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AnteayerJournal of Nursing Scholarship

Issue Information

Journal of Nursing Scholarship, Volume 53, Issue 4, Page 387-390, July 2021.

The Great Unmasking of 2021

Journal of Nursing Scholarship, Volume 53, Issue 4, Page 391-392, July 2021.

The Relationship Between Emotional Intelligence and Nurse–Nurse Collaboration

Abstract

Purpose

The purpose of this study was to examine the relationship between emotional intelligence and nurse–nurse collaboration among registered nurses in Jordan.

Design

This study used a cross-sectional, quantitative survey design to query 342 nurses who worked in two hospitals in Jordan.

Methods

We used Arabic versions of valid, reliable instruments to measure emotional intelligence and nurse–nurse communication.

Findings

A total of 311 questionnaires were returned (91% response rate). Nurses’ emotional intelligence was positively and significantly correlated with the nurse–nurse collaboration subscales. The results also indicated a statistically significant mean difference in communication subscale scores by gender and nursing unit.

Conclusions

The present study demonstrated that nurse–nurse collaboration is linked to benefits for nurses in terms of improved job satisfaction, better nurse retention, improved quality of patient care, and enhanced healthcare efficiency and productivity. This suggests that improving nurse–nurse collaboration may have spillover effects of benefits, not only for nurses but for patients, organizations, and the overall healthcare system.

Clinical Relevance

Building an environment that encourages collaboration among nurses can greatly impact the performance of nurses and its benefit to nurses. Encouraging employees to participate in activities and to collaborate in making this an integral part of their evaluation will contribute to improving the teamwork in patient care.

Integrating Genomic Professional Skills Into Nursing Practice: Results From a Large Cohort of Israeli Nurses

Abstract

Purpose

To explore the association of genomic knowledge, self-epistemic authority (SEA; i.e., subjective perception of knowledge expertise), perceived importance of genomics in nursing, and the integration of genomic skills into nursing practice.

Design

A cross-sectional study of nurses working in pediatric, obstetric, and internal wards of two medical centers in Israel between February and October 2018.

Methods

Participants completed anonymous questionnaires about genomic knowledge, SEA, perceived importance of genomics, and the performance of genomic skills in nursing practice. Associations between variables were analyzed using Pearson correlations, and a hierarchical regression model was used to determine which variables explained the performance of genomic practices among participants.

Findings

Altogether 423 nurses participated in the study. The mean genomic knowledge was low (55.05 ± 14.82%). Nurses reported a low integration of genomic skills in their practice (M = 1.90, SD = 0.71), although their overall perceived importance of genomics was positive (M = 2.88, SD = 0.68). Positive correlations were found between SEA and the integration of genomic skills in nursing practice. Obstetric nurses had more genomic knowledge, more positive perceptions about genomics, and performed more genomic skills in their nursing practice.

Conclusions

Although nurses realized the importance of genomics to their practice, and genomics is part of the Israeli nursing core curriculum, we found disappointingly low levels of knowledge and performance of genomic skills in nursing practice.

Clinical Relevance

The results call for action to establish ongoing education programs in genomics for nurses, which would lead to the inclusion of genomic skills into routine nursing practice, and prepare nurses for providing personalized medicine.

A Mixed‐Methods Study of Nurse Managers’ Managerial and Clinical Challenges in Mental Health Centers During the COVID‐19 Pandemic

Abstract

Purpose

The worldwide outbreak of the COVID-19 pandemic has posed challenges for nurses. The aim of this study was to examine the managerial and clinical challenges of nurse managers in mental health centers during the current COVID-19 pandemic.

Design

A mixed-methods study based on an analysis of data obtained in focus groups with 25 nurse managers from two mental health centers in Israel.

Methods

The quantitative phase was conducted prior to the group sessions using a structured self-administered questionnaire that examined the nurse managers’ (a) background data, (b) communication with the staff nurses, (c) perceptions of nurses’ functioning, (d) perceptions of their own functioning, and (e) management as impacted by the pandemic. The qualitative phase included three sessions of focus groups in which the nurse managers discussed both their challenging and positive issues during the pandemic.

