Structural Empowerment and the Nursing Practice Environment in Magnet® Organizations

Associations and Predictive Pathways Between Shared Governance, Autonomy, Magnet Status, Nurse-Sensitive Indicators, and Nurse Satisfaction: A Multisite Study

BACKGROUND

Evidence is limited to the effects of shared governance (SG) and autonomy on nurse-sensitive indicators (NSIs).

PURPOSE

To explore the effects of SG, autonomy, and Magnet status on nurse and patient outcomes.

METHODS

A cross-sectional survey study was conducted using a convenience sample of 404 nurses from 4 hospitals. Descriptive analyses of variance (ANOVAs), and path analysis were conducted to identify hypothesized associations and predictive pathways among study variables.

RESULTS

Nurse managers reported higher perceptions of SG, autonomy, and satisfaction than staff nurses. SG and autonomy were significant predictors of patient falls and hospital-acquired pressure injuries. Nurses' autonomy, SG, and Magnet accreditation were significant predictors of nurse satisfaction.

CONCLUSIONS

Leadership support of SG and autonomous practice are key strategies to improve nurse satisfaction and NSI outcomes.

A Road Map for the Development of a Decisional Authority Framework for Professional Governance Using Accountability Grids

Although resources are available to guide structures and processes for professional governance, limited information exists about defining and legitimizing the decisional authority needed to support direct care nurses' ownership of clinical practice as well as the role of nursing leaders. This article presents a road map for creating and implementing clinical nurse, nurse leader, and nurse executive accountability grids with clearly delineated authority to provide a decisional authority framework for professional governance in one organization.

Nurses' work experiences 5 years after hospital merger in the province of Quebec/Canada-An exploratory qualitative study

In recent years, healthcare organisations in North America have undergone major structural changes. In particular, the province of Quebec in Canada adopted a reform in 2015 which led to the merging of healthcare organisations into centralised regional administrations (the 'CISSS'). As research indicates negative impacts of mergers on patient outcomes and difficulties for the nursing work group in particular, the present paper aims to answer calls for more research about the long-term effects of major organisational changes on nurses' professional practice and well-being. We used an exploratory qualitative research design and report on data collected from 42 nursing professionals, ranging from clinical nurses, nurse practitioners, to head nurses and nursing advisors. Drawing on the job demands-resources model and the person-environment fit theory, our findings yield three main conclusions regarding the state of nursing practice 5 years after the 2015 reform: (1) emergence of a new demand for work harmonisation; (2) growing gaps in the nursing practice environment across departments; (3) evidence of a structural disempowerment of the nursing practice in healthcare organisations. There is hope that a vast project for practice harmonisation initiated and led by local senior nursing advisors will bring about positive outcomes for the nursing practice, and nurses' overall working conditions in the province.

Abandoning Blue-Collar Management: Leading Nursing Professionals Into a New Age for Practice

Leading professionals require a different set of skills from those used for most employee work groups. This article reviews the reasons why nursing professionals need different leadership capacity and what some of those changes might be.

Nurse performance: A path model of clinical leadership, creative team climate and structural empowerment

AIMS AND OBJECTIVES

This study aimed to: (a) identify and examine the influence of clinical leadership, creative team climate (CTC) and structural empowerment (SE) on the nurse performance (NP) of clinical nurses in hospitals in Turkey, and (b) establish a model designed to verify the fit and effect of these factors.

BACKGROUND

Nurse performance is a significant indicator of work efficiency, patient care quality and patient safety. Existing studies explaining the mechanisms that lead to higher nurse performance have been limited.

DESIGN

This descriptive, cross-sectional study used relation prediction modelling and adhered to STROBE guidelines.

METHODS

This study used an online survey to collect data from volunteered 664 clinical nurses working in hospitals in Turkey. The data were analysed using SPSS version 26.0 and the AMOS 24.0 program. Path analysis was used to verify/test the hypothetical model, and the fit was evaluated by χ² /df, GFI, AGFI, NFI, CFI, IFI, RFI, TLI, RMR and RMSEA.

