NURS 8114 Investigating a Critical Practice Question Through a Literature Review

NURS 8114 Investigating a Critical Practice Question Through a Literature Review

Part 2: Critical Assessment Paper

Nursing shortage is a significant clinical problem that has a considerable impact on the outcomes of patient care. It increases the workload for nurses and significantly lowers the safety and quality of patient care. Increasing work engagement among nurses has been proposed as an effective strategy that can help address the nursing shortage. Work engagement refers to a positive, fulfilling, work-related state of mind characterized by vigor, dedication, and absorption. My proposed critical question in relation to the nursing shortage is: “In hospitals experiencing nursing shortage, does increasing work engagement among registered nurses reduce their turnover rate in 12 months?” The purpose of this paper is to critically assess the search outcomes that synthesize the evidence from the literature review and discuss the need for a practice change initiative focusing on quality improvement.

 Bhatti et al. (2018) examined the mediating role of work engagement, that is, vigor and dedication, between job resources and job performance rated by the supervisor. The study found that work engagement mediated the relationship between job characteristics and nurses’ performance. Work engagement mediated the relationship between job security and the nurses’ job performance (Bhatti et al., 2018). Lack of job security among nurses leads to high turnover. From the article, we learn that it is essential that health organizations increase nurses’ work engagement to increase their work performance and improve their sense of job security. Health organizations can employ strategies to increase nurses’ vigor and dedication in their work, which will promote their sense of job security and, in turn, reduce high turnover (Bhatti et al., 2018). For instance, organizations and supervisors can increase nurse’s participation in decision-making and autonomy, which creates feelings of engagement and commitment with their work and organizations. The strategies can, in turn, create positive behavior and improved performance, and reduce nursing shortage.

Cao and Chen (2021) explored the relationships between resilience, empathy, compassion fatigue, work engagement, and turnover intention in Chinese hemodialysis nurses. Compassion fatigue had the greatest significant impact on turnover intention, followed by work engagement and resilience. In addition, work engagement was a negative and significant contributor to the intention to quit in HD nurses (Cao & Chen, 2021). It indicates that more nurses’ engagement in work is associated with a lower likelihood of leaving their present position. A high degree of compassion fatigue and low work engagement and resilience levels can result in higher turnover intention among nurses. Quality improvement to reduce nursing shortage can focus on strategies such as mindfulness-based intervention, resilience training programs, and establishing a positive work environment for nurses (Cao & Chen, 2021). These strategies can effectively reduce compassion fatigue, improve resilience, promote work engagement, and decrease turnover intention.

Cao et al. (2020) examined turnover intention among newly licensed registered nurses. The study evaluated the impact of organizational justice, work engagement, and nurses’ perception of care quality on turnover intention. Organizational justice was directly related to high work engagement, great nurses’ perception of care quality, and low turnover (Cao et al., 2020). Besides, the low turnover intention was partially mediated by work engagement. Improving organizational justice could improve work engagement and nurses’ perception of care quality. It can also reduce turnover intention, which is crucial to improving care quality and addressing the shortage of nurses. The article provides evidence for policymakers and leaders to implement targeted interventions to improve nurses’ work engagement, promote high-quality care, and create better strategies against losing nurses (Cao et al., 2020). Leaders should offer nurses fair opportunities for learning and personal growth and provide them with spiritual support and encouragement. The practice change can further improve nurses’ perceived care quality and professional confidence and ultimately their intention to stay, thus reducing turnover and nursing shortage.

De Simone et al. (2018) sought to analyze the role of self-efficacy, agentic capacities, job satisfaction, and work engagement on hospital turnover intention. The study revealed that job satisfaction, work engagement, self-efficacy, and agentic capacities were positively interrelated and negatively correlated with turnover intention. In addition, job satisfaction and work engagement had direct or indirect effects on nurses’ turnover intention (De Simone et al., 2018). The article confirms that nurses with higher job satisfaction, work engagement, and self-efficacy have less intention of changing hospitals. Hospital administrators and nurse managers should thus focus on interventions to increase job satisfaction, work engagement, and self-efficacy to promote nurses’ wellbeing.

The article enlightens us on the importance of managers implementing strategies to improve self-efficacy, self-regulation skills, work engagement, and job satisfaction. The strategies can reduce nurses’ turnover intention, nursing shortage, and burnout and increase patient satisfaction with nursing care (De Simone et al., 2018). Health organization leaders can increase nurses’ work engagement by acting on self-efficacy development through interventions to promote positive emotions and successful behaviors. They can also increase engagement by strengthening nurses’ motivation and directing their efforts towards professional goals.

