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Aim This study aimed to describe nurses' experiences of working as members of unit practice councils. Background Health care organisations worldwide want personnel to participate in decision-making. Unit practice councils promote unit-level decision-making over unit-specific issues. Despite extensive research on shared decision-making, few studies have examined the experiences of nurses serving as members of these councils. Methods A descriptive qualitative study design was used with semi-structured interviews of 16 nurses in two clinics of a Finnish university hospital. Interviews were analysed using thematic analysis. Results The analysis revealed two themes describing nurses' experiences as members of unit practice councils: (i) inchoate unit practice councils with insufficient allocated working time and (ii) partial empowerment of nurses through the organisation's evolving Magnet project. Conclusions Unit practice councils in the studied organisations are inchoate and unable to effectively advance shared decision-making or support nurses' professional autonomy. In the future, the councils require constant support from all leadership levels of the organisation. Implications for nursing management Sharing decision-making power could be a win-win situation where nurse leaders relinquishing power over certain matters gain time to immerse in wider issues. While acknowledging different organisational roles, there is room for trusting each other's professionality and respecting autonomous work.

Aims This study sought to contribute to research on entrepreneurial intention by identifying which constructs of the entrepreneurial profile and internal conditions of health care organisations support entrepreneurship and contribute to the entrepreneurial intention of these organisations' employees. Background In addition to psychological attributes, cognitive processes, motivations, sociodemographic and professional characteristics, and entrepreneurial skills, the literature indicates that internal conditions of organisations also contribute to explaining entrepreneurial intention. Methods To evaluate this model empirically, the primary data were collected with questionnaires distributed to nurses in two public hospitals-the Tras-os-Montes and Alto Douro Hospital Center and the Local Health Unit of the Northeast. A total of 638 nurses filled out the questionnaire. The data were analysed using inferential and regression analyses. Results The results suggest that the dimensions related to personal attributes, namely, motivation and entrepreneurial skills, are the constructs that best explain the entrepreneurial intention of these professionals within their organisations. Conclusions A broad discussion is needed about how to implement internal conditions that promote an intrapreneurial and innovative culture in health care organisations. Implications for nursing management Health care organisation administrators need to prioritise intrapreneurship while structuring their management strategies, thereby creating favourable internal conditions (e.g., support, autonomy, rewards, time availability and appropriate organisational procedures) that enhance their nurses' entrepreneurial intention.

Background Relationships exist between aged care nurses’ perceptions of psychosocial work characteristics, job satisfaction and mental health, suggesting these characteristics may be important for the management of aged care services. Aim An expanded demand–control–support model that included justice perceptions was examined to determine its impact on multiple types of psychological and organisational well-being outcomes (i.e. job satisfaction, psychological distress and depression). Method Data were collected from a sample of 173 aged care nurses using a self-report survey and analysed using hierarchical multiple regression. Results A significant proportion (27–28%) of the variance in aged care nurses’ satisfaction, depression and psychological distress was explained by the psychosocial factors included in the model. Job control had the most consistent impact with direct effects on job satisfaction, psychological distress and depression. Informational justice was associated with both psychological distress and depression. Conclusions Targeting job control may provide the biggest response for nurse managers in aged care, as it is likely to influence nurses’ job satisfaction, psychological distress and depression. Implications for nursing management Facility managers should implement organisational policies and procedures that promote higher levels of control over how nurses perform their work in order to improve nurse well-being in aged care settings.

AIM: To assess and synthesise studies reporting direct associations between the structural empowerment of frontline nurses and quality outcomes, and to identify gaps in the current literature.BACKGROUND: The empowerment of nurses seems essential for delivering high-quality patient care. Understanding the relationship between empowerment and quality outcomes would enable nurse managers to make informed choices on improving the quality of care.METHODS: A scoping review examining the relationship between the structural empowerment of nurses and the quality, effectiveness, safety, efficiency and patient-centredness of care in hospitals. Searching in MEDLINE, CINAHL, Business Source Premier and Embase identified 672 potentially relevant articles. Independent selection, quality assessment, data extraction and analysis were completed.RESULTS: Twelve cross-sectional studies originating from North America were included. These studies showed a variety of quality outcomes and statistics used. All studies reported positive associations between the structural empowerment of nurses, nurse assessed quality of care and patient safety climate, and work and unit effectiveness.CONCLUSIONS: Nurses having access to empowering structures positively affects the quality outcomes, i.e. quality, effectiveness, safety, efficiency and patient-centredness of patient care in hospitals.IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers and leaders should ensure empowering work conditions for nurses in order to increase hospitals' quality of patient care.

Aim To describe the tactical and the operational decisions made by nurse managers when managing the daily unit operation in peri-operative settings. Background Management is challenging as situations change rapidly and decisions are constantly made. Understanding decision-making in this complex environment helps to develop decision support systems to support nurse managers’ operative and tactical decision-making. Design Descriptive cross-sectional design. Method Data were collected from 20 nurse managers with the think-aloud method during the busiest working hours and analysed using thematic content analysis. Results Nurse managers made over 700 decisions; either ad hoc (n = 289), near future (n = 268) or long-term (n = 187) by nature. Decisions were often made simultaneously with many interruptions. Ad hoc decisions covered staff allocation, ensuring adequate staff, rescheduling surgical procedures, confirmation tangible resources and following-up the daily unit operation. Decisions in the near future were: planning of surgical procedures and tangible resources, and planning staff allocation. Long-term decisions were: human recourses, nursing development, supplies and equipment, and finances in the unit. Conclusions Decision-making was vulnerable to interruptions, which sometimes complicated the managing tasks. Implications for Nursing Management The results can be used when planning decision support systems and when defining the nurse managers’ tasks in peri-operative settings.

