Psychological responses of hospital-based nurses working during the COVID-19 pandemic in the United States: A cross-sectional study.

Studies show decreased well-being during the COVID-19 pandemic, especially for healthcare providers from Asia. Less is known about the psychological responses of working during the pandemic on hospital-based registered nurses (RNs) in the United States (US). Therefore, the purpose of this paper is to report the well-being of U.S.-based hospital RNs working during the initial acute phase of COVID-19 and compare it with well-being among healthcare workers described in two global meta-analyses. We conducted a cross-sectional survey in May-June 2020 (N = 467). Well-being was measured using the following tools: Generalized Anxiety Disorder-7, Patient Health Questionnaire-2 for depressive symptoms, Impact of Events Scale-Revised for traumatic stress, and the Insomnia Severity Index. Compared with global rates from two meta-analyses, US-based RNs reported significantly more traumatic stress (54.6% vs. 11.4% and 21.5%; p < .001) and depressive symptoms (54.6% vs. 31.8% and 21.7%; p < .001). Rates of insomnia were also higher in U.S.-based RNs than in the meta-analysis that reported insomnia (32.4% vs 27.8%; p < .033). Rates of anxiety symptoms among US-based RNs did not differ from that reported in one meta-analysis (37.3% vs. 34.4%), while it was significantly higher in the other (37.3% vs. 22.1%; p < .001). Hospital-based RNs from the US exhibited over twice the rates of trauma and nearly double the rates of depressive symptoms than shown in reports from hospital workers globally during the acute phase of the COVID-19 pandemic. The lasting effects of this distress are unknown and warrant ongoing evaluation and solutions to better support emotional well-being and prevent burnout in the workplace.

Factorial Validity of the Decisional Involvement Scale as a Measure of Content and Context of Nursing Practice.

Decisional involvement is widely recognized as an essential component of a professional nursing practice environment. In recent years, researchers have added to the conceptualization of nurses' role in decision-making to differentiate between the content and context of nursing practice. Yet, instruments that clearly distinguish between these two dimensions of practice are lacking. The purpose of this study was to examine the factorial validity of the Decisional Involvement Scale (DIS) as a measure of both the content and context of nursing practice. This secondary analysis was conducted using data from a longitudinal action research project to improve the quality of nursing practice and patient care in six hospitals (N = 1,034) in medically underserved counties of Pennsylvania. A cross-sectional analysis of baseline data from the parent study was used to compare the factor structure of two models (one nested within the other) using confirmatory factor analysis. Although a comparison of the two models indicated that the addition of second-order factors for the content and context of nursing practice improved model fit, neither model provided optimal fit to the data. Additional model-generating research is needed to develop the DIS as a valid measure of decisional involvement for both the content and context of nursing practice.

Nurse manager job satisfaction and intent to leave.

An electronic survey was used to collect data from 291 nurse managers working in U.S. hospitals. Seventy percent were satisfied or very satisfied with their jobs and 68% were either likely or very likely to recommend nursing management as a career choice. Seventy-two percent of these nurse managers were also planning to leave their positions in the next 5 years. The four most common reasons reported for intent to leave included burnout, career change, retirement, and promotion. Burnout was the most common reason cited by the entire sample but the fourth most common reason for leaving cited by those nurse managers who were planning to leave and also satisfied or very satisfied with their positions. Recommendations for nursing leaders include evaluating the workload of nurse managers, providing career counseling, and developing succession plans.

A thematic analysis of shared experiences of essential health and support personnel in the COVID-19 pandemic.

AIMS AND OBJECTIVES: Studies have shown that the COVID-19 pandemic has taken a toll on individuals who interact with patients with SARS-CoV-2 but focused largely on clinicians in acute care settings. This qualitative descriptive study aimed to understand the experiences and well-being of essential workers across settings during the pandemic. BACKGROUND: Multiple studies of the well-being of individuals who have cared for patients during the pandemic have included interviews of clinicians from acute care settings and revealed high levels of stress. However, other essential workers have not been included in most of those studies, yet they may also experience stress. METHODS: Individuals who participated in an online study of anxiety, depression, traumatic distress, and insomnia, were invited to provide a free-text comment if they had anything to add. A total of 2,762 essential workers (e.g., nurses, physicians, chaplains, respiratory therapists, emergency medical technicians, housekeeping, and food service staff, etc.) participated in the study with 1,079 (39%) providing text responses. Thematic analysis was used to analyze those responses. RESULTS: Four themes with eight sub-themes were: Facing hopelessness, yet looking for hope; Witnessing frequent death; Experiencing disillusionment and disruption within the healthcare system, and Escalating emotional and physical health problems. CONCLUSIONS: The study revealed major psychological and physical stress among essential workers. Understanding highly stressful experiences during the pandemic is essential to identify strategies that ameliorate stress and prevent its negative consequences. This study adds to the research on the psychological and physical impact of the pandemic on workers, including non-clinical support personnel often overlooked as experiencing major negative effects. RELEVANCE TO CLINICAL PRACTICE: The magnitude of stress among all levels of essential workers suggests the need to develop strategies to prevent or alleviate stress across disciplines and all categories of workers.

