J Nurs Manag [JOURNAL]
Sun
200 papers
Digital Competence and Career Adaptability Among Nurses: The Parallel Mediating Roles of Technological Self-Efficacy and Learning Agility.
Ibrahim IA, Mounib SA, Eldesoky ES … +3 more , Elsayed RS, Abou Zeid MAG, Elatroush HG
J Nurs Manag · 2026 · PMID 41995209 · Full text
BACKGROUND: The rapid digital transformation of healthcare systems requires nurses to continuously update their competencies to remain effective, adaptable, and resilient. Although digital competence, technological self-...
BACKGROUND: The rapid digital transformation of healthcare systems requires nurses to continuously update their competencies to remain effective, adaptable, and resilient. Although digital competence, technological self-efficacy, and learning agility are recognized as key factors influencing career adaptability, the mechanisms connecting these constructs within nursing contexts remain underexplored. AIM: This study investigated the relationship between digital competence and career adaptability among clinical nurses, with a focus on the mediating roles of technological self-efficacy and learning agility. METHODS: A cross-sectional, correlational design was employed, involving 307 nurses recruited from two specialized university hospitals using stratified sampling. Data were collected using validated instruments measuring digital competence, technological self-efficacy, learning agility, and career adaptability. Partial Least Squares Structural Equation modeling was utilized to test the hypothesized parallel mediation model, following STROBE reporting guidelines. RESULTS: Nurses reported a moderate level of digital competence (M = 3.46, SD = 0.42) and technological self-efficacy (M = 3.64, SD = 0.46), while learning agility and career adaptability were rated high (M = 3.85, SD = 0.47; M = 4.50, SD = 0.43, respectively). Digital competence had significant positive direct effects on career adaptability (β = 0.185, p < 0.01), learning agility (β = 0.184, p < 0.01), and technological self-efficacy (β = 0.254, p < 0.001). Both learning agility (β = 0.167, p < 0.01) and technological self-efficacy (β = 0.236, p < 0.001) were also significant predictors of career adaptability. Moreover, digital competence exerted significant indirect effects on career adaptability through technological self-efficacy (β = 0.060, p < 0.05) and learning agility (β = 0.031, p < 0.05). CONCLUSION: Digital competence emerged as a fundamental determinant of nurses' career adaptability, operating directly and indirectly through technological self-efficacy and learning agility. These findings highlight the importance of fostering digital readiness and adaptive learning among nurses. Nursing leaders should prioritize professional development initiatives to enhance workforce adaptability and sustain effective practice in technology-driven healthcare environments.
Psychological Distress and Presenteeism During the Pandemic Period: A Quantitative Study Among Nurses From Emergency and Critical Care.
Mu X, Baldonedo-Mosteiro M, González MB … +3 more , Baldonedo-Cernuda R, Franco-Correia S, Mosteiro-Díaz MP
J Nurs Manag · 2026 · PMID 41995116 · Full text
AIM: To assess the psychological status and the prevalence of presenteeism among Spanish nurses working in emergency departments (EDs) and intensive care units (ICUs) and to explore the association between these variable...
AIM: To assess the psychological status and the prevalence of presenteeism among Spanish nurses working in emergency departments (EDs) and intensive care units (ICUs) and to explore the association between these variables. BACKGROUND: Nurses working in ED and ICU settings experience higher levels of psychological stress, including burnout and lower job satisfaction. Anxiety and depression are common in this group and may contribute to nursing presenteeism. Presenteeism is defined as continuing to work despite feeling ill or unwell. There are gaps in research addressing the psychological status and presenteeism of ED and ICU nurses in Spain. METHODS: A cross-sectional study using the Kessler Psychological Distress Scale (K-10) and the Stanford Presenteeism Scale (SPS-6) was conducted between April and December 2022. In total, 182 participants were included. The study followed the STROBE guidelines. FINDINGS: Psychological distress was identified in 35.7% of participants, and a presenteeism prevalence of 43.8% was observed among nurses. A statistically significant association between psychological distress and presenteeism was found (p < 0.001). Age, educational background, and perceived work-related stress (p = 0.05) were identified as factors associated with psychological distress. Perceived work-related stress was also significantly associated with presenteeism (p < 0.05). CONCLUSIONS: More than one-third of nurses working in ED and ICU settings experienced psychological distress, and a high prevalence of presenteeism was identified. Presenteeism was associated with higher levels of psychological distress. IMPLICATIONS FOR NURSING: Early detection of psychological distress and the implementation of workplace interventions may help reduce presenteeism among nurses.
Effects of Toxic Leadership Behavior and Emotional Exhaustion on Patient Safety Incident Reporting.
Poku CA, Ahiadzese YA, Oyortey HK … +4 more , Lamptey SNO, Asante J, Lumor DA, Hagan D
J Nurs Manag · 2026 · PMID 41995113 · Full text
INTRODUCTION: Patient safety is a vital component of healthcare delivery, and identifying and reporting incidents are essential to raising the standard of care. Nurse managers are noted in some organizations to display a...
