Achieving Magnet accreditation in the UK: a case study at Rochdale NHS Trust

AIMS: This study explored the Magnet accreditation process in the first health care organization outside the USA to attempt to gain the award, Rochdale NHS Trust United Kingdom. The development was supported by the American Nurses Credentialing Center as a pilot project and the research conducted as a case study in organizational response to the requirements of a new accreditation system. METHOD: Information was collected via 23 face-to-face and three telephone interviews carried out with 11 senior figures at Rochdale during the 2-year period of the Magnet project, from field notes of meetings attended by the researchers and from analysis of documents associated with the project. RESULTS: The work of applying for Magnet accreditation built upon a previous 2-3 year programme of shared governance and clinical leadership throughout the Trust which senior staff felt had been an essential foundation for the Magnet project. The process enabled staff to assemble evidence which held up a mirror to their practice and contributed to other quality-related initiatives. The experience at Rochdale suggests that Magnet enables care areas to identify and celebrate examples of good practice and for lessons to be learned and shared within the organization. Although the Magnet concept is primarily nursing oriented, medical and allied health professionals were able to contribute and benefit. The application was successful and Rochdale was awarded Magnet status in April 2002. CONCLUSIONS: The Magnet project at Rochdale was essentially a process of collecting evidence to formally recognize previous leadership initiatives and their effects within the organization. The emergent approach to implementing the Magnet project was one which attempted to integrate and utilize existing systems and resources. The project provides evidence that Magnet can be transferred to non-US health care systems. The principal issues associated with this transfer were the costs incurred, the interpretation of terminology and the engagement of medical and allied health professionals.     

Long-term adherence to a local guideline on postoperative body temperature measurement: mixed methods analysis

Aim To find out whether a successful multifaceted implementation approach of a local evidence‐based guideline on postoperative body temperature measurements (BTM) was persistent over time, and which factors influenced long‐term adherence. Methods Mixed methods analysis. Patient records were retrospectively examined to measure guideline adherence. Data on influencing factors were collected in focus group meetings for nurses and a plenary meeting with an interactive questionnaire for doctors. Results Records from 102 surgical patients were studied, totalling 1226 BTM. According to the guideline, an indication for BTM was present in 55% (679/1226). Actually, BTM were taken in 60% (736/1226), of which 55% (403/736) was in accordance with the guideline. The overall adherence rate to the guideline was 50% (617/1226). Belief in the advantages of the guideline and strong staff support appeared to facilitate long‐term adherence. Barriers were, the controversial nature of the guideline, the lack of self‐efficacy among nurses and doctors as to clinical judgement to identify an infection when refraining from BTM, and a lack of management and staff doctor support. Furthermore, newly appointed nurses and doctors were trained to measure BTM during their initial medical or nursing education, which was in contradiction with the guideline. Conclusions A multifaceted implementation strategy is not sufficient to maintain long‐term adherence. To ensure long‐term adherence, especially of controversial guidelines, adherence should be monitored and reported regularly over time. Strong staff support and leadership on all wards is crucial to maintain awareness. Medical and nursing curricula should include the pros and cons of taking BTM, combined with enhancing self‐efficacy.     

Transformation: are nurse leaders in critical care ready?

Aim The aim was to determine whether nursing leaders met the criteria for transformational and/or transactional leadership. Background Many changes have occurred in South Africa and are reflected in the health-care systems. As a result, it has become crucial to source leaders who are able to manage the change process effectively so as to ensure the success and survival of our health-care organizations. Methods The 45-item Multifactor Leadership Questionnaire (Rater) was completed by 41 respondents out of a population of 121. A proportional stratified simple random sampling technique was used to select the raters of seven leaders. Results Most nursing leaders role-modelled the culture of the organisation but did not stimulate their followers intellectually and did not demonstrate innovative motivation or individual consideration. Consequently, their followers may exhibit a lack of commitment to collective goals, with detrimental effects on the health-care organisation as a whole. Conclusions and implications for nursing managers Nursing leaders should be trained to become transformational leaders so as to encourage their followers to become innovative and motivated to render high quality nursing care.     

