A pre-post interventional study to reduce time spent on clinical documentation by nurses and midwives.

AIM: To evaluate the impact of a co-designed intervention to reduce time spent on clinical documentation and increase time for direct patient care. DESIGN: A pre- and post-test interventional study with multi-method evaluation, reported according to the Transparent Reporting of Evaluations with Nonrandomised Evaluations Designs guidelines. METHODS: An intervention to decrease the burden of documentation was co-designed and implemented. Pre- and post-intervention data were collected via time and motion studies and the Burden of Documentation for Nurses and Midwives (BurDoNsaM) survey. Documentation audits were conducted to assess intervention fidelity. RESULTS: Twenty-six shifts were observed (13 pre-intervention, 13 post-intervention). Although the coronavirus pandemic contributed to decreases in staffing levels by 38% (from 118 to 73 staff), the number of task episodes completed increased post-intervention, across all shift patterns. Documentation took less time to complete post-intervention when assessing time per episode. A mean increase of 201 episodes was observed on morning shifts, 78 on evening shifts and 309 on night shifts. There were small increases for time spent on direct patient care compared to pre-intervention but there was less time per episode. Results from the BurDoNsaM survey indicated that participants felt documentation took less time post-intervention. Documentation audits found completion improved as staff gained familiarity, but deteriorated when staffing levels were reduced. CONCLUSION: The intervention was able to reduce time spent completing documentation, increasing the time available for direct patient care. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Completing clinical documentation is part of the daily work of nurses and midwives. Clinical documentation needs to accurately capture key information in a concise and streamlined manner to avoid unnecessary burdens and release time for direct patient care. IMPACT: This study tested a co-designed intervention to address the burden of clinical documentation for nurses and midwives, The intervention reduced time spent on clinical documentation and increased time for direct patient care, This study could be replicated to reduce the burden of clinical documentation in other settings and benefit clinicians and patients by releasing more time for direct patient care. REPORTING METHOD: The study is reported using the Transparent Reporting of Evaluations with Nonrandomised Evaluations Designs (TREND) guidelines. PATIENT OR PUBLIC CONTRIBUTION: The research project and intervention evaluated in this study were co-designed through a clinician-researcher collaboration. A research team that consisted of clinically based nurses and midwives and nurse scientists was formed to address the burden of clinical documentation. As the end-users of clinical documentation, the clinically based nurse and midwife co-investigators were involved in the design, conduct, interpretation of the data, and preparation of the manuscript.

Nurse and midwife navigator resilience, well-being, burnout, and turnover intent: A multi-methods study.

PURPOSE: To explore levels of Navigator resilience, well-being, burnout, and turnover intent. DESIGN: A longitudinal, multi-methods study concurrently collected quantitative and qualitative data over three years. METHODS: A survey and Action Learning Groups. FINDINGS: No statistically significant change in resilience, well-being, burnout, or turnover intent. Supports, self-care and leaving the position, were used to maintain well-being. CONCLUSIONS: While quantitative measures did not change, qualitative data demonstrated how adaptive coping mechanisms maintain well-being. Recommendations for nurses working in Navigator, or similar community/public health roles include work-based programs targeting support, good leadership, governance systems including their impact on turnover intent. CLINICAL EVIDENCE: Job turnover intent can be used as a mechanism to monitor resilience and well-being.

Nurse Navigators - Champions of the National Rural and Remote Nursing Generalist Framework: A solution.

