Magnet hospital nurses describe control over nursing practice

Intensity of Interprofessional Collaboration and related factors in Intensive Care Units. A descriptive cross-sectional study with an analytical approach

OBJECTIVE

To determine the Intensity of Collaboration between the intensive care professionals of a third level hospital.

METHOD

Descriptive cross-sectional study with an analytical approach.

SETTING

6 intensive care units of a third level hospital.

SAMPLE

nurses and doctors. Consecutive type non-probabilistic sampling.

DATA COLLECTION

sociodemographic, economic, motivation and professional satisfaction variables, and the intensity of collaboration using the "Scale of Intensity of Interprofessional Collaboration in Health."

RESULTS

A total of 102 health professionals (91 nurses and 11 doctors) were included. The mean overall Intensity of Collaboration (IoC) was moderate. Men showed higher scores in all factors (p<.05). The IoC global score was higher in the group of professionals with ≤10 years of experience (p=.043) and those who were highly satisfied with the profession (p=.037). Physicians presented higher scores in the global IdC (p=.037) and in the Collaboration mean (p=.020) independently in the multivariate models. A negative linear relationship (rho: -0,202, p=.042) was observed between age and the overall IoC score. Professionals aged ≤30years reported a higher perception of Shared Activities (p=.031). Negative linear relationships were observed between years of experience and total IoC score (rho: -0,202, p=.042) and patients' Perception score (rho: -0.241, p=0.015). The research activity also showed to be a variable related to a greater degree of Collaboration at a global level and in some of the factors (p<.05). The scale of IoC obtained a Cronbach's α of 0,9.

CONCLUSIONS

The intensity of interprofessional collaboration in ICUs is moderate. Professionals with experience of ≤10 years, a higher level of satisfaction and participation in research activities show a greater intensity of collaboration. Doctors perceive collaboration more intensely than nurses. All factors contribute equally to the internal consistency of the questionnaire.

Job crafting mediates the relation between creativity, personality, job autonomy and well-being in Lebanese nurses

AIM

To better understand the functionality of job crafting and its relationship with personality and job autonomy in the context of non-Western health care as an adaptive problem-solving work behaviour that is related to creativity.

BACKGROUND

Job crafting could be a strategy nurses use to solve problems as health care organisations become more unpredictable.

METHODS

This cross-sectional study sampled 547 nurses from seven hospitals in Lebanon. Data were analysed using structural equation modelling (SEM).

RESULTS

The job crafting dimensions of increasing structural job resources and increasing challenging job demands partially mediated the relationship between creativity and subjective well-being, and they fully mediated the relationship between job autonomy and subjective well-being. Creativity, job autonomy, and agreeableness were related to the approach job crafting dimensions, and two of these job crafting dimensions were in turn related to subjective well-being.

CONCLUSION

Creative nurses tend to job craft more and this is associated with their subjective well-being. Nurses high on extraversion and emotional stability experienced higher subjective well-being.

IMPLICATIONS FOR NURSING MANAGEMENT

Nursing administration and leaders may want to create an environment fostering creativity and encouraging approach-oriented job crafting.

Study of the Strengths and Weaknesses of Nursing Work Environments in Primary Care in Spain

BACKGROUND

Nursing work environments are defined as the characteristics of the workplace that promote or hinder the provision of professional care by nurses. Positive work environments lead to better health outcomes. Our study aims to identify the strengths and weaknesses of primary health care settings in Spain.

METHODS

Cross-sectional study carried out from 2018 to 2019. We used the Practice Environment Scale of the Nursing Work Index and the TOP10 Questionnaire of Assessment of Environments in Primary Health Care for data collection. The associations between sociodemographic and professional variables were analyzed.

RESULTS

In total, 702 primary care nurses participated in the study. Responses were obtained from 14 out of the 17 Spanish Autonomous Communities. Nursing foundation for quality of care, management and leadership of head nurse and nurse-physician relationship were identified as strengths, whereas nurse participation in center affairs and adequate human resources to ensure quality of care were identified as weaknesses of the nursing work environment in primary health care. Older nurses and those educated to doctoral level were the most critical in the nursing work environments. Variables Age, Level of Education and Managerial Role showed a significant relation with global score in the questionnaire.

CONCLUSION

Interventions by nurse managers in primary health care should focus on improving identified weaknesses to improve quality of care and health outcomes.

Perception of Shared Governance Among Registered Nurses in Ambulatory Care Center at a Tertiary Care Hospital in Saudi Arabia

Background

Shared governance is considered a model for mounting autonomous decision making in nursing profession and practice. This study aimed to assess how registered nurses in an outpatient department in a tertiary care hospital perceive shared governance.

