J Nurs Manag [JOURNAL]
Sun
200 papers
Identifying Change Fatigue in Nurses From Southwestern China via Latent Profile Analysis: A Multicenter Cross-Sectional Study.
Wang L, Chai D, Wu M … +2 more , Tang Y, Mi J
J Nurs Manag · 2026 · PMID 42363668 · Full text
OBJECTIVE: To identify latent profiles of change fatigue among nurses in Southwestern China and explore factors associated with distinct profiles. BACKGROUND: Healthcare resources in Southwestern China are unevenly distr...
OBJECTIVE: To identify latent profiles of change fatigue among nurses in Southwestern China and explore factors associated with distinct profiles. BACKGROUND: Healthcare resources in Southwestern China are unevenly distributed, and the region features considerable ethnic diversity. Against the backdrop of ongoing reforms in the healthcare system, nurses-as frontline implementers-are constantly exposed to intensive and frequent updates in policies, technologies, and workflows, making them susceptible to change fatigue. This sustained exposure precipitates "change fatigue," a syndrome that erodes psychological resilience and professional identity, and is prospectively linked to heightened turnover intention, measurable deterioration in nursing quality and an increased incidence of patient-safety events. METHODS: From July to September 2025, we recruited nurses from various tiers and types of medical institutions across Southwestern China. Data were collected using a general information questionnaire, the Change-Related Stress Scale, the Grandey Emotional Labor Strategy Scale, the Connor-Davidson Resilience Scale (CD-RISC), and the Chinese Nurse Job Stressors Scale. Latent profile analysis (LPA) was employed to identify subgroups of change fatigue. Univariate analysis and multinomial logistic regression with Firth's penalized likelihood estimation were used to examine factors associated with profile membership. RESULTS: A total of 1383 valid questionnaires were included. LPA revealed three distinct profiles of change fatigue: low fatigue (17.5%, n = 242), moderate fatigue (61.6%, n = 852), and high fatigue (20.9%, n = 289). Multinomial logistic regression showed that nurses in the high fatigue group were significantly more likely to work in the intensive care unit (OR = 2.31, 95% CI: 1.40-3.85, p = 0.001) and internal medicine (OR = 2.12, 95% CI: 1.26-3.61, p = 0.005). Working 1-2 night shifts per week increased odds of high fatigue by 53% (OR = 1.53, 95% CI: 1.03-2.27, p = 0.034). Compared with minimal emotional labor (Level 1, 14-30 points), both moderate (Level 2, 31-50 points: OR = 0.14, p = 0.030) and high (Level 3, 51-70 points: OR = 0.09, p = 0.010) emotional labor levels were associated with significantly lower odds of high fatigue, suggesting that deficient emotional labor engagement may represent a risk configuration. Work stress Level 3 increased odds of high fatigue 33-fold (OR = 32.71, 95% CI: 13.27-103.37, p < 0.001). Psychological resilience showed no independent significant association with profile membership in multivariate models. CONCLUSION: Change fatigue exhibits a heterogeneous tripartite structure. Minimal emotional labor engagement (Level 1) was associated with higher odds of high fatigue compared with moderate and high levels, suggesting that deficient emotional labor may represent a distinct risk configuration. Both modifiable workplace factors (ICU/internal medicine placement, night shifts, and job stress) and emotional labor patterns were associated with profile membership, supporting the potential value of organizational interventions and targeted emotional labor training. IMPLICATIONS FOR NURSING MANAGEMENT: These findings provide an evidence-based foundation for precision prevention. Nursing leaders should integrate the six-item Change Fatigue Measurement Scale into routine occupational health surveillance to enable profile-based risk stratification. High-fatigue nurses (20.9%) require immediate workload relief and mental health referral; moderate-fatigue nurses (61.6%) represent a critical prevention window for resilience training and peer support; low-fatigue nurses (17.5%) should serve as peer mentors and change champions. Priority interventions should target ICU and internal medicine units given the 2- to 2.3-fold increased high-fatigue risk. Leaders should limit consecutive night duties to ≤ 2 shifts, ensure ≥ 11 h rest between shifts, and enforce weekly overtime caps (≤ 8 h). Differentiated emotional labor training is essential: Nurses with minimal engagement need professional identity strengthening and authentic expression workshops, while those with excessive engagement require boundary-setting training and mindfulness-based stress reduction. Resilience-building interventions must be embedded within organizational support initiatives rather than implemented as standalone programs. In ethnically diverse, resource-constrained contexts, culturally tailored change communications and phased implementation timelines are critical to avoid "reform stacking."
Relationship Between Sleep-Related Worry, Compassion Fatigue, and Retention Intention Among Nurses: A Multicenter Cross-Sectional Study.
Peng F, Zeng X, Wu J
J Nurs Manag · 2026 · PMID 42363643 · Full text
AIMS: To examine the current situation of sleep-related worry, compassion fatigue, and retention intention among nurses in general hospitals in China, and explore whether there might be any connection among the three. DE...
