The nursing shortage in China is more serious than in most developed countries, but the loss of nurses through their voluntarily leaving nursing practice has not attracted much attention in Chinese society. The aim of this study is to add to the understanding of nurses leaving nursing practice in China by exploring the process from recruitment to final exit. The qualitative research method draws on a grounded theory approach, especially the constant comparative method of analysis. The indepth interviews were conducted with 19 nurses who have left clinical care. The selection of the study participants was guided by the principle of theoretical sampling. Two core conceptual categories emerged from leavers’ account of their leaving: “Mismatching Expectations: Individual vs. Organizational” and “Individual Perception of Power”. By illuminating the interrelationship between these two core categories, four nursing behaviour patterns are identified: (1) Voluntary leaving (2) Active staying (3) Adaptive staying (4) Passive staying. These behaviour patterns provide an explanation about why and how nursing wastage occurs. The analysis suggests: (1) the higher the degree of mismatch that the nurses recognised between individual and organizational expectations of nursing and the greater the extent of imbalance of power the individual nurses perceived, the more likely it is that the nurses intend to leave the powerless status of being a clinical nurse within the organization; (2) the more difficult it becomes for the nurses to achieve their individual expectations by exercising nursing autonomy in their nursing career, the more likely it is that they actually empower themselves to leave nursing practice. The study suggests that nursing wastage could be avoided if the individual and organizational expectations of nursing were more aligned, and the individual nurses were able to exercise nursing autonomy in their professional practice and career. Although the findings are limited in studying the current nursing workforce situation in China, the theoretical perspective may contribute to the international debate on nursing employment towards effective nursing workforce management and retention strategies.

The nursing workforce has experienced considerable change during the previous decade, resulting in a chronic shortage of nurses. Issues such as economic rationalism, increased workloads, changes in nursing education and the advancing age of the current nursing workforce are the chief contributors to this shortage (Australian Institute of Health & Welfare, 2005b; Buerhaus, Staiger, & Auerbach, 2000b). Operating room (OR) nursing is a primary specialty area that has been especially affected by rising nurse attrition and a reduction in nurse recruitment (Australian College of Operating Room Nurses, 2003; Australian Health Workforce Advisory Committee, 2002). Accordingly, the loss of skilled nurses from the OR specialty compounds the negative effects on morale for those who remain in the environment, as they struggle to provide safe patient care while concomitantly being responsible for the clinical development of neophyte and inexperienced nurses (Australian Health Workforce Advisory Committee, 2002; Arndt, 1998). In the midst of working in the OR environs where the nature of the associated stressors is unique, resilient qualities may assist nurses to meet and overcome these challenges. If there is to be a continued nursing presence in the OR, it is essential that nurses be given the opportunity to develop resilience. At this time when nurse retention rates are continuing to decline steadily, there is a compelling need to identify and describe the relationship between resilience and its predictors in the context of the OR. To date, little is known about predictors of resilience and their potential to ameliorate the effects of workplace stress in the OR. The overall purpose of this study was to identify and describe the predictors of resilience in OR nurses. A literature review and concept analysis of resilience was initially conducted. Hope, self-efficacy, coping and personal characteristics were identified as defining characteristics of resilience. Next, the research was conducted as a mixed method phased study that was underpinned by the pragmatist paradigm, and employed a sequenced combination of qualitative followed by quantitative inquiry (Morgan, 1998). The first phase used a mini-ethnography to identify and describe the components of workplace culture in an OR in relation to their potential impact on nurses’ ability to adapt in this culture. A triangulated approach was used involving participant observation, a reflective journal, field notes and interviews. This phase revealed that competence, knowledge, collaboration, peer support and the ability to manage challenges were central components of OR workplace culture. From these categories, three themes were abstracted and subsequently developed into constructs that were measured and validated in the larger second phase. The second phase used a predictive correlation survey to describe empirically the relationship between resilience and its hypothesised predictors in a systematic random national sample of nurses who were members of the Australian College of Operating Room Nurses (ACORN), and a combined sample of hospital nurses purposively drawn from two similar hospital sites. The survey included scales measuring perceived competence, collaboration, managing stress, self-efficacy, hope, coping, and resilience, as well as gathering information about the demographic characteristics of nurse respondents. Out of a total potential sample of 1,730 OR nurses, the overall response rate was 51.7% (n = 896). Differences between the ACORN and hospital samples were found in age, years of experience, education and years of employment; therefore, the national and hospital samples’ findings were analysed separately. Five independent variables – hope, self-efficacy, coping, managing stress and competence – predicted resilience in the larger sample of ACORN respondents (n = 772). For the substantially smaller sample of hospital respondents (n = 124), hope, self-efficacy and managing stress predicted resilience. Given that the smaller hospital sample resulted in a similar model, this consistency lends strength and weight to the revised resilience model. Over 60% of the variance in resilience was explained by the independent variables in each model. Given the dearth of literature describing the efficacy of resilience in ameliorating stress in OR contexts, the results of this study have extended the theoretical application of the resilience concept to include a nursing context. There is a need to implement resilience-building strategies that address the culture of the OR, both at the departmental and organisational levels. Strategies that provide a supportive workplace environment in relation to goal-orientation, the provision of stress management and education programs, and strategies that facilitate cultural assimilation may improve resilience, and hence retention and recruitment rates in the OR. The findings of this study support the need for further research not only to test the stability of the proposed model among other groups of nurses but also to explore further predictors of resilience in the OR setting.

