Exploring nurses' emotional reactions to and reporting of patient-on-nurse workplace violence: A mixed-methods study.

BACKGROUND: Workplace violence, including violent, intimidating, and disruptive acts, commonly occurs in healthcare settings. Type 2 workplace violence in nursing refers to patient/visitor behaviors directed toward clinicians, contributing to physical and psychological harm. Nurse victims often do not report these events to employers or law enforcement, making it challenging to address workplace violence. OBJECTIVES: Our research examined nurse reactions to Type 2 workplace violence by identifying what behaviors they perceived as aggressive and reportable. Specific aims included: 1) developing and testing video vignettes to portray realistic patient aggression scenarios; 2) identifying nurse understandings of aggressive events that prompt affective reactions, and; 3) examining clinical characteristics related to the nurse victim's likelihood to report. DESIGN: Through a sequential mixed-methods design, we qualitatively developed novel video vignettes portraying Type 2 workplace violence to experimentally examine how nurses interpreted them within a quantitative repeated measures survey. METHODS: Two expert nurse research panels (n = 10) created five vignettes, from which nurses (n = 282) completed a survey with 1382 unique responses. Analyses included descriptive statistics and repeated measures ANOVA/regression models. RESULTS: Video vignettes realistically portrayed workplace violence events, eliciting negative emotional responses among nurses that increased in magnitude with statistical significance as the level of displayed aggression escalated. Statistically significant factors influencing nurse reporting of workplace violence included; 1) the level of aggression displayed by the patient; 2) the level of harm received by the nurse; 3) whether the nurse felt the patient's actions were intentional, and; 4) the nurse's perceived frequency of exposure to workplace violence. CONCLUSIONS: Results suggested that nurse victims of Type 2 workplace violence experience depression, anger, fear, and anxiety, which may contribute to long-term mental health consequences. Findings also identified factors related to nurse reporting behaviors, which may help mitigate workplace violence in healthcare settings by informing research and promoting workplace practices that encourage reporting and safety. REGISTRATION: Not registered. TWEETABLE ABSTRACT: Nurse reactions to workplace violence: Video vignettes reveal escalating aggression's impact on reporting. #EndNurseAbuse #WorkplaceViolence.

Why nurses do not report patient aggression: A review and appraisal of the literature.

AIM: To establish the current state of the science about why nurses do or do not report being the victim of patient aggression, a form of type II workplace violence. This aim includes identifying and analysing current gaps in the literature. BACKGROUND: It is increasingly more common for patients to instigate aggressive acts towards nurses, leading to significant consequences. Nursing victims often do not report acts of patient aggression to others, making it difficult for health care leaders and researchers to address this challenge. EVALUATION: The review process involved searching five databases, using the PRISMA framework to reduce 355 records to 65 sources for review and synthesis. KEY ISSUES: The findings of this review highlight key takeaways about why nursing victims do not report episodes of patient aggression, which include their fears, attitudes and abilities related to reporting; and their perspective of the patient aggression event. Workplace environments are central to most of these factors, emphasizing the importance of nursing and other health care leaders to put systems in place that promote nurse reporting behaviours. CONCLUSIONS: Patient aggression is a widespread problem with severe consequences. Review findings can inform future research while having practical relevance for health care leaders. IMPLICATIONS FOR NURSING MANAGEMENT: Health care leaders need to consider how workplace structures, practices, and cultures can encourage or stifle nurse reporting behaviours. By understanding nurse reporting behaviours, processes can be developed to promote nursing victim reporting and deter patient aggression.

Creating a National Standard for Prelicensure Clinical Evaluation in Nursing.

BACKGROUND: Measuring clinical outcomes in prelicensure students is desired by key stakeholders but is fraught with challenges. There are currently no standardized, psychometrically validated clinical-outcome measures available for prelicensure nursing programs, requiring each program to design its own measures. METHOD: We conducted a review of the potential antecedents of this gap, as well as models for standardized clinical outcome measures and recommendations from within health-professions education. RESULTS: There are benefits to pursuing a standardized clinical outcome tool, including an improved student learning experience and unifying our communication regarding graduate nurse preparation to valued stakeholders. CONCLUSION: Nursing education has a unique opportunity to emulate our colleagues in medicine and pharmacy by working at the national level to create a standardized tool using current psychometric methods for development and validation. [J Nurs Educ. 2021;60(12):686-689.].

