Mediating Role of Rumination in Second Victim Experience to Turnover Intention in Psychiatric Nurses.

BACKGROUND: Psychiatric nurses often face patient safety incidents that can cause physical and emotional harm, even leading to s econd victim syndrome and staff shortages. Rumination-a common response after nurses suffer a patient safety event-may play a specific role between the second victim experience and turnover intention. Understanding these mechanisms is crucial for supporting psychiatric nurses and retaining psychiatric nursing resources. OBJECTIVES: The study aimed to explore the associations among second victim experience, rumination, and turnover intention in psychiatric nurses and confirm how second victim experience influences turnover intention through rumination and its subtypes. METHODS: A descriptive, cross-sectional study was adapted to survey 252 psychiatric nurses who experienced a patient safety incident at three hospitals in China between March and April 2023. We used the Sociodemographic and Patient Safety Incident Characteristics Questionnaire (the Chinese version of the Second Victim Experience and Support Tool), the Event-Related Rumination Inventory, and the Turnover Intention Scale. Path analysis with bootstrapping was employed to accurately analyze and estimate relationships among the study variables. RESULTS: There was a positive association between second victim experience and turnover intention. In addition, both invasive and deliberate rumination showed significant associations with second victim experience and turnover intention. Notably, our results revealed that invasive and deliberate rumination played partial mediating roles in the relationship between second victim experience and turnover intention in psychiatric nurses. DISCUSSION: The negative experience and turnover intention of the psychiatric nurse second victims are at a high level. Our results showed that invasive rumination positively mediated the relationship between second victim experience and turnover intention, and deliberate rumination could weaken this effect. This study expands the knowledge of the mechanisms underlying the effect of the second victim experience on turnover intention. Organizations must attach importance to the professional dilemmas of the psychiatric nurses' second victims. Nurse managers can reduce nurses' turnover intention by taking measures to reduce invasive rumination and fostering deliberate meditation to help second victims recover from negative experiences.

Burnout in hospital staff using partial least squares path modeling for job-person fit: The case of a tertiary referral hospital in southwest Iran.

Recent studies on burnout (BO) have included both individual and situational factors, referred to as job-person fit (JPF). The present study aimed to evaluate the prevalence rate of BO in the hospital staff working at a tertiary referral hospital in southwest Iran and then to highlight the importance of the person in the context of his/her work life. This cross-sectional study was conducted in 2020 on all hospital staff using a three-part questionnaire comprised of personal and work-situational factors, the Perceived Stress Scale (PSS), and the Psychological Empowerment Scale (PES). The partial least squares (PLS) path modelling and the neural network (NN) model were used to identify the significant variables within the BO dimensions. A total of 358 staff completed the questionnaire and were recruited for the study. Emotional exhaustion (EE) was seen in 137 medical staff (38.3%) and depersonalization (DP) was observed in 75 individuals (20.1%). Thinking about job change was the most important factor positively correlated with EE. Positive stress and work experience were among the most significant factors negatively associated with PA and DP, respectively. The hospital staff experienced BO in a way comparable to the national results. Work-situational and personal variables interacted with the three dimensions of BO in the hospital staff. More experienced staff also felt more accomplished and successful, resulting in the identification of a decreased level of DP and elevated PA.

Analysis of Electronic Health Record Use and Clinical Productivity and Their Association With Physician Turnover.

