I. Aim

To develop a scale for evaluating the nursing practice ability of new and veteran staff nurses in acute hospitals.

II. Methods

Six hospitals located in several metropolitan areas were selected thorough snowball sampling. The questionnaire survey was conducted on staff nurses who evaluated their own nursing practice ability (self-assessment) and senior nurses (team leaders and chief nurses) who evaluated the nursing practice ability of the staff nurses (others assessment). The pilot survey was conducted in December 2007 and the main survey was conducted in January 2008. Self-assessment and others assessment data were analyzed by item analysis and internal correlation coeffi cients were calculated between self and others assessments. Factor analysis using the maximum likelihood method incorporating factors with eigenvalues of 1 or larger was conducted with the promax rotation using only self-assessment data.

III. Results

Data were collected from the self-assessments of 1023 staff nurses and the others assessments of 1023 senior nurses. The results of item analyses showed no sealing or fl oor eff ects and the scores for all questions were higher for others assessments than for self-assessments. In addition, the internal correlation coefficient demonstrated adequate consistency between self-assessments and others assessments. Therefore, the scale was developed using only data from self-assessments. The analysis of the self-assessment data revealed the following five factors of nursing practice ability: \“Basic nursing care that is appropriate for the patient\'s situation\”, \“Nursing care for patients who are highly dependent on medical treatment\”, \“Development of individualized nursing processes for each patient\”, \“Fulfilling one\'s role as a member of a team\”, and \“Nursing care that maintains patient safety\”. Based on these factors, a 47-item nursing practice ability scale was developed.

The aim of this longitudinal questionnaire study was to find predictors for young nurses leaving their hospitals within one year of hire in the aspect of individual, organizational and health related factors, and to suggest a way to prevent turnover among nurses who had less than five years of experience. First survey was conducted in September 2007; 1430 nurses responded (response rate: 63.7%). The questionnaire was comprised of individual factors, organizational factors, and healthrelated factors. Subsequently, we investigated into whether the respondents resigned from their jobs in the respective hospitals within one year as of September 2008. Among the 1307 analyzed people, 182 (13.9%) resigned within one year, while 1125 continued to work. We clarified as fellow.

1. The more years of experience the nurses had, the higher the rate of leaving within one year was.

2. The group of nurses leaving hospitals had more subjective health problems than those who stayed, and health related presenteeism predicted turnover of nurses, so it is important to pay attention to health and work performance among nurses with less than 2 years of experience.

3. The study presented significant predictors of turnover were a chance to discuss, the relationship between nurses and doctors, adequate facilities, and overtime among nurses with 3-5 years of experience. This result revealed the ways of preventing their resignation were to prepare further education appreciated their roles and positions, to mutually understand among healthcare members, and to manage working hours and the work environment.

4. The health related presenteeism of the group of leaving hospitals was higher than staying nurses hence it was important to the organization to manage safety and health, especially health management.

The present study aimed to develop a scale to measure attitudes and behaviors which foster organizational learning from incidents, based on Cannon and Edmondson\'s theory.

Methods: We developed a questionnaire and conducted a pilot test. The questionnaire was then distributed to nursing staff working at 4 hospitals.

Results: Questionnaires were returned by 1099 nurses (response rate, 77%). Factor analysis obtained three subscales, as follows: “Identify and give feedback to address the at-risk behavior” (4 items, α=0.79), “make efforts to identify the problem” (4 items, α=0.71), and “discuss safety in the workplace” (3 items, α=0.81). Confirmatory factor analysis revealed a good fit for the model (AGFI=0.94, CFI=0.96, RMSEA=0.064). All three subscales addressed tenure status and gender; nurses with longer tenure and those who were female obtained higher scores.

Conclusions: We obtained three subscales which were consistent with the original concept. Scale reliability and validity of the scale were confirmed by the Cronbach α (0.71-0.81) and by the confirmatory factor analysis. Subscale relationship with tenure was reasonable as longer tenure allows nurses to more easily identify, give feedback about, and discuss the problem. While the lower scores obtained by male nurses are not inconsistent with the concept of the scale, it is possible that these were caused by the small sample of male nurses in the working group.

This study examined a relationship among Work Engagement, Job Satisfaction and turnover intention among registered midwives and nurses working in public hospitals providing secondary medical care. The participants were 114 registered midwives and nurses working in general internal medicine, ICU (intensive care unit) and obstetric wards of 6 public hospitals. The Japanese version of the Utrecht Work Engagement Scale (UWES-J, 17 items) and the Japanese version of Stamps' Job Satisfaction (48 items) were used in the study. The results were as follows:

1. Scores for Work Engagement were 2.8±0.9 and those for Job Satisfaction was 140.9±24.4. There was no difference in those scores between midwives and nurses.