Identifying optimal labor and delivery nurse staffing: The case of cesarean births and nursing hours.

BACKGROUND: Numerous studies have identified a relationship between nurse staffing and adverse patient outcomes in medical / surgical patient populations. However, little is known about the impact of labor and delivery (L&D) nurse staffing and adverse birth outcomes, such as unintended cesarean delivery, in low-risk term-gestation women. PURPOSE: We examined nurse staffing patterns on the likelihood of cesarean sections (C-sections) among low- risk, full gestation births and provided a testing framework to distinguish optimal from ineffective levels of nurse staffing. METHODS: This retrospective descriptive study used hours of productive nursing time per delivery as the treatment variable to determine direct nursing time per delivery and its impact on the likelihood of a C-section. For comparisons, we also assessed the likelihood of augmentations and of inductions, as well as the number of neonatal intensive care unit (NICU) hours per birth. We limited our sample to those births between 37 and 42 weeks of gestation. Two complimentary models (the quadratic and piecewise regressions) distinguishing optimal staffing patterns from ineffective staffing patterns were developed. The study was implemented in eleven hospitals that are part of a large, integrated healthcare system in the Southwest. DISCUSSION: While a simple linear regression of the likelihood of a C-section on nursing hours per delivery indicated no statistically distinguishable effect, our 'optimal staffing' model indicated that nurse staffing hours employed by using a large sample of hospitals were actually minimizing C-sections (robustness checks are provided using similar model comparisons for the likelihood of augmentation and induction, and NICU hours). Where the optimal staffing models did not appear to be effective for augmentations, inductions, and NICU hours, we found significant differences between facilities (i.e., significant fixed effects for hospitals). In all specifications, we also controlled for weeks of gestation, race, sex of the child, and mother's age.

Can I relate? A review and guide for nurse managers in leading generations.

AIMS: The purpose of this review is to help the nurse leader develop an understanding of the five generations currently in the health care workforce by providing defining characteristics, general behaviours, and strategies for the nurse manager to employ for each generational cohort. BACKGROUND: Generations are groups of people born during the same 15-20 year time period who share similar experiences before adulthood, which shape long-term behaviours. Key descriptors and characteristics are provided. EVALUATION: The current generational cohorts in the health care workforce are Traditionalists (born between 1922 and 1945), baby boomers (born between 1946 and 1964), Generation X (born between 1965 and 1979), millennials (born between 1980 and 1995), and Generation Z (born after 1995). KEY ISSUES: Health care teams often comprise members of three or more generations. Intergenerational differences in team members can result in challenges; however, different perspectives provided by multiple generations can be used advantageously to strengthen the team's efficiency and outcomes. CONCLUSIONS: There are strengths in each generation. Key differences can be harnessed to build stronger teams through comprehensive communication strategies, customized reward systems, and workplace flexibility. Examples are provided for each area. IMPLICATIONS: Managers can use intergenerational differences to create a rich environment that bridges generational differences and fosters workforce cohesion.

Nursing Gender Pay Differentials in the New Millennium.

BACKGROUND: The gender pay gap in the United States is an ongoing issue, affecting women in nearly all occupations. Jobs traditionally associated with men tend to pay better than traditionally female-dominated jobs, and there is evidence to suggest within-occupation gender pay differences as well. PURPOSE: We compared and contrasted gender wage disparities for registered nurses (RNs), relative to gender wage disparities for another female-dominated occupation, teachers, while controlling for sociodemographic factors. METHODS: Using data in the American Community Survey, we analyzed the largest U.S. random representative sample of self-identified RNs and primary or secondary school teachers from 2000 to 2013 using fixed-effects regression analysis. RESULTS: There is greater disparity between nurse pay by gender than in teacher pay by gender. In addition, the net return in wages for additional education is higher for school teachers (21.7%) than for RNs (4.7%). CONCLUSIONS: Findings support preferential wages for men in nursing, more so than for men in teaching. CLINICAL RELEVANCE: The substantial gender disparities are an indirect measure of the misallocation of resources in effective patient care.

Evaluating the Implementation of an Interdisciplinary Evidence-Based Practice Educational Program in a Large Academic Medical Center.

