J Nurs Manag [JOURNAL]
Sun
200 papers
Interacting Effects of Gender and Workplace Conflict on Subjective Social Status and the Mediating Role of Professional Benefits in Registered Nurses: A Cross-Sectional Study in China.
Du Y, Liu C, Chen X … +1 more , Zhang Y
J Nurs Manag · 2026 · PMID 42113095 · Full text
PURPOSE: The objectives of this study were to examine whether there is a relationship between workplace conflict and subjective social status and to explore whether gender serves as a moderating variable and perceived pr...
PURPOSE: The objectives of this study were to examine whether there is a relationship between workplace conflict and subjective social status and to explore whether gender serves as a moderating variable and perceived professional benefits act as a mediating variable in this relationship. METHODS: Data were derived from a sample of 8575 registered nurses across 29 hospitals in Shanghai. We examined gender differences in the relationship between workplace conflict and nurses' subjective social status by employing a multilinear regression model that incorporated the interaction between gender and workplace conflict. Additionally, we explored whether professional benefits differently mediated the relationship between workplace conflict and subjective social status for male and female nurses through gender-specific mediation analyses. RESULTS: The association between workplace conflict and subjective social status differed by gender (p < 0.001). Female nurses who experienced workplace conflict demonstrated a reduced subjective social status (β = -0.63, 95% CI: -0.78 to -0.47, p < 0.001), with their subjective social status scores further diminishing as the frequency of conflict increased (β = -0.65, 95% CI: -0.78 to -0.52, p for trend < 0.001). Conversely, among male nurses, a positive correlation was observed (β = 0.56, 95% CI: 0.06 to 1.06, p for trend = 0.028). Among female nurses, the direct association between workplace conflict and the subjective social status score was statistically significant (β = -0.37, 95% CI: -0.49 to -0.25, p < 0.001), and an indirect effect mediated through professional benefits was also observed (β = -0.43, 95% CI: -0.50 to -0.36, p < 0.001). The proportion of mediation was 0.54 (95% CI: 0.45 to 0.64, p < 0.001). CONCLUSIONS: Gender plays a significant interactive role in the relationship between workplace conflict and nurses' subjective social status. Among female nurses, professional benefits function as a partial mediator. Accordingly, it is recommended that healthcare institutions address the concerns and needs of female nurses by enhancing their professional benefits to increase their subjective social status. IMPLICATIONS FOR NURSING MANAGEMENT: Managers can improve nurses' subjective social status by increasing their sense of professional benefits. When encountering workplace conflict, healthcare managers could consider involving male nurses in conflict management and encouraging male nurses who have successfully resolved conflicts to share their experiences in conflict management.
Intention to Delay Retirement and Its Influencing Factors Among Near-Retirement Nurses: A Cross-Sectional Study.
Chen J, Yang F, Liu S … +5 more , Tan Z, Ye C, Gao J, Ding S, Zhou M
J Nurs Manag · 2026 · PMID 42108534 · Full text
BACKGROUND: The ageing nursing workforce poses a growing challenge to healthcare systems worldwide. Delaying retirement among experienced nurses has been proposed as a potential workforce strategy, yet empirical evidence...
BACKGROUND: The ageing nursing workforce poses a growing challenge to healthcare systems worldwide. Delaying retirement among experienced nurses has been proposed as a potential workforce strategy, yet empirical evidence from China remains limited, particularly from a management-oriented perspective under ongoing retirement-age reforms. AIM: To examine the prevalence of delayed retirement intention and to identify individual, occupational, and organisational factors associated with such intention among near-retirement nurses in Guangzhou, China. METHODS: A theory-informed cross-sectional survey was conducted from May to August 2025 among 298 nurses aged ≥ 45 years from 37 hospitals in Guangzhou. Guided by an integrated push-pull and job demands-resources framework, a structured questionnaire measured sociodemographic and work characteristics, economic and family stress, job satisfaction and occupational burnout. Data were analysed using descriptive statistics, nonparametric tests, Spearman correlation and ordinal logistic regression. RESULTS: Only 13.4% of near-retirement nurses expressed willingness to delay retirement, whereas 38.3% were unwilling. In multivariable ordinal logistic regression, contract-based employment, higher professional title, greater economic and family stress and lower occupational burnout were independently associated with higher levels of delayed retirement intention. CONCLUSION: Near-retirement nurses demonstrated a generally low intention to delay retirement. Organisational and employment-related factors were prominently associated with delayed retirement intention, underscoring the importance of work-system conditions in shaping late-career retention. IMPLICATIONS FOR NURSING MANAGEMENT: The findings suggest that modifiable organisational factors-such as occupational burnout, late-career role design and employment arrangements-are associated with delayed retirement intention. These areas may represent potential points of attention for nursing management when considering strategies to support the retention of experienced nurses under retirement-age reform.
A Study of Changes in Newly Graduated Registered Nurses' Resilience, Satisfaction With the Work Environment, and Intention to Stay During a Two-Year Training Program and Corresponding Mediating Effects: A Longitudinal Study.
Tzeng IS, Cheng CH, Liao RW
J Nurs Manag · 2026 · PMID 42108497 · Full text
BACKGROUND: Newly graduated registered nurses (NGRNs) are likely to leave their jobs because they cannot adapt to nursing work. In Taiwan, a two-year on-the-job training program was implemented to help NGRNs meet the dem...