INTRODUCTION: Patient safety is a vital component of healthcare delivery, and identifying and reporting incidents are essential to raising the standard of care. Nurse managers are noted in some organizations to display a toxic leadership style, which exacerbates nurses' already existing emotional exhaustion. Nurses' emotional exhaustion may harm the reporting of patient safety incidents. Using the job demands-resources theory as the primary guiding framework, the study assessed the relationship between emotional exhaustion and patient safety incident reporting among nurses while examining the mediating role of toxic leadership of nurse managers in a teaching hospital in Ghana. METHODS: The study employed a cross-sectional design. Using convenience sampling, 282 nurses from the various units of a teaching hospital completed the Maslach Burnout Inventory, the Toxic Leadership Behavior of Nurse Managers Scale, and the Survey on Patient Safety Culture tools. Pearson moment-product correlation and Hayes' PROCESS Macro mediation analyses were conducted to examine the effects of toxic leadership behavior of nurse managers on the relationship between nurses' emotional exhaustion and patient safety incident reporting. Analysis was performed at a significance of 0.05. RESULTS: Close to half (43.6%, n = 123) of participants indicated their likelihood of reporting patient safety incidents in their units. There was a significant negative correlation between patient safety incident reporting and emotional exhaustion (r = -0.617, p < 0.01). The results also showed a significant indirect effect of emotional exhaustion on patient safety incident reporting through nurse managers' toxic leadership behavior (c = -0.0590, 95% CI: [-0.0818, -0.0370]). IMPLICATIONS FOR NURSING MANAGEMENT: The toxic leadership behavior of nurse managers acts as a mediator, exacerbating the negative relationship between emotional exhaustion and patient safety incident reporting. The results highlight the need to address emotional exhaustion and toxic leadership behavior of nurse managers to foster a culture of transparent patient safety incident reporting. Improving reporting and minimizing the harmful effects of emotional exhaustion require addressing the role of toxic leadership.
Components Influencing Nurses' Employability in Organisational Transitions: A Mixed-Methods Study.
Isobe T, Takemura Y, Kunie K
J Nurs Manag · 2026 · PMID 41994988 · Full text
BACKGROUND: Sustainable careers are becoming increasingly important in nursing, as workforce shortages and high turnover rates challenge global healthcare systems. Employability, which refers to the skills that enable in...
BACKGROUND: Sustainable careers are becoming increasingly important in nursing, as workforce shortages and high turnover rates challenge global healthcare systems. Employability, which refers to the skills that enable individuals to obtain and maintain employment, is essential for nurses undergoing interorganisational transitions. AIM: This study examined the components of nurses' employability and evaluated their relative importance in recruitment decisions across various healthcare settings in Japan. METHODS: The study employed a mixed-methods approach. It comprised a qualitative phase, involving semistructured interviews with nurse recruiters to identify key employability components, followed by a quantitative phase that employed conjoint analysis to evaluate the relative significance of these components. The participants included recruiters from hospitals, long-term care facilities and homecare nursing agencies. RESULTS: Seven key employability components were identified: long-term retention potential, practical nursing skills, an optimistic approach to challenges, willingness to learn about nursing as a profession and ideology, relationship-building abilities, commitment to organisational improvement and intrinsic motivation for nursing. The conjoint analysis revealed both common and setting-specific priorities. Hospitals valued "Practical skills", "Establishing relationships" and "Motivation for nursing", irrespective of bed size. Homecare nursing agencies emphasised practical skills, relationship building and nurses' motivation. In contrast, long-term care facilities prioritised interpersonal relationships with others. Across all the settings, clarity regarding the reasons for and objectives of previous job changes was critical for recruitment decisions. CONCLUSION: This study enhances our understanding of how employability is conceptualised and evaluated in nursing recruitment. Employability is not limited to individual competencies but reflects the alignment between nurses' professional orientation and organisational values, supporting sustainable nursing careers. IMPLICATIONS FOR NURSING AND/OR HEALTH POLICY: This study underscores the importance of tailoring employability to meet the unique needs of healthcare facilities. By enhancing employability, nurses can achieve their desired career goals and adapt to evolving organisational needs, thereby benefiting both individuals and healthcare systems.
Technophobia and Its Associated Factors Among Registered Nurses in China: A Cross-Sectional Multicenter Study.
Sun X, Liu X, Chang X … +3 more , Hu N, Qi X, Li X
J Nurs Manag · 2026 · PMID 41992642 · Full text
AIM: To examine the level of technophobia and identify its associated sociodemographic, occupational, and psychosocial factors among registered nurses in China. BACKGROUND: The rapid digital transformation of healthcare...
AIM: To examine the level of technophobia and identify its associated sociodemographic, occupational, and psychosocial factors among registered nurses in China. BACKGROUND: The rapid digital transformation of healthcare systems demands that nurses effectively adopt and use digital technologies. Technophobia-defined as negative emotional reactions toward technology-may impede nurses' adaptation to technological innovations. However, no study is currently available on technophobia and its associated factors in registered nurses. DESIGN: A multicenter, cross-sectional study. METHODS: A total of 1559 registered nurses from two university-affiliated tertiary hospitals in Northeast China were surveyed between September and October 2025. Data were collected using a self-administered questionnaire including sociodemographic factors, occupational factors, the validated Chinese version of the Technophobia Scale, the Multidimensional Scale of Perceived Social Support, and the Athens Insomnia Scale. A generalized linear model was fitted to identify independent predictors of technophobia. RESULTS: The nurses' median technophobia score was 26.00 (P-P: 13.00-39.00), indicating a low-to-moderate level overall. The generalized linear model revealed that male gender (β = 0.201), having one child (β = 0.130), living alone (β = 0.091), having a higher perceived workload (β = 0.048), and poorer sleep quality (β = 0.015) were independently associated with greater technophobia. Conversely, higher job satisfaction (β = -0.081) and stronger social support (β = -0.003) were independently associated with lower technophobia; however, the effect size for social support was relatively small, all p < 0.05. CONCLUSIONS: Technophobia among registered nurses in China is at a moderately low level. Interventions targeting modifiable factors-such as workload management, sleep health, job satisfaction, and social support-through structured digital literacy training, peer support mechanisms, and other supportive workplace strategies may help mitigate technophobia and enhance nurses' readiness for digital transformation. PATIENT OR PUBLIC CONTRIBUTION: Nurses voluntarily participated in the survey. The findings may indirectly benefit patients through improved nurse engagement with digital health systems and safer, more efficient care delivery.
