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Felder M, Kuijper S, Allen D, Bal R, Wallenburg I. Job crafting as retention strategy: An ethnographic account of the challenges faced in crafting new nursing roles in care practice. Int J Health Plann Manage 2024; 39:722-739. [PMID: 38348506 DOI: 10.1002/hpm.3780] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/18/2024] [Accepted: 01/29/2024] [Indexed: 05/06/2024] Open
Abstract
Nursing shortages in the global north are soaring. Of particular concern is the high turnover among bachelor-trained nurses. Nurses tend to leave the profession shortly after graduating, often citing a lack of appreciation and voice in clinical and organisational decision-making. Healthcare organisations seek to increase the sustainability of the nursing workforce by enhancing nursing roles and nurses' organisational positions. In the Netherlands, hospitals have introduced pilots in which nurses craft new roles. We followed two pilots ethnographically and examined how nurses and managers shaped new nursing roles and made sense of their (expected) impact on workforce resilience. Informed by the literature on professional ecologies and job crafting, we show how managers and nurses defined new roles by differentiating between training levels and the uptake of care-related organisational responsibilities beyond the traditional nursing role. We also show how, when embedding such new roles, nurses needed to negotiate specific challenges associated with everyday nursing practice, manifested in distinct modes of organising, work rhythms, embodied expertise, socio-material arrangements, interprofessional relationships, and conventions about what is considered important in nursing. We argue that our in-depth case study provides a relational and socio-material understanding of the organisational politics implicated in organising care work in the face of workforce shortages.
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Affiliation(s)
- Martijn Felder
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Syb Kuijper
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Davina Allen
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Roland Bal
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Iris Wallenburg
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Steege LM, Arsenault Knudsen ÉN, Brzozowski S, Cho H. Addressing Occupational Fatigue in Nurses: A User-Centered Design Approach for Fatigue Risk Management. J Nurs Adm 2022; 52:167-176. [PMID: 35179143 DOI: 10.1097/nna.0000000000001125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To understand hospital nurses' current fatigue risk management (FRM), identify design goals and principles, and obtain feedback on FRM design concepts. BACKGROUND FRM systems can address fatigue and associated risks, yet they are not widely implemented in hospital nursing. This may be due to a lack of contextually appropriate FRM tools. METHODS A user-centered design approach was used, including interviews with 21 hospital nursing stakeholders. FINDINGS Nurses described integrated fatigue monitoring and management activities to pursue balance between work demands and capacity to meet those demands as individual nurses, within the unit, across the hospital, and over time. Seven principles were identified and applied to 2 initial design concepts for tools to support FRM. Participants' feedback on designs was positive. CONCLUSIONS This study advances the science and practice for FRM in nursing. The design principles and concepts from this study can be used to facilitate implementation of FRM systems in hospitals.
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Affiliation(s)
- Linsey M Steege
- Author Affiliations: Associate Professor (Dr Steege), School of Nursing, University of Wisconsin-Madison; Nurse Scientist (Dr Arsenault Knudsen), UW Health-Hospitals and Clinics; and PhD Candidate (Ms Brzozowski), School of Nursing, and Research Affiliate (Dr Cho), School of Nursing, University of Wisconsin-Madison
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Abstract
Nurse staffing is linked to safety, quality, and experience outcomes. In the context of the COVID-19 pandemic, staffing has become more critical as overwhelming demand has met diminishing supply of healthy nurses, capacity for care, and the innovation necessary to deliver optimal quality and experience to patients and the people who care for them. Press Ganey data scientists, along with industry experts, sought to evaluate staffing before the pandemic and its effects on clinical quality, experience, and nurse engagement. Furthermore, interviews with expert nurse researchers and nursing leaders helped to identify the kind of innovation necessary to accommodate the variable demand in patient volumes, acuity, nurse availability, and teamwork. Valuable insights from this work will help healthcare leaders in their quest to optimize nursing care.
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Affiliation(s)
- Christina Dempsey
- Author Affiliation: Chief Nursing Officer Emerita (Dr Dempsey) and Data Scientist (Mr Batten), Press Ganey Associates, South Bend, Indiana
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Rosenfeld P, DeMarco K, Rodenhausen N. Forever Changed: RNs Speak of their COVID-19 Experiences through a System-Wide Nursing Web Site. J Nurs Adm 2022; 52:12-18. [PMID: 34897207 DOI: 10.1097/nna.0000000000001097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A COVID19RNStories website allowed RNs in this integrated health system to "tell their stories" during the recent pandemic. From April to August 2020, approximately 100 items were posted with 4 themes emerging. COVID19RNStories had no preconceived hypotheses or specific questions to answer: RNs shared whatever they felt was relevant to their experiences. This approach provided real-time information on issues and concerns of RNs during the 1st wave of COVID-19. This article discusses the identified themes with recommendations for nursing leaders to support staff during the pandemic and future unexpected emergency situations.
