The importance of work environment: evidence-based strategies for enhancing nurse retention

As the nation faces a growing nursing shortage, it is imperative that home care leaders implement evidence-based strategies to improve nurse recruitment and retention. Previous research indicates that characteristics of the work environment that support nursing practice enhance nurses' job satisfaction and reduce turnover. Yet, there is little evidence to assist in prioritizing initiatives to improve the work environment of nurses. In this nationwide survey, home care nurses were asked to rate the importance of specific agency work environment traits, as listed on the Nursing Work Index-Revised, in supporting their home care practice. The 10 agency traits rated as most important are presented, and evidence-based recommendations for creating a culture of nurse retention are discussed.     

Leadership by collaboration: Nursing's bold new vision for academic-practice partnerships

In 2016 the American Association of Colleges of Nursing issued a report, Advancing Healthcare Transformation: A New Era for Academic Nursing that included recommendations for more fully integrating nursing education, research, and practice. The report calls for a paradigm shift in how nursing leaders in academia and practice work together and with other leaders in higher education and clinical practice. Only by doing so can we realize the full benefits of academic nursing in this new era in which integration and collaboration are essential to success. In this paper we: 1) examine how academic nursing can contribute to healthcare innovation across environments; 2) explore leadership skills for deans of nursing to advance the goals of academic nursing in collaboration with clinical nursing partners, other health professions and clinical service leaders, academic administrators, and community members; and, 3) consider how governance structures and policy initiatives can advance this work.     

护理组长负责制在心脏外科ICU质量管理中的应用

目的 调动护理专业技术骨干工作积极性,提高护理质量。方法在心脏外科ICU设立护理组长岗位,确定其岗位职责,享受相应奖金待遇。结果激发了护理专业技术骨干的工作积极性,护理投诉降低,各项危重护理质量指标得到提高。结论实行护士长领导下的护理组长负责制,能使ICU人力资源得到合理应用,是提高护理质量的有效手段。     

Community/Public Health Nursing Practice Leaders' Views of the Doctorate of Nursing Practice

ABSTRACT Objectives: This paper presents thoughts of practice leaders in the community/public health nursing (C/PHN) specialty on advanced nursing practice (ANP) and the necessary educational preparation for such practice.
Design and Sample: Practice leaders were engaged in conversations specifically focused on the Doctor of Nursing Practice (DNP) as preparation for ANP in their specialties, and asked to consider the benefits of, and challenges to, this educational program.
Measures and Results: The resulting remarks were then assessed for themes by the interviewers and these are presented along with thoughts on the future of education for ANP.
Conclusion: Overall, there was much agreement among the practice leaders interviewed about the importance of a broad skill set for ANP in the specialty. However, the practice leaders interviewed here also identified the practical challenges involved in educating nurses at the DNP level in the C/PHN specialty, as well as some concerns about the definitions of ANP for the future.     

From scientific discovery to health outcomes: A synergistic model of doctoral nursing education

Across the globe, health system leaders and stakeholder are calling for system-level reforms in education, research, and practice to accelerate the uptake and application of new knowledge in practice and to improve health care delivery and health outcomes. An evolving bi-dimensional research-practice focused model of doctoral nursing education in the U.S. is creating unprecedented opportunities for collaborative translational and investigative efforts for nurse researchers and practitioners. The nursing academy must commit to a shared goal of preparing future generations of nurse scientists and practitioners with the capacity and motivation to work together to accelerate the translation of evidence into practice in order to place nursing at the forefront of health system improvement efforts and advance the profession.     

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.     

The organizational environment and evidence-based nursing

The Province-Wide Nursing Project (PWNP) was designed to remove some of the structural barriers that can impede the ability of nurses in selected health care settings to assess, implement and evaluate best nursing practice. Literature on capacity building and research utilization suggests that the organization is the most important factor in promoting best nursing practice. Therefore, managers and nursing leaders need to encourage the creation of optimum work environments. A survey undertaken by the PWNP Research Centre team assessed the extent to which the 23 agencies in the 4 Participating Complexes provided supportive environments for evidence-based practice. The Characteristics of Agencies in Participating Complexes: Demographics and Resources questionnaire investigated the resources available to help nurses improve their standards of practice in agencies participating in the project. Larger agencies, especially those associated with academic centres, had considerably more resources than agencies in smaller towns. Participation in the Province-Wide Nursing Project enabled agencies to develop strategies to improve the use of evidence in nursing practice.     