Beyond the Frontlines: Burnout Among Emergency Healthcare Providers in Jordan.
Alwidyan MT, Algharaibeh OM, Aljanabi MM … +2 more , Ashour AF, Oteir AO
J Nurs Manag · 2026 · PMID 41986944 · Full text
BACKGROUND: Burnout among emergency healthcare providers, including physicians, nurses, and paramedics, is a growing global concern, particularly in developing countries where prevalence rates can reach 70%-80%. Burnout...
BACKGROUND: Burnout among emergency healthcare providers, including physicians, nurses, and paramedics, is a growing global concern, particularly in developing countries where prevalence rates can reach 70%-80%. Burnout negatively impacts healthcare systems and patient outcomes. However, limited studies compare burnout rates across these professions or focus on the Middle Eastern context, including Jordan. This study aims to assess burnout prevalence among emergency physicians, nurses, and paramedics in Jordan and identify associated demographic and work-related factors. METHODS: A cross-sectional descriptive study was conducted using a paper-based, self-administered questionnaire incorporating the Copenhagen Burnout Inventory (CBI). Participants were drawn from emergency departments in 15 hospitals and 13 ambulance stations. Data were analyzed using SPSS Version 25, employing descriptive statistics, ANOVA, and logistic regression to identify burnout predictors. RESULTS: A total of 560 participants completed the survey (response rate: 70%). The prevalence rates for personal, work-related, and patient-related burnout were 83.7%, 79.2%, and 64.0%, respectively, with overall high burnout rates (75.6%). Sleep deprivation (p ≤ 0.002), poor supervisor relationships (p ≤ 0.01), and attempts to change workplaces (p ≤ 0.03) were associated with all burnout dimensions. Female participants and those with one to three children showed higher burnout odds (p = 0.004, p = 0.045, respectively). No significant differences in burnout rates were observed among professions. CONCLUSIONS: This study highlights alarmingly high burnout prevalence rates among emergency healthcare providers in Jordan, stressing the need for tailored strategies to mitigate burnout and improve the resilience of the healthcare system. Future research should explore the long-term impacts of systemic factors and post-COVID-19 dynamics.
Nurses' Challenges in Performing Ultrasound Hip-Screening Techniques for Home Visits to Newborns and Infants: A Descriptive Case Study.
Shirouchi M, Matsumoto H, Honda C … +8 more , Shiomi M, Hosoya N, Kinjo T, Aoki K, Hattori T, Okada K, Fujiwara K, Yoshioka-Maeda K
J Nurs Manag · 2026 · PMID 41972426 · Full text
AIMS: Early detection of developmental dysplasia of the hip in newborns and infants is essential to ensure lifelong mobility. As several municipalities conduct nurse-led hip ultrasound screenings during newborn and infan...
AIMS: Early detection of developmental dysplasia of the hip in newborns and infants is essential to ensure lifelong mobility. As several municipalities conduct nurse-led hip ultrasound screenings during newborn and infant home visits, nurses must acquire the accurate technique smoothly and effectively. Clarifying the challenges nurses face when performing ultrasound procedures helps support effective education. This study aimed to identify challenges inexperienced nurses face when performing basic ultrasound using the Graf-method in home settings. DESIGN: Descriptive case study. METHODS: Ultrasound training was provided to 22 nurses in Japan to enable use during newborn and infant home visits. We analyzed 25 video cases from three nurses who required > 180 s to obtain a standard plane image. Videos were transcribed and inductively analyzed to identify challenges with reference to Yin's case study methodology. RESULTS: Conditions of the challenges were categorized into knowledge, skills, and attitudes with reference to Bloom's taxonomy. The knowledge gap led to the failure to correctly judge whether the femoral head/standard plane was captured. Skill deficiencies led to failure to move the probe vertically and difficulty maintaining the infant's straight lateral position. The combination of inadequate knowledge and skills resulted in failures to (1) place the probe directly over the femoral head, (2) display the image in the correct position and orientation, and (3) move the probe correctly regarding direction and range while maintaining the image in the correct position and orientation. Regarding attitude gaps, nurses failed to improve the procedure. CONCLUSIONS: Improving ultrasound proficiency for developmental hip dysplasia detection requires training in anatomy integration, sensory experience, and probe-screen coordination while addressing posture, equipment handling, and motor skills. TRIAL REGISTRATION: University Hospital Medical Information Network Clinical Trial Registry: UMIN000051929.
Identification of the Relationship Between Health Professionals' Managerial Attitudes and Distractions in the Operating Room: A Mixed Design Study.
Güner Y, Üçüncüoğlu M
J Nurs Manag · 2026 · PMID 41968781 · Full text
BACKGROUND: Operating rooms are high-risk environments where managerial attitudes and workplace distractions significantly impact patient safety and teamwork. However, the relationship between these factors remains insuf...
