Nursing Work Environment Impact

Introduction

A deficient or unsatisfactory working environment jeopardizes diverse health care delivery aspects. Nurses' work environment includes the entire aspect of the relationship between nurses and their work environment. There is mounting pressure that an unhealthy nursing working environment contributes to escalated costs in the health sector service providers in terms of increased cases of dissatisfied patients, negligence, poor reputation of the hospitals, and high rates of turnover. The nurses ' working environment influence patients' care quality, patient well -being, and nurses' job outcomes. Therefore the health care administrators should pay more attention to the nurses working environments. The nurses’ unique working environment creates a foundation for the nurses and patient well -being, thus warranting the focus and resource of healthcare administrators. This essay examines the impact of the work environment on nurses' work quality and performance.

Global multidimensional issues that impact on nursing

Diverse challenges are facing the nursing profession that potentially impacts significantly to nurses such that, there are days they find it hard to wake up to go to work. The health care sector is an upcoming primary sector globally. To maintain equilibrium between health services delivery and reception, various regulations, policies, and strategies are coming up to enrich this rapidly growing nursing profession. Nurses are the backbone of global health and play a pivotal role in healthcare sector enlargement and success (Powell & Milstead, 2019). Nurses are considered as patient's advocates and a patient-doctor relationship bridge. The nurse's lowest hierarchy position in the health sectors enables them to remain constant and close to both patients and families. Nurses campaign for good health and try their best to keep the public safe and protected. Moreover, nurses play a crucial role in the health sector through the enhancement of patient care and safety as well as upgrading the standards of the health sector.

Bureaucracy in the health care sector

Bureaucracy in the health care sector is a significant factor affecting nurses and the nursing profession. According to Fortier & Malloy (2019), healthcare bureaucracy refers to health care institutions that are characterized by multilayered processes and systems. These policies and procedures are designed to maintain and control uniformity within the healthcare sector. However, healthcare bureaucracy has amounted to a more constrained medical professionalism. Nurses are complaining of too much bureaucracy. The healthcare demands rationalization, standardization, and optimization process are becoming complicated deals. To this end, nurses who are involved in offering help to patients are subjected to a high number of fragmenting directives from their seniors and the administrators, therefore, devising work to cope with the ineffective problem-solving schedules. Thus, bureaucracy in the healthcare sector is destroying more and more value of the nursing profession in various healthcare systems globally

Bureaucracy in the health care sector impedes real-time safety (Fortier & Malloy, 2019). Nurses are expected to attend to patients' care and attend to emergencies. However, bureaucracy interferes with nursing roles as the barriers rooted in politics and budget issues inhibit the various departments in hospitals from working and fixing problems collaboratively. For instance, nurses may establish that there is a lack of hot water in several intensive care units; however, they cannot solve the problem due to tight healthcare bureaucratic policies rooted in politics and budget issues.

The large workload for nurses

According to Duffield et al. (2011), heavy nursing workload leads to deterioration in nurse's motivation and job dissatisfaction. The heavy workload in the nursing profession can lead to absenteeism, poor job performance, and high turnover rates and potentially threaten patient’s quality care and health sector service provider’s effectiveness. The workload negatively correlates with nurses' work quality and performance. Nurses experiencing heavy workloads provide lower levels of overall patients quality care, safe care, and detailed nursing, and on their edge, they experience stress and fatigue. According to Despins (2019), understaffing is a significant threat to patient's safety and nurses’ well- being. Duffield and colleagues further explain that better patient outcomes achieved when a higher proportion of care hours provided by registered nurses relative to care provided by nursing assistants or licensed practical nurses. The probability of serious complications or death is high when fewer nurses are assigned to patients care.

Inadequate staffing leads to increased depersonalization and attrition level as well as nurses' dissatisfaction. Moreover, it leads to compromised qualities of patients care, thus wastage of hospital resources and time. This is triggered by the continuous fluctuation of critically ill patients, due to nurse extreme staffing flexibility that leads to inappropriate rations of nurse-to-patient care. Therefore health service providers must engage in dramatic innovations to systematically test and devise new staffing models.

