Addressing the nursing work environment to promote patient safety

TOPIC: The nursing work environment has a critical impact on patient safety. Yet confusion on the specific roles and competencies of nurses, staff ratio issues, and lack of nurse empowerment create weaknesses that result in safety risks. PURPOSE: These interrelated issues must be addressed systemically to impact the nursing care system. DISCUSSION: Educational reform focusing upon standardized, higher level nursing education using a military model, appropriate staff ratio laws derived from the outcomes literature, and recurrent training incorporating policy-making powers can result in nurse empowerment and improved patient safety. CONCLUSION: Improving the nursing environment requires a broad approach to benefit patient safety. By treating the work environment as a complex system, approaches can result in greater nurse professionalism, empowerment, and patient safety.     

Ethical issues faced by nursing editors

This study reports on ethical issues faced by editors of nursing journals, a topic which has not appeared in the nursing literature. A survey of nursing editors (n = 88)was conducted via e-mail; this article is the content analysis of survey questions about ethics. Eight categories of ethical issues emerged: problems with society/association/publisher; decisions about inflammatory submissions; informed consent or IRB issues; conflicts of interest; advertising pressures; duplicate publications and/or plagiarism; difficult interactions with authors; and authorship. Some issues were similar to those published about medical editors; however, others were unique. This study can assist authors to better understand some of the ethical issues in publishing, can help editors to view their issues in the context of what others experience, and can assist societies and publishers to work toward avoiding these ethical issues in the future. Professional discussions about ethics in nursing publications should be the subject of ongoing research and scientific inquiry.     

The relationship between healthy work environments and retention of nurses in a hospital setting

ritter d . (2011) Journal of Nursing Management 19, 27–32
The relationship between healthy work environments and retention of nurses in a hospital setting Aim The purpose of the present paper was to determine the effect a healthy work environment has on the retention of nurses in a hospital setting. Background There is a nursing shortage that has been ongoing and is expected to continue, resulting in challenges for the healthcare system in the United States. The significance of this issue is the impact the nursing shortage will have on healthcare organizations and patients. Evaluation The present paper included an extensive review of the current literature. The literature reviewed encompassed scholarly peer-reviewed journal articles. This article focused on nurses, work environments and the impact of the work environments on retention. Key issues Important issues that emerged from this analysis were the dangers of an unhealthy environment, the impact a healthy work environment has on patient outcomes and retention, the Magnet link to healthy work environments and the manager’s role in creating and sustaining a healthy work environment. Conclusion The literature provided evidence of the link between healthy work environments and the retention of nurses in a hospital setting. Implications for nursing management The implications for management are to implement changes now to create a healthy work environment that will recruit and retain nurses to secure their position in the future.     

Advocating for nurses and nursing

Every nurse has the opportunity to make a positive impact on the profession through day-to-day advocacy for nurses and the nursing profession. In this article the author defines advocacy; describes advocacy skills every nurse can employ to advocate for a safe and healthy work environment; and explains how nurses can advocate for nursing as part of their daily activity whether they are point-of-care nurses, nurse managers, or nurse educators. The advocacy practices discussed are applicable whether advocating on one's own behalf, for colleagues at the unit level, or for issues at the organizational or system level.     

Focus paper: A method for discussing nursing issues

A position paper can be one avenue or method of providing a framework for discussing nursing issues with peers, colleagues, and health care executives. A position paper/issue paper will frequently focus on one view with subsections, but can raise many other questions as well as touching on additional nursing issues. It should be clear when developing a position paper that the goal of the paper is to provide a framework for discussion--with the major emphasis being on issues being raised, not resolved. The paper should also address how nursing is affected by these issues and how the entire hospital may be affected. Last, a position paper should also articulate your--the nurse executive's--position on the issues under discussion.     

Emotional intelligence in relation to nursing leadership: does it matter?

Aim  Discuss the importance of studying emotional intelligence (EI) of nursing leaders and the job satisfaction of nursing staff.
Background  The nursing shortage and issues with retention signifies the importance of assessing the influence nurse managers have on staff job satisfaction.
Evaluation  A review of the literature on the development of EI and the level of study involving nursing leadership was conducted to determine the need for further research in this area.
Key issues  Neurobehavioural research involving the limbic system has indicated that EI can be learned through educational programmes.
Conclusion  There is a need for further research in the area of EI of nurse managers in their role as leaders and the impact they have on the job satisfaction level of their nursing staff.
Implications for nursing management  The increasing nursing shortage and turnover rates signify the importance of research in the EI level of nursing leaders. Future research may include implementing educational programmes in the area of EI for nursing leaders resulting in a more positive work environment. Determining if EI influences nursing job satisfaction will provide a foundation for ongoing programme implementation to support and develop our nursing leaders.     

