J Nurs Manag [JOURNAL]
Sun
200 papers
Improving Emergency Department Staff Satisfaction Through Lean Thinking: Evidence From a Mixed Study.
Pastor-Puigdomènech A, Sánchez M, Font-Cabrera C … +3 more , Fabrellas N, Benito-Aracil L, Guix-Comellas EM
J Nurs Manag · 2026 · PMID 41860164 · Full text
AIMS: To compare job satisfaction among emergency department staff before and after the implementation of Lean Thinking and to explore staff experiences regarding this methodology, identifying associated satisfaction fac...
AIMS: To compare job satisfaction among emergency department staff before and after the implementation of Lean Thinking and to explore staff experiences regarding this methodology, identifying associated satisfaction factors. BACKGROUND: Lean Thinking, originally developed in the automotive industry, is increasingly applied in healthcare to optimise processes and improve patient care. Staff engagement and perceptions are key determinants of successful implementation. METHODS: A mixed-methods pre-post design was conducted. The Font-Roja job satisfaction questionnaire was administered preintervention and 1 year postimplementation, and semistructured interviews were conducted with emergency department staff. RESULTS: Overall job satisfaction increased (3.31-3.43; p = 0.029), with significant improvements in job monotony (3.30-3.64; p = 0.038) and physical work setting (3.31-3.75; p = 0.007). Qualitative analysis revealed ten subthemes including improved organisation and teamwork, a more methodical workflow, the need for adaptation, and concerns about potential dehumanisation. CONCLUSION: Lean Thinking increased job satisfaction in the emergency department, favouring structured work and better interprofessional communication. The professionals supported its continuity and highlighted the need for follow-up meetings and constant improvements.
Drivers to Stay or to Leave: Perceptions of the Nursing Work Environment Across Diverse Healthcare Sectors.
M Connelly D, A Guitar N, Prentice K … +1 more , E Hay M
J Nurs Manag · 2026 · PMID 41854226 · Full text
BACKGROUND: Long-term care and home and community care sectors are not perceived as workplaces of choice for nurses. AIM: To describe (1) what creates a desirable work environment in long-term care, home and community ca...
BACKGROUND: Long-term care and home and community care sectors are not perceived as workplaces of choice for nurses. AIM: To describe (1) what creates a desirable work environment in long-term care, home and community care, and hospital sectors for nurses; (2) what motivates nurses to work in these sectors; and (3) what influences nurses to leave these sectors when they do. DESIGN: An open, cross-sectional online survey. METHODS: Registered Practical Nurses and Registered Nurses across Ontario were recruited broadly to rate 14 statements in a survey regarding their beliefs about three healthcare sectors (i.e., long-term care, home and community, and hospital sector) and 20 statements regarding their perceptions of motivation, and attrition-related factors, to work in these sectors. RESULTS: Data from Registered Practical Nurses (N = 264) and Registered Nurses (N = 109) were analyzed (total N = 373, completion rate = 90.7%). Nurses report that they leave work in long-term care and/or home and community care because they are seeking better work-life balance, an increase in pay, and because they do not feel valued or appreciated by their employer. While nurses agree that their schooling has prepared them well to work in these sectors, they also agree that they would be more motivated to work within these sectors if they were able to determine their own availability. CONCLUSION: Financial and nonfinancial influences were reported within the motivating and push factors for nurses to work in these sectors. The reported beliefs of nurses enforced the stigma attached to working as a nurse within these two sectors and provided novel insight into the system and organizational challenges for nurse workforce recruitment and retention.
The Moderation of Self-Compassion Between the Relationship of Compassion Competence and Caring Behavior.
Alanazi MT, Alharbi MF
J Nurs Manag · 2026 · PMID 41851874 · Full text
BACKGROUND: Understanding factors influencing caring behavior and compassion competence is crucial for delivering compassionate nursing care. Recent research suggests that self-compassion significantly affects both carin...
BACKGROUND: Understanding factors influencing caring behavior and compassion competence is crucial for delivering compassionate nursing care. Recent research suggests that self-compassion significantly affects both caring behavior and compassion competence. PURPOSE: The study aims to investigate the moderating effect of self-compassion on pediatric nurses' caring behavior and compassion competence in Riyadh, Saudi Arabia. METHODS: This study employed a nonexperimental quantitative design with a descriptive cross-sectional approach, involving 202 pediatric nurses. Data were gathered through a four-part structured self-administered questionnaire, which included demographic information, a compassion competence scale, a caring behavior inventory (16-item version), and a self-compassion scale. RESULTS: The majority of participants were female (97%) and aged 31-40 years (45.5%), with 6-10 years of experience (38.6%). Self-compassion scores averaged 3.48 (SD = 0.52), compassion competence averaged 4.06 (SD = 0.59), and caring behavior averaged 86.33 (SD = 10.31). A moderate positive correlation was found between self-compassion and compassion competence (r = 0.285, p < 0.001), a weak positive correlation was found between self-compassion and caring behavior (r = 0.183, p = 0.009), and a moderate positive correlation was found between compassion competence and caring behavior (r = 0.397, p < 0.001). CONCLUSION: This study reveals that pediatric registered nurses exhibit high levels of compassion, competence, and caring behavior. However, self-compassion does not significantly influence the relationship between these two factors. The findings offer a framework for further exploration of the influences on caring behavior and compassion competence among pediatric nurses, aiding in the development of policies and interventions to enhance pediatric patient care.
