Organizations assist employees to deal effectively with demanding work and the work environment, including their personal problems, through an Employee Assistance Programme (EAP). The essence of the EAP is the application of knowledge about behaviour and behavioural health to make accurate assessments, followed by appropriate action to improve the productivity and healthy functioning of the employees. According to the report from the Employee Wellness Directorate of the Eastern Cape, the Employee Assistance Programme Practitioners saw 576 employees in 2010. These statistics only represent a few districts in the Eastern Cape as some districts do not have Employee Assistance Practitioners offering employee assistance, hence this number could be higher. In some instances employees do self-referral, which may increase the number without the managers knowing who is utilizing the EAP. This makes it difficult for the managers to monitor such employees and the effectiveness of the intervention rendered. Managers refer employees but do not have control over whether employees made use of the EAP and on the progress in sessions as they do not always receive the feedback. The Employee Assistance counsellor may receive a written referral from the nursing manager and then consults the referred employee in private. The employee gives consent and then the EAP counsellor addresses the problem at hand. If it is a complex case needing expert intervention arrangements are made. If the intervention requires follow up sessions, the EAP counsellor makes the necessary arrangements through the referring manager until the problem is resolved. The EAP counsellor monitors the employee and asks the manager to support the employee without divulging details of the problem that was being addressed. However, the Nursing Managers do not know how effective the programme is and whether the employees benefit from the use. The above-mentioned problem led the researcher to ask the following questions: • What are the perceptions that Nurse Managers in the Department of Health in the Eastern Cape Province have of the effectiveness of the Employee Assistance Programme? • How can Nurse Managers optimize employees’ use of the EAP? The goal of this study was to identify the perceptions of Nurse Managers of the Employee Assistance Programme in order to determine how the programme’s use can be optimized. The researcher used a qualitative, explorative, descriptive and contextual design. The research population was selected purposively and included the Nursing Managers in the Department of Health in the Chris Hani District, Eastern Cape, who have referred employees to the Employee Assistance Programme. Semi-structured interviews were used during the data gathering process. Interviews were conducted at a venue convenient to the participants. Open-ended questions were asked to enable participants to express their perceptions on the topic. The researcher also used observation and field-notes to ensure that the data gathering provided rich information. The data was analysed using Tesch’s method of data analysis. Trustworthiness was ensured by using Guba’s model of trustworthiness. The ethical strategies of informed consent, confidentiality and anonymity, avoidance of harm and voluntary participation were ensured. Two themes emerged from the data analysis. Theme one showed that the participants had contrasting perceptions regarding the effectiveness of the current Employee Assistance Programme. Some felt that they have benefitted from the programme while others felt differently. Theme two described the participants’ views elated to improving the utilization of the EAP. Positive and negative factors that impacted on the implementation of EAP have been identified. Results show that both the employer and the employees could benefit if EAP is well implemented. Decentralization of EAP could be very cost effective and could save the employer thousands of rands because resources would be utilized better.

Nurse managers are essential in providing safe and effective patient care. The nurse manager position is a professional role necessary for the overall success of a hospital, clinic, or home health agency. The national education minimum for the initial entry to practice for registered nurses in the United States varies from diploma-training school to collegiate education at Associate, Bachelor, and Masters levels. Other professional healthcare workers need a Doctoral degree upon entry into practice. Nurse managers who lead multidisciplinary teams of other professionals are not required to achieve higher academic credentials in the United States beyond the initial entry to practice minimum. This study examined the relationships among nurse manager education levels, leadership style, and empowerment. It explored how the nurse managers' levels of education and empowerment correlate to the patient safety chain of transformational leadership that leads to a safety culture. Additionally, the variable Magnet designation was examined. The investigation was an observational one-sample study design (N = 142). An electronic survey was used to assess perceived leadership style, empowerment, and safety culture. Data were collected on professional social media platforms, including LinkedIn. Additionally, Nurse managers at the 2022 ANCC Magnet/Pathways Conference were approached to complete the online survey. The investigation results suggest that education does not influence leadership style or empowerment; however, this study's findings suggest that nurse managers with an undergraduate degree are significantly more effective in their leadership abilities than nurse managers with graduate degrees (p =.036). In this investigation, Doctoral-prepared nurse managers were more likely to use a transactional form of leadership than Bachelor or Masters prepared nurse managers (p = .029). The participants' empowerment levels were lower than in similar nurse manager studies before 2020. This finding may be a post-pandemic symptom. Moreover, nurse managers who work in Magnet–designated facilities are more likely to perceive their work environment as safe (p = .006). Magnet status was additionally associated with nurse managers' ability to create success and influence their team (p = .037). The ANCC Magnet and Pathways Programs may blueprint an effective, safe nursing service.

