Rushton Cynda, Nelson Katie, Bergman Alanna, Boyce Danielle, Jenkins Christian, Swoboda Sandra M, Hanson Ginger
Johns Hopkins University School of Nursing, Baltimore, MD, USA.
Johns Hopkins Berman Institute of Bioethics, Baltimore, MD, USA.
J Nurs Manag. 2024 May 9;2024:6808266. doi: 10.1155/2024/6808266. eCollection 2024.
During a public health crisis, such as the COVID-19 pandemic, nurse leaders coordinate timely high-quality care, maintain profit margins, and ensure regulatory compliance while supporting the health and wellbeing of the nursing workforce. In a rapidly changing environment where resources may be scarce, nurse leaders are vulnerable to moral injury; however, organizational effectiveness may help to buffer moral challenges in healthcare leadership, thereby fostering greater moral resilience and reducing turnover intention.
To understand mechanisms by which perceived organizational effectiveness contributes to nurse leaders' moral wellness (i.e., moral injury and moral resilience) and thereby effects work outcomes (i.e., engagement, burnout, and turnover intention).
A cross-sectional survey of nurse leaders ( = 817) from across the United States was conducted using a snowball methodology, independent -tests, and structural equation modeling to examine theoretical relationships among moral injury, moral resilience, and organizational effectiveness.
Higher ratings on every facet of perceived organizational effectiveness were significantly related to greater moral resilience ( < 0.001 for all -tests) and lower moral injury ( < 0.001 for all -tests) among nurse leaders. Structural equation models indicated both moral resilience and moral injury were significant mediators of the relationship between organizational effectiveness and work outcomes. Moral resilience and moral injury significantly mediated the effect of organizational effectiveness on burnout. Moral resilience was also a significant mediator of the relationship between organizational effectiveness and moral injury.
Dismantling organizational patterns and processes in healthcare organizations that contribute to moral injury and lower moral resilience may be important levers for increasing engagement, decreasing burnout, and reducing turnover of nurse leaders.
在公共卫生危机期间，如新冠疫情大流行期间，护士领导者要协调及时的高质量护理，维持利润率，并确保合规，同时还要保障护理人员的健康和福祉。在资源可能稀缺的快速变化环境中，护士领导者容易受到道德伤害；然而，组织有效性可能有助于缓冲医疗保健领导中的道德挑战，从而增强道德复原力并降低离职意愿。
了解感知到的组织有效性对护士领导者道德健康（即道德伤害和道德复原力）的影响机制，进而影响工作成果（即敬业度、倦怠和离职意愿）。
采用滚雪球抽样法对来自美国各地的817名护士领导者进行横断面调查，使用独立样本t检验和结构方程模型来检验道德伤害、道德复原力和组织有效性之间的理论关系。
护士领导者对组织有效性各方面的评价越高，其道德复原力越强（所有t检验p<0.001），道德伤害越低（所有t检验p<0.001）。结构方程模型表明，道德复原力和道德伤害都是组织有效性与工作成果之间关系的重要中介变量。道德复原力和道德伤害显著中介了组织有效性对倦怠的影响。道德复原力也是组织有效性与道德伤害之间关系的重要中介变量。
消除医疗保健组织中导致道德伤害和降低道德复原力的组织模式和流程，可能是提高护士领导者敬业度、减少倦怠和降低离职率的重要杠杆。