AIM The aim of this study was to investigate how restricted decision-making autonomy and conflicting demands impact operational managers' work performance and health. BACKGROUND Managers at operational level (first- and second-line managers') in health care organisations are commonly exposed to strain in their work situation with high demands and a challenging work context. Although they play an important role, the knowledge about the causal associations between stressful job demands and their consequences is limited. METHODS A prospective design with questionnaire data collected at two points in time, 1 year apart, from a sample of operational managers (N = 162) at five Swedish hospitals was used to conduct a structural equation model analysis with cross-lagged paths. RESULTS Restricted decision-making autonomy was negatively associated with both the managers' health and their managerial work performance over time. CONCLUSIONS Health care managers' work performance and health may be sustained by the top management allowing them a higher degree of autonomy in their decision-making. IMPLICATIONS FOR NURSING MANAGEMENT This study suggests that nursing leaders should create the circumstances for operational managers' to have higher levels of autonomy in their area of responsibility and the freedom to prioritize their managerial workload.

Aim(s) This study explores the views of midwifery managers and key stakeholders, regarding the facilitators and barriers to employing new graduate midwives in midwifery continuity of care models. Background Maternity services in Australia are shifting towards midwifery continuity of care models, where midwives work in small group practices, requiring a change to the management of staff. Public policy in Australia supports maternity services to be reconfigured in this way. Historically, experienced midwives work in these models, as demand grows; new graduates are employed to staff the models. Method(s) A qualitative descriptive approach exploring the manager's experience of employing new graduate's in the models. Managers, clinical educators and hospital midwifery consultants (n = 15) were recruited by purposeful sampling. Results Drivers, enablers, facilitators and barriers to employing new graduates in the models were identified. Visionary leadership enabled the managers to employ new graduates in the models through initial and ongoing support. Managing the myths stemming from fear of employing new graduates to work in midwifery continuity of care models was challenging. Conclusion Managers and other key stakeholders provide initial and ongoing support through orientation and providing a reduced workload. Implications for nursing management Visionary leadership can be seen as critical to supporting new graduates into midwifery continuity of care models. The challenges for management to overcome include managing the myths stemming from fear of employing new graduates to work in a flexible way around the needs of the women within an organisation culture.

Aim To test the psychometric properties of a boundary spanning measure by nurse managers. Background The health-care environment requires hospital units to coordinate efforts autonomously across their boundaries and to manage relationships with other professionals, units and departments. Boundary spanning has become increasingly important for first-line nurse managers as unit gatekeepers; however, the available measures are limited. Method The 30-item instrument was developed from a literature review. Survey participants were 4918 nurses at 231 hospital units. Statistical analyses of construct validity and internal consistency were performed. Furthermore, the correlation between nurses' scores on the Nurse Managers Boundary Spanning Scale and nurses' evaluations of their managers were examined. Results Three factors and 26 items were derived from factor analyses: connecting and mediating, informing and feedback utilisation, and resource acquisition. Cronbach's subscales' alpha coefficients were above 0.9. Correlation analysis indicated that the Nurse Managers Boundary Spanning Scale score correlated with nurses' positive perceptions of their managers. Conclusion This study demonstrates tentative support for the validity and reliability of the Nurse Managers Boundary Spanning Scale. Although further study is needed, the Nurse Managers Boundary Spanning Scale shows possibilities as a new measurement of nursing leadership. Implications This study underscores measures to build on nurse managers' roles by building on the limited research available.

Aim This review aimed to synthesise literature describing the development and/or implementation and/or evaluation of a professional practice model to determine the key model components. Background A professional practice model depicts nursing values and defines the structures and processes that support nurses to control their own practice and to deliver quality care. Evaluation A review of English language papers published up to August 2014 identified 51 articles that described 38 professional practice models. Articles were subjected to qualitative analysis to identify the concepts common to all professional practice models. Key issue Key elements of professional practice models were theoretical foundation and six common components: leadership; nurses’ independent and collaborative practice; environment; nurse development and reward; research/innovation; and patient outcomes. Conclusions A professional practice model provides the foundations for quality nursing practice. This review is an important resource for nurse leaders who seek to advance their organisation in a journey for excellence through the implementation of a professional practice model. Implications for nursing management This summary of published professional practice models provides a guide for nurse leaders who seek to develop a professional practice model. The essential elements of a professional practice model; theoretical foundation and six common components, are clearly described. These elements can provide the starting point for nurse leaders’ discussions with staff to shape a professional practice model that is meaningful to direct care nurses.