BACKGROUND: Operating rooms are high-risk environments where managerial attitudes and workplace distractions significantly impact patient safety and teamwork. However, the relationship between these factors remains insufficiently explored. PURPOSE: This study aims to identify the relationship between healthcare professionals' managerial attitudes and distractions in the operating room. METHODS: A mixed-methods research design was employed. Quantitative data were collected using a descriptive and cross-sectional approach, while qualitative data were obtained through a phenomenological design. 82 healthcare professionals in the operating room of a hospital were involved in the study. The Operating Room Management Attitude Scale and the Distractions in Surgery Index were used for quantitative assessment and analyzed via SPSS 22.0. Semistructured in-depth interviews provided qualitative data, which were evaluated using content analysis. RESULTS: Managerial attitudes were identified as key determinants of team dynamics and workplace distractions. The total mean score of the Operating Room Management Attitude Scale was 148.95 ± 37.5, with the most affected subscales being stress and fatigue (30.85 ± 7.46) and work values (28.48 ± 8.12). The most common sources of distraction included temperature (62.68%), unavailable or not working equipment (57.8%), and tiredness (68.9%). Furthermore, inadequate organizational structures, communication deficiencies, and environmental factors contributed to increased distraction levels. Leadership style directly affected employees' job satisfaction and stress levels. CONCLUSIONS: Implications for practice: Implementing effective management strategies, ensuring a balanced distribution of workload, and minimizing distractions in the operating room can enhance patient safety by improving the efficiency and well-being of healthcare professionals. Future research should focus on evaluating the effectiveness of targeted interventions to mitigate these challenges.
An Integrative Review of Automation Integration in Emergency Nursing Practice: Evidence Synthesis and Contextual Application to Rafidia Governmental Hospital, Palestine.
Aqtam I, Shouli M, Alkorom S
J Nurs Manag · 2026 · PMID 41968743 · Full text
AIM: To synthesize evidence on automation integration in emergency nursing and propose a contextually appropriate implementation framework for a governmental hospital in Palestine. DESIGN: Integrative review. METHODS: Fo...
AIM: To synthesize evidence on automation integration in emergency nursing and propose a contextually appropriate implementation framework for a governmental hospital in Palestine. DESIGN: Integrative review. METHODS: Following the Whittemore and Knafl methodology, we conducted a comprehensive search across PubMed, CINAHL, Scopus, Web of Science, IEEE Xplore, and regional databases from January 2015 to March 2025. Two independent reviewers screened articles, with conflicts resolved through discussion. The quality of included studies was appraised using the Mixed Methods Appraisal Tool (MMAT). A total of 47 sources were included and analyzed thematically using NVivo 14, guided by sociotechnical systems theory and ethics of care principles. RESULTS: Five themes emerged: (1) types of automation with proven efficacy in emergency nursing; (2) outcomes including workflow efficiency gains (up to 40% time savings reported in high-resource settings) and safety improvements (30%-50% error reduction); (3) contextual barriers (infrastructure, financial constraints, and workforce readiness) and facilitators (nurse involvement and phased implementation); (4) ethical considerations specific to Arab healthcare contexts; and (5) alignment of local pilot experiences at Rafidia Hospital with global evidence. Key gaps identified include the absence of formal governance, limited evaluation infrastructure, and a lack of embedded sustainability planning, gaps that are particularly consequential in politically constrained, resource-limited environments. CONCLUSION: Automation holds significant promise for emergency nursing in Palestine, but success depends on contextual adaptation, nurse-led design, and sustainable planning.
Predictors of Organisational Commitment and Retention Intent Among Midcareer Nurses: Addressing the Midcareer Dip in Taiwan.
Wei CW, Chen YC, Hu CW
J Nurs Manag · 2026 · PMID 41958147 · Full text
BACKGROUND: The global nursing workforce shortage has been intensified by the COVID-19 pandemic, placing frontline nurses under sustained pressure and potentially diminishing their organisational commitment. This study a...
BACKGROUND: The global nursing workforce shortage has been intensified by the COVID-19 pandemic, placing frontline nurses under sustained pressure and potentially diminishing their organisational commitment. This study aimed to examine differences in organisational commitment among midcareer nurses in Taiwan across demographic and work-related characteristics and to investigate the relationships between work excitement, work frustration and organisational commitment in order to identify key predictors of organisational commitment. METHODS: A cross-sectional design with convenience sampling was employed. A total of 240 registered female nurses working at or above the regional hospital level in northern Taiwan were recruited between July and December 2024 through online professional nursing networks. Data were collected using a demographic questionnaire, the Work Excitement Scale, the Work Frustration Scale and the Organisational Commitment Scale. Descriptive statistics, independent t-tests, one-way ANOVA and multiple regression analyses were performed. RESULTS: Participants had a mean age of 32.54 years and an average of 10.36 years of nursing experience. Higher organisational commitment was observed among nurses who were older, held managerial positions, worked regular day shifts and perceived lighter workloads. Work excitement was positively associated with organisational commitment, whereas work frustration and perceived workload were negative predictors. Importantly, nurses in the midcareer stage (3-8 years of tenure) demonstrated significantly lower organisational commitment compared with those at earlier or later career stages, whereas chronological age was not an independent predictor after adjustment for tenure and other covariates. CONCLUSION: Midcareer nurses encounter distinct challenges, including heavy workloads, constrained career advancement and discrepancies between expectations and workplace realities, which together undermine their organisational commitment. As this group represents the core of the nursing workforce, tailored retention strategies are essential. Drawing on international best practices, Taiwan should establish structured professional development and continuing education frameworks that support midcareer nurses across clinical, educational, managerial and research trajectories. Such initiatives are crucial to enhancing job satisfaction, reinforcing commitment and promoting long-term workforce stability.
Nurse Leaders' Assertiveness as Perceived by Staff Nurses and Its Influence on Their Job Performance in Al-Qassim Region Hospitals.
Alshudukhi AI, Almansour AM
J Nurs Manag · 2026 · PMID 41954280 · Full text
BACKGROUND: Assertiveness is recognized as a crucial leadership competency in nursing, linked to efficient communication, decision-making, and patient safety. Previous studies have investigated assertiveness in nursing;...
