Strengthening frontline nurse investment in organizational goals

Frontline nurses are foundational to any organizational goal concerning patient care. In addition, healthcare delivery reform has supported the formalization of specific goals that hospitals must advance to stay financially viable and to deliver high-quality care. As a result, goals for frontline staff are continuously evolving. Frontline nurses must demonstrate a commitment not only to delivering excellent patient care but also to advancing larger institutional performance. The authors discuss a framework for nurse executives to help organizations achieve enhanced nurse investment in organizational goals.     

American academy of nursing consensus recommendations to advance system level change for nurse well-being

The COVID-19 pandemic has required close examination of workforce-related stressors that over decades have contributed to widespread burnout, negative health outcomes, including mental health outcomes, and the loss of the well-educated professionals who are the future of the nursing profession. In the United States and globally, evidence points to factors known to diminish well-being, including inequities, issues of minority status, persistent discrimination, and demanding work environments. The American Academy of Nursing (AAN), dedicated to organizational excellence, nursing leadership and evidence-based policy, develops statements reflecting its mission and those of its nursing affiliates and corporate member, The American Nurses Association. Within nursing, despite the efforts of its members toward advancement, professional fulfillment is often constrained by the systems in which nurses practice and workplace factors over which they have little control. Action by key organizations to initiate changes at systems levels in workplace safety, to increase professional mobility, and propel policies that increase access to health care resources could improve nurse well-being. This paper proposes recommendations from the AAN Expert Panels on Building Health Care System Excellence, Psychiatric Mental Health and Substance Use, and Global Health Expert Panels for the American Academy of Nursing to leverage related policy in the arenas of government and professional/healthcare organizations. Transforming health care work environments and advancing nurse well-being and equity can be accomplished through key, innovative policy changes. These will be achieved through collaboration among associations, organizations, nonprofit groups, and with the public and the media.     

Hospital nurse practice environment, burnout, job outcomes and quality of care: test of a structural equation model

Title. Hospital nurse practice environment, burnout, job outcomes and quality of care: test of a structural equation model. Aim. The aim of the study was to investigate relationships between nurse practice environment, burnout, job outcomes and nurse‐assessed quality of care. Background. A growing line of work confirms that, in countries with distinctly different healthcare systems, nurses report similar shortcomings in their work environments and the quality of care in hospitals. Neither the specific work environment factors most involved in dissatisfaction, burnout and other negative job outcomes, and patient outcomes, nor the mechanisms tying nurse job outcomes to quality of care are well understood. Method. A Nurse Practice Environment and Outcome causal structure involving pathways between practice environment dimensions and outcome variables with components of burnout in a mediating position was developed. Survey data from 401 staff nurses across 31 units in two hospitals (including the Revised Nursing Work Index, the Maslach Burnout Inventory, and job outcome and nurse‐assessed quality of care variables) were used to test this model using structural equation modelling techniques. The data were collected from December 2006 to January 2007. Results. Goodness of fit statistics confirmed an improved model with burnout dimensions in mediating positions between nurse practice environment dimensions and both job outcomes and nurse‐assessed quality of care, explaining 20% and 46% of variation in these two indicators, respectively. Conclusion. These findings suggest that hospital organizational properties, including nurse–physician relations, are related to quality of care assessments, and to the outcomes of job satisfaction and turnover intentions, with burnout dimensions appearing to play mediating roles. Additionally, a direct relationship between assessments of care quality and management at the unit level was observed.     

Ethical climate in managed care organizations

Managed care organizations employ nurses as medical utilization reviewers; however, little is known about the ethical climate of these organizations. This study describes different ethical climates in which utilization review nurses work and the implications of these differences for nurse administrators. The nurse participants, although demographically similar across three managed care organizations, perceived distinct ethical climates across the organizations. Nurses were employed to make complex decisions regarding medical care utilization; however, none of the organizations had an ethics committee to help nurse reviewers in this decision-making process. The need for such committees, as well as clarification of a consistent and deliberate ethical climate by nurse administrators, is discussed.     

