Overtime and alertness of rotating-shift nurses: An observational study using ecological momentary assessment.

AIMS AND OBJECTIVES: This study aimed to determine the effect of overtime on alertness at work among rotating-shift nurses in South Korea and to investigate whether these effects of overtime vary across the different types of shifts. BACKGROUND: Nurse overtime is prevalent in healthcare settings to manage nursing shortages and staffing needs; however, it negatively affects patient and nurse outcomes. Furthermore, little attention has been paid to the effects of previous overtime shifts and overtime for consecutive shifts on alertness during work. DESIGN: A prospective observational study was employed. The study followed STROBE checklist for observational studies. METHODS: Data were collected between June 2019 and February 2020 from 82 nurses who worked in acute care hospitals. An ecological momentary assessment was used to capture real-time data of overtime and alertness. Alertness scores were estimated using the sleep/wake data measured by an actigraph. Mixed-effect models were employed to investigate the association between overtime and alertness. RESULTS: A majority of the shift nurses worked overtime. Episodes of a decline in alertness scores to the level of increased accident or serious error risk (alertness score ≤80) were most frequently seen during night shifts (98.9%), followed by day (59.8%) and evening shifts (10.1%). Previous-day overtime hours and consecutive overtime days were associated with decreased alertness scores during work. A significantly positive correlation was observed between alertness scores ≤80 and previous-day overtime hours and consecutive overtime days in all shifts. CONCLUSIONS: The study findings indicate that a majority of nurses who work overtime experience decreased alertness while on duty. RELEVANCE TO CLINICAL PRACTICE: Policy development at the government, organisational and unit level is needed to guarantee adequate rest for shift nurses by adjusting work schedules and assignments and limiting overtime.

Humanities-Based Educational Preparation and Empathy in Novice Nurses: Critical Thinking and Analytic Practice.

ABSTRACT: Empathy has been associated with improved patient outcomes in practicing nurses, but empathy levels have been shown to decline in nursing students with increased clinical exposure. Integrating content from the humanities in the nursing classroom, not common in nursing education, supports professional empathy development and maintenance. Whether competencies gained from humanities-based liberal education courses support empathy in nursing students as they emerge into practice is not known. The purpose of this quantitative, nonexperimental, descriptive, pilot research was to explore the relationship between humanities-based liberal education and empathy in recently graduated, baccalaureate-prepared practicing nurses ( n = 40).

Occupational fatigue, individualized nursing care, and quality of nursing care among hospital nurses.

PURPOSE: This study aimed to evaluate the relationships among nurse fatigue, individualized nursing care, and nurse-reported quality of care. DESIGN: The study used a cross-sectional design. Data from 858 registered nurses providing bedside care in hospitals were collected between March and April 2021 in the United States. METHODS: Participants completed a self-administered online survey, including the Occupational Fatigue Exhaustion Recovery scale, the Individualized Care Scale-Nurse version, and a single item assessing nursing care quality. Relationships among the study variables were examined using multiple linear and logistic regression models. FINDINGS: Nurses' higher levels of acute fatigue were significantly associated with decreased perceptions of individualized nursing activities provided to patients on their last shifts, specifically related to personal life condition and decision-making control. Nurses' higher levels of chronic fatigue were significantly associated with decreased perception of individualized nursing activities provided to patients on their last shifts related to clinical condition, personal life condition, and decision-making control. Nurses with higher levels of acute or chronic fatigue, and who perceived their nursing care activities as less individualized were less likely to assess their quality of care as excellent. CONCLUSION: These findings suggest that addressing hospital nurses' acute and chronic fatigue may contribute to promoting the delivery of individualized nursing care and in improving patients' quality of care. CLINICAL RELEVANCE: Healthcare institutions are encouraged to regularly monitor and manage nurse fatigue to improve the delivery of individualized and quality nursing care to their patients.

Occupational fatigue, workload and nursing teamwork in hospital nurses.

