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Emergency healthcare professionals (EHPs) face significant occupational stressors requiring the skilled use of adaptive coping strategies. Some EHP resort to maladaptive coping (MC) strategies that negatively impact their mental health, yet MC strategies are not clearly defined in the literature. Examining factors that predispose EHP to MC can support interventions to improve coping and well-being.This systematic review examined MC among EHP working in pre-hospital and hospital-based settings. The primary aim was to identify factors associated with MC strategies used by EHP.Embase, Ovid, CINAHL Plus, PsychInfo, and the Cochrane Library were systematically searched for quantitative studies measuring MC use among EHP. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 2020 checklist was used to guide the review. Studies were included if they: (a) targeted licensed healthcare professionals providing patient care, (b) occurred in emergency department or pre-hospital emergency setting, and (c) examined provider coping. Studies were excluded if they: (a) did not include EHPs, (b) did not differentiate results in mixed samples, (c) did not clearly measure coping strategies, (d) failed to include MC strategies in the results, or (e) were not available in full text. Risk of bias and study quality was appraised using Joanna Briggs Institute (JBI) Critical Appraisal Checklist. Bandura's Social Cognitive Theory (SCT) guided the final synthesis, drawing conclusions from the evidence to identify factors associated with MC in EHP.A total of 14 cross-sectional studies, published between 2003 and 2021, were included in the review. Included studies were conducted in either pre-hospital, hospital, or a combination of both settings. Most studies included mixed samples or emergency physicians. A variety of coping strategies were significantly correlated with poor mental health outcomes including venting, denial, disengagement, self-blame, and substance use. Among personal factors, EHPs who were female, older than 50, living alone, with personal trauma history were significantly more likely to use MC strategies. Additionally, EHP with children, work experience, higher life satisfaction, and resilience were negatively associated with MC. Environmental factors positively associated with MC included work stress, workload, and poor benefits. Trauma exposure had a positive, but non-significant relationship.Emergency healthcare professionals use a variety of coping strategies, many of which are maladaptive and significantly related to poor mental health outcomes. Several personal and environmental factors contribute to behavior that reflect the use of MC strategies, but findings are sparse. Researchers should consider current limitations and challenges, particularly mental health stigma, when designing future studies.The evidence in this review suggests that certain factors predispose EHP for use of MC strategies. This review highlights an important research gap necessitating more robust studies to identify MC risk factors among EHP in chronically high-stress environments.

Background Quality patient care requires collaboration among health professionals. In 2016, 250,000 U.S. citizens died from preventable medical errors. One individual does not cause such errors. Researchers cite a lack of nurse–physician collaboration (NPC) as a contributing factor. Method Streubert's phenomenological design guided this study. A rigorous analysis of eight nurse interviews was conducted and reached data saturation. Results A developed formalized “exhaustive description” of nurses' lived experiences with NPC was validated by all nurse participants. One new finding was that nurses had difficulty initiating NPC for their patients early in their career and this remained an issue at times. Conclusion This is the first U.S. qualitative study in which nurses described their positive and negative experiences with NPC and their desire to improve NPC for enhanced patient outcomes. Implications for nurse educator specialists, hospital administrators, and researchers were derived. [ J Contin Educ Nurs . 2022;53(9):397–403.]

Lack of staff engagement in quality improvement (QI) is a persistent challenge in improving quality in health care. In this study, we examined variables associated with nurse-reported participation in QI using data from over 500 registered nurses employed in US hospitals. Of the 16 studied variables, based on the adjusted multivariate regression analysis, the following were positively associated (p

AIM The aim of this integrative review was to explore psychosocial vulnerabilities in women after a breast cancer diagnosis that are related to their paid work. DESIGN The review methodology was guided by Whittemore and Knafl. The Mehnert Cancer Survivorship and Work Model provided a lens through which to view vulnerability in working women with a focus on facilitating interventions to improve both recovery and work outcomes. DATA SOURCES PUBMED, CINAHL, Web of Science, and PsycNET databases were searched for English language papers published between January 2014-June 2020. REVIEW METHODS Titles and abstracts were screened. Inclusion/exclusion criteria were then applied to full text screen of the remaining articles following PRISMA guidelines. Thirteen studies meeting the inclusion criteria were critically appraised using the Critical Appraisal Skills Programme (CASP) checklist. A constant comparison approach was used to systematically distil findings into categories and assess their fit within the Mehnert Model subdomains. RESULTS Vulnerabilities coalesced predominantly within the following subdomains: (a) changes in identity and role functioning; (b) social reintegration; (c) coping strategies; and (d) social supports. Patterns and themes within these subdomains were related both positively and negatively to form the contours of a survivor's satisfaction/dissatisfaction with quality of life related to work and breast cancer recovery. CONCLUSION Overall, findings highlight the importance of employment and work environments in bolstering women's psychosocial health after a breast cancer diagnosis. IMPACT Findings from this review support adapting psychosocial distress screening to include vulnerabilities relating to work life. Nurses are ideally positioned to facilitate this screening and engage clinicians in a dialogue surrounding patient's support needs due to nursing's central role on the interdisciplinary team. Nurses may also foster collective accountability for implementing ongoing multidisciplinary survivorship care plans that include a return to work component.

To educate nursing students and practicing registered nurses about population health management (PHM), a team of faculty and PHM clinical leaders created an innovative, scalable, turnkey ready, multimedia e-learning module. The module has four lessons; takes approximately three hours to complete; and can be accessed using a weblink from computers, smart phones, and tablets. The module engages learners with videos, flashcards, case studies, and a variety of interactive knowledge checks. Each learner can obtain a record of completion, which can be shared with faculty. Faculty implemented the module with 48 senior prelicensure nursing students who reported improved self-efficacy in PHM.

Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is the first national, standardized, publicly reported survey of patients’ perspectives of hospital care closely linked to hospitals’ reimbursement and reputation. Thus, it is critical to learn about what interventions work for improving HCAHPS. Eight peer-reviewed studies examining nursing-led interventions at improving patient satisfaction in hospitals, measured by the HCAHPS, were identified. Using the Critical Appraisal Skills Program for cohort studies, each study was evaluated for a level of evidence. Interventions that increased HCAHPS were (1) nursing rounds, (2) the use of discharge nurses, (3) follow-up phone calls by nurses, and (4) continuing education for nurses. However, the quality of evidence is low and based on single-site, pre–postdesign studies. Hospital leaders should focus their efforts on a combination of nurse rounding, comprehensive discharge planning to improve patients’ overall experience with hospital care, and their likelihood to recommend the hospital.

© 2020 Wiley-VCH GmbH Two new neutral ruthenium(II) complexes [Ru(η6-p-cymene)Cl2(1)] (3) and [Ru(η6-p-cymene)Cl2(2)] (4) (1=5-(phenylamino)-3-pyrrolidin-1-ylisothiazole-4-carbonitrile; 2=3-morpholin-4-yl-5-(phenylamino)isothiazole-4-carbonitrile) have been synthesized and characterized using elemental analysis, IR, UV-Vis and NMR spectroscopy. The crystal structure was confirmed for complex 3 and both ligands. Examination of the interactions of ligands and complexes with CT-DNA (Calf Thymus DNA), as well as with HSA (Human Serum Albumin) revealed that ligands and complexes could interact with CT-DNA through intercalation and could bind strongly with HSA. Docking experiments toward DNA dodecamer indicate excellent accordance with experimental ΔG values. The cytotoxic activity of ligands and complexes was evaluated by MTT assay against HCT116 and HeLa tumoral cells. The complexes 3 and 4 showed good activity and selectivity on HCT116 cells. Neither of the tested compounds shows cytotoxic activity against a healthy MRC-5 cell line. Flow cytometry analysis showed the apoptotic death of the HCT116 cells with a cell cycle arrest in the S-phase.

Internationally educated nurses (IENs) are an important part of the U.S. nursing workforce. Optimizing their transition-to-practice (TTP) experiences in the United States is crucial for ensuring high-quality patient and IENs’ outcomes. The purpose of this integrative review is to analyze and synthesize the current evidence surrounding IEN TTP experiences in the United States from 2000 to 2018 to inform improvements in TTP. Eighteen studies were included. TTP was defined through IENs’ description of facilitators and barriers of the transition process and presented in seven themes. Two themes were facilitators: support from family and nursing colleagues, and perceptions of self-efficacy. The remaining five themes were barriers: (a) the stigma associated with educational preparation, (b) communication and language, (c) differences in culture, (d) differences in nursing practice, and (e) legal issues. Findings are important for improving TTP programs. Further research focusing on the outcomes of transition programs is needed to inform policymaking surrounding IEN recruitment and retention.

Background: In the era of the Patient Protection and Affordable Care Act, quality of care and patient safety in health care have never been more visible to patients or providers. Registered nurses (nurses) are key players not only in providing direct patient care but also in evaluating the quality and safety of care provided to patients and families. Purpose: We had the opportunity to study a unique cohort of nurses to understand more about the common predictors of nurse-reported quality of care and patient safety across acute care settings. Approach: We analyzed cross-sectional survey data that were collected in 2015 from 731 nurses, as part of a national 10-year panel study of nurses. Variables selected for inclusion in regression analyses were chosen based on the Systems Engineering Initiative for Patient Safety model, which is composed of work system or structure, process, and outcomes. Results: Our findings indicate that factors from three components of the Systems Engineering Initiative for Patient Safety model–Work System (person, environment, and organization) are predictive of quality of care and patient safety as reported by nurses. The main results from our multiple linear and logistic regression models suggest that significant predictors common to both quality and safety were job satisfaction and organizational constraints. In addition, unit type and procedural justice were associated with patient safety, whereas better nurse-physician relations were associated with quality of care. Conclusion: Increasing nurses’ job satisfaction and reducing organizational constraints may be areas to focus on to improve quality of care and patient safety. Practical Implications: Our results provide direction for hospitals and nurse managers as to how to allocate finite resources to achieve improvements in quality of care and patient safety alike.

Background Evidence-based management practices (EBMPs) that improve nurses' work environments have been linked to improvements in patient outcomes such as patient satisfaction and mortality. Yet, the extent to which nurse managers implement these EBMP or the factors associated with their implementation is not known. Aims Guided by the Promoting Action on Research Implementation in Health Services (PARIHS) Framework, we examined individual, evidence, and organizational characteristics associated with nurse managers' implementation of the five EBMPs. Methods A cross-sectional, correlational, survey design was used. Nurse managers from 10 public hospitals in New York City were recruited. Evidence and contextual variables were measured with the Organizational Readiness for Change Assessment instrument. EBMPs were measured with a modified version of the Practice Environment Scale of the Nursing Work Index. All multi-item scales were validated with confirmatory factors analysis in the studied sample. Additionally, the scales had Cronbach's alpha reliability greater than .8. A multivariate linear regression analysis with robust standard error correction was used to analyze the data and to adjust for clustering of managers in hospitals. Results A total of 331 nurse managers responded for a 47.4% response rate. Bachelor's degree, number of staff supervised, managers' personal experience with evidence for EBMPs, staff culture, and organizational resources were significant predictors of nurse managers' implementation of EBMPs for NWE improvement (p Linking evidence to action Staff culture was positively associated with implementation of all five EBMPs for improving nurses' work environments. Managers should prioritize nursing unit culture that encourages staff to innovate and change in order to improve care.

