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BackgroundMany long-term care facilities in the United States face significant problems with nurse retention and turnover. These challenges are attributed, at least in part, to moral distress and a negative nurse practice environment.ObjectiveThe purpose of the study was divided into two parts: first, to investigate the relationships among nurse practice environment, moral distress, and intent to stay; second, to explore the potential mediating effect of the nurse practice environment on the intent to stay among those with high levels of moral distress.DesignThis study was a descriptive, cross-sectional survey using targeted sampling.ParticipantsA total of 215 participants completed the surveys. Participants were nationally representative of long-term care nurses by age, years of experience, employment status, and type of health setting.MethodsThis study was an online national survey of long-term care nurses' perceptions of their intent to stay, moral distress level (Moral Distress Questionnaire), and nurse practice environment (Direct Care Staff Survey). Structural equation modeling analysis explored intent to stay, moral distress, and the nurse practice environment among long-term care nurses.ResultsThe mean moral distress score was low, while the mean nurse practice environment and intent to stay scores were high. Moral distress had a significant, moderately negative association with the nurse practice environment (β = -0.41), while the nurse practice environment had a significant, moderately positive association with intent to stay (β = 0.46). The moral distress had a significant, moderately negative association with intent to stay (β = -0.20). The computed structural equation modeling suggested a partially mediated model (indirect effect = -0.19, p = 0.001).ConclusionSince the nurse practice environment partially mediates the relationship between moral distress and intent to stay, interventions to improve the nurse practice environment are crucial to alleviating moral distress and enhancing nurses' intent to stay in their jobs, organizations, and the nursing profession.Clinical relevanceOur study demonstrated that the nurse practice environment mediates moral distress and intent to stay. Interventions to improve the nurse practice environment are crucial to alleviating moral distress and enhancing nurses' intent to stay in their jobs, organizations, and the nursing profession.

Aim: This study examines the moderating role of specific job resources in the association between job demands, vigour, sustainable performance and fatigue in nursing home staff. Design: A multi‐location cross‐sectional survey study in line with the STROBE guidelines. Methods: Online self‐completion questionnaires were distributed in the Summer of 2022. A total of 667 healthcare employees from 24 nursing home locations in the Netherlands participated in this study. Data were analysed using hierarchical multiple regression analysis. Results: Job resources were able to moderate the relation between job demands on the one hand, and vigour, sustainable performance and fatigue on the other. Regression analyses revealed that high cognitive job resources moderated (i.e., strengthened) the positive association between cognitive job demands and successively cognitive liveliness, physical strength and sustainable performance. Furthermore, high emotional job resources moderated (i.e., buffered) the positive relation between emotional job demands and emotional and cognitive fatigue, respectively. Conclusions: It can be concluded that job resources are crucial for nursing home staff to deal with their high job demands. Maintaining a healthy balance between job demands and sufficient, matching, job resources to promote vigour and sustainable performance, as well as to prevent fatigue of staff, seems to be important. Implications for the Profession: There is an urgent need to train nursing home staff to cope better with increasing job demands. Because job demands cannot be reduced in many situations, this study revealed that the idea of boosting job resources instead is appealing to both staff and managers. Patient or Public Contribution: Dutch healthcare staff from 24 nursing home locations were involved in this study by responding to the online survey. [ABSTRACT FROM AUTHOR]

Background: Licensed nurses working in long-term care facilities experience ethical challenges if not resolved can lead to moral distress. There is a lack of an English-language validated tool to adequately measure moral distress in the long-term care setting. Aims: To describe the modification and psychometric evaluation of the Moral Distress Questionnaire. Methods: Instrument development and psychometric evaluation. Internal consistency using Cronbach's α to establish reliability was conducted using SPSS version 27.0 while SPSS Amos version 27.0 was used to perform a confirmatory factor analysis of the Moral Distress Questionnaire Participants: A national sample of US-licensed nurses who provided direct resident care in long-term care settings were recruited via a targeted sampling method using Facebook from 7 December 2020 to 7 March 2021. Ethical Consideration: The study was approved by the university's human research protection program. Informed consent was provided to all participants. Results: A total of 215 participants completed the surveys. Confirmatory analysis indicated that the 21-item scale with a 4-factor structure for the Moral Distress Questionnaire model met the established criteria and demonstrates an acceptable model fit (CMIN/DF = 2.0, CFI = 0.82, TLI = 0.77, RMSEA = 0.07). Factor loadings for each item depict a moderate to a strong relationship (range 0.36–0.70) with the given underlying construct. Cronbach's α coefficient was 0.87 for the overall scale and 0.60–0.74 for its subscales which demonstrate good reliabilities. Discussion: This is the first English-language validated tool to adequately measure moral distress in the long-term care setting experienced by US long-term care nurses. This reliable and well-validated tool will help identify moral distress situations experienced by US long-term care nurses. Conclusion: The modified 21-item English version of the Moral Distress Questionnaire is reliable tool that demonstrates good psychometric properties to validly measure sources of moral distress among direct resident care nurses. [ABSTRACT FROM AUTHOR]

Aims: To gain insight into how direct care staff in Dutch nursing homes experienced work during the COVID‐19 pandemic. Design: A qualitative study consisting of semi‐structured, face‐to‐face focus groups was conducted using "the active dialogue approach". Methods: Participants (n = 29) were care staff from four care teams at Dutch nursing homes. Teams were selected based on the number of COVID‐19 infections amongst residents. Data were analysed with conventional content analysis. Results: Themes emerging from the data were the loss of (daily) working structure, interference between work and private life for direct care staff, the importance of social support by the team and a leader, and the effects on relationship‐centred care of the measures. Results offer concrete implications for similar situations in the future: psychological support on‐site; autonomy in daily work of care staff; an active role of a manger on the work floor and the importance of relationship‐centred care. [ABSTRACT FROM AUTHOR]