Integrating a nursing professional practice model and nursing informatics in a collective bargaining environment.

The integration of a professional practice model of nursing and nursing informatics support for that model is congruent with the goals of a professional nursing union. Thus, the collective-bargaining unit can be a powerful ally to nursing management in achieving the integration of a professional practice model of nursing and nursing informatics. This alliance is based on a shared vision of the nature of professional nursing practice and a common concern for the quality of working life and working environment of the professional nurse. This alliance can provide the basis for decision making about the type of nursing information system to be selected or developed for installation in a particular organization. Use of a participatory decision-making process will ensure that all nursing stakeholders are committed to the decision made and prepared to assist with the resolution of implementation issues as they arise. A harmonious alliance of nursing management and the nursing union ensures a partnership that will protect the clinical nursing caregiver and provide a unified voice for nursing within the organization to resist any attempt by other stakeholders to implement an information system that will not meet the needs of nursing. If nursing management and the collective bargaining unit share the concept of a professional model of nursing practice and view nursing informatics as a tool to assist the nursing staff to operationalize the professional model of nursing, then collaboration in resolving issues related to the implementation of nursing information systems will facilitate the process of achieving the integration of a professional practice model of nursing and nursing informatics support for that model.     

Beyond generational differences: a literature review of the impact of relational diversity on nurses' attitudes and work

wolff A.C., ratner P.A., robinson S.L., oliffe J.L. & Hall L.M. (2010) Journal of Nursing Management 18, 948–969
Beyond generational differences: a literature review of the impact of relational diversity on nurses' attitudes and work Aim Based on a review of the empirical literature, we examine the influence of selected diversity attributes on nurses’ work-related attitudes and behaviour. Background The nursing workforce has become increasingly heterogeneous in its age, educational attainment, and ethnicity/race distributions. There is considerable speculation, in the literature, that the work values of recent nursing graduates are discordant with more experienced nurses. Results A review of studies published between 1980 and 2009 in nursing, healthcare, psychology, and organizational behaviour led to the inclusion of 19 peer-reviewed research articles, from which our analyses are drawn. Key issues The findings indicate that age diversity leads to negative behaviour toward others in the workgroup (e.g. poor collegial relationships) whereas perceived work-values diversity is negatively associated with individuals’ own attitudes and behaviour toward their work as well as toward other members of their workgroup. Conclusions There is inconclusive evidence about the attributes that most significantly influence nurses’ attitudes and work; however, preliminary evidence supports the salience of work values. Implications for nursing management Irrespective of the actual diversity within workgroups, how nurses see one another can have a significant impact on members of their workgroups and their functioning. Broader conceptualizations of diversity are necessary.     

Power and empowerment in nursing: a fourth theoretical approach

Title. Power and empowerment in nursing: a fourth theoretical approach. Aim. This paper is a discussion of the use of poststructuralism as a means of exploring power and empowerment in nursing. Background. Power and empowerment are well‐researched areas of nursing practice, but the issue of how to empower nurses and patients continues to cause debate. Power and empowerment are complex issues and other researchers have provided some clarity by proposing three theoretical approaches: critical social theory, organizational theory and social psychological theory. We support their work and propose an additional poststructural approach as a means of analyzing power and empowerment in nursing. Discussion. The concept of power in nursing may be critiqued by drawing on the work of Michel Foucault and paying particular attention to two areas: disciplinary power and knowledge/power relationships. Foucault’s contention was that behaviour is standardized through disciplinary power and that power and knowledge are intertwined. Nurses who seek an understanding of empowerment must first grasp such workings as hierarchical observation, normalizing judgement, the examination, and power/knowledge relationships, and that cognizance of such issues can promote nursing practice that is empowering. They need to adopt a more critical stance to understanding power and empowerment in nursing, and one way of fostering such criticism is to view nursing practice through a poststructural lens. Conclusion. A poststructural approach merits a place alongside other approaches to understanding power and empowerment in nursing.     

The professional subcultures of students entering medicine,nursing and pharmacy programmes

This study sought to determine the attitudes, beliefs and values towards clinical work organization of students entering undergraduate medicine, nursing and pharmacy programmes in order to frame questions for a wider study. In the Faculty of Medical and Health Sciences, The University of Auckland students entering medicine, nursing and pharmacy programmes completed a questionnaire based on that used by Degeling et al. in studies of the professional subcultures working in the health system in Australia, New Zealand, England and elsewhere. Findings indicate that before students commence their education and training medical, nursing and pharmacy students as groups or sub-cultures differ in how they believe clinical work should be organized. Medical students believe that clinical work should be the responsibility of individuals in contrast to nursing students who have a collective view and believe that work should be systemized. Pharmacy students are at a mid-point in this continuum. There are many challenges for undergraduate programmes preparing graduates for modern healthcare practice where the emphasis is on systemized work and team based approaches. These include issues of professional socialization which begins before students enter programmes, selection of students, attitudinal shifts and interprofessional education.     

