Nursing Leadership and COVID-19:: Defining the Shadows and Leading Ahead of the Data

The COVID-19 pandemic overwhelmed health care systems and exposed major gaps in preparedness and response plans. The crisis challenged nurse leaders to develop and implement novel care delivery plans while preventing disease transmission to patients and staff. COVID-19 required nurse leaders to make decisions in an environment of conflicting data and directives. The authors share essential nurse leader competencies vital to the development and support of thriving nurse leaders. As crises persist and future challenges arise, nurse leaders can leverage these essential competencies to successfully drive engagement, lead ahead of consensus, and define the shadows of limited, incomplete, and conflicting data.     

Shaping the Future of the Critical Care Nursing Workforce

Professional organizations can be valuable partners in identifying strategies that help nurse leaders chart a course toward positive experiences for both staff and patients. These associations leverage their networks and provide national perspectives that support their identified nursing specialties. As 1 example, the American Association of Critical-Care Nurses (AACN) seeks to reinforce healthy work environments, help nurses make their optimal contributions, ensure that patients receive optimal care, and help nurses shape the nursing profession and health care. Engaging professional nursing organizations as strategic thinking partners may serve nurse leaders efforts to shape a positive future for the nursing workforce.     

Using a Learning Health Care System to Advance Nursing and Patient Care

In a learning health care system (LHS), clinical operations are integrated with research to support investigative endeavors that address real-world clinical questions, including those focused on nursing care. At a southern university medical center, an established LHS has helped to facilitate the examination of practice innovations prior to system-wide implementation and enables nurse leaders to provide solutions to clinical practice and patient care issues.     

Utilizing Innovative Technology to Improve Health Care

Staff expectations of leaders to recruit and retain nonexistent nursing personnel is an impossible task. In an effort to ease the burdens of an increasingly complex health care environment, caring, transformational nurse leaders can harness the power of innovative technology to improve health care. This article provides examples of several technological innovations as solutions to each of the Institute for Health Care Improvement’s Quintuple aims. Consideration is given to the importance of envisioning, inspiring, and supporting environments of curiosity, adaptation, and creativity necessary to advance the vision of sustainable, quality health care.     

Nurse Executives Impacting the Human Experience in Health Care

The human experience in health care over the past 2 and one-half years has been unprecedented. Impacted by the COVID-19 pandemic, march on the United States Capitol, economic crisis, social injustice, and growing concerns regarding structural racism—our health system is under siege. Executive nurse leaders find themselves at the crossroads of motivating colleagues to provide excellence in nursing and patient care while confronting both a current and future shortage of registered nurses. Over 30 nurse leaders from around the globe meet and strategize on creating a preferred future for health care. The purpose of this article is to describe The Beryl Institute, the formation of the nurse executive council, the work of its members, and a collective call to action.     

The Perianesthesia Nurse as Advocate in the Policy Arena: Driving the Health Care Agenda

Nurses must become leaders in creating public policy that is relevant to health care. Understanding the extent of the policy process-the components, models, and processes-will provide a framework for the nurse to work in the policy arena and effect change in a positive way.     

Nurse administrator's role in health policy: teaching the elephant to dance

Historically, policies guiding the American health care delivery system have focused primarily on financing disease care. This emphasis on disease, rather than health, has sustained the idea of medical primacy while resulting in poor economic and health outcomes. Nursing's unique health-oriented contributions are undervalued and underutilized in the present system. This article addresses how and why nurse administrators should become involved in the policy arena. The article also emphasizes the need for skilled nurse leaders to influence the national agenda through political activism so that comprehensive nursing care is available and accessible.     

The Autonomous-collaborative Care Model: meeting the future head on

As care needs continue to increase in complexity in inpatient settings, and nurses' scope of practice evolves to keep pace with these changing demands, it is imperative that nurse leaders ensure nursing care delivery models are well aligned to current realities. Older, traditional models of nursing service may no longer foster safe, effective and efficient care or contribute to job satisfaction and high-quality work life for nurses. This paper describes the Autonomous-Collaborative Care Model and its application in a continuing care setting. This innovative and flexible model fosters autonomy and accountability in nursing practice, reduces duplication in the execution of nursing tasks, enhances effective communication and outlines mechanisms for collaboration among various members of the nursing and interprofessional teams. The model has positioned the authors' organization to meet impending shortages of nursing personnel by ensuring that the right category of nurse is assigned to the appropriate patient, by reducing non-nursing work and by supporting nurses' autonomy to practise to their full scope.     