Nursing Outside the Lines: Identity, Policy, and the Rise of Gig Economy Nursing.
Ghimire A
J Nurs Manag · 2026 · PMID 41849154 · Full text
BACKGROUND: Australia's nursing workforce is under intensifying strain, yet an increasing subset of registered nurses (RNs) are not seeking permanence-they are choosing to work exclusively through agencies. This trend is...
BACKGROUND: Australia's nursing workforce is under intensifying strain, yet an increasing subset of registered nurses (RNs) are not seeking permanence-they are choosing to work exclusively through agencies. This trend is commonly framed as a matter of flexibility or pay. However, such explanations understate what exclusive agency nursing does to professional identity, how it operates as a response to organizational dysfunction, and how policy-practice arrangements enable transient careers within a regulated high-income system. OBJECTIVES: To generate an interpretive, policy-relevant account of how exclusive casual agency employment shapes nurses' professional identities, motivations, career trajectories, and engagement with collective professional advocacy. METHODS: An interpretivist, constructionist qualitative design was employed. Semistructured interviews were conducted with 16 Melbourne-based RNs who worked exclusively through nursing agencies. Data were analyzed using reflexive thematic analysis (RTA), and the manuscript was reported in line with the Reflexive Thematic Analysis Reporting Guidelines (RTARG). RESULTS: Five themes were constructed. Exclusive agency nursing involved the crafting of a professional self "beyond the ward," marked by transactional workplace relationships, strategic emotional boundary-setting, and a shift toward adaptability as a core competence. Agency work was frequently narrated as strategic withdrawal and resistance to permanent-role conditions-bureaucratic overload, inflexible rostering, and unsupportive leadership cultures associated with burnout. Participants situated their careers within a "casualization ecosystem" in which organizational reliance on contingent labor, agency intermediation, and policy/funding dynamics collectively sustain demand for agency nurses. Yet, this work model generated persistent ambivalence about long-term sustainability and was perceived to fragment professional belonging and weaken collective voice in advocacy and industrial representation. CONCLUSIONS: Exclusive agency nursing is not simply an individual preference for flexibility; it is an identity project and a system-level signal of deteriorating employment conditions in permanent roles. Workforce responses that focus only on recruitment incentives or short-term staffing solutions risk entrenching casualization and its downstream effects. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse leaders should treat agency reliance as both a staffing strategy and an organizational diagnostic. Reforming permanent roles requires actionable changes-credible roster flexibility, visible supportive leadership, and working conditions that reduce burnout-alongside structured integration practices for agency nurses to protect team cohesion, care continuity, and professional sustainability.
The Impact of Stigma on Autonomous Motivation Among Psychiatric Hospital Staff in China: The Mediating Role of Turnover Intention.
Yin Y, Hei L, Zhao M … +2 more , Sun S, Yuan B
J Nurs Manag · 2026 · PMID 41848027 · Full text
OBJECTIVES: Stigma is a persistent psychosocial stressor in psychiatric care settings, yet its impact on the motivation of nursing staff and other healthcare professionals remains underexplored. This study examined how f...
OBJECTIVES: Stigma is a persistent psychosocial stressor in psychiatric care settings, yet its impact on the motivation of nursing staff and other healthcare professionals remains underexplored. This study examined how four dimensions of stigma-perceived stigma, self-stigma, social concealment, and positive response-relate to autonomous motivation and whether turnover intention mediates these relationships. METHODS: A cross-sectional survey was conducted with 2813 employees from 36 psychiatric hospitals across six provinces in China. Validated scales measured stigma dimensions, turnover intention, and autonomous motivation. Structural equation modeling with bootstrapped confidence intervals tested direct and indirect pathways. RESULTS: Perceived stigma directly predicted lower autonomous motivation, whereas self-stigma and social concealment reduced motivation only indirectly via turnover intention. Notably, since the positive response dimension was reverse-scored, higher stigma scores (representing lower positive response) were associated with reduced autonomous motivation through both direct and indirect pathways. Perceived stigma showed no significant indirect effect through turnover intention. CONCLUSIONS: Different stigma dimensions influence motivation through distinct psychological mechanisms. Strategies that reduce internalized stigma, foster value-affirming behaviors, and address turnover-related strain may help sustain autonomous motivation in high-pressure psychiatric settings. These findings offer actionable insights for nursing managers seeking to strengthen workforce engagement and retention.
Nursing Professionals' Perceptions of Career Planning and Development in Nursing and Organisational Support.
Kallio H, Koivunen M, Liljeroos H … +2 more , Kuusisto A, Kangasniemi M
J Nurs Manag · 2026 · PMID 41847727 · Full text
BACKGROUND: The global shortage of nursing staff has drawn attention to the limited appeal of a career in nursing. Career planning and development for nurses highlights the importance of individual career interests but a...