The professional subcultures of students entering medicine, nursing and pharmacy programmes

This study sought to determine the attitudes, beliefs and values towards clinical work organization of students entering undergraduate medicine, nursing and pharmacy programmes in order to frame questions for a wider study. In the Faculty of Medical and Health Sciences, The University of Auckland students entering medicine, nursing and pharmacy programmes completed a questionnaire based on that used by Degeling et al. in studies of the professional subcultures working in the health system in Australia, New Zealand, England and elsewhere. Findings indicate that before students commence their education and training medical, nursing and pharmacy students as groups or sub-cultures differ in how they believe clinical work should be organized. Medical students believe that clinical work should be the responsibility of individuals in contrast to nursing students who have a collective view and believe that work should be systemized. Pharmacy students are at a mid-point in this continuum. There are many challenges for undergraduate programmes preparing graduates for modern healthcare practice where the emphasis is on systemized work and team based approaches. These include issues of professional socialization which begins before students enter programmes, selection of students, attitudinal shifts and interprofessional education.     

Going blank: factors contributing to interruptions to nurses' work and related outcomes

hall l.m., ferguson-paré m., peter e., white d., besner j., chisholm a., ferris e., fryers m., macleod m., mildon b., pedersen c. & hemingway a. (2010) Journal of Nursing Management 18, 1040–1047
Going blank: factors contributing to interruptions to nurses’ work and related outcomes Aim To examine interruptions to nurses’ work, the systems issues related to these and the associated outcomes. Background While some research has described the role interruptions play in medication errors, work is needed to examine specific factors in the nursing work environment that cause interruptions and to assess the impact of these on nurses’ work and patient outcomes. Methods The present study utilized a mixed method design that involved work observation to detect nursing interruptions in the workplace followed by focus groups with a subsample of nurses. Results A total of 13 025 interruptions were observed. Equal numbers of these took place on medical and surgical units. The predominant source of interruptions was members of the health team, who interrupted more frequently on medical units. Conclusions Differences in the type of patient and the care needs between medical and surgical units may be a contributing factor to these findings. As members of the health team were among the leading source of interruptions, an interdisciplinary team-based approach to changing the organization and design of work should be explored. Implications for nursing management Nurse leaders should examine ways in which nurses’ work can benefit from system improvements to reduce interruptions that lead to patient safety issues such as treatment delays and loss of concentration.     

Preventive work with families: issues facing public health nurses

This paper examines the issues that nurses experience when entering the family system to work preventively. The theoretical basis of family-centered nursing is analysed and the need for empirical work is identified in order to develop a knowledge base for this practice. Some unique characteristics of the public health nursing role are discussed with emphasis on territorial issues, power relationships and accountability problems. The need for public health nurses to function as advanced generalists across different system levels is recommended and family skills necessary for effective family nursing are examined. The authors identify the unique role of public health nurses because they have access to healthy families and families dealing with early stages of health concerns. The authors support the general structure of public health practice as of value for preventive work with families. However, clarity regarding referrals, contracting and the rights of clients is called for to facilitate collaborative family-centred nursing.     

A qualitative study to determine the restratification of nursing

The theory of occupational closure is a neglected area in the field of nursing. This article attempts to determine its relevance to nursing within the current political and economic climate where skills shortages within the field of medicine and the introduction of the European Working Time Directive in Britain, has presented new opportunities for nursing on several fronts. The study attempted to identify the impact of this policy upon the working relationships of doctors and nurses. It also attempted to determine how doctors and nurses classify the work of nursing in current context and the reasons for so doing. A series of semi-structured interviews were conducted with a group of doctors and nurses working in a large teaching hospital in the English Midlands. The study showed that a restratification of nursing has occurred whereby a three-tier classification system has emerged within the hierarchy of nursing. The findings have opened up a debate concerning issues of power, territorialism and new directions for the future of nursing.     