AIMS: To evaluate the relationships between workload, nursing teamwork and nurse fatigue and the moderating effect of nursing teamwork on the relationship between workload and fatigue. DESIGN: This cross-sectional online survey study used data from 810 United States hospital nurses collected between March and April 2021. METHODS: Workload, nursing teamwork and fatigue were measured using the Quantitative Workload Inventory, the Nursing Teamwork Survey, and the Occupational Fatigue Exhaustion Recovery scale. Hierarchical multiple linear regression models were used. RESULTS: All the nursing teamwork subscales (i.e. trust, team orientation, backup, shared mental model, team leadership) were significantly negatively related to acute and chronic fatigue. Nursing teamwork components of team orientation, shared mental model and team leadership moderated the relationship between workload and chronic fatigue. The relationships between workload and chronic fatigue were stronger when these components of nursing teamwork were high. No moderating effects were found with acute fatigue. CONCLUSION: Efforts to increase nursing teamwork may be a promising strategy in managing nurse fatigue. It is equally important to monitor and modify high workload to protect nurses from elevated fatigue. IMPACT: WHAT PROBLEM DID THE STUDY ADDRESS?: Fatigue is negatively associated with the health and safety of hospital nurses and patients. Nursing teamwork has been shown to improve the nursing care of hospitalized patients; yet, it is rarely explored in relation to nurse fatigue. WHAT WERE THE MAIN FINDINGS?: Greater nursing teamwork is significantly associated with lower acute and chronic fatigue. The relationships between workload and chronic fatigue were stronger when nursing teamwork (i.e. team orientation, shared mental model and team leadership) was high than when nursing teamwork was low. WHERE AND ON WHOM WILL THE RESEARCH HAVE AN IMPACT?: Improving nursing teamwork, in addition to monitoring and modifying workloads, can be a promising approach for managing fatigue in healthcare organizations.

Primary care nurses' perception of leadership and the influence of individual and work setting characteristics: A descriptive study.

AIMS: The aim of this study is to describe primary care nurses' perceptions of their formal leaders' leadership behaviours and outcomes and explore differences based upon nurses' individual and work setting characteristics. BACKGROUND: Formal nursing leadership is positively associated with patient, nurse workforce and organizational outcomes, yet no studies have examined primary care nurses' perception of formal leadership behaviours and outcomes in the United States. METHODS: Cross-sectional survey data from 335 primary care nurses were analysed to assess perceived leadership behaviours associated with transformational, transactional and passive-avoidant leadership styles, perceived leadership outcomes and individual and work setting characteristics. RESULTS: Positive leadership behaviours (transformational) were lower than those reported for other settings. There were significant differences in nurses' perceptions of their leaders' leadership behaviours and outcomes based upon individual and work setting characteristics. CONCLUSION: This study confirmed differences in perception of leadership and that individual and work setting characteristics influence nurses' perception of their leaders in primary care. IMPLICATIONS FOR NURSING MANAGEMENT: Leaders must be versatile and consider the unique needs of each staff member and the influence of clinic characteristics.

Effects of Work Environments and Occupational Fatigue on Care Left Undone in Rotating Shift Nurses.

PURPOSE: This study aimed to examine the effects of work environments and occupational fatigue on care left undone in rotating shift nurses, and to identify the indirect (mediation) effect of work environments on care left undone through nurses' occupational fatigue in South Korean acute care hospitals. DESIGN: This study employed a cross-sectional design using an online survey to collect data from 488 rotating shift nurses of acute care hospitals in Korea between November and December 2018. METHODS: A mobile schedule management application for shift nurses was used to advertise the study and to send a link to the online survey. The survey included questions on the nurses' work environment characteristics, care left undone activities, and the Korean version of the Occupational Fatigue Exhaustion/Recovery scale. Poisson regression was used to explore the relationships among work environments, occupational fatigue, and care left undone. Hayes' Model 4 and a bootstrapping analysis were used to identify the mediating effect of occupational fatigue on the relationship between work environments and care left undone. FINDINGS: The average number of tasks left undone was 3.45 (SD = 2.19). The higher the acute and chronic fatigue levels noted among nurses, the higher were the occurrences of care left undone. Conversely, the higher the intershift recovery level, the lower were the occurrences of care left undone. The results showed a positive relationship between care left undone and overtime hours and the number of patients per nurse. Moreover, nurses' occupational fatigue mediated the relationship between work environments and care left undone. Night shifts per month and the number of consecutive days off had an indirect effect on care left undone through occupational fatigue. CONCLUSIONS: High levels of occupational fatigue and poor intershift recovery among nurses can lead to care left undone. Nurses' occupational fatigue mediates the effect of work environment on care left undone. CLINICAL RELEVANCE: It is crucial for healthcare administrators and leaders to develop policies and mandatory regulations to facilitate better working conditions for nurses, consequently reducing their occupational fatigue and decreasing the occurrence of care left undone in acute care hospitals.