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Affiliation(s)
- Peri Rosenfeld
- Author Affiliations : Director of Outcomes Research and Program Evaluation and Director of Center for Innovations in the Advancement of Care (Dr Rosenfeld); and Senior Director (Ms DeMarco) and Vice President of Nursing and Patient Care Services Operations (Ms Rodenhausen), Departments of Nursing, NYU Langone Health, New York
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Abstract
OBJECTIVE The aim of this study was to explore the occupational stress perception of nurses and how they manage it during the COVID-19 pandemic. BACKGROUND The management of occupational stress is a key factor in promoting nurses' well-being. METHODS A descriptive cross-sectional study was conducted. RESULTS The top occupational stressors from the nurses' perspectives (N = 236) as measured by using an updated version of the Nursing Stress Scale (NSS) included wearing a face mask at all times in the hospital, unpredictable staffing and scheduling, not enough staff to adequately cover the unit, feeling helpless in the case a patient fails to improve, and being assigned to a COVID-19 patient. The mean stress score was 31.87. The updated NSS Cronbach's α was 0.92, and the interclass interclass correlation coefficient was 0.914. CONCLUSION Nurse administrators are in a strategic position to develop interventions (eg, open door policy, meetings, and employee assistance programs) to assist nurses in effectively managing stress.
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Affiliation(s)
- Alham Abuatiq
- Author Affiliations: Assistant Professor (Dr Abuatiq), College of Nursing, South Dakota State University, Brookings; and Director Professional Practice (Dr Borchardt), Avera McKennan Hospital & University Health Center, Sioux Falls, South Dakota
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Curto C. Celebrating Magnet® Nursing Excellence: Meet the Recipients of the 2020 National Magnet Nurse of the Year® Awards and ANCC Magnet Prize®. J Nurs Adm 2021; 51:533-536. [PMID: 34705758 DOI: 10.1097/nna.0000000000001059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This month's Magnet® Perspectives column spotlights the recipients of the 2020 American Nurses Credentialing Center (ANCC) Magnet Program® National Magnet Nurse of the Year Awards and the ANCC Magnet Prize®, sponsored by Cerner, who were recognized during the ANCC National Awards virtual event on May 14, 2021.
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Affiliation(s)
- Christine Curto
- Author Affiliation : Assistant Director, Magnet Recognition Program®, American Nurses Credentialing Center, Silver Spring, Maryland
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Kinlay SH, Whiting J, Audain P, Conrad P, Kulma A, Agus MSD, Sandora TJ. Novel Deployment of Pediatric Biocontainment Unit Nurses in Response to COVID-19. Am J Nurs 2021; 121:53-58. [PMID: 34673694 DOI: 10.1097/01.naj.0000799008.92892.b4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Most existing biocontainment units (BCUs) in U.S. hospitals are designed to care for a limited number of patients infected with epidemiologically significant pathogens. The COVID-19 pandemic presented substantial challenges to hospital preparedness and operations because of its high incidence rate and the high risk of transmission to staff members. This article describes a novel practice innovation: a hospital-wide deployment of nurses on a trained BCU team to support hospital staff in safely caring for patients with COVID-19. Their responsibilities included assisting in the development of guidelines and providing training on safety protocols and the appropriate use of personal protective equipment. The authors show how this deployment contributed significantly to staff education and support during the pandemic.
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Affiliation(s)
- Stephanie Heather Kinlay
- Stephanie Heather Kinlay is an RN in the biocontainment unit (BCU) and medical ICU (MICU) at Boston Children's Hospital, where Pascale Audain is an RN in the BCU and MICU and the MICU-based infection prevention coordinator, Paula Conrad is an infection preventionist, Michael S. D. Agus is the co-medical director of the BCU and chief of the division of medical critical care, and Thomas J. Sandora is the co-medical director of the BCU and a pediatric infectious diseases physician. At the time of this writing, Amy Kulma was an RN in the BCU and MICU and Jon Whiting was director of nursing in the MICU; Whiting is now vice president and associate chief nurse of clinical and patient care operations at Boston Children's Hospital. Contact author: Stephanie Heather Kinlay, . The authors have disclosed no potential conflicts of interest, financial or otherwise
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Abstract
OBJECTIVE The purpose of this study was to determine chief nursing officer (CNO) perspectives on how to sustain the infrastructure required for successful American Nurses Credentialing Center (ANCC) Magnet® redesignation. BACKGROUND American Nurses Credentialing Center Magnet designation is a prestigious achievement reflective of years of dedication, innovation, mentoring, and leadership support. As challenging as the initial attainment of Magnet status can be, sustaining the success and becoming redesignated is considered even more difficult by many CNOs. However, there have been no published reports indicating how to be successful in Magnet redesignation. METHOD A grounded theory qualitative approach was used, and data were collected through telephone interviews with CNOs who had successfully attained at least 1 redesignation. RESULTS Fourteen CNOs participated; data were organized into 6 themes and 15 subthemes describing the critical elements for Magnet redesignation. CONCLUSION Relationships among the 6 themes and subthemes are theorized in the form of a wheel with 6 spokes. When "set in motion," the wheel gathers momentum and all of the model elements become coalesced into the organizational ethos.
