Professional Nurse Councils

Chief nurse executives and hospital administrators continue to debate the efficacy of empowering nurses through the structure of a nurse practice council. The author presents a new approach to a successful strategy to re-engineer an organization's nurse practice council that increases the value to the organization and creates excitement and energy in the staff with improved productivity.

The Perioperative Nursing Data Set in Korean: Translation, Validation, and Testing

Researchers in South Korea translated the Perioperative Nursing Data Set (PNDS) into Korean and tested its validity and usefulness in South Korean clinical settings. To evaluate the usefulness of the translated PNDS, 142 nurses were surveyed, and the narrative nursing notes of 20 surgical patients discharged from two tertiary hospitals in Seoul, South Korea, were analyzed and mapped using the PNDS. Although nurses found it to be useful, the researchers recommend certain additions to the PNDS, including the addition of action-related statements, to improve its usefulness in Korean perioperative settings.

Lessons learned when Magnet designation is not received

Magnet designation is the highest level of acknowledgement accorded healthcare organizations in recognition of professional nursing care. After our nursing leadership team attended a Magnet conference in 1998, we were inspired, and so was our staff. In 2004, we submitted our documentation and were notified that it met the criteria, and our site visit was scheduled. We did not receive Magnet designation, but we viewed our experience as an opportunity to learn. The authors describe how a disappointing outcome was turned into an experience of great learning and transformation.

The impact of hospital structure and restructuring on the nursing workforce

OBJECTIVE

Health systems throughout much of the world have been subject to 'reform' in recent years as countries have attempted to contain the rapidly rising costs of health care. Changes to hospital structures (restructuring) have been an important part of these reforms. A significant impact of current approaches to restructuring is the loss of, or changes to, nursing management roles and functions.

SETTING

Australian hospitals

PRIMARY ARGUMENT

Little evaluation has been undertaken to determine the impact of hospital structure and organisational restructuring on the nursing workforce.

CONCLUSIONS

There is some indication that nurses have experienced a loss of key management positions, which may impact on their capacity to ensure that adequate and safe care is provided at the ward level.

Creating an Environment for Caring Using Lean Principles of the Virginia Mason Production System

As healthcare leaders search for viable options to cut costs, increase efficiencies, and improve the product that they offer to customers, many are looking at different business models to adopt. At the same time, an aging workforce of nurses feel the pressure of being overworked and understaffed, resulting in both decreased job and patient satisfaction. Virginia Mason Medical Center in Seattle, Wash, has implemented the Virginia Mason Production System, using proven concepts adapted from the Toyota Production System that effectively eliminate "muda" or waste, in workplace processes. The authors discuss the application of the Virginia Mason Production System and how it has resulted in increased time for nurses to care for their patients.

Shared Governance

The shared governance literature contains numerous examples of how to design and implement nursing shared governance models. However, there is a major gap between design/implementation and a change in culture. A change in nursing culture will support viability of this governance model. The authors detail the steps taken by a shared governance transition team to help a large nursing organization make changes in governance process and perception as well as to incorporate a maintenance plan.

[The nurse's administrative point of view in the hospitalar macro system: a reflexive study]

The study aimed at investigating the nurses' administration points of view concerning managing activities in the hospital macro-system, based on the Administration Contingent Theory A group of 9 nurses responsible for the administration of nursing services at 6 reference hospitals in Fortaleza/Ceara, participated of the study. Data were assessed by means of free interview techniques, from August to December 2001. The results suggest that the administrative approach focused the development of Leadership and Control activities. The interview outcomes reveal that nursing administration in a Hospital Macro-system was not perceived as an easy task, but feasible nevertheless. The greatest difficulty seemed to be due to a poor reflexive practice about the nurse's administrative attributions.

The Magnetism of Theory

Theory was largely considered to be the province of academia until the Magnet Recognition Program brought it into the mainstream of hospital nursing practice. The author describes how 1 hospital selected a nursing theory and philosophy, integrated the concepts across nursing services, and positively affected the hospital as a whole. Jean Watson's theory of human caring was chosen because it closely aligned with the culture of the organization. Specific implementation strategies are discussed, and outcomes of the process are described. This article will assist others engaged in similar endeavors.