RESULTS

The fit index of the modified path model was χ² /df = 3.730, GFI = 0.904, AGFI = 0.892, NFI = 0.907, CFI = 0.923, IFI = 0.923, RFI = 0.906, TLI = 0.912, RMR = 0.078 and RMSEA = 0.064. Through creative team climate and structural empowerment, clinical leadership had the greatest standardised direct (β = .35) and indirect (β = .17) effects on clinical nurse performance, the final outcome variable. Creative team climate (β = .23) and structural empowerment (β = .19) also had a significant standardised direct effect on nurse performance. Clinical leadership, creative team climate and structural empowerment explained 39% of the total variance of nurse performance.

CONCLUSIONS

This study shows that clinical nurse performance in hospitals was significantly influenced by clinical leadership, creative team climate and structural empowerment. The results suggest that intervention programmes considering these factors could be implemented to enhance nurse performance.

RELEVANCE TO CLINICAL PRACTICE

Improved nurse performance requires strong clinical leadership, creative team climate and structural empowerment. Therefore, healthcare organisations may implement initiatives to enhance nurse performance by taking these factors into account.

Current situation and influencing factors of the nursing practice environment in five tertiary general hospitals in Shenzhen: a cross-sectional study

Objective

This study investigates the current situation and influencing factors of the nursing practice environment in Shenzhen, China, and provides suggestions for improving it.

Background

Nursing shortage is an urgent global problem and also of concern in China. Studies have shown that better work environments are related to high job satisfaction and better patient outcomes.

Methods

The 37-item Practice Environment Scale was used to assess the nursing practice environment. Respondents were 1116 nurses from five general tertiary hospitals in Shenzhen.

Results

The mean satisfaction score for the nursing practice environment was 3.63 ± 0.72 (where 5 is the highest possible score). Position, being a specialist nurse, choice of nursing major, educational attainment, and night shifts significantly affected nurses' working environment satisfaction.

Conclusion

The practice environment of nurses was satisfactory. We recommend reducing the workload and encouraging nurses to complete specialist training, and supporting nurses to expand their roles in hospitals and society to improve the nursing practice environment.

Nurses' critical reflections of working in unit practice councils-A qualitative interview study

AIM

This study aimed to describe nurses' experiences of working as members of unit practice councils.

BACKGROUND

Health care organisations worldwide want personnel to participate in decision-making. Unit practice councils promote unit-level decision-making over unit-specific issues. Despite extensive research on shared decision-making, few studies have examined the experiences of nurses serving as members of these councils.

METHODS

A descriptive qualitative study design was used with semi-structured interviews of 16 nurses in two clinics of a Finnish university hospital. Interviews were analysed using thematic analysis.

RESULTS

The analysis revealed two themes describing nurses' experiences as members of unit practice councils: (i) inchoate unit practice councils with insufficient allocated working time and (ii) partial empowerment of nurses through the organisation's evolving Magnet project.

CONCLUSIONS

Unit practice councils in the studied organisations are inchoate and unable to effectively advance shared decision-making or support nurses' professional autonomy. In the future, the councils require constant support from all leadership levels of the organisation.

IMPLICATIONS FOR NURSING MANAGEMENT

Sharing decision-making power could be a win-win situation where nurse leaders relinquishing power over certain matters gain time to immerse in wider issues. While acknowledging different organisational roles, there is room for trusting each other's professionality and respecting autonomous work.

Effect of Shared Governance on Nurse-Sensitive Indicator and Satisfaction Outcomes by Magnet® Recognition Status

OBJECTIVE

Researchers examined associations between Index for Professional Nursing Governance (IPNG) types and outcomes.

BACKGROUND

Effects of professional nursing governance on nurse-related outcomes by Magnet® status are not well studied.

METHODS

Associations were evaluated between average IPNG scores from 2170 RNs, and nurse-sensitive indicators (NSIs) as well as patient and RN satisfaction outcomes (N = 205 study units; 20 hospitals), following Magnet requirements.

RESULTS

Magnet hospitals had significantly better IPNG shared governance scores than non-Magnet hospitals (Magnet, 106.7; non-Magnet, 101.3). For Magnet hospitals, units scoring as shared governance outperformed traditional governance for 9 of 19 outcomes (47.4%) (NSI, 2; patient satisfaction, 3; RN satisfaction, 4). Self-governance outperformed shared governance for 8 of 15 outcomes (53.3%) (NSI, 2; patient satisfaction, 6; RN satisfaction, 0). For non-Magnet hospitals, shared governance significantly outperformed traditional governance for 1 of 15 outcomes (6.7%) (patient satisfaction).