Methods

We conducted a cross-sectional study among a convenient sample of registered nurses in an outpatient department. A self-administered, Index of Professional Nursing Governance (IPNG) questionnaire was used to measure the study outcome. A descriptive analysis was used to describe nurses' characteristics and study outcomes.

Results

A total of 186 nurses completed the questionnaire. Of whom, 151 (92.1%) were female, and 78 (47.3%) were aged between 20 and 30 years. Only 54 (29.3%) and 59 (31.7%) had indicated a shared decision in terms of controls and influence scales, respectively. The majority of the nurses indicated traditional shared across shared governance scales except in the access information scale.

Conclusion

The findings showed a prevalent traditional nursing management style in the study setting. Supportive strategies and education must be provided for both managers and staff nurses to develop and implement shared governance in their practice.

A Professional Nursing Acute Care Practice Curriculum

Caring for multiple complex patients simultaneously is 1 of the biggest challenges for clinical nurses (CNs) in acute care. We utilized the results of research to develop a 6-hour Professional Nursing Practice Curriculum (PNPC) specifically for CNs who are professionally and legally responsible for providing holistic care to an assigned group of patients on inpatient clinical units in acute care hospitals. The curriculum can be used by faculty to prepare senior nursing students for their 1st professional practice role in an acute care setting. Components of the PNPC will be beneficial for nurse leaders in an assessment of their educational practices for transitioning newly licensed RNs to practice and addressing professional development needs of CNs.

Older nurses' experiences of providing direct care in hospital nursing units: a qualitative systematic review

BACKGROUND

Most developed countries throughout the world are experiencing an aging nursing workforce as their population ages. Older nurses often experience different challenges then their younger nurse counterparts. With the increase in older nurses relative to younger nurses potentially available to work in hospitals, it is important to understand the experience of older nurses on high paced hospital nursing units. This understanding will lend knowledge to ways of lessening the loss of these highly skilled experienced workers and improve patient outcomes.

OBJECTIVES

To identify, evaluate and synthesize the existing qualitative evidence on older nurses' experiences of providing direct care to patients in hospital nursing units.

INCLUSION CRITERIA

The review considered studies which included registered nurses 45 years and over who work as direct caregivers in any type of in-patient hospital nursing unit. The phenomenon of interest was the experience of older nurses in providing direct nursing care in any type of in-patient hospital nursing unit (i.e. including but not limited to medical/surgical units, intensive care units, critical care units, perioperative units, palliative care units, obstetrical units, emergency departments and rehabilitative care units). The review excluded studies focussing entirely on enrolled nurses, licensed practical nurses and licensed vocational nurses.

TYPES OF STUDIES

Qualitative data including, but not limited to the following methodologies: phenomenology, grounded theory, ethnography, action research and feminist research.

METHODS

The databases CINAHL, PubMed, PsycINFO, Embase, AgeLine, Sociological Abstracts and SocINDEX were searched from inception; the search was conducted on October 13, 2017; no date limiters or language limiters were applied. Each paper was assessed by two independent reviewers for methodological quality using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Qualitative Research. Any disagreements that arose between the reviewers were resolved through discussion. Data extraction was conducted by two independent reviewers using the standardized qualitative data extraction tool from JBI. The qualitative research findings were pooled using JBI methodology. The JBI process of meta-aggregation was used to identify categories and synthesized findings.

RESULTS

Twelve papers were included in the review. Three synthesized findings were extracted from 12 categories and 75 findings. The three synthesized findings extracted from the papers were: (1) Love of nursing: It's who I am and I love it; (2) It's a rewarding but challenging and changing job; it's a different job and it can be challenging; (3) It's a challenging job; can I keep up?

CONCLUSIONS

Older nurses love nursing and have created an identity around their profession. They view their profession positively and believe their job to be unlike any other, yet they identify many ongoing challenges and changes. Despite their desire to continue in their role they are often faced with hardships that threaten their ability to stay at the bedside. A key role of hospital administrators to keep older nurses in the workplace is to develop programs to prevent work related illness and to promote health. Given the low ConQual scores in the current systematic review, additional research is recommended to understand the older nurses' experience in providing direct care in hospital nursing units as well as predicting health age of retirement and length of bedside nursing.

Job autonomy, perceptions of organizational policy, and the safety performance of nurses

AIMS

This study aimed to identify the relationship between nurses' job autonomy, perceptions of organizational policy, and safety performance by identifying the safety performance predictors of nurses working in acute health care settings in South Korea.

METHODS

Using data from a structured questionnaire, this cross-sectional descriptive study assessed the relationship between nurses' job autonomy, perceptions of organizational policy, and safety performance. In 2016, of the 290 nurses from nine acute care hospitals in South Korea invited to participate in the survey, 254 successfully did. Using cross-sectional data, characteristics of hospitals and nurses were analysed with t tests, one-way analyses of variance, Pearson correlations, and regression models.