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Affiliation(s)
- Linda D Urden
- Author Affiliations: Professor (Dr Urden), University of San Diego Hahn School of Nursing and Health Science; Director of Education and Professional Advancement (Dr Baclig), AMN Healthcare Education Solutions, San Diego; and Clinical Nurse Specialist (Dr Sanchez), Nursing, Keck Hospital of USC, Los Angeles California
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Butterworth L, Nasr A, Pyke-Grimm KA, Swisher D, Johnson K. The Impact of Volunteering at a Family Camp for Children and Adolescents With Cancer: The Experience of Pediatric Intensive Care Nurses. J Nurs Adm 2021; 51:526-531. [PMID: 34550106 DOI: 10.1097/nna.0000000000001058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study explored the experience of pediatric ICU (PICU) nurses who volunteered at a camp for families of children and adolescents with cancer. BACKGROUND PICU nurses are at risk of developing symptoms of posttraumatic stress disorder, compassion fatigue, depression, and burnout due to exposure(s) to traumatic events. Spending time with patients, families, and nurse colleagues at camp may reduce the effects of this exposure. METHODS A qualitative descriptive study was conducted using content analysis. Fifteen nurse participants completed a precamp questionnaire and semistructured focus groups immediately following camp. Individual interviews were conducted 6 months after camp. RESULTS Three categories emerged: 1) personal factors, changes in the nurses themselves; 2) patient and family factors, changes in how nurses perceived patients and families; and 3) work-related factors, relationships with colleagues. CONCLUSIONS Supporting PICU nurses to participate with patients, families, and colleagues outside of the hospital may reduce burnout and support nurses' well-being.
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Affiliation(s)
- Lori Butterworth
- Author Affiliations: CEO (Ms Butterworth), AIM Youth Mental Health, Carmel, California and Founder, Jacob's Heart Children's Cancer Support Services, Watsonville, California; and Director of Nursing Research (Dr Nasr), Stanford Children's Health, Stanford School of Medicine; and Nurse Scientist and Postdoctoral Fellow in Palliative Care (Dr Pyke-Grimm), Stanford Children's Health; and PICU Nurse (Ms Swisher), Stanford Children's Health, Palo Alto, California; and SVP Patient Care Services and Chief Nursing Executive (Dr Johnson), Queens Health System, Honolulu, Hawaii
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Medland J, Kolar B. Supporting the Health of Our Nurses Using the 4A Model. J Nurs Adm 2021; 51:484-487. [PMID: 34550102 DOI: 10.1097/nna.0000000000001051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Despite the well-documented need for nurse-focused efforts on health and wellness, too few healthcare organizations have made a meaningful impact on this issue. Nurse health should be integrated into the strategic and operational workings of the organization. Environments of health and wellness require attention, accountability, action, and accessibility. Although individual choice is the starting point, true success will be achieved when nurse health is a nonnegotiable outcome consistent with quality, safety, finance, and patient experience.
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Affiliation(s)
- Jacqueline Medland
- Author Affiliations: Clinical Associate Professor (Dr Medland), Edson College of Nursing and Health Innovation, Arizona State University, Phoenix; and Executive Consultant (Mr Kolar), Avail Advisors, Naperville, Illinois
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Heuston MM, Leaver C, Harne-Britner S. Using Data from a 360° Leadership Assessment to Enhance Nurse Manager Transformational Leadership Skills. J Nurs Adm 2021; 51:448-454. [PMID: 34432737 DOI: 10.1097/nna.0000000000001044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to compare self-perception of leadership practices among nurse managers (NMs), day shift nurses, and night shift nurses (NSNs). BACKGROUND Nurse managers have complex roles in healthcare, with clinical, administrative, and 24-hour accountability for unit activities. Transformational leadership inspires performance beyond expectations, while transcending self-interest for the good of the organization. METHODS A comparative, secondary data analysis study of the Leadership Practices Inventory (LPI) 2018. RESULTS Day shift nurses' and NSNs' mean scores had lower perceptions of leadership practices than NMs' self-assessment. Day shift nurses, NSNs, and NMs identified the highest mean scores in "enable others to act" (8.57, 8.62, and 8.82, respectively). CONCLUSIONS The LPI assessment, the defined observer groups, and unique data visualization informed development of a comprehensive follow-up plan supporting individual and group leadership development. Research examining differences in perceptions of LPI practices across observer groups, particularly direct report staff nurses, is warranted.