Findings

The most important challenges were related to the need to protect patients from infection and communicating with families and primary caregivers. Work policies and procedures were less well adapted to pandemic conditions; nevertheless, nurse managers felt a sense of purpose, duty, and pride in their work. Three themes emerged: (a) "management complexity" included the change from a familiar routine to a new reality, working in capsules, protecting against infection, functional confusion, and insights into future epidemics; (b) "challenging communication" included communication with patients through glass walls and communication with staff through screens and (c) "bright spots" referred to staff cohesion and the provision of respectful care.

Conclusions

Mental health nurse managers have experienced during the pandemic a change in their roles from being less managerial to focusing more on clinical work. Communication between nurse managers and staff nurses and between mental health patients and staff were the main challenges. Nurse managers favorably noted the uniformity and humanity of the staff, sense of cohesion, and shared responsibility.

Clinical Relevance

In the first wave of the pandemic, there was confusion as to the functional role of ward nurse managers, as the focus of their activities became more clinical and less managerial. During and after the pandemic, preventive interventions should be carried out in order to assist patients, staff nurses, and nurse managers in mental health centers.

Identifying Strategies for the Management of Interruptions for Novice Triage Nurses Using an Online Modified Delphi Method

Abstract

Purpose

To use the Delphi Method to identify strategies used by triage nurses to effectively manage interruptions.

Design

This study was based on the concepts of Benner’s Novice to Expert Model. An online, modified Delphi approach was used to engage triage, education, and operational management experts in generating consensus recommendations on successful strategies to address triage interruptions in the emergency department.

Methods and Analysis

A panel of nine triage, education, and operational management experts were selected based on their publication and presentation history. This panel participated in three Delphi rounds, providing individual responses during each round. All responses were entered into a RedCap database, which allowed research team members to synthesize the results and return summaries to the participants. Final consensus was reached among this panel regarding recommendations for successful strategies to address triage interruptions that can be encompassed in a training module. The experts were then asked to identify the best instructional modality for teaching each of the interruption management strategies.

Findings

Eight strategies to mitigate the impact of interruptions were identified: (a) ensure nurses understand impact of interruptions; (b) ensure nurses understand consequences of interruptions on cognitive demands of healthcare workers that could influence behavior and lead to errors; (c) apologize to current patient before tending to interruption and give expectation of when you will return; (d) triage the interruption and decide to (i) ignore interruption, (ii) acknowledge, but delay servicing, interruption, or (iii) acknowledge and service interruption, delaying completion of interrupted task; (e) identify urgent communication as anything clinically significant that impacts the patient immediately or requires immediate intervention; (f) use focused questions to clarify whether interruption can wait; (g) redirect nonpriority interruptions; and (h) finish safety-critical task or tasks near completion before tending to an interruption. The Delphi participants recommended the best teaching modality was simulation for six of the strategies.

Conclusions

Participants agreed that there are strategies that can be taught to novice triage nurses to mitigate the impact of interruptions. The experts in operations management, emergency nursing, and education agree that creating simulations to teach each of these strategies is an effective way to educate nurses.

Clinical Relevance

Interruptions impact the quality of care provided to patients. Training nurses to prevent interruptions and mitigate the impact of interruptions when they occur has the potential to improve patient outcomes.

Defining Telepresence as Experienced in Telehealth Encounters: A Dimensional Analysis

Abstract

Purpose

Telehealth’s uptake has increased substantially in recent years, with an especially large jump in 2020 due to the emergence of COVID-19. This article provides background on and explores “telepresence” in healthcare literature. Telepresence strongly impacts the patient experience, but it is poorly defined in current research. The aim was to conceptually define telepresence using qualitative methods.

Design

Dimensional analysis was used to analyze telepresence in clinical literature and create a clearer definition of telepresence as a concept. Multiple databases were searched for articles related to telepresence. Thirteen international articles related to telepresence were selected for analysis.

Methods

Dimensional analysis allowed for multiple viewpoints to be explored within each distinct context and perspective.

Findings

Twenty-five dimensions were discovered within the articles, which were synthesized to seven core dimensions of telepresence: connection, technological mediation, experienced realism, trust, being supportive, collaboration, and emotional consequence.

Conclusions

Telepresence is highly impactful on the patient’s experience of telehealth care visits. The conceptual map produced by this dimensional analysis provides direction for clinicians to improve their ability to be present with patients during telehealth care. Potential implications include a starting point for future qualitative research, and the use of this dimensional analysis to inform clinical guidelines, improve clinician training, and assist in the development of new care models.