BACKGROUND: Newly graduated registered nurses (NGRNs) are likely to leave their jobs because they cannot adapt to nursing work. In Taiwan, a two-year on-the-job training program was implemented to help NGRNs meet the demands and adapt to nursing jobs. However, the effects of the program on NGRNs' satisfaction with the work environment, individual resilience, and intention to stay, as well as the relationships among these factors, remain unclear. AIM: The aim of this study was to investigate the changes in NGRNs' perceptions of the work environment, individual resilience, and intention to stay after they complete each stage of the on-the-job training program and to examine the mediating effect of resilience on the relationship between the work environment and nurses' intention to stay. METHODS: A repeated-measures study was conducted at a medical center in Taiwan to survey NGRNs after they completed each stage of the training program. The survey questionnaire included the NGRNs' background information, satisfaction with the work environment, individual resilience, and intention to stay. Changes across the training stages and the associated mediating effects were analyzed. RESULTS: We observed that NGRNs' satisfaction with the work environment (p < 0.001) and intention to stay (p < 0.001) decreased significantly across the three waves of the survey, whereas individual resilience increased significantly (p < 0.05). Furthermore, we observed that individual resilience significantly mediated the impact of satisfaction with the work environment on nurses' intention to stay (p < 0.05). CONCLUSION: The training program can significantly improve NGRNs' individual resilience. However, with respect to their satisfaction with the work environment and intention to stay, the training may require adjustment; alternatively, additional measures may be needed to mitigate the effects of job changes on NGRNs.
Turnover Intention and Its Relationship With Work-Related Factors Among Nurses in Spain: A Cross-Sectional Study.
Camacho-Montaño LR, Gómez-Arribas SB, Moreno-Casbas MT … +6 more , Ropero-Sánchez A, Bernués-Caudillo L, Calleja-Toledano P, Recas-Martín A, Zamora J, Padilla-Bernáldez J
J Nurs Manag · 2026 · PMID 42106195 · Full text
BACKGROUND: Nurse turnover intention is a multifactorial construct shaped by individual, occupational, organizational, and policy-level factors. Although widely studied in some regions, evidence from Southern Europe, par...
BACKGROUND: Nurse turnover intention is a multifactorial construct shaped by individual, occupational, organizational, and policy-level factors. Although widely studied in some regions, evidence from Southern Europe, particularly Spain, remains scarce. Understanding these factors in diverse healthcare contexts is essential for designing effective retention strategies that are both locally relevant and internationally informative. OBJECTIVE: This study aims to explore turnover intention prevalence and associated factors among nurses across different care settings in Spain. DESIGN: A cross-sectional study. SETTINGS: Primary care, hospitals, emergency services, or social healthcare settings. PARTICIPANTS: A total of 20,316 actively employed nurses. METHODS: An online survey was disseminated by the Spanish Ministry of Health and other institutional channels. Turnover intention was the primary outcome and was measured with a single item asking whether nurses intended to leave the profession within the next 10 years (yes/no). Work-related variables and perceptions of care quality and patient safety were also collected. Multivariable logistic regression was used to identify key predictors across care settings. RESULTS: Of the 20,316 participants, most were women (84.8%) and 50.3% were under 35 years. Overall, 39.58% reported an intention to leave the nursing profession within 10 years. Turnover intention was significantly associated with perceptions of care quality (OR = 1.706, p < 0.001) and patient safety (OR = 1.809, p < 0.001), regional disparities, and temporary employment contracts (OR = 1.333, p < 0.001). In primary care, working as a generalist and on afternoon shifts increased turnover risk, while in hospitals, long shifts (> 7.5 h) were influential. CONCLUSIONS: This study provides novel insights into nurse turnover intention in Spain, highlighting the interplay of modifiable institutional factors and regional disparities in a decentralized health system. Turnover intention was strongly associated with organizational conditions, reinforcing the urgent need for tailored, context-sensitive retention strategies. Standardizing definitions, measurements, and temporal frameworks remains critical for advancing comparative research and developing effective, evidence-based interventions to strengthen the nursing workforce.
Factors Influencing ICU Nurses' Proficiency in Point-of-Care Gastrointestinal Ultrasound: A National Cross-Sectional Study.
Wang G, Liu Y, Wang S … +8 more , Gao S, Lin H, Wu Q, Huang D, Pan Y, Zhao Y, Wei H, Wei L
J Nurs Manag · 2026 · PMID 42106166 · Full text
AIMS: To evaluate point-of-care gastrointestinal ultrasound (GI-POCUS) proficiency, identify influencing factors, and examine its clinical application among intensive care unit (ICU) nurses in China. BACKGROUND: GI-POCUS...
AIMS: To evaluate point-of-care gastrointestinal ultrasound (GI-POCUS) proficiency, identify influencing factors, and examine its clinical application among intensive care unit (ICU) nurses in China. BACKGROUND: GI-POCUS supports gastrointestinal function assessment, enteral nutrition guidance, and dysfunction detection in patients who are critically ill. However, its use among ICU nurses remains limited, and the factors influencing proficiency are unclear. METHODS: A national cross-sectional survey was conducted among 2009 ICU nurses from 21 provinces in China using a structured online questionnaire covering their demographic and unit characteristics, GI-POCUS training, practice, skills, proficiency, and clinical application. Participants were recruited from various ICU settings, with the majority from adult ICUs and a small proportion from pediatric and neonatal ICUs. Data were analyzed using SPSS 27.0 with descriptive statistics, chi-square tests, t-tests, and multivariate logistic regression. RESULTS: Only 297/2009 (14.8%) of ICU nurses rated their GI-POCUS proficiency as "good," whereas 1205/2009 (59.9%) rated it as "poor." GI-POCUS proficiency was significantly associated with billability, training participation, usage frequency, documentation of GI-POCUS findings in nursing charts, proficiency in probe operations, ability to perform qualitative and quantitative analyses, and diagnostic accuracy and sensitivity (p < 0.05). Clinically, only 492/2009 (24.5%) of ICU nurses could identify intestinal necrosis or ischemia. 1232/2009 (61.3%) applied GI-POCUS to assess gastric emptying and residual volume, and 1069/2009 (53.2%) used it to guide feeding tube placement. 1032/2009 (51.4%) of ICU nurses could identify gastric transverse and longitudinal section images, whereas the recognition rate for intestinal wall blood flow signals was the lowest at only 369/2009 (18.4%). CONCLUSION: GI-POCUS proficiency among ICU nurses in China is low. Promoting sustainable implementation requires organizational support, leadership engagement, and integration into routine critical care nursing practice. IMPLICATIONS FOR LEADERS: Nursing leaders should establish structured GI-POCUS training pathways, integrate ultrasound use into routine ICU workflows and electronic documentation systems, and advocate for institutional recognition including billing mechanisms. These leadership actions can enhance nurses' proficiency and promote sustainable nurse-led GI-POCUS implementation.
