Rebuilding nursing post pandemic with wellbeing as the foundation

https://doi.org/10.14528/snr.2023.57.2.3248 Decades of research by Gallup in wellbeing reveals among the five types of wellbeing, it is wellbeing at work that is the most important, and this importance is highlighted post covid (Clifton & Harter, 2021). That is because we spend so much of our time at work and wellbeing at work influences all other four types of wellbeing. The most important predictor of wellbeing at work is the interaction the worker has with their immediate manager (Clifton & Harter, 2021). This finding is also pronounced post covid (Clifton & Harter, 2021). The Caring Science International Collaborative (CSIC), an international collaborative, is helping to examine latent constructs like caring and satisfaction in models that provide insight into more complex constructs like wellbeing at work. Understanding how different constructs relate to outcomes like turnover intent, within rigorous and collaborative researchbased organization like this will help nurses move to a more self-directed position in healthcare. CSIC has been studying constructs aligned with wellbeing at work for nurses to develop and scientifically test a model of wellbeing at work that can be used globally to rebuild nursing post pandemic with wellbeing as the foundation. This model of wellbeing at work can be used to add to models that study outcomes, to specify measurement models that not only measure system and patient variables, but importantly include nurses' wellbeing at work as a central predictor of outcomes. Concepts the CSIC has been studying within this 35item model of wellbeing at work include assessment of job satisfaction, clarity of role and system, nurse's report of caring for self, and if the nurse perceives their direct manager acts in a caring way toward them. This brief article is about the research of a group of nurses from 18 countries and the findings they are discovering in their collaborative work about wellbeing at work, and how this relates to nurse outcomes, including intent for turnover. Job satisfaction, according to CSIC, is based on sociotechnical systems theory (Trist & Bamforth, 1951). According to this theory, workers report job satisfaction when they have the social and technical resources to perform their work. A recent study of the CSIC reveals there are six factors of job satisfaction, including three social and three technical (Nelson et al., 2022b). Social factors include satisfaction with relationships with coworkers, communication with their direct manager, and being able to care and plan for patients throughout their stay on their respective unit of care. Technical variables include satisfaction with professional growth, autonomy to perform their work using their education and experience, and how the organization rewards them for the effort and good work put forth. Clarity within this international study is based on the work by Felgen (Nelson & Felgen, 2021). According to this writing, clarity includes understanding not only what their tasks are but also how to manage their time in relationship to these tasks. Possibly most importantly, is clarity on how the system works so they can successfully navigate the resources within the organization so they can fully realize how to enact the role and provide continuous oversight of the patients they care for, to ensure the plan of care is followed through and carried out. This not only helps the patient speed toward recovery, but it helps build trust with the patient which ultimately adds to the Editorial/Uvodnik

Decades of research by Gallup in wellbeing reveals among the five types of wellbeing, it is wellbeing at work that is the most important, and this importance is highlighted post covid (Clifton & Harter, 2021). That is because we spend so much of our time at work and wellbeing at work influences all other four types of wellbeing. The most important predictor of wellbeing at work is the interaction the worker has with their immediate manager (Clifton & Harter, 2021). This finding is also pronounced post covid (Clifton & Harter, 2021).
The Caring Science International Collaborative (CSIC), an international collaborative, is helping to examine latent constructs like caring and satisfaction in models that provide insight into more complex constructs like wellbeing at work. Understanding how different constructs relate to outcomes like turnover intent, within rigorous and collaborative researchbased organization like this will help nurses move to a more self-directed position in healthcare. CSIC has been studying constructs aligned with wellbeing at work for nurses to develop and scientifically test a model of wellbeing at work that can be used globally to rebuild nursing post pandemic with wellbeing as the foundation. This model of wellbeing at work can be used to add to models that study outcomes, to specify measurement models that not only measure system and patient variables, but importantly include nurses' wellbeing at work as a central predictor of outcomes. Concepts the CSIC has been studying within this 35item model of wellbeing at work include assessment of job satisfaction, clarity of role and system, nurse's report of caring for self, and if the nurse perceives their direct manager acts in a caring way toward them. This brief article is about the research of a group of nurses from 18 countries and the findings they are discovering in their collaborative work about wellbeing at work, and how this relates to nurse outcomes, including intent for turnover.
Job satisfaction, according to CSIC, is based on sociotechnical systems theory (Trist & Bamforth, 1951). According to this theory, workers report job satisfaction when they have the social and technical resources to perform their work. A recent study of the CSIC reveals there are six factors of job satisfaction, including three social and three technical (Nelson et al., 2022b). Social factors include satisfaction with relationships with coworkers, communication with their direct manager, and being able to care and plan for patients throughout their stay on their respective unit of care. Technical variables include satisfaction with professional growth, autonomy to perform their work using their education and experience, and how the organization rewards them for the effort and good work put forth.
Clarity within this international study is based on the work by Felgen (Nelson & Felgen, 2021). According to this writing, clarity includes understanding not only what their tasks are but also how to manage their time in relationship to these tasks. Possibly most importantly, is clarity on how the system works so they can successfully navigate the resources within the organization so they can fully realize how to enact the role and provide continuous oversight of the patients they care for, to ensure the plan of care is followed through and carried out. This not only helps the patient speed toward recovery, but it helps build trust with the patient which ultimately adds to the