Hospital nursing organizational factors,nursing care left undone,and nurse burnout as predictors of patient safety: A structural equation modeling analysis

BackgroundPromotion of patient safety is among the most important goals and challenges of healthcare systems worldwide in countries including China. Donabedian’s Structure-Process-Outcome model implies that patient safety is affected by hospital nursing organizational factors and nursing care process. However, studies are imperative for a clear understanding about the mechanisms by which patient safety is affected to guide practice.ObjectiveThe objective of this study was to explore the impact of hospital nursing work environment, workload, nursing care left undone, and nurse burnout on patient safety.DesignThis was a cross-sectional study conducted in 23 hospitals in Guangdong province, China in 2014. Data from nurses (n = 1542) responsible for direct care on 111 randomly sampled medical and surgical units were analyzed.MethodsWork environment was measured by the Practice Environment Scale of Nursing Work Index. Workload was measured by day shift unit patient-nurse ratio and non-professional tasks conducted by nurses. Nursing care left undone was measured by 12 items addressing necessary nursing activities. Nurse burnout was measured by the emotional exhaustion subscale of the Maslach Burnout Inventory-Human Services Survey. Patient safety was measured by three items indicating nurses’ perception of overall patient safety and nine items addressing patient adverse events. Structural equation modeling was used to examine a hypothesized model that supposed work environment and workload have both direct and indirect effects on patient safety through nursing care left undone and nurse burnout.ResultsThe findings generally supported the hypothesized model. Better work environment was associated with better patient safety both directly and indirectly. Lower workload primarily indirectly related to better patient safety. Nursing care left undone and nurse burnout were mediators negatively associated with patient safety.ConclusionsImproving work environment, increasing nurse staffing levels, and providing sufficient support for nurses to spend more time on direct patient care would be beneficial to patient safety improvement.     

Teaching and community hospital work environments

The Institute of Medicine report suggests that nursing work environments experience threats to patient safety related to organizational management and workforce deployment practices, work design, and organizational culture. Organizational factors contribute to nursing and potentially patient outcomes, yet few studies have examined the differences in practices perceived by nurses employed in different settings. Nurses from 16 medical and surgical units in eight randomly selected acute care hospitals representing teaching and community organizations participated in this project. Nurses working in teaching hospitals reported lower levels of role tension, yet their perceptions of the quality of work, the work environment, nursing unit leadership, quality of care, and levels of job stress and job satisfaction were higher than their colleagues in the community sites. This study highlights some important differences between teaching and community hospitals that can inform nurse executives and policy makers of the unique work-life issues for different groups of nurses.     

Governance education for nurses: Preparing nurses for the future

The complexities of today's health care environment require organizational governing boards to have deeper understanding of health needs, influences, and outcomes with diverse board leadership. Nurses understand the complexities and demands of health care, but few nurses are engaged on boards of directors and many nurses feel unprepared for the governance leadership role. The nurse of the future requires governance knowledge and competencies to influence organizational policies that will improve health care outcomes and advance health promotion. Governance education is a necessary component of preparing the nurse of the future to influence health care transformation. Until nurses can confidently embrace governance leadership as a part of their professional identity, convincing and expecting non-nurse board leaders to appoint nurses to boards will continue to be a challenge. This paper describes a strategy for incorporating governance competencies into nursing curricula across all education levels by leveraging the American Hospital Association Governance Core Competencies (2009) and the Massachusetts Nurse of the Future Core Competencies©-RN (Massachusetts Department of Higher Education Nursing Initiative, 2016).     