RESULTS

On a scale of one to five, the mean job autonomy was 3.37, mean perceptions of organizational policy was 3.09, and mean safety performance was 3.75. Statistically significant positive correlations were found among job autonomy, perceptions of organizational policy, and safety performance. Multiple regression results found 44% of the variation in safety performance explained by job autonomy, length of employment, and perceptions of organizational policy.

CONCLUSION

Job autonomy and perceptions of organizational policy were positively related to safety performance. Hospital executives and nurse managers should work to enhance job autonomy and positive perceptions of organizational policy, to contribute to improving patient safety.

Turkish adaptation and psychometric characteristics of the Nursing Authority and Autonomy Scale

AIM

To adapt the Nursing Authority and Autonomy Scale (NAAS) into Turkish the Nursing Authority and Autonomy Scale (NAAS) to Turkish and assess its psychometric properties for Turkish nurses and nurse managers.

BACKGROUND

The NAAS is a tool that specifically measures nursing authority and autonomy from the perspectives of nurses and nurse managers.

METHODS

The study sample consisted of 160 nurse managers and 266 staff nurses. Content validity was assessed using expert approval. Construct validity was assessed using confirmatory factor analysis. Internal consistency was assessed using Cronbach's α, and the test-retest reliability was assessed using Pearson's correlation coefficients.

RESULTS

The model achieved a good fit. The internal reliability of the NAAS' authority and autonomy in nursing practice and importance of nursing practice subscales were .84. The Cronbach's α of the instrument was .88. The test-retest scores within an interval of 3 weeks were statistically not significant.

CONCLUSIONS

The Turkish version of the NAAS has good psychometric properties and this scale can be employed to measure nurses' authority and autonomy.

IMPLICATION FOR NURSING MANAGEMENT

Nurse managers and educators should use an appropriate scale such as NAAS in order to assess nurses' clinical authority and autonomy to improve patient outcomes and develop nurses.

The role of high-involvement work practices and professional self-image in nursing recruits' turnover: A three-year prospective study

BACKGROUND

The retention of young graduate nurses has become a major management challenge among hospitals in Western countries, which is amplified in a context of aging of populations and an increasing demand for services from patients. Moreover, as it has been reported that 50% of experienced nurses do not recommend a career in nursing, it is likely that retention problems occur not only at the level of the organization, but also at the level of the nursing profession. Although research has identified some predictors of nurse turnover, it is unclear which factors influence nurses' turnover from the organization and from the profession and how these factors interrelate with one another over time.

OBJECTIVE

The present study extends previous research on nurse turnover by looking at the combined effects of nurses' pre-entry expectations, perceived high-involvement work practices, and professional self-image, on intended and actual turnover from the organization and the profession.

DESIGN AND METHODS

A prospective, longitudinal study of a sample of 160 graduated nurses affiliated with the Quebec Nurses' Association, Canada, was conducted. Participants were surveyed at three points in time, spread over a 3-year period. Graduated nurses' pre-entry expectations and professional self-image were surveyed at graduation (Time 1), while perceived high-involvement work practices, professional self-image, and intention to leave the organization and the profession were captured six months following nurses' entry into the labor market (Time 2). Finally, participants were surveyed with respect to organizational and professional turnover three years after the Time 2 survey (Time 3). Structural equations modeling was used to examine the structure of the measures and the relationships among the constructs.

RESULTS

Although pre-entry expectations had no effect, perceived high-involvement work practices were positively related to Time 2, professional self-image (controlling for pre-entry professional self-image). Moreover, high-involvement work practices exerted an indirect, negative effect on organizational and professional turnover through intention to leave the organization, and an indirect negative effect on intention to leave the profession through professional self-image. Nonetheless, professional self-image did not affect turnover.

CONCLUSIONS

The current study indicates that hospitals and nurse directors can take advantage of developing high-involvement work practices as these practices foster a stronger professional self-image among nurses, thereby contributing to their sense of value as care providers, and indirectly reduce intended and actual turnover from the organization and the profession.

Including the Family Member in Interdisciplinary Team Meetings

This study explored the interaction patterns of family members of individuals with disabilities in a simulated interdisciplinary team problem-solving process. Participants included 15 members of a training cohort within a Leadership Education in Neurodevelopmental and Related Disabilities program. Family trainees and non-family trainees engaged in a simulated team discussion at two points during the training year (Time 1 and Time 2). To understand how family members and other professionals interact in interdisciplinary problem-solving meetings, we applied three coding schemes to the interdisciplinary team discussions to measure language similarity, dominance and domineeringness, problem solving, and balance of power. The results suggested there were trends in the communication dynamics between family trainees and non-family trainees at Time 1 and Time 2. For example, language similarity between groups was high at both Time 1 and Time 2, yet families were less successful at controlling the team conversation at Time 2. The implications of these and other results are discussed.