Little is known about how nurses learn and use coping and adaptation skills in the workplace. Quantitative studies have identified the factors, nature, and outcomes of nursing stress. However, qualitative studies describing the human experience associated with workplace stress are lacking. The phenomenon of interest for this study using focused ethnographic method is the self-described experience of coping and adaptation associated with workplace stress of registered nurses working 12-hour shifts employed in acute care hospital facilities in east central and central Florida. Three aspects of the phenomena were examined: the self-described experiences of stress, the manner in which coping skills are acquired, and the manner in which adaptation strategies are developed by experienced bedside nursing working 12-hour shifts in acute care hospital facilities. The purposive sample included nine female bedside nurses with five or more years’ experience, working 12 hour shifts in acute care hospital facilities on bedside units, with patient ratios of 4:1 or greater. Data were collected using semi-structured, digitally recorded interviews at mutually convenient locations. The qualitative data were analyzed using inductive, constant, comparative process of coding, sorting, generalizing, and memoing to guide exploration and identify emergent themes and patterns. The predominant theme of stress emerged as the overwhelming sense of duty to the patient. Additional themes of coping and adaptation were noted. Recommendations for research, education, practice and policy are offered to support a healthy and sustainable nursing workforce.

Yes / This study aimed to determine factors that influence the nursing workforce shortage and their impact on nurses. This study applied a systematic review design. Using Cochrane library guidelines, five electronic databases were systematically searched (Research 4life-PubMed/Medline, Scopus, Embase, CINAHL) from 2010-2021. The remaining articles with pertinent information were presented in a data extraction sheet for further thematic analysis. A Reporting Items for Systematic Reviews and Meta-Analysis Flow Diagram was adopted and used. The studies published from 2010-2021 and in English language were examined and included in the systematic review. Four themes were identified as factors influencing the nursing workforce shortage, including Policy and planning barriers, Barriers to training and enrolment, Factors causing nursing staff turnover and Nurses' stress and burnout. Nursing workforce shortage is a global challenge that roots in multiple causes such as individual, educational, organizational and managerial and policy-making factors.

