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The purpose of the study was to explore in literature what different leadership styles and behaviors of head nurses have a positive influence on the outcomes of patient safety or quality of care.

We reviewed the literature from January 2000 until September 2011. We searched Pubmed, Embase, Cinahl, Psychlit, and Econlit.

We found 10 studies addressing the relationship between head nurse leadership and safety and quality. A wide array of styles and practices were associated with different patient outcomes. Transformational leadership was the most used concept in the studies. A trend can be observed over these studies suggesting that a trustful relationship between the head nurse and subordinates is an important driving force for the achievement of positive patient outcomes. Furthermore, the effects of these trustful relationships seem to be amplified by supporting mechanisms, often objective conditions like clinical pathways and, especially, staffing level.

This study offers an up-to-date review of the limited number of studies on the relationship between nurse leadership and patient outcomes. Although mostly transformational leadership was found to be responsible for positive associations with outcomes, also contingent reward had positive influence on outcomes. We formulated some comments on the predominance of the transformational leadership concept and suggested the application of complexity theory and political leadership for the current context of care. We formulated some implications for practice and further research, mainly the need for more systematic empirical and cross cultural studies and the urgent need for the development of a validated set of nurse-sensitive patient outcome indicators.

Federal and state governments collaborate on state Medicaid nursing facility long-term care (SMNF-LTC) programs. These programs are increasingly expensive as the baby-boomers retire. Yet serious resident outcome problems continue in spite of the Centers for Medicare and Medicaid Services’ (CMS) extensive process-focused regulatory efforts. This study identifies a promising and simpler auxiliary path for improving resident outcomes.

Drawing on a longitudinal (1997–2005), 48-state data set and panel-corrected, time-series regression, we compare the effects on resident outcomes of CMS process-focused surveys and four minimally regulated program structural features on which the states vary considerably.

We find that each of these four structural features exerts a greater effect on resident outcomes than process quality.

We suggest augmenting current process-focused regulation with a less arduous approach of more extensive regulation of these program features.

To date SMNF-LTC program regulation has focused largely on member facility processes. While regulating processes is appropriate, we show that regulating program structural features directly, an arguably easier task, might well produce considerable improvement in the quality of resident outcomes.

Recent New Zealand reports have identified the nursing workforce for its potential to make a significant contribution to increased productivity in health services. The purpose of this paper is to review critically the recent and current labour approaches to improve nursing productivity in New Zealand, in a context of international research and experience.

An examination of government documents regarding productivity, and a review of New Zealand and international literature and research on nursing productivity and its measurement form the basis of the paper.

It is found that productivity improvement strategies are influenced by theories of labour economics and scientific management that conceptualise a nurse as a labour unit and a cost to the organisation. Nursing productivity rose significantly with the health reforms of the 1990s that reduced nursing input costs but impacts on patient safety and nurses were negative. Current approaches to increasing nursing productivity, including the “productive ward” and reconfiguration of nursing teams, also draw on manufacturing innovations. Emerging thinking considers productivity in the context of the work environment and changing professional roles, and proposes reconceptualising the nurse as an intellectual asset to knowledge‐intensive health organisations.

Strategies that take a systems approach to nursing productivity, that view nursing as a capital asset, that focus on the interface between nurse and working environment and measure patient and nurse outcomes are advocated.

The paper shows that reframing nursing productivity brings into focus management strategies to raise productivity while protecting nursing and patient outcomes.

The purpose of this paper is to develop a nursing quality indicator (NQI) framework and provide a comprehensive reporting mechanism for nursing care.

Mixed method, including patient records audit, patient experience questionnaire, nurse self-report questionnaire and collecting ward-level information. The sample was 53 patients and 22 nurses.

Outputs from the NQI framework domains offer a more comprehensive understanding of nursing quality compared to when domains are analysed separately. The NQI framework also provides a more inclusive mechanism for assuring nursing care.

Sample size was limited to 53 English-speaking patients who consented to participating in the study.

One design strength was the ability to describe individual patient care across the four domains and subsequently show relationships between nursing knowledge, nursing interventions and patient outcomes/experiences. Additionally, corroborated information from three sources (documentation review, patient and nurse responses) strengthened the conclusion that the NQI framework could provide more comprehensive assurances on nursing quality and identify care improvements.

