Supportive Workplace Wellness Cultures and Mattering Are Associated With Less Burnout and Mental Health Issues in Nurse Managers.

OBJECTIVE: The aims of this study were to describe burnout, mental health, and healthy lifestyle behaviors of nurses in a managerial role and assess associations among workplace culture factors (perceived culture, mattering, support, and staff shortages) with burnout, mental health outcomes, and healthy lifestyle behaviors. BACKGROUND: Nurse managers foster unit-based wellness cultures, yet burnout and mental health problems adversely impact the culture and well-being of staff. METHODS: A cross-sectional, descriptive correlational design was used. The Florida Organization for Nursing Leadership enabled distribution of a wellness survey to nurse managers. RESULTS: There were 125 participants. Healthy lifestyle behaviors were infrequently practiced. Analysis revealed significant correlations among workplace culture factors, burnout, and mental health outcomes. When compared with nurse managers with staff shortages, those without staff shortages were 6.11 times more likely to not screen positive for burnout. CONCLUSIONS: Health systems should address workplace culture factors and staff shortages to reduce burnout, improve mental health, and enhance healthy behaviors in nurse managers.

Adaptation of SafeCare, an evidence-based parenting program, for caregivers of infants in the neonatal intensive care unit.

BACKGROUND: While there are several parenting programs for NICU caregivers, no studies, to our knowledge, have developed parenting programs aimed at preventing child maltreatment that specifically address these parental factors: parental stress, parental self-efficacy, and positive parent-infant interaction. OBJECTIVES: The objectives of this study were to: 1) Identify adaptations and/or augmentations needed to optimize SafeCare® for NICU caregivers, and 2) Examine the acceptability and preliminary effects of the adapted SafeCare NICU (SCNC) program with NICU caregivers. METHODS: This study consisted of two phases: formative (phase one) and pilot (phase two). For phase one, 5 NICU former caregivers and 5 NICU staff were interviewed to make relevant, NICU-specific adaptations for SCNC. Phase two consisted of a pilot study, where 13 current NICU caregivers were enrolled in the adapted SCNC program. Outcomes included acceptability and preliminary effects of parental stress, parental self-efficacy, and parent-infant interaction. RESULTS: Adaptations to SafeCare consisted of adding a pre-session to discuss individualized experiences, incorporation of adjusted developmental milestones, a NICU-specific resource sheet, and individualized adaptations to activities based on relevant medical concerns. Out of the 13 participants, 8 completed SCNC (61.5 % retention rate). Participants indicated significant reductions in stress after SCNC (Parental stress index score = 61.7) compared to baseline (79.2, p = 0.02). Among participants who completed SCNC (n = 8), all stated they supported this program for implementation among NICU caregivers. DISCUSSION: The adapted SCNC demonstrated acceptability among NICU caregivers.

The use of mHealth apps to improve hospital nurses' mental health and well-being: A systematic review.

BACKGROUND: Nursing well-being has become a heightened focus since the COVID-19 pandemic. Nurses are leaving the profession early in their careers or retiring sooner than expected. Those who remain in the workforce report higher levels of burnout, anxiety, depression, and exhaustion. There is concern that there may be a shortage of at least half a million nurses by 2030. AIMS: This systematic review aimed to investigate the evidence of using a mental health promotion mHealth app to improve the mental health of hospital nurses. METHODS: A systematic search was conducted in CINAHL Plus with Full Text, MEDLINE with Full Text, Professional Development Collection, Psychology and Behavioral Sciences Collection, Sociological Collection, PsycInfo, Embase, and PubMed with search dates of January 2012-November 15, 2022. The mHealth intervention needed to be asynchronously delivered through a smartphone with hospital nurse participants to be included in this review. RESULTS: Of the 157 articles screened for this review, six were included. Primary outcome variables were anxiety, burnout, coping, depression, self-efficacy, stress, well-being, and work engagement. Intervention types included mindfulness-based interventions (MBIs), cognitive behavioral therapy (CBT), stress inoculation therapy (SIT), psychoeducation, and stress management. Anxiety, depression, well-being, and burnout improved with MBIs; depression improved with CBT; and anxiety and active coping improved with SIT. LINKING EVIDENCE TO ACTION: This review demonstrated promising findings in using mHealth apps to improve the mental health of hospital nurses. However, more randomized controlled trials with larger sample sizes may reveal which type of mHealth app and how much exposure to the intervention is more effective in improving specific mental health symptoms. Longitudinal follow-up is also recommended to study sustainability of the mental health improvements.

