Factors influencing nurse manager retention, intent to stay or leave and turnover: A systematic review update.

AIMS: To understand factors influencing nurse manager retention or intention to leave, develop a preliminary theoretical model and identify strategies and interventions for workforce planning. DESIGN: Systematic review update of literature with integrated design of mixed research synthesis. METHODS: We included peer-reviewed articles examining factors influencing retention or intention to leave for front-line, middle or patient care nurse managers. Authors independently screened articles for inclusion and assessed included articles for quality. We adhered to a convergent synthesis approach. DATA SOURCES: Nine databases included MEDLINE, EMBASE, PsychINFO, CINAHL Plus with Full Text, ERIC, Health Source Nursing/Academic Edition, Scopus, ProQuest Dissertations and Theses and LILACS in January 2023. RESULTS: Thirty-five studies published between 1990 and 2022, 22 quantitative and 13 qualitative or mixed methods, were included. 155 factors influencing nurse manager retention, intention to stay, or turnover were reported. Job satisfaction was most frequently examined (n = 7), followed by factors such as empowerment (n = 3), decision-making (n = 3) and resilience (n = 2). We developed a preliminary theoretical model demonstrating staff relations and leadership, organizational and job characteristics, socio-demographics, personal characteristics, well-being and nurse manager relationship with work influence managers' intention to stay or to leave. CONCLUSIONS: Nurse managers who were empowered, satisfied with their work, received constructive feedback and found meaning in their roles showed greater intent to stay. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Nurse administrators can ensure managers are provided with authority to make decisions that promote autonomy. Work cultures that allow for regular meaningful constructive feedback from staff and leaders may contribute to nurse managers feeling valued. IMPACT: Understanding factors that influence job retention or intention to leave may help nurse managers and their supervisors identify areas for strategy and intervention design to ensure sustainability of this workforce. REPORTING METHOD: PRISMA 2020 Guidelines. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

A first look at consistency of documentation across care settings during emergency transitions of long-term care residents.

BACKGROUND: Documentation during resident transitions from long-term care (LTC) to the emergency department (ED) can be inconsistent, leading to inappropriate care. Inconsistent documentation can lead to undertreatment, inefficiencies and adverse patient outcomes. Many individuals residing in LTC have some form of cognitive impairment and may not be able to advocate for themselves, making accurate and consistent documentation vital to ensuring they receive safe care. We examined documentation consistency related to reason for transfer across care settings during these transitions. METHODS: We included residents of LTC aged 65 or over who experienced an emergency transition from LTC to the ED via emergency medical services. We used a standardized and pilot-tested tracking tool to collect resident chart/patient record data. We collected data from 38 participating LTC facilities to two participating EDs in Western Canadian provinces. Using qualitative directed content analysis, we categorized documentation from LTC to the ED by sufficiency and clinical consistency. RESULTS: We included 591 eligible transitions in this analysis. Documentation was coded as consistent, inconsistent, or ambiguous. We identified the most common reasons for transition for consistent cases (falls), ambiguous cases (sudden change in condition) and inconsistent cases (falls). Among inconsistent cases, three subcategories were identified: insufficient reporting, potential progression of a condition during transition and unclear reasons for inconsistency. CONCLUSIONS: Shared continuing education on documentation across care settings should result in documentation supports geriatric emergency care; on-the-job training needs to support reporting of specific signs and symptoms that warrant an emergent response, and discourage the use of vague descriptors.

Lessons from professional nursing associations' policy advocacy responses to the COVID-19 pandemic: An interpretive description.

