New Nurse Leaders: Creating a Work-Life Balance and Finding Joy in Work

New nurse leaders assume complex and demanding roles. These time-consuming positions can prevent work-life balance and eventually lead to burnout. Joy in work has been described as a concept in health care opposite of burnout. The Institute for Healthcare Improvement developed a four-step model for addressing barriers to joy in the workplace. This article will describe how new nurse leaders can use the four-step model to evaluate barriers to joy in the workplace. Strategies for change to address common challenges that prevent joy and work-life balance will also be provided.     

Back to Basics: Speak Up

Being able to identify problems and bring them to the attention of OR team colleagues is crucial for the safety of both patients and perioperative team members; however, being able to do this means being comfortable with speaking up under circumstances that may be difficult. Disruptive or intimidating coworker behavior also makes speaking up difficult, but it is important to address in the interest of providing safe, effective care to patients. To remedy this, health care workers should create awareness of the problem and motivate others to take action; establish a culture of respect; set expectations to help eliminate disrespectful behavior; and create a learning environment that eliminates hierarchical structures, fosters professionalism, demonstrates respect, and enforces a zero tolerance policy.     

Addressing a Key Leadership Challenge: Workplace Violence

Workplace violence is a growing concern among health care workers, especially staff working in emergency departments. Emergency department leaders have oversight accountability that includes mitigation of workplace violence risks and staff education related to workplace violence prevention. Challenges associated with workplace violence events include disruption of safe patient care, decreased staff job satisfaction, and increased turnover. Improving safety for staff, patients, and visitors requires a culture focused on safety. A summary of current regulations, standards, and resources available to date is provided, including a list of mitigation strategies that can be easily translated into practice by emergency nurse leaders.     

A remembrance of the past, an investment for the future.

Occupational health nursing has evolved from a single dimension practice into a complex role providing primary care, health maintenance, and disease prevention programs at the worksite. The focus of the 1990s will be on managed care, health care reform, and competition for resources. Occupational health nurses are in a strategic position to foster the objectives set forth in Healthy People 2000. Occupational health nurses must take the lead in the development and implementation of cost effective health care programs at the worksite. Occupational health nurses must communicate and demonstrate the nature and value of their contributions; demonstrate their competencies; and become knowledgeable in all areas of occupational health and safety. They must acknowledge that they are leaders in workplace health and safety.     

High reliability and implications for nursing leaders

Aim  To review high reliability theory and discuss its implications for the nursing leader.
Background  A high reliability organization (HRO) is considered that which has measurable near perfect performance for quality and safety.
Evaluation  The author has reviewed the literature, discussed research findings that contribute to improving reliability in health care organizations, and makes five recommendations for how nursing leaders can create high reliability organizations.
Key issues  Health care is not a safe industry and unintended patient harm occurs at epidemic levels. Health care can learn from high reliability theory and practice developed in other high-risk industries.
Conclusions  Viewed by HRO standards, unintended patient injury in health care is excessively high and quality is distressingly low. HRO theory and practice can be successfully applied in health care using advanced interdisciplinary teamwork training and deliberate process design techniques.
Implications for nursing management  Nursing has a primary leadership function for ensuring patient safety and achieving high quality in health care organizations. Learning HRO theory and methods for achieving high reliability is a foremost opportunity for nursing leaders.     

Clinical leadership: using observations of care to focus risk management and quality improvement activities in the clinical setting

In an era when patient safety and quality of care are a daily concern for health care professionals, it is important for nurse managers and other clinical leaders to have a repertoire of skills and interventions that can be used to motivate and engage clinical teams in risk assessment and continuous quality improvement at the level of patient care delivery. This paper describes how a cohort of clinical leaders who were undertaking a leadership development program used a relatively simple, patient-focused intervention called the 'observation of care' to help focus the clinical team's attention on areas for improvement within the clinical setting. The main quality and safety themes arising out of the observations that were undertaken by the Clinical Leaders (CLs) were related to the environment, occupational health and safety, communication and team function, clinical practice and patient care. The observations of care also provided the CLs with many opportunities to acknowledge and celebrate exemplary practice as it was observed as a means of enhancing the development of a quality and safety culture within the clinical setting. The 'observation of care' intervention can be used by Clinical Leader's to engage and motivate clinical teams to focus on continuously improving the safety and quality of their own work environment and the care delivered to patients within that environment.     