The study purpose was to assess the evidence on the effects of hospital restructuring that included layoffs, on nurses who remained employed, using a systematic review of the research literature to contribute to policy formation. Papers addressing research, hospital restructuring resulting in layoffs, effects on nurses, and a stated relationship between the independent and dependent variables were included. Data were extracted and the quality of each study was assessed. The final group of included studies had 22 empirical papers. The main effects were significant decreases in job satisfaction, professional efficacy, ability to provide quality care, physical and emotional health, and increases in turnover, and disruption to healthcare team relationships. Nurses with fewer years of experience or who experienced multiple episodes of restructuring experienced greater effects. Other findings remain inconclusive. Further research is required to determine if these effects are temporal or can be mitigated by individual or organizational strategies.

This paper aims to present an integrative review of the research studies on nursing unit layouts.

Studies selected for review were published between 1956 and 2014. For the purpose of this review, a framework for integrative review was developed using research orientations. The three primary dimensions – technical, psychological and social – of the designed environment and various combinations of these dimensions were used to define the research orientations of these studies.

Of all the publications reviewed for the paper, 21 presented technical orientations, 16 psychological orientations, 3 social orientations, 20 psychotechnical orientations, 10 sociotechnical orientations, 2 psychosocial orientations and 13 presented psychosociotechnical orientations. With only a few exceptions, several issues related to nursing unit layouts were investigated no more than one time in any one category of research orientations. Several other seemingly important issues including patient and family behavior and perception, health outcomes and social and psychosocial factors in relation to unit layouts have not been studied adequately.

Future studies on nursing unit layouts will need to focus on patient and family behavior and perception, health outcomes and social and psychosocial factors in different units. They will also need to focus on developing theories concerning the effects of layouts on the technical, psychological and social dimensions of nursing units.

Despite a long history of research on nursing unit layouts, an integrative review of these studies is still missing in the literature. This review fills in the gap using a novel framework for integrative review developed based on research orientations.

The purpose of this paper is to explore the influence of peer mentoring on critical care nursing students’ learning outcomes in critical care units.

A qualitative exploratory research design was used to conduct the study. Ten critical care nursing students were recruited from critical care units in the five private and two public hospitals. Descriptions of their experiences were gained through individual face-to-face interviews.

The study reinforces peer mentoring as a vital strategy in helping the critical care nursing students to attain their learning outcomes. However, peer mentoring was not consistent in all hospitals and there were no structured support systems to ensure that peer mentoring was formalized. Making peer mentoring a vital component in the registered nurses core competencies would enable efficiency and guarantee the viability of peer mentoring.

Mentors for the critical care nursing students were not included in the study.

The study identified a need for incorporating a formalized mentorship programme into the core competencies of all qualified critical care nurses, the unit mentor to familiarise themselves with the prescribed learning objectives of the critical care nursing student and an allocation of supernumerary time for the critical care nursing student and mentors to allow for formal mentoring responsibilities to take place.

The study reinforces peer mentoring as a vital strategy in helping the critical care nursing students to attain their learning outcomes and conscietises registered nurses of their responsibility as mentors.

Background – Reliable and valid hospital nurse staffing measures are a major requirement for health services research. As the use of these measures increases, discussion is growing as to whether current nurse staffing measures adequately meet the needs of health services researchers.

Objective – This study assesses whether the measures, sampling frameworks, and data sources meet the needs of health services research in areas such as staffing assessment; patient, nurse, and financial outcomes; and prediction of staffing.

Methods – We performed a systematic review of articles from 1990 through 2007, which use hospital nurse staffing measures in original research, or which address the validity, reliability, and availability of the measures. Taxonomies of measures, sampling frameworks, and sources were developed. Articles were analyzed to assess what measures, sampling strategies, and sources of data were used and to ascertain whether the measures, samples, and sources meet the needs of researchers.

Results – The review identified 107 articles that use hospital nurse staffing measures for original research. Multiple types of measures, some of which are used more often than others and some of which are more valid than others, exist in each of the following categories: staffing counts, staffing/patient load ratios, and skill mix. Sampling frameworks range from hospital units to all hospitals nationally, with all hospitals in a state being the most common. Data sources range from small-scale surveys to national databases. The American Hospital Association Annual Survey is the most frequently used data source, but there are limitations with its nurse staffing measures. Arguably, the multiplicity of measures and differences in sampling and data sources are due, in part, to data availability. The limitations noted by other researchers and by this review indicate that staffing measures need improvements in conceptualization, content, scope, and availability.

Discussion – Recommendations are made for improvements to research and administrative practice and to data.

The purpose of this paper is to examine the reasons given by nurses for working part-time; compare the work experiences, satisfactions, and psychological well-being of nursing staff working full-time vs part-time; and identify possible antecedents and sources of leverage to encourage part-time nurses to work full-time.