Educating staff nurses is pivotal in the evolving healthcare environment. Two staff development models used in the healthcare setting are unit-based and centralized. Unit-based education is a staff development model that places educators on individual units. These educators direct the educational development of staff nurses on their assigned units. Centralized education meets generalized learning needs and provides nursing departments with scheduled education sessions or impromptu meetings regarding changes to policies and procedures. In addition, centralized educators are assigned to address the learning needs of the nurses on several units with universal orientation (Cummings & McCaskey, 1992), coordinate and implement intravenous and blood transfusion therapy courses, physical assessment courses, professional update programs, and universal workshops and conferences (Cummings & McCaskey, 1992). In contrast, unit-based educators are more familiar with the unit's practices and staff nurses while providing more individualized staff education than the centralized model. This research was conducted to explore the association between the type of staff development model and staff nurses' evaluations of their clinical educators, their anxiety, and their clinical reasoning. The researcher used a quantitative descriptive comparative, cross-sectional, intact group design. The sample included staff nurses (N = 86) from a tertiary care medical center in New York City. The staff nurses were from two units with a unit-based educator and two units with a centralized educator. Data were collected from the first week of September 2022 to the first week of December 2022. Two reports are described below that are based on this research, which included administering four different scales. Not all respondents completed all four scales. The first report concerns the findings on two instruments that measured the staff nurses' evaluation of clinical educators. The Clinical Educator Evaluation Questionnaire (CEEQ), developed for this study, measured nurses' perceptions of the extent to which their staff educators' methods were consistent with Malcolm Knowles's Adult Learning Theory. The Nursing Clinical Teacher Effectiveness Inventory (NCTEI) measured staff nurses' perceptions of their current staff educators as clinical educators. An exploratory factor analysis was conducted on the CEEQ questionnaire developed by the researcher, a Pearson’s correlation analysis between the two surveys, the CEEQ and the NCTEI, and a Chi-square analysis and independent t test was conducted to compare demographic variable among the unit-based and centralized education groups was also conducted. In addition, differences between group responses for independent sample comparisons were examined using t tests. There were significant differences between the groups, t(100) = 3.31, p = .001, on the CEEQ. The 59 participants in the unit-based group scored higher (M = 119.76, SD = 19.62) than the 43 participants in the centralized group (M = 106.86, SD = 19.17) on perceptions of their instructors' methods as consistent with the adult learning theory. The groups also differed on the perceived effectiveness of their nurse educators as clinical instructors, t(94) = 2.66, p = .009, on the NCTEI. The 55 participants who represented the unit-based group (M = 250.5, SD = 70.34) had higher means than the 41 participants in the centralized group (M = 212.8, SD = 66.14). The second report concerns staff nurses' anxiety during staff education as measured using the State Anxiety Inventory (SAI) and staff nurses' self-report of their clinical reasoning as measured by the Nurses Clinical Reasoning Scale (NCRS). Differences between the group responses for independent sample comparisons were examined using t tests. The anxiety of the 48 participants in the unit-based group (M = 35.7, SD = 11.47) was compared to the anxiety of the 38 participants in the centralized group (M = 37.2, SD = 11.35). No statistically significant differences were found, t(84) = -.633, p = .528. Similarly, there was no significant difference between the groups on the NCRS, t(85) = -.188, p = .852. The 48 participants who represented the unit-based group (M = 59.1, SD = 6.61) did not differ from the 39 participants in the control group (M = 59.3 SD = 6.80) on clinical reasoning. Findings showed that the staff nurses evaluated the unit-based educators more highly but that the two models did not differ regarding their effects on anxiety and clinical reasoning. This is the first study to examine staff nurses’ evaluations of their clinical educators. Findings indicate that staff nurses reported more effectiveness for unit-based educators than centralized educators regarding practices that aligned with Malcolm Knowles’s Adult Learning Theory. In addition, this is also the first research study to examine the relationships of staff development models to anxiety and clinical reasoning during staff education. Although the two models did not differ on their effect on anxiety and clinical reasoning, additional research is recommended to explore other variables that may further justify the investment in unit-based education.