Nurse executive transformational leadership and organizational commitment

OBJECTIVE: To investigate the relationship between nurse executive leadership and organizational commitment among nurses in acute care hospitals. BACKGROUND: A key challenge for organizations is to maximize the contributions of all workers by cultivating their commitment. Nurse leaders are in a position to influence organizational commitment among nurses. METHODS: The theoretical constructs underlying this study are the transformational leadership theory and the Etzioni's organizational theory. A cross-sectional, field survey of nurse executives, nurse managers, and staff nurses was conducted to assess nurse executive transformational and transactional leadership and their relationship to organizational commitment. Hypotheses were tested using correlational analysis, and univariate statistics were used to describe the sample. RESULTS: An inverse relationship between nurse executive transformational and transactional leadership and alienative (highly negative) organizational commitment was statistically significant. A positive association was demonstrated between nurse executive leadership and nurse manager leadership. CONCLUSIONS: This study supports the effect of nurse executive leadership on nurse manager leadership and on organizational commitment among nurses despite role distance. To the extent that transformational leadership is present, alienative organizational commitment is reduced. This relationship shows the importance of nurse executive leadership in organizational involvement among nurses in the dynamic context of contemporary hospital settings.     

The influence of leadership practices and empowerment on Canadian nurse manager outcomes

Aim To examine the influence of senior nurse leadership practices on middle and first-line nurse managers’ experiences of empowerment and organizational support and ultimately on their perceptions of patient care quality and turnover intentions. Background Empowering leadership has played an important role in staff nurse retention but there is limited research to explain the mechanisms by which leadership influences nurse managers’ turnover intentions. Methods This study was a secondary analysis of data collected using non-experimental, predictive mailed survey design. Data from 231 middle and 788 first-line Canadian acute care managers was used to test the hypothesized model using path analysis in each group. Results The results showed an adequate fit of the hypothesized model in both groups but with an added path between leadership practices and support in the middle line group. Conclusions Transformational leadership practices of senior nurses empower middle- and first-line nurse managers, leading to increased perceptions of organizational support, quality care and decreased intent to leave. Implications for Nursing Management Empowered nurse managers at all levels who feel supported by their organizations are more likely to stay in their roles, remain committed to achieving quality patient care and act as influential role models for potential future leaders.     

Factors influencing intentions to stay and retention of nurse managers: a systematic review

Aims This systematic review aimed to explore factors known to influence intentions to stay and retention of nurse managers in their current position. Background Retaining staff nurses and recruiting nurses to management positions are well documented; however, there is sparse research examining factors that influence retention of nurse managers. Evaluations Thirteen studies were identified through a systematic search of the literature. Eligibility criteria included both qualitative and quantitative studies that examined factors related to nurse manager intentions to stay and retention. Quality assessments, data extraction and analysis were completed on all studies included. Twenty-one factors were categorized into three major categories: organizational, role and personal. Key issues Job satisfaction, organizational commitment, organizational culture and values, feelings of being valued and lack of time to complete tasks leading to work/life imbalance, were prominent across all categories. Conclusion These findings suggest that intentions to stay and retention of nurse managers are multifactoral. However, lack of robust literature highlights the need for further research to develop strategies to retain nurse managers. Implications for nurse management Health-care organizations and senior decision-makers should feel a responsibility to support front-line managers in relation to workload and span of control, and in understanding work/life balance issues faced by managers.     

Managed care organization and the quality of diabetes care: the Translating Research Into Action for Diabetes (TRIAD) study

OBJECTIVE: To examine the association between the organizational model and diabetes processes of care. RESEARCH DESIGN AND METHODS: We used data from the Translating Research into Action for Diabetes (TRIAD), a multicenter study of diabetes care in managed care, including 8354 patients with diabetes. We identified five model types: for-profit group/network, for-profit independent practice association (IPA), nonprofit group/network, nonprofit IPA, and nonprofit group/staff. Process measures included retinal, renal, foot, lipid, and HbA(1c) testing; aspirin recommendations; influenza vaccination; and a sum of these seven processes of care over 1 year. Hierarchical regression models were constructed for each process measure and accounted for clustering at the health plan and provider group levels and adjusted for participant age, sex, race, ethnicity, diabetes treatment and duration, education, income, health status, and survey language. RESULTS: Participant membership in the model types ranged from 9% in nonprofit IPA models to 38% in nonprofit group/staff models. Over 75% of participants received most of the processes of care, regardless of model type. However, among for-profit plans, group/network models provided on average more processes of care than IPA models (5.5 vs. 4.7, P < 0.0001), and group/network models generally increased the probability of receiving a process by >or=10 percentage points. Among nonprofit plans, no effect of model type was found. CONCLUSIONS: Among for-profit plans, group/network models provided better diabetes processes of care than IPA models. Although reasons are speculative, this may be due to the clinical infrastructure available in group models that is not available in IPA models.     

