Develop a Searchable Question Using an Appropriate Framework

Shortage of staff within oncology departments causes an issue to deliver quality care to the patient, imposes heavy workload, and can lead to nurse burnout. To this end, a specific, well-elaborated research question can be achieved using the PICO framework: Population, Intervention, Comparison, and Outcome (Gribben & Semple, 2020). The PICO framework, in this manner, creates an effective yet focused search strategy that has the capability to retrieve suitable and focused evidence.

Searchable Question: In oncology nursing staff experiencing high workloads (P), does the implementation of flexible scheduling and mentorship programs (I), compared to traditional shift systems without structured mentorship (C), reduce nurse turnover and improve job satisfaction (O)?"

Population (P): Oncology nursing staff

Intervention (I): Flexible scheduling and mentorship programs

Comparison (C): Traditional shift systems without structured mentorship

Outcome (O): Reduced turnover rates and improved job satisfaction

This question will explore whether interventions targeting scheduling flexibility and mentorship can reduce the impacts of staffing shortages. Focusing on oncology nurses enables evidence to be identified that is specific to the demands and stressors unique to oncology, making findings more applicable and meaningful for practice improvements in this specialty.

Develop an Effective Search Strategy

To achieve the most relevant evidence on staff retention and job satisfaction in oncology nursing, a search strategy was developed by using a combination of Medical Subject Headings (MeSH) terms, Boolean operators, and appropriate academic databases (Gusenbauer & Haddaway, 2019). The process involves selecting keywords aligned with the PICO framework and using a systematic approach to refine the search.

Step 1: Identify Key Terms and MeSH Terms

The first step was to identify key terms derived from the PICO-based research question. The primary keywords identified included:

These terms were cross-checked in the National Library of Medicine's PubMed database against the MeSH terms for optimal relevance and standardized indexing within studies. The following corresponding MeSH terms are identified below:

Step 2: Combine Keywords with Boolean Operators

A more targeted search that produces targeted results while reducing irrelevant research was made possible by the use of boolean operatorsAND, OR, and NOTto organize the search phrase (Hemedan et al., 2022).

AND was used to link specific and relevant elements of the subject together (e.g., "Oncology Nursing AND Job Satisfaction"), so that both the concepts find their representation in the search outcomes.

OR extended the scope of the search by incorporating term variations and synonyms: "Flexible Scheduling OR Shift Flexibility," which captures studies that use different terminologies (Shaffril et al., 2020).

NOT was applied to exclude the irrelevant study that is not about the topic, for example studies that were only pediatric. This was achieved by the use of the words "NOT Paediatric" which excluded all the irrelevant material.

Sample Search String:

These keywords and Boolean operators were used to create the following sample search string:

Step 3: Select Relevant Databases

PubMed: Peer-reviewed medical and clinical literature with wide-ranging scopes, making it particularly valuable for nursing and health-care interventions and studies involving oncology (Hamad et al., 2024).

CINAHL (Cumulative Index to Nursing and Allied Health Literature): The database indexes journals related to nursing and allied health and is most valuable for locating research findings that are applicable to issues like job satisfaction, mentor-ship, and retention in the clinical arenas of oncology (Beks et al., 2022).

Cochrane Library: Systematic reviews and other higher-level evidence, this is an excellent place to find synthesized results of interventions, like flexible scheduling or mentorship (Scaciota et al., 2021).

Embase: It contains much clinical and biomedical literature. It is a good source in retrieving special studies on retention of nursing staff, particularly in the oncology care setting (Ayiku et al., 2020).

Step 4: Apply Filters and Limits

To narrow the search and increase relevance, filters were applied to limit the results of the search based on specific criteria:

• Publication Date: Only studies within the last five years were considered to ensure that evidence was current.

• Language: Restricted to English to make it easier to find and consistent.

• Type of Study: These are systematic reviews, RCTs, and cohort studies. High up in the evidence hierarchy are these types of studies that provide more authentic data to help take clinical decisions.

Step 5: Review and Refine Results

The results obtained were filtered to eliminate irrelevant data. Titles and abstracts were scanned for exclusion purposes where studies were not specifically aligned with oncology nursing or retention strategies. Studies which were duplicates were also eliminated.

Overview of Levels of Evidence

As far as the nursing staff adequacy and oncology-related measures are concerned, it is crucial to address the issue of levels of evidence. The levels of evidence hierarchy indicates the strength of study designs and their internal validity; therefore, health-care practitioners are encouraged to adhere to most adherent studies first when looking at the evidence to enhance practice.