The Association Between Magnet ® Recognition and Patient Outcomes : A Scoping Review.

BACKGROUND: Previous systematic reviews have explored nurse, patient, and organizational outcomes in Magnet®-recognized hospitals compared with non-Magnet hospitals, yet these did not comprehensively review a wide variety of patient outcomes. AIM: The purpose of this scoping review was to describe the findings from published research evaluating patient outcomes in Magnet-recognized hospitals compared with non-Magnet hospitals. METHODS: A medical librarian conducted a systematic search for published peer-reviewed, English-language literature and a search of the reference lists for retrieved publications to identify articles addressing Magnet compared with non-Magnet hospitals related to patient outcomes. RESULTS: Four patient outcomes improved in Magnet-designated hospitals: mortality, patient satisfaction, failure to rescue, and falls. Four patient outcomes showed undesirable or mixed outcomes. Five patient outcomes had insufficient evidence regarding patient outcomes when treated at Magnet-recognized hospitals. CONCLUSION: Magnet Recognition® is associated with improvement in a distinct set of patient outcomes, but not all key outcome measures. Standardized outcomes and rigorous study designs are needed to further explore the impact of Magnet Recognition on a wide variety of patient outcomes.

Improving population health and well-being in academic institutions and health care systems with the Chief Wellness Officer: A vital yet untapped nursing leadership role.

BACKGROUND: There is an epidemic of chronic conditions throughout the world. Although the majority of chronic disease can be prevented, the U.S. invests so little of its healthcare spending in wellness and prevention. Nurses are an ideal profession to lead a needed paradigm shift as chief wellness officers (CWOs). PURPOSE: The aim of this paper is to describe the role of the CWO in improving population health and well-being in universities and health systems. METHODS: An example of how the CWO role was implemented at a large public land grant university is provided. The socioecological model and life course perspective was adopted as the framework to guide an ambitious wellness strategic plan using an evidence-based quality improvement strategy. DISCUSSION: The CWO is a vital leadership role in today's institutions of higher learning and health systems. CONCLUSION: There is an urgent need for nurses to step up into these impactful CWO positions.

A cognitive-behavioral skills building program improves mental health and enhances healthy lifestyle behaviors in nurses and other hospital employees.

BACKGROUND: Mental health outcomes in nurses have historically indicated a greater prevalence of anxiety, depression, and suicide than the general population. It is vital to provide programming for healthcare workers to gain the necessary skills to reduce burnout and improve their mental and physical health. AIMS: The aims of this study were to evaluate mental health outcomes and healthy lifestyle beliefs and behaviors among nurses and other hospital employees who completed MINDBODYSTRONG, a cognitive-behavioral skill building program. METHODS: A pre-experimental, pre- and poststudy design was used to examine mental health and well-being outcomes among 100 hospital personnel who participated in MINDBODYSTRONG, a program designed to improve coping and resiliency and decrease stress, anxiety, and depressive symptoms. Outcomes measured included healthy lifestyle behaviors, healthy lifestyle beliefs, anxiety, depression, stress, and burnout. RESULTS: One hundred hospital personnel, including 93 nurses, completed the pre- and post-survey. Among all participants, post- MINDBODYSTRONG scores for healthy lifestyle beliefs (p = .00; Cohen's d = 0.52) and healthy lifestyle behaviors (p = .00; Cohen's d = -0.74) increased significantly with medium effects, while depression (p = .00; Cohen's d = -0.51), anxiety (p = .00; Cohen's d = -0.54), stress (p = .00; Cohen's d = -0.33), and burnout (p = .00; Cohen's d = -0.37) decreased significantly with small and medium effects. The program produced even stronger positive effects on mental health outcomes for participants who started the study with higher levels of depression and anxiety. LINKING EVIDENCE TO PRACTICE: Anxiety, depression, stress, and burnout decreased significantly postintervention. Participants also significantly improved their healthy lifestyle beliefs and behaviors with the MINDBODYSTRONG program. MINDBODYSTRONG is an effective program that reduces anxiety, depression, burnout, and stress and improves healthy lifestyle beliefs and behaviors in hospital-based clinicians. It is of utmost importance to provide evidence-based programs to improve mental resiliency and decrease stress, anxiety, burnout, and depressive symptoms, which will ultimately improve the safety and quality of health care.

