Self-reported Competences of Expatriate Practicing Nurses in Kuwait: A Descriptive Study.

AIM: The aim of the study was to explore the perceived self-reported competence of nurses who worked in Kuwaiti hospitals and the predictors influencing the level of competence. BACKGROUND: Competence in nursing is found to affect patient safety and the quality of care provided to patients. The vast majority of nurses working in the health system are non-Kuwaitis. Thus, it is of the utmost importance to assess nurses' competences as the first step toward ensuring the best quality of care. METHODS: A cross-sectional, descriptive, correlational design was used. A non-random convenience sample of 220 practicing expatriate nurses working in public hospitals completed the NPC-35 scale and a demographic form. Data collection was done over a period of three weeks from January 26th, 2020 to February 16th, 2020. RESULTS: The findings of the study showed that nurses perceived their competence as good. The results also showed that years of experience, enrollment in a traditional program of study, exposure to training programs, working in accredited hospitals and nationality explained 56% of the variation in the level of Nursing Professional Competence (NPC). CONCLUSION: The results indicate that nurse leaders and policy makers need to improve nursing orientation and training programs so that they are competence based. The results of the study also point to the importance of revisiting the nursing recruitment policy and managing expatriate nurses while making better investment in educating and producing Kuwaiti national nurses.

Women's career progression to management positions in Jordan's health sector.

PURPOSE: This study aims to identify and explore experiences, perspectives, barriers and enablers to women's career progression to management positions in the health-care sector and to assess women's and men's perceptions of the policies and practices of the health-care system concerning gender equality and nondiscrimination between women and men. DESIGN/METHODOLOGY/APPROACH: A cross-sectional survey was conducted among health-care professionals in ten selected hospitals, including physicians, registered nurses/midwives and pharmacists with or without managerial positions. FINDINGS: This study included a total of 2,082 female and 1,100 male health-care professionals. Overall, 70% of women and men reported that opportunities for advancement are based on knowledge and skills in their institution. However, 58.9% of women (p < 0.001) reported that women are more likely to face barriers to career advancement than men do in their workplace. Lack of women in general/line management and discrimination against women by supervisors at the point of promotion were the main barriers to women's career progression, as they were reported by two-thirds of women. The main barrier, as perceived by men (62.3%) was that women have family and domestic responsibilities. PRACTICAL IMPLICATIONS: To overcome barriers in women's career progression, there is a need to establish a career planning and capacity-building program for women in the health sector. ORIGINALITY/VALUE: Jordanian female health-care professionals face different barriers that affect their career progression, including inequity and discrimination in the workplace, negative views about women's abilities, lack of qualifications and training, hostile cultural beliefs and family responsibilities.

Authentic leadership, nurse-assessed adverse patient events and quality of care: The mediating role of nurses' safety actions.

BACKGROUND: Authentic leadership has been consistently cited as a strong precursor of sustained job performance and work effectiveness in nurses; however, studies linking authentic leadership with nurses' safety actions, nurse-assessed adverse patient events and nursing care quality are scarce. AIM: To examine whether nurses' safety actions mediate the relationship between authentic leadership, nurse-assessed adverse events and nursing care quality. METHODS: A multi-centre, cross-sectional study involving 1,608 nurses employed in acute care facilities in Oman. Multi-stage regression analysis was conducted in testing for the mediation model. FINDINGS: Nurse managers in Oman were perceived to be highly authentic by their staff nurses. Authentic leadership significantly predicted nurses' safety actions (ß = 0.168, p < .001), decrease in nurse-assessed adverse events (ß = -0.017, p = .024) and increase in care quality (ß = 0.121, p < .001). Further, the association between authentic leadership and nurse-assessed adverse events (ß = -0.063, p = .057) and care quality (ß = 0.038, p = .002) was mediated by nurses' safety actions. CONCLUSION: Results suggest the importance of developing nurse managers' authentic leadership to foster nurses' safety actions and reduce adverse patient outcomes and promote nursing care quality. IMPLICATIONS FOR NURSING MANAGEMENT: Organizational efforts to address patient safety issues should be directed towards developing authentic leadership in nurse managers through leadership programmes, periodic evaluation of leadership competencies (e.g., 360-degree or a bottom-up performance evaluation), and a creation of a safe culture in which nurses can openly report safety concerns for corrective action.

Missed nursing care, staffing levels, job satisfaction, and intent to leave among Jordanian nurses.

