The tenure of directors of nursing

Director of nursing (DON) tenure is often a question of debate, with some believing that there is rapid turnover among DONs. A survey of university and university-affiliated hospitals was conducted to assess turnover among DONs and the reasons they leave their positions. Over a 10-year period, hospitals averaged 2.5 DONs per hospital. The majority of hospitals (57%) had one to two DONs and 19% had four or more DONs during this 10-year period. Fifty percent of the current DONs have been in their positions for 5 or more years. Termination and requested resignation were cited most frequently as the reasons past DONs left their positions (40%). In spite of the high termination rate, both DONs and chief executive officers (CEOs) feel that they work effectively together.     

Nurse executive effectiveness

Community hospital chief nurse executives (CNEs) and chief executive officers (CEOs) ranked, in a nationwide survey, seven characteristics of nurse executive effectiveness. Human management skill was ranked first by both groups. CNEs cited CEO support as the second most important factor in their effectiveness, while CEOs ranked total organizational view second. Both groups cited the need for fiscal management skills for CNEs. Results differ from an earlier study of university hospital based CNEs and CEOs. Such discrepancies, including differences in education, tenure, and salary, hold strong implications for the pursuit of careers in nursing administration.     

Vision 2020, part I: profile of the future nurse leader

The demand for knowledgeable and skilled nursing leaders at the first, middle, and executive levels of management in healthcare organizations drove a multi-phased project about the kinds of nurse managers who will be needed in the future and their educational needs. This first article in a two-part series describes seasoned nurse leaders' opinions about the educational preparation, experiences, and competencies desired in nurse managers for the year 2020.     

Transferring dying nursing home residents to the hospital: DON perspectives on the nurse’s role in transfer decisions

This qualitative study elicits factors that influence decision-making by nurses about transferring a dying resident from the nursing home to the hospital. Focus groups with directors of nursing (DONs) from long-term care facilities revealed those decisions are influenced by knowledge (or lack thereof) of resident or family preferences, nurse interactions with physicians, nursing home technological and personnel resources, and nurse concerns about institutional liability. DONs can improve transfer decisions by communicating with all parties, clarifying nursing home processes for end-of-life care, and scheduling early and thorough conversations with residents and families about end-of-life care. DONs can implement improvements through staff education on communication issues, rigorous evaluation and performance outcome measures related to patient transfer, and conveyance to staff of the institution’s mission and the nursing service’s values. (Geriatr Nurs 2001;22:313-7)     

Importance of role competencies for Chinese directors of nursing based on the Forces of Magnetism

spicer j.g., guo y., liu h., hirsch j., zhao h., ma w. & holzemer w . (2011) Journal of Nursing Management 19, 153–159
Importance of role competencies for Chinese directors of nursing based on the forces of magnetism Aim The aim of the present study was to survey directors of nursing (DONs) and chief operating officers (COOs) in the People’s Republic of China on the importance of DON role competencies based on the Forces of Magnetism. Background The present study describes part of an international collaborative effort to support the attainment of the Chinese Ministry of Health’s plan to strengthen and to increase the knowledge and skill levels of nurse administrators. Methods A random sample of 300 Chinese DONs and COOs was surveyed in the autumn of 2008. Results Compared with the COOs, the DONs were predominately female, had less graduate education and had more years of experience in their current role. Although the two groups perceived structural empowerment to be important, the DONs placed significantly greater importance on transformational leadership. Conclusion The Chinese DONs and COOs rated the role competencies based on the Forces of Magnetism to be important for DONs to be effective. Implications for nursing management The study’s findings support the transferability of the Forces of Magnetism to nursing management in hospitals internationally.     

Transferring dying nursing home residents to the hospital: DON perspectives on the nurse's role in transfer decisions.

