Posted: February 26th, 2023

Reading Research Literature

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Week 6 Assignment: Reading Research Literature (RRL) Worksheet (graded)

Assignment Directions


1. The Week 6 Assignment: Reading Research Literature (RRL) Worksheet is a learning activity that requires you to read an assigned article for the session you are taking the course, then answer questions on the required Reading Research Literature (RRL) Worksheet. Both the required article and worksheet may change from session to session.

2. The NR439 Reading Research Literature Worksheet Rubric  must be used to answer each of the criteria that will be graded for this assignment. The grading rubric is located at the bottom of this page below the References area.

3. Read the required research article assigned, then answer each question in your own words on the required Reading Research Literature (RRL) worksheet about the study.

4. Your required article is available to you in an announcement that has been posted in  preview week and again in  Week 5. Please go to your announcements to locate the required article assigned for this session. Look for the announcement with the following heading:  IMPORTANT: Assigned Article for Week 6 Assignment

5. Download and complete  the required 

Reading Research Literature (RRL) worksheet Links to an external site.

. This must be used.

6. The assignment contains the following and the below can be used to help answer each criteria area of the worksheet.  Do not copy and paste the information below into your RRL worksheet. After reading the required research article, think about the research study and include what you learned from reading the study using your own words.

· Purpose of the Study: Using information from the required article and your own words, thoroughly  summarize the purpose of the study. Describe what the study is about. Thoroughly summarize and include excellent details for the criteria.

· Type of Research & the Design: Using information from the required article and your own words, thoroughly  summarize the description of the type of research and the design of the study. Include how it supports the purpose (aim or intent) of the study. Thoroughly summarize and include excellent details for the criteria.

· Sample: Using information from the required article and your own words,  summarize the population (sample) for the study; include key characteristics, sample size, sampling technique. Thoroughly summarize and include excellent details for the criteria.

· Data Collection: Using information from the required article and your own words,  summarize one data that was collected and how the data was collected from the study. Thoroughly summarize and include excellent details for the criteria.

· Data Analysis: Using information from the required article and your own words,  summarize one of the data analysis/tests performed or one method of data analysis from the study; include what you know/learned about the descriptive or statistical test or data analysis method. Thoroughly summarize and include excellent details for the criteria.

· Limitations: Using information from the required article and your own words,  summarize one limitation reported in the study. Thoroughly summarize and include excellent details for the criteria.

· Findings/Discussion: Using information from the required article and your own words,  summarize one of the authors' findings/discussion reported in the study. Include one interesting detail you learned from reading the study. Thoroughly summarize and include excellent details for the criteria.

· Reading Research Literature: Summarize why it is important for you to read and understand research literature. Summarize what you learned from completing the reading research literature activity worksheet. Thoroughly summarize and include excellent details for the criteria.

· Use APA in-text citations. No more than two direct quotes can be used.

7. You are required to complete the worksheet using the productivity tools required by Chamberlain University, which is Microsoft Office Word 2013 (or later version), or Windows and Office 2011 (or later version) for MAC. You must save the file in the " x" format. Do NOT save as Word Pad. Microsoft Office 365 is available for free through Resources/Technologies/Microsoft Office 365.

8. Review the tutorial for your  Week 6 Assignment. The tutorial may look slightly different session to session. Grading criteria and rubric will be the same.

9. Submit the completed Reading Research Literature Worksheet to the Week 6 Assignment.

Chamberlain College of Nursing NR439: RN Evidence-Based Practice

Week 6: Reading Research Literature Worksheet

Date: February 18, 2023

Complete the required worksheet after reading the assigned article for the session. The NR439 Reading Research Literature Worksheet Rubric must be used to answer each of the graded criterion for the following:

Name: Oscar L Perez Torres

Purpose of the Study

Type of Research & the Design


Data Collection

Data Analysis



Reading Research Literature

NR439_RRL_Worksheet_5.21_ST 1

Author Affiliations: Clinical Professor of Nursing (Dr Haizlip), University of Virginia; Postdoctoral Fellow (DrMcCluney), Univer- sity of Virginia School of Nursing and Darden School of Business; Associate Professor of Business Administration (Dr Hernandez), University of Virginia Darden School of Business; and Assistant Professor of Nursing (Dr Quatrara) and Professor of Nursing, Emerita (Dr Brashers), University of Virginia, Charlottesville.