INTRODUCTION: Nurse Navigators were introduced in Queensland, Australia, in 2016. Nurse Navigators coordinate person-centred care, create partnerships, improve care coordination and outcomes and facilitate system improvement, independently of hospital or community models. They navigate across all aspects of hospital and social services, liaising, negotiating and connecting care as needed. People stay with Nurse Navigators for as long as required, though the intent is to transition them from high-care needs to self-management. Nurse Navigators are a working model in rural and remote areas of Queensland. OBJECTIVE: To describe where the rural and remote Nurse Navigator position fits within the Rural Remote Nursing Generalist Framework and to define the depth and breadth of the rural and remote Nurse Navigator's scope of practice. DESIGN: Using template analysis, data from focus groups and interviews were analysed against the domains of the recently released National Rural and Remote Nursing Generalist Framework. Navigators working in rural and remote areas across Queensland Health were invited to an interview (n = 4) or focus group (n = 9), conducted between October 2019 and August 2020. FINDINGS: Rural and remote Nurse Navigators are proficient in all domains of the framework and actively champion for their patients, carers and the communities where they live and work. DISCUSSION: This research demonstrates that rural and remote Nurse Navigators are a working model of advanced nursing practice, acting as 'champions' of The Framework. CONCLUSION: The Nurse Navigator model of care introduced to Queensland exemplifies proficient registered nurse practice to the full extent of their knowledge and skill.

Co-design of an intervention to reduce the burden of clinical documentation: A clinician-researcher collaboration.

AIM: To co-design an intervention to reduce the burden of clinical documentation for nurses and midwives. METHODS: A clinician-researcher collaboration used an action research approach to co-design an intervention to reduce clinical documentation. The study consisted of three phases: 1) Analysis of pre-intervention data, 2) Evaluation of existing documentation, 3) Intervention co-design and implementation. RESULTS: A total of 116 documents were reviewed using a three-stage evaluation process, identifying 28 documents that could be discontinued and 33 documents to be modified for the intervention. This resulted in an average of 7 documents for women who had a vaginal birth (decreased from 13), 9 documents for women who had a caesarean (decreased from 18), and 7 documents for newborns (previously 7-10). The minimum number of documents for a mother and baby reduced from 20 pre-intervention to 14 post-intervention. CONCLUSION: The collaboration successfully co-designed and implemented an intervention to address the burden of clinical documentation that can be replicated in other healthcare settings.

A point prevalence study of palliative care need and referral rates in adult inpatients.

AIM AND OBJECTIVES: To gain an understanding of palliative care need and service utilisation in adult inpatients. The objectives were to 1) Determine the size and characteristics of the population of adult inpatients who were appropriate for palliative care referral, 2) Establish what percentage of patients, who were appropriate for a palliative care referral, had been referred to and/or were receiving palliative care. BACKGROUND: Internationally there is evidence of high levels of unmet palliative care need. Early access to palliative care is associated with improved outcomes including improved quality of life and reduced healthcare costs. DESIGN: An observational point prevalence study was reported using the STROBE guidelines. METHODS: Data were collected directly from inpatient medical records at a 578-bed tertiary private-not-for-profit hospital by three Registered Nurses on 3 June 2021. Palliative care need was assessed using the prognostic criteria for the 12 conditions outlined in the Gold Standards Framework. RESULTS: A total of 270 inpatients met study inclusion criteria. At a hospital population level, 29% (n = 78) of adult inpatients could have benefitted from palliative care. Of the 78 patients assessed as meeting criteria for palliative care, 29% (n = 23) were currently receiving palliative care with a majority of patients 71% (n = 55) not receiving palliative care. CONCLUSIONS: This study prospectively collected data and included all 12 conditions outlined in the Gold Standards Framework and found a high level of palliative care need. There was evidence of a high level of unmet palliative care need across conditions and treating specialities. RELEVANCE TO CLINICAL PRACTICE: Estimates of palliative care need can be used to improve access to palliative care and assess operational requirements, including the staffing levels required to meet the level of palliative care need for adult inpatients.

Nurse resilience for clinical practice: An integrative review.