Professional Communication and team culture

The delivery process in today’s healthcare systems incorporates various interfaces and patient handoffs among diverse healthcare professionals with differing levels of occupational training and education (Dellafiore et al., 2019). A patient may interact with various hospital employees upon hospitalization, for instance, nurses, physicians, technicians, among others. Therefore, effective clinical practice demands the transmission of accurate information in all levels of the health sector, thus necessitating team collaboration. Ineffective communication among healthcare professionals subjects the patients at risk due to information misinterpretation, lack of critical information, overlooking status dynamics, and unclear orders over the telephones.

Nurses working in environments where there is communication and collaborative teamwork culture provide quality care to patients and perform well. Effective communication helps in reducing medical errors likely to occur, causing injury or sudden patient death. According to O’Daniel & Rosenstein (2008), communication failures are the leading triggers of delays in treatment, medical errors, and wrong-site surgeries, and they ranked as the second root causative for both postoperative and operative events and fatal falls. Regular, valuable, and effective communication promotes nurses' quality care to patients and performance. Nurses working in environments with constant contact provide quality care in patients. Clinical skills require valuable communication skills the entire organization levels and including oral and non-verbal communication, as well as written. Worth noting patients in the care of nursing professionals suffer medical errors with alarming frequency. Several cases of medical errors are rooted in interpersonal interactions.

Involving nurses in decision making

Kolarova et al. (2019) argue that nurses are considered as patient advocates, and they are the vital link between doctors and patients. Therefore, it is crucial to involve nurses in decision making. Nurses are assigned patients care primary responsibilities by administrators, pharmacists, and physicians. However, only about 8% of the physicians recognize nurses in the team of decision making. Nurses working in environments where they are included in decision making provides quality patients care and improved work performance.

On the other hand, nurses that feel relatively inferior to alter things dislike their working environment. Lack of nurses' empowerment is an obstacle in the nurse's way of exercising their full skills and potential inpatient quality care (Lu, Zhao & While, 2019). Failure to incorporate the experienced nurses' perspective and operational decisions results in costly errors, thus jeopardizing the patient's safety and healthcare financial viability. Nurses believe that they are accountable for their practices. Therefore, they believe in the provision of quality care.

According to Kolarova et al. (2019), ideal decision making is vital in patients to care outcomes enhancement. Clinical nursing decision making demands a heterogeneous approach to education, research, and practice to promote patient care outcomes. Use of a conceptual framework, for instance, NDM to guide decision making for acute care nurses, provides untapped information for nursing and nursing science and nursing education. Decision making in nursing covers a wide range of processes and factors. Today, nursing research examines nursing practice environmental culture, nurse experience, nurses understanding of patient status, education, autonomy, and situational awareness as pointers for decision-making. Experienced nurses bring on board a wide range of previous patients' experiences to their nursing practice, thus influencing, unconscious, and intuitive processes that contribute to the decision-making process (Sundean et al., 2019). The use of the NDM guide conceptual framework helps in a better understanding of how better to support less experienced nurses in their decision making to enhance patients care outcomes (Nibbelink & Reed, 2019).

Recognition and appreciation

The majority of nurses who fail to receive recognition from their employers are dissatisfied. Lack of attention leads to poor morale, discontent, suboptimal care outcomes, and reduced productivity. Santoso, Supriyati & Djamal (2019) highlight that recognition of nurses’ contributions and achievement are fundamental requirements for professional and personal growth.. Inadequate credit in the nursing career is a primary reason for high turnover rates in the nursing profession and links it with decreasing nurse satisfaction. Hospitals recognized for retaining and attracting nurses emphasize development and growth and provide multiple rewards to nurses' expertise and clinical advancement opportunities.