The influence of interpersonal relationships on nurse managers' work engagement and proactive work behavior.

OBJECTIVE: This study tested the effects of interpersonal relationships on nurse managers' work engagement and proactive work behavior. BACKGROUND: An engaged workforce may help healthcare organizations improve performance. In healthcare, nurse managers are responsible for creating motivating work environments. They also need to be engaged, yet little is known about what influences nurse managers' performance. METHODS: A self-administered electronic survey was used to collect data from 323 nurse managers working in acute care hospitals. Instruments included the Relational Coordination Scale, Utrecht Work Engagement Scale, and Proactive Work Behavior Scale. RESULTS: Interpersonal relationships with nurse administrators were most predictive of nurse managers' work engagement. Interpersonal relationships with physicians were most predictive of nurse managers' proactive work behavior. CONCLUSION: Organizational cultures that foster quality interpersonal relationships will support the job performance of nurse managers.

The COVID-19 Study of Healthcare and Support Personnel (CHAMPS): Protocol for a Longitudinal Observational Study.

BACKGROUND: Early in the development of the COVID-19 pandemic, it was evident that health care workers, first responders, and other essential workers would face significant stress and workplace demands related to equipment shortages and rapidly growing infections in the general population. Although the effects of other sources of stress on health have been documented, the effects of these unique conditions of the COVID-19 pandemic on the long-term health and well-being of the health care workforce are not known. OBJECTIVE: The COVID-19 Study of Healthcare and Support Personnel (CHAMPS) was designed to document early and longitudinal effects of the pandemic on the mental and physical health of essential workers engaged in health care. We will investigate mediators and moderators of these effects and evaluate the influence of exposure to stress, including morbidity and mortality, over time. We will also examine the effect of protective factors and resilience on health outcomes. METHODS: The study cohort is a convenience sample recruited nationally through communities, professional organizations, networks, social media, and snowball sampling. Recruitment took place for 13 months to obtain an estimated sample of 2762 adults who provided self-reported information administered on the web through structured questionnaires about their work environment, mental and physical health, and psychosocial factors. Follow-up questionnaires will be administered after 6 months and annually thereafter to ascertain changes in health, well-being, and lifestyle. Participants who consented to be recontacted form the longitudinal cohort and the CHAMPS Registry may be contacted to ascertain their interest in ancillary studies for which they may be eligible. RESULTS: The study was approved by the Institutional Review Board and launched in May 2020, with grants from Travere Therapeutics Inc, McKesson Corporation, anonymous donors, and internal funding from the M. Louise Fitzpatrick College of Nursing at Villanova University. Recruitment ended in June 2021 after enrolling 2762 participants, 1534 of whom agreed to participate in the longitudinal study and the registry as well as to be contacted about eligibility for future studies. CONCLUSIONS: The CHAMPS Study and Registry will enable the acquisition of detailed data on the effects of extended psychosocial and workplace stress on morbidity and mortality and serve as a platform for ancillary studies related to the COVID-19 pandemic. TRIAL REGISTRATION: ClinicalTrials.gov NCT04370821; https://clinicaltrials.gov/ct2/show/NCT04370821. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/30757.

Relational coordination among nurses and other providers: impact on the quality of patient care.

AIM: The present study examined nurse reports of relational coordination between nurses and other providers and the impact of relational coordination on patient care quality. BACKGROUND: While communication between providers has been traditionally considered important to improve quality, relational coordination extends this view, emphasising the value of high-quality relationships exemplified by shared goals, shared knowledge and mutual respect; and high-quality communication that is timely, frequent, accurate and problem-solving. METHODS: Direct care registered nurses (RNs) (n=747) completed surveys to assess relational coordination across five provider functions and six types of patient care units. Nurses also reported perceptions about patient care quality. RESULTS: In all analyses, relational coordination between nurses and other providers was significantly related to overall quality, in the expected directions. As relational coordination increased, nurses reported decreases in adverse events such as hospital-acquired infections and medication errors. CONCLUSIONS: Enhancing relational coordination between nurses and other providers is central to improving the quality of patient care. IMPLICATIONS FOR NURSE MANAGERS AND NEW KNOWLEDGE: The emerging theory of relational coordination provides a useful new research-based framework for managers to use to improve provider relationships, communication and the quality of care.