Aim To explore the regulation of advanced nurse practice internationally and to identify differences and commonalities. Background Regulation of advanced practice nursing does not occur in many countries. Ireland is currently in the minority in regulating advanced practice at a national level. Key issues Lack of regulation poses difficulties for national governments and for society due to uncertainty in advanced practice concept and role. Methods A literature review of 510 scholarly nursing papers published in CINAHL, PubMed and MEDLINE between 2002 and 2013 and 30 websites was undertaken. Results There is a lack of consistency in legislative systems internationally. Nursing organisations have recognised advanced nurse practice by regulation in some countries and by voluntary certification in others. Conclusions Research has demonstrated that care delivered by advanced nurse practitioners has enhanced patient outcomes yet regulation of advanced practice is not undertaken in most countries. Implications for nurse manager Nurse managers need to know that criteria for the regulation of advanced practice are in place and reflect the minimum requirements for safe practice.

Aim To examine the current state of empowerment of nurses in Italy. Background Empowerment is a broad concept that is also relevant to the field of nursing practice. Its comprehension and use are important because empowerment allows nurses to take control of their own practice. A clear understanding of empowerment is necessary for nurses to take advantage of this important tool. Design Focus groups were conducted. Methods A literature review was performed, and two focus groups were selected between January and February 2014. Results Sixteen nurses participated in the research. Empowerment is seen as being strongly connected to autonomy and is not associated with power, as the word itself suggests. Italian nurses define empowerment as the creation of conditions that help to establish the possibility for people to develop and express their value and potential. Conclusions Empowerment is defined as a condition in which the individual nurse takes control of his/her own practice and thereby provides awareness and confidence to a group. Implications for nursing management Italian nurses need to feel appreciated and supported by their own organisations. If warranted, empowerment would allow them to contribute to enhance care, which is the core of the nursing profession.

Aim To examine clinical leadership of registered nurses in an emergency department, based on evidence that it is important for nurses to feel psychologically and structurally empowered in order to act as clinical leaders. Background Every registered nurse has the ability to act as a clinical leader. Clinical leadership is the registered nurse's behaviours that provide direction and support to patients and the team in the delivery of patient care. This study explores the connection between the need for structural and psychological empowerment and clinical leadership behaviours. Methods A mixed method, non-experimental survey design was used to examine the psychological empowerment, structural empowerment and clinical leadership of registered nurses working in an emergency department. Results Emergency department nurses believe they show clinical leadership behaviours most of the time, even though their sense of being psychologically empowered is only moderate. Conclusion While registered nurses believe they perform clinical leadership behaviours, it is also clear that improvements in structural and psychological empowerment would improve their ability to act as clinical leaders. Implications for nursing management The results show that for nurses to be able to provide clinical leadership to their patients and colleagues, management must create empowering environments.

Aim (a) To explore staff nurses' actual decisional involvement and preferred level of decisional involvement, the decisional dissonance, and the attributing factors; and (b) to understand staff nurses' perceptions about the process of decisional involvement at their work place in Taiwan. Background Research related to nurses' decisional involvement was scarce and mainly emphasized the level of involvement without examining the possible attributing factors and the process of nurses' decisional involvement. Method A two-phase internet mixed-method study design was used. A total of 125 staff nurses completed the internet survey using decisional involvement scale and 15 completed online forum discussion questions. Result Nurses' actual decisional involvement was significantly lower than preferred decisional involvement. The attributing factor to nurses' actual decisional involvement included the level of education, type of hospital, work unit and workload. There were no differences of preferred decisional involvement among different demographic data. Regarding nurses' perceptions of decisional involvement, three themes were identified: dependent on administrators, fear of getting into trouble, and the power of consensus. Conclusions The low level of actual decisional involvement and preferred decisional involvement might be associated with workload, management style and the fear of getting into troubles. Implication The government, health care organisations, nursing leaders should reexamine the influence of work setting factors, workload and management style to nurses' actual decisional involvement.

Background Job satisfaction is a critical factor in health care. Strong empirical evidence supports a causal relationship between job satisfaction, patient safety and quality of care. Objective To determine the level of nurses’ job satisfaction and its associated factors. Method A stratified random sample of 421 registered nurses working at a large hospital in Mashhad, Iran was surveyed. Result The results showed that autonomy, task requirement and work interaction had scores higher than their respective median on the subscales. There were significant differences between demographic characteristics and the autonomy, task requirement, work interaction, salary, work condition, professional development, supportive nursing management, decision making, professional status subscales and mean total job satisfaction. In univariate analysis, young age, being female and being married were significantly associated with a higher level of job satisfaction. The adjusted R 2 for this model was 0.14, indicating that the model explained 14% of the variability. The regression model was highly significant, F (4298) = 13.194, P < 0.001. Conclusions and implications for nursing management The authors emphasise that the human resources policies and incentives need to be re-visited. Efforts undertaken to improve working conditions, supportive nursing management, improved professional status, professional development and increased salaries are some of the ways for nurse managers to improve job satisfaction.

