Christine T Kovner

Abstract

Aims: To examine the effect of transformational leadership on early career nurses' intent to stay, job satisfaction and organizational commitment. Background: Lack of leadership support is one of the top reasons staff nurses leave. Current studies reported mixed results about the impact of transformational leadership on key nurse outcomes. However, little is known whether leadership directly or indirectly affects satisfaction, organizational commitment and intent to stay. Design: This study was a cross-sectional study of nurses who had been licensed for 7·5-8·5 years which was part of a 10-year longitudinal panel design. Methods: The analytic sample was 1037 nationally representative newly licensed Registered Nurses. Data were collected from January–March 2013. We used a probit model to model the relationship between transformational leadership and intent to stay, organizational commitment and job satisfaction. Results: Transformational leadership did not have a significant impact on intent to stay and job satisfaction, but significantly associated with organizational commitment. Organizational commitment, job satisfaction, mentor support, promotional opportunities and age were positively associated with intent to stay, while ethnicity, non-local job opportunities and work settings were negatively associated with intent to stay. Conclusions: Transformational leadership had no direct relationship with intent to stay and job satisfaction and had a small direct positive effect on organizational commitment. Transformational leadership has potential to slow attrition and retain nurses by creating a positive work environment that supports nurses. Any improvement in job satisfaction and organizational commitment would positively increase the change in probability for intent to stay.

Abstract

A multidisciplinary sample of emergency department providers across the United States (n=450) were surveyed to identify barriers to referral for elevated blood pressure (BP) in the emergency department and differences between provider type. Registered nurses reported less knowledge of stage I hypertension (P=.043) and prehypertension (P

Abstract

Objective: The objective of this study was to examine early-career frontline nurse managers' (FLNMs') reported educational preparedness and participation in quality improvement (QI). BACKGROUND: Frontline nurse managers are vitally important for leading QI.However, it is not well known if they have adequate knowledge and skills to lead this important function. METHODS: We examined cross-sectional survey data from 42 FLNMs using descriptive statistics. RESULTS: About 30%of FLNMsreported being very prepared across 12 measured QI skills by schools or employers and 35% reported participating in a specific clinical effort to improve patient care on their unit more than once a month. More than 50% reported having good organizational support for QI, but only about 30% reported being rewarded for their contributions to QI. CONCLUSION: Our study highlights opportunities for development in QI for FLNMs and offers some solutions for nurse executives that can bridge the educational gaps.

Abstract

Background: Registered nurses across the globe bear a heavy injury burden. Every shift, nurses are exposed to a variety of hazards that can jeopardize their health, which negatively impacts their ability to provide high-quality patient care. Previous research suggests that inexperienced, or newly licensed nurses, may have an increased risk for certain occupational injuries. However, the current knowledge base is insufficient to fully understand how work hours influence newly licensed nurses' occupational injury, given the significant variation in hospital organization and work characteristics. Objective: To describe newly licensed nurses' shift work characteristics and determine the association between shift type and scheduling characteristics and nurse injury, before and after adjusting for individual and combined effects of demographics, external context, organizational context, and work context, following the Organization of Work model. Design: This study is a secondary analysis of a nationally representative survey of newly licensed registered nurses using a cross-sectional design. Participants: The analytic sample includes 1744 newly licensed registered nurses from 34 states and the District of Columbia who reported working in a hospital and were within 6-18 months of passing their state licensure exam at the time of survey administration. Methods: Descriptive statistics were calculated, followed by bivariate and multivariate Poisson regression models to assess the relationship between shift type and scheduling characteristics and nurse injury. Lastly, full models with the addition of demographics, external context, organizational context, and work context variables were calculated. Results: The majority (79%) of newly licensed nurses worked 12-h shifts, a near majority worked night shift (44%), and over half (61%) worked overtime (mandatory or voluntary) weekly. Nurses working weekly overtime were associated with a 32% [incidence rate ratio (IRR) 1.32, CI 1.07-1.62] increase in the risk of a needle stick and nurses working night shift were associated with a 16% [IRR 1.16, CI 1.02-1.33] increase in the risk of a sprain or strain injury. Conclusions: Overtime and night shift work were significantly associated with increased injury risk in newly licensed nurses independent of other work factors and demographic characteristics. The findings warrant further study given the long-term consequences of these injuries, costs associated with treatment, and loss of worker productivity.