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Affiliation(s)
- Melanie M Heuston
- Author Affiliations : Vice President, and Chief Nursing and Patient Care Services Officer (Dr Heuston), and Administrative Director of Professional Practice and Development (Dr Harne-Britner), Meritus Medical Center, Hagerstown, Maryland; and Director of Academic Nursing Development (Dr Leaver), American Association of Colleges of Nursing, Washington, DC
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Clements C, Barsamian J, Burnham N, Cruz C, Darcy AMG, Duphiney L, FitzGerald J, Holland S, Joyce C, DeSanto-Madeya S. Supporting Frontline Staff During the COVID-19 Pandemic. Am J Nurs 2021; 121:46-55. [PMID: 34438429 DOI: 10.1097/01.naj.0000790632.18077.c1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT The coronavirus disease 2019 (COVID-19) pandemic that emerged in early 2020 put unprecedented physical, mental, and emotional strain on the staff of health care organizations, who have been caring for a critically ill patient population for more than a year and a half. Amid the ongoing pandemic, health care workers have struggled to keep up with new information about the disease, while also coping with the anxiety associated with caring for affected patients. It has also been a continual challenge for nurse leaders to provide adequate support for staff members and keep them informed about frequently changing practices and protocols. In this article, nursing leaders at an academic medical center in Boston reflect on the initial COVID-19 patient surge, which occurred from March to June 2020, and identify key actions taken to provide clinical and emotional support to frontline staff who cared for these patients. Lessons learned in this period provide insight into the management of redeployed staff, use of emotional support and debriefing, and relationship between access to information and staff morale. The knowledge gained through these initial experiences has been a vital resource as health care workers continue to face challenges associated with the ongoing pandemic.
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Affiliation(s)
- Charlotte Clements
- Charlotte Clements is a nurse educator at Beth Israel Deaconess Medical Center in Boston, where Jennifer Barsamian and Ann Marie Grillo Darcy are nurse specialists, Nicolette Burnham , Claire Cruz , and Jacqueline FitzGerald are nursing directors, Lindsay Duphiney is a nurse educator, Susan Holland is a patient safety coordinator and risk manager, Christine Joyce is a resource nurse, and Susan DeSanto-Madeya is a nurse scientist. Contact author: Charlotte Clements, . The authors have disclosed no potential conflicts of interest, financial or otherwise
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Abstract
BACKGROUND Hospitalized patients who have diabetes often experience hospital-acquired hypoglycemia, a potentially serious adverse event; as a result, management of this condition has become an important quality of care indicator in the inpatient environment. A growing body of research and evidence-based clinical guidelines support proper timing of point of care (POC) blood glucose (BG) measurements, mealtime insulin administration, and meal delivery to reduce the incidence of both hypoglycemic and hyperglycemic events. Monitoring and improving the timing of these three patient care interventions are recognized as a crucial step in the safe and effective care of patients with diabetes. PURPOSE The objective of the QI project was to improve the timing of mealtime insulin administration related to bedside BG monitoring and meal delivery for patients with diabetes who receive mealtime insulin; a secondary goal was to decrease the number of episodes of recurrent hypoglycemia. The overall strategy was to change staff members' approach to mealtime insulin management from a series of individual tasks to a process-oriented collaborative approach. METHODS Nurses on the medical-surgical unit at one hospital within a large health system formed a QI team with staff members in information technology and food and nutrition services. The team implemented an eight-week QI pilot project (July 3 to August 26, 2017) using a multidisciplinary approach to coordinate between POC BG measurement, mealtime insulin administration, and meal delivery. RESULTS More than two years after the hospital-wide rollout of the practice change, follow-up analysis has shown that, on both noncritical and critical care units, recurrent hypoglycemia has decreased. For example, comparing data obtained in a six-month period before the pilot project (November 2016 through April 2017) with the same six-month period in 2018 and 2019, more than a year after the pilot project, the percentage of patient stays (admissions) on noncritical care units in which there was a recurrence of hypoglycemia fell from 41.8% (of 1,162 total hospital admissions) to 35.1% (of 792 total hospital admissions); similarly, the percentage of patient stays on critical care units in which recurrent hypoglycemia occurred decreased from 36.8% to 22.8%. CONCLUSIONS Findings suggest that ensuring a consistent 30-minute window between POC BG measurement and meal delivery enabled nursing staff to perform timely POC BG measurements and administer a more optimal mealtime insulin dose. Increasing interdisciplinary communication, collaboration, and awareness of best practice guidelines relating to proper mealtime insulin administration resulted in a sustained improvement in timing between POC BG measurements and mealtime insulin administration and between mealtime insulin administration and meal delivery.
