BACKGROUND:Nurse work engagement is a persistent issue in healthcare. Low engagement reduces professional dedication and sense of belonging, increases the likelihood of turnover, impedes collaboration and treatment continuity, and, ultimately, has a negative impact on care quality and patient safety. The issue warrants particular attention in the demanding context of intensive care. Therefore, maintaining higher levels of work engagement among ICU nurses is important for workforce retention and high-quality patient care. OBJECTIVE:To assess the association between a healthy work environment and work engagement among ICU nurses and to test the hypothesized mediating roles of self-efficacy and compassion fatigue. METHODS:A cross-sectional survey involving ICU nurses was conducted at four general hospitals in China from November 2025 to January 2026. The Healthy Work Environment Assessment Tool (HWEAT), Utrecht Work Engagement Scale (UWES), General Self-Efficacy Scale (GSES), and Compassion Fatigue Short Scale (CF-Short Scale) were used. Statistical analyses were conducted in SPSS 25.0 and structural equation modeling in AMOS 26.0. RESULTS:Significant indirect associations were identified through self-efficacy and compassion fatigue, which together accounted for part of the association between a healthy work environment and work engagement. The results indicated that a healthy work environment was positively associated with self-efficacy (β = 0.67, p < 0.001) and work engagement (β = 0.46, p < 0.001) and negatively associated with compassion fatigue (β = -0.51, p < 0.001). Additionally, self-efficacy was positively associated with work engagement (β = 0.33, p < 0.001) and negatively associated with compassion fatigue (β = -0.36, p < 0.001). Compassion fatigue was negatively associated with work engagement (β = -0.22, p < 0.001). The hypothesized model demonstrated acceptable fit: χ2/df = 3.240, CFI = 0.983, RMSEA = 0.079, and GFI = 0.933. CONCLUSION:This study assessed the association between a healthy work environment and work engagement among ICU nurses and examined the indirect roles of self-efficacy and compassion fatigue. Hospital administrators may consider prioritizing healthy work environments and implementing initiatives that support nurses' self-efficacy and address compassion fatigue, given their associations with work engagement. Notably, the cross-sectional nature of the data precludes causal interpretation; the findings should, therefore, be interpreted as associations rather than causal effects. REPORTING METHOD:The study was reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines for observational research. IMPLICATION FOR NURSING MANAGEMENT:The findings indicate that a healthy work environment, self-efficacy, compassion fatigue, and work engagement are closely interrelated among ICU nurses. Nursing managers may adopt an integrated strategy that combines environmental support with efforts to promote self-efficacy and address compassion fatigue, thereby potentially supporting work engagement among ICU nurses. Meanwhile, greater attention to the healthy work environment and nurses' self-efficacy may help support workforce resilience, care quality, and staff retention.
BACKGROUND:Measuring patient-level complexity of nursing care in acute medical wards is essential for staffing and care planning, yet validated brief instruments in Spanish settings are scarce. The Sistema Informativo della Performance Infermieristica (SIPI) is a brief, intervention-based index designed to quantify nursing-care complexity on general wards. AIM:To translate SIPI into Spanish and evaluate its clinimetric properties in acute medical hospital wards. METHODS:A cross-sectional clinimetric instrument validation study. SIPI was translated into Spanish by two bilingual nurses, and a third bilingual nurse performed a back-translation, which was reviewed by one of the original SIPI authors to ensure semantic equivalence. Construct validity was assessed in 212 hospitalised patients in four internal medicine wards. Convergent validity was examined using nurses' perception of the complexity of care. Known-groups validity was assessed by examining whether SIPI behaved as expected in relation to patient age and admission type. The optimal cut-off was determined using a receiver operating characteristic analysis to evaluate discriminant validity. RESULTS:The Spanish version was semantically equivalent to the original, with only minor wording adjustments. Convergent validity was supported: SIPI scores increased significantly across the four nurse-rated complexity levels and were significantly higher in patients rated as high versus low complexity. In the ROC analysis, SIPI discriminated high- from low-complexity patients with excellent accuracy (AUC = 0.94; 95% CI 0.91-0.97); the optimal cut-off of 53.50 yielded 88.4% sensitivity, 86.0% specificity, 87.6% positive predictive value and 86.9% negative predictive value. Known-groups validity was supported, as patients classified as high complexity by SIPI were significantly older than those classified as low complexity, and SIPI scores were significantly higher in urgent versus scheduled admissions. IMPLICATIONS FOR NURSING MANAGEMENT:The Spanish version of SIPI offers nurse managers a brief, patient-level measure of nursing-care complexity that could complement existing staffing and workload systems to support early identification of high-complexity patients and more equitable, transparent resource allocation, pending confirmation in multicentre, outcome-based studies. CONCLUSION:The Spanish version of SIPI showed adequate clinimetric properties, similar to the original Italian version, supporting its use as a brief instrument for measuring the patient-level complexity of nursing care in acute medical hospital wards.
