Exploring New Graduate Nurses' Perceptions of Factors Influencing Job Satisfaction and Resignation Ideation During COVID-19.

Using an observational design, new graduate nurses' perceptions of job satisfaction and resignation ideation during COVID-19 were explored. Higher job satisfaction was associated with higher self-confidence, lower stress, and working in first choice of unit. A higher likelihood of resignation ideation was associated with coworker incivility, higher stress, and not working in first choice unit. New graduate nurses need support from nursing professional development practitioners for challenges faced throughout the transition-to-practice year.

The Impact of Coronavirus Disease 2019 Visitor Restrictions on the Attitudes of Emergency Department Staff.

INTRODUCTION: During the first 2 years of the pandemic, visitors for patients with COVID-19 were prohibited from emergency departments in the United States with few exceptions, leaving patients without their caregivers and advocates. Little is known about emergency nurses and nursing assistive personnel beliefs regarding this issue. Therefore, this study's purpose was to describe and assess relationships among emergency nursing and assistive personnel attitudes and perceptions regarding emergency department "no-visitor policies" for patients with COVID-19. METHODS: This institutional review board-approved observational study was conducted in a health care system in the Southwestern United States. Nursing personnel (n = 180; 21.74% response rate) working in 11 emergency departments completed the survey during the fall of 2021. Bivariate correlations and multivariable linear regression modeling were performed to explore relationships among survey questions. RESULTS: Most participants (61%) strongly/very strongly believed that restriction of visitors for patients with COVID-19 was necessary for the protection of staff and patients. In addition, 65% reported strongly/very strongly agreeing that it was unethical and 75% felt upset when these patients died alone. Most (81%) strongly/very strongly agreed that exemptions to the policy should be made in some cases, including imminent death. Respondents' recognition of patients' displeasure with visitor policy, recognition that a lack of visitors affected efficiency, and feeling upset when these patients died alone negatively predicted agreement that restriction was necessary. CONCLUSION: Although most participants favored visitation restrictions for patients with coronavirus disease 2019, their beliefs were complex. Navigating stringent visitation policies and vulnerable patients' needs can result in moral distress for ED personnel.

Work Engagement, Burnout, and Well-being in Nursing Professional Development Practitioners.

Work engagement, burnout, and well-being in nursing professional development practitioners during the second year of COVID-19 were explored. Increased levels of work engagement were associated with decreased burnout and higher levels of well-being. Significant differences were noted in work engagement and burnout among those with more than 1 year of nursing professional development experience. Examining the health of the specialty highlights current concerns and provides insight into developing interventions to address the consequences of the pandemic.

Through the Lens of the Social Determinants of Learning™: Experiences of Online Prenursing Students During the COVID-19 Pandemic.

BACKGROUND: Prenursing students represent the future pipeline of nursing students, yet their perceptions of how COVID-19 affected their experience as prenursing students are unknown. METHOD: Short-answer data ( n = 289) in US prenursing students were collected in fall 2020. Deductive thematic analysis was applied according to the social determinants of learning (SDOL™) framework. RESULTS: Participants verbalized fears of contracting COVID-19 (physical health) and difficulties with stress and anxiety (psychosocial health). Participants shared pandemic-related financial challenges (economic instability), changes in living situations (physical environment), and the lack of hoped-for social connections (social environment). Many struggled with focus; others confirmed their goals (self-motivation). CONCLUSION: The SDOL framework can be utilized by educators to conceptualize the influence of the COVID-19 pandemic on the experiences of online prenursing students and leveraged to develop targeted interventions to improve students' well-being as they apply to nursing programs.

Acute care nurse managers' definitions of and barriers to well-being: A thematic analysis of open-ended survey questions.

BACKGROUND: During the COVID-19 pandemic, acute care nurse managers functioned in a critical role by helping to advance the mission and goals of their organization while navigating a rapidly evolving healthcare landscape. This resulted in high levels of ongoing job-related stress which is linked to negative physical, psychological, and job-related outcomes. Little is known about the perceptions regarding their own professional well-being during this time. AIM: The aim of this study was to qualitatively describe acute care nurse managers' perceptions of and barriers to their professional well-being. METHODS: Using a qualitative descriptive approach, nurse managers from a hospital system in the southwestern United States responded to two short-answer, survey-based questions in 2022: (1) "Describe the definition of nurse-manager well-being in your own words" and (2) "What do you feel is your biggest barrier to professional well-being?" Reflexive thematic analysis was utilized to analyze participant responses (N = 80). RESULTS: Professional well-being is a complex concept influenced by the nurse manager's ability to navigate work-life balance; care for their own physical, emotional, and spiritual selves; give and receive support from stakeholders; and manage feelings of thriving vs. struggling in the role. Barriers most cited as influencing well-being included having too little time to get things done coupled with increasing workloads, feeling stuck in the middle among stakeholders, and coping with ongoing staffing challenges. LINKING EVIDENCE TO ACTION: The definition of and barriers to well-being are influenced by the specific needs and experiences of the nurse manager. While not all barriers can be immediately removed, the identification of individual and organization-specific barriers needs to be taken seriously, reviewed by those who can promote change, and evidence-based solutions for improvement piloted or implemented when feasible.