CONCLUSIONS

Having shared or self-governance is a strategy that can be considered by nurse leaders to improve select nurse-related outcomes.

Nurse managers' perception of governance among Korean nurses

AIM

This study aims to ascertain nurse managers' perception of nurses' governance and explore their perception of facilitating and hindering factors of shared governance.

BACKGROUND

Shared governance has been introduced in nursing as a plan to improve nursing service quality. There is limited understanding about how governance is implemented.

METHODS

A mixed-methods design was used to elicit Korean nurse managers' views.

RESULTS

Quantitative data revealed the level of nurses' governance perceived by nurse managers as shared governance. However, among the subdomains, 'control over personnel' and 'participation in committee structures' indicate traditional governance. Analysis of qualitative data identified the factors that facilitate or hinder the subdomains: 'stifled atmosphere', 'nurse manager's encouragement', 'lack of opportunity and perception of the given authority' and 'flexible organisational structure'.

CONCLUSION

Findings from the study can be used to inform shared governance programmes for hospitals.

IMPLICATIONS FOR NURSING MANAGEMENT

Health care organisations, nurse managers and nurses must take action at each level to improve the current nurse governance situation. A flexible organisational culture with opinion windows for participation by nurses is important for shared governance. Supportive leadership of nurse managers and nurse-directed implementation could advance shared governance.

The work environment of haemodialysis nurses and its mediating role in burnout

BACKGROUND

The work environment can contribute to the occurrence of nurses' burnout.

OBJECTIVES

This study assessed the work environment of haemodialysis nurses and the extent of burnout they have suffered, and it explored the connection between work environment and burnout.

DESIGN

A multicentre cross-sectional study was conducted in 53 public, hospital-based haemodialysis units in Greece.

PARTICIPANTS

A total of 537 haemodialysis nurses participated. The majority consisted of females (90.8%) who possessed a university degree or a degree from a technological institute (72.6%). They had an average of 15 years of experience in dialysis.

MEASUREMENTS

The Practice Environment Scale of the Nursing Work Index and the Copenhagen Burnout Inventory (CBI) were used. The demographic characteristics of the participants were also collected.

RESULTS

Although the nurses rated their work environment as healthy, they were experiencing a moderate degree of burnout. The multivariate linear regression analysis with the CBI scales as dependent variables was applied. The increased nurses' participation in hospital affairs was associated with decreased personal (coefficient β = -9.4, 95% confidence interval [CI] = -17.4 to -1.3, p = 0.023), work-related (coefficient β = -12.9, 95% CI = -22.5 to -3.5, p = 0.008) and patient-related burnout (coefficient β = -15.9, 95% CI = -24.5 to -7.4, p = < 0.001). The better collegial nurse-physician relationships were associated with decreased personal (coefficient β = -10.7, 95% CI = -18.3 to -3.0, p = .007) and work-related burnout (coefficient β = -15.1, 95% CI = -23.3 to -7.0, p =  < 0.001).

CONCLUSIONS

The work environment of haemodialysis nurses was associated with burnout. Its improvement is an important tool in administrations' effort to ensure the nursing staff's well-being.

Research on hospital-based shared governance: a scoping review

Purpose

The purpose of this study is to review research on hospital-based shared governance (SG), focussing on its core elements.

Design/methodology/approach

A scoping review was conducted by searching the Medline (Ovid), CINAHL (EBSCO), Medic, ABI/INFORM Collection (ProQuest) and SveMed+ databases using SG and related concepts in hospital settings as search terms (May 1998–February 2019). Only original research articles examining SG were included. The reference lists of the selected articles were reviewed. Data were extracted from the selected articles by charting and then subjected to a thematic analysis.

Findings

The review included 13 original research articles that examined SG in hospital settings. The studied organizations had implemented SG in different ways, and many struggled to obtain satisfactory results. SG was executed within individual professions or multiple professions and was typically implemented at both unit- and organization-levels. The thematic analysis revealed six core elements of SG as follows: professionalism, shared decision-making, evidence-based practice, continuous quality improvement, collaboration and empowerment.

Practical implications

An SG framework for hospital settings was developed based on the core elements of SG, the participants and the organizational levels involved. Hospitals considering SG should prepare for a time-consuming process that requires belief in the core elements of SG. The SG framework can be used as a tool to implement and strengthen SG in organizations.