AIM:To examine the current state of large language model (LLM) evaluation in clinical nursing, synthesize the evaluation dimensions and metrics reported in the literature, and develop a preliminary evaluation framework for LLMs in clinical nursing through expert consultation. BACKGROUND:The advancement of artificial intelligence products, exemplified by LLMs, has generated excitement about their potential applications in clinical nursing practice, but their effectiveness remains uncertain. METHODS:A scoping review was conducted in accordance with Arksey and O'Malley's framework and incorporated experts' consultation. A literature search was conducted across Web of Science, PubMed, Embase, and the Cochrane Library, from their inception to June 21, 2025. Three expert meetings involving eight experts were conducted between August and October 2025 to synthesize evaluation frameworks and scenarios. RESULTS:A total of 42 studies were included, and the GPT family was the most frequently evaluated. Thirty-seven evaluation metrics were extracted and refined through expert consultation into six primary domains: performance and accuracy, clinical validity and safety, workflow integration and efficiency, usability and user experience, model reliability and ethical considerations, and competency development. A scenario classification and a proposed minimum technical reporting checklist were also developed to support the transparent and comparable evaluation of LLMs in clinical nursing. CONCLUSION:This study used a scoping review and expert consultation to summarize contemporary literature on LLM evaluations in clinical nursing practice. It provides a preliminary, structured basis for developing and refining a standardized evaluation framework. IMPLICATIONS FOR NURSING MANAGEMENT:This study highlights the need for systematic and context-sensitive evaluation of LLMs in clinical nursing. The findings provide nursing managers with a structured reference for identifying core evaluation dimensions, interpreting evidence, and planning the evaluation and deployment of nursing-specific LLM applications.
OBJECTIVE:To evaluate the effectiveness of a structured innovation training program based on the '4P' theory (Person, Process, Press and Product) in enhancing the innovation capability of clinical nurses. METHODS:We conducted a 1-year training program with 122 nurses at The Second Affiliated Hospital of Anhui Medical University. In this single-group pretest-posttest quasi-experimental study, data were collected before and after the intervention using questionnaires and analysed with paired-sample t-tests. RESULTS:Compared to the pretraining period, the posttraining scores for innovation capability among all participants, including innovative person, innovative process and innovative press, showed a significant increase (p < 0.05), while no statistically significant difference was observed in the innovative product score (p < 0.05). Repeated measures analysis of variance revealed that the improvement in posttraining innovation capability scores was significantly greater in the high-efficiency innovation group (Δ = 8.10 ± 1.74) than in the proactive innovation group (Δ = 5.90 ± 3.29) (F = 21.309, p < 0.05). However, the improvement in posttraining innovative press scores was significantly higher in the proactive innovation group (Δ = 2.92 ± 5.23) compared to that in the high-efficiency innovation group (Δ = 0.46 ± 5.67) (F = 11.699, p < 0.05). CONCLUSION:This study demonstrates that an innovation training strategy based on the '4P' theory effectively enhances the innovation capability of clinical nurses. This is achieved by systematically stimulating individual innovative potential, providing methodological training, creating a supportive environment and promoting outcome translation, thereby validating the clinical applicability of this theory.
BACKGROUND:Work engagement is a pivotal concept associated with nurses' occupational well-being, performance, and retention. According to the job demands-resources (JD-R) model, work engagement is enhanced by job resources in the workplace. In nursing settings, hierarchical structures and interpersonal sensitivities may inhibit open expression, suggesting that psychological safety plays an important role in workplace interactions and work engagement. However, the mechanisms through which organizational climate and leadership influence work engagement via psychological safety have not been sufficiently examined. AIM:This study examined the mediating effect of psychological safety on the relationships between organizational climate, servant leadership, and work engagement among Japanese hospital nurses. METHOD:A questionnaire survey was conducted among nurses working in hospital wards in Japan. The study analyzed data on 306 participants, using the Japanese Utrecht Work Engagement Scale-9, Japanese Psychological Safety Scale, Ward Organizational Climate Scale, and Servant Leadership Scale, Japanese version. Structural equation modeling was performed to examine the mediating effect of psychological safety. RESULTS:Organizational climate had a significant positive association with psychological safety, which, in turn, was significantly associated with work engagement. Organizational climate showed a significant indirect association with work engagement through psychological safety. Servant leadership, however, did not demonstrate significant effects on either psychological safety or work engagement. CONCLUSIONS:These findings imply that organizational climate is associated with nurses' work engagement through psychological safety. Within the tested model, organizational climate showed a stronger association with psychological safety than servant leadership. These findings also extend the application of the JD-R model by suggesting that psychological safety may function as an interpersonal mechanism linking organizational climate to nurses' work engagement. IMPLICATIONS FOR NURSING MANAGEMENT:The findings highlight the importance of prioritizing the development of a workplace environment that allows nurses to speak openly and seek consultation with confidence.