AIM: To evaluate and synthesize research that has investigated nurse resilience, to develop an understanding of what nurses' feel affects their resilience, their experiences and how resilience can impact individual nurses, patients and employers. DESIGN: Integrative review. DATA SOURCES: CINAHL, MEDLINE and PsycINFO, searched from the date each database was available to July 2019. REVIEW METHODS: Primary research studies explicitly investigating resilience in any type of licensed nurse were eligible for inclusion. Studies were critically appraised for methodological quality using the Joanna Briggs Institute Quality Appraisal Framework. Data from each study were abstracted, coded and themes were identified according to the review aims and key findings of each study. RESULTS: Twenty-seven studies met the inclusion criteria. Eight sub-themes and three main themes were identified: The Resilient Nurse, Nurses' Experiences of Resilience and Employment Conditions and Nurse Resilience. CONCLUSION: Nurse resilience is a complex and dynamic process, and high levels of resilience are associated with reduced psychological harm and increased well-being. Attempts to determine the characteristics of the resilient nurse have been inconclusive and research has predominately focussed on individual factors which could affect resilience, with minimal research exploring external factors which affect nurse resilience including work environment and conditions. Nursing work was characterized by adversity and nurses described the development and use of strategies to maintain their resilience. IMPACT: This review found that individual factors have received most attention in research investigating nurse resilience. Findings suggest that nurse resilience protects against negative psychological outcomes and nurses independently develop and use strategies to manage adversity. Factors in the workplace which affect resilience are under-researched, and addressing this gap could assist with the development of comprehensive interventions and policies to build and maintain nurse resilience.

Is nursing and midwifery clinical documentation a burden? An empirical study of perception versus reality.

AIMS AND OBJECTIVES: To measure time spent on clinical documentation and nurses and midwives' perceptions of this aspect of their role. BACKGROUND: Nurses and midwives rely on accurate documentation when planning care. However, documenting and communicating care can be onerous, time-consuming and at times duplicated or redundant. While documentation provides a record and means of communicating care, it should not detract from the delivery of care. DESIGN: An observational time and motion study and survey design reported using the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. METHODS: The study was conducted with Western Australian nurses and midwives working in a private not-for-profit hospital from July-October 2019. An observational study was undertaken to measure the practice of documentation on each shift. Participants' perceptions of clinical documentation were measured using a self-report survey. RESULTS: A total of 120 hr of observation were undertaken. Total observed time spent on documentation was 28.1% on morning shifts, 22.7% on afternoon shifts and 20.9% on night duty. The mean self-reported time for clinical documentation was 50.4% on morning shifts, 40.7% on afternoon shifts and 37.9% on night duty. Issues with duplication and unnecessary paperwork were identified. CONCLUSIONS: Although participants tended to overestimate time spent on documentation, it still consumed a significant proportion of time. Frustrations with paperwork may amplify nurses' negative perceptions of documentation. Clinical documentation needs to be reviewed, revised and reduced to release time back to direct patient care and reduce clinician dissatisfaction. RELEVANCE TO CLINICAL PRACTICE: Clinical documentation is required in all areas of clinical practice and forms an important legal record. Understanding the demands of clinical documentation can assist in reviewing and improving documentation to release time back to direct patient care.

Yarning as an Interview Method for Non-Indigenous Clinicians and Health Researchers.

In this article, we discuss the origins, epistemology, and forms of Yarning as derived from the literature, and its use in research and clinical contexts. Drawing on three Yarns, the article addresses the extent to which non-Indigenous researchers and clinicians rightfully use and adapt this information-gathering method, or alternatively, may engage in yet another form of what can be described as post-colonialist behavior. Furthermore, we argue that while non-Indigenous researchers can use Yarning as an interview technique, this does not necessarily mean they engage in Indigenous methodologies. As we note, respectfully interviewing Aboriginal and Torres Strait Islander peoples can be a challenge for non-Indigenous researchers. The difficulties go beyond differences in language to reveal radically different expectations about how relationships shape information giving. Yarning as a method for addressing cross-cultural clinical and research differences goes some way to ameliorating these barriers, but also highlights the post-colonial tensions.