Level I Systematic reviews and meta-analyses of RCTs: Synthesize the evidence from RCTs as systematic reviews and meta-analysis. This is the strongest level of evidence accumulated through the findings of several RCTs (Yang et al., 2021). Although very few studies exist for specific oncology employee retention, these sources have vital information regarding whether interventions work in a general sense.

Level II (RCTs): RCTs are the gold standard for determining how well an intervention may work. For this research question, studies that are RCTs comparing mentor-ship and flexible scheduling on job satisfaction represent good quality evidence (Ristl et al., 2020). Studies in this category have excellent internal validity since they were randomized, but applicability would vary for different clinical settings.

Level III: Cohort Studies: A cohort study, particularly a one that is designed based on observational data over time, can be used in the analysis of long-term retention trends (Desai et al., 2020). Nurse retention and turnover cohort studies will be relevant in oncology settings for real-world applications and identification of risk factors associated with burnout.
Lower Levels (Case-control and cross-sectional studies, Expert opinions): Though case-control and cross-sectional studies are weaker than RCTs, these are sometimes the most practicable approaches when examining issues in the workplace like job satisfaction and retention (Zeraatkar et al., 2021). However, expert opinions remain the least reliable form of evidence.

Evidence-based implementation from different levels will help the oncology departments carry out the best practices in terms of reliable data; therefore, the risk of practicing poor retention strategies will also be reduced.

Critical Appraisal of Three Articles

Article 1: Examining the Effects of a Structured Mentor-ship Program on the Nurse Mentor: A Pilot Study Engaging Oncology Nurses

Drury, Z., Kotobalavu, C., Hofmann, L., & Austria, M. (2022). Examining the effects of a structured mentorship program on the nurse Mentor: a pilot study engaging oncology nurses. The Journal Name for the Article Examining the Effects of a Structured Mentorship Program on the Nurse Mentor: A Pilot Study Engaging Oncology Nurses Is the Clinical Journal of Oncology Nursing (CJON). https://doi.org/10.1188/22.cjon.27-30

In this pilot study, Drury et al. (2022) examined the professional satisfaction and well-being of oncology nurse mentors who went through a structured mentorship program in oncology nursing. The study was performed for 12 months; the participants were oncology nurses who had acted as mentors in a structured program aiming to support new nurses during their roles. This research focuses on the broader impacts of mentorship, which reach not only the mentees but also the mentors: the prevention of burnout and the increase of job satisfaction and compassion satisfaction.

Appraisal: The research design was quasi-experimental based on a sample of nurse mentors from an oncology department. The sample was relatively small in size as the study was a pilot in nature, but the findings point to a very positive benefit of mentor-ship within oncology nursing and similar highly stressful fields. Mentor's compassion satisfaction was increased with a reduction in burnout scores. These findings are consistent with the benefits of mentor-ship programs to enhance nurse job satisfaction and support structured mentor-ship as a practical means for workforce mood maintenance. Because it does not have the controls of an RCT, the quasi-experiment design slightly restricts the strength of any conclusions that might be drawn.

Usefulness: This research has a specific importance for oncology nursing sections that are formulating ways to retain staff and improve their well-being. In this context, the outcomes provide evidence for a positive influence of mentor-ship on both the mentors and the mentees, thus promoting mentor-ship as a more effective practice that encourages a team-oriented and healthy environment. For nurse mentors, the experience of helping, guiding, and enhancing the skills of their proteges gives them a sense of fulfillment and purpose in their work. Mentoring in this context may help counteract some of the adverse emotional effects of working in an oncology setting, thus helping to mitigate the high levels of burnout and turnover typically encountered in such demanding fields.

Findings of this study have implications for health-care administrators as well, who should establish formal, well-supported mentor-ship programs to help with staff retention. The more formalized oncology mentor-ship programs can be instituted to help bridge the gap for new nurses as they make the transition into the very challenging oncology field. Turnover rates decrease and there is a more experienced workforce for patients and the health-care system.

Article 2: "Factors Influencing Nurses Intention to Work in the Oncology Specialty: A Cross-Sectional Study"

Alrasheedi, O., Schultz, T. J., & Harvey, G. (2021). Factors influencing nurses intention to work in the oncology specialty: multi-institutional cross-sectional study. BMC Palliative Care, 20(1). https://doi.org/10.1186/s12904-021-00764-9

Factors Influencing Nurses' Intention to Work in the Oncology Specialty, conducted by Alrasheedi et al. (2021) was a cross-sectional study that discussed personal and workplace-related factors affecting nurses' intentions to enter or remain in the field. One of the significant concerns faced by the field is high levels of burnout and emotional demand in oncology. A diverse sample of nurses employed in different health-care settings were surveyed with regard to aspects related to job satisfaction, professional support, work-life balance, and perceived burnout levels in oncology settings.

