESULTS: Of 327 recruitment emails sent, 28 nurses joined the expert panel. Emergency nurses reached a consensus on preference for employee-led self-care activities, including enhancing social well-being and strengthening emotional well-being. None of the employer-led strategies reached group consensus regarding high effectiveness, accessibility, and the likelihood of participation. Additionally, emergency nurses favored in-person support strategies over other delivery methods. DISCUSSION: Numerous studies have explored the impact of the COVID-19 pandemic on health care workers. Although experts and researchers seek to determine the best support strategies, this study highlights how emergency nurses wish to be supported. Employers can tailor support strategies for maximum effect by understanding health care worker perceptions and preferences.