Reflection: an educational strategy to develop emotionally‐competent nurse leaders

Aim This paper explores educational strategies for nurses that focus on reflectivity and promote the development of self‐awareness, relationship and communication skills and ability to lead with presence and compassion in the midst of change. Background Today nurses move rapidly from carefully‐controlled educational experiences to a fast‐ paced clinical world of increasing patient complexity amid calls for improved quality of care. Making the transition to clinical competence and leadership in practice requires a strong sense of self and emotional intelligence. Evaluation Pedagogies that integrate theoretical and data‐based textbook learning with experiential learning and reflection are a foundation for the development of emotionally‐ and intellectually‐competent leaders and requires new ways of assessing learner outcomes. Key issues Reflection is a key instructional strategy for preparing transformational nurse leaders for interdisciplinary settings where they lead patient care management. The remarkable global spread of reflection in nursing education, practice and research follows an emphasis on developing self‐awareness as a leadership strategy for improving individual and organizational performance. Conclusions Empirical, experiential and anecdotal evidence suggests that reflection has the potential to prepare emotionally‐capable nurse leaders. Implications for Nursing Management As educators create more reflective and nurturing learning environments, they will promote the development of emotionally‐competent nurse leaders who will, in turn, inspire individual and organizational growth and positive change in society.     

The challenges of primary health care nurse leaders in the wake of New Health Care Reform in Norway

Background

The local municipality, whose management style is largely inspired by the New Public Management (NPM) model, has administrative responsibilities for primary health care in Norway. Those responsible for health care at the local level often find themselves torn between their professional responsibilities and the municipality’s market-oriented funding system. The introduction of the new health care reform process known as the Coordination Reform in January 2012 prioritises primary health care while simultaneously promoting a more collaborative and multidisciplinary approach to health care. Nurse leaders experience constant cross-pressure in their roles as members of the municipal executive team, the execution of their professional and administrative duties, and the overall political aims of the new reform. The aim of this article is to illuminate some of the major challenges facing nurse leaders in charge of nursing homes and to draw attention to their professional concerns about the quality of nursing care with the introduction of the new reform and its implementation under NPM-inspired municipal executive leadership.

Method

This study employs a qualitative design. In-depth interviews were conducted with 10 nurse leaders in 10 municipalities, with a phenomenological-hermeneutic approach used for data analysis and interpretation.

Result

Findings highlighted the increasingly complex challenges facing nurse leaders operating in the context of the municipality’s hierarchical NPM management structure, while they are required to exercise collaborative professional interactions as per the guidelines of the new Coordination Reform. The interview findings were interpreted out of three sub-themes 1) importance of support for the nurse leader, 2) concerns about overall service quality, and 3) increased tasks unrelated to nursing leadership.

Conclusion

The priorities of municipal senior management and the focus of the municipality’s care service need clarification in the light of this reform. The voices of those at the frontlines of the caring services need to be heard as the restructuring of the caring services may have implications both for funding allocation and for the quality of patient care.

     

Key challenges facing American nurse leaders

What are the key challenges facing nurse leaders in the United States? To find out, I asked 20 prominent nurse leaders to respond to that question and tell me their top three issues. Their voices tell a compelling story on challenges faced by the nurse leaders in American healthcare. The focus is no longer just on the process of how care is delivered, but on the outcomes of that care. More attention is being given to documenting that the care is provided according to specific standards associated with better outcomes. Many of the standards are directly related to the care given by nurses, including some indicators that are specifically sensitive to nurse intervention. There is also a new focus on federal reporting of patient satisfaction with the services provide. Producing quality outcomes, high patient satisfaction and effective measurements of both are now a central theme for the entire hospital administrative team. For the nurse leader, however, it represents explicit accountability for managing and leading the staff responsible for providing the patient care. Safety and quality issues are directly linked to financial pressure. Reimbursement for hospital is being whittled away as financial accountability for services receives greater scrutiny from the federal government and private insurers. Close on the heels of the financial challenge is the ever present workforce shortage. The most troublesome challenge identified by these nurse leaders is the absence of an adequate pipeline for nursing leaders. It is an exciting time for nursing in the United States. Challenges to be sure, but these nurse leaders have identified the priorities that will create a successful future.     

