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(2010) Journal of Nursing Management 948-969 Based on a review of the empirical literature, we examine the influence of selected diversity attributes on nurses' work-related attitudes and behaviour. The nursing workforce has become increasingly heterogeneous in its age, educational attainment, and ethnicity/race distributions. There is considerable speculation, in the literature, that the work values of recent nursing graduates are discordant with more experienced nurses. A review of studies published between 1980 and 2009 in nursing, healthcare, psychology, and organizational behaviour led to the inclusion of 19 peer-reviewed research articles, from which our analyses are drawn. The findings indicate that age diversity leads to negative behaviour toward others in the workgroup (e.g. poor collegial relationships) whereas work-values diversity is negatively associated with individuals' own attitudes and behaviour toward their work as well as toward other members of their workgroup. There is inconclusive evidence about the attributes that most significantly influence nurses' attitudes and work; however, preliminary evidence supports the salience of work values. Irrespective of the actual diversity within workgroups, how nurses see one another can have a significant impact on members of their workgroups and their functioning. Broader conceptualizations of diversity are necessary. [ABSTRACT FROM AUTHOR]

Aim: Little or no attempt has been made to determine why nurses leave Canada, remain outside of Canada, or under what circumstances might return to Canada. The purpose of this study was to gain an understanding of Canadian-educated registered nurses working in the USA. Data sources: Data for this study include the 1996, 2000 and 2004 USA National Sample Survey of Registered Nurses and reports from the same time period from the Canadian Institute for Health Information. Findings: This research demonstrates that full-time work opportunities and the potential for ongoing education are key factors that contribute to the migration of Canadian nurses to the USA. In addition, Canada appears to be losing baccalaureate-prepared nurses to the USA. Discussion: These findings underscore how health care policy decisions such as workforce retention strategies can have a direct influence on the nursing workforce. Policy emphasis should be on providing incentives for Canadian-educated nurses to stay in Canada, and obtain full-time work while continuing to develop professionally. Conclusion: Findings from this study provide policy leaders with important information regarding employment options of interest to migrating nurses. Study limitations: This study describes and contrasts nurses in the data set, thus providing information on the context of nurse migration from Canada to the USA. Data utilized in this study are cross-sectional in nature, thus the opportunity to follow individual nurses over time was not possible. [ABSTRACT FROM AUTHOR]

The overall purpose of this study was to examine the career planning and development needs of registered nurses (RNs) working in native reserves and in Inuit communities in rural and remote areas of Ontario, Canada. A total of 142 surveys were sent out, and 68 questionnaires were returned for an overall response rate of 48%. Nurses are adept at scanning the work environment, conducting self-assessments and reality checks of their workplace. At the same time, they require further direction in developing a career vision and understanding their future career options. The research provides evidence that career planning may contribute to nursing retention. [ABSTRACT FROM AUTHOR]

OBJECTIVE:: The impact of interventions designed to improve the nursing work environment on patient and nurse outcomes was examined. BACKGROUND:: Nursing work environments have been characterized as contributing to patient outcomes as a result of organizational management practices, workforce deployment, work design, and organizational culture. METHODS:: This quasi-experimental study involved 16 unit managers, 1,137 patients, and 296 observations from registered nurses over time. RESULTS:: After participation in the intervention, study nurses reported higher perceptions of their work and work environment. Demographic nurse, unit, and hospital characteristics also had an impact on the work environment and outcomes. CONCLUSIONS:: Findings in this study highlight the importance of understanding factors in the work environment that influence patient and nurse outcomes. [ABSTRACT FROM AUTHOR]

OBJECTIVE:: To investigate the effects of perceived supervisory support provided by registered nursing staff on job stress and job satisfaction among nurse aides (NAs) working in long-term care. BACKGROUND:: Job-related stress is a major problem for NAs working in long-term care settings leading to reduced job satisfaction. No studies have used a theoretical framework to study the nature of relationships between immediate supervisors and NAs' job stress and satisfaction. METHODS:: Nurse aides from 10 facilities in Ontario (N = 222) completed measures on the supportive capacity of the supervisor (Supportive Supervisory Scale), work stressors (Expanded Nursing Job Stress Scale), and satisfaction (Job Satisfaction Scale). RESULTS:: Multiple linear regression analysis supported an adaptation of Cohen-Mansfield's stress-coping model. Thirty-three percent of the total variance in job satisfaction was explained by supervisory support, stress, birthplace, and first language spoken of the NAs. Greater supervisory support was also associated with reduced job stress. CONCLUSIONS:: The results suggest that supervisory support for NAs is an important determinant of NAs' job satisfaction. [ABSTRACT FROM AUTHOR]