Comparison of nurse practice environments in Denmark and the USA

AIMS

The aims were to translate, validate and test the reliability of the Practice Environment Scale of the Nursing Work Index in a Danish context; and to compare Danish nurses' ratings of their nurse work environments with the highest rated work environments, USA magnet hospitals.

BACKGROUND

Patient quality and safety are priorities for managers, administrators and policy makers worldwide. A supportive work environment is an important factor to improve quality and safety. The most used scale to measure the nurse work environment is Practice Environment Scale of the Nursing Work Index. There is no Danish translation of the scale or a comparison of nurse work environment between Denmark and other countries.

METHODS

The translation and cultural adaption followed the steps recommended by the World Health Organization. Content validity was evaluated using cognitive interviewing in-person and through surveys. The reliability was tested using Cronbach's alpha. Finally, Practice Environment Scale of the Nursing Work Index ratings from 127 nurses were compared with results from Magnet and non-Magnet hospitals using t-tests.

FINDINGS

The Danish translation of Practice Environment Scale of the Nursing Work Index had a high validity and reliability. Danish nurses rated their nurse work environment more favourable than nurses in non-Magnet hospitals and at the same level as Magnet hospitals. Lowest Danish scores were found in the two hospital-level subscales in items related to staff nurses' involvement in discussions on daily problems, the visibility of the chief nursing officer and importance of up-to-date nursing documentation.

CONCLUSION

Danish nurses report a supportive nurse work environment with overall scores at the same level as Magnet hospitals. Opportunities for improvement were identified in the subscales.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

A first step to improve patient quality and safety is addressing factors that influence quality and safety. Using the Danish Practice Environment Scale of the Nursing Work Index, interventions to improve specific areas can be planned, implemented and evaluated. Further, Practice Environment Scale of the Nursing Work Index is a nursing quality indicator that can be included in quality databases in Denmark.

Staff nurse clinical leadership: a concept analysis

PURPOSE

The purpose of this article is to provide a concept analysis of staff nurse clinical leadership (SNCL). A clear delineation of SNCL will promote understanding and encourage communication of the phenomenon. Clarification of the concept will establish a common understanding of the concept, and advance the practice, education, and research of this phenomenon.

METHODS

A review of the literature was conducted using several databases. The databases were searched using the following keywords: clinical leadership, nursing, bedside, staff nurse, front-line, front line, and leadership. The search yielded several sources; however, only those that focused on clinical leadership demonstrated by staff nurses in acute care hospital settings were selected for review.

FINDINGS

SNCL is defined as staff nurses who exert significant influence over other individuals in the healthcare team, and although no formal authority has been vested in them facilitates individual and collective efforts to accomplish shared clinical objectives.

CONCLUSION

The theoretical definition for SNCL within the team context will provide a common understanding of this concept and differentiate it from other types of leadership in the nursing profession. This clarification and conceptualization of the concept will assist further research of the concept and advance its practical application in acute care hospital settings.

Nurses well-being in intensive care units: study of factors promoting team commitment

BACKGROUND

Intensive care units (ICUs) are challenging work environments because of the critical condition of patients, and ICU nurses frequently lament low job satisfaction and high staff turnover. Nevertheless, organizational and work characteristics, and the quality of relationships with staff can help to maintain nurses' enthusiasm and increase job satisfaction.

AIM

The aim of this study was to analyse how nursing work environment factors affect identification and commitment among ICU nurses.

DESIGN

A cross-sectional study was carried out in 12 ICUs from four Italian urban hospitals.

METHOD

A total of 222 nurses participated and completed a self-reported questionnaire.

RESULTS AND CONCLUSION

Results show that nursing work characteristics are directly related to team commitment, and that the nursing work characteristics and team commitment relationship was mediated by both perceived supervisor support and job satisfaction.

RELEVANCE TO CLINICAL PRACTICE

Our findings may concretely contribute to literature and offer additional suggestions to improve nurses' work conditions and patient health in ICUs.

Convergence: How Nursing Unions and Magnet are Advancing Nursing

PROBLEM

Historically, unions and professional associations such as the American Nurses Association have been adversaries in the fight to represent the best interests of the nursing profession.

METHODS

We reviewed the literature on the evolution of nursing unions, nursing's historical unease about unions, the Magnet designation in nursing, the tensions between the unions and Magnet, the core values and commonalities they share, and the obligations of nursing as a profession.

FINDINGS

Refocusing on the advancement of our profession provides a positive pathway in which the collective efforts of nursing unions and professional initiatives such as the Magnet designation converge during these turbulent times for our profession.

