ANCC certification: personal and professional affirmation

Certification is sited as one way of demonstrating competency. There are currently many reasons for pursuing certification, including personal satisfaction, validation of one's ability to effectively fulfill leadership roles, and to augment organizational efforts to become an ANCC Magnet Hospital. Regardless of the reason, achieving certification requires preparation and completion of an examination. Cary (2001) notes there are 4 avenues through which certification status can be recognized: public acknowledgement, financial compensation, career advancement, and retention. Colleagues who complete this process desire and deserve to be acknowledged and affirmed. Do you recognize colleagues in the attached list of ANCC certified nurses? If yes, take a minute and congratulate them on their accomplishment.     

Hospital restructuring and nursing leadership: a journey from research question to research program

The 1990s brought new fiscal realities to healthcare, leading to nursing job loss estimates in tens of thousands following widespread hospital restructuring to manage costs and improve efficiency. This research aimed at examining (a) how multiple episodes of hospital restructuring leading to layoff of nurses affected nurses who remained employed and (b) whether and how nursing leadership mitigated or intensified the negative effects of hospital restructuring on nurses. This dissertation comprised 3 empirical studies leading to 5 publications. The first study was a systematic literature review; the second and third used structural equation modeling to develop and test theoretical models addressing nursing practice environments and effects of hospital restructuring on nurses. The combined findings in this dissertation illustrate that hospital restructuring had significant negative physical/emotional health effects on nurses who remained employed. Nurses who worked for resonant (emotionally intelligent) leadership reported positive health and well-being, and opportunities to provide quality patient care. Nurses who worked for dissonant leadership reported greater negative effects of hospital restructuring. These findings led to a beginning theory of relational energy--a mechanism of mitigation whereby resonant nursing leaders invest energy into collaborative relationships with nurses, thereby positively influencing health and well-being, and, ultimately, outcomes for patients.     

Three Threads for Weaving Nursing Excellence Into the Fabric of an Organization

The ANCC Magnet Recognition Program® provides a framework for creating a culture of nursing excellence. Organizations seeking Magnet® designation and subsequent redesignations must create structures and processes to aid in the sustainment of excellence despite challenges that arise such as a pandemic. In this article, we offer strategies for nurse leaders to position their organizations for sustained excellence through enculturation of 3 threads: authentic, transformational leadership; nurse empowerment through strong professional governance structures; and peer engagement strategies that generate energy and enthusiasm. Implementation of these strategies was instrumental to achieving 2 redesignations for the health system.     

Developing the leadership skills of new graduates to influence practice environments: a novice nurse leadership program

The authors of the recently published Institute of Medicine on the Future of Nursing report emphasized the importance of preparing nurses to lead change to advance health care in the United States. Other scholars linked practice environments to safe quality care. In order for nurses to fully actualize this role in practice environments, they need to possess leadership skills sets that identify and respond to challenges faced. New nurses are no exception. This article presents a program with a 5-year track record that is designed to support transition and enhance the skill sets of leadership for new nurses in their first year of practice. Qualitative and quantitative evaluation measurements at baseline and postprogram provided data for evaluation of the first 4 cohorts in the program. Evaluative outcomes presented indicate that new nurses gained leadership and translational research skills that contributed to their ability to influence practice environments. Nonetheless, practice environments continue to need improvement and ongoing leadership from all levels of nursing must be upheld.     

安徽省873名中医院护士长变革型领导力影响因素分析

目的 了解安徽省内中医院护士长变革型领导力现状,并分析其影响因素,为提高护士长管理效能提供参考依据。方法 采用便利抽样法,选取安徽省内56所中医院873名护士长作为调查对象,使用一般资料调查表、护士长变革型领导力自评量表、护士长核心能力评估量表进行调查。采用多重线性回归分析护士长变革型领导力的影响因素。结果 中医院护士长变革型领导力得分为（109.43±12.40）分,多重线性回归分析结果显示：医院等级、护理管理能力、人际关系能力、护理科研能力及护理教育能力进入回归方程（P<0.001）,共解释总变异的53.0%。结论 中医院护士长变革型领导力处于中上水平。中医院护士长护理管理能力、人际关系能力、护理科研能力、护理教育能力及所在医院等级是变革型领导力的影响因素。建议中医医院管理者重视对护士长核心能力的培养,促进护士长变革型领导行为,并采取有效措施对变革型领导力的提升效果进行评价、追踪,提高护理质量。     

Achieving magnet redesignation: a framework for cultural change

Magnet recognition is the highest award that the ANCC bestows on an institution and exemplifies a hospital's accomplishments in providing commitment, support, and resources for nursing excellence throughout the organization. Magnet hospitals attain their status based on structure and outcome criteria known as the 14 Forces of Magnetism. The authors discuss one hospital's journey and the outstanding models integrated in their organization that paved the way for their first award, followed by their journey toward redesignation.     