The authors declare no conflicts of interest. Correspondence: Dr Haizlip, University of Virginia School

of Nursing, McLeod Hall PO Box 800782, Charlottesville, VA 22908-0782 (

DOI: 10.1097/NNA.0000000000000882

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JONA Volume 50, Number 5, pp 267-


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Mattering: How Organizations, Patients, and Peers Can Affect Nurse Burnout and Engagement

Julie Haizlip, MD, MAPP Courtney McCluney, PhD Morela Hernandez, PhD er H

Beth Quatrara, DNP, RN, CMSRN, ACNS-BC Valentina Brashers, MD

OBJECTIVE: The aim of this study was to explore professional mattering in a broad cohort of nurses. BACKGROUND:Mattering is a construct from social psychology that describes the feeling that one makes a difference in the lives of others and has significance in one's community. METHODS:Across-sectional surveyassessingmattering, meaning, social support, burnout, and engagement was administered to nurses and nurse practitioners working in various specialties in the United States. RESULTS: Higher levels of mattering at work were associated with lower burnout and higher engagement. Mattering was correlated with perceived social support from one's organization, supervisor, peers, and subor- dinates. Open-ended responses describing experiences of mattering at work included demonstrating profes- sional competence, positive interactions with patients and interprofessional peers, and receiving recognition from one's organization. CONCLUSIONS: A perception of mattering at work is associated with lower levels of burnout. Our data suggest that affirming interactions with other health- care team members promote a sense of mattering.

It is no secret that the prevalence of nurse burnout is high. It has been almost 2 decades since a 1999 study of more than 10 000 inpatient RNs demonstrated that 43% of those surveyed reported a high degree of emo- tional exhaustion.1More recently, researchers have re- ported that roughly half of direct care and charge nurses in oncology and critical care are experiencing burnout and secondary traumatic stress.2 Other stud- ies have demonstrated that this emotional exhaustion not only is limited to the inpatient setting but also oc- curs in nurses in other practice settings.3 It has been further demonstrated that emotional exhaustion and associated cynicism predict a nurse's desire to leave his or her current job or, perhaps, the profession4 and that nurse turnover is an important issue that has a signifi- cant financial impact (5.2-8.1 million dollars) on the average hospital.5 What is less obvious, perhaps, is what those who lead healthcare organizations can do to practically address this problem.

The National Academy ofMedicine has convened an Action Collaborative on Clinician Well-Being and Resilience and issued a call to explore and address burn- out as an underrecognized threat to safe and high-quality care.6 This collaborative, which includes national nurs- ing leaders from the American Nurses Association, the American Association of Critical Care Nurses, the National League for Nursing, and the American As- sociation of Colleges of Nursing among others, seeks to understand the elements of organizations and prac- tices that contribute to distress. However, the findings of their studies will not be immediate, and the issues of burnout, dissatisfaction, and turnover are pressing. Furthermore, several of the systems issues that have been proposed to contribute to burnout such as heavy


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patient loads, low levels of perceived organizational and social support, and implementation of electronic health records will not have easy fixes.1,7 Some authors have proposed that helping nurses reconnect to the meaning of their work may reduce burnout.8 However, others report that having meaningful professions or conducting work that is personally significant and that has a positive meaning for others does not reduce the felt experience of burnout.9 So the question becomes,what can be done in the short term to ameliorate the stresses ofworking in healthcare?

In other professions, it has been suggested that a sense of mattering can enhance an individual's ability to cope with various work-related stresses.10-12 Mattering is a psychosocial construct that describes an individual's perception that he or shemakes a difference in the lives of others and is significant in the world.13,14 As it was initially defined in the literature, mattering is com- posed of 4 domains: awareness, reliance, importance, and ego extension. Awareness encompasses the simple idea that others are aware of your presence and, more- over, your absencewould be noticed. Reliance suggests that others depend on you or that you affect the lives of those around you. Importantly, however, reliance is something that must be perceived by the individual. It is not enough to cognitively know others depend on you (e.g., if I am not there, the unit will be short staffed), but rather, you must feel as though others need and desire your specific contribution. Feeling impor- tant to others is the result of their genuine expressed care and concern. Finally, ego extension represents the notion that others feel a sense of pride in your successes or dis- appointment in your failures, as though your perfor- mance reflects not only on yourself but also on them.