INTRODUCTION:The increasing nursing attrition rate has become a major concern. Job satisfaction is a key predictor of nurse turnover, yet the effectiveness of strength-based approaches remains underexplored. This study aimed to explore the feasibility and preliminary effects of implementing Appreciative Inquiry (AI) on job satisfaction among intensive care unit (ICU) nurses. METHODS:Following ethical approval, AI using the 5-D cycle was implemented over a five-month period with ICU nurses. The intervention involved a series of sessions designed to explore the nurses' best experiences, core values, and wishes through dialog and inquiry. The Minnesota Satisfaction Questionnaire (MSQ) was administered pre- and postintervention to assess job satisfaction changes, and focus group interviews were conducted to gather qualitative insights. RESULTS:Sixty-three ICU nurses participated in the study. Quantitative analysis showed no statistically significant increase in general job satisfaction (mean score: 68.8 to 70.0) and intrinsic satisfaction (43.4 to 44.2). However, specific MSQ subitems, particularly those related to receiving praise and sense of accomplishment, showed preliminary improvements (p < 0.05), although these findings are exploratory. Qualitative findings revealed that impactful nursing care often stems from personal interactions, highlighting why nurses find meaning and appreciation in their work. Many participants expressed interests in exploring more appreciative topics, suggesting AI's potential for broader workplace improvement. CONCLUSION:AI is a novel approach within the Hong Kong nursing context. While overall findings did not reach statistical significance, this study suggests AI application within an ICU setting is feasible. The preliminary feedback indicates its potential to enhance staff engagement and targeted aspects of job satisfaction. Further controlled and rigorous research is recommended to explore the AI impact on healthcare environments. IMPLICATIONS FOR NURSING MANAGEMENT:Nurse managers can practically integrate AI by using strength-based dialog and inquiry to focus on best practices during staff reviews, targeting specific workplace stressors, and implementing structured recognition practices to celebrate staff successes.
AIM:This study aims to investigate the relationship between a leadership approach oriented toward collaborator involvement and adaptive performance, with work engagement and group identification as motivational mediators. Personal change predisposition was examined as a moderator between collaboration-oriented leadership, work engagement, and adaptive performance. BACKGROUND:Adaptive performance is essential for maintaining high-quality patient care in rapidly changing healthcare settings. Although collaborative leadership has been associated with several positive organizational outcomes, the mechanisms through which it supports healthcare professionals' adaptive performance remain unclear. METHODS:The authors conducted a cross-sectional study in a hospital in northern Italy. An online questionnaire was administered to 418 healthcare professionals, and more than half of the respondents were nurses. RESULTS:Collaboration-oriented leadership may support adaptive performance positively, both directly and indirectly, through work engagement and group identification. Change predisposition had a moderating effect only between leadership and adaptive performance and between leadership and work engagement, suggesting that collaboration-oriented leadership is more effective in enhancing adaptivity and engagement when healthcare professionals exhibit lower levels of change predisposition. CONCLUSION:The findings highlight the importance of adopting a bottom-up leadership approach by actively involving and supporting team members to promote adaptive strategies in organizational contexts and situations characterized by greater resistance to change of human resources. IMPLICATIONS FOR NURSING MANAGEMENT:In terms of practical implications, nurse managers and care-unit leaders could increase staff work engagement and the sense of group identification by providing additional supports to the professionals who are less predisposed to embrace organizational changes and are more resistant to innovation.