Evidence-based nursing leadership: Evaluation of a Joint Academic-Service Journal Club

This article describes the importance of evidence-based nursing leadership in the development and evaluation of a joint academic-service nursing leadership journal club. The use of scientific evidence and the embracing of an environment of continuous learning are essential to quality practice; however, nursing leadership has been slow to apply evidence-based practice to their own work. A noontime monthly meeting schedule, incentivized by lunch, was organized as a nursing leadership journal club. Articles were selected and reviewed monthly, and the process was formally evaluated using a written evaluation at the end of year 1. Eighteen articles were appraised by the group with 6 topics identified. Positive results included increased knowledge, competence of the leader, and attainment of goals. Recommendations include revision of goals, plans to share leadership of the group, development of a rigorous evaluation of outcomes, and dissemination of findings. The journal club was valuable in increasing awareness of nursing leadership research, promoting leadership development, and improving competence in the performance of research appraisals. Process improvement and further study are needed to increase understanding regarding the benefits of leadership journal clubs.     

某三级甲等医院护士长领导力现状及其影响因素

[目的]了解某三级甲等医院护士长领导力现状及其影响因素,为进一步开展针对性干预,提高护士长领导力提供依据。[方法]采用一般情况调查问卷、护理管理者领导力问卷对某三级甲等医院87名护士长进行问卷调查。[结果]护士长领导力总分为100.31分±13.17分,低于均分的维度为创新能力、控制力和决断力,条目均分分别为(2.99±0.64)分、(3.22±0.64)分和(3.34±0.58)分。单因素分析显示:年龄≥51岁、工作年限≥31年、接受过相关培训的护士长领导力得分明显高于其他组,担任护士长年限≤5年的护士长领导力得分明显低于其他组,且差异均有统计学意义(P0.05)。多元线性回归分析显示,担任护士长年限和接受相关培训对护士长领导力有显著预测作用。[结论]护士长领导力得分处于中等水平,对护士长进行培训可有效提高护士长领导力水平,接下来可针对护士长创新能力、控制力和决断力方面进行相应的培训和干预。     

Investing relational energy: the hallmark of resonant leadership

Recent research has shown that hospital restructuring that included staff layoff has adversely affected the role, health and well-being of nurses who remained employed. Further research found that nurses working in environments that reflected resonant (emotionally intelligent) leadership reported the least negative effects to their healt and well-being following hospital restructuring. What remained unclear was the mechanism by which this mitigation occurred. The purpose of this paper is to explore additional findings from this leadership research and discuss one explanation unique to the academic literature for the mitigation variable--the investment of relational energy by resonant nursing leadership to build relationships with nurses and manage emotion in the workplace.     

护理人员科研能力及其影响因素的调查

目的 通过对临床医院护理人员科研能力的调查,探讨其影响因素,找出护理人员在科学研究中存在的不足,采取有效的措施,培养护理人员的科研能力.方法 于2009年8月自行设计问卷,采用分层随机抽样的方法,对102名在编护理人员的科研能力及影响因素进行调查.结果 被调查的护理人员科研能力较差.主要影响因素为科研相关知识缺乏、工作忙、时间紧、领导不重视 另外,护理人员的学历、职称、职务对其科研能力也有一定的影响（P＜0.01）.结论 护理人员的科研能力亟待提高,医院领导要重视护理人员科研能力的培养,通过多种途径提高护理人员的整体科研水平.     

Best quality patient care: a historical perspective on Magnet hospitals

Donabedian's Structure-Process-Outcome paradigm is used to analyze the evolution and research on the concept of magnetism through 4 phases. The identifying foci of the original 1983 study were 4 outcomes. A large number and array of structural features were derived from the identified Magnet hospitals. The quest for excellence in nursing care continued with the Gold Standard of Magnetism case studies utilizing all identified Magnet structures, processes, and outcomes. The advent of the American Nurses Credentialing Center Magnet Recognition Program stimulated much valuable and insightful research related to outcomes associated with the large group of magnetic structures. Magnet hospital staff nurses (SNs) identification of processes/functions most essential to quality patient care highlights the Process phase. Many of the vast array of structural features attributed to Magnet hospital in 1983 are outdated and differentially defined and have not been tested for their relationship to either processes or outcomes. Identification of magnetism from an SN perspective has lagged. Recommendations include updating and clarifying structural criteria; increasing focus on the SN perspective of magnetism by continuing identification of processes; and challenging leadership in Magnet hospitals to initiate multisite evidence-based practice initiatives to link structures with process-enabling outcomes. Now may well be the time for nursing to exert leadership in expanding the Magnet concept to the total patient-care operation in a hospital.     