Purpose Staff nurse turnover is a costly problem for healthcare managers, which has been extensively studied. Now, managers are facing a new challenge attributed to nurses leaving their current positions to become advanced practice nurses. We aimed to identify factors associated with new nurses' career choice as advanced practice nurses. Methods We used descriptive comparative design to analyze data from 946 nurses who reported working as new staff nurses in 2006 and 10 years later reported working as advanced practice nurses. Results We add to the topic of nurses' turnover by identifying the factors associated with nurses leaving their jobs to become advanced practice nurses. The factors include being younger, not married, enrolled into a formal education program, and having a bachelor's degree at entry into nursing practice. Conclusions To better manage staff nurse turnover due to nurses becoming advanced practice nurses, managers should monitor educational policy trends on bachelor's entry into practice, new nurses' enrollment status into formal education program upon hire, and new nurses' demographics.

Nurse practitioners (NPs) are educated to provide high-quality patient- and family-centered care to underserved, culturally diverse, medically complex populations. Nurse practitioner faculty plan curricular activities that challenge NP students to critically assess individuals and populations with the goal of preparing NP students to be "practice-ready" upon graduation. Nurse practitioner clinical training occurs in practice settings with NP preceptors, with specific areas of clinical expertise. However, there is a lack of NP clinical preceptors educationally prepared to clinically teach and evaluate NP students. This article presents the design, implementation, evaluation, and outcomes from a 3-year grant funded by the United States Human Resources and Administration Services that featured a web-based Primary Care Nurse Practitioner Preceptor Development Program. Ninety percent of NPs who precepted NP students completed all web-based learning modules. Preceptors with educational preparation via online modules to guide NP student learning in clinical settings are a critical resource for faculty to prepare NP students to be practice-ready upon graduation. This web-based learning platform for online NP preceptor education may be a successful approach for expanding and improving the NP preceptor pool nationwide.

Background The Institute of Medicine (IOM) report, The Future of Nursing, included recommendations to increase nurse diversity, the percent of nurses obtaining a bachelor’s degree, and inter-professional education. Purpose The purpose of this paper is to report the progress toward achievement of these recommendations. Methods We used a longitudinal, multi-state data from four cohorts of nurses newly licensed in 2004 to 2005, 2007 to 2008, 2010 to 2011, and 2014 to 2015 to examine and compare the trends. Finding The percentage of males who became licensed increased, from 8.8% in 2004 to 2005 cohort to 13.6% in the 2014 to 2015 cohort. The percentage of white-non-Hispanic nurses who were licensed decreased from 78.9% in 2007 to 2008 to 73.8% in 2014 to 2015. These differences primarily reflect an increase in white-Hispanic nurses. More nurses are obtaining a bachelor’s degree as their first professional degree, from 36.6% in 2004 to 2005 cohort to 48.5% in 2014 to 2015 cohort. About 40% of the 2014 to 2015 cohort reported that they learned to work in inter-professional teams. Collegial nurse-physician relations had an upward positive trajectory over time increasing almost 7%. Discussion The diversity and education of new nurses have increased, but are short of meeting the IOM recommendations.

Introduction. Thrombophlebitis of the internal jugular vein may appear as a rare complication of oropharyngeal infection and tonsillectomy procedure. Clinical features usually include an acute onset of inflammation with formation of venous thrombosis and secondary septic propagation (Lemierre?s syndrome). The aim of this work was to present a rare case of internal jugular vein thrombophlebitis as a late complication following tonsillectomy. Case outline. We present an otherwise healthy 25-year-old male patient on whom tonsillectomy was performed due to chronic tonsillitis. Two weeks after surgery, the patient was rehospitalized for high temperature, diffuse swelling on the left side of the neck, fatigue, painful swallowing, and constrained mouth opening. Thrombophlebitis of the left internal jugular vein was diagnosed by the neck ultrasound. Complete recovery was achieved in three weeks? time by the combination of antibiotics and anticoagulant/ antithrombotic therapy. Conclusion. Tonsillectomy is a risk factor for the internal jugular vein thrombosis in adults with chronic tonsillitis, especially if fibrous adhesions are expected or found during the surgical procedure.

© 2018 Elsevier B.V. Two piano-stool ruthenium(II) complexes [Ru(η6-p-cymene)(N-MeIm)3]Cl2·2H2O (1) and [Ru(η6-p-cymene)(N-PrIm)Cl2] (2) respectively have been synthesized and characterized by elemental, spectral and structural analysis. Crystal structures of (1) and (2) have been verified by X-ray diffraction analysis. Docking experiments toward DNA dodecamer have been done. Good ΔG binding values of the complexes with imidazole derivatives comparable with ethylene-diamine complex indicate a high potential of these compounds in the formation of DNA lesions and therefore their good cytotoxic status. The interaction of CT-DNA with ruthenium(II) complexes has been studied by means of absorption and fluorescence measurements. The binding constant, Kb and the Stern–Volmer quenching constant reveal that complex (2) binds well to CT-DNA. The cytotoxic activity of Ru(II) complexes with N-RIm (R = methyl or propyl) were evaluated by MTT assay. A-549, HT-29 and HeLa cells were sensitive to all compounds tested, while the breast carcinoma cell line MCF-7 was resistant only to the complex (1). Flow cytometric analysis and fluorescent microscopy showed that ruthenium(II) complexes in HeLa cells induce apoptosis and G0/G1 cell cycle arrest and almost completely inhibit DNA synthesis. Western blot also demonstrated proteolytic cleavage of poly-(ADP-ribose) polymerase (PARP) in HeLa cells after treatment with both tested substances.

