Barbara L. Wilson

Job satisfaction among a multigenerational nursing workforce

AIM To explore generational differences in job satisfaction. BACKGROUND Effective retention strategies are required to mitigate the international nursing shortage. Job satisfaction, a strong and consistent predictor of retention, may differ across generations. Understanding job satisfaction generational differences may lead to increasing clarity about generation-specific retention approaches. METHOD The Ontario Nurse Survey collected data from 6541 Registered Nurses. Participants were categorized as Baby Boomer, Generation X or Generation Y based on birth year. Multivariate analysis of variance explored generational differences for overall and specific satisfaction components. RESULTS In overall job satisfaction and five specific satisfaction components, Baby Boomers were significantly more satisfied than Generations X and Y. CONCLUSION It is imperative to improve job satisfaction for younger generations of nurses. IMPLICATIONS FOR NURSING MANAGEMENT Strategies to improve job satisfaction for younger generations of nurses may include creating a shared governance framework where nurses are empowered to make decisions. Implementing shared governance, through nurse-led unit-based councils, may lead to greater job satisfaction, particularly for younger nurses. Opportunities to self schedule or job share may be other potential approaches to increase job satisfaction, especially for younger generations of nurses. Another potential strategy would be to aggressively provide and support education and career-development opportunities.

Bullies at work: the impact of horizontal hostility in the hospital setting and intent to leave.

The phenomenon of bullying or peer incivility in nursing is not new or confined to nurses. Behaviors consistent with horizontal hostility (HH) range from overt behavioral manifestations such as infighting among nurses; sabotage (where pertinent information is intentionally withheld); passive-aggressive behavior; eye rolling in response to a question; or verbal remarks that are snide, rude, and demeaning, to more covert behaviors including failure to respect confidences and privacy. Horizontal hostility can lead to profound and long-lasting effects, including diminished productivity and increased absenteeism. This study surveyed RNs at a community hospital in the Southwest to determine (a) the degree of HH in the workplace and (b) the extent that the perception of HH affected ill calls and the likelihood of leaving their current position. The authors make recommendations about the prevention, identification, and handling of HH behaviors.

Creative approaches to increasing hospital-based nursing research.

Magnet®-designated and aspiring hospitals use research and evidence-based practice initiatives to demonstrate new knowledge and innovation, a key component of the Magnet Recognition Program®. Four creative approaches to supporting and conducting institutional nursing research and the implementation of evidence-based care are illustrated, along with examples of successful nurse staff-led projects.

Reflections on Meeting Women's Childbirth Expectations

When care providers support their personal worth, use caring communication, facilitate consumer participation in decision making, seek optimal outcomes, and know the patient holistically, female patients feel that their dignity is respected. We compare womens expectations for dignified care in contemporary society with the expectations of women 40 years ago. Some progress has been made toward valuing womens voices and participation in decision making, the availability of interventions for optimal outcomes, and recognition of the importance of cultural competence. Continued work is needed to meet womens expectations for receiving individualized and tailored care, information about intervention effectiveness and risks, and support for the birth process that the family desires. A renewed focus on the recipient of care as a coparticipant in her birthing experiences may result in improved outcomes and resolution of tensions between childbearing women and sociopolitical forces and standards of care.

Duration of Maternal Stress and Depression: Predictors of Newborn Admission to Neonatal Intensive Care Unit and Postpartum Depression.

BackgroundMaternal psychosocial factors contribute to adverse pregnancy outcome, but very few studies have assessed associations of duration and experiences of stress, depression, and intimate partner violence (IPV) with maternal and newborn outcomes. ObjectivesIt was hypothesized that duration and level of maternal stress, depression, and IPV would predict increased risk of adverse maternal/newborn outcomes. MethodsA secondary data analysis of a population-based data set collected by the Utah Department of Health Pregnancy Risk Assessment and Monitoring System and birth certificates for 4682 live births was conducted, reflecting a total population size of 143,373 live births in 2009–2011. Exposures of interest were experiences and duration of maternal stress, depression, and IPV before and during pregnancy. Outcomes were gestational age, birth weight, newborn admission to the neonatal intensive care unit (NICU), and postpartum depression (PPD) symptoms and diagnosis. ResultsAfter controlling for maternal demographics, body mass index, and smoking, women with greater duration of depression before and during pregnancy showed an increase in admission of their newborn to NICU (adjusted odds ratios [aORs] = 1.66–2.48, p < .001), PPD symptoms (aORs = 3.94–9.13, p < .001), and diagnosis of PPD (aORs = 7.72–59.60, p < .001). More kinds of experiences of maternal stress were associated with higher odds of PPD symptoms (aORs = 1.34–5.51, p < .001), but not PPD diagnosis or NICU admissions. DiscussionLonger lasting maternal depression and stress are associated with poorer outcomes for mothers and newborns. Future prospective studies should evaluate the usefulness of preconception and continuous prenatal risk identification of maternal depression and stress. This would facilitate timely psychosocial interventions as an approach to improving maternal/newborn outcomes for these higher risk women.

