Anxiety, job satisfaction, supervisor support and turnover intentions of mid-career nurses: A structural equation model analysis.

AIMS: To explore the effects of four predictors of anxiety (work constraints, work/family conflict, verbal abuse and negative team orientation) among nurses and their subsequent effects on job satisfaction and turnover intentions; and to examine the moderating effect of supervisor support on the relationship between job satisfaction and turnover intentions. BACKGROUND: Work-related anxiety is a well-known predictor of employee burnout. Research suggests the prevalence of stress in the workplace varies by occupation, with stress among nurses one of the highest. METHODS: We employed data from the 2015 national survey of licensed registered nurses (n=1,080). We assessed the conceptual model using partial least squares structural equation modeling (PLS-SEM). RESULTS: Work constraints, work/family conflict, and negative team orientation lead to anxiety, which diminished job satisfaction and ultimately increased turnover intentions. Supervisor support weakened the job dissatisfaction-turnover relationship. CONCLUSIONS: These findings suggest that the common experiences reported by health care professionals lead to anxiety and ultimately turnover intentions and emphasize the role of supervisor support. IMPLICATIONS FOR NURSING MANAGEMENT: The supervisor's role is crucial to the implications of workplace-generated anxiety for nurse job satisfaction and turnover intentions. As such, nurse managers need to develop tangible strategies to help nurses navigate these contextual constraints.

Nutritional Interventions in Heart Failure: A Systematic Review of the Literature.

BACKGROUND: Heart failure (HF) is a major health care burden and there is a growing need to develop strategies to maintain health and sustain quality of life in persons with HF. The purpose of this review is to critically appraise the components of nutrition interventions and to establish an evidence base for future advances in HF nutrition research and practice. METHODS AND RESULTS: Cinahl, Pubmed, and Embase were searched to identify articles published from 2005 to 2015. A total of 17 randomized controlled trials were included in this review. Results were divided into 2 categories of nutrition-related interventions: (1) educational and (2) prescriptive. Educational interventions improved patient outcomes such as adherence to dietary restriction in urine sodium levels and self-reported diet recall. Educational and prescriptive interventions resulted in decreased readmission rates and patient deterioration. Adherence measurement was subjective in many studies. Evidence showed that a normal-sodium diet and 1-liter fluid restriction along with high diuretic dosing enhanced B-type natriuretic peptide, aldosterone, tumor necrosis factor α, and interleukin-6 markers. CONCLUSIONS: Educational nutrition interventions positively affect patient clinical outcomes. Although clinical practice guidelines support a low-sodium diet and fluid restriction, research findings have revealed that a low-sodium diet may be harmful. Future research should examine the role of macronutrients, food quality, and energy balance in HF nutrition.

The work of managing a chronic illness: A job description.

RATIONALE: Self-management of a chronic illness is a struggle for many patients. There is substantial evidence that patients are not as successful as they and their providers would like. Considering patient self-management through an innovative and diverse lens could help patients, providers and the health care system to consider novel changes to improve success. AIMS AND OBJECTIVES: To provide a complete view of patient work by utilizing the human resources management practice of job analysis to develop an initial job description for patients suffering from chronic illness. METHODS: Study design was descriptive qualitative with analysis aiming to identify those reoccurring ideas from the data. Thirty patients, with at least one chronic illness, in three focus groups were assembled for this study. Verbatim recordings and notes were used to categorize the data provided. Five coders analyzed the data independently, and jointly met to discuss the themes identified. Demographic data was collected via surveys. RESULTS: Patients with chronic illness engage in five primary 'job' duties including self-care (actions taken to effectively manage physical and psychological symptoms), managing relationships (effective management of relationships with employers, family, friends and providers to ensure the best outcomes), managing resources (understanding and managing finances, health and prescription medication insurance), coordination (managing and scheduling visits to providers) and research/education (gathering information and conducting research relative to all aspects of managing one's illness). Relevant knowledge, skills, abilities (KSAs) and other resources were identified that are necessary for patients to effectively perform the five job duties. CONCLUSIONS: Creating a job description for the 'job' of patient is a crucial step in understanding the work chronically ill patients undertake. Knowing the duties, their associated tasks and KSAs, and resources required to perform those tasks enables patients and their providers and advocates to better identify ways to assist, relieve and encourage these patients in order to maximize patient success.

Reducing turnover intentions among first-year nurses: The importance of work centrality and coworker support.

Turnover among nurses has been recognized as a frequent and enduring problem in healthcare worldwide. The widespread nursing shortage has reached the level of a healthcare crisis. The COVID-19 pandemic has illustrated the importance of understanding the contributing factors of nurse turnover, and more importantly how to mitigate the problem. Using cross-sectional survey data collected from 3370 newly licensed nurses working across 51 metropolitan areas within 35 U.S. states, we explore how role overload and work constraints can both diminish job satisfaction and increase turnover intentions of new nurses. Coworker support and work role centrality are identified as moderators of these relationships which show potential to mitigate these negative outcomes. This study highlights the importance of coworker support and work centrality in improving job satisfaction and subsequent turnover intentions among newly licensed nurses.