Aim. This paper reports on structures and processes of hospital care influencing 30-day mortality for acute medical patients. Background. Wide variation in risk-adjusted 30-day hospital mortality rates for acute medical patients indicates that hospital structures and processes of care affect patient death. Because nurses provide the majority of care to hospitalized patients, we propose that structures and processes of nursing care have an impact on patient death or survival. Method. Amodel hypothesizing the impact of nursing-related hospital care structures and processes on 30-daymortality was tested. Patient data from the Ontario, CanadaDischarge Abstract Database 2002-2003, nurse data from the Ontario Nurse Survey 2003, and hospital staffing data from the Ontario Hospital Reporting System 2002-2003 files were used to develop indicators for variables hypothesized to impact 30-day mortality. Two multiple regression models were implemented to test the model. First, all variables were forced to enter the model simultaneously. Second, backward regression was implemented. Findings. Using backward regression, 45% of variance in risk-adjusted 30-day mortality rates was explained by eight predictors. Lower 30-day mortality rates were associated with hospitals that had a higher percentage of Registered Nurse staff, a higher percentage of baccalaureate-prepared nurses, a lower dose or amount of all categories of nursing staff per weighted patient case, higher nurse-reported adequacy of staffing and resources, higher use of care maps or protocols to guide patient care, higher nurse-reported care quality, lower nurse-reported adequacy of manager ability and support, and higher nurse burnout. Conclusion. Just as hospitals and clinicians caring for patients focus carefully on completing accurate diagnosis and appropriate and effective interventions, so too should hospitals carefully plan and manage structures and processes of care such as the proportion of Registered Nurses in the staff mix, percentage of baccalaureateprepared nurses, and routine use of care maps to minimize unnecessary patient death. [ABSTRACT FROM AUTHOR]

The effectiveness of methods for determining nurse staffing is unknown. Despite a great deal of interest in Canada, efforts conducted to date indicate that there is a lack of consensus on nurse staffing decision-making processes. This study explored nurse staffing decision-making processes, supports in place for nurses, nursing workload being experienced, and perceptions of nursing care and outcomes in Canada. Substantial information was provided from participants about the nurse staffing decision-making methods currently employed in Canada including frameworks for nurse staffing, nurse-to-patient ratios, workload measurement systems, and 'gut' instinct. A number of key themes emerged from the study that can form the basis for policy and practice changes related to determining appropriate workload for nursing in Canada. These include the use of (a) staffing principles and frameworks, (b) nursing workload measurement systems, (c) nurse-to-patient ratios, and (d) the need for uptake of evidence related to nurse staffing. [ABSTRACT FROM AUTHOR]

The extent to which nursing interventions provided during hospitalization are associated with patients' therapeutic self-care and functional health outcomes was explored with a voluntary sample of 574 patients. Nurses collected data on patient outcomes at admission and discharge using the minimum data set (MDS) and the therapeutic self-care scale (TSCS). Research assistants audited charts for documentation of nursing interventions. The results indicated that nursing interventions aimed at exercise promotion, positioning, and self-care assistance predicted functional status outcome. Higher functional status outcome predicted therapeutic self-care ability at hospital discharge. The results demonstrate that nurses can use MDS and TSCS data on patient outcomes to gain insight into the effectiveness of their interventions. [ABSTRACT FROM AUTHOR]

Narrative interviews were conducted with hospital nurses participating in a research study designed to provide support and assistance to hospitals as they addressed work life issues for nurses in an attempt to create quality work environments. The eight interviews were conducted in a sample of Canadian hospitals and generated themes relating to an imbalance between the effort that nurses put into their work and rewards attained from it. Seigrist's ((1996) Journal of Occupational Health Psychology, 1, 27-41, (2002) In: P.L. Perrewe & D.G. Ganster (Eds.), Historical perspectives on stress and health. Research in Occupational Stress and Well Being (vol. 2). Boston, MA: Jai Press) effort-reward imbalance model was used to frame this study. The nurses' narratives suggest that multiple factors constitute the nurses' work environment and their experiences and perceptions of it. Issues which surfaced repeatedly in the interviews related to changing needs of hospitalized patients in today's health care system and the associated workload, the widespread shortage of nurses, and the imbalance this creates for nursing work. A crucial finding is the extent to which the nurse is impacted by the adequacy of care they are able to provide. These narratives outline the tremendous burden of guilt and the overcommitment that nurses bear when factors in the work environment prevent them from providing complete, quality care. Nurses are experiencing frustration and stress that is impacting their worklife, family and home life, personal health, and possibly patient outcomes. [ABSTRACT FROM AUTHOR]