Indiana University-Purdue University Indianapolis (IUPUI) / The Bureau of Labor Statistics projected a shortage of registered nurses (RNs) growing to an estimated 581,500 by the year 2025 (an increase of 22 percent since 2008). Recent economical downturns have found many healthcare organizations experiencing a positive effect with the stabilization of nursing turnover. Once the economy begins to recover, however, experts predict the profession of nursing will still face the largest shortage in history according to projections by the American Nurses Association. Because lack of job satisfaction is a precursor to resignation, additional research regarding the identification of interventions that increase RN job satisfaction may result in retaining professionally qualified and prepared staff. This study proposed to identify through focus groups, staff nurse perceptions of nurse manager behaviors that influence RN staff nurse job satisfaction. A sample of 28 RNs, each participating in one of five focus groups, answered questions related to satisfaction with nurse manager behaviors. The investigator used qualitative content analysis to identify patterns within and across focus group data. Major findings of the study resulted in the identification of two conceptual categories (manager behaviors supportive of RNs and RN’s perceived disconnect of work issues from the manager’s role) and three major themes related to supportive behaviors (communication, respect, and feeling cared for). The results suggest the following as staff nurse preferences for nurse manager behaviors: open and honest communication that involves listening, consistency, and confidentiality; an increased level of respect including fairness and recognition of a job well done; and the sense of feeling cared for as when a manager meets individual needs and supports staff as professionals. The investigator compared the categories and themes to previous tools used in healthcare, which indicate the need for further item and/or tool development as well as further research regarding RNs’ perceived disconnect of work issues from the manager’s role.

Chemical dependency in the health profession is a growing concern. With easy access to controlled substances, many nurses divert prescription drugs and even work while under the influence. Nurses who are under the influence and working with patients are an obvious public hazard. Many states in the USA have non-punitive programs to offer recovery to nurses with chemical dependency and return them to work. In California this program is named the Diversion Program. Part of the requirements of successful completion of the Diversion Program is to attend weekly meetings called support groups. These support groups are facilitated by other nurses experienced in the field of chemical dependency. This study explored the experiences of nurse facilitators of support groups for nurses with chemical dependency in the California, USA, Diversion Program. Data were collected through twelve individual interviews selected through purposeful, non-probability convenience sampling. A phenomenological research design was used that was descriptive, explorative, and contextual. The data analysis revealed four major themes: (1) experience of communication within the Diversion Program; (2) experience of the structure of the Diversion Program; (3) experience of their role within the Diversion Program; and (4) experience of facilitation of support groups. The study revealed that even though many of the nurse facilitators‟ experiences were positive with respect to the support groups they expressed concern about the communication patterns within the Diversion Program. To offer support for the nurse facilitators, guidelines and a conceptual framework were created to enhance their experience and mitigate their feelings of marginalization from the Diversion Program. / Health Studies / D.Litt. et Phil. (Health Studies)

The aim of this study was to investigate the role of the ward manager in creating a conducive clinical learning environment for nursing students. An explorative descriptive research method was employed. Findings reveal that the ward managers are generally satisfied with the way in which they handled the important role they play in facilitating teaching and learning for nursing students. They feel strongly, however, that the nursing students themselves need to be active in the learning process. While acknowledging the efforts of the ward managers in creating and maintaining the learning environment, nursing students were dissatisfied about several aspects that appeared to be lacking in the clinical environment, such as good interpersonal relations, support, exposure to practice administrative skills (for example, problem-solving and decision-making) and lack of feedback about their performance. There appears to be a need to develop more effective support structures within the learning environment so that nursing students can obtain sufficient exposure to learning opportunities. / Health Studies / M.A. (Advanced Nursing Sciences)

This study investigated relationships among hardiness, stress, and coping strategies among mid-level nurse managers in hospitals. Coping strategies were hypothesized to be positively related to stress. In addition, hardiness and its components were hypothesized to be positively related to stress and coping strategies. Demographics were hypothesized to be unrelated to stress, hardiness, and coping strategies. Both hardiness and coping strategies were hypothesized to be predictors of stress. Pearson correlation coefficients, multiple regression, and linear regression were used in data analysis. Stress was associated with specific coping strategies viz., confrontation, selfcontrolling, accepting responsibility, and escape-avoidance. High hardiness, particularly commitment and challenge, was associated with low levels of stress and with problemfocused coping strategies. By contrast, low hardiness was associated with high stress and use of emotion-focused strategies. Significant demographics, when compared to study variables, included age, experience, time with supervisors, number of direct reports, highest degrees obtained, and formal or informal higher education in management. Young nurse managers who were less experienced in nursing and management, and who had fewer direct reports, reported the highest stress levels among nurse managers. High hardiness, particularly commitment, was a strong predictor of low levels of stress; use of escape-avoidance was a significant predictor of occupational stress. This study supported the theoretical suppositions of lower stress if hardiness and specific coping strategies are high among mid-level nurse managers. Potential exists for work-related stress to be reduced by increasing hardiness and adaptive coping strategies. Implications for higher education research and practice are discussed.

