Workplace violence in healthcare settings is on the rise, particularly against nurses. Most healthcare violence research is in acute care settings. The purpose of this paper is to present descriptive ...findings on the prevalence of types and sources of workplace violence among nurses in different roles (i.e., direct care, leader, educator), specialties, care sectors (i.e., acute, community, long-term care) and geographic contexts (i.e., urban, suburban, rural) within the province of British Columbia (BC), Canada. This is a province-wide survey study using a cross-sectional descriptive, correlational design. An electronic survey was emailed by the provincial union to members across the province in Fall 2019. A total of 4462 responses were analyzed using descriptive and chi-square statistics. The most common types of workplace violence were emotional abuse, threats of assault and physical assault for all nursing roles and contexts. Findings were similar to previous BC research from two decades ago except for two to ten times higher proportions of all types of violence, including verbal and physical sexual assault. Patients were the most common source of violence towards nurses. Nurses should be involved in developing workplace violence interventions that are tailored to work environment contexts and populations.
Abstract
Objectives
Nurses are at a high risk of developing mental health problems due to exposure to work environment risk factors. Previous research in this area has only examined a few factors ...within nurses’ work environments, and those factors were not conceptualized with the goal of improving workplace mental health. The purpose of this study is to identify the most important work environment predictors of nurse mental health using a comprehensive and theoretically grounded measure based on the National Standard of Psychological Health and Safety in the Workplace.
Methods
This is an exploratory cross-sectional survey study of nurses in British Columbia, Canada. For this study, responses from a convenience sample of 4029 actively working direct care nurses were analyzed using random forest regression methods. Key predictors include 13 work environment factors. Study outcomes include depression, anxiety, post-traumatic stress disorder (PTSD), burnout and life satisfaction.
Results
Overall, healthier reports of work environment conditions were associated with better nurse mental health. More specifically
balance
,
psychological protection
and
workload management
were the most important predictors of depression, anxiety, PTSD and emotional exhaustion. While
engagement
,
workload management
,
psychological protection
and
balance
were the most important predictors of depersonalization,
engagement
was the most important predictor of personal accomplishment.
Balance
,
psychological protection
and
engagement
were the most important predictors of life satisfaction.
Conclusions
Routine assessment with standardized tools of nurses’ work environment conditions and mental health is an important, evidence-based organizational intervention. This study suggests nurses’ mental health is particularly influenced by worklife balance, psychological protection and workload management.
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IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, UL, UM, UPUK, VSZLJ
The long-term care (LTC) sector has been at the epicentre of COVID-19 in Canada. This study aimed to understand the impact that the Single Site Order (SSO) had on staff and leadership in four LTC ...homes in the Lower Mainland of British Columbia, Canada.
A mixed method study was conducted by analyzing administrative staffing data. Overtime, turnover, and job vacancy data were extracted and analyzed from four quarters before (April 2019 - March 2020) and four quarters during the pandemic (April 2020 - March 2021) using scatterplots and two-part linear trendlines across total direct care nursing staff and by designation (i.e., registered nurses (RNs), licenced practical nurses (LPNs) and care aids (CAs)). Virtual interviews were conducted with a purposive sample of leadership (10) and staff (18) from each of the four partner care homes (n = 28). Transcripts were analyzed in NVivo 12 using thematic analysis.
Quantitative data indicated that the total overtime rate increased from before to during the pandemic, with RNs demonstrating the steepest rate increase. Additionally, while rates of voluntary turnover showed an upward trend before the pandemic for all direct care nursing staff, the rate for LPNs and, most drastically, for RNs was higher during the pandemic, while this rate decreased for CAs. Qualitative analysis identified two main themes and sub-themes: (1) overtime (loss of staff, mental health, and sick leave) and (2) staff turnover (the need to train new staff, and gender/race) as the most notable impacts associated with the SSO.
The results of this study indicate that the outcomes due to COVID-19 and the SSO are not equal across nursing designations, with the RN shortage in the LTC sector highly evident. Quantitative and qualitative data underscore the substantial impact the pandemic and associated policies have on the LTC sector, namely, that staff are over-worked and care homes are understaffed.
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CEKLJ, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Background
In 2013, the Mental Health Commission of Canada created a National Standard that includes 13 workplace factors associated with employee mental health.
Purpose
This study (a) examined the ...psychometric properties of Guarding Minds at Work (GMW), the instrument used to measure the Standard’s 13 workplace factors and (b) assessed BC nurses’ workplace risk factors.
Methods
A province-wide survey study of 3,077 direct care nurses working in acute care settings was conducted.
Results
Subscale internal consistencies were acceptable. For most items, the original alphas were greater than the alpha-if-item-deleted. All corrected item-subtotal correlations were moderate to high. The 13-factor structure showed an adequate model fit based on absolute fit indices (SRMR = 0.057 and RMSEA = 0.054) but the relative fit indices were lower than the recommended cutoff (CFI = 0.827 and TLI = 0.815). Nurses identified nine of the 13 GMW factors as serious or significant concern in their workplace.
Conclusions
The findings were consistent with a plethora of evidence pointing to shortcomings in nurses’ work environments. This was the first study partially supporting the reliability and validity of the GMW. More work is required to refine the GMW and gain a better understanding of its psychometric properties.
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NUK, OILJ, SAZU, UKNU, UL, UM, UPUK, VSZLJ
Aims
To describe and compare registered nurse (RN) and licensed practical nurse (LPN) emotional exhaustion, intention to leave and reasons for leaving.