BACKGROUND: Assertiveness is recognized as a crucial leadership competency in nursing, linked to efficient communication, decision-making, and patient safety. Previous studies have investigated assertiveness in nursing; however, there is a paucity of research on the impact of nurse leaders' assertiveness on staff job performance, especially within the Saudi context, where healthcare reforms under Vision 2030 prioritize workforce leadership and development. AIM: The objective of this study was to evaluate the assertiveness of nurse leaders and investigate its correlation with the job performance of staff nurses in hospitals located in the Al-Qassim region of Saudi Arabia. METHODOLOGY: The study utilized a cross-sectional quantitative design. A total of 406 nurses from 17 hospitals were selected through convenience sampling for participation. Data were gathered utilizing two validated instruments: the Functional Assertiveness Scale (FAS) and the Job Performance Scale (JPS). Reliability was established, with FAS α = 0.962 and JPS α = 0.988. The analysis of the data used SPSS v26 to run descriptive statistics, t-tests, ANOVA, Pearson correlations, and regression. It also gave effect sizes and confidence intervals. RESULTS: The findings reveal that nurse leaders demonstrated a considerable degree of assertiveness (M = 4.43, SD = 0.81), while staff nurses indicated a significant level of job performance (M = 4.68, SD = 0.70). A notable positive correlation exists between assertiveness and job performance (p < 0.001). Both objective effectiveness and pragmatic politeness, as subdimensions of assertiveness, independently predicted job performance. Assertiveness and performance exhibited significant variation across demographic characteristics such as gender, nationality, and education. CONCLUSION: The assertiveness of nurse leaders has a significant impact on the job performance of staff, underscoring its relevance as both a theoretical concept and a practical skill.
Construction and Efficiency Estimation of a Nursing Human Resource Evaluation System in Integrated Medical-Nursing Elderly Care Institutions Using Data Envelopment Analysis.
He M, Cheng P, Liu Y … +4 more , Zhang Z, Yang Y, Ho KY, Li Y
J Nurs Manag · 2026 · PMID 41954235 · Full text
BACKGROUND: Efficient allocation of nursing human resources (NHR) is critical for optimizing care quality in integrated medical-nursing elderly care institutions. However, standardized tools for assessing NHR efficiency...
BACKGROUND: Efficient allocation of nursing human resources (NHR) is critical for optimizing care quality in integrated medical-nursing elderly care institutions. However, standardized tools for assessing NHR efficiency remain underdeveloped. OBJECTIVE: This study aimed to develop and validate a data envelopment analysis (DEA)-based evaluation system for nursing human resource efficiency in integrated elderly care institutions, with empirical application in clinical settings. METHODS: Employing a cross-sectional design, the research evaluated NHR efficiency in integrated medical-nursing elderly care institutions. A preliminary indicator system was developed through comprehensive literature review and field investigations, followed by two rounds of Delphi consultations with 17 multidisciplinary experts specializing in nursing management, elderly care administration, integrated medical-nursing operations, health economics, and public health. Expert reliability was determined by assessing response rates, authority levels (qualifications and experience), consensus (agreement rates), and coordination (Kendall's W test). Based on this established indicator system, the DEA model was employed to evaluate the operational efficiency of 12 integrated medical-nursing elderly care institutions in Hainan Province, China. RESULTS: The constructed evaluation system featured a three-level hierarchical structure totaling 68 indicators (9 first-level, 19 second-level, and 40 third-level indicators). Two rounds of expert consultation demonstrated strong participation (response rates: 100% and 94.1%, respectively) and high reliability (authority coefficients: 0.88 and 0.92). Expert consensus was confirmed through statistical analysis (Kendall's W: 0.471 and 0.348; average coefficient of variation: 0.16 and 0.12; all p < 0.001). Subsequent DEA implementation across 12 institutions revealed 5 were fully efficient (OE = TE = SE = 1.000), while the remaining 7 showed varying inefficiency patterns: 4 exhibited pure technical efficiency (TE = 1.000) with scale inefficiency (SE < 1.000), and 3 demonstrated both technical and scale inefficiency (TE < 1.000, SE < 1.000). CONCLUSION: The nursing human resource efficiency evaluation system developed in this study demonstrated strong validity through a rigorous Delphi expert consultation process, showing high expert engagement and authoritative consensus. The comprehensive three-level indicator system exhibits well-organized structure with strong specialty-specific relevance for integrated medical-nursing care settings. DEA application confirmed the system's effectiveness in objectively evaluating nursing efficiency, supporting its practical utility for healthcare management in elderly care institutions.
The Relationship Between Nursing Managers' Leadership Styles and Nurses' Artificial Intelligence Literacy: A Cross-Sectional Study.
Tong J, Xie J, Xiang Y … +2 more , Zhou Y, Deng P
J Nurs Manag · 2026 · PMID 41952446 · Full text
AIM: To determine the relationship between nursing managers' diverse leadership styles and nurses' artificial intelligence (AI) literacy. BACKGROUND: Nurses' AI literacy serves as a core competency for optimizing clinica...