AIMS: To examine the current situation of sleep-related worry, compassion fatigue, and retention intention among nurses in general hospitals in China, and explore whether there might be any connection among the three. DESIGN: This study adopts a cross-sectional and descriptive design. METHODS: From January to February 2024, a survey was conducted on 1831 on-duty nurses from eight tertiary general hospitals in China (Sichuan, Hubei, and Shenzhen) using a convenience sampling method. The survey instruments included general information questionnaires, The Anxiety and Preoccupation about Sleep Questionnaire, The Compassion Fatigue Short Scale, and The Questionnaire for Nurse Intention to Remain Employed. Collected data were subsequently analyzed. RESULTS: The mean scores for sleep-related worry, compassion fatigue, and retention intention among nurses in general hospitals in China were 30.40 ± 11.28, 48.03 ± 27.26, and 22.79 ± 3.71, respectively. Significant negative correlations were observed between retention intention and both compassion fatigue and sleep-related worry, while a significant positive correlation was found between sleep-related worry and compassion fatigue. Furthermore, compassion fatigue partially mediated the relationship between sleep-related worry and retention intention, with the mediation effect accounting for 65.15% of the total effect. CONCLUSION: This study indicates that nurses' sleep-related worry and compassion fatigue may be related to their retention intention. IMPLICATIONS FOR NURSING MANAGEMENT: This study reveals that there may be a certain connection between nurses' sleep-related worry, compassion fatigue, and retention intention. It is suggested that nursing managers should prioritize improving nurses' sleep quality, alleviating their sleep-related worry, and enhancing organizational support. These measures may to some extent alleviate the phenomenon of compassion fatigue and even change the retention intention of nurses, thereby effectively curbing the brain drain of talents.
Moderating Role of Job Satisfaction on Organizational Climate and Professional Identity in Nurses: A Multicenter Cross-Sectional Study.
Chen C, Liu H, Lai J
J Nurs Manag · 2026 · PMID 42359498 · Full text
BACKGROUND: Organizational climate plays a key role in shaping nurses' professional identity, which is essential in mitigating postpandemic nursing shortages. However, whether job satisfaction moderates the association b...
BACKGROUND: Organizational climate plays a key role in shaping nurses' professional identity, which is essential in mitigating postpandemic nursing shortages. However, whether job satisfaction moderates the association between organizational climate and professional identity remains underexplored in Chinese tertiary hospitals. AIM: To explore the association between organizational climate and nurses' professional identity and to verify the moderating effect of job satisfaction on this relationship, grounded in the Job Demands-Resources framework and the Person-Environment Fit Theory. METHODS: This multicenter cross-sectional study recruited 580 nurses across five tertiary hospitals in Changsha, Hunan Province, between July and August 2025. Organizational climate, professional identity, and job satisfaction were assessed using the Nurse Organizational Climate Scale, the Nurse Professional Identity Rating Scale, and the Minnesota Satisfaction Questionnaire (Short-Form), respectively. The moderation model was tested using Spearman's rank correlation and hierarchical linear regression. RESULTS: Nurses exhibited a moderate level of professional identity, with a median score of 109.0 (IQR: 90.0-120.0). Organizational climate was positively correlated with professional identity (r = 0.681, p < 0.001), and such an association was positively moderated by job satisfaction (β = 0.086, p < 0.01). Specifically, the positive association between organizational climate and professional identity became stronger with increasing levels of job satisfaction. CONCLUSION: The organizational climate is positively associated with professional identity, and job satisfaction moderates this relationship. Our findings carry significant implications for future interventions to improve nurses' professional identity, suggesting a dual-strategy approach that optimizes the objective organizational climate while simultaneously enhancing nurses' subjective job satisfaction. IMPLICATIONS FOR NURSING MANAGEMENT: Foster a supportive organizational climate (e.g., resource guarantee, shared decision-making, and transformational leadership) and systematically enhance job satisfaction (e.g., emotional support, professional supervision, and fair incentives). A dual-strategy approach targeting both the environment and subjective satisfaction is key to strengthening nurses' professional identity and addressing workforce shortages.
Inclusive Leadership Is Associated With Nurse-Perceived Nurse-Patient Relationship Quality Through the Mediation Link of Self-Control and Resilience: A Cross-Sectional Study.
Wen Y, Zhuang L, Wang S
J Nurs Manag · 2026 · PMID 42358137 · Full text
BACKGROUND: The nurse-patient relationship is a cornerstone of high-quality care, yet its cultivation is challenged by the demanding clinical environment. Although inclusive leadership is recognized as a supportive organ...
BACKGROUND: The nurse-patient relationship is a cornerstone of high-quality care, yet its cultivation is challenged by the demanding clinical environment. Although inclusive leadership is recognized as a supportive organizational factor, the precise psychological mechanisms through which it is linked to this relationship remain underexplored. This study examines whether self-control and resilience mediate the link between inclusive leadership and nurse-perceived nurse-patient relationship quality, both independently and in sequence. METHODS: A cross-sectional survey of 429 registered nurses working in hospitals in China's Sichuan Province was conducted in accordance with the STROBE guidelines. Participants completed validated scales to measure their perceptions of inclusive leadership, self-control, resilience, and the nurse-patient relationship. Data were analyzed using descriptive statistics, confirmatory factor analysis, correlation analysis, and mediation analysis with the Hayes PROCESS macro (Model 6). RESULTS: There were positive correlations between inclusive leadership and self-control, resilience, and the nurse-perceived nurse-patient relationship (rs > 0.27, ps < 0.001). Mediation analysis confirmed a significant direct link between inclusive leadership and the nurse-perceived nurse-patient relationship (β = 0.18, 95% CI: [0.08, 0.28]). The total indirect effect was also significant (β = 0.25, 95% CI: [0.18, 0.32]). Self-control (β = 0.05, 95% CI: [0.02, 0.07]) and resilience (β = 0.18, 95% CI: [0.12, 0.25]) mediated the relationship independently. Furthermore, a theoretically specified sequential indirect pathway through self-control and resilience was statistically supported (β = 0.02, 95% CI: [0.01, 0.04]). CONCLUSION: The findings provide initial evidence suggesting that inclusive leadership is associated with a stronger nurse-perceived nurse-patient relationship, with this association being mediated by self-control and resilience, both independently and sequentially. Healthcare organizations should consider developing inclusive leadership and implementing interventions that concurrently strengthen nurses' self-regulatory capacity and resilience to cultivate optimal therapeutic relationships.