Increasingly, administrative databases are playing major roles in decisions regarding the effectiveness and funding of the health-care system. These databases contain information taken from patients' charts after their discharge and include their age, gender, diagnoses, medical interventions and length of stay. Although nurses are the largest health-care provider group in all sectors of the Canadian health-care system, the nature and effectiveness of their contributions to patient care are not captured on administrative databases because no information about nurses' contribution to care is abstracted from charts.The Nursing and Health Outcomes Project (NHOP) was established by the Ontario Ministry of Health and Long-Term Care to identify nursing-sensitive patient outcomes and their attendant nursing inputs and processes that could be housed on databases. This article describes the background to this project and reports on the progress to date. The implications of having this information on databases will be examined. [ABSTRACT FROM AUTHOR]

Rural household adoption of the PC and Internet for accessing medical and healthcare information was investigated using survey data collected from 305 households randomly selected from non-metropolitan, rural counties across Alabama. The diffusion-adoption model for new technologies was employed to create five adoption stages relevant to this technology and its applications to communication of information in the health field. Descriptive household characteristics of age, education, income, and children revealed differences between adoption stages, with age and education having major impacts. Use of traditional sources of health information and the Internet were compared in relation to age and availability of medical services. Older, less educated households lagged behind in use of the Internet for health information. Medical professionals, doctors and pharmacists, were the most utilized information source by rural households; but those households connected to the Internet used on-line sources, even e-mail to communicate with their doctors. [ABSTRACT FROM AUTHOR]

Patient satisfaction with nursing care quality is an important indicator of the quality of care provided in hospitals. This study tested a newly developed patient-centered measure of patient satisfaction with nursing care quality within a random sample of 14 hospitals in Ontario, Canada. Results of this study revealed that the newly developed instrument had excellent psychometric properties. Total scores on satisfaction with nursing care were strongly related to overall satisfaction with the quality of care received during hospitalization. The results of this study yielded actionable, patient-focused results that can be used by managers to address areas requiring improvement. [ABSTRACT FROM AUTHOR]

This study explores the strategies employed by nurse executives to rebuild the nursing workforce in a sample of 140 Canadian hospitals following a period of restructuring, as well as identifying the mechanisms being used to monitor ongoing nursing expenditures in an era of fiscal accountability. The most common restructuring strategy employed was to change the nursing staff mix. Nurses' responses to these efforts was concerning. Focused initiatives developed by nurse executives to rebuild nurse staffing levels included increasing the employment of full-time nurses, as well as enhancing support roles utilised in the hospital healthcare system (e.g. professional practice leaders, case managers, clinical nurse specialists, nurse practitioners, nurse educators). Future efforts to monitor nursing expenditures should be balanced examining potentially positive as well as negative nursing cost utilisation. [ABSTRACT FROM AUTHOR]

In an effort to help staff nurses understand their organization's vision and strategy, a career planning and development program (CPDP) was offered to staff to promote ownership for career development and visualize pathways for adaptation.The CPDP included a group workshop followed by individual coaching sessions.A four phase planning process was used: 'scanning the environment, completing a self-assessment and reality check, creating a career vision, and developing a strategic career plan including a component on self-marketing strategies.'For 3 consecutive years, CPDP participants and the control were evaluated for their relative self-efficacy, job satisfaction, organizational commitment, and absenteeism.CPDF participants were more likely to create a career vision and plan, but had lower levels of job satisfaction. [ABSTRACT FROM AUTHOR]

