J Nurs Manag [JOURNAL]
Sun
200 papers
Identification of Critical Variables and Critical Gap Variables in Hospital Nurses' Job Satisfaction During the Dynamic Adjustment Phase of COVID-19 Prevention in China: A Hybrid Machine Learning and Decision Analysis Approach.
Tang F, Feng L, Liu S … +4 more , Ye M, Liu C, Chuang YC, Xu W
J Nurs Manag · 2026 · PMID 42057425 · Full text
PURPOSE: This study aims to analyze the critical variables and gap variables affecting hospital nurses' job satisfaction and propose improvement strategies based on the knowledge domains of nursing decision-makers. METHO...
PURPOSE: This study aims to analyze the critical variables and gap variables affecting hospital nurses' job satisfaction and propose improvement strategies based on the knowledge domains of nursing decision-makers. METHODS: This study, conducted between September and October 2022 during the dynamic adjustment phase of COVID-19 prevention and control in China, was based on the McCloskey/Mueller Satisfaction Scale (MMSS) and developed a hybrid machine learning and decision analysis tool model. The random forest (RF) method was used to estimate the importance of each variable in the data, and the importance-performance analysis (IPA) was used to identify critical gap variables and propose improvement strategies. RESULTS: The RF analysis (OOB error rate = 17.93%) identified "Decision-making" (C, importance score = 0.053) and "Control-work conditions" (C, importance score = 0.067) as the most influential factors (critical variables) in determining nurses' job satisfaction. The IPA analysis identified C as the most critical gap variable, indicating a significant need to improve nurses' involvement in hospital decision-making processes. CONCLUSIONS: To improve nurse job satisfaction and retention, hospital decision-makers and nursing departments should implement policies that enhance nurses' involvement in decision-making, particularly those with experience in pandemic-related healthcare challenges. Addressing these factors could foster a more supportive and resilient nursing work environment.
A Theoretical Framework of Implicit Care Rationing in Australian Long-Term Aged Care Settings: A Straussian Grounded Theory Study.
Wang X, Bail K, Traynor V
J Nurs Manag · 2026 · PMID 42057400 · Full text
BACKGROUND: Implicit care rationing (ICR), where care delivery is strategically arranged by frontline healthcare professionals under resource constraints, is widely acknowledged across healthcare settings. However, its t...
BACKGROUND: Implicit care rationing (ICR), where care delivery is strategically arranged by frontline healthcare professionals under resource constraints, is widely acknowledged across healthcare settings. However, its theoretical conceptualisation remains underdeveloped in the context of long-term aged care (LTAC) settings worldwide. AIM: This study aimed to develop a theoretical framework of ICR in Australian LTAC by exploring the actual care decision-making processes of hands-on healthcare staff through the lens of Donabedian's model. METHODS: Using a Straussian grounded theory approach, data were collected in two phases. Phase 1 involved developing a preliminary framework through in-depth interviews with 26 registered nurses, clinical managers and personal care workers. Phase 2 validated and refined the framework through focus group discussions with another 18 healthcare staff in the above roles. A combination of online and in-person strategies was used for participant recruitment and data collection. Constant comparative analysis was conducted concurrently with data collection and supported by an iterative review of relevant literature. RESULTS: The developed theoretical framework of ICR unravels the relevant influencing factors, the cognitive pathway and the prompt care delivery outcomes that are evident in Australian LTAC. This framework conceptualises ICR as a dynamic, shift-level decision-making process concerned with the order and completeness of care delivery. This cognitive process is driven by the intuitive assessment of healthcare staff of both external and internal impact factors, guided by a risk-averse, consequence-focused mindset and trade-offs between person-centred and task-focused care approaches. CONCLUSIONS: The developed theoretical framework enhances academic consistency and rigour through an evolutionary reconceptualisation of ICR grounded in strategic healthcare resource allocation. It clarifies the relationship between ICR and missed care, challenging their interchangeable use in previous research. This framework also offers practical insights to inform workforce strategies, measurement development and targeted interventions, ultimately contributing to improved care quality and safety in Australian LTAC.
Competency of Infection Control Nurses and Associated Factors: A Cross-Sectional Study.
Li W, Lin P, Yang Q … +8 more , Yang H, Tan X, Feng X, Luo H, Li W, Li Y, Zhang Y, Tian L
J Nurs Manag · 2026 · PMID 42053444 · Full text
BACKGROUND: Nosocomial infections (NIs) are a global concern, straining healthcare resources and patient safety. Infection control nurses (ICNs) play a crucial role in NI management. However, comprehensive surveys assess...