BACKGROUND:Newly graduated psychiatric nurses often experience challenges during the transition to professional practice, which may influence their professional commitment. Although workplace anxiety represents an important psychological factor, organizational factors such as spiritual leadership and error management climate may also contribute to variations in professional commitment. However, the relationships among these psychological and organizational factors remain insufficiently understood. OBJECTIVE:To examine the associations of workplace anxiety, spiritual leadership, and error management climate with professional commitment among newly graduated psychiatric nurses using generalized additive models (GAMs) and random forest (RF) models to integrate explanatory and predictive analyses. METHODS:A cross-sectional study was conducted among 264 newly graduated psychiatric nurses recruited from three tertiary psychiatric hospitals in Tianjin, China. Data on workplace anxiety, spiritual leadership, error management climate, and professional commitment were collected using validated questionnaires. A GAM was applied to examine adjusted associations and interaction patterns, while RF analysis was performed to evaluate the predictive contribution of candidate factors. RESULTS:Error management climate showed a significant positive association with professional commitment in the GAM analysis (F = 8.24, p = 0.004) and demonstrated the greatest predictive contribution in the RF model according to permutation-based variable importance. Spiritual leadership did not show a significant main association with professional commitment (F = 3.70, p = 0.055), but its association with professional commitment varied according to levels of error management climate (Bonferroni-adjusted p = 0.013). Workplace anxiety was not independently associated with professional commitment in the GAM analysis (F = 0.39, p = 0.533) but showed relatively high predictive contribution in the RF. GAM and RF generated predictions showed strong agreement (r = 0.842). CONCLUSION:Professional commitment among newly graduated psychiatric nurses is associated with the combined contribution of psychological experiences and organizational conditions. Error management climate demonstrated relatively greater predictive contribution within the RF framework, while workplace anxiety and spiritual leadership may contribute to professional commitment in context-dependent ways. IMPLICATIONS FOR NURSING MANAGEMENT:Nursing managers should consider strengthening error management climate, optimizing leadership practices, and providing psychological support to facilitate professional adaptation and promote professional commitment among newly graduated psychiatric nurses.
BACKGROUND:Nursing care motivation is a key determinant of caring behaviours and quality of care outcomes. However, existing instruments do not adequately capture motivation specific to the nursing care context. OBJECTIVE:To develop a valid and reliable instrument to determine nurses' motivation and willingness to provide care, as well as the factors guiding their caring behaviour. DESIGN:Instrument development and psychometric testing of content validity, reliability and construct validity. METHODS:This methodological study included 30 nurses for the pilot study, 397 for principal component analysis (PCA), 350 for confirmatory factor analysis (CFA) and 30 for test-retest reliability. Face and content validity, construct validity and reliability analyses were conducted to develop the scale and assess its psychometric properties. Data were collected between December 2024 and December 2025. RESULTS:The content validity index of the scale was 0.98. PCA revealed a five-factor structure with 27 items, explaining 72.35% of the total variance. Factor loadings ranged from 0.65 to 0.89. CFA supported the model with acceptable fit indices (χ2/df = 2.446, CFI = 0.94, TLI = 0.93 and RMSEA = 0.06). The Cronbach's α coefficient of the scale was 0.952, the Guttman split-half was 0.843, and the test-retest reliability was 0.937. CONCLUSION:The Nursing Care Motivation Scale (NCMS) is a valid and reliable tool that can be used by nurses. IMPLICATION FOR NURSING MANAGEMENT:The NCMS provides nurse managers with a practical tool to identify modifiable factors influencing nursing care motivation, inform targeted interventions and enhance the quality and sustainability of patient-centred care.
BACKGROUND:Poor nurse well-being is a significant concern, adversely affecting patient care quality and satisfaction and contributing to poor job satisfaction, increased sickness absence and workforce retention issues. There are calls for evidence-based policies and interventions to address poor nurse well-being, but no consensus exists on which outcomes should be captured to assess nurse well-being. We used a salutogenic and consensus approach to develop a Core Outcome Set (COS) for nurse well-being. METHODS:A Delphi methodology was employed. Participants were recruited from two stakeholder groups: (1) nurse well-being professionals, identified through relevant publications, conference/meeting attendance lists and peer recommendations, and (2) registered nurses working in the UK National Health Service (NHS), recruited via social media, professional nursing bodies and practitioner networks. The stakeholder panel completed two rounds of an online Delphi survey, rating 43 previously identified well-being outcomes on a nine-point Likert scale, from 'not important' to 'critical.' Consensus was defined as ≥ 75% of stakeholders agreeing a well-being outcome was critical for inclusion in the COS. RESULTS:Fifty-four stakeholders completed the first Delphi round, and 45 participated in both rounds. Thirteen well-being outcomes met the a priori threshold for inclusion in the COS: general well-being, health, sleep, positive relationships, personal safety, psychological need satisfaction, psychological safety, job satisfaction, morale, life-work balance, compassion satisfaction, satisfaction with patient care and good nursing practice. The final COS was agreed by the stakeholder panel, without amendments. CONCLUSION:This study establishes a COS defining the nurse well-being outcomes that should be captured when assessing nurse well-being. Appropriate existing measurement instruments can be selected to capture these outcomes; future research is needed to identify and evaluate the most appropriate instruments and assess the feasibility of routinely capturing all 13 outcomes. IMPLICATIONS FOR NURSING MANAGEMENT:The COS provides nurse managers and workforce leaders with an agreed set of outcomes to support consistent nurse well-being measurement, benchmarking and workforce monitoring. Its use can support evaluation of well-being interventions, evidence-informed decision-making and the development of strategies and workplaces that enable nurses to thrive.