Aim To describe the level of job satisfaction of advanced nurse practitioners (ANP) and advanced midwife practitioners in the Republic of Ireland (RoI). Background Job satisfaction is related to productivity, performance, turnover and health, and thus is a challenge for nursing and healthcare organisations. Method Job satisfaction data were collected from 47 ANPs using the Misener Nurse Practitioner Job Satisfaction Scale. Results High levels of global job satisfaction were reported. All ANPs reported satisfaction with autonomy, sense of accomplishment, challenge, social interaction and status in the organisation. Lower levels of job satisfaction were attributed to the amount of involvement in research (55%), opportunities to receive compensation for services provided outside normal working hours (55%), the amount (44%) and the quality of administrative support (51%), and the opportunity to negotiate bonuses and resources in return for productivity (36%). Conclusion Advanced nurse practitioners in RoI have high levels of job satisfaction with areas relating to clinical practice but are dissatisfied with areas that lead to empowerment within organisations. Efforts to improve the negotiating and leadership skills of ANPs may improve job satisfaction. Implications for nursing management Enhancing inter-professional collegial relationships and improving managerial recognition of the role within nursing are key areas to be targeted to promote job satisfaction of ANPs.

Aim To explore the level of moral distress and potential associations between moral distress indices and (1) nurse–physician collaboration, (2) autonomy, (3) professional satisfaction, (4) intention to resign, and (5) workload among Italian intensive care unit nurses. Background Poor nurse–physician collaboration and low autonomy may limit intensive care unit nurses' ability to act on their moral decisions. Methods A cross-sectional correlational design with a sample of 566 Italian intensive care unit nurses. Results The intensity of moral distress was 57.9 ± 15.6 (mean, standard deviation) (scale range: 0–84) and the frequency of occurrence was 28.4 ± 12.3 (scale range: 0–84). The mean score of the severity of moral distress was 88.0 ± 44 (scale range: 0–336). The severity of moral distress was associated with (1) nurse–physician collaboration and dissatisfaction on care decisions (r = −0.215, P

Aim This study investigated the extent to which the job demands and job control of nurses were related to their work–life balance. Background The inability to achieve work–life balance is one of the major reasons for the declining retention rate among nurses. Job demands and job control are two major work domain factors that can have a significant influence on the work–life balance of nurses. Method The study measured the job demands, job control and work–life balance of 2040 nurses in eight private hospitals in Taiwan in 2013. Results Job demands and job control significantly predicted all the dimensions of work–life balance. Job demands increased the level of work–life imbalance among nurses. While job control showed positive effects on work/personal life enhancement, it was found to increase both work interference with personal life and personal life interference with work. Conclusion Reducing the level of job demands (particularly for psychological demands) between family and career development and maintaining a proper level of job control are essential to the work–life balance of nurses. Implications for nursing management Flexible work practices and team-based management could be considered by nursing management to lessen job demand pressure and to facilitate job engagement and participation among nurses, thus promoting a better balance between work and personal life.

Aim The primary aim of this study was to examine the relationships between structural empowerment, psychological empowerment and job satisfaction among staff nurses, after controlling for their leaders’ use of empowering behaviours. Background Nurses’ job satisfaction is a critical factor in health-care organisations because of its association with nurse turnover and quality of patient care. Nurses continue to report high levels of job dissatisfaction. Methods Cross-sectional data for 1007 Canadian staff nurses were analysed using hierarchical multiple regression. Results Structural empowerment was the strongest independent predictor of job satisfaction, followed by leader empowering behaviours and psychological empowerment. After accounting for the effects of structural empowerment and leader empowering behaviours, the four dimensions of psychological empowerment showed only small independent effects on job satisfaction. Psychological empowerment did not mediate the effects of structural empowerment on job satisfaction. Conclusion Nurses’ job satisfaction is most influenced by their access to organisational empowerment structures. Leader empowering behaviours, structural empowerment, and psychological empowerment, operating together, enhance nurses’ job satisfaction. Implications for Nursing Management Nurse leaders should use a variety of empowerment strategies that are important to nurses’ job satisfaction and potentially to the quality of patient care and nurse turnover.

Aim This study examined how leader-member exchange differentiation could affect nurses' perception of organisational justice as well as the moderating effect of task interdependence on this link. Background Teams are essential to the health-care industry. However, the perception of injustice may lead to a high level of nurse turnover. Method Data was collected from 187 nurses distributed in eight units in a mid-western hospital in the USA. Hierarchical linear modeling was used to analyze the cross-level interaction of leader-member exchange variability and task interdependence on individual-level perceptions of justice. Results Leader–member exchange variability was significantly related to distributive justice and interactional justice but not significantly related to procedural justice. The interaction term was significantly related to interpersonal justice, but not to procedural justice or distributive justice. Conclusion This study showed that if leaders demonstrated a variation in treatment of different subordinates, nurses could perceive this as unfair regarding distribution and interaction; when the group was highly task interdependent, this kind of perception of ‘unfairness,’ particularly regarding interpersonal treatment, became even more salient. Implications for nursing management Preferential and inconsistent treatment by them within the work group could introduce nurses' perceptions of unfair treatment. It is of crucial importance to provide training for supervisors on how to display relatively consistent behaviour towards nurses, particularly when the teams are highly task interdependent.