BACKGROUND: Professional nursing associations across jurisdictions engaged in significant policy advocacy during the COVID-19 pandemic to support nurses, the public and health systems. While professional nursing associations have a long history of engaging in policy advocacy, scholars have rarely critically examined this important function. PURPOSE: The purpose of this study was twofold: (a) to examine how professional nursing associations engage in the process of policy advocacy and (b) to develop knowledge specific to policy advocacy in the context of a global pandemic. METHODS: This study was conducted using interpretive description. A total of eight individuals from four professional nursing associations (two local, one national and one international) participated. Data sources included semi-structured interviews conducted between October 2021 and December 2021 and internal and external documents produced by organizations. Data collection and analysis occurred concurrently. Within-case analysis was conducted prior to cross-case comparisons. FINDINGS: Six key themes were developed to illustrate the lessons learned from these organizations including their organization's role in supporting a wide audience (professional nursing associations as a compass); the scope of their policy priorities (bridging the gaps between issues and solutions), the breadth of their advocacy strategies (top down, bottom up and everything in between), the factors influencing their decision-making (looking in and looking out), their evaluation practices (focus on contribution, not attribution) and the importance of capitalizing on windows of opportunity. CONCLUSIONS: This study provides insight into the nature of policy advocacy carried out by professional nursing associations. IMPACT: The findings suggest the need for those leading this important function to think critically about their role in supporting a wide range of audiences, the breadth and depth of their policy priorities and advocacy strategies, the factors that influence their decision-making, and the ways in which their policy advocacy work can be evaluated to move towards greater influence and impact.

Authentic leadership, organizational culture and the effects of hospital quality management practices on quality of care and patient satisfaction.

AIM: To examine the influence of hospital culture and authentic leadership on the effects of quality improvement practices on patient satisfaction. BACKGROUND: Nurses in formal leadership roles shape and are shaped by organizational culture to achieve high performance standards to influence quality of care. DESIGN: Using structural equation modelling, we tested a model on quality improvement practices across three participant groups that differed based on authentic leadership and hospital culture. METHODS: We used survey data from a cross-sectional study conducted in 2015 measuring nurse. Managers' perceptions of authentic leadership, implementation of quality improvement, and organizational culture in Canadian hospitals. RESULTS: 226 nurse managers participated. Our model estimations fit for the high-relational group and mixed group. Our model explained 50.7% and 39.5% variance in our outcome variable of patient satisfaction for the high-relational group and mixed group, respectively. Our model failed to fit the low-relational group. CONCLUSION: Authentic leadership and developmental/group hospital cultures improve quality management practices, quality of care and patient satisfaction. In organizations with low authentic leadership and hierarchical/rational cultures, strategies should target increasing authentic leadership and shifting to developmental cultures. Organizations with high authentic leadership and/or developmental/group cultures should target employee engagement, autonomy and teamwork. IMPACT: We examined how different combinations of authentic leadership and hospital culture influence the effects of quality management practices on quality improvement and patient satisfaction. Findings demonstrate that having both high authentic leadership and developmental or group hospital cultures are essential for quality improvement practices to enhance the quality of care and patient satisfaction. These organizations would benefit the most from systemic programs aimed at standardizing quality management practices as they have the culture and leadership to support these practices. For hospitals with hierarchical/rational cultures and/or low authentic leadership, enhancing hospital culture and leadership through leadership training and accreditation programs is critically needed. PATIENT OR PUBLIC CONTRIBUTION: The College and Association of Registered Nurses of Alberta contributed to this study by facilitating data collection and supporting the conduct of the study through messaging to its members.

Incidence of Pressure Injury Among Older Adults Transitioning from Long-term Care to the ED.

OBJECTIVE: To identify sociodemographic, health condition, and organizational/process factors associated with pressure injury (PI) incidence during older adults' emergency transitions from long-term care (LTC) to the ED. METHODS: Emergency transitions were tracked for older adults within included LTC facilities to participating EDs in two urban centers located in provinces in Canada. Binary logistic regression was used to examine the influence of sociodemographic, service use, and client health and function factors on the incidence of PIs during transitions from LTC facilities to EDs. RESULTS: Having a mobility issue (odds ratio [OR], 4.318; 95% CI, 1.344-13.870), transitioning from a publicly owned versus a nonprofit volunteer LTC facility (OR, 4.886; 95% CI, 1.157-20.634), and time from ED arrival to return to LTC being 7 to 9 days (OR, 41.327; 95% CI, 2.691-634.574) or greater than 9 days (OR, 77.639; 95% CI, 5.727-1,052.485) significantly increased the odds of experiencing a new skin injury upon return to LTC. A higher number of reported reasons for emergency transition (up to 4) significantly decreased the odds of a new PI upon return to LTC (OR, 0.315; 95% CI, 0.113-0.880). CONCLUSIONS: The study findings can be used to identify LTC residents at increased risk for developing new skin injuries during an emergency transition, namely, those with mobility impairment, those requiring inpatient care for 6 or more days, and those transitioning from publicly owned LTC facilities. Evaluating the uptake and effectiveness of single-pronged and multipronged interventions such as visual cues for patient turning through online monitoring, consistent risk assessments, and improved nutrition in all care settings are vital next steps in preventing skin injuries in this population.