Appraisal: This cross-sectional study provides valuable information through a large sample size, featuring nurses with varying experience and areas in oncology. Mentor-ship and professional development opportunities stood out as significant determinants of one's desire to remain in oncology specialty. This study found that structured mentor ship arrangements and defined pathways to professional development resulted in nurses enjoying higher job satisfaction and reduced burnout, with an increased likelihood of continued work in oncology. Responses singled out work-life balance as critical, with nurses emphasizing the need for schedule flexibility for the emotional and physical demands of working in oncology.

Usefulness: The findings are extremely relevant to oncology departments looking to improve retention and staff satisfaction. In the context of demonstrating significant job satisfaction impact from mentor-ship and flexible scheduling, the research supports the development of targeted retention strategies based on specific needs within oncology nursing. Mentor-ship programs can be utilized in oncology units to help new hires find guidance, professional development, and coping strategies for the unique challenges of oncology care. Flexible scheduling may also help solve work-life balance concerns, which are often a reason for high turnover in oncology.
These findings for health-care administrators suggest investing in mentor-ship and flexible work policies as part of a broader strategy to improve nurse retention. This benefits individual nurses but also strengthens the oncology workforce, which leads to better continuity of care and a more stable health-care team.

Article 3: "Nurse Practice Environments and Outcomes: Implications for Oncology Nursing"

Friese, C. R. (2018). Nurse Practice Environments and Outcomes: Implications for Oncology Nursing. Oncology Nursing Forum, 32(4), 765772. https://doi.org/10.1188/05.onf.765-772

The article Nurse Practice Environments and Outcomes: Implications for Oncology Nursing by Friese (2018) discusses how aspects of the nursing practice environment affect job satisfaction, retention, and patient outcomes in oncology units. A survey-based study was conducted in several oncology departments with regard to staffing adequacy, management support, access to resources, and collaborative teamwork. This study aimed to clarify the direct influence of these environmental factors on both nurse retention and quality of care.

Appraisal: This research study uses a sound cross-sectional survey design in gathering data from various oncology units. The use of standardized tools makes the results highly reliable. However, being a cross-sectional study does not allow the drawing of causality about the link between the environments of practice and the nurses' outcomes. This reliance on self-reported data further introduces the possibility of self-reporting bias due to personal perception. Although the sample size was reasonable, the findings could be generalized further if more studies were conducted with more cohorts and a larger population.

Usefulness: The insights drawn from this study are significant in terms of oncology nursing practice. By identifying the components of supportive practice environments (e.g., effective communication and adequate staffing), nurse leaders will have an opportunity to implement evidence-based strategies to enhance nurse satisfaction and retention. Given the shortfalls of staffing in oncology, maintaining a positive workplace is crucial. The findings function as a valuable hands-on resource, guiding attempts to change both policy and practice within the oncology environment and thus improving the care provided to patients. This research underscores the importance of cultivating supportive conditions that enhance nurses' capacity to experience growth in their professional spheres.

1. Conclusion and Answer to the Research Question

The evidence examined indicates that the provision of flexible work hours and providing mentorship program attract more prospective nurses in the field of oncology nursing. The provision of a flexible work schedule enables oncology nurses to achieve a better work-life balance thus ultimately reducing burnout and improving job satisfaction. Numerous studies have demonstrated that flexible work arrangements reduce turnover rates, which is an important advantage in the oncology field due to the need for consistent staffing to provide optimum care.

Likewise, a well-organized mentoring program increases the chances of nurses staying on the job. This is because new nurses are supported through mentorship as they learn how to cope with the specifics of oncology. New nurses are brought into a beneficial inclusionary habit as they learn how to cope with sensed stresses in their work. Such containment of mentor-ship programs enhances professional learning as well as emotional health thus improving job commitment and dedication for the nursing fraternity.

Answer To The Research Question: Implementation of flexible scheduling and structured mentor-ship programs has decreased turnover of oncology nurses as compared to the job satisfaction and other factors. Evidence emanating from cohort studies, quasi-experimental studies, and meta-analyses provides research-based support toward such interventions reducing the oncology staffing shortages and enhanced quality patient care that could also benefit the workforce through reduced turnover. This supports a call for implementing work flexibilities and formalizing mentorship programs as a strategic intervention in the cancer environment.

The above evidence-based practices help establish a more supportive, sustainable work environment in oncology departments. In addition to retaining nurses, such measures influence patient outcomes because a stable and satisfied workforce improves continuity and quality of oncology care.

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