Editorial

In any country, the workplace environment is extremely important to the provision of quality care. Nightingale noticed (Meleis 2007) the importance of the patient’s environment in terms of a patient’s ability to regain his/her health status. Similarly, a nurse’s workplace environment is important if a nurse is to achieve a healthy work status and be able to provide quality care. This role of the workplace environment, in the provision of health care, is just beginning to be recognized and addressed. This topic is particularly important now, and will continue to be so the future, as this workplace environment can also contribute to, or help resolve, an organization’s nursing shortage. Historically, in health care work environments, nurses functioned as unpaid students, providing care to patients as a service to their employers, receiving an education in return. ‘The drive [of the hospital] was to control the nurse in every aspect of the nurse’s life’ (Maggs 2004, p. 152). The organization did very little to create a healthy working environment for nurses. As a result of practicing within these types of environments, nurses began to demonstrate oppressed group behaviors. Many of these behaviors are still demonstrated in today’s workplaces by nurses with a variety of educational levels, skills and experience. In our first paper, Roberts provides a review of the literature on the effects of oppressed group behaviors on the nursing workplace, and suggests interventions for improvements in this area. In contrast, in today’s health care environment, where nurses are critical to the provision of quality health care, more and more organizations are recognizing the role that the workplace serves in both the retention of nurses and the provision of quality care. In addition, various professional documents mandate that nurses also participate in activities designed to improve their work environment. For example, the Code of Ethics for Nurses (American Nurses Association 2001), states the ‘nurse participates in establishing, maintaining, and improving health care environments and conditions of employment conducive to the provision of quality health care and consistent with the values of the profession through individual and collective action’ (p. 4). Frequently, authors or researchers may indicate that environments, or the nurses themselves, can take actions to motivate or empower others. Yet, it is not possible for someone to motivate or empower another. Instead, nurses can participate in creating motivating and empowering environments and also use those environments to motivate and empower themselves. In this issue, Bogue, Lindell, and Sieloff provide an example of creating an empowering environment through the use of shared governance. Supporting these positions of the United States, the International Council of Nurses (ICN) also recognizes the importance of the workplace environment when they state the ‘ICN supports the evidence demonstrating that positive practice environments have a favourable impact on nurse retention and satisfaction and, in turn, on teamwork, continuity of patient care and patient outcomes’ (ICN 2007, para 3). Furthermore, the ICN encourages national nursing organizations to ‘disseminate information on the working conditions of nurses … in an effort to inform nurses’ (ICN 2007, para 11). The ICN also expects ‘nurses [to be] involved in strategic planning, budgeting, efficient resource planning and utilization, and the planning, management and evaluation of programs and services. Nurses must accept their responsibilities in health services policy and decision-making, including their responsibility for relevant professional development’ (2000, para 2). In this issue, Poulton’s article ‘explores the extent to which Community Health Nurses engage in community focused public health practice and the facilitators and barriers to such practice’. Supporting the ICN’s position, the American Nurses Association’s Standards of Professional Performance (2004) state ‘the registered nurse provides leadership in the professional practice setting and the profession’ (p. 40). One of the ways that the registered nurse provides this leadership is through ‘integrat[ion of] research findings into practice’ (American Nurses Association, 2004, p. 40). In addition, the definition of a profession requires that a group possesses unique knowledge on which they base their practice. Although, within nursing, practice is frequently linked to only clinical practice, this author believes that nursing practice also encompasses administration/management, education and research. Therefore, nursing knowledge, developed through research, is needed to not only improve the work environment, but to continue to validate nursing’s professional status. As a result, in addition to the articles already mentioned, other articles in this issue were selected to aid nurses, at all levels within an organization, to work together to further improve their workplace environment. Topics addressed include: leadership, retention of registered nurses, off-shift, workload, and nursing in rural areas. Administrators and managers of workplace environments, if registered nurses, are also held to the same codes and standards as other registered nurses. And, thus, they are expected to also take actions to continue to further improve workplace environments. In this issue, Marriner-Tomey’s article ‘identifies recent research related to nursing leadership and management’s effects on work environment using the 14 forces of magnetism’. Although the Magnet program may not currently be relevant to