Leadership at the Nexus: Culture, Spirituality, and Religiosity as Strategic Determinants of Positive Clinical Work Environments.
Dias JM, Cruz J, Blaževičienė A … +1 more , Červený M
J Nurs Manag · 2026 · PMID 42106022 · Full text
AIM: To synthesize the contributions of this special issue examining how workplace culture, spirituality, religiosity, and mentorship shape positive clinical work environments and inform contemporary nursing management....
AIM: To synthesize the contributions of this special issue examining how workplace culture, spirituality, religiosity, and mentorship shape positive clinical work environments and inform contemporary nursing management. BACKGROUND: Amid workforce shortages, rising clinical complexity, and escalating moral demands, nursing management is often evaluated through operational metrics that fail to capture the ethical and relational foundations of sustainable practice. Growing evidence highlights the importance of organizational culture, meaning-making, and inclusive leadership in supporting nurse retention and well-being. DESIGN: Editorial synthesis of contributions within the special issue. RESULTS: The papers demonstrate that workplace culture is enacted through everyday leadership practices, ethical clarity, and relational consistency, directly influencing psychological safety and professional commitment. Spirituality is framed as a professional resource supporting meaning-making and resilience when reflection and dialog are enabled. Religiosity and cultural diversity require culturally responsive leadership to foster trust and inclusion. Mentorship emerges as a strategic leadership function that strengthens confidence, moral coherence, and retention. Collectively, the contributions shift attention from individual resilience to organizational stewardship of ethical and relational infrastructure. CONCLUSIONS: Positive work environments are intentionally shaped through leadership that governs culture, inclusion, and mentorship alongside operational performance. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers must extend their focus beyond operational performance to stewardship of culture and ethical climate. Workplace culture, spirituality, religiosity, and mentorship are structural drivers of psychological safety, retention, and professional commitment. Leaders should foster inclusive, respectful environments that support ethical dialog and cultural humility and formalize mentorship as a strategic workforce priority. Embedding values-based and relational leadership within governance frameworks is essential for sustaining workforce resilience.
Perceptions and Enhancement Needs of Psychiatric Nurses on Patient Safety Competency: A Phenomenological Study.
Shen C, Xu L, Jiang Q … +1 more , Li Y
J Nurs Manag · 2026 · PMID 42104538 · Full text
INTRODUCTION: Patient safety competency among nurses is increasingly emphasized, yet research on patient safety competency among psychiatric nurses remains scarce. AIM: To deeply explore the cognition of psychiatric nurs...
INTRODUCTION: Patient safety competency among nurses is increasingly emphasized, yet research on patient safety competency among psychiatric nurses remains scarce. AIM: To deeply explore the cognition of psychiatric nurses on patient safety competency and explore the demands of nurses for enhancing patient safety competency. METHODS: The study was conducted from June to July 2025 with 16 psychiatric nurses. Data were collected through in-depth personal interviews and thematic analyzed using Colaizzi's seven-step phenomenological analysis method. RESULTS: Three main themes and 13 subthemes are formed: (1) The connotation of patient safety competency, including "protecting one's own safety is the prerequisite for ensuring patient safety," "understanding patients," "observation," "nurse-patient communication," "nurse-patient relationship," and "handling adverse events;" (2) influencing factors of patient safety competency, including "manpower resources," "leadership," "teamwork," and "adverse event management system;" and (3) the demand for improvement of patient safety competency, such as "emphasize theory over practice," "outdated training content and monotonous formats," and "desire for more experience sharing." CONCLUSIONS: This study conducted an in-depth investigation into the connotation, influencing factors and improvement demands of patient safety competency among nurses in the field of mental health, revealing the specificity of psychiatric nurses' perceptions of patient safety competency. IMPLICATIONS FOR PRACTICE: This provides a basis for health administration departments and hospital managers to develop relevant on-the-job training programs and intervention strategies to enhance the patient safety competency of psychiatric nurses, thereby improving the quality of nursing care and delivering superior services to patients. It holds practical significance for the optimization of specialized psychiatric nursing and even the broader healthcare field.
Can Technology Use Alleviate Workforce Needs in Finnish Assisted Living Services? A Convergent Mixed-Methods Study of Automatic Medicine Dispensers and Night-Time Monitoring.
Väisänen V, Karhulahti-Nordström H, Saukkonen P … +3 more , Ruotsalainen S, Josefsson K, Sinervo T
J Nurs Manag · 2026 · PMID 42104531 · Full text
BACKGROUND: Workforce needs are growing in older people care, exacerbated by the aging population. Technological solutions offer potential means to address this challenge. However, their effects on work and worktime mana...