Chemical dependency in the health profession is a growing concern. With easy access to controlled substances, many nurses divert prescription drugs and even work while under the influence. Nurses who are under the influence and working with patients are an obvious public hazard. Many states in the USA have non-punitive programs to offer recovery to nurses with chemical dependency and return them to work. In California this program is named the Diversion Program. Part of the requirements of successful completion of the Diversion Program is to attend weekly meetings called support groups. These support groups are facilitated by other nurses experienced in the field of chemical dependency. This study explored the experiences of nurse facilitators of support groups for nurses with chemical dependency in the California, USA, Diversion Program. Data were collected through twelve individual interviews selected through purposeful, non-probability convenience sampling. A phenomenological research design was used that was descriptive, explorative, and contextual. The data analysis revealed four major themes: (1) experience of communication within the Diversion Program; (2) experience of the structure of the Diversion Program; (3) experience of their role within the Diversion Program; and (4) experience of facilitation of support groups. The study revealed that even though many of the nurse facilitators‟ experiences were positive with respect to the support groups they expressed concern about the communication patterns within the Diversion Program. To offer support for the nurse facilitators, guidelines and a conceptual framework were created to enhance their experience and mitigate their feelings of marginalization from the Diversion Program. / Health Studies / D.Litt. et Phil. (Health Studies)

The highly complex role of the Chief Nursing Officer (CNO) requires the refinement of a multitude of competencies and leadership skills in this unprecedented time of healthcare reform. As the senior most patient advocate in our medical centers the CNO is responsible for translating research into practice, policy development and implementation creating value based patient-centric strategies to transform health care. The ability to sustain and thrive in this role is essential in repositioning nursing as a knowledgeable discipline actively contributing to the redesign of healthcare. This exploratory descriptive phenomenological study was designed to explore and describe the elements that contribute to the sustainment of CNOs in their practice of nurse executive leadership. Ray’s (1989) Theory of Bureaucratic Caring, Authentic Leadership Theory (Wong & Cummings, 2009), and Resiliency Theory (Earvolino- Ramirez (2007) provided the theoretical lens through which this study was grounded. Semi-structured telephonic interviews were conducted with twenty CNOs all with two consecutive years experience in their current role. Six themes emerged after thorough content analysis which describes the lived experience of sustainment. Each theme was supported by several subthemes. Themes emerged as: Loving the Profession, Having a Broader Impact Reflecting on One’s Own Work, Learning to Manage Conflict, Maintaining Work/Life Balance Working with Supportive Leaders. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2014. / FAU Electronic Theses and Dissertations Collection

In this thesis I am concerned to examine the management behaviours and predilections of managers across the two settings of health and theatre considered to be divergent. To do this I explore and map methods, similarities and differences managers employ to ???manage??? workers across the industries. I also deconstruct creativity and its manifestations in both managerial behaviours and environmental contexts and map the complexity issues that managers face in different settings. Further, I explore the extent to which management activity is contextual to the identity of participant organisational aims and processes and examine the level of calculated chaos experienced by managers across the settings. Central to this approach is the utilisation of multi-method design incorporating interview, micro-ethnography, auto-ethnography and a RAND expert panel to assist with interpretation of the results. Core findings include high degrees of similarity in the roles and functions and support systems utilised by managers across the settings despite substantial differences in environmental contexts and organisational aims and processes. Differences were identified in the areas of: levels of chaos, interactions, purposes, and environmental characteristics. To account for these differences I apprehended seven metafactors grounded in the data sets. These seven metafactors can be found in each setting but emerge in different ways. The metafactors that I apprehend are order versus disorder; creativity; experimentation and change; risk; reflection; trust and respect; and time and pressure. While I discuss these seven metafactors as separate factors in reality they are fundamentally inter-related. Suggestions for future research are included.