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Aim: To characterize registered nurses' (RNs') perceptions of nurse leaders' transformational leadership (TL) qualities in Finnish university hospitals and identify predictors of positive and negative evaluations. Background: Transformational leadership can improve health care but requires development. Information on TL is typically derived from survey results, which are vulnerable to confounders. Method: Cross‐sectional survey. Registered nurses' perceptions of nurse leaders were measured with the TL scale. Kohonen's self‐organizing map was used to cluster the data based on RNs' opinions and questionnaire items. Logistic regression explained background characteristics' effects on cluster formation. Results: A total of 1,970 RNs participated and evaluated their nurse leaders' TL qualities as moderate. Giving feedback and rewarding clustered separately from other TL qualities. Females and permanent workers evaluated nurse managers more negatively but nurse directors positively. Positive perceptions of nurse managers' TL predicted better TL among nurse directors. Vice nurse managers gave the most positive evaluations. A total of 197 RNs had no opinions about nurse directors' TL. Conclusions: Registered nurses evaluated nurse managers' TL qualities as moderate and were unfamiliar with nurse directors. Background characteristics affecting evaluations differed between leader types. Implications for Nursing Management: Giving feedback and rewarding should be more closely associated with other TL qualities. Transformational leadership requires transformational approaches from both nurse managers and directors. [ABSTRACT FROM AUTHOR]

Aim: To examine reward type preferences and their relationships with the significance of rewarding perceived by registered nurses in Finland. Background: Previous studies have found relationships between nurses' rewarding and their motivation at work, job satisfaction and organisational commitment. Methods: Data were collected in a cross‐sectional, descriptive, questionnaire survey from 402 registered nurses using the Registered Nurses' Perceptions of Rewarding Scale in 2015, and analysed with descriptive and multivariate statistical methods. Results: Registered nurses assigned slightly higher values to several non‐financial than to financial rewards. The non‐financial reward types appreciation and feedback from work community, worktime arrangements, work content, and opportunity to develop, influence and participate were highly related to the significance of rewarding. Conclusions: We identified various rewards that registered nurses value, and indications that providing an appropriate array of rewards, particularly non‐financial rewards, is a highly beneficial element of nursing management. Implications for Nursing Management: It is important to understand the value of rewards for nursing management. Nurse managers should offer diverse rewards to their registered nurses to promote excellent performance and to help efforts to secure and maintain high‐quality, safe patient care. The use of appropriate rewards is especially crucial to improving registered nurses' reward satisfaction and job satisfaction globally in the nursing profession. [ABSTRACT FROM AUTHOR]

Aim To examine the relationship between nurse staffing and patient length of stay in an acute-care hospital over a 1-year period. Background Although there has been prior research on the relationship between nurse staffing and length of stay in acute-care hospitals, there is a need for more information on how nurse staffing is related to length of stay longitudinally. Methods Retrospective time-series registry data from 20 acute-care inpatient units of a Finnish university hospital as a monthly time series in 2008 were analysed by linear mixed models. Results The ratio of registered nurses to all nurses was 72.4%. Nurses worked mainly (96%) full time, and 63% had permanent employment contracts. Statistically significant variation was found in time series of five variables. Statistically significant relationships were found between length of stay and patient acuity, diagnosis-related group-volume, census and nursing hours per patient day at the unit level. Nursing hours per patient day had the strongest correlation with length of stay. Conclusion and implications for nursing management A rational response to the variations in patient care needs and intensity in the complex care environment is flexible nurse staffing. Increasing nursing hours per patient day to achieve shorter length of stays is not the only solution, well-functioning care processes are also essential. [ABSTRACT FROM AUTHOR]

Background. Measures of spousal effect during parturient pain should take a tripartite approach involving the parturients, spouses, and midwives. Aim. To develop and validate three questionnaires measuring spousal presence in management of parturient pain in Nigeria. Methods. There are two phases: (1) development of questionnaires, Abuja Instrument for Midwives (AIM), Abuja Instrument for Parturient Pain (AIPP), and Abuja Instrument for Parturient Spouses (AIPS), utilizing literatures, Kuopio instrument for fathers (KIF) and expertise of health professionals, and (2) pilot study to validate the questionnaires which were administered in two hospitals in Nigeria: midwives (n=10), parturients (n=10), and spouses (n=10).  Results. Internal consistency for the three questionnaires indicated Cronbach’s alpha coefficient of 0.789 (AIM), 0.802 (AIPP), and 0.860 (AIPS), while test-retest reliability was r=0.99 (AIM), r=0.99 (AIPP), and r=0.90 (AIPS). Conclusions. AIM, AIPP, and AIPS provide a means of investigating the effectiveness of spousal presence in management of parturient pain in Nigeria. However, further testing of each instrument is needed in a larger population to replicate the beneficial findings of AIMS, AIPP, and AIPS which can contribute rigor to future studies. [ABSTRACT FROM AUTHOR]