BACKGROUND: Workforce needs are growing in older people care, exacerbated by the aging population. Technological solutions offer potential means to address this challenge. However, their effects on work and worktime management remain unclear, especially in the setting of assisted living services. Our aim was to assess the potential of two established technologies, automatic medicine dispensing and night-time monitoring, in alleviating workforce needs in Finnish assisted living facilities. METHODS: The effects of the two technologies on workforce needs were studied using a convergent mixed-methods design, incorporating quantitative time and motion analysis and qualitative analysis of two open-ended survey questions. Linear regression analysis and data-driven thematic analysis were employed. The quantitative and qualitative results were integrated and compared afterward. RESULTS: Our quantitative results indicated that medicine dispensing technology can streamline medicine management and administration, but effects on direct care time were not found. Use of night-time monitoring technology was associated with more direct care during nights and reduced nightly staffing. The qualitative analysis highlighted medicine dispensers freeing up time for other work and night-time monitoring reducing the need for nightly rounds. However, several technology-related problems and a loss of medication competencies were perceived. Our results converged on several positive workforce effects, notably optimizing medication management and promoting individualized care during nights. CONCLUSION: Technology use could be promoted in assisted living services, when it demonstrably streamlines care work, increases work efficiency, allows for reduced staffing, or promotes individualized and patient-centered care. National care policy can incentivize the use of similar technologies, for example, through staffing level legislation. However, care unit management should prepare for potential technology-related errors and acute emergencies by upkeeping both technology and medication competencies of nurses and ensuring the presence of sufficient staff. Importantly, the potential efficiency gains must not come at the expense of quality or safety of care.
Evaluation of Nurses' Practice Environment in Cardiovascular Hospitals: Nurses' Perceptions.
Al-Ganmi AHA, Mohammed TR, Mousa AM … +2 more , Majeed HM, Alsolais AM
J Nurs Manag · 2026 · PMID 42101414 · Full text
BACKGROUND: An attractive practice environment for nurses is essential in cardiac hospitals; however, limited studies are known about practice environment in this setting. This study aimed to evaluate nurses' perceptions...
BACKGROUND: An attractive practice environment for nurses is essential in cardiac hospitals; however, limited studies are known about practice environment in this setting. This study aimed to evaluate nurses' perceptions of the practice environment in XXX cardiac hospitals. Additionally, this study seeks to identify nurse-related factors that influence nurses' nursing practices in these hospitals. METHODS: A cross-sectional study utilizing a self-report questionnaire was conducted among a convenience sample of 115 nurses working in cardiac hospitals. Nurses' perceptions of the practice environment in cardiac hospitals were explored via the Nursing Work Index. A descriptive analysis was performed in the form of categorical variables presented as frequencies and percentages, and the continuous variables were presented as the means and standard deviations. Multiple linear regression was performed to analyze the relationship between sociodemographic factors and the level of environmental practice. The level of significance was set at a p value = (p ≤ 0.05). RESULTS: The findings indicate an overall favorable practice environment, with 56% of the nurses reporting a good level of practice in the cardiac setting. Cardiac nurses held a positive perception of their nursing practice in cardiac care settings. Overall, the participants responded well, with a total mean score of (M ± SD = 3.38 ± 0.02) for their perceptions of leadership, staff support, nursing supervisory skills, participation in hospital committees, staffing and resource adequacy and collegial nurse‒physician relations. Nursing qualifications, years of experience and participation in nursing work management-related training courses were predictors of cardiac nurses' perceptions of the practice environment (p value = p ≤ 0.014). CONCLUSION: Survey nurses' perceptions of the practice environment in cardiac hospitals provide insight into nurses' actual readiness for providing high-quality care and hence positive patient health outcomes. Cardiac nurses should be involved in decision-making authority and advocate for the workplace to better support their independence, all to improve the nursing practice environment in cardiovascular hospitals.
Strengthening Early Nursing Practice: Psychometric Validation of the Turkish Version of the Professional Interpersonal Competence Scale.
Özalp C
J Nurs Manag · 2026 · PMID 42093308 · Full text
OBJECTIVE: To culturally adapt the Professional Interpersonal Competence Evaluation Scale for novice nurses in Turkiye. BACKGROUND: This methodological study aimed to translate, culturally adapt, and evaluate the psychom...
OBJECTIVE: To culturally adapt the Professional Interpersonal Competence Evaluation Scale for novice nurses in Turkiye. BACKGROUND: This methodological study aimed to translate, culturally adapt, and evaluate the psychometric properties of the Professional Interpersonal Competence Evaluation Scale for novice nurses. STUDY DESIGN AND METHODS: This methodological study was conducted with 450 nurses working in two public hospitals between October and December 2024. The construct validity of the scale was evaluated using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Reliability was assessed using Cronbach's alpha, McDonald's omega, and split-half reliability coefficients. RESULTS: The Kaiser-Meyer-Olkin value was 0.929, and Bartlett's test of sphericity was significant (χ = 6852.706, p < 0.001), indicating sampling adequacy for factor analysis. EFA revealed a two-factor structure consisting of 26 items, explaining 44.485% of the total variance, with factor loadings ranging from 0.403 to 0.789. CFA results supported the two-factor model with acceptable fit indices (χ/df = 4.62, RMSEA = 0.078, CFI = 0.94, TLI = 0.92). Item-total correlations ranged from 0.353 to 0.753 (p < 0.001). The internal consistency of the scale was high (Cronbach's α = 0.945; McDonald's ω = 0.948). CONCLUSION: The results indicate that the Professional Interpersonal Competence Evaluation Scale for novice nurses is a reliable and valid evaluation tool for Turkiye.
Exploring Mutuality in Nurse-Care Recipient Relationships in a Primary Care Setting: A Qualitative Descriptive Study.
Busca E, Santomauro I, Caristia S … +6 more , Durante A, Manservisi F, Milani S, Basso I, Bassi E, Dal Molin A
J Nurs Manag · 2026 · PMID 42093074 · Full text
BACKGROUND: In primary care (PC), nurses ensure continuity and person-centered care, fostering long-term relationships with patients and caregivers. How mutuality, a relational process closely linked to patient-centered...