Clinical Relevance

A telepresence definition brings clarity to an ill-defined concept. COVID-19 magnifies the need for a better understanding of telepresence, which allows clinicians to improve telehealth encounters.

Nurses and Midwives as Global Partners to Achieve the Sustainable Development Goals in the Anthropocene

Abstract

Purpose

To highlight ongoing and emergent roles of nurses and midwives in advancing the United Nations 17 Sustainable Development Goals by 2030 at the intersection of social and economic inequity, the climate crisis, interprofessional partnership building, and the rising status and visibility of the professions worldwide.

Design

Discussion paper.

Methods

Literature review.

Findings

Realizing the Sustainable Development Goals will require all nurses and midwives to leverage their roles and responsibility as advocates, leaders, clinicians, scholars, and full partners with multidisciplinary actors and sectors across health systems.

Conclusions

Making measurable progress toward the Sustainable Development Goals is critical to human survival, as well as the survival of the planet. Nurses and midwives play an integral part of this agenda at local and global levels.

Clinical Relevance

Nurses and midwives can integrate the targets of the Sustainable Development Goals into their everyday clinical work in various contexts and settings. With increased attention to social justice, environmental health, and partnership building, they can achieve exemplary clinical outcomes directly while contributing to the United Nations 2030 Agenda on a global scale and raising the profile of their professions.

Nursing and the Sustainable Development Goals: A Scoping Review

Abstract

Purpose

In 2015, all member states that comprise the United Nations unanimously adopted the Sustainable Development Goals (SDGs), a set of ambitious and inclusive targets toward global economic, social, and environmental betterment. Nurses have a key role to play in the achievement of the SDGs. The aim of this article was to conduct a scoping review to synthesize the literature related to nursing and the SDGs.

Methods

This scoping review utilized Arksey and O’Malley’s five-stage framework. Several electronic databases were searched for literature published from 2015 to 2020 using the key words “nurse OR nurses OR nursing” and “Sustainable Development Goals OR SDGs”.

Findings

A total of 447 articles were identified through the databases searches, of which 35 articles were deemed relevant and included for final review and content analysis. Analysis of relevant literature on nursing and the SDGs revealed two distinct, yet connected, perspectives: the nurse and the profession.

Conclusions

Individual nurses may feel disconnected from the SDGs and struggle to relate the goals to their clinical role, calling for an increase in awareness and education on the goals. The wider profession could also increase both research and policy with relation to the SDGs, strengthening nursing’s position to have a voice in and contribute towards achievement of the goals.

Clinical Relevance

Individual nurses and the wider nursing profession have opportunities to more meaningfully contribute to the SDGs, beginning with an increased awareness through education and a commitment to research and participation in local and global decision making.

The Association Between Quality and Safety Climate of a Hospital Ward, Family Members’ Empowerment, and Satisfaction With Provided Care

Abstract

Purpose

This study was designed to examine the perceptions of ward quality and safety held by family members and nurses, and investigate its impact on family members' empowerment, and satisfaction with patient hospitalization.

Design

A cross-sectional study on two study groups was conducted at a large public hospital in Israel. The first group comprised 86 family members of patients hospitalized for more than 72 hours in acute critical condition in intensive care units (ICU) or general wards (GW). The second group included 101 registered nurses who treated the patients in the ICU or GW.

Methods

Data were collected by a validated self-administered structured questionnaire. All participants voluntarily signed an informed consent and answered questions related to their demographic characteristics, perceptions, and attitudes toward quality and safety climate, empowerment, and satisfaction with the patients' hospitalization. Pearson correlations coefficient, t-test for independent samples, and a multiple regression model were performed to analyze the data.

Findings

The mean age of family members was 51.4 ± 14.1 years and of nurses was 40.9 ± 9.9 years. A significant positive association was found between ward quality and safety climate and empowerment of the family member (r = .716; p < .001); empowerment of the family member and family members' satisfaction with the patients' hospitalization (r = .695; p < .001); and ward safety and quality climate and family members' satisfaction with the patients' hospitalization (r = .763; p <.001). Family members ranked ward quality and safety climate (M = 4.20 ± 0.60 vs. M = 3.61 ± 0.40), and their satisfaction with the patients' hospitalization (M = 4.49 ± 0.69 vs. M = 4.07± 0.54), which were significantly (p < .001) higher than the nurses’ estimate. The significant predictors for family members’ satisfaction with patients' hospitalization were commitment to quality leadership (b = .210; p = .027); implementing a quality improvement (b = .547; p < .001); and hand-off communication (b = .299; p = .001).