Patient safety is an important outcome for nurses who provide patient care within an environment that may increase the incidence of errors or impose them to omit care; these errors mostly happen because of staff shortage. The purpose of this study is to identify the types and reasons of "missed nursing care" among Jordanian nurses, and to examine the relationships between "missed nursing care", staffing, intent to leave, and job satisfaction. A cross-sectional descriptive design was used. A convenience sample of 300 nurses completed the Arabic version of MISSCARE which included items to measure types and reasons for "missed nursing care", staffing adequacy, job satisfaction, and intent to leave. The results of this study indicated that Labor resources were the most common cause of "missed nursing care". The results also showed that a low number of nurses per shift were associated with a high level of "missed nursing care". Nurse managers need to tackle staffing problems that may increase the rate of missed care and result in negative outcomes on the patients, nurses, as well as organizations. Nurse administrators could conduct evidence-based staffing plans to manage nurse to patient ratio to decrease missed care and enhance satisfaction.

Exploration of advanced practice nurses' competencies necessary for achievement of universal health coverage in Jordan.

BACKGROUND: Given the global shortage of the health workforce and the nature of diseases, strengthening and improving health care systems become a necessity. One of the solutions that is recommended by the literature is to utilize advanced practice nurses (APNs) to accelerate the progress toward the Sustainable Development Goals and universal health coverage (UHC). PURPOSE: To delineate APN practice and competencies in relation to UHC and primary care in Jordan from the perspective of nurse administrators, clinical nurse specialist, academics, and policymakers. PROCEDURE: A descriptive exploratory survey design was utilized to identify APN competencies that are important in achieving UHC. The survey developed by one of the authors (JH) at a PAHO Collaborating Center to delineate APN practice and APN competencies was adapted and utilized. A convenience sample of 94 nurse leaders was recruited from the education sector, nursing associations, councils, and hospitals. RESULTS: The results showed that all four competencies (clinical care; interdisciplinary and patient-centered communication; systems of care; and using evidence for best practice) were rated as agree/strongly agree across all four domains. There was a consensus of participates on dimensions of all competency domains. CONCLUSION: The current study confirms that the role of APNs is still in its infancy in Jordan. The current study provides nurse educators with baseline information that can be utilized as a framework for APN education programs. The faculty readiness to start new competency-based APN programs or revise the current graduate programs needs to be assessed.

Involvement in health policy and political efficacy among hospital nurses in Jordan: A descriptive survey.

AIM: The aims of this study were to (a) examine the levels of nurses' political efficacy and involvement in health policy; and (b) explore the relationships between political efficacy, involvement in health policy and participants' background variables. BACKGROUND: Nurses as citizens and health care providers have the right to express their opinions and beliefs in regard to issues that are concerned with the health care system or the public health domain. METHODS: A descriptive, cross-sectional design using was utilized. A self-administered questionnaire (Political Efficacy Scale & Involvement in Health Policy Scale) was completed by a convenience sample of 302 nurses. RESULTS: The results of this study showed low levels of involvement in health policy and political efficacy, and a positive weak correlation between political efficacy and involvement in health policy. The perceived level of political efficacy was associated positively with nurses' age and experience. CONCLUSIONS: Nurse administrators and managers may empower, support and encourage nurses to enhance their involvement in health policy. IMPLICATIONS FOR NURSING MANAGEMENT: The findings have implications for nursing leaders and administrators to design appropriate strategies to enhance nurses' involvement in health policy development.

Missed nursing care and its relationship with confidence in delegation among hospital nurses.

AIMS AND OBJECTIVES: To (i) identify the types and reasons for missed nursing care among Jordanian hospital nurses; (ii) identify predictors of missed nursing care based on study variables; and (iii) examine the relationship between nurses' confidence in delegation and missed nursing care. BACKGROUND: Missed nursing care is a global concern for nurses and nurse administrators. Investigating the relation between the confidence in delegation and missed nursing care might help in designing strategies that enable nurses to minimise missed care and enhance quality of services. METHODS: A correlational research design was used for this study. A convenience sample of 362 hospital nurses completed the missed nursing care survey, and confidence and intent to delegate scale. RESULTS: The results of the study revealed that ambulating and feeding patients on time, doing mouth care and attending interdisciplinary care conferences were the most frequent types of missed care. The mean score for missed nursing care was (2.78) on a scale from 1-5. The most prevalent reasons for missed care were "labour resources, followed by material resources, and then communication". Around 45% of the variation in the perceived level of "missed nursing care" was explained by background variables and perceived reasons for missed nursing. However, the relationship between confidence in delegation and missed care was insignificant. CONCLUSION: The results of this study add to the body of international literature on most prevalent types and reasons for missed nursing care in a different cultural context. RELEVANCE TO CLINICAL PRACTICE: Highlighting most prevalent reasons for missed nursing care could help nurse administrators in designing responsive strategies to eliminate or reduces such reasons.