This qualitative study elicits factors that influence decision-making by nurses about transferring a dying resident from the nursing home to the hospital. Focus groups with directors of nursing (DONs) from long-term care facilities revealed those decisions are influenced by knowledge (or lack thereof) of resident or family preferences, nurse interactions with physicians, nursing home technological and personnel resources, and nurse concerns about institutional liability. DONs can improve transfer decisions by communicating with all parties, clarifying nursing home processes for end-of-life care, and scheduling early and thorough conversations with residents and families about end-of-life care. DONs can implement improvements through staff education on communication issues, rigorous evaluation and performance outcome measures related to patient transfer, and conveyance to staff of the institution's mission and the nursing service's values.     

Decisional involvement of senior nurse leaders in Canadian acute care hospitals

wong c.a., laschinger h., cummings g.g., vincent l. & o ’connor p . (2010) Journal of Nursing Management  18, 122–133
Decisional involvement of senior nurse leaders in Canadian acute care hospitals Aim The aim of the present study was to describe the scope and degree of involvement of senior nurse leaders (SNLs) in executive level decisions in acute care organizations across Canada. Background Significant changes in SNL roles including expansion of decision-making responsibilities have occurred but little is known about the patterns of SNL decision-making. Methods Data were collected by mailed survey from 63 SNLs and 49 chief executive officers (CEOs) in 66 healthcare organizations in 10 Canadian provinces. Regression analyses were used to examine whether timing, breadth of content expertise and the number of decision activities predicted SNL decision-making influence and quality of decisions. Results Breadth of content expertise and number of decision activities with which the SNL was involved were significant predictors of decision influence explaining 22% of the variance in influence. Overall, CEOs rated SNL involvement in decision-making higher than the SNL. Conclusions Senior nurse leaders contribute to organizational processes in healthcare organizations that are important for nurses and patients, through their participation in decision-making at the senior team level. Implications for nursing management Findings may be useful to current and future SNLs learning to shape the nature and content of information shared with CEOs particularly in the area of professional practice issues.     

An exploration of nursing home organizational processes

The purpose of this study is to explore the relationship between nursing home staffs' perceptions of organizational processes (communication, teamwork, and leadership) with characteristics (turnover, tenure, and educational preparation) of the nursing home administrator (NHA) and director of nursing (DON). NHAs and DONs rate communication, teamwork, and leadership significantly higher than direct care staff do (registered nurses, licensed practical nurses, certified nurse aides [CNAs]). CNAs have the lowest ratings of communication and teamwork. Turnover of the NHA and DON is significantly and negatively associated with communication and teamwork. Two thirds of DONs surveyed hold less than a baccalaureate degree; this does not influence staffs' ratings of communication, teamwork, and leadership. Findings from this study highlight the need to explore differences in perceptions between administrative and direct care staff and how these may or may not influence staff development and quality improvement activities in nursing homes.     

Vision 2020, part 2: Educational preparation for the future nurse manager

The demand for knowledgeable and skilled nursing leaders at the first, middle, and executive levels of management in healthcare organizations drove a multiphased project concerning the types of nurse managers that will be needed in the future and their educational needs. In Part 1 (June 2003), national nurse leaders identified the increased need for knowledgeable and skilled nurses in first-line, mid-level, and executive management positions in the healthcare delivery system. This article describes the second Vision 2020 survey of nurse managers in Massachusetts on the current and future demand for nurse managers and their academic preparation and continuing education needs. It concludes with a model curriculum revision for a master's program in nursing management for the public urban university in Boston.     