Background Registered nurse job turnover is an ongoing problem in the USA resulting in significant financial costs to both organizations and society. Most research has focused on organizational turnover with few studies about internal or unit-level turnover. Turnover of new nurses in hospitals has particular importance as almost 80% of new nurses work in hospitals and have higher turnover rates when compared to experienced nurses. This paper focuses on new nurses' unit-level turnover rates in hospitals. Objectives The purpose of this study is to: (1) identify factors that predict new nurses staying in the same units, positions, and job titles to inform unit-level retention strategies, and (2) examine the changes in work environment perceptions over time between nurses who remain in the same unit, position, and title to those who changed unit, position and/or title. Study design A panel survey design was used to analyze changes over time. Participants Participants were newly licensed registered nurses who were licensed for the first time between August 1st, 2004 and July 31st, 2005. The nurses came from metropolitan statistical areas or rural areas that were nested to reflect a nationally representative USA sample (58% response rate). The analytic sample for this study was 1335. Data sources Data were collected in January 2006 and 2007 following the Dillman total design approach. All potential respondents received paper surveys and non-responders received repeated mailings. Results Using multinomial regression the five variables with the largest effects on unit retention were (1) variety (positive), (2) having another job for pay (negative), (3) first basic degree (having a bachelors or higher degree increased the probability of staying), (4) negative affectivity (positive), and (5) job satisfaction (positive). Nurses who changed unit, and/or position, and/or title reported more positive change scores on a variety of work attitudes. Discussion Almost 30% of new nurses working in hospitals leave their unit, and/or position, and/or title during their first year of work. Our results point to the variables on which managers can focus to improve unit-level retention of new nurses. Although participants were from a nationally representative sample of nurses who were newly licensed in 2004–2005, with the geographical shifts in the USA population in the last 10 years the sample may not be geographically representative of new nurses who graduated in 2015.

Background Readiness of the nursing workforce in quality and safety competencies is an essential indicator of a health system's ability to deliver high-quality and safe health care. A previous study identified important quality and safety education gaps between associate- and baccalaureate-prepared new nurses who graduated between 2004 and 2005. The purpose of this study was to assess changes in nursing workforce quality and safety education preparedness by examining educational gaps between associate and bachelor's degree graduates in two additional cohorts of new nurses who graduated between 2007–2008 and 2014–2015. Methods A cross-sectional, comparative design and chi-square tests were used to trend the quality and safety educational preparedness differences between associate and bachelor's degree nurse graduates from 13 states and the District of Columbia licensed in 2007–2008 (N = 324) and 2014–2015 (N = 803). Results The number of quality and safety educational gaps between bachelor's and associate degree nurse graduates more than doubled over eight years. In the 2007–2008 cohort, RNs with a bachelor's degree reported being significantly better prepared than RNs with an associate degree in 5 of 16 topics. In the 2014–2015 cohort, bachelor's degree RNs reported being significantly better prepared than associate degree RNs in 12 of 16 topics. Conclusion Improving accreditation and organizational policies requiring baccalaureate education for all nurses could close quality and safety education gaps to safeguard the quality of patient care.

Background Between 45% and 94% of registered nurses (RNs) experience verbal abuse, which is associated with physical and psychological harm. Although several studies examined predictors of RNs' verbal abuse, none examined predictors of RNs' experiences of verbal abuse by RN colleagues. Purpose To examine individual, workplace, dispositional, contextual, and interpersonal predictors of RNs' reported experiences of verbal abuse from RN colleagues. Methods In this secondary analysis, a cross-sectional design with multiple linear regression analysis was used to examine the effect of 23 predictors on verbal abuse by RN colleagues in a sample of 1,208 early career RNs. Finding Selected variables in the empirical intragroup conflict model explained 23.8% of variance in RNs' experiences of verbal abuse by RN colleagues. Conclusion A number of previously unstudied factors were identified that organizational leaders can monitor and develop or modify policies to prevent early career RNs' experiences of verbal abuse by RN colleagues.

We explored direct and indirect influences of physical work environment on job satisfaction in a nationally representative sample of 1,141 early-career registered nurses. In the fully specified model, physical work environment had a non-significant direct effect on job satisfaction. The path analysis used to test multiple indirect effects showed that physical work environment had a positive indirect effect (p

Ongoing assessments of nurses' preparedness in quality and safety competencies are absent from prelicensure education programs. Yet acquiring knowledge and skills in these areas is critical for nurses to meet the recommendations of key health care stakeholders. The study presented in this article used a cross-sectional, comparative design to examine differences in reported preparedness between two cohorts of entry-level registered nurses licensed to practice in 2004–05 and 2007–08 across 15 U.S. states. The results showed that the 2007–08 cohort reported improvements (p

The O-O-N-N-O-type pentadentate ligands H(3)1,3-pd3a and H(3)1,3-pd2ap (H(3)1,3-pd3a stands for 1,3-propanediamine-N,N,N'-triacetic acid; H(3)1,3-pd2ap stands for 1,3-propanediamine-N,N'-diacetic-N-3-propionic acid) and the corresponding novel octahedral nickel(II) complexes have been prepared and characterized. H(3)1,3-pd3a and H(3)1,3-pd2ap ligands coordinate to nickel(II) ion via five donor atoms (three deprotonated carboxylate atoms and two amine nitrogens) affording octahedral geometry in case of all investigated Ni(II) complexes. A sixth place within octahedra has been occupied by the molecule of water. A six coordinate, octahedral geometry has been established crystallographically for the K[Ni(1,3-pd3a)(H2O)]center dot 3H(2)O complex. Structural data correlating similar chelate Ni(II) complexes have been used for an extensive strain analysis. This is discussed in relation to information obtained for similar complexes. The infra-red and electronic absorption spectra of the complexes are interpreted and compared with related complexes of known geometries. Density functional theory (DFT) has been used to model the most stable geometry isomer and Natural Energy Decomposition Analysis (NEDA) to reveal the energetic relationship of these compounds. The results from density functional studies have been compared with X-ray data. NEDA has been done for the [LNi] and [H2O] units. (C) 2013 Elsevier B.V. All rights reserved.

