The role of the chief nursing officer in leading the practice: lessons from the Benner tradition

There is a real danger that measurable tasks and procedures can be misconstrued for nursing practice in contemporary healthcare organizations focused on the measurement of quality, safety, and productivity. This study uses the work of Patricia Benner to address the complex nature of nursing practice and discusses why the chief nursing officer must create an environment within the organization for the practice to be fully lived out if he or she is to be successful as the leader of the discipline.

Illuminating the inner leadership journey by engaging intention and mindfulness as guided by caring theory

Sustained, high-performance nursing leadership can be effectively guided by caring theory. While much of leadership performance is manifested by external behaviors, highly effective leaders are also grounded by internal work of self-reflection and growth. This article focuses primarily on the inward journey of leadership as guided by Jean Watson's Theory of Human Caring. Key elements of the theory are interpreted within the context of the emerging, urgent, high-stakes challenges of the current healthcare environment. The links between self-nurturance and caring-healing leadership of others are explored.

Collaboration through clinical integration

Rising healthcare costs and the nursing shortage have affected the ability of healthcare organizations to provide a collaborative environment for high-quality care. Recent studies show that the nursing shortage has resulted in increased work loads, fewer support resources, and nurse dissatisfaction, resulting in difficulty providing quality care. Henneman cited a lack of collaboration as a contributing factor to the fragmentation of care and poor outcomes which plague our healthcare system. Knaus et al found that hospitals where collaboration was present reported 41% lower mortality than predicted number of deaths. Hospitals where there was a little collaboration exceeded predicted mortality by 58%. Positive collaborative relations have also been tied to a decrease in negative patient outcomes, increased organizational commitment, and nurse satisfaction as well as reduced cost and greater responsiveness for healthcare providers. The aim of this discussion is to introduce the participant to the concept of collaboration and use of the Donabedian structure-process-outcome model to provide a framework for embedding best practice components necessary for multidisciplinary collaboration in an acute care setting. The National Joint Practice Commission recommendations and the work of Schmalenberg et al were utilized to establish structural and process components necessary for a collaborative practice environment. Trinity Regional Health System utilized this information in conjunction with the Center for Case Management to develop a care model and improve patient outcomes. The average length of stay (LOS) decreased from 4.24 to 3.37 days and cost per admission from $6723 to $5919 in just over 1 year.

Mission (IM) possible? Nurse civility in the NICU

Nurses will work in a unit and choose to stay because they feel pride in their work and are respected. Eliminating horizontal hostility at the unit level begins with a commitment from the NICU's leadership. Establishing and maintaining an environment of civility is essential if the unit is to successfully recruit and maintain the best staff to care for the patients entrusted to it.

Factors affecting incident reporting by registered nurses: the relationship of perceptions of the environment for reporting errors, knowledge of the nursing practice act, and demographics on intent to report errors

Patient safety has assumed an international focus. In the past, the focus on detecting and preventing errors was up to the individual clinician, often the registered nurse. With impetus from the Institute of Medicine and other national agencies, a shift to emphasis on systems and processes and near miss and error reporting has occurred. Information from caregiver reporting has taken on new importance. This study was conducted to explore nurses' willingness to report errors of varying degrees of severity and the factors that impacted that intent. Registered nurses were selected randomly from the Texas Board of Nurse Examiners' roster and surveyed regarding perceptions of the environment for reporting, perceptions of reasons for not reporting, knowledge of the nursing practice act, and demographic variables. A majority of nurses were willing to report all levels of errors. Primary position, reasons for not reporting, and years since initial licensure were predictors of intent to report incidents with no injury and those with minimal injury. All but four nurses (99%) indicated that they would report incidents resulting in moderate to severe injury or death.

The level and determinants of mission statement use: a questionnaire survey

BACKGROUND

Although mission statements are one of the most popular management instruments, little is known about the nature and direction of the presumed relationship between mission statements and organizational performance. In particular, empirical insights into the degree of mission statement use by individual organizational members are insufficient.

OBJECTIVES

We address the observed knowledge gap by (a) measuring the level of mission statement use (e.g., explaining the mission statement, making linkages to extant programs or practices, communicating enthusiasm, and adapting the mission statement to the personal work situation) by individual organizational members, and (b) identifying the antecedents that influence mission statement use.