Originality/value

The review resumes the tradition of systematically reviewing SG literature, which had not been done in the 21st century. General tendencies of the research scene and research gaps are pointed out.

Nurse Manager Core Competencies: A Proposal in the Spanish Health System

Nurses who are capable of developing their competencies appropriately in the field of management are considered fundamental to the sustainability and improvement of health outcomes. These core competencies are the critical competencies to be developed in specific areas. There are different core competencies for nurse managers, but none in the Spanish health system. The objective of this research is to identify the core competencies needed for nurse managers in the Spanish health system. The research was carried out using the Delphi method to reach a consensus on the core competencies and a Principal Component Analysis (PCA) to determine construct validity, reducing the dimensionality of a dataset by finding the causes of variability in the set and organizing them by importance. A panel of 50 experts in management and healthcare engaged in a four-round Delphi study with Likert scored surveys. We identified eight core competencies from an initial list of 51: decision making, relationship management, communication skills, listening, Leadership, conflict management, ethical principles, collaboration and team management skills. PCA indicated the structural validity of the core competencies by saturation into three components (α Cronbach >0.613): communication, leadership and decision making. The research shows that eight competencies must be developed by the nursing managers in the Spanish health system. Nurse managers can use these core competencies as criteria to develop and plan their professional career. These core competencies can serve as a guideline for the design of nurse managers’ development programs in Spain.

Role of job satisfaction and work environment on the organizational commitment of nurses: a cross-sectional study

Background: Nursing shortage is a major global concern about healthcare. In this regard, nurses' organizational commitment is an important issue that should be focused on. Since limited data are available about the factors associated with nurse organizational commitment, further research is needed.Aim: This study aimed to examine the influence of job satisfaction and work environment on the organizational commitment of nurses.Design: A predictive design was employed.Methods: The sample comprised 595 nurses at a university hospital in Turkey. A hierarchical regression analysis applied to analyze the data.Results: Significant predictors identified as "self-realization", "nurses' participation in management and representative power", "nurse managers' attitudes and leadership qualities", "general quality", and "communication among physicians, nurses and colleagues".Conclusion: The development of strategies for increasing job satisfaction among nurses and creating positive work environments may lead administrators to increase organizational commitment in helping to the problem of nursing shortage.

Nursing shared governance at hospitals - it's Finnish future?

PURPOSE

The purpose of this study is to describe council structure, its benefits, supportive and obstructive factors and developmental needs as a part of shared governance in a university hospital.

DESIGN/METHODOLOGY/APPROACH

This is a descriptive study, where semi-structured interviews with 12 nurses was conducted in 2014 and documents from 75 council meetings from 2009 to 2014 were gathered and analyzed. Qualitative content analysis method was used on the data.

FINDINGS

The study hospital has been developing nursing shared governance with unique structure and processes of councils. Professors and university researchers act as chair and members are voluntary nursing staff. The factors supporting the councils are nurse managers' support, enthusiastic personnel and neighboring university. The factors obstructing the councils are lack of time, understanding and skills. The work of the councils benefits the organization by improving patient care, harmonizing nursing practices and informing decision-making. The council's developmental needs were more visibility, concentration into everyday problems and interprofessionality.

RESEARCH LIMITATIONS/IMPLICATIONS

Applying nursing shared governance structures into an organization improves the professional practice environment of nursing personnel.

PRACTICAL IMPLICATIONS

The study hospital has its own, unique council structure. It did not cover the whole hospital or all of the nursing personnel, but it is already producing promising results. It should be given an official status and more support from nurse managers, and it should be developed into an inter-professional discussion. The results presented here indicate that shared governance, even, in its early stage, contributes positively to the quality of care, harmonizes nursing practices and informs decision-making. Applying shared governance structures into an organization improves the professional practice environment of nursing personnel. The study showed concrete supporting and obstructing factors that should be notified in nursing leadership.

ORIGINALITY/VALUE

Despite the extensive empirical studies on nursing shared governance, there is very little research on councils in the Scandinavian countries.

Effect of a Systemwide Approach to a Reduction in Central Line-Associated Bloodstream Infections

BACKGROUND

Unit-based initiatives were deployed independently creating silos in practice variability across the system with little impact on reduction of central line-associated bloodstream infections (CLABSI).

PROBLEM

The goal was to decrease CLABSI systemwide by establishing standardized evidence-based practice (EBP) procedures to advance nursing practice.