BACKGROUND: In primary care (PC), nurses ensure continuity and person-centered care, fostering long-term relationships with patients and caregivers. How mutuality, a relational process closely linked to patient-centered communication, develops in this context remains underexplored. AIMS: To describe the characteristics of mutuality and explore how it develops in the relationships between nurses and care recipients in a PC setting. METHOD: A qualitative descriptive study was conducted in a PC setting. Participants included 14 nurses trained in Family and Community Nursing and 27 care recipients (patients and family caregivers). Data were collected between May and July 2024 through semistructured interviews. A total of 28 interviews were conducted, including both individual and dyadic interviews with patients and caregivers. Data were analyzed using framework analysis, guided by a conceptual framework on mutuality in the nurse-patient relationship. The framework focused on influencing factors, the mutuality process, and outcomes. RESULTS: Findings from 28 interviews revealed that mutuality was influenced by both organizational and personal factors. Nursing care delivery models that ensured continuity of care and nurse autonomy supported trust, stable, and long-term relationships. The process of mutuality unfolded progressively through three dimensions: (1) building and going beyond the formal encounter, (2) being a consistent point of reference, and (3) deciding and sharing care. Mutuality emerged as a co-constructed relationship, shaped by clear communication, trust, and shared responsibilities, with informal caregivers recognized as integral participants. Outcomes included strengthened professional identity and satisfaction for nurses and improved emotional well-being, self-care, and self-efficacy for care recipients. CONCLUSION: In PC, mutuality transforms task-oriented interactions into meaningful, trust-based relationships, enhancing patient-centered communication and shared decision-making. Care continuity and autonomy, combined with investment in relational skills, are essential to sustain mutuality, improve communication, and enhance care quality.
Perceived organizational Support and Nurses' Caring Behaviors: The Serial Mediating Roles of Perceived Stress and Career Calling.
Zhu W, Wu Q
J Nurs Manag · 2026 · PMID 42089446 · Full text
AIM: To examine the association between perceived organizational support (POS) and nurses' caring behaviors and to explore the serial mediating roles of perceived stress and career calling (CALL) in this relationship. BA...
AIM: To examine the association between perceived organizational support (POS) and nurses' caring behaviors and to explore the serial mediating roles of perceived stress and career calling (CALL) in this relationship. BACKGROUND: Caring behaviors are essential for high-quality nursing care and patient satisfaction. However, heavy workloads and psychological pressure may weaken nurses' caring performance. POS, as a key job resource, may be associated with caring behaviors alongside lower perceived stress and stronger intrinsic motivation, such as CALL. METHODS: A cross-sectional survey was conducted among 648 nurses from six tertiary hospitals in Chongqing, China. Standardized questionnaires were used to assess POS, perceived stress, CALL, and caring behaviors. The hypothesized serial mediation model was tested using structural equation modeling (SEM) with bias-corrected bootstrapping, and additional PROCESS analysis was performed to verify robustness. RESULTS: Organizational support was positively associated with caring behaviors (β = 0.33, p < 0.001), and a significant indirect association via perceived stress and CALL (β = 0.12, 95% CI [0.07, 0.24]). The model explained 26% of the variance in caring behaviors (R = 0.26), and the indirect path accounted for about 26.7% of the total effect. Findings were consistent in PROCESS analyses and were in line with the hypothesized serial mediation model. CONCLUSION: POS was associated with nurses' caring behaviors, both directly and through an indirect pathway involving perceived stress and CALL. These findings suggest that perceived stress and CALL may represent potential pathways linking organizational support with caring behaviors. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers may consider fostering supportive organizational environments, implementing stress management interventions, and developing programs that help strengthen nurses' CALL, as these factors may be associated with more favorable caring behaviors and nursing practice.
The Influence of Psychological Capital on Innovative Behavior: Examining the Mediating Mechanism of Job Crafting in Operating Room Nurses.
Liang X, Li Z, Liang W … +4 more , Lu D, Tang Y, Wu C, Cui J
J Nurs Manag · 2026 · PMID 42089403 · Full text
AIM: This study aimed to assess the levels of psychological capital, job crafting, and innovative behavior among operating room nurses and to examine the mediating mechanism of job crafting in the relationship between ps...
AIM: This study aimed to assess the levels of psychological capital, job crafting, and innovative behavior among operating room nurses and to examine the mediating mechanism of job crafting in the relationship between psychological capital and innovative behavior. METHODS: A multicenter cross-sectional study was conducted. In June 2025, a total of 361 operating room nurses from six tertiary hospitals in Nanjing, China, were recruited via convenience sampling. Data were collected electronically using validated scales: Demographic Questionnaire, the Psychological Capital Questionnaire, the Job Crafting Scale, and the Nurse Innovative Behavior Scale. Data were analyzed using SPSS 26.0 and AMOS 28.0. Structural equation modeling with bootstrapping tested the mediation model, controlling for educational level and specialist nurse status. RESULTS: Participants reported moderate-to-high levels of psychological capital, job crafting, and innovative behavior. Correlation analysis revealed that innovative behavior was significantly and positively correlated with both psychological capital and job crafting. Hierarchical regression analysis, controlling for significant covariates, showed that both psychological capital and job crafting contributed significantly to the variance in innovative behavior. Mediation analysis demonstrated that job crafting partially mediated the relationship between psychological capital and innovative behavior. CONCLUSIONS: Operating room nurses reported moderately high levels of psychological capital, job crafting, and innovative behavior. Furthermore, job crafting was identified as a significant partial mediator in the relationship between psychological capital and innovative behavior. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing management can foster innovation in operating room nurses by developing psychological capital and job crafting skills through targeted training and academic support.