Examining the hurdles in defining the practice of Nurse Navigators.

BACKGROUND: Nurse navigators are an emerging workforce providing care to people with multiple chronic conditions. The role of the navigators is to identify patients requiring support in negotiating their health care. PURPOSE: A critical discourse analysis was used to examine qualitative data collected from nurse navigators and consenting navigated patients to identify key indicators of how nurse navigators do their work and where the success of their work is most evident. DISCUSSION: Nurse navigators help patients who have lost trust in the health system to re-engage with their interdisciplinary health care team. This re-engagement is the final step in a journey of addressing unmet needs, essential to hospital avoidance. CONCLUSION: Nurse navigators provide a continuum of authentic and holistic care. To acknowledge the true value of nurse navigators, their performance indicators need to embrace the value-added care they provide.

The impact of organisational values on nurse resilience: A mixed-methods study.

AIM: To investigate the impact of organisational values on nurse resilience. BACKGROUND: Nurses encounter significant occupational adversity, which can result in negative psychological consequences. Investigating the role of resilience as a protective factor focuses on what enables some nurses to positively adapt in challenging work environments. Comparatively, little attention has been paid to organisational factors and nurse resilience. METHOD: A two-phase mixed-methods design comprising a cross-sectional survey and focus groups. RESULTS: Three hundred and ninety-four nurses responded to the survey with 25 participating in four follow-up focus groups. Significant associations were found between resilience levels and agreement with organisational values (p = .022) and agreement about the importance of values (p = .018). Three themes relating to organisational values were identified: pressures and challenges; supports and strategies; and impact of organisational values. CONCLUSIONS: Organisational values may positively impact resilience if nurses concur with those values and believe they are shared by their employer. IMPLICATIONS FOR NURSING MANAGEMENT: To promote nurse resilience, organisations and nurse leaders should consider developing, implementing and operating with a set of employee-adopted values, which need to be demonstrably upheld across the organisation.

Development and content validation of the Burden of Documentation for Nurses and Midwives (BurDoNsaM) survey.

AIM: To develop a validated tool to measure nursing and midwifery documentation burden. BACKGROUND: While an important record of care, documentation can be burdensome for nurses and midwives and may remove them from direct patient care, resulting in decreased job satisfaction, associated with decreased patient satisfaction. The amount of documentation is increasing at a time where staff rationalisation results in decreasing numbers of clinicians at the bedside. No instrument is available to measure staff perceptions of the burden of clinical documentation. DESIGN: Survey development, followed by rwo rounds of content validation (April and May 2019). METHODS: Based on the literature a 28 item survey, with items in 6 subscales, representing key areas of documentation burden was developed. Item (I-CVI), subscale (S-CVI/Ave by subscale) and overall content validity indexes (S-CVI/Ave) were calculated following two review rounds by an expert panel of clinical and academic nurses and midwives. RESULTS: Level of agreement for the first iteration of the survey was low, with many items failing to reach the critical I-CVI threshold of 0.78. No subscale reached a S-CVI/Ave above 0.8 and the overall scale only achieved a S-CVI/Ave score of 0.67. Thirteen items were removed, seven were edited and five new items added, based on the expert panel feedback, substantially improving the content validity. All individual items achieved an I-CVI ≥0.78, the S-CVI/Ave was above 0.85 for all subscales and the total S-CVI/Ave was 0.94. CONCLUSION: The Burden of Documentation for Nurses and Midwives (BurDoNsaM) survey can be considered as content valid, according to the content validity analysis by an expert panel. IMPACT: The BurDoNsaM survey may be used by nurse leaders and researchers to measure the burden of documentation, providing the opportunity to review practice and implement strategies to decrease documentation burden, potentially improving patient satisfaction with the care received.

Issues affecting nurses' capability to use digital technology at work: An integrative review.