APPROACH

A new innovative method, the Ferrari Method for Practice Standardization, enhanced the quality infrastructure by merging EBP and lean methodology to translate nursing innovations into practice. Leveraging a culture of shared decision making to support autonomy, as well as collaborating interprofessionally, allowed the organization to standardize and sustain CLABSI prevention.

OUTCOMES

The Ferrari Method for Practice Standardization successfully reduced CLABSI rates by 48% over a 1-year improvement cycle. Eight standardized EBP clinical procedures were developed and implemented across the organization.

CONCLUSION

The implementation of the Ferrari Method for Practice Standardization swiftly moves new knowledge into clinical practice to improve outcomes. Using standardized improvement methodology, it eases the interprofessional approval processes, maximizes autonomy, and focuses on quality care.

Work environment and accreditation: analysis by mixed explanatory sequential method

Abstract Objective: To analyze the - possible - interference of Accreditation in the work environment of the nursing team. Method: Mixed explanatory sequential method study. The first (preponderant) quantitative phase of the research was the application of the Brazilian version of Nursing Work Index Revised (B-NWI-R) to a representative sample (n = 226) of nursing workers from three hospitals, one of them being certificate of excellence by national Accreditation and two unsealed hospitals. After descriptive analysis of the data, it was possible to connect the information, which culminated in the data collection, through interviews (n = 39), of the second (qualitative) stage of the mixed research. The final analysis included the application of inferential statistics and qualitative analysis by the Collective Subject Discourse (DSC), connected in the B-NWI-R dimensions. Results: There was no statistically significant association in the comparisons. However, the results presented better in the certified hospital, ratifying the DSC of this institution. Conclusion: Accreditation did not significantly interfere with nursing staff perception of the work environment.

Development of an empowerment model for burnout syndrome and quality of nursing work life in Indonesia

Objectives

This study aimed to develop an empowerment model for burnout syndrome and quality of nursing work life (QNWL).

Methods

This study adopted a mixed-method cross-sectional approach. The variables included structural empowerment, psychological empowerment, burnout syndrome and QNWL. The population consisted of nurses who have civil servant status in one of the regional hospitals in Indonesia. The participants were recruited using multi-stage sampling measures with 134 respondents. Data were collected using questionnaires, which were then analysed using partial least squares. A focus group discussion was conducted with nurses, chief nurses and the hospital management to identify strategic issues and compile recommendations.

Results

Structural empowerment influenced psychological empowerment (path coefficient = 0.440; t = 6.222) and QNWL (path coefficient = 0.345; t = 4.789). Psychological empowerment influenced burnout syndrome (path coefficient = −0.371; t = 4.303), and burnout syndrome influenced QNWL (path coefficient = −0.320; t = 5.102). Structural empowerment increased QNWL by 39.7%.

Conclusion

The development of a structural empowerment model by using the indicators of resources, support and information directly influenced the psychological empowerment of the sample of nurses. As an indicator of meaning, psychological empowerment decreased burnout syndrome. In turn, burnout syndrome, as the indicator of personal achievement, could affect the QNWL. Structural empowerment directly influenced the QNWL, particularly within the workplace context. Further studies must be conducted to analyse the effects of empowerment, leadership styles and customer satisfaction.

Realigning Shared Governance With Magnet® and the Organization's Operating System to Achieve Clinical Excellence

In 2012, an academic medical center successfully overhauled a 15-year-old shared governance to align 6 house-wide and 30 unit-based councils with the new Magnet Recognition Program® and the organization's operating system, using the processes of LEAN methodology. The redesign improved cross-council communication structures, facilitated effective shared decision-making processes, increased staff engagement, and improved clinical outcomes. The innovative structural and process elements of the new model are replicable in other health institutions.

Care management and nursing governance in a maternity ward: grounded theory

ETJECTIVE

To understand the care management strategies used by nurses in the governance of nursing practice in a maternity ward.

METHOD

Qualitative study based on grounded theory conducted with 27 participants, partitioned into four sample groups. The data were collected through semi-structured interviews and analyzed through open, axial, and selective coding.

RESULT

The care management strategies used by the nurses were: planning professional practice, leading the nursing team, search for scientific knowledge, and training inthe best practices in obstetric care.

CONCLUSION

Associating care management with nursing governance can foster better care outcomes and strengthen nursing autonomy when coordinating nursing work in maternity wards.

