Amy Witkoski Stimpfel

Abstract

Aim(s): Organizational culture has been studied for over four decades among nurses, across countries and contexts. However, wide variation exists in how the concept has been defined and at what level of the organization it is measured. The aim of this study was to use a dimensional analysis to conduct a conceptual synthesis of unit culture from a nursing perspective. Design: Dimensional analysis, rooted in grounded theory methodology, was used to describe unit culture from a nursing perspective. Methods: A literature search was conducted in April 2022. Inclusion criteria were (1) peer review publications, (2) used the term ‘unit culture’ or ‘ward culture’, (3) references nurses' role in unit culture, (4) published in the last 20 years and (5) written in English. One hundred fifteen articles met inclusion criteria, but dimensional saturation was researched after coding 24 articles. Results: Findings were synthesized into four core dimensions and 10 subdimensions. Dimensions of unit culture included customs (practice norms, communication and prioritization), shared beliefs (assumptions, values and attitudes), hierarchy (social and informational) and atmosphere (emotional climate and collaboration). Conditions that shape unit culture include individual nurse characteristics, working conditions, unit policies/procedures and leadership. Unit culture impacts nurse work experiences and decision-making processes, which can affect outcomes including nurse wellbeing, practice behaviours and adherence to unit policies. Conclusions: Identifying the dimensions of unit culture helps to bring clarity to a concept that is not well defined in existing literature. Impact: This model of unit culture can be used to guide development of new instruments to measure unit culture or guide researchers in utilizing existing measures. Developing measures specific to unit culture are warranted to strengthen researchers' ability to assess how changing conditions of a unit (e.g. leadership, workload) changes unit culture and its related outcomes. Patient or Public Contribution: No Patient or Public Contribution.

Abstract

The pandemic exacerbated job stress and burnout among nurses, increasing turnover and intentions to leave, in a workforce struggling with severe shortages. Shortages and turnover are associated with decreased quality of care, poor nurse health, and increased costs. This article reports the findings of a study that sought to identify characteristics of the job, work environment, and psychosocial health outcomes that may predict nurses’ intent to stay at their current nursing position within the next year. Utilizing a cross-sectional design, we electronically surveyed working nurses (n = 629) during the summer of 2020 across 36 states. Demographics, work characteristics, and validated measures of anxiety, insomnia, and depressive symptoms were assessed. Logistic regression models identified factors associated with nurses’ intent to stay at their jobs. Colleague support, organizational support, and organizational pandemic preparedness were associated with increased odds of intent to stay, while both mild and moderate/severe depressive symptoms were associated with decreased odds of intent to stay. Because over a quarter of nurses surveyed reported moderate to severe depressive symptoms, which were strongly associated with turnover intention, organizational leadership should examine mental health resources available to nurses and work characteristics that could be contributing to nurses’ poor psychosocial health. Additionally, further research is needed to assess the meaning of organizational support to nurses in a post-COVID-19 context, as well how to create a work environment in which nurses are able to provide support to their colleagues.

Abstract

Background: Understanding alcohol use among nurses may inform interventions related to the coping mechanisms nurses use for workplace stress and trauma. Alcohol use can be caused by a variety of factors and has serious implications on a nurse's personal health and professional practice. Understanding psychosocial factors and preventive measures may assist in the development of interventions to improve coping mechanisms and reduce the incidence of alcohol misuse. Purpose: To review the psychosocial factors and preventive measures associated with alcohol use among nurses. Methods: For this integrative review, systematic searches were conducted in CINAHL, PubMed, PsychNet, and ProQuest Central. Included studies were peer-reviewed and addressed alcohol use among nurses in the United States. Articles were appraised using methods-specific tools indicated by the Whittemore and Knafl framework. Data were extracted and themes identified using constant comparison. Results: Of 6,214 nonduplicate articles screened, 78 were selected for full-text review and 13 were included after application of inclusion criteria. Synthesis resulted in four themes: (1) occupational stress and trauma, (2) workplace characteristics, (3) mental health implications, and (4) protective factors. The data show that workplace stress and trauma contribute to alcohol use among nurses. Night shifts, rotating shifts, and shift length are factors related to alcohol use, as are mental health problems such as anxiety, depression, trauma, and suicide. Protective factors that reduce alcohol use among nurses include faith, resilience, and perceived organizational support. Conclusion: Alcohol use among nurses presents challenges for the nursing profession and regulatory bodies with specific and interrelated phenomena related to the role and identity of nurses. A better understanding of these factors through research will facilitate a healthier nursing workforce that is better prepared to take on the rewards and challenges of a nursing career.

