Navigating uncertainties for promoting nurse-led changes in work environments: A participatory action research

Area of Science:

• Nursing Science
• Healthcare Management
• Organizational Psychology

Background:

• The nursing work environment significantly impacts nurse well-being and patient care quality.
• Improving the nursing work environment faces challenges in identifying effective interventions and integration strategies.
• Evolving nursing practices, complex demands, and staff shortages necessitate understanding nurse challenges and support systems.

Purpose of the Study:

• To explore strategies for promoting and supporting nurse-led changes aimed at improving the nursing work environment.

Main Methods:

• Participatory action research conducted on three nursing wards in a Dutch academic hospital (September 2022 - October 2023).
• Involved action research teams with diverse ward nurses.
• Data collection through observations, PhotoVoice workshops, and individual interviews, analyzed using rigorous and accelerated data reduction.

Main Results:

• Identified behavioral patterns that either hindered or facilitated change, categorized into three themes: strengthening relationships, taking the lead, and being up to the task.
• Highlighted the importance of collaboration, proactive attitudes, and capability building for positive environmental changes.
• Observed that feelings of uncertainty hindered nurses from taking responsibility for facilitating change.

Conclusions:

• Nurse-led changes are influenced by mechanisms that facilitate or hinder progress, with uncertainty playing a significant role.
• Nurses value collaboration and proactivity but face challenges with responsibility recognition and perceived competencies.
• Enhancing nurses' resilience and management of uncertainty is crucial for healthcare organizations to foster positive changes.