Academic Differences in BSN Admission Routes: Implications for Persistence.

BACKGROUND: To increase retention of prelicensure nursing students, several routes are used for admission to nursing programs. Students can be accepted as an early matriculation (EM) student at the point of university admission or they can follow a traditional competitive approach (TR) for admission. METHOD: A retrospective matched cohort study design was used to explore the differences among selected academic variables in two groups of prelicensure undergraduate students (n = 136) in the same program. RESULTS: EM students had significantly lower science grade point averages (GPAs), pre-program GPAs, and junior-level GPAs than TR students. However, there were no significant differences between the two groups in scores on the RN Fundamentals ATI examination, an important predictor of future NCLEX-RN success. CONCLUSION: EM students were as successful as their counterparts on standardized examinations in the first semester of a nursing program. More research is needed to understand program outcomes associated with students entering nursing programs via different routes. [J Nurs Educ. 2023;62(5):302-306.].

Well-being in acute care nurse managers: A risk analysis of physical and mental health factors.

BACKGROUND: Nurse managers have experienced tremendous stress during the COVID-19 pandemic, contributing to negative psychological outcomes. Positive professional well-being is a construct that can be promoted to mitigate poor psychological outcomes and burnout in nurses. Little is known about the health, healthy behaviors, effects of stress on homelife, and well-being of nurse managers in the United States (U.S.). AIMS: The aims of the study were to explore nurse managers' well-being related to self-reported stress and health perceptions and habits. METHODS: A sample of 80 (41% response rate) nurse managers responded to a cross-sectional web-based survey sent via email in a southwestern U.S. 13-hospital system. Nurses answered 39 quantitative questions about demographics, well-being (9-item Well-Being Index [WBI]), perceptions of stress affecting homelife, and perceptions of health and health-related behaviors. RESULTS: Mean WBI (2.9 [2.7]) indicated risk for poor psychological outcomes. Managers (75%) reported stress from work affected their personal lives and a decline in overall health during the pandemic. Most (80%) reported burnout and emotional problems. Nurse managers had 8.1 times increased risk of poor WBI scores if stress from work affected their personal life than if they reported no spillover stress into their personal life (OR = 8.1, 95% CI [2.6, 25.0]). LINKING EVIDENCE TO ACTION: Findings from this study add a nuanced understanding of nurse managers' well-being. The strongest risk factor for poor WBI scores was stress levels affecting personal life. Interventions to improve well-being in nurse managers are needed. Limitations are the convenience sampling, limited geographic location, and response rate of <50%. Further research is needed to support nurse managers in stress reduction and development of boundaries that prohibit the spillover effect of workplace stress. Organizations may consider a combination of administrative support and changes as well as provision of on-the-job training of interventions that support individual well-being.

Online prelicensure nursing students' experiences of academic incivility during COVID-19: A qualitative inquiry.

AIM: The aim of this study was to describe online prelicensure nursing students' experiences of incivility during COVID-19. DESIGN: Qualitative descriptive. Five optional open-ended questions were presented to nursing students to share their experiences with incivility during the pandemic. METHODS: Data were collected from September to October 2020 as a part of a larger multimethod study on stress, resilience and incivility with nursing students and faculty (n = 710) from a large public undergraduate nursing programme in the southwestern United States. Out of the initial 675 students who completed the survey, 260 individuals responded to three or more of the open-ended questions which were reviewed and coded using reflexive thematic analysis. RESULTS: Thirteen themes were organized into four analytical categories: (1) experiencing incivility, (2) causes and consequences of incivility, (3) the pandemic and academic incivility and (4) promoting civility in the academic setting. CONCLUSIONS: Prelicensure nursing students perceived unrealistic expectations, a lack of awareness and miscommunication hindered academic performance, as well as, created feelings of stress, discouragement and inadequacy. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Fostering academic civility during virtual educational experiences may require training in proper coping strategies when challenged with incivility. IMPACT: As the body of research emerges concerning the effects of COVID-19 and undergraduate nursing education, understanding prelicensure students' experiences of academic incivility could prove to be beneficial to designing strategies co-created with students to promote positive educational outcomes. Understanding students' viewpoints of uncivil experiences revealed prioritizing civility awareness is essential in creating healthy academic environments, improving clinical performance and providing safe patient care. REPORTING METHOD: The COREQ (COnsolidated criteria for REporting Qualitative research) checklist was used. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Connecting lived experiences of pre-nursing students during COVID-19 with learner well-being: A qualitative inquiry.