Background
Different skill mix/care delivery ...models are being used to address nurse shortages and rising health‐care costs. Skill mix may include RNs and LPNs. More LPNs are being employed in areas, such as acute care, that have been previously staffed by all RNs. Little is known about nurse outcomes since the introduction of LPNs to acute care settings.
Methods
This study was a cross‐sectional correlational design. A stratified, random sample of acute care nurses completed surveys via Fluidsurveys. The survey was modelled after the RN4CAST nursing workforce survey.
Results
For both groups of nurses higher levels of emotional exhaustion were associated with intention to leave and workload was the most frequent reason cited for intention to leave. More RNs than LPNs cited career advancement as a reason to leave, and more LPNs than RNs identified poor salary as a reason to leave.
Conclusions
Emotional exhaustion is linked to intention to leave health care.
Implications for nursing management
Nurse managers should address work environment factors associated with turnover intentions, such as professional development opportunities and shared decision‐making.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK, VSZLJ
The COVID-19 pandemic disrupted the world beginning in Mar 2020. The impact of the pandemic was widespread, affecting how many interacted with the health care system, including nursing students. The ...safety of the traditional clinical learning environment (CLE) for nursing students was questioned as COVID-19 spread quickly, putting staff and nursing students at risk for catching and transmitting the virus. Here, Sferrazza et al investigate nursing students' perception of the quality of their experiences in the CLE as it changed with the pandemic.
Context: To mitigate the risk of spread of COVID-19 in long-term care (LTC), the Public Health Agency of Canada instituted several rapid redesign and resource redeployment practices, including ...single-site policies. Objective: This study aims to understand factors that influence implementation of the Single Site Order (SSO). Methods: Consolidated Framework for Implementation Research (CFIR) guided data collection and analysis. Ten leadership team members and 18 staff were interviewed across 4 LTC homes in British Columbia (BC), Canada. In NVivo 12, a deductive framework analysis was used. Findings: Seven notable CFIR constructs (intervention source, evidence strength and quality, costs, culture, networks and communication, readiness for implementation, and patient needs and resources) were found to be most influential in the implementation of the SSO. We present these constructs and the factors within. Limitations: Our study was limited to the BC context. However, we believe that the findings offer useful insights into the complexity of policy implementation in LTC. Implications: In a system already facing staffing concerns and a highly dependent and increasingly frail resident population, implementation of the SSO further taxed already stretched resources.
The two key components of models of nursing care delivery are mode of nursing care delivery and skill mix. While mode of nursing care delivery refers to the independent or collaborative work of ...nurses to provide care to a group of patients, skill mix is defined as direct care nurse classifications. Previous research has typically focused on only one component at a time (mode or skill mix). There exists little research that investigates both components simultaneously. This study examined the effect of mode of nursing care delivery and skill mix on nurse emotional exhaustion and job satisfaction after controlling for nurse demographics, workload factors, and work environment factors. A secondary analysis was done with survey data from 416 British Columbia medical–surgical registered nurses. Data were analyzed using hierarchical multiple regression and moderated regression. Registered nurses in a skill mix with licensed practical nurses reported lower emotional exhaustion when caring for more acute patients compared with those in a skill mix without licensed practical nurses. While mode of nursing care delivery was not related to nurse outcomes, work environment factors were the strongest predictors of both nurse outcomes. Skill mix moderated the relationship between patient acuity and emotional exhaustion. Nurse managers should invest in nurses’ conditions of work environments.
Retaining talented and experienced nurses in clinical practice and academia is crucial for maintaining continuity, ensuring high-quality care and education, and fostering a positive work environment. ...Although factors influencing nursing staff retention are well documented, little is known about how workplace factors impact nursing faculty retention outcomes.
A national survey involving 645 nursing faculty across Canada was undertaken. Multivariate regression analysis with interaction effects was conducted to determine the association between work-related factors (i.e., workplace culture and work-life imbalance) and faculty job and career satisfaction, turnover intentions, and professional outlook.
Supportive workplace culture positively influenced faculty job and career satisfaction and professional outlook, while it negatively impacted turnover intentions. Conversely, work-life imbalance decreased faculty job and career satisfaction and professional outlook (i.e., confidence in nursing program, profession), and it increased intentions to leave the job.
Our results offer insights into the work-life experiences of Canadian faculty members and shed light on key factors that impact their job-related outcomes. In the context of competing resources, every effort must be made to improve modifiable workplace factors such as the academic work environment and create targeted interventions and policies to promote faculty retention.
(1) Background: While the association between nurse mental health and quality and safety of patient care delivery was well documented pre-pandemic, fewer research studies have examined this ...relationship in the context of COVID-19. This study examines the impact of various mental health symptoms experienced by nurses on quality and safety before and during the COVID-19 pandemic; (2) Methods: A secondary analysis of cross-sectional survey data from 4729 and 3585 nurses in one Canadian province between December 2019 and June-July 2020 was conducted. Data were analyzed using between group difference tests and logistic regression; (3) Results: Compared to pre-COVID-19, during COVID-19 nurses reported a higher safety grade, a greater likelihood of recommending their units for care and lower quality of nursing care. Most mental health symptoms were higher during COVID-19 and higher levels of mental health symptoms were correlated with lower ratings of quality and safety both pre- and during COVID-19; (4) Conclusion: Mental health symptoms have implications for nurses' quality and safety of patient care delivery, with the association between mental health symptoms and quality and safety following a dose-response relationship before and during COVID-19. These findings suggest that it is worthwhile for nurse mental health symptoms to be included as hospital level performance metrics.
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