Practice environment as perceived by nurses in acute care hospitals in Sharjah and North Emirates.

AIM: To explore nurses' perceptions of their practice environment in acute care hospitals in Sharjah and North Emirates in the United Arab Emirates (UAE). BACKGROUND: The health of the environment in which registered nurses' work is critical to nursing outcomes. The interest to examine the practice environment extended to the Gulf area which has a complex healthcare system including the UAE. METHODS: The study used an exploratory descriptive design with a qualitative part using two focus group interviews. The sample size was 450 nurses selected through a random sampling method. A self-administered questionnaire including the Practice Environment Scale of Nursing Work Index (PES-NWI) was used. In addition, semi-structured interviews for two focus groups were done. RESULTS: The results showed that UAE practicing nurses reported favorable perceptions of most aspects of their practice environment. Unfavorable perceptions were only reported for Staffing and Resource Adequacy. The analysis of focus group discussions resulted in different emerged themes such as Lack of Recognition and Career Promotion, and Nurses' Workload due to Paper and Administrative Work. CONCLUSIONS: The findings of this study suggest that strategic interventions are needed to secure adequate staff and resources and implement an effective system for evaluation of performance.

Perceptions of reporting practices and barriers to reporting incidents among registered nurses and physicians in accredited and nonaccredited Jordanian hospitals.

AIMS AND OBJECTIVES: To explore the awareness of the incident reporting system, incident reporting practices and barriers to reporting incidents among Jordanian staff nurses and physicians in accredited and nonaccredited hospitals. BACKGROUND: Reporting medical incidents is an important element of patient safety enhancement and quality of care improvement and it should be an integral part of the organisational culture. DESIGN: A descriptive exploratory survey was used for the present study. METHODS: A modified version of the Incident Reporting Questionnaire was used to collect data from 307 nurses and 144 physicians at seven hospitals (four accredited and three not accredited) in Jordan. The response rate was 28·8% for nurses and 58·8% for physicians. RESULTS: Nurses were more aware of the incident reporting system than physicians. Physicians were less likely to report any incident on 50% or more of occasions. The major three barriers to reporting incidents were believing that there was no point in reporting near misses, lack of feedback and fear of disciplinary actions. CONCLUSION: The study showed significant differences between nurses in accredited and nonaccredited hospitals regarding barriers to reporting incidents and reporting practices. RELEVANCE TO CLINICAL PRACTICE: Nurse administrators should modify existing systems for reporting incidents to overcome the barriers as shown in the present study.

The challenges of working in underserved areas: a qualitative exploratory study of views of policy makers and professionals.

BACKGROUND: The inadequate number of health care providers, particularly nurses, in underserved areas is one of the biggest challenges for health policymakers. There is a scarcity of research in Jordan about factors that affect nurse staffing and retention in underserved areas. PURPOSE: To elucidate the views of staff nurses working in underserved areas, directors of health facilities in underserved areas and key informants from the policy and education arena on issues of staffing and retention of nurses in underserved areas. METHODS: An exploratory study using a qualitative approach with semi-structured interviews was utilized to elucidate the views of 22 key informants from the policy and education arena, 11 directors of health centers, and 19 staff nurses on issues that contribute to low staffing and retention of nurses in underserved areas. The five stage 'framework approach' proposed by Bryman et al. (1993) was utilized for data analysis. RESULTS: Nursing shortage in underserved areas in Jordan are exacerbated by a lack of financial incentives, poor transportation and remoteness of these areas, bad working conditions, and lack of health education institutions in these areas, as well as by opportunities for internal and external migration. Young Jordanian male nurses usually grab any opportunity to migrate and work outside the country to improve their financial conditions; whereas, female nurses are more restricted and not encouraged to travel abroad to work. Several strategies are suggested to enhance retention in these areas, such as promoting financial incentives for staff to work there, enhancing the transportation system, and promoting continuous and academic education. CONCLUSION: Nurses' administrators and health care policy makers could utilize the findings of the present study to design and implement comprehensive interventions to enhance retention of staff in underserved areas.

