Role of front-line nurse leadership in improving care

Professional Isolation: Impact on Rural Nurses Resuscitation Practices and Experiences

AIM

The aim of this discussion paper is twofold: (1) To critically examine the challenges related to resuscitations among rural nurses and how these contribute to a sense of professional isolation and (2) To discuss practical solutions and strategies that could be implemented to mitigate the effects of professional isolation.

BACKGROUND

Professional isolation is not unique to rural nursing practice. It is a complex issue often observed in low-resourced environments that are geographically distant from larger hospitals, such as small rural emergency departments. With a greater research focus placed on the recruitment and retention challenges associated with professional isolation, studies often overlook the intermediary factors contributing to this issue, such as the effect of resuscitations on rural nurses. In addition, there are few studies that have evaluated interventions or strategies to address professional isolation.

DESIGN

A critical discussion paper.

METHODS

This discussion paper is based on data drawn from current evidence and is guided by the authors research experience as part of a doctoral study.

RESULTS

Professional isolation negatively affects rural nurses' experiences of resuscitation by creating barriers to skill acquisition and professional growth and reducing career intent in rural areas. Strategies such as leadership training, rural mentorship, debriefing and cognitive aids are possible strategies that could address these challenges.

CONCLUSIONS

The trajectory of professional isolation is contingent upon the capacity of rural nurses to have access to professional avenues that enhance connection, sharing of knowledge, skills and experiences. Addressing professional isolation is crucial for the well-being of rural nurses and the overall sustainability and growth of the rural healthcare workforce.

Frontline nurse leaders' competences in evidence-based healthcare: A scoping review

AIM

To identify evidence on frontline nurse leaders' competences in evidence-based healthcare (EBHC) and the instruments measuring these competences.

DESIGN

A scoping review.

DATA SOURCES

The search was conducted in June 2021 and complemented in June 2022. The CINAHL, ProQuest, Medline (Ovid), Scopus, Web of Science databases and MedNar along with the Finnish database Medic were searched.

REVIEW METHOD

The scoping review was conducted in accordance with the Joanna Briggs institute methodology for scoping reviews. Titles, abstracts and full-text versions were screened independently by two reviewers according to the inclusion criteria. Deductive-inductive content analysis was used to synthesize data.

RESULTS

A total of 3211 articles published between 1997 and 2022 were screened, which resulted in the inclusion of 16 articles. Although frontline nurse leaders had a positive attitude towards EBHC, they had a lack of implementing EBHC competence into practice. Part of the instruments were used in the studies, and only one focused especially on leaders. None of instruments systematically covered all segments of EBHC.

CONCLUSION

There is a limited understanding of frontline nurse leaders' competence in EBHC. It is important to understand the importance of EBHC in healthcare and invest in the development of its competence at all levels of leaders. Frontline nurse leaders' support is essential for direct care nurses to use EBHC to ensure the quality of care and benefits to patients. Leaders must enhance their own EBHC competence to become role models for direct care nurses. It is also essential to develop valid and reliable instruments to measure leaders' competence covering all EBHC segments. The results can be utilized in the assessment and development of frontline nurse leaders' EBHC competence by planning and producing education and other competence development methods.

Nurses' roles in changing practice through implementing best practices: A systematic review

Nurses play an important role in the implementation of best practices. However, the role of nurses in changing practice by implementing best practices requires further exploration. No systematic review was found that summarised the best available evidence on the roles of nurses in changing practice through the implementation of best practices. This study summarised the best available evidence on the roles of nurses in changing practice through the implementation of best practices. A systematic review was used to search for studies in the English language, where a best practice was implemented in a clinical context and which included findings regarding the roles of nurses when implementing best practices. Scopus, EBSCOhost (Academic Search Ultimate, APA PsycInfo, CINAHL with Full Text, ERIC, Health Source: Nursing/Academic Edition, MasterFILE Premier, MEDLINE Complete), PUBMED, and ScienceDirect databases were searched from January 2013 to June 2021. The search generated 1343 citations. After removing duplicates and applying eligibility criteria, 27 studies were included. Five definite roles were identified as follows: leadership, education and training, collaboration, communication and feedback and development and tailoring of the best practice. These roles are interrelated, but equally crucial in order to implement best practices. This study found five interrelated but equally crucial nurse roles in changing practice through the implementation of best practices.

Contribution

The study's findings and gaps identified can be used for further nursing research, improving practice change and health outcomes through the implementation of best practices and the role nurses can play in this process.

Reinstating Elective Surgeries in MedStar Health: A Roadmap for Healthcare Organizations

Introduction

Coronavirus disease 2019 (COVID-19) infections have strained hospital resources worldwide. As a result, many facilities have suspended elective operations and ambulatory procedures. As the incidence of new cases of COVID-19 decreases, hospitals will need policies and algorithms to facilitate safe and orderly return of normal activities. We describe the recommendations of a task force established in a multi-institutional healthcare system for resumption of elective operative and ambulatory procedures applicable to all hospitals and service lines.

Methods

MedStar Health created a multidisciplinary task force to develop guidelines for resumption of elective surgeries/procedures. The primary focus areas included the establishment of a governance structure at each healthcare facility, prioritization of elective cases, preoperative severe acute respiratory syndrome coronavirus 2 testing, and an assessment of the needs and availability of staff, personal protective equipment, and other essential resources.

Results

Each hospital president was tasked with establishing a local perioperative leadership team answering directly to them and granted the authority to prioritize elective surgery and ambulatory procedures. An elective surgery algorithm was established using a simplified Medically Necessary Time Sensitive score, with multiple steps requiring a "go/no-go" assessment based on local resources. In addition, mandatory preoperative COVID testing policies were developed and operationalized.

Conclusions

Even when the COVID pandemic has passed, hospitals and surgical centers will require COVID screening and testing, case prioritization, and supply chain management to provide care essential to the surgical patient while protecting their safety and that of staff. Our guidelines consider these factors and are applicable to both tertiary academic medical centers and smaller community facilities.