From Awareness to Action: Nurses' Experiences of Infection Control Measures in Clinical Practice.
Özkan İ, Polat Dunya C, Guder N … +2 more , Salhaoglu M, Karataş Erbay F
J Nurs Manag · 2026 · PMID 42358091 · Full text
AIM: This study aimed to explore nurses' experiences with the implementation of infection control measures, with a particular focus on perceived barriers, compliance practices, and organizational support mechanisms. BACK...
AIM: This study aimed to explore nurses' experiences with the implementation of infection control measures, with a particular focus on perceived barriers, compliance practices, and organizational support mechanisms. BACKGROUND: While infection control is a critical component of patient safety, the practical implementation of infection control protocols often encounters systemic and environmental barriers, particularly in inpatient care settings. METHODS: A qualitative study was conducted using the interpretative phenomenological analysis (IPA) approach. Semistructured interviews were conducted online via Zoom with 15 nurses working in internal medicine units at a university hospital in Türkiye between September and December 2024. Each participant had at least 2 years of professional experience. Data were analyzed inductively in line with IPA principles to identify recurring themes and meaning structures. RESULTS: Four main themes emerged: (1) Awareness and Compliance, reflecting nurses' knowledge and routine practices related to infection control; (2) Challenges in Implementation, including workload pressures, staffing shortages, and physical environment limitations; (3) The Role of Training, emphasizing the perceived value of interactive and practice-based education; and (4) Monitoring and Continuous Improvement, highlighting the need for regular audits and constructive feedback mechanisms. Notably, the barriers identified were predominantly organizational and systemic rather than individual, underscoring the importance of institutional support. CONCLUSION: Although nurses demonstrated strong awareness and commitment to infection prevention, structural and managerial challenges appeared to limit the consistent implementation of infection control measures. Strengthening institutional support, revising audit mechanisms, and enhancing staff engagement may help support sustainable infection control practices. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse leaders and healthcare administrators may consider addressing workforce capacity, supporting practice-oriented training approaches, and implementing constructive supervision and feedback systems to enhance adherence to infection control standards and promote a culture of safety in clinical practice.
Lived Experiences of Nurse Migration to High-Income Countries: A Qualitative Inquiry.
Karadag A, Seven M, Uçanbelen A … +1 more , Ashby N
J Nurs Manag · 2026 · PMID 42358052 · Full text
BACKGROUND: Nurse migration is increasing worldwide, raising critical challenges for workforce sustainability, regulation, and integration in both home and destination countries. AIMS: This study explores the experiences...
BACKGROUND: Nurse migration is increasing worldwide, raising critical challenges for workforce sustainability, regulation, and integration in both home and destination countries. AIMS: This study explores the experiences of Turkish nurses who migrated to the United States of America, the United Kingdom, and Germany, focusing on motivations, enabling factors, and challenges during immigration and integration. METHODS: A qualitative descriptive design was employed, and 23 Turkish nurses were recruited through purposive sampling. Data were collected via semistructured interviews conducted on secure video platforms. RESULTS: Content analysis revealed five themes. The decision to migrate reflected motivations of low pay, workplace violence, limited professional opportunities, and lack of respect, which collectively diminished nurses' professional self-worth in Türkiye. The immigration process highlighted barriers in language, licensing exams, credentialing, and visas. Life after immigration involved facing discrimination, adapting to a new culture, and pursuing professional growth. Reflections and outlook described overall satisfaction with the decision and future personal and professional career plans. Recommendations underscored the need for streamlined credentialing and stronger integration supports in destination countries, alongside improved workplace conditions, career opportunities, and respect for nurses in Türkiye. CONCLUSION: This study underscores the multifaceted drivers of nurse migration and calls for reforms to strengthen retention in Türkiye, while urging destination countries to adopt multidimensional support for integration to ensure a stable global nursing workforce. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers in source countries must lead systemic reforms addressing the conditions that diminish professional self-worth-unsafe workloads, low pay, workplace violence, and lack of professional respect-to meaningfully reduce migration intent. In destination countries, nurse managers are central to designing structured onboarding, mentorship, and culturally responsive integration pathways that support the adaptation and long-term retention of internationally educated nurses.
Exploring the Double-Edged Sword Effect of Responsible Leadership on Nurses' Proactive Behavior: The Mediating Roles of Affective Commitment and Emotional Exhaustion.
Zhang H, Wang Q, Zhao J … +2 more , Wang M, Wang J
J Nurs Manag · 2026 · PMID 42357982 · Full text
BACKGROUND: While leadership has been identified as a critical antecedent, the mechanisms underlying the impact of responsible leadership, particularly its potential dual pathways, remain underexplored among nurses. OBJE...