AIM: To determine the relationship between nursing managers' diverse leadership styles and nurses' artificial intelligence (AI) literacy. BACKGROUND: Nurses' AI literacy serves as a core competency for optimizing clinical workflows and safeguarding patient safety. Although leadership has been recognized as a critical factor in the adoption of technology, empirical evidence linking specific leadership styles to AI literacy among nurses remains unclear. METHODS: A cross-sectional study was conducted between October and November 2025, involving 1644 nurses recruited from 15 general tertiary hospitals across Sichuan, Jilin, Tibet, Hunan, and Hubei Provinces in China. Data were collected using five standardized instruments: a demographic information form, the AI Literacy Scale, the Multifactor Leadership Questionnaire (MLQ), the Authentic Leadership Questionnaire (ALQ), and the Servant Leadership Questionnaire (SLQ). The univariate analysis, Pearson correlation analysis, and multiple linear regression analysis were employed to examine the relationships among the study variables. RESULTS: Univariate analysis revealed significant differences in nurses' AI literacy associated with work experience, received AI-related training, and prior experience in using AI (all p < 0.05). Four leadership styles (transformational, transactional, authentic, and servant leadership) were observed to be positively correlated with AI literacy (r = 0.184-0.378, p < 0.001). Multiple linear regression identified five significant predictors of AI literacy: received AI-related training (β = 0.147, p < 0.001), prior experience in using AI (β = 0.131, p < 0.001), transformational leadership (β = 0.163, p < 0.001), transactional leadership (β = 0.073, p = 0.037), and authentic leadership (β = 0.113, p = 0.015), with the model explaining 20.2% of variance. CONCLUSIONS: Our study demonstrated that transformational, transactional, and authentic leadership in nursing managers were positively associated with nurses' AI literacy, whereas servant leadership showed no significant predictive effect. These findings highlight the multidimensional nature of leadership in fostering AI literacy among nurses and inform the strategic design of targeted leadership development initiatives within healthcare organizations.
The Mediating Effect of Innovation Self-Efficacy and Organizational Innovation Atmosphere on Digital Leadership and Green Creativity of Clinical Nurses: A Cross-Sectional Study.
Han Y, Wang Y, Liu Y … +5 more , Wang Z, Dong X, Zhao X, Liu X, Fang K
J Nurs Manag · 2026 · PMID 41947395 · Full text
BACKGROUND: The healthcare industry is facing trends toward digital transformation and sustainable development. Green creativity, defined as nurses' ability to propose innovative environmental solutions in clinical pract...
BACKGROUND: The healthcare industry is facing trends toward digital transformation and sustainable development. Green creativity, defined as nurses' ability to propose innovative environmental solutions in clinical practice, has become an important driving force for the transformation toward green healthcare. Digital leadership, a leadership approach that utilizes digital technology and information tools to achieve sustainable development, is becoming an important driving force for promoting nurses' green creativity. Exploring the interaction mechanism between the two is crucial for cultivating nurses' green creativity. METHOD: A cross-sectional study was conducted on 500 clinical nurses from 24 provinces and 4 municipalities in China using convenience sampling. The Digital Leadership Scale, Innovation Self-Efficacy Scale, Nurse Organizational Innovation Climate Scale, and Green Creativity Scale were used to measure clinical nurses' digital leadership, innovation self-efficacy, nurse organizational innovation atmosphere, and green creativity, respectively. Pearson correlation analysis and structural equation modeling (SEM) were used to analyze the relationships among digital leadership, innovation self-efficacy, organizational innovation atmosphere, and green creativity. RESULT: Digital leadership was found to be a positive predictor of both nurses' innovation self-efficacy and organizational innovation atmosphere, with the latter two being significant positive predictors of nurses' green creativity. Innovative self-efficacy and organizational innovation atmosphere played a significant mediating role in the relationship between digital leadership and green creativity. CONCLUSION: Based on the complex adaptive system, this study reveals that digital leadership significantly promotes nurses' green creativity through the chain-mediated pathway of innovative self-efficacy and organizational innovation atmosphere, which provides a theoretical basis and management strategy for subsequent interventions for nurses' green creativity by nursing managers in order to synergistically improve the quality of nursing care and sustainable development.
The Relationship Between Barriers to Medical Error Disclosure and Patient Safety Culture: A Cross-Sectional Study.
Chen GR, Luo X, Huang RR … +3 more , Xiong HY, Ding XM, Pan SH
J Nurs Manag · 2026 · PMID 41947348 · Full text
BACKGROUND: Changes in the patient safety culture in hospitals can increase error disclosure, but the relationship between these factors remains unclear. OBJECTIVES: To explore nurses' perceptions of barriers to the disc...
BACKGROUND: Changes in the patient safety culture in hospitals can increase error disclosure, but the relationship between these factors remains unclear. OBJECTIVES: To explore nurses' perceptions of barriers to the disclosure of medical errors in the context of a patient safety culture and to identify relevant influencing factors. DESIGN: Cross-sectional study. SETTINGS: Two tertiary and two secondary comprehensive hospitals in southwestern China. PARTICIPANTS: Chinese registered nurses who were employed in secondary or tertiary comprehensive hospitals. METHODS: In May 2023, electronic questionnaires were distributed to all nurses in the selected hospitals. The survey included nurses' characteristics, a hospital survey on patient safety culture, and the Chinese version of the barriers to error disclosure assessment (C-BEDA) tool. The data thus collected were subjected to descriptive and multiple linear regression analyses. RESULTS: The effective recovery rate was 96.23% (792/823). Nurses reported that financial concerns represented the greatest barrier to medical error disclosure, followed by psychological barriers and knowledge barriers. A multiple linear regression analysis revealed that working departments, communication openness, feedback and communication about errors, nonpunitive responses to errors, teamwork across units, and hand-offs and transitions collectively accounted for 27.2% of the variation in nurses' confidence and knowledge barriers. Age, title, managerial position, tenure, marital status, and continuous improvement in organizational learning explained 28.7% of the variation in the institutional barriers faced by nurses. Gender, title, tenure, supervisor/manager expectations, actions taken to promote patient safety, and openness to communication explained 10.2% of the variation in the psychological barriers faced by nurses. CONCLUSIONS: To encourage nurses to disclose medical errors effectively, hospitals must first address nurses' concerns regarding economic issues and provide them with comprehensive training in error disclosure alongside psychological support. Hospitals should prioritize the establishment of a patient safety culture at the unit level, particularly with respect to organizational learning, continuous improvement, and openness to communication.
