The impact of the re-engineered world of health-care in Canada on nursing and patient outcomes

The healthcare environment is knowledge driven and knowledge and human resource dependent. Despite the paucity of evidence on which to shape and evaluate organizational change, health-care in Canada has undergone many changes in the last 15 years. In the pursuit of enhanced productivity, healthcare administrators have turned to industrial and engineering models. Using available Canadian research and policy reports, and where necessary, American literature, this paper describes the impact of re-engineering on nursing and on the relationship between nursing and patient outcomes. It also identifies emerging trends and ways forward.     

Ten steps for managing organizational change.

Managing interdepartmental relations in healthcare organizations is a major challenge for nursing administrators. The authors describe the implementation process of an organization-wide change effort involving individuals from departments throughout the medical center. These strategies can serve as a model to guide effective planning in other institutions embarking on change projects, resulting in smoother and more effective implementation of interdepartmental change.     

Leadership: a key strategy in staff nurse retention

Nursing administrators are challenged to recruit and retain staff nurses in the midst of increasing job vacancies and staff nurse turnover rates averaging 21%. The prevailing issues related to staff nurse recruitment and retention in the current healthcare environment are briefly reviewed as introductory content. The article outlines the case from nursing administration literature that effective leadership styles of nurse managers and nurse administrators enhance staff nurse retention. As nurse administrators continue to struggle with staff nurse recruitment and retention, evidenced-based strategies are discussed that address leader preparation and organizational leadership structure including advanced education, leadership training, and shared leadership models.     

Staff nurse turnover costs: Part II, Measurements and results

This study demonstrated that the costs of nursing turnover can be high (over +10,000 per RN turnover), and that the potential for adverse impact on the nursing department, the hospital environment, and the healthcare environment exists. The results of this study are important, particularly in the midst of a national nursing shortage, for several reasons. CNEs are responsible for obtaining, allocating, and managing nursing department resources; knowledge of nursing turnover costs will allow them to make more informed decisions about how best to allocate scarce resources. The findings of this study are also important to hospital administrators because they demonstrate the financial impact of high rates of nursing turnover on healthcare delivery. Finally, these findings provide nurse researchers direction for future research into the costs and benefits of nursing turnover and retention activities, so that cost-effective methods of minimizing organizational costs can be determined.     

Implications of organizational learning for nursing managers from the cultural, interpersonal and systems thinking perspectives

This paper discusses the implications of organizational learning to healthcare administrators, in particular nursing managers, from the cultural, interpersonal and systems thinking perspectives. In the various perspectives the reasons for organizational ineffectiveness and remedies are presented. There is little doubt that pressure for nurses to perform is escalating as healthcare institutions attempt to improve the quality of service through restructuring and change, which leads to greater job dissatisfaction, higher turnover, lower morale and increased industrial actions of nurses. An integrated approach to organizational learning is arguably important for the effective management of nurses during periods of transition.     

Quality assurance in rural hospitals

Within the last decade there has been an expanding amount of information on quality assurance in healthcare. Despite the prolific citations on the topic, only a few address the needs and concerns regarding quality assurance programs in rural healthcare institutions. The author summarizes the more frequently expressed concerns of nursing administrators in implementing a comprehensive quality assurance program in the rural environment.     

Alternative work arrangements: senior administrative job-share

As the healthcare workforce ages and workers expect increasingly flexible work environments, employers are looking for creative strategies to maintain a healthy and vital workforce. This paper offers one such strategy. It describes a job-share experience by two senior administrators within a large healthcare authority and provides the findings from a survey evaluation.     

Issues and trends in nursing service administration education.

The Council on Graduate Education for Administration in Nursing (CGEAN) was established to further the development and improvement of graduate education for administration in nursing. The Council seeks to identify the nature and direction of education for administration in nursing in various healthcare systems, providing guidelines for programs offering administration. A major goal of CGEAN is facilitating dialogue between nursing service administrators and graduate level educators who are engaged in teaching and research related to administration in nursing. This column, sponsored by members of the Council, will analyze and respond to position statements and trends related to the delivery of health services and graduate education for administrators in nursing.     

The middle-range theory of nursing intellectual capital

Title. The middle-range theory of nursing intellectual capital Aim. This paper is a report of the development of the middle-range theory of nursing intellectual capital. Background. Rising healthcare costs and advances in technology have contributed to the need for better understanding of the influence of nurses’ knowledge, skills and experience on patient and organizational outcomes. Method. The middle-range nursing intellectual capital theory was developed using the strategies of concept and theory derivation. The principles of research synthesis were used to provide empirical support for the propositions of the theory. Findings. The middle-range nursing intellectual capital theory was derived from intellectual capital theory to make it relevant and applicable to a specific aspect of nursing, continuing professional development. It proposes that the nursing knowledge available in healthcare organizations is influenced by variables within the work environment, and influences patient and organizational outcomes. Conclusion. The middle-range nursing intellectual capital theory should be tested in different healthcare systems and in different settings and countries to determine its effectiveness in guiding research.     