Aim To provide a synthesis of literature on international policy concerning pro-fessional regulation in nursing and midwifery, with reference to routes of entry intotraining and pathways to licensure.Background Internationally, there is evidence of multiple points of entry into initialtraining, multiple divisions of the professional register and multiple pathways tolicensure.Evaluation Policy documents and commentary articles concerned with models ofinitial training and pathways to licensure were reviewed. Item selection, qualityappraisal and data extraction were undertaken and documentary analysis wasperformed on all retrieved texts.Key issues Case studies of five Western countries indicate no single uniform systemof routes of entry into initial training and no overall consensus regarding theoptimal model of initial training.Conclusions Multiple regulatory systems, with multiple routes of entry into initialtraining and multiple pathways to licensure pose challenges, in terms of achievingcommonly-agreed understandings of practice competence.Implications for nursing management The variety of models of initial trainingpresent nursing managers with challenges in the recruitment and deployment ofpersonnel trained in many different jurisdictions. Nursing managers need to con-sider the potential for considerable variation in competency repertoires amongnurses trained in generic and specialist initial training models.Keywords

Aims This paper explores the collaborative development of a Master's level advanced practice programme in the context of the radical reform and remodelling of the UK's National Health Service. Some of the educational, managerial and practice challenges are discussed. Background Changes to education and training in response to key strategic reviews undertaken by the Greater Manchester Strategic Health Authority (North West of England) established a need to develop nurses and allied health care practitioners to advanced practitioner level. This paper considers how employers, commissioners and educationalists worked together to produce a Master's level programme to prepare nurses and other health care practitioners for sustainable advanced practice roles. Key issues Developing innovative and effective curricula to meet the needs of post graduate students from varied backgrounds preparing to practice in different contexts with different client groups is challenging. However, the development of individual learning pathways and work-based learning ensures that the student's work and intended advanced practice role remains at the centre of their learning. Analysis of each student's knowledge and skill deficits alongside an analysis of the organization's readiness to support them as qualified advanced practitioners (APs) is instrumental in ensuring that organizations are ready to support practitioners in new roles. Conclusion Work-based learning and collaboration between students, employers and higher education institutions can be used to enable managers and students to unravel the network of factors which affect advanced practice in health and social care. Additionally, collaborative working can help to create opportunities to develop strategies that will facilitate change. Implications for nursing management Sustainable change concerned with the introduction of advanced practitioner roles present a real challenge for managers at a strategic and operational level. Commissioning flexible, collaborative and service-led educational programmes can assist in ensuring that change is sustainable and produce practitioners who are fit for practice, purpose and award.

Aims This paper reports on a Training Needs Analysis for Non-Medical Prescribers commissioned by a south of England Strategic Health Authority. Background The aim of the TNA was to inform future policy, educational provision and practice development and provide nurse managers with significant information on the perceived Continuing Professional Development (CPD) needs of the non-medical prescribers. Methods Data were collected from a sample of 270 non-medical prescribers using an in-depth questionnaire, and telephone interviews with a purposive sample of 11 key stakeholders. Results The findings report: • The qualifications that non-medical prescribers possess. • The level of confidence described by the non-medical prescribers in their role. • What non-medical prescribers identify as their present and future CPD requirements in relation to prescribing. • What education and training provision non-medical prescribers have attended in relation to their prescribing role since qualifying. Conclusions The findings suggest, first that short courses that were specific to the non-medical prescribers role were considered to be the most popular and useful. However, courses needed to be advertised well in advance. Second, training gaps were identified. Implications for nursing management Pharmacology and prescribing are rapidly changing and require regular CPD in order to keep up to date with the latest developments. Non-medical prescribing is a comparatively new innovation to the NHS, therefore those who are not medically qualified need mentorship from experienced prescribers, as well as the encouragement from nurse managers to be confident prescribers themselves and enhance patient care.

Aim To investigate the potential of recent conceptual developments in the sociology of education for conceptualising academic leadership in nursing. Background During an investigation into the current status and future trajectory of academic nursing in Ireland, academic leadership emerged as a major concern for respondents. Method The languages of legitimation of academic leaders were elicited in in-depth interviews and analysed as expressions of underlying legitimation principles. Results The concept of legitimation principles provides a way of thinking about how academic nursing is positioned in the health and higher education sectors, how its leaders construct its identity, practices and purposes, and clarifies the proper focus and goals of academic leadership in nursing. Conclusions Academic leadership is concerned with legitimating the discipline of nursing as an autonomous, coherent and distinctive professional and academic endeavour. This legitimacy must be secured in academic, clinical and wider contexts in which academic nursing is viewed with ambivalence; leaders must take account of the impact of nursing history on the current status and future trajectory of the discipline. Implications for nursing leadership The analytic tools facilitate a better understanding of the internal and external conditions under which academic nursing will flourish, or wither, in contemporary higher education.

Aim This study aimed to identify and examine predictors of short-term absences of staff nurses working in hospital settings reported in the research literature. Background Front-line staff nurse absenteeism contributes to discontinuity of patient care, decreased staff morale and is costly to healthcare. Evaluation A systematic review of studies from 1986 to 2006, obtained through electronic searches of 10 online databases led to inclusion of 16 peer-reviewed research articles. Seventy potential predictors of absenteeism were examined and analysed using content analysis. Key issue Our findings showed that individual ‘nurses’ prior attendance records’, ‘work attitudes’ (job satisfaction, organizational commitment and work/job involvement) and ‘retention factors’ reduced nurse absenteeism, whereas ‘burnout’ and ‘job stress’ increased absenteeism. Remaining factors examined in the literature did not significantly predict nurse absenteeism. Conclusions Reasons underlying absenteeism among staff nurses are still poorly understood. Lack of robust theory about nursing absenteeism may underlie the inconsistent results found in this review. Further theory development and research is required to explore the determinants of short-term absenteeism of nurses in acute care hospitals. Implications for nursing management Work environment factors that increase nurses’ job satisfaction, and reduce burnout and job stress need to be considered in managing staff nurse absenteeism.