BACKGROUND: Recently, restructuring of the nursing workforce has been undertaken in a number of countries in an effort to provide efficient and cost-effective services to users. This often takes the form of the introduction of unregulated workers to carry out support roles with registered nurses. However, these changes have not been evaluated for efficacy or impact on nurses, patients or the health care system. PURPOSE: The purpose of this study was to determine the relationship between staff mix models comprising regulated staff (Registered Nurses and Registered Practical Nurses) or regulated and unregulated staff (Registered Nurses and unregulated workers), and nursing and quality outcomes. METHODS: This comparative correlational study was conducted in a random sample of 30 adult, acute care patient units within eight hospitals located in Toronto, Canada. Registered Nurses employed on 30 randomly selected hospital units, grouped by the two staff mix models (15 units per group), were surveyed using previously validated instruments to measure role conflict, role ambiguity, job satisfaction, perceived effectiveness of care and perceived quality of care. RESULTS: Results indicated that Registered Nurses in this study experienced high levels of role conflict, regardless of the type of staff mix model within which they worked. Registered Nurses on units employing both Registered Nurses and unregulated workers reported higher levels of job satisfaction. On units employing both Registered Nurses and unregulated workers, Registered Nurses perceived that the quality of care was lower. CONCLUSIONS: Staff mix model was related to Registered Nurses' perceptions of the quality of patient care. It was also evident that other variables within the work environment might have more influence on the outcomes examined than the independent variable of staff mix. [ABSTRACT FROM AUTHOR]

PURPOSE: To describe nursing work life issues as portrayed in the media during the SARS crisis in Toronto. METHODS: Content analysis of local and national news media documents in Canada. Media articles were sorted and classified by topic, and themes were identified. FINDINGS: Themes were: (a) changing schemas of nursing practice: the new normal; (b) barriers to relational nursing work; (c) work life concerns: retention and recruitment; (d) nursing virtue: nurses as heroes and professionals; (e) paradoxical responses to nurses from the community; and (f) leadership in nursing during the SARS crisis. CONCLUSIONS: This analysis enhanced understanding of how nurses are portrayed in the media, but it indicated the significance of quality of work life and issues about work-home life. Some descriptions of the care and caring of nurses have made nursing seem like an important and influential profession to potential applicants who might previously have dismissed nursing as a career. [ABSTRACT FROM AUTHOR]

BACKGROUND: Little research has been conducted that examined the intended effects of nursing care on clinical outcomes. OBJECTIVE: The objective of this study was to evaluate the impact of different nurse staffing models on the patient outcomes of functional status, pain control, and patient satisfaction with nursing care. RESEARCH DESIGN: A repeated-measures study was conducted in all 19 teaching hospitals in Ontario, Canada. SUBJECTS: The sample comprised hospitals and adult medical-surgical and obstetric inpatients within those hospitals. MEASURES: The patient's functional health outcomes were assessed with the Functional Independence Measure (FIM) and the Medical Outcome Study SF-36. Pain was assessed with the Brief Pain Inventory and patient perceptions of nursing care were measured with the nursing care quality subscale of the Patient Judgment of Hospital Quality Questionnaire. RESULTS: The proportion of regulated nursing staff on the unit was associated with better FIM scores and better social function scores at hospital discharge. In addition, a mix of staff that included RNs and unregulated workers was associated with better pain outcomes at discharge than a mix that involved RNs/RPNs and unregulated workers. Finally, patients were more satisfied with their obstetric nursing care on units where there was a higher proportion of regulated staff. CONCLUSIONS: The results of this study suggest that a higher proportion of RNs/RPNs on inpatient units in Ontario teaching hospitals is associated with better clinical outcomes at the time of hospital discharge. [ABSTRACT FROM AUTHOR]

In this article we describe the process used to introduce and structure a nursing perspective as part of a balanced scorecard framework within a provincial hospital performance report. Results of a critical literature review and consultative process with key informants are outlined. Nurse-sensitive indicators emerged in the areas of system integration and change, clinical utilization and outcomes, patient satisfaction, and financial performance. [ABSTRACT FROM AUTHOR]

The pressure for increasing productivity in the context of a nursing shortage has surfaced the need to measure nursing productivity with more sophisticated tools.The author has outlined a framework for assessing nursing productivity that includes the 'contribution of nursing knowledge and skill, and factors such as organizational trust and commitment.'This framework includes nursing knowledge indicators such as educational preparation, experience, career development, autonomy, organizational trust and commitment, and employee satisfaction.The model also includes nursing productivity indicators such as direct care hours, turnover, absenteeism, orientation and education, nursing errors, and patient satisfaction.Results of this study are expected to assist organizations in refining their ability to recruit, develop, and maintain the most effective nursing workforce. [ABSTRACT FROM AUTHOR]