It is not difficult to envision how the concept of mattering can apply to one's professional life. Each of us wants to believe that we contribute to our work en- vironment in a meaningful way. As investigators have begun to consider what it means to matter at work,15

2 new dimensions have been proposed—interpersonal and societal mattering. Interpersonal mattering describes an individual's perception of feeling recognized, valued, and appreciated by the people with whom they work. Societal mattering represents the belief that one's work contributes to society or meets a societal need. Mattering at work may be particularly important for healthcare professionals, because this desire to posi- tively influence others' lives is at the heart of our profes- sional identity. Formany healthcare providers, “helping others” is how they identify the meaning of their work. Receiving feedback from patients, colleagues, or the organization that suggests that one's efforts are indeed making a positive impact could heighten one's sense of mattering. Such external feedback is distinct from the in- trinsic benefits and meaning that healthcare professionals


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often derive from helping others; rather, we propose that a sense of mattering is derived from the cues provided by their interpersonal and social contexts.

We postulate that this enhanced sense of mattering may buffer the daily stressors and potentially diminish the incidence of burnout. This study is designed to an- swer the research questions: “Is there a relationship between a sense of mattering and burnout in nurses” and “Are the current definitions of mattering relevant to nursing practice?”. It also begins to investigate the relationships between mattering in nurses and ob- jective measures of meaning, perceived support, and engagement.

Methods Weused a cross-sectional survey design to collect data from nurses and nurse practitioners in the United States working across specialties. The survey consisted of several previously validated scales and 2 open-ended questions.We recruited participants through TurkPrime, a research platform that improves the quality of crowdsourcing data collection processes,16 to survey nurses across geographic regions and healthcare set- tings, which increases the ecological validity of our findings. We restricted our sample to nurses and nurse practitioners working full or part-time in the United States.

Measures Demographic Questionnaire Demographic data collected included age, gender, in- come, race/ethnicity, profession, primary specialty, highest level of education, and job characteristics.

Mattering at Work Scale Mattering was measured using the 10-itemMattering at Work scale (a = .93) on a 6-point Likert scale an- chored by 1 (disagree very much) and 6 (agree very much) that measures the dimensions of interper- sonal and societal mattering.15 Example items in- clude “I am connected to society through my work” and “I feel like I matter to my colleagues/coworkers.” Higher scores indicate higher perceptions of mattering at work.

Work and Meaning Inventory Meaning of work was measured using the 10-item Work and Meaning Inventory (a = .93) on a 5-point Likert scale anchored by 1 (absolutely untrue) and 5 (absolutely true) thatmeasures themeaning an individ- ual derives from their work.17 Example items include “I have found a meaningful career” and “My work helps me better understand myself.” Higher scores indicate higher perceived meaning of work.

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Social Support Social support was measured using an adapted 15-item Eisenberger Social Support Scale (a = .93) on a 5-point Likert scale anchored by 1 (strongly disagree) and 5 (strongly agree).18We captured respondents' perception of social support from their organization, supervisor, peers or nurses at their same level, and subordinates. Example items include “Help is available from my organization when I have a problem” and “My super- visor shows a lot of concern for me.” Higher scores indicated higher perceived social support.

Burnout Burnout was measured using the 10-item subscale for Burnout in the Professional Quality of Life scale (a = .75) on a 5-point Likert scale anchored by 1 (never) and 5 (very often).19 Example items include “I feel worn out because of my work as a nurse” and “I feel bogged down by the system.” Five items were reverse-coded so that higher scores indicated higher experiences of burnout.

Engagement Engagement wasmeasured using the 18-itemmeasure of Job Engagement (a = .95) on a 5-point Likert scale anchored by 1 (strongly disagree) and 5 (strongly agree).20

Example items include “I devote a lot of energy to my job” and “I work with intensity on my job.” Higher scores indicated higher perceived engagement at work.

Open-ended Questions Participants were asked to respond to the following questions: “Please tell us what is meaningful to you about your work,” and “Please tell us about a time when you felt like you mattered at work.”

Procedure After approval by theUniversity of Virginia's Social and Behavioral Science Institutional Review Board, our online survey created throughQualtrics®was launched through TurkPrime. Informed consent was obtained from participants before beginning the survey. Identi- fying information was not collected; anonymity was maintained. Participants were given 1 hour to complete the survey; on average, the survey required approximately 20minutes to complete. It took approximately 10 days to collect an appropriate sample size for our analysis.