New Graduate Nurses' Incivility Experiences: The Roles of Workplace Empowerment, Nursing Leadership and Areas of Worklife.

AIMS: To determine what extent are workplace empowerment, New Graduate Nurses' (NGN) perceptions of nurse leaders, trust in management, and areas of worklife predict coworker incivility experiences? BACKGROUND: NGNs' perceptions of nursing leaderships' control over workload contribute to coworker incivility experiences were tested. The relationship between workplace empowerment, authentic leadership, and areas of work life (workload control and fair resource allocation) to coworker incivility experiences were examined. DESIGN: Secondary analysis of Starting Out, national survey, Time 1 dataset. Select factors of workplace empowerment, authentic leadership, areas of worklife, trust in management and NGNs' co- worker incivility experiences were situated within an ecological approach. Multiple linear regression was used to test whether a negative relationship of workplace empowerment, areas of worklife and authentic leadership to NGNs co-worker incivility experiences and important new findings were discovered. RESULTS: First, NGNs' perceptions of workplace empowerment predict coworker incivility experiences when controlling for authentic leadership and trust in management. Second, NGNs' perceptions of areas of worklife predict coworker incivility experiences when controlling for authentic leadership, trust in management, and workplace empowerment. Third, NGNs' perceptions of authentic leadership do not predict coworker incivility experiences when controlling for workplace empowerment and trust in management. Finally, NGNs' perceptions of authentic leadership do predict coworker incivility experiences when trust in management and workplace empowerment are not controlled. CONCLUSIONS: NGNs' perceptions of authentic leadership would benefit from workplace empowerment of the nurse leader in workplace environments to mitigate coworker incivility experiences.

Informed consent challenges and strategies: A qualitative study of the orthodontists' perspective.

OBJECTIVE: To identify the barriers and strategies perceived by orthodontists when obtaining consent from their adult patients concerning patients' comprehension or recollection of treatment information. SETTINGS AND SAMPLE POPULATION: The sample comprised 12 orthodontists working in 8 different cities in Alberta, Canada. METHODS: An exploratory investigation using qualitative inquiry was conducted. Participants were recruited through a combination of purposive, maximum variation and snowball sampling. Data were collected through audio-recorded, semi-structured interviews until saturation was reached. Then, data were analysed using thematic analysis. Quality and credibility were achieved by employing member checks, memo writing and analyst triangulation strategies. RESULTS: Two major themes were identified, with subthemes: (1) Challenges that may interfere with patients' comprehension and recollection of treatment information (i. patients' internal barriers, ii. patients' external barriers and iii. financial barriers); and (2) strategies to optimize information delivery and communication (i. tailoring the content to be delivered, ii. communication fashion, iii. communication timing and iv. being accommodative). CONCLUSION: The participants reported barriers that may be overlooked in the daily routine of orthodontic practices. Information is provided that may guide orthodontists to overcome or minimize these challenges, increase patient comprehension and improve the quality of informed consent processes.

A review: Developing an ecological model approach to co-worker incivility experiences of new graduate nurses.

