1,721,129 research outputs found
Transformative impact of Magnet designation: England case study
No full textAims:? To test the impact of the implementation of Magnet principles of improving nurses’ work environments.Background:? Magnet hospital designation developed in the USA in the 1980s to recognise hospitals that had created excellent patient care environments and supported the professional practice of nursing. A pilot initiative in England was the first test of the applicability of Magnet standards outside the USA.Methods:? Research methods included surveys of nurses in the demonstration hospital in a predesign and postdesign and comparisons to survey results of nurses practicing in a national sample of 30 National Health Service Trusts.Results:? Prior to beginning the Magnet journey, the demonstration hospital had a nurse work environment that was somewhat less positive than the national sample NHS hospitals. Nurses practicing in the demonstration hospital were somewhat less satisfied with their jobs than nurses in other NHS hospitals. Following a two-year period during which the evidence-based Magnet standards were implemented and Magnet Designation was awarded, the quality of the nurse practice environment had improved significantly, as had job satisfaction of nurses and their appraisals of the quality of patient care. The quality of the nurse practice environment after Magnet designation was better than that of a national sample of NHS trusts. Improved nurse outcomes were because of the improved practice environment rather than staffing enhancements.Conclusions:? Implementation of the Magnet hospital intervention was associated with a significantly improved nursing work environment as well as improved job-related outcomes for nurses and markers for quality of patient care.Relevance to clinical practice:? Nurses can use Magnet principles to improve the quality of their work environment
Patient satisfaction with hospital care and nurses in England: an observational study
No full textObjectives To inform healthcare workforce policy decisions by showing how patient perceptions of hospital care are associated with confidence in nurses and doctors, nurse staffing levels and hospital work environments. Design Cross-sectional surveys of 66 348 hospital patients and 2963 inpatient nurses. Setting Patients surveyed were discharged in 2010 from 161 National Health Service (NHS) trusts in England. Inpatient nurses were surveyed in 2010 in a sample of 46 hospitals in 31 of the same 161 trusts. Participants The 2010 NHS Survey of Inpatients obtained information from 50% of all patients discharged between June and August. The 2010 RN4CAST England Nurse Survey gathered information from inpatient medical and surgical nurses. Main outcome measures Patient ratings of their hospital care, their confidence in nurses and doctors and other indicators of their satisfaction. Missed nursing care was treated as both an outcome measure and explanatory factor. Results Patients' perceptions of care are significantly eroded by lack of confidence in either nurses or doctors, and by increases in missed nursing care. The average number of types of missed care was negatively related to six of the eight outcomes - ORs ranged from 0.78 (95% CI 0.68 to 0.90) for excellent care ratings to 0.86 (95% CI 0.77 to 0.95) for medications completely explained - positively associated with higher patient-to-nurse ratios (b=0.15, 95% CI 0.10 to 0.19), and negatively associated with better work environments (b='0.26, 95% CI '0.48 to '0.04). Conclusions Patients' perceptions of hospital care are strongly associated with missed nursing care, which in turn is related to poor professional nurse (RN) staffing and poor hospital work environments. Improving RN staffing in NHS hospitals holds promise for enhancing patient satisfaction
‘Care left undone’ during nursing shifts: associations with workload and perceived quality of care
No full textBackground There is strong evidence to show that lower nurse staffing levels in hospitals are associated with worse patient outcomes. One hypothesised mechanism is the omission of necessary nursing care caused by time pressure—‘missed care’.Aim To examine the nature and prevalence of care left undone by nurses in English National Health Service hospitals and to assess whether the number of missed care episodes is associated with nurse staffing levels and nurse ratings of the quality of nursing care and patient safety environment.Methods Cross-sectional survey of 2917 registered nurses working in 401 general medical/surgical wards in 46 general acute National Health Service hospitals in England.Results Most nurses (86%) reported that one or more care activity had been left undone due to lack of time on their last shift. Most frequently left undone were: comforting or talking with patients (66%), educating patients (52%) and developing/updating nursing care plans (47%). The number of patients per registered nurse was significantly associated with the incidence of ‘missed care’ (p<0.001). A mean of 7.8 activities per shift were left undone on wards that are rated as ‘failing’ on patient safety, compared with 2.4 where patient safety was rated as ‘excellent’ (p<0.?001).Conclusions Nurses working in English hospitals report that care is frequently left undone. Care not being delivered may be the reason low nurse staffing levels adversely affects quality and safety. Hospitals could use a nurse-rated assessment of ‘missed care’ as an early warning measure to identify wards with inadequate nurse staffing.</p
Development and testing of the ‘Culture of Care Barometer’ (CoCB) in healthcare organisations: a mixed methods study
Full text linkObjective: concerns about care quality have prompted calls to create workplace cultures conducive to high-quality, safe and compassionate care and to provide a supportive environment in which staff can operate effectively. How healthcare organisations assess their culture of care is an important first step in creating such cultures. This article reports on the development and validation of a tool, the Culture of Care Barometer, designed to assess perceptions of a caring culture among healthcare workers preliminary to culture change.Design/setting/participants: an exploratory mixed methods study designed to develop and test the validity of a tool to measure ‘culture of care’ through focus groups and questionnaires. Questionnaire development was facilitated through: a literature review, experts generating items of interest and focus group discussions with healthcare staff across specialities, roles and seniority within three types of public healthcare organisations in the UK. The tool was designed to be multiprofessional and pilot tested with a sample of 467 nurses and healthcare support workers in acute care and then validated with a sample of 1698 staff working across acute, mental health and community services in England. Exploratory factor analysis was used to identify dimensions underlying the Barometer.Results: psychometric testing resulted in the development of a 30-item questionnaire linked to four domains with retained items loading to four factors: organisational values (α=0.93, valid n=1568, M=3.7), team support (α=0.93, valid n=1557, M=3.2), relationships with colleagues (α=0.84, valid n=1617, M=4.0) and job constraints (α=0.70, valid n=1616, M=3.3).Conclusions: the study developed a valid and reliable instrument with which to gauge the different attributes of care culture perceived by healthcare staff with potential for organisational benchmarking