Background: Previous studies show that nurse retention is one of the most effective strategies to counteract nursing shortages. Few studies have focused on the crucial resource of registered specialist nurses in operating departments. Aim: The overall aim of this thesis was to gain knowledge on registered specialist nurses’ and assistant nurses’ work in operating departments and on what factors they consider to be important for attractive work. Methods: In Study I, operating room nurses were interviewed regarding their perspective on their work. In Studies II and III, specialist registered nurses and assistant nurses at operating departments in a Swedish county council responded to the Attractive Work Questionnaire. Study IV is a case study with interviews, a review of organisational goal documents and data concerning the number of planned, acute and cancelled operations. Findings: The adaption of the Attractive Work Questionnaire for nurses in operating departments was satisfying. The most important factors for attractive work were: Relationship, Leadership and Status. The factors with the largest discrepancies between their important to work attractiveness and their rating at the nurses’ current work were: Salary, Organisation and Physical Work Environment. It was important for nurses to be able to prepare for and be in control of the different work tasks. However, the daily operating schedule guided the nurses’ work, and changes in the schedule, nurse shortages and the design of the premises constituted obstacles to their work. Conclusion: The Attractive Work Questionnaire provided specific information to management on what to focus on to make work attractive. The majority of the identified attractive factors are already known to be of importance in nurse retention; however, factors requiring more investigation are Equipment, Physical Work Environment and Location (of the workplace). Their work prerequisites did not enable the specialist and assistant nurses to reach what they saw as their daily goals. Regularly occurring activities, such as acute and cancelled operations, were interpreted as obstacles to reaching daily goals.

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<p dir="ltr">Nursing, deeply rooted in social justice principles, faces the contemporary imperative of achieving health equity. However, the perception of social justice among nurses, particularly newly graduated registered nurses (NGRNs), remains unclear, posing a significant challenge amid high turnover rates in this population, threatening the realization of health equity goals.</p><p dir="ltr">Through this study, I sought to enhance nursing knowledge by delving into the understanding, cocreation, processing, and response to social justice among NGRNs. Utilizing a constructivist grounded theory methodology, I explore NGRNs’ narratives and perceptions concerning social justice, addressing the research question: How do NGRNs understand, cocreate, process, and respond to social justice in their nursing practice?</p><p dir="ltr">Findings from the grounded theory study reveal seven categories with subsequent subcategories, culminating in the development of a proposed theoretical framework. This framework elucidates four overarching global themes: “Best Care for all, No Matter What,” “Novice Emancipators,” “Making the Human Connection,” and “Supportive Organizational Culture.” I used theoretical modeling to delineate a middle-range theory titled “NGRN Evolving Process of Social Justice Transition.”</p><p dir="ltr">The study’s conclusions have significant implications for nursing education, practice, research, and policy. They highlight the importance of shaping future nursing landscapes through a focus on NGRNs’ social justice transition. Emphasizing the pivotal role of social justice identity in NGRNs’ progression to expert nurses, the study underscores the critical need to foster this identity during NGRNs’ transition period. Implications extend to curriculum structure, onboarding programs, leadership, and policy, aiming to promote person-centered care and health equity. This study marks the inception of a journey towards continual support for NGRNs as advocates for social justice, potentially catalyzing substantial societal change with nursing at the forefront of the pursuit of equity.</p>

School-based health centers (SBHCs) have faced challenges in securing adequate funding for operations and developing sound business systems for billing and reimbursement. Specifically, administrators often lack strategies to develop and sustain funding levels to support appropriate resources for business operations. The focus of this descriptive study was to explore best practice strategies to develop and sustain funding through the experiences of SBHC administrators. The conceptual framework included Elkington's sustainability theory, which posits that corporate social responsibility, stakeholder involvement, and citizenship improve manager's effect on the business system. Twenty full-time SBHC administrators working in separate locations throughout the state of Maryland participated in semistructured telephone interviews. The van Kaam process was used to cluster descriptive experiences in data analysis that resulted in the development of thematic strategies for implementing best practices relevant to developing and sustaining funding for SBHC business operations. Major themes provided by the participants were interagency communications, creating marketing plans, and disparities in the allocation of funding for programs and professional staff. Findings indicated SBHC administrators continue to face challenges in developing and sustaining adequate funding for operations in the state of Maryland. Suggestions for future research include how administrators can develop marketing plans and explore long-range funding for SBHC services. The findings in this study may contribute to positive social change by demonstrating to officials in the Maryland State Department of Education the significance of SBHCs, and the need to increase mental health services.

