Chief nursing officer retires

Chief nursing officer for England Dame Chris Beasley retires this month. She is known best for achieving cuts in healthcare-associated infection rates and reducing mixed-sex wards. But she has also worked to give nurses a higher profile in the NHS and most recently pioneered the development of the high impact actions for nursing and midwifery.     

A journey of leadership: from bedside nurse to chief executive officer

Understanding leadership from the inside out was a journey that spanned a 40-year career in health care. This article describes an individual's journey of becoming an effective executive leader using the LEADS in a caring environment--capabilities framework. This framework was recently developed in Canada and is now used broadly to understand the complexity and depth of health care leadership skills and challenges. The author utilizes the framework to explore leadership skill development from a personal perspective to a broader system transformation level. Challenges and successes along this journey are included to highlight the manner in which leadership evolves with experience, time, and determination. A retrospective view of a successful career in health care provides the model for others to consider a similar career path using a theoretical base and a thoughtful process of personal development.     

The role of the chief nursing officer in leading the practice: lessons from the Benner tradition

There is a real danger that measurable tasks and procedures can be misconstrued for nursing practice in contemporary healthcare organizations focused on the measurement of quality, safety, and productivity. This study uses the work of Patricia Benner to address the complex nature of nursing practice and discusses why the chief nursing officer must create an environment within the organization for the practice to be fully lived out if he or she is to be successful as the leader of the discipline.     

Putting post-registration nursing students on-line: important lessons learned

A web site and discussion forum to support a part time degree course for nurses was introduced not only to support student learning but also to encourage students to use and develop their IT skills. Previous cohorts had identified that health informatics skills needed to be addressed more explicitly throughout the programme. The aims of the project were to: (i) evaluate the use of the web site and discussion forum; (ii) determine the barriers to using the web site and discussion forum; (iii) identify ways of overcoming any barriers. The first aim was addressed by analysing web page hits and contributions to the discussion forum. Students' experiences of using the web site and the discussion forum were collected using a questionnaire and followed up by a focus group made up of high and low users of the discussion forum. Students who had accessed the web site most often felt they had been able to communicate with their peers (Spearman's rho, p < 0.01) and had gained peer support by accessing the web site (Spearman's rho, p > 0.05). None of the participants in this study had used a discussion forum before and whilst some students had the skills and confidence to contribute to the on-line discussions, others 'lurked' and some did not access the discussion facility at all. Strategies for improving the engagement and quality of on-line learning are proposed from the lessons learned during this study.     

Elder RNs' perspectives on nursing education: lessons learned

Nursing faculty are challenged with recruiting students and preparing graduates to practice in increasingly complex healthcare settings. The nursing shortage compounds the burden faced by faculty in meeting the needs of the profession. A grounded theory study that explores the perceptions of nurses aged 65 years and older regarding the state of the nursing profession in light of the shortage revealed many interesting aspects of "early" nursing education that are worth revisiting. The author describes the research and uses narrative data to describe what brought elder nurses into nursing, the positive and negative aspects of their education, and the lessons we can learn from their wisdom and experience.     

Second-degree, entry-into-practice master's of nursing program: lessons learned

The accelerated, second-degree option, entry-into-practice master's of nursing degree poses a unique educational opportunity to place more highly qualified nurses at the bedside. The authors discuss one school of nursing's program and lessons learned after reviewing data collected on program implementation over a 3-year period.     

Unfolding case studies in pre-registration nursing education: lessons learned

Nursing education is undergoing radical change worldwide. There is criticism surrounding the content of education and the delivery. As a result, traditional methods of teaching and learning have been replaced by strategies that place greater emphasis on active learner interaction, critical thinking, and decision-making. Assisting pre-registration nurses to become competent and confident in clinical practice requires immersion in practice with sufficient support and coaching based on real life scenarios. Simulation via an unfolding case study approach is one way to provide interactive learning experiences where students acquire new skills that advance their clinical judgment with the aim of becoming safe, competent practitioners. Lessons learned from implementing an unfolding case study are discussed in this paper.     

Evaluating an intensive ward-based writing coach programme to improve nursing documentation: lessons learned

JEFFERIES D., JOHNSON M., NICHOLLS D., LANGDON R. & LAD S. Evaluating an intensive ward-based writing coach programme to improve nursing documentation: lessons learned. International Nursing Review59, 394-401 Aim: This study aimed to develop a ward-based writing coach programme to improve the quality of patient information in nursing documentation. Background: Omissions in the patient information make nursing notes an unreliable source for care planning. Strategies to improve the quality of nursing documentation have been unsuccessful. An education programme, with one-to-one coaching in the clinical environment, was tested. Method: A concurrent mixed methods approach including a pre-post test intervention and control design for the quantitative component combined with a qualitative approach using a focus group (eight nurses) was used. Healthcare records for 87 patients (intervention) (46 pre and 41 post) and 88 patients (control) (51 pre and 37 post) were reviewed using the Nursing and Midwifery Content Audit Tool for quality nursing documentation. Sixteen nurses from two intervention wards participated in an introductory workshop with 2 weeks of coaching. No intervention was given to the control ward. Results: No significant differences were found between the wards across the 14 criteria representing quality documentation; most criteria were present in 75% or more of the records. Improvements were demonstrated in both the intervention and comparison units. Themes identified from the focus groups included the impact these changes had on nurses and patients, perceived difficulties with nursing documentation, medicolegal aspects and the attributes of an effective writing coach. Conclusion: Writing coaching is a supportive approach to improving nursing documentation. Also, regular auditing prompts nurses to improve nursing documentation. Further research using larger sample sizes can further confirm or refute these findings.     

Implementing a nursing program via live interactive video: lessons learned

Flexibility in scheduling and sensitivity to meeting the educational needs of today's diverse student population is a must in nursing education. The authors present an overview of how a college of nursing implemented an entire generic BSN program via live interactive television for nursing students 45 miles from the main campus. The authors describe the experience of initiating the program, facilitating faculty and student adaptation to the challenges of live interactive video education, and a summary of the first five years.     

Views on teaching-learning: lessons learned from nursing education in Sweden

Although change sometimes feels risky, nurse educators continually search for more effective ways of teaching. Different approaches to teaching-learning were experienced during a visiting professorship at a Swedish university. Ethnographic methods involving participant observation and interviews with faculty and students were used to understand the educational philosophy and methods of teaching and learning. Reflection exercises and suggestions provide ideas about how these approaches might be adapted for use in the United States.     

Trastuzumab cardio-oncology: lessons learned

Treatment with the humanized monoclonal antibody trastuzumab can significantly improve outcomes for patients with early or metastatic HER2-positive breast cancer. In a small proportion of patients, trastuzumab is associated with an increased risk of cardiac dysfunction. Although the mechanisms have yet to be fully established, trastuzumab may block HER2 signaling in cardiomyocytes, which is believed to be important for protecting the cardiomyocytes from stress such as that induced by treatment with anthracyclines. The risk of trastuzumab-associated cardiac dysfunction can be reduced if patients are evaluated thoroughly for risk factors before treatment (e.g., hypertension, low ejection fraction at onset, hyperglycemia, prior congestive heart failure). In addition, cardiac function must be assessed before and during the treatment period. If cardiac dysfunction occurs during treatment, early intervention can expand the possibilities of reinstitution of trastuzumab treatment. The integration of nonanthracycline adjuvant regimens offers opportunities for cardiac-compromised patients.