Caroline Marchionni

Creating a Healthy Workplace for New-Generation Nurses

PURPOSE To examine dimensions of the psychosocial work environment that influence the psychological health of new-generation nurses. BACKGROUND While much work has been done concerning the health of nurses in general, research on the relationship between the nursing work environment and the psychological well-being of new-generation nurses at the start of their careers is limited. DESIGN A correlational descriptive design was used for this quantitative study. Survey data were collected from new nurses (N=309) whose names were obtained from a provincial licensing registry in Quebec, Canada. FINDINGS Among new nurses, 43.4% stated that they have a high level of psychological distress. These nurses were significantly more likely to perceive an imbalance between effort expended on the job and rewards received, low decisional latitude, high psychological demands, high job strain, as well as low social support from colleagues and superiors (p < or = 0.05). CONCLUSIONS Understanding the relationship between the work environment and health as experienced by new-generation nurses is imperative for creating interventions to successfully recruit and retain these young nurses. CLINICAL RELEVANCE Generation Y nurses in Quebec, faced with high levels of psychological distress because of their exposure to difficult nursing work environments, might leave the profession thereby exacerbating an already salient nursing shortage.

‘If we can't do more, let's do it differently!': using appreciative inquiry to promote innovative ideas for better health care work environments

AIM To examine the use of appreciative inquiry to promote the emergence of innovative ideas regarding the reorganization of health care services. BACKGROUND With persistent employee dissatisfaction with work environments, experts are calling for radical changes in health care organizations. Appreciative inquiry is a transformational change process based on the premise that nurses and health care workers are accumulators and producers of knowledge who are agents of change. METHODS A multiple embedded case study was conducted in two interdisciplinary groups in outpatient cancer care to better understand the emergence and implementation of innovative ideas. RESULTS The appreciative inquiry process and the diversity of the group promoted the emergence and adoption of innovative ideas. Nurses mostly proposed new ideas about work reorganization. Both groups adopted ideas related to interdisciplinary networks and collaboration. A forum was created to examine health care quality and efficiency issues in the delivery of cancer care. CONCLUSION This study makes a contribution to the literature that examines micro systems change processes and how ideas evolve in an interdisciplinary context. IMPLICATIONS FOR NURSING MANAGEMENT The appreciative inquiry process created an opportunity for team members to meet and share their successes while proposing innovative ideas about care delivery. Managers need to support the implementation of the proposed ideas to sustain the momentum engendered by the appreciative inquiry process.

The needs and expectations of generation Y nurses in the workplace.

Generation Y nurses represent the new nursing workforce. This article describes a study examining the needs, motivations, and expectations of generation Y nurses at the start of their careers. New nurses, on average 24.1 years old in 2007, were interviewed. The generation Y nurses reported that recognition was a key motivator. Their needs are stability, flexible work schedules and shifts, recognition, opportunities for professional development, and adequate supervision.

Impact of a Pivot Nurse in Oncology on Patients With Lung or Breast Cancer: Symptom Distress, Fatigue, Quality of Life, and Use of Healthcare Resources

PURPOSE/OBJECTIVES To examine the impact on continuity of nursing care delivered by a pivot nurse in oncology to improve symptom relief and outcomes for patients with lung or breast cancer. DESIGN Randomized controlled trial in which participants were randomly assigned to an intervention group (n = 93) with care by a pivot nurse in oncology and usual care by clinic nurses or to a control group (n = 97) with usual care only. SETTING Three outpatient ambulatory oncology clinics in a large university health center in Quebec, Canada. SAMPLE 113 patients with lung cancer and 77 patients with breast cancer. METHODS Participants in both groups completed the Symptom Distress Scale, Brief Fatigue Inventory, and Functional Assessment of Cancer Therapy Scale-General version 4 at eight intervals over six months. Healthcare usage was evaluated through a review of hospital records. MAIN RESEARCH VARIABLES Symptom distress, fatigue level, quality of life, and healthcare usage. FINDINGS Researchers found no significant differences in symptom distress, fatigue, quality of life, and healthcare usage between groups. CONCLUSIONS The new nursing role did not have an impact on the patient outcomes under study. IMPLICATIONS FOR NURSING Experienced nurses with specialized knowledge of oncology symptom assessment and management may reduce the symptom burden experienced by ambulatory patients with breast or lung cancer during active treatment.

Turnover intention among new nurses: a generational perspective.

With the current nursing shortage, it is crucial to understand the aspects of the nursing work environment that are related to turnover in new generation nurses. The Practice Environment Scale of the Nursing Work Index was administered to new nurses in Quebec from different generations to determine what domains of the work environment were related to turnover intention. Results can help nurses in leadership and development positions target interventions to retain new graduates.

Implementation of Evidence-Based Practices in the Context of a Redevelopment Project in a Canadian Healthcare Organization

PURPOSE The recent introduction of a project management office (PMO) in a major healthcare center, led by a nurse, provides a unique opportunity to understand how a PMO facilitates successful implementation of evidence-based practices in care delivery. DESIGN A case study with embedded units (individuals, projects, and organization). In this study, the case is operationally defined as the PMO deployed in a Canadian healthcare center. METHODS The sources of evidence used in this study were diverse. They consisted of 38 individual interviews, internal documents, and administrative data. The data were collected from March 2009 to November 2011. Content analysis was used to analyze the qualitative data. FINDINGS PMO experts help improve practices, and the patients thus receive safer and better quality care. Several participants point out that they could not make the changes without the PMOs support. They mention that they succeeded in changing their practices based on the evidence and acquired knowledge of change management with the PMO members that can be transferred to their practice. CONCLUSIONS With the leadership of the nurse director of the PMO, members provide a range of expertise and fields in evidence-based change management, project management, and evaluation. CLINICAL RELEVANCE PMO facilitates the implementation of clinical and organizational practices based on evidence to improve the quality and safety of care provided to patients.

The project management office: Transforming healthcare in the context of a hospital redevelopment project

It has been shown that classifying projects into a typology allows improved allocation of resources and promotes project success. However, a typology of healthcare projects has yet to be developed. The projects encountered by the Transition Support Office at the McGill University Health Centre in Montreal, Quebec, where a major redevelopment project is under way, were classified into a typology unique to the healthcare context. Examples of the 3 project types, Process, People, and Practice, are provided to clarify the specific support strategies and context-adapted interventions that were instrumental to their success.

Bringing knowledge to action in the context of a major organizational transition.

In the context of organizational transitions in health care institutions, the decisions taken by leaders and clinicians are informed by multiple sources and by a multitude of actors at all levels of the organization. A study was conducted in the context of a major organizational transition at the McGill University Health Centre in Montreal, Quebec, Canada. The purpose was to examine the body of literature around the notions of “evidence” in decision-making processes in health care. Key informants who had a strategic decision-making role linked to the transition activities were interviewed to explore their perceptions of the types of evidence used to support changes in the organization. Results revealed that managers and clinicians relied on multiple sources of evidence and shared similar concerns about reliability and validity of scant evidence.