The pathway from mental health, leaves of absence, and return to work of health professionals: Gender and leadership matter.

Health professions are ranked among the most stressful occupations and have a much higher likelihood of absenteeism from work. In this article, we present findings from four health professional case studies in our Healthy Professional Worker partnership, involving surveys with 1,860 respondents and 163 interviews with nurses, physicians, midwives, and dentists conducted between December 2020 and April 2021. We found that the pathway from mental health experiences through to the decision to take a leave of absence and return to work differed between the health professions and that both gender and leadership matter greatly. There is a need to de-stigmatize mental health issues and encourage greater awareness and support from supervisors and colleagues. Leadership can play an important role in mitigating mental health issues, and as such investment in both leadership training and mentorship are important first steps in acting upon our research findings.

Change fatigue in nurses: A qualitative study.

AIMS: To provide a conceptual update on change fatigue in nursing as it relates to rapid and continuous change implementation. This doctoral dissertation examined nurses' experiences of rapid and continuous organizational change, with a core component of the study examining the concept of change fatigue. BACKGROUND: Change fatigue is understood as the overwhelming feelings of stress, exhaustion and burnout fuelled by feelings of ambivalence and powerlessness associated with rapid and continuous change in the workplace. Change fatigue may cause workers to become withdrawn and greatly influences their decision to leave the workplace and even their profession. Little research to date has explored change fatigue in nurses. METHODS: Were qualitative in nature. DESIGN: A critical hermeneutic approach was used. Face-to-face interviews were conducted with 14 Registered Nurses. Open-ended questions were used. Theoretical thematic analysis and inductive analysis of data were completed using Brown and Gilligan's voice-centred relational method. The study spanned from 2015 - 2018. RESULTS: Nurses did experience many of the core elements of change fatigue noted in the non-nursing literature, including exhaustion, apathy, powerlessness, and burnout. Two additional themes emerged pertaining to nurses' understandings of why they were experiencing change fatigue. These themes included the intensification of nursing work and repeated and ongoing self-sacrifice. CONCLUSION: Participants offered important insight into an emergent concept in the discipline of nursing. IMPACT: The negative experiences associated with change fatigue are important for administrators and other stakeholders to recognize and acknowledge, as they must work to alleviate change fatigue in their institutions to preserve the well-being of the nursing workforce. This knowledge is also important to nursing scholars, who may further research the topic and embed it into nursing curricula.

Nurses' engagement with power, voice and politics amidst restructuring efforts.

Change is inevitable, and increasingly rapid and continuous in healthcare as organizations strive to adapt, improve and innovate. Organizational change challenges healthcare providers because it restructures how and when patient care delivery is provided, changing ways in which nurses must carry out their work. The aim of this doctoral study was to explore frontline nurses' experiences of living with rapid and continuous organizational change. A critical hermeneutic approach was utilized. Participants described feeling voiceless, powerless and apolitical amidst rapid and continuous organizational changes which fuelled apathy, cynicism and disengagement from the organization. However, critical analysis of the data showed that nurses actively engaged with power, voice and politics through resistant and transgressive behaviours in micro-ethical moments of practice. There is a need to reconceptualize the concepts of voice, power and politics in nursing as there is dissonance between nurses' beliefs about these concepts and what they are enacting in practice. Recognizing their enactment of power, voice and political agency at the micro-level may empower nurses. Empowerment would mitigate the high levels of reports of powerlessness experienced in practice during organizational changes.

Politics of change: the discourses that inform organizational change and their capacity to silence.

Changes in healthcare organizations are inevitable and occurring at unprecedented rates. Such changes greatly impact nurses and their work, yet these experiences are rarely explored. Organizational change discourses remain grounded in perspectives that explore and explain systems, often not the people within them. Change processes in healthcare organizations informed by such organizational discourses validate only certain perspectives and forms of knowledge. This fosters exclusionary practices, limiting the capacity of certain individuals or groups of individuals to effectively contribute to change discourses and processes. The reliance on mainstream organizational discourses in healthcare organizations has left little room for the exploration of diverse perspectives on the subject of organizational change, particularly those of nurses. Michel Foucault's work challenges dominant discourse and suggest that strong reliance's on specific discourses effectively disqualify certain forms of knowledge. Foucault's writings on disqualified knowledge and parrhesia (truth telling and frank speech) facilitate the critical exploration of discourses that inform change in healthcare organizations and nurses capacities to contribute to organizational discourses. This paper explores the capacity of nurses to speak their truths within rapidly and continuously changing healthcare organizations when such changes are often driven by discourses not derived from nursing knowledge or experience.

Nurses amidst change: the concept of change fatigue offers an alternative perspective on organizational change.

This article aims to clarify the concept of change fatigue and deems further exploration of the concept within the discipline of nursing is relevant and necessary. The concept of change fatigue has evolved from the discipline of management as a means to explore organization change and its associated triumphs and failures. Change fatigue has typically been described as one and the same as change resistance, with very little literature acknowledging that they are in fact distinct concepts. Concept clarification has highlighted the striking differences and few similarities that exist between the concepts of change fatigue and change resistance. Further exploration and subsequent research on the concept of change fatigue is needed within the discipline of nursing. The concept not only presents new and alternative perspectives on the processes of organization change, but provides opportunity for theory development that recognizes the impact organizational change has on nurses' work lives.

An Evolutionary Concept Analysis of Palliative Care in Oncology Care.