The impact of leadership styles on nurses' satisfaction and intention to stay among Saudi nurses.

AIM: To examine the impact of leadership styles of nurse managers on Saudi nurses' job satisfaction and their intent to stay at work. BACKGROUND: Increasing nurses' satisfaction is one of the key elements in meeting challenges of quality outcomes, patient satisfaction and retention of staff nurses in hospitals. METHODS: This study used a descriptive correlational design. The Multifactor Leadership Questionnaire (MLQ-5X), Job Satisfaction Survey (JSS), the McCain's Intent to Stay Scale and a demographic form were used to collect the data from a convenience sample of 308 Saudi nurses. RESULTS: Saudi nurses were moderately satisfied in their jobs. In addition, nurses were more satisfied with leaders who demonstrated transformational leadership styles, and those who were more satisfied with their jobs intended to say at work. The background variables, the transformational leadership style and the transactional style explained 32% of the variation in job satisfaction. CONCLUSIONS: The results of the study emphasized the importance of transformational leadership, which indicates the need for further attention to training and development of effective leadership behaviours. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse administrators in Saudi Arabia should capitalize on the importance of transformational leadership style in enhancing the level of job satisfaction.

The relationships between safety climate, teamwork, and intent to stay at work among Jordanian hospital nurses.

PURPOSE: The purpose of the present study is to examine the relationships among safety climate, teamwork, and intent to stay at work as perceived by Jordanian hospital nurses. METHODS: A descriptive correlational design was used to investigate these relationships among a convenience sample of 381 hospital nurses. Data were collected through a self-administered questionnaire that included the Safety Climate and Teamwork Scale and the McCain's Intent to Stay Scale. Descriptive statistics, Pearson correlation, analysis of variance, and hierarchical regression analysis were used to analyze the data. RESULTS: The findings showed (a) a strong positive correlation between safety climate and teamwork; and (b) moderate positive correlations between safety climate and intent to stay at work, and between teamwork and intent to stay at work. Moreover, the overall model of hierarchical regression showed that 45% of the variation in the level of intent to stay at work was explained by background variables, leadership styles, decision-making styles, and safety climate. CONCLUSION: The findings emphasized the positive effect of safety climate and teamwork on the level of nurses' intent to stay. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse administrators should design and implement strategies that create a culture of safety climate and teamwork in their organizations.

Adverse events in Jordanian hospitals: types and causes.

Adverse events in health care have become an important issue for health-care professionals, administrators, health policy-makers, public and patients. Literature on adverse events in Jordan is scarce. The purpose of the study was (i) to identify the common types and major causes of adverse events in Jordanian hospitals from the nurses' perspective; and (ii) to estimate the frequency of adverse events in Jordanian hospitals. Qualitative and quantitative data regarding the perceived types, causes and incidence of adverse events were collected using a web-based questionnaire. A total of 75 valid responses with qualitative and quantitative data were obtained. The results indicated (i) that medication errors, wrong diagnosis, hospital acquired infections, bed sores and falls were the most common types of adverse events; and (ii) that workload and inadequate staffing, technical performance, negligence and poor ethics, poor management, psychosocial job demands and written guidelines were the most common causes of adverse events. On average, participants in the study believed that adverse events occurred in about 28% of all hospital admissions. Nurse and hospital administrators and health policy-makers should develop and institute effective strategies and policies to prevent or minimize the occurrence of adverse events.

Turnover rate among registered nurses in Jordanian hospitals: an exploratory study.

The aim of this study is to (i) determine the turnover rate among registered nurses in Jordanian hospitals; and (ii) compare the turnover rate between (a) male and female registered nurses; (b) northern, middle and southern regions; (c) public, private and university hospitals; (d) rural and urban hospitals; and (e) general and specialized hospitals. A descriptive, cross-sectional retrospective survey design was used. A structured interview method was utilized to collect data. A proportional random sample of 25% of the total number of Jordanian hospitals was taken. The results showed that the overall turnover rate was 36.6%. There were variations according to geographical region, health sector and place of residence. Turnover among registered nurses in Jordanian hospitals is considered a problem that requires effective strategies to deal with. Further research is required to identify the causes, and to explain the differences in the turnover rates according to the different study variables.