The certified psychiatric nurse practitioner: advanced practice psychiatric nursing reclaimed

During the decade of the 1990s, health care reform, market forces, population needs, new knowledge in neuroscience and changes in advanced practice regulation provided the impetus for the development of the role of the psychiatric nurse practitioner. Debate about issues of role, scope of practice, educational preparation, titling, and credentialing for the advanced practice psychiatric nurse (APPN) of the future intensified as the American Nurses Credentialing Center (ANCC) proceeded with its controversial decision to develop a certification examination for the psychiatric nurse practitioner-in advance of consensus among advanced practice psychiatric nurses about those widely debated issues. Ironically, now that the ANCC adult and family psychiatric nurse practitioner (PMHNP) examinations exist, with test content outlines that clearly identify the professional standards and scope of practice relevant to the role of the certified psychiatric nurse practitioner, those contentious issues of role, scope of practice, educational preparation and credentialing (if not titling) seem considerably less thorny. In fact, by credentialing the role of the psychiatric nurse practitioner sooner rather than later, ANCC may have saved advanced practice psychiatric nursing for psychiatric nurses. This article proposes to (1). explain that assertion, (2). clarify what the scope of practice relevant to the newly certified role means in terms of credentialing requirements for existing types of psychiatric nurse practitioner, and (3). identify some of the controversies that linger with the debut of the PMHNP certification examination(s).     

Trauma Resuscitation/Critical Care Fellowship for Emergency Physicians: A Necessary Step for the Future of Academic Emergency Medicine

Emergency physicians (EPs) have long been de-facto providers of trauma resuscitation and critical care in academic and community hospital settings, and are significantly involved in out-of-hospital trauma care and trauma research. A one-year fellowship has been developed and implemented to provide advanced training in trauma resuscitation and critical care to EPs with a special interest in the field. This fellowship provides additional depth and breadth of training to prepare graduates for leadership roles in academic and specialized trauma centers. This is the first fellowship of its kind for EPs, and may serve as a model for fellowships at other institutions.     

Effects of a multifaceted,multidisciplinary, hospital-wide quality improvement program on weaning from mechanical ventilation

OBJECTIVE: To examine the effects of a mechanical ventilation weaning management protocol that was implemented as a hospital-wide, quality improvement program on clinical and economic outcomes. DESIGN: Prospective, before-and-after intervention study. Data from a preimplementation year are compared with those of the first 2 yrs after protocol implementation. PATIENTS AND SETTING: Patients older than 18 yrs in diagnosis-related group 475 and group 483, who were admitted to the adult medical, surgical, and cardiac intensive care units (ICU) in a university hospital. INTERVENTIONS: After the baseline year, a weaning management program was implemented throughout our institution. Primary endpoints were mortality, days on mechanical ventilation, ICU and hospital lengths of stay, hospital costs, and the percentage of patients requiring tracheostomy. MAIN RESULTS: The number of patients increased from 220 in the baseline year (year 0) to 247 in the first year (year 1), then to 267 in the second year (year 2). The mean Acute Physiology and Chronic Health Evaluation (APACHE) II score increased from 22.2 to 24.4 in year 1 (p =.006) and to 26.2 in year 2 (p <.0005). When year 0 was compared with year 1, mean days on mechanical ventilation decreased from 23.9 to 21.9 days (p =.608), hospital length of stay decreased from 37.5 to 31.6 days (p =.058), ICU length of stay decreased from 30.5 to 25.9 days (p =.133), and total cost per case decreased from $92,933 to $78,624 (p =.061). When year 0 was compared with year 2, mean days on mechanical ventilation decreased from 23.9 days to 17.5 days (p =.004), mean hospital length of stay decreased from 37.5 to 24.7 days, mean ICU length of stay decreased from 30.5 to 20.3 days, total cost per case decreased from $92,933 to $63,687, and percentage of patients requiring tracheotomy decreased from 61% to 41% (all p <.0005). There was also a reduction in the percentage of patients requiring more than one course of mechanical ventilation during the hospitalization from 33% to 26% (p =.039), a total cost savings of $3,440,787 and a decrease in mortality between all 3 yrs from 32% to 28% (p =.062). CONCLUSIONS: A multifaceted, multidisciplinary weaning management program can change the process of care used for weaning patients from mechanical ventilation throughout an acute care hospital and across multiple services. This change can lead to large reductions in the duration of mechanical ventilation, length of stay, and hospital costs, even at a time when patients are sicker.     