An audit of mental health questions on U.S. nursing licensure applications: Evidence to guide urgent action for change.

BACKGROUND: Nurses often forgo needed mental healthcare due to stigma and fear of losing their license. The decision to access care or disclose mental health struggles is intensified when registered nurses (RNs) or advanced practice registered nurses (APRNs) discover that licensure applications ask invasive mental health questions that could impact their ability to work. AIMS: This study highlights findings from an audit of mental health and substance use questions included in RN and APRN licensure applications across the United States. METHODS: A sequential 4-step approach was used to retrieve RN and APRN licensure applications: (1) review of Board of Nursing (BON) websites, (2) communication with BON staff, (3) communication with Deans of Nursing to ask for retrieval assistance, and (4) creation of mock applicants. An embedded checklist within the Dr. Lorna Breen Heroes Foundation's Remove Intrusive Mental Health Questions from Licensure and Credentialing Applications Toolkit guided the audit. Two study team members reviewed the applications independently for intrusive mental health questions, which were designated as non-compliant with the Toolkit's recommendations and arbitrated for consensus. States were designated as non-compliant if ≥1 item on the checklist was violated. RESULTS: At least one RN and APRN application was obtained from 42 states. Only RN applications were obtained from five states, while only APRN applications were obtained from three states. Only 13 states (26%) fully adhered to the Took-Kit checklist. LINKING EVIDENCE TO ACTION: The majority of BONs did not fully adhere to the Took-Kit checklist. Guidance from national organizations and legislation from state governments concerning the removal or revision of probing mental health and substance use questions is urgently needed to cultivate a stigma-reducing environment where nurses are supported in seeking needed mental health treatment.

The state of mental health, burnout, mattering and perceived wellness culture in Doctorally prepared nursing faculty with implications for action.

BACKGROUND: Depression, anxiety, and burnout are an epidemic in the nursing profession. Unlike nurses in clinical settings, little is known about the mental health of doctorally prepared nursing faculty in academic settings, especially when separated by degree type (Doctor of Philosophy in Nursing [PhD] vs. Doctor of Nursing Practice [DNP]) and clinical or tenure track. AIMS: The study aims were to: (1) describe the current rate of depression, anxiety, and burnout in PhD and DNP-prepared nursing faculty and tenure and clinical faculty across the United States; (2) determine if differences exist in mental health outcomes between PhD and DNP-prepared faculty and tenure and clinical faculty; (3) explore whether wellness culture and mattering to the organization influence faculty mental health outcomes; and (4) gain insight into faculty's perceptions of their roles. METHODS: An online descriptive correlational survey design was used with doctorally prepared nursing faculty across the U.S. The survey was distributed to faculty by nursing deans and included: demographics; valid and reliable scales for depression, anxiety, and burnout; an assessment of wellness culture and mattering; and an open-ended question. Descriptive statistics described mental health outcomes; Cohen's d was used to determine effect sizes between PhD and DNP faculty for the mental health outcomes; and Spearman's correlations tested associations among depression, anxiety, burnout, mattering, and workplace culture. RESULTS: PhD (n = 110) and DNP (n = 114) faculty completed the survey; 70.9% of PhD faculty and 35.1% of DNP faculty were tenure track. A small effect size (0.22) was found, with more PhDs (17.3%) screening positive for depression than DNPs (9.6%). No differences were observed between tenure and clinical track. Higher perceptions of mattering and workplace culture were associated with less depression, anxiety, and burnout. Identified contributions to mental health outcomes yielded five themes: lack of appreciation, role concerns, time for scholarship, burnout cultures, and faculty preparation for teaching. LINKING EVIDENCE TO ACTION: Urgent action must be taken by college leaders to correct system issues contributing to suboptimal mental health in both faculty and students. Academic organizations need to build wellness cultures and provide infrastructures that offer evidence-based interventions to support faculty well-being.