García-Iglesias et al. (2020) examined the work engagement, psychosocial risks, and psychological wellbeing of Spanish nurses. The

study also analyzed existing relationships and their associations with self-reported mental health problems of nurses. According to the study findings, self-perceived health and vigor at work were identified as predictive factors of mental health. High levels of work engagement were associated with a low perception of psychosocial risks, which lowers the likelihood of psychosocial distress (García-Iglesias et al., 2020). Low levels of psychosocial distress were associated with low turnover rates. Since high nurses engagement was associated with reduced psychosocial distress, it is crucial that organizations implement strategies to increase nurses’ engagement levels to improve their mental health. A high level of mental wellbeing is associated with increased productivity, job motivation levels, and low turnover rates (García-Iglesias et al., 2020). Furthermore, managers should promote a healthy working environment for nurses to reduce psychosocial distress, reducing turnover rates and nursing shortages.

Ghazawy et al. (2021) examined nurses’ perception of work engagement to identify factors influencing nurses’ engagement with their work and determine factors predicting job performance and turnover intention in multiple hospitals. The study established that the workplace, availability of motives and incentives, and ability to make decisions were significant predictors of high work engagement levels among nurses (Ghazawy et al., 2021). Work engagement was associated with a considerable increase in job performance and turnover intention. Factors such as autonomy, skill variety, and performance feedback were positively and significantly correlated with work engagement (Ghazawy et al., 2021). When nurses’ work engagement is high, they perform better and have low turnover levels. Nurses’ intention to leave decreases when they are more engaged.

The article established that motives and incentives were positively associated with a higher level of work engagement. Leaders can reduce nursing turnover by providing the needed resources for nurses to perform their roles since they would be more engaged and committed to the organization (Ghazawy et al., 2021). Besides, nurses’ work engagement can be increased by offering them motives/incentives such as certificates in various specialties and encouraging them to make decisions in their job. There is a need for a practice change where nurses are given role identification rewards and promotional paths with continuous training to increase engagement (Ghazawy et al., 2021). Besides, nurse managers can consider redesigning the job task and strengthening nurses’ sense of belonging and commitment to increase engagement and reduce turnover.

Hetzel-Riggin et al. (2020) aimed to advance the understanding of burnout in the nursing profession. The study hypothesized three types of work engagement, vigor, dedication, and absorption in addition to resiliency, to mediate the relationship between work-related stress and burnout. The three types of work engagement and resiliency partially mediated the relationship between work-related stress and burnout (Hetzel-Riggin et al., 2020). Burnout in nurses was affected by these levels of work engagement and resiliency. We can conclude that work-related stress may lead to general disengagement and reduced persistence in the nursing profession. Work-related stress is associated with decreasing nurses’ ability to handle stress and remain dedicated to the profession, minimizing their sense of personal accomplishment on the job (Hetzel-Riggin et al., 2020). Factors contributing to burnout increase the chances for nursing turnover, thus exacerbating the nursing shortage. Quality improvement initiatives should focus on reducing occupational stress among nurses to increase their work engagement and, in turn, minimize nursing turnover.

Li et al. (2019) examined the relationship between work practice environment and turnover intention by considering the mediation of work engagement and the moderation of work pressure among community health nurses. The study established that the work practice environment was positively associated with higher work engagement and lower turnover intention (Li et al., 2019). Work engagement, to some degree, mediated the connection between the work practice environment and turnover intention.  Attainment of work goals can increase nurses’ confidence and enable them to realize the value in work, which would promote engagement and retain them in the organization (Li et al., 2019). Therefore, nurse managers working on quality improvement initiatives to reduce nursing shortage should develop retention schemes tailored to meet nurses’ career development and self‐wealth needs. The retention schemes can focus on empowerment, participative leadership style, providing an adequate material base, and training opportunities at work.

Tomietto et al. (2019) examined a model developed to assess the impact of work engagement on workability as perceived by nurses. The study also examined the parameters between workability and job satisfaction and between job satisfaction and turnover intention. The study confirmed an association between workability, job satisfaction, and turnover intention (Tomietto et al., 2019). Work engagement enhanced workability in the nursing profession. Besides, the study established that job satisfaction strongly impacts turnover intention, especially in nurses <45 years. Therefore, we can conclude that work engagement is a key determinant of workability, which influences job satisfaction, and job satisfaction influences turnover intention. In quality improvement initiatives, leaders need to enhance organizational strategies to sustain workability and improve nurses’ work engagement and job satisfaction (Tomietto et al., 2019).  Promoting workability is valuable in enhancing job satisfaction and in decreasing turnover intention in nurses. Consequently, nurse managers should design human resource management strategies to enhance work engagement and workability and ultimately reduce nursing turnover.