BACKGROUND: The global shortage of nursing staff has drawn attention to the limited appeal of a career in nursing. Career planning and development for nurses highlights the importance of individual career interests but also the role of nurse managers in facilitating career opportunities. AIM: To describe nurses' and nurse managers' perceptions of career planning and development in nursing. This knowledge is needed to support nurses and develop sustainable workforce strategies for nursing management. METHODS: A qualitative descriptive study was conducted using semistructured interviews and analysed through inductive content analysis. Data were collected in 2022 from 26 nurses and nurse managers at one central hospital and two healthcare centres in Finland. The semistructured interview guide was developed based on previous literature. RESULTS: Based on our results, two main categories emerged. Firstly, career planning and development in nursing was defined as a goal-oriented professional strategy to which nurses have a professional right. This was seen as a means of expanding nurses' competencies, enabling them to take on advanced roles, and strengthening their influence in care across all career paths from bedside nursing to leadership positions. Secondly, organisational support for nurses' career planning and development was considered essential and should be multilayered and progressive. Key elements included career-oriented organisational values, a clear and achievable career model within the organisation itself and consistent daily support and follow-up mechanisms. CONCLUSIONS: Career planning and development addresses nurses' need for personal and professional development. Nurse managers can facilitate this by facilitating peer mentoring and a career-oriented work culture, expanding career opportunities beyond the unit level and developing career ladders as a part of sustainable workforce planning to improve nurses' retention in the profession. Further evaluative and comparative research on this topic is needed.
The Relationship Between Clinical Nurses' Perceptions of the Power Used by Nursing Managers and Professional Silence Behaviors: An Example From Türkiye.
Çelikkanat Ş, Eminoğlu Güven A, Güngörmüş Z
J Nurs Manag · 2026 · PMID 41841547 · Full text
BACKGROUND: The power that nurse managers exercise significantly determines the extent to which clinical nurses can voice their opinions and communicate effectively within the organization. AIM: This study aimed to exami...
BACKGROUND: The power that nurse managers exercise significantly determines the extent to which clinical nurses can voice their opinions and communicate effectively within the organization. AIM: This study aimed to examine the relationships between clinical nurses' perceptions of nurse managers' use of power and nurses' professional silence. METHOD: This cross-sectional study was conducted with 292 clinical nurses from July 25, 2024, to February 17, 2025. Data were collected using a personal information form (comprising the Nurse Manager Perception Questionnaire [NMPQ] in its second section), the Employee Silence Behavior Scale, and the Perceived Power in Nurse Managers Scale. Data were analyzed using the Mann-Whitney U test and Pearson correlation analysis. RESULTS: The findings revealed that single nurses and those without children perceived nurse managers' power differently. Clinical nurses who believed that their nurse managers met expectations, communicated effectively, and adopted a team-oriented approach had significantly higher perceptions of "charismatic power," "reward power," "legitimate power," and "expert power" (p < 0.05). Conversely, perceptions of coercive power were higher among clinical nurses who could not communicate effectively with their managers and who did not believe their managers influenced their working conditions (p < 0.05). A significant positive correlation was found between clinical nurses' silence and their perception of nurse managers' coercive power (p < 0.05). CONCLUSION: The study concluded that as clinical nurses' perception of nurse managers' coercive power increased, their professional silence also increased. Conversely, effective communication, meeting expectations, and a team-oriented approach enhanced their perceptions of nurse managers' charismatic, expert, legitimate, and reward power. These findings suggest that how nurse managers use power decisively influences the communication and silence behaviors of clinical nurses. Therefore, organizational and managerial strategies aimed at reducing clinical nurses' silence are essential for ensuring a safe working environment and delivering quality nursing care.
Structural Model of Medication Errors in Clinical Nursing: A Structural Equation Model Based on the Ecological Systems Theory.
Kim J, Song Y
J Nurs Manag · 2026 · PMID 41834487 · Full text
BACKGROUND: Medication errors remain a critical patient safety issue. Although prior research has examined individual and environmental determinants, few studies have investigated their complex interrelationships within...
BACKGROUND: Medication errors remain a critical patient safety issue. Although prior research has examined individual and environmental determinants, few studies have investigated their complex interrelationships within an integrated theoretical framework, particularly in clinical nursing practice. AIM: To examine the structural relationships among the nursing work environment, communication with health professionals, fatigue, and medication errors among clinical nurses, grounded in Bronfenbrenner's ecological systems theory. METHODS: A cross-sectional study was conducted involving 230 clinical nurses from four tertiary hospitals in South Korea. Data were collected using validated self-report questionnaires measuring the nursing work environment, communication with health professionals, fatigue, and medication errors. Structural equation modeling, supported by confirmatory factor analysis, was used to evaluate direct and indirect pathways and to assess overall model fit. RESULTS: The proposed model demonstrated acceptable fit (χ/df = 2.98, RMSEA = 0.08, CFI = 0.93). The nursing work environment exerted a significant direct effect on communication (β = 0.80, p < 0.001), and communication was significantly associated with reduced fatigue (β = -0.78, p = 0.005). Fatigue had a direct effect on medication errors (β = 0.32, p = 0.003), while communication showed both direct and indirect effects on medication errors. The model explained 64.3% of the variance in communication, 45.4% in fatigue, and 29.8% in medication errors. CONCLUSION: A supportive nursing work environment facilitates effective interprofessional communication, which in turn mitigates fatigue and reduces medication errors. Communication functions as a key mediating mechanism within this structural pathway. IMPLICATIONS FOR NURSING MANAGEMENT: To reduce medication errors, nurse managers should prioritize fostering positive work environments, implementing structured communication protocols, and establishing systematic fatigue management strategies. Such organizational initiatives may enhance communication efficiency and strengthen patient safety outcomes.
