Mélanie Lavoie-Tremblay

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.

Boundary work and the introduction of acute care nurse practitioners in healthcare teams

AIM This article is a report of a study of boundary work following the introduction of an acute care nurse practitioner role in healthcare teams. BACKGROUND Acute care nurse practitioners enacting their roles in healthcare teams have faced a number of challenges including a mix of positive and negative views of the acute care nurse practitioner role from healthcare team members and acute care nurse practitioner roles crossing the boundaries between the medical and nursing professions. Understanding the process by which the boundaries between professions changed following the introduction of an acute care nurse practitioner role was important since this could affect scope of practice and the teams ability to give patient care. METHODS The study was conducted in two university-affiliated teaching hospitals in Canada. A descriptive multiple case study design was used. Data were collected from March to May 2009. RESULTS Participants (N = 59) described boundary work as a process that included: (1) creating space; (2) loss of a valued function; (3) trust; (4) interpersonal dynamics; and (5) time. The development of trust among team members was essential. The co-location of team members working on common projects, and medical and nursing leadership facilitated boundary work. CONCLUSION The micro-level processes of boundary work in healthcare teams have important implications for the development of full scope of practice for acute care nurse practitioners, effective inter-professional teamwork and the integration of new roles in healthcare systems. Future research needs to be undertaken in different contexts, and with patients and families.

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.

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.

Shiftwork: what health care managers need to know.

Shiftwork is one of health care workers oldest problems and is known to have important implications on health. Health risks are compounded with age and the amount of cumulated shiftwork. No shift system is clearly advantaged, yet the workers ability to choose the shift system seems to maximize adaptation to shiftwork. When designing a work schedule, it is important to take into consideration the shift pattern, length of the shift, and the number of consecutive days worked. A poorly designed work schedule can impact the quality of care, the personal and professional outcomes for health care workers, patient satisfaction, length of stay, unplanned absenteeism, cost effectiveness, and productivity. Long-term studies of shiftworkers may disproportionately represent workers who have adapted to shiftwork. Self-scheduling is an interesting alternative in the quest for a more responsive work environment and is a strategy for retention among new, mid-career, and senior nurses. Planned on-site napping may be a useful tool to combat the pernicious effects of sleep debt on performance. Guidelines must be developed and initiatives implemented and evaluated to protect health care workers, especially older female shiftworkers, from the negative impact of shiftwork as they represent a precious resource in a shrinking supply.

Contribution of the psychosocial work environment to psychological distress among health care professionals before and during a major organizational change.

The aim of this study was to investigate the relationships between 4 dimensions of the psychosocial work environment (psychological demands, decision latitude, social support, and effort-reward) among health care professionals as well as their psychological distress during a reorganization process. A correlational descriptive design was used for this quantitative study. A total of 159 health care professionals completed the questionnaire at T1, and 141 at T2. First, before the work reorganization, effort-reward imbalance was the sole variable of the psychological work environment that significantly predicted psychological distress. Second, the high overall level of psychological distress increased during the process of organizational change (from T1 to T2). Finally, effort-reward imbalance, high psychological demands, and low decision latitude were all significant predictors of psychological distress at T2, during the organizational change. In conclusion, to reduce the expected negative outcomes of restructuring on health care practitioners, managers could increase the number of opportunities for rewards, carefully explain the demands, and clarify the tasks to be performed by each of the employees to reduce their psychological burden and increase their perceptions of autonomy.

Pluralism in PMO performance: The case of a PMO dedicated to a major organizational transformation

The focus of this article is on the contribution made by the project management office (PMO) to organizational performance. It explores the particular case of a PMO dedicated to a major organizational transformation within a Canadian university hospital. The national government has asked hospitals to provide strict control over their budgets through implementing strong governance mechanisms. How can PMO performance be assessed within this context? Perception of two different groups has been analyzed within a competing values framework, allowing for a combination of four different performance conceptions. Results show certain similarities in the barriers to PMO performance but, most importantly, they reveal that between the two groups a paradox exists regarding what is valued in PMO performance. Results bring empirical evidence of the application of the competing values framework to the health care sector, but also to a wide variety of industries, public or private.

Transformational and abusive leadership practices: impacts on novice nurses, quality of care and intention to leave.

AIMS To investigate the impact of nurse managers exercising transformational vs. abusive leadership practices with novice nurses. BACKGROUND In a nursing shortage context, it is important to understand better the factors that potentially influence the retention of nurses in the early stages of their career. A large body of research has found that transformational leadership practices have a positive influence on employee functioning. However, very little research exists about the detrimental impact of abusive leadership practices, much less in a nursing context. DESIGN A cross-sectional design where 541 nurses from the province of Quebec (Canada) were questioned in the fall of 2013. METHODS A self-administered questionnaire was completed by nurses with less than five years of nursing experience. RESULTS Results from three linear regression analysis indicated that transformational leadership practices potentially lead to high quality care and weak intention to quit the healthcare facilities. Conversely, abusive leadership practices potentially lead to poorer quality care and to strong intention to quit the healthcare facilities and the nursing profession. CONCLUSION Paying close attention to the leadership practices of nurse managers could prove effective in improving patient care and increasing the retention of new nurses, which is helpful in resolving the nursing shortage. Our results specifically suggest not only that we promote supportive leadership practices (transformational leadership) but, most of all, that we spread the word that abusive leadership creates working conditions that could be detrimental to the practice of nursing at career start.

Psychosocial Work Environment and Prediction of Quality of Care Indicators in One Canadian Health Center

BACKGROUND Few studies link organizational variables and outcomes to quality indicators. This approach would expose operant mechanisms by which work environment characteristics and organizational outcomes affect clinical effectiveness, safety, and quality indicators. QUESTION What are the predominant psychosocial variables in the explanation of organizational outcomes and quality indicators (in this case, medication errors and length of stay)? The primary objective of this study was to link the fields of evidence-based practice to the field of decision making, by providing an effective model of intervention to improve safety and quality. METHODS The study involved healthcare workers (n = 243) from 13 different care units of a university affiliated health center in Canada. Data regarding the psychosocial work environment (10 work climate scales, effort/reward imbalance, and social support) was linked to organizational outcomes (absenteeism, turnover, overtime), to the nurse/patient ratio and quality indicators (medication errors and length of stay) using path analyses. RESULTS The models produced in this study revealed a contribution of some psychosocial factors to quality indicators, through an indirect effect of personnel- or human resources-related variables, more precisely: turnover, absenteeism, overtime, and nurse/patient ratio. Four perceptions of work environment appear to play an important part in the indirect effect on both medication errors and length of stay: apparent social support from supervisors, appreciation of the workload demands, pride in being part of ones work team, and effort/reward balance. CONCLUSIONS This study reveals the importance of employee perceptions of the work environment as an indirect predictor of quality of care. Working to improve these perceptions is a good investment for loyalty and attendance. In general, better personnel conditions lead to fewer medication errors and shorter length of stay.

How to facilitate the orientation of new nurses into the workplace.

The orientation of new nursing graduates into the workplace is an impressive challenge. A research study was performed to identify the key elements of a program that would address the various issues regarding this orientation. A team of researchers from Laval University and the Centre Hospitalier Universitaire de Quebec (CHUQ) used a descriptive and participative research method and identified five key elements that must be considered in order for this orientation to succeed.