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Volume 22(3); June 2016

Original Articles
Nurse Staffing Levels and Proportion of Hospitals and Clinics Meeting the Legal Standard for Nurse Staffing for 1996~2013
Sung Hyun Cho, Ji Yun Lee, Kyung Ja June, Kyung Jin Hong, Yunmi Kim
J Korean Acad Nurs Adm 2016;22(3):209-219.   Published online June 30, 2016
DOI: https://doi.org/10.11111/jkana.2016.22.3.209
PURPOSE
To analyze the proportion of medical institutions meeting the legal standard for nurse staffing.
METHODS
Data collected from 29,282 institutions between 1996 and 2013 were analyzed. Nurse staffing was measured as daily patient census per registered nurse (RN). The standard for general hospitals, hospitals, and clinics is 2.5 or less, and that for long-term care hospitals is 6.0 or less of the daily patient census per RN. Clinics may substitute nursing assistants for RNs by 50% or 100% depending on their daily inpatient census; long-term care hospitals may substitute nursing assistants for RNs by two thirds of the required number of RNs.
RESULTS
The proportion of general hospitals, hospitals, clinics, and long-term care hospitals meeting the standards was 63%, 19%, 63%, and 94%, respectively, in 2013. While general hospitals had an increase in the proportion during the 1996-2013 period, small changes were found in hospitals and clinics. In 2013, nurses were estimated to care for 16 (interquartile range: 12~24) patients per shift in general hospitals. Three quarters of clinics had no RNs in 2013.
CONCLUSION
Many medical institutions did not meet the legally mandated minimum staffing level. The government must implement policy actions for all medical institutions to meet the legal standards.

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The Effects of Hospital Nurses' Self-Esteem and Communication Skill on Self-Leadership and the Quality of Nursing Service
Hee Jung Song, Sang Mi Lee
J Korean Acad Nurs Adm 2016;22(3):220-229.   Published online June 30, 2016
DOI: https://doi.org/10.11111/jkana.2016.22.3.220
PURPOSE
The objective of this study was to investigate the influence of hospital nurses' self-leadership, communication skill, and self-esteem on the quality of nursing service.
METHODS
The participants, 230 nurses working at a general hospital in Seoul, completed a cross-sectional descriptive questionnaire survey between January 17 and 28, 2014. The collected data were analyzed using the SPSS 19.0 program for descriptive statistics, t-test, one way & two way ANOVA, correlation, and multiple regression analysis.
RESULTS
Nurses' self-esteem and communication skill had significant main effects on self-leadership and the quality of nursing service, but the interaction effect of the two independent variables was not significant. Variables that significantly influenced the quality of nursing service were self-leadership, communication skill, self-esteem, and career longevity. The explanatory power of these variables for the quality of nursing service was 54.4%.
CONCLUSION
Findings indicate a need for education programs for nurses which are designed to promote communication skill and enhance self-esteem and self-leadership skills which will in turn enhance the quality of nursing service.

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Predicting Patient Safety Behaviors of Nurses in Inter-Hospital Transfer
Sunhee Park, Taewha Lee
J Korean Acad Nurs Adm 2016;22(3):230-238.   Published online June 30, 2016
DOI: https://doi.org/10.11111/jkana.2016.22.3.230
PURPOSE
The purpose of this study was to investigate predictors of nurses' patient safety behavior during inter-hospital transfer. The study was based on the Theory of Planned Behavior (TPB).
METHODS
A descriptive survey design was used. Data were collected with a self-administrated 39-item questionnaire completed by 111 nurses from a university hospital in Seoul, South Korea. The questionnaire was developed based on the Theory of Planned Behavior (TPB) guideline and included measure of self- reported past patient safety behaviors, intentions, attitudes, subjective norms and perceived behavioral controls. Ethical approval was granted by the hospital review board. Hierarchical regression analyses were carried out.
RESULTS
The average score of patient safety behavior was 4.21±0.63 (5 point scale). The TPB variables explained 49.9%of the variance in patient safety behavior. Intention and subjective norm were the most significant predictors of nurses' patient safety behavior. Attitude was related to nurses'patient safety behavior.
CONCLUSION
TPB variables predicted the nurses'patient safety behavior during inter-hospital transfer of patients except for perceived behavioral controls. The results of this study suggest that better strategies for subjective norms and intentions related to patient safety behavior will be helpful in safety culture reform.