Oppel, Winter & Schreyögg (2019) link the work environment to attitudes, behaviors, and clinicians' motivations. These behaviors and orientation, in turn, affect the nurse provision of quality care to patients and outcomes. Oppel and colleagues explain that various researches indicate that nurses gain satisfaction fully when they work in an environment that has leadership that empowers and motivates them and healthcare arrangements along with more positive group environments; this reflects group support and collaboration elements. Moreover, such attributes impact a nurse's turnover and significantly to patients' safety. Therefore, improving the working healthcare environment enhances the patient's safety and reduces overall healthcare costs. According to Anderson (2019), a report by the International Council of Nursing and the Institute of Medicine indicates that a primary reason for the shortage of nurses currently and in the future relates to the extreme working environment. Improvement of the nurses' working environment would entice new students to nursing, as well as engaging current nursing professionals in patients, care delivery development innovative models that are instrumental in nurturing the future generation of nurses. Notably, improving nurses' working environment may also promote the safety and quality of patient care.

Cordial interpersonal relationships

According to Festin et al. (2019), nurses devote much of their time to healthcare institutions, and thus, the workplace is like a family to them. The nursing profession's job helps them to infuse meaning to their lives, and it is not just a way to earn money to improve their livelihood. Therefore, nursing creates a tremendous impact on the nurse's well-being and job satisfaction. Interpersonal conflict in the nurses' working environment is negatively co-related with unproductive work behaviors, and in some instances, it is a predictor of counterproductive working behavior, among other stressors. According to Dias et al. (2019), the strain linked with inters personal conflict in the work environment for nurses are increased absenteeism. Additionally, mistreatment between Supervisory nurses and subordinate nurses impacts negatively to the overall performance of nurses as well as extra-role performance. On the other hand, nurses that enjoy harmonious interpersonal relations have an influencing effect on them, relevant to the health care institutions.

Benefits of a pleasant work environment for nurses

The barometers above examine the performance and development of clinical nurses and health sectors globally. Safe and ethical working environments for nurses are imperative for generating excellent outcomes regarding the superiority of work, productivity, optimal care for patients and society only when adopted from healthcare institutions from top to bottom levels (Heistad, 2019). As Earl Nightingale quotes that "our environment the world in which we live, work and reflect our attitudes and expectations," there is a need for a pleasant work environment for nurses. A friendly working environment raises high self- esteem, increased job satisfaction, improved sense of well- being, high service outcomes, increased dedication and pride towards work, cordial interpersonal relationships, reduce job stress and burnout, improved health with less of depression and anxiety and promotes the well- being of community and patients.

Recommendations

Nursing management has a crucial role to play in the creation of a supportive and attractive working environment. The administrators need to understand that a healthy working environment for nurses reduces the turnover rates, and patients receive quality health care (Heistad, 2019). Therefore improving the nurses' work environment and communication satisfaction reduces the nurses' intention to quit their job. It is also imperative to provide an appropriate working environment and further education for nurses as well as suitable communication channels in the hospital.

The organization of healthcare services and its impact on their area of work

The provision of affordable, high-quality healthcare services is rapidly turning to be a difficult situation. Azzolini, Ricciardi & Gray (2018) attribute this to health care systems complexities and services. Quality investigation and interpretation, use, costs, delivery, accessibility, financing, organization, and health care outcomes are fundamental to informing providers, insurers, government officials, consumers, and all the stakeholders executing health-related issues decisions.

According to Squires et al. (2019), the decision-makers and the public rely on the health service research (HSR) field as a primary information source on how well countries meet the health care challenges. The HRS's primary objective is to transmit information that eventually contributes to citizens' health improvement. Drawing from a range of disciplines knowledge, theories, and methods, HSR is a multifaceted field covering beyond applied and basic research; thus it draws on entire professions of healthcare and academic disciplines such as epidemiology, biostatistics, health medicine, economics, operations research, nursing, sociology, and psychology.