A College of Nursing's Upward Spiral During a Global Pandemic.

BACKGROUND: In March 2020, COVID-19 forced institutions of higher education, faculty, staff, and students to transition to emergency remote learning. This unprecedented time provided the opportunity to reenvision the delivery of nursing education and operation of the college of nursing, using the principles of the four Cs of interorganizational partnering as a guide supported by positive organizational scholarship. METHOD: The Villanova University Fitzpatrick College of Nursing designed and implemented strategies to provide seamless learning opportunities for students in undergraduate and graduate nursing programs, while providing necessary support and future planning for the upcoming academic year. RESULTS: Online and virtual learning platforms integrated into curricula assisted students to meet course objectives and program outcomes. Strategies for effective communication, collegiality, and collaboration within and among the college, university, and nursing community served as mechanism for innovation. CONCLUSION: Communication, cooperation, coordination, and collaboration, along with positive organizational strategizing and support contributed to a successful transition during the COVID-19 pandemic; many of the approaches implemented during the emergency transition will continue into the future.[J Nurs Educ. 2020;59(12):675-682.].

Sustaining Innovations in Complex Health Care Environments: A Multiple-Case Study of Rapid Response Teams.

OBJECTIVES: Rapid response teams (RRTs) are one innovation previously deployed in U.S. hospitals with the goal to improve the quality of care. Sustaining RRTs is important to achieve the desired implementation outcomes, reduce the risk of program investment losses, and prevent employee disillusionment and dissatisfaction. This study sought to examine factors that do and do not support the sustainability of RRTs. METHODS: The study was conceptually guided by an adapted version of the Planning Model of Sustainability. A multiple-case study was conducted using a purposive sample of 2 hospitals with high RRT sustainability scores and 2 hospitals with low RRT sustainability scores. Data collection methods included (a) a hospital questionnaire that was completed by a nurse administrator at each hospital; (b) semistructured interviews with leaders, RRT members, and those activating RRT calls; and (c) a review of internal documents. Quantitative data were analyzed using descriptive statistics; qualitative data were analyzed using content analysis. RESULTS: Few descriptive differences were found between hospitals. However, there were notable differences in the operationalization of certain factors between high- and low-sustainability hospitals. Additional sustainability factors other than those captured by the Planning Model of Sustainability were also identified. CONCLUSIONS: The sustainability of RRTs is optimized through effective operationalization of organizational and project design and implementation factors. Two additional factors-individual and team characteristics-should be included in the Planning Model of Sustainability and considered as potential facilitators (or inhibitors) of RRT sustainability.

Chief nursing officer turnover and the crisis brewing: views from the front line.

OBJECTIVE: This American Organization of Nurse Executives study examined perceptions of staff nurses, nurse managers, and nurses in other organizational roles as part of an initiative examining CNO turnover. Here, we report findings that complete the 3-phased effort to better understand how nurse executive turnover affects the work environment and patient care. BACKGROUND: The CNO plays a key role in promoting nurse satisfaction and improving quality, safety, and effectiveness in healthcare organizations. However, little is known about the impact of nurse executive turnover on staff, managers, or patient care delivery. METHODS: An online survey was used to gather participants' views. RESULTS: Approximately 1,277 nurses employed in hospitals across the United States responded to this survey. They reported that their CNO listened and responded to staff and backed up staff in decision making, even when doing so involved conflicts with physicians. However, they also perceived that the CNO was not always visible on units and accessible to staff and had less power and authority than other top-level hospital executives in the organization. CONCLUSION: Strategies are needed to address the concerns of staff nurses and managers who are left behind when CNO turnover occurs.

Chief nursing officer retention and turnover: a crisis brewing? Results of a national survey.

Anecdotal evidence suggests growing concerns about chief nursing officer (CNO) dissatisfaction, intent to leave, and turnover. However, little evidence documents the magnitude of the problem or whether CNO turnover requires direct action. This article reports the results from the first phase of a three-phase study examining CNO turnover and retention in U.S. hospitals. CNOs were invited to complete an online survey to gather data about their experiences with turnover and to identify CNO retention issues. Our sample includes responses from 622 CNOs employed in hospitals and healthcare systems across the United States. Approximately 38 percent of the respondents reported having left a CNO position-13 percent within two years before the survey and 25 percent within five years before the survey. Of these, approximately one-quarter had been asked to resign, had been terminated, or had lost their jobs involuntarily. When asked about the context of their departure, a high percentage reported leaving their position to pursue another CNO position (50 percent) or for career advancement (30 percent); approximately 26 percent reported leaving because of conflicts with the chief executive officer. Of great concern is the finding that approximately 62 percent of respondents anticipate making a job change in less than five years, slightly more than one-quarter for retirement. Respondents clearly indicated that CNO turnover is a problem that requires attention. The knowledge gained from this study can be used by healthcare leaders to develop strategies and policies aimed at recruiting and retaining CNOs and easing the transition for CNOs and others in the organization when CNO turnover does

Nurse managers' perceptions and experiences regarding staff nurse empowerment: a qualitative study.

