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"They say they listen. But do they really listen?": A qualitative study of hospital doctors' experiences of organisational deafness, disconnect and denial. "他们说他们会倾听。但他们真的倾听了吗?医院医生对组织失聪、脱节和否认的定性研究。
IF 2.1 Q2 Medicine Pub Date : 2024-05-31 DOI: 10.1177/09514848241254929
Jennifer Creese, John Paul Byrne, Edel Conway, Gerard O'Connor, Niamh Humphries

The sharing of information and feedback directly from service-providing staff to healthcare organisational management is vital for organisational culture and service improvement. However, hospital doctors report feeling unable to communicate effectively with management to provide evidence and affect improvement, and this can impact job satisfaction, workplace relations, service delivery and ultimately patient safety. In this paper, we draw on data elicited from a Mobile Instant Messaging Ethnography (MIME) study involving 28 hospital doctors working in Irish hospitals, to explore the barriers preventing them from speaking up and effecting change, and the impact of this on staff morale and services. We identify three major barriers, consistent with previous literature, to effective feedback and communication: (1) organisational deafness, (2) disconnect between managers and frontline staff, and (3) denial of the narratives and issues raised. We draw these together to identify key implications from these findings for healthcare managers, and suggest policy and practice improvements.

提供服务的员工与医疗机构管理层直接分享信息和反馈,对于机构文化和服务改进至关重要。然而,医院医生表示,他们感到无法与管理层进行有效沟通,以提供证据并影响改进工作,这会影响工作满意度、工作场所关系、服务提供,并最终影响患者安全。在本文中,我们利用移动即时信息人种学(MIME)研究中获得的数据,探讨了阻碍他们畅所欲言和实现变革的障碍,以及这些障碍对员工士气和服务的影响。我们发现了阻碍有效反馈和沟通的三大障碍,这与之前的文献一致:(1) 组织失聪,(2) 管理者与一线员工脱节,(3) 对所提出的叙述和问题的否认。我们将这些因素归纳在一起,以确定这些发现对医疗管理人员的主要影响,并提出政策和实践改进建议。
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引用次数: 0
Towards a shared understanding of the learning health system in a large academic-based health system: A qualitative analysis. 在以学术为基础的大型医疗系统中实现对学习型医疗系统的共同理解:定性分析。
IF 2.1 Q2 Medicine Pub Date : 2024-05-15 DOI: 10.1177/09514848241254928
Allyson L Varley, Trudi Venters Horton, Maria Pisu, Raegan W Durant, Michael J Mugavero, Andrea L Cherrington, Kevin R Riggs

Healthcare delivery is currently undergoing major structural reform, and the Learning Health System (LHS) has been proposed as an aspirational model to guide healthcare transformation. As efforts to build LHS take considerable investment from health systems, it is critical to understand their leaders' perspectives on the rationale for pursuing an LHS and the potential benefits for doing so. This paper describes the qualitative analysis of semi-structured interviews (n = 17) with health system leaders about their general perceptions of the LHS, description of key attributes and potential benefits, and perception of barriers to and facilitators for advancing the model. Participants universally endorsed the goal of the local health system aspiring to become an LHS. Participants identified many recognized attributes of LHS, though they emphasized unique attributes and potential benefits. There was also heterogeneity in participants' views on what to prioritize, how to structure the local LHS within existing initiatives, and how new initiatives should be implemented. Improving conceptual clarity of attributes of the LHS would improve its potential in guiding future reform.