countries around the world, the factors that have been identified to attract nurses to work environments may be applicable. The Magnet factors have also been demonstrated to be instrumental in retaining nurses within work settings. In our next paper, Karlowicz and Ternus report on their exploration of ‘the work experiences of psychiatric registered nurses (RNs) that influence retention within the first year of employment’. Several work environment factors were found to contribute to a registered nurse’s decision to leave a position within the first year. By replicating this research within other specialty work environments, nurse administrators and managers can determine if actions can be taken to further improve the first year’s experience of newly hired registered nurses. Our next paper presents a factor that may also contribute to RN retention: job involvement. Katrini, Atabay, Gunay and Guneri identified that ‘job involvement [the degree of importance of one’s job to one’s self-image] is related to organizational identification’. Among job dimensions, task identity and autonomy explained a significant proportion of variance in job involvement. Nurses in administrative and management positions can reflect on what could change within their environments to increase job involvement and, therefore, RNs’ identification with the organization, and consider repeating this research in their setting to validate their ideas. In other articles related to improving RN retention, Leiter, Jackson, and Shaughnessy help administrators and managers ‘understand value differences between generations … [in order] to develop more responsive work settings for nurses of all ages’. Farag recommends another strategy to nurse managers: ‘reflect on how they interact with different age cohorts, and involve nurses from various age cohorts in the development of policies to create a flexible work environment’. Liou’s research findings assist administrators and managers to ‘consider nurses’ personal characteristics and experiences to increase the [nurses’] organizational commitment and enhance their intention to stay’. Webster, Flint and Courtney recommend that information from exit interviews of registered nurses, upon leaving an organization, can be used to ‘identify an organization’s strengths and weaknesses and [help] develop initiatives to support retention’ of registered nurses. Literature (Lai et al. 2008) has demonstrated the relationship between nurses’ satisfaction and their intent to stay with a particular employer. Murrells, Robinson and Griffiths take this relationship further by exploring the development of ‘an early career job satisfaction instrument that is valid and reliable across the four United Kingdom nursing branches’. Additional research could then be done to validate that this instrument is also reliable and valid in other countries. Work environments for night shift nurses are often very different than those experienced by day shift nurses, and may include many factors that contribute to nurse dissatisfaction. West, Boughton, and Byrnes found that, for mid-life off-shift nurses, the ‘personal cost of effective juggling may be high for the jugglers’ themselves … [and] also for health systems that provide the mid-life shift-working nurse with no alternative than reduction in working hours’. The relationship between a registered nurses’ workload, their satisfaction with their work environment and the resulting quality of care provided is also worthy of further exploration. Aalto, Karhe, Koivisto, and Välimäki ‘describe the connection between the burden of nurses’ work experience and patient dissatisfaction using electronic indicators available in databases’. By incorporating electronic databases, the authors validate the importance of providing connections between the databases so that data can be more effectively used to facilitate nurses’ work. As job strain may negatively contribute to perceived workload, Edvardsson, Sandman, Nay, and Karlsson ‘identified predictors of job strain in residential nursing care staff working with people with dementia’. Their findings may lead to additional research related to job strain in other work settings. Sawatzky-Dickson and Bodnaryk’s research tested the reliability and validity of the Winnipeg assessment of neonatal nursing needs tool. They found that ‘the tool provided a reasonable and reliable estimation of the number of nurses required for a given collection of patients in order to provide the highest quality of care’. While the research focused on neonatal work areas, additional research could demonstrate the generalizability of the WANNT to other settings and related work areas. The location of the workplace environment, whether urban, suburban or rural, may also contribute to all levels of registered nurses’ efforts to further improve the workplace environment. In this issue, Lockhart describes how supportive nurses and nursing groups, in rural areas, can facilitate nursing practice. This issue has compiled nursing research articles designed to assist nurses at all levels to further improve their workplace environments. These articles have included a variety of: (1) countries represented, (2) research methods, (3) settings and (4) workplace factors. This diversity demonstrates that improving the workplace environment is a global concern as organizations seek to improve their abilities to recruit and retain registered nurses. Although much work has been done, more continues to be needed if the profession is to work together to continue to address the nursing shortage.

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