BACKGROUND: Nosocomial infections (NIs) are a global concern, straining healthcare resources and patient safety. Infection control nurses (ICNs) play a crucial role in NI management. However, comprehensive surveys assessing ICNs' competency are lacking. This study aimed to assess the competency of ICNs in China and identify influencing factors. METHODS: A cross-sectional survey was conducted between December 2021 and January 2022 across 14 cities in Hunan Province, China. Using convenience sampling, 1010 ICNs completed an online self-designed questionnaire comprising 69 items. Multiple linear regression analyses were performed to identify factors associated with ICNs' competency. RESULTS: A total of 946 valid questionnaires were collected. The overall competency score of ICNs was 272 points (P25-P75: 253-300). Among the six primary competency domains, "Personal characteristics and qualities" demonstrated the highest performance, with a median score of 30 (P25-P75: 28-35) and a score rate of 85.71%. "Knowledge of NI prevention and control," "Management and coordination ability," and "Motivation" each showed a score rate of 80.00%, with median scores of 64 (P25-P75: 60-73), 40 (P25-P75: 37-44), and 24 (P25-P75: 22-27), respectively. "Skills in NI prevention and control" had a score rate of 78.89%, with a median score of 71 (P25-P75: 64-78). "Teaching and research ability" ranked lowest, with a score rate of 71.68% and a median score of 43 (P25-P75: 39-48). Several influencing factors were identified, including "years of experience in NI management" (p < 0.001, β = 0.133, and 95% CI = 1.574-4.989), technical title (p < 0.001, β = 0.177, and 95% CI = 3.208-22.460), and average monthly income (p < 0.001, β = 0.196, and 95% CI = 4.557-11.875). CONCLUSION: Competency of ICNs is at the upper-middle level: The focus of improving the competency of ICNs is to strengthen the training of NI prevention and control skills, including NI detection, risk identification, and information construction, and to improve their teaching and research ability.
Measuring Positive and Negative Attitudes Associated With the Use of Artificial Intelligence in Nursing Profession: Cross-Cultural Adaptation and Psychometric Analysis of ASUAITIN.
Chen Z, Wu X, Li H … +2 more , Ke S, Lin R
J Nurs Manag · 2026 · PMID 42052955 · Full text
BACKGROUND: Artificial intelligence (AI) technologies have appeared in many specific clinical nursing scenarios, but its actual adoption effect remains challenging. Assessing nurses' attitude toward the use of artificial...
BACKGROUND: Artificial intelligence (AI) technologies have appeared in many specific clinical nursing scenarios, but its actual adoption effect remains challenging. Assessing nurses' attitude toward the use of artificial intelligence technologies will help optimize the integration of AI technologies in the field of nursing. AIM: The aim of this study is to cross-culturally adapt the Attitude Scale towards the Use of Artificial Intelligence Technologies in Nursing (ASUAITIN) to the Chinese nursing cultural context and verify its reliability and validity in the nurse population. METHODS: This cross-sectional study adhered to the STROBE guidelines and was designed to translate the ASUAITIN into Chinese. Experts and clinical nurses were invited to discuss and modify the content and concepts, as well as to assess its alignment with the Chinese cultural context. A total of 436 clinical nurses from 20 hospitals in Fujian Province, China, were surveyed from March to April 2025, and the psychometric properties of the Chinese version of ASUAITIN were evaluated. RESULTS: The Chinese version of ASUAITIN consists of 15 items and 2 dimensions, namely, positive attitude and negative attitude, which demonstrates acceptable content validity. Exploratory factor analysis showed that the scale consists of 2 factors, explaining 68.92% of the total variance, with loadings of each factor ranging from 0.704 to 0.912. Confirmatory factor analysis supported the two-factor structure and indicated acceptable model fit and good convergent validity and was able to fully represent the scale structure. Meanwhile, the internal consistency and test-retest reliability were satisfactory. CONCLUSION: The Chinese version of ASUAITIN showed acceptable validity and reliability and can, therefore, be used to assess Chinese nurses' attitudes toward the use of AI technologies. IMPLICATIONS FOR NURSING MANAGEMENT: The scale provides the nursing management with a practical tool to assess nurses' attitudes toward the use of AI technologies and promote smoother integration of AI technologies. It supports targeted training programs to enhance nurses' AI application.
The Relationship Between Perceived Organizational Support, Perceived Professional Benefits, and Professional Values Among Nurses: Variable-Centered and Individual-Centered Analyses.
Zhengyu W, Lijuan S, Haibo Y … +6 more , Yani Z, Hui M, Zhongxia Z, Xiaodan Y, Yunxia B, Jianqin C
J Nurs Manag · 2026 · PMID 42051223 · Full text
OBJECTIVE: To examine the relationships among perceived organizational support, perceived professional benefits, and professional values in nurses. METHODS: A cross-sectional survey was conducted with 742 nurses from fiv...
OBJECTIVE: To examine the relationships among perceived organizational support, perceived professional benefits, and professional values in nurses. METHODS: A cross-sectional survey was conducted with 742 nurses from five hospitals in China. Participants completed measures of perceived organizational support, perceived professional benefits, and professional values. Mediation analysis and latent profile analysis were employed. RESULTS: Perceived professional benefits partially mediated the relationship between perceived organizational support and professional values (indirect effect = 0.327, 95% CI [0.249, 0.414]). Five distinct profiles of perceived organizational support and perceived professional benefits were identified, which differed significantly in professional values (F = 171.282, p < 0.001). CONCLUSIONS: Perceived organizational support influences professional values both directly and indirectly through perceived professional benefits. The heterogeneity in nurses' perceptions underscores the need for targeted interventions tailored to different subgroups.
Effect of Nurses' Working Conditions Improvement Policy on Patient Outcomes in General Hospitals: A Quasiexperimental Study Using National Health Insurance Claims Data From Korea.