First-line nurse leaders' health-care change management initiatives

macphee m. & suryaprakash n . (2012) Journal of Nursing Management 20, 249–259
First-line nurse leaders’ health-care change management initiatives Aim To examine nurse leaders’ change management projects within British Columbia, Canada. Background British Columbia Nursing Leadership Institute 2007–10 attendees worked on year-long change management initiatives/projects of importance to their respective health-care institutions. Most leaders were in first-line positions with <3 years’ experience. Method Consenting leaders’ project reports (N = 133) were content analysed for specific themes: types of projects; scope of projects (e.g. unit or local level, departmental, institutional); influence targets or key stakeholder groups targeted by the projects; leadership successes and challenges. Results Of study participants, 77% successfully completed their projects. Staff tool and resource development and existing services improvement were major project types. Care delivery teams were the major influence targets. Only 25% of projects were at the unit level. Many projects had broader scopes, such as institutional levels. Participants cited multiple leadership successes, including enhanced leadership styles and organizational skills. Conclusion First-line nurse leaders were able to successfully manage projects beyond their traditional scope of responsibilities. The majority of projects dealt with staff needs and healthcare restructuring initiatives. Implications for nursing management Constant change is a global reality. Change management, a universal competency, must be included in leadership development programmes.     

Transition support for the newly licensed nurse: a programme that made a difference

dyess s. & parker c.G. (2012) Journal of Nursing Management  20, 615–623 Transition support for the newly licensed nurse: a programme that made a difference Aim To describe and evaluate a collaborative programme that supports newly licensed registered nurses (RNs). Background New RN transition is recognized globally as a challenge. Nurse managers desire successful programmes that support transition into professional practice. One community developed and implemented an on-going programme that supported the new RNs transition and leadership development. Methods One hundred and nine newly licensed nurses participated in a 10-month programme. Quantitative data were collected and analysed. The present study reports on the evaluation of the programme. Results Skill acquisition occurred, retention improved, and transition was supported. Leadership development and psychosocial and technical skills sets improved for participants involved with the programme. Conclusions and implications for Nursing Management The results of the present study suggest that transition support is valuable. Enhanced retention, improved transition and leadership development were noted. Newly licensed RNs gained leadership, patient care and professionalism skills, and were supported with their transition. The results demonstrate that Nurse Managers need to consider opportunities to offer their newly licensed nurses a programme that is targeted for transition support and leadership development.     

'The responsibility of someone else': a focus group study of collaboration between a university and a hospital regarding the integration of caring science in practice

Scand J Caring Sci; 2012; 26; 579–586 ‘The responsibility of someone else’: a focus group study of collaboration between a university and a hospital regarding the integration of caring science in practice Aim: The aim of the study was to develop insights into how nurses, senior preceptors and head nurses experience the integration of caring science in practice and how they value the contributions of nursing students to the integration of caring science in practice. Background: Research still reveals differences between theory and practice by nursing students. In Sweden, clinical education units have become one way of creating consistency between university and health care practices on values of caring. Method: The study is hermeneutic in design comprising data from three focus group interviews. The participants include registered nurses, senior preceptors and head nurses. Result: The study shows that roles and mandates are not clearly defined between the different actors. The university and hospital collaboration in caring science integration was regarded as ‘someone else’s responsibility’. Research and development seemed excluded from the everyday life of the hospital units. The students seemed to fall somewhere between the hospital ‘practice and concrete world of production’ and the university ‘theory world of education and research’. Three themes emerge: ‘integration – someone else’s responsibility’, ‘the hospital – a culture of production’ and ‘the hospital and the university – different realities’. Discussion: The results suggest the need for professionals within health care and university to reflect on their responsibilities in terms of research and development. The ethos of caring science implies the alleviation of suffering and caring for vulnerable patients including research and development.     

Nurse executive director effectiveness: a systematic review of the literature

AIM: This report systematically reviews studies of nurse executive director effectiveness to identify recurring themes that might inform current practice and future research. BACKGROUND: Increasing competition in healthcare markets is increasing the demands on nurse executive directors. There is a need to identify factors that contribute to effectiveness in the role so that these can be developed and effectiveness improved. EVALUATION: Reports were identified using electronic databases, an internet search and review of references in all reports initially identified. The methodology of these reports was reviewed and recurring themes were identified. KEY ISSUES: Ten themes that might be associated with nurse executive director effectiveness emerged from the review. CONCLUSIONS: The literature relating to nurse executive director effectiveness is limited but there are sufficient recurring themes to inform current practice and to investigate in new research.