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Background

Newly graduated nurses often face demanding working conditions including high workload, stress, and irregular working hours. During the first years of practice, burnout symptoms are common. Recovery, including sleep, can be seen as a key protective factor in the associations between stress, shift work and negative health outcomes. Previously, a proactive, group-based intervention (recovery programme) for new nurses, promoting individual strategies for recovery, decreased burnout and fatigue symptoms post-intervention and showed preventive effects on somatic symptoms over time. To optimise the implementation and outcomes of an intervention, it is important to understand its mechanisms of impact (i.e., how it produces change) as well as to identify contextual factors influencing its implementation.

Objective

To deepen the understanding of the recovery programme’s mechanisms of impact and to explore how its implementation, including participants’ opportunities for recovery and the feasibility of recovery strategies, was influenced by the context.

Design

Qualitative descriptive design.

Participants and setting

Twelve nurses (nine women) who had participated in the intervention at four Swedish hospitals, between 12 and 25 months (M = 19) after participation.

Methods

Semi-structured individual telephone interviews were conducted and analysed using thematic analysis.

Results

The programme’s proposed mechanisms of impact, including increased knowledge about sleep, enhanced motivation for behavioural change, and the use of recovery strategies, were confirmed. Motivation to apply recovery strategies was supported by a shift in mind-set regarding the importance of self-care; to improve readability; and follow-up on the behavioural change process during sessions. Contextual factors influencing recovery opportunities and the feasibility of strategies were related to both the work context and the individual. These factors included demanding schedules, extended and disrupted working hours, workload, opportunities for recovery at work, social norms, the organisation of work procedures, private life circumstances, and the deprioritisation of personal recovery needs. Booster sessions and reminders were suggested to facilitate the continued use of recovery strategies after the programme.

Conclusions

When supporting nurses in developing individual recovery strategies, it is important to provide opportunities to share experiences with other new nurses and to follow-up on their behavioural change process. Importantly, several organisational factors should also be considered. Organisations should work systematically with the planning and management of working hours that promote recovery, create opportunities for recovery during work shifts, organise work procedures with recovery in mind, and continuously monitor and manage employees’ stress and fatigue symptoms. Together, such efforts could promote a social norm that supports recovery.

BACKGROUND: The COVID-19 pandemic exacerbated distressing situations among healthcare professionals, due to resource limitations and complex patient care challenges.

RESEARCH OBJECTIVES: The research aims to explore the frequency of RNs' exposure to distressing situations across various care settings during the pandemic and assess the association between this exposure and: (1) stress of conscience, (2) intentions to leave the profession, (3) job satisfaction, and (4) self-rated health in the late phase of the pandemic. In addition, the aim was to describe other common situations they encountered during the pandemic.

RESEARCH DESIGN: A cross-sectional multi-method study was conducted with participants recruited from a national cohort of Registered Nurses (RNs) between October 2021 and January 2022. In total, 3,958 individuals met the eligibility criteria, with 2,237 participants (56.5%) responding to the survey. Among these respondents, 1,881 answered questions about distressing situations, and 239 shared open-ended responses about their experiences.

RESULTS: The results showed that during the peak of the COVID-19 pandemic, between 24% and 70% of RNs encountered distressing situations on a weekly basis or more often. Over 70% reported difficulties in communication due to personal protective equipment. Additionally, just over 40% of RNs reported working in situations lacking clear guidelines and facing prioritization challenges. RNs exposed to these distressing situations were frequently nearly twice as likely to experience stress of conscience (44% vs. 21%, [OR] = 2.87) and showed a stronger intention to leave the profession (25% vs. 14%, [OR] = 1.98). Moreover, they reported lower job satisfaction (85% vs. 92%, [OR] = 0.50) and poorer self-rated health (34% vs. 50%, [OR] = 0.52) compared to their counterparts with less exposure. In addition, RNs experienced a lack of support, understaffing, and working beyond their expertise, leading to emotional and physical exhaustion. They felt inadequate due to overwhelming workloads and limited recovery time.

CONCLUSION: The COVID-19 pandemic has significantly impacted RNs, underscoring the need for strong organizational support and leadership. Nurses require guidance from leaders and institutions to manage distress and ethical challenges effectively. Future strategies should prioritize adequate staffing, skill development, teamwork, mental health resources, and transparent communication to support nurses' wellbeing and recovery, ensuring the delivery of high-quality care.

Background: Nurse shortage has been a worldwide problem. Work exhaustion fuels nurses' turnover intentions. However, there is limited understanding of how peak workload and time pressure contribute to work exhaustion and turnover intentions. Aims: To test the influence of peak workload and time pressure on work exhaustion and nurses' turnover intentions. Design: A research design of using follow-up surveys was employed. Methods: Complete survey responses were obtained from 423 nurses in Taiwan during 2023 and 2024. Structural equation modeling was used for analysis. Results: Peak workload was related with time pressure. Both factors were positively associated with work exhaustion, which in turn was positively associated with turnover intentions. Interestingly, both factors were not directly related to turnover intentions. Conclusion: Work exhaustion is pivotal in the impact of peak workload and time pressure on turnover intention. The unique value of this study is to identify the key role of work exhaustion in fueling turnover intention. Implications for Nursing Management: The results inform the nurse managers that they could consider incorporating more flexibility into nursing routines to reduce peak workload. Additionally, increased support from auxiliary staff, recovery environment, and work flexibility may help alleviate nurses' perceived time pressure or workplace exhaustion.