Aim The aim of the present study was to review the current literature on oppressed group behaviours in nursing, with emphasis on interventions to change the behaviours, and on instruments that have been developed to measure it. Background Oppressed group behaviours have been described in nurses for over two decades and their presence has been related to decreased nurse self-advocacy, and other negative aspects of the nursing workplace. Evaluation Systematic review of the literature on oppressed group behaviour in nursing. Key issues Oppressed group behaviours are frequently found in nurses. Interventions have been created and tested to decrease oppressed group behaviours. Conclusion Oppressed group behaviours are frequently found in nurses. Interventions exist that can decrease oppressed group behaviours and the decrease is related to increased work force performance, satisfaction and retention of nurses in the workplace. Implications for nurse managers Nurse Managers can improve the workplace by measuring oppressed group behaviours and utilizing interventions to break the cycle of oppression in the workplace culture. Utilizing these innovations improve the workplace culture for nursing.

Background Contemporary nursing leadership roles in critical care are a reflection of the changing environment in which critical care is provided. Key issues In the UK, critical care nursing faces challenges in the form of: reduced number and seniority of medical staff cover for acute wards; mandated responsibility for management of patients outside of critical care units, without corresponding responsibility for managing staff; increased public and political awareness of deficits in critical care; increased use of Assistant Practitioners; and emphasis on longer-term outcomes from intensive care. Evaluation New leadership roles have met these challenges head on with two main foci: patient management across the acute/critical care interface and hospital wide policies and practice. Conclusions The leadership roles examined in this paper highlight three underpinning goals: improved quality and safety of patient care; improved communication between professionals; and empowerment of junior nurses and doctors. Implications for nursing management There has been considerable investment in strategic leadership roles for critical care nursing; evidence is developing of the return on this investment for patient and service outcomes. Consideration must now be given to the preparation, mentorship and development of leadership roles for the next generation of nurse leaders. Keywords: communication, critical care nursing, leadership, patient outcomes

Aim To explore generational differences in job satisfaction. Background Effective retention strategies are required to mitigate the international nursing shortage. Job satisfaction, a strong and consistent predictor of retention, may differ across generations. Understanding job satisfaction generational differences may lead to increasing clarity about generation-specific retention approaches. Method The Ontario Nurse Survey collected data from 6541 Registered Nurses. Participants were categorized as Baby Boomer, Generation X or Generation Y based on birth year. Multivariate analysis of variance explored generational differences for overall and specific satisfaction components. Results In overall job satisfaction and five specific satisfaction components, Baby Boomers were significantly more satisfied than Generations X and Y. Conclusion It is imperative to improve job satisfaction for younger generations of nurses. Implications for Nursing Management Strategies to improve job satisfaction for younger generations of nurses may include creating a shared governance framework where nurses are empowered to make decisions. Implementing shared governance, through nurse-led unit-based councils, may lead to greater job satisfaction, particularly for younger nurses. Opportunities to self schedule or job share may be other potential approaches to increase job satisfaction, especially for younger generations of nurses. Another potential strategy would be to aggressively provide and support education and career-development opportunities.

Aim To investigate the relationship between dimensions of the psychosocial work environment and the intent to quit among a new generation of nurses. Background As a new generation of nurses enters the workforce, we know little about their perception of their current work environment and its impact on their intent to stay. Method A self-administered questionnaire was distributed to 1002 nurses. Results The nurses who intended to quit their positions perceived a significant effort/reward imbalance as well as a lack of social support. The nurses who intended to quit the profession perceived a significant effort/reward imbalance, high psychological demands and elevated job strain. Conclusion The balance between the level of effort expended and reward received plays an important role in young nurses’ intent to leave. Implications for nursing managers Nurse Managers must offer Nexters, from the beginning of their career, a meaningful work and supportive environment. Without the efforts of the organization to improve the work environment and support nurses, this generation may not feel valued and move to another organization that will support them or another career that will offer fulfilment.

The term practice development (PD) has been used todescribe a range of (1) approaches and (2) methods andprocesses in organizing and delivering diverse changesin nursing practice for many years. The term seems tobe as flexible as a piece of elastic. Better thought of as acontinuum, PD has been said to broadly incorporatetwo approaches: technical PD and emancipatory PD,although the concept of transformational PD is nowemerging. Technical PD consists of a range of activitiesthat tend to focus on the development of one aspect ofpractice (e.g. continence benchmarking; implementa-tion of an audit and subsequent action plan; changinghow handovers of care of carried out). There are alsoones whereby the development is typically a short-termproject where the emphasis is one getting the outcomein place as soon as possible. Technical PD can bethought of as having similarities with some methods ofauditing, benchmarking and some evaluation methods.For the most part, the UK literature on PD tends to beoriented around emancipatory PD (for example, Man-ley & McCormack 2003, 2004). Emancipatory PDconsists of a broad range of activities that tend to belarge scale and underpinned by a set of processes thatinclude working from a shared values and beliefs base,include skilled facilitation of the process, involvingstakeholders as well as learning and evaluation. Thusemancipatory PD places equal emphasis on the pro-cesses (including learning very much at the centre) aswell as the outcomes and tends to be concerned withachieving wide-scale development of practice throughthe three overarching processes of enlightenment,empowerment and emancipation. In emancipatory PDthere is a fundamental assumption that new insights andpractical understandings will lead to practical actionwithin a social group (Habermas 1972, Fay 1987) and

