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Issue: When frontline employees' voice is not heard and their ideas are not implemented, patient care is negatively impacted, and frontline employees are more likely to experience burnout and less likely to engage in subsequent change efforts., Critical Theoretical Analysis: Theory about what happens to voiced ideas during the critical stage after employees voice and before performance outcomes are measured is nascent. We draw on research from organizational behavior, human resource management, and health care management to develop a multilevel model encompassing practices and processes at the individual, team, managerial, and organizational levels that, together, provide a nuanced picture of how voiced ideas reach implementation., Insight/advance: We offer a multilevel understanding of the practices and processes through which voice leads to implementation; illuminate the importance of thinking temporally about voice to better understand the complex dynamics required for voiced ideas to reach implementation; and highlight factors that help ideas reach implementation, including voicers' personal and interpersonal tactics with colleagues and managers, as well as senior leaders modeling and explaining norms and making voice-related processes and practices transparent., Practice Implications: Our model provides evidence-based strategies for bolstering rejected or ignored ideas, including how voicers (re)articulate ideas, whom they enlist to advance ideas, how they engage peers and managers to improve conditions for intentional experimentation, and how they take advantage of listening structures and other formal mechanisms for voice. Our model also highlights how senior leaders can make change processes and priorities explicit and transparent., (Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc.)

Background: Our understanding of how highly reliable care delivery is brought about remains elusive, in part, because there is limited evidence regarding the organizational practices that enable safety organizing-the behaviors and processes underlying high reliability., Purpose: Because safety organizing relies on discretionary effort and lowering barriers to sharing expertise and discussing threats to safety and errors, we investigate three pay practices and their effects on information sharing and, in turn, safety organizing. Specifically, we examine average pay level, minimum pay rates, and pay dispersion on nursing units and their relationship with information sharing and safety organizing., Method: Cross-sectional analyses of survey data from 1,461 registered nurses in 45 nursing units in three Midwestern hospitals on safety organizing linked to administrative data on pay practices from the organization's human resource systems. Pay data and survey responses were aggregated to the nursing unit level. PROCESS and structural equation modeling were used to simultaneously test for direct and indirect effects of pay variables on information sharing and safety organizing., Results: PROCESS and Mplus path analysis indicated that paying a higher minimum rate in the unit and having lower pay dispersion have indirect, desirable associations with safety organizing through information sharing., Conclusion: Pay practices can help organizations enhance safety organizing. In particular, higher pay rates for the lowest level nurses and lower pay dispersion among nurses are associated with unit-level information sharing and safety organizing., Practice Implications: Having pay practices associated with lower within-unit variation and higher pay for the lowest paid members of a unit may be viable strategies for greater information sharing and safety organizing., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Hospitals are often tasked with improving patient care while simultaneously increasing operational efficiency. Although efficiency may be gained by maintaining higher patient volume per nurse (higher workload), high-quality patient care requires low levels of nurse turnover, which might be adversely affected by an increase in workload., Purpose: Drawing upon job demands-resources theory, we hypothesized that hospital-level workload will predict nurse turnover and that nurse turnover will predict patient mortality, and that registered nurse hiring rates and human resource management practices will moderate (buffer) the positive relationship between nurse workload and nurse turnover, whereas quality care structures will moderate (buffer) the positive relationship between nurse turnover and patient mortality., Methods: We tested this model utilizing multiple sources of time-lagged data collected from a sample of 156 hospitals in the United States., Results: Our findings suggest that (a) nurse workload is associated with higher nurse turnover, (b) nurse turnover is positively associated with patient mortality, (c) nurse staffing buffers the workload-turnover relationship as a first-stage moderator, and (d) quality care structures act as a second-stage moderator that mitigates the effects of turnover on mortality., Conclusions/practice Implications: The reduction of nurse turnover and patient mortality requires investments in adequate levels of nurse staffing and implementation of quality care structures., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Research suggests that changes in nurse roles can compromise perceived organizational safety. However, over the past 15 years, many infusion tasks have been reallocated from specialty nurse infusion teams to individual generalist nurses-a process we call infusion task reallocation . These changes purportedly benefit employees by allowing care providers to practice at the "top of their license." However, job demands-resources theory suggests that changing core task arrangements can either enrich or merely enlarge jobs depending on their effects on demands and resources, with corresponding consequences for performance (e.g., safety). There is relatively little research directly exploring these effects and their mechanisms., Purpose: This study examines the relationship between infusion task reallocation and perceptions of organizational safety. We also explore the extent to which this relationship may be mediated by infusion-related resources and psychological safety., Methodology: Data were collected through a survey of 623 nurses from 580 U.S. hospitals. The relationship between infusion task reallocation and perceptions of organizational safety, as well as the potential mediating roles of infusion-related resources and psychological safety, was examined using structural equation modeling., Results: Infusion task reallocation was negatively associated with respondents' perceptions of organizational safety, with nurses working in organizations without an infusion team indicating lower perceptions of organizational safety than nurses working in organizations with an infusion team. This relationship was mediated by nurse perceptions of psychological safety within the organization, but not by infusion-related resources, suggesting that task reallocation is associated with lower perceived organizational safety because nurses feel less psychologically safe rather than because of perceived technical constraints., Practice Implications: The results indicate that, although infusion task reallocation may be a cost-reducing approach to managing clinical responsibilities, it enlarges rather than enriches the job through higher demands and fewer resources for nurses and, in turn, lower perceived organizational safety., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Human suffering is prevalent and costly in health care organizations. Recent research links the use of compassion practices with improved patient experience and employee well-being, but little is known about how these practices create and sustain compassion to address workplace suffering and enhance care quality., Purpose: This study examines the dynamics of compassion practices, specifically how compassion practices create and sustain compassion in caregiving work., Methodology: We conducted a qualitative field study at two acute care hospitals utilizing three forms of data collection: semistructured interviews, nonparticipant observation, and archival data. Data were analyzed utilizing thematic coding., Results: Both organizations attempted to foster workplace compassion through their hiring, socialization, employee support, and rewards practices., Conclusion: Organizations enable compassion through common organizational practices that perform three functions: (a) infusing the organization with new members and resources to enact compassion, (b) sustaining compassion by reinforcing its appropriateness in the workplace, and (c) replenishing compassion resources by improving and restoring employee well-being and ability to provide high-quality compassionate care., Practice Implications: This study provides managers with a detailed guide for how health care organizations use compassion practices as a managerial tool to address two key challenges: (a) high rates of employee ill-being due to the demanding nature of the work and (b) providing high-quality compassionate care.