Objective: Moral distress emanating from value conflicts comprising ethical dimensions pose a threat to nurses’ health and retention, as well as to the quality of care. The aim of the present study was to investigate the relationships between the frequency of ethical value conflicts (EVC), and the perceived distress when they occur, respectively, and nurses’ work-related stress, burnout symptoms, turnover intent, team effectiveness, and patient safety.

Method: A two-wave longitudinal cohort questionnaire study was performed among registered nurses at six hospitals in two Swedish regions. Cross-sectional analyses (T1) were based on 1817 nurses in 228 care units (CU), and longitudinal analyses (T1 – T2) on 965 nurses in 190 CU. Hypothesis testing was performed using multilevel controlled regression modeling.

Result: The results indicated that nurses who were often exposed to EVC also to a higher extent tended to report these conflicts as stressful. Frequent exposure to EVC induced by insufficient resources, inapt organizational structures or interpersonal staff relations were cross-sectionally associated with work-related stress, burnout symptoms, turnover intent, and team effectiveness. The longitudinal analyses indicated that EVC induced by a lack of resources primarily had negative effects on nurses’ health and well-being. At the CU level, such conflicts also impaired team effectiveness. At the individual level, EVC induced by organizational constraints or interpersonal relations negatively affected care effectiveness.

Conclusions: EVC are related to negative consequences in healthcare, and such processes take place both on the individual and organizational levels.</p>

Aim:

To investigate how NGNs perceived and applied an intervention for preventing stress-related ill health embedded in a transition-to-practice programme when enter-ing their professional life.

Design:

A qualitative exploratory descriptive design was selected for this study to gain insights and perspectives on the adoption and utilization of the intervention.

Methods:

In this qualitative methodology process evaluation, semi-structured and audio-recorded interviews were conducted with a sample of 49 nurses. Data were collected between December 2016 and July 2017, and were sorted in NVivo 12 Plus, followed by thematic analysis.

Results:

The analysis resulted in three change processes stimulated by the intervention: (a) Building acceptance of being new; (b) Gaining insight into professional devel-opment and health and (c) Practical steps for skills development, healthy habits and better-organized work. In addition to the three themes, barriers that hindered the progression of the processes were also described. Each process influenced the development of the others by stimulating a deeper understanding, motivation to change and courage to act. Several barriers were identified, including the use of cognitively demanding intervention tools, fatigue, high work demands, inconvenient work hours and a hostile social climate on the ward.

Conclusion:

This process evaluation showed that newly graduated nurses used knowledge from the intervention and adopted new behaviours largely in accordance with how the intervention was intended to work.

Impact:

When entering a new profession, it is crucial to receive a well-thought-out, structured and targeted introduction to the new professional role, tasks and work group. Nurses stated that the intervention increased their understanding of the role as new nurses and their insight into how to develop skills that promoted better functioning and recovery. The intervention also stimulated the development of new health behaviour and some new learning strategies.

Purpose

While transition programs are widely used to facilitate newly graduated nurses transition to healthcare settings, knowledge about preconditions for implementing such programs in the hospital context is scarce. The purpose of this study was to explore program coordinators’ perspectives on implementing a transition program for newly graduated nurses.

Design/methodology/approach 

An explorative qualitative study using individual interviews. Total of 11 program coordinators at five acute care hospital administrations in a south-west region in Sweden. Data was subjected to thematic analysis, using NVivo software to promote coding.

Findings

The following two themes were identified from the analysis: Create a shared responsibility for introducing newly graduated nurses, and establish legitimacy of the program. The implementation process was found to be a matter of both educational content and anchoring work in the hospital organization. To clarify the what and why of implementing a transition program, where the nurses learning processes are prioritized, was foundational prerequisites for successful implementation.

Originality/value 

This paper illustrates that implementing transition programs in contemporary hospital care context is a valuable but complex process that involves conflicting priorities. A program that is well integrated in the organization, in which responsibilities between different levels and roles in the hospital organization, aims and expectations on the program are clarified, is important to achieve the intentions of effective transition to practice. Joint actions need to be taken by healthcare policymakers, hospitals and ward managers, and educational institutions to support the implementation of transition programs as a long-term strategy for nurses entering hospital care.

BACKGROUND:

Transition programs for newly graduated nurses in hospital settings are reported to provide learning opportunities, strengthening confidence, workplace integration and skills, retention and job satisfaction. Still, our knowledge of long-term effects is scarce and few studies have used control groups.

OBJECTIVE:

To explore the long-term impact of having attended a transition program on the nurses’ experiences of the first years of practice. More specifically, ideology-infused psychological contract, ethical stress, perceived organizational support, job satisfaction, opportunities for learning, and intention to stay in the nursing profession, were explored as outcome variables.

