Merja Miettinen

The Job Satisfaction of Finnish Nursing Staff: The Development of a Job Satisfaction Scale and Survey Results

This paper describes the development of the Kuopio University Hospital Job Satisfaction Scale (KUHJSS) and the results of the survey. The scale was developed through a systematic literature review, and its validity and reliability were assessed using several psychometric properties including expert evaluation (n = 5), a pilot survey (n = 172), and exploratory factor analysis. The final version of KUHJSS included 37 items. A large sample psychometric evaluation was made by nursing staff (n = 2708). The exploratory factor analysis revealed seven factors with modest internal consistency (0.64–0.92). The staff reported relatively high job satisfaction. The greatest satisfaction was derived from motivating factors associated with the work; the least, from the jobs demands. Respondents who considered their working units to provide an excellent quality of care reported the highest job satisfaction in every subarea (P < .0001). The KUHJSS proved to be a reliable and valid tool for measuring job satisfaction in hospital care.

Patient safety culture in acute care: A web-based survey of nurse managers' and registered nurses' views in four Finnish hospitals

Nurse managers (NMs) and registered nurses (RNs) have key roles in developing the patient safety culture, as the nursing staff is the largest professional group in health-care services. We explored their views on the patient safety culture in four acute care hospitals in Finland. The data were collected from NMs (n = 109) and RNs (n = 723) by means of a Hospital Survey on Patient Safety Culture instrument and analyzed statistically. Both groups recognized patient safety problems and critically evaluated error-prevention mechanisms in the hospitals. RNs, in particular, estimated the situation more critically. There is a need to develop the patient safety culture of hospitals by discussing openly about them and learning from mistakes and by developing practices and mechanisms to prevent them. NMs have central roles in developing the safety culture at the system level in hospitals in order to ensure that nurses caring for patients do it safely.

Changes in Transformational Leadership and Empirical Quality Outcomes in a Finnish Hospital over a Two-Year Period: A Longitudinal Study

This paper describes the changes in transformational leadership and quality outcomes that occurred between 2008 and 2011 in a Finnish university hospital that is aiming to meet the Magnet standards. Measurements were conducted in 2008-2009 and subsequently in 2010-2011 by surveying nursing staff and patients. Nursing staff were surveyed using web-based surveys to collect data on transformational leadership (n 1 = 499, n 2 = 498) and patient safety culture (n 1 = 234, n 2 = 512) and using both postal and web-based surveys to gather information on job satisfaction (n 1 = 1176, n 2 = 779). Questionnaires were used to collect data on care satisfaction from patients (n 1 = 678, n 2 = 867). Transformational leadership was measured using the 54-item TLS, job satisfaction with the 37-item KUHJSS, patient safety culture with the 42-item HSPSC, and patient satisfaction using the 42-item RHCS questionnaire. Transformational leadership, which was the weakest area, was at the same level between the two measurement occasions. Job satisfaction scores increased between 2008 and 2010, although they were generally excellent in 2008. The scores for nonpunitive responses to errors and events reported were also higher in the 2010-2011 surveys. The highest empirical outcome scores related to patient satisfaction. The project and the development initiatives undertaken since 2008 seem to have had positive effects on empirical quality outcomes.

An integrative review of a preoperative nursing care structure.

AIMS AND OBJECTIVES The aims of this integrative literature review are to define the role of a preoperative nurse and to describe the main components and hypothetical outcomes of a preoperative nursing care structure before a surgical patient arrives to an elective procedure. BACKGROUND The development of medical care has impacted surgical processes, and patients are now spending less time in hospital settings. Patients often enter the hospital on the day of a procedure and are discharged as soon as it is medically safe, creating challenges for nursing care. Preoperative clinics have been opened, and the importance of preoperative nursing care has been widely understood. Previous literature has provided descriptions about the roles, tasks and outcomes of preoperative nurses; however, the terminology is heterogeneous, and the optimal model remains unknown. DESIGN A systematic procedure for searching, selecting, and evaluating the literature was followed. The data were collected from PubMed and CINAHL between 1 January 2004 and 20 September 2014. In total, 41 articles were included in the study and were analysed by qualitative inductive content analysis. RESULTS The data provided seven main tasks of a preoperative nurse, tools to support preoperative nursing and outcomes of structured preoperative nursing care. CONCLUSION A preoperative nurse is a specialised coordinator of patient care, and the main purposes of this role are to meet the patients and the familys needs individually and to prepare them for the scheduled procedure and postoperative recovery. By following the structure of the seven main tasks and using different supportive tools, preoperative nursing can positively impact patient and provider satisfaction, patient safety, quality of care and cost savings. RELEVANCE TO CLINICAL PRACTICE A preoperative nursing care structure should be implemented in clinical practice and then evaluated to measure whether the hypothetical outcomes reported in this literature review can be achieved.