目前,医疗保健服务正在经历重大的结构改革,学习型医疗系统(LHS)已被提出作为指导医疗保健转型的理想模式。建立学习型医疗系统需要医疗系统投入大量资金,因此了解医疗系统领导者对建立学习型医疗系统的理由和潜在益处的看法至关重要。本文介绍了对医疗系统领导者进行的半结构式访谈(n=17)的定性分析,访谈内容包括他们对长效医疗系统的总体看法、对其关键属性和潜在益处的描述,以及对推进该模式的障碍和促进因素的看法。与会者普遍赞同地方医疗系统立志成为地方医疗系统的目标。与会者指出了许多公认的地方保健系统属性,但也强调了其独特属性和潜在效益。与会者对优先考虑的事项、如何在现有倡议中构建地方健康服务体系以及如何实施新倡议的看法也不尽相同。在概念上进一步明确地方保健系统的属性,将提高其指导未来改革的潜力。
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引用次数: 0
The characteristics of leadership and their effectiveness in quality management in healthcare - A systematic literature review and a content analysis. 领导力的特点及其在医疗质量管理中的有效性--系统文献综述和内容分析。
IF 2.1 Q2 Medicine Pub Date : 2024-05-14 DOI: 10.1177/09514848241254921
Susanna Friman, Riikka Maijala, Sini Eloranta, Sakari Suominen, Tuija Ikonen

Effective quality leadership is identified as a critical factor for organisational success. Leadership style has an important role in the implementation of quality management. This systematic review describes the characteristics of leadership in quality management in healthcare, and analyses their association with successful or unsuccessful quality management by using content analysis. Papers published in peer-reviewed journals between 2011 and June 2023 were selected by exploring the Abi/Inform, Business Source Complete, Cinahl, Pubmed and Web of Science electronic databases. Altogether 3014 records were found. PRISMA-protocol was used for selection of studies. 12 original and three review articles were included. Six leadership characteristics were identified that were linked to successful or unsuccessful implementation of quality management. The six categories were strategic, knowledge-oriented, value-based, supportive, participatory and communicative leadership. Supercategories and subcategories of successful and unsuccessful implementation are described. The results can be used to identify the leadership characteristics that promote successful quality management in healthcare organisations. In education for leaders and managers, attention should be in the characteristics and style of leadership and their impact on the effectiveness of quality management.

有效的质量领导被认为是组织成功的关键因素。领导风格在实施质量管理方面发挥着重要作用。这篇系统性综述描述了医疗质量管理中领导力的特点,并通过内容分析分析了这些特点与质量管理成功与否的关系。通过检索 Abi/Inform、Business Source Complete、Cinahl、Pubmed 和 Web of Science 电子数据库,筛选出 2011 年至 2023 年 6 月间发表在同行评审期刊上的论文。共找到 3014 条记录。在选择研究时使用了 PRISMA 协议。共收录了 12 篇原创文章和 3 篇评论文章。确定了与成功或失败实施质量管理相关的六个领导特征。这六个类别分别是战略型领导、知识导向型领导、价值型领导、支持型领导、参与型领导和沟通型领导。描述了成功和不成功实施质量管理的超级类别和子类别。研究结果可用于确定促进医疗机构成功实施质量管理的领导特征。在对领导者和管理者的教育中,应关注领导的特点和风格及其对质量管理有效性的影响。
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引用次数: 0
A systematic review of typologies on aged care system components to facilitate complex comparisons. 对老年护理系统各组成部分的类型进行系统审查,以便于进行复杂的比较。
IF 1.6 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-05-01 Epub Date: 2023-05-29 DOI: 10.1177/09514848231179176
Jenni Suen, Suzanne Dyer, Wendy Shulver, Tyler Ross, Maria Crotty

Objectives: Typologies are frequently utilised in analyses of the quality, funding, and efficiency of aged care systems. This review aims to provide a comprehensive resource identifying and critiquing existing aged care typologies. Methods: Systematic search of MEDLINE, Econlit, Google Scholar, greylit.org and Open Grey databases from inception to July 2020, including typologies of national, regional or provider aged care systems. Article screening, data extraction, and quality appraisal were conducted in duplicate. Results: 14 aged care typologies were identified; five applied to residential care, two to home care and seven to mixed settings; eight examined national systems and seven regional or provider systems. Five typologies classifying national financing or home care services, provider financing of staff and services and quality of residential care were considered high quality. The schematic provided summarises the focus area and aids in typology selection. Discussion: The aged care typologies identified cover a wide range of areas and contexts of aged care provision. This schematic, summary and critique will aid researchers, providers, and aged care policy makers to examine their own setting, compare it to other approaches to aged care provision and assist in identifying alternatives and important considerations, when undertaking aged care reform.