Values and workplace expectations to facilitate retention: perspectives from nurses at two ends of the career spectrum
Full text linkBackground: Nursing shortages are detrimental to healthcare services due to the loss of skills and experience in patient care. In England, the retention of NHS nurses in their early- and late-career stages is of particular interest because they have the highest leaver rates. Aim: To explore in detail what early- and late-career NHS nurses value and expect from their employers to retain them in their jobs and the profession. Insights from nurses at two ends of the career spectrum could offer a new perspective and shed light on seemingly persistent and detrimental factors for retention. Methods: Semistructured focus groups and interviews, using Microsoft Teams, were conducted between April 2023 and February 2024 with early-career nurses (i.e., first registration between 2019 and 2024) and late-career nurses (i.e., 55 years and over). We also analysed open-text comments from a related survey (2023), which explored nurses' working lives and retention. Results: 27 nurses participated in the qualitative study, and 784 nurses provided open-text comments from the cross-sectional survey. Except for tailored support when entering the profession and adequate remuneration when leaving nursing, the organisational factors cited by nurses as key to their retention were similar for both groups. Some of these 'persistent' factors potentially detrimental to retention across both groups included a negative work culture, lack of adequate resources and limited opportunities for career development. Perceived inadequate remuneration should not be underestimated either. Conclusion: Support from the leadership team and/or colleagues seems to partially alleviate the stress of working in strenuous environments. However, addressing 'persistent' and detrimental organisational factors throughout nurses' careers should continue to be a priority to retain them, safeguard their well-being and enable them to deliver the standard of care they aspire to. Nursing Management Implications: The findings have significant implications for improving the retention of early- and late-career NHS nurses
Front-line management, staffing and nurse–doctor relationships as predictors of nurse and patient outcomes. A survey of Icelandic hospital nurses
No full textObjective: To investigate aspects of nurses' work environments linked with job outcomes and assessments of quality of care in an Icelandic hospital. Background: Prior research suggests that poor working environments in hospitals significantly hinder retention of nurses and high quality patient care. On the other hand, hospitals with high retention rates (such as Magnet hospitals) show supportive management, professional autonomy, good inter-professional relations and nurse job satisfaction, reduced nurse burnout and improved quality of patient care. Methods: Cross-sectional survey of 695 nurses at Landspitali University Hospital, Reykjavik. Nurses' work environments were measured using the nursing work index-revised (NWI-R) and examined as predictors of job satisfaction, the Maslach burnout inventory (MBI) and nurse-assessed quality of patient care using linear and logistic regression approaches. Results: An Icelandic adaptation of the NWI-R showed a five-factor structure similar to that of Lake (2002). After controlling for nurses' personal characteristics, job satisfaction, emotional exhaustion and nurse rated quality of care were found to be independently associated with perceptions of support from unit-level managers, staffing adequacy, and nurse-doctor relations. Conclusions: The NWI-R measures elements of hospital nurses' work environments that predict job outcomes and nurses' ratings of the quality of patient care in Iceland. Efforts to improve and maintain nurses' relations with nurse managers and doctors, as well as their perceptions of staffing adequacy, will likely improve nurse job satisfaction and employee retention, and may improve the quality of patient care
Registered nurse, health care support worker, medical staffing levels and mortality in English Hospital Trusts: a cross-sectional study
Full text linkObjectives: To examine associations between mortality and registered nurse (RN) staffing in English hospital trusts taking account of medical and healthcare support worker (HCSW) staffing.Setting: Secondary care provided in acute hospital National Health Service (NHS) trusts in England.Participants: Two data sets are examined: Administrative data from 137 NHS acute hospital trusts (staffing measured as beds per staff member). A cross-sectional survey of 2917 registered nurses in a subsample of 31 trusts (measured patients per ward nurse).Outcome measure: Risk-adjusted mortality rates for adult patients (administrative data).Results: For medical admissions, higher mortality was associated with more occupied beds per RN (RR 1.22, 95% CI 1.04 to 1.43, p=0.02) and per doctor (RR 1.10, 95% CI 1.05 to 1.15, p <0.01) employed by the trust whereas, lower HCSW staffing was associated with lower mortality (RR 0.95, 95% CI 0.91 to 1.00, p=0.04). In multivariable models the relationship was statistically significant for doctors (RR 1.08, 95% CI 1.02 to 1.15, p=0.02) and HCSWs (RR 0.93, 95% CI 0.89 to 0.98, p<01) but not RNs (RR 1.14, 95% CI 0.95 to 1.38, p=0.17). Trusts with an average of ?6 patients per RN in medical wards had a 20% lower mortality rate compared to trusts with >10 patients per nurse (RR 0.80, 95% CI 0.76 to 0.85, p<0.01). The relationship remained significant in the multivariable model (RR 0.89, 95% CI 0.83 to 0.95, p<0.01). Results for surgical wards/admissions followed a similar pattern but with fewer significant results.Conclusions: Ward-based RN staffing is significantly associated with reduced mortality for medical patients. There is little evidence for beneficial associations with HCSW staffing. Higher doctor staffing levels is associated with reduced mortality. The estimated association between RN staffing and mortality changes when medical and HCSW staffing is considered and depending on whether ward or trust wide staffing levels are considered
Cleanliness costs: identifying associations between infection and length of stay in post-war hospitals
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