Wan et al. (2018) assessed turnover intention among experienced nurses and examined the effects of work environment, job characteristics, and work engagement on turnover intention. The study established that work environment was positively associated with higher work engagement and lower turnover intention. Work engagement, to some extent, mediated the relationship between the work environment and nursing turnover (Wan et al., 2018). Besides, job characteristics were positively related to higher work engagement and lower turnover intention. The working environment contributes to nursing engagement and turnover intention. Administrators should fulfill nurses’ learning, growth, and development needs by redesigning nursing work to increase engagement that subsequently keeps them in current practice (Wan et al., 2018). Quality improvement initiatives to retain nurses should focus on increasing work engagement by creating a supportive work environment. The initiatives should also improve job characteristics, particularly in the aspect of participation in hospital affairs and autonomy.

Important information for writing discussion questions and participation

Welcome to class

Hello class and welcome to the class and I will be your instructor for this course. This is a -week course and requires a lot of time commitment, organization, and a high level of dedication. Please use the class syllabus to guide you through all the assignments required for the course. I have also attached the classroom policies to this announcement to know your expectations for this course. Please review this document carefully and ask me any questions if you do. You could email me at any time or send me a message via the “message” icon in halo if you need to contact me. I check my email regularly, so you should get a response within 24 hours. If you have not heard from me within 24 hours and need to contact me urgently, please send a follow up text to

I strongly encourage that you do not wait until the very last minute to complete your assignments. Your assignments in weeks 4 and 5 require early planning as you would need to present a teaching plan and interview a community health provider. I advise you look at the requirements for these assignments at the beginning of the course and plan accordingly. I have posted the YouTube link that explains all the class assignments in detail. It is required that you watch this 32-minute video as the assignments from week 3 through 5 require that you follow the instructions to the letter to succeed. Failure to complete these assignments according to instructions might lead to a zero. After watching the video, please schedule a one-on-one with me to discuss your topic for your project by the second week of class. Use this link to schedule a 15-minute session. Please, call me at the time of your appointment on my number. Please note that I will NOT call you.

Please, be advised I do NOT accept any assignments by email. If you are having technical issues with uploading an assignment, contact the technical department and inform me of the issue. If you have any issues that would prevent you from getting your assignments to me by the deadline, please inform me to request a possible extension. Note that working fulltime or overtime is no excuse for late assignments. There is a 5%-point deduction for every day your assignment is late. This only applies to approved extensions. Late assignments will not be accepted.

If you think you would be needing accommodations due to any reasons, please contact the appropriate department to request accommodations.

Plagiarism is highly prohibited. Please ensure you are citing your sources correctly using APA 7th edition. All assignments including discussion posts should be formatted in APA with the appropriate spacing, font, margin, and indents. Any papers not well formatted would be returned back to you, hence, I advise you review APA formatting style. I have attached a sample paper in APA format and will also post sample discussion responses in subsequent announcements.

Your initial discussion post should be a minimum of 200 words and response posts should be a minimum of 150 words. Be advised that I grade based on quality and not necessarily the number of words you post. A minimum of TWO references should be used for your initial post. For your response post, you do not need references as personal experiences would count as response posts. If you however cite anything from the literature for your response post, it is required that you cite your reference. You should include a minimum of THREE references for papers in this course. Please note that references should be no more than 5 years old except recommended as a resource for the class. Furthermore, for each discussion board question, you need ONE initial substantive response and TWO substantive responses to either your classmates or your instructor for a total of THREE responses. There are TWO discussion questions each week, hence, you need a total minimum of SIX discussion posts for each week. I usually post a discussion question each week. You could also respond to these as it would count towards your required SIX discussion posts for the week.

I understand this is a lot of information to cover in 5 weeks, however, the Bible says in Philippians 4:13 that we can do all things through Christ that strengthens us. Even in times like this, we are encouraged by God’s word that we have that ability in us to succeed with His strength. I pray that each and every one of you receives strength for this course and life generally as we navigate through this pandemic that is shaking our world today. Relax and enjoy the course!

Hi Class,

Please read through the following information on writing a Discussion question response and participation posts.

Contact me if you have any questions.