Data Analysis Descriptive statistics were used to describe sample char- acteristics. Survey data were uploaded to SPSS (version 24; Armonk, New York) for analysis. We used Pearson r statistic to report correlations between mattering, meaning, social support, burnout, and engagement. In ad- dition to statistical analyses, we conducted a content

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analysis of the open-ended responses to capture partici- pants' descriptions of mattering at work. Two researchers (J.H. and C.M.) analyzed the themes identified in the content analysis and achieved consensuswith strong agreement.

Results Three-hundred twenty-four RNs completed our sur- vey, from a possible total of 362.We excluded respon- dents who provide incomplete responses to our survey items or did not finish the survey. Demographic char- acteristics are presented in Table 1. A majority of par- ticipants were female and white, had earned a BSN, and were, on average, 39 years old. Most of our re- spondents' primary specialty was adult medical, and a majority worked full-time and worked in private in- patient settings. On average, participants had worked in their current position for slightlymore than12 years. There were no significant correlations found between the demographic data reported in Table 1 on the vari- ables we measured in this study.

The nurses in this sample tended to experience high levels of engagement at work (mean [SD], 4.38 [0.60]). Respondents also reported moderately high levels of mattering at work (mean [SD], 4.93 [0.74]), meaning of work (mean [SD], 4.33 [0.69]), and social support from peers (mean [SD], 3.86 [0.84]) and subordinates (mean [SD], 3.84 [0.84]).Moderate levels of social sup- port from their organization (mean [SD], 3.50 [1.06]) and supervisor (mean [SD], 3.42 [0.92]) were reported. Finally, the sample indicated relatively low levels of burnout (mean [SD], 2.18 [0.61]). Correlational analy- ses indicates that mattering is positively associated with meaning, social support, and engagement. In contrast, mattering demonstrates a strong negative correlation with burnout. Cronbach's ameasure of internal consis- tency, means, standard deviations, and correlations for our variables are presented in Table 2.

In response to the open-ended question about the meaning of their work, 82% of participants replied that helping others or serving patients was their pri- mary motivation. Eight percent noted their profes- sional expertise, and 4% discussed relationships with peers or their organization in response to the question about meaning. When asked about an experience of mattering, respondents provided descriptions of positive encounters and relationships with patients (52%). Additional themes also emerged in the stories that resulted in a sense of mattering. These themes in- cluded demonstration of their professional expertise (25%), interactions with colleagues and/or the or- ganization (42%), feeling appreciated (34%), being cared for as a person (4%), and knowing one has gone the extra mile for a patient or colleague (10%). Themes, examples from respondents, the component


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Table 1. Demographic Information

Total 324

Gender Women 304 (94%) Men 18 (6%)

Race/ethnicity White 254 (78%) Black 32 (10%) Latinx/a/o 16 (5%) Other 22 (6%)

Age, y Mean (SD), 39.12 (12.6) Income Mean (SD; range), 5.94

(1.86; $50 000-$75 000) Profession Nurse 263 (81%) Nurse practitioner 23 (7%) Other 34 (11%)

Primary specialty Medical 2 (32%) Surgery 18 (6%) Pediatrics 34 (11%) OB/GYN 21 (7%) Radiology 5 (2%) Other 141 (44%)

Current resident Yes 28 (9%) No 291 (90%)

Highest education BSN 241 (74%) MSN 37 (11%) DNP 13 (4%) PhD 7 (2%)

Organizational setting Academic 34 (11%) Private outpatient 96 (30%) Private inpatient 161 (50%) Health department 27 (8%)

Region Urban 123 (38%) Rural

79 (24%)

Suburban 119 (37%)

Hours per week Full-time 219 (68%) Part-time 71 (22%) Half-time 25 (8%) Less than half-time 5 (2%)

Tenure in position Mean (SD), 12.58 (10.88)

Table 2. Descriptive Statistics, a Reliability, and Co

a Mean SD 1

1. Mattering .89 4.93 0.74 — 2. Meaning .95 4.33 0.69 0.67a — 3. Support a. Organization .95 3.50 1.06 0.43a 0.4 b. Supervisor .91 3.42 0.92 0.35a 0.3 c. Peer .89 3.86 0.84 0.48a 0.4 d. Subordinate .94 3.84 0.84 0.44a 0.3

4. Burnout .80 2.18 0.61 −0.47a −0. 5. Engagement .97 4.38 0.60 0.50a 0.5

aP < .01.