The purpose of this study was to create a system-wide education program in a large academic medical center to increase exposure and understanding of the evidence-based practice (EBP) process with multidisciplinary healthcare professionals. We also hoped to increase their confidence in utilizing and implementing EBP at the bedside. Although our approach to educating professional staff on EBP provided initial benefits, holding the gains over a 1-year period proved to be difficult.

Employment and Wage Disparities for Nurses With Activity Limitations.

PURPOSE: No studies quantify the labor market disparities between nurses with and without activity difficulties (physical impairment or disability). We explore disparate treatment of nurses with activity difficulties at three margins of the labor market: the ability to get a job, the relative wage rate offered once a nurse has a job, and the annual hours of work given that wage rate. DESIGN: Key variables from the American Community Survey (ACS) were analyzed, including basic demographic information, wages, hours of work, and employment status of registered nurses from 2006 to 2014. FINDINGS: Although there is relatively little disparity in hourly wages, there is enormous disparity in the disabled's employment and hours of work opportunities, and hence a moderate amount of disparity in annual wages. CONCLUSIONS: This has significant implications for the nursing labor force, particularly as the nursing workforce continues to age and physical limitations or disabilities increase by 15-fold from 25 to 65 years of age. CLINICAL RELEVANCE: Physical or psychological difficulties increase sharply over the course of a nurse's career, and employers must heighten efforts to facilitate an aging workforce and provide appropriate job accommodations for nurses with activity limitations.

Exploring the Psychosocial Predictors of Gestational Diabetes and Birth Weight.

OBJECTIVE: To determine the best sociodemographic and behavioral predictors for gestational diabetes mellitus (GDM) and birth weight (BW) and whether stress, depression, or abuse influences GDM and BW after controlling for sociodemographic variables. DESIGN: Retrospective correlational. SETTING: Utah Pregnancy Risk Monitoring System and birth certificate data. PARTICIPANTS: We analyzed data from the birth certificates of 4,682 women with live births between 2009 and 2011 in Utah. During that time, a total of 143,373 live births occurred in the state. Data were predominantly from non-Hispanic White, married, or partnered women with average age of 27.5 years and average body mass index (BMI) of 25.1. METHODS: Stress, cumulative depression, and abuse were operationalized based on previous analysis, and control and covariate data (e.g., age, BMI, race, ethnicity, education, marital status) were collected. Bivariate analysis was used to identify associations between variables, and a hierarchical stepwise logistical regression was conducted to identify best predictors of GDM and BW. RESULTS: We did not find that cumulative depression, stress, or abuse was a predictor of GDM, and only cumulative stress was a predictor of BW. More incidences of GDM were observed in women who were poor, older, less educated, non-White, obese, or experienced depression during pregnancy. CONCLUSION: Unlike depression or abuse, stress is often overlooked by providers. This finding represents an unmet opportunity for nurses to screen for and assist women with stressors to positively affect birth weight.

Bladder Management With Epidural Anesthesia During Labor: A Randomized Controlled Trial.

PURPOSE: Many labor nurses routinely include continuous urinary catheterization (CC) as part of their standard care for women who receive intrapartum epidural anesthesia, to prevent urinary retention, thought to delay fetal descent. Recent studies question use of CCs during labor, as they may predispose patients to urinary tract infections (UTIs), even though the catheters are in place for a relatively short period of time. The objective of this study was to determine the influence of CCs versus intermittent catheters (ICs) (only as needed) on the duration of second stage of labor and the incidence of postpartum UTIs. STUDY DESIGN AND METHODS: Randomized controlled trial. English-speaking low-risk nulliparous women ≥37 weeks gestation with a single fetus in a vertex presentation who requested an epidural were eligible for participation. Prior to epidural placement, cervical status was documented, women were encouraged to void, and then women were randomized to receive either CC or IC as the method for urinary bladder management for the duration of the first stage of labor. Final sample size included 123 participants; 55 in the CC group and 68 in the IC group. RESULTS: No differences were noted in length of second stage labor, and the overall incidence of UTIs in both groups was low. There was a significantly increased likelihood of cesarean birth in women who had CC (P < .01) when compared to women who had IC. The overall cesarean rate in the CC group was 27.3%, versus 10.3% in the IC group. CLINICAL IMPLICATIONS: Intermittent catheterization only as needed appears to be best practice for bladder management for laboring women with an epidural. There was a significantly higher rate of cesarean birth among women in the CC group. The relationship between route of birth and use of continuous indwelling urinary catheters for women in labor with epidurals for pain relief needs more study.