Transformational Leadership and Nurses' Adaptive Performance: The Roles of Psychological Capital and Workplace Spirituality.
Abukhalifa AMS, Aboramadan M
J Nurs Manag · 2026 · PMID 42076820 · Full text
AIM: This study examines the mechanisms through which transformational leadership enhances nurses' adaptive performance within a conflict-affected environment characterized by chronic uncertainty, escalating demands, and...
AIM: This study examines the mechanisms through which transformational leadership enhances nurses' adaptive performance within a conflict-affected environment characterized by chronic uncertainty, escalating demands, and severe resource constraints. It introduces a novel-mediated moderation model in which psychological capital (PsyCap) serves as a mediator and workplace spirituality (WPS) functions as a moderator. BACKGROUND: Adaptive performance is vital in contemporary healthcare, yet its antecedents remain underexplored. While transformational leadership is recognized as a driver of employees' psychological resources, little is known about how these resources translate into adaptive outcomes in nursing. This article represents one of the first empirical studies in nursing and management research to simultaneously test the direct effect of transformational leadership on adaptive performance, the mediating role of PsyCap, and the moderating role of WPS. By positioning WPS as a boundary condition, it demonstrates how spiritual values and meaning at work strengthen the influence of PsyCap on adaptability, marking a theoretical insight with practical significance. METHODS: This study adopted a quantitative cross-sectional design and surveyed registered nurses providing direct patient care in five major public hospitals across the Gaza Strip, Palestine. Data were collected via an online questionnaire using purposive sampling, and structural equation modeling was employed to test a moderated mediation model. RESULTS: The results indicate that transformational leadership is positively associated with nurses' adaptive performance and PsyCap. PsyCap partially mediates the relationship between transformational leadership and adaptive performance. In addition, WPS strengthens the positive association between PsyCap and adaptive performance, supporting the proposed moderated mediation model. CONCLUSIONS: Adaptive performance in healthcare can be enhanced when leadership, psychological resources, and spirituality are aligned. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing leaders should deliberately enact transformational behaviors, systematically cultivate PsyCap, and nurture WPS to build resilient, adaptive nursing teams capable of thriving amid turbulence.
Nurse and Patient Outcomes in Private and Public Hospitals in South Africa During the COVID-19 Pandemic: A Cross-Sectional Study.
Coetzee SK, Aiken LH, Blignaut AJ … +5 more , Erasmus A, Scheepers N, Tau B, Bam NE, Fourie E
J Nurs Manag · 2026 · PMID 42071176 · Full text
BACKGROUND: Nurse and patient outcomes in South Africa were poor before COVID-19 and are believed to have worsened during and after the pandemic. Limited evidence exists on modifiable organisational factors contributing...
BACKGROUND: Nurse and patient outcomes in South Africa were poor before COVID-19 and are believed to have worsened during and after the pandemic. Limited evidence exists on modifiable organisational factors contributing to these outcomes hindering targeted interventions. PURPOSE: This paper aims to develop a better understanding of potentially modifiable organisational factors of hospitals that, if addressed, would likely contribute to improving nurse wellbeing and retention, and quality and safety of patient care. METHODS: Data were collected from 143 private and public hospitals (n = 4298 nurses) across South Africa using a cross-sectional survey. Independent variables included working time with COVID-19 patients, incidence of death and dying, resources, staffing, and the practice environment; dependent variables focused on nurse outcomes (job satisfaction, intent to leave, burnout, mental and physical health) and patient outcomes (quality of care and patient safety). RESULTS: Nurse and patient outcomes were worse in public compared to private hospitals. Favourable practice environments had the strongest association with nurse and patient outcomes, followed by staffing and resources. Within the practice environment, nurse management, leadership and support of nurses showed the greatest association with job satisfaction (OR = 4.71; 95% CI = 3.97-5.58), lower intent to leave (OR = 2.81; 95% CI = 2.33-3.38) and more favourable mental health (OR = 2.58; 95% CI = 2.19-3.04). Greater nurse participation in hospital affairs was associated with more favourable nurse assessments of quality of care (OR = 3.74; 95% CI = 3.22-4.33 to OR = 6.51; 95% CI = 3.81-4.95) and patient safety (OR = 4.35; 95% CI = 3.81-4.95). CONCLUSION: Interventions to improve nurse wellbeing and retention as well as quality and safety of care should focus on improving hospital practice environments, specifically nurse manager expertise, nurse leadership, nurse participation in hospital affairs, and adequate staffing and resources.
A Critical Intervention for Sustainable Health: Climate Change Awareness Among Nurse Managers.
Ekici E, Mat SB, Ozkol O … +1 more , Isık F
J Nurs Manag · 2026 · PMID 42060318 · Full text
PURPOSE: This study aimed to evaluate the effectiveness of a nurse-led educational program designed to improve nurse managers' awareness, knowledge, and attitudes regarding climate change and its health impacts. BACKGROU...