Yoon HJ, Kwon H
J Nurs Manag · 2026 · PMID 42050849 · Full text
BACKGROUND: A good nursing work environment is a key determinant of patient safety. In 2018, the Korean government introduced the Nurse Working Conditions Improvement Policy (NWCIP), accompanied by a revision of the nurs...
BACKGROUND: A good nursing work environment is a key determinant of patient safety. In 2018, the Korean government introduced the Nurse Working Conditions Improvement Policy (NWCIP), accompanied by a revision of the nurse staffing grade calculation method. Under this policy, hospitals with revenue growth due to upward adjustments in nurse staffing grade were recommended to allocate revenue growth for improving nurses' working conditions. OBJECTIVE: To evaluate whether funding under the NWCIP, aimed at improving nurses' working conditions, is associated with changes in patient outcomes. METHODS: A quasiexperimental study was conducted using National Health Insurance claims data from 198,318 adult inpatients across 99 general hospitals. After confirming the parallel trends assumption, a difference-in-differences approach was used to evaluate the policy's effect. Patient outcomes were compared between the first quarters of 2018 (baseline) and 2019 (postimplementation). Hospitals were categorized into an intervention group (those that received nurses' working conditions improvement fund) and a comparison group (those that did not). Outcomes included in-hospital mortality, 7-day readmission, and length of stay. Among the 99 hospitals, 60 were assigned to the intervention group and 39 to the comparison group. RESULTS: According to difference-in-differences analysis, the intervention group showed a 19% increase in 7-day readmission (adjusted odds ratio = 1.19; 95% confidence interval: 1.09-1.29; p < 0.001) and a 5% decrease in length of stay (adjusted incidence rate ratio = 0.95; 95% confidence interval: 0.92-0.97; p < 0.001), with no significant change in in-hospital mortality. CONCLUSIONS: General hospitals subject to the NWCIP did not show improved patient outcomes: They had a higher risk of readmission despite a shorter length of stay. IMPLICATIONS FOR NURSING MANAGEMENT: The use of revenue growth to improve nurses' working conditions should be mandated rather than recommended, prioritizing high-impact staffing investments, such as hiring additional nurses, most directly linked to patient outcomes.
Effective Onboarding for Front-Line Nurse Managers in Healthcare: A Descriptive Qualitative Study.
Hakkarainen M, Kunnari T, Kuha S … +2 more , Hulkko T, Kanste O
J Nurs Manag · 2026 · PMID 42050821 · Full text
AIM: To describe nurse managers' perceptions of effective onboarding for front-line nurse managers in healthcare. BACKGROUND: Many front-line nurse managers are retiring, resulting in a loss of expertise. New competence...
AIM: To describe nurse managers' perceptions of effective onboarding for front-line nurse managers in healthcare. BACKGROUND: Many front-line nurse managers are retiring, resulting in a loss of expertise. New competence requirements and widespread turnover intention among front-line nurse managers are challenging healthcare organisations. Organisational support and effective onboarding are needed; however, qualitative research on the content of onboarding for front-line nurse managers is lacking. DESIGN: A qualitative descriptive study. METHODS: In 2023, data were collected remotely through six semistructured group and five individual interviews with 18 nurse managers in Finland. The participants worked in specialist and emergency care, primary healthcare and medical services within a single healthcare region. The data were analysed using inductive content analysis. RESULTS: The data yielded 33 subcategories and 12 categories that describe nurse managers' views on effective onboarding for front-line nurse managers in healthcare. The main categories were developing leadership growth through onboarding, clarifying leadership foundations in onboarding, designing a high-standard and up-to-date onboarding process, ensuring well-rounded onboarding support and strengthening workplace bonds through onboarding. CONCLUSIONS: Front-line nurse manager onboarding requires systematic execution that includes personal, organisational and social aspects. Onboarding should focus on developing managers' leadership qualities. Ensuring a structured and comprehensive onboarding programme that highlights the professional requirements of front-line nurse managers, as well as the relevant theoretical and practical aspects of managerial work, can support a smooth transition into the new role. A primary limitation of this study is the potential influence of researcher subjectivity in data interpretation and analysis. To mitigate this, multiple researchers were involved in the analysis process to enhance credibility and reduce individual bias. IMPLICATIONS FOR NURSING MANAGEMENT: Individual onboarding should help new front-line nurse managers grow into and develop attachments to the manager role while receiving support from top management, supervisors, colleagues and employees. IMPACT: This study highlights the need for a structured, personalised onboarding process for front-line nurse managers, focussing on leadership development and multidimensional support. A well-designed onboarding programme can enhance leadership skills, facilitate integration into the work community and support smoother transitions, ultimately contributing to improved organisational performance and healthcare outcomes.
Impact of Job Demands, Resources, Shift Patterns, and Regulatory Focus on Nurses' Presenteeism and Work Engagement: A Cross-Sectional Study.
Lee J
J Nurs Manag · 2026 · PMID 42050798 · Full text
This cross-sectional study explored how job demands, resources, shift patterns, and regulatory focus influence nurses' presenteeism and work engagement. A sample of 176 nurses across various hospital wards participated....