Horizontal hostility: a threat to patient safety.

OBJECTIVE: The objective of this study was to determine the perceived level of horizontal hostility (HH) in a 220-bed acute care community hospital and whether the threat of or experience with HH influenced nurse behaviors directly related to patient safety. BACKGROUND: While the acknowledgement and presence of HH in nursing are gaining prominence, little is known about how a nurse's experience with HH directly influences his/her actions with patients under their care, even when the nurse realizes these actions may not be in the patient's best interest. METHODS: We used a 28-item survey tool aimed at determining the level of perceived HH in an acute care Magnet-aspiring hospital in the Southwest and then asked about nurses' actions as a result of that experience. Almost 500 nurses were surveyed over a 2-month period in 2011. RESULTS: Of the nurses who had personally experienced HH, a high number reported performing interventions or actions that could compromise patient care and/or safety, including (a) failing to clarify an unreadable order, (b) lifting or ambulating heavy or debilitated patients without assistance rather than asking for help, (c) using an unfamiliar piece of equipment without asking for clarification, and (d) carrying out an order that the nurse did not believe was in the best interest of the patient, among other behaviors. CONCLUSION: The presence of HH has clear implications for patient safety. Recommendations for addressing and managing HH are provided and geared to the hospital leadership level.

Identifying and applying a targeted evidence-based practice change in the maternal/child health inpatient setting.

As the literature on implementation research continues to expand, it's important to address the unique aspects and challenges of research dissemination and implementation in maternal/child health settings. This article describes a nurse-initiated evidence-based practice (EBP) study on urinary catheterization at a labor and delivery unit in the southwestern United States. It describes successful strategies for implementing EBP, as well as barriers encountered, and provides recommendations for the facilitation of EBP in the maternal/child inpatient setting.

A modified measure of health care disparities applied to birth weight disparities and subsequent mortality.

We describe how a modified Gini index serves as an improved method of estimating health care disparities. The method, although general, is applied to an example of birth weight disparities and to their effect on subsequent mortality. The method provides the between-group results obtainable from current methods (i.e. how Hispanics generally fare relative to non-Hispanic Whites) but adds measures of within-group disparities (i.e. which specific Hispanics experience the greatest disparate treatment). Our application to birth weights and receipt of prenatal care, which may provide an upper bound because of omitted variables, shows that the time-of-birth disparities are associated with increased infant mortality within the first year of life.

Ethnicity and newborn outcomes: the case of African American women.

PURPOSE: Although previous studies have confirmed the relationship between socioeconomic status, ethnicity, education, and occupation on birth outcomes, less is known about the relationship of providers influence or hospital characteristics on birth outcomes for minority women. It is not well understood whether hospital or physician characteristics exert an equal or greater affect compared with maternal sociodemographic factors, particularly for Black childbearing women known to be at particular risk for adverse birth outcomes. DESIGN: This retrospective descriptive study sought to determine whether variation in neonatal birth outcomes for Black women was attributable to hospital characteristics, physician influence, or patient sociodemographics. METHODS: Fixed and random effects were conducted to empirically determine the relative importance of hospital, physician, and patient characteristics (partitioning the variation of differences in birth outcome to each component) using a large administrative dataset. FINDINGS: Considerable variability existed among hospitals over and above hospital ownership or number of hospital beds. CONCLUSIONS: Ethnicity was a statistically significant predictor of adverse outcomes, as was the number of prenatal visits and maternal education. There is a significant relationship between adverse newborn outcomes and ethnicity after controlling for hospital and physician characteristics. CLINICAL RELEVANCE: Ongoing birth disparities in African American childbearing women are a significant public policy issue with important research and clinical implications. This research adds to nursing knowledge by helping eliminate some factors previously thought to have contributed to the high incidence of perinatal complications for African American women and their newborns.

Bullies at work: the impact of horizontal hostility in the hospital setting and intent to leave.

The phenomenon of bullying or peer incivility in nursing is not new or confined to nurses. Behaviors consistent with horizontal hostility (HH) range from overt behavioral manifestations such as infighting among nurses; sabotage (where pertinent information is intentionally withheld); passive-aggressive behavior; eye rolling in response to a question; or verbal remarks that are snide, rude, and demeaning, to more covert behaviors including failure to respect confidences and privacy. Horizontal hostility can lead to profound and long-lasting effects, including diminished productivity and increased absenteeism. This study surveyed RNs at a community hospital in the Southwest to determine (a) the degree of HH in the workplace and (b) the extent that the perception of HH affected ill calls and the likelihood of leaving their current position. The authors make recommendations about the prevention, identification, and handling of HH behaviors.