The Leadership Role of Nurse Educators in Mental Health Nursing

Leadership behaviors and actions influence others to act, and leadership in clinical practice is an important mediator influencing patient outcomes and staff satisfaction. Indeed, positive clinical leadership has been positioned as a crucial element for transformation of health care services and has led to the development of the Practice Doctorate Movement in the United States. Nurse educators in health care have a vital leadership role as clinical experts, role models, mentors, change agents, and supporters of quality projects. By enacting these leadership attributes, nurse educators ensure a skilled and confident workforce that is focused on optimizing opportunities for students and graduates to integrate theory and practice in the workplace as well as developing more holistic models of care for the consumer. Nurse educators need to be active in supporting staff and students in health care environments and be visible leaders who can drive policy and practice changes and engage in professional forums, research, and scholarship. Although nurse educators have always been a feature of the nursing workplace, there is a paucity of literature on the role of nurse educators as clinical leaders. This discursive article describes the role and attributes of nurse educators with a focus on their role as leaders in mental health nursing. We argue that embracing the leadership role is fundamental to nurse educators and to influencing consumer-focused care in mental health. We also make recommendations for developing the leadership role of nurse educators and provide considerations for further research such as examining the impact of clinical leaders on client, staff, and organizational outcomes.     

Fostering positive spaces in public health using a cultural humility approach

Culturally competent frameworks used within health care systems are contributing to the discrimination and marginalization of sexually and/or gender diverse persons. In this discursive paper, we argue that cultural humility ought to be implemented as the best practice approach for fostering sexually and gender diverse positive spaces in public health settings. A paradigm shift away from cultural competence frameworks toward cultural humility is necessary. This shift can be achieved by enhancing educational opportunities for public health nursing students and professionals and by recruiting organizational leaders to be champions for systemic change. In order to achieve this, we must establish effective educational programs that espouse cultural humility practices and develop valid measurement tools for assessing the provision of culturally humble care. This would equip educators, students, practitioners, and organizational leaders with the necessary tools to guide and assess their performance. Integrating a culturally humble approach will ultimately enhance self‐reported cultural safety in public health spaces and reduce health inequities experienced by sexually and/or gender diverse clients and staff members.     

Is "latex safe" possible? Using a systematic approach in occupational health.

1. Exposure to natural rubber latex, either by contact or by inhalation, can pose an extreme workplace hazard for sensitive health care workers. Latex reduction strategies are necessary to provide a safer work environment for those who are sensitive, and to prevent future sensitization of healthy workers. 2. Developing a latex reduction plan requires a multifaceted approach. An interdisciplinary task force is highly recommended to achieve optimal latex reduction. 3. Educating staff about latex safety for both health care workers and the patient population is important in providing a safer work environment.     

Safety Culture and Care: A Program to Prevent Surgical Errors

Surgical errors are under scrutiny in health care as part of ensuring a culture of safety in which patients receive quality care. Hospitals use safety measures to compare their performance against industry benchmarks. To understand patient safety issues, health care providers must have processes in place to analyze and evaluate the quality of the care they provide. At one facility, efforts made to improve its quality and safety led to the development of a robust safety program with resources devoted to enhancing the culture of safety in the Perioperative Services department. Improvement initiatives included changing processes for safety reporting and performance improvement plans, adding resources and nurse roles, and creating communication strategies around adverse safety events and how to improve care. One key outcome included a 54% increase in the percentage of personnel who indicated in a survey that they would speak up if they saw something negatively affecting patient care.     