This cross-sectional study explored how job demands, resources, shift patterns, and regulatory focus influence nurses' presenteeism and work engagement. A sample of 176 nurses across various hospital wards participated. Emotional demands, job resources, regulatory focus, presenteeism, and work engagement were measured through surveys, while physical demands were measured using smart bands during shifts. Hierarchical regression revealed that presenteeism was positively associated with physical demands and a prevention-dominant focus. Work engagement showed a positive correlation with relationships with supervisors and a negative correlation with prevention-dominant focus. Including shift patterns and dominant regulatory focus significantly increased the explanatory power of the models for both outcomes. The findings highlight the importance of reassessing shift patterns, implementing effective staffing strategies, and fostering managerial support to mitigate presenteeism and enhance work engagement. Addressing organizational culture and improving job resources could contribute to nurses' well-being and job performance.
Psychological Capital and Work Engagement Among Mental Health Nurses in Saudi Arabia: The Mediation Role of Motivation at Work.
Alqhtani SS, Aldhafeeri NA, Almutairy AM … +5 more , Alsharekh A, Alanazi S, Soraia LA, Alotaibi AS, Alharbi N
J Nurs Manag · 2026 · PMID 42047495 · Full text
BACKGROUND: Mental health nurses (MHNs) often work in challenging work environments that can affect their emotional well-being and job performance. The high work demands, stress, and limited resources could influence MHN...
BACKGROUND: Mental health nurses (MHNs) often work in challenging work environments that can affect their emotional well-being and job performance. The high work demands, stress, and limited resources could influence MHNs' psychological capital (PsyCap), motivation, and engagement. Therefore, this study aims to explore the relationship between PsyCap and work engagement (WE), with a focus on the mediating role of motivation at work (MAW) among MHNs. METHODS: This study used a descriptive multivariate correlational design. A convenience sample was used to recruit 210 MHNs from a psychiatric hospital in Saudi Arabia in western region. MHNs completed three validated online questionnaires: the Psychological Capital Questionnaire-Short Version (PCQ-12), the Utrecht Work Engagement Scale (UWES-9), and the Motivation at Work Scale (MAWS). Data were analyzed using R software, performing descriptive and inferential tests and structural equation modeling (SEM). RESULTS: PsyCap showed a positive relationship with MAW (r = 0.67, p < 0.001) and WE (r = 0.67, p < 0.001). MAW was strongly associated with WE (r = 0.87, p < 0.001). SEM revealed that the influence of PsyCap on WE was fully mediated by MAW (direct path ß = 0.00. p = 0.938; indirect ß = 0.74, p < 0.001). The result showed that professional title predicts MAW and WE; age and educational level were predictors of PsyCap. CONCLUSION: PsyCap contributes to higher levels of WE among MHNs, with MAW playing a central mediating role. These findings highlight the importance of motivation in enabling psychological resources to be translated into WE. Therefore, targeted interventions that focus on enhancing MAW may improve WE, enhance nurse retention, and improve patient outcomes.
Network Analysis of Sleep Quality and Psychiatric Symptoms Among ICU Nursing Staff.
Li Y, Zhang Y, Chen W … +8 more , He W, Jian J, Xu J, Sun Y, Ma X, Ding Z, Zhao D, Shi H
J Nurs Manag · 2026 · PMID 42037554 · Full text
BACKGROUND: Intensive care unit (ICU) nurses are at high risk for sleep problems and psychological symptoms. This study aimed to construct a network model to explore the interrelationships between sleep quality and psych...
BACKGROUND: Intensive care unit (ICU) nurses are at high risk for sleep problems and psychological symptoms. This study aimed to construct a network model to explore the interrelationships between sleep quality and psychiatric symptoms among ICU nurses and to identify central and bridge symptoms for precise intervention. METHODS: A multicenter cross-sectional study was conducted from January to March 2025 among registered nurses working in ICUs. Psychiatric symptoms were assessed using the Symptom Checklist-90 (SCL-90), and sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI). A Gaussian Graphical Model was estimated using the EBICglasso algorithm. Centrality indices (strength, closeness, betweenness, and expected influence) and bridge centrality were calculated to identify key symptoms. The stability of the network was assessed using nonparametric and case-dropping bootstrap analyses. RESULTS: A total of 5560 nurses were included in the analysis. The network model revealed a well-connected structure. Centrality analysis indicated that "subjective sleep quality", "anxiety", and "sleep and eating problems" were the most central symptoms in the entire network. Bridge centrality analysis identified "sleep and eating problems" as the most critical bridge symptoms, forming the strongest connections between the sleep and psychiatric symptom communities. The network demonstrated excellent stability, with a correlation stability coefficient of 0.75 for both strength and bridge strength. CONCLUSION: The findings highlight the pivotal roles of subjective sleep quality, sleep and eating problems, and anxiety as potential targets for precise interventions. Focusing on these symptoms may effectively disrupt the vicious cycle between poor sleep and psychological distress, thereby improving overall well-being.
Determinants of Night-Shift Scheduling Quality for Nurses in Korea: A Multilevel Approach.
Park K, Oh J, An J … +2 more , Chu YS, Chu HS
J Nurs Manag · 2026 · PMID 42027179 · Full text
BACKGROUND: Night-shift work burdens nurses and increases the likelihood of medical errors. This study aims to identify the factors that influence the quality of night-shift scheduling. METHODS: This study is framed as a...