AIM: To explore how an ecological approach be used to explore relationships among workplace empowerment, authentic leadership, trust in management, areas of work life and co-worker incivility experiences of new graduate nurses. DESIGN: Key concepts related to new graduate nurses' incivility experience informed the research question building on the findings of our first author's integrative review. Second, relevant theories and concepts were identified by conducting a literature review. Third, the themes build on prior theories and factors to propose a hypothetical model. DATA SOURCES: (2016-2019) CINAHL, OVID, PSYCINFO, PUBMED, EBSCO, ERIC, SCOPUS, Cochrane Library; PROQUEST and Google Scholar. REVIEW METHODS: (a) Constructs identified in an IR (Blackstock et al., 2018) guided a literature review on predictive variables linked to new graduate nurse's co-worker incivility experiences; (b) an ecological approach was explored; and (c) we demonstrate how multidimensional organizational factors related to incivility experiences of new graduate nurses can be situated in an ecological model. RESULTS: Structural and organizational factors, and nurse leaders influencing new graduate nurses' experiences are situated in an ecological model. Placing new graduate nurses' co-worker incivility experiences in the microsystem and close to the mesosystem (nurse supervisor) and exosystem (workplace empowerment) of our ecological model provides new insights into their incivility experiences and informs future research. CONCLUSION: The ecological approach and operational definition of incivility help to clarify incivility behaviours as not merely individual behaviours observed by others needing corrective cognitive behaviours, nor support in a graduate transition program, but rather a symptom of work environment factors contributing to multidimensional work environments of new graduate nurses' and influence incivility behaviours. IMPACT: New graduate nurse co-worker incivility research could measure change across time and across system domains informed by this ecological approach and can shape new ways of thinking about how to prevent and mitigate incivility.

Theory utilization in applied qualitative nursing research.

AIMS: To explore the nuances of theory utilization in qualitative methodologies, discuss the different relationships that applied qualitative methodologies have with theory and use the foundational underpinnings of interpretive description to challenge strongly entrenched ideas of theory that have extended into applied qualitative nursing research. DESIGN: Methodology discussion paper. DATA SOURCES: Narrative literature review and personal observations. CONCLUSION: Many qualitative research traditions have viewed the use of an explicit theoretical framework as an integral grounding for qualitative research studies. Much of the discussion of theory in extant qualitative methodological literature focuses on its use in the context of traditional methodologies such as ethnography, phenomenology and grounded theory, with less attention on methodological approaches developed for applied and practice disciplines such as nursing. Uncritical adoption of ideas about theory based on traditional qualitative methodological conventions can result in findings with little utility for application to the practice context. IMPACT: Nursing researchers should think critically about how theory is used in research endeavours geared towards applied practice and ensure that their methodological choices are in alignment with their philosophical and disciplinary epistemological positionings.

How nursing leaders promote evidence-based practice implementation at point-of-care: A four-country exploratory study.

AIMS: To describe strategies nursing leaders use to promote evidence-based practice implementation at point-of-care using data from health systems in Australia, Canada, England and Sweden. DESIGN: A descriptive, exploratory case-study design based on individual interviews using deductive and inductive thematic analysis and interpretation. METHODS: Fifty-five nursing leaders from Australia, Canada, England and Sweden were recruited to participate in the study. Data were collected between September 2015 and April 2016. RESULTS: Nursing leaders both in formal managerial roles and enabling roles across four country jurisdictions used similar strategies to promote evidence-based practice implementation. Nursing leaders actively promote evidence-based practice implementation, work to influence evidence-based practice implementation processes and integrate evidence-based practice implementation into everyday policy and practices. CONCLUSION: The deliberative, conscious strategies nursing leaders used were consistent across country setting, context and clinical area. These strategies were based on a series of activities and interventions around promoting, influencing and integrating evidence-based practice implementation. We conjecture that these three key strategies may be linked to two overarching ways of demonstrating effective evidence-based practice implementation leadership. The two overarching modes are described as mediating and adapting modes, which reflect complex, dynamic, relationship-focused approaches nursing leaders take towards promoting evidence-based practice implementation. IMPACT: This study explored how nursing leaders promote evidence-based practice implementation. Acknowledging and respecting the complex work of nursing leaders in promoting evidence-based practice implementation through mediating and adapting modes of activity is necessary to improve patient outcomes and system effectiveness.