BACKGROUND: While leadership has been identified as a critical antecedent, the mechanisms underlying the impact of responsible leadership, particularly its potential dual pathways, remain underexplored among nurses. OBJECTIVES: This study aims to investigate the mechanisms through which responsible leadership influences nurses' proactive behavior, focusing on the mediating roles of affective commitment and emotional exhaustion. METHODS: A multisource, multi-time point survey was conducted. Data were collected from nurse-leader dyads across two time points, 45 days apart. A mediation model was constructed and tested using SPSS 24.0 and AMOS 19.0. RESULTS: The empirical findings show that responsible leadership positively affects nurses' proactive behavior (b = 0.280, SE = 0.118, p = 0.019 < 0.05). Both affective commitment (95% CI: [0.002, 0.109]) and emotional exhaustion (95% CI: [-0.112, -0.001]) of nurses serve as partial mediators in the relationship between responsible leadership and proactive behavior. CONCLUSIONS: Drawing on the Job Demands-Resources model, this study addresses the theoretical gap by revealing the paradoxical pathways through which a single leadership style can exert both motivational and health-impairing effects, specifically in the case of responsible leadership. These findings suggest that nursing managers should foster responsible leadership to strengthen affective commitment and promote proactive behavior, while simultaneously mitigating the risk of emotional exhaustion through adequate resources, psychological safety, and regular support. This study provides empirical evidence to inform nursing management practices and workforce development strategies. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.
Latent Profile Analysis and Influencing Factors of Clinical Nurses' Evidence-Based Practice Implementation: A Cross-Sectional Study.
Chen Y, Wang J, Zhang Y … +2 more , Cao X, Zhao L
J Nurs Manag · 2026 · PMID 42357863 · Full text
AIM: The purpose of this study was to investigate the current status and potential profiles of clinical nurses' implementation of evidence-based practices (EBPs), explore influencing factors across different profiles, an...
AIM: The purpose of this study was to investigate the current status and potential profiles of clinical nurses' implementation of evidence-based practices (EBPs), explore influencing factors across different profiles, and provide a basis for developing strategies to enhance clinical nurses' EBP competence. DESIGN: A cross-sectional study. METHODS: From January to March 2025, a convenience sampling method was used to select 289 clinical nurses from 24 provinces across China. A survey was conducted using a demographic questionnaire and the three EBP scales-short version to assess implementation. Latent profile analysis identified distinct latent profiles of EBP implementation among Chinese clinical nurses, and multivariate logistic regression examined the factors influencing profile membership. RESULTS: The results revealed three latent profiles of EBP implementation among clinical nurses: low participation type (15%), moderate participation type (27%), and high participation type (58%). Multivariate logistic regression analysis indicated that EBP beliefs, EBP organizational culture, and readiness were the primary influencing factors of EBP implementation. CONCLUSION: This study demonstrates that Chinese clinical nurses generally exhibit positive engagement in EBP implementation. EBP beliefs, EBP organizational culture, and readiness are key factors influencing implementation. Efforts should focus on fostering EBP beliefs while simultaneously providing a supportive implementation environment to ensure sustainable EBP.
Head Nurse Digital Leadership and Staff Nurse-GenAI Collaboration in Chinese Hospitals: The Mediating Role of Digital Self-Efficacy and the Moderating Role of Nurse Perceived Job Autonomy.
Wu Q
J Nurs Manag · 2026 · PMID 42345517 · Full text
AIMS: To examine how head nurse digital leadership is associated with staff nurse-generative artificial intelligence (GenAI) collaboration, specifically exploring the mediating role of digital self-efficacy and the moder...
AIMS: To examine how head nurse digital leadership is associated with staff nurse-generative artificial intelligence (GenAI) collaboration, specifically exploring the mediating role of digital self-efficacy and the moderating role of nurse perceived job autonomy. BACKGROUND: GenAI is shifting nursing practice from solo task execution to active nurse-AI collaboration. While digital leadership is theorised to facilitate this transition, the specific mechanisms and boundary conditions, particularly in the context of Chinese tertiary hospitals, remain insufficiently explored. METHODS: A time-lagged study design was employed, collecting data from 336 frontline nurses across 18 tertiary hospitals in China. The moderated mediation model was tested using PROCESS Model 4 and PROCESS Model 7 with 5000 bootstrap resamples. RESULTS: Digital leadership was positively associated with nurse-GenAI collaboration. Digital self-efficacy served as a critical mediator in this relationship. Furthermore, perceived job autonomy significantly moderated the relationship between digital leadership and digital self-efficacy. The indirect effect of leadership on collaboration through self-efficacy was also significant when nurses reported higher levels of job autonomy. CONCLUSION: Head nurses who demonstrate strong digital leadership are associated with more effective GenAI collaboration, potentially by nurturing nurses' digital confidence. However, the strength of this association appears contingent upon the structural resource of job autonomy, which may afford nurses greater freedom to experiment with and integrate AI tools into clinical practice. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing leaders should move beyond top-down AI implementation towards distributed leadership models that prioritise the development of nurses' digital self-efficacy. To maximise the benefits of AI adoption, hospital administrators must foster autonomous work environments that empower nurses to act as proactive partners with technology, ultimately enhancing workflow efficiency and clinical resilience in high-workload settings.
"More Than My Own Effort": A Qualitative Study of Factors Influencing EBP Competence Among Traditional Chinese Medicine Specialist Nurses.
Li Y, Chen Y, Xu W … +2 more , Sun J, Du S
J Nurs Manag · 2026 · PMID 42339535 · Full text
AIMS: To explore factors influencing evidence-based practice (EBP) competence among traditional Chinese medicine (TCM) specialist nurses using the Capability, Opportunity, Motivation, and Behavior (COM-B) model. BACKGROU...