HSR inform and evaluate health policy innovations. These include Medicaid and Medicare coverage, private health insurance innovations, disparities in care access and utilization and trends among individuals without health insurance (Squires et al., 2019). The health care sector is continually changing, and HSR examines organizational change impacts on access to quality, care, and efficiency, for instance, profit growth in health care systems. Upon the introduction of a new treatment and diagnostic technologies, HSR examines their impact on health care cost and patient care outcomes.

Squires et al. (2019) argue that HSR also outlines the need to examine services contribution to individual health as well as the society at large. The HSR applied at the population level is essential, specifically in understanding the health policy and health system's performance impact on the public's health. In the US, the National Healthcare Disparities, National Healthcare Quality Report, and Healthy People Year 2010 exemplifies the nation's capacity to assess change and monitor quality. These reports are pointers of inconsistent quality care in America and also indicate that it could be sustainably enhanced. The associated health care services costs are monitored by Medicare and Medicaid Services (CMS). According to the CMS report, American healthcare is the most expensive globally and consumes about 16% of America's GDP.

Apart from health policies, HSR examines the process of patient care and interactions with providers (Squires et al., 2019). For instance, HSR enhancements to examine doctor-patient patterns of communication and describe patient satisfaction impact, adherence, and care outcomes. HSR measurement strategies advances have impacted possible policy motivations. Prospective payments of home healthcare, nursing homes, and hospitals by Medicare were facilitated by the case-mix measurement of robust systems development. CMS initiated performance pay illustration, rewarding health institutions with better quality performance through the application of the robust and valid measure of quality. Health care policy innovations are sustainably facilitated by advancing health system performance measurements.

Health services goals and patient outcomes

According to Kaufman et al. (2019), health services' primary objective is the protection and improvement of both individuals and population health at large. Transformational changes are fundamental for health care systems to achieve these goals. The HRS sector avails measurement tools that assess the progress towards these goals as outlined in the National Healthcare Quality Report. Importantly, healthcare researchers are engaged in the development and evaluation of innovative approaches to enhance institutions' innovations in healthcare, use of technology, financing, and health professionals' roles. In the 21st century, the goals for health services include the elements mentioned below:

Patient safety: Health care services should not harm patients. According to Gould (2019), the IOM report that highlighted “To Err is Human” indicated that a range of 46000 to 98000 Americans was losing their lives due to common medical errors across the health care setup. This was triggered by the inexistence of systems that prevent medical errors from reaching the patient or prevent errors from occurring as opposed to a lack of healthcare professional's dedication to quality.

Effectiveness: Effective care is founded on scientifically holding evidence that treatment increases the possibility of achieving the desired health outcomes (Kaufman et al., 2019). Evidence is obtained from clinical research (usually randomized regulated trials), laboratory experiments, outcomes research, and epidemiological studies. Evidence strength and availability varies by treatment and disorder

Patient-centered: Patient-centered care recognizes that it is imperative to listen to the patient's needs, preferences, and values to provide high-quality care (Gould, 2019). The health care services are personalized for the individual patient, coordinated care, and involve family and friends to the patient. Also, health care provides both emotional and physical support.

Timeliness: Receiving and seeking healthcare services is frequently linked with long waiting hours in the emergency rooms and doctors' offices and delays in securing an appointment (Gould, 2019). The inability to provide timely care denies people the critically required services or allows health outcomes to worsen and health conditions to progress. Therefore, today, health care is making efforts to be organized in pursuit of meeting patient needs timely.

Equity: The health care system is obliged to benefit everyone without discrimination. However, there is convincing and robust evidence that in the past, health care systems have failed to achieve this goal. The ethnic and racial minorities receive more indigent quality care relative to the majority population, even after factoring access to health services differences (Gould, 2019). Therefore in today's health care systems, nurses are required to offer services to all without discrimination to promote health care.