Predictors of toxic leadership behaviour among nurse managers: A cross-sectional study.

AIM: To identify the predictors of toxic leadership behaviour in nurse managers. BACKGROUND: Toxic leadership is becoming increasingly prevalent in nursing; however, the literature provides very limited evidence of the different factors that promote toxic leadership behaviour in nurse managers. METHODS: A descriptive, cross-sectional design was used. Two hundred and forty nurse managers from ten hospitals in the Central Philippines were included in the study. Data were collected using the Nurse Information Form and the Toxic Leadership Behaviours of Nurse Managers Scale (ToxBH-NM). Hierarchical multiple regression was used to analyse the data collected. RESULTS: The mean of average item score of the ToxBH-NM was 1.250 (SD = 0.470). Multiple regression analyses identified the years of experience in a managerial role (ß = -0.165, p = .031), job status (part time) (ß = 0.177, p = .002), ward census (30 patients, 40 patients and above 40 patients) ([ß = 0.231, p = .005]; [ß = 0.345, p < .004]; [ß = 0.262, p = .012]), number of units managed (2 units and > 3 units) ([ß = 0.292, p < .001]; [ß = 0.235, p < .001]), hospital type (private hospital) (ß = 0.271, p = .007) and hospital level (secondary hospitals) (ß = 0.226, p = .036) predicted toxic leadership behaviour in nurse managers. CONCLUSIONS: Overall, nurse managers were appraised as non-toxic leaders. Nurse managers who held a part-time job status, those who had lower experience in the managerial role and those who were assigned to wards or units with high patient admission numbers reported increased toxic leadership behaviours. Further, nurse managers who managed more than 2 units, those who were employed in private hospitals and those who worked in secondary hospitals reported increased toxic leadership behaviours. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse administrators can consider the different predictors identified when planning and developing leadership interventions and organisational strategies (e.g. limiting the number of units per nurse manager, provision of full-time job employment, assignment of assistant nurse managers, formulation of policy specific to managing toxic behaviours), which may assist in the determent of toxic behaviours in nurse managers.

Policy Advocacy and Nursing Organizations: A Scoping Review.

Policy advocacy is a fundamental component of nursing's social mandate. While it has become a core function of nursing organizations across the globe, the discourse around advocacy has focused largely on the responsibilities and accountabilities of individual nurses, with little attention to the policy advocacy work undertaken by nursing organizations. To strengthen this critical function, an understanding of the extant literature is needed to identify areas that require further research. We conducted a scoping review to examine the nature, extent, and range of scholarly work focused on nursing organizations and policy advocacy. A systematic search of six databases produced 4,731 papers and 68 were included for analysis and synthesis. Findings suggest that the literature has been increasing over the years, is largely non-empirical, and covers a broad range of topics ranging from the role and purpose of nursing organizations in policy advocacy, the identity of nursing organizations, the development and process of policy advocacy initiatives, the policy advocacy products of nursing organizations, and the impact and evaluation of organizations' policy advocacy work. Based on the review, we identify several research gaps and propose areas for further research to strengthen the influence and impact of this critical function undertaken by nursing organizations.

Influence of Sponsorship Bias on Treatment Effect Size Estimates in Randomized Trials of Oral Health Interventions: A Meta-epidemiological Study.