The Impact of Compulsory Citizenship Behavior on Organizational Silence in Nurses: The Roles of Presenteeism and Psychological Inflexibility.
Guo M, Yang H, Tang W … +3 more , Wang D, Ding J, Li X
J Nurs Manag · 2026 · PMID 41834418 · Full text
BACKGROUND: Compulsory citizenship behavior (CCB) and organizational silence are prevalent among nurses, undermining nursing care quality and potentially threatening patient safety. Prior studies have shown that CCB can...
BACKGROUND: Compulsory citizenship behavior (CCB) and organizational silence are prevalent among nurses, undermining nursing care quality and potentially threatening patient safety. Prior studies have shown that CCB can lead to employee silence; however, this relationship has not been examined among nurses, and the underlying mechanisms and boundary conditions remain unclear. AIM: This study aimed to test whether presenteeism mediates the association between CCB and organizational silence, with psychological inflexibility serving as a moderator of this process. METHODS: A cross-sectional study was conducted among nurses recruited via convenience sampling from three hospitals in Xi'an, Shaanxi Province, China. Four questionnaires were administered to assess CCB, presenteeism, organizational silence, and psychological inflexibility. A total of 400 valid responses were analyzed using Hayes' PROCESS macro in SPSS to test a moderated mediation model. RESULTS: Presenteeism mediated the relationship between CCB and organizational silence (β = 0.085, 95% CI: 0.039-0.131). Psychological inflexibility moderated the association between CCB and presenteeism: the positive effect of CCB on presenteeism was stronger among nurses high in psychological inflexibility (simple slope = 0.398, p < 0.001) than among those low in psychological inflexibility (simple slope = 0.217, p < 0.001). CONCLUSION: Presenteeism helps explain how CCB relates to organizational silence among Chinese nurses, and psychological inflexibility strengthens the adverse effect of CCB on presenteeism. Reductions in CCB and presenteeism may be associated with lower levels of organizational silence. IMPLICATIONS FOR NURSING MANAGEMENT: To improve nursing care and public health, healthcare managers should consider interventions aimed at reducing nurses' experiences of CCB and presenteeism to help decrease organizational silence. In addition, strategies to reduce psychological inflexibility may help nurses better cope with demanding tasks and stressful work environments.
Promoting Positive Nursing Practice Environments: Outcomes of a Randomized Trial in Primary Care.
Pereira SCA, Santos EJFD, Ferreira RA … +2 more , Fassarella CS, Ribeiro OMPL
J Nurs Manag · 2026 · PMID 41834150 · Full text
BACKGROUND: The nursing practice environment is widely recognized as a key factor in promoting care quality and safety. It is associated with greater professional satisfaction, improved nurse retention, and reduced adver...
BACKGROUND: The nursing practice environment is widely recognized as a key factor in promoting care quality and safety. It is associated with greater professional satisfaction, improved nurse retention, and reduced adverse events. Despite its importance being broadly acknowledged in the literature, there are few structured interventions aimed at promoting the nursing practice environment. OBJECTIVE: To evaluate the effectiveness of the Positive Nursing Practice Environment Promotion Program (PPAPEP) in improving primary care nurses' perceptions of their work environment and attitudes toward patient safety. METHODS: A randomized, controlled, parallel-group, double-blind clinical trial was conducted in primary healthcare units in Northern Portugal between September 2024 and April 2025. A total of 48 nurses participated, allocated by stratified randomization into intervention and control groups. The instruments Scale for the Environments Evaluation of Professional Nursing Practice-Shortened Version and the Safety Attitudes Questionnaire-Short Form were applied at three time points: preintervention, postintervention, and three-month follow-up. Statistical analysis included paired and independent t-tests, repeated-measures ANOVA, and correlation analysis. RESULTS: The PPAPEP produced modest improvements in overall perceptions of the nursing practice environment in the intervention group, with small significative changes in the structure and process subscales. No statistically significant changes were observed in the safety climate. Follow-up analyses showed an inverted U-shaped pattern, indicating that the immediate positive effects slightly decreased over time. Perceptions of the practice environment and safety climate were strongly correlated at all time points. CONCLUSIONS: The PPAPEP has demonstrated effectiveness in improving the nursing practice environment. Effects on the safety climate were limited, suggesting that sustained changes require continuous interventions, periodic reinforcement, and institutional involvement. The strong association between nurses' perceptions of the work environment and the safety climate highlights the need for integrated strategies that simultaneously promote good working conditions and patient safety. TRIAL REGISTRATION: ClinicalTrials.gov.identifier: NCT06762015.
Voices From the Frontline: A Qualitative Study of Nurses' Experiences With Documentation and Its Influence on Patient Safety.
Alghamdi RS, Albloushi M, Alshareef M … +4 more , Alshamry H, Alabdulaal A, Alshakarah N, Alrashidi M
J Nurs Manag · 2026 · PMID 41830114 · Full text
AIM: This study aimed to explore nurses' perceptions, experiences, and challenges related to clinical documentation and its influence on patient safety in Saudi Arabia. BACKGROUND: Nursing documentation, a critical aspec...