Loss of Magnet® Designation and Changes in RN Work Engagement: A Report on How 1 Hospital's Culture Changed Over Time

OBJECTIVE

The aim of this study was to examine the loss of Magnet® designation and how RNs' work engagement changed at 1 community hospital.

BACKGROUND

The importance of RN work engagement to promote quality and safety is widely recognized in healthcare. Ongoing consistent research is critical to determine what organizational structures are needed to support RN work engagement.

METHODS

This was a comparative, descriptive, correlational study of RN cohorts at 2 time points: time 1 (T1), in 2011 during Magnet designation (n = 119), and time 2 (T2), in 2016, approximately 2 years after the loss of Magnet designation (n = 140).

RESULTS

The cohort of RNs at T2 reported significantly lower work engagement in the time period after the loss of Magnet designation when compared with the RN cohort at T1 during Magnet designation (P ≤ .0002).

CONCLUSION

These results provide insights for clinical leaders striving to support a culture of RN work engagement and quality care.

Deference to Expertise: Making Care Safer

Since the seminal report by the Institute of Medicine, To Err Is Human, was issued in 1999, significant efforts across the health care industry have been launched to improve the safety and quality of patient care. Recent advances in the safety of health care delivery have included commitment to creating high-reliability organizations (HROs) to enhance existing quality improvement activities. This article will explore key elements of the HRO concept of deference to expertise, describe the structural elements that support nurses and other personnel in speaking up, and provide examples of practical, evidence-based tools to help organizations support and encourage all members of the health care team to speak up.

The Center for Nursing Excellence: A Health System Model for Intentional Improvement and Innovation

An innovative Center for Nursing Excellence model that supports structural empowerment and the achievement of exemplary nursing, patient, and organizational outcomes was implemented in 2 separate health systems in the western United States. Formal leadership roles for nursing practice, research, professional education, and Magnet® continual readiness are aligned to ensure that Magnet designation is attained and maintained in system hospitals.

New nurses' perceptions of professional practice behaviours, quality of care, job satisfaction and career retention

AIM

To test a model examining the effects of structural empowerment and support for professional practice on new graduate nurses' perceived professional practice behaviours, perceptions of care quality and subsequent job satisfaction and career turnover intentions.

BACKGROUND

The nursing worklife model describes relationships between supportive nursing work environments and nurse and patient outcomes. The influence of support for professional practice on new nurses' perceptions of professional nursing behaviours within this model has not been tested.

METHODS

Structural equation modelling in Mplus was used to analyse data from a national survey of new nurses across Canada (n = 393).

FINDINGS

The hypothesised model was supported: χ²(122) = 346.726, P = 0.000; CFI = 0.917; TLI = 0.896; RMSEA = 0.069. Professional practice behaviour was an important mechanism through which empowerment and supportive professional practice environments influenced nurse-assessed quality of care, which was related to job satisfaction and lower intentions to leave nursing.

CONCLUSION

Job satisfaction and career retention of new nurses are related to perceptions of work environment factors that support their professional practice behaviours and high-quality patient care.

IMPLICATIONS

Nurse managers can support new graduate nurses' professional practice behaviour by providing empowering supportive professional practice environments.

Direct care nurses on the shared governance journey towards positive patient outcomes

AIMS AND OBJECTIVES

To describe shared governance in action through the example of one paediatric institution's decision to institute daily chlorhexidine bathing.

BACKGROUND

Shared governance processes are discussed extensively in the literature; however, implementation of the processes can be challenging. Recently nurses at one paediatric hospital were involved in a hospital-wide practice change where the theoretical approach of shared governance was actualised. Several questions arose from direct care nurses about unwarranted variations in bathing practices across settings and whether bathing standardisation could address the recent increase in central line-associated bloodstream infections. Shared governance council members identified daily chlorhexidine bathing as a potential intervention to standardise bathing across the hospital and to decrease infection rates. At this time, chlorhexidine bathing had been widely adopted in adult hospitals but was less commonly practiced in paediatric institutions.

DESIGN

This is a position paper describing the use of shared governance to make a house-wide practice decision and positively impact patient outcomes.

METHOD

Inquiry Council members conducted a systematic evidence search on best practices around chlorhexidine bathing. This evidence was used in Practice Council discussions to standardise house-wide practice. Once consensus was achieved, council members collaborated with Education Council to ensure understanding, competency, and the adoption and sustainment of the practice change.