Importance: Physician turnover takes a heavy toll on patients, physicians, and health care organizations. Survey research has established associations of electronic health record (EHR) use with professional burnout and reduction in professional effort, but these findings are subject to response fatigue and bias. Objective: To evaluate the association of physician productivity and EHR use patterns, as determined by vendor-derived EHR use data platforms, with physician turnover. Design, Setting, and Participants: This retrospective cohort study was conducted among nonteaching ambulatory physicians at a large ambulatory practice network based in New England. Data were collected from March 2018 to February 2020. Main Outcomes and Measures: Physician departure from the practice network; 4 time-based core measures of EHR use, normalized to 8 hours of scheduled clinical time; teamwork, percentage of a physician's orders that are placed by other members of the care team; and productivity measures of patient volume, intensity, and demand. Results: Among 335 physicians assessed for eligibility, 314 unique physicians (89.2%) were included in the analysis (123 [39%] women; 100 [32%] aged 45-54 years), with 5663 physician-months of data. The turnover rate was 5.1%/year (32 of 314 physicians). Physicians completed a mean 2.6 appointments/hour (95% CI, 2.5-2.6 appointments/hour) and 206 appointments/month (95% CI, 197-215 appointments/month) with 5.5 hours (95% CI, 5.3-5.8 hours) of EHR time for every 8 hours of scheduled patient time. After controlling for gender, medical specialty, and time, the following variables were associated with turnover: inbox time (odds ratio [OR], 0.70; 95% CI, 0.61-0.82; P < .001), teamwork (OR, 0.68; 95% CI, 0.52-0.87; P = .003), demand (ie, proportion of available appointments filled: OR, 0.49; 95% CI, 0.35-0.70; P < .001), and age 45 to 54 years vs 25 to 34 years (OR, 0.19; 95% CI, 0.04-0.93; P = .04). Conclusions and Relevance: In this study, physician productivity and EHR use metrics were associated with physician departure. Prospectively tracking these metrics could identify physicians at high risk of departure who would benefit from early, team-based, targeted interventions. The counterintuitive finding that less time spent on the EHR (in particular inbox management) was associated with physician departure warrants further investigation.

Touchpoints: A Business Strategy to Retain New Graduate Nurses.

OBJECTIVE: The aim of this study was to reduce the turnover of new RNs (NRNs) completing a 1-year nurse residency program. BACKGROUND: Businesses use touchpoints to retain both internal and external customers, yet no evidence was found in retaining NRNs. Touchpoints, distinct points in the company-customer experience, play a vital role in the customer's experience with the company. Employees are one of a company's many customer types. METHODS: This quality-improvement project implemented touchpoints to improve NRN retention rates. RESULTS: Retention rates and job-satisfaction scores were significantly higher among the touchpoint-intervention cohort compared with the nonintervention cohort. Implementation costs were far less than those associated with NRN turnover. CONCLUSIONS: Touchpoints are a practical management approach for NRN retention.

Evidence-Based Practice Culture and Mentorship Predict EBP Implementation, Nurse Job Satisfaction, and Intent to Stay: Support for the ARCC© Model.

BACKGROUND: The Advancing Research and Clinical practice through close Collaboration (ARCC© ) Model is a system-wide framework for implementing and sustaining evidence-based practice (EBP) in hospitals and healthcare systems. The model involves assessing organizational culture and readiness for EBP in addition to the development of a critical mass of EBP mentors who work with point-of-care clinicians to facilitate the implementation of evidence-based care. Determining how the various components of the ARCC© Model relate to one another is important for understanding how EBP culture and mentorship impact EBP implementation, nurses' job satisfaction, and intent to stay. AIMS: The current study aimed to test a model that could explain the relationships and direct pathways among eight key variables in the ARCC© Model: (1) EBP culture, (2) mentorship, (3) knowledge, (4) beliefs, (5) competency, (6) implementation, (7) nurses' job satisfaction, and (8) intent to stay. METHODS: Structural equation modeling was used to test relationships among the variables in the ARCC© Model with data obtained from an earlier cross-sectional descriptive study with 2,344 nurses from 19 hospitals and healthcare systems across the United States. RESULTS: The final structural equation model found that EBP culture and mentorship were key variables that positively impacted EBP knowledge, beliefs, competency, implementation, job satisfaction, and intent to stay among nurses. LINKING EVIDENCE TO ACTION: As described in the ARCC© Model, establishing a strong sustainable EBP culture along with a critical mass of EBP mentors is crucial for the development of EBP competency and consistent implementation of evidence-based care by nurses. A strong EBP culture along with EBP mentorship also can result in higher job satisfaction and intent to stay. Implementation of the ARCC© Model is a key strategy in assisting systems to reach health care's Quadruple Aim.

Incorporating a Civility Program Into a Healthcare System: Journey or Expedition?