Health policy and the private sector. New vistas for nursing

During the past two decades, the drive to rein in rising health care costs has shifted some of the power in health care policy making from professional groups, government agencies, and not-for-profit health care organizations to large for-profit corporations (1-4). This has been a world-wide phenomenon, as the provision and financing of health care services is shifted from governments to private health care organizations (5,6). In the United States, the shift in power is manifested in profound ways. Market competition and bottom-line economics have permeated the health care system, creating powerful new incentives for mergers, other corporate restructuring, and the shift to for-profit status by formerly not-for-profit insurance companies and providers. Private sector health care is now increasingly influenced by for-profit organizations (3). Moreover, the health insurance industry has been transformed as traditional indemnity insurance is replaced by versions of managed care. The role of government, or the public sector, in setting parameters for health care financing and standards for the delivery of health care services is increasingly outpaced in cost cutting by organizations that directly face the bottom line. In addition, private foundations, many of which are under the auspices of managed care organizations, now fund a large proportion of health care research and demonstration projects, a task once largely within the realm of the government. Through education and experience, nurses have developed political sophistication and understanding of policy making in the public sector (7). The challenge now is to educate nurses to adapt their political and policy strategies to the new health care milieu. This challenge is particularly crucial for advanced practice nurses, who must survive in a managed care environment.     

护士长有效激励护士的做法与效果

为充分调动护士的工作积极性、主动性和创造性,确保优质、高效地完成各项护理工作,护士长必须不断地对护士实施有效激励。在管理实践中,通过采取目标激励、参与激励、沟通激励、公平激励等技巧,有效地提升了护士的价值观和责任感,激发了他们的工作热情,挖掘了其潜能;促进了科室团队建设,增强了集体凝聚力,鼓舞了护士的群体士气,使科室的各项工作质量得到了全面提高。     

Understanding the impact of power in organizations.

Although implementation of Shared Governance appears to have failed, it failed primarily on the surface. Many staff nurses actively involved in the Shared Governance movement not only were empowered but were dramatically affected on a professional level. Several council chairpersons were empowered to assume management roles in the transition back to the hierarchial model--a manifestation of their professional growth and development. At the unit level, several units lobbied the new leadership to allow them to continue to do peer review and unit-based council management of unit governance issues. Three councils lobbied to continue to do their work, although in a modified role, in the reestablished hierarchial structure. The three remaining councils were those of Practice, Quality, and Research. If nurse leaders at any level within the organization are to guide their departments forward while in the throes of the current chaos in health care, they must develop and use their power bases, both formal and informal, as individuals and then as leaders. Russell Coile identifies the need for more clinical expertise (expert power) on the executive team of health care organizations. He predicts that 50% of the executive team will be nurses and physicians and that only health care executives with an MBA or financial backgrounds, who also have well-developed informal power bases with skills in relationship development, facilitation, and networking, will be part of the new system. Those with a diversified informal power base will be most successful in guiding their organization to its destination. The future for nursing leaders is in the sharing of information; it is about embracing diversity and recognizing the contributions others can make that are refreshingly different; it is also about clearly defining a balance in life, because balanced leaders who have found a way to nurture and meet their own needs are better positioned to do the same for others. Ultimately, understanding the impact of power in an organization, regardless of organizational structure, begins with understanding and defining your own power base.     