CONCLUSION

The single, central organizing idea of nursing-where nursing unions and Magnet converge-is the pivotal role of nurses in delivering high-quality patient care. The often-maligned dialectic between unions and Magnet has advanced and not hindered the nursing profession.

Nursing work environment in Saudi Arabia

AIM

The purpose of this study was to assess the work environment as perceived by nurses in a large tertiary hospital in Saudi Arabia.

BACKGROUND

The quality of patient care services has been associated with the quality of work environment of nurses. It is therefore important to assess the work environment in order to acquire baseline data and enable the institution to benchmark their status from established quality standards.

METHOD

This study used a descriptive survey with 1007 staff nurses across service units of a 1000-bed government-operated hospital. The American Association of Critical-Care Nurses (AACN) Healthy Work Environment Assessment Questionnaire was used for data collection. Scores were aggregated and interpreted.

RESULT

Effective decision making, authentic leadership, appropriate staffing, true collaboration, skilled communication and meaningful recognition were rated as good (mean range 3.53-3.76).

CONCLUSION

Healthy work environments mutually benefit patients, nurses, nurse managers, health care providers, the health team, administration, the institution and the community at large.

IMPLICATIONS FOR NURSING MANAGEMENT

Valuable baseline data on the status of the work environment in this setting were generated. This should allow administrators and staff to work together in improving weaknesses and strengthening further whatever gains that are attained to ensure consistent provision of safe and quality patient care.

Decisional Involvement

Enhancing nurse involvement in decision-making is a starting point in addressing the nursing shortage, recruitment, and retention. The purpose of this descriptive comparative secondary data analysis was to describe the level of registered nurses’ actual and preferred decisional involvement (DI) in two studies carried out during 2004 and 2010 and to describe the difference in the levels of actual and preferred DI between the 2004 study ( N = 290) and the 2010 ( N = 111) study in a Midwestern medical center after a new shared governance structure was implemented. In the 2004 and 2010 studies, there were statistically significant differences between actual and preferred levels of DI. A statistically significant decrease in means occurred in actual and preferred DI in 2010 as compared with that in 2004. A concerted effort must be made by nursing leaders to enhance DI, offer adequate resources, promote learning and growth, and recognize nursing contributions within a shared governance.

Professional dignity in nursing in clinical and community workplaces

The purpose of this qualitative study was to analyse nurses’ professional dignity in their everyday working lives. We explored the factors that affect nursing professional dignity in practice that emerge in relationships with health professionals, among clinical nurses working in hospitals and in community settings in central Italy. The main themes identified were: (i) nursing professional dignity perceived as an achievement; (ii) recognition of dignity beyond professional roles. These two concepts are interconnected. This study provides insights into professional dignity in nursing being perceived as an achievement linked to the intrinsic dignity of every human being. The ‘nursing professional dignity perceived as an achievement’ was perceived as having declined in different social factors. Some factors of nursing professional dignity perceived as an achievement were attained more easily in community settings. ‘Recognition of dignity beyond professional roles’ underpins the intrinsic dignity as an expression of humanity, embedded in persons regardless of any profession, and values, such as: respect, moral integrity, humility, working conscientiously and kindness.

A seven country comparison of nurses' perceptions of their professional practice environment

Papastavrou E., Efstathiou G., Acaroglu R., da Luz M.D.A., Berg A., Idvall E., Kalafati M., Kanan N., Katajisto J., Leino-Kilpi H., Lemonidou C., Sendir M., Sousa V.D. & Suhonen R. (2011) Journal of Nursing Management A seven country comparison of nurses' perceptions of their professional practice environment Aims  To describe and compare nurses' perceptions of their professional practice environment in seven countries. Background  There is evidence of variation in the nursing professional practice environments internationally. These different work environments affect nurses' ability to perform and are linked to differing nurse and patient outcomes. Methods  A descriptive, comparative survey was used to collect data from orthopaedic and trauma nurses (n = 1156) in Finland, Cyprus, Greece, Portugal, Sweden, Turkey and Kansas, USA using the 39-item Revised Professional Practice Environment instrument. Results  Differences were found between participants from the northern countries of Europe, Kansas, USA, and the Mediterranean countries regarding perceptions about control over practice. No between-country differences were reported in the internal work motivation among the nurses from any of the participating countries. Conclusions  Although between-country differences in nurses' professional practice environment were found, difficulties related to demographic, cultural and health system differences and the way in which nursing is defined in each country need to be considered in the interpretation of the results. Implications for Nursing Management  The results support investment to improve nurse's work environment, which is important for improving the quality of patient care, optimizing patient outcomes and developing the nursing workforce.