AIM: To explore pre-nursing students' experiences and identify factors influencing their well-being as learners during COVID-19. DESIGN: A qualitative descriptive design was used. METHODS: Short answer study data (n = 289) were collected in Fall 2020 as part of a larger IRB-approved survey-based study focused on pre-nursing students. Participants were presented with three short answer questions designed to elicit a description of their experiences as a pre-nursing student. NVivo and reflexive thematic analysis were used to analyse participant responses. RESULTS: Six themes related to learner well-being emerged from the data. Learner well-being was supported by achieving academic goals, experiencing positive feelings about current course content, creating connections with peers and envisioning themselves as nurses in the future. Negative contributors to pre-nursing student well-being included managing fears of program rejection and juggling multiple roles and demands. Online learning necessitated by COVID-19 created opportunities for loneliness and isolation from peers, technological difficulties and additional psychological stress, which also contributed negatively to learner well-being. CONCLUSION: These findings illustrate pre-nursing students' experiences and provide support for the influence of the learning environment and factors within the individual on the well-being of learners. IMPACT: Students preparing to apply to nursing programs are an understudied population and little is known about their well-being as learners. Survey-based open-ended short answer questions can be utilized to gain rich insight into their experiences. The study themes and sub-themes can be utilized for discussion and reflection in courses with pre-nursing students and as a starting point for additional conversations between pre-nursing students and educators regarding improving the support of well-being in learners. Additional research and evidence-based interventions that promote learner well-being in pre-nursing students are needed as they prepare for nursing program admission and to support their academic progression. PATIENT OR PUBLIC CONTRIBUTION: Members of the public were not involved in the design or conduct of the study, analysis, or interpretation of the data, or in the preparation of the manuscript because the study focus is on gaining an understanding the experiences of pre-nursing students and their well-being.

Resilience, Stress, Anxiety, and Depression: Exploring the Mental Health of New Graduate Nurses Transitioning to Practice During COVID-19.

Background Transitioning to practice during the COVID-19 pandemic multiplied the stressors and challenges typically encountered by new graduate nurses (NGNs), yet research exploring mental health variables of this subset of nurses remains sparse. Method This study used an observational design and convenience sampling. NGN alumni (n = 192) from a pre-licensure nursing program were surveyed during the summer of 2021 regarding their experiences with resilience, anxiety, depression, and stress while transitioning to practice during the COVID-19 pandemic. Results Participants reported moderate to severe levels of stress (76%), anxiety (27.6%), and depression (31.2%) while transitioning to practice. Most (79%) described themselves as resilient. The highest mean scores for stress, anxiety, and depression occurred during the fourth to eighth month of practice. Conclusion Nursing professional development specialists, managers, and other stakeholders need effective strategies to monitor and promote NGNs' well-being and mental health to prevent burnout and turnover throughout the first year of practice. [J Contin Educ Nurs. 2022;53(12):533-543.].

Relationships Among Resilience, Stress, and Persistence in Prenursing Students During COVID-19.

BACKGROUND: The coronavirus disease-2019 (COVID-19) pandemic has created personal, financial, and academic challenges for prenursing students, which may hinder academic persistence. Understanding and supporting their well-being is important, as they prepare to apply to nursing programs. PURPOSE: The purpose of this study was to explore relationships among stress, resilience, and academic persistence in prenursing students intending to apply to either an on-campus or accelerated online nursing program. METHODS: A cross-sectional descriptive correlational research design was used. Online survey data (N = 364) were collected during the COVID-19 pandemic. RESULTS: Campus-based prenursing students reported higher levels of stress and lower levels of resilience than their accelerated online counterparts. A significant negative relationship was noted between stress and scores on resilience and persistence measures in both groups. CONCLUSIONS: Program-specific interventions promoting resilience and stress management techniques are needed to support prenursing student persistence, especially as they prepare for admission to nursing programs.