BACKGROUND: Digital capability, that is the ability to live, work, participate and thrive in a digital world, is imperative for nurses because increasingly nurses' work and patient outcomes are influenced by technology. AIM: To evaluate and synthesise the evidence regarding the development of digital capability in nurses and the strategies that support effective integration of digital skills into the workplace. DESIGN: Whittemore and Knafl's methodology, following the preferred reporting items for systematic reviews (PRISMA) guidelines. DATA SOURCES: CINAHL, Embase, PsychINFO, Medline (Ovid) and PubMed databases were searched for articles published in English from 2008-2019. Search terms included; digital capabil*, digital literacy, informatics, nursing informatics, health informatics, nurs*, knowledge, knowledge integration, competency, continuing education, nursing skills, workplace and work environment. REVIEW METHODS: A total of 35 studies were retrieved for quality assessment by two reviewers using standardised critical appraisal instruments from the Joanna Briggs Institute (JBI-MAStARI and JBI-QARI). Minimum essential criteria and scores were agreed prior to appraisal. RESULTS: The 17 studies included comprised quantitative (n = 7), qualitative (n = 8) and mixed methods (n = 2). Integration of digital capability in nurses' workplaces is dependent on user proficiency and competence (theme 1). Nurses use technology to access data at the point of care, specifically accessing evidence to guide care (theme 2a) as well as accessing the medical records (theme 2b). Nurses have several concerns related to the use of technology at point of care (theme 3), some of which can be resolved through investment for implementation (theme 4). CONCLUSIONS: There are key attributes of digitally proficient nurses. Nurses with these attributes are more inclined to use digital technology in their work. Involvement of the nurses as end users in the development of digital systems to ensure they are fit for purpose, alongside investment in professional development opportunities for nurses to develop digital capability, should be prioritised.

Student Nurses' Digital Literacy Levels: Lessons for Curricula.

The rapid uptake of technology is changing the way health professionals provide care to patients and communities. While this presents opportunities to improve, enhance, and positively transform care and treatment, graduates must have the requisite knowledge, skills, and attitudes to make effective use of the technology and data available to them. This research explored nursing students' self-reported digital literacy levels. We undertook a student survey at one university in Australia, utilizing the validated Self-Assessment Nursing Informatics Competencies Scale-SF30 instrument. Overall, 90% of students rated their basic computer knowledge and skills as at least "competent" including performing basic troubleshooting, using the Internet, and conducting online literature searches. However, only 55% of students considered their overall applied computer skills as at least "competent," which included using applications for diagnostic coding and to extract data from clinical data sets. Students have digital literacy in everyday settings; however, their ability to translate this into practice is limited, restricting their access to and use of digital tools in the workplace. Our findings provide the opportunity to address practice issues related to digital literacy and to embed appropriate content in curricula to enable the delivery of improved patient care and the appropriate use of data in various settings.

Neonatal Admission and Its Relationship to Maternal Pain: Pain Scores and Analgesia.

The aim of this study was to determine whether postnatal women whose babies required neonatal intensive care unit (NICU) admission self-reported lower pain scores and required less analgesia than women whose babies remained with them. A prospective matched audit comparing pain scores and analgesia requirements where every woman with a baby admitted to the NICU was matched to 2 women whose babies remained on the ward was undertaken. Matches were based on age, number of previous births, type of birth, episiotomy, and epidural or spinal analgesia use. Data were collected on pain scores and analgesia administered in the first 72 hours postbirth. A total of 150 women were recruited and matched from November 2015 to May 2017. No statistically significant differences were found between the 2 groups for opiate analgesia use (P = .91) or pain scores (P = .89). Regardless of NICU admission, significantly higher pain scores were reported in participants who had episiotomies (P = .03). Birth via cesarean birth resulted in significantly higher pain scores (P < .01) and greater opiate administration (P < .01). This study found no statistically significant difference between pain scores or analgesia use of mothers whose babies required NICU admission and mothers whose babies remained with them.