Realizing your marketing influence, Part 1. Meeting patient needs through collaboration

To what degree do or should marketing and nursing overlap? If marketing is about meeting patient needs, who better than the nursing staff to inform marketing decisions? Meeting patient needs profitably ensures that patient care can continue to move toward excellence. As competition continues to intensify and reimbursement remains insufficient, using all of the healthcare system's available intellectual capital is imperative to achieving maximum competitive advantage. The author applies current marketing theory to the healthcare environment and provides practical suggestions on how nursing administrators and staff can work collaboratively with marketing colleagues to develop and implement strategic marketing programs. This is the first in a series of 3 articles, which will move readers from broad marketing strategy to specific applications. The second (June, 2002) and third articles (July/August, 2002) will focus on internal marketing and using professional certification as a marketing tool.     

The best of both worlds: a consideration of gender in team building

As teams continue to supplant individuals as the fundamental work unit, healthcare organizations increasingly are turning to high-performance care and service groups as keys to success. In this article, the author presents research and findings of an ethnographic case study of a mixed-gender work team of healthcare administrators. Focusing on gender issues and their impact on outcomes, the study offers insights for promoting cultural change and improving nursing practice systems that will influence health policy and support a new architecture for the healthcare industry.     

Diffusion of innovation: the leaders' role in creating the organizational context for evidence-based practice

Successfully leading change represents one of the most, if not the most, challenging aspects of a leader's role. The traditional top-down command and control structures and processes present in healthcare institutions and nursing are the enemies of effective change. Transitioning from traditional structures to structures that are more of a partnership between point-of-service staff and administrators is the foundation for creating an evidence-based practice culture.     

The role of nursing leadership in creating caring environments in health care delivery systems

Nurse administrators play a key role in articulating the uniqueness of nursing in complex, corporatized health systems. They also have the privileged opportunity to co-create with nurse colleagues an environment for practice that is perceived by all constituencies as caring. This article addresses how an explicit view of Nursing as Caring can serve as the foundation for the successful and substantive integration of caring. Practical strategies to enhance the organization as a caring environment are discussed.     

A Delphi Application Health Care, Practice, Education and Education Administration; Circa 1992

Exploration of the future is an essential component of effective long-range planning. Navigating the change process is the anticipated object. The author used the Delphi technique to identify the probable future events in health care and in nursing practice, education, and education administration. Concomitant strategies required by nursing education administrators to manage future programs are identified.     

Communication. Improving RNs' organizational and professional identification in managed care hospitals

Nurse administrators are searching for an expanded repertoire of strategies to attract and retain qualified nursing staff in today's managed care environment. This study examined hospital registered nurses' interpretations of managed care and the effects of those views on nurses' identification with their employing organization and the nursing profession. Findings show that nurses held greater identification with their occupation than their organization. Significant factors influencing nurses' attachment to both of these reference groups included uncertainty about managed care changes, information received about managed care changes, and effects of managed care on the nursing role. Communication principles and strategies are presented to nurse leaders for use in fostering a stronger organizational affiliation among staff nurses while maintaining a strong identification with the nursing profession.     

Values expressed in philosophies of nursing services

Do nurses value "caring"? Does it matter that nurses respect individual rights while caring for groups of patients? What values are shared by nurses and are they evident in institutions? How important are nursing values in a changing healthcare system? Should nurse administrators ensure that nursing values remain integral to managed care? What is the nurse's responsibility for communicating nursing values throughout the organization? The authors discuss the values expressed in nursing service philosophies and how they reflect a changing healthcare system.     

The Cochrane Library can answer your nursing care effectiveness questions.

Systematic reviews help nurses to manage the overwhelming volume of available information by synthesizing valid data from primary studies and summarizing the results of interventions. One reliable source of systematic reviews of healthcare interventions is the Cochrane Library. This paper briefly describes the Cochrane Collaboration and the Cochrane Library. It also encourages nurse clinicians and nurse administrators to use the Cochrane Library and encourages nurse researchers to contribute to the Cochrane Library by conducting systematic reviews in the field of nursing care effectiveness.     

A Model for Professional Rehabilitation Nursing Practice

As partners in health care, clinical and administrative nurses must share in the work, risks, and rewards inherent in nursing practice while promoting high-quality results in a cost-conscious and cost-effective environment. One way to achieve these results is by developing a nontraditional rehabilitation structure and nursing practice model. This article discusses practical strategies for constructing and implementing such a model; it also identifies tangible outcomes of using the model. The healthcare environment in the 1990s demands a high level of involvement on the part of staff; the rehabilitation nursing model presented in this article meets this challenge.