目的:在分析老年护理系统的质量、资金和效率时,经常会用到类型学。本综述旨在提供一份综合资料,对现有的老年护理类型进行识别和批评。方法:系统检索 MEDLINE、Econlit、Google Scholar、greylit.org 和 Open Grey 数据库(从开始到 2020 年 7 月),包括国家、地区或提供方老年护理系统的类型。文章筛选、数据提取和质量评估一式两份。结果确定了 14 种老年护理类型;其中 5 种适用于寄宿护理,2 种适用于家庭护理,7 种适用于混合环境;8 种研究了国家系统,7 种研究了地区或提供者系统。五种类型对国家资助或家庭护理服务、提供者对员工和服务的资助以及寄宿护理的质量进行了分类,被认为是高质量的。所提供的示意图概括了重点领域并有助于类型选择。讨论:所确定的老年护理类型涵盖了老年护理提供的广泛领域和背景。本示意图、总结和评论将帮助研究人员、提供者和老年护理政策制定者审视自身的环境,将其与其他老年护理提供方法进行比较,并在进行老年护理改革时帮助确定替代方案和重要考虑因素。
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引用次数: 0
Hospital workforce engagement, satisfaction, burnout and effects on patient mortality: Findings from the English national health service staff surveys. 医院员工的参与度、满意度、职业倦怠以及对患者死亡率的影响:英国国家医疗服务人员调查的结果。
IF 1.6 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-05-01 Epub Date: 2023-05-25 DOI: 10.1177/09514848231179175
Robert E Boyle, Leon Jonker, Sudha Xirasagar, Hayrettin Okut, Robert G Badgett

Previous studies of healthcare organizations' workforces and their performance have focused on burnout and its impact on care. The aim of this research is to expand on this and examine the association of positive organizational states, engagement and recommendation of employer as a place to work, in comparison to burnout on Hospital performance. Methods: This was a panel study of the respondents to the 2012-2019 yearly Staff Surveys of the English National Health Service (NHS) hospital Trusts with hospital performance measured by the adjusted inpatient Summary Hospital-level Mortality Indicator (SHMI). Results: In univariable regression, all three organizational states significantly and negatively correlated with SHMI, with recommendation and engagement showing a nonlinear effect. In multivariable analysis, all three states remained significant predictors of SHMI. Engagement and recommendation showed mutual correlation, with engagement being a more prevalent state than recommendation. Conclusion: Our study indicates that organizations could benefit from monitoring multiple workforce variables to preserve or enhance workforce well-being, while optimizing organizational performance. The surprising finding that higher burnout was associated with improved short-term performance requires further investigation, as does the finding of less frequent staff recommendation of work compared to staff engagement with their work.

以往对医疗机构员工及其绩效的研究主要集中在职业倦怠及其对医疗服务的影响上。本研究的目的是在此基础上进行扩展,研究积极的组织状态、参与度以及将雇主推荐为工作场所与职业倦怠相比对医院绩效的影响。研究方法这是一项针对英国国家卫生服务系统(NHS)医院信托基金 2012-2019 年度员工调查受访者的小组研究,医院绩效以调整后的住院病人医院级死亡率汇总指标(SHMI)来衡量。研究结果在单变量回归中,所有三种组织状态都与 SHMI 呈显著负相关,其中推荐和参与呈现非线性效应。在多变量分析中,所有三种状态仍然是 SHMI 的重要预测因素。敬业度和推荐度相互关联,敬业度比推荐度更普遍。结论:我们的研究表明,在优化组织绩效的同时,组织可以通过监控多个劳动力变量来维护或提高劳动力的福利。令人惊讶的发现是,较高的职业倦怠与短期绩效的提高相关联,这一发现需要进一步调查,与员工对工作的参与度相比,员工对工作的建议频率较低这一发现也需要进一步调查。
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引用次数: 0
Antecedents of innovative work behavior among leading physicians: Empirical evidence from German hospitals. 主要医生创新工作行为的前因:来自德国医院的经验证据。
IF 1.6 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-05-01 Epub Date: 2023-04-25 DOI: 10.1177/09514848231172073
Bettina Kriegl, Herbert Woratschek, Andrea Raab

