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Aim. This paper reports a study testing a hypothesized model of the determinants of nurse intention to remain employed in current hospitals of employment. Background. Previous research has shown that stronger nurse intention to remain employed is associated with higher job satisfaction, higher organizational commitment, higher perceived manager support, lower burnout, higher work group cohesion, being older, having more years of nursing experience and having lower levels of education. Methods. A descriptive survey design was adopted. Over 13,000 Ontario, Canada nurses were invited to complete a mailed survey between February and May 2003. The Ontario Nurse Survey includes instruments and items measuring job satisfaction, burnout, professional nursing practice environment, demographic characteristics of nurse respondents and items about intention to remain employed. Two multiple regression models, one including all variables and the other using a stepwise method, were used to test the proposed model. Results. Regression models explained 34% of variance in nurse intention to remain employed. The strongest predictors were nurse age, overall nurse job satisfaction and years of employment in the current hospital. Although the proposed model hypothesized six categories of predictors of intention to remain employed, only four of these were statistically significant determinants of nurse intention to remain: job satisfaction, personal characteristics of nurses, work group cohesion and collaboration, and organizational commitment of nurses. The other two categories of predictors, nurse burnout and nurse manager ability and support, may be predictors of job satisfaction and have indirect effects on intention to remain employed that are mediated through job satisfaction. Conclusion. Possible strategies to strengthen predictors of intention to remain employed include employment practices that reflect moral integrity, incorporate clear communication systems, maximize employee involvement in decision-making, promote praise and recognition, and establish a shared vision and goals.

The purpose of this article is to provide initial insight from rational and phenomenologic theoretical perspectives into how nurses integrate baseline and follow-up outcomes assessment data into practice to inform their clinical decision-making. Preliminary findings from 29 nurse interviews indicate that some nurses use outcomes assessment data for evaluating their interventions and for decisions concerning initial and/or discharge planning. Nurses' perceived usefulness of outcomes data was based on task complexity and nurses' level of expertise.

Objective: Healthcare aides (unregulated care providers), who deliver the majority of direct care in Canadian nursing homes, have high levels of emotional exhaustion and cynicism. However, they also have remarkably high levels of job efficacy. Strategies to empower this workforce may reduce cynicism and draw on their high levels of job efficacy. The primary objective of this study was to act as proof-of-principle to determine whether quality improvement teams led by healthcare aides could be established in nursing homes and function on a daily basis. Methods: This study was a pilot test of a complex intervention using a mixed methods approach. We used a combination of education, networking and coaching to engage staff teams in quality improvement in 1 of 3 areas (pain control, skin care or behaviour management). We measured healthcare aides’ quality of work life, informal communication and research (best practice) use before and after the intervention. To understand the effect of quality of care at the bedside we used risk-adjusted quality indicators derived from Resident Assessment Instrument - Minimum Data Set 2.0 data. Results: A total of 10 teams participated in the intervention. At least 70% of the teams succeeded in learning and applying the improvement model and methods for local measurement. For 50% of the teams, data showed measurable improvement in the clinical areas. There were no significant differences between pre and post measures of survey variables. Conclusions: We have demonstrated the ability of healthcare aides to engage in quality improvement initiatives at the bedside in a collaborative environment and advance our results as an important contribution to person-centered healthcare.

Background The current profile of residents living in Canadian nursing homes includes elder persons with complex physical and social needs. High resident acuity can result in increased staff workload and decreased quality of work life. Aims Safer Care for Older Persons [in residential] Environments is a two year (2010 to 2012) proof-of-principle pilot study conducted in seven nursing homes in western Canada. The purpose of the study is to evaluate the feasibility of engaging front line staff to use quality improvement methods to integrate best practices into resident care. The goals of the study are to improve the quality of work life for staff, in particular healthcare aides, and to improve residents' quality of life. Methods/design The study has parallel research and quality improvement intervention arms. It includes an education and support intervention for direct caregivers to improve the safety and quality of their care delivery. We hypothesize that this intervention will improve not only the care provided to residents but also the quality of work life for healthcare aides. The study employs tools adapted from the Institute for Healthcare Improvement's Breakthrough Series: Collaborative Model and Canada's Safer Healthcare Now! improvement campaign. Local improvement teams in each nursing home (1 to 2 per facility) are led by healthcare aides (non-regulated caregivers) and focus on the management of specific areas of resident care. Critical elements of the program include local measurement, virtual and face-to-face learning sessions involving change management, quality improvement methods and clinical expertise, ongoing virtual and in person support, and networking. Discussion There are two sustainability challenges in this study: ongoing staff and leadership engagement, and organizational infrastructure. Addressing these challenges will require strategic planning with input from key stakeholders for sustaining quality improvement initiatives in the long-term care sector.

UNLABELLED: Generational differences in values, expectations and perceptions of work have been proposed as one basis for problems and solutions in recruitment and retention of nurses. METHOD: This study used a descriptive design. A sample of 8207 registered nurses and registered practical nurses working in Ontario, Canada, acute care hospitals who responded to the Ontario Nurse Survey in 2003 were included in this study. Respondents were categorized as Baby Boomers, Generation X or Generation Y based on their birth year. Differences in responses among these three generations to questions about their own characteristics, employment circumstances, work environment and responses to the work environment were explored. RESULTS: There were statistically significant differences among the generations. Baby Boomers primarily worked full-time day shifts. Gen Y tended to be employed in teaching hospitals; Boomers worked more commonly in community hospitals. Baby Boomers were generally more satisfied with their jobs than Gen X or Gen Y nurses. Gen Y had the largest proportion of nurses with high levels of burnout in the areas of emotional exhaustion and depersonalization. Baby Boomers had the largest proportion of nurses with low levels of burnout. CONCLUSION: Nurse managers may be able to capitalize on differences in generational values and needs in designing appropriate interventions to enhance recruitment and retention of nurses.