AIM: This study aimed to explore nurses' perceptions, experiences, and challenges related to clinical documentation and its influence on patient safety in Saudi Arabia. BACKGROUND: Nursing documentation, a critical aspect of clinical practice, directly influences patient safety, care continuity, and legal accountability. Despite the increasing adoption of electronic health records, nurses continue to encounter numerous challenges in maintaining accurate and timely documentation, particularly in high-pressure healthcare environments. METHODS: A qualitative descriptive design was employed. Nine nurses with at least two years of clinical experience from various teaching hospitals in Saudi Arabia were recruited through purposive sampling. Data were collected through face-to-face semistructured interviews conducted between June and September 2023. Thematic analysis was conducted following an inductive coding approach supported by MAXQDA software to identify recurring themes and subthemes. RESULTS: Three major themes emerged: (1) the perceived value of documentation as a legal and clinical tool; (2) barriers to effective documentation, including time constraints, lack of training, inconsistent practices, and weak handovers; and (3) nurses' efforts to improve documentation quality despite feeling unheard in institutional decision-making. The participants highlighted a shift in perception, viewing documentation not only as a protective measure but also as a key component of patient safety and care quality. CONCLUSION: The findings underscore the need for improved documentation training, standardized practices, and greater involvement of nurses in policy development. Addressing these gaps may enhance documentation accuracy, reduce burden, and promote safer patient outcomes.
Professional Self-Perception Among Critical Care Nurses in China: A Nationwide Cross-Sectional Survey.
Liu X, Zhang X, Pan Z … +10 more , Xu Y, Sun Z, Tang H, Chen L, Tang J, Jia Z, Huang Y, Peng Y, Zhang H, Liu Z
J Nurs Manag · 2026 · PMID 41830100 · Full text
OBJECTIVE: This study aimed to conduct a nationwide cross-sectional investigation to gain a comprehensive understanding of the professional self-perception among critical care nurses in China. This investigation focused...
OBJECTIVE: This study aimed to conduct a nationwide cross-sectional investigation to gain a comprehensive understanding of the professional self-perception among critical care nurses in China. This investigation focused on three dimensions: the Thriving at Work Scale (TWS), the Voice Behavior Scale (VBS), and the Adjustment Focus Scale (AFS). METHOD: An electronic questionnaire was distributed to intensive care unit (ICU) nurses across China using stratified and convenience sampling. TWS, VBS, and AFS scores and sociodemographic factors were collected. Multivariable ordinal logistic regression (MOLR) was employed to explore the influencing factors on professional self-perception (tertiled TWS, VBS, and AFS scores). RESULT: A total of 583 valid questionnaires were collected. The TWS, VBS, and AFS scores were 49 (44-54), 37 (31-40), and 48 (45-55), respectively. MOLR analysis revealed significant associations between gender and TWS (adjusted OR, 95% CI: 2.01, 1.32-3.07, p < 0.001), VBS (adjusted OR, 95% CI: 2.15, 1.39-3.33, p < 0.001), and AFS (adjusted OR, 95% CI: 1.74, 1.14-2.66, p = 0.002). Average monthly household income was significantly associated with TWS (adjusted OR, 95% CI: 1.51, 1.19-1.92, p < 0.001), VBS (adjusted OR, 95% CI: 1.35, 1.05-1.74, p = 0.018), and AFS (adjusted OR, 95% CI: 1.47, 1.16-1.86, p = 0.002). Professional title was inversely related to TWS (adjusted OR, 95% CI: 0.73, 0.55-0.96, p = 0.027) and VBS (adjusted OR, 95% CI: 0.64, 0.47-0.88, p = 0.006). In addition, associations were found between marital status and TWS, ICU experience and position and VBS, and age and AFS (p < 0.05). CONCLUSION: Our findings suggest that critical care nurses in China exhibit a moderate level of professional self-perception. Young, single, female ICU nurses with lower household income, middle-level professional titles, lower positions, and less ICU experience are associated with lower professional self-perception. Nursing managers can intervene to enhance professional self-perception by targeting individuals with these influencing factors.
Leadership in Action: Exploring Nurse Leaders' Experiences and Practices in Creating Civility: A Constructivist Grounded Theory.
Ota M, Gilbert J, Lam L … +1 more , Hills D
J Nurs Manag · 2026 · PMID 41826794 · Full text
BACKGROUND: Civility is essential to ensuring the wellbeing of nurses and the delivery of quality patient care. Given that nurse leaders influence the behaviours and expectations of nurses in their teams within health an...
BACKGROUND: Civility is essential to ensuring the wellbeing of nurses and the delivery of quality patient care. Given that nurse leaders influence the behaviours and expectations of nurses in their teams within health and aged care settings, further insight is needed in understanding the practices of nurses holding leadership positions in creating civility. PURPOSE: The aim of this study was to explore the experiences of nurse leaders in promoting and maintaining civility in nursing care teams in Australian regional and rural health and aged care settings. METHODS: Using a constructivist grounded theory methodology, 11 regional and rural nurse leaders in Victoria, Australia, were individually interviewed. Interview transcripts, recordings and memos were analysed using reflexivity and constant comparison to inform the substantive theory. FINDINGS: The substantive theory titled ACTS Theory for Creating Civility in Nursing conceptualises the practices of nurse leaders in creating civility across four elements (acknowledge, communicate, teach and support). Acknowledging individual skills and personal circumstances, practising compassionate communication, role-modelling acceptable behaviours and providing support were core practices in fostering civility. DISCUSSION: Ongoing implementation and evaluation of precepting, mentoring, and professional accountability programmes aimed at improving nurse leaders' communication and leadership skills is needed to address this ongoing workforce issue.