Healthcare professionals' innovative work behavior (IWB) plays a key role in the development and implementation of innovative solutions in hospitals. However, relevant antecedents of IWB have not been fully captured to date. This study empirically examines the relationships between proactive personality, collaborative competence, innovation climate, and IWB. Hypotheses were tested using a sample of 442 chief physicians from 380 German hospitals. The results indicate a positive and significant influence of proactive personality, collaborative competence, and innovation climate on IWB, with collaborative competence having a stronger influence on IWB than innovation climate. Managers should note that important resources for IWB are accessible through a variety of actors and relationships. To leverage these resources and thus promote IWB, more emphasis should be placed on an employee's network.

医护人员的创新工作行为(IWB)在医院开发和实施创新解决方案的过程中发挥着关键作用。然而,迄今为止,人们尚未充分了解创新工作行为的相关前因。本研究对积极主动型人格、协作能力、创新氛围和 IWB 之间的关系进行了实证研究。研究以来自 380 家德国医院的 442 名主任医师为样本,对假设进行了检验。结果表明,积极主动型人格、协作能力和创新氛围对 IWB 有积极而显著的影响,其中协作能力比创新氛围对 IWB 的影响更大。管理者应该注意到,综合医院工作流程的重要资源可以通过各种参与者和关系获得。为了充分利用这些资源,从而促进 IWB,应更加重视员工的人际网络。
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引用次数: 0
How does staff and patient feedback on hospital quality relate to mortality outcomes? A provider-level national study. 员工和患者对医院质量的反馈与死亡率结果有何关系?一项医疗机构层面的全国性研究。
IF 1.6 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-05-01 Epub Date: 2023-06-27 DOI: 10.1177/09514848231179182
Antonio Michael Borrelli, Rebecca J Birch, Katie Spencer

This study aimed to use national data to examine the relationship between staff and inpatient survey results (National Health Service (NHS) Friends and Family Test (FFT)) and assess how these align with more traditional measurements of hospital quality as captured by the summary hospital mortality indicator (SHMI). Provider level FFT responses were obtained for 128 English non-specialist acute providers for staff and inpatients between April 2016 and March 2019. Multilevel linear regression models assessed the relationship between staff and patient FFT recommendations, and separately how SHMI related to each of staff and patient FFT recommendations. A total of 1,536 observations were recorded across all providers and financial quarters. Patients were more likely to recommend their provider (95.5%) than staff (76.8%). In multivariable regression, a statistically significant association was observed between staff and patient FFT recommendations. A statistically significant negative relationship was also observed between staff FFT recommendations and SHMI. The association between SHMI and staff FFT recommendations suggests that staff feedback tools may provide a useful analogue for providers in potential need of intervention and improvement in care. For patients meanwhile, qualitative approaches and hospital organisations working in partnership with patients may provide better opportunities for patients to drive improvement.

本研究旨在利用国家数据来检验员工和住院患者调查结果(国家医疗服务体系(NHS)亲友评测(FFT))之间的关系,并评估这些结果与医院死亡率汇总指标(SHMI)所反映的更传统的医院质量衡量标准之间的关系。在 2016 年 4 月至 2019 年 3 月期间,我们获得了 128 家英国非专科急症医疗机构的员工和住院患者的 FFT 答复。多层次线性回归模型评估了员工和患者FFT建议之间的关系,并分别评估了SHMI与员工和患者FFT建议之间的关系。所有医疗机构和财务季度共记录了 1,536 项观察结果。患者推荐其医疗服务提供者的可能性(95.5%)高于员工(76.8%)。在多变量回归中,发现员工和患者的 FFT 推荐之间存在统计学意义上的显著关联。在统计意义上,员工 FFT 建议与 SHMI 之间也存在明显的负相关。SHMI 与员工 FFT 建议之间的关联表明,员工反馈工具可以为可能需要干预和改善护理的医疗服务提供者提供有用的类比信息。同时,对于患者而言,定性方法和医院组织与患者合作可能会为患者提供更好的机会来推动改善。
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引用次数: 0
Measuring social responsibility towards employees in healthcare settings in Egypt and its interrelation to their job satisfaction. 衡量埃及医疗机构员工的社会责任及其与工作满意度的相互关系。
IF 1.6 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-05-01 Epub Date: 2023-01-28 DOI: 10.1177/09514848231154754
Mohamed Abd-Rabou, Mona Ashry, Heba Elweshahi

Objectives: Developing a valid tool to measure perceived social responsibility (SR) practices towards employees and examining the impact of employee-centered SR considerations on the employees' job satisfaction.