Walden University College of Management and Technology This is to certify that the doctoral study by Ingrid Hayes-Burrell has been found to be complete and satisfactory in all respects, and that any and all revisions required by the review committee have been made. Review Committee Dr. Ify Diala, Committee Chairperson, Doctor of Business Administration Faculty Dr. Anne Davis, Committee Member, Doctor of Business Administration Faculty Dr. Yvette Ghormley, University Reviewer, Doctor of Business Administration Faculty Chief Academic Officer Eric Riedel, Ph.D. Walden University 2015 â?? School-based health centers (SBHCs) have faced challenges in securing adequate funding for operations and developing sound business systems for billing and reimbursement. Specifically, administrators often lack strategies to develop and sustain funding levels to support appropriate resources for business operations. The focus of this descriptive study was to explore best practice strategies to develop and sustain funding through the experiences of SBHC administrators. The conceptual framework included Elkington's sustainability theory, which posits that corporate social responsibility, stakeholder involvement, and citizenship improve manager's effect on the business system. Twenty full-time SBHC administrators working in separate locations throughout the state of Maryland participated in semistructured telephone interviews. The van Kaam process was used to cluster descriptive experiences in data analysis that resulted in the development of thematic strategies for implementing best practices relevant to developing and sustaining funding for SBHC business operations. Major themes provided by the participants were interagency communications, creating marketing plans, and disparities in the allocation of funding for programs and professional staff. Findings indicated SBHC administrators continue to face challenges in developing and sustaining adequate funding for operations in the state of Maryland. Suggestions for future research include how administrators can develop marketing plans and explore long-range funding for SBHC services. The findings in this study may contribute to positive social change by demonstrating to officials in the Maryland State Department of Education the significance of SBHCs, and the need to increase mental health services.

<p dir="ltr">Employee staffing and scheduling are critical aspects of resource management in labor-intensive, customer-centric service organizations. This thesis investigates the optimal decision-making process for these critical tasks in the presence of non-stationary uncertainty, such as case-mix resident need, recommended staffing hours, and potential staffing turnover, a challenge prevalent in various domains, including healthcare and nursing home management.</p><p dir="ltr">The research begins predicting resident needs accurately. For this purpose, we present a novel Bayesian modeling approach to predict nursing home need-based resident census and staffing time. The resultant time series data of need-based resident census and staffing time are nonstationary with potential correlations between resource utilization groups. We thus propose Bayesian latent variable models with time-varying latent states to capture the dynamic patterns of resident service needs. We demonstrate the superiority of the proposed Bayesian prediction models by comparing their forecasting performance with several popular benchmark models, using historical assessment and aggregate staffing data from representative nursing homes.</p><p dir="ltr">The thesis further incorporates a rolling-horizon scheduling approach that integrates a periodically evolving Bayesian forecasting method into a series of stochastic look-ahead decision actions over multiple periods. To deal with the workforce scheduling with nonstationary demand uncertainty, we introduce a stochastic lookahead optimization framework that executes two-stage stochastic programming periodically along a rolling horizon to address the evolving non-stationary uncertainty. We obtain two-stage stochastic programming models to design effective work schedules, specifically assigning nurses to various shifts while balancing the staff workload and accommodating fluctuating resident needs.</p><p dir="ltr">We finally introduce the SNHSSO framework (stochastic nursing home staffing and scheduling optimizer), encompassing data modeling and addressing multi-period, multi-uncertainty, and multi-objective staffing and scheduling challenges. When the SNHSSO Optimizer is executed with the provided inputs, it generates recommended staffing decisions for longer planning horizons, as well as schedules and contingency plans for shorter planning horizons. These adapted decisions and adjusted parameters are archived for future reference, facilitating subsequent iterations of the process. SNHSSO optimizes caregiver assignments by taking into account probabilistic forecasts of service requirements, resident acuity, and staff turnover, all within two-stage stochastic mixed integer linear programs. Our approach leverages a scenario-based rolling horizon methodology to effectively solve the SNHSSO model.</p><p dir="ltr">The empirical foundation of this work is built on case studies conducted using Minimum Data Set (MDS) data spanning five years from 2014 to 2018 in Indiana nursing homes.</p>