Abstract

Background: Key predictors of early career nurses' turnover are job satisfaction, organizational commitment, job search, intent to stay, and shock (back injuries) based on the literature review and our previous research. Existing research has often omitted one of these key predictors. Objectives: The purpose of this study in a sample of early career nurses was to compare predictors of turnover to nurses' actual turnover at two time points in their careers. Design: A multi-state longitudinal panel survey of early career nurses was used to compare a turnover model across two time periods. The sample has been surveyed five times.Participants: The sample was selected using a two-stage sample of registered nurses nested in 51 metropolitan areas and nine non-metropolitan, rural areas in 34 states and the District of Columbia. Methods: The associations between key predictors of turnover were tested using structural equation modeling and data from the earliest and latest panels in our study. We used predictors from the respondents who replied to the Wave-1 survey in 2006 and their turnover status from Wave 2 in 2007 (N = 2386). We compared these results to the remaining respondents' predictors from Wave 4 in 2011 and their turnover status in Wave 5 in 2013 (N = 1073). We tested and found no effect for missingness from Wave 1-5 and little evidence of attrition bias. Results: Strong support was found for the relationships hypothesized among job satisfaction, organizational commitment, intent to stay, and turnover, with some support for shock and search in the Wave 1-2 sample. However, for Wave 4-5 sample (n = 1073), none of the paths through search were significant, nor was the path from shock to turnover. Conclusions: Nurses in the second analysis who had matured longer in their career did not have a significant response to search or shock (back injuries), which may indicate how easily experienced registered nurses find new jobs and/or accommodation to jobs requiring significant physicality. Nurse turnover is a major concern for healthcare organizations because of its costs and related outcomes. The relevant strength and relationships of these key turnover predictors will be informative to employers for prioritizing strategies to retain their registered nurse workforce. We need more research on programs that implement changes in the work environment that impact these two outcomes, as well as research that focuses on the relevant strength or impact to help administrators prioritize translation of results.

Abstract

Background: Nursing faculty shortages threaten a country's ability to produce the amount of nurses necessary to sustain the delivery of healthcare services. Programs that "fast track" graduate education options for registered nurses are one solution to the problem. Objectives: To 1) evaluate admission criteria into PhD programs for direct entry from a bachelor's degree; 2) ascertain bachelors and masters degree nursing students' perspectives on pursuing a BSN to PhD course of study; 3) clarify factors that influence students' decision-making processes behind pursuing a PhD and identify characteristics of those who would be likely recruits for PhD study; 4) to test the survey questions to develop an instrument for future use. Design: A cross-sectional pilot study. Setting: A nursing program at a large urban university in the United States of America with an enrollment of over 1400 students. Participants: Currently enrolled bachelor's, master's, and doctor of nursing practice students. Methods: Students were sampled via a 10-question (including one open-ended question) electronic mail survey that included 1385 eligible subjects. Results: Among the 606 respondents (57% response rate), 63% were between ages 18 and 30 and 87% indicated that full tuition funding with a living stipend would make them more interested in pursuing a PhD. Current program track was a significant predictor of course of study and area of interest (p = .029). Analysis of the 427 respondents to the open-ended question revealed themes around "time" and "money" as the main barriers to study. The desire to gain clinical experience prior to PhD study was the third theme and an unanticipated finding. Conclusions: The questionnaire offered some predictive ability for gauging intent to study for a PhD among bachelor's and graduate degree prepared nurses. The results do offer some suggestions for nursing workforce development to help address faculty shortages.

Abstract

On October 29, 2012, a 12-ft storm surge generated by Hurricane Sandy necessitated evacuation and temporary closure of three New York City hospitals including NYU Langone Medical Center (NYULMC). NYULMC nurses participated in the evacuation, and 71 % were subsequently deployed to area hospitals to address patient surge for periods from a few days up to 2 months when NYULMC reopened. This mixed methods study explored nurses' experience in the immediate disaster and the subsequent deployment. More than 50 % of deployed nurse participants reported the experience to be extremely or very stressful. Deployed nurses encountered practice challenges related to working in an unfamiliar environment, limited orientation, legal concerns about clinical assignments. They experienced psychosocial challenges associated with the intense experience of the evacuation, uncertainty about future employment, and the increased demands of managing the deployment. Findings provide data to inform national and regional policies to support nurses in future deployments.

Abstract

OBJECTIVE:: Recent changes in U.S. health care and economics may influence the demand for nurses and the work choices of newly licensed RNs (NLRNs). We sought to compare the work lives of two cohorts of NLRNs licensed six years apart. METHODS:: Data were collected from two groups of NLRNs in 14 states via mailed surveys. The first group consisted of a subset of NLRNs surveyed for a larger study in 2004-05; the second group was surveyed by similar methods in 2010-11. Responses were weighted to adjust for differences in response rates according to geographic area. RESULTS:: Response rates were 58% and 47%, respectively, for the 2004-05 cohort (N = 774) and the 2010-11 cohort (N = 1,613). The NLRNs in the later cohort were less likely to work in hospitals, special-care units, and direct care and more likely to work as managers, be enrolled in formal education programs, and view their work environments positively, resulting in more commitment to the organization. Also, those in the later cohort reported fewer local job opportunities, and a greater number held a second job CONCLUSIONS:: These findings indicate a shift from the traditional work patterns of NLRNs, who often began their careers in hospitals. Employers' heightened awareness of such changing trends among NLRNs may help them in planning for RN recruitment and retention.

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We explored direct and indirect influences of physical work environment on job satisfaction in a nationally representative sample of 1,141 early-career registered nurses. In the fully specified model, physical work environment had a non-significant direct effect on job satisfaction. The path analysis used to test multiple indirect effects showed that physical work environment had a positive indirect effect (p