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of mattering, and the frequency of these topics are presented in Table 3.

Discussion The results of this cross-sectional survey study sup- port our hypothesis that a sense of mattering may be an important factor to consider in the professional satisfaction and psychological health of nurses. The quantitative data demonstrate a positive association between a sense of professional mattering and a num- ber of other metrics related to work satisfaction and engagement. Significant positive relationships were found between mattering, meaning of work, perceived social support at work, organizational commitment, and organizational engagement. Of particular interest was the finding that mattering was more highly corre- latedwith perceived social support frompeers and sub- ordinates than with perceived social support from one's supervisor. The nursing literature has often fo- cused on the relationship between nurses and their unit managers as being critical to the experience of the individual nurse.21 Although our data do endorse that perceived social support from one's supervisor is associated with professional mattering, they also suggest that the relationship with peers may be even more important. This finding supports the assertion that nurse-to-nurse peer relationships have important effects on the work environment22 and certainly de- serves further investigation.

The survey data also demonstrated a significant negative correlation between professional mattering and burnout as measured by the ProQoL.19 These data only demonstrate that there is a negative relationship— that those with higher scores on professional mattering scales have lower indicators of burnout—and we can- not make assumptions about causality. However, these findings are consistent with our hypothesis that a greater sense of professional mattering may be pro- tective against burnout.

rrelations Among Survey Items

2 3 4 5 6 7

1a — 3a 0.62a — 7a 0.64a 0.50a — 4a 0.45a 0.31a 0.57a — 52a −0.49a −0.47a −0.45a −0.32a — 4a 0.37a 0.26a 0.43a 0.42a −0.35a

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Table 3. Content Analysis of Open-ended Responses to Mattering Question

Theme Example Frequency

Professional competence

“Nurses save lives, whether its catching an arrhythmia or doing CPR on someone.” (R44; reliance, societal)

“Stopped a patient from arresting because I noticed his O2 Sat dropping and he was slightly short of breath. Found he had a pulmonary embolism on V/Q Scan.” (R64; reliance)

80 (25%)

Relationship with patients

“I had a newmomwho was scared to take care of her premmie baby. I worked with this mom everyday to learn how to handle, bathe, and feed her baby. She turned into a confident capable caretaker for her baby. It was so rewarding to see her grow and become themom she needed and hoped to be for her baby.” (R132, reliance, interpersonal)

163 (52%)

Interaction with colleagues

“I remember telling others that I am looking for a new job and the response was that people were very sad and that they needed me to stay. That I'm a hard worker and if I left the unit would be in huge trouble.” (R212; awareness)

“Whenever a coworker says thank you for my help. After every case when a MD says thank you. A person who I meet in public says the institution I work for has helped him/her. This in part is my success.” (R319; awareness, ego extension)

79 (24%)

Experiences with organization

“I was asked to speak to Joint Commission formy department's process and procedures. After, I was praised by my immediate supervisor and later received a personal hand written note from the company's CEO thanking me for an outstanding job. I later found out the Joint Commission representative used me, saying my name, as an example of excellence when speaking to the CEO about her findings.” (R234; ego extension)

“I received a compliment from my coworker when I helped them with a task when they were crunched for time. This led to me receiving recognition frommymanager.” (R36; importance)

58 (18%)

Feeling appreciated “A patient specifically mentioned my name as someone who went out of their way to take of them and make them comfortable.” (R93; awareness, importance, interpersonal)

“When I was told directly I make a difference to others and to the organization. Also when a patient says thank you.” (R59; awareness)

108 (34%)

Going the extra mile “A patient's family was unable to make it in time for her double bypass surgery as they were traveling across the country. I took the presponsibility to stay with her as her support system until her family arrived. She expressed extreme gratitude many times.” (R61; awareness, interpersonal)

“When I helped a patient find something they had misplaced that was very valuable to them.” (R304; awareness, interpersonal)

34 (10%)

Being cared for as a person

“Whenmy daughter passed and so many of my coworkers and supervisors showed lots of love and support.” (R258; importance, interpersonal)

12 (4%)

