Challenges and leadership strategies for managers of nurse practitioners

AIM: The aim of this paper is to report on the findings from our research into the recent introduction of nurse practitioners in Alberta, Canada. Through an organizational research perspective, we identify the critical role of health care managers in developing a sustainable nurse practitioner role. BACKGROUND: Previous literature has focused on nurse practitioners themselves as the key factor in their integration into the health care system. Although they are qualified and organizationally well placed, managers of nurse practitioners have been overlooked as a critical part of implementation strategies. KEY ISSUES: We interviewed 25 nurse practitioners and seven of their managers. Through our data analysis we identified three major challenges for managers: (1) clarifying the reallocation of tasks; (2) managing altered working relationships within the team; (3) continuing to manage the team in an evolving situation. Associated with these challenges, we propose leadership strategies that managers may find useful as they work through the consequences of introducing the nurse practitioner role. These strategies are: * encourage all team members to sort out 'who does what'; * ensure that task reallocation preserves job motivating properties; * give consideration to how tasks have been allocated when issues identified as 'personal conflict' arise; * pay attention to all perspectives of the working relationships within the team; * facilitate positive relationships between team members; * lead from a 'balcony' perspective; * work with the team to develop goals that are not over focused on the nurse practitioner; * regularly share with other managers the experiences and lessons learned in introducing nurse practitioners. CONCLUSION: For managers to be most effective, they need to address three challenges that are of a managerial, not clinical, nature. By implementing specific leadership strategies, managers of nurse practitioners can facilitate the introduction of the new role and improve its sustainability in health organizations.     

Changes of nursing organization in a surgical department: effects on work satisfaction and quality of care

• ? The aim of the study was to evaluate the effects of an organizational change programme in a surgical department in Sweden (the introduction of modular nursing) on the nursing staffs perception of job satisfaction and quality of care, and to identify factors which promote or hinder this organizational change.
• ? Planning and implementation of the change programme took about 1 year and comprised structural changes and staff training.
• ? Assessments of job satisfaction and quality of care were made immediately before, and 1 year after, implementation of the change programme. Data were collected from the staff of two wards.
• ? Virtually no statistically significant changes were found when looking at the department as a whole. However, considerable differences were noted between the two wards, particularly in the following areas: relationships with colleagues, identification and commitment, and perceived quality of care.
• ? The quality of the interpersonal relationships, and the leadership of the wards' head nurses, appeared to be crucial determinants of the outcome.

     

Evaluation of the implementation of Assistant in Nursing workforce in haemodialysis units

Chow J, Miguel SS. International Journal of Nursing Practice 2010; 16 : 484–491
Evaluation of the implementation of Assistant in Nursing workforce in haemodialysis units The aim of this project was to evaluate the introduction of Assistant in Nursing (AINs) in the haemodialysis units at a major tertiary Area Health Service in Sydney, Australia. All nursing staff were asked to complete a baseline and follow‐up survey to determine changes to their attitudes to the new skill mix model and their satisfaction with the new organization of care delivery in their dialysis units. Comparison of the baseline and follow‐up surveys in the paired data was favourable with nurses acknowledging that they would cope well with the introduction of AINs, and they were more likely to disagree with the statement that their workload would increase after the introduction of AINs in the follow‐up survey. There was little difference in (i) the workload of the dialysis units before and during the intervention; and (ii) the incidence of patient and nursed related adverse outcome events.     

The Effect of Intentional Nursing Rounds Based on the Care Model on Patients' Perceived Nursing Quality and their Satisfaction with Nursing Services

Purpose

This study examined the effects of intentional nursing rounds based on the care model on patients' perceived nursing quality and their satisfaction with nursing services.

Job satisfaction of Italian nurses: an exploratory study

AIM: The purpose of this research was to determine the factors that lead to feelings of job satisfaction and dissatisfaction experienced by nurses operating in three Italian hospitals. BACKGROUND: A high level of job satisfaction is related to a feeling of well-being, productivity and patient satisfaction. Furthermore, job satisfaction is considered capable of reducing turnover and absenteeism. METHOD: Data were collected using the narrative interview technique. Sixty-four interviews were undertaken, resulting in the collection of 381 stories: 207 referring to job satisfaction experiences and 174 referring to job dissatisfaction experiences. RESULTS: The five job satisfaction factors are: job content; professional relationships; responsibility, independence and professional growth; relationships with patients and their families; and relationships with coordinators. The four job dissatisfaction factors are: coordinator management style; activity programming and organization; relationships with doctors; and relationships with patients. CONCLUSIONS: Results indicate that the present nursing management techniques should be improved to become more effective in increasing job satisfaction. To be more precise there emerge three separate areas of improvement: investment in professional training and managerial training; renovation of organizational models; and permanent monitoring of job satisfaction.     