BACKGROUND: Night-shift work burdens nurses and increases the likelihood of medical errors. This study aims to identify the factors that influence the quality of night-shift scheduling. METHODS: This study is framed as a secondary data analysis. Original data are drawn from nurses' roster schedules and questionnaires completed by unit managers. The dataset had a nested structure comprising 1566 nurses within 81 wards. Multilevel analysis was conducted to examine factors influencing the quality of night-shift scheduling at both the individual and organizational levels. RESULTS: The majority of participants were female (95.7%, n = 1498). The night-duty RN-to-patient ratio was 8.83 (SD = 2.34). The mean overall quality of night-shift scheduling among participants was 2.90 (SD = 0.35). In Model 2, which included both individual- and organizational-level variables, the only statistically significant individual-level predictor of the quality of night-shift scheduling was gender (β = - 0.88, p = 0.032). At the organizational level, the number of night-shift-only RNs (β = 0.24, p = 0.001), ward type (β = 0.12, p = 0.026), and the night-duty RN-to-patient ratio (β = 0.25, p = 0.002) were significant. CONCLUSION: The quality of night-shift scheduling was greater for female nurses, Comprehensive Nursing and Care Service (CNCS) wards supported by governmental policy, wards with an RN-to-patient ratio of more than 8 during night shifts, and wards with more night-shift-only RNs. Therefore, these results indicate that the composition and number of nursing staff in a ward contribute to improving the working conditions and environments of nurses' shift work. NURSING IMPLICATIONS: The higher quality of night-shift scheduling observed in CNCS wards and wards run on the basis of the policy of night-shift-only RNs suggests that governmental support positively influences individual nurses' shift work environments. These findings support the need for policy-level interventions to improve the quality of shift work.
Circadian Rhythm Traits Matter More Than Shift Work Demands in the Sleep-Depression-Safety Behavior Pathway Among Shift-Working Nurses.
Zhao H, He Y, Li Q … +3 more , Wang S, Lin L, Huang Z
J Nurs Manag · 2026 · PMID 42027173 · Full text
OBJECTIVES: The study examined how shift work demands and circadian rhythm traits influence the sleep-depression-safety behavior chain in shift-working nurses. METHODS: A cross-sectional study was conducted from May 1, 2...
OBJECTIVES: The study examined how shift work demands and circadian rhythm traits influence the sleep-depression-safety behavior chain in shift-working nurses. METHODS: A cross-sectional study was conducted from May 1, 2024, to May 31, 2025, recruiting shift-working nurses from a tertiary hospital. Their circadian traits, sleep quality, depressive symptoms, and safety behavior were assessed using the Circadian Type Inventory (CTI, measuring flexible-rigid [FR] and languid-vigorous [LV]), the Morningness-Eveningness Questionnaire-5 (MEQ-5), the Pittsburgh Sleep Quality Index (PSQI), the Patient Health Questionnaire-9 (PHQ-9), and the Safety Behavior Questionnaire (SBQ). Objective shift work demands (total night shift count, shift work hours, shift workload exposure, and shift schedule entropy) were calculated based on data from the nursing management system. Piecewise structural equation modeling (SEM) and generalized additive models (GAMs) were used for data analysis. RESULTS: The optimal SEM explained 22% of the variance in sleep quality, 44% in depressive symptoms, and 22% in safety behavior level. Languidity (higher LV score) was strongly associated with both poor sleep quality (β = 0.29) and depressive symptoms (β = 0.28), whereas flexibility (higher FR score) was positively associated with safety behavior, exerting both direct (β = 0.21) and indirect (β = 0.04) effects. Depressive symptoms showed the strongest negative association with safety behavior (β = -0.27). Circadian rhythm traits showed stronger associations with the sleep-psychological-safety behavior chain than shift work demands, which were mainly associated with safety behavior and only weakly with sleep quality and depressive symptoms. GAMs revealed that five key predictors (shift schedule entropy, FR, chronotype, sleep quality, and depressive symptoms) had predominantly linear effects on safety behavior. CONCLUSION: Circadian rhythm traits should be prioritized in shift scheduling to optimize the sleep-psychological-behavioral pathway, while balancing shift work demands may help improve their safety behavior among shift-working nurses.
Stress Experiences and Support Needs of Nursing Managers in Patient Safety Incidents: A Phenomenological Qualitative Study.
Zeng W, Yang Y, Zhang L … +3 more , Wei H, Jiang L, Li Q
J Nurs Manag · 2026 · PMID 42018445 · Full text
BACKGROUND: The impact of patient safety incidents on healthcare professionals has drawn increasing attention. As key managerial forces on the clinical frontline, nurse managers not only bear important responsibilities i...