Associations Between Nursing Faculty Expertise in the United Nations Sustainable Development Goals and Research Impact Metrics: A Cross-Sectional Study.
Ruksakulpiwat S, Thongking W, Niyomyart A … +6 more , Benjasirisan C, Phianhasin L, Kongkar R, Praha N, Adams J, El-Osta A
J Nurs Manag · 2026 · PMID 41943903 · Full text
BACKGROUND: The United Nations Sustainable Development Goals (SDGs) offer a comprehensive global framework for promoting health, equity, and sustainability. Whereas alignment with the SDGs is increasingly encouraged in a...
BACKGROUND: The United Nations Sustainable Development Goals (SDGs) offer a comprehensive global framework for promoting health, equity, and sustainability. Whereas alignment with the SDGs is increasingly encouraged in academic institutions, the extent to which faculty expertise in SDGs influences traditional research impact metrics remains insufficiently explored. OBJECTIVE: To investigate the relationship between nursing faculty expertise in SDGs and research impact metrics. METHODS: A retrospective cross-sectional design was employed using data from 121 nursing faculty members at Mahidol University, Thailand. Information on SDG-related expertise and research performance was obtained from the Mahidol University Research Excellence Database (MUREX) and Scopus. SDG expertise was operationalized using SDG alignment data derived from the Scopus Author Profile, which applies machine learning and keyword-based text mining to map publications to the 17 SDGs. Descriptive statistics, Pearson's correlation, and multiple linear regression analyses were used to examine associations between SDG expertise, academic experience, and research impact metrics, including H-index, citation count, and research output. Extreme Gradient Boosting (XGBoost) was applied as a complementary machine learning approach to identify influential features and potential nonlinear patterns, with the Synthetic Minority Oversampling Technique (SMOTE) used to address imbalance in categorical SDG expertise classes. RESULTS: Faculty members with greater expertise in SDGs demonstrated significantly higher research impact metrics. SDG expertise significantly predicted H-index (β = 0.65, p < 0.001), total citations (β = 31.78, p = 0.004), and total research output (β = 2.41, p < 0.001). Research experience was also a significant predictor of research impact. Machine learning analyses identified SDG expertise breadth and international collaboration as influential features, and faculty aligned with SDG13 (Climate Action) demonstrated a higher proportion of top-cited publications. CONCLUSION: SDG expertise is a key determinant of academic impact, reinforcing the need for greater institutional support for SDG-aligned research. Interdisciplinary collaboration and engagement with broader sustainability challenges may enhance faculty research visibility. Future research should explore longitudinal trends and policy implications for integrating SDGs into faculty assessment frameworks.
Seasonal and Regional Variations in Nursing Workload in French Intensive Care Units: A National Study Using the Nursing Activities Score.
Poiroux L, Blanchard PY, Caillet A … +3 more , Bruyneel A, Dauvergne JE, FNIR Study Group
J Nurs Manag · 2026 · PMID 41940789 · Full text
AIM: To compare intensive care unit (ICU) nursing workload between spring-summer and winter and to examine factors associated with workload variation across French regions. BACKGROUND: Critical care nursing workload is h...
AIM: To compare intensive care unit (ICU) nursing workload between spring-summer and winter and to examine factors associated with workload variation across French regions. BACKGROUND: Critical care nursing workload is high and may fluctuate with seasonal demand and regional ICU bed capacity, challenging fixed-staffing models. METHODS: Secondary analysis of two nationwide prospective cross-sectional surveys in French ICUs (April-July 2023; January-March 2024). Workload was measured using the Nursing Activities Score (NAS). Outcomes were NAS per patient, NAS per nurse, and NAS per nurse > 100%. ICU-level linear mixed models assessed associations with season and regional ICU bed availability (below, versus, at, or above the national mean), adjusting for ICU characteristics. RESULTS: Forty-three ICUs contributed 2703 nurses and 18,772 patient NAS assessments (8759 NAS per-nurse observations). At the individual level, median NAS per nurse was lower in spring-summer than in winter (124.3% vs. 127.1%; p value = 0.043), whereas NAS per patient was higher in spring-summer (61.3% vs. 59.4%; p < 0.001). The proportion of shifts with NAS per nurse > 100% was higher in winter (69.3% vs. 67.3%; p = 0.044), and the patient-to-nurse ratio was higher (2.06 ± 0.7 vs. 1.96 ± 0.7; p < 0.001). ICUs in regions with fewer ICU beds consistently showed higher NAS per nurse across seasons. In multivariable models, winter (β = 4.5, 95% CI: 2.3-6.7) and residence in under-resourced regions (β = 19.2, 95% CI: 5.9-32.5) were associated with higher NAS per nurse. CONCLUSIONS: ICU nursing workload varies by season and regional ICU bed capacity; baseline workload frequently exceeds 100%, limiting surge adaptability and exposing limits of fixed-staffing ratios. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers may rely on objective and longitudinal workload information to support sustainable decision-making in intensive care. Embedding indicators such as the NAS into staffing policies may facilitate anticipatory planning, reduce reactive staffing responses, and support patient safety and workforce stability.
Effects of Leader-Member Exchange Quality on the Internalization of Emotional Regulation: The Moderating Effect of Mentoring Functions.
Chu LC
J Nurs Manag · 2026 · PMID 41937482 · Full text
BACKGROUND: Research has indicated that the internalization of emotion regulation is an important process for promoting positive work outcomes among employees. In Taiwan nursing contexts, however, the collectivist cultur...