Exploring the nurse navigator role: A thematic analysis.

BACKGROUND: Patients with complex chronic conditions experience fragmentation of care, unnecessary hospitalization and reduced quality of life, with an increased incidence of poor health outcomes. AIM(S): The aim of this paper was to explore how nurse navigators manage client care. This was achieved through an examination of narratives provided by the nurse navigator that evaluated their scope of practice. METHOD(S): All nurse navigators employed by Queensland Health were invited to participate in a study evaluating the effectiveness of the service. Eighty-four self-reported vignettes were thematically analysed to understand the work from the nurses' perspectives. RESULTS: Two themes emerged from the vignettes. Theme 1, the layers of complexity, is comprised of three sub-themes: the complex patient, the complex system and patient outcomes. Theme 2, professional attributes, has two sub-themes: person-centred care and clinical excellence. CONCLUSION: Navigators innovatively integrate services and address the fragmented nature of the health system. They apply expert clinical and social skills, through consistent and robust communication, to meet the needs of those with multiple chronic conditions. IMPLICATIONS FOR NURSING MANAGEMENT: Results provide insight into the new role, illuminating the work they achieve, despite system complexities.

A comparison of nurse shift workers' and non-shift workers' psychological functioning and resilience.

AIMS: To investigate the impact of shift work on the psychological functioning and resilience of nurses by comparing nurses who work shifts and nurses who work regular hours. DESIGN: A comparative descriptive design using an online self-report questionnaire. METHOD: Data were collected from employed Registered and Enrolled Nurses (N = 1,369) who were members of the Queensland Nurses and Midwives Union (QNMU) in 2013. The survey included standardized measures of resilience, depression, anxiety, compassion satisfaction, compassion fatigue, and intention to leave the profession. RESULTS: Generalized Linear Mixed Model analysis revealed shift workers had significantly lower levels of compassion satisfaction. However, there were no significant differences between the groups on resilience, depression, anxiety, stress, compassion fatigue or intention to leave nursing. CONCLUSION: The findings suggest that shift work is not associated with worse psychological functioning or lower resilience in nurses. However, this study requires replication using a longitudinal design to confirm these findings.

A re-examination of the individual differences approach that explains occupational resilience and psychological adjustment among nurses.

AIMS: This study re-examines the validity of a model of occupational resilience for use by nursing managers, which focused on an individual differences approach that explained buffering factors against negative outcomes such as burnout for nurses. BACKGROUND: The International Collaboration of Workforce Resilience model (Rees et al., 2015, Frontiers in Psychology, 6, 73) provided initial evidence of its value as a parsimonious model of resilience, and resilience antecedents and outcomes (e.g., burnout). Whether this model's adequacy was largely sample dependent, or a valid explanation of occupational resilience, has been subsequently un-examined in the literature to date. To address this question, we re-examined the model with a larger and an entirely new sample of student nurses. METHODS: A sample of nursing students (n = 708, AgeM ( SD ) = 26.4 (7.7) years), with data examined via a rigorous latent factor structural equation model. RESULTS: The model upheld many of its relationship predictions following further testing. CONCLUSIONS: The model was able to explain the individual differences, antecedents, and burnout-related outcomes, of resilience within a nursing context. IMPLICATIONS FOR NURSING MANAGEMENT: The results highlight the importance of skills training to develop mindfulness and self-efficacy among nurses as a means of fostering resilience and positive psychological adjustment.

The prevalence of peripheral intravenous cannulae and pattern of use: A point prevalence in a private hospital setting.

