Aims To describe the distribution of critical value reports, departmental patterns, and HIS-recorded acknowledgment timeliness in a large tertiary hospital in 2023 and to identify targets for process optimization.Background Critical value reporting is a key healthcare quality and safety process, but whole-hospital evidence on item distribution, departmental variation, and HIS acknowledgment timeliness across high-load settings remains limited.Methods This retrospective, descriptive, observational study analyzed all consecutive laboratory-related critical value records from the Affiliated Hospital of Nantong University in 2023. Records with complete timestamps were included. Variables included test item, department, visit type, specimen collection time, result dispatch time, clinical recipient, and HIS acknowledgment time. HIS acknowledgment time was defined as the interval between result dispatch/reporting and the first documented clinical acknowledgment/response in the HIS. A timely HIS acknowledgment was defined as documented acknowledgment within 15 min; a delayed HIS acknowledgment was defined as documented HIS acknowledgment requiring more than 60 min. Data were analyzed descriptively using median with interquartile range and frequency with percentage.Results A total of 53,639 critical value records were analyzed. The highest proportions were for WBC count (21.46%), microbial culture (14.10%), PLT count (12.97%), and cTnI (12.86%). The top departments were the hematology ward (22.13%), ICU (20.65%), and emergency department (17.46%). The overall median HIS acknowledgment time was 35 s (IQR 20-96 s), and the overall timely acknowledgment rate was 94.57%. The highest untimely acknowledgment rates were observed in the emergency department (9.53%), ICU (6.98%), and hematology outpatient clinic (6.39%). The highest delayed acknowledgment rates were observed in the hematology outpatient clinic (2.51%), emergency department (2.15%), and ICU (1.01%).Conclusion(s) HIS-recorded critical value acknowledgment was generally timely, but untimely and delayed acknowledgment clustered in specific high-load departments. These findings can inform process optimization. Because clinical interventions and patient outcomes were not evaluated, no conclusions about patient safety outcomes can be drawn.Implications for Nursing Management Nurse managers should ensure clear accountability for critical value acknowledgment, implement unit-level escalation protocols, monitor item- and department-level timeliness dashboards, support mobile alert access, and conduct regular audits and training, particularly in the emergency department, ICU, and hematology outpatient clinic.
Background Workplace bullying remains an important concern in nursing management. In South Korea, workplace bullying has been prohibited under the Labor Standards Act since 2019, but evidence regarding nurses' experiences of workplace bullying and their perceptions of support following implementation remains limited. This study examined workplace bullying among Korean nurses, perceived changes following implementation of the Anti-Workplace Bullying Law, awareness of organizational prevention and response systems, and perceived helpfulness of psychosocial support.Methods A cross-sectional online survey was conducted among 306 staff nurses working in acute care or long-term care hospitals from March to April 2022. Workplace bullying was assessed using the Korean version of the Negative Acts Questionnaire-Revised. Data were analyzed using descriptive statistics, independent samples t-tests, and chi-square tests.Results Overall, 25.2% of participants were classified as having been exposed to workplace bullying during the previous 6 months, with work-related negative behaviors being the most prominent. A decrease in bullying following implementation of the law was perceived by 39.0% of nurses with recent bullying experience and 58.5% of those without recent bullying experience. Only 45.1% reported that an organizational prevention and response system was in place, while 37.9% were unsure. Annual leave or time off and peer support were rated as the most helpful support options. Nurses with recent bullying experience rated manager-based and several in-house support options as less helpful.Conclusions Nurses' perceptions of change and support following implementation of the law were not uniform according to recent bullying experience. Strengthening the visibility, clarity, and accessibility of reporting and support mechanisms, as well as providing flexible psychosocial support options may improve the practical responsiveness of workplace bullying prevention efforts.Implications for Nursing Management Nursing managers should address work-related negative behaviors in routine practices, such as workload allocation and information sharing, ensure that reporting and support mechanisms are accessible, and provide multiple support pathways rather than relying primarily on manager-based support.