Methods: A cross sectional survey of employees at three private hospitals was conducted. Data was collected using a self-administered questionnaire. It consists of baseline characteristics, structured SR measuring scale, job satisfaction questionnaire and Perception of Empowerment Instrument (PEI).

Results: The questionnaire developed to measure SR towards employees showed excellent internal consistency reliability (Cronbach's alpha is > 0.7). A considerable number of SR criteria were perceived as partially or fully met by the majority of studied employees except for rewarding, training activities, salary satisfaction and enhancement activities. Significant correlation was found between employees' job satisfaction and all domains of SR as well as employees' empowerment. Multiple linear regression analysis showed that significant predictors of employee's satisfaction are fulfillment of economic and social responsibility criteria as well as the level of perceived empowerment.

Conclusions: In healthcare industry in Egypt, fulfillment of the basis for SR is one of the predictors of achieving high job satisfaction. Extra-performance rewarding and career development should be looked at while managing human resources.

目标开发一种有效工具来衡量员工感知到的社会责任(SR)实践,并研究以员工为中心的社会责任考虑因素对员工工作满意度的影响:方法:对三家私立医院的员工进行了横断面调查。方法:对三家私立医院的员工进行了横断面调查,采用自填式问卷收集数据。它包括基线特征、结构化员工代表测量量表、工作满意度问卷和授权感知工具(PEI):结果:为测量员工满意度而编制的问卷显示出良好的内部一致性可靠性(Cronbach's alpha > 0.7)。除奖励、培训活动、薪酬满意度和提升活动外,大多数被调查员工认为部分或完全满足了相当多的员工代表标准。研究发现,员工的工作满意度与员工满意度的所有领域以及员工的授权之间存在明显的相关性。多元线性回归分析表明,员工满意度的重要预测因素是经济和社会责任标准的履行情况以及感知到的授权水平:在埃及的医疗保健行业,履行社会责任的基础是实现高工作满意度的预测因素之一。在进行人力资源管理时,应关注额外绩效奖励和职业发展。
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引用次数: 0
Implementation of clinical assistants in a pediatric oncology department: An impact analysis. 儿科肿瘤科临床助理的实施:影响分析。
IF 1.6 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-05-01 Epub Date: 2023-03-23 DOI: 10.1177/09514848231165193
Cristina Adroher, Celia Calvo, Laura Pavon, Ricard Casadevall, Esther Alvarez, Mariona Marsal, Francesc Lopez, Miquel Pons, Manel Del Castillo, Andres Morales

Bureaucratic and administrative tasks associated with health care provision have historically fallen on health care professionals, which is one among the factors contributing to low job satisfaction and lower productivity. Incorporating new professional roles that help to better respond to the needs of both patients and professionals can increase the quality and efficiency of service provision. This article aims to evaluate the impact of the clinical assistant's introduction in the Sant Joan de Déu Barcelona Children's Hospital's pediatric oncology department, in terms of (i) displacement of activity loads carried out by this new professional role and the consequent time freed up for physicians, (ii) physicians' satisfaction and (iii) efficiency of the new care model. This is an observational and retrospective study using administrative data based on the type of activity performed by clinical assistants and the measurement of the time freed up in favor of the physicians. The potential skill mix productivity increase, survey of physicians' satisfaction, and reduction in costs with the new model was analyzed. During the first year of its implementation in the pediatric oncology department, clinical assistants have performed 13,553 requests (69% of the total), representing a total saving of 266.83 hours or 6.67 workweeks of 40 hours. They performed 74% of outpatient surgical requests in the oncology department, 87% of day hospital requests and 54% of total requests in the outpatient consultations area. Physicians are overall satisfied with the new role and think they can use the time gained to do other things such as research or improving the quality of care. The role change allows reducing the cost per request by 56% in relation to the conventional model. In conclusion, the introduction of clinical assistants in the oncology department could be efficient to the extent that it displaces a significant part of the bureaucratic and administrative tasks previously performed by health care professionals and thus enables to reduce the cost of these processes. This delegation allows them to work more closely to the maximum of their competences and the physicians to have more time for higher added value clinical tasks and increase professional satisfaction.