How To Obtain Contact Hours By Reading This Issue Instructions: 1.2 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded once you register, pay the registration fee, and complete the evaluation form online at https://villanova.gosignmeup.com . In order to obtain contact hours you must: 1. Read the article, “A Multi-State Assessment of Employer-Sponsored Quality Improvement Education for Early-Career Registered Nurses,” found on pages 12–19, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz. 2. Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study. 3. Go to the Villanova website to register for contact hour credit. You will be asked to provide your name, contact information, and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated. This activity is valid for continuing education credit until December 31, 2014. Contact Hours This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated. Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. Objective Review the results of a descriptive study that assessed employer-sponsored quality improvement (QI) education and registered nurses’ preparedness across a wide range of QI steps and processes. Disclosure Statement Neither the planners nor the authors have any conflicts of interest to disclose. Background: Increasing participation of registered nurses (RNs) in quality improvement (QI) is a promising strategy to close the health care quality chasm. For RNs to participate effectively in hospital QI, they must have adequate QI knowledge and skills. Methods: This descriptive study assessed employer-sponsored QI education and RNs’ preparedness across a wide range of QI steps and processes. RNs from 15 U.S. states who were employed in hospitals and were initially licensed to practice in 2007 to 2008 were surveyed. Results: Fewer than one third of respondents reported being very prepared across all measured QI topics. More than half reported receiving zero hours of training in these same topics in the last year. Lack of educational offerings on the topic was the top reason respondents gave for not obtaining QI training. Conclusion: The QI education offered by employers to RNs could be substantially improved. Nurse educators play a critical role in making these improvements.

Aims To examine the effect of transformational leadership on early career nurses' intent to stay, job satisfaction and organizational commitment. Background Lack of leadership support is one of the top reasons staff nurses leave. Current studies reported mixed results about the impact of transformational leadership on key nurse outcomes. However, little is known whether leadership directly or indirectly affects satisfaction, organizational commitment and intent to stay. Design This study was a cross-sectional study of nurses who had been licensed for 7·5-8·5 years which was part of a 10-year longitudinal panel design. Methods The analytic sample was 1037 nationally representative newly licensed Registered Nurses. Data were collected from January–March 2013. We used a probit model to model the relationship between transformational leadership and intent to stay, organizational commitment and job satisfaction. Results Transformational leadership did not have a significant impact on intent to stay and job satisfaction, but significantly associated with organizational commitment. Organizational commitment, job satisfaction, mentor support, promotional opportunities and age were positively associated with intent to stay, while ethnicity, non-local job opportunities and work settings were negatively associated with intent to stay. Conclusions Transformational leadership had no direct relationship with intent to stay and job satisfaction and had a small direct positive effect on organizational commitment. Transformational leadership has potential to slow attrition and retain nurses by creating a positive work environment that supports nurses. Any improvement in job satisfaction and organizational commitment would positively increase the change in probability for intent to stay.

BACKGROUND Numbering close to 300,000 nurse managers represent the largest segment of the health care management workforce. Their effectiveness is, in part, influenced by their job satisfaction. PURPOSE We examined factors associated with job satisfaction of novice frontline nurse managers. METHODOLOGY/APPROACH We used a cross-sectional, correlational survey design. The sample consisted of responders to the fifth wave of a multiyear study of new nurses in 2013 (N = 1,392; response rate of 69%) who reported working as managers (n = 209). The parent study sample consisted of registered nurses who were licensed for the first time by exam 6-18 months prior in 1 of 51 selected metropolitan statistical areas and 9 rural areas across 34 U.S. states and the District of Columbia. We examined bivariate correlations between job satisfaction and 31 personal and structural variables. All variables significantly related to job satisfaction in bivariate analysis were included in a multivariate linear regression model. In addition, we tested the interaction effects of procedural justice and negative affectivity, autonomy, and organizational constraints on job satisfaction. The Cronbach's alphas for all multi-item scales ranged from .74 to .96. FINDINGS In the multivariate analysis, negative affectivity (β = -.169; p = .006) and procedural justice (β = .210; p = .016) were significantly correlated with job satisfaction. The combination of predictors in the model accounted for half of the variability in job satisfaction ratings (R = .51, adjusted R = .47; p

Interprofessional education is a critical precursor to effective teamwork and the collaboration of health care professionals in clinical settings. Numerous barriers have been identified that preclude scalable and sustainable interprofessional education (IPE) efforts. This article describes NYU3T: Teaching, Technology, Teamwork, a model that uses novel technologies such as Web-based learning, virtual patients, and high-fidelity simulation to overcome some of the common barriers and drive implementation of evidence-based teamwork curricula. It outlines the program's curricular components, implementation strategy, evaluation methods, and lessons learned from the first year of delivery and describes implications for future large-scale IPE initiatives.

Background Current evidence suggests that the economic recession has induced retired RNs to reenter nursing and working nurses to work more hours and delay retirement, thus easing the projected RN shortage. We wondered whether the economic downturn had affected new nurses' work attitudes and behaviors, including those related to turnover. Objective The purpose of this study was to compare perceptions about job opportunities, as well as key attitudinal variables (such as job satisfaction and intent to stay), in two cohorts of newly licensed RNs. Methods Our data came from two sources: a subset of new RNs licensed between August 1, 2004, and July 31, 2005, who were part of a larger 2006 study on turnover, and a later cohort of new RNs licensed between August 1, 2007, and July 31, 2008. We mailed survey questionnaires to one cohort before the recession in 2006 and to a second cohort during the recession in 2009. Results We found that RNs' commitment to their current employers was higher in the later cohort than in the earlier one, although neither nurses' incomes nor their reported job satisfaction levels had changed. Conclusions Our findings suggest that, despite some improvements in working conditions, newly licensed RNs may just be waiting for the recession to end before changing jobs. Health care organizations' efforts to improve RNs' working conditions and wages, and to implement or support existing programs aimed at increasing retention, should be continued.