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Affiliation(s)
- Lucille Hughes
- Lucille Hughes is director of diabetes education and Maura Caragher is inpatient diabetes education coordinator at Mount Sinai South Nassau, Oceanside, NY. Contact author: Lucille Hughes, . The authors have disclosed no potential conflicts of interest, financial or otherwise
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Lasater KB, Aiken LH, Sloane DM, French R, Anusiewicz CV, Martin B, Reneau K, Alexander M, McHugh MD. Is Hospital Nurse Staffing Legislation in the Public's Interest?: An Observational Study in New York State. Med Care 2021; 59:444-450. [PMID: 33655903 PMCID: PMC8026733 DOI: 10.1097/mlr.0000000000001519] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The Safe Staffing for Quality Care Act under consideration in the New York (NY) state assembly would require hospitals to staff enough nurses to safely care for patients. The impact of regulated minimum patient-to-nurse staffing ratios in acute care hospitals in NY is unknown. OBJECTIVES To examine variation in patient-to-nurse staffing in NY hospitals and its association with adverse outcomes (ie, mortality and avoidable costs). RESEARCH DESIGN Cross-sectional data on nurse staffing in 116 acute care general hospitals in NY are linked with Medicare claims data. SUBJECTS A total of 417,861 Medicare medical and surgical patients. MEASURES Patient-to-nurse staffing is the primary predictor variable. Outcomes include in-hospital mortality, length of stay, 30-day readmission, and estimated costs using Medicare-specific cost-to-charge ratios. RESULTS Hospital staffing ranged from 4.3 to 10.5 patients per nurse (P/N), and averaged 6.3 P/N. After adjusting for potential confounders each additional patient per nurse, for surgical and medical patients, respectively, was associated with higher odds of in-hospital mortality [odds ratio (OR)=1.13, P=0.0262; OR=1.13, P=0.0019], longer lengths of stay (incidence rate ratio=1.09, P=0.0008; incidence rate ratio=1.05, P=0.0023), and higher odds of 30-day readmission (OR=1.08, P=0.0002; OR=1.06, P=0.0003). Were hospitals staffed at the 4:1 P/N ratio proposed in the legislation, we conservatively estimated 4370 lives saved and $720 million saved over the 2-year study period in shorter lengths of stay and avoided readmissions. CONCLUSIONS Patient-to-nurse staffing varies substantially across NY hospitals and higher ratios adversely affect patients. Our estimates of potential lives and costs saved substantially underestimate potential benefits of improved hospital nurse staffing.
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Affiliation(s)
- Karen B. Lasater
- Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
| | - Linda H. Aiken
- Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
| | - Douglas M. Sloane
- Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania
| | - Rachel French
- Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
| | - Colleen V. Anusiewicz
- Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
| | - Brendan Martin
- National Council of State Boards of Nursing, Chicago, IL
| | - Kyrani Reneau
- National Council of State Boards of Nursing, Chicago, IL
| | | | - Matthew D. McHugh
- Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
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Speroni KG, Wisner K, Stafford A, Haines F, Al-Ruzzieh MA, Walters C, Budhathoki C. Effect of Shared Governance on Nurse-Sensitive Indicator and Satisfaction Outcomes: An International Comparison. J Nurs Adm 2021; 51:287-296. [PMID: 33882557 DOI: 10.1097/nna.0000000000001014] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Researchers examined associations between Index for Professional Nursing Governance (IPNG) scores and outcomes, by US and international hospitals. BACKGROUND Nursing governance and effects on nurse-related outcomes are not well studied. METHODS Associations were evaluated using average IPNG scores from 2170 RNs and nurse-sensitive indicators (NSIs) and patient and RN satisfaction outcomes (n = 205 study units, 20 hospitals, 4 countries). RESULTS International units had better IPNG shared governance scores (113.5; US = 100.6; P < 0.001), and outcomes outperforming unit benchmarks (6 of 15, 40.0%; US = 2 of 15, 13.3%). Shared governance significantly outperformed traditional governance for 5 of 20 (25.0%) US outcomes (patient satisfaction = 1, RN satisfaction = 4) and for 3 of 11 (27.3%) international (patient satisfaction = 1, RN satisfaction = 2). Internationally, self-governance significantly outperformed traditional governance and shared governance for 5 of 12 (41.7%) outcomes (NSI = 2, patient satisfaction = 3). CONCLUSIONS Shared governance is a strategy that can be considered by nurse leaders for improving select outcomes.