Care of guinea pigs

ABSTRACT:

This article covers all aspects of husbandry and nutrition, enabling the veterinary nurse to feel confident in advising owners about the correct care of guinea pigs. It describes signs of health, allowing the nurse to conduct an examination in a nurse's clinic and be able to recognise the first signs of disease. The last section covers nursing of the sick guinea pig, enabling nurses to care for guinea pigs in the clinic, and give advice to owners about how to nurse their pets at home.     

Care of the patient critically ill with inflammatory bowel disease

The nurse is instrumental in providing and coordinating the complex care of the patient critically ill with inflammatory bowel disease. Knowledge of the disease process and its complications provides the nurse a foundation for understanding the clinical course of the disease and for planning patient care. Management of alterations in nutritional status, wound healing, and fluid and electrolyte balance ensure an optimal recovery trajectory.     

A Clinical Update on Delirium: Focus on the Intensive Care Unit Patient

Acute care nurse practitioners manage a wide range of patient diagnoses and problems encountered in critical care, including management of delirium. As such, they are positioned to be leaders in the prevention, recognition, and management of delirium in the intensive care unit setting. Delirium in the hospitalized patient is linked with a prolonged length of stay, higher risk of death, and cognitive decline. Delirium will occur in up to 87% of intensive care unit patients with severe illness or recovering from major surgery. This overview of current evidence-based practice guidelines and an accompanying case study will assist interdisciplinary teams of health care providers to diagnose, treat, and manage hospitalized patients with delirium, with a focus on the complex care of the critically ill patient population.     

Cultivating a culture of research in nursing through a journal club for leaders: A pilot study

Aim

To describe whether an action learning‐inspired journal club for nurse leaders can develop the leaders' self‐perceived competences to support a research culture in clinical nursing practice.

Background

Development of clinical research capacity and nurse leaders with the requisite competences are key factors in evidence‐based health care practice. This study describes how nurse leaders at a large regional hospital took part in a journal club for nurse leaders, with a view to developing their competences to support a nursing research culture in their departments.

Methods

A pilot study using a multimethod approach to evaluate the journal club for nurse leaders. Four nurse leaders participated in the journal club for nurse leaders. Content analysis on the data was performed.

Results

Data revealed that participation in journal club for nurse leaders gave the leaders a feeling of increased competences to support nursing research culture in their departments. They stated that the action learning approach and the competences of the facilitator were key factors in this outcome.

Conclusions

An action learning‐inspired journal club for nurse leaders can be useful and meaningful to nurse leaders in developing leadership competences.

Implications for nursing management

As an approach in journal club for nurse leaders, action learning can develop nurse leaders' competence to support a research culture, and thus ensure evidence‐based nursing is practised.     

Ineffective participation: reactions to absentee and incompetent nurse leadership in an intensive care unit

Aim  The aim of the present study was to analyse reactions to ineffective leader participation in an intensive care unit (ICU).
Background  Critical examination of leadership failures helps identify nurse manager behaviours to avoid.
Method  An online survey collected data from 51 interacting healthcare providers who work in an intensive care unit.
Results  Participants reported dissatisfaction with nurse leaders who were perceived as absent or ill prepared. Participants categorized intensive care unit productivity and morale as moderate to low. Multiple regression suggested the best predictor of perceived unit productivity was supervisor communication; the best predictor of employee morale was perceived leader mentoring.
Conclusions  Intensive care unit nurses reported wanting active participation from their leaders and expressed dissatisfaction when supervisors were perceived as absent or incompetent. Ineffective leader participation significantly correlated with lower employee perceptions of productivity and morale.
Implications for nursing management  Senior managers should recruit and develop supervisors with effective participation skills. Organizations primarily concerned about productivity should focus on developing the communication skills of nurse leaders. Units mainly concerned with employee morale should emphasize mentorship and role modelling. Formal assessment of nurse leaders by all intensive care unit team members should also be used to proactively identify opportunities for improvement.     