Efficiency: The health care system in the US is the most expensive on a global scale, yet there is consistency in the evidence that the US fails to produce the highest levels of patients satisfaction or the best health outcomes (Kaufman et al., 2019). The objective is to establish inefficiency and waste continually in the health care services provided and eliminate them

Aspects of quality management in Healthcare and Implications

Based on the widespread diffusion of quality management principles in healthcare among various practitioners, researchers and educators have started experimenting with them in the recent years as an approach of examining how to use them for healthcare services improvement (Kitsios et al., 2019). Primarily these principles in healthcare support the quality management principles in general, though, at the same time, they are modified according to health sector specificities. The following are the basic principles of quality management in healthcare:

Customer focus: Public or private healthcare organizations, like other organizations, must respect the customer-centered approach when providing healthcare services. The approach is crucial in the development of private and public services as it constitutes a primary driver for health care service reforms (Duffy, 2018). Therefore, the needs, expectations, and demands of health services seekers must be prioritized. To this end, healthcare services must be developed and designed based on the client's/patient's needs, requirements, and expectations, thus taking into account all the health care environment requirements as well as the entire society.

Leadership: Leadership is another novelty of a new version of the ISO 9001. It is fundamental in healthcare organization's management and the quality of management system of the healthcare institutions that adopts customer-centered approach. According to (Delgado et al.,2019), both doctors and managers contribute equally to the healthcare service quality. While doctors practice in the field of their professional practice, the managers help in the area of safety and quality for the entire services provided by healthcare.

Stakeholder involvement: Adequate worth must also be provided to investors, local and global community, employees, and the society at large concerning non -financial and financial aspects of an organization's performance (Duffy, 2018). Therefore, defining the healthcare service demands identification of needs, requirements, and expectations of all the stakeholders and interested parties in addition to the health insurance and service provider, including patients as well as doctors and physicians.

People and care vision: Employees in an organization have an exceptional role in presenting all areas of man's life and work. Man creates beliefs, values, and attitudes under the influence of various external factors and makes decisions (Duffy, 2018). To this end, employees, as a significant valuable resource, become a powerful lever for strengthening the competitive advantage of various contemporary healthcare institutions.

Process orientation: The health care service requires the implementation of multidisciplinary and integrated processes that unify diverse functions, a variety of healthcare providers, and clinical specialist activities. Ernst (2019) argues that it is necessary to understand process orientation basic concepts. For instance, it is introducing new roles such as the bearer, the owner, and the executor of the process. It is also necessary to add evaluation and rewarding systems based on the achieved results of the process as opposed to the results achieved within the individual units in an organization.

Continual improvement: Al Khamisi, Khan & Munive-Hernandez (2019) argue that the organization shall continually improve the quality management system adequacy, suitability, and effectiveness. Therefore, all healthcare institutions must focus on continual improvement principle that contributes to development, encourages learning as well as continual improvement of the healthcare.

Mutually beneficial supplier relationship: Third-party services such as information and communication, technical support, recruitment services, business consulting, catering and training and sanitation have a critical effect on health care organization quality and outcomes (Ernst, 2019). Quality services can be provided with consideration of all the known request stakeholders, interested third parties, and mutually beneficial relationships with suppliers in known healthcare requests, thus gaining much traction.

Partnership for quality across healthcare services: Coordination between diverse healthcare organizations as providers as a single complex service is essential in the provision of healthcare services (Al Khamisi, Khan & Munive-Hernandez, 2019). This may be two or three different healthcare organizations. In a regional context, a string of network of healthcare by networking at various levels contains a partnership for quality across healthcare services. Entirely, this is realized to provide users with complete healthcare and covering all the health care issues with appropriate specialist medical knowledge.