AIM: To study nurse managers' perceptions and experiences of staff nurse structural empowerment and its impact on the nurse manager leadership role and style. BACKGROUND: Nurse managers' leadership roles may be viewed as challenging given the complex needs of patients and staff nurses' involvement in both clinical and organizational decision-making processes in interdisciplinary care settings. DESIGN: Qualitative phenomenological study. METHODS: Individual semi-structured interviews were conducted with 8 medical or surgical nurse managers in a 600-bed Belgian university hospital between December 2013 and June 2014. This hospital was undergoing conversion from a classical hierarchical, departmental structure to a flat, interdisciplinary model. RESULTS: Nurse managers were found to be familiar with the structural empowerment of clinical nurses in the hospital and to hold positive attitudes toward it. They confirmed the positive impact of empowerment on their staff nurses, as evidenced by increased responsibility, autonomy, critical reflection and enhanced communication skills that in turn improved the quality and safety of patient care. Structural empowerment was being supported by several change initiatives at both the unit and hospital levels. Nurse managers' experiences with these initiatives were mixed, however, because of the changing demands with regard to their manager role and leadership style. In addition, pressure was being experienced by both staff nurses and nurse managers as a result of direct patient care priorities, tightly scheduled projects and miscommunication. CONCLUSION: Nurse managers reported that structural empowerment was having a favorable impact on staff nurses' professional attitudes and the safety and quality of care in their units. However, they also reported that the empowerment process had led to changes in the managers' roles as well as daily practice dilemmas related to the leadership styles needed. Clear organizational goals and dedicated support for both clinical nurses and nursing unit managers are imperative to maintaining an empowering practice environment which can ensure the best care and healthy, engaged staff.

The Shift Coupon: an innovative method to monitor adverse events.

Adverse events are one method of measuring hospital quality; however, collecting these data is problematic. This article reports findings from a study conducted to collect data about the occurrence of adverse events in the hospital setting using an instrument called the Shift Coupon. The results demonstrated the viability of the Shift Coupon to collect adverse events data and identified the most commonly reported adverse events and nurse-reported causes of adverse events.

Entorno clínico de la enfermera hospitalaria / The Clinical Environment of Hospital Nursing

Este artículo presenta un estudio piloto en el que se explora la posibilidad de utilizar el instrumento validado en los EE.UU. para identificar los atributos de "mejor servicio" en un entorno clínico de enfermería en hospitales españoles. En este estudio piloto sólo se ha incluido un hospital español. En los EE.UU. hemos analizado un número superior de hospitales, en los que las observaciones se compararon con las que se presentan en este artículo (Aiken et al, 2000; Havens y Aiken, 1999). Las observaciones del hospital universitario de Barcelona indican que un estudio más comprensivo de los hospitales españoles podría ser muy revelador y útil para la futura potenciación de la práctica profesional de la enfermería en España. Entre los países, la reestructuración de la plantilla hospitalaria y el rediseño del trabajo en el ámbito hospitalario parecen ser generalizados y destacadamente similares (Sochalski y Aiken, 1999; Sochalski et al, 1998).Las observaciones de este estudio piloto indican que los hospitales españoles y estadounidenses están implementando variaciones en la organización del trabajo de enfermería. Nosotros sugerimos que las observaciones obtenidas a partir de un programa de investigación de larga evolución en los EE.UU. podrían tener implicaciones para la organización de la enfermería hospitalaria en el ámbito internacional; a saber: que se obtienen mejores resultados referentes a pacientes y profesionales de enfermería cuando éstos son autónomos para aplicar sus conocimientos en la toma de decisiones en el cuidado de los pacientes, para controlar el ámbito de atención al paciente, incluida la movilización de los recursos necesarios, y cuando establecen buenas relaciones con los médicos. Se dispone de evidencias empíricas de acuerdo con las cuales esta organización del trabajo de enfermería produce mejores resultados sobre pacientes y plantilla. Por tanto, el modelo del hospital magnético es un planteamiento innovador que puede tener una aplicación global como estrategia para potenciar tanto la calidad de la atención al paciente como el ámbito de la práctica clínica de la enfermería. (AU)