This evolutionary concept analysis reports on the concept of palliative care in oncology. Despite its relevance to oncology, the concept of palliative care remains misunderstood, resulting in erroneous interpretations by nurses and health care providers alike. Consequently, integration of palliative care remains heterogeneous and highly contextual. Findings highlight the complexity and ambiguity of the concept of palliative care in the context of oncology care. The nuances and complexity of when to integrate palliative care for patients living with cancer, as well as its evolution from its origins in the hospice movement, have led to its ambiguity in clinical practice.

New Graduate Nurses Navigating Entry to Practice in the Covid-19 Pandemic.

BACKGROUND: The Covid-19 pandemic has significantly impacted organizational life for nurses, with known physical and psychological impacts. New graduate nurses are a subset of nurses with unique needs and challenges as they transition into their registered nurse roles. However, this subset of nurses has yet to be explored in the context of the Covid-19 pandemic. PURPOSE: To explore the experiences of new graduate nurses entering the profession in Ontario, Canada, during the Covid-19 pandemic approximately one year after entering the profession. METHODS: Thorne's interpretive description method was utilized. FINDINGS: All participants identified as completing second entry nursing programs, offering a unique perspective on new graduate nurse transition. Four themes emerged in the data: 'Virtual Didn't Cut It,' 'Go Where You Know,' 'Picking Up the Pieces,' and 'Learning When to Say No and Let Go.' Participants felt ill prepared to enter the profession and were cognizant of the various challenges facing the nursing profession, and how these pre-existing challenges were exacerbated by the pandemic. They acknowledged the need to protect themselves against burnout and poor mental health, and as such, made calculated early career decisions - demonstrating strong socio-political knowing. Half of the participants had already left their first nursing job; citing unmet orientation, mental health, and wellbeing needs. However, all participants were steadfast in remaining in the nursing profession. CONCLUSIONS: Second entry new graduate nurses remain a unique subset of nurses that require more scholarly attention as their transition experiences may differ from the traditional trajectory of new graduate nurses.

Change Resistance as Practicing Moral Authenticity: A Qualitative Study.

BACKGROUND AND PURPOSE: Organizational changes are increasingly rapid and continuous in health care as organizations strive to meet multiple external pressures. Much change in health care fails and nurse resistance is commonly blamed for such failure. Nurse resistance to organizational change is often described as overt behaviours and are deemed destructive to the change process. Much of the literature describing organizational change comes from the perspectives of administrators, there is little known about nurses' experiences of organizational change. The purpose of this inquiry was to explore the nature of frontline nurses' experiences of rapid and continuous change. METHODS: A qualitative critical hermeneutic design was applied. 14 Registered Nurses participated in face-to-face interviews. Openended questions were used. The setting was an urban pediatric teaching hospital located in Canada. Research ethics board approval was obtained as required. Member reflections ensured accurate portrayals of participant's experiences. RESULTS: The findings from this study suggest that acts of resistance to change are not overt, but rather covert behaviors in micro-ethical moments. Nurses engaged in resistance as means to provide morally authentic care at the bedside. These acts were utilized to take back power over their practice amidst feelings of powerlessness, however, paradoxically, when participants described the concept of power, they understood it solely in the context of feeling powerless within the planning, implementation and evaluation of organizational change initiatives. Nurses engagement with resistant behaviours in the context of organizational change demonstrated ethical action and political agency that enabled morally authentic nursing practice. IMPLICATIONS FOR PRACTICE: The findings from this study offer new understandings of a well-established concept in nursing and can be used when considering the ethical dimensions of nursing work amidst rapidly changing health care institutions.

Visitor Restrictions, Palliative Care, and Epistemic Agency: A Qualitative Study of Nurses' Relational Practice During the Coronavirus Pandemic.

Efforts to curb spread of COVID-19 has led to restrictive visitor policies in healthcare, which disrupt social connection between patients and their families at end of life. We interviewed 17 Canadian nurses providing palliative care, to solicit their descriptions of, and responses to, ethical issues experienced as a result of COVID-19 related circumstances. Our analysis was inductive and scaffolded on notions of nurses' moral agency, palliative care values, and our clinical practice in end-of-life care. Our findings reveal that while participants appreciated the need for pandemic measures, they found blanket policies separating patients and families to be antithetical to their philosophy of palliative care. In navigating this tension, nurses drew on the foundational values of their practice, engaging in ethical reasoning and action to integrate safety and humanity into their work. These findings underscore the epistemic agency of nurses and highlight the limits of a purely biomedical logic for guiding the nursing ethics of the pandemic response.

Thinking about strengths in end-of-life nursing practice: the case of intensive care unit nurses.

BACKGROUND: The intensive care unit (ICU) is a care context that is sometimes described as being unconducive to the values and ideals of a good death in end-of-life care. Such assumptions render the ICU emblematic of a troubling discourse about end-of-life care in this clinical context. AIM: To stimulate a reflective examination of intensive care nursing practice with respect to end-of-life care. METHODS: The work of contemporary nursing scholar Laurie Gottlieb is used to perform a strengths-based relational ethical examination of previously published literature that describes critical care nurses' experiences of providing end-of-life care in the ICU. FINDINGS: This literature suggests that the relational ethical value of authentic engagement, which is fundamental to the disciplinary ethos of expert palliative care nursing, is reflected in the everyday practice of intensive care nurses whose patients die while under their care. CONCLUSION: A strengths-based approach can make visible the relational ethical practice of critical care nurses who care for dying patients and their families in the ICU.