The pivotal role of nurse managers, leaders and educators in enabling excellence in nursing care

Mcsherry R., pearce P., Grimwood K. & Mcsherry W. (2012) Journal of Nursing Management 20, 7–19
The pivotal role of nurse managers, leaders and educators in enabling excellence in nursing care Aim The aims of this paper are to present the findings from a discursive analysis of key issues associated with providing excellence in nursing care; and to provide an exemplar framework to support excellence in nursing care and describe the potential benefits when excellence in nursing care occurs. Background The challenge facing the nursing profession is in ensuring that the core principles of dignity, respect, compassion and person (people) centered care become central to all aspects of nursing practice. To regain the public and professional confidence in nursing, nurse leaders, managers and educators play a pivotal role in improving the image of nursing. Key issues Excellence in nursing care will only happen by ensuring that nurse managers, leaders and educators are able to respond to the complexity of reform and change by leading, managing, enabling, empowering, encouraging and resourcing staff to be innovative and entrepreneurial in practice. Conclusions Creating healthcare environments that enable excellence in nursing care will not occur without the development of genuine shared working partnerships and collaborations between nurse managers, leaders and educators and their associated organizations. Implications for nursing management The importance of adopting an authentic sustainable leadership approach to facilitating and supporting frontline staff to innovate and change is imperative in restoring and evidencing that nurses do care and are excellent at what they do. By focusing attention on what resources are required to create a healthcare environment that enables compassion, safety and excellence in nursing care and what this means would be a reasonable start on the journey to excellence in nursing.     

Patient safety and interprofessional education: A report of key issues from two interprofessional workshops

ABSTRACT

This article presents the outcomes of two workshops which explored historical and recent issues on patient safety that directly relate to leaders in the interprofessional field. The article considers the impact of flattened team-based structures where collaborative working constantly considers safe patient-centred high-quality care. These issues are mainly rooted in changes within a UK context, but the historical case studies present situations which could enlighten and enliven discussions of patient safety in an international context. The article was sparked by discussion of recurrent themes in healthcare that have undermined the abilities of medical practitioners to adequately manage hazard in clinical care settings throughout modern history. Examining the issues that confront healthcare practitioners and care workers in their dealings with patients and clients, such as the aged or the severely disabled, can reveal commonalities across global healthcare settings, in the past and present, that provide a useful tool in facilitating the goals of interprofessional education (IPE). The potential of IPE has links to both how professionals respond together to care situations and involve the general public in shared health understandings. The outcomes focus on how to ensure ministrations where optimal team-based collaborative care is recognised and constantly sought. We conclude that IPE has much to offer in this arena and more evidence of impact here is well worth pursuing.     

Emotions at work: what is the link to patient and staff safety? Implications for nurse managers in the NHS

Aims  This paper sets the discussion of emotions at work within the modern NHS and the current prioritisation of creating a safety culture within the service.
Background  The paper focuses on the work of students, frontline nurses and their managers drawing on recent studies of patient safety in the curriculum, and governance and incentives in the care of patients with complex long term conditions.
Methods  The primary research featured in the paper combined a case study design with focus groups, interviews and observation.
Results  In the patient safety research the importance of physical and emotional safety emerged as a key finding both for users and professionals. In the governance and incentives research, risk emerged as a key concern for managers, frontline workers and users.
Conclusion  The recognition of emotions and the importance of emotional labour at an individual and organizational level managed by emotionally intelligent leaders played an important role in promoting worker and patient safety and reducing workplace risk.
Implications for nurse managers  Nurse managers need to be aware of the emotional complexities of their organizations in order to set up systems to support the emotional wellbeing of professionals and users which in turn ensures safety and reduces risk.     