BACKGROUND: In this meta-epidemiological study, we aimed to examine associations between treatment effect size estimates and sponsorship bias in oral health randomized clinical trials. METHODS: We selected oral health related meta-analyses that included a minimum of five randomized controlled trials. We extracted data, in duplicate, related to influence of sponsorship bias. We quantified the extent of bias associated with influence of sponsorship on the magnitude of effect size estimates of continuous variables using a two-level meta-meta-analytic approach with random-effects models to allow for intra- and inter-meta-analysis heterogeneity. RESULTS: We initially identified 540 randomized trials included in 64 meta-analyses. Risk of sponsorship bias was judged as being "unclear" in 72.8% (n = 393) of the trials, while it was assessed as "low" in 16.7% (n = 90) and as "high" in 10.6% (n = 57) of the trials. Using a meta-epidemiological analysis (37 meta-analyses, including 328 trials that analyzed 85,934 patients), we identified statistically significant larger treatment effect size estimates in trials that had "high or unclear" risk of sponsorship bias (difference in treatment effect size estimates=0.10; 95% confidence intervals: 0.02 to 0.19) than in trials that had "low" risk of sponsorship bias. CONCLUSIONS: We identified significant differences in treatment effect size estimates between dental trials based on sponsorship bias. Treatment effect size estimates were 0.10 larger in trials with "high or unclear" risk of sponsorship bias. PRACTICAL IMPLICATIONS: Clinicians should have an adequate knowledge of sponsorship bias in a clinical trial and be able to estimate the degree to which the conclusions of a systematic review are synthesized and interpreted, based on trials with low risk of sponsorship bias.

Improving care for residents in long term care facilities experiencing an acute change in health status.

BACKGROUND: Long term care (LTC) facilities provide health services and assist residents with daily care. At times residents may require transfer to emergency departments (ED), depending on the severity of their change in health status, their goals of care, and the ability of the facility to care for medically unstable residents. However, many transfers from LTC to ED are unnecessary, and expose residents to discontinuity in care and iatrogenic harms. This knowledge translation project aims to implement a standardized LTC-ED care and referral pathway for LTC facilities seeking transfer to ED, which optimizes the use of resources both within the LTC facility and surrounding community. METHODS/DESIGN: We will use a quasi-experimental randomized stepped-wedge design in the implementation and evaluation of the pathway within the Calgary zone of Alberta Health Services (AHS), Canada. Specifically, the intervention will be implemented in 38 LTC facilities. The intervention will involve a standardized LTC-ED care and referral pathway, along with targeted INTERACT® tools. The implementation strategies will be adapted to the local context of each facility and to address potential implementation barriers identified through a staff completed barriers assessment tool. The evaluation will use a mixed-methods approach. The primary outcome will be any change in the rate of transfers to ED from LTC facilities adjusted by resident-days. Secondary outcomes will include a post-implementation qualitative assessment of the pathway. Comparative cost-analysis will be undertaken from the perspective of publicly funded health care. DISCUSSION: This study will integrate current resources in the LTC-ED pathway in a manner that will better coordinate and optimize the care for LTC residents experiencing an acute change in health status.

Development and psychometric testing of the toxic leadership behaviors of nurse managers (ToxBH-NM) scale.

AIM: This paper describes the development and testing of the psychometric property of the Toxic Leadership Behaviors of Nurse Managers (ToxBH-NM) Scale. BACKGROUND: Toxic leadership is growing increasingly pervasive in the field of nursing. However, the current literature lacks comprehensive attempts to explain how toxic leadership disrupts work processes in the field of nursing, a reality confounded in part by the absence of a reliable and a valid scale on which to examine toxic leadership behaviours in nurse managers. METHODS: An exploratory sequential research design was used to formulate and evaluate the psychometric property of ToxBH-NM Scale. The content validity was examined by experts in nursing administration. A sample of 313 nurses from selected hospitals was recruited to assess the scale's reliability and validity. The factor structure of the newly developed scale was determined by exploratory factor analysis (EFA). RESULTS: Exploratory factor analysis for ToxBH-NM Scale revealed 30 items loading on four factors. The overall Cronbach's α coefficient of the scale was 0.975, and Cronbach's α coefficient ranged from 0.895 to 0.965 for the four factors. Corrected item-to-total (0.310-0.69) and item-to-item correlations (0.47-0.66) were acceptable. The Scale-content Validity Index was 0.957, and the Item-content Validity Index ranged from 0.833 to 1.000. The test-retest reliability coefficient of ToxBH-NM Scale was 0.801, with a reliability coefficient that ranged from 0.745 to 0.911 for the four factors. The four factors explained 71.84% of the observed variance. CONCLUSIONS: ToxBH-NM Scale shows good psychometric properties and can be used to evaluate toxic leadership behaviours among nurse managers. IMPLICATIONS FOR NURSING MANAGEMENT: The use of ToxBH-NM Scale can aid nurse managers in better understanding and managing their own leadership behaviours within their organisations and in fostering desirable work outcomes among employees, a positive work climate and overall organisational success.