The complexity of developing a nursing information system: a Brazilian experience

Information systems development is a complex process involving technical, organizational, social, and environmental issues. The active participation of nurses in information systems development is important but not easily accomplished, especially in settings in which the nurses are not familiar with the technology. Participatory design, which focuses on community participation, is an approach to information systems development that is not often used. This article explains this approach and describes the experience of using the participatory-design approach in designing a nursing information system project in a Brazilian teaching hospital. Traditional systems- development approaches are not sensitive to individuals' needs or political and organizational dimensions. The focus of the article is on the basic topics discussed with nurses and the relevance of those topics to the design of nursing information systems. A nursing classification system is a basic component of an information system and a relevant instrument for the creation of formalized nursing knowledge. However, we should not neglect other approaches that can contribute to a better understanding of nursing work situations and the development of nursing knowledge.     

Modelling nursing activities: electronic patient records and their discontents

A fully integrated and operating EPR in a clinical setting is hard to find: most applications can be found in outpatient or general practice settings or in isolated hospital wards. In clinical work practice problems with the electronic patient record (EPR) are frequent. These problems are at least partially due to the models of health care work embedded in EPRs. In this paper we will argue that these problems are at least partially due to the models of health care work embedded in current EPRs. We suggest that these models often contain projections of nurses' and doctors' work as it should be performed on the ward, rather than depicting how work is actually performed. We draw upon sociological insights to elucidate the fluid and pragmatic nature of healthcare work and give recommendations for the development of an empirically based EPR, which can support the work of nurses and other health care providers. We argue that these issues are of great importance to the nursing profession, since the EPR will help define the worksettings of the future. Since it is a tool that will impact the development of the nursing profession, nurses have and should have a stake in its development.     

The Italian economic crisis and its impact on nursing services and education: hard and challenging times

Bortoluzzi G. & Palese A. (2010) Journal of Nursing Management 18 , 515–519
The Italian economic crisis and its impact on nursing services and education: hard and challenging times Aims Three levels of impact are reported and discussed in this commentary: the ‘macro’ level, which corresponds to policy(ies); the ‘meso’ level, which corresponds to nursing services and nursing education; and the ‘micro’ level, which deals with clinical practice and education, where interactions between patients and nurses and/or students take place. Background The Italian economy is showing some signs of recovery after the worst economic crisis of past decades. However, these signs are still quite weak and insufficient to declare that the country is finally coming out of it. Key issues Several negative impacts of the economic crisis on nursing services and nursing education are documented. Reports have started to document initial signs of the economical crisis impact on patients too. Present and future issues related to nursing services, education and clinical practice are commented both from national data and from nurses’ daily perceptions. Implications for nursing management The Italian economic crisis will leave a heavy burden on the shoulders of future generations. Nurses’ leaders are coping with these challenges, innovating the nursing system and preparing a sustainable future for generations of patients and nurses.     

Foucault could have been an operating room nurse

BACKGROUND: Operating room nursing is an under-researched area of nursing practice. The stereotypical image of operating room nursing is one of task- and technically-orientated aspects of practice, where nurses work in a medical model and are dominated by constraints from outside their sphere of influence. This paper explores the possibility of understanding operating room nursing in a different way. AIM: Using the work of Michel Foucault to analyse the work of operating room nursing, this paper argues the relevance of the framework for a more in-depth analysis of this specialty area of practice. CONTENT: The concepts of power, discipline and subjectivity are used to demonstrate how operating room nursing is constructed as a discipline and how operating room nurses act to govern and construct the specialty. Exemplars are drawn from extensive professional experience, from guidelines of professional operating room nursing associations, as well as published texts. The focus is predominantly on the regulation of space and time to maintain the integrity of the sterile surgical field and issues of management, as well as the use of the ethical concept of the 'surgical conscience'. CONCLUSIONS: This form of analysis provides a level and depth of inquiry that has rarely been undertaken in operating room nursing. As such, it has the potential to provide a much needed, different view of operation room nursing that can only help to strengthen its professional foundations and development.     

‘I feel like a salesperson’: the effect of multiple‐source care funding on the experiences and views of nursing home nurses in England

The difficulties faced in the recruitment and retention of nursing staff in nursing homes for older people are an international challenge. It is therefore essential that the causes of nurses’ reluctance to work in these settings are determined. This paper considers the influence that multiple‐source care funding issues have on nursing home nurses’ experiences and views regarding the practice and appeal of the role. The methodology for this study was hermeneutic phenomenology. Thirteen nurses from seven nursing homes in the North East of England were interviewed in a sequence of up to five interviews and data were analysed using a literary analysis method. Findings indicate that participants are uncomfortable with the business aspects that funding issues bring to their role. The primary difficulties faced are: tensions between care issues and funding issues; challenges associated with ‘selling beds’; and coping with self‐funding residents’ changing expectations of care. The findings of the study suggest that multiple‐source care funding systems that operate in nursing homes for older people pose challenges to nursing home nurses. Some of these challenges may impact on their recruitment and retention.