Aim The aim of this study was to explore the reason for nurses’ participation in postregistration education. Background The study was located in one third level institution in Ireland and prospective candidates who applied to undertake a programme of studies were invited to complete the postal questionnaire and return it to the college anonymously in advance of commencing their studies. Method A descriptive survey research design was adopted with the use of a questionnaire for data collection. The respondents had an opportunity to make additional comments in a questionnaire, which generated some qualitative data. Results A total of 243 questionnaires were returned which represented a 46.7% response rate. The major reasons for participating in postregistration education were ‘to obtain promotion to a higher grade/position’ (99%) and ‘to enable me extend my clinical role’ (98%). Conclusion Investment in nursing education should take into account the reasons for participation in continuing education and professional development as identified in this study and in other studies so as to focus efforts that improve planning for long-term continuing education and professional development. The adoption of such a strategic approach by employers will ensure more precise targeting of scarce continuing education and professional development resources. Equally, expectation without adequate investment is not realistic if the profession wants to move forward in this era of rapid change in the delivery of health care.

Objective This study describes experiences of work empowerment among staff members at the Rheumatism Foundation Hospital in Helsinki, Finland. Methods The data were collected on two occasions in 2004 and 2005 using a structured questionnaire with background variables and items concerning verbal, behavioural and outcome empowerment. The questionnaires were sent to all (n1 = 115, n2 = 112) members of multidisciplinary teams at the Rheumatism Foundation Hospital, with the exception of physicians, departmental secretaries and administrative personnel. The response rate at both data collections was 58%. The data were analysed by statistical methods. Results No statistically significant differences were seen in work empowerment between the two data collections. Perceptions of work-related empowerment were relatively strong. Conclusions Work-related empowerment appears to be relatively constant and independent of changes in the organization. Indeed there is good reason to ask whether work empowerment is primarily a function of the individual employee's strengths and competencies.

Aim The main aim of this paper is to uncover whether the actual career choices and job values of newly qualified nurses are in accordance with the predictions they made at the commencement of their nursing education. Background A cohort of Norwegian nurse students was followed from the beginning of their education in 1998 through nursing school and 2,years after graduating. Methods Questionnaire data from 221 nursing students at three points in time: 1998, 2001 and 2003 were analysed with frequency distributions and paired samples t-tests. For 140 respondents data from all three points were available. Results Initially motives like human contact, helping others, job security were important, and 92% had a wish for further education. Career preferences were often midwifery, public heath and nursing practice in high tech areas. Towards the end of the bachelor course (2001), there was more ambiguity in the helping motives. On one hand, the students wanted to be altruistic but on the other hand, they wanted gratitude in return when giving help to patients. Seventy five per cent of the students had plans for further education within a period of about 2 years after graduation. Midwifery, public health work and high tech practice were still preferred. Findings from 2003 indicated only 16% had started or finished further education 2 years after graduation. When appraising future job challenges in 2001 and 2003, there is a decrease in emphasis on the values human contact and part-time work and an increase in emphasis on high salary and job security. Conclusions During the student period, the bachelor programme was regarded as a basis for further education, but 2 years after graduation only 16% had realized further education. Preferences related to job values regarding a prospective job reveal a decrease in the importance of human contact and an increase in the importance of a high salary and job security from 2001 to 2003.

Summary From this review of the literature, it could be sugges-ted that there is no consensus regarding the meaning ofempowerment. This is primarily because of thenumerous perspectives from which empowerment canbe viewed. It is suggested that organizational theoriesof empowerment are somewhat narrow, as it isimpossible to separate the individual’s perceptions,along with what motivates them from the work envi-ronment. The view of empowerment from manage-ment and psychological perspectives begins toacknowledge the capacity of the individual to interpretsituations. However, the focus of these perspectivesseems to be based on the management strategy,motivating individuals to believe in their own self-efficacy and thus improve their productivity. There is arelative paucity of research exploring empowermentfrom the perspective of nurses. No research to date hasused an approach that includes midwifery and allbranches of nursing to explore how empowerment isconceptualized. The study Ten focus groups, including 93 participants from mid-wifery and each branch of nursing were held at loca-tions in the Republic of Ireland. These locations roughlycorresponded to former Irish health board regions. Datawere collected in mid 2001. The focus group guidecomprised of the following questions.• What do you understand by the term empower-ment?• Can you give any examples of empowerment in yourpractice?• What things enhance empowerment?• What things inhibit empowerment?