Guidance through information: Today, healthcare institutions exchange a significant number of different healthcare information and provide a high number of healthcare services through the support of modern information technologies. In the recent past, there has been an escalating number of international standards linked with the application of specific information technologies in the healthcare sector, and ISO institutions has formed various technical committees in the health sector field. According to Kitsios et al. (2019), healthcare informatics standardization indicates that within the healthcare data is collected more efficiently while information is transmitted more effectively.

Demand oriented care: Healthcare needs an ideal approach to determine the customers' needs and expectations. According to Al Khamisi, Khan & Munive-Hernandez (2019), healthcare is identified as people working for people. Therefore, the fundamental change that must be enacted in the healthcare sector is to change the treatment paradigm based on the doctor's opinion without taking into consideration the patient's opinion to the treatment based on the patient's needs, expectations, and demands.

Impact of Leadership Capability in Healthcare

In diverse sectors of the developed countries, the contemporary health care providers is coupled with workforce challenges, fiscal constraints, consumer demands dynamics and expectations, a mandate for patient-centered care improvement, escalating demands for access to care and issues concerning healthcare quality and safety (Lamb, Martin‐Misener, Bryant‐Lukosius & Latimer, 2018). Effective governance is vital to the efforts of effective management in healthcare maximization.

Effective leadership in healthcare settings ensures a high-quality system of healthcare that continually provides efficient and safe care. According to Lamb, Martin‐Misener, Bryant‐Lukosius, & Latimer (2018) recent commissions, inquiries, and reports have promoted clinical leadership and clinician engagement as fundamental to sustaining and achieving improvements to patient safety and care quality. Clinical leadership is widely linked with effective clinical leadership to patient outcomes.

According to Lamb, Martin‐Misener, Bryant‐Lukosius, & Latimer (2018), effective leadership in healthcare is linked with optimal performance in hospitals. Effective clinical leadership is allied to hospital functions diversity, and the healthcare system integral component. Therefore, the development of clinical leadership skills among various healthcare professionals and nurses is fundamental. However, despite the broader recognition of useful healthcare leadership significance to patient outcomes, there are many barriers to healthcare leadership participation.The future strategies should be objective of addressing these barriers to enhance clinical leadership quality in-hospital care. As the focus on healthcare performance intensifies, leadership to improve quality and increase efficiencies will be of growing significance.

According to Brooten & Gordon (2018), having a language that describes Advanced Practice Nurses APN leadership enables the APN nurses to identify leadership capacities that they demonstrate as a part of daily routine in their practice. The capability to recognize and subsequently describe their leadership would enable APN to articulate their direction clearly to decision-makers, the public, and various healthcare professionals. This is likely to enhance the understanding of the APN role and trigger APN leadership capacities optimization.

Critical reflection of nurse’s personal development and influence to the nursing career in future

According to Rosa et al. (2019), nurses generally have limited experience, so they are likely to experience challenges as first-time nurses. On the other hand, established nurses understand their professional roles, but maybe aspiring to advance their careers and become a nurse leader. To this end, the nurses need to develop an approach to attain their career objectives while abiding by regulations of nursing.NDP specialist’s aid inexperienced nurses in school to practice transition, and seasoned nurses are advised to develop while advancing their careers continually.

Professional development is fundamental to the nursing career because it puts more emphasis on assessing learning needs, continuous education, and upholding competency. Nurses need to learn continuously throughout their careers. According to Rosa et al. (2019), nurses need to be updated on healthcare trends, patient care, techniques, and treatments. NPD specialists are available to offer advice to nurses on licensing and certification requirements and addressing nurse’s needs for additional instructions. Furthermore, NPD specialist ensures that nurses always demonstrate competency under their supervision.

According to Schwendimann et al. (2019), the Role of Nursing Professional Development in aiding Institute of Medicine’s Future of Nursing Recommendations, the 2010 IOM report emphasized the significance of student’s preparation for a nursing career at the graduate, baccalaureate and associate levels. Moreover, across the healthcare continuum, the recruitment and retention of adequately prepared nurses rely on opportunities provided to nurses to enhance skill and competency.