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Effect of General Hospital Nurses' Perception of Patient Safety Culture and Burnout on Safety Management Activities
Hyun Mi Jang, Ju Young Park, Young Ju Choi, Sung Won Park, Han Na Lim
J Korean Acad Nurs Adm 2016;22(3):239-250.   Published online June 30, 2016
DOI: https://doi.org/10.11111/jkana.2016.22.3.239
PURPOSE
The aim of this study was to examine effects of patient safety culture and burnout on safety management activities with a focus on clinical experience of nurses in general hospitals.
METHODS
Self-administered questionnaires were given to nurses in a general hospital in C Province, and 107 questionnaires were used for final analysis. Collected data were analyzed using SPSS/WIN 21.0 Program for t-test, ANOVA, Pearson correlation coefficients, and multiple regression.
RESULTS
The highest score as perceived by general hospital nurses for patient safety culture was for 'Immediate superior/Manager'(3.84), for burnout, the highest score was for 'Emotional exhaustion' (4.13), and for safety management activities, the highest score was for 'Prevention of infection' (3.96). Patient safety culture and safety management activities perceived by general hospital nurses showed significant positive correlations (r=.35 p<.001). The correlations between burnout and safety management activities perceived by the nurses showed significant negative correlations (r=-.37, p<.001). Results of hierarchical regression analysis conducted to identify factors that affect safety management activities showed that patient safety culture (β=.40 p<.001) was effective for controlling safety management activities.
CONCLUSION
The findings indicate a need to build a patient safety culture that fits the characteristics and situations of various hospitals.

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Effects of Workplace Spirituality and Organizational Citizenship Behavior on Nursing Performance
Gyeong Min Noh, Myung Sook Yoo
J Korean Acad Nurs Adm 2016;22(3):251-259.   Published online June 30, 2016
DOI: https://doi.org/10.11111/jkana.2016.22.3.251
PURPOSE
The purpose of this study was to examine the effects of workplace spirituality and organizational citizenship behavior on nurses' performance of nursing.
METHODS
This study was done over a 6 month period, with 395 nurses participants from 5 different general hospitals with 400 beds in 4 regions of Korea. Data were gathered using self-reported questionnaires from July 23 to August 21, 2015. Data were analyzed using descriptive statistics, independent t-test, one way ANOVA, Pearson correlation coefficients, and multiple regression analyses with IBM SPSS 21.0 program.
RESULTS
Nursing performance showed positive correlations with workplace spirituality and organizational citizenship behavior. The significant predictors of the nursing performance by nurses were a master's degree or higher (β=.26), civic virtue (β=.19), courtesy (β=.12), 40 years of age or older (β=.09), a sense of empathy (β=.07), and a bachelor's degree in nursing (β=.06). These variables explained 39.2% of the variance in nursing performance by nurses.
CONCLUSION
Based on the outcomes of this study, there is a need to develop intervention programs that can inspire nurse to show spontaneous organizational citizenship behavior, and enhance their workplace spirituality. Related variables including academic credentials should also be taken into account.

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PURPOSE
The present study was aimed to examine the degree of nurses' emotional labor and occupational stress and demonstrate the moderating and mediating effects of work-family conflict in the relationship among emotional labor, occupational stress, turnover intention of nurses.
METHODS
The participants for this study were 307 nurses currently working in two general hospitals in G city in Korea. Data were collected using structured questionnaires and analyzed for descriptive statistics, t-test, ANOVA, Mann-Whitney U Test, Kruskal Wallis Test, Pearson correlation coefficients and hierarchical multiple regression with SPSS/WIN 21.0 program.
RESULTS
It turned out that work-family conflict plays an important role in the relationship among emotional labor, occupational stress, turnover intention of nurses.
CONCLUSION
Therefore, to reduce nurses' turnover intention, it is necessary to have an intervention focusing on work-family conflict. Also, it is necessary for both the government and hospitals to establish a supportive system and a program to relieve nurses from their work-family conflict.

