Optimizing nurses' enacted scope of practice to its full potential as an integrated strategy for the continuous improvement of clinical performance: A multicentre descriptive analysis.

AIM: This study aims at better understanding the relationships between nurses' enacted scope of practice, work environment and work satisfaction, missed care, and organizational indicators of performance. BACKGROUND: The enacted scope of practice model describes the determinants and consequences of the actual enactment of the nursing scope of practice. METHOD: A correlational design was used to investigate nurses' enacted scope of practice in five Canadian healthcare centres. RESULTS: Suboptimal enacted scope of practice were found in the current sample. Significant positive correlations were found between the total enacted scope of practice score, use of qualification, control over tasks, decisional latitude and psychological demand as well as role ambiguity. Moreover, a higher enacted scope of practice was correlated with lower organizational indicators of short-term absenteeism. CONCLUSION: Results suggest an insufficient deployment of nurses' enacted scope of practice, likely caused by some job characteristics, leading to lower work satisfaction and negative patients and organizational outcomes. IMPLICATIONS FOR NURSING MANAGEMENT: Optimizing nurses' enacted scope of practice would be a significant integrated strategy for improving organizational performance, patient care and nurses' satisfaction and well-being. Nurses and frontline managers must be involved in the decision-making process necessary to improve nurses' enacted scope of practice.

Psychosocial work environment and prediction of quality of care indicators in one Canadian health center.

BACKGROUND: Few studies link organizational variables and outcomes to quality indicators. This approach would expose operant mechanisms by which work environment characteristics and organizational outcomes affect clinical effectiveness, safety, and quality indicators. QUESTION: What are the predominant psychosocial variables in the explanation of organizational outcomes and quality indicators (in this case, medication errors and length of stay)? The primary objective of this study was to link the fields of evidence-based practice to the field of decision making, by providing an effective model of intervention to improve safety and quality. METHODS: The study involved healthcare workers (n = 243) from 13 different care units of a university affiliated health center in Canada. Data regarding the psychosocial work environment (10 work climate scales, effort/reward imbalance, and social support) was linked to organizational outcomes (absenteeism, turnover, overtime), to the nurse/patient ratio and quality indicators (medication errors and length of stay) using path analyses. RESULTS: The models produced in this study revealed a contribution of some psychosocial factors to quality indicators, through an indirect effect of personnel- or human resources-related variables, more precisely: turnover, absenteeism, overtime, and nurse/patient ratio. Four perceptions of work environment appear to play an important part in the indirect effect on both medication errors and length of stay: apparent social support from supervisors, appreciation of the workload demands, pride in being part of one's work team, and effort/reward balance. CONCLUSIONS: This study reveals the importance of employee perceptions of the work environment as an indirect predictor of quality of care. Working to improve these perceptions is a good investment for loyalty and attendance. In general, better personnel conditions lead to fewer medication errors and shorter length of stay.

Multicentre implementation of a nursing competency framework at a provincial scale: A qualitative description of facilitators and barriers.

RATIONALE: Nurses are responsible for engaging in continuing professional development throughout their careers. This implies that they use tools such as competency frameworks to assess their level of development, identify their learning needs, and plan actions to achieve their learning goals. Although multiple competency frameworks and guidelines for their development have been proposed, the literature on their implementation in clinical settings is sparser. If the complexity of practice creates a need for context-sensitive competency frameworks, their implementation may also be subject to various facilitators and barriers. AIMS AND OBJECTIVES: To document the facilitators and barriers to implementing a nursing competency framework on a provincial scale. METHODS: This multicentre study was part of a provincial project to implement a nursing competency framework in Quebec, Canada, using a three-step process based on evidence from implementation science. Nurses' participation consisted in the self-assessment of their competencies using the framework. For this qualitative descriptive study, 58 stakeholders from 12 organizations involved in the first wave of implementation participated in group interviews to discuss their experience with the implementation process and their perceptions of facilitators and barriers. Data were subjected to thematic analysis. RESULTS: Analysis of the data yielded five themes: finding the 'right unit' despite an unfavourable context; taking and protecting time for self-assessment; creating value around competency assessment; bringing the project as close to the nurses as possible; making the framework accessible. CONCLUSION: This study was one of the first to document the large-scale, multi-site implementation of a nursing competency framework in clinical settings. This project represented a unique challenge because it involved two crucial changes: adopting a competency-based approach focused on educational outcomes and accountability to the public and valorizing a learning culture where nurses become active stakeholders in their continuing professional development.

Sources of Stress and Coping Strategies Among Undergraduate Nursing Students Across All Years.

BACKGROUND: Undergraduate nursing students experience high levels of stress during their programs. The literature on their stress is extensive, however, what is less well-known are the specific sources of stresses for students in different years of study. PURPOSE: The aim of this study is to understand nursing students' sources of stress and coping strategies in each year of study. METHOD: A transversal descriptive qualitative study was used. A sample of 26 undergraduate students attending a university in Montreal, Canada were recruited and participated in a semi-structured interview. Data were analysed using inductive thematic analysis. RESULTS: The sources of stress differed according to year of study and related significantly to the specific novelty of that year. For first-year students, their stress was related to their academic courses. High clinical performance expectations and a lack of time for their personal lives was a main source of stress for second-year students. The prospect of graduating and transitioning into the work environment caused stress for students in their final year. Students across all years of study utilized similar coping strategies. CONCLUSION: The findings suggest that interventions can be developed to address the sources of stress experienced by nursing students in each year of study.

Turnover intention among new nurses: a generational perspective.