Worth noting, the current healthcare system complexity demands increasing nurse’s specialization. Nurses who are initially adequately prepared and develop professionally continually throughout their profession are a fundamental aspect of obtaining positive patient outcomes (Rosa et al., 2019). Therefore, the nurse’s professional development is crucial for healthcare excellence. Also, mentored nurses are likely to become leaders in their profession.

According to Schwendimann et al. (2019), by 2020, the number of nurses with a doctorate will double. NPD specialist supports this recommendation by helping nurses to explore appropriate study programs and encouraging nurses to seek their doctorates. This is achieved through educators' critical roles in supporting this recommendation by inspiring leaders to help and forming partnerships with schools.

References

Al Khamisi, Y. N., Khan, M. K., & Munive-Hernandez, J. E. (2019). Knowledge-based lean Six Sigma system for enhancing quality management performance in healthcare environment. International Journal of Lean Six Sigma, 10(1), 211-233.

Anderson, B. A. (2019). Facing the Nursing Workforce Shortage: Policies and Initiatives to Promote a Resilient Healthcare System. Caring for the Vulnerable, 363.

Avia, I., & Hariyati, R. T. S. (2019). Impact of hospital accreditation on quality of care: A literature review. Enfermeria clinica, 29, 315-320.

Azzolini, E., Ricciardi, W., & Gray, M. (2018). Healthcare organizational performance: why changing the culture really matters. Annali dell'Istituto superiore di sanita, 54(1), 6-8.

Brooten, D., & Gordon, Y. (2018). Documenting and Communicating Advanced Practice Nurses' Effectiveness. Pacific Rim International Journal of Nursing Research, 22(1), 1-5.

Delgado, J., García, E., Ribes, J., García, M., & Fernández, P. (2019). CN44 Standardized nursing care in the department of radiotherapy of a network of cancer centres. Annals of Oncology, 30(Supplement_5), mdz274-013.

Dellafiore, F., Caruso, R., Conte, G., Grugnetti, A. M., Bellani, S., & Arrigoni, C. (2019). Individual-level determinants of interprofessional team collaboration in healthcare. Journal of interprofessional care, 1-6.

Despins, L. (2019). Measuring Nursing Workload in an Intensive Care Unit Using NGOMSL Model. In HCI International 2019–Late Breaking Papers: 21st HCI International Conference, HCII 2019, Orlando, FL, USA, July 26–31, 2019, Proceedings (p. 412). Springer Nature.

Dias, J. S., Rocha, L. P., Carvalho, D. P. D., Tomaschewski-Barlem, J. G., Barlem, E. L. D., & Dalmolin, G. D. L. (2019). Construction and validation of a tool to assess nursing interpersonal relations. Revista brasileira de enfermagem, 72(2), 408-413.

Duffield, C., Diers, D., O'Brien-Pallas, L., Aisbett, C., Roche, M., King, M., & Aisbett, K. (2011). Nursing staffing, nursing workload, the work environment and patient outcomes. Applied nursing research, 24(4), 244-255.

Duffy, J. R. (2018). Quality caring in nursing and health systems: Implications for clinicians, educators, and leaders. Springer Publishing Company.

Ernst, J. (2019). The curse of bureaucratisation or the blessings of professionalisation? Nurses’ engaged adoption of quality management in hybrid managerial positions. Scandinavian Journal of Management, 101050.

Festin, M. R., Lumbiganon, P., Tolosa, J. E., Fishbein, M., Francis, J., Eccles, M. P., ... & Presseau, J. (2019). Health Care Work Environments. Cambridge Handbook of Psychology, Health and Medicine, 81, 329.

Fortier, E., & Malloy, D. (2019). Moral Agency, Bureaucracy & Nurses: A Qualitative Study.

Gould, J. C. (2019). The Institute of Medicine and the Pursuit of Quality. In Quality in Obesity Treatment (pp. 23-27). Springer, Cham.