AIMS: To explore factors influencing evidence-based practice (EBP) competence among traditional Chinese medicine (TCM) specialist nurses using the Capability, Opportunity, Motivation, and Behavior (COM-B) model. BACKGROUND: EBP underpins quality and safety in nursing. TCM nursing is increasingly delivered across TCM and general hospital settings, yet integration of EBP within TCM nursing remains challenging. Little is known about what shapes EBP competence and practice among TCM specialist nurses who play key roles in delivering TCM nursing techniques and mentoring others. METHODS: A qualitative study using semistructured interviews was conducted with 17 TCM specialist nurses between April and August 2024. Data were analyzed using theory-informed thematic analysis. Initial coding was conducted inductively, and themes were subsequently refined and interpreted in relation to the COM-B model. RESULTS: Four overarching domains were identified and interpreted in relation to the COM-B model: capability-related factors (basic and advanced skills), opportunity-related factors (stakeholder buy-in, resource constraints, available time, and evidence-related challenges), motivation-related factors (role clarity and volitional tensions), and behavioral enactment of EBP competence in practice (inadequate engagement in EBP, self-directed learning, and practice-grounded expertise). CONCLUSIONS: Findings highlight the need for targeted strategies to enhance capability, expand institutional and systemic opportunities, address capability, opportunity, and motivation-related barriers, and strengthen the enactment of EBP competence in practice. Such efforts may help strengthen the development and enactment of EBP competence among TCM specialist nurses.
Self-Leadership Based on Caring Among Primary Nurses: A Qualitative Study in Hospital Settings.
Yuwanto MA, Yosep I, Pramukti I … +1 more , Mediawati AS
J Nurs Manag · 2026 · PMID 42339515 · Full text
Healthcare organisations increasingly require nurses to enact leadership within everyday clinical practice to sustain care quality in complex and resource-constrained environments. This study aimed to explore how self-le...
Healthcare organisations increasingly require nurses to enact leadership within everyday clinical practice to sustain care quality in complex and resource-constrained environments. This study aimed to explore how self-leadership grounded in caring is enacted by primary nurses and to examine organisational and relational factors shaping this process. A qualitative descriptive design was employed, involving semistructured interviews with ten primary nurses working across inpatient wards, intensive care units and emergency departments. Data were analysed using thematic analysis. Six interrelated themes were identified: self-regulation as the foundation of self-leadership, caring practices as a relational framework for care delivery, professional identity and clinical autonomy, systemic and interpersonal barriers, organisational support as an enabling condition and perceived impacts on care quality. The findings indicate that leadership enacted at the point of care operates through self-regulation and caring-oriented interactions, supporting professional accountability and autonomous decision-making, while being shaped by organisational conditions and systemic constraints. Participants perceived that integrating leadership with caring may enhance care quality, strengthen nurse-patient relationships and support professional satisfaction. This study contributes to nursing management scholarship by providing empirical insight into leadership as a relational and contextually situated process in everyday care rather than solely an individual competency, suggesting the relevance of organisational strategies that support nurses' leadership and caring practices.
Understanding Workplace Violence in ED: The Maternity Nurses' Experience Using Descriptive Phenomenology.
Ahmed AS, Castelino G, De Leon R … +8 more , Paulose L, Mathew S, Varghese SA, De Jesus DH, Mariyamma RR, Ali Alomari AM, Salim Ibrahem RA, Silang JPB
J Nurs Manag · 2026 · PMID 42338020 · Full text
INTRODUCTION: Workplace violence (WPV) in clinical settings is a global issue in healthcare. Recent studies have shown that attitudes toward WPV are evolving. According to the World Health Organization, WPV affects betwe...
INTRODUCTION: Workplace violence (WPV) in clinical settings is a global issue in healthcare. Recent studies have shown that attitudes toward WPV are evolving. According to the World Health Organization, WPV affects between 8% and 38% of healthcare workers, especially in culturally diverse nations like the Middle East. The emergency department (ED), as one of the busiest and most critical hospital units, has been reported as the most common focal point for WPV. Thus, this study describes the WPV experiences of maternity nurses and emphasizes the importance of understanding this phenomenon to inform effective interventions. METHODS: The study followed a descriptive phenomenology approach. Fifteen ED nurses were selected and interviewed with a semistructured interview guide and an audio recorder. Participants were recruited via telephone invitations based on confirmed WPV reports. One-on-one interviews were conducted until data saturation was reached. Audio recordings were transcribed, and data were analyzed using Colaizzi's thematic analysis method, ensuring trustworthiness and rigor in accordance with Lincoln and Guba's criteria. RESULTS: Data analysis identified 10 subthemes and 5 emerging themes describing maternity nurses' WPV experience in a tertiary care setting. Themes include demanding emergency care through verbal aggressiveness; sociocultural differences influencing nurse-patient interaction and emergency nursing care; misaligned expectations and policy awareness; nurses' adaptation and competing care demands; and managing WPV with manpower resources and collaboration. CONCLUSION/RECOMMENDATIONS: The study reveals that WPV has multiple drivers: system-based, situation-grounded, and contextual. This evidence, along with the body of current literature, supports the plea to have a zero-tolerance policy for WPV, especially in maternity settings where the safety of the woman and her child is the utmost priority.
Clinical Mentorship in Nursing Practice in the UAE: A Mixed-Methods Study of Mentor Perspectives on Effectiveness, Training, and Support.
Dias JM, Aderibigbe SA, Abraham MS
J Nurs Manag · 2026 · PMID 42334010 · Full text
BACKGROUND: Clinical mentorship is a cornerstone of nursing education, supporting the development of clinical competence, professional identity, and readiness for practice. Although mentorship has been widely studied int...