The early retiree divests the health workforce: a quantitative analysis of early retirement among Canadian Registered Nurses and allied health professionals.

BACKGROUND: Early retirement (before age 65) is the norm among registered nurses (RNs) and allied health professionals (AHPs) employed in Canada's public system. As a country whose population is rapidly aging, it is in Canada's best interest to try and extend the work lives of RNs and AHPs. OBJECTIVES: (1) To test the predictive validity of our conceptual model of early retirement among publicly employed, Canadian RNs and AHPs and (2) to compare, across professions, model fit and factor significance METHODS: We conducted multivariable logistic regression in two data sets, one consisting of 483 retired RNs and the other of 177 retired AHPs. The number of AHP respondents limited our ability to comprehensively test the model. RESULTS: Eighty-five percent of RNs and 77% of AHPs had retired early. (1) Results indicate that 25% of variance in RN early retirement and 19% of variance in AHP early retirement was explained by included variables. (2) Organizational restructuring increased odds of early retirement by more than 100% among RNs and AHPs. Among RNs (but not AHPs), both financial possibility and caregiving responsibilities predicted early retirement at statistically significant levels, while a "desire to stop working" predicted retirement at or after 65 years of age. CONCLUSIONS: Clearly, there is much more to learn about RN and AHP pathways to early retirement. Further research, ideally research exploring the role of workplace characteristics, attitudes, and beliefs towards retirement and work-related factors, could deepen our understanding of the phenomenon of RN/AHP early retirement.

Factors affecting job satisfaction in long-term care unit managers, directors of care and facility administrators: A secondary analysis.

AIM: To identify demographic-, individual- and organisational-level predictors of job satisfaction among managers in residential long-term care (LTC) facilities. BACKGROUND: Job satisfaction predicts turnover among managers in LTC settings. However, factors affecting job satisfaction among LTC facility managers remain poorly understood. METHODS: A secondary analysis of data from Phase 2 of the Translating Research in Elder Care programme including 168 managers (unit managers, directors of care and facility administrators) from 76 residential LTC homes in three Canadian provinces. Michigan Organizational Assessment Questionnaire Job Satisfaction Subscale was used to measure job satisfaction. Predictors of job satisfaction determined using general estimating equations. RESULTS: The efficacy subscale of burnout was positively predicted job satisfaction at the individual level (B = .104, p = .046). At the organisational level, social capital (B = .224, p = .018), adequate orientation (B = .166, p = .015) and leadership (B = .155, p = .018) were associated with higher job satisfaction. CONCLUSIONS: These data suggest that improving LTC managers' self-perceived efficacy, leadership, social capital and adequate orientation may enhance their job satisfaction. IMPLICATIONS FOR NURSING MANAGEMENT: Predictors of managers' job satisfaction are modifiable and therefore may be amenable to intervention.

Influence of blinding on treatment effect size estimate in randomized controlled trials of oral health interventions.

