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.     

Global nursing leadership: a practical guide

Nursing leaders of today must be prepared for a nursing practice environment inclusive of local, national, and global work and issues. The educational preparation of nursing leaders should incorporate a fundamental curriculum that offers a broad preparation and basic leadership skills along with guidelines and experiences to support global outreach and collaboration with many cultures and health care environments. This article provides a practical guide on entry into Global Nursing Leadership for nursing leaders from the nurse executive including all levels of nursing management.     

Internationalizing nursing curricula in a rapidly globalizing world

Rapid transformations in our globalizing world means there is an urgency for nurse educators to revitalize curricula to prepare nurses better for practice and the emphasis on achieving global health for all has never been greater. Nurses are being urged to collaborate across borders to achieve the United Nations' Sustainable Development Goals, through research, practice, policy and education. Thus, nurse educators and leaders need to consider the critical importance of internationalizing nurses’ education at all levels, as well being committed to their roles in curricula reform and using innovative technology. There are challenges to internationalization, but the benefits include helping nurses to grow cultural competence, developing strength in nursing voices globally, capacity building in global health, health policy and advocacy, growing scholarship in nursing across borders, developing the skills and knowledge of nurses from low-income countries, and forming partnerships to work together to achieve global health.     

Creative Solutions to Assure New Graduate Preparation and On-Boarding

The pandemic has caused nurse leaders to rethink how to best prepare nurses for practice in challenging times. Creative strategies employed by nurse leaders in academia and in community settings can ensure that new graduate nurses are ready for practice. This article discusses ideas for implementation or refocus that are required to meet the needs of the novice nurse and community partners.     

Demands of immigration among nurses from Canada and the Philippines

The purpose of this study was to describe and compare the demands of immigration on nurses from Canada and those from the Philippines, who immigrate to the USA and work in Hawaii. The findings can assist policy-makers in formulating plans to alleviate the shortage of nurses through effective immigration recruitment practices. Nurse educators can gain support for the recruitment of students from a diverse array of cultures. Managers and nursing leaders can use this information in designing recruitment, orientation, support and retention programmes for nurses that are specific to their cultural needs. The two groups of nurses were sampled from acute care staff nurse populations in Hawaii. Aroian's instrument, the Demands of Immigration scale, was used to measure and compare the distress levels of the nurses. The findings include a higher level of distress experienced by nurses from Canada compared with nurses from the Philippines. This might be attributed to a preponderance of social and collegial support available to the Philippine nurses in Hawaii where one-fourth of the population is derived from their country of origin.     

Creating the conditions for growth: a collaborative practice development programme for clinical nurse leaders

boomer c.a. & mccormack b. (2010) Journal of Nursing Management  18, 633–644
Creating the conditions for growth: a collaborative practice development programme for clinical nurse leaders Aim To evaluate a 3-year practice development (PD) programme for clinical nurse leaders. Background The development of effective leaders is a key objective to progress the modernization agenda. This programme aimed to develop the participants alongside development of the culture and context of care. Methods Programme evaluation methodology to determine the ‘worth’ of the programme, inform the experience of the participation, effect on workplace cultures and determine effectiveness of the process used. Results Created the conditions for growth under two broad themes: process outcomes demonstrating growth as leaders contributing to cultural shifts; and general outcomes demonstrating practice changes. Conclusions Developing communities of reflective leaders are required to meet demands within contemporary healthcare. PD provides a model to develop leaders to achieve sustainable changes and transform practice. Implications for nursing management Active collaboration and participation of managers is crucial in the facilitation of and sustainability of cultural change. Approaches adopted to develop and sustain the transformation of practice need to focus on developing the skills and attributes of leaders and managers as facilitators.     