Advancing working and learning through critical action research: creativity and constraints

Continuous professional development is an essential component within many health care ‘Learning Organisations’. The paper describes the first phase of an initiative to develop a professional practice development framework for nurses in an NHS general hospital. The project was undertaken within a critical action research methodology. A tripartite arrangement between the hospital, a university and professional nursing organisation enabled clinical, educational and research support for the nurses (co-researchers) engaged in the project. Initial challenges were from some managers, educationalists and the ethics committee who did not appear to understand the action research process. A multi-method approach to data collection was undertaken to capture the change process from different stakeholders’ perceptions. Triangulation of the data was undertaken. Despite organisational constraints, transformational leadership and peer support enabled the co-researchers to identify and initiate three patient-focused initiatives. The change process for the co-researchers included: enlightening personal journey, exploring the research–practice gap, enhancing personal and professional knowledge, evolving cultural change and collaborative working, empowering and disempowering messages. A hospital merger and corporate staff changes directly impacted on the project. A more flexible time-scale and longer term funding are required to enable continuity for trust-wide projects undertaken in dynamic clinical settings.     

The relationship between effective nurse managers and nursing retention

Hospital executives are challenged to recruit and retain clinical nurses in a time when the national hospital nurse turnover rates are averaging above 20%. This literature review outlines nursing research that studied characteristics of nurse managers' leadership styles that enhance hospital nurse retention. Five consistent themes provided evidence of leadership traits that lead to job satisfaction and nurse retention. These were transformational leadership style, extroverted personality traits, magnet hospital organizational structures that support nurse empowerment, autonomy and group cohesion, tenure, and graduate education. Data from these studies provide a foundation for directing strategic plans to increase nurse retention and job satisfaction.     

Management vs symbolic leadership and hospitals in transition—a Swedish example

Aim To describe, analyse and interpret symbolic leadership in Swedish public hospitals.
Background Swedish hospitals are undergoing major structural changes. Hospitals are amalgamated in order to increase productivity and accessibility and reduce health care costs.
Method In-depth interviews have been performed with 54 politicians, senior civil servants, medical directors and trade union representatives at nine hospitals. The interviews have been analysed and interpreted following a grounded theory approach.
Findings The results show that leadership is manifested in two dimensions—management and symbolic leadership. The management dimension comprises general leadership aspects like planning, regulation and control. In the symbolic leadership dimension, the leader acts as a guide, inspirer and visionary. Leaders consider they are acting in two large arenas: a public arena and a hospital arena. In the public arena their professional competence is thought to be most important and in the hospital arena their social competence.
Conclusions Structural changes in Swedish hospitals have forced the actors to come out into the public arena, where they increasingly meet the media and have to defend budget cut-backs. This reduces their manoeuvring space in the hospital arena. When leaders work as a team, and make full use of their symbolic role, this helps to promote the process of transition. Symbolic leadership has a potential to increase the role repertory for not least the head nurse.     

Betrayed trust: healing a broken hospital through servant leadership

An investigative reporter with The Washington Post broke the news of a no-confidence vote by the medical staff of a hospital in the suburbs of Washington, District of Columbia. The chaos that followed created a perfect storm for needed change and offered the rare opportunity for unbridled deep and creative collaboration. Issues the hospital faced as a result of this crisis and subsequent events that tested the authenticity of change are summarized. This article focuses on the approach used by the registered nurse chief executive officer (RN-CEO) to humanize the hospital, viewing it as though it were a patient and leading a clinical approach to organizational recovery and health. The relationship that developed between the medical staff leaders and the RN-CEO was pivotal to the hospital's recovery and evolved as a hybrid of servant leadership. Outcomes achieved over a 7-year period and attributable to this relational model are summarized. Finally, the RN-CEO shares lessons learned through experience and reflection and advice for nurses interested in pursuing executive leadership roles.     

A nurse-physician co-leadership model in psychiatric hospitals: results of a survey among leading staff members in three sites

In three psychiatric hospitals in Baden-Wuerttemberg, Germany, a physician-nurse shared leadership model was implemented in 1997 by the hospital management. The whole hospital, departments, and single wards are led each by a leadership team consisting of a physician, psychologist or social worker and a nurse, being responsible for organization, staff, and budgets. The consequences for staff opinion in leadership positions were evaluated. All 165 leading staff members of all professional groups were anonymously interviewed with a questionnaire containing 45 items regarding their satisfaction with this new leadership model. The response rate was 79.4%. Overall, the leading staff members were satisfied with the shared leadership model both in their own clinical practice and in general. Non-medical staff members were significantly more in favour of several aspects of shared leadership than physicians, but even the latter reported to be generally satisfied. However, both professional groups estimated leading positions to be only modestly attractive. The results yield some evidence that the change from traditional leadership models to the physician-nurse shared leadership model may have advantages in the management of psychiatric hospitals.