护士与患者对护理安全影响因素评价的调查及分析

目的了解护士与患者对医院护理安全影响因素的评价。方法自行设计护理安全影响因素调查问卷,包括护士素质与能力、护理工作内部环境、临床工作场所、组织管理、患者、照护人员（家属或护工）6维度、43条目,对399名护士和503名患者进行调查。结果43条目中有41条目护士和患者的评分均在4分以上且标准差小于1,占总条目的95．35％;11条目护士和患者评价存在显著性差异（P〈0．05）,其中6条目患者评分高于护士,均为护士素质与能力维度,5条目护士评分高于患者,涉及护理工作内部环境3条目、临床工作场所1条目、组织管理1条目。结论加强对护士素质的培养,提高患者对护理安全环节管理的认识与配合,是今后护理安全管理的努力方向。     

Back to Basics: Preventing Surgical Site Infections

A surgical site infection (SSI) is an unintended and oftentimes preventable consequence of surgery. There is a significant amount of literature related to preventing SSIs, and it is up to practitioners in each care setting to review the evidence and work together to implement SSI prevention measures, such as nasal decolonization, antibiotic prophylaxis, preoperative showers, preoperative oxygen supplementation, and antimicrobial sutures. In addition, practitioners can follow several recommendations to reduce the risk of SSIs, including following proper hand hygiene practices; wearing clean, facility-laundered scrub attire; following a surgical safety checklist; and speaking up when a break in sterile technique is witnessed. The benefits of preventing SSIs are preventing patient mortality and decreasing the burden that SSIs pose on the national health care system. It is up to health care leaders to drive and support SSI prevention initiatives.     

Exploring the Relationship Between Psychological Capital and Turnover Among New Nurses

The COVID-19 pandemic drastically changed the health care work environment and exacerbated workplace demands and stress. New graduate nurses (NGNs) transitioning into their first registered nurse role were not exempt. Little is known about the emotional well-being of NGNs during the COVID-19 pandemic. In this article, we share NGN psychological capital (PsyCap) trends from 2019 to 2022 and explore the relationship between NGN PsyCap and turnover. Organizational, leadership, and individual implications for practice are discussed. Findings from this study can help health care leaders tailor emotional development and coping strategies for this important segment of the nursing workforce.     

Promote Radiation Safety for Nurses: A Policy Perspective

Radiologic and imaging nurses (RINs) continue to be exposed to radiation at the workplace. However, many studies identified that most health care systems do not have policies on radiation safety training for RINs; the less educated they are on radiation safety, the more fear they have with radiation and the less comfortable they are with assisting patients while receiving medical imaging procedures. This policy perspective will identify gaps in radiation protection training, and development of education training, and suggest strategies for compliance with annual radiation training. We recommend that radiology or nursing departments should develop and enforce a policy mandating annual radiation safety training for RINs and that The Joint Commission should evaluate the institutional adherence to that policy.     

Eliminating lateral violence in the ambulatory setting: one center's strategies

Lateral violence (eg, disruptive, disparaging, or uncivil behavior inflicted by one peer on another) creates an unpleasant work environment that can have harmful effects on individual nurses, team members, patients, and the bottom line of the health care organization. Educating nurses about the most common forms of lateral violence and strategies for handling inappropriate behavior can be the first step toward eliminating this behavior. Effective nursing leaders develop and maintain a “zero-tolerance” culture that includes clear and concise behavioral expectations and consequences for employees who exhibit unprofessional behavior. Use of a code of conduct, open communication, and quick resolution of issues that arise are strategies that one ambulatory surgery center has used to successfully combat lateral violence in the workplace.     

Evidence-based leadership: Nursing's new mandate

In its landmark report, “Keeping Patients Safe: Transforming the Work Environment of Nurses,” the Institute of Medicine (IOM) issued a startling wake-up call for nursing and health care leaders.¹ Acknowledging the critical role of nurses in patient safety, this exhaustive study concluded that inherent in the work environment of nurses are serious threats to patient safety. The pervasiveness of these threats is evident in key areas of the organization.     

Diversity,Equity, Inclusion: Crucial for Organizational Learning and Health Equity

Achieving health equity requires a diversity of perspectives, values, and insights, yet the composition of the United States’ nursing workforce does not reflect the communities where they practice. Nurse leaders can advance health equity and exemplary clinical outcomes by creating diverse, equitable, and inclusive health care teams. Such teams are well-equipped for organizational learning, a crucial process for advancing health equity. Nurse leaders advance health equity by fostering diversity, equity, inclusion, and thus organizational learning in the workplace.