PURPOSE: This study aimed to evaluate the effectiveness of a nurse-led educational program designed to improve nurse managers' awareness, knowledge, and attitudes regarding climate change and its health impacts. BACKGROUND/INTRODUCTION: Climate change is one of the most urgent global public health challenges, jeopardizing key determinants of health such as air quality, access to safe drinking water, food security, and adequate housing. As frontline healthcare providers, nurses are uniquely positioned to identify environmental health risks and promote climate-resilient healthcare practices. Despite this critical role, evidence suggests that nurses' awareness and preparedness for climate-related health threats are insufficient. Therefore, strengthening climate literacy among nurse leaders is essential to enhance adaptation capacity in health systems. METHODS: This study used a pretest-posttest experimental design with hospital-level randomization and included 108 nurse managers working in two public hospitals in Istanbul. Participants were randomly assigned to intervention and control groups. The study was conducted between March and June 2025, with data collection carried out between April and May 2025. Data were collected using a Descriptive Information Form and the Climate Change Awareness Scale (CCAS). The intervention group received 90 min of face-to-face training, including theoretical content, case-based learning, and interactive assessment, whereas the control group received a 90-min lecture after data collection on climate change and its health impacts, followed by a brief question-and-answer session. Measurements were taken at baseline, immediately after the intervention, and 1 month later. Data were analyzed using Friedman and Wilcoxon signed-rank tests. RESULTS/FINDINGS: The intervention group demonstrated significant improvements in total and subscale CCAS scores at the postintervention time point compared with baseline and the control group (p < 0.05). Although a slight decrease was observed at the 1-month follow-up, scores remained higher than pretest levels. In the control group, although small differences were observed in certain subscales in the between-group comparisons, no statistically significant within-group changes were observed between the pretest, posttest, and follow-up scores. DISCUSSION: The findings suggest that structured and nurse-led climate training for nurse managers has the potential to strengthen climate-related awareness and preparedness capacity. CONCLUSION: Even short-term training increases nurse managers' awareness of climate change and health. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT06905548.
The Influence of Achievement Motivation on Nurses' Health-Related Procrastination: The Mediating Role of Social Support.
Zhang H, Sheng Y, Hu M … +3 more , Cao L, Xu L, Chen L
J Nurs Manag · 2026 · PMID 42059800 · Full text
AIMS: The primary aim of this study is to examine the mechanisms linking achievement motivation (including motive for success (MS) and motive to avoid failure (MF)) and social support to nurses' health-related procrastin...
AIMS: The primary aim of this study is to examine the mechanisms linking achievement motivation (including motive for success (MS) and motive to avoid failure (MF)) and social support to nurses' health-related procrastination (NHRP) and to determine whether social support plays a mediating role in this relationship. BACKGROUND: The health of nurses has long been a subject of widespread concern. Compared with general procrastination, NHRP is more directly linked to their health issues, which not only harms their own well-being but may also affect nursing quality and patient safety. Exploring its intrinsic mechanisms with achievement motivation and social support from the perspective of positive psychology is essential for developing effective strategies to reduce NHRP and serves as a cornerstone for ensuring nursing quality and patient safety. METHODS: From February to July 2025, 346 samples of nurses from first-class comprehensive hospital in Shanghai were selected as participants. The mediating effect of social support on achievement motivation and the NHRP was investigated via the General Data Questionnaire, Nurses' Health-related Procrastination Scale, Social Support Rating Scale, and Achievement Motivation Scale. The mediation effects were tested using the PROCESS macro (Version 4.0), which utilizes linear regression analysis and the bootstrap method. RESULTS: A total of 320 valid questionnaires were collected, yielding an effective response rate of 92.47%. The results indicated that social support was positively correlated with MS (r = 0.339, p < 0.01) and negatively correlated with both MF (r = -0.283, p < 0.01) and NHRP (r = -0.482, p < 0.01). Furthermore, NHRP was negatively correlated with MS (r = -0.433, p < 0.01) and positively correlated with MF (r = 0.397, p < 0.01). Notably, social support was found to partially mediate the relationship between achievement motivation and NHRP. The specific mediating effects of social support were significant, with indirect effect values of -0.468 between MS and NHRP and 0.422 between MF and NHRP, accounting for 31.0% and 29.8% of the total effects, respectively. CONCLUSION: Achievement motivation can directly influence NHRP and can also indirectly affect it through the mediating role of social support. From the perspective of positive psychology, stimulating nurses' achievement motivation regarding their own health responsibility and fostering a supportive organizational atmosphere can effectively reduce their health-related procrastination, thereby laying a foundation for enhancing overall nursing service quality. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing managers should pay attention to nurses' physical and mental health and actively identify and guide the orientation of their achievement motivation: on the one hand, cultivate their positive motivation for "striving for success," and on the other hand, alleviate the anxiety stemming from "fear of failure," thereby fostering the formation of health behaviors through intrinsic mechanisms. Furthermore, it is essential to consciously build a team atmosphere with high social support and to reduce NHRP by establishing effective peer support systems and communication channels.
Second Victim Trauma Recovery Pathway of Emergency Nurses After Patient Safety Incidents: A Grounded Theory Study.
Lin T, Zhang Y, Gao Y
J Nurs Manag · 2026 · PMID 42059601 · Full text
OBJECTIVE: Drawing on Strauss and Corbin's grounded theory, this study systematically examined the internal mechanisms underlying trauma recovery among emergency nurses as secondary victims of patient safety incidents. A...
OBJECTIVE: Drawing on Strauss and Corbin's grounded theory, this study systematically examined the internal mechanisms underlying trauma recovery among emergency nurses as secondary victims of patient safety incidents. A context-specific theoretical model was developed to provide empirical evidence to inform the design of targeted support strategies for nursing managers. METHODS: A combination of purposive and theoretical sampling was used to recruit 18 frontline emergency nurses who had experienced patient safety incidents in the emergency department of a tertiary Grade A hospital in Chengdu between January and June 2025. Data were collected through semistructured, in-depth interviews. NVivo 12.0 was applied to conduct open, axial, and selective coding. Additional interviews were undertaken to confirm theoretical saturation. RESULTS: The analysis yielded 68 initial categories, 22 subcategories, and 7 core categories. These findings informed the construction of a circular, dynamic theoretical model of trauma recovery comprising four sequential stages: trauma stress trigger, cognitive appraisal and emotional response, acquisition of intervention and support, and recovery reconstruction and career reorientation. Managerial support and proactive coping strategies emerged as key factors influencing trauma recovery. CONCLUSION: Trauma recovery among emergency nurses as secondary victims of patient safety incidents represents a dynamic, cyclical process shaped by the interaction of individual, organizational, and contextual factors. Nursing managers can apply the stage-specific features of this model to establish a stratified and integrated support system, thereby improving psychological recovery, sustainable career development, emergency nursing management, and patient safety outcomes. IMPLICATIONS FOR NURSING MANAGEMENT: Emergency nursing managers should implement phased support strategies: immediate nonblaming crisis intervention with temporary duty adjustment during acute stress; structured psychological counseling and peer support groups during emotional processing; accessible three-tier support framework combining managerial, professional, and organizational resources; and career development opportunities transforming trauma into professional growth. These measures operationalize "just culture" principles, fostering nurses' well-being, team resilience, and patient safety.