Abstract

BACKGROUND: Midwives are a vital component of addressing maternal mortality crisis in the United States (US); however, there is scant understanding of the elements of midwifery practice that affect patient outcomes and the stability of the midwifery workforce in the country. This study investigates US midwives’ perceptions of factors influencing their practice and willingness to stay in the profession. METHODS: We applied a pragmatic qualitative design using summative content analysis techniques to code 1,035 comments from a national sample of 2,887 certified nurse-midwives and certified midwives. Two coders identified categories and themes of midwives’ perceptions of their practice environments, which were confirmed by an independent auditor. RESULTS: Eight themes emerged from the data: I love midwifery but…; feeling valued and respected…or not; workload; time and its consequences; the multilevel geography of midwifery practice; changes at odds with quality midwifery care; midwives withdrawing from practice to cope; and the ambiguity of “I just want to practice like a midwife.” CONCLUSION: Midwives readily identified aspects of their practice environment that negatively impact quality of care and stability of the midwifery workforce, including not valuing midwives, high workload, regulatory restrictions, and moral distress; however, respondents expressed strong commitment to the profession of midwifery. The findings also demonstrated the lack of a universally accepted definition of midwifery care within respondents’ professional communities and among respondents. Initiatives to increase integration of midwifery into the US perinatal health system will benefit from taking these findings into consideration.

Abstract

Objective To describe the initial influence of the Covid-19 pandemic on U.S. nurses' psychosocial health, and to identify factors associated with poor psychosocial health outcomes. Methods We conducted a convergent (QUAN+qual) mixed methods study. From June to August 2020, we administered surveys (N = 629) and conducted semi-structured interviews (N = 34) among nurses working across healthcare settings in 18 states. We developed separate multivariable logistic regression models for three psychosocial outcomes (anxiety, depressive symptoms, insomnia). We used content analysis to process and analyze qualitative data, and integrated results in the final analysis step. Results Nurses reported high rates of depressive symptoms (22%), anxiety (52%), and insomnia (55%). Disturbances to sleep were both a contributing factor to, and an outcome of, poor psychosocial health. Conclusions Evidence-based interventions addressing work stress and sleep, and proactive monitoring of nurses' psychosocial health by employers are urgently needed.

Abstract

Aim: To explore the resources supporting current nurse practice in the post-emergency country of Liberia, using the nursing intellectual capital framework, as nurses work to meet the targets set by Government of Liberia's Essential Package of Health Services. Design: Case study. Methods: Data were collected in Liberia February–June 2019. Direct observation, semi-structured interviews and photographs were used to investigate how nurse practice is supported. Field notes, transcripts and photographs were coded using both directed and conventional content analysis. Reports were then generated by code to triangulate the data. Results: Thirty-seven nurses at 12 health facilities participated. The intellectual capital supporting inpatient and outpatient nurse practice differs in important ways. Inpatient nurse practice is more likely to be supported by facility-based protocols and trainings, whereas outpatient nurse practice is more likely to be supported by external protocols and trainings, often developed by the Liberian government or non-governmental organizations. This can lead to uneven provision of inpatient protocols and trainings, often favouring private facilities. Similarly, inpatient nurses rely primarily on other nurses at their facilities for clinical support while outpatient nurses often have external professional relationships that provided them with clinical guidance. Conclusion: Much has been accomplished to enable outpatient nurses to provide the primary- and secondary-care target services in the Essential Package of Health Services. However, as the Liberian government and its partners continue to work towards providing certain tertiary care services, developing analogous protocols, trainings and clinical mentorship networks for inpatient nurses will likely be fruitful, and will decrease the burden on individual facilities. Impact: Nurses are often expected to meet new service provision targets in post-emergency states. Further research into how best to support nurses as they work to meet those targets has the potential to strengthen health systems.