BACKGROUND: The impact of patient safety incidents on healthcare professionals has drawn increasing attention. As key managerial forces on the clinical frontline, nurse managers not only bear important responsibilities in incident response but may also become "second victims." The pressure they experience and their need for support warrant systematic investigation. OBJECTIVES: To explore the multidimensional stress experiences and support needs of nurse managers during patient safety incidents, providing a theoretical basis and practical guidance for building scientific management and support systems. DESIGN: A phenomenological qualitative study. METHODS: Using purposive sampling, 14 nurse managers from a tertiary hospital in Nanjing, China, were recruited for semistructured interviews. Data were analyzed using Colaizzi's seven-step method. RESULTS: Four core themes emerged: (1) complex coping situations under multiple stressors; (2) systemic support deficiencies and dilemmas; (3) growth within the managerial role; and (4) pathways for individual-organizational synergy. CONCLUSION: Nurse managers are important yet often overlooked "second victims" in patient safety incidents. Their support needs present distinct institutional and structural characteristics. Healthcare organizations should establish systematic support systems, strengthen psychological follow-up and collaboration mechanisms, and enhance coping efficacy and organizational resilience among nurse managers.
Future Training and Competency Needs in Hospital-at-Home Care: A Mixed-Methods Study From the Perspective of Healthcare Administrators and Managers.
Terhi-Maija I, Henna H, Miia J
J Nurs Manag · 2026 · PMID 42017654 · Full text
BACKGROUND: The growing complexity of hospital-at-home care highlights the pressing need for continuous professional development to enhance specialized skills. AIM: This study aimed to describe the future training and co...
BACKGROUND: The growing complexity of hospital-at-home care highlights the pressing need for continuous professional development to enhance specialized skills. AIM: This study aimed to describe the future training and competency needs in hospital-at-home care from the perspective of healthcare administrators and managers. DESIGN: A mixed-method convergent design was used to integrate quantitative and qualitative data on similar topics simultaneously, providing a more comprehensive understanding of system-level competency requirements than either method alone. METHODS: The data were collected through a nationwide survey (n = 25) and interviews (n = 46), covering all wellbeing services counties in Finland in 2023. Descriptive statistics were used for quantitative data and inductive content analysis for qualitative data. RESULTS: Quantitative results indicate needs for additional training in RAI assessment (68%), mental health care (60%), substance abuse expertise (48%), and managing disruptive behaviors (44%). Qualitative findings highlight broader future competence needs, including digital health; cultural and linguistic competence; interprofessional collaboration; managerial competence; home-environment quality and safety; clinical competence; and autonomy in evidence-based practice. Overall, the mixed-method findings differ yet complement one another: quantitative data identify concrete skill gaps, while qualitative insights emphasize wider, system-level competencies to meet the evolving demands of home-based care. CONCLUSION: Taken together, these complementary findings indicate that advancing the workforce will require a dual approach: addressing concrete skill deficits while simultaneously developing the broader competencies needed to meet the evolving demands of home-based care. IMPLICATIONS FOR NURSING MANAGEMENT: This study informs the creation of structured competency frameworks, enabling nursing leaders to meet the evolving demands of home-based care.
Unsteady Foundations: The Effects of Environmental Instability on Nurses and Implications for Nursing Management-An Integrative Review.
Page R, Carter G
J Nurs Manag · 2026 · PMID 42015364 · Full text
AIM: To determine the state of the science of how instability in the nursing practice environment affects nurses. BACKGROUND: The COVID-19 pandemic, workforce shortages, and an aging population have highlighted the criti...
AIM: To determine the state of the science of how instability in the nursing practice environment affects nurses. BACKGROUND: The COVID-19 pandemic, workforce shortages, and an aging population have highlighted the critical need to build and maintain stable nursing practice environments. Factors such as staffing inconsistencies, fluctuating workloads, and workplace violence create instability. While research has explored nursing practice environments broadly, limited research has been conducted on how instability affects nurses. METHODS: An integrative review was conducted using CINAHL, PsycINFO, and PubMed, with search terms related to instability and fluctuations in the nursing practice environment. Articles from 2014 to 2026 were included if they addressed instability in the nursing practice environment and its impact on nurses in hospital settings. Fifteen studies were included in this integrative review. FINDINGS: Instability in the nursing practice environment has many sources. Organizational support plays a significant role in determining the magnitude and management of environmental instability. Adverse nurse outcomes from instability in the nursing practice environment include decreased well-being, increased turnover, and workplace violence. IMPLICATIONS FOR NURSING MANAGEMENT: Effective leadership and management are necessary to create and maintain positive nursing practice environments, manage environmental instability, and improve nurse well-being and retention. Targeted strategies such as collaborating with policymakers, strengthening the nursing workforce pipeline, and supporting nurses in their practice environments can mitigate environmental instability and its adverse effects on nurses. CONCLUSIONS: Instability is a common feature of nursing practice environments. Excessive instability can cause adverse nurse outcomes. Nurse leaders are optimally situated to mitigate environmental instability and provide leadership support to improve nurse outcomes.
Wraparound Supports: The Key to the Transition and Integration of Internationally Educated Registered Nurses in Rural Alberta, Canada.
Sedgwick M, Kelley H
J Nurs Manag · 2026 · PMID 42011540 · Full text
BACKGROUND: Internationally educated nurses (IENs) face multiple challenges during their transition and integration to nursing settings in host countries. Two foci are prevalent in the extant literature: IENs' experience...