Articulating nursing in an interprofessional world

It is essential that nurses in practice clearly articulate their role in interprofessional clinical settings. Assumptions, stereotypes, power differentials and miscommunication can complicate the interaction of healthcare professionals when clarity does not exist about nurses' knowledge, skills and roles. Conflicting views among nurse scholars as to the nature of nursing knowledge and its relationship to practice complicate the task of nurses in explaining their performance and role to others in interprofessional environments. Interprofessionality is potentially misunderstood by nurse leaders, practitioners and educators, isolating nurses in an increasingly inter-disciplinary healthcare system. The theorization of contemporary nursing is explored through the views and perspectives of current nurse scholars. The ability to explain nursing knowledge, skills and roles to others in interprofessional interactions is a nursing competency, as well as an interprofessional one. Nurses, nurse leaders and nurse educators are challenged to engage in interprofessionalism so as to have an influence in the evolution of healthcare education and practice environments.     

Cultural safety and the socioethical nurse

This article explores the social and ethical elements of cultural safety and combines them in a model of culturally safe practice that should be of interest and relevance for nurses, nurse educators and nurse ethicists in other cultures. To achieve this, the article briefly reviews and critiques the main underpinnings of the concept from its origins and development in New Zealand, describes its sociocultural and sociopolitical elements, and provides an in-depth exploration of the key socioethical elements. Finally, a model is presented to illustrate the strong connection between the social and ethical components of cultural safety that combine to produce culturally safe practice through the activities of a 'socioethical' nurse.     

Evidence-based practice and school nursing.

School nurses need to demonstrate that their practice is based on the best evidence available, which is usually data obtained from research. Evidence-based practice involves combining the best evidence available with nursing expertise and patient and family preferences to determine optimum care. Evidence-based practice guidelines are developed by carefully reviewing the available evidence on a topic and synthesizing this information into recommendations for practice. This article defines evidence-based practice and best evidence, describes the development of evidence-based practice guidelines, discusses factors that affect the use of research and evidence-based practice guidelines in school nursing, and reviews current sources of evidence-based practice guidelines for school nurses. Strategies that school nurses can use to incorporate evidence into their practice are discussed. One recommendation is that school nurses partner with nurse leaders and nurse researchers to develop evidence-based practice guidelines relevant to school nurse practice.     

设立护理组长实施外科护理人员分层级管理的实践与效果

目的探索在分层级管理中设立护理组长对外科护理质量及患者满意度的影响。方法通过民主测评、理论技术考核设立护理组长岗位,制订护理组长工作职责并严格考评。结果设立护理组长后调动了护士的工作积极性,提高了护理质量和患者满意度,科室护理质量指标全部达到优秀。结论设立护理组长是护理分层级管理中提高护理质量的有效措施。     

Perspectives of cultural competence in health care

AIM: The aim of this study was to explore the views of one group of healthcare professionals on the importance of cultural awareness in healthcare practice. METHOD: A qualitative approach was used. Ten nurses of varying age from two counties in Scotland who worked across a range of clinical practice areas were interviewed. The interviews were largely unstructured but included an opening question and prompts for the interviewer FINDINGS: A lack of knowledge and understanding was demonstrated by the participants in relation to the diverse cultural groups who constitute the population of this country, and a gap in nurse education and training provision across a range of healthcare areas. CONCLUSION: Nursing curricula need to include more knowledge and learning about cultural awareness, and nurses need more practical experience of caring for patients from different cultures. The findings assisted in the development of a framework for nurse education that embraces the concept of cultural competency.     

Promoting leadership and management in Australian general practice nursing: what will it take?

Aim This paper outlines the current state of Australian practice nursing, describes the context of general practice and establishes the importance of promoting leadership and management in this setting. Background Australian general practice nurses have emerged as key stakeholders in primary health care. However, their role in leadership and management has been largely invisible. The reasons for this are multifactorial, including the delay to establish a strong professional organization, their negative power relationships with general medical practitioners, limited nursing leadership and poorly defined roles. To date, the impetus for practice nurse growth has been largely external to the nursing profession. Growth has been driven by the increasing burden of chronic disease and workforce shortages. This has further weakened the control of nurse leaders over the development of the specialty. Conclusions The Australian practice nurse role is at a crossroads. While the practice nurse role is a viable force to improve health outcomes, the growing strength of the practice nurse challenges traditional professional roles and practice patterns. Implications for nursing management There is an urgent need to develop practice nurse leaders and managers to not only embrace the challenges of Australian general practice from an operational perspective, but also undertake a clinical leadership role. As clinical leaders, these nurses will need to develop a culture that not only optimizes health outcomes but also advances the status of the nursing profession.     