Advancing practice by developing a primary care nursing programme

The discussion of advanced practice in nursing is ongoing, yet the need for practice to advance and develop across the health economy is called for in much of the current literature and government policy. This article considers an educational intervention that set out to advance primary care nursing. The programme aimed to facilitated nurses to understand clients, families and carers in the community setting, to offer a high standard of care, to support specialist practitioner team leaders to work across community nursing disciplines and to make their own career development choices. Advancing practice in this novel primary care nursing programme required change management, collaboration, partnership, leadership and involvement of the staff nurses themselves.     

Embracing a Competency‐Based Specialty Curriculum for Community‐Based Nursing Roles

The Quad Council competencies for public health nursing (PHN) provide guidance in developing curricula at both the generalist and specialist level. However, these competencies are based on nursing roles in traditional public health agencies and community/public health is defined more broadly than official agency practice. The question arises as to whether community‐based specialties require largely the same knowledge and skill set as PHN. The purpose of the competency cross‐mapping project reported here was to (a) assess the intersection of the Quad Council competencies with four community‐based specialties and (b) ensure the appropriateness of a Quad Council‐based curriculum to prepare graduates across these four specialties (home health, occupational health, environmental health, and school nursing). This article details the multistep cross‐mapping process, including validation with practice leaders. Results indicate strong alignment of community‐based specialty competencies with Quad Council competencies. Community‐based specialty‐specific content that did not align well is identified, along with examples of didactic and clinical strategies to address gaps. This work indicates that a Quad Council‐based curriculum is appropriate to prepare graduates in community‐based specialties when attention to the specialty‐specific competencies in the clinical setting is included. This work guides the development of a doctorate of nursing practice curriculum in PHN, encompassing the four additional community‐based specialties.     

Preparing nurses for the 21st century: reenvisioning nursing education and practice.

Significant advances in biomedical science and in the complexity of health care, coupled with a worsening nursing shortage and numerous reports of unsafe and inadequate patient care, have prompted concerns about both nursing education and nursing practice. Beginning in 2000, the American Association of Colleges of Nursing (AACN) made a thorough study of nursing education, regulation, and practice issues. Input and consultation were sought from AACN members, nursing practice leaders, regulators, and other health professionals. Results of this work indicated the need for a new nursing professional, the clinical nurse leader, who could effectively coordinate, manage and evaluate care for groups of patients in complex health systems. Master's-degree education is proposed for piloting the preparation of clinical nurse leaders. Close coordination with nurse executives and administrators to develop the new education program and new models for care delivery is planned. Critical components of the pilot testing will be evaluation of the patient and nurse outcomes associated with the use of clinical nurse leaders and focused work to develop a new legal scope and credentials for them.     

Setting the climate for evidence-based nursing practice: what is the leader's role?

Nurses are being challenged today to justify their practice. Many clinical and policy decisions in nursing are based upon isolated, ritualistic and unsystematic forms of clinical practice. The growing movement towards establishing evidence-based nursing practice (EBNP) is situated in a systematic appraisal of the best evidence available. Nurse leaders have an obligation to cultivate sound clinical and economic practices leading to quality patient care and positive work life environments for nurses.     

Authentic leaders creating healthy work environments for nursing practice.

Implementation of authentic leadership can affect not only the nursing workforce and the profession but the healthcare delivery system and society as a whole. Creating a healthy work environment for nursing practice is crucial to maintain an adequate nursing workforce; the stressful nature of the profession often leads to burnout, disability, and high absenteeism and ultimately contributes to the escalating shortage of nurses. Leaders play a pivotal role in retention of nurses by shaping the healthcare practice environment to produce quality outcomes for staff nurses and patients. Few guidelines are available, however, for creating and sustaining the critical elements of a healthy work environment. In 2005, the American Association of Critical-Care Nurses released a landmark publication specifying 6 standards (skilled communication, true collaboration, effective decision making, appropriate staffing, meaningful recognition, and authentic leadership) necessary to establish and sustain healthy work environments in healthcare. Authentic leadership was described as the "glue" needed to hold together a healthy work environment. Now, the roles and relationships of authentic leaders in the healthy work environment are clarified as follows: An expanded definition of authentic leadership and its attributes (eg, genuineness, trustworthiness, reliability, compassion, and believability) is presented. Mechanisms by which authentic leaders can create healthy work environments for practice (eg, engaging employees in the work environment to promote positive behaviors) are described. A practical guide on how to become an authentic leader is advanced. A research agenda to advance the study of authentic leadership in nursing practice through collaboration between nursing and business is proposed.     