BACKGROUND: Internationally educated nurses (IENs) face multiple challenges during their transition and integration to nursing settings in host countries. Two foci are prevalent in the extant literature: IENs' experiences in urban nursing settings and internationally educated healthcare professionals' experiences. There is a distinct gap with understanding IENs' experiences while transiting and integrating into rural nursing practice and communities. OBJECTIVE: This study aimed to understand IENs' experience of rural nursing practice and the strategies they used to enhance their transition and integration into the rural workforce and community settings. METHOD: Semistructured interviews and participant photographs representing their experiences from the qualitative phase of a sequential mixed methods design were conducted in Alberta, Canada. FINDINGS: The transition and integration of IENs depend upon the wraparound support they received through interactions and connections with healthcare leaders, managers, administrative members, nursing colleagues, and community members. Embedded in these interactions and connections were various strategies IENs used to help them navigate and manage their desire to "fit in" and to be accepted in their rural nursing and community settings. CONCLUSION: IENs were highly motivated to become accepted as contributing members of the nursing team and rural communities. To achieve this goal, they engaged in behaviors to become a valuable member of the nursing team by acquiring additional practice knowledge and skills to enhance their competencies. They also used strategies to connect and "fit into" their new community. Wraparound supports included not only the employer and nursing colleagues but also key community members with social capital. These supports were key to IENs' engagement in and navigation of the transition and integration processes. IMPLICATIONS FOR NURSING MANAGEMENT: Healthcare leaders, managers, and key community members play pivotal roles in the development of cross-cultural, inclusive work, and living places by providing wraparound supports that reduce the cultural and rural practice distance between IENs and their nursing colleagues as well as creating opportunities for establishing cultural-sensitive work and living environments.
Fostering Spiritually Supportive Work Environments in Healthcare: Leadership Recommendations From a Narrative Review.
Joseph RA, Tharpe AH, Ortman H … +1 more , Crager JM
J Nurs Manag · 2026 · PMID 42011090 · Full text
BACKGROUND: Spiritual support creates a positive clinical work environment for nurses. The literature increasingly shows that spiritually supportive settings improve nurse well-being, reduce burnout, and elevate patient...
BACKGROUND: Spiritual support creates a positive clinical work environment for nurses. The literature increasingly shows that spiritually supportive settings improve nurse well-being, reduce burnout, and elevate patient care quality. AIM: This narrative review examines how different elements shape spiritually supportive work environments and support nurse well-being, drawing on peer-reviewed publications from 2020 to 2025 and data from major national professional organizations. METHODS: A comprehensive literature review was conducted using peer-reviewed publications from 2020 and 2025, along with data from major national professional organizations. Findings were analyzed to examine how different elements shape spiritually supportive work environments and support nurse well-being. RESULTS: The analysis reveals that spiritually supportive settings significantly improve nurse well-being, decrease burnout, and elevate patient care quality. These environments also yield organizational benefits, such as higher nurse retention and enhanced patient satisfaction. The literature highlights that spirituality and religiosity foster resilience, reduce moral distress, and strengthen nurse-patient relationships, contributing to a compassionate workforce. CONCLUSION: Recommendations are to embed spiritual support in healthcare settings to mitigate nurse burnout and workforce shortages, ensuring high-quality, patient-centered care. Additional recommendations are to advocate for systemic changes, including spiritual leadership and inclusive policies, to cultivate environments that nurture both nurses and patients, positioning spiritual support as a cornerstone of quality, sustainable healthcare delivery.
Identifying Nurses at Risk of Nursing Interruptions During Medication Administration Using Machine Learning: A Multicenter Cross-Sectional Study.
Dong X, Ding S, Wang S … +8 more , Liu M, Gan G, Cao H, Wang X, Chen N, Tan B, Xie J, Ng PHF
J Nurs Manag · 2026 · PMID 42010760 · Full text
BACKGROUND AND AIMS: Nursing interruptions during medication administration (NIMA) critically contribute to medication administration errors. However, validated prediction tools for NIMA risk assessment are unavailable....
BACKGROUND AND AIMS: Nursing interruptions during medication administration (NIMA) critically contribute to medication administration errors. However, validated prediction tools for NIMA risk assessment are unavailable. This study aimed to develop and internally validate three machine learning-based prediction models (logistic regression [LR], decision tree [DT], and Naive Bayes [NB]) for identifying nurses' individualized risk of NIMA. METHODS: A total of 4758 Chinese nurses were recruited from 12 tertiary hospitals between November 2023 and January 2024. The outcome was defined as the occurrence of ≥ 1 NIMA during the latest work shift. We used univariate analysis and LR to identify predictors. Participants were randomly allocated to training (n = 3806; 80%) and internal validation (n = 952; 20%) sets. Three machine learning models were implemented in Python, with performance evaluated via 1000-iteration stratified bootstrapping. Key performance metrics included AUC, accuracy, recall, specificity, precision, F1-score, and G-mean. Models comparisons used the DeLong test. The best model was further assessed with the Hosmer-Lemeshow test and calibration curves. RESULTS: Overall, 52.1% of nurses experienced at least one NIMA event. Predictive features of NIMA included 18 factors, such as department type, marital status, shift type, general self-efficacy level, and the needs of multiple people. In the test set, AUCs ranged from 0.679 to 0.748. The LR model performed best, achieving the highest AUC of 0.748 (95% CI: 0.717-0.779), an accuracy of 0.694 (95% CI: 0.664-0.724), and other performance metrics, including precision, recall, specificity, F1-score, and G-mean. The calibration of the LR model was supported by the Hosmer-Lemeshow test (X = 7.062, p = 0.530). CONCLUSIONS: This study systematically evaluated multiple influencing factors of NIMA and developed three internally validated risk prediction models of NIMA. The LR-based nomogram and the web-based calculators showed the most consistent performance and may support risk stratification and targeted nursing management, pending external validation and feasibility assessment.