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    Ji‐Soo Kim
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Development of a Performance Appraisal Tool for Postoperative Anesthesia Care Unit Nurses
Yoon Young Lee
J Korean Acad Nurs Adm 2016;22(3):270-278.   Published online June 30, 2016
DOI: https://doi.org/10.11111/jkana.2016.22.3.270
PURPOSE
The purpose of this study was to develop a performance appraisal tool (PAT) for postoperative anesthesia care unit (PACU) nurses.
METHODS
This study was a descriptive, non-experimental methodological study. The PAT was developed through a literature review and tests for validity and reliability.
RESULTS
Subsequent to a review of the literature on nursing performance of PACU nurse, a 63 item questionnaire was developed. Through factor analysis, 61 items in 3 domains with 8 factors were derived. Cronbach's α coefficient of the final instrument was .99.
CONCLUSION
This tool is an efficient PAT for PACU providing meaningful feedback for professional growth in PACU nurses.

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    Myoungjin Min, Soyoung Yu
    Journal of Korean Academy of Nursing Administration.2017; 23(1): 90.     CrossRef
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Relationships among Nursing Work Environment, Job Embeddedness, and Turnover Intention in Nurses
Hae Jin Ko, Jeong Hee Kim
J Korean Acad Nurs Adm 2016;22(3):279-291.   Published online June 30, 2016
DOI: https://doi.org/10.11111/jkana.2016.22.3.279
PURPOSE
The purpose of this study was to investigate the relationship among nursing work environment, job embeddedness, and turnover intention in order to provide basic data for efficient management of human resources in nursing organizations.
METHODS
A cross-sectional, descriptive study design was conducted with 177 nurses who had worked for more than 6 months in five general hospitals on Jeju Island. A self-report questionnaire was used for data collection.
RESULTS
About 88% of the participants reported that they were considering a turnover plan because of overload in their jobs and poor salaries. Nursing work environment was significantly related to job embeddedness and turnover intention. Job embeddedness was significantly related to turnover intention. Hierarchical multiple regression analysis showed that factors affecting turnover intention were the organizational embeddedness factors of organization fit and organization sacrifice.
CONCLUSION
The results indicate that nurses' turnover intention is associated with nursing work environment and job embeddedness. To reduce nurses' turnover intention and improve nurses' retention, nurse managers should improve the nursing work environment and consider job embeddedness, particularly in relation to the organization fit and sacrifice.

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    Yo-Na Kim
    The Korean Journal of Health Service Management.2017; 11(1): 67.     CrossRef
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PURPOSE
This study was done to build and verify a model of clinical nurses' turnover intention using organizational characteristics, job satisfaction and job embeddedness.
METHODS
The study participants were 389 hospital nurses. SPSS and AMOS 22.0 program were used to analyze the data and the modeling of turnover intention.
RESULTS
A total of 41% of turnover intention was explained by job satisfaction, job embeddedness and organizational characteristics. Nurses with higher job satisfaction and job embeddedness showed lower turnover intention, while organizational characteristics had an indirect effect on their turnover intention. It was found that organizational characteristics had positive effects on both job satisfaction and job embeddedness, and job embeddedness played a mediating role between organizational characteristics and turnover intention.
CONCLUSION
To reduce nurses' turnover intention, hospitals' organizational characteristics should be considered. Nurse managers should strive to increase nurses' job satisfaction and job embeddedness through an understanding of the factors of organizational characteristics such as organizational fairness, nursing work environment, motivation, organizational citizenship behavior, and transformational leadership.

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    Soo Jung Kim, Hee Je Yun, Yeong Hun Park, Young Jun Lee, Jung Hwan Heo, Gi Hwan Park, Ji Won Kim, I Gyeong Jo
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PURPOSE
The purpose of this study was to identify relationships among self-esteem, social support, nursing organizational culture, experience of workplace bullying, and the consequences of workplace bullying in hospital nurses, and then to provide basic information for developing workplace bullying prevention programs.
METHODS
Participants were 122 hospital nurses from three general hospitals. Data collection was done during April and May 2015. Data were collected using self-report questionnaires which were used to identify participants' characteristics, self-esteem, social support, nursing organizational culture, and workplace bullying.
RESULTS
Approximately one quarter of the nurses had experienced workplace bullying in the past six months. Hierarchical regression analysis showed that experience of workplace bullying (β=.45) and self-esteem (β=-.31) explained 53.3% of the variance in consequences of workplace bullying.
CONCLUSION
Based on the findings that experiencing workplace bullying and having a low self-esteem were likely to increase workplace bullying in hospital nurses, there is a need to develop prevention and intervention programs on avoiding or dealing with workplace bullying.

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