With the current nursing shortage, it is crucial to understand the aspects of the nursing work environment that are related to turnover in new generation nurses. The Practice Environment Scale of the Nursing Work Index was administered to new nurses in Quebec from different generations to determine what domains of the work environment were related to turnover intention. Results can help nurses in leadership and development positions target interventions to retain new graduates.

Methadone Access for Opioid Use Disorder During the COVID-19 Pandemic Within the United States and Canada.

Importance: Methadone access may be uniquely vulnerable to disruption during COVID-19, and even short delays in access are associated with decreased medication initiation and increased illicit opioid use and overdose death. Relative to Canada, US methadone provision is more restricted and limited to specialized opioid treatment programs. Objective: To compare timely access to methadone initiation in the US and Canada during COVID-19. Design, Setting, and Participants: This cross-sectional study was conducted from May to June 2020. Participating clinics provided methadone for opioid use disorder in 14 US states and territories and 3 Canadian provinces with the highest opioid overdose death rates. Statistical analysis was performed from July 2020 to January 2021. Exposures: Nation and type of health insurance (US Medicaid and US self-pay vs Canadian provincial). Main Outcomes and Measures: Proportion of clinics accepting new patients and days to first appointment. Results: Among 268 of 298 US clinics contacted as a patient with Medicaid (90%), 271 of 301 US clinics contacted as a self-pay patient (90%), and 237 of 288 Canadian clinics contacted as a patient with provincial insurance (82%), new patients were accepted for methadone at 231 clinics (86%) during US Medicaid contacts, 230 clinics (85%) during US self-pay contacts, and at 210 clinics (89%) during Canadian contacts. Among clinics not accepting new patients, at least 44% of 27 clinics reported that the COVID-19 pandemic was the reason. The mean wait for first appointment was greater among US Medicaid contacts (3.5 days [95% CI, 2.9-4.2 days]) and US self-pay contacts (4.1 days [95% CI, 3.4-4.8 days]) than Canadian contacts (1.9 days [95% CI, 1.7-2.1 days]) (P < .001). Open-access model (walk-in hours for new patients without an appointment) utilization was reported by 57 Medicaid (30%), 57 self-pay (30%), and 115 Canadian (59%) contacts offering an appointment. Conclusions and Relevance: In this cross-sectional study of 2 nations, more than 1 in 10 methadone clinics were not accepting new patients. Canadian clinics offered more timely methadone access than US opioid treatment programs. These results suggest that the methadone access shortage was exacerbated by COVID-19 and that changes to the US opioid treatment program model are needed to improve the timeliness of access. Increased open-access model adoption may increase timely access.

Retaining nurses and other hospital workers: an intergenerational perspective of the work climate.

PURPOSE: This article describes and compares work climate perceptions and intentions to quit among three generations of hospital workers and nurses. BACKGROUND: Never before in history has the workplace comprised such a span of generations. The current workforce includes three main generations: Baby Boomers (born between 1946 and 1963), Generation X (born between 1964 and 1980), and Generation Y (born between 1981 and 2000). However, very little research has linked turnover among nurses and other healthcare workers to their generational profile. METHOD: A quantitative study with a correlational descriptive design was used. 1,376 hospital workers of the three generations (with 42.1% nurses, 15.6% support staff, 20.1% office employees, and 22.1% health professionals or technicians), employed in a university-affiliated hospital, completed a self-administered questionnaire. They answered the Psychological Climate Questionnaire and a measure of turnover intention. RESULTS: Generation Y hospital workers obtained a significantly lower score on the "Challenge" scale than did Baby Boomers. On the "Absence of Conflict" and "Warmth" scales, the opposite occurred, with Baby Boomers obtaining a significantly lower score than Generation Y respondents. If the nurse job category is taken separately, Generation Y nurses expressed a negative perception of the "Goal Emphasis" scale, compared with Baby Boomers. The proportion of Generation Y nurses who intend to quit is almost three times higher than that of other hospital workers from Generation Y. The main reason given by workers from Generations Y and X who intend to quit the organization is their own career advancement. The main reason given by Baby Boomers who intend to quit is retirement. CONCLUSIONS: Retention strategies that focus on improving the work climate are beneficial to all generations of hospital workers and nurses. If generation-specific retention strategies are developed, these should focus on the three areas identified to have intergenerational differences: challenges, absence of conflict, and warmth. CLINICAL RELEVANCE: New nurses will benefit from strategies aimed at supporting their career advancement in the workplace.

"Collective climate" in hospital settings: a tool to better target work climate improvement strategies.

Work climate continuous improvement programs are implemented to create and maintain healthy workplaces. This article presents evidence-based supports for the use of "collective climates" as a tool to better target improvement strategies, taking into account that work climate is not only a key for attraction and retention issues but also for performance and quality issues. Our study in 3 different Canadian hospitals shed light on 6 typical configurations that involve specific organizational development strategies.

Measurement and management of work climate: cross-validation of the CRISO Psychological Climate Questionnaire.

This paper presents research results that offer answers to the "why," "what" and "how" of work climate measurement. It also submits to the scientific community a confirmatory cross-validation procedure applied to a new measurement tool, consistent with the works of Jones and James's (1979) and of Parker et al. (2003) on psychological climate. The results depict a good model fit for both the English and French versions of the questionnaire. This new instrument offers a comprehensive and manageable approach for the development of a healthy workplace.

Interpersonal aggression and burnout: the mediating role of psychological climate.

Using the theoretical perspectives offered by stressor-stress-strain framework and fairness theory, the authors propose that psychological climate will mediate the positive relationship between interpersonal aggression and employee burnout. Data from a survey of 1893 hospital employees suggested that psychological climate partially mediated the relationship between interpersonal aggression and two of the three dimensions of burnout, emotional exhaustion and depersonalization. The theoretical and practical implications of these findings and directions for future research are discussed.