Important information on Writing a Discussion Question

• Your response needs to be a minimum of 150 words (not including your list of references)
• There needs to be at least TWO references with ONE being a peer reviewed professional journal article.
• Include in-text citations in your response
• Do not include quotes—instead summarize and paraphrase the information
• Follow APA-7th edition
• Points will be deducted if the above is not followed

Participation –replies to your classmates or instructor

• A minimum of 6 responses per week, on at least 3 days of the week.
• Each response needs at least ONE reference with citations—best if it is a peer reviewed journal article
• Each response needs to be at least 75 words in length (does not include your list of references)
• Responses need to be substantive by bringing information to the discussion or further enhance the discussion. Responses of “I agree” or “great post” does not count for the word count.
• Follow APA 7th edition
• Points will be deducted if the above is not followed

• Remember to use and follow APA-7th edition for all weekly assignments, discussion questions, and participation points.
• Here are some helpful links
• The is a great resource

Conclusion

Nurses engaged in their work have high levels of energy, are enthusiastic about their work, and are completely immersed in their work activities.  The literature review confirms that increasing nursing engagement is associated with increased job satisfaction and reduced turnover. The reviewed articles established that nurses engaged in their job and given autonomy had higher job satisfaction levels reduced intention to leave. The findings can be applied in the clinical setting to address nursing shortage by promoting nurses’ work engagement, improving their work environment, and enhancing their job characteristics. Nurse managers who implement strategies to achieve these factors are likely to experience reduced turnover and nursing shortages in their organizations. The articles support my critical question that hospitals experiencing nursing shortages can increase work engagement among registered nurses to reduce their turnover rate.

References

Bhatti, M. A., Mat, N., & Juhari, A. S. (2018). Effects of job resources factors on nurses job performance (mediating role of work engagement). International journal of health care quality assurance. https://doi.org/10.1108/IJHCQA-07-2017-0129

Cao, X., & Chen, L. (2021). Relationships between resilience, empathy, compassion fatigue, work engagement and turnover intention in hemodialysis nurses: A cross‐sectional study. Journal of Nursing Management. https://doi.org/10.1111/jonm.13243

Cao, T., Huang, X., Wang, L., Li, B., Dong, X., Lu, H., … & Shang, S. (2020). Effects of organizational justice, work engagement and nurses’ perception of care quality on turnover intention among newly licensed registered nurses: a structural equation modeling approach. Journal of clinical nursing, 29(13-14), 2626-2637. https://doi.org/10.1111/jocn.15285

De Simone, S., Planta, A., & Cicotto, G. (2018). The role of job satisfaction, work engagement, self-efficacy and agentic capacities on nurses’ turnover intention and patient satisfaction. Applied Nursing Research, 39, 130-140. https://doi.org/10.1016/j.apnr.2017.11.004

García-Iglesias, J. J., Gómez-Salgado, J., Ortega-Moreno, M., & Navarro-Abal, Y. (2020). Relationship between work engagement, psychosocial risks, and mental health among Spanish nurses: A cross-sectional study. Frontiers in public health, 8, 1087. https://doi.org/ 10.3389/fpubh.2020.627472

Ghazawy, E. R., Mahfouz, E. M., Mohammed, E. S., & Refaei, S. A. (2021). Nurses’ work engagement and its impact on the job outcomes. International Journal of Healthcare Management, 14(2), 320-327. https://doi.org/10.1080/20479700.2019.1644725

Hetzel-Riggin, M. D., Swords, B. A., Tuang, H. L., Deck, J. M., & Spurgeon, N. S. (2020). Work engagement and resiliency impact the relationship between nursing stress and burnout. Psychological Reports, 123(5), 1835-1853. https://doi.org/10.1177/0033294119876076

Li, B., Li, Z., & Wan, Q. (2019). Effects of work practice environment, work engagement and work pressure on turnover intention among community health nurses: mediated moderation model. Journal of advanced nursing, 75(12), 3485-3494. https://doi.org/10.1111/jan.14130

Tomietto, M., Paro, E., Sartori, R., Maricchio, R., Clarizia, L., De Lucia, P., … & PN Nursing Group. (2019). Work engagement and perceived workability: an evidence‐based model to enhance nurses’ wellbeing. Journal of advanced nursing, 75(9), 1933-1942. https://doi.org/10.1111/jan.13981

Wan, Q., Li, Z., Zhou, W., & Shang, S. (2018). Effects of work environment and job characteristics on the turnover intention of experienced nurses: The mediating role of work engagement. Journal of Advanced Nursing, 74(6), 1332-1341. https://doi.org/10.1111/jan.13528

Name: NURS_8114_Module4_Assignment_Rubric