Budgetary investment in evidence-based practice by chief nurses and stronger EBP cultures are associated with less turnover and better patient outcomes.

BACKGROUND: Hospitals and healthcare systems strive to meet benchmarks for the National Database of Nursing Quality Indicator (NDNQI) measures, Centers for Medicare & Medicaid Services (CMS) Core Measures, and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) outcome indicators. Prior research indicates that Chief Nursing Officers and Executives (CNOs, CNEs) believe that evidence-based practice (EBP) is important for ensuring the quality of care, but they allocate little funding to its implementation and report it as a low priority in their healthcare system. It is not known how EBP budget investment by chief nurses affects NDNQI, CMS Core Measures, and HCAHPS indicators or key EBP attributes and nurse outcomes. AIMS: This study aimed to generate evidence on the relationships among the budget devoted to EBP by chief nurses and its impact on key patient and nurse outcomes along with EBP attributes. METHODS: A descriptive correlational design was used. An online survey was sent to CNO and CNE members (N = 5026) of various national and regional nurse leader professional organizations across the United States in two recruitment rounds. Data collected included CNO/CNE EBP Beliefs, EBP Implementation, and perceived organizational culture of EBP; organizational culture, structure, personnel, and resources for EBP; percent of budget dedicated to EBP; key performance measures (NDNQI, CMS Core Measures, HCAHPS); nurse satisfaction; nurse turnover; and demographic questions. Descriptive statistics were used to summarize sample characteristics. Kendall's Tau correlation coefficients were calculated among EBP budget, nursing outcome measures, and EBP measures. RESULTS: One hundred and fifteen CNEs/CNOs completed the survey (a 2.3% response rate). The majority (60.9%) allocated <5% of their budget to EBP, with a third investing none. An increase in EBP budget was associated with fewer patient falls and trauma, less nursing turnover, and stronger EBP culture and other positive EBP attributes. A greater number of EBP projects were also associated with better patient outcomes. LINKING EVIDENCE TO ACTION: Chief nurse executives and CNOs allocate very little of their budgets to EBP. When CNEs and CNOs invest more in EBP, patient, nursing, and EBP outcomes improve. System-wide implementation of EBP, which includes appropriate EBP budget allocation, is necessary for improvements in hospital quality indicators and nursing turnover.

Evidence-based practice improves patient outcomes and healthcare system return on investment: Findings from a scoping review.

BACKGROUND: Evidence-based practice and decision-making have been consistently linked to improved quality of care, patient safety, and many positive clinical outcomes in isolated reports throughout the literature. However, a comprehensive summary and review of the extent and type of evidence-based practices (EBPs) and their associated outcomes across clinical settings are lacking. AIMS: The purpose of this scoping review was to provide a thorough summary of published literature on the implementation of EBPs on patient outcomes in healthcare settings. METHODS: A comprehensive librarian-assisted search was done with three databases, and two reviewers independently performed title/abstract and full-text reviews within a systematic review software system. Extraction was performed by the eight review team members. RESULTS: Of 8537 articles included in the review, 636 (7.5%) met the inclusion criteria. Most articles (63.3%) were published in the United States, and 90% took place in the acute care setting. There was substantial heterogeneity in project definitions, designs, and outcomes. Various EBPs were implemented, with just over a third including some aspect of infection prevention, and most (91.2%) linked to reimbursement. Only 19% measured return on investment (ROI); 94% showed a positive ROI, and none showed a negative ROI. The two most reported outcomes were length of stay (15%), followed by mortality (12%). LINKING EVIDENCE TO ACTION: Findings indicate that EBPs improve patient outcomes and ROI for healthcare systems. Coordinated and consistent use of established nomenclature and methods to evaluate EBP and patient outcomes are needed to effectively increase the growth and impact of EBP across care settings. Leaders, clinicians, publishers, and educators all have a professional responsibility related to improving the current state of EBP. Several key actions are needed to mitigate confusion around EBP and to help clinicians understand the differences between quality improvement, implementation science, EBP, and research.