PURPOSE/OBJECTIVES: Incivility contributes to employee dissatisfaction, turnover, patient errors, and a disrespectful culture. Turnover rates and employee exit interviews alerted hospital leaders to uncivil behaviors exhibited by staff. A clinical nurse specialist (CNS) team captured this as an opportunity to create a civility program to develop team cohesiveness and improve patient safety. The purpose of this process improvement project was to identify uncivil behaviors in a pediatric hospital. DESCRIPTION OF THE PROJECT/PROGRAM: Using the Plan-Do-Study-Act model, an interprofessional team led by CNSs collaborated on a program to assess, intervene, and evaluate a program to improve civility. A preprogram survey, the Negative Acts Questionnaire-Revised, was used to assess staff perceptions of their work environment. Staff attended an education program on ways to recognize and intervene in situations involving less than standard civil behavior. Classes included communication application in uncivil situations using scenarios paired with evidence-based practice articles. Unit leaders reset behavioral expectations learned from a leader-specific class on managing unproductive behaviors. OUTCOME: Staff completed a postprogram Negative Acts Questionnaire-Revised survey 6 months after conclusion of classes. Survey results indicated the civility program effected a reduction in frequency of negative behaviors indicating an overall positive shift in workplace civility. CONCLUSION: The program provided staff with tools to recognize and intervene for improving civility, which impacted the overall work environment and patient safety.

Disparities in Nurse Job Dissatisfaction and Intent to Leave: Implications for Retaining a Diverse Workforce.

OBJECTIVE: To determine if Black nurses are more likely to report job dissatisfaction and whether factors related to dissatisfaction influence differences in intent to leave. BACKGROUND: Minority nurses report higher job dissatisfaction and intent to leave, yet little is known about factors associated with these differences in community settings. METHOD: Cross-sectional analysis of 11 778 nurses working in community-based settings was conducted. Logistic regression was used to estimate the association among race, job satisfaction, and intent to leave. RESULTS: Black nurses were more likely to report job dissatisfaction and intent to leave. Black nurses' intent to leave decreased in adjusted models that accounted for dissatisfaction with aspects of their jobs including salary, advancement opportunities, autonomy, and tuition benefits. CONCLUSION: Nurse administrators may find opportunities to decrease intent to leave among Black nurses through focused efforts to target areas of dissatisfaction.

Nurses' occupational satisfaction during Covid-19 pandemic.

BACKGROUND: Covid-19 has brought healthcare workers in general and nurses in particular into the limelight as never before. It is important to study the intensity of the impact of this pandemic on the profession. OBJECTIVE: This study aims to assess the occupational satisfaction during the pandemic of Covid-19 among the nurses in Israel, to shed light on conditions of work and to identify factors associated with low occupational satisfaction. METHODS: Cross-sectional study of 130 Israeli nurses. Minnesota Satisfaction and Measure of Job Satisfaction questionnaire with 28 items was used to assess occupational satisfaction. RESULTS: In the multivariable model, nurses working in the community had higher occupational satisfaction than those working in hospitals (ß = 0.24, p = .032); nurses who took care of patients who tested positive for Covid-19 had significantly lower occupational satisfaction than others (ß = -0.48, p = .009). Most of the sample reported lack of personal protective equipment (PPE). Nurses who experienced lack of PPE reported lower occupational satisfaction than those who did not (3.4 vs. 3.8, p = .039). Occupational satisfaction was mainly based on the component, built by the intrinsic characteristics of the occupation related to the personal accomplishment. Most of nurses had to increase their workload as a result of staff shortages, but the elevation of the workload was not associated with lower occupational satisfaction. CONCLUSION: Even under the circumstances of the pandemic, the most important nurses` occupational values are worthwhile accomplishments, importance of professional challenge, diversity and interest in the job, personal growth and development and independence in their practice.

Can a clinical skills facilitator improve staff retention in a children's hospital?

Clinical skills facilitators are experienced nurses responsible for staff education and support in a clinical area, where they are employed supernumerary to the team. This article discusses the implementation and evaluation of a pilot clinical skills facilitator role on a medical ward in a children's hospital in an NHS trust in England, aimed at improving the retention of nursing staff. A baseline survey was conducted at the start of the pilot and a follow-up survey was conducted at the end, nine months later. The surveys contained ten statements about three factors important for staff retention: clinical skills, job satisfaction and well-being at work. Improvements were seen in all ten statements and a review of staff retention data showed that no member of staff had left the ward in the year of pilot implementation, compared with four the year before. The development of clinical skills facilitator roles on children's wards is therefore of potential benefit for staff retention.