Reflection: an educational strategy to develop emotionally‐competent nurse leaders

Aim This paper explores educational strategies for nurses that focus on reflectivity and promote the development of self‐awareness, relationship and communication skills and ability to lead with presence and compassion in the midst of change. Background Today nurses move rapidly from carefully‐controlled educational experiences to a fast‐ paced clinical world of increasing patient complexity amid calls for improved quality of care. Making the transition to clinical competence and leadership in practice requires a strong sense of self and emotional intelligence. Evaluation Pedagogies that integrate theoretical and data‐based textbook learning with experiential learning and reflection are a foundation for the development of emotionally‐ and intellectually‐competent leaders and requires new ways of assessing learner outcomes. Key issues Reflection is a key instructional strategy for preparing transformational nurse leaders for interdisciplinary settings where they lead patient care management. The remarkable global spread of reflection in nursing education, practice and research follows an emphasis on developing self‐awareness as a leadership strategy for improving individual and organizational performance. Conclusions Empirical, experiential and anecdotal evidence suggests that reflection has the potential to prepare emotionally‐capable nurse leaders. Implications for Nursing Management As educators create more reflective and nurturing learning environments, they will promote the development of emotionally‐competent nurse leaders who will, in turn, inspire individual and organizational growth and positive change in society.     

Assessing nurse graduate leadership outcomes: the "typical day" format

Readiness for professional nursing practice in the current diverse and complex healthcare environment requires leadership capabilities. Faculty are challenged to identify specific leadership capabilities needed by graduate nurses upon entry into professional practice and to develop models from which they can accurately and authentically assess their demonstration. This article presents the development and implementation of an innovative leadership outcome assessment model. The model was developed in collaboration with nurse practice leaders and uses nurse practice leaders as external assessors and a "typical day" in nursing practice format.     

Recipe for success: stories of evidence-based practice implementation

Through a collaborative partnership with administrators at a university, nurse leaders at a local hospital worked to create a culture in which nurses could provide evidence-based practice (EBP). The Best Practice Series was started, and two participants' experiences of implementing EBP in their units are described with encouraging results.     

Facilitating safe care: a qualitative study of Iranian nurse leaders

Aim The purpose of this study was to explore and describe how nurse leaders facilitate safe care from the perspectives of both nurses and nurse leaders. Background The health-care system’s success in improving patient safety pivots on nursing leadership. However, there is a lack of knowledge in the international literature about how nurse leaders facilitate provision of safe care and reaching the goal of a safe health-care system. Method A qualitative design using a content analysis approach was applied for data gathering and analysis. In this study, 20 nurses (16 nurses and four head nurses) working in a referral teaching hospital in Tehran, Iran, were recruited through purposive sampling. Semi-structured interviews and 10 hours of structured observations were conducted to collect data. Results The data analysis resulted in three main themes: ‘providing environmental prerequisites for safe nursing practice’, ‘uniting and integrating health-care providers’, and ‘creating an atmosphere of safe care’. Conclusion The results indicate that to facilitate providing safe care, nurse leaders should improve nurses’ working conditions, develop the nurses’ practical competencies, assign duties to nurses according to their skills and capabilities, administer appropriate supervision, improve health-care providers’ professional relationships and encourage their collaboration, empower nurses and reward their safe practice. Implications for nursing management Approaching the challenge of patient safety requires the health-care system to combine its efforts and strategies with nursing leadership in its vital role of facilitating safe care and improving patient safety.     