Reflections on meeting women's childbirth expectations.

When care providers support their personal worth, use caring communication, facilitate consumer participation in decision making, seek optimal outcomes, and know the patient holistically, female patients feel that their dignity is respected. We compare women's expectations for dignified care in contemporary society with the expectations of women 40 years ago. Some progress has been made toward valuing women's voices and participation in decision making, the availability of interventions for optimal outcomes, and recognition of the importance of cultural competence. Continued work is needed to meet women's expectations for receiving individualized and tailored care, information about intervention effectiveness and risks, and support for the birth process that the family desires. A renewed focus on the recipient of care as a coparticipant in her birthing experiences may result in improved outcomes and resolution of tensions between childbearing women and sociopolitical forces and standards of care.

Labor and delivery nurse staffing as a cost-effective safety intervention.

Numerous studies have identified a relationship between staffing levels and nurse-sensitive outcomes for medical and surgical patients, but little has been published on the impact of nurse-sensitive outcomes for the childbearing family and even less that examines the relationship of intrapartum staffing on adverse perinatal outcomes. Using a derivation of Donabedian's classic structure, process, and outcomes framework, a model is proposed, which would allow obstetrical primary care providers and administrators alike the opportunity to examine the influence of nurse staffing on adverse obstetrical events, including unanticipated cesarean birth in low-risk women or newborn intensive care unit admissions. It is recognized that hospitals carry a significant burden in the prevention of adverse outcomes that range from nurse staffing levels to the internal process and infrastructure of the hospital setting. Patient outcomes are a direct result not only of the patient's health status and characteristics (eg, socioeconomic position and ethnicity), but also of interactions with the healthcare delivery system. As such, the opportunity to examine hospital characteristics (structure and processes) that may be detrimental to safe patient outcomes is of paramount importance in providing optimal outcomes for childbearing women and their families.

The relationship between cesarean section and labor induction.

BACKGROUND: Numerous study results vary when analyzing the relationship between labor induction and the likelihood of cesarean delivery; and few have accounted for the multiple influences of maternal sociodemographic characteristics combined with the provider and hospital in subsequent birth outcomes such as cesarean section. OBJECTIVE: This study evaluated the likelihood of cesarean birth following labor induction while accounting for maternal, hospital, and provider characteristics. METHODS: A cross-sectional retrospective descriptive design using secondary data was employed to determine what variation in cesarean births was due to differences of hospitals, providers, and patients using the Quality Health Outcomes Model (QHOM). Data were partitioned by primiparous and multiparous women. The individual demographic, system, and provider outcomes in all hospitals and single birth center for Maricopa County in 2005 (N=62,816) were analyzed, using both random effects and fixed effects models. RESULTS: For primiparous women, an increased likelihood of cesarean births was associated with medical inductions, maternal age, being Black, and the number of prenatal visits; and less likely in teaching hospitals and women with higher educational attainment. In multiparous women, cesarean births were associated with increased maternal age and medical inductions; and less likely in for-profit hospitals and following elective induction. DISCUSSION: Labor inductions were associated with an increased likelihood of cesarean sections based on parity, age, race, number of prenatal visits, education, and hospital teaching status and ownership. Because the QHOM emphasizes multiple contextual variables that influence the delivery and outcomes of care, it can prove ideal for the study of birth outcomes following interventions such as the induction of labor. CLINICAL RELEVANCE: Nurses should be well educated about the risks of elective labor induction prior to term gestation and "elective" cesarean birth.

Using human factors engineering in designing and assessing nursing personnel responses to mock code training.

Because timely and efficient responses of nurses are paramount to patient survival in cardiac and respiratory codes, it is crucial to determine best methods of training nursing personnel to respond effectively to code situations. Human factors engineering (HFE) is a relatively new approach in health care that attempts to understand human vulnerabilities that contribute to error and then design systems that minimize the likelihood of error occurring. This study embedded the principles of HFE in the design, implementation, and evaluation of mock code training to determine whether mock codes using HFE were helpful and if so, which inpatient units would benefit the most from such drills.