Implementation of a ward staff self-rostering system: improving morale and retention.

Staff morale is an important factor in maintaining and improving nurse recruitment and retention. Evidence suggests more flexible working patterns can improve nurses' work-life balance and subsequently their workplace satisfaction. This article describes a ward-based quality improvement project that introduced a self-rostering system that enabled nurses to select their own shifts for a given four-week roster period. The aim was to increase staff satisfaction and subsequently improve retention and recruitment. The article describes the project and discusses the positive outcomes.

Battling Burnout at the Frontlines of Health Care Amid COVID-19.

Nursing is a physically and emotionally demanding profession. Grueling job roles and challenging work environments, specifically in acute or critical care settings, place health care professionals at risk of burnout. Burnout in health care professionals results from a chronic negative work experience, leading to job dissatisfaction and, ultimately, poor patient outcomes. Symptoms and prevalence of burnout can be alleviated by implementing individual-focused strategies and minor modifications in work environments, job demands, and responsibilities. Currently, risk for burnout is increasing as COVID-19 challenges health care systems in which advanced practice nurses and other health care professionals struggle continuously to deliver high-quality patient care. In this article, the circumstances surrounding COVID-19 are considered and an overview is provided of burnout phenomenon, its causal factors, and its consequences. With consideration of current evidence in literature, I discuss some suggested strategies to improve resilience and facilitate well-being among health care professionals at individual and organizational levels.

Methodological approach for measuring the effects of organisational-level interventions on employee withdrawal behaviour.

BACKGROUND: Theoretical frameworks have recommended organisational-level interventions to decrease employee withdrawal behaviours such as sickness absence and employee turnover. However, evaluation of such interventions has produced inconclusive results. The aim of this study was to investigate if mixed-effects models in combination with time series analysis, process evaluation, and reference group comparisons could be used for evaluating the effects of an organisational-level intervention on employee withdrawal behaviour. METHODS: Monthly data on employee withdrawal behaviours (sickness absence, employee turnover, employment rate, and unpaid leave) were collected for 58 consecutive months (before and after the intervention) for intervention and reference groups. In total, eight intervention groups with a total of 1600 employees participated in the intervention. Process evaluation data were collected by process facilitators from the intervention team. Overall intervention effects were assessed using mixed-effects models with an AR (1) covariance structure for the repeated measurements and time as fixed effect. Intervention effects for each intervention group were assessed using time series analysis. Finally, results were compared descriptively with data from process evaluation and reference groups to disentangle the organisational-level intervention effects from other simultaneous effects. RESULTS: All measures of employee withdrawal behaviour indicated statistically significant time trends and seasonal variability. Applying these methods to an organisational-level intervention resulted in an overall decrease in employee withdrawal behaviour. Meanwhile, the intervention effects varied greatly between intervention groups, highlighting the need to perform analyses at multiple levels to obtain a full understanding. Results also indicated that possible delayed intervention effects must be considered and that data from process evaluation and reference group comparisons were vital for disentangling the intervention effects from other simultaneous effects. CONCLUSIONS: When analysing the effects of an intervention, time trends, seasonal variability, and other changes in the work environment must be considered. The use of mixed-effects models in combination with time series analysis, process evaluation, and reference groups is a promising way to improve the evaluation of organisational-level interventions that can easily be adopted by others.

Factors That Influence Millennial Generation Nurses' Intention to Stay: An Integrated Literature Review.

OBJECTIVE: To synthesize literature exploring the expectations of millennial nurses and factors that influence their retention. BACKGROUND: Long-anticipated nursing shortages are happening nationwide in part from boomer retirements. These supply issues are expected to worsen because of an aging population who will require complex healthcare going forward. Millennial nurse turnovers, however, represent the biggest threat to supply. METHODS: This extensive literature review was conducted following published guidelines. Thirteen publications regarding millennials' expectations of work were analyzed. RESULTS: Millennials expect strong leadership, advancement opportunities, alignment of organizational and personal values, good coworker relationships, healthy work-life balance, recognition, and cutting-edge technology. CONCLUSIONS: Millennials have specific expectations for work, and they will leave if these go unmet. Findings from this review provide valuable insight into this generation of nurses to help leaders create appropriate retention strategies. The limited literature on this topic highlights the need for more research.