Organizational Factors Associated With Technical Efficiency of Nursing Care in US Intensive Care Units.

BACKGROUND: Few studies have evaluated technical efficiency of nursing care, and no such studies have been conducted in intensive care units (ICUs). PURPOSE: To explore relative technical efficiency of US ICUs and identify organizational factors associated with efficiency in providing quality of nursing care. METHODS: A total of 404 adult ICUs from the 2014 National Database of Nursing Quality Indicators were included. Data envelopment analysis was used to estimate technical efficiency, and multilevel modeling was employed to determine effects of organizational factors on efficiency. RESULTS: Nurse-to-patient ratio showed the strongest positive correlation with technical efficiency. Units in non-Magnet and small-size hospitals had higher technical efficiency than those in Magnet and medium- or large-size hospitals. CONCLUSIONS: A higher nurse-to-patient ratio greatly improved technical efficiency of nursing care in ICUs and the effect differed between hospitals. Administrators and policy makers can translate the study findings into management strategies to provide efficient nursing care in ICUs.

Effects of Individual Nurse and Hospital Characteristics on Patient Adverse Events and Quality of Care: A Multilevel Analysis.

PURPOSE: This study aimed to investigate effects of individual nurse and hospital characteristics on patient adverse events and quality of care using a multilevel approach. DESIGN: This is a secondary analysis of a combination of nurse survey data (N = 1,053 nurses) and facility data (N = 63 hospitals) in Canada. METHODS: Multilevel ordinal logistic regression was employed to examine effects of individual nurse and hospital characteristics on patient adverse events. Multilevel linear regressions were used to investigate effects of individual nurse and hospital characteristics on quality of care. FINDINGS: Organizational safety culture was associated with patient adverse events and quality of care. Controlling for effects of nurse and hospital characteristics, nurses in hospitals with a stronger safety culture were 64% less likely to report administration of wrong medication, time, or dose; 58% less likely to report patient falls with injury; and 60% less likely to report urinary tract infections; and were more likely to report higher levels of quality of care. Additionally, the effects of individual-level baccalaureate education and years of experience on quality of care differed across hospitals, and hospital-level nurse education interacted with individual-level baccalaureate education. CONCLUSIONS: This study makes significant contributions to existing knowledge regarding the positive effect of organizational safety culture on patient adverse events and quality of care. CLINICAL RELEVANCE: Healthcare organizations should strive to improve their safety culture by creating environments where healthcare providers trust each other, work collaboratively, and share accountability for patient safety and care quality.

Impact of Medicare Advantage penetration and hospital competition on technical efficiency of nursing care in US intensive care units.

This study aimed to evaluate technical efficiency of US intensive care units and determine the effects of environmental factors on technical efficiency in providing quality of nursing care. Data were obtained from the 2014 National Database of Nursing Quality Indicators and the Centers for Medicare and Medicaid Services. Data envelopment analysis was used to estimate technical efficiency for each intensive care unit. Multilevel modeling was used to determine the effects of environmental factors on technical efficiency. Overall, Medicare Advantage penetration and hospital competition in a market did not create pressure for intensive care units to become more efficient by reducing their inputs. However, these 2 environmental factors showed positive influences on technical efficiency in intensive care units with certain levels of technical efficiency. The implications of the study results for management strategies and health policy may vary according to the levels of technical efficiency in intensive care units. Further studies are needed to examine why and how intensive care units with particular levels of technical efficiency are differently affected by certain environmental factors.