Collaborative nursing leadership project in the People's Republic of China

SPICER, J.G., GUO, Y., LIU, H., HIRSCH, J., ZHAO, H., MA, W. & HOLZEMER, W. (2010) Collaborative nursing leadership project in the People's Republic of China. International Nursing Review 57 , 180–187 Background: A nursing leadership project for directors of nursing (DONs) in China was implemented by the Ministry of Health, Peking Union Medical College, School of Nursing; Chinese Nurses' Association and University of California, San Francisco, School of Nursing. Aims: The aims were: (1) to establish a leadership project, (2) to survey DONs on the perceived importance of role competencies, and (3) to develop an education program. Methods: A survey was completed by the DONs on the importance of role competencies related to the forces of magnetism. The DONs rated their job satisfaction. Four leadership educational modules were developed. Findings: The 28‐item survey was completed by 208 (68%) DONs from public tertiary hospitals who rated each item on a six‐point Likert scale. The mean scores of the items ranged from 4.29 [standard deviation (SD) 1.21] to 5.66 (SD 0.70), suggesting they felt that most were very important. DONs who reported higher job satisfaction perceived two dimensions of the forces (structural empowerment and exemplary professional practice) as significantly more important than those with lower job satisfaction. The greatest work challenge reported was shortage of nurses. The four educational modules were pilot tested with ten DONs in Beijing and they provided positive feedback. Conclusion: The DONs perceived that the forces of magnetism competencies were important to their work settings in China. The modules were positively received and plans are underway to develop a train‐the‐trainer program. Study limitations: While the instrument was developed for this study, the validity and reliability were demonstrated.     

Contract management. Filling the void created by CNE vacancies.

Contract management can provide interim chief nurse executives (CNEs) during the search process for a permanent executive. Experienced and effective, interim nursing executives can communicate to all audiences, prepare the organization for the next permanent nursing executive, and their presence avoids problems that arise during a long recruitment period. Typically, interim nursing executives find that working through contract management is a rewarding and challenging experience.     

Leadership roles, competencies, and education: how prepared are our nurse managers?

Although they are responsible for the operation of business units, nurse managers are often less well prepared to manage the business activities than the clinical activities. Perceptions of nurse managers and nurse executives regarding competencies required for nursing management roles and the educational preparation required to attain them were examined. Results indicate the groups are in basic agreement about required competencies, though nurse managers appear less clear about nurse executive role responsibilities. Nurse executives value the acquisition of a master's degree as essential for nurse manager performance, while fewer nurse managers agree. Strategies nurse executives may employ to develop nurse manager business knowledge include traditional undergraduate and graduate degree programs, online programs, certificate programs, continuing education, inservice education offerings, seminars, and mentoring activities.     

The nurse executive: challenges for the 21st century

AIM: The aim of this paper is to examine the challenges facing the nurse executive in the 21st century by questioning the traditional attributions of leadership to the nurse executive role. BACKGROUND: Historically, the leadership role in nursing has been assumed by the nurse executive. The predominantly female character of nursing, however, has ensured that demonstrations of leadership amongst nurses have been infrequent and compatible with prevailing male-defined ideologies. Examples of this include career restructuring and educational reforms in Australia. FINDINGS: This paper found that the apparent lack of leadership in nursing was able to be traced back to early management theories which categorized leadership as a function of management. CONCLUSIONS: If nurses are to assume leadership positions in the health care system of the 21st century, nurse leaders will have to let go of traditional managerial practices and behaviours. In the emerging health care system of the new century, nurse executive practices will focus on achieving change rather than predictability in organizational outcomes.     

Nurse executive and staff nurse perceptions of the effects of reorganization in Veterans Health Administration hospitals

OBJECTIVE: To examine nurse executive perceptions of effects of service line reorganization on nurse executive roles, nursing staff and patient care, and compare nurse executive responses to staff nurse reports of job satisfaction and quality of care in the same types of Veterans Health Administration facilities. BACKGROUND: Although a growing body of research focuses on the association between nurse staffing structures, nurse satisfaction, and patient outcomes, relatively little attention has been paid to the effects of hospital restructuring on nursing management and nursing staff. METHODS: Data on hospital and nursing service organization and nurse executive perceptions were collected through structured interviews with 125 nurse executives conducted from December 2002 through May 2003. Staff nurse data were derived from a survey of Veterans Health Administration nursing staff conducted from February through June 2003 at the same facilities. RESULTS: Nurse executives in Veterans Health Administration described significant changes in the nurse executive role, and new challenges for managing nursing practice and achieving consistent quality of nursing care. Although nursing management perceived differences in the overall effects of restructuring on nursing staff depending on the type of reorganization, staff nurses reported significant differences in perceived quality of patient care across organization types.     