Sustainability in Telehomecare: Exploring Practical Nurses' Perceptions, Engagement, and Leadership Implications.
Rydgren M, Anåker A, Estman L … +2 more , Andtfolk M, Fagerström L
J Nurs Manag · 2026 · PMID 41814951 · Full text
BACKGROUND: Healthcare systems are adapting to environmental challenges and digital transformations. Practical nurses' perceptions and engagement are key to advancing sustainability in everyday care in a digital setting....
BACKGROUND: Healthcare systems are adapting to environmental challenges and digital transformations. Practical nurses' perceptions and engagement are key to advancing sustainability in everyday care in a digital setting. Hence, it is essential to explore whether practical nurses within telehomecare settings are prepared for the adoption of sustainable practices and the implications of their perceptions of sustainability within nursing practice for nursing leadership. AIM: To explore how practical nurses perceive and engage with sustainability within telehomecare. DESIGN: This study had a qualitative exploratory design. METHODS: Ten practical nurses working in telehomecare were interviewed between February and April 2024 in Finland. The interviews were individual and semistructured. Data were analyzed through reflexive thematic analysis. RESULTS: The main themes identified in this study, Emerging Eco-Consciousness in Telehomecare and Constrained Eco-Engagement in Telehomecare, encapsulate the tension between emerging environmental awareness and the limitations of telehomecare settings. The participants demonstrated limited awareness of and engagement with sustainability in their professional roles. Moreover, they regarded the concept of sustainability as ambiguous and had a fragmented understanding of what it entails in the context of healthcare. Their capacity to actively engage in sustainable practices was shaped by challenges related to assuming responsibility, the need to balance professional values with the potential negative outcomes of sustainable digital practices, and limited opportunities for involvement in key organizational decision-making processes. CONCLUSION: This study highlights a need to cultivate greater consciousness among healthcare professionals and leaders of the critical role of sustainability in healthcare delivery. The results highlight the importance of integrating targeted education and training on environmental issues and sustainable practices to foster climate-health literacy and deepen engagement and of equipping leaders to champion green transitions. Enhancing knowledge and competence in sustainability can, in combination with an ethical, green, transformational leadership style, support organizational shifts toward more environmentally sustainable healthcare systems.
Experiences of Newly Graduate Nurses With Workplace Violence: A Qualitative Meta-Synthesis.
Rantung G, Zhong Y
J Nurs Manag · 2026 · PMID 41810267 · Full text
AIMS: To explore and integrate qualitative evidence on the experiences of workplace violence as reported in studies involving newly graduated nurses, with a focus on its forms, coping mechanisms and resulting effects. DE...
AIMS: To explore and integrate qualitative evidence on the experiences of workplace violence as reported in studies involving newly graduated nurses, with a focus on its forms, coping mechanisms and resulting effects. DESIGN: Qualitative meta-synthesis. METHODS: The review included qualitative studies relevant to the topic. A systematic search was conducted from database inception to September 2024. The quality of the included studies was appraised using the Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research. Two reviewers independently screened titles, abstracts, and full texts before inclusion. Data analysis was conducted using a thematic synthesis approach. DATA SOURCES: A systematic literature search was conducted in eight databases: CINAHL, Scopus, Emcare, Web of Science, ProQuest, Embase, MEDLINE, and PsycINFO. RESULTS: Eighteen studies were included. The synthesis identified five forms of workplace violence, four coping strategies, and five consequence domains. These findings informed a conceptual model illustrating workplace violence as a cyclical, systemically reinforced process linking its manifestations, the coping responses employed by new nurses and the resulting personal and professional impacts. CONCLUSION: New nurses experienced cyclical and systemic workplace violence. Their coping mechanisms provided temporary relief but did not address the root causes of workplace hostility. This led to lasting negative effects and reinforced further workplace violence, requiring both individual and organisational interventions to disrupt the cycle.
Nurses' Cross-Border Work Intentions Driven by Psychological Empowerment: A Cross-Sectional Study.
Zhang R, Wang X, Leung AYM … +8 more , Jin X, Dai H, Wang Y, Zhang J, Deng R, Poon ACY, Mio KW, Liu M
J Nurs Manag · 2026 · PMID 41810266 · Full text
BACKGROUND: Given the globalization of the nursing workforce, psychological empowerment represents a critical intrinsic determinant of nurses' mobility intentions, specifically regarding cross-border work. AIM: To identi...