Aims This paper reports phase one of a two-part study in a New South Wales area health service, which aimed to evaluate the grading system for clinical nurse consultants. Background Since its inception in 1986, the role and scope of practice of clinical nurse consultants in New South Wales has been viewed with differing expectations leading to role conflict from the nurse consultants themselves and others in health care including managers and other clinicians. Method A quantitative approach was used for this study. A survey comprising of open and closed questions was mailed to all clinical nurse consultants (n = 42) employed in the area. Results The data presented suggest that ambiguity continues about the role, the scope and the differences within the grading system of clinical nurse consultants. Conclusions Clinical nurse consultants need leadership training and support from their managers to fulfil their role. More work is required to clarify the role of clinical nurse consultants.

Aim This study explores and extends some recent Foucauldian critiques of reflection and clinical supervision in nursing. Background Although reflection is often accepted uncritically, several writers have claimed that it is being employed (albeit perhaps unwittingly) as a management tool to facilitate the governmentality of the workforce by establishing conditions whereby so-called reflective practitioners monitor and regulate their own practice in an essentially self-repressive way. Evaluation/examination We evaluated these critiques and extended them with reference to Foucault's later writing, particularly on the ‘care of self’. Key issues and conclusions Our exploration of these critiques prompted us to distinguish between two different projects of reflection, which we term the ontological and the epistemological. The ontological project regards the aim of reflection as personal growth under the direction of an enlightened guide, and we argue that there is a real danger that such an approach might degenerate into what one critic has termed ‘a subtle but persuasive exercise of power’. The epistemological project, on the other hand, is concerned with an exploration by practitioners of their own methods of thinking about their practice, and as such, has the potential to become truly emancipatory.

The aim of this study was to make a synthesis of three studies that deal with the following research question: 'How does clinical nursing supervision enhance nurses' experiences of well-being in relation to their psychosocial work environment?'Clinical nursing supervision is one way to support nurses in coping with their stressful work situation.A hermeneutic approach was used to reflect and interpret nurses' experiences of well-being in relation to clinical nursing supervision and psychosocial work environment.The findings suggest that clinical nursing supervision has an influence on nurses' experiences of well-being and in relation to their psychosocial work environment. Nurses attending clinical nursing supervision reported increased satisfaction with their psychosocial work environment.The significance of caring and nursing becomes evident when nurses realize and understand that clinical nursing supervision positively influences their existence and well-being. The value of work becomes clear when nurses reflect on themselves as professionals and as authentic human beings in clinical nursing supervision. This will lead to the emergence of self-recognition.

Aim and background This study examines the influence of changes in work conditions on stress outcomes as well as influence of changes in stress outcomes on work conditions. As such, it answers questions still open in the literature regarding causality of work environmental characteristics and the health of nurses. Method A complete, two wave panel design was used with a time interval of 3 years. The sample consisted of 381 hospital nurses in different functions, working in different wards. Results Changes in work conditions are predictive of the outcomes, especially of job satisfaction and emotional exhaustion. The strongest predictors of job satisfaction were social support from supervisor, reward and control over work. The strongest predictors of emotional exhaustion were work and time pressure and physical demands. Reversed relationships were also found for these outcomes. Conclusion The results of this study are consistent with transactional models of stress that indicate that stressors and stress outcomes mutually influence each other. To prevent nurses from a negative spiral, it seems of importance to intervene early in the process.

Aim To explore registered nurses’ perceptions of standards of nursing practice and factors that affect nursing practice standards. Background Nursing governance affects nurses’ ability to manage nursing practice standards. Lack of nursing professional autonomy has been associated with occupational dissatisfaction, stress, turnover and low morale, which impact upon care quality. Method Grounded theory was used. Data, gathered by semistructured interviews with 142 nurses, theoretically sampled from three National Health Service hospitals were analysed using constant comparative analysis. Findings Nurses were dissatisfied with their governance over factors that they believed had most influence on nursing practice standards. Perceived lack of control over factors that affect practice standards generated dissatisfaction, frustration and demoralization. Conclusions Nurses’ perceived lack of governance over their practice requires investigation and attention if occupational dissatisfaction, stress, turnover and low morale, which impact on quality care, are to be reduced. Dissatisfaction with nursing governance indicates a need to review nurses’ professional involvement in clinical governance.

The aim of the study was to investigate to what extent the registered nurses at a university hospital intend to quit their present jobs and the reasons for this. A total of 833 nurses at a university hospital responded to two mailed, work-environment questionnaires (Quality Work Competence and Huddinge University Hospital Model Questionnaire). About 54% (n = 449) intended to quit and 35% (n = 155) had already taken steps to do so. Main reasons were dissatisfaction with the salary (65%), psychologically strenuous and stressful work (32%), a wish to 'try something new' (28%) and limited opportunities to make a professional career (19%). Nurses who intended to quit ('quitters') rated a higher work tempo (P < 0.001), experienced an increased work-related exhaustion (P < 0.001) and a lower quality of patient care (P < 0.01). They also perceived to a lower degree that their competence was made good use of (P < 0.001) and that they had fewer opportunities of developing their own competence (P < 0.001) and making a professional career. They were less satisfied with the support from their superiors for participating in nursing research and developing projects (P < 0.001). Finally, the 'quitters' knew to a significantly lesser extent (P < 0.001) why they had the actual salary they had, what the salary was based on and what to do to improve it. However, it was found that the hospital still had a 'core group' of highly motivated and dedicated nurses with an unusually high amount of mental energy left. All findings regarding the 'quitters' are factors amenable to interventions.