METHODS:

A questionnaire survey was carried out among registered nurses from November 2019 to January 2020, with a 54% response rate. The analysis was based on 149 nurses who had attended a transition program, and 72 who had not attended. The nurses had seniority between one and three years. Independent samples t-test were used to investigate differences between the groups.

RESULTS:

The two groups showed small and non-significant differences in the outcome variables. However, regarding the frequency of ethical value conflicts induced by insufficient resources, as well as experiences of ethical value conflict distress, the group of nurses who had attended a transition program showed statistically significantly higher mean values, although the effect sizes were small.

CONCLUSION:

Newly graduated nurses need more than transition programs and skills training to progress in their nursing role and develop competence, increase job satisfaction, and reduce stress. Achieving these goals requires a long-term supportive learning environment that is integrated into everyday work.

Aim: To explore if and how nurses' perceived organizational support affects their ability to handle and resolve ethical value conflicts.

Design: A mixed methods design with a longitudinal questionnaire survey and focus group interviews.

Methods: A questionnaire survey in six hospitals in two Swedish regions provided data from 711 nurses responding twice (November–January 2019/2020 and November–January 2020/2021). A cross-lagged path model tested the mutual prospective influence between the organizational climate of perceived organizational support, frequency of ethical value conflicts, and resulting moral distress. Four focus group interviews were conducted with 21 strategically selected nurses (April–October 2021). Qualitative data collection and analysis were inspired by Grounded Theory.

Results: A climate of perceived organizational support was empowering, contributing to role security. It prospectively decreased the frequency of ethical value conflicts but not the moral distress when conflicts did occur.

Conclusion: It is important to facilitate the development of perceived organizational support among nurses, but also to reduce the occurrence of ethical value conflicts that the nurses cannot resolve.

Implications for the Profession: By ensuring a shared care ideology, good interprofessional relations within the entire care organization, providing clear and supportive organizational structures, and utilizing competence adequately, healthcare managers can facilitate and support the development of perceived organizational support among nurses. Nurses who are empowered by perceived organizational support are stimulated by and take pride in their work and experience the work as meaningful and joyful.

Impact: The study addressed the question of whether healthcare organizations could support nurses to resolving ethical value conflicts, and thus reduce moral distress. Perceived organizational support is related to factors such as ideological caring alignment and supportive organizational preconditions. This study contributes specific knowledge about how healthcare organizations can empower nurses to effectively resolve ethical value conflicts and thereby reduce their moral distress.

Patient or Public Contribution: No patient or public contribution.

INTRODUCTION: Research indicates that newly graduated registered nurses struggle to develop practical skills and clinical understanding and to adapt to their professional role. To ensure quality of care and support new nurses, it is vital that this learning is elucidated and evaluated. Aim The aim was to develop and evaluate the psychometric properties of an instrument assessing work-integrated learning for newly graduated registered nurses, the Experienced Work-Integrated Learning (E-WIL) instrument.

METHOD: The study utilized the methodology of a survey and a cross-sectional research design. The sample consisted of newly graduated registered nurses (n = 221) working at hospitals in western Sweden. The E-WIL instrument was validated using confirmatory factor analysis (CFA).

RESULTS: The majority of the study participants were female, the average age was 28 years, and participants had an average of five months' experience in the profession. The results confirmed the construct validity of the global latent variable E-WIL, "Transforming previous notions and new contextual knowledge into practical meaning," including six dimensions representing work-integrated learning. The factor loadings between the final 29 indicators and the six factors ranged from 0.30 to 0.89, and between the latent factor and the six factors from 0.64 to 0.79. The indices of fit indicated satisfactory goodness-of-fit and good reliability in five dimensions with values ranging from α = 0.70 to 0.81, except for one dimension showing a slightly lower reliability, α = 0.63, due to the low item number. Confirmatory factor analysis also confirmed two second-order latent variables, "Personal mastering of professional roles" with 18 indicators, and "Adapting to organisational requirements" with 11 indicators. Both showed satisfactory goodness-of-fit, and factor loading between indicators and the latent variables ranged from 0.44 to 0.90 and from 0.37 to 0.81, respectively.

CONCLUSION: The validity of the E-WIL instrument was confirmed. All three latent variables could be measured in their entirety, and all dimensions could be used separately for the assessment of work-integrated learning. The E-WIL instrument could be useful for healthcare organisations when the goal is to assess aspects of newly graduated registered nurses' learning and professional development.