Health-related behaviors, self-rated health, and predictors of stress and well-being in nursing students.

BACKGROUND: Nursing students are at increased risk for the consequences of stress on wellbeing. Little is known about nursing students' health promoting behaviors and how these relate to health, stress, and well-being. PURPOSE: The purpose was to describe perceived stress and measures of well-being (self-compassion, happiness, and life satisfaction) along with self-reported health promoting behaviors and health status in order to identify factors that could affect stress and well-being in nursing students. METHODS: A multi-site team employed cross-sectional research methods to explore well-being, stress, and potential physical and emotional health-relevant factors in undergraduate nursing students. Baccalaureate Nursing students from three nursing programs in North Texas participated in a web-based survey. Undergraduate students (n = 417) reported being junior or senior level in a traditional (74.1%) or an alternative nursing training program (on-line, fast-track, or weekend nursing program; 24.9%) in the fall of 2019. Recruitment fliers went to a total of 2264 potential participants via university e-mail. Consenting students completed online surveys collecting demographic and health related factors as well as measures of well-being and stress. RESULTS: More than half (56.6%) of students reported worsening health since starting nursing school. Exercise and meditation were related to higher measures of well-being and lower stress, but this relationship diminished in the multivariate model when considering individual demographic and health related factors. Our multivariate model suggests that self-rated health status remains a main potential predictor of reduced stress and improved well-being. CONCLUSIONS: Self-reported health factors are related to wellbeing in nursing students. Targeted interventions to improve well-being among nursing students may be necessary and would fit with national recommendations for nursing education programs. Resiliency skills training with mindfulness practices may help nursing students reduce stress, improve overall well-being, and equip students to avoid burnout and stress-related illness once in the workforce.

Association of stress, resilience, and nursing student incivility during COVID-19.

Although incivility in nursing education is linked with negative physical and psychological effects on students, it is unclear how resilience and stress interact and relate to student incivility. The purpose was to understand the role of resilience and stress with peer incivility in a sample of prelicensure nursing students during coronavirus disease 2019. The study design was cross-sectional and correlational. Data were from an online survey administered to undergraduate nursing students of one college of nursing in a southwestern US state during September-October 2020. In a sample of 490 students, ordinal regression model results supported that including a stress and resilience interaction term resulted in a nonsignificant effect of stress and resilience, as the main effect correlates on low-level uncivil student behavior. More research is needed to understand the prevalence of stress and resilience at different points in prelicensure nursing education so that targeted interventions can be developed and deployed to assist students.

Relationships among stress, resilience, and incivility in undergraduate nursing students and faculty during the COVID-19 pandemic: Policy implications for nurse leaders.

BACKGROUND: Developing successful targeted interventions to reduce incivility for undergraduate nursing students and educators will require understanding the differences in their unique experiences. Although resilience may act as protective buffer against stressors, little is known about the relationships between stress, resilience, and perceptions of the frequency of incivility in the academic environment. PURPOSE: The purpose of this study was to compare relationships among and differences between perceptions of incivility frequency and self-reported stress and resilience levels in undergraduate nursing students and faculty during the COVID-19 pandemic. METHOD: A comparative descriptive and correlational research design was utilized. An online survey was used to collect data from undergraduate nursing students and faculty (n = 710) at one public university. RESULTS: Students were significantly more stressed and less resilient than faculty. Faculty reported significantly greater low and high-level student and low-level faculty incivility behaviors than students. CONCLUSION: Understanding student and faculty perceptions of uncivil behavior frequency occurring at the intersection of high stress and moderate resilience levels is key to the creation of targeted interventions and policy development.

Modified Early Warning System as a Predictor for Hospital Admissions and Previous Visits in Emergency Departments.

This study addresses the development of a modified early warning system (MEWS) to predict hospital admissions from emergency departments (EDs) using the 2010 National Hospital Ambulatory Medical Care Survey (NHAMCS). A MEWS score was created for each patient in the NHAMCS data set using the vital signs recorded at admission. Multiple logistic regression analyses indicated that for every 1 unit increase in the MEWS score, patients were 33% more likely to be admitted to the hospital for further care even after controlling for demographics. Females were 19% less likely to be admitted and older persons were more likely to be admitted. A MEWS score of 13 resulted in almost 90% chance of admission to the hospital. Results indicate that an early warning system may be used to identify signs of physiological decline in many health care settings. Use of MEWS in EDs could be a helpful predictor of the need for hospitalization and could serve as a focus for early decision making and as a point of comparison for efficacy of interventions both in the emergency department and if the patient is admitted to the hospital.