Aim To examine the relationship of a comprehensive health care orientation process with a hospital's attractiveness. Background Little is known about indicators of the employee orientation process that most likely explain a hospital organisation's attractiveness. Method Empirical data collected from registered nurses ( n = 145) and physicians ( n = 37) working in two specialised hospital districts. A Naive Bayes Classification was applied to examine the comprehensive orientation process indicators that predict hospital's attractiveness. Results The model was composed of five orientation process indicators: the contribution of the orientation process to nurses' and physicians' intention to stay; the defined responsibilities of the orientation process; interaction between newcomer and colleagues; responsibilities that are adapted for tasks; and newcomers' baseline knowledge assessment that should be done before the orientation phase. Conclusions The Naive Bayes Classification was used to explore employee orientation process and related indicators. The model constructed provides insight that can be used in designing and implementing the orientation process to promote the hospital organisation's attractiveness. Implications for nursing management Managers should focus on developing fluently organised orientation practices based on the indicators that predict the hospital's attractiveness. For the purpose of personalised orientation, employees' baseline knowledge and competence level should be assessed before the orientation phase. [ABSTRACT FROM AUTHOR]

Aims The purpose was to describe Finnish registered nurses' experiences of rewarding. The aim was to gather detailed information on the rewarding of nurses to help nurse managers and leaders to update existing reward strategy and to develop an effective reward system. Background Rewarding has been found positively to influence nurses' occupational well-being and commitment to their work, and the attractiveness of the health care field. Methods A series of focused interviews with 10 registered nurses was conducted in 2011. Qualitative content analysis method was used. Result The nurses reported positive experiences with rewarding in the form of monetary compensation and other benefits, the positive aspects of nursing work and opportunities for professional development. The experiences of unsatisfactory rewarding generally stemmed from negative emotional experiences, lacking rewards and inequality in rewarding. Conclusion It is essential to listen to nurses and to provide appropriate acknowledgement and appreciation of their work in order to develop an effective reward system. Implications for nursing management It is important to listen to nurses' experiences of rewarding because it enables nurse managers to maintain and increase the attractiveness of nursing and health care work in general. [ABSTRACT FROM AUTHOR]

Aim To examine newly hired nurses' and physicians' perceptions of their orientation process in two Finnish hospitals, and to explore correlations between the background variables and the four aspects of a comprehensive orientation process. Background Internationally, health care organisations are being challenged to recruit and retain a competent workforce. Although health care orientation programmes increase retention and provide safe and quality care, studies examining it are limited. Method A cross-sectional, descriptive questionnaire survey of registered nurses ( n = 145) and physicians ( n = 37) working in two specialised hospital settings was conducted in 2009-2010. Result Nurses' and physicians' perceptions regarding the orientation process ranged from low to moderate. The results showed that 'appointed preceptor', 'duration of orientation' and 'profession' correlated positively and significantly with a comprehensive orientation process. Conclusion The orientation process needs to be updated constantly and refined by evaluation data. In addition, incentives and effective support from the hospital organisation must be considered in order to perform the orientation process in a more comprehensive manner. Implications for nursing management The results indicate that investment is needed to improve the orientation process in health care. Health care managers are in a crucial position to support the orientation process in practice and value it as a retention strategy. [ABSTRACT FROM AUTHOR]

Aim The overall aim of this study was to examine nurses' and patients' perceptions of the Magnet model components of transformational leadership and empirical quality outcomes in four Finnish hospitals and to determine if the evidence for transformational leadership and empirical quality outcomes is the same or different in the four hospitals. Background This report presents baseline measurements for a longitudinal study of the adaptation of the Magnet model in Finnish hospitals. Methods Web-based surveys and mailed questionnaires were used in 2008-2009 to collect data from patients ( n = 2566) about their satisfaction with care, and from nursing staff about transformational leadership ( n = 1151), job satisfaction ( n = 2707) and patient safety culture ( n = 925) in the selected hospitals. Results Awareness of the work of nursing leaders was low. Nurses reported a high level of job satisfaction. Patient safety culture varied considerably between the four hospitals. Patients believed they generally received excellent quality care. Conclusions Leadership systems are in transition at the hospitals. Patient safety culture is a complex phenomenon that may be unfamiliar to respondents. The results of the study provide a baseline description to guide the journey toward development of Magnet standards. Implications for nursing management Finnish nursing leaders, especially nursing directors, should increase their visibility by working more closely with their staff. They should also pay attention to giving direct feedback about work generally and patient safety issues in particular. [ABSTRACT FROM AUTHOR]

Aim The aim of the present study was to examine Estonian nurses’ thinking with regard to how they perceive their autonomy, control over practice, teamwork and organizational support in regional, central and general hospitals. Background Despite the well-documented fact that there is a need to improve nurses’ working environments in hospitals to promote safe patient care, in Europe broader studies on this topic have not received priority thus far. Methods A nationally representative stratified random sample of 478 acute care hospital nurses was surveyed using the Nursing Work Index-Revised (NWI-R) instrument in 2005/2006. Results Nurses perceived their autonomy, control over practice and organizational support remarkably lower than nurse–physician relationships. Age and tenure were highly related to the nurses’ perceptions. Conclusions The Estonian nurses’ ambivalent perceptions of the organizational attributes reflected the effects ascribed to hospital reforms. Implications for nursing management There is an urgent need for nurse managers to be particularly alert and attentive with regard to nurses who have been practising the profession for more than a decade. Support for their practice should be provided with the long-term goal of assuring the retention of those experienced nurses. Continuous monitoring of nurses’ perceptions should be used systematically as a tool for staffing decisions at the hospital level. [ABSTRACT FROM AUTHOR]