Written responses to the questions “Please tell us what is meaningful to you about your work” and “Please tell us about a timewhen youmattered at work” provide depth to our quantitative statistical analysis. The answers about meaning were fairly general and often succinct. However, the responses to the question about mattering were often narratives about an experi- ence with a specific patient or colleague. Responses to the mattering question demonstrated the impact a small gesture or appreciative comment can have. Although we provided no context or education about the psy- chosocial construct of mattering, respondents detailed experiences that demonstrated each of the 4 initially described components of mattering (awareness, reliance, importance, and ego extension), as well as both of the professional domains of mattering (interpersonal and societal). We therefore believe that the current defini- tions of mattering and mattering at work reflect the experience of nurses.

The narratives about mattering that demonstrated relationships with or dedication to patients were not surprising. The primacy of a nurse's responsibility to respect, serve, and advocate for patients is core to the

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professional identity and ethics of nursing.23 These stories illustrate how the interactions with patients can validate one's professional role and can instill a sense of mattering. Recognitions such as the DAISY Award for Extraordinary Nurses highlight specific descriptions of a nurse's caring and compassion and provide a tangible reminder of how nurses matter in the lives of patients and their families.24,25

Gratitude from a patient or family member is clearly meaningful, and yet, for some nurses, simply knowing for themselves that they had provided skilled and compassionate care was enough. However, nurses have limited control over how their patients will re- spond to them. Even when optimal care is delivered, a patient who is scared or in pain may not respond appreciatively.

For this reason, perhaps, themost notable finding from the qualitative data about experiencingmattering was the importance of interactionswith interprofessional colleagues. Relationships with coworkers and the or- ganization were brought up 10-fold more often when discussing mattering (42%) as compared with mean- ing (4%). Responses to the question about mattering


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demonstrate how even small, seemingly inconsequen- tial interactions with colleagues can contribute signif- icantly to an individual's sense of mattering. Nurses also expressed that knowing that their peers or organi- zations depend on them provided a sense of mattering. Specifically, daily interactions and small acts of grati- tude, recognition, and caring between colleagues were noticed and remembered by nurses, and those interac- tions contributed to their sense of mattering.

One disturbing finding in the data is that there are individual nurses who can clearly articulate the mean- ing of their work who, when asked about mattering, responded with a statement such as “I cannot remem- ber the last time I mattered” (n = 7). It is not surprising to find that these individuals had higher burnout scores compared with the larger sample (mean, 2.79 vs 2.18). It is unlikely that the efforts of these nurses are not ap- preciated by someone. However, it is clear that these nurses are not getting or not recognizing positive, ex- ternal feedback that their contributions are noticed and valued. This suggests that there are opportunities for peers or organizations to intervene and create an environment that promotes a sense of mattering.

Implications for Leaders This study demonstrates that, in a broad sample of nurses, a higher perception of mattering is correlated with self-reported lower levels of burnout and higher scores on meaning in work, engagement, and insti- tutional commitment surveys. It further shows that nurses derive a sense of mattering from their patients, from their professional expertise, and from feeling


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appreciated and supported by their patients, colleagues, and organization. These findings may serve to help nurse leaders address issues of nursing burnout, turn- over, and attrition.

There are a number of dissatisfiers in nursing prac- tice that are challenging to address such as understaff- ing, diminishing reimbursement, and implementation of new technologies such as the electronic health re- cord. As solutions for these challenges are being sought and trialed, it is within the power of an institution to create and encourage strong relationships and positive feedback processes among those who work there. An organization can create a forum for demonstrations of genuine gratitude for and among nurses. Although many organizations already recognize examples of professional excellence and organizational apprecia- tion of extraordinary effort, taking notice of the day- to-day efforts of those who consistently demonstrate commitment to their patients and colleagues may be equally important. The DAISY Award provides recog- nition for patient-focused efforts.24,25 Might we find similar ways to celebrate efforts that enhance the work lives of our colleagues? According to the data from this study, these seemingly simple interventions have a no- table effect on individual nurses and promote a sense of mattering.

In conclusion, we propose that nurse leaders may foster a greater sense ofmattering in their staff by gen- erating a culture that encourages strong relationships and explicit cues of appreciation among nurses as well as other interprofessional colleagues. This feeling of mattering could in turn lead to higher levels of resil- ience and engagement.


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