Preparing nurses for the 21st century: reenvisioning nursing education and practice.

Significant advances in biomedical science and in the complexity of health care, coupled with a worsening nursing shortage and numerous reports of unsafe and inadequate patient care, have prompted concerns about both nursing education and nursing practice. Beginning in 2000, the American Association of Colleges of Nursing (AACN) made a thorough study of nursing education, regulation, and practice issues. Input and consultation were sought from AACN members, nursing practice leaders, regulators, and other health professionals. Results of this work indicated the need for a new nursing professional, the clinical nurse leader, who could effectively coordinate, manage and evaluate care for groups of patients in complex health systems. Master's-degree education is proposed for piloting the preparation of clinical nurse leaders. Close coordination with nurse executives and administrators to develop the new education program and new models for care delivery is planned. Critical components of the pilot testing will be evaluation of the patient and nurse outcomes associated with the use of clinical nurse leaders and focused work to develop a new legal scope and credentials for them.     

Decreasing Nurse Leader Work Role Overload Through Flexible Work Interventions

The nurse leader role is critical to ensure a quality work environment that influences clinical nurse satisfaction, decreased turnover, and patient outcomes. A primary source of stress in nurse leaders that contributes to burnout is organizational stress such as operational task-oriented activities. The purpose of this study was to evaluate how flexible workplace interventions influence nurse leaders perceptions of role overload and job satisfaction. It was found that flexible work interventions positively impact nurse leader satisfaction, perceived stress, and work role balance in an acute care hospital.     

Characteristics of nurse leaders in hospitals in the USA from 1992 to 2008

Aim Describe the nurse leader workforce in hospitals in the USA over time by exploring three research questions: (1) What are the characteristics of the nurse leader workforce in US hospitals? (2) How does the nurse leader workforce change over time? (3) How do nurses in executive positions (administrators) differ from nurses in first-line supervisory positions (supervisors)? Background Effective nurse leaders use management skills to ensure safe patient care in hospitals in the USA. Changes in the nurse leader workforce have an impact on patient care. Method A non-experimental design was used to explore the characteristics of 10 150 nurse leaders using the 1992, 1996, 2000, 2004 and 2008 National Sample Surveys of Registered Nurses. Results Number of masters and doctorally prepared nurse leaders increased from 14.5% to 23.2% along with an increase in mean age. A 30% decrease in the number of nurses in leadership positions was found. Male nurses reported significantly higher salaries P < 0.000. Conclusions Nurse leaders are older and have achieved higher educational degrees. Salary disparities based on gender still prevail. Implications for nursing management Identifying and developing future leaders with necessary skills and competencies is critical for organizational success.     

The hidden treasure in nursing leadership: informal leaders

downey m., parslow s. & smart m. (2011) Journal of Nursing Management 19 , 517–521
The hidden treasure in nursing leadership: informal leaders Aim The goal of the present article was to generate awareness of characteristics of informal leaders in healthcare with the emphasis on nurses in acute care settings. There is limited research or literature regarding informal leaders in nursing and how they positively impact nursing management, the organization and, ultimately, patient care. Identification of nurses with leadership characteristics is important so that leadership development and mentoring can occur within the nursing profession. Background More than ever, nursing needs energetic, committed and dedicated leaders to meet the challenges of the healthcare climate and the nursing shortage. This requires nurse leaders to consider all avenues to ensure the ongoing profitability and viability of their healthcare facility. Key issues This paper discusses clinical nurses as informal leaders; characteristics of the informal nurse leader, the role they play, how they impact their unit and how they shape the organization. Implication for nursing management Informal nurse leaders are an underutilized asset in health care. If identified early, these nurses can be developed and empowered to impact unit performance, efficiency and environmental culture in a positive manner.