BACKGROUND: Given the globalization of the nursing workforce, psychological empowerment represents a critical intrinsic determinant of nurses' mobility intentions, specifically regarding cross-border work. AIM: To identify latent profiles of nurses' psychological empowerment, examine associated factors, and explore the relationship between these profiles and cross-border working intention. METHODS: A cross-sectional multicenter study was conducted from March to September 2023. Using convenience sampling, clinical nurses were recruited through liaisons from nursing societies in nine cities of Guangdong Province. Data were collected through questionnaires covering sociodemographic questionnaire, psychological empowerment, and cross-border working intention, with analyses including chi-square tests, logistic regression, and latent profile analysis (LPA) performed using SPSS 23.0 and Mplus 8.3. RESULTS: A total of 3671 valid questionnaires were collected, and 39.5% of the respondents reported cross-border intentions. LPA identified three psychological empowerment profiles among nurses, ranked from high to low: the core-driven empowerment profile (16.94%), the adaptive empowerment profile (70.42%), and the constrained empowerment profile (12.64%). The nurses with lower salary, intermediate title, and without specialist nurse qualification were more likely to fall into the constrained empowerment profile. Psychological empowerment was positively correlated with nurses' cross-border work intention. The core-driven profile showed the highest cross-border work intention (50.6%), followed by the adaptive (38.2%) and constrained profiles (31.7%). For cross-border work, the constrained profile prioritized salary (87.1%) as the key concern, while the core-driven profile focused more on good promotion opportunities (70.3%). CONCLUSION: Psychological empowerment exerts a positive impact on clinical nurses' cross-border work intention, with the three identified empowerment profiles exhibiting divergent motivational priorities and decision logics. These findings highlight the need for subgroup-specific strategies to balance nursing workforce mobility and stability. IMPLICATIONS FOR NURSING MANAGEMENT: The findings support a differentiated human resource strategy based on nurses' psychological empowerment profiles. For core-driven nurses, institutions should provide international career development channels to strengthen their domestic job embeddedness. For adaptive nurses, tailored skill training and decision-making autonomy should be offered to guide their mobility aspirations. For constrained nurses, competitive compensation and family support services should be prioritized to address their stability needs and rebuild professional confidence. These targeted measures balance talent mobility and domestic workforce stability.
Beyond Reporting: A Qualitative Approach to Managing Ethical Incidents in Healthcare.
Järvisalo P, von Bonsdorff M, Haatainen K … +1 more , Härkänen M
J Nurs Manag · 2026 · PMID 41810265 · Full text
BACKGROUND: Patient safety incident reporting systems foster a nonblaming culture and support organizational learning. By incorporating an ethical dimension, these systems can support nursing managers in addressing ethic...
BACKGROUND: Patient safety incident reporting systems foster a nonblaming culture and support organizational learning. By incorporating an ethical dimension, these systems can support nursing managers in addressing ethical incidents, strengthen healthcare professionals' ethical competence and conduct, and promote the delivery of high-quality patient care. AIM: This study aimed to describe the types of reported ethical incidents, outline the actions and measures implemented to prevent recurrence, and reflect on how our findings inform the organization of ethical incident prevention management. DESIGN: This retrospective register study was conducted using an artificial intelligence-based closed data analysis program and inductive content analysis. The standards for reporting qualitative research (SRQR) checklist was used. RESEARCH CONTEXT: Data were collected using the HaiPro system at a university hospital in Finland from 2018 to 2021. During this time, 3615 patient safety incident reports were submitted, of which 579 (16%) were categorized as ethical incidents and subsequently analyzed. ETHICAL CONSIDERATIONS: Ethical requirements were met. According to the Finnish ethical guidelines, an ethical review was unnecessary for this register study. The research permit was provided by the participating organization. RESULTS: We found two main categories: (1) ethical incidents, with subcategories of professional conduct and patient care management and (2) actions and preventive measures, emphasizing continuous improvement, enhancing professional competence, fostering professional communication and conduct, improving data management, and enhancing patient care through the reporting system. CONCLUSIONS: Cultivating an ethical culture through the strategic management of ethical incidents is vital. An efficient structure for handling such incidents can improve decision-making, ensure accountability, support professionals, and reduce their burden, ultimately enhancing care quality. IMPLICATIONS: This study provides valuable insights for nursing managers on effectively addressing ethical incidents. Their role is pivotal in shaping an ethical culture through strategic leadership, promoting educational initiatives, and supporting the implementation of ethical practices.
The Effectiveness of Virtual Reality Air-to-Ground Handoff Education in Realistic Operations on Learning Among Emergency Nurses in Taiwan.
Chou YS, Ma HP, Huang CY … +3 more , Li CJ, Chou LY, Cheng SF
J Nurs Manag · 2026 · PMID 41799947 · Full text
AIM: This study evaluated the effectiveness of virtual reality (VR) simulation training in enhancing emergency room (ER) nurses' preparedness for air-to-ground patient handoff and psychological safety, defined as partici...
AIM: This study evaluated the effectiveness of virtual reality (VR) simulation training in enhancing emergency room (ER) nurses' preparedness for air-to-ground patient handoff and psychological safety, defined as participants' perceived confidence and comfort within the training environment. BACKGROUND: Aeromedical transport is critical in regions with complex terrain or limited resources. The reception phase poses time-sensitive and environmental challenges, and insufficient training increases the risk of handoff errors and patient harm. Existing programs focus mainly on in-flight care, with little attention to reception. VR offers an immersive, standardized, and safe platform for reception training. DESIGN: A quasiexperimental design using a nonrandomized, sequential cohort allocation by training date with two-group repeated measures was employed. METHODS: Seventy-six emergency nurses from a northern Taiwan medical center were assigned by training date to a traditional drill group ( = 33) or a VR simulation group ( = 43). The "H.A.N.D.O.F.F." curriculum, based on the 2024 CDC air-to-ground handoff protocol, was implemented. Outcomes included the Air-to-Ground Patient Handoff Preparedness Inventory and Psychological Safety Scale. Data were collected at baseline, postintervention, and 8 weeks and analyzed using generalized estimating equations. RESULTS: Baseline score refers to participants' initial preparedness prior to the intervention, and no significant differences were found between groups at baseline ( > 0.05). Postintervention, the VR group reported significantly higher preparedness and psychological safety than controls ( < 0.001), and these improvements were sustained at the 8-week follow-up ( < 0.001). CONCLUSIONS: This study demonstrated that VR simulation significantly improves preparedness for air-to-ground patient handoff, highlighting its practical value. Future applications may extend to military, police, and fire departments to foster interprofessional collaboration and enhance emergency response capabilities.