The relationship between nurse staffing and length of stay in acute-care: a one-year time-series data

AIM To examine the relationship between nurse staffing and patient length of stay in an acute-care hospital over a 1-year period. BACKGROUND Although there has been prior research on the relationship between nurse staffing and length of stay in acute-care hospitals, there is a need for more information on how nurse staffing is related to length of stay longitudinally. METHODS Retrospective time-series registry data from 20 acute-care inpatient units of a Finnish university hospital as a monthly time series in 2008 were analysed by linear mixed models. RESULTS The ratio of registered nurses to all nurses was 72.4%. Nurses worked mainly (96%) full time, and 63% had permanent employment contracts. Statistically significant variation was found in time series of five variables. Statistically significant relationships were found between length of stay and patient acuity, diagnosis-related group-volume, census and nursing hours per patient day at the unit level. Nursing hours per patient day had the strongest correlation with length of stay. CONCLUSION AND IMPLICATIONS FOR NURSING MANAGEMENT A rational response to the variations in patient care needs and intensity in the complex care environment is flexible nurse staffing. Increasing nursing hours per patient day to achieve shorter length of stays is not the only solution, well-functioning care processes are also essential.

Evidence-based practice in a hospital setting in Finland – the organization and activities

Background:Evidence-based practice (EBP) is a major paradigm of health care and policy worldwide. In nursing, the transformation has not been very fast due to the challenges in closing the gap between clinical practice and research; this is the case in Finland, too. There is evidence gained from many research studies in nursing that major factors affecting EBP include lack of knowledge and skills, as well as lack of organization or understanding how to support nurses in EBP. Objective:The aim of this presentation is to describe the development of EBP in nursing; how it has been organized and what the activities are organized and followed as suggested in Magnet Hospitals. Methods:Discussion paper based on an example from one of the five university hospital with 800 beds in Finland. Results:EBP in nursing was organized following Magnet Hospital system in an university hospital with 800 beds. A council for EBP was initiated and formed in 2010. The council consists of frontline clinical nurses, nurse directors, teachers, researchers and representative of the nursing leadership. The purpose of the council is to advance EBP in patient care and management, support the use of research and other evidence by organizing systematic education to nurses and leaders, JBI guidelines, information retrieval, journal clubs and learning from the best practices. EBP tutors and mentors started their work in 2013 in the units. Several activities are on the way, e.g. preventing patients’ falls, pain management, hygiene and continuing education of EBP to nurse leaders and frontline nurses. The council is a part of the hospitals Nursing Development, Teaching and Research Unit (NDTRU) lead by chief nursing officer. Discussion:Organizing EBP in clinical practice should be sysematic and well organized. Conclusion:Since 2010, EBP has evolved and the interest among practicing nurses has increased. Results of the activity should be measured in a reliable way.

Elective Surgery Cancellations During the Time Between Scheduling and Operation

Purpose Surgery cancellations cause harm to patients, extra work for preoperative staff, and financial loss for organizations. Day of surgery cancellations are a widely used indicator for operative effectiveness, but there is a lack of knowledge concerning the effects of cancellations during earlier stages of a patients preoperative waiting period. The purpose of this study was to measure the reasons, frequencies, and timing of elective surgery cancellations after scheduling. Design Qualitative prospective follow‐up study. Methods Data were collected during a 2‐month period in 13 operative specialties by a semistructured follow‐up form and analyzed by inductive content analyses and statistical methods. Findings Most of the cancellations occurred before the day of surgery and appeared because patients were not in a suitable condition for the planned operation or because of lack of organizational resources. Conclusions More attention should be focused on patients’ suitability and organizational resources in earlier stages of preoperative period.

Tietorakenteet potilaan hoitotietojen kirjaamisessa – Case hoitotyön yhteenveto

The aim of this study was to evaluate how the data structure of a national nursing discharge summary and the contents of nursing records of a transferring patient were followed within nursing discharge summaries. In this study, we described the overlapping data structures of nursing discharge summaries that had been compiled by both nurses and doctors. In addition, we described what other data structures were used. The data (N=87) were collected from the electronic patient record system in electronic format from nine inpatient wards of the research organization. The data were analyzed by calculating the frequencies and percentages of the use of data structures. The link between the different headings of the data was tested with the chi-square test and the odds rations were calculated to describe the strength of association between headings. According to the results, although the national data structure of the nursing discharge summary was used well, its use was not systematic within the same summary, and regional content titles were only partially used. Overlapping data structures were used in both nursing discharge summaries and medical summaries. Non-structured designs, which do not belong to the national structure, were also used. Therefore, health care electronic data structures must be further developed to ensure uniform completion per the determined data structure. In addition, health care professionals must be thoroughly trained to use the determined data structures; patients require uniform summaries that contain clear and usable information to support their own treatment.