Heistad, A. L. (2019). How Does the Workplace Environment Affect the Health and Decision of Registered Nurses to Remain in Critical Care? (Master's thesis, Nursing).

Kaufman, B. G., Spivack, B. S., Stearns, S. C., Song, P. H., & O’Brien, E. C. (2019). Impact of accountable care organizations on utilization, care, and outcomes: a systematic review. Medical Care Research and Review, 76(3), 255-290.

Kitsios, F., Stefanakakis, S., Kamariotou, M., & Dermentzoglou, L. (2019). E-service Evaluation: User satisfaction measurement and implications in health sector. Computer Standards & Interfaces, 63, 16-26.

Kolarova, T., Bouvier, C., Caplin, M., Conroy, S., Davies, P., Dureja, S., ... & Hicks, R. (2019, March). Unmet Needs in the Global NETs Patient Community From the Perspectives of Patients, Patient Advocates, and NET Health Professionals. In PANCREAS (Vol. 48, No. 3, pp. 442-442). TWO COMMERCE SQ, 2001 MARKET ST, PHILADELPHIA, PA 19103 USA: LIPPINCOTT WILLIAMS & WILKINS.

Lamb, A., Martin‐Misener, R., Bryant‐Lukosius, D., & Latimer, M. (2018). Describing the leadership capabilities of advanced practice nurses using a qualitative descriptive study. Nursing open, 5(3), 400-413.

Lu, H., Zhao, Y., & While, A. (2019). Job satisfaction among hospital nurses: a literature review. International journal of nursing studies.

Mormer, E., & Stevans, J. (2019). Clinical quality improvement and quality improvement research. Perspectives of the ASHA Special Interest Groups, 4(1), 27-37.

Nibbelink, C. W., & Reed, P. G. (2019). Deriving the Practice-Primed Decision Model from a naturalistic decision-making perspective for acute care nursing research. Applied Nursing Research, 46, 20-23.

O’Daniel, M., & Rosenstein, A. H. (2008). Professional communication and team collaboration. In Patient safety and quality: An evidence-based handbook for nurses. Agency for Healthcare Research and Quality (US).

Oppel, E. M., Winter, V., & Schreyögg, J. (2019). Examining the relationship between strategic HRM and hospital employees’ work attitudes: an analysis across occupational groups in public and private hospitals. The International Journal of Human Resource Management, 30(5), 794-814.

Powell, D. L., & Milstead, J. A. (2019). The Impact of Globalization: Nurses Influencing Global Health Policy. and PolitiCs A Nurse’s Guide, 193

Rosa, W. E., Upvall, M. J., Beck, D. M., & Dossey, B. M. (2019). Nursing and Sustainable Development: Furthering the Global Agenda in Uncertain Times. Online Journal of Issues in Nursing, 24(2).

Santoso, B., Supriyati, Y., & Djamal, A. H. (2019, July). The Effect of Team Work and Motivation of Nurses’ Work on the Quality of Health Services at a Military Hospital in Indonesia. In International Conference on Banking, Accounting, Management, and Economics (ICOBAME 2018). Atlantis Press.

Schwendimann, R., Fierz, K., Spichiger, E., Marcus, B., & De Geest, S. (2019). A master of nursing science curriculum revision for the 21st century–a progress report. BMC medical education, 19(1), 135.

Squires, A., Germack, H., Muench, U., Stolldorf, D., Witkoski-Stimpfel, A., Yakusheva, O., ... & Martsolf, G. (2019). The Interdisciplinary Research Group on Nursing Issues: Advancing Health Services Research, Policy, Regulation, and Practice. Journal of Nursing Regulation, 10(2), 55-59.

Sundean, L. J., White, K. R., Thompson, L. S., & Prybil, L. D. (2019). Governance education for nurses: Preparing nurses for the future. Journal of Professional Nursing.