Gray Reflections: Poetry as a Pathway to Nursing Student Empathy and the Creation of Meaning in a Long-Term-Care Clinical Practicum.

The unique needs of the aging adult require caregivers who can completely comprehend the experience of this population. Purposefully educating nursing students to enhance development of empathy is crucial for the provision of adequate care. Innovative pedagogical strategies that produce opportunities for nursing students to reflect on patient care experiences are an opportunity for educators to guide the creation of meaning in practice for nursing students. The use of poetry reading and writing enhances the student reflective process in clinical practicum environments and may serve as a strategy to support empathic development in nursing students.

Improving satisfaction among established patients in a midwestern pain clinic.

BACKGROUND: A problem in many health care practices is deciding the appropriate appointment length for new and established patients. Patients become frustrated when there is inadequate time to have their needs met, yet when a patient's clinic time is spontaneously lengthened, the provider gets behind in schedule, causing delays and greater frustration for others. AIM: The aims of this evidence based project were to determine whether implementation of a flexible appointment system would improve the current scheduling process in a pain clinic by allowing complex patients the opportunity to schedule a longer clinic appointment and would improve patient satisfaction. DESIGN: This evidence-based practice innovation followed a program evaluation process using a descriptive, existing survey completed by clinic staff and patients. SETTING: A Midwestern pain clinic caring for patients with acute and chronic pain diagnoses. PARTICIPANTS: A convenience sample of 120 patients were surveyed before and after the process change. Thirteen staff members completed the survey on SurveyMonkey pre and post procedural change at the same intervals the patients were surveyed. RESULTS: Patients were more satisfied with the time that they spent in the exam room and the waiting room. The process change improved communication with staff and patients and provided an opportunity to discuss their concerns and health changes prior to their scheduled appointment. CONCLUSION: Allowing an option for flexible scheduling in appointment lengths provided an opportunity to meet patient needs, offer improved service, and improve patient-provider communication.

Evaluating nursing hours per patient day as a nurse staffing measure.

AIMS: To identify the techniques used to measure nurse staffing and to evaluate the reliability, validity and limitations of nursing hours per patient day (NHPPD). BACKGROUND: Numerous studies have attempted to identify appropriate nurse staffing levels; however, variations in nurse staffing measures may have caused inconsistent findings regarding the relationships between nurse staffing and quality of care. EVALUATION: Seventeen studies using nurse staffing measures were reviewed. KEY ISSUES: Six common nurse staffing measures were identified: nurse-to-patient ratios, full-time equivalents, NHPPD, skill mix, nurse-perceived staffing adequacy and nurse-reported number of assigned patients. CONCLUSIONS: Among nurse staffing measures, NHPPD is the most frequently used and is considered to be highly beneficial. This measure shows some evidence of high inter-rater reliability. The predictive validity of NHPPD for patient falls is high, whereas that for pressure ulcers is low. IMPLICATIONS FOR NURSING MANAGEMENT: For NHPPD to be applied more effectively as a nurse staffing measure, there is a need for additional reliability testing in various types of units with large sample sizes; further validity research for additional patient outcomes; appropriate adjustments in its application to capture variations in the characteristics of nurses, patients and hospital units; and a consistent data collection procedure.

Holistic review in admissions: a strategy to diversify the nursing workforce.

Individuals both within and outside the nursing profession have called for more diversity in nursing, from the education arena to the workforce. Implementing initiatives that address diversity and determining their effects have been limited. The University of Illinois at Chicago College of Nursing used the American Association of Medical Colleges Holistic Review Project as a platform to implement a process and paradigm shift for admissions to its nursing programs. We believe that the use of holistic admissions can increase the diversity among nursing students and provide the first step toward a diversified nursing profession. In hopes of assisting other institutions, we describe our experiences with preparing and implementing a holistic admissions process within the context of lessons learned and continued challenges. Furthermore, we hope our efforts will serve as a catalyst for a national dialogue on the use of holistic review as a strategy for the development of a more diverse nursing workforce.