2. Staff with turnover intention showed significantly lower scores for Work Engagement and Job Satisfaction score than those without such intention.

3. Work Engagement was moderately correlated with Job Satisfaction among staff with turnover intention (r = 0.457, p<0.01), but there was no correlation in staff without such intention.

4. There was no difference in scores for Work Engagement and Job Satisfaction among three wards. However, Staff with turnover intention scored significantly lower for Work Engagement than those without such intention in ICU and obstetrics wards, and there was significant difference in Job Satisfaction among staff working only in obstetrics wards.

These findings indicated that Work Engagement among staff in public hospitals providing secondary medical care correlated with the turnover intention and it is necessary to understand Work Engagement of staff in each ward individually, when we addressing the problem of turnover.

This research aimed firstly, to clarify related factors among job-continuing intention, job satisfaction and burnout for nurses in mid-career, then secondly, to investigate factors supporting nurses' job-continuity. Questionnaires were distributed to 1,064 nurses who worked at three general hospitals of 200 - 700 beds. The study focused on 331 nurses who had five years through fourteen years of nursing experience. Two questionnaires were used: the Pines Burnout survey (Inaoka 1988) and another survey containing five components (administrative system, relationships among colleagues, nursing specialties, and self actualization as nurses (Nakayama, Nojima 2001). The following results were obtained: 40% of nurses did not want to continue working at their hospitals. Through discrimination analysis, factors identified as related to job-continuity were self actualization as nurses, administrative systems, job satisfaction and burnout. Through multiple regression analysis, factors identified as affecting job satisfaction were the administrative system in the organization, and relationships among colleagues. Also revealed through multiple regression analysis was that individual professional specialty was a factor affecting job satisfaction. Specifically, a high-level professional specialty was correlated to high job satisfaction and low burnout. These findings suggest that appropriate measures be taken by nursing administrators. The researchers recommend improving overall working conditions, including providing an in-house framework for nurses to pursue individual professional specialties, thereby enhancing self actualization as nurses. In addition, early detection of symptoms of staff burnout is recommended in order for administrators to take necessary countermeasures for the improvement of staffs' mental health.

In this study, we aimed to clarify the factors providing nurses with a positive feeling and sense of satisfaction concerning their work. We conducted semi-structured interviews with 18 nurses working at general hospitals, and studied the results through qualitative analysis. The results indicated that their senses of job satisfaction were influenced by factors in 6 categories: [positive feelings about the work], [professional autonomy], and [checking work achievements] with regard to their work, [support from superiors] and [relationships with other people] with regard to interpersonal relationships, and a [good working environment]. The respondents had gained [positive feelings about the work], such as pride and a sense of satisfaction in their work, by actively seeking professional goals and achieving their [professional autonomy]. Further, [checking work achievements] enhanced the [positive feelings about the work] and [professional autonomy]. The respondents were encouraged by [support from superiors], including appropriate advice and communication provided by superiors facilitating growth and development, and [relationships with other people], including positive evaluation by their colleagues and doctors and approval by their patients. For a [good working environment], proper working conditions and workload, as well as the opportunity to take a leave of absence and attend academic society meetings, were important. The results suggested that the respondents had a heightened sense of job satisfaction by meeting the criteria in the 3 categories with regard to their work with support from superiors and other people in a [good working environment].

Due to the serious nurse shortage, delegation is well reported among developed countries such as America, England and Australia. Delegation is a quality control in order to decrease the amount of nursing care, and allows unlicensed assistive personnel to give limited nursing care under guidelines. This research aims to compare what contents are included in the decision-making frameworks and delegation system in those countries. Website contents of nursing board in America (American Nurses Association), England (Nursing and Midwifery Council), and Australia (Australian Nursing and Midwifery Council) were compared, using a text analysis software SPSS^® Text Analysis for Surveys. As for copy right, permission from every nursing board was obtained. As a result, America has a definition of delegation, and scope of delegable nursing care, nurses' responsibility and accountability, five right delegations. In England, without decision-making framework to support each nurse's decision in delegating tasks, making regulations about delegation was the nurse managers' responsibility in hospital and on nursing boards. According to Australian guideline, each state has diff erent frameworks; this implies the situation of availability of nurses in urban and country areas. Plus, The Nurses Act 1992 prohibits nurses to delegate any nursing tasks; however, the Nursing Board determined the interpretation of the law as what can be nursing tasks may change due to the situation. What we learned from Australia was the interpretations of the law as well as what need to be done by nurses were of necessity in Japan before implementing a delegation system. As for England, situating nursing managers and boards to have responsibility to decide delegation system without responsibility for a staff level nurse, might be another option to consider for introduction in Japan.