Editorial/Uvodnik
Rebuilding nursing post pandemic with wellbeing as the foundation Dobro počutje kot temelj za obnovo zdravstvene nege po pandemiji wellbeing of the nurse by feeling their job is making a difference in a relationship that is important to them.
Caring is not only an emotion, but an action, and this model focuses on the actions of caring derived from Watson's 10 processes of caring (Watson, 2008). These processes are referred to as processes of Caritas by Watson (2008). Five of the 10 processes proposed by Watson relate to both intentional caring for self, and caring by their nurse manager (Nelson, 2022). These five behaviors include Caritas process 2 (Instill faith and hope), Caritas process 9 (meeting basic needs), Caritas process 4 (helping and trusting relationships), Caritas process 8 (creation of a healing environment), and Caritas process 5, (promote expression of all feelings). What was unique to caring for self was inclusion of caritas process 10 (support belief in miracles or what seems impossible). What was unique to caring of manager was caritas process 7 (teaching in a way to ensure learning) (Nelson, 2021).
From 2019 to 2021, the CSIC collaborated to study a model that included 19 items for job satisfaction, four items for clarity or role and system, six items for caring for self, and six items for caring of direct manager. It was found Watson's theory (2008) was not valid in Western Scotland, so they used a 7-item assessment that was derived from a 2010 National Health Service (NHS) report that included concept of caring advocated for within the NHS Scotland. This 7-item scale from the NHS was found to be psychometrically sound (Williamson, Smith, Brown, & Nelson, 2021b). Structural equation modeling was used to assess this model among 4,022 nurses from 10 countries and was found to have good model fit in all countries (Nelson et al., 2022a;Nelson et al., 2022b). Countries studied included Brazil, Canada, China, Israel, Russian Federation, Scotland, Serbia, Slovenia, Turkey, and United States of America (USA). Invariance testing was used to ensure bias did not occur between participating countries (Nelson et al., 2022b).
Follow up research to the 2019-2021 research, using the newly tested model of wellbeing at work is testing how the model relates to nurse's intent for turnover, sick days, difficulty in working during the pandemic, and if nurses report residual trauma from the pandemic. Preliminary findings of the data from the countries of Jordan, Israel, Scotland, Poland, and the USA reveals 42% of the 80% explained variance of wellbeing at work is explained by the caring of the manager. These findings are consistent with the recent research by Gallop (Clifton & Harter, 2021). It was the caring of the manager that had the highest factor loadings in every factor analysis in the countries Jordan, Israel, Poland, and Scotland. It was second in the USA. Organizational rewards was first for the USA and second for the other four countries. These preliminary findings also reveal that wellbeing at work predicts about 36% of nurses actively looking for a new job. Nurses who report wellbeing at work are likely not to leave.
Results from each of the participating hospitals/ facilities descriptive statistics, such as the mean scores and standard deviations, and analyses have helped participating countries and facilities understand the strengths and challenges of the constructs and dimensions of each hospital/facility to work on improving wellbeing of nurses, post pandemic. It is helpful to know that the 35-item assessment does not represent bias between countries so the results can be discussed globally, and programs to improve wellbeing and assess it more deeply as it relates to outcomes, beginning with the outcome of retention of nurses.
Scotland and some facilities in the US have stepped forward to analyze and present the data at the unit level, gathering the staff and leaders from each unit to have a conversation about the results. Scotland has completed unit level presentations and about 30 of the facilities, from three health systems, in the state of Tennessee within the US have decided to do the same, and study and present wellbeing at work at the unit level. It is expected that what occurred in Scotland in May of 2023 will occur in the US hospitals as well. The hospital in Scotland has been integrally involved in this international research on wellbeing for about 10 years and working at the unit level to improve operations of care and associated outcomes (Williamson, Smith, Brown, & Nelson, 2021a;Williamson et al., 2021b).
In May of 2023, there were 18-unit level presentations in the participating hospital in Scotland. Each unit had the opportunity to respond to three questions presented by the nurse researcher, including 1) what in the data was surprising, 2) what in the results was most useful, and 3) based on the discussion what actions should be taken. Attendees of the session were also asked why they stay on the unit, seeking to build a model of measurement for retention that is specified for the context. Higher scores of post-pandemic residual trauma were an indicator of the intensity of the discussion before the discussion began. Most of the 18 units did not want to share about the results before they revealed the trauma they were still feeling from working through the pandemic. The results were presented for 20 minutes, and the discussion lasted for 25 minutes, with each unit being allotted 45 minutes total for a unit-level presentation and discussion. The 25 minutes of discussion were filled with, often passionately, emotional review of the difficulty working in the pandemic. These stories of trauma that nurses shared, along with the responses to the three questions and content of why they stay in their current job were used to develop meaningful action plans. Developed actions plans will be used to build nursing back after the pandemic but with wellbeing at work as the foundation.
This experience of nurses sharing these stories and subsequent action planning is not conveyed adequately with text, because the emotion of the discussion is difficult to replicate adequately in text. What did result, and can be explained here, is the nurses were grateful to tell their story, and why they remain within their current job. The plan is to build from the richness of nurses' passion for care, and building the aspects of wellbeing that were identified in the conversation. The model of wellbeing at work used by the CSIC mirrored the spontaneous and passionate conversation with nurses and leaders at the unit level. On a psychometric level, it provided a powerful predictive validation of the instrument itself, that the measure of wellbeing behaved in a way one would expect in a conversation about wellbeing at work.
Building nursing back, from the pandemic, will not occur by measurement of the construct alone. The results must be presented in a way to provide time for the nurses to vent about their experience. If this is not done, floating to units other than their home unit will always be an emotional trigger as the trauma of floating will create another day of stress within work, not because of the work itself, but the trauma associated with the pandemic experience. Losing a coworker brings on a deeper sense of loss for those who have not addressed the trauma bond that developed for many who worked through the pandemic together. We have much to learn about healing and retaining nurses, but measurement alone is not enough. It must be the stories, told by the nurses, that are used to identify the strengths and weaknesses to do more of what the nurses now cherish, and do less of those things that created trauma. This is how we will build nursing back than ever before, with wellbeing at work being the foundation built from.