Sustaining the nursing workforce - exploring enabling and motivating factors for the retention of returning nurses: a qualitative descriptive design.

BACKGROUND: The nursing shortage represents a persistent and urgent challenge within the healthcare industry. One of the most cost-effective and time-efficient solutions to address this issue is the recruitment of inactive nurses to rejoin the nursing workforce, while simultaneously ensuring the long-term sustainability of their careers following their return to work. The aim of this study is to explore the factors that facilitate the retention of nurses who have returned to work, from their perspective. METHODS: To achieve this aim, a qualitative descriptive design was employed. A total of 15 registered nurses who had not practiced nursing for a minimum of three years prior to their return to work, and had been working as nurses for at least three months following their return, were selected from seven healthcare institutions using convenience sampling. Face-to-face or online semi-structured interviews were conducted, and qualitative inductive analysis was employed to analyze the collected data. RESULTS: The analysis revealed five key themes, two of which were related to the enabling factors making it possible for the nurses to continue their work, while the remaining three pertained to the motivating factors driving the pursuit of professional careers. The two themes associated with enabling factors were identified as "Conditions and support that sustain work-life balance" and "A workplace that acknowledges my career, and encourages my growth as an experienced nurse". The three themes related to motivating factors were entitled "Pride in reconnecting with and contributing to society," "Cultivating confidence through incremental professional development and future envisioning," and "Enrichment of my own and my family's life". CONCLUSIONS: Returning nurses constitute a valuable asset for healthcare institutions. To effectively retain these nurses, it is crucial to implement multi-dimensional approaches that enable and motivate them to sustain and enrich their professional and personal lives while continuing their work in the nursing field.

Exploring nurses' clinical judgment concerning the relative importance of fall risk factors: A mixed method approach using the Q Methodology.

BACKGROUND: Nurses are pivotal in averting patient falls through their assessment of cues presented by patients and their environments, rendering clinical judgments regarding the risk of falling, and implementing tailored interventions. Despite the intricate cognitive processes entailed in nurses' judgment, no prior studies have explored their approach to assessing the risk of falling. OBJECTIVE: This study aimed to examine how nurses judge the risk of falling among patients with different conditions, whether there are differences in the importance of risk factors as judged by nurses, how they justify their judgments, and what attributes of the nurses influence their judgments. DESIGN: A mixed method approach using the Q Methodology was employed. SETTING(S): Three public and private hospitals in Japan. PARTICIPANTS: Eighteen nurses participated in the study. METHODS: Participants were tasked with ranking 36 patient scenarios, each featuring a distinct set of fall risk factors. Subsequently, post-sorting interviews were conducted to gather insights into their typical approach to assessing fall risk and the rationale behind their ranking decisions. A by-person principal component factor extraction was employed to examine differences in the rankings of the scenarios. The interview data were analyzed descriptively to elucidate the reasons behind these discrepancies. RESULTS: Nurses engage in complex cognitive manipulations when evaluating the risk of patient falls, drawing extensively from their wealth of experience while utilizing assessment tools to support their judgments. In essence, nurses identify patients' tendency to act alone without calling a nurse, impaired gait and cognition, sedative use, drains, and limited information sharing among healthcare professionals as key fall risks. In addition, nurses vary in the importance they attribute to certain risk factors, leading to the discrimination of three distinct judgment profiles. One group of nurses judges patients with cognitive impairment and acting alone as high risk. Another group of nurses considers patients with unstable gait and acting alone as high risk. The last group of nurses sees patients wearing slippers as high risk. The post-sorting interviews revealed that their judgments are closely related to the healthcare context and patient population. CONCLUSIONS: Nurses operate within diverse contexts, wherein they interact with patients of varying characteristics, collaborate with professionals from diverse disciplines, and have access to varying levels of human and physical resources. This nuanced understanding empowers the formulation of judgments that are finely attuned to the specific context at hand. STUDY REGISTRATION: Not registered.

Exploring factors that motivate nursing students to engage in skills practice in a laboratory setting: A descriptive qualitative design.