BACKGROUND: Recent methodologic evidence suggests that lack of blinding in randomized trials can result in under- or overestimation of the treatment effect size. The objective of this study is to quantify the extent of bias associated with blinding in randomized controlled trials of oral health interventions. METHODS: We selected all oral health meta-analyses that included a minimum of five randomized controlled trials. We extracted data, in duplicate, related to nine blinding-related criteria, namely: patient blinding, assessor blinding, care-provider blinding, investigator blinding, statistician blinding, blinding of both patients and assessors, study described as "double blind", blinding of patients, assessors, and care providers concurrently, and the appropriateness of blinding. We quantified the impact of bias associated with blinding on the magnitude of effect size using a two-level meta-meta-analytic approach with a random effects model to allow for intra- and inter-meta-analysis heterogeneity. RESULTS: We identified 540 randomized controlled trials, included in 64 meta-analyses, analyzing data from 137,957 patients. We identified significantly larger treatment effect size estimates in trials that had inadequate patient blinding (difference in treatment effect size = 0.12; 95% CI: 0.00 to 0.23), lack of blinding of both patients and assessors (difference = 0.19; 95% CI: 0.06 to 0.32), and lack of blinding of patients, assessors, and care-providers concurrently (difference = 0.14; 95% CI: 0.03 to 0.25). In contrast, assessor blinding (difference = 0.06; 95% CI: -0.06 to 0.18), caregiver blinding (difference = 0.02; 95% CI: -0.04 to 0.09), principal-investigator blinding (difference = - 0.02; 95% CI: -0.10 to 0.06), describing a trial as "double-blind" (difference = 0.09; 95% CI: -0.05 to 0.22), and lack of an appropriate method of blinding (difference = 0.06; 95% CI: -0.06 to 0.18) were not associated with over- or underestimated treatment effect size. CONCLUSIONS: We found significant differences in treatment effect size estimates between oral health trials based on lack of patient and assessor blinding. Treatment effect size estimates were 0.19 and 0.14 larger in trials with lack of blinding of both patients and assessors and blinding of patients, assessors, and care-providers concurrently. No significant differences were identified in other blinding criteria. Investigators of oral health systematic reviews should perform sensitivity analyses based on the adequacy of blinding in included trials.

The Impact of Quality Assurance Initiatives and Workplace Policies and Procedures on HIV/AIDS-Related Stigma Experienced by Patients and Nurses in Regions with High Prevalence of HIV/AIDS.

Stigma is commonly experienced by people living with HIV/AIDS and by those providing care to HIV/AIDS patients. Few intervention studies have explored the impact of workplace policies and/or quality improvement on stigma. We examine the contribution of health care workplace policies, procedures and quality assurance initiatives, and self- and peer-assessed individual nurse practices, to nurse-reported HIV/AIDS-stigma practices toward patients living with HIV/AIDS and nurses in health care settings. Our sample of survey respondents (n = 1157) included managers (n = 392) and registered/enrolled nurses (n = 765) from 29 facilities in 4 countries (South Africa, Uganda, Jamaica, Kenya). This is one of the first studies in LMIC countries to use hierarchical linear modeling to examine the contributions of organizational and individual factors to HIV/AIDS stigma. Based on our results, we argue that organizational interventions explicitly targeting HIV/AIDS stigma are required to reduce the incidence, prevalence and morbidity of HIV/AIDS.

A contextual work-life experiences model to understand nurse commitment and turnover.

AIMS: The aim of this study was to present a discussion and model depicting most effecting work-life experience contextual factors that influence commitment and turnover intentions for nurses in Sri Lanka. BACKGROUND: Increasing demand for nurses has made the retention of experienced, qualified nursing staff a priority for healthcare organizations and highlights the need to capture contextual work-life experiences that influence nurses' turnover decisions. DESIGN: Discussion paper. DATA SOURCES: This discussion paper and model is based on our experiences and knowledge of Sri Lanka and represents an integration of classic turnover research and commitment theory and others published between 1958 - 2017, contextualized to reflect the reality faced by Sri Lanka nurses. IMPLICATIONS FOR NURSING: The model presents a high-level view of intrinsic, extrinsic, personal and professional antecedents to nurse turnover where relevance can be used by researchers, policy makers, clinicians and educators to establish focused and limited scope models and examine comprehensive contexts. CONCLUSION: This model emphasizes the role that work-life experiences play to fortify (or weaken) nurses' motivation to remain committed to their organization, profession, family, and country. Understanding of contextual work-life influences on nurses' intent to stay should lead to evidence-based strategies that result in a higher number of nurses wanting to remain in the nursing profession and work in the health sector in Sri Lanka.