DESIGN

Questionnaires were used to collect data from a sample of 510 nurses from three Flemish hospitals. Mission statement use was measured by means of Fairhurst's Management of Meaning Scale. Antecedents of mission statement use were derived from the Theory of Planned Behavior and the mission statement literature.

RESULTS

The findings indicate that mission statement use is low on average. Attitude, subjective norm, perceived behavioral control, and formal involvement in mission statement communication proved to be significant determinants of mission statement use and accounted for 43% of the variance. The results of the conducted regression analyses indicate that nurses (a) who have a positive attitude towards the mission statement, (b) who perceive pressure from superiors and colleagues to use the mission statement, (c) who feel they are in control of performing such behavior, and (d) who are formally involved in the mission statement communication processes are more likely to use the mission statement. Furthermore, the results indicated that demographic characteristics are not associated with mission statement use.

CONCLUSIONS

To effectively increase mission statement use, investments should focus on redesigning a work environment that stresses the importance of the organizational mission statement and provides detailed information on the ways that individual organizational members can contribute in realizing the mission statement.

The rural nurse work environment and structural empowerment

Rural health care organizations struggle to attract and retain nurses, yet much of the research has focused on characteristics of the nurse work environment or empowerment in urban hospitals. The purpose of this study was to examine the nurse work environment in rural areas across settings by describing the relationship between structural empowerment and characteristics of the nurse work environment. Nurses ( N = 97) working in home care agencies and hospitals were surveyed. Significant differences were found between the groups, with home care nurses having significantly higher empowerment scores than medical/surgical nurses. A strong correlation was found between characteristics of the nurse work environment and empowerment. Policy makers are using evidence to guide development of policies, but much of the research has been conducted in urban hospital settings. This study begins to provide evidence that differences exist between urban and rural areas and between practice settings.

Nurses supporting nurses: creating a mentoring program for staff nurses to improve the workforce environment

BACKGROUND

The hospital workforce environment has been recognized as an important factor for nurse retention and patient safety, yet there is ongoing evidence that inadequate communication, intraprofessional oppression, and lack of collaboration and conflict resolution continue to disempower nurses and hinder improvement of workforce conditions.

PURPOSE

A 3-year academic-hospital partnership developed and used a registered nurse (RN) mentor and advocacy program to improve the RN work environment and selected patient outcomes.

METHOD

The partnership initiated mentor-mentee teams and a Workforce Environment Governance Board, and obtained preliminary data on outcomes related to mentor-mentee teamwork, changes in the level of support within each unit, and the impact of improved working conditions on nurse and patient satisfaction, nurse vacancy and turnover rates, and 3 patient safety outcomes related to fall and pressure ulcer prevention and use of restraints.

DISCUSSION

Dedicated mentors not only engaged in supporting fellow nurses but also assisted with enhancing the overall work environment for RNs. The partnership enhanced mutual respect between frontline RNs and managers, and allowed frontline RNs to improve the culture of support.

CONCLUSIONS

The comprehensive approach to incorporating mentor-mentee teams changes the way fellow nurses and others perceive nurses, augments support by managers and coworkers, and improves patient care outcomes.

Measuring the emotional intelligence of clinical staff nurses: an approach for improving the clinical care environment

BACKGROUND

Significant correlations have been demonstrated between emotional intelligence (EI) and high levels of performance and other organizational variables related to retention and workplace environment. Although these variables are also important for safe care and healthy work relationships, there is little research on the EI of clinical staff nurses. The purpose of this study was to measure EI as related to performance level of clinical staff nurses, and to collect data on important related career/organizational variables.

METHODS

Thirty-six nurses in 3 urban hospitals in Honolulu, Hawaii, participated. EI, nursing performance level, and career/organizational variables were measured.

DISCUSSION

Significant positive correlations between clinical performance level and EI scores were observed. However, a large percentage of the clinical staff demonstrated below average total EI scores and subscores (perceiving emotions, experiencing emotions).

CONCLUSIONS

Findings from this study offer the first evidence that the performance level of clinical staff nurses correlates positively with EI. A high percentage of nurses in this study scored below average on both total EI score and important subscores. These findings warrant further investigation. EI may offer a framework and specific skills to enhance collaboration, positive conflict behaviors, and healthy relationships in the clinical care environment.