Creating an education and research consortium. Framework and development

Today's schools of nursing and clinical organizations providing nursing care need to synchronize their efforts to maximize one another's achievements. This article describes how complementary goals of two or more organizations can be achieved through mutual efforts, and briefly details the process of consortium development and the role of leaders in this process. Interorganizational collaboration examples are discussed at two institutions in two different regions of the country, and the authors offer a number of ways that nursing education and practice can work together to meet their overlapping needs, attack the nursing shortage, and move nursing education and practice toward evidence-based care.     

The lived experience of clinical development unit (nursing) leadership in Western Sydney, Australia

BACKGROUND: A network of nine Clinical Development Units (Nursing) (CDU(N)) were recently created in the Western Sydney Area Health Service. These units are designed to develop patient-focused nursing practice through group process and action research, based on principles of transformational leadership. AIMS OF THE STUDY: Although there is documented evidence from Australia and the United Kingdom (UK) that CDUs and Nursing Development Units (NDUs) are very successful in improving both patient and staff satisfaction, there is also growing evidence that the stressors experienced by nurse leaders are threatening the survival of some of these units. This study set out to develop an understanding of the phenomena of Clinical Development Unit (Nursing) leadership when these stressors were likely to impinge. STUDY DESIGN: Hermeneutic phenomenology was employed in order to identify how these experiences changed over time. Two rounds of interviews were conducted: approximately 4--6 months after the launch and, again, 12 months later. FINDINGS: The Clinical Development Unit (Nursing) philosophy provided a framework on which these very motivated leaders began to enhance nursing accountability in their units through reflective practice and participatory governance. While reinforcing many previously published positive and negative aspects of Clinical Development Units and Nursing Development Units, this paper also highlights how the expectations and experiences of these leaders changed over time with unanticipated pressures of work, a high turnover of clinical leaders, a perceived diminution of management support and unrealistic self-expectations. A significant theme that emerged as these stressors began to impinge was the leaders' own need for leadership in order to sustain their confidence and motivation. IMPLICATIONS FOR NURSING: Insights harvested from this study have since been incorporated into a revised leadership preparation programme and support mechanisms for the leaders of eight new Clinical Development Units (Nursing) in the Western Sydney Area Health Service.     

Building high-impact science: the dean as innovator

If funding level is accepted as an empirical referent of research productivity, the nursing profession's relatively low volume of funded research puts its capacity to influence practice and policy based on scientific evidence at a disadvantage. For the profession to effectively compete with other "high-impact," health-related disciplines, nursing leaders must find ways for a greater proportion of nursing faculty to excel as scientists, producing sufficient volume and quality of work in their careers to have a major influence on health care. In addition, if nursing leaders are to enhance nurses' interest in scientific development and use, the academic environment needs to foster greater connectivity of students at all levels of education with the scientific enterprise.     

Crisis at Guy's Hospital (1880) and the nature of nursing work

This historical study aims to refine understanding of the nature of nursing work. The study focuses on the 1880 crisis at Guy's Hospital in London to examine the nature and meaning of nursing work, particularly the concept of nursing work as many ‘little things.’ In this paper, an examination of Margaret Lonsdale's writing offers an original contribution to our understanding of the ways in which nursing work differs from medical practice. In this way, we use the late‐nineteenth‐century controversy at Guy's Hospital as a prism through which to examine the contested nature of nursing work. Lonsdale's ideas are corroborated by examination of writings by nurse leaders Florence Nightingale and Eva Luckes. Luckes, in particular, elaborated what was meant by nursing as the performance of a thousand little things, which are specific to nursing work. While physicians had been performing much of what was considered to be nursing work, nurses developed some of these and other interventions into a unique body of work characterized by meticulous attention to significant details. Some implications regarding current nursing practice are discussed.     

Improving Healthy Work Environments Through Specialty Nursing Professional Development