This study aimed to explore the relationship between the experience of abuse and depressive symptoms among children and adolescents in a post-conflict setting while controlling for perceived support and individual background factors. This cross-sectional study was conducted in the post-conflict setting of Borama, Somaliland. A total of 645 adolescents that attended upper primary and lower secondary schools were included. The exposure variables were (a) experience of physical abuse, (b) experience of psychological abuse, and (c) experience of either or both forms of abuse. The outcome was depressive symptoms as measured by the Patient Health Questionnaire-9. Physical and psychological abuse were associated with higher levels of depressive symptoms (B = 2.74, p < 0.001 and B = 1.62, p < 0.001, respectively). The girls had higher levels of depressive symptoms than the boys (B = 0.71, p = 0.004). Moreover, a greater age was associated with higher levels of symptoms (B = 0.17, p = 0.033). Higher social support levels were associated with lower levels of depressive symptoms (B = −0.08, p = 0.001). Our findings suggest that interventions providing social support to adolescents who experience abuse may be beneficial in reducing depressive symptoms.

The COVID-19 pandemic put pressure on healthcare organizations, making them dependent on sufficient resources and employees’ performance. Recovery is a key factor in maintaining safe operations, employee health, and retention. However, during the pandemic, working hours became more demanding, which limited time for recovery between shifts. The responsibility to ensure employee recovery in relation to working hours lies at the organizational level. The aim of this study was to examine how working hours, staffing, and recovery were managed at the organizational level during the COVID-19 pandemic in Swedish health care, studied from the perspective of HR representatives. Qualitative interview data based on 19 HR representatives from 16 Swedish regions was analyzed using thematic analysis. The results showed that during the COVID-19 pandemic, organizations maximized working hours and reorganized employees, care, and HR. Actions were taken to buffer job demands, including providing support and identifying employees who were not feeling well. Inadequate staffing and skill mix influenced the management of working hours, staffing, and recovery. Our findings highlight the use of short-term solutions to manage the situation at hand, which could lead to exhaustion of human capital long-term and subsequent effects on safety, performance, and employee retention. We term this phenomenon the organizational recovery paradox. © 2024 The Author(s).

Background: Registered nurses working on the frontline during the COVID-19 pandemic encountered significant challenges, including exposure to critical incidents. Critical incidents refer to sudden unexpected clinical events that surpass an individual's ability to cope, leading to considerable psychological distress, which could potentially result in the development of post-traumatic stress disorder symptoms. Research has shown a high prevalence of post-traumatic stress disorder symptoms among healthcare workers, particularly those in close contact with COVID-19 patients.

Objective: To assess the levels of post-traumatic stress symptoms among registered nurses in relation to exposure to working conditions during the COVID-19 pandemic, such as how much their work was affected by the pandemic, re-deployment, working hours hindering sufficient recovery between shifts and critical incidents.

Design: Cross sectional study.

Setting(s): The registered nurses working in multiple health care services covering all 21 geographic regions in Sweden.

Participants: A total of 1,923 registered nurses, who are part of a Swedish national cohort and have been followed since their nursing education, were invited to participate in a survey in late September 2021 (15 to 19 years post graduation).

Methods: The data were analyzed using descriptive statistics, unpaired t-tests, and one-way analysis of variance. Cohen's d was employed to quantify differences in mean levels between subgroups.

Results: The response rate were 56.5 %. Over 50 % of experienced registered nurses reported significant disruptions to their work environments. In total, 85 % of registered nurses were exposed to at least one critical incident in their work during the pandemic, with 60 % facing organisational changes and nearly 50 % experiencing emotionally distressing situations. The exposure to work situations involving critical incidents consistently demonstrated strong associations with higher levels of post-traumatic stress disorder symptoms compared to those not exposed, with effect sizes ranging from moderate to high.

Conclusions: This study underscores the profound impact that working conditions, such as redeployment and exposure to critical incidents, have on the mental health of registered nurses. We offer valuable insights into registered nurses’ pandemic-related challenges, highlighting the need for support and interventions to prevent and manage critical incidents, ultimately promoting their well-being. We also highlight the significance of thorough workforce readiness planning for future pandemics and other challenging health care scenarios, such as staff shortage. © 2024 The Author(s)

Aim: To investigate how NGNs perceived and applied an intervention for preventing stress-related ill health embedded in a transition-to-practice programme when entering their professional life. Design: A qualitative exploratory descriptive design was selected for this study to gain insights and perspectives on the adoption and utilization of the intervention. Methods: In this qualitative methodology process evaluation, semi-structured and audio-recorded interviews were conducted with a sample of 49 nurses. Data were collected between December 2016 and July 2017, and were sorted in NVivo 12 Plus, followed by thematic analysis. Results: The analysis resulted in three change processes stimulated by the intervention: (a) Building acceptance of being new; (b) Gaining insight into professional development and health and (c) Practical steps for skills development, healthy habits and better-organized work. In addition to the three themes, barriers that hindered the progression of the processes were also described. Each process influenced the development of the others by stimulating a deeper understanding, motivation to change and courage to act. Several barriers were identified, including the use of cognitively demanding intervention tools, fatigue, high work demands, inconvenient work hours and a hostile social climate on the ward. Conclusion: This process evaluation showed that newly graduated nurses used knowledge from the intervention and adopted new behaviours largely in accordance with how the intervention was intended to work. Impact: When entering a new profession, it is crucial to receive a well-thought-out, structured and targeted introduction to the new professional role, tasks and work group. Nurses stated that the intervention increased their understanding of the role as new nurses and their insight into how to develop skills that promoted better functioning and recovery. The intervention also stimulated the development of new health behaviour and some new learning strategies. © 2023 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.