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Affiliation(s)
- Karen Gabel Speroni
- Author Affiliations : Nursing Research Consultant, Johns Hopkins Bayview Medical Center, and Adjunct Faculty (Dr Speroni), Johns Hopkins School of Nursing, Baltimore, Maryland; Magnet® Program Director (Dr Wisner), Salinas Valley Memorial Healthcare System; Clinical Nurse Educator, Perioperative Services, and Infection Preventionist (Dr Stafford), University of Maryland Shore Regional Health, Easton, Maryland; Magnet® Program Director (Ms Haines), King Faisal Specialist Hospital & Research Center, Jeddah, Saudi Arabia; Chief Nursing Officer (Dr Al-Ruzzieh), King Hussein Cancer Center, Amman, Jordan; and Senior Director Hospital Capacity Management & Emergency Nursing Services (Dr Walters), Johns Hopkins Bayview Medical Center, Baltimore, Maryland; Associate Professor (Dr Budhathoki), School of Nursing, Johns Hopkins University, Baltimore, Maryland
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Morozova G, Martindale AB, Richards H, Stirling J, McIntyre C, Currie IS. The Vanguard Study: Human Performance Evaluation of UK National Organ Retrieval Service Teams Utilizing a Single Scrub Practitioner in Multiorgan Retrieval. Transplantation 2021; 105:1082-1089. [PMID: 32639406 DOI: 10.1097/tp.0000000000003385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The National Organ Retrieval Service (NORS) 2015 review recommended a single scrub practitioner provide support simultaneously to abdominal and cardiothoracic teams in UK multiorgan retrieval. Previously, this model had been used only by the combined abdominal and cardiac team in Scotland. This study reports the impact on performance as part of the Vanguard project, which utilized the single scrub practitioner role with 5 NORS teams, to determine applicability United Kingdom wide. METHODS Participants comprised members of abdominal (n = 56) and cardiothoracic (n = 54) teams attending UK thoraco-abdominal retrievals. Data were collected by validated psychometric scales to assess individual workload, anxiety, confidence, demands/coping resources, and teamwork. Additional data were collected through open comments and quantitative data describing context and outcome of retrieval. RESULTS Abdominal and cardiothoracic teams showed different responses when using single (Vanguard) or dual scrub practitioners (Standard). Vanguard configuration was associated with significantly higher anxiety for abdominal but not cardiothoracic teams. Perceived workload increased for abdominal teams during Vanguard but decreased for cardiothoracic teams. Scrub practitioners reported elevated anxiety and decreased confidence in retrievals using Vanguard configuration. CONCLUSIONS This is the first large study examining human performance during organ retrieval in the United Kingdom. Despite previous regional success, this study showed a significant negative impact of the single scrub practitioner when extrapolated widely to UK teams. As a result of this study, NORS declined to implement the single scrub model. These data support the use of human performance analysis as an essential part of successful development in organ retrieval practice.
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Affiliation(s)
- Gala Morozova
- Human Performance Science Research Group, Institute of Sport, Physical Education and Health Sciences, Moray House School of Education and Sport, University of Edinburgh, Edinburgh, United Kingdom
| | - Amanda B Martindale
- Human Performance Science Research Group, Institute of Sport, Physical Education and Health Sciences, Moray House School of Education and Sport, University of Edinburgh, Edinburgh, United Kingdom
| | - Hugh Richards
- Human Performance Science Research Group, Institute of Sport, Physical Education and Health Sciences, Moray House School of Education and Sport, University of Edinburgh, Edinburgh, United Kingdom
| | | | | | - Ian S Currie
- NHS Blood and Transplant, Bristol, United Kingdom
- Edinburgh Transplant Centre, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
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Clark LTS, Sanchez S, Phelan C, Sokol-Hessner L, Bruce K, DeSanto-Madeya S. COVID-19 inpatient cohorting team: Successes and lessons learned. Nurs Manag (Harrow) 2021; 52:38-45. [PMID: 33908921 DOI: 10.1097/01.numa.0000737624.29748.4e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Lauren T S Clark
- At Beth Israel Deaconess Medical Center in Boston, Mass., Lauren T.S. Clark is a cardiac surgery clinical nurse and lead quality improvement management system fellow, Sandra Sanchez is the office of bed management and transfer center nursing director, Cynthia Phelan is an associate chief nurse, Lauge Sokol-Hessner is the patient safety medical director, Kendra Bruce is a cardiac medicine unit-based educator, and Susan DeSanto-Madeya is a nurse scientist and an associate professor at the University of Rhode Island College of Nursing in Kingston, R.I
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18
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Abstract
The COVID-19 crisis created unique and interesting challenges for health care systems and changed how health care professionals delivered care. Evidence suggests that leadership skills remain of utmost importance during crises as it is the leader who often determines the response of the follower. A descriptive qualitative approach was used to ascertain the essence of nurse executive leadership and innovation during the COVID-19 crisis. Nurse executives were recruited via personal invitations to participate in the study. Participants were asked about their current challenges of COVID-19 on health care delivery, their leadership style, and what innovative processes their teams deployed. Using a thematic analysis approach, 3 themes emerged and resonated from the interviews: the importance of communication; the need for leadership presence; and mental toughness. With any health care crisis, leadership is essential to guide followers. As demonstrated by these findings, communication, leadership presence, and mental toughness are 3 key components to promoting and providing quality care in an austere, complex, and changing health care environment. Further understanding of the roles of these key concepts may add insight into nurse leaders and leadership development.
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Affiliation(s)
- Lyn Stankiewicz Losty
- College of Nursing, Walden University, Minneapolis, Minnesota (Dr Losty); and UCLA Health, Santa Monica, California (Dr Bailey)
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Abstract
For more than 40 years, shared governance has supported structural empowerment and engaged nurses in their practice. Although progress has been made in advancing nursing ownership of practice through shared governance, mature nursing autonomy has yet to be achieved. It is time to evolve to professional governance, emphasizing accountability, professional obligation, collateral relationships, and decision making. Nurse leaders are provided with historical context and recommendations for effectively leading professional governance in an empowering work culture.