Data on the impact of student, teacher, and principal racial and gender composition in urban schools on teacher work outcomes are limited. This study, a secondary data analysis of White and Black urban public school teachers using data taken from the restricted use 2003-04 Schools and Staffing Survey (SASS), examines the effects of relational demography on teacher job satisfaction adjusting for other known determinants of job satisfaction. Relational demography is conceptualized as a set of racial and gender congruency items between teachers and principals, teachers and teachers, and teachers and students. The results of the study show that some components of relational demography directly affect teacher job satisfaction, over and above the effects of work-related attitudes.

brewer c.s., kovner c.t., greene w., tukov-shuser m. & djukic m. (2012) Predictors of actual turnover in a national sample of newly licensed registered nurses employed in hospitals. Journal of Advanced Nursing68(3), 521–538. Abstract Aim. This paper is a report of a study of factors that affect turnover of newly licensed registered nurses in United States hospitals. Background. There is a large body of research related to nursing retention; however, there is little information specific to newly licensed registered nurse turnover. Incidence rates of turnover among new nurses are unknown because most turnover data are not from nationally representative samples of nurses. Method. This study used a longitudinal panel design to obtain data from 1653 registered nurses who were recently licensed by examination for the first time. We mailed surveys to a nationally representative sample of hospital registered nurses 1 year apart. The analytic sample consisted of 1653 nurses who responded to both survey mailings in January of 2006 and 2007. Results. Full-time employment and more sprains and strains (including back injuries) result in more turnover. Higher intent to stay and hours of voluntary overtime and more than one job for pay reduces turnover. When we omitted intent to stay from the probit model, less job satisfaction and organizational commitment led to more turnover, confirming their importance to turnover. Magnet Recognition Award® hospitals and several other work attributes had no effect on turnover. Conclusion. Turnover problems are complex, which means that there is no one solution to decreasing turnover. Multiple points of intervention exist. One specific approach that may improve turnover rates is hospital policies that reduce strains and sprains.

About 25% of newly licensed registered nurses (NLRNs) leave their first job within two years, but only 2% leave the nursing profession in this same timeframe. Therefore, the researchers sought to discover what new nurses like best about being a nurse, in hopes of gaining information that might help facilities to reduce turnover rates. Data were collected between January and March 2009 from 1,152 NLRNs licensed in 15 US states. Krippendorff's method was used to analyze survey responses. Five themes emerged: “providing holistic patient care,” “having an autonomous and collaborative practice,” “using diverse knowledge and skills to impact patient outcomes,” “receiving recognition,” and “having a job that is secure and stimulating.” Strategies are discussed that organizations might employ in helping NLRNs to realize what they best like about their work, which might lead to improved retention rates.

Background The impact of personal, organizational, and economic factors on nurses' job satisfaction have been studied extensively, but few studies exist in which the effects of physical work environment--including perceptions of architectural, interior design, and ambient features on job satisfaction-are examined. Objectives The purpose of this study was to examine the effect of perceived physical work environment on job satisfaction, adjusting for multiple personal, organizational, and economic determinants of job satisfaction. Methods A cross-sectional, predictive design and a Web-based survey instrument were used to collect data from staff registered nurses in a large metropolitan hospital. The survey included 34 questions about multiple job satisfaction determinants, including 18 Likert-type measures with established good validity (comparative fit index = .97, Tucker-Lewis index = .98, root mean square error of approximation = .06) and reliability (r ≥ .70). Results A response rate of 48.5% resulted in a sample of 362, with 80% power to detect a medium effect of perceived physical environment on job satisfaction. On average, nurses had negative perceptions of physical work environment (M = 2.9, SD = 2.2). Although physical environment was related positively to job satisfaction (r =.256, p = .01) in bivariate analysis, in ordered probit regression, no effect of physical work environment on job satisfaction was found. Discussion In future studies, this relationship should be examined in larger and more representative samples of nurses. Qualitative methods should be used to explore how negatively perceived physical work environment impacts nurses. Rebuilding of U.S. hospitals, with a planned investment of $200 billion without considering how physical environment contributes to nurse work outcomes, threatens to exacerbate organizational nurse turnover.

In an effort to better understand turnover rates in hospitals and the effect of new nurses on them, this study sought to describe the characteristics and attitudes toward work of newly licensed RNs, a population important to both the nursing profession and the health care system.A survey was mailed to a random sample of new RNs in 35 states and the District of Columbia. A total of 3,266 returned surveys met the inclusion criteria, for a response rate of 56%. RNs who qualified had completed the licensing examination and obtained a first license between August 1, 2004, and July 31, 2005. Data pertaining to four areas were collected: respondent characteristics, work-setting characteristics, respondents' attitudes toward work, and job opportunities. Respondents who were not working were asked to specify why.Of the eligible newly licensed RNs, 58.1% had an associate's degree, 37.6% had a bachelor's degree, and 4.3% had a diploma or a master's or higher degree as their first professional degree. They were generally pleased with their work groups but felt they had only moderate support from supervisors. About 13% had changed principal jobs after one year, and 37% reported that they felt ready to change jobs. More than half of the respondents (51%) worked voluntary overtime, and almost 13% worked mandatory overtime. Also, 25% reported at least one on-the-job needlestick in a year; 39%, at least one strain or sprain; 21%, a cut or laceration; and 46%, a bruise or contusion; 62% reported experiencing verbal abuse. A quarter of them found it "difficult or impossible" to do their jobs at least once per week because of inadequate supplies.This study provides descriptive evidence that a majority of newly licensed RNs are reasonably satisfied and have no plans to change jobs, but the group is not homogeneous. The negative attitudes expressed in response to some survey questions suggest that newly licensed RNs may not remain in the acute care settings where they start out. Investing in better orientation and management may be the key to retaining them in hospitals. The authors will be following these RNs for two years and will develop predictive models of turnover rates.