基于信息化平台的积分制管理对提高护士长执行力的实践

摘要：目的 探讨基于信息化平台的积分制管理模式在提升护士长执行力中的应用效果。方法 采用整群抽样法,选取60名护士长作为研究对象,2019年1-12月采用传统模式进行管理（应用前）,2020年1-12月采用积分制管理模式（应用后）,比较应用前后护士长执行力得分及各项护理质量检查得分情况。结果 应用积分制管理后,护士长执行力得分、各项护理质量检查得分较应用前均明显提升,差异有统计学意义（P＜0.05）。 结论 基于信息化平台的积分制管理模式在提升护士长执行力中有明显的促进作用,从而提升护理管理效能。     

Dysrhythmia management content in ADN and BSN curricula

BACKGROUND: The purposes of this study were to compare nurse educators' perceptions of the importance of selected dysrhythmia management competencies for the graduates of associate degree in nursing (ADN) and baccalaureate of science in nursing (BSN) programs, and to compare what related content is taught at the ADN and BSN level for dysrhythmia management. METHOD: A quantitative, nonexperimental design with a mailed survey was used to compare how nurse educators perceive the importance of dysrhythmia competencies in selected ADN and BSN programs in the states of Illinois and Iowa, and to determine what related content is taught. RESULTS: A total of 33 ADN and 24 BSN programs returned the survey for a 58.2% (57 of 98) response rate. Results indicated that ADN and BSN faculty in Illinois and Iowa perceived that selected dysrhythmia management content is important and that such content is currently provided at both the ADN and BSN level. CONCLUSIONS: Health care institutions can have confidence that new graduates from either educational preparation have had dysrhythmia management content and can expand their level of expertise.     

Hospital nursing: It's a battle!' A follow-up study of English graduate nurses

The purpose of this follow-up study, conducted 4 years after the initial study, was to elicit the recollections of English graduate nurses regarding their first year as qualified nurses in hospital nursing The method was qualitative, specifically a grounded theory approach was used The design was retrospective The initial study took place when informants were in their final year before graduation The follow-up study began after informants had been practising for between 3 and 4 years Data were collected through semi-structured, indepth, audio-taped interviews and were analysed through the constant comparative classification of patterns and themes Research questions were ‘what do graduates nurses recall about their first year of practice in hospital nursing?’ and ‘what do they perceive as the difficulties of maintaining their standards?’ Findings revealed the core variable as role stress The stressful experience of living up to their individual perceptions of the role of being a graduate nurse was related to the influence of educational socialization, self-expectations, and nursing management expectations     

对聘用护理人员实施分层次管理的方法与体会

目的探讨聘用护理人员的分层次管理方法。方法根据应聘人员的学历、能力、考取资格证书情况分别聘为护理员、助理护士、护士、护师、主管护师，并承担不同的岗位职责，享有不同福利待遇和遵照不同年度考核及晋升标准。结果优化了聘用护理人员的学历及职称结构，节约了护理人力资源成本，提高了基础护理合格率，提升了聘用护理人员的综合素质。结论对聘用护理人员实施分层次管理有利于人力资源的合理使用和护理成本的控制。     

Recruiting and retaining registered nurses in rural community hospitals. Some administrative assessments

The costs and impacts associated with the recruitment and retention of nurses are substantial. In rural areas, these efforts are hampered by the recurring maldistribution of available nurses away from such environments. Based on a survey of 195 directors of nursing (DONs) practicing in rural community hospitals, the authors compare administrative assessments of recruitment and retention efforts of DONs practicing in various-sized rural facilities. Current full-time equivalent registered nurse staff vacancy rates are also reported in relation to these differing assessments.