Prevalence and Predictors of Missed Nursing Care in Greek Public Hospitals: A National Cross-Sectional Study.
Giannarou A, Igoumenidis M, Stefanopoulos N … +4 more , Tzenalis A, Galanis P, Chiappinotto S, Palese A
J Nurs Manag · 2026 · PMID 42059103 · Full text
AIM: To describe the prevalence of Missed Nursing Care and its predictors in Greek public hospitals. BACKGROUND: Missed Nursing Care is defined as any aspect of required patient care that is omitted or delayed. Despite t...
AIM: To describe the prevalence of Missed Nursing Care and its predictors in Greek public hospitals. BACKGROUND: Missed Nursing Care is defined as any aspect of required patient care that is omitted or delayed. Despite the available studies, little is still known in countries with significant nursing shortages, such as Greece, where 2.23 registered and assistant nurses per 1000 population have been reported, significantly below the EU-27 average. METHODS: A national cross-sectional study was conducted in 28 of 124 public hospitals in Greece. Nurses and nursing assistants working in medical or surgical units, providing direct care to adult patients, and with at least 3 months of experience were eligible. The MISSCARE Survey Part A (5-point Likert scale; 1 = never, 5 = always missed), Part B (reasons, four-point Likert scale; 1 = not significant, 4 = significant reason) and the Practice Environment Scale of the Nurse Work Index (4-point Likert scale; 1 = totally agree, 4 = totally disagree) were used. Descriptive and inferential statistics were applied. RESULTS: A total of 676 nurses participated. The Missed Nursing Care Part A total score was 2.06 (±0.65), with patients' daily activities (mean = 2.32 ± 0.73) receiving higher scores than activities related to health status and treatments (mean = 1.80 ± 0.63). The overall score on the Practice Environment Scale of the Nurse Work Index was 2.53 (±0.49). Multiple linear regression analysis showed that issues in nursing care standards for quality of care, staffing adequacy and communication within the team were the most significant predictors of Missed Nursing Care. CONCLUSION: Missed Nursing Care is a major problem in Greek hospitals. Inadequate staffing is a key factor in missed care according to nurses' perceptions. Increasing nursing staff, along with implementing standards for nursing care and improving communication among team members, will enhance the quality of health services in Greece. IMPLICATIONS FOR NURSING MANAGEMENT: Strengthening staffing levels and reinforcing nursing standards are essential strategies for reducing Missed Care in Greek public hospitals.
The Impact of Mushroom Management on Nurses' Job Satisfaction: The Mediating Role of Organizational Identification.
Aydın D, Demir Ö, Karakoyun Ö … +2 more , Ecer N, Ayhan E
J Nurs Manag · 2026 · PMID 42059094 · Full text
BACKGROUND: Mushroom management, a leadership style characterized by withholding information, excluding employees from strategic processes, and maintaining top-down control, has been linked to adverse organizational outc...
BACKGROUND: Mushroom management, a leadership style characterized by withholding information, excluding employees from strategic processes, and maintaining top-down control, has been linked to adverse organizational outcomes. However, its impact on nurses and the psychological mechanisms through which this influence operates remain underexamined. PURPOSE: This study examines the direct and indirect effects of mushroom management on nurses' job satisfaction, with organizational identification (OI) as the mediating variable, guided by affective events theory and social identity theory. METHODS: A cross-sectional survey was conducted with 317 nurses employed in private hospitals in Diyarbakır, Türkiye. Data were collected using validated Turkish versions of the Mushroom Management Scale (Birincioğlu and Tekin, 2018), Job Satisfaction Scale (Judge et al., 2008; Keser and Bilir, 2019), and Organizational Identification Scale (Mael, 1988; Tüzün and Özdoğan, 2006). All scales use a five-point Likert format (1 = strongly disagree to 5 = strongly agree). Confirmatory factor analysis confirmed good model fit (χ/df = 2.21, CFI = 0.95, RMSEA = 0.062). Mediation was tested using Hayes' PROCESS macro (Model 4) in SPSS 23.0 with 5000 bootstrap samples. RESULTS: Mushroom management had significant negative effects on OI (standardized β = -0.46, p < 0.001) and job satisfaction (standardized β = -0.21, p = 0.001). OI positively predicted job satisfaction (standardized β = 0.48, p < 0.001). Mediation analysis confirmed a significant indirect effect (standardized β = -0.22, 95% CI [-0.31, -0.14]), with OI accounting for 51% of the total effect indicating partial mediation. CONCLUSIONS: Mushroom management is associated with lower OI and job satisfaction among nurses, with OI serving as a key identity-based psychological mechanism. Healthcare leaders should prioritize transparent communication, participatory decision-making, and identity-affirming leadership practices to enhance nurse well-being and retention. IMPLICATIONS FOR NURSING MANAGEMENT: Findings highlight the need for structured information-sharing protocols, mushroom-management-specific leadership training, and shared governance structures in private hospital settings. Periodic organizational climate monitoring using validated instruments is recommended.
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