Nursing faculty shortage in Canada: A scoping review of contributing factors.

BACKGROUND: Strong nursing faculty is paramount to promote disciplinary leadership and to prepare future nurses for practice. Our understanding of the factors associated with or predictive of nurse faculty retention and/or turnover is lacking. PURPOSE: The aim of this review is to identify and synthesize the existing literature on factors contributing to nurse faculty shortage in Canada and implications on nursing practice. METHODS: A scoping review based on the Arskey and O'Malley's five stage framework for scoping reviews was undertaken. Utilizing the PRISMA protocol, a comprehensive and structured literature search was conducted in five databases of studies published in English. FINDINGS: Limited through search inclusion and relevance of research, nine studies out of 220 papers met the criteria for this review and were thematically analyzed. Identified themes were supply versus demand; employment conditions; organizational support; and personal factors. DISCUSSION: Impending retirement of faculty, unsupportive leadership, and stressful work environments were frequently reported as significant contributing factors to the faculty shortage. CONCLUSION: This scoping review provides insights into how Canada's schools of nursing could engage in grounded efforts to lessen nursing faculty shortage, both nationally and globally. We identified a gap in the literature that indicates that foundational work is needed to create context-specific solutions. The limited studies published in Canada suggest that this is a critical area for future research and funding.

How Robots Help Nurses Focus on Professional Task Engagement and Reduce Nurses' Turnover Intention.

PURPOSE: To examine how robot-enabled focus on professional task engagement and robot-reduced nonprofessional task engagement are related to nurses' professional turnover intention. DESIGN: We adopted a two-wave study design. METHODS: We collected the first wave of data in a large hospital in Taiwan during October and November 2019 and the second wave between December 2019 and February 2020. We used the data collected from 331 nurses who participated in both waves. FINDINGS: We found that robot-enabled focus on professional task engagement is positively related to nurses' overall job satisfaction and perceived health improvement. Robot-reduced nonprofessional task engagement is positively related to nurses' perceived health improvement. Both overall job satisfaction and perceived health improvement are negatively related to nurses' professional turnover intention. CONCLUSIONS: Robots' ability to focus nurses' efforts in professional tasks may help improve nurses' health and overall job satisfaction, and by extension reduce their turnover intention. CLINICAL RELEVANCE: Nurse managers could suggest hospitals introduce robots, particularly those that can share nurses' nonprofessional workload. This, meanwhile, could focus nurses' efforts on professional task engagement.

The mediating effect of exhaustion in the relationship between effort-reward imbalance and turnover intentions: A 4-year longitudinal study from Sweden.

OBJECTIVES: Earlier studies suggest that imbalance between effort and reward at work associates with exhaustion. Others have found that exhaustion increases turnover intentions; an important precursor of actual turnover that also associates with counterproductive work behaviors. Few, however, have studied the associations between effort-reward imbalance (ERI) and employees' intentions to leave their current employment, and whether exhaustion is underpinning that relationship. Here, we investigate the mediating role of exhaustion in the effort-reward imbalance - turnover intentions relationship. METHODS: Data from three waves covering a time span of four years from the Swedish Longitudinal Occupational Survey of Health (SLOSH) were analysed using structural equation modeling. Cross-lagged mediation analyses were conducted to estimate if associations from ERI to subsequent turnover intentions were mediated by exhaustion. Other causal directions (direct and reversed direct effects, reversed mediation) were also examined. RESULTS: A direct path from ERI T1 to turnover intentions T2 was found, but not from ERI T2 to turnover intentions T3. Additionally, results showed that ERI at time points T1/T2 associated significantly with exhaustion two years later (T2/T3). Also, exhaustion at T1 showed a small but statistically significant direct association with turnover intentions at T2 (no association was found between exhaustion T2 and turnover intentions T3). A small, but statistically significant indirect effect from ERI to turnover intentions was found (estimate 0.005; 95% CI 0.002-0.010). CONCLUSIONS: Providing a good balance between effort and reward for workers is essential to protect employee health and help retain employees in the organization.