A healthy work environment (HWE) is an interrelated system of people, structures, and practices enabling nurses to engage in work processes and relationships identified by clinical nurses as standards of quality care to patients in hospitals. In HWEs, nurses can make a maximum positive contribution to their patients and the organization. According to AACN, the six standards of an HWE include skilled communication, true collaboration, effective decision-making, appropriate staffing, meaningful recognition, and authentic leadership. HWEs have been correlated with employee engagement and organizational commitment. Much of HWE literature findings are based on designs that assess the presence or absence of HWE and the outcomes of HWE. Few studies evaluate the impact of professional development interventions on HWE. The authors aimed to investigate the effect of an acute care professional development intervention for three nursing units on staff nurse perception of HWE.Study aimThis study aimed to administer a pre- and post-intervention assessment of the work environment among staff nurses working on acute care units in a Magnet® hospital in southeastern Louisiana.MethodsThis study used a pre-test and post-test single group study quantitative design where subjects completed online assessments before and after an educational intervention. The intervention included an educational presentation tailored for each hospital unit’s nursing specialty and patient population. Education topics reinforced the HWE standards and TeamSTEPPS® communication techniques to enhance teamwork. The online assessments included demographic questions and a valid and reliable AACN HWE survey. The HWE survey consists of 18 questions, 3 for each standard. The sample included staff nurses working in three acute care units. Demographic questions included gender, age, education, certification, participation in shared governance, career ladder participation, years in the current unit, hours worked per week, and years in nursing. Following the baseline assessment collection, an educational intervention was developed and delivered to the staff nurses. The intervention ranged from 4 to 8 hrs. It included specialty-focused education topics based on each unit’s patient populations (e.g., cardiac, pulmonary/sepsis, and stroke/renal care). The participants received information on certification, TeamSTEPPS® techniques for feedback, and conflict management. Following the intervention, electronic HWE surveys were sent to participants via e-mail for reassessment. Both the pre- and post-test participation was voluntary. No identifying information was collected, and the study was Institutional Review Board approved.ResultsA total of 53 staff nurses (50 females; 3 males) working among three acute care inpatient units completed the pre/post-test and intervention. The results were analyzed using SPSS. There was a significant increase in the means for 9 of 18 HWE survey questions from the pre- to post-test (P < .05). These results demonstrated a positive impact of the professional development intervention on staff nurse perception of HWE.ConclusionsImproving nurse work environments results in improved nurse empowerment, nurse satisfaction, and increased patient safety [DiChiara, J. (2015); https://revcycleintelligence.com/news/how-the-nursing-work-environment-affects-patient-outcomes]. This study demonstrated the benefit of a professional development that supported HWE standards on staff nurse perception of HWE in acute care work environments. This intervention study could serve as a strategy for units aiming to improve nurse perception of HWEs.     

Listening to nurses' moral voices: building a quality health care environment

In this paper we describe a research project in nursing ethics aimed at exploring the meaning of ethics for nurses providing direct care with clients. This was a practice-based project in which participants who were staff nurses, nurses in advanced practice, and students in nursing were asked to tell us (or describe to us) how they thought about ethics in their practice, and what ethical practice meant to them. We then undertook to analyze, describe and understand the enactment of ethical practice, the opportunities for and barriers to such enactment, as well as the resources nurses need for ethical practice. We drew out implications of these findings for nursing leaders. We identified practice realities that create a climate for ethical or moral distress, and the way in which nurses attempt to maintain their moral agency. Practice realities included nurses' ethical concerns about policies guiding care; the financial, human and temporal resources available for care; and the power and conflicting loyalties nurses encounter inproviding good care. Maintaining moral agency involved use of a variety of ethical resources and the identification of resources needed to provide good care, as well as the processes used to enact moral agency. Nurse leaders are also moral agents. Important implications of these findings for nursing leaders are that they need moral courage to be self-reflective, to name their own moral distress, and to act so that their nursing staff are able to be moral agents. Nurse leaders need to be the moral compass for nurses, using their power as a positive force to promote, provide and sustain quality practice environments for safe, competent and ethical practice.     

护理实习生软技能水平的调查分析

目的:调查护理实习生软技能水平,分析相关影响因素,并提出改善策略,以提高护生的综合素质和实习质量。方法:采用由付艳芬设计的护理软技能测评量表,对武汉协和医院316名护生进行问卷调查。结果:护生软技能总均分为(3.79±0.77)分,其中人际关系技能维度得分最高(3.91±0.29)分,组织管理技能最低(3.66±0.79)分。学历、父母文化程度以及是否班团干部是影响护生护理软技能的相关因素。结论:护生具有较高的护理软技能水平,建议护理院校及实习医院在认知技能和管理能力上为护生提供更多的锻炼机会,进一步提高护生的护理软技能水平。     

Exploring ethics in practice: creating moral community in healthcare one place at a time

Examining everyday ethical situations in clinical practice is a vital but often overlooked activity for nursing leaders and practitioners, as well as most other healthcare professionals. In this paper, we share how a series of practitioner-led Ethics in Practice sessions (EIPs), which originated within a busy urban teaching hospital, were adapted and translated, first into home care and more recently, into an EIP session for public health nurses. The success of EIP sessions rests with their focus on issues that are selected by practitioners. The aims of EIPs are to foster ethical leadership within communities of practice, create safe places to share concerns, use relevant research evidence and other literature to support informed discussion, and generate stories that deepen our understanding of the ethical situations we encounter in our work. We hope our experience inspires nursing leaders, nursing colleagues and fellow healthcare professionals to consider using the EIP approach to build moral community and the idea of moral imagination with their clinical colleagues, one place at a time.