BACKGROUND:Voluntary resignation among nurses poses a growing challenge for healthcare organisations, with implications for workforce stability and quality of care. While intention to leave has been widely examined, little is known about the experiences of nurses who have already enacted their decision to resign, particularly across different life stages. AIM:To explore the reasons underlying voluntary resignation among nurses and examine how these reasons vary across generational cohorts, with the goal of informing life-stage-sensitive workforce retention strategies. METHODS:A qualitative descriptive study was conducted in a large Italian university hospital. Nurses who voluntarily resigned between March and November 2025 participated in semistructured exit interviews. Data were collected through detailed field notes and analysed inductively using thematic analysis. RESULTS:Sixty-six nurses participated. Resignation emerged as a multifactorial process shaped by the interaction between organisational conditions and evolving life-stage priorities. Generation Z participants reported insufficient onboarding, unmet expectations and difficulties balancing work with academic or personal commitments. Generation Y emphasised workload pressures, limited recognition, poor organisational climate and restricted career development. Generation X highlighted physical strain, scheduling needs and logistical barriers such as commuting and parking difficulties. Across all groups, chronic understaffing, limited flexibility and insufficient managerial support were consistently identified as key contributors. CONCLUSIONS:Voluntary resignation reflects a complex interplay between organisational factors and life-stage-specific needs rather than isolated dissatisfaction. The findings highlight under-recognised determinants-such as micrologistical stressors and personal development aspirations-that influence enacted turnover. IMPLICATIONS FOR NURSING MANAGEMENT:Nurse managers should adopt life-stage-sensitive retention strategies, including structured onboarding, supportive leadership, flexible scheduling, recognition of competencies and attention to logistical and quality-of-life factors. Addressing both organisational and relational dimensions may enhance staff retention and contribute to a more sustainable workforce.
PURPOSE:Sleep disorders among nurses are highly prevalent, affecting well-being, clinical performance, and patient safety. A comprehensive mapping of global research trends is lacking. This study evaluates the evolution and focal points of research on sleep disorders among nurses over the last 4 decades, utilizing bibliometric analyses. METHODS:We performed a bibliometric analysis of 1553 English-language publications retrieved from the Web of Science Core Collection (WoSCC) (1985-2025). Publication trends, country and institutional contributions, collaboration networks, cocitation, and keyword co-occurrence were analyzed. RESULTS:Research output increased steadily, with a sharp surge after 2020, reflecting the impact of COVID-19. The United States and China were leading contributors, but international collaboration was sparse. Core themes included insomnia and sleep quality, shift work and circadian misalignment, and psychological sequelae such as stress, depression, and burnout. Recent hotspots emphasized patient safety, measurement validation, and intervention trials. CONCLUSION:The field is expanding rapidly yet remains fragmented. Harmonized measurement, system-level interventions, and stronger international collaboration are required to translate research into sustainable improvements in nurse health and patient safety.
BACKGROUND:Nurse retention is a pressing issue globally, particularly in Jordan, where governmental hospitals face significant challenges in maintaining a stable nursing workforce. AIM:This study aims to investigate the relationship between NMs' scheduling flexibility and nurse retention. METHODS:A cross-sectional correlational study was conducted involving 155 nurses from five governmental hospitals across Jordan. Data were collected from 1 October-1 November, 2024 using the Work Schedule Flexibility Survey (WSFS) and the Revised Casey-Fink Nurse Retention Survey. RESULTS:Nurses reported low levels of scheduling flexibility (M = 1.52, SD = 0.28) and retention factors (M = 49.9, SD = 10.5). Scheduling flexibility was positively correlated with job retention (r = 0.79, p < 0.01). Age and years of nursing experience were significant positive predictors of retention, whereas excessive night shifts, increased workload, and demanding work schedules were significant negative predictors. CONCLUSION:Improving scheduling flexibility, reducing workload, and strengthening managerial support may enhance nurse retention. This study provides context-specific evidence from Jordanian nurses to inform workforce policies and sustainable retention strategies in health care. IMPLICATIONS FOR NURSING MANAGEMENT:Flexible scheduling is an important nursing management strategy that enhances nurses' job satisfaction and well-being. Since high turnover rates remain a global challenge, nurse managers should promote flexible work arrangements to improve work-life balance, reduce burnout, and strengthen staff retention. Such practices can also enhance organizational commitment and quality of patient care.
