title: Does clinical incident seriousness and receipt of work-based support influence mood experienced by nurses at work? A behavioural diary study.
abstract: BACKGROUND
  While the relationship between general perceptions of the work environment and negative mood is well detailed, little is known about the effect of specific clinical incident characteristics on the mood experienced at work by nurses. This study examines the effect of incident seriousness and receipt of work-based support in the worst event of a shift from managers and colleagues on the Negative and Positive Affect experienced by nurses at work.
  
  
  METHODS
  We approached the total cohort of medical and surgical nurses in 4 large district general hospitals in England, 17% volunteered. Some 171 nurses filled end of shift and standard entry (every 90 min) computerised behavioural diaries over three consecutive shifts. The diaries measured Incident Seriousness, Receipt of Managerial and Co-worker Support, Negative Affect and Positive Affect. Results were analysed using multilevel modelling (MLwiN 2.19).
  
  
  RESULTS
  Following the worst clinical incident of a shift, nurses reported higher Negative Affect (β=1.28, [95%CI: 0.12, 2.45], z=2.17, p<.05) and lower Positive Affect (β=-2.39, [95%CI: -3.96, -0.82], z=2.99, p<.005) which persisted for the remainder of the shift. Most critically, Negative Affect was more elevated after serious incidents (β=0.07, [95%CI: 0.04, 0.10], z=3.5, p<.005). Nurses who reported Receipt of Managerial Support following an incident reported significantly lower levels of Positive Affect compared to those reporting no such contact (β=-5.30, [95%CI: -9.51, -1.09], z=2.47, p<.05). The interaction between Incident and the Receipt of Work-Based Support on NA was not significant (β=2.34 [95%CI: -0.82, 3.95], z=1.45, p>.05). Receipt of Colleague Support had no relationship with Negative Affect or Positive Affect. Free text reports mainly revealed the negative impact of managerial support, although there were instances of contact with managers which were sought following exposure to difficult clinical situations.
  
  
  CONCLUSIONS
  Serious clinical incidents have enduring effects on Negative Affect and Positive Affect for the remainder of the shift. Nurse Positive Affect was significantly worse following the worst clinical incident of shift when managerial support was received. Further research is required to determine the positive and negative effects of managerial support on the mood experienced by nurses at work.
authors.affiliation: School of Nursing and Midwifery, University of Dundee, 11 Airlie Place, Dundee DD1 4HJ, United Kingdom. m.c.jones@dundee.ac.uk
authors.forename: Martyn C
authors.initials: MC
authors.lastname: Jones
authors.forename: Derek W
authors.initials: DW
authors.lastname: Johnston
mesh_terms: D000339:Affect; D002055:Burnout, Professional / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D004739:England; D005260:Female; D006801:Humans; D007400:Interprofessional Relations; D008297:Male; D009718:Nurse Administrators; D009741:Nursing Staff, Hospital / Q000458:organization & administration / Q000523:psychology*; D061214:Patient Safety; D012944:Social Support; D017132:Workplace