Data warehouse approach to nursing management

AIM

This article describes a data warehouse approach when designing an information system to meet nursing management needs in acute hospital setting.

BACKGROUND

The rapidly changing health care environment has created new challenges for nursing leaders and requires appropriate, accurate and timely data for decision-making.

METHOD

Key aspects of current information needs were identified by a nursing expert group. A data warehouse-based Nursing Management Information System was produced and piloted in nine wards. A survey and interviews were conducted to evaluate the piloting.

RESULTS

Data from the patient administrative system together with nursing rostering data and measures for nursing care intensity brought new opportunities for nursing management.

CONCLUSIONS

A Nursing Management Information System is suggested to be built using data warehouse model. Successful implementation of a Nursing Management Information System requires systematic data quality checks. An information analyst is essential for interpreting and communicating nursing data to multi-professional management groups.

The Safety Organizing Scale: development and validation of a behavioral measure of safety culture in hospital nursing units

BACKGROUND

Evidence that medical error is a systemic problem requiring systemic solutions continues to expand. Developing a "safety culture" is one potential strategy toward improving patient safety. A reliable and valid self-report measure of safety culture is needed that is both grounded in concrete behaviors and is positively related to patient safety.

OBJECTIVE

We sought to develop and test a self-report measure of safety organizing that captures the behaviors theorized to underlie a safety culture and demonstrates use for potentially improving patient safety as evidenced by fewer reported medication errors and patient falls.

SUBJECTS

A total of 1685 registered nurses from 125 nursing units in 13 hospitals in California, Indiana, Iowa, Maryland, Michigan, and Ohio completed questionnaires between December 2003 and June 2004.

RESEARCH DESIGN

The authors conducted a cross-sectional assessment of factor structure, dimensionality, and construct validity.

RESULTS

The Safety Organizing Scale (SOS), a 9-item unidimensional measure of self-reported behaviors enabling a safety culture, was found to have high internal reliability and reflect theoretically derived and empirically observed content domains. The measure was shown to discriminate between related concepts like organizational commitment and trust, vary significantly within hospitals, and was negatively associated with reported medication errors and patient falls in the subsequent 6-month period.

CONCLUSIONS

The SOS not only provides meaningful, behavioral insight into the enactment of a safety culture, but because of the association between SOS scores and reported medication errors and patient falls, it also provides information that may be useful to registered nurses, nurse managers, hospital administrators, and governmental agencies.

Comparison of nurse, system and quality patient care outcomes in 8-hour and 12-hour shifts

BACKGROUND

Many nurses desire 12-hour shifts. However, there are concerns about implementation.

OBJECTIVE

We sought to compare the effects of 8- and 12-hour shifts on nurse, system, and quality patient care outcomes.

METHODS

We used a cross-sectional design with data collected from multiple sources in 2003-2004, including a nurse survey and administrative and patient records. We studied hospital nurses and patients in general adult wards, with outcomes including burnout, job satisfaction, scheduling satisfaction, preferences, intention to stay, and employee safety. System outcomes included recruitment and turnover, staffing, absenteeism, and related costs. A variety of quality patient care outcomes were measured from the 3 different types of data.

RESULTS

Thirteen New York City hospitals participated; 805 surveys were examined from 99 nursing units (response rate 42%). Compared with nurses working 8-hour shifts, those working 12-hour shifts were on average more satisfied with their jobs, experienced less emotional exhaustion, 10 times more likely to be satisfied with schedules, 2 times as likely to perceive 12-hour schedules as important, and 58% less likely to report missing shifts; units with 12-hour shifts had lower vacancy rates and weeks to fill the position (all P values < or =0.05). There were no differences in patient outcomes.

CONCLUSIONS

Nurses working 12-hour shifts were more satisfied. There were no differences in quality outcomes. Flexibility and choice in shift length are important elements in a positive nurse work environment. This study represents an innovative attempt by a labor-management bargaining group to make an evidence-based decision. We encourage others to conduct similar studies.

Barriers to Achieving Patient-Centered Care In Ireland

In today's healthcare environment, patient care has become fragmented and impersonalized even though we desire to give person-centered care. Many factors affect the way we must deliver nursing care. This article discusses patient care in Ireland in the contemporary intensive care setting that has become more task-oriented and less patient-centered.