Background: Previous studies have shown that the rapid transition to emergency remote teaching due to the COVID-19 pandemic was challenging for healthcare teachers in many ways. This sudden change made them face ethical dilemmas that challenged their values and ethical competence. Research aim: This study aimed to explore and gain a deeper understanding of the ethical dilemmas healthcare teachers faced during the COVID-19 pandemic. Research design: This was an inductive qualitative study using a hermeneutic approach. Semi-structured interviews were conducted and analysed thematically. Participants and research context: Healthcare teachers (n = 20) from eight universities and universities of applied sciences in the Nordic and Baltic countries participated. Ethical considerations: This study was based on the research ethics of the Norwegian National Research Ethics Committee for Medicine and Health Sciences and approved by the Norwegian Agency for Shared Services in Education and Research. Findings: Healthcare teachers faced several ethical dilemmas due to restrictions during the COVID-19 pandemic. The analysis revealed three main themes: How should I deal with students’ ill-being, and what can I as a teacher do?; What can I demand from myself and my students, what is good teaching?; How do I manage the heavy workload and everyone’s needs, and who gets my time? Conclusions: This study highlights the importance of healthcare teachers’ continuous need for pedagogic and didactic education, especially considering new technology and ethical issues. During the pandemic, the ethical consequences of remote teaching became evident. Ethical values and ethical dilemmas should be addressed in healthcare education programmes at different levels, especially in teacher education programmes. In the coming years, remote teaching will grow. Therefore, we need more research on this issue from an ethical perspective on its possible  © The Author(s) 2023.

There is a global nurse shortage, and researchers have made great efforts in trying to unveil the reasons for turnover and how to increase retention. However, such research has had a tendency to study variables related to intention to leave (ITL) or turnover as isolated phenomena. Objective. To simultaneously explore what factors motivate experienced nurses in the workplace and the underlying reasons for strong ITL and high staff turnover within the profession. Design. An inductive qualitative content analysis was used based on data from open-ended survey questions. The data originated from the longitudinal analyses of nursing education/employment/entry (LANE) in work-life study. The qualitative data analyzed in this study were distributed in October 2017-January 2018, to all nurses in three cohorts corresponding to 11-, 13- and 15-year postgraduation. Of the 2,474 nurses answering the survey, 1,146 (46%) responded to one or more of the open-ended questions. Results. The result showed that what motivates experienced nurses, their intention to leave (ITL), and reasons for turnover could be described in the form of five broad categories, namely, organizational characteristics, work characteristics, relationships at work, work recognition, and health issues. There was rarely a one single reason described, rather several reasons needed to be experienced over time for nurses to stay motivated or leave the profession. Conclusions. There is no single reason that makes nurses leave the profession, nor is there one single reason that makes them motivated to stay. Retention and turnover are complex processes and need to be addressed as this, not as a single isolated phenomenon. © 2023 Anna Hörberg et al.

Purpose

This study aims to investigate how aspects of the sex/gender were scrutinized in a team’s production of clinical guidelines for psychiatric compulsory care and what the implications were for the final guidelines and for interprofessional learning.

Design/methodology/approach

The study is a case study, where interviews were conducted and a narrative analysis was used.

Findings

The results reflected how sex/gender arose in a discussion about gender differences when using restraining belts. Furthermore, discussions are presented where profession-specific experiences and knowledge about sex/gender appeared to stimulate interprofessional learning. However, the team’s learning about the complexity of sex/gender resulted in guidelines that emphasized aspects of power and focused on the individual patient. Thus, discussions leading to analysis and learning related to gender paradoxically produced guidelines that were gender-neutral.

Originality/value

The study highlights the potential interprofessional learning in discussions of sex/gender and its complex relation in medicine.

The study aims to investigate new graduate nurses the perceptions of educational preparedness, their challenges, and their expectations during their transition to hospital care and introduction to work.

Background: Previous research has raised questions about new graduate nurses’ (NGNs) preparedness for work in the clinical setting, and transition programs have been implemented to smooth the transition process. Information about NGNs’ expectations of both transition programs and their introduction to work when first entering the nursing profession is scarce.

Design: A cross-sectional survey design was used. Method: NGNs enrolled in a regional transition program in six hospitals were recruited from three-cohorts during September 2021, January 2022 and September 2022. After responding to a survey both a qualitative and quantitative approach was used when analyzing responses.

Results: Quantitative and qualitative findings derived from 248 NGNs responses showed that 65% of the NGNs perceived that nursing education in general prepared them for clinical work, that they were prepared for and committed to workplace learning but require support from a well-designed transition program as well as from colleagues and managers in their ward unit.

The conclusion is that the preparation provided by nursing education as well as organizational factors in the healthcare workplace influence new graduate nurses’ readiness for clinical work, the challenges they perceive, and their needs for learning and supp