BACKGROUND: Clinical mentorship is a cornerstone of nursing education, supporting the development of clinical competence, professional identity, and readiness for practice. Although mentorship has been widely studied internationally, evidence from Arab countries remains limited. This study examined nursing professionals' perceptions of clinical mentorship and explored factors influencing mentorship effectiveness within healthcare settings in the United Arab Emirates (UAE). METHODS: A sequential explanatory mixed-methods design, grounded in a pragmatic worldview, was employed. Quantitative data were collected through a cross-sectional survey of 75 nursing professionals working across healthcare facilities in the UAE. Descriptive and inferential statistics were used to examine mentorship experiences and perceived effectiveness. Qualitative data from open-ended survey responses were analyzed thematically to explain and enrich quantitative findings. Integration occurred during interpretation through the comparison of quantitative and qualitative results. RESULTS: Most participants (76.0%, n = 57) reported that mentorship positively influenced students' preparedness for clinical practice under four themes. The themes are enhanced clinical competence, bridging theory and practice, the importance of supportive mentor behaviors, and the value of continuous learning support. Participants also identified challenges that affected mentorship effectiveness, including communication barriers, limited student engagement, time constraints, and inadequate mentor preparation. Among respondents who completed the evaluation stress item (n = 44), 41.3% (n = 31) reported no stress when evaluating students, whereas 17.3% (n = 13) reported evaluation-related stress associated with unclear assessment criteria, workload pressures, and competing clinical responsibilities. More than half of participants (54.7%, n = 41) preferred a combination of compensation approaches, particularly continuing professional development opportunities and formal recognition. CONCLUSION: Clinical mentorship is an important contributor to nursing students' preparedness and professional development. Strengthening mentor training, clarifying evaluation processes, addressing workload pressures, and implementing meaningful recognition strategies may enhance the effectiveness and sustainability of mentorship in clinical practice settings.
The Experiences of Intermediate-Titled Clinical Nurses' Promotion to Senior Titles: A Phenomenological Study.
Zheng S, Zhu H, Gong J
J Nurs Manag · 2026 · PMID 42333895 · Full text
BACKGROUND: Nurses show low enthusiasm for senior title promotion despite its career benefits. Understanding their experiences and difficulties can inform more effective policy implementation. INTRODUCTION: The nurse pro...
BACKGROUND: Nurses show low enthusiasm for senior title promotion despite its career benefits. Understanding their experiences and difficulties can inform more effective policy implementation. INTRODUCTION: The nurse promotion system directly affects remuneration and work enthusiasm. Mobilizing nurses' initiative within this framework remains a key challenge for policymakers and hospital administrators. AIM: To explore the views and experiences of clinical nurses with intermediate titles on the promotion system of senior titles. METHODS: A descriptive phenomenological study was conducted. A total of 13 clinical nurses with intermediate professional titles from 11 different departments (the average years of obtaining the intermediate title were 7.54 years) participated in face-to-face semistructured interviews. The data were analyzed using Colaizzi's seven-step data analysis method (1978). The COREQ guidelines were followed for reporting. Rigor was ensured through member checking and peer debriefing. RESULTS: Five categories emerged: Escape (perceived inadequacy, clinical/family burden, and lack of guidance/role models); Transform (clinical influence, environmental impact, and enhanced self-awareness); Challenge (research learning, degree hurdles, and trial/failure); Reflection (early career planning, perseverance, and continuous self-growth); and Expect (career/psychological support, research environment, and diversified criteria). These categories formed a cyclical process from Escape to Transform, interrupted by Challenge, leading to Reflection, and culminating in Expect for systemic change. DISCUSSION: Nursing managers and educators should attach great importance to the promotion experience of nurses, promptly address their promotion needs, and provide career planning training and guidance as early as possible. CONCLUSIONS: By planning career development in advance, actively learning and enhancing professional and research capabilities, the comprehensive ability and professional pride of nurses can be strengthened, and the promotion rate of senior professional titles for nurses can be increased. IMPLICATIONS FOR NURSING POLICY: Nurse managers, policy makers, and nursing schools should jointly design a career development framework including mentorship, protected research time, methodological support, career planning workshops, diversified criteria, and innovation-friendly environments. Context-tailored implementation may enhance nurses' promotion enthusiasm and success rates.
Organizational Dehumanization, Perceived Stress, and Patient Depersonalization in French Nurses: A Cross-Sectional Test of the Spillover Model.
Mollet MC, Zerhouni O, Isnard Bagnis C … +1 more , Romo L
J Nurs Manag · 2026 · PMID 42333741 · Full text
OBJECTIVE: To examine the association between organizational dehumanization (OD) and nursing staff's perceived stress and to test whether perceived stress statistically mediates the relationship between OD and patient de...
OBJECTIVE: To examine the association between organizational dehumanization (OD) and nursing staff's perceived stress and to test whether perceived stress statistically mediates the relationship between OD and patient depersonalization, as proposed by the spillover model. DESIGN: Cross-sectional online survey. METHODOLOGY: A total of 291 registered nurses in France completed an online questionnaire measuring OD, perceived stress, and depersonalization. Mediation analysis with bias-corrected bootstrapping was used to examine the hypothesized pathway linking OD to patient depersonalization through perceived stress. RESULTS: OD is significantly associated with perceived stress. Perceived stress functioned as a partial and statistically significant mediator in the relationship between OD and depersonalization. A significant direct effect of OD on depersonalization persisted, suggesting that stress only partially explains the relationship. CONCLUSIONS: The findings provide cross-sectional support for the spillover hypothesis: OD is associated with psychological strain which in turn is associated with depersonalized attitudes toward patients. These findings suggest that OD may be part of a stressful work climate in which depersonalization is more likely to be observed, although causal interpretations cannot be drawn. IMPACT: The results highlight OD as a potential psychosocial risk factor for nurses and as a contextual correlate of depersonalization in patient care. Policies should be informed by further longitudinal and intervention studies before drawing firm conclusions about mechanisms or causality. Also, interventions should prioritize reducing the perceived stress of staff and restoring the ethical quality of the work environment over merely managing individual stress. IMPLICATION FOR NURSING MANAGEMENT: These findings suggest that nursing managers should address OD as a contextual risk factor by reducing dehumanizing organizational practices and strengthening ethical, resource-preserving work conditions, rather than relying solely on individual stress-management strategies.