OBJECTIVES: The aim of this study was to explore factors that motivate students to engage in skills practice in a laboratory setting, and to identify their motivation types and the regulatory styles. METHODS: Semi-structured interviews were conducted with 23 nursing students from three universities between November 2017 and January 2018. A thematic analysis was used to identify factors associated with students' motivation to engage in skills practice in a laboratory. The types and the regulatory styles of student motivation were identified based on the self-determination theory. RESULTS: Seven motivating factors were identified. These factors included the students' desire "to acquire the skills necessary to work as a nurse", the "desire to improve skills in preparation for clinical practicum", and their felt "obligations to patients as a nurse". Moreover, "the impetus to study arising from the objective evaluation of oneself and others" and "wanting to pass the skills examination" motivated the students to engage in skills practice. A "learning environment that facilitates students' learning" and the "supportive involvement of educators" facilitated their learning. Based on the self-determination theory, the students were found to embrace extrinsic motivation with four regulatory styles of motivation, namely integrated, identified, introjected, and external regulation. CONCLUSIONS: Nurse educators should understand the motivating factors of students, and help students embrace a more internally controlled motivation by helping them envision their future careers as nurses, and by fostering their ethical duty to care for patients.

Competence development as perceived by degree and non-degree graduates in Japan: a longitudinal study.

BACKGROUND: A degree programme is believed to prepare graduates with a higher level of competence than their diploma counterparts. However, there have been inconsistent findings reported as to whether or not degree-graduates outperformed those who take diplomas. OBJECTIVES: This study aimed to identify graduates' perceptions of competence development in their first year of employment, and to compare the competence levels of graduates with different educational backgrounds. DESIGN: This study adopted a longitudinal design. SETTINGS: This study has been performed in five hospitals in Japan. PARTICIPANTS: 122 Japanese graduates participated in this study. METHODS: The self-assessed competence of the graduates was collected in the 3rd, 6th, 9th, and 12th months of their employment using a survey method. The data were analysed using a linear mixed model. RESULTS: The results suggested that the graduates perceived their competence to be rapidly growing during the first half of the graduate year, and slowly later. The results also indicated that the graduates' perception of their competence showed a significant variation. The most striking finding of the study was that, on average, the non-degree graduates rated their competence higher than their degree counterparts. CONCLUSIONS: The current university orientation on emphasising intellectual and theoretical components of education, with less focus on practical components might have led to the development of lower competence among the BN graduates. A fine balance between theoretical and practical components needs to be established in a university curriculum.

Graduate nurses' perceptions of mismatches between themselves and their jobs and association with intent to leave employment: a longitudinal survey.

BACKGROUND: Graduate nurses experience mismatches between themselves and their jobs. One of these is the demands-abilities misfit, which is a mismatch between the abilities of employees and those required by a job (demands). Another is the supplies-needs misfit, which occurs when employees' work-specific needs are not fulfilled by opportunities (called environmental supplies) work can supply to reinforce them. OBJECTIVES: The aim of this study was to investigate how graduate nurses' perceptions of the demands-abilities and supplies-needs misfits changed over time, and to examine how these misfits impact their intention to leave the jobs. DESIGN: A longitudinal study design was used. SETTING: Five hospitals in the western region of Japan cooperated in the study. PARTICIPANTS: A total of 176 graduate nurses participated in the study one or more times. From among them, 150, 109, 102, and 96 graduates participated in the study conducted in the 3rd, 6th, 9th, and 12th months of the employment, respectively. In addition, 62 graduates participated in all studies. METHODS: Surveys were distributed to the graduates 3, 6, 9 and 12 months after their employment commenced. The results were analysed using multiple regression analysis. RESULTS: The results showed that the graduates perceived both demands-abilities and supplies-needs misfits, although the degree of the demands-abilities misfit became smaller towards the end of the graduate year. As for the impact on graduates' turnover intention, the graduates' abilities and their perception of the environmental supplies served as more significant predictors of their turnover intention, rather than the misfits per se. The variances of turnover intention explained by the supplies-needs variables were greater than those explained by the demands-abilities variables from the third to ninth months into the employment. On the other hand, the variance explained by the demands-abilities variables increased towards the end of the year, and finally exceeded that of the supplies-needs variables. CONCLUSIONS: The graduates' turnover intention is complex, and may not be explained by simple demands-abilities and supplies-needs misfits. Different factors influence their turnover intention at different times to different degrees.