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 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.

Coordination across healthcare system levels is a global imperative to ensure efficient resource utilization and provide high-quality care. The substantial body of research on coordination in healthcare mainly concerns coordination across professional and organizational domains. Consequently, there is a dearth of empirical research aimed at delineating the determinants of coordination across healthcare system levels. This paper describes and analyses the barriers and enablers of healthcare coordination across national, regional, and local system levels in a populous Swedish region. Individual interviews and focus group discussions, encompassing a total of 63 individuals, were conducted with managers, administrators, and politicians. The findings of the paper underscore that the barriers identified were most often of a structural or institutional character, whereas the enablers of the studied cross-level coordination were mostly relational. Therefore, we propose that future research should aim to further delineate the prerequisites for personal relationships to emerge, as well as how they may act as enablers of coordination across healthcare system levels.

The public sector is becoming increasingly complex. As complexity leadership theory has been formulated in order to understand leadership in such a context, it thus seems appropriate that it should inform public leadership research. However, the applicability of complexity leadership theory and the concomitant adaptive leadership practices have thus far been underexplored empirically in a public sector context. To address this omission, this article uses a qualitative case study to exemplify how adaptive leadership practices may manifest themselves in a public sector context. The article’s findings indicate that adaptive leadership practices that reduce, rather than induce, tension within the dynamics of actors’ interactions may be a more viable route to handle challenges within a public sector context. Future research could beneficially pay greater attention to the public sector context when studying how adaptive leadership practices might manifest themselves in public sector organizations, as well as when assessing the merits of complexity leadership theory in informing public leadership.

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.

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