Influencing Factors of Thriving at Work of Operating Room Nurses: A Qualitative Study Based on Social Ecosystem Theory.
Li R, Ma W, Hu Y … +2 more , Xu Y, Li L
J Nurs Manag · 2026 · PMID 42333716 · Full text
BACKGROUND: The thriving at work of operating room nurses is crucial to patient safety, the quality of nursing care, and team stability. However, the current understanding of the status quo, influencing factors, and mech...
BACKGROUND: The thriving at work of operating room nurses is crucial to patient safety, the quality of nursing care, and team stability. However, the current understanding of the status quo, influencing factors, and mechanisms underlying thriving at work among Chinese operating room nurses remains limited. AIM: This study aimed to explore the factors influencing thriving at work among operating room nurses based on social ecosystem theory. DESIGN: A descriptive qualitative research design was used. METHODS: Sixteen operating room nurses were recruited in Xinjiang from February to March 2025 and interviewed face-to-face. Data were analyzed using NVivo 12.0 software, and themes were identified via Colaizzi's seven-step analysis. RESULTS: The analysis yielded three themes and nine subthemes aligned with the domains of social ecosystem theory: (1) microsystem: coping ability and personal character; (2) mezzosystem: work-family role conflict and responsibilities, collaboration of the work team, positive feedback for work, colleague-related emotional experiences, and nurse manager support and empowerment; and (3) macrosystem: societal perceptions of the nursing role and professional standards for operating room practice. CONCLUSIONS: From the perspective of social ecosystem theory, this study systematically identified influencing factors of operating room nurses' thriving at work at micro-, mezzo-, and macrolevels for the first time. In the future, managers should attach importance to these factors, establish an individual-organization-society multidimensional support system, and implement personalized management strategies to facilitate coordinated development of individuals and organizations.
Nurses' Silence Behavior as a Mediator Between Authentic Leadership and Near-Miss Reporting Intention: A Cross-Sectional Study.
Ku IH, Ko S
J Nurs Manag · 2026 · PMID 42333710 · Full text
BACKGROUND: Near-miss reporting intention is essential for patient safety; however, reporting rates among nurses remain low. Nurses' silence behavior-the intentional withholding of work-related concerns-is a key barrier...
BACKGROUND: Near-miss reporting intention is essential for patient safety; however, reporting rates among nurses remain low. Nurses' silence behavior-the intentional withholding of work-related concerns-is a key barrier to reporting. While authentic leadership is known to promote nurses' voice behavior, research examining the relationships between authentic leadership, nurses' silence behavior, and near-miss reporting intention remains limited. Therefore, this study aimed to examine the abovementioned relationships and to test the mediating role of nurses' silence behavior. METHODS: A predictive correlation design was used. Data were collected from 171 nurses at three general and tertiary hospitals in South Korea between August 20 and September 15, 2022. The mediating effect of silence behavior on the relationship between authentic leadership and near-miss reporting intention was tested using the PROCESS macro (Model 4). RESULTS: Authentic leadership was negatively associated with nurses' silence behavior (B = -0.27, p < 0.001), and silence behavior was negatively associated with near-miss reporting intention (B = -0.65, p = 0.008). Authentic leadership did not have a significant direct effect on near-miss reporting intention (B = 0.36, p = 0.142) but had a significant indirect effect through the mediator (B = 0.18, 95% CI = 0.03-0.37). CONCLUSION: Authentic leadership is indirectly linked to higher near-miss reporting intentions through lower individual silence behavior among nurses. To enhance reporting intentions, it is necessary to mitigate situational constraints associated with silence and foster an environment conducive to open communication. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers should consistently practice authentic leadership to dismantle rigid hierarchical atmospheres and cultivate an open communication climate. This targeted strategy may help reduce nurses' silence behavior and encourage active participation in patient safety-strengthening behaviors, thereby creating a secure healthcare setting.
Action Model for Unforeseen Inadequacy in Nurse Qualifications and Staffing: A Descriptive Study of the Experiences of Nurses and Nurse Managers.
Lehtomäki K, Kannisto K, Stolt M
J Nurs Manag · 2026 · PMID 42333038 · Full text
AIM: This study aimed to explore the experiences of nurses and nurse managers when using the Unforeseen Situations of Staffing and Qualifications action Model (USSQM) and to describe their views on the further developmen...
AIM: This study aimed to explore the experiences of nurses and nurse managers when using the Unforeseen Situations of Staffing and Qualifications action Model (USSQM) and to describe their views on the further development needs of the USSQM. METHODS: A descriptive qualitative study was employed. Nineteen (n = 19) nurses and nurse managers from one department of a University Hospital in Finland were selected for semistructured focus-group interviews by purposive sampling. Data were collected from January to October 2025; the interview guide focused on participant's experiences of the use of USSQM. Data were analyzed using inductive content analysis. RESULTS: The analysis of the results revealed six themes: (1) Integration of the USSQM into clinical routine, (2) Providing decision-making support and practice clarity, (3) Strengthening the fundamentals of the USSQM, (4) Safeguarding nurse well-being and ethics, (5) Fostering communication and cooperation, (6) Utilization of digital solutions. Nurses and nurse managers described that USSQM was mainly used to assess workload status and manage patient flow. Participants described experiencing a tension between their strong professional ethics and the fundamental objectives of the USSQM. Consequently, they expressed that it was challenging to follow the reorganization and prioritization guidelines dictated by the model. CONCLUSIONS: The participants described the USSQM as a practical and usable action model for daily practice. However, future refinement of the USSQM must focus on integrating objective workload indicators to reduce subjectivity and utilizing digital solutions for automated data retrieval. Additionally, adequate information and support from organizational leadership should be ensured during the implementation process to facilitate the comprehensive use of the USSQM. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers especially experienced that USSQM gave them support in decision-making; therefore, nurse managers play an essential role in ensuring the implementation of the USSQM in the units. They serve as role models and support nurses in decision-making when tasks need to be reorganized or prioritized during periods of high workload.
