Creating a favorable practice environment for nurses

Chronic nurse turnover and attendant personnel shortages threaten patient care. Inadequate pay and benefits are primary factors leading to nurses' job dissatisfaction and, subsequently, to turnover. However, recent meta-analyses suggest that a favorable practice setting can improve nurses' satisfaction and minimize turnover. The practice environment's potential to positively influence nurses' job satisfaction is analyzed in a large academic medical center. Nurse supervisors, job characteristics, management style, and service quality emphasis--not just money and benefits--surface as key factors associated with a positive practice milieu. Implications for raising nurses' job satisfaction, reducing turnover, and improving care delivery are discussed.     

Creating a professional practice environment on a shoestring

Did you ever think, “If we just had a little money we could…”? The current health care environment is wrought with financial stressors that can be overwhelming and take up most of our time. Such stress can limit the development of a professional practice environment if you let it. How do you not only survive but thrive in this financial climate?     

Creating a profile of a nurse effective in caring

BACKGROUND: Watson's Theory of Caring and Caritas proposes that caring and love potentiate healing. Creating a profile of the characteristics of a "Caritas nurse" has implications for integrating caring and love into patient care, and measuring the impact of caring on patient and operational outcomes. METHODS: This psychometric study examined the profile of nurses effective in caring. The Caring Factor Survey and the Healthcare Environment Survey were selected to measure caring and work environment conditions as reported by the patient and by the nurse, respectively. RESULTS: The results of this study revealed that nurses of all ages who received high scores in caring were most frustrated with the work environment, were most experienced, worked only the hours scheduled, were most affected by the relationship with the patient, derived the most enjoyment from the relationship with their coworkers, and provided continuity of care most consistently. DISCUSSION AND IMPLICATIONS: Findings from this study indicate that further inquiry into the profile of nurses effective in caring and evaluation of the presence of caring and love on patient outcomes is warranted.     

Visualizing and realizing caring in practice through guided reflection

Guided reflection provides a challenging and supportive milieu for practitioners to learn through reflection towards achieving desirable work This work inevitably demands confrontation with self and the conditions of practice that limit the achievement of desirable work It also demands an understanding of what is desirable nursing From an ideological position, desirable work is generally defined in terms of humanistic caring The paper discusses how caring can be visualized and realized in practice through the experiences practitioners reflect on and share within guided reflection This work is illustrated using using guided reflection dialogue     

Creating a culture of caring: A collaborative academic‐practice approach to clinical education

Strong academic and practice partnerships are needed in the ever‐changing health care environment. Sometimes an invisible barrier exists between clinical practice and academia; academic‐practice partnerships are a way to bridge this barrier. Since 2008a team‐based model of clinical education known as the Culture of Caring (COC) has brought together three academic institutions with a large hospital system to develop a unified clinical experience and curriculum that improves the student, provider, and patient experience. In the COC model the team consists of academic‐practice leaders, clinical instructors, staff nurses, and students. Together they engage in a structured curriculum that is integrated into both the clinical environment and the academic setting. Each week of clinical the students focus on a topic that is paired with journal articles and learning activities that allow the team to engage in learning that is applicable to the clinical practice environment. The learning activities allow students to engage in learning about evidence‐based practice and quality improvement initiatives that are taking place on the unit. The implementation of this collaborative approach to a clinical nursing education model has had a positive impact on the working relationships between the academic partners and clinical practice leaders.     

Creating an evidence-based practice environment: one hospital's journey

There is increasing effort in promoting evidence-based practice (EBP) that supports the best possible care to patients and families. This article describes essential concepts for developing an environment of EBP and its implementation at a large pediatric hospital. Essential components for creating an EBP environment include vision, engagement, integration, and evaluation. An institutional initiative to decrease procedure-related pain demonstrates how EBP is used to improve clinical care.     

Creating an adult learning culture through practice development

The development of a learning culture is becoming a dominant theme in the strategic plans of health care organisations. This is arising through a drive to improve standards of practice, bridge the perceived theory-practice gap and create means of integrating learning with practice. There have been many initiatives to create such a change, including continuous professional development, reflective practice, clinical supervision and work based learning. This paper presents an account of a practice development strategy that aimed to create a learning culture as a sub-element of the overall programme of work. Working with individual project leaders, the intention was to shift the emphasis away from classroom based education, to learning at and from work. This was achieved through a combination of action research, the application of adult learning theory and facilitation. The paper describes the context of the development strategy, the facilitation processes adopted including the theoretical underpinnings and some 'tentative' outcomes achieved.     

Creating an environment for caring using lean principles of the Virginia Mason Production System

As healthcare leaders search for viable options to cut costs, increase efficiencies, and improve the product that they offer to customers, many are looking at different business models to adopt. At the same time, an aging workforce of nurses feel the pressure of being overworked and understaffed, resulting in both decreased job and patient satisfaction. Virginia Mason Medical Center in Seattle, Wash, has implemented the Virginia Mason Production System, using proven concepts adapted from the Toyota Production System that effectively eliminate "muda" or waste, in workplace processes. The authors discuss the application of the Virginia Mason Production System and how it has resulted in increased time for nurses to care for their patients.     

Advancing nursing theory through theory-guided practice: the emergence of a critical caring perspective

Critical caring is proposed as a hybrid, midrange theory that builds on nursing science and critical feminist theories. As such, it has the potential to root public health nursing practice in an expanded nursing caring science that reincorporates the social justice agenda characteristic of early public health nursing practice but not featured prominently in contemporary nursing theories. Critical caring transforms the carative processes of Watson's theory into 7 carative health-promoting processes that form the "core" of public health nursing practice and reflect the legacy and reality of public health nursing practice.