BACKGROUND: Research has indicated that the internalization of emotion regulation is an important process for promoting positive work outcomes among employees. In Taiwan nursing contexts, however, the collectivist culture and high power distance within the Chinese community, along with the hierarchical and highly structured nature of nursing work, are not conducive to the internalization of emotional regulation. This study was focused on exploring mechanisms or policies within hospitals that can improve the internalization of emotional regulation among nursing staff. This study examined how the quality of leader-member exchange (LMX) influences the internalization of emotional regulation and explored the moderating role of mentorship in this relationship. METHODS: A two-stage questionnaire survey was conducted to limit common method bias. Female nurses in a medical center in central Taiwan participated. The recruitment period for this study started in April 2020 and ended in June 2020. A total of 300 questionnaires were distributed at each stage, and 252 matched pairs of responses were retrieved (valid response rate = 84%). The proposed hypotheses were verified using hierarchical regression conducted with SPSS Version 25.0. RESULTS: The findings suggest that LMX quality positively influences the internalization of emotional regulation (β = 0.26, p < 0.01). Additionally, the results confirm that mentoring functions strengthen this positive relationship (β = 0.18, p < 0.01), highlighting their role as a moderating factor. CONCLUSIONS: This study confirmed that establishing high-quality LMX relationships can enhance the internalization of emotional regulation among female nursing staff. In addition, mentors can provide effective guidance and feedback, thereby improving the quality of LMX and their internalization of emotional regulation. Strengthening LMX relationships and establishing a comprehensive mentoring system are important for hospitals.
Negotiating the Unknown: Lessons Learned From Australian Healthcare Professionals Working Through the COVID19 Pandemic.
Byrne AL, Preston R, Calleja P … +8 more , Cameron D, George S, Munt R, Zupan B, Delport S, Jakimowicz S, Harvey C, Brown J
J Nurs Manag · 2026 · PMID 41928625 · Full text
AIM: To explore the experiences of healthcare professionals who worked in patient-facing roles during the pandemic. DESIGN AND METHODS: This study, conceptualized at the beginning of the pandemic response in Australia, a...
AIM: To explore the experiences of healthcare professionals who worked in patient-facing roles during the pandemic. DESIGN AND METHODS: This study, conceptualized at the beginning of the pandemic response in Australia, aimed to understand healthcare professionals' experiences regarding the professional and personal impacts of working through the COVID-19 pandemic. Nine healthcare professionals participated in semistructured interviews. Thematic analysis resulted in four themes. The COREQ checklist guided the process (see Supporting File 1). RESULTS: The overall themes included (1) Little Whispers, Moving into A Pandemic; (2) Confusion and Chaos; (3) Pushing Boundaries and Finding Ways of Coping; and (4) Stories of Trauma, Stories of Opportunity. Findings suggest that healthcare professionals were initially naïve about the significance of the pandemic and experienced increased feelings of vulnerability as its impact became clearer. A lack of consistent messaging was reported to increase feelings of confusion and chaos. CONCLUSION: To cope, healthcare professionals reported relying on each other and worked to identify innovative solutions to care. Stories highlight complex responses to the increased pressures and expectations of working through the pandemic, opening a space for future research. CONTRIBUTION TO NURSING: This study provides insight into the experiences of Australian healthcare professionals working directly with patients during the COVID-19 pandemic. The findings suggest that participants experienced feelings of vulnerability and fear as they grew to understand the risks of the pandemic. The findings from this study can contribute to lessons learned from the pandemic to enable preparedness for future pandemic responses. REPORTING METHOD: COREQ.
Factors Influencing Occupational Grief Among Pediatric Emergency and Intensive Care Unit Nurses in South China: A Cross-Sectional Study.
Liang Y, Jiang X, Peng Y … +7 more , Sun L, Liu H, Chen J, Zhou Y, Luo Y, Shi X, Yin C
J Nurs Manag · 2026 · PMID 41925127 · Full text
AIM: This study aimed to assess the level of occupational grief among pediatric emergency and intensive care unit nurses and identify the factors influencing it. DESIGN: Descriptive cross-sectional study. METHODS: Conduc...
AIM: This study aimed to assess the level of occupational grief among pediatric emergency and intensive care unit nurses and identify the factors influencing it. DESIGN: Descriptive cross-sectional study. METHODS: Conducted from March to May 2024, the study included 265 pediatric nurses from 13 tertiary hospitals in South China. Data were collected via electronic questionnaires, which encompassed sociodemographic questions, the Chinese Version of the Grief Traits and State Scale for Nurses (GSSNs), the Disenfranchised Grief Scale (DGS), the Chinese Version of the Professional Grief Support Scale for ICU Nurses (PGSS-INs), the Chinese Version of the Psychological Detachment Subscale, and the Chinese Version of the Psychological Resilience Scale. Descriptive statistics, t-tests, one-way ANOVA, Pearson correlation analysis, and multiple linear regression models were used. RESULTS: Occupational grief was found to be at a high level among the 265 pediatric nurses (mean score: 48.54 ± 9.458 and range: 17-85). Univariate analysis showed significant differences in grief scores based on age, religion, work experience, death education, end-of-life care education, and experienced the loss of a close friend or family member. Pearson correlation analysis found negative correlations between total occupational grief and psychological resilience, psychological detachment, competence in handling patient deaths, acceptance of patient deaths, and psychological preparedness for patient deaths and a positive correlation with disenfranchised grief. Multiple linear regression identified elderly age, lack of death education, personnel loss experience, higher disenfranchised grief, and lower acceptance of patient death as significant factors. CONCLUSION: Occupational grief in pediatric emergency and ICU nurses directly impacts mental health. Nursing managers should prioritize mental health, provide systematic death education, and establish psychological support interventions.
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