State-of-the-art patient care. The impact of doctorally prepared clinical nurses

Delivery of state-of-the-art patient care requires new models to foster the development of professional nurses and integrate practice, research, and education. The Chief Nursing Officer of University Hospital/Associate Dean of the College of Nursing at a tertiary health science center positioned doctorally prepared nurses in clinical practice settings to assist in actualizing a vision of state-of-the-art patient care. Strategic targets for performance improvement included building collaboration between the college and hospital, supporting advanced education for nurses, moving the nursing culture from one of co-dependence to one of professionalism, fostering research at the unit level, and capitalizing on the strengths of nurse leaders. Creating an environment where staff nurses use critical thinking skills and access their advanced practice nurse (APN) resources as they do their work has been a win-win-win situation for the patients, the hospital, and the college at the health science center.     

Creating room for evidence-based practice: Leader behavior in hospital wards

The integration (routinizing and sustaining) of evidence-based practice (EBP) into hospital management is a key element for improving patient safety and ensuring better patient outcomes. Hospital managers and clinical leaders play crucial roles in this integration. Interactions between leaders and integration context influence the improvement's quality, but leader-based actions that are effective for improving nursing practice remain unclear. The relationship between leaders could also either hinder or enable this implementation process. The aim of this study was to generate a theory about patterns of leader behavior that leaders are engaged in when attempting to integrate EBP in a clinical setting. We used a classic grounded theory methodology to generate a substantive EBP theory. In this study, through participant observation, we observed 63 nurses (15 specialist, 39 registered, and 9 assistant nurses). From these, five ward leaders (two head nurses, one assistant head nurse, and two teaching nurses) participated in individual interviews, and 18 clinical nurses participated in four focus groups. “Creating room for EBP” emerged as a theory for explaining the way in which the leaders attempted to resolve their main concern: How to achieve EBP treatment and care with tight resources and without overextending the nurses. Creating room for EBP encompasses a process of interactions, including positioning for, executing, and interpreting responses to EBP.     

Cultivating joy: Improving nurse resilience through use of a practice playbook

Purpose/aimsThe purpose of this study was to determine whether resiliency activities, compiled into a practice playbook designed for implementation by nurse leaders and self-initiation by clinical nurses, improves resilience in both the nurse leaders and direct care nurses who implement them.BackgroundEvidence indicates strengthening nurse resilience increases well-being, protects against burnout, improves retention and increases patient safety.MethodsA resilience playbook was assembled to include stress-reduction activities. Resilience was measured at baseline and after two phases during which participants engaged in leader-led and self-initiated activities. The Connor-Davidson Resilience Scale (CD-RISC) was used to measure resilience.ResultsA total of 118 nurses completed both phases; 17 leaders and 101 clinical nurses. A significant increase in mean CD-RISC scores was detected among those who participated in self-initiated activities (p = 0.01). Initiating or participating in leader-led activities did not positively impact resilience scores. Further, clinical nurses who participated in leader-led activities were not more likely to participate in self-initiated activities.ConclusionsThis study supports self-initiated resilience-strengthening activities as beneficial to nurses, but not leader-led initiatives. These results are especially important for nursing leaders as they strive to reduce burnout, improve nurse retention and achieve exceptional practice quality.     

The Impact of Accreditation on Nursing Transition Into Practice Residency Programs

The evidence is clear: transition to practice (TTP) residency programs are essential for new graduate nurses (NGNs) entering the profession, for effective organizational efficiency, and for enhanced, safe patient care. Meanwhile, some nurse leaders struggle to inspire others, including chief executive and financial officers, to invest in TTP residency programs, and some nurse leaders are not convinced of the value. In this article, we reinforce the case for TTP residency programs and the impact of their being accredited. We do so by offering an example of a health care system's experience standardizing a TTP across 7 states (53 acute care hospitals). Furthermore, we offer a model to demonstrate how accredited programs benefit nurses and organizations by having a significantly lower turnover rate than nonaccredited programs. Finally, this article offers concrete actions that nurse leaders can take to ensure a safe and meaningful journey for new graduate nurses entering our profession.