AIMS AND OBJECTIVES: To determine the prevalence and pattern of use of peripheral intravenous cannulae in hospital wards. BACKGROUND: Peripheral intravenous cannulae are commonly used in acute health care to directly access the bloodstream for the administration of medications, intravenous fluids and blood products. Peripheral intravenous cannulae are associated with multiple adverse events including hospital-acquired bloodstream infection, thrombophlebitis and pain/discomfort. Administration of intravenous fluids is associated with impaired mobility and nocturia which may increase falls risk in the older people. DESIGN: Observational, point prevalence study. METHODS: Three private hospitals comprising a total of 1,230 beds participated in the study. Nurses recorded the presence of a peripheral intravenous cannulae, duration of insertion, state of the dressing and whether the peripheral intravenous cannulae was accessed in the previous 24 hr and for what purpose. Nurses were also asked whether they would replace the peripheral intravenous cannulae should it fail. RESULTS: Approximately one-quarter of patients had a peripheral intravenous cannulae, the majority of which had been present for <24 hr. The major use of the peripheral intravenous cannulae was antibiotic administration. Administration of intravenous fluids occurred in the presence of normal oral fluid intake. Nurses would not replace one-third of peripheral intravenous cannulae in the event of failure. A majority of patients were at increased falls risk, and one-third of these were receiving intravenous fluids. CONCLUSIONS: There is room for improvement in the utilisation of peripheral intravenous cannulae, particularly in removal and associated use of intravenous fluids. Alternative strategies for medication administration and timely switch to the oral route may reduce the risks associated with intravenous fluids. RELEVANCE TO CLINICAL PRACTICE: Vigilance is required in the use of peripheral intravenous cannulae. Consider transition of medication administration to oral intake where possible to minimise risks associated with the use of invasive devices and increased fluid intake.

What is the impact of shift work on the psychological functioning and resilience of nurses? An integrative review.

AIM: To synthesize existing research to determine if nurses who work shifts have poorer psychological functioning and resilience than nurses who do not work shifts. BACKGROUND: Research exploring the impact of shift work on the psychological functioning and resilience of nurses is limited compared with research investigating the impact of shifts on physical outcomes. DESIGN: Integrative literature review. DATA SOURCES: Relevant databases were searched from January 1995-August 2016 using the combination of keywords: nurse, shift work; rotating roster; night shift; resilient; hardiness; coping; well-being; burnout; mental health; occupational stress; compassion fatigue; compassion satisfaction; stress; anxiety; depression. REVIEW METHODS: Two authors independently performed the integrative review processes proposed by Whittemore and Knafl and a quality assessment using the mixed-methods appraisal tool by Pluye et al. RESULTS: A total of 37 articles were included in the review (32 quantitative, 4 qualitative and 1 mixed-methods). Approximately half of the studies directly compared nurse shift workers with non-shift workers. Findings were grouped according to the following main outcomes: (1) general psychological well-being/quality of life; (2) Job satisfaction/burnout; (3) Depression, anxiety and stress; and (4) Resilience/coping. We did not find definitive evidence that shift work is associated with poorer psychological functioning in nurses. Overall, the findings suggest that the impact of shift work on nurse psychological functioning is dependent on several contextual and individual factors. CONCLUSION: More studies are required which directly compare the psychological outcomes and resilience of nurse shift workers with non-shift workers.

Maximising nurses' and midwives' response rates to surveys.

BACKGROUND: Low response rates to surveys have been a long-standing issue in research. This includes research involving nurses and midwives. To gain representative samples, appropriate measures to maximise response rates need to be used. AIM: To explore ways to maximise response rates from nurses and midwives, using a hospital-wide survey as an example. DISCUSSION: All nurses and midwives at the study hospital were invited to participate in a survey. To encourage participation and elicit an adequate response rate, several strategies were used. A total of 1,000 surveys were distributed and 319 (32%) were returned. All the required age groups, levels of experience and types of nursing registration were represented in the responses and data saturation was achieved. CONCLUSION: It is important to pay attention to obtaining a representative sample. Further investigation of response rates to surveys by nurses and midwives is warranted. IMPLICATIONS FOR PRACTICE: Strategies to maximise response rates from a target population should be used when conducting surveys.