An online survey was developed, pre-tested and validated, and sent to the regional associations of nurses in Spain for distribution to their members. Data collection involved a cross-sectional design. A total of 2,094 valid questionnaires were completed online. The majority of responding nurses were located in Catalunya and Gipuzkoa. Respondents were given 15 reasons and asked to indicate the extent to which each played a role in their decision to work part-time. Job context and job content scales bearing multi items reliable measures were also employed. All scales met the criteria of reliability.

Nurses working full-time included more males, were older, had longer nursing experience (both job and unit tenure), reported higher levels of both job resources (autonomy, self-development opportunities), higher levels of positive work attitudes (job involvement, affective commitment, work engagement), more medication use, and a higher intention to quit. Full-time and part-time nursing staff were similar on marital status, levels of social support (supervisor, co-worker, spouse, and family), self-reported absenteeism, levels of burnout, levels of psychological well-being (psychosomatic symptoms, self-reported health), and potential accident propensity. Some of the more concrete results include: first, reasons for working part-time were varied with some being voluntary (going to school) and others involuntary (poor health). Second, different clusters of individuals likely exist (e.g. students, caretakers, transitioning to retirement or other career options). Third, part-time nursing staff tended to report a more negative workplace (less autonomy, fewer opportunities for self-development) and less favorable work attitudes (less engagement, job involvement, and affective commitment) than their full-time counterparts.

First, all data were collected using self-report questionnaires, raising the possibility of response set tendencies. Second, all data were collected at one point in time, making it difficult to determine cause-effect relationships. Third, although the sample was very large, it was not possible to determine its representativeness or a response rate given the data collection procedure employed. Fourth, the large sample size resulted in relatively small mean differences reaching levels of statistical significance. Fifth, many of the nurse and work/organizational outcomes were themselves significantly correlated inflating the number of statistically significant relationships reported. Finally, it is not clear to what extent the findings apply to Spain only.

Health care organizations interested in encouraging and supporting part-time nursing staff to consider working full-time may have some sources of leverage. Part-time nursing staff indicated generally lower levels of commitment involvement and engagement compared to their full-time colleagues. Part-time nursing staff in this study reported lower levels of job resources, such as autonomy and self-development opportunities. Increasing nursing staff input into decision making, increasing levels of nursing staff empowerment, increasing supervisory development that in supporting and respecting the nursing staff contributions, reducing levels of workplace incivility, and improving nursing work team functioning would make the work experiences of part-time nursing staff more meaningful and satisfying. In addition, offering more flexible work schedules and tackling the stereotype associated with working only part-time would also address factors associated with working part-time. A more long-term strategy would involve enhancing both the psychological and physical health of nursing staff through the introduction of a corporate wellness initiative. Increasing the work ability of nursing staff by improving their psychological and physical well-being addresses a common factor in the part-time work decision.

There is a call in the paper for Spanish authorities to consider implementing the “Magnet hospital program” which is one model that has been shown to improve nurse and patient outcomes and is one solution to the shortage of hospital nurses in attracting them to work on a full-time basis. The process of Magnet recognition involves implementing 14 evidence-based standards.

Experts claim that the part-time phenomenon is a growing trend and is there to stay. The authors still do not know sufficiently about the HR implications for having a large workforce of part-time employees. In this paper, a tentative attempt was made to better understand this phenomenon, especially when there is a shortage of qualified nurses in the health sector. Several promising research directions follow from this investigation. First, nurses working part-time need to be polled to identify factors that would encourage and support them should they desire to change to full-time work. Second, the authors learn more about the relatively low levels of involvement, commitment, and engagement of part-time nurses, a phenomenon that most organizations wish to minimize.

This study aims to test a model examining the impact of leader empowering behaviour on experienced nurses’ self-efficacy, interprofessional collaboration, job turnover intentions and adverse patient outcomes.

Structural equation modelling in Mplus was used to analyse cross-sectional survey data from experienced nurses in Alberta, Ontario, and Nova Scotia, Canada (n = 478).

The results supported the hypothesized model: (164) = 333.021, p = 0.000; RMSEA = 0.047; CFI = 0.965; TLI = 0.959; SRMR = 0.051. Indirect effects were observed between leader empowering behaviour and nurses’ assessment of adverse events and leader empowering behaviour and nurses’ job turnover intentions through interprofessional collaboration.

Leader empowering behaviour plays a role in creating collaborative conditions that support quality patient care and the retention of experienced nurses.

The findings will be of interest to academic and hospital leaders as they consider strategies to retain experienced nurses, such as nurse manager selection, development and performance management systems.

The influx of new graduate nurses to the nursing profession and changing models of care requires the retention of experienced nurses in the workforce. The findings suggest that leader empowering behaviour and interprofessional collaboration are important factors in supporting quality patient care and stabilizing the nursing workforce.