Enhancing shared governance for interdisciplinary practice

Cincinnati Children's Hospital Medical Center has a strong history of embracing staff empowerment and shared decision making. Shared governance for nursing was implemented in 1989; a separate allied health structure was created in 1999. The two operated in parallel with few occasions for interface, and with little collaboration. With the beginning of the medical center's efforts to pursue perfect patient care in 2002, there was a marked increase in the frequency of interprofessional initiatives and collaborations in the organization. By 2005, this increase in collaborative practice precipitated discussions questioning the purpose and efficiency of two separate structures. Over the next two years, planning ensued to merge these structures to better reflect the current interprofessional reality. The enhanced shared governance structure at Cincinnati Children's was launched in 2008. Each discipline now governs its own practice, but as patient care issues overlap, there is a structure in place to resolve patient issues that cross disciplines. The new Patient Care Governance Council includes physician and family representatives.

Transforming work place relationships through shared decision making

AIM

Using Donabedian's Structure-Process-Outcomes (SPO) paradigm, this study explored the SPO linkages related to nurse-nurse leader shared decision making around workload issues, such as safe staffing assignments.

BACKGROUND

Shared decision making represents nurses' control over practice, which is associated with positive nurse outcomes, such as job satisfaction. This study is based upon four project sites where nurse-led project teams addressed workload issues.

METHODS

Participatory action research was used, with the authors acting as participant observers. Four sites were case ordered and analysed: least successful to most successful outcomes. Cross-case matrices were constructed to identify SPO linkages. Data included observation field notes, interviews and focus groups.

RESULTS

Operations leaders with formal access to empowerment structures, such as information and resources, were the critical link to successful outcomes. Sites with conflict that blocked team-operations leader relationships were unable to engage in effective, sustainable decision making.

CONCLUSIONS

Effective work relationships among teams consisting of staff and front-line leaders contributed to successful outcomes, but team-operations leader relationships made the biggest difference.

IMPLICATIONS FOR NURSING MANAGEMENT

Formal access to power through leadership is critical for building and sustaining processes that promote and sustain nurses' control over practice.

Persistent isolationist or collaborator? The nurse's role in interprofessional collaborative practice

AIM

The present study explores current understanding about interprofessional collaborative client-centred practice and nursing's role in this form of care delivery.

BACKGROUND

A profession-only focus on nursing practice has been challenged at professional, national governmental and World Health Organization levels stressing for more interprofessional patient-centred collaborative teamwork.

EVALUATION

Moving to patient-centred collaborative practice is fraught with barriers. Enablers can result in building trust, power sharing and shared decision-making. Changing current workplace environments requires institutional commitments to support collaborative team development.

KEY ISSUE(S)

Nurses can become collaborative members of teams through: (1) re-socialize; (2) understanding and articulating nurses roles, knowledge and skills to others; (3) other health providers sharing the same to nurses; (4) identifying where shared roles, knowledge and skills exist; and (5) learning to work in collaborative teams. Nurses must address some fundamental issues about practice that negate collaboration and patient-centred care.

CONCLUSIONS

All professionals, including nurses, must move away from a service-oriented delivery to a patient-centred collaborative approach to care.

IMPLICATIONS FOR NURSING MANAGEMENT

The values within health organizations need to be underpinned by collaborative interprofessional patient-centred practice. To accomplish this goal, administrators and managers must support assessment of employees and visiting physicians as to their conformance with agency established expectations for such practice.

The divergent opinions of nurses, nurse managers and nurse directors: the case in Lebanon

AIM

The present study provides an overview of the status of the nursing profession in Lebanon and compares and contrasts the opinions of directors, nurse supervisors/managers and nurses regarding the nursing profession and the workplace.

BACKGROUND

There are limited publications concerning the working conditions of nurses in Lebanon, and no studies on the views of directors, supervisors/managers and nurses regarding the priorities of the nursing profession. Such data are necessary to build a sound theoretical basis on which recommendations for improving the nursing profession in Lebanon are made as well as to compare and contrast cross cultural findings.

METHOD

Data were collected from 45 hospitals using a mixed methods design. Qualitative data was obtained from 45 nursing directors whereas quantitative data were collected from 64 nursing supervisors and 624 nurses.

RESULTS

Similarities and differences in the opinions of nurses, nurse supervisors/managers and nurse directors regarding critical issues for the nursing profession are discussed and contrasted.

CONCLUSIONS/IMPLICATIONS

Nurses are more likely to be satisfied and committed to their profession when they feel that their opinions are being heard and that their work environment promotes professional advancement.

A concept analysis of decisional involvement

The purpose of this article is to examine the phenomenon of "decisional involvement" using the process of concept analysis as outlined by Walker and Avant in Strategies for Theory Construction in Nursing. Today, nurses practice in a complex healthcare environment that is often structured within the organizational framework of shared governance. This framework advocates nurses having a voice in decisions that are made concerning their work environment and practice. Therefore, it is critical for nurses to understand the process of decisional involvement, its relationship to participation in decision-making, its defining attributes, antecedents, consequences, model cases, and empirical referents.