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Affiliation(s)
- Tim Porter O'Grady
- Author Affiliations: Senior Partner, Health Systems (Dr Porter-O'Grady), Tim Porter-O'Grady Associates LLC, and Clinical Professor, Emory University, School of Nursing, Atlanta, Georgia; and Chief Executive Officer (Dr Clavelle), Clavelle Consulting LLC, Arvada, Colorado, and Assistant Professor, University of Colorado College of Nursing, Anschutz Medical Campus, Aurora
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Abstract
During the 2020 global pandemic crisis, some health care teams pulled together while others fell apart. The teams who pulled together put aside their differences and became stronger, putting their patients first and then each other. Those teams grew stronger, but some teams completely fell apart. They spent their days nitpicking, complaining, and arguing-making decisions based on what was best for themselves, not patients or their coworkers. The common denominator in determining how well teams performed was the leader. Employees looked to their leaders to successfully lead them through crisis, whether it was on a small or global scale. Depending on leader behaviors, the leader strengthened or weakened the team; trust was built or broken. That is a heavy burden to carry knowing that employees were so dependent on them and how they showed up every day. What lessons can leaders learn from the coronavirus-2019 (COVID-19) pandemic that can help them strengthen and sustain a healthy, professional, and supportive workforce culture during a crisis and beyond?
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Affiliation(s)
- Renee Thompson
- Healthy Workforce Institute, Oldsmar, Florida (Dr Thompson); and Graduate School of Leadership & Change, Antioch University, Yellow Springs, Ohio (Dr Kusy)
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21
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Brown H, Carrera B, Stanley L. Optimizing Nurse Staffing During a Pandemic. J Contin Educ Nurs 2021; 52:109-111. [PMID: 33631018 DOI: 10.3928/00220124-20210216-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This article describes how a health care organization optimized staffing during the COVID-19 crisis by capitalizing on the expertise of nursing professional development practitioners to create a rapid deployment onboarding plan. The rapid onboarding training plan provided Riley Hospital for Children at Indiana University Health with a sense of stability in an uncertain time. Designing a plan that easily could be modified allowed the organization to be prepared during the pandemic and at a point where staffing needs must meet surge capacity. [J Contin Educ Nurs. 2021;52(3):109-111.].
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Abstract
Lessons learned from one hospital's COVID-19 experience.
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Affiliation(s)
- Kimberly Cross
- At Beth Israel Deaconess Medical Center in Boston, Mass., Kimberly Cross is a nurse director of cardiac medicine, Alice Bradbury is a nurse director of general medicine, Nikki Burnham is a nurse director of inpatient surgery, Denise Corbett-Carbonneau is a nurse director of general medicine, Kym Peterson is a nurse specialist in neuroscience and general medicine, Cynthia Phelan is an associate chief nurse of patient care services, and Susan DeSanto-Madeya is a nurse scientist and the Weyker chair for palliative care and associate professor at the University of Rhode Island College of Nursing in Kingston, R.I
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Abstract
A strong shared governance framework gives nurses control over their practice. Whether unit based or system wide, shared governance provides the infrastructure to deliver high-quality patient care, especially in a crisis. This month's Magnet® Perspectives column takes a closer look at the concept of shared governance, how it has evolved, why it is important, and how it helped nurses in Magnet hospitals navigate the early months of the COVID-19 pandemic. We explore the critical nature of ensuring that everyone's voice is heard to not only survive but also ultimately thrive during times of change.
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Affiliation(s)
- M Maureen Lal
- Author Affiliation : Director, Magnet Recognition Program , American Nurses Credentialing Center, Silver Spring, Maryland
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24
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Joseph R, Highton M, Goodrich C. Let's talk about scrubs: A reflection during COVID-19. Nurs Manag (Harrow) 2021; 52:26-32. [PMID: 33633009 DOI: 10.1097/01.numa.0000733624.74420.43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Rachel Joseph
- At Liberty University in Lynchburg, Va., Rachel Joseph is an associate professor, Mary Highton is an associate professor, and Cindy Goodrich is a professor
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25
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Abstract
Dynamic nursing leadership and engagement of nursing at all levels are critical to effective care delivery. During the COVID-19 crisis, many organizations suspended non-COVID-related meetings, including professional governance councils where practice decisions are made. This article highlights how shared or professional governance was leveraged during this global pandemic at a large academic medical center and community hospital effectively sustaining autonomous nursing practice while responding to a rapidly changing environment and impacting quality patient care.
