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Background: The turnover of new and mid-career nurses has been increasing, leading to challenges in recruiting and retaining nursing staff. Objectives: Securing and retaining mid-career nurses is crucial for ensuring high-quality care. However, little is known about mid-career nurses' experiences regarding turnover. This study aimed to understand the experiences of mid-career nurses and identify strategies to enable mid-career nurses to maintain long-term employment in health services. Design: Colaizzi's phenomenological methodology was adopted to illuminate the subjective meaning derived from the work-related challenges of mid-career nurses, leading to turnover. Focus group interviews were conducted to delve into the work challenges faced by mid-career nurses. Method: The participants were 23 mid-career nurses working in one tertiary hospital and six secondary hospitals across three Korean cities, recruited using purposive and snowball sampling. The inclusion criteria entailed a minimum of three years of nursing experience and current employment within a designated department or clinical area within the hospital environment, commonly known as a nursing unit. Such units encompassed a range of clinical settings, including medical-surgical units, intensive care units, and emergency rooms. The interview data were transcribed verbatim, and significant statements were extracted from abstract sentences to derive themes through an analytical process. Results: Analysis of the work experiences of 23 mid-career nurses in medical institutions yielded 15 themes and 4 theme clusters derived from 353 meaningful statements. These theme collections were identified as 'Difficulties endured as a mid-career nurse', 'Meaningless and regrettable new graduate nurses' education', 'An inexpressibly poor work environment', and 'Systems and policies needed to remain in the hospital'. Conclusions: Difficulties faced by mid-career nurses including the establishment of an education and career development system, provisions for guaranteed leave, a diverse and flexible work system, opportunities for effective communication, and engagement with the opinions of mid-career nurses should promptly be addressed. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to develop a valid and reliable new intensive care unit nursing classification tool, including direct and indirect nursing activities, by measuring the nursing intensity provided to patients. Background: Prior tools primarily examine patients' medical records or disease severity/interactions, systematically failing to reflect comorbidity risk factors. Design: The Delphi technique was used to test the content validity of the Korean Patient Classification System on Nursing Intensity for Critical Care Nurses (KPCSNIC). Methods: Data were collected from four hospitals in two provinces from 26 December 2017 to 30 January 2018. To verify construct validity, staff nurses classified 365 patients, comparing differences by medical department and type of stay. To verify interrater reliability, data collectors and the head nurses of three intensive care units classified 87 patients. Results: The KPCSNIC had 8 categories, 44 nursing activities and 105 criteria. Reliability was high (r =.84). Construct validity was verified by revealing differences according to medical department and type of patient. Using total scores, four KPCSNIC groups were identified. Conclusion: The KPCSNIC developed in this study can support staffing for nursing intensity by providing more specific evaluation criteria. Moreover, it reflects nursing intensity, including direct and indirect nursing activities. Summary statement: What is already known about this topic? In order to secure the quality of nursing care, it is important to allocate an appropriate number of nurse staffing based on nursing demand and nursing time reflecting to the number and severity of patients, and shift of work.The patient acuity tools used in Korea are limited as they primarily examine patients' physiological characteristics based on medical records or quantify disease severity and interactions, systematically failing to reflect risk factors for comorbidities.The intensive care unit patient classification tool that is currently used underestimates clinical nursing intensity, as it does not realistically evaluate patient‐related disease factors and indirect nursing activities. What this paper adds? This study developed a new patient classification tool that reflects patients' clinical characteristics and classified them according to nursing intensity.In addition to direct nursing activities, indirect nursing activities that were invisible and difficult to measure can be scored using this tool. The implications of this paper: Since this tool enables quantitative measurement of nursing workload, data using this tool can be used as evidence for invoicing for nursing care fees, previously calculated as a percentage of inpatient fees per day.This study was conducted in a first‐grade hospital with a high level of nurse staffing. To secure the validity and reliability of the tool, additional research is needed, using the tool in a greater number and wider range of hospitals. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to calculate the total daily nursing workload and the optimal number of nurses per general unit based on the nursing intensity. Design: This study was conducted using a cross‐sectional study. Methods: Three units at one general hospital were investigated. Patient classification according to nursing needs was performed for over 10 days in each unit in September 2018. The direct and non‐direct nursing time and nursing intensity scores were analysed using descriptive statistics. Results: For the internal medicine unit, the average direct nursing time per patient was 1.0, 1.5, 2.2 and 2.9 h for Groups 1, 2, 3 and 4, respectively. For the surgical unit, the average direct nursing time per patient was 0.9, 1.4, 2.1 and 2.6 h for Groups 1, 2, 3 and 4, respectively. 5 and 9 additional nurses were needed in the internal medicine and surgical nursing units. Patient Contribution This study confirmed that the optimal number of nurses was not achieved and that the nursing intensity was very high. Long‐term efforts, such as improving the nursing environment, should be made to ensure an optimal number of nurses in various nursing units. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to review the literature on patient classification tools (PCTs) for assessing nursing strength and to compare South Korean and international tools. Design: Integrative literature review. Methods: We searched the relevant literature published from 2000–2017 in PubMed and two electronic databases in Korea in March 2017. Twenty‐five published studies were reviewed. Results: In most Korean studies, patients were classified by PCT, which were tested to ensure validity and reliability, followed by measurement of nursing time and development of the conversion index. In international studies, PCTs used were simpler than those in Korean studies; the results of estimation for optimum nurse staffing were reported. Most studies insufficiently reflected indirect nursing needs and patients' non‐clinical factors. The current PCTs used in Korean studies inadequately reflect the reality of nursing field. Therefore, development of new PCTs reflecting nursing intensity based on direct and indirect nursing activities is necessary. [ABSTRACT FROM AUTHOR]

Aim: To develop a new general wards patient classification tool based on the nursing intensity level that reflects patients' clinical characteristics and indirect nursing activities. Design: A cross‐sectional design was adopted. This methodological study developed a patient classification system to sort general ward patients based on the intensity of their nursing needs and verified the validity and reliability of this classification system. Methods: Thirteen experts verified the tools' content validity. Data collectors and head nurses classified 150 patients from two hospitals with four general wards and various nurse staffing levels. Inter‐rater reliability was analysed. Staff nurses classified 846 patients following the Korean patient classification system on nursing intensity scores that reflected patients' clinical status. Content validity was verified based on the classification results. Using K‐group cluster analysis, score ranges for four groups were identified. Results: The developed tool includes 8 domains, (symptom management, infection control, nutrition and medication, personal hygiene and secretion, activity, sleep and rest, guidance in nursing/emotional support, nursing activity planning and coordination, indirect activity), 24 subdomains, 66 nursing activities and 124 criteria. Inter‐rater reliability showed high agreement. [ABSTRACT FROM AUTHOR]

Aim: To develop a competency assessment instrument for nurses who have completed an outcome‐based educational program based on national standards and to assess the content‐, construct‐, and criterion‐related validity of that instrument. Methods: In the development stage, the competencies of nurses with 1–3 years' clinical experience after the completion of nursing education and training programs, based on national standards, were identified. A systematic literature review was conducted to derive the competencies in addition to the 12 national standard competencies. In the evaluation stage, the content‐, construct‐, and criterion‐related validity of the developed tool were verified. For verification of the content validity at each stage, the participants were 10 nurse managers of general hospitals and 10 nurse professors. A factor analysis was conducted to assess the construct validity and the Cronbach's alpha coefficients and item‐total correlation were used to assess the reliability of the developed scale. For the factor analysis, the participants were 141 nurses with 1–3 years' clinical experience who were recruited from four general hospitals. In order to evaluate the construct‐ and criterion‐related validity, the correlations between a nursing performance measurement scale, a self‐leadership tool, and the developed scale were examined. Results: A competency assessment instrument, consisting of 19 items on a 4‐point scale, was developed and validated for assessing the competencies among nurses with 1–3 years' experience. Conclusions: Nursing research, policy awareness, and leadership competencies were required by the Korean Accreditation Board of Nursing Education for nursing college graduates, but were removed due to poor content validity, indicating a need for nursing professionals to bridge the gap between educational standards in nursing colleges and clinical settings. [ABSTRACT FROM AUTHOR]