与提供医疗服务相关的官僚和行政任务历来由医疗专业人员承担,这是导致工作满意度低和生产率低下的因素之一。融入新的专业角色,帮助更好地满足病人和专业人员的需求,可以提高服务质量和效率。本文旨在从以下几个方面评估巴塞罗那 Sant Joan de Déu 儿童医院儿科肿瘤科引入临床助理的影响:(i) 这一新的专业角色所承担的工作负荷的转移以及由此为医生腾出的时间;(ii) 医生的满意度;(iii) 新护理模式的效率。这是一项观察性和回顾性研究,使用的是基于临床助理所从事活动类型的行政数据,并对为医生腾出的时间进行测量。研究分析了新模式可能带来的技能组合生产率提高、医生满意度调查和成本降低。在儿科肿瘤科实施新模式的第一年,临床助理共完成了 13553 项手术申请(占总数的 69%),总共节省了 266.83 个小时,即 6.67 个工作周(40 个小时)。他们完成了肿瘤科 74% 的门诊手术申请、87% 的日间医院申请和门诊咨询区 54% 的总申请。医生们对新的角色总体上感到满意,并认为他们可以利用获得的时间做其他事情,如研究或提高医疗质量。与传统模式相比,角色的转变使每次请求的成本降低了 56%。总之,在肿瘤科引入临床助理是有效的,因为它取代了以前由医护人员承担的大部分官僚和行政工作,从而降低了这些工作的成本。这种授权使他们能够更密切地工作,最大限度地发挥自己的能力,使医生有更多的时间从事附加值更高的临床工作,并提高职业满意度。
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引用次数: 0
Reducing turnover intentions among first-year nurses: The importance of work centrality and coworker support. 减少第一年护士的离职意向:工作中心性和同事支持的重要性。
IF 1.6 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-05-01 Epub Date: 2023-03-28 DOI: 10.1177/09514848231165891
Martha C Andrews, Andrew Woolum, Jessica Mesmer-Magnus, Chockalingam Viswesvaran, Satish Deshpande

Turnover among nurses has been recognized as a frequent and enduring problem in healthcare worldwide. The widespread nursing shortage has reached the level of a healthcare crisis. The COVID-19 pandemic has illustrated the importance of understanding the contributing factors of nurse turnover, and more importantly how to mitigate the problem. Using cross-sectional survey data collected from 3370 newly licensed nurses working across 51 metropolitan areas within 35 U.S. states, we explore how role overload and work constraints can both diminish job satisfaction and increase turnover intentions of new nurses. Coworker support and work role centrality are identified as moderators of these relationships which show potential to mitigate these negative outcomes. This study highlights the importance of coworker support and work centrality in improving job satisfaction and subsequent turnover intentions among newly licensed nurses.

护士流失已被公认为是全球医疗保健领域经常出现的一个持久问题。普遍存在的护士短缺问题已经达到了医疗危机的程度。COVID-19 大流行说明了了解护士流失诱因的重要性,更重要的是如何缓解这一问题。我们利用在美国 35 个州 51 个大都会地区工作的 3370 名新获得执照的护士的横截面调查数据,探讨了角色超负荷和工作限制是如何降低新护士的工作满意度并增加其离职意向的。同事支持和工作角色中心性被认为是这些关系的调节因素,它们显示出缓解这些负面结果的潜力。本研究强调了同事支持和工作中心性在提高新执业护士的工作满意度和离职意向方面的重要性。
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引用次数: 0
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Health Services Management Research
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