Individualised care and the professional practice environment: nurses' perceptions

AIM

To describe individualised care and the professional practice environment from nurses' point of view and to explore the associations between them.

BACKGROUND

There is an increasing emphasis on individualised nursing care within the literature and the health-care context. Preliminary evidence suggests that the implementation of individualised care is associated with the practice style of care, work organization and the practice environment.

METHODS

An exploratory correlational survey was used. Data were collected using the Individualised Care Scale and Revised Professional Practice Environment instruments from nurses and nurse managers (n=207, response rate 59%) working in in-patient wards of three acute hospitals' 13 different units in Finland in 2008. Data were analysed based on descriptive statistics and Spearman's rho correlations.

FINDINGS

Nurses perceived that they generally support patient individuality and that the care they provided was individualised. Nurses' perceptions about the support of individuality and views on individuality of care provided were associated with handling conflict, work motivation, control over practice, leadership and autonomy, relationships with physicians and cultural sensitivity.

DISCUSSION

The findings support the perception that individualised care and the professional practice environment are associated. There is a need for further studies to examine these associations more closely. Manipulating aspects of the environment may possibly be used to increase the ability of the nurses to provide individualised care. Patient perspectives should be included in future studies. Because of the national data, the results are indicative only.

CONCLUSIONS

The recognition of the associations between individualised care and professional practice environment elements may help to develop individualised clinical nursing care.

Nurse specialty subcultures and patient outcomes in acute care hospitals: A multiple-group structural equation modeling

BACKGROUND

Hospital organizational culture is widely held to matter to the delivery of services, their effectiveness, and system performance in general. However, little empirical evidence exists to support that culture affects provider and patient outcomes; even less evidence exists to support how this occurs.

OBJECTIVES

To explore causal relationships and mechanisms between nursing specialty subcultures and selected patient outcomes (i.e., quality of care, adverse patient events).

METHOD

Martin's differentiation perspective of culture (nested subcultures within organizations) was used as a theoretical framework to develop and test a model. Hospital nurse subcultures were identified as being reflected in formal practices (i.e., satisfactory salary, continuing education, quality assurance program, preceptorship), informal practices (i.e., autonomy, control over practice, nurse-physician relationships), and content themes (i.e., emotional exhaustion). A series of structural equation models were assessed using LISREL on a large nurse survey database representing four specialties (i.e., medical, surgical, intensive care, emergency) in acute care hospitals in Alberta, Canada.

RESULTS

Nursing specialty subcultures differentially influenced patient outcomes. Specifically, quality of care (a) was affected by nurses' control over practice, (b) was better in intensive care than in medical specialty, and (c) was related to lower adverse patient events; nurses in intensive care and emergency specialties reported fewer adverse events than did their counterparts in medical specialties.

CONCLUSIONS

Understanding the meaning of subcultures in clinical settings would influence nurses and administrators efforts to implement clinical change and affect outcomes. More research is needed on nested subcultures within healthcare organizations for better understanding differentiated subspecialty effects on complexity of care and outcomes in hospitals.

The Impact of Work Environment on Telephone Advice Nursing

Telephone advice nursing (TAN) is part of a current effort to improve patient access while reducing cost and encouraging self-care. However, the environment in which TAN occurs can significantly affect both nurse and patient outcomes. This research builds on findings from a large health maintenance organization study by Valanis et al. in which questionnaires and call descriptions were used to correlate TAN nurse and caller/patient perceptions of calls at three regional sites. The survey tools were used to identify nurse perceptions of their work environments (WEs) as well as caller perceptions of using the advice service. The sample included 88 nurse questionnaires and 865 caller questionnaires. Multivariate analysis of covariance revealed significant site perception differences in the WE of stress, communication, and autonomy, whereas no significant differences were noted in collegial relationships and organizational support. Each site was also determined to be a unique predictor of patient perceptions of satisfaction with the advice. Findings indicate nursing professionals act as a filter to mask stressful WE effects experienced by nurses and ensure patient outcomes thereby supporting patient satisfaction with the service.

Nine structures and leadership practices essential for a magnetic (healthy) work environment

Improving clinical nurse work environments is a major challenge faced by nurse executives today. To meet this challenge, nurse leaders must implement the "right" structures and best leadership practices so that clinical nurses can engage in the work processes and relationships that are empirically linked to quality patient outcomes. What are these "right" structures and best leadership practices? Meta-analyses of 2 sets of publications were used to identify organizational structures and best leadership practices essential to a healthy work environment, that is, a work environment that enables them to engage in the work processes and relationships needed for quality patient care outcomes. The first set was 12 publications from 7 professional organizations/regulatory bodies that advocated forces, hallmarks, and standards for a healthy work environment. The second set was 18 publications from the Essentials of Magnetism structure-identification studies, in which the aggregated results from 1300 interviews with staff nurse, manager, and physician "experts" were compared with the agency results. Broadening the categories and final aggregation yielded the 9 most important and influential structures essential to a quality work environment. Suggestions for implementing these structures are provided.

