Maximizing nurses' advocacy role to improve patient outcomes

Perioperative nurses are eminently situated, academically prepared, and professionally qualified to positively affect patient outcomes. Increasing efficiency and justifying the need for an RN in the perioperative milieu revolve around nurses' role as patient advocates. Perioperative nurses can take many measures to maximize this role, including reducing surgical site infections by enabling the timely administration of antimicrobial prophylaxis and by ensuring that surgical staff members realize the documented risks of removing hair from the surgical site.     

The making of a nurse manager: the role of experiential learning in leadership development

cathcart e . b ., greenspan m . & quin m . (2010) Journal of Nursing Management 18, 440–447
The making of a nurse manager: the role of experiential learning in leadership development Aim To articulate the experientially acquired knowledge, skill and ethics embedded in nurse manager practice and describe the ways in which they were developed. Background The role of the nurse manager is usually described in lists of competencies, talents and traits which fail to capture the experience-based judgment and practical knowledge in this pivotal organizational role. Method Using Benner’s methodology of practice articulation, 32 nurse managers wrote and interpreted first person narratives of their practice. The experience level of the group ranged from new nurse managers to those with more than 10 years’ role tenure. The seminars were facilitated by a seasoned nurse executive and nurse manager with expertise in narrative interpretation. Results Interpretation of the paradigm case of one nurse manager suggests that complex leadership challenges can be a source of significant experiential learning for the individual and for the group. Conclusions Articulating and reflecting on experiential learning elucidates the skilled knowledge and judgment embedded in nurse manager practice which cannot be accessed in any other way. Implications for nursing management Articulating the practical knowledge which is necessary for effective nurse manager practice can hasten the development of role incumbents.     

The relationship between nursing leadership and patient outcomes: a systematic review

AIM: The purpose of this review was to describe findings of a systematic review of studies that examine the relationship between nursing leadership and patient outcomes. BACKGROUND: With recent attention directed to the creation of safer practice environments for patients, nursing leadership is called on to advance this agenda within organizations. However, surprisingly little is known about the actual association between nursing leadership and patient outcomes. METHODS: Published English-only research articles that examined formal nursing leadership and patient outcomes were selected from computerized databases and manual searches. Data extraction and methodological quality assessment were completed for the final seven quantitative research articles. RESULTS: Evidence of significant associations between positive leadership behaviours, styles or practices and increased patient satisfaction and reduced adverse events were found. Findings relating leadership to patient mortality rates were inconclusive. CONCLUSION: The findings of this review suggest that an emphasis on developing transformational nursing leadership is an important organizational strategy to improve patient outcomes.     

The emergency department case manager: effect on selected outcomes

The purpose of this research is to examine the effect of having nursing case managers (NCMs) assigned in the emergency department (ED). This research evaluates criteria from the following aspects: inappropriate admissions to the intensive care unit precertification of admissions to the hospital, intensive case unit diversion rates for the hospital, cost savings, and staff and patient satisfaction. The method utilized was a pretest and posttest design examining data on several variables before and after placing the NCMs in the ED. The time frame for the study is 1 year in an urban, 534-bed acute care teaching facility. NCMs were assigned to the ED 7 days a week and were responsible for precertification for admissions and working with physicians to determine that patients are admitted to the most appropriate level of care. Data will be collected through a variety of sources.     

Music as intervention: a notable endeavor to improve patient outcomes

Music interventions have been used in medicine and nursing throughout history. Music therapy is an easy-to-administer, relatively inexpensive, noninvasive intervention that has been used to reduce heart rate, blood pressure, myocardial oxygen consumption, gastrointestinal function, anxiety, and pain. A review of theoretic and empirical base for the use of music therapy to improve patient outcomes in a variety of areas of clinical practice is presented. Implications for practice and future research are suggested.     

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.     

Clinical pathways to improve patient outcomes

Abstract

A dynamic plan of care should be established for each diagnosis to optimise patient outcomes. There is evidence to support the view that these dynamic plans or clinical pathways improve patient compliance. This pathway would create a relationship between the clinician and patient, increase autonomy, and decrease paternalism. It will delineate frequency, duration, pain, and time to reach the anticipated functional goal of the patient. Informed consent and patient rights have been discussed in the literature as an ethical challenge. A respect for the legal implications of an informed consent must continue, along with an open dialogue about the clinical pathway. The informed consent would transition from a legal document to an active clinical pathway, providing increased autonomy, improved outcomes, and better patient compliance.     

The clinical nurse specialist: developing the case manager role

Case management improves cost and quality outcomes in patient care. The clinical nurse specialist is a key person to implement this role and to assure that the nursing focus is on quality outcomes as well as cost factors.     

The role of the case manager in a disease management program

Disease management programs provide new opportunities and roles for case managers to provide population-based healthcare to the chronically ill. This article identifies common components of disease management programs and examines roles assumed by case managers in disease management programs such as baseline assessment, performing economic analyses of diseases and their respective associated resource utilization, developing and/or implementing care guidelines or algorithms, educational interventions, disease management program implementation, and outcomes assessment. Areas of expertise needed to be an effective case manager in a disease management program are also identified.     

The role of the case manager in a disease management program

Disease management programs provide new opportunities and roles for case managers to provide population-based healthcare to the chronically ill. This article identifies common components of disease management programs and examines roles assumed by case managers in disease management programs such as baseline assessment, performing economic analyses of diseases and their respective associated resource utilization, developing and/or implementing care guidelines or algorithms, educational interventions, disease management program implementation, and outcomes assessment. Areas of expertise needed to be an effective case manager in a disease management program are also identified.     

Using nurse leader development to improve nurse retention and patient outcomes: a framework

With many factors converging, it is critical that nurse leaders have the knowledge and competency to develop outstanding relationships with registered nurses in order to retain them and thus improve patient outcomes. Senior nurse leaders of Methodist Le Bonheur Healthcare, a 7-hospital system based in Memphis is addressing these issues through a comprehensive leader development framework. Through organizational commitment and supported by a federal grant, a program that focuses on creation of individual development plans, provision of development education, and one-to-one on-site coaching has been implemented.