The interactive effects of role overload and resilience on family-work enrichment and associated outcomes.

Using an interactionist perspective and conservation of resources (COR) theory, this study examined the interactive effects of resilience and role overload on family-work enrichment and the outcomes of surface acting, emotional exhaustion, and job satisfaction. The model was tested using a sample of 156 full time employees who completed surveys at two time periods. As expected, resilience was positively related to family-work enrichment and family-work enrichment was negatively related to surface acting and emotional exhaustion and positively related to job satisfaction demonstrating mediating effects for family-work enrichment. Role overload moderated the positive relationship between resilience and family-work enrichment such that the relationship was weaker when role overload was high indicating a boundary condition for the favorable effects of resilience. Finally, support was found for the conditional indirect effects of resilience on surface acting, emotional exhaustion, and job satisfaction through family-work enrichment such that the relationships were weaker when role overload was high.

Nutritional support therapy after GLIM criteria may neglect the benefit of reducing infection complications compared with NRS2002: Reanalysis of a cohort study.

OBJECTIVES: The aim of this study is to validate the Global Leadership Initiative on Malnutrition (GLIM) criteria and determine the number of Nutritional Risk Screening 2002 (NRS2002)-positive patients who do not meet the GLIM, as well as examine whether these patients would benefit from nutritional support therapy. METHODS: A reanalysis of a published prospective observational study was performed. The subjects were rediagnosed per the NRS2002 and GLIM criteria. The prevalence of malnutrition was reported, and the difference in rate of infection complications and total complications between the nutritional support therapy and glucose-electrolyte cohorts was calculated. RESULTS: Among 1831 cases in the original database, 827 cases (45.2%) were NRS2002-positive. A total of 391 cases were identified by the GLIM criteria as malnourished (21.4%) and of these, subjects in the nutritional support therapy cohort had fewer infection complications than those in the glucose-electrolyte cohort (13.0% vs. 23.0%; P = 0.010). The remaining 436 patients were NRS2002 positive but GLIM negative (23.8%). The rate of infection was also significantly lower in the support cohort than in the nonsupport cohort (8.0% vs. 15.7%; P = 0.011). Nutritional support was proven o be a protective factor for infection complications in both GLIM-positive (odds ratio: 0.407; 95% confidence interval, 0.232-0.714; P = 0.002) and NRS2002-positive/GLIM-negative patients [odds ratio: 0.314; 95% confidence interval, 0.161-0.612; P = 0.001). CONCLUSIONS: The GLIM criteria have been validated, and are useful in identifying malnourished patients who may have fewer infection complications due to nutritional support therapy. However, the criteria neglected half of the patients identified by NRS2002, among whom nutritional support therapy also decreased the rate of infection complications.

Impact of nutrition support on clinical outcome and cost-effectiveness analysis in patients at nutritional risk: A prospective cohort study with propensity score matching.

OBJECTIVES: There is a lack of evidence regarding the economic effects of nutrition support in patients at nutritional risk. The aim of this study was to perform a cost-effectiveness analysis by comparing an adequate nutrition support cohort with a no-support cohort. METHOD: A prospective observational study was performed in the surgical and medical gastroenterology wards. We identified patients at nutritional risk and the provision of nutrition support by the staff, unaware of the risk status, was recorded. Cost data were obtained from each patient's statement of accounts, and effectiveness was measured by the rate of infectious complication. To control for potential confounding variables, the propensity score method with matching was carried out. The incremental cost-effectiveness ratio was calculated based on the matched population. RESULTS: We screened 3791 patients, and 440 were recruited for the analysis. Patients in the nutrition support cohort had a lower incidence of infectious complications than those in the no-support cohort (9.1 versus 18.1%; P = 0.007). This result was similar in the 149 propensity matched pairs (9.4 versus 24.2%; P < 0.001). The median hospital length of stay was significantly reduced among the matched nutrition support patients (13 versus 15 d; P < 0.001). The total costs were similar among the matched pairs (US $6219 versus $6161). The incremental cost-effectiveness analysis suggested that nutrition support cost US $392 per patient prevented from having infectious complications. CONCLUSION: Nutrition support was associated with fewer infectious complications and shorter length of stay in patients at nutritional risk. The incremental cost-effectiveness ratio indicated that nutrition support had not increased costs significantly.

Got political skill? The impact of justice on the importance of political skill for job performance.

The present study examined the moderating effects of procedural and distributive justice on the relationships between political skill and task performance and organizational citizenship behavior (OCB) among 175 supervisor-subordinate dyads of a government organization. Using Mischel's (1968) situationist perspective, high justice conditions were considered "strong situations," whereas low justice conditions were construed as "weak situations." We found that when both procedural and distributive justice were low, political skill was positively related to performance. Under conditions of both high procedural and high distributive justice, political skill was negatively related to performance. Finally, under conditions of low distributive justice, political skill was positively related to OCB, whereas under conditions of high distributive justice, political skill had little effect on OCB. These results highlight the importance of possessing political skill in weak but not strong situations.