Conclusions

Positive relationships between quality and safety climate, empowerment, and satisfaction with patients' hospitalization suggest that by improving the ward quality and safety climate, and family empowerment, we may also improve family satisfaction. Although family members reported being satisfied with hospitalization in the ICU and GW, quality leadership and implementing a quality improvement among the nurses and hand-off communication between nurses and patients' families, will be targeted to improve family satisfaction with the patients’ hospitalization.

Clinical Relevance

Nurses who provide care for patients in a critical condition should maintain high levels of safety and quality care in order to improve the patients’ family empowerment and satisfaction. Specifically, their efforts should target a commitment to quality leadership, implementing quality improvement, and hand-off communication.

Urinary Incontinence Is Associated With Increased All‐Cause Mortality in Older Nursing Home Residents: A Meta‐Analysis

Abstract

Purpose

Urinary incontinence is a syndrome common in older adults, but it is not clear whether urinary incontinence is associated with the risk for mortality in elderly nursing home residents.

Methods

We conducted a systematic review and meta-analysis in PubMed, Cochrane, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science databases. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of the included studies. The meta-analysis was summarized using a random-effects or fixed-effects model, and the heterogeneity among studies was examined using the I2 statistic.

Findings

Six cohort studies with 1,656 participants were included in the final analysis. The NOS score for each study was greater than 6. Urinary incontinence was significantly associated with a higher risk for mortality in nursing homes, with a hazard ratio (HR) of 1.20 (95% confidence interval [CI] 1.12–1.28, I 2 = 41.6%). The significant association of urinary incontinence with increased mortality risk was observed in subgroup analysis according to region, status of dementia, and follow-up period, with a pooled HR of 2.02 (95% CI 1.32–3.11, I 2 = 0%) for Asian countries, 1.18 (95% CI 1.11–1.26, I 2 = 41.6%) for Western countries, 1.17 (95% CI 1.09–1.26, I 2 = 0%) for patients with dementia, 1.35 (95% CI 1.13–1.60, I 2 = 58.9%) for patients without dementia, 1.16 (95% CI 1.07–1.25, I 2 = 43.2%) for studies with a follow-up period of 1 year, and 1.30 (95% CI 1.15–1.48, I 2 = 24.5%) for studies with a follow-up period of more than 1 year.

Conclusions

Urinary incontinence is associated with an increased risk for death among residents of care facilities. Therefore, it was necessary to screen the elderly dwelling in nursing homes who were experiencing or at risk for urinary incontinence with useful tools (e.g., overactive bladder symptom score, bladder control self-assessment questionnaire, three incontinence questions). In addition, early interventions strategies, such as weight loss, stopping smoking, pelvic floor muscle training, and medical and surgical treatments would contribute to decreasing the risk for urinary incontinence and preventing adverse outcomes in nursing home residents.

Clinical Relevance

In our study, we found that the elderly with urinary incontinence who resided in nursing homes had a higher risk for mortality than those without urinary incontinence. Therefore, urinary incontinence in the elderly residing in nursing homes is of particular concern. Early detection and intervention are important for the elderly with urinary incontinence, and caregivers should be made aware of this importance.

The Effectiveness of the Transitional Care Program Among People Awaiting Coronary Artery Bypass Graft Surgery: A Randomized Control Trial

Abstract

Purpose

This study examined the effectiveness of the Transitional Care Program (TCP) on the anxiety, depression, cardiac self-efficacy, number of hospitalizations, and satisfaction with care among people awaiting elective coronary artery bypass graft (CABG) surgery.

Design

The study design was a randomized controlled trial.

Methods

The participants with coronary artery disease who met the study criteria (n = 104) were randomly assigned to the intervention group (n = 52) receiving the TCP plus routine care, or the control group (n = 52) receiving routine care only. The TCP, developed based on the Transitional Care Model, comprised hospital discharge planning and six weekly home telephone follow-ups to provide health education, counseling, monitoring, and emotional support tailored to the individual’s needs. Data were collected at baseline, and then at weeks 1, 6, and 8 after program enrollment. Data were analyzed using descriptive statistics, repeated-measures analysis of variance, and the Z test.