Organizational Climate and Occupational Health Outcomes in Hospital Nurses

OBJECTIVE

The objective of this study was to determine relationships between organizational climate (OC) factors and occupational health outcomes (lost workdays, musculoskeletal injury, blood and body fluid exposures, injuries, and burnout) among hospital-based nurses.

METHODS

Measures were obtained through a self-administered, anonymous survey distributed in 13 New York City hospitals. Multivariate models appropriate for clustered data were developed. These analyses controlled for nurse and employment characteristics. Independent effects of OC factors were examined.

RESULTS

Surveys from 2047 predominantly registered nurses were obtained (response rate 50%). More than 75% reported lost workdays due to illness in the previous 4-month period and over one third reported experiencing some type of injury. OC factors were independently associated with injuries and measures of burnout (P < or = 0.05).

CONCLUSIONS

OC is significantly associated with the health and well-being of hospital nurses.

Why you should consider working at a magnet hospital

Here are the reasons I love working at a Magnet facility.

Innovative Solutions: Leading the Way

In an effort to improve patient outcomes, there has been a global initiative to prevent avoidable adverse events. The rapid response team or medical emergency team concept has been in existence for the past several years and there has been a significant improvement in patient outcomes. This article will describe one institution's success in taking this concept even further by rounding on general care units before patient problems are evident. The focus of this discussion will be on the remarkably positive nursing staff outcomes that have been achieved as a result of a program called the Early Nursing Intervention Team, a totally nurse-led program.

Health care-based interventions for women who have experienced sexual violence: a review of the literature

Thirty publications that evaluated health care-based interventions for women who experienced sexual violence were reviewed. The findings highlight that clinicians often need training in the provision sexual assault care, and that not all emergency departments have sexual assault care protocols. Studies examining effectiveness found that Sexual Assault Nurse Examiner programs are very helpful, that health care-based sexual assault treatment settings attract more women than do forensic-based settings, that sexual assault survivors often prefer a combination of medication and counseling treatment, and that preexam administration of a video explaining the collection of forensic evidence may reduce women's stress during the procedure. Studies on postexposure HIV prophylaxis found that many women did not complete the treatment regimen, often because of side effects. Emergency contraception to prevent postrape pregnancy is not consistently offered to women. Only one study reported on abortion as part of the range of sexual assault services.

Preparedness for Influenza Pandemic in Hong Kong Nursing Units

BACKGROUND

To present preparedness planning for an influenza pandemic for two nursing subunits: nursing services in hospitals and schools of nursing in universities.

DISCUSSION

The preparedness plan is modeled on a modified Haddon matrix, a logical approach to identify measures appropriate for the pre-event, event, and postevent phases of an influenza pandemic. For the pre-event phase, the objective is to ensure preparedness for the potential pandemic outbreak through training, communication, surveillance, infection control, and vaccination. Once the pandemic outbreak is declared, the aim is to implement effective measures to ensure a rapid and appropriate response. For the postevent phase, the plan is focused on the restoration of core functions, vigilance for a second or possibly more waves of the pandemic, and psychosocial support to staff and students.

CONCLUSION

Measures required to prepare for, respond to, and manage the consequences of influenza pandemic are identified. This planning indicates the need to balance a logical approach with contextual perspectives and the importance for nursing leaders to develop plans for subunits of larger entities.

Magnet hospital characteristics and northern Canadian nurses' job satisfaction

Retention of health professionals is a serious problem in northern and rural Canada. Magnet hospital factors are known to increase job satisfaction, which contributes to retention. The purpose of this paper is to examine the extent to which magnet hospital characteristics (management support, nurse-doctor and nurse-manager relationships, professional autonomy and responsibility) contribute to northwestern Canadian hospital nurses' job satisfaction. Participants were 123 nurses from 13 hospitals in western Canada. They completed a survey and structured interview that provided data on their attitudes and perspectives about their hospital jobs. We found that some magnet hospital characteristics apply in northern and rural western Canadian hospitals. Our findings indicate that management support and nurse-manager relations are important to nurses' job satisfaction, but participants' views of management were fairly negative, an issue that management needs to address. Nurses' ability to work professionally and autonomously is also important to their satisfaction. There are indications that nursing supervisory skill sets need to be upgraded in some instances.