The authors present a highly statistically oriented argument for examining work attitudes and activities among three groups of caregivers [RNs, RPNs, and HCAs] working in long-term care. The investigators used both work sampling, written surveys, and interviews with a sample of 46 caregivers in a large university-affiliated LTC facility in Toronto, Canada. While RNs stated their strong affinity for direct patient care activities, they perform the lowest percentage of direct care, chiefly due to their accountability for planning and coordinating the care provided by others. The HCAs who provided the bulk of direct patient care 'valued it the least,' apparently finding little gratification with this aspect of their role. This study suggests that there is a need to examine and clarify work roles and perceptions for all caregivers as part of any work redesign process. A higher level of RN involvement in direct patient care activities, along with 'attention to enhancing the importance' of these activities for staff employed in the HCA role, could be beneficial. [ABSTRACT FROM AUTHOR]

The author examines staff mix models and the concerns raised with their implementation, with the intent of suggesting potential areas for developing administrative policies to deal with the related issues. The role of the unregulated worker should be developed and conceptualized as complementary to that of the nurse, thus educational programs for the nurse must include a heavy emphasis on coordinating, supervising and managing the care provided by other members of the care delivery team. Literature describing a wide variety of assistive roles was examined resulting in a basic separation into two sub-categories; assistive roles with a patient care focus, and assistive roles with a patient care unit focus. Patient care assistive roles were further subdivided into those that could be considered nurse extender models, nurse extender partnership I models, partnership models, and associated care delivery redesign approaches. [ABSTRACT FROM AUTHOR]

Fiscal constraints have heightened attention to health care costs and patient outcomes as measures of health care system effectiveness. Determining which patient and costs outcomes nurses may be held accountable for requires differentiating the impact of dependent, independent and interdependent nursing activities. A nursing role effectiveness model that includes a number of structural variables is offered to help track quality improvement and research activities. Some of the nurse-sensitive patient outcomes that have been identified include: freedom from complications, clinical outcomes, functional health outcomes, knowledge outcomes, perceived health benefit (or satisfaction), and costs outcomes. This model can be used to evaluate the effectiveness of current as well as evolving nurse roles, processes, and structural changes. [ABSTRACT FROM AUTHOR]

As the health care industry refines quality assurance and quality improvement standards, the accountability of individual care providers is intensifying. Care providers work within a system of interdependent roles and functions and collaborate to attain the common goal of quality care. A conceptual model was developed which relates the achievement of specific outcomes to nurses' independent, dependent, and interdependent roles and functions. Empirical literature was used to identify outcomes associated with nurses' role functions. Outcomes associated with nurses' independent role functions included the prevention of complications, clinical outcomes, knowledge of diseases and treatments, satisfaction, and cost outcomes. Outcomes associated with nurses' dependent role included adverse incidents which caused problems or prolonged hospital stays. Outcomes associated with nurses' interdependent role included interdisciplinary team functioning. [ABSTRACT FROM AUTHOR]

Background: Demand for rehabilitation services is expected to increase due to factors such as an aging population, workforce pressures, rise in chronic and complex multi-system disorders, advances in technology, and changes in interprofessional health service delivery models. However, health human resource (HHR) strategies for Canadian rehabilitation professionals are lagging behind other professional groups such as physicians and nurses. The objectives of this study were: 1) to identify recruitment and retention strategies of rehabilitation professionals including occupational therapists, physical therapists and speech language pathologists from the literature; and 2) to investigate both the importance and feasibility of the identified strategies using expert panels amongst HHR and education experts.Methods: A review of the literature was conducted to identify recruitment and retention strategies for rehabilitation professionals. Two expert panels, one on Recruitment and Retention and the other on Education were convened to determine the importance and feasibility of the identified strategies. A modified-delphi process was used to gain consensus and to rate the identified strategies along these two dimensions.Results: A total of 34 strategies were identified by the Recruitment and Retention and Education expert panels as being important and feasible for the development of a HHR plan for recruitment and retention of rehabilitation professionals. Seven were categorized under the Quality of Worklife and Work Environment theme, another seven in Financial Incentives and Marketing, two in Workload and Skill Mix, thirteen in Professional Development and five in Education and Training.Conclusion: Based on the results from the expert panels, the three major areas of focus for HHR planning in the rehabilitation sector should include strategies addressing Quality of Worklife and Work Environment, Financial Incentives and Marketing and Professional Development. [ABSTRACT FROM AUTHOR]