AIM:To examine the association between authentic leadership and nurses' innovative behaviour and to test the parallel mediating roles of psychological empowerment and leader-member exchange. DESIGN:A two-wave, time-lagged, multicentre survey design. METHODS:Clinical nurses from 12 public hospitals across eastern, central and western China participated. A total of 2291 nurses completed the baseline survey, and 1812 completed the follow-up assessment and were included in the final analysis, yielding a retention rate of 79.1%. Authentic leadership, psychological empowerment and leader-member exchange were measured at Time 1, and nurses' innovative behaviour was measured at Time 2. Structural equation modelling and bootstrap analysis were conducted to test the hypothesised mediation model. RESULTS:Authentic leadership was positively associated with psychological empowerment and leader-member exchange. Both mediators were positively associated with nurses' innovative behaviour. The direct association between authentic leadership and innovative behaviour was not significant after the mediators were included. Psychological empowerment demonstrated a stronger mediating effect than leader-member exchange. CONCLUSION:Authentic leadership may support nurses' innovative behaviour primarily by strengthening psychological empowerment, with leader-member exchange providing an additional relational pathway. IMPLICATIONS FOR THE PROFESSION:Nurse managers should develop authentic leadership practices that strengthen nurses' psychological resources and workplace relationships to foster innovation in clinical settings. REPORTING METHOD:This study adhered to STROBE reporting guidelines.
BACKGROUND:Compassion fatigue among midwives is prevalent and poses significant risks, adversely affecting both their personal well-being and the quality of maternal and infant care. However, a tailored, practical tool for predicting compassion fatigue risk in this population is lacking. OBJECTIVE:To analyze factors influencing compassion fatigue in midwives, construct a predictive model for compassion fatigue risk, and provide evidence-based strategies for prevention. METHODS:In this cross-sectional study, 209 midwives from 29 public hospitals in western China were enrolled via convenience sampling. Compassion fatigue was assessed using the Professional Quality of Life Scale, alongside measures of the Traumatic Stress Scale for Midwives, Social Support Rating Scale, 10-Item Connor-Davidson Resilience Scale, and Simplified Coping Style Questionnaire. Univariate analysis and multivariate logistic regression identified risk factors for compassion fatigue. A risk prediction model was constructed and a nomogram model was developed, followed by model evaluation and internal validation. RESULTS:Six independent predictors were identified: age, sleep quality, perceived recognition in the past month, frequency of traumatic events, and positive/negative coping strategies. The model achieved an area under the receiver operating characteristic curve (area under the curve [AUC]) of 0.820 (95% confidence interval [CI]: 0.763-0.876). After internal validation via bootstrapping, the AUC decreased to 0.786 (95% CI: 0.779-0.815). The Hosmer-Lemeshow test yielded χ2 = 5.777, p = 0.672. CONCLUSION:Based on the stress process theory, this study found that 91.86% of midwives experienced compassion fatigue at any level; 63.6% had moderate to severe levels-the threshold considered clinically significant for the purpose of the prediction model. Six independent predictors were identified: age, sleep quality, perceived recognition in the past month, frequency of traumatic events, and positive/negative coping. A nomogram prediction model was developed using these predictors. The model demonstrated good discriminative ability (AUC = 0.820, 95% CI: 0.763-0.876) and calibration (Hosmer-Lemeshow p = 0.672). This nomogram provides nursing managers with a practical, low-cost tool to identify midwives at high risk of compassion fatigue, providing a reference for targeted preventive strategies. IMPLICATIONS FOR NURSING MANAGEMENT:This nomogram may assist managers in early identification of midwives at risk for compassion fatigue and facilitate risk-stratified preventive strategies, with external validation needed before broader clinical implementation. The findings highlight the actionable areas for intervention-including psychological support, trauma-informed care, sleep and workload management, and professional recognition practices-which may help mitigate compassion fatigue and promote workforce stability.