Abstract

Purpose:RNs have served as the bedrock of the response to the COVID-19 pandemic, working under unprecedented and difficult conditions. In this study, we sought to understand the experiences of nurses working across a range of care settings in the United States during the first six months of the pandemic, and to learn more about barriers to and facilitators of their work.Methods:This is a qualitative descriptive study. We recruited participants online through regional professional nursing membership listservs, program directors of occupational health nursing training programs, and social media. After completing a survey, potential participants were invited to complete an individual semistructured interview via the Zoom platform. From June through August 2020, we conducted 34 interviews. Content analysis was performed using ATLAS.ti software.Results:The overarching theme - "Losing the art and failing the science of nursing" - underscored the barriers nurses faced in the early months of this pandemic. It reflected the deeply painful disruptions in the care nurses were accustomed to providing their patients. Themes that reflected barriers included disrupted nurse-patient connection, lack of personal protective equipment and fear of infection, lack of evidence-based guidance, and understaffing, all of which drastically altered the delivery of nursing care. Themes that reflected facilitators to nurses' work included camaraderie and strength and resourcefulness.Conclusions:The study findings give important direction to nurse leaders, researchers, and organizations concerning potential areas of support that nurses need during and after this pandemic. Future research should investigate the long-term impact of COVID-19 and similar public health crises on nurses, as well as interventions that could support the workforce after an extended crisis.

Abstract

Introduction: Well-being and turnover intent represent key aspects to the promotion of a healthy workforce. Alarming levels of burnout and low levels of well-being have been documented in health professionals across care settings. Not only do high levels of burnout, low well-being and high turnover affect health professionals, but they are associated with poor patient care. However, limited research has investigated this topic specifically in hospice interdisciplinary team (IDT) members, nurses, chaplains, social workers. Thus, the purpose of this study was to explore hospice IDT members’ well-being, and turnover intent. Methods: This observational, pilot study used quantitative surveys to examine the well-being, and turnover intention at baseline and at 3 months. Twenty-five hospice IDT members at one site participated. Results: Paired t-tests and percent change demonstrated significant decreases in compassion satisfaction (44.5 vs. 42.1, p = 0.04) and secondary traumatic stress score (18.5 vs. 13.3, p = 0.0001) and a significant increase in burnout score (17.6 vs. 20.5, p = 0.03) from baseline to follow up. Employee turnover slightly decreased from baseline to follow-up. Conclusions: In this pilot study, hospice IDT members had low levels of well-being at baseline that worsened over 3-months indicating a higher potential risk for burnout. Moreover, given the COVID-19 pandemic, this may be an ominous sign of what lies ahead for hospice providers regarding turnover, leading to significant long-term staffing problems in the field. If these results hold true in a larger sample, it could necessitate developing and testing further strategies to ensure a healthy and stable workforce.

Abstract

Objective: The purpose of this integrative review is to examine the literature on vaccine hesitancy among American healthcare workers during the COVID-19 vaccine rollout. Methods: A review of quantitative literature on acceptance, intention, refusal, or hesitation to accept the COVID-19 vaccine was conducted, searching in PubMed, Cumulative Index for Nursing and Allied Health Literature, PsycINFO, and Web of Science. Because of the immediacy of the topic, research letters were included in addition to articles. The 18 publications were appraised for quality using the Critical Appraisal Checklist for Cross-Sectional Studies by the Center for Evidence-Based Management. Results: Estimates of vaccine hesitancy among healthcare workers were similar to the general population. The literature indicates demographic characteristics associated with vaccine hesitancy, including being younger, female, Black, Hispanic, or Latinx. However, examination of the demographic data also points to gaps in the understanding and implications of those characteristics. The newness or perceived rush of vaccine development and implementation were the most cited sources for hesitancy. Conclusion: The studies in this review give clear areas of need for translational research on dissemination and implementation relating to the correlational data, including in areas of comorbid, diasporic, and reproductive health concerns. However, with the gravity of the pandemic and quick arrival of the COVID-19 vaccine happening in the midst of an infodemic, adjunctive interventions could be warranted to combat hesitancy.