Horizontal hostility: a threat to patient safety.

Objective: The objective of this study was to determine the perceived level of horizontal hostility (HH) in a 220-bed acute care community hospital and whether the threat of or experience with HH influenced nurse behaviors directly related to patient safety. Background: While the acknowledgement and presence of HH in nursing are gaining prominence, little is known about how a nurse’s experience with HH directly influences his/her actions with patients under their care, even when the nurse realizes these actions may not be in the patient’s best interest. Methods: We used a 28-item survey tool aimed at determining the level of perceived HH in an acute care Magnet-aspiring hospital in the Southwest and then asked about nurses’ actions as a result of that experience. Almost 500 nurses were surveyed over a 2-month period in 2011. Results: Of the nurses who had personally experienced HH, a high number reported performing interventions or actions that could compromise patient care and/or safety, including (a) failing to clarify an unreadable order, (b) lifting or ambulating heavy or debilitated patients without assistance rather than asking for help, (c) using an unfamiliar piece of equipment without asking for clarification, and (d) carrying out an order that the nurse did not believe was in the best interest of the patient, among other behaviors. Conclusion: The presence of HH has clear implications for patient safety. Recommendations for addressing and managing HH are provided and geared to the hospital leadership level.

Bladder Management With Epidural Anesthesia During Labor: A Randomized Controlled Trial.

Purpose:Many labor nurses routinely include continuous urinary catheterization (CC) as part of their standard care for women who receive intrapartum epidural anesthesia, to prevent urinary retention, thought to delay fetal descent. Recent studies question use of CCs during labor, as they may predispose patients to urinary tract infections (UTIs), even though the catheters are in place for a relatively short period of time. The objective of this study was to determine the influence of CCs versus intermittent catheters (ICs) (only as needed) on the duration of second stage of labor and the incidence of postpartum UTIs. Study Design and Methods:Randomized controlled trial. English-speaking low-risk nulliparous women ≥37 weeks gestation with a single fetus in a vertex presentation who requested an epidural were eligible for participation. Prior to epidural placement, cervical status was documented, women were encouraged to void, and then women were randomized to receive either CC or IC as the method for urinary bladder management for the duration of the first stage of labor. Final sample size included 123 participants; 55 in the CC group and 68 in the IC group. Results:No differences were noted in length of second stage labor, and the overall incidence of UTIs in both groups was low. There was a significantly increased likelihood of cesarean birth in women who had CC (P < .01) when compared to women who had IC. The overall cesarean rate in the CC group was 27.3%, versus 10.3% in the IC group. Clinical Implications:Intermittent catheterization only as needed appears to be best practice for bladder management for laboring women with an epidural. There was a significantly higher rate of cesarean birth among women in the CC group. The relationship between route of birth and use of continuous indwelling urinary catheters for women in labor with epidurals for pain relief needs more study.

A modified measure of health care disparities applied to birth weight disparities and subsequent mortality

We describe how a modified Gini index serves as an improved method of estimating health care disparities. The method, although general, is applied to an example of birth weight disparities and to their effect on subsequent mortality. The method provides the between-group results obtainable from current methods (i.e. how Hispanics generally fare relative to non-Hispanic Whites) but adds measures of within-group disparities (i.e. which specific Hispanics experience the greatest disparate treatment). Our application to birth weights and receipt of prenatal care, which may provide an upper bound because of omitted variables, shows that the time-of-birth disparities are associated with increased infant mortality within the first year of life.

Using human factors engineering in designing and assessing nursing personnel responses to mock code training.

Because timely and efficient responses of nurses are paramount to patient survival in cardiac and respiratory codes, it is crucial to determine best methods of training nursing personnel to respond effectively to code situations. Human factors engineering (HFE) is a relatively new approach in health care that attempts to understand human vulnerabilities that contribute to error and then design systems that minimize the likelihood of error occurring. This study embedded the principles of HFE in the design, implementation, and evaluation of mock code training to determine whether mock codes using HFE were helpful and if so, which inpatient units would benefit the most from such drills.

Keeping an eye on patient safety using human factors engineering (HFE): a family affair for the hospitalized child.

Barbara L. Wilson Column Editor: Bonnie Gance-Cleveland Family-Centered Care provides a forum for sharing information about basic components of caring for children and families, including respect, information sharing, collaboration, family-to-family support, and confidence building.