INTRODUCTION:Climate change and environmental degradation are increasingly recognised as major global health threats. This necessitates adaptation within health systems and urgent development of mitigatory measures. Nurses and midwives are central to the environmental impact of healthcare and to advancing sustainable practices. This study explored nurses' and midwives' attitudes toward sustainability and climate change and perceived barriers to sustainable practice. METHOD:A cross-sectional survey design was used, employing the Sustainability Attitudes in Nursing Survey (SANS-2) instrument to assess attitudes to sustainability and climate change. The survey included nine core Likert-scale items (1 = strongly disagree to 7 = strongly agree) and five further researcher-designed questions. A convenience and snowball sample of nurses, midwives and students was recruited via professional networks and social media across Ireland, the United Kingdom, Germany, and other European countries. Quantitative data were analysed using descriptive statistics and analysis of variance (ANOVA) to explore differences by professional role. Open-ended responses were examined using content analysis to identify recurring themes. RESULTS:There were 256 complete responses. Most participants agreed that climate change (78%) and sustainability (87.1%) are important issues for nursing and midwifery. The majority supported their inclusion in nursing and midwifery curricula (climate change: 68.8%; sustainability: 77.7%). While most participants reported applying sustainability principles at home (84.4%), only just over half reported doing so in their nursing and midwifery practice (53.5%). Significant relationships were found between sustainable behaviours at home and work (p < 0.001) and between perceived time availability and belief in climate change importance (p ≈ 0.001). DISCUSSION:Findings reveal strong recognition of sustainability's relevance but limited translation into practice, particularly among students and early-career staff. Hierarchical structures and a lack of confidence inhibited challenges to unsustainable practices. Educational reform embedding sustainability within nursing curricula, aligned with the UN Sustainable Development Goals, is essential to empower nurses and midwives as climate health advocates. IMPLICATIONS FOR NURSING MANAGEMENT:Nurse managers and leaders should embed sustainability within clinical governance, quality improvement, staff development and leadership practice. Creating psychologically safe environments where nurses can raise concerns about unsustainable practices, alongside visible leadership support and targeted education, may facilitate the translation of positive sustainability attitudes into environmentally responsible practice.
BACKGROUND:Empowerment in nurses is a multidimensional construct that has favorable results for both the patient and the employee and is emphasized in order to provide high-quality healthcare. For this concept to be translated into practice, measurement tools developed in this field are of critical importance. Although several validated instruments assess structural, psychological, or behavioral empowerment separately, each having been validated independently, using distinct samples, scoring frameworks, and item structures, no instrument evaluating all three dimensions simultaneously within a single scale has been identified. This gap limits nurse managers in comprehensively diagnosing empowerment and in evaluating the effectiveness of empowerment interventions. OBJECTIVE:The study was conducted to develop a valid and reliable measurement tool aiming to determine the empowerment levels of nurses in a multidimensional manner in terms of structural, psychological, and behavioral dimensions. METHODS:In this methodological study, the standard scale development and validation procedures required for instruments to be psychometrically sound were employed. An initial 256-item pool was generated based on a comprehensive literature review and an autoethnographic approach involving 36 nurses. Subsequently, face and content validity (Lawshe's technique) were evaluated. Data were collected between May and September 2017 from nurses (N = 1992) working across 10 hospitals affiliated with a regional health group in Istanbul; the study was completed with a final sample of 743 nurses (37.3%). Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to determine the construct validity of the scale. Cronbach's alpha, item analyses, and test-retest analyses were employed to assess reliability. RESULTS:The draft nursing empowerment scale (NES), developed as a result of the face and content validity studies, consisted of 136 items and was administered to the sample group. The EFA conducted resulted in a NES consisting of 103 items and three factors (structural, psychological, and behavioral), explaining 49.95% of the total variance (KMO = 0.97; Bartlett χ2 = 58,144.65, p < 0.001). The scale factor structure was supported by supplementary CFA. The goodness-of-fit indicators (χ2/df = 3.75; RMSEA = 0.06; CFI = 0.92; NFI = 0.90; GFI = 0.90; AGFI = 0.88) were favorable. Internal consistency was observed (Cronbach's α = 0.98 overall; subscale α = 0.91-0.98) and 15-day test-retest correlation was r = 0.86 (subscale r = 0.73-0.83). CONCLUSIONS:The NES demonstrates good psychometric properties as a comprehensive, multidimensional research instrument. Future research should test the scale on independent and diverse samples. Its considerable length (103 items) is acknowledged as a practical limitation, and the development of a shorter, practice-oriented form is planned. IMPLICATIONS FOR NURSING MANAGEMENT:The NES enables the simultaneous, multidimensional measurement of structural, psychological, and behavioral empowerment within a single instrument. It could be useful in determining empowerment levels and evaluating the effectiveness of targeted empowerment strategies.
