The influence of workplace culture on nurses’ learning experiences: a systematic review of the qualitative evidence.

Abstract

Background A healthy workplace culture enables nurses to experience valuable learning in the workplace. Learning in the workplace is valuable as it can enable the provision of evidence based and continuously improving safe patient care, which is central to achieving good patient outcomes. Therefore, nurses need to learn within a workplace that supports the implementation of evidence based, professional practice and enables the best patient outcomes; the influence of workplace culture may play a role in this. Objectives To critically appraise and synthesize the best available qualitative evidence to understand both the nurse’s learning experiences within the workplace, and the factors within the workplace culture that influence those learning experiences. Inclusion criteria Participants Registered and enrolled nurses, regulated by a nursing and midwifery authority and/or recognised health practitioner regulation agency (or its international equivalent). Phenomena of interest The nurse’s learning experience, either within an acute health care workplace, or within a workplace related learning environment and the influence of workplace culture on the nurse’s learning experience (within the workplace, or workplace related learning environment). Context This review considered studies that included nurses working in an acute health care organization within a Western culture. Studies This review considered studies that focused on qualitative evidence and included phenomenological, grounded theory and critical theory research designs. Search strategy Published and unpublished studies in English from 1980-2013 were sought using a three-step search strategy. Methodological quality Methodological quality was assessed by two assessors using a standardized checklist from the Joanna Briggs Institute (JBI) Qualitative Assessment and Review Instrument (QARI). Data collection Qualitative data was extracted from included papers using the JBI-QARI standardized data extraction tool. Data synthesis Qualitative research findings were pooled using the JBI QARI Instrument. This involved the aggregation and synthesis of findings to generate a set of categories which were then subjected to a meta-synthesis in order to produce a single comprehensive set of synthesized findings that could be used as a basis for evidence-based practice. Results Fourteen articles were identified following appraisal and a total of 105 findings (85 unequivocal and 20 credible) were extracted from included studies and grouped into eight categories based on similarity of meaning. Subsequently, categories were grouped into two synthesized findings. The two synthesized findings were as follows: 1. Organizational influences Enabling nurses to demonstrate accountability for their own learning, along with clear organizational systems that provide resources, time, adequate staffing and support, demonstrates encouragement and value of nurses’ learning and education. 2. Relational Dynamics Nurses value their peers, expert nurses, preceptors, mentors and educators to facilitate and encourage their learning and professional development. Conclusion An optimal workplace culture is central for nurses to experience valuable and relevant learning in the workplace. To emphasize the importance of nurses’ learning in the workplace, working and learning is understood as an integrated experience. Consequently, a dual system that enables nurses to demonstrate accountability for their own learning, along with clear organizational and educational systems is required to demonstrate the value in nurses’ learning and education.