A systems perspective on nursing productivity

Nurse productivity: using evidence to enhance nurses' use of time

The UK is experiencing a nursing shortage, making it challenging to maintain the staffing levels required to deliver effective patient care. One way of enhancing the care delivered by the existing workforce could be to optimise nurse productivity; however, previous efforts to do this have been largely ineffective, due in part to a focus on the processes of care delivery rather than the nursing activities within these processes. In this article, the author explores the concept of nurse productivity and suggests that enhancing productivity requires the identification of nursing activities and consideration of how these may be undertaken in a more time-efficient manner - or removed altogether. The author discusses two such activities: intentional (hourly) rounding, and fixed-time manual vital signs for patients on general wards. The author also considers the potential of using automatic continuous remote monitoring on general hospital wards to free up nurses' time for other care activities.

Lean leadership attributes: a systematic review of the literature

Purpose

Emphasis on quality and reducing costs has led many health-care organizations to reconfigure their management, process, and quality control infrastructures. Many are lean, a management philosophy with roots in manufacturing industries that emphasizes elimination of waste. Successful lean implementation requires systemic change and strong leadership. Despite the importance of leadership to successful lean implementation, few researchers have probed the question of ideal leadership attributes to achieve lean thinking in health care. The purpose of this paper is to provide insight into applicable attributes for lean leaders in health care.

Design/methodology/approach

The authors systematically reviewed the literature on principles of leadership and, using Dombrowski and Mielke’s (2013) conceptual model of lean leadership, developed a parallel theoretical model for lean leadership in health care.

Findings

This work contributes to the development of a new framework for describing leadership attributes within lean management of health care.

Originality/value

The summary of attributes can provide a model for health-care leaders to apply lean in their organizations.

Leading nursing to achieve organizational performance: Consider the role of nursing intellectual capital [corrected]

The success and performance of healthcare organizations relies on the strategic management of knowledge. Nursing Intellectual Capital (NIC) has emerged as a concept involving nursing knowledge resources that create value in healthcare organizations. This article aims to discuss the importance of considering knowledge resources in the context of healthcare performance, with specific reference to NIC. Reflections are then provided on how leaders can look to advance NIC for improved performance.

Structural positioning of nurse leaders and empowerment

AIMS AND OBJECTIVES

To analyse the reporting structures of nursing leaders of publicly funded hospitals and seek both the views of nurse leaders and Chief Executive Officers/Chief Operating Officers on the structural positioning of nurse leaders in the organisation.

BACKGROUND

Concern that the continuing restructuring within hospital structures and focus on economic outputs in health services is diminishing the value of nursing leadership.

DESIGN

Qualitative surveys with Nursing leaders and Chief Executive Officers of public hospitals.

METHODS

Seventeen Directors of Nursing and 10 Chief Executive Officer/Chief Operating Officers' responses were received using two semi-structured questionnaires. Themes were developed from data coded and analysed by hand.

RESULTS

Four broad themes emerged from analysis of the data: (1) variable positional reporting between Director of Nursing and Chief Executive Officers occurred; (2) variable levels of inclusion and influence at the executive decision-making level; (3) ambiguous financial responsibilities and accountabilities held by Director of Nursing; and (4) blurred lines existed between operational and professional reporting lines. Findings unique to the research indicate that the varying levels of visibility and inclusion impact on the structural positioning of nurse leaders which influences authority and empowerment.

CONCLUSION

Responses from the data analysis indicate that the structural power of nurse leaders defined by the factors of opportunity, power and proportion were hindered by dual accountability reporting lines and a lack of financial control.

RELEVANCE TO CLINICAL PRACTICE

The structural positioning of nurse leaders is vital to ensure that they are empowered and able to meet the adaptations required in a changing environment that supports the delivery of effective, quality healthcare.

Factors affecting intensive care units nursing workload

Background:

The nursing workload has a close and strong association with the quality of services provided for the patients. Therefore, paying careful attention to the factors affecting nursing workload, especially those working in the intensive care units (ICUs), is very important.

Objectives:

This study aimed to determine the factors affecting nursing workload in the ICUs of the hospitals affiliated to Tehran University of Medical Sciences.

Materials and Methods:

This was a cross-sectional and analytical-descriptive study that has done in Iran. All nurses (n = 400) who was working in the ICUs of the hospitals affiliated to Tehran University of Medical Sciences in 2014 were selected and studied using census method. The required data were collected using a researcher–made questionnaire which its validity and reliability were confirmed through getting the opinions of experts and using composite reliability and internal consistency (α = 0.89). The collected data were analyzed through exploratory factor analysis (EFA), confirmatory factor analysis (CFA) and using SPSS 18.0 and AMOS 18.0.

Results:

Twenty-five factors were divided into three major categories through EFA, including structure, process, and activity. The following factors among the structure, process and activity components had the greatest importance: lack of clear responsibilities and authorities and performing unnecessary tasks (by a coefficient of 0.709), mismatch between the capacity of wards and the number of patients (by a coefficient of 0.639), and helping the students and newly employed staff (by a coefficient of 0.589).

Conclusions:

The nursing workload is influenced by many factors. The clear responsibilities and authorities of nurses, patients' admission according to the capacity of wards, use of the new technologies and equipment, and providing basic training for new nurses can decrease the workload of nurses.