Employee innovation behaviour in health care: the influence from management and colleagues

AIM: This article reports how 'important others' and position in the organizational hierarchy relate to employee innovation behaviour. Empowerment of healthcare workers to engage in innovation behaviour is desired by management in Norwegian municipalities as it is regarded as a way of getting more health care for less money. Innovation behaviour is also desired by nurses' and other healthcare workers' professional organizations of as it is regarded as a way of improving the working conditions of the healthcare worker. BACKGROUND: The theoretical discussion in this paper includes corporate entrepreneurship, 'important others' and employee innovation behaviour. METHODS: This article reports on a study concerning empowerment of nurses and other healthcare workers (n = 555) in Norwegian municipalities. The statistical methods used include multiple regressions. FINDINGS: The study reveals that there were differences between the nurse (registered nurses), auxiliary nurses (nurse aides) and unskilled healthcare workers concerning how they perceived the opinion of the management and the opinion of the colleagues about how suitable it was to present innovation behaviour at the workplace. Moreover, the different groups of healthcare workers assign different levels of importance to this influence. CONCLUSIONS: It is suggested that the findings put forward in this article may lead to an improved understanding of the dynamics behind employee innovation behaviour, and that such knowledge could improve the care provided to the patients, the cost of the care and the working conditions of nurses and other healthcare workers.     

The accidental entrepreneur: One nurse manager's story

This is an overview from one nurse's perspective and story. There are many more stories that are yet to be written by other nurse entrepreneurs. “The entrepreneurial personality contains a gamut of distinguishing traits and characteristics that support innovation and degrees of risk taking.”² I believe that all nurses have unique characteristics and gifts that support innovation and creativity because they are in roles and settings where they can see areas for improvement. Entrepreneurial nurses who step forward and think “I can do this” will create the environment for a reformed and effective health care system—who better to see how best to care for patients?I challenge readers to think critically and see their organizations and roles in a new light that seeks innovation and improvement in numerous facets of how things are done. Be the change that makes things get done differently and, more importantly, done better.     

临床护理人力资源配置研究

目的 通过对部分军队医院护理人力资源现况的调研，依据卫生资源配置的有关理论，通过专家调查、护理人力资源利用效率情况分析及护理项目的分级研究，提出医院护理人力资源微观配置结构比例标准。方法 采用整群抽样的方法调查部分军队医院护理人员利用情况，进行了描述性分析研究。结果 不同等级的医院、不同的科室工作量和工作效率并不完全相同，忙闲不均，各级护理人员在多数操作项目中没有层次差别，因而人力资源的能级浪费与不适宜服务并存。结论 对护理项目进行分级研究，从而配置护理人员内部结构，将护理人员按照完成的护理项目合理组合，形成最佳的能力结构和职称结构，真正实现以病人为中心的整体护理。     

The first evaluation of the advanced practice nurse role in Finland - the perspective of nurse leaders

fagerström l. & glasberg a.-l. (2011) Journal of Nursing Management 19, 925–932 The first evaluation of the advanced practice nurse role in Finland – the perspective of nurse leaders Aims The aim of this study is to explore and describe nurse leaders’ (NLs) experiences of the role of advanced practice nurses (APNs). Background The first group of advanced practice nurses (17) in Finland graduated in 2006 and were thereafter employed by seven different organizations in more or less clearly defined advanced practice nurses roles. Methods Seven nurse leaders at the relevant organizations were interviewed a year after the introduction of the advanced practice nurses role. Content analysis was used to analyze the data. Results All of the nurse leaders emphasized the importance of the advanced practice nurses role in their organization. The advanced practice nurses’ scope of practice comprised a more autonomous and independent role than registered nurses. Advanced practice nurses are an important resource in the care of patients with chronic diseases and acute health problems. An important aspect regarding support for the advanced practice nurses role is the provision of information to all health-care personnel and patients about the role and clearly defined areas of responsibility. Conclusions Advanced practice nurses are an important resource in the development of evidence-based nursing and improve the availability of health-care services for patients. Implications for nursing management Nurse leaders are responsible for creating sustainable structures and the prerequisites needed for advanced practice nursing through the formation of supportive organizational systems.     

Designing A System for Safe Staffing

Developing effective systems to ensure safe and appropriate nurse staffing is a critical priority for both chief nursing officers as well as the governance and leadership of health care organizations. Bedside nurses will gain confidence in their employer’s commitment to ensuring safe nurse staffing if they are actively engaged in designing staffing systems in a meaningful way. Investment in comprehensive, well-integrated staffing systems can offer an effective and viable alternative to regulatory solutions.