Nursing leadership from the perspective of clinical group supervision: a paradoxical practice

bondas t. (2010) Journal of Nursing Management 18, 477–486
Nursing leadership from the perspective of clinical group supervision: a paradoxical practice Aim Increase understanding of nursing leadership in group clinical supervision (CS). Background Leadership in CS has received little interest besides the theories in use and administrative CS. Method Hermeneutic interpretation of written narratives of 24 clinical nurse supervisors. Results Continuity in structuring, story and mission and reflection in group and leadership processes and theories of nursing and caring characterize leadership in CS. Leadership by inhibiting and creating fear, inapproachability and indistinctiveness were patterns in content brought to CS. Supervision when leadership was involved illuminated a reflexive change in focus from leadership to nursing care, from particular experiences to nursing and caring science, and from the unfamiliar to the well known and the well known to the unknown. Conclusions Continuity and reflective changes using nursing and caring theories seem to be core ideas of nursing leadership from the perspective of CS. The poles of separation and communion show opposites of nursing leadership as it is illuminated in CS. The findings add knowledge to Bondas’ theory of caritative leadership. Implications for nursing management CS is a reflexive practice of support and guidance that seems to have an impact on the trajectory of nursing care and staff development using nursing and caring theories.     

The impact of management of change projects on practice: a description of the contribution that one educational programme made to the quality of health care

This paper is based on the authors' experience of teaching and supervising the first intake of the management unit of the diploma for charge nurses offered by the Department of Professional Development and Training, Glasgow College of Nursing and Midwifery, Glasgow, Scotland. The students on this course undertake a project comprising of a documented research-based action plan aimed at the achievement of a selected topic for change directly linked with their practice. All the students except one were G grade charge nurses from a wide variety of clinical backgrounds. This paper will briefly consider the work of Barriball et al. who suggest categories of outcomes of continuing professional education. This is contrasted with Scheller, who highlights three problems when attempting to measure the impact of continuing education on practice. Despite these problems, it is beneficial to attempt to consider the impact of continuing professional education on practice. The work of Francke et al. will be featured in which they ascertain the determinants of changes in nurses' behaviour after continuing professional education. The authors believe that the management of change project, undertaken by the students, enhances the possibility that knowledge gained from the management unit will impact on their practice. Two examples of students' projects will be used to support the paper. The first concerns changing to a 12-hour shift pattern in an intensive care setting and the second relates to the implementation of the named nurse system.     

United Nations’ Sustainable Development Goal 3 Target Indicators: Examples of Advanced Practice Nurses’ Actions

In 2015, the United Nations created 17 Sustainable Development Goals. Sustainable Development Goal 3, “Good Health and Wellbeing,” includes 13 health target metric goals. This short report describes how advanced practice nurses (APNs) have addressed Goal 3 around the world. Given the variation in the APN roles internationally, it is important to capture common aspects of projects conducted during the first 5 years of this initiative. This report serves as a template for further evaluations of the importance of APNs in supporting global health policies. These findings inform how the workforce can effectively pursue these goals.     

Differentiated practice, patient-oriented care and quality of work in a hospital in the Netherlands

This article describes a quantitative study of the relationship between differentiated practice on the one side and patient-oriented care and quality of work on the other. Nursing wards where differentiated practice has been implemented (intervention group) have been compared with wards where differentiated practice has not been implemented (reference group). The research variables with regard to differentiated practice, patient-oriented care and quality of work have been measured by questionnaires. Subjects were 68 nurses and six supervisors from six nursing wards from one hospital. The results show that the extent to which differentiated practice had been implemented varied between the wards. With regard to patient-oriented care differences have been found between the intervention and reference group on the variables patient assignment and use of the nursing process, but not on the variables of tasks and communication. Concerning quality of work, differences have been found on: social support from the supervisor, social-emotional leadership and health complaints. Rank order correlations between differentiated practice and patient-oriented care and between differentiated practice and quality of work were not significant. Practical implications with regard to the use of differentiated practice and implications for further research are discussed.     

护士分层管理的实践及体会

根据护士的学历、专业技能、年资等将护士分为4个层级,界定各层级护士职责,进行培训、使用、考核等。通过实施护士分层管理,护理质量及患者、医生、护士对护理工作满意度均得以提高。     

Advanced practice nurses: A new resource for Swedish primary health‐care teams

Altersved E, Zetterlund L, Lindblad U, Fagerström L. International Journal of Nursing Practice 2011; 17 : 174–180 Advanced practice nurses: A new resource for Swedish primary health‐care teams This study is associated with the first evaluation of the four first advanced practice nurses (APNs), part of a primary health‐care team in Sweden. The aim is to describe health‐care teams' experiences of the new APN role and investigate what opportunities and barriers to the role exist. Eighty‐one respondents answered a 14‐question questionnaire with a Likert scale and one open‐ended question. The Kruskal–Wallis test was used to investigate differences between professional groups' answers. The qualitative material was analysed using deductive content analysis. Though mostly positive experiences of the role were found, differences did exist between the professional groups. APNs are considered a resource in that access to care, cooperation and patient flow increased. Barriers include APNs' limited autonomy and inability to prescribe medication. To further develop the role, the right to prescribe medication and strategic leadership within the Swedish health‐care system, policy and legislation are needed.     

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.