Front-line management, staffing and nurse–doctor relationships as predictors of nurse and patient outcomes. A survey of Icelandic hospital nurses

OBJECTIVE

To investigate aspects of nurses' work environments linked with job outcomes and assessments of quality of care in an Icelandic hospital.

BACKGROUND

Prior research suggests that poor working environments in hospitals significantly hinder retention of nurses and high quality patient care. On the other hand, hospitals with high retention rates (such as Magnet hospitals) show supportive management, professional autonomy, good inter-professional relations and nurse job satisfaction, reduced nurse burnout and improved quality of patient care.

METHODS

Cross-sectional survey of 695 nurses at Landspitali University Hospital, Reykjavík. Nurses' work environments were measured using the nursing work index-revised (NWI-R) and examined as predictors of job satisfaction, the Maslach burnout inventory (MBI) and nurse-assessed quality of patient care using linear and logistic regression approaches.

RESULTS

An Icelandic adaptation of the NWI-R showed a five-factor structure similar to that of Lake (2002). After controlling for nurses' personal characteristics, job satisfaction, emotional exhaustion and nurse rated quality of care were found to be independently associated with perceptions of support from unit-level managers, staffing adequacy, and nurse-doctor relations.

CONCLUSIONS

The NWI-R measures elements of hospital nurses' work environments that predict job outcomes and nurses' ratings of the quality of patient care in Iceland. Efforts to improve and maintain nurses' relations with nurse managers and doctors, as well as their perceptions of staffing adequacy, will likely improve nurse job satisfaction and employee retention, and may improve the quality of patient care.

Creating a context for excellence and innovation: comparing chief nurse executive leadership practices in magnet and non-magnet hospitals

Chief nurse executives create a context for leadership, innovation, and practice in hospitals. It is valuable to get a sense of nurse executives' perceptions regarding their leadership practices and how they value them. Furthermore, it is of interest to see if there is significant differentiation in these perceptions between chief nurse executives in Magnet hospitals and those in non-Magnet hospitals. This article discusses a study of the leadership practices of these 2 groups of nurse executive's leadership practices and reports the results. Concluding is a brief discussion regarding impact and importance of the nurse executive related to excellence and innovation.

Nurse-physician relationships in hospitals: 20,000 nurses tell their story

"Good" relationships between nurses and physicians are important to high-quality patient care. Five different types of nurse-physician relationships exist on clinical units. What are the differences in the nurse-physician climate between magnet and comparison hospitals? What are the organizational structures and best leadership practices that help nurses develop collegial and collaborative relationships with physicians?

Essential elements of an optimal clinical practice environment

OBJECTIVE

This study describes essential elements for an optimal clinical practice environment wherein scholarly nursing practice flourishes.

BACKGROUND

Existing literature confirms that a healthy work environment that supports professional scholarly nursing practice is essential to retention and satisfaction of clinical nurses, enhanced patient safety, and improved patient/family outcomes.

METHODS

A subset of data from a larger qualitative study was analyzed using content analysis. Semistructured interviews were conducted at the workplaces of 36 experienced clinical nurses. Data on workplace facilitators and barriers to scholarly nursing practice are reported.

RESULTS

: The major study finding is that the optimal practice environment embraces scholarly nursing practice and balances care giving with professional development. The 4 themes integral to this balance included the following: (1) the practice environment needs to openly value scholarly nursing practice, (2) seamless support is needed at every level of the organization, (3) even clinical scholars have professional development needs, and (4) it is a 2-way street.

CONCLUSION

This study provides new insights into unique key elements essential for the development of scholarly nursing practice in hospital environments.

Magnet forces: a structure for a transformation in inpatient psychiatric nursing

Recovery is a cornerstone of the federal government's transformation vision for mental health care. Recovery is most often depicted as a process by which people with serious mental illness reengage with activities that create a meaningful existence and a purpose in life. Psychiatric nurses are expected to partner with patients in the recovery process during inpatient treatment. This may prove difficult given the current emphasis on medical models of care and the state of the science in inpatient psychiatric nursing. In this article, the authors describe how magnet forces that focus on empowering nurses, empowering evidence-based care, and strengthening unit-based leadership have the potential for generating transformational change at the point of service. Engaging in the recovery movement within the magnet structure may generate innovations critical to the growth of the specialty. J Am Psychiatr Nurses Assoc, 2008; 14(5), 346-352.