AIMS:To identify the latent profiles of Chinese Generation Z new nurses' job crafting, explore their demographic characteristics, and examine the predictive role of innovative behaviors in distinct job crafting profiles. BACKGROUND:New nurses experience high levels of stress and turnover intention during early career transition, highlighting the importance of proactive work behaviors. Although job crafting and innovative behavior are both considered important for professional development and workforce sustainability, evidence on their association and heterogeneity among new nurses remains limited. METHODS:This cross-sectional study was conducted using convenience sampling among new nurses from three tertiary hospitals in Midwestern China between March and May 2023. Participants completed the Innovative Behavior Scale, the Job Crafting Scale, and a demographic questionnaire. Latent profile analysis (LPA) was applied to identify potential subgroups of job crafting among new nurses. LPA was conducted using Mplus 8.3, while descriptive statistics, chi-square tests, analysis of variance, and multinomial logistic regression were performed using SPSS 27.0. RESULTS:Three job crafting profiles were identified: "low job crafting profile" (43.3%), "moderate job crafting profile" (47.5%), and "high job crafting profile" (9.2%). Significant differences were observed in age, marital status, educational attainment, and innovative behavior (P< 0.05). Multinomial logistic regression further indicated that innovative behavior was a significant predictor of profile membership (P< 0.05). CONCLUSION:Heterogeneity in job crafting among Chinese Generation Z new nurses and the key role of innovative behavior in shaping job crafting patterns are evident, with implications for targeted managerial strategies to support professional development. IMPLICATIONS FOR NURSING MANAGEMENT:Practical implications include tailoring management strategies to each profile: supporting foundational skills and psychological safety for nurses in the low job crafting profile, promoting gradual task enhancement and professional confidence-building for nurses in the Moderate job crafting profile, and sustaining empowerment and leadership development among nurses in the high job crafting profile.
BACKGROUND:Hospital nurses face increasing logistical-administrative demands and the widespread use of digital systems. Both may affect job satisfaction and patient safety by increasing workload and contributing to missed nursing care. OBJECTIVE:To quantify logistical-administrative workload and satisfaction with health technology among hospital nurses and to identify associations with job satisfaction and the prevalence of missed care. DESIGN:Cross-sectional survey. SETTING(S):A national cross-sectional survey of all nurses working in hospitals in Belgium was conducted between September 16 and October 18, 2024. PARTICIPANTS:A total of 3613 hospital nurses (79% staff nurses and 21% nurse managers) completed the entire online survey. METHODS:An online questionnaire assessed the proportion of time spent on administrative and logistical tasks, satisfaction with health technologies, job satisfaction, and 15 types of missed nursing care. Multivariable logistic and Poisson regression models, adjusted for sociodemographic and work environment factors, were applied. RESULTS:Nurses reported spending a median of 18% per shift on logistical-administrative tasks, with staff nurses spending more time than nurse managers (20% vs. 10%, p < 0.001) on these tasks. Overall, 71.7% were satisfied with their job, yet 72.1% reported at least one missed care activity. Higher logistical-administrative workload was associated with greater odds of job dissatisfaction (ORa = 1.15, 95% CI [1.10-1.20]) and more missed care (IRRa = 1.12 [1.04-1.20]). Dissatisfaction with health technologies was similarly linked to job dissatisfaction (ORa = 1.30 [1.07-1.58]) and missed care (IRRa = 1.17 [1.10-1.24]). Poor or average work environment was strongly associated with job dissatisfaction (ORa = 15.51 [12.04-19.71]) and missed care (IRRa = 1.36 [1.28-1.50]). CONCLUSIONS:Higher perceived logistical-administrative workload and lower satisfaction with health technologies were associated with increased job dissatisfaction and missed nursing care among hospital nurses. These findings highlight the importance of considering how administrative demands and digital tools are integrated into daily nursing work when addressing working conditions and care quality.
BACKGROUND:Clinical reasoning (CR) is a complex, context-dependent process that is essential for safe nursing care. Existing reviews have primarily focused on nursing students rather than practicing clinical nurses. Rapid changes in patient acuity and the increasing integration of digital technologies into healthcare highlight the need for an updated synthesis that reflects contemporary clinical environments. AIMS:To identify and synthesize factors influencing CR among nurses in contemporary healthcare settings using the decision-making ecology (DME) model. DESIGN:Integrative review. METHODS:The review followed the framework proposed by Whittemore and Knafl (2005). Literature searches were conducted in CINAHL, Cochrane Library, EMBASE, and PubMed for peer-reviewed studies published between January 2014 and June 2025. Data evaluation was performed using the Mixed Methods Appraisal Tool Version 2018. RESULTS:A total of 25 studies were included, and 116 factors were initially extracted. After synthesis, 55 factors were identified and organized into 17 subdomains within four domains of the DME model: decision-maker, case, organizational, and external. CONCLUSION:This review systematically identified multidimensional factors influencing nurses' CR using the DME model. CR competence should be understood not solely as an individual attribute but as a capability shaped by practice, organizational, and broader sociocultural environments. The findings highlight both established determinants and emerging technology-related influences on CR. IMPLICATIONS FOR NURSING MANAGEMENT:Nurse managers should provide opportunities for case-based learning, peer feedback, and reflective discussion tailored to nurses' levels of CR competence and clinical practice environments. Organizations should support the development of CR by ensuring adequate human and material resources, clear guidelines, and open organizational cultures that enable nurses to express and act on their clinical judgments. As technologies become more integrated into clinical practice, policymakers should promote their appropriate use to strengthen CR while minimizing technology-related barriers.