Clinical Work Experiences of Nurses Returning to Work Postpartum: A Systematic Review and Qualitative Meta-Synthesis.
Tian J, Hu Y, Yuan Y … +3 more , Yang H, Tan M, Zheng H
J Nurs Manag · 2026 · PMID 42010757 · Full text
BACKGROUND: The global nursing shortage underscores the critical need to retain experienced clinicians. The postpartum return to clinical practice represents a vulnerable transition period that can significantly impact n...
BACKGROUND: The global nursing shortage underscores the critical need to retain experienced clinicians. The postpartum return to clinical practice represents a vulnerable transition period that can significantly impact nurse retention, yet the nuanced lived experiences of nurses during this reintegration are not well synthesized. AIM: To systematically review and synthesize qualitative evidence on the clinical work experiences of nurses returning to work after childbirth. DESIGN: A systematic review and meta-synthesis. METHODS: A systematic search was conducted in PubMed, Cochrane Library, CINAHL, Web of Science, Embase, China National Knowledge Infrastructure (CNKI), Wanfang Database, Weipu Database and China Biomedical Literature Database (CBM) to identify qualitative studies published between December 1990 and December 2025 that focused on the clinical work experiences of nurses returning to work postpartum. This systematic review follows the meta-synthesis method guided by ENTREQ and PRISMA and uses the Critical Appraisal Skills Programme (CASP) to assess the quality of included studies. Qualitative findings from the primary studies were integrated and analyzed using thematic synthesis. RESULTS: A total of 19 studies were included, with 76 main findings extracted, summarized into 9 subthemes, and organized into 3 main themes: The Multi-Faceted Challenges of Reintegrating into Professional Practice, Enduring Multidimensional Physical and Psychological Strain, and Relying on a Multilayered Support Ecosystem for Successful Transition. CONCLUSION: The return to clinical work postpartum is a period of multidimensional strain and identity negotiation. Retention is contingent upon a coherent support ecosystem. Moving beyond broad work-family conflict narratives, this review offers a targeted evidence base supporting essential structural enablers-such as flexible work policies, protected lactation facilities, and tailored reintegration pathways-alongside culturally competent interpersonal support, to promote sustainable reintegration and preserve an experienced nursing workforce. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers should proactively establish supportive structural policies, including flexible scheduling and dedicated lactation facilities, to support the successful reintegration of postpartum nurses. Developing tailored return-to-work orientation pathways and fostering a supportive, empathetic ward culture are critical managerial strategies to mitigate transition-related stress, enhance job satisfaction, and retain experienced clinical staff amidst the global nursing shortage.
Why Self-Leadership Alone Is Not Enough: How Professional Self-Concept and Organizational Commitment Shape Male Nurses' Intention to Stay.
Lee D, Shim M, Lee J
J Nurs Manag · 2026 · PMID 42010730 · Full text
BACKGROUND: Self-leadership, conceptualized as self-regulatory cognitive and behavioral strategies through which individuals influence their motivation and performance, has gained increasing attention in organizational r...
BACKGROUND: Self-leadership, conceptualized as self-regulatory cognitive and behavioral strategies through which individuals influence their motivation and performance, has gained increasing attention in organizational research. However, its conceptual role in nursing-particularly in relation to retention among male nurses-remains insufficiently clarified. This study examined the association between self-leadership and intention to stay among male nurses, alongside testing the mediating roles of professional self-concept and organizational commitment. METHODS: A cross-sectional survey was conducted with 194 male nurses employed in general and tertiary hospitals in South Korea. Data were collected using validated self-report instruments measuring self-leadership, professional self-concept, organizational commitment, and intention to stay. Parallel mediation analysis was performed using PROCESS macro with 10,000 bootstrap resamples to estimate indirect effects. RESULTS: Self-leadership was positively associated with professional self-concept, organizational commitment, and intention to stay. When both mediators were included in the model, the direct effect of self-leadership on intention to stay became nonsignificant, while significant indirect effects were observed through professional self-concept and organizational commitment. These findings indicate that self-leadership influences retention primarily through identity-related and organizational attachment mechanisms. CONCLUSIONS: Self-leadership appears to function as an upstream regulatory capacity that contributes to retention indirectly by strengthening professional identity and organizational commitment, rather than exerting a direct effect on retention decisions. These findings clarify the conceptual positioning of self-leadership in nursing retention research and highlight the need for multilevel retention strategies. IMPLICATIONS FOR NURSING MANAGEMENT: Retention strategies for male nurses should integrate structured self-leadership development with organizational initiatives that promote professional identity consolidation and inclusive workplace environments.
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