Aim(s) To examine work-context associations with self-reported plastic-related occupational scenario burden and perceived support priorities among operating-room nursing staff.Background Operating rooms rely heavily on plastic-containing disposable materials and smoke-generating workflows, but nursing-management evidence on how staff report these occupational scenarios remains limited.Method(s) This exploratory multicentre cross-sectional survey included 448 eligible nursing personnel from nine recruitment groups in China (eight hospital-based; one visiting-nurse training cohort); 415 frontline staff formed the analytic population. The principal outcome was a 0-100 formative occupational scenario-burden index. Adjusted linear regression included recruitment-group fixed effects, with alternative index definitions and binary distribution-based outcomes examined as sensitivity analyses.Results Among 415 frontline operating-room nursing staff, the mean occupational scenario-burden score was 50.7 (SD 12.4); 408 participants had complete data for the principal regression. Night-shift status was associated with a 3.86-point higher score (HC3 95% CI 0.96-6.76), and this association remained positive across the principal sensitivity analyses. Orthopaedic involvement was associated with a 4.93-point higher score in the original index, although the estimate attenuated after specialty-specific content was removed. The most frequently endorsed support priorities were rest-area water infrastructure (69.9%), meal-container reform (63.6%) and ventilation/smoke-management optimisation (63.4%).Conclusion(s) Night-shift work was associated with higher self-reported occupational scenario burden, with positive point estimates across the principal sensitivity analyses, whereas the specialty-related association was more sensitive to index composition. These findings identify organisational priorities for review and provide a basis for prospective studies integrating validated scenario measures with objective exposure assessment.Implications for Nursing Management Staff-endorsed priorities provide a practical agenda for nurse managers to review workflows, smoke-control practices, procurement, rest-area infrastructure and night-shift support and to select priorities for prospective evaluation.
Background The relationship between nurse managers' leadership behaviors and digital leadership remains insufficiently understood. Aims This study aimed to examine the relationship between nurse managers' employee-, task-, and change-oriented leadership behaviors as perceived by nurses and their perceived overall digital leadership. Methods This descriptive cross-sectional study included 231 nurses working in three public hospitals. Data were collected using the Leadership Behavior Scale and the Digital Leadership Scale. Descriptive and comparative analyses, Pearson correlation analysis, and bivariate simple linear regression were performed. Results Task-oriented leadership received the highest mean score, whereas change-oriented leadership received the lowest. Overall digital leadership was positively correlated with all leadership behavior dimensions, with the strongest association observed for change-oriented leadership (r = 0.697, p < 0.001). In the bivariate regression analysis, change-oriented leadership was positively associated with overall digital leadership and accounted for 48.6% of its variance (R- 2 = 0.486, p < 0.001). Overall digital leadership did not differ significantly according to the demographic and work-related characteristics examined. Conclusions Although task-oriented leadership received the highest mean score, change-oriented leadership showed the strongest association with overall digital leadership. These findings highlight the relevance of change-oriented leadership in digitally transforming healthcare environments; however, the observed association should not be interpreted as causal or as an independent effect over other leadership dimensions. Implications for Nursing Management The findings highlight the importance of integrating digital competencies with change-oriented leadership development in nursing management education and continuing professional development. Supporting nurse managers in developing digital competencies alongside their capacity to guide organizational change may strengthen leadership readiness for increasingly technology-enabled healthcare environments.
Background The nursing and midwifery profession constitutes a substantial portion of the global health workforce, with the majority being women. Despite this, women nurses and midwives are underrepresented in healthcare leadership.Objectives To explore the perspectives and experiences of nurses and midwives to identify system- and organizational-level strategic opportunities for advancing women into leadership.Design Two-phased mixed-methods design employing an exploratory sequential approach and weaving narrative methods.Setting Large public and private healthcare services in Australia.Participants Phase one included twenty-five nursing and midwifery leaders. Phase two included 158 nurses and midwives.Methods Data from the organizational change management stream of the Advancing Women in Healthcare Leadership national initiative was used. Phase one consisted of qualitative semistructured interviews and informed phase two, which comprised an online survey with qualitative and quantitative components. Qualitative data were analyzed thematically; quantitative data were analyzed descriptively.Results System-level opportunities for advancing women nurses and midwives into healthcare leadership included reforming legal agreements and challenging perceived hierarchies within professional roles. Organizational-level opportunities included building leadership capacity through inclusive organizational policies and processes; fostering inclusive organizational cultures through awareness and engagement; expanding mentoring and networking opportunities; enhancing leadership development through accessible, tailored training; and embedding equity and transparency in recruitment and promotion.Conclusion Advancing women nurses and midwives into healthcare leadership needs a shift from individual efforts to systemic strategies. Addressing structural barriers and fostering empowerment, healthcare systems can build inclusive, resilient leadership pipelines that reflect the diversity and expertise of the nursing and midwifery workforce.Patient or Public Contribution This study examines nursing careers and workforce issues rather than nursing care. Consequently, no patients or members of the public were involved in its design, conduct, or reporting.