Findings

The intervention group had lower anxiety and depression than did the control group at weeks 1, 6, and 8 after program enrollment. At weeks 6 and 8, the intervention group exhibited higher cardiac self-efficacy and satisfaction with care than the control group. Further, the intervention group had a significantly lower number of hospitalizations than the control group at week 8.

Conclusions

The TCP can reduce anxiety, depression, and number of hospitalizations, while increasing cardiac self-efficacy and satisfaction with care among people awaiting CABG.

Clinical Relevance

Nurses are in a pivotal position to make care transitions safer. Provision of discharge education and regular telephone contacts could enhance positive outcomes regarding patients awaiting elective cardiac surgery.

Understanding Women’s Cardiovascular Health Using MyStrengths+MyHealth: A Patient‐Generated Data Visualization Study of Strengths, Challenges, and Needs Differences

Abstract

Purpose

The purpose of this data visualization study was to identify patterns in patient-generated health data (PGHD) of women with and without Circulation signs or symptoms. Specific aims were to (a) visualize and interpret relationships among strengths, challenges, and needs of women with and without Circulation signs or symptoms; (b) generate hypotheses based on these patterns; and (c) test hypotheses generated in Aim 2.

Design

The design of this visualization study was retrospective, observational, case controlled, and exploratory.

Methods

We used existing de-identified PGHD from a mobile health application, MyStrengths+MyHealth (N = 383). From the data, women identified with Circulation signs or symptoms (n = 80) were matched to an equal number of women without Circulation signs or symptoms. Data were analyzed using data visualization techniques and descriptive and inferential statistics.

Findings

Based on the patterns, we generated nine hypotheses, of which four were supported. Visualization and interpretation of relationships revealed that women without Circulation signs or symptoms compared to women with Circulation signs or symptoms had more strengths, challenges, and needs—specifically, strengths in connecting; challenges in emotions, vision, and health care; and needs related to info and guidance.

Conclusions

This study suggests that visualization of whole-person health including strengths, challenges, and needs enabled detection and testing of new health patterns. Some findings were unexpected, and perspectives of the patient would not have been detected without PGHD, which should be valued and sought. Such data may support improved clinical interactions as well as policies for standardization of PGHD as sharable and comparable data across clinical and community settings.

Clinical Relevance

Standardization of patient-generated whole-person health data enabled clinically relevant research that included the patients’ perspective.

Issue Information

Journal of Nursing Scholarship, Volume 53, Issue 3, Page 255-258, May 2021.

Nursing Big Data Science

Journal of Nursing Scholarship, Volume 53, Issue 3, Page 259-261, May 2021.

How Emergency Nurses Develop Resilience in the Context of Workplace Violence: A Grounded Theory Study

Abstract

Purpose

To understand how emergency nurses develop resilience in the context of workplace violence.

Design

This study employed grounded theory methodology. Thirty nurses from three hospital emergency departments in Taiwan were interviewed between August and December 2018.

Methods

Semistructured interviews were used to collect data. Interviews were audio-recorded and transcribed verbatim.

Findings

The process through which emergency nurses who had experienced workplace violence developed resilience took place in three stages: the release of emotions after the assault; the interpretation of conflicting thoughts and actions; and the establishment of strategies to cope with workplace violence in the future. The core theme was the motivating role of professional commitment to emergency patient care.

Conclusions

The results of this study can inform the development of support systems to enhance the resilience of nurses experiencing workplace violence by alerting healthcare administrators and governing institutions to their needs.

Clinical Relevance

Emergency nurses viewed professional growth and professional commitment as an invisible motivator in the development of resilience following an encounter with workplace violence.

Corrigendum

Journal of Nursing Scholarship, EarlyView.

Perceptions of Using Multiple Mobile Health Devices to Support Self‐Management Among Adults With Type 2 Diabetes: A Qualitative Descriptive Study

Abstract

Purpose

This study identified facilitators and barriers pertaining to the use of multiple mobile health (mHealth) devices (Fitbit Alta® fitness tracker, iHealth® glucometer, BodyTrace® scale) that support self-management behaviors in individuals with type 2 diabetes mellitus (T2DM).

Design

This qualitative descriptive study presents study participants’ perceptions of using multiple mobile devices to support T2DM self-management. Additionally, this study assessed whether participants found visualizations, generated from each participant’s health data as obtained from the three separate devices, useful and easy to interpret.