CONCLUSIONS

Patients with central lines are at decreased risk for acquiring a central line-associated blood stream infection due, in part, to the change in nursing practice to include daily chlorhexidine bathing. The shared governance structure was the vehicle through which this practice was vetted and instituted.

RELEVANCE TO CLINICAL PRACTICE

This paper provides a real-life example of leveraging shared governance structures and the direct care nurse leaders within the councils when an organisation faces critical needs in patient care.

Governance of professional nursing practice in a hospital setting: a mixed methods study

Objective:

to elaborate an interpretative model for the governance of professional nursing practice in a hospital setting.

Method:

a mixed methods study with concurrent triangulation strategy, using data from a cross-sectional study with 106 nurses and a Grounded Theory study with 63 participants. The quantitative data were collected through the Brazilian Nursing Work Index - Revised and underwent descriptive statistical analysis. Qualitative data were obtained from interviews and analyzed through initial, selective and focused coding.

Results:

based on the results obtained with the Brazilian Nursing Work Index - Revised, it is possible to state that nurses perceived that they had autonomy, control over the environment, good relationships with physicians and organizational support for nursing governance. The governance of the professional nursing practice is based on the management of nursing care and services carried out by the nurses. To perform these tasks, nurses aim to get around the constraints of the organizational support and develop management knowledge and skills.

Conclusion:

it is important to reorganize the structures and processes of nursing governance, especially the support provided by the organization for the management practices of nurses.

Updating the definition and role of public health nursing to advance and guide the specialty

National changes in the context for public health services are influencing the nature of public health nursing practice. Despite this, the document that defines public health nursing as a specialty--The Definition and Role of Public Health Nursing--has remained in wide use since its publication in 1996 without a review or update. With support from the American Public Health Association (APHA) Public Health Nursing Section, a national Task Force, was formed in November 2012 to update the definition of public health nursing, using processes that reflected deliberative democratic principles. A yearlong process was employed that included a modified Delphi technique and various modes of engagement such as online discussion boards, questionnaires, and public comment to review. The resulting 2013 document consisted of a reaffirmation of the one-sentence 1996 definition, while updating supporting documentation to align with the current social, economic, political, and health care context. The 2013 document was strongly endorsed by vote of the APHA Public Health Nursing Section elected leadership. The 2013 definition and document affirm the relevance of a population-focused definition of public health nursing to complex systems addressed in current practice and articulate critical roles of public health nurses (PHN) in these settings.

Effects of unit empowerment and perceived support for professional nursing practice on unit effectiveness and individual nurse well-being: a time-lagged study

BACKGROUND

Recruitment and retention strategies have emphasized the importance of positive work environments that support professional nursing practice for sustaining the nursing workforce. Unit leadership that creates empowering workplace conditions plays a key role in establishing supportive practice environments that increase work effectiveness, and, ultimately, improves job satisfaction.

OBJECTIVES

To test a multi-level model examining the effect of both contextual and individual factors on individual nurse job satisfaction. At the unit level, structural empowerment and support for professional nursing practice (organizational resources) were hypothesized to be predictors of unit level effectiveness. At the individual level, core self-evaluation, and psychological empowerment (intrapersonal resources) were modeled as predictors of nurse job satisfaction one year later. Cross-level unit effects on individual nurses' job satisfaction were also examined.

DESIGN

This study employed a longitudinal survey design with 545 staff nurses from 49 hospital units in Ontario, Canada. Participants completed a survey at two points in time (response rate of 40%) with standardized measures of the major study variables in the hypothesized model. Multilevel structural equation modeling was used to test the model.

RESULTS

Nurses shared perceptions of structural empowerment on their units indirectly influenced their shared perceptions of unit effectiveness (Level 2) through perceived unit support for professional nursing practice, which in turn, had a significant positive direct effect on unit effectiveness (Level 2). Unit effectiveness was also strongly related to individual nurse job satisfaction one year later. At Level 1, higher core self-evaluation had a direct and indirect effect on job satisfaction through increased psychological empowerment.

CONCLUSIONS

The results suggest that nurses' job satisfaction is influenced by a combination of individual and contextual factors demonstrating utility in considering both sources of nurses' satisfaction with their work in creating effective nursing work environments.