Longitudinal Interplay Between Team Resilience and Team Stress in Low-Stability Clinical Nursing Teams: A Cross-Lagged Panel Network Analysis.
Wang Z, Gao L, Meng S … +2 more , Song X, Luan X
J Nurs Manag · 2026 · PMID 42322059 · Full text
AIM: To estimate longitudinal predictive relationships between team resilience and team stress among low-stability clinical nursing teams, identifying core driving factors and bridging mechanisms using cross-lagged panel...
AIM: To estimate longitudinal predictive relationships between team resilience and team stress among low-stability clinical nursing teams, identifying core driving factors and bridging mechanisms using cross-lagged panel network analysis. BACKGROUND: Chronic instability in clinical nursing teams disrupts workflows and triggers systemic team stress, which is further exacerbated by digital health technology burdens and moral distress. Understanding how specific dimensions of team resilience interact with these facets of team stress over time is essential for developing precise organizational interventions. DESIGN: A two-wave longitudinal panel study. METHODS: Data from the Nurse Team Health Management Research Cohort across two waves (October 2024 and December 2025) included 5164 clinical nurses aggregated into 285 low-stability nurse teams. Team resilience and team stress were assessed using the Analyzing and Developing Adaptability and Performance in Teams to Enhance Resilience Scale and a customized Nursing Job Stressor Inventory. A cross-lagged panel network was estimated to identify influential nodes and network conduits. RESULTS: Digital health technology burden exhibited the highest predictive power, driving team stress and significantly predicting subsequent moral distress. Moral distress emerged as a potentially destructive bridge, which may negatively predict multiple resilience dimensions over time. Conversely, cooperation with other departments appeared to serve as a protective bridge, mitigating subsequent subjective work stress and digital technology burden. Monitoring exhibited a potentially paradoxical effect, positively predicting subsequent subjective work stress. CONCLUSION: Digital health technology burden drives occupational stress in low-stability nursing teams. Moral distress may erode team resilience, whereas cross-departmental cooperation acts as a potential protective shield. IMPLICATIONS FOR NURSING MANAGEMENT: This study shifts the focus of occupational stress management from the individual to the team level. To stabilize nursing teams facing chronic instability and high turnover, healthcare administrators should move beyond generic stress reduction. Targeted interventions must focus on alleviating digital workflow burdens, instituting routine ethical debriefings to resolve moral distress, and formalizing boundary-spanning cooperation protocols.
How Does the Absence of Job Embeddedness Contribute to Nurses' Turnover Intention? A Fuzzy-Set Qualitative Comparative Analysis.
Wang X, Liu M, Zhang JE … +7 more , Deng R, Li M, Jin X, Dai H, Wang Y, Wang X, Leung AYM
J Nurs Manag · 2026 · PMID 42321977 · Full text
BACKGROUND: Nurse turnover is a significant contributor to the global nursing shortage, and nurses' turnover intentions are typically caused by a combination of factors. Nurses' job embeddedness is an important factor in...
BACKGROUND: Nurse turnover is a significant contributor to the global nursing shortage, and nurses' turnover intentions are typically caused by a combination of factors. Nurses' job embeddedness is an important factor influencing nurses' turnover intentions. However, existing studies have examined only the net effects of the individual constructs on turnover intention, overlooking the combined effects of the job embeddedness dimensions. AIM: To explore how the dimensions of job embeddedness combine to form configurations that lead to nurses' turnover intention or no turnover intention. DESIGN: A cross-sectional study using fuzzy-set qualitative comparative analysis. SETTING(S): Six medical institutions in the Hong Kong Special Administrative Region, China. PARTICIPANTS: From March to June 2023, a total of 232 employed nurses were included using a convenience sampling method. METHODS: The fuzzy-set qualitative comparative analysis was used to analyze the set relationships between the six dimensions of job embeddedness and turnover intention. Robustness checks and predictive validity analyses, based on set theory methods, were employed to verify the robustness of the condition configurations and their ability to predict the outcome variables. Finally, ordered logit regression was used to examine the associations between the configurations and turnover intention. RESULTS: Fuzzy-set qualitative comparative analysis indicated that multiple job embeddedness-related conditions combine to lead to nurses' turnover intention. Necessity analysis shows that job embeddedness-related conditions are not necessary conditions for the presence or absence of nurses' turnover intention. Sufficiency analysis identified five configurations contributing to nurses' turnover intention (solution coverage = 0.525) and six configurations contributing to no turnover intention (solution coverage = 0.668), and these configurations were categorized into six groups. Significant associations were found between these configurations and turnover intention. CONCLUSION: The results suggest that the absence of organization fit and organization sacrifice is the core condition that contributes to nurses' turnover intention. Mutual collaboration and competition between the dimensions of job embeddedness combined to create multiple configurations that prevented nurses' turnover intention. This study provides new insights and ideas for managers to implement targeted interventions to reduce nurses' turnover intention in response to these configurations.
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