Methods

Semistructured interviews were completed with a convenience sample of participants (n = 20) from a larger randomized control trial on T2DM self-management. Interview questions focused on participants’ use of three devices to support T2DM self-management. A study team member created data visualizations of each interview participant’s health data using RStudio.

Results

We identified two themes from descriptions of study participants: feasibility and usability. We identified one theme about visualizations created from data obtained from the mobile devices. Despite some challenges, individuals with T2DM found it feasible to use multiple mobile devices to facilitate engagement in T2DM self-management behaviors.

Discussion

As mHealth devices become increasingly popular for diabetes self-management and are integrated into care delivery, we must address issues associated with the use of multiple mHealth devices and the use of aggregate data to support T2DM self-management.

Clinical Relevance

Real-time patient-generated health data that are easily accessible and readily available can assist T2DM self-management and catalyze conversations, leading to better self-management. Our findings lay an important groundwork for understanding how individuals with T2DM can use multiple mHealth devices simultaneously to support self-management.

Nursing in Albania: A Catalytic Force in Transforming Health Professionals and Health Care

Abstract

Purpose

Transitions in nursing education and professionalism that align with global nursing standards are elucidated as critical success factors in transforming health professionals and health care in Albania. Progressive educational and regulatory pathways throughout the 2000s (1999–2020) are emphasized for their impact on the Albanian health system, including the achievement of universal healthcare coverage.

Methods

Data collected by the Ministry of Health and Sport and the Regulatory Authority for nursing and other healthcare professions in Albania were analyzed and outcomes explicated with regard to Albania’s major health challenges.

Discussion and Conclusions

Three milestones affirmed nursing as a driving force in the Albanian healthcare system: (a) nurses constitute the largest health professional workforce via a nurse–patient ratio of 1:400 in contrast to a physician–patient ratio of 1:2,500; (b) nurses are frontline care providers via clinical leadership in the management of primary healthcare centers, which ensure universal healthcare coverage; and (c) nurses are first responders via their presence and compassionate caring in the primary healthcare centers, including making critical shifts in converting primary healthcare centers to urgent care centers as needed.

Clinical Relevance

Nursing advancements have implicated quality care and professionalism in Albania across the health professions via three critical pathways: (a) health professional education at a university degree level for entry into practice (since 1999), which was prompted by and driven by nursing’s quest to be a self-regulated profession (achieved in 2007); (b) healthcare global standards sparked by nursing’s mandate toward professional autonomy, as achieved via regulatory procedures and policies; and (c) interprofessional healthcare initiatives that serve as collaborative platforms for innovative educational, clinical, and research projects.

Effort–Reward Imbalance and Its Effects on Satisfaction With Working Conditions and Sleep‐Related Problems: Comparison of Nurses and Other Occupations

Abstract

Purpose

This study aimed to compare effort–reward imbalance (ERI) among registered nurses, social workers, and elementary school teachers, and to analyze the effects of ERI on satisfaction with working conditions and sleep-related problems.

Design

A secondary data analysis was conducted using cross-sectional data from the Korean Working Conditions Survey collected in 2017. The study sample included 276 registered nurses, 97 social workers, and 229 elementary school teachers.

Methods

The effort index was measured using two dimensions (work intensity and working time quality) with seven subdimensions. The reward index consisted of three dimensions (social support, earning, and prospects) with five subdimensions. The ERI index was computed by dividing the average effort score by the average reward score. Linear or logistic regression analysis was conducted to compare efforts, rewards, and ERI among the three occupations and to examine the effects of ERI on satisfaction and sleep-related problems.

Findings

Nurses had a significantly higher effort score than the other two groups. However, nurses had a lower reward score than elementary school teachers, but a higher score than social workers. The highest ERI index was found among nurses (0.47 ± 0.16), followed by social workers (0.39 ± 0.30) and elementary school teachers (0.30 ± 0.15). All three occupations showed an inverse relationship between ERI and satisfaction with working conditions and positive relationships between ERI and sleep-related problems.

Conclusions

The high ERI (i.e., more effort relative to reward) perceived by nurses was associated with diminished satisfaction and increased sleep-related problems.

Clinical Relevance

To attract future generations to nursing as a career choice and to ensure a sustainable nurse workforce, the nurse-perceived ERI should be decreased by reducing work demands and increasing both monetary and nonmonetary rewards.

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