"Awakening consciousness": Safe Care Linkage Theory From a Mixed Perspective-A Constructivist Grounded Theory Study.
Yan L, Wu X, Huang Y … +3 more , Liu L, Wang F, Hu X
J Nurs Manag · 2026 · PMID 41799946 · Full text
AIM: To explore how healthcare professionals, older adults, and caregivers across different contexts conceptualize and implement safe care and develop a substantive theory that reflects their perspectives. BACKGROUND: Ge...
AIM: To explore how healthcare professionals, older adults, and caregivers across different contexts conceptualize and implement safe care and develop a substantive theory that reflects their perspectives. BACKGROUND: Geriatric care is delivered in a model of ongoing change, with healthcare professionals, older adults, and caregivers highlighting its impact on patient safety. However, there is a shortage of literature on how all care stakeholders conceptualize safe geriatric care. METHODS: Constructivist grounded theory methodology was employed in this study. Between February 2023 and September 2024, semistructured interviews were conducted. Twenty-five healthcare professionals, 24 inpatients, 19 care workers, and 18 family members from ten hospitals and one primary health center within China participated in the study. Data analysis included initial coding, focused coding, and theoretical coding using constant comparative, memo writing, and field notes. RESULTS: The substantive theory to emerge from this study was named "Awakening consciousness-Safe care linkage theory." This theory is informed by four levels: (a) Concept-motivation level: Generating intrinsic driving force; (b) environment-institution level: Building a safe care ecosystem; (c) practice-interaction level: Practicing safe care behavior pattern; and (d) balance-choice level: Counterbalance the unsafe care crisis. These four levels form the linkage response to implementing safe care for older adults in the hospital, and together with the escort strategy (safety criteria) and progression mechanism (feeling safe) emerging in the data, constitute the linkage ecology of safe care. CONCLUSION: The study presents the process of awakening the safety awareness of care stakeholders within geriatric care. Understanding the nature and interrelation of safe care linkage theory could direct practitioners, researchers, and policy-makers in better efforts to improve the safety of geriatric care. This substantive theory also provides comprehensive theoretical support for future interventions and research to form a safe care ecosystem. IMPLICATIONS FOR NURSING MANAGEMENT: The substantive theory provides a theoretical basis for understanding the complex nature of safe care, which illustrates the unsafe care crisis care stakeholders encounter, the criteria they obey, the strategies they use, and the influences of these strategies to practice safe care in complicated situations. Findings will assist nursing leaders in identifying areas to improve care safety and developing and integrating more effective strategies by redesigning optimal management processes to awaken care stakeholders' safety awareness and take actions suited to the linkage mechanism of a safe care ecosystem. Chinese Clinical Trial Registry: ChiCTR 2300067421.
Developing a Complex Intervention Plan for Physical Activity in Overweight and Obese Endometrial Cancer Patients: A Multimethod Study.
Wang Y, Yang J, Wang J … +9 more , Gong J, Gong Y, Li Q, Yang D, Zhu H, Liu P, Chen Y, Xiong Y, Li X
J Nurs Manag · 2026 · PMID 41799945 · Full text
AIMS AND OBJECTIVES: This study aims to develop a comprehensive physical activity (PA) intervention tailored for overweight and obese patients with endometrial cancer (EC). It integrates theoretical frameworks, empirical...
AIMS AND OBJECTIVES: This study aims to develop a comprehensive physical activity (PA) intervention tailored for overweight and obese patients with endometrial cancer (EC). It integrates theoretical frameworks, empirical evidence, expert opinions, and stakeholder perspectives to assist clinical providers in implementing standardized PA guidelines. BACKGROUND: Obesity is a significant risk factor for EC and is closely linked to treatment outcomes. Although previous studies have focused on the role of PA in weight loss and survival, they lack detailed, evidence-based guidance specifically tailored for EC patients. DESIGN AND METHODS: We developed a PA instruction program using the Evidence-Based Nursing Practice Pathway and the Medical Research Council's Framework for Complex Interventions. The development process consisted of three phases: a preparatory phase, the development and implementation of evidence-based interventions, and the refinement of the program through Delphi consultation. RESULTS: The program framework was developed using multiple methods, including evidence searches (guidelines and expert consensus), semistructured interviews, and expert consultations. It encompasses preinstruction, implementation methods, and strategies for maintaining PA. Instructional materials such as posters, brochures, videos, and checklists were created to facilitate clinical integration. CONCLUSIONS: This study is the first to develop a tailored PA program for overweight EC patients. The rigorous design, based on complex intervention frameworks and expert input, has the potential to improve clinical practice, enhance tumor remission rates, and improve fertility outcomes. RELEVANCE TO CLINICAL PRACTICE: Utilizing the MRC framework, this study integrated evidence and stakeholder feedback to develop a tailored intervention program. It aims to increase PA among overweight and obese EC patients by providing educational materials for clinicians and patients, thereby promoting its adoption in clinical practice. ClinicalTrials.gov_identifier: NCT06312917.
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