Using data collected from 1,906 RNs from Metropolitan Statistical Areas in 29 states, the purpose of this study was to examine the characteristics and work attitudes of older RNs compared to RNs less than age 50 at two time periods, and compare among the older RNs those who are working in nursing, working outside nursing, and not working. Older RNs reported more distributive justice (fairness of rewards), work group cohesion, and supervisory support and less organizational constraint, and quantitative workload than younger RNs. Overall, older RNs were more satisfied, had greater organizational commitment, and had less desire to quit than younger RNs. There were no significant differences between older and younger RNs for autonomy, mentor support, or variety. Strategic efforts by employers and government could be used to retain older workers, attract RNs working in nonnursing settings back into nursing, and recruit retired RNs into the nursing workforce.

The Institute of Medicine identified interprofessional education (IPE) as a key innovation for achieving the triple aim of better care, better outcomes, and reduced healthcare costs. Yet, a shortage of qualified faculty and difficulty with aligning learners' schedules often prevent sustainable and scalable IPE. A virtual IPE intervention was developed to circumvent these barriers and compared to a blended-learning IPE intervention. We used a pre-test and post-test design with two comparison interventions to test the effects of these IPE interventions on changes in teamwork knowledge, skills, and attitudes. The interventions were delivered to pre-licensure learners at a large, metropolitan medical and a nursing school. We used one-sample and independent-sample t-tests to analyze data from 220 learners who received the blended-learning intervention in 2011 and 540 learners who received the virtual learning intervention in 2012. The students in the blended-learning intervention did not significantly (p 0.05) outperform the students in the virtual learning intervention for any of the measured outcomes, except for medical students' attitudes around team value. Virtual IPE learning is an effective, scalable, and sustainable solution for imparting foundational teamwork knowledge in health profession students.

The objective of this study was to examine early-career frontline nurse managers' (FLNMs') reported educational preparedness and participation in quality improvement (QI).Frontline nurse managers are vitally important for leading QI. However, it is not well known if they have adequate knowledge and skills to lead this important function.We examined cross-sectional survey data from 42 FLNMs using descriptive statistics.About 30% of FLNMs reported being very prepared across 12 measured QI skills by schools or employers and 35% reported participating in a specific clinical effort to improve patient care on their unit more than once a month. More than 50% reported having good organizational support for QI, but only about 30% reported being rewarded for their contributions to QI.Our study highlights opportunities for development in QI for FLNMs and offers some solutions for nurse executives that can bridge the educational gaps.

In digital economy very important role has information capital which produce numerous benefits and costs for organizations. But, organization capital creates grate value in an organization only if it is aligned with organization strategy. So, main management problem is being able to make alignment of information capital and organization strategy

We explored direct and indirect influences of physical work environment on job satisfaction in a nationally representative sample of 1,141 early-career registered nurses. In the fully specified model, physical work environment had a non-significant direct effect on job satisfaction. The path analysis used to test multiple indirect effects showed that physical work environment had a positive indirect effect (p .05) on job satisfaction through ten variables: negative affectivity, variety, workgroup cohesion, nurse-physician relations, quantitative workload, organizational constraints, distributive justice, promotional opportunity, local and non-local job opportunities. The findings make important contributions to the understanding of the relationship between physical work environment and job satisfaction. The results can inform health care leaders' insight about how physical work environment influences nurses' job satisfaction.

Objective: The objective of this project was to develop core competencies in pain assessment and management for prelicensure health professional education. Such core pain competencies common to all prelicensure health professionals have not been previously reported. Methods: An interprofessional executive committee led a consensus-building process to develop the core competencies. An in-depth literature review was conducted followed by engagement of an interprofessional Competency Advisory Committee to critique competencies through an iterative process. A 2-day summit was held so that consensus could be reached. Results: The consensus-derived competencies were categorized within four domains: multidimensional nature of pain, pain assessment and measurement, management of pain, and context of pain management. These domains address the fundamental concepts and complexity of pain; how pain is observed and assessed; collaborative approaches to treatment options; and application of competencies across the life span in the context of various settings, populations, and care team models. A set of values and guiding principles are embedded within each domain. Conclusions: These competencies can serve as a foundation for developing, defining, and revising curricula and as a resource for the creation of learning activities across health professions designed to advance care that effectively responds to pain

Background: The impact of registered nurse (RN) staffing on patient care quality has been extensively studied.Identifying additional modifiable work environment factors linked to patient care quality is critical as theprojected shortage of approximately 250,000 RNs over the next 15 years will limit institutions’ ability to rely on RNstaffing alone to ensure high-quality care.Purpose: WeexaminedtheassociationbetweenRNs’ratingsofpatientcarequalityandseveralnovelworkenvironmentfactorsadjustingfortheeffectsoftwostaffingvariables:reportedpatient-to-RNratiosandratingsofstaffingadequacy.Methodology: We used a cross-sectional, correlational design and a mailed survey to collect data in 2009 from anationalsampleofRNs(n=1,439)intheUnitedStates.Amultivariatelogisticregressionwasusedtoanalyzethedata.Findings: Workgroup cohesion, nurseYphysician relations, procedural justice, organizational constraints, and physicalwork environment were associated with RNs’ ratings of quality, adjusting for staffing. Furthermore, employment in aMagnet hospital and job satisfaction were positively related to ratings of quality, whereas supervisory support was not.Practice Implications: Our evidence demonstrates the importance of considering RN work environment factorsotherthanstaffingwhenplanningimprovementsinpatientcarequality.Healthcaremanagerscanuse the resultsofour study to strategically allocate resources toward work environment factors that have the potential to improvequality of care.Key words: nurse staffing, nurse work environment, nursing practice environment, patient care quality, work environment redesignMaja Djukic, PhD, RN, is Assistant Professor, College of Nursing, New York University, New York. E-mail: md1359@nyu.edu.Christine Kovner, PhD, RN, is Professor, College of Nursing, New York University, New York. E-mail: ctk1@nyu.edu.Carol S. Brewer, PhD, RN, is Professor, School of Nursing, University at Buffalo, New York. E-mail: csbrewer@buffalo.edu.Farida K. Fatehi, MS, is Junior Research Analyst, College of Dentistry, New York University, New York. E-mail: fkf200@nyu.edu.Daniel Cline, MSN, RN, CRNP, is PhD Candidate and John A. Hartford Foundation BAGNC Scholar 2010Y2012, College of Nursing,New York University, New York. E-mail: ddc272@nyu.edu.This work was supported by the Robert Wood Johnson Foundation. Permission to conduct the study was granted by the New York University andthe University at Buffalo Institutional Review Boards.This paper was presented on April 2011 at the American Association of Nurse Executives 44th Annual Meeting and Exposition Meeting inSan Diego, California.The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.DOI: 10.1097/HMR.0b013e3182388cc3

Interprofessional education is a critical precursor to effective teamwork and the collaboration of health care professionals in clinical settings. Numerous barriers have been identified that preclude scalable and sustainable interprofessional education (IPE) efforts. This article describes NYU3T: Teaching, Technology, Teamwork, a model that uses novel technologies such as Web-based learning, virtual patients, and high-fidelity simulation to overcome some of the common barriers and drive implementation of evidence-based teamwork curricula. It outlines the program's curricular components, implementation strategy, evaluation methods, and lessons learned from the first year of delivery and describes implications for future large-scale IPE initiatives.

This paper is a report of a study of factors that affect turnover of newly licensed registered nurses in United States hospitals.There is a large body of research related to nursing retention; however, there is little information specific to newly licensed registered nurse turnover. Incidence rates of turnover among new nurses are unknown because most turnover data are not from nationally representative samples of nurses.This study used a longitudinal panel design to obtain data from 1653 registered nurses who were recently licensed by examination for the first time. We mailed surveys to a nationally representative sample of hospital registered nurses 1 year apart. The analytic sample consisted of 1653 nurses who responded to both survey mailings in January of 2006 and 2007.Full-time employment and more sprains and strains (including back injuries) result in more turnover. Higher intent to stay and hours of voluntary overtime and more than one job for pay reduces turnover. When we omitted intent to stay from the probit model, less job satisfaction and organizational commitment led to more turnover, confirming their importance to turnover. Magnet Recognition Award(®) hospitals and several other work attributes had no effect on turnover. Turnover problems are complex, which means that there is no one solution to decreasing turnover. Multiple points of intervention exist. One specific approach that may improve turnover rates is hospital policies that reduce strains and sprains.

This department highlights emerging nursing leaders and scientists who have demonstrated great promise and findings in advancing innovation and patient care leadership in practice, policy, research, education and theory. This interview profiles Maja Djukic, PhD, RN, assistant professor, New York University College of Nursing.

This review offers an analysis of practice overlap between physicians and registered nurses (RNs) who are not advanced practice nurses. Additionally, it spotlights opportunities for expanding traditional professional boundaries to establish novel care delivery models. The examples of RN role expansion offer a beginning for discussion regarding how the health professionals’ knowledge and skills can be best used in designing an effective and efficient health care system. Although limited data exist on cost effectiveness and workload implications of the novel care delivery models, policy makers can use the findings of this review to begin to inform U.S. health care reform.

This article describes the work experience of a national cohort of 229 RNs who participated in a survey on work environment at two different time periods. Survey results of the RNs’ experience within two and a half years of their initial RN licensure (time period two) are described in detail, and comparisons are made to their experiences one year earlier (time period one). Using Krippendorff’s technique for content analysis, six inter-related themes emerged at time period two. Findings indicate that the working environment of RNs impacts both nurses’ satisfaction and their dissatisfaction. Factors associated with dissatisfaction center on the lack of nurse manager leadership, persistent verbal abuse, high patient-to-nurse ratios, and the physical demands of bedside nursing that result in injuries. Suggestions from the nurses themselves are used to guide strategies to improve the work environment and retain nurses.

The purpose of this analysis is to describe the attrition process from application to associate and baccalaureate basic RN programs through the first 2 years of work using estimates from best available nationally representative data. Results of the analysis show that although about 41,000 qualified applicants are not admitted to basic RN programs, most students (76.2%) who enroll in basic RN programs graduate, and most RN graduates who pass the National Council Licensure Examination stay in their first nursing job (73.8%) and nursing (97.9%) for at least 2 years. The results suggest that room for improvement exists for retention across educational and work settings, but the system appears to be most leaky at the point of admitting qualified applicants. Precise data about attrition from educational and employment settings are essential for resolving educational capacity and workforce retention issues, but precise data are difficult to obtain. A solution may be to assign each applicant a unique identifier.

The purpose of this study was to describe the differences between traditional-baccalaureate graduates (TBGs) who had a baccalaureate degree in nursing and no other academic degree or diploma and second-degree baccalaureate graduates (SDGs) who had both a baccalaureate degree in nursing and a baccalaureate or higher degree in a field other than nursing. Using a sample of 953 newly licensed registered nurses (NLRNs), we compared SDGs and TBGs on demographic and work characteristics, including attitudes toward work, intent to stay in their current job, and whether they are searching for a job. TBGs worked slightly more hours per week and were more likely to provide direct care. SDGs were more likely to plan to stay indefinitely in their first job and were less uncertain of plans to stay. SDGs experienced higher family–work conflict and lower workgroup cohesion. Full-time SDGs earn over $2,700 more income per year. Potential explanations for the salary difference are the greater human capital that SDGs bring to the job and their older age. Understanding the workforce productivity of these two groups is important for both organizational planning and policy for recruitment and retention.