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Affiliation(s)
- Beverly Hancock
- Author Affiliations: Senior Director, Leadership Development (Dr Hancock), American Organization for Nursing Leadership (AONL), Chicago, Illinois; Associate Professor and Associate Chair (Dr Catrambone) and Assistant Professor (Dr Mayer), Rush University College of Nursing, Chicago, Illinois; Nursing Excellence Liaison (Dr Mayer) and President of the Professional Nursing Staff (Ms Hoskins), Rush University Medical Center, Chicago, Illinois; Past President, Nursing Professional Governance Organization (Term for 2019-2020), RN3, Lake Street Primary Care Office, Rush Oak Park Physicians Group (Ms Chierici), and Director, Ambulatory Nursing, Nursing Practice and Magnet Performance, Department of Patient Care Services (Ms Start), Rush Oak Park Hospital, Oak Park, Illinois
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26
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Foster S. Signposts on the road to recovery. Br J Nurs 2021; 30:257. [PMID: 33641403 DOI: 10.12968/bjon.2021.30.4.257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Sam Foster, Chief Nurse, Oxford University Hospitals, reflects on ways in which nurse leaders can help their staff recover from the stresses of working during the COVID-19 pandemic.
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Affiliation(s)
- Sam Foster
- Chief Nurse, Oxford University Hospitals
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Currin-McCulloch J, Chapman B, Carson C, Fundalinski K, Hays M, Budai P, Kaushik S. Hearts above water: Palliative care during a pandemic. Soc Work Health Care 2021; 60:93-105. [PMID: 33554768 DOI: 10.1080/00981389.2021.1885562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 01/06/2021] [Accepted: 01/31/2021] [Indexed: 06/12/2023]
Abstract
Social workers and nurses, as members of interprofessional palliative medicine teams, faced unfamiliar challenges and opportunities as they endeavored to provide humanistic care to patients and families during the coronavirus (COVID-19) pandemic. Typical methods for engaging patients and families in medical decision-making became thwarted by visitation restrictions and patients' dramatic health declines. This paper presents an innovative social work and nursing intervention aimed at enhancing humanistic patient/family care and advanced directive dialogs. Through incorporating a narrative synthesis of the teams' reflective journals from COVID-19, the paper chronicles the intervention implementation, patient/family responses, and team members' personal and professional meaning-making processes.
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Affiliation(s)
| | - Brooke Chapman
- UCHealth Palliative Medicine, Medical Center of the Rockies, Loveland, Colorado, USA
| | - Colleen Carson
- UCHealth Palliative Medicine, Medical Center of the Rockies, Loveland, Colorado, USA
| | - Kathleen Fundalinski
- UCHealth Palliative Medicine, Medical Center of the Rockies, Loveland, Colorado, USA
| | - Magan Hays
- UCHealth Palliative Medicine, Medical Center of the Rockies, Loveland, Colorado, USA
| | - Peggy Budai
- UCHealth Palliative Medicine, Poudre Valley Hospital, Fort Collins, Colorado, USA
| | - Shivani Kaushik
- Colorado State University School of Social Work, Fort Collins, Colorado, USA
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Abstract
As the American Nurses Credentialing Center (ANCC) marks its 30th anniversary in 2021, the world's largest and most prestigious nurse credentialing organization has unveiled a new Credentialing Framework for Nursing Excellence. In this month's "Magnet Perspectives," the directors of the ANCC's 6 credentialing programs introduce a new conceptual framework, outline the key concepts for exceptional nursing practice, and describe how ANCC's programs interconnect to invoke a powerful model that healthcare organizations can use to develop and sustain nursing excellence.
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Affiliation(s)
- Sheri Cosme
- Author Affiliations: Director (Dr Cosme), Accreditation Program, Practice Transition Accreditation Program; Director (Dr DeGarmo), APRN Initiatives; Director (Ms Graebe), Nursing Continuing Professional Development & Joint Accreditation Program; Director (Ms Horahan), Certification Services and ANA Enterprise Customer Service; Director (Dr Lal), Magnet Recognition Program®; Director Pathway to Excellence® Program (Dr Pabico), American Nurses Credentialing Center, Silver Spring, Maryland
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Abstract
Editor's note: This is the second article in a new series on clinical research by nurses. The series is designed to give nurses the knowledge and skills they need to participate in research, step by step. Each column will present the concepts that underpin evidence-based practice-from research design to data interpretation. The articles will also be accompanied by a podcast offering more insight and context from the author.
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Affiliation(s)
- Bernadette Capili
- Bernadette Capili is director of the Heilbrunn Family Center for Research Nursing at Rockefeller University, New York City. This manuscript was supported in part by grant No. UL1TR001866 from the National Institutes of Health's National Center for Advancing Translational Sciences Clinical and Translational Science Awards Program. Contact author: . The author has disclosed no potential conflicts of interest, financial or otherwise. A podcast with the author is available at www.ajnonline.com
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30
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Castelnuovo F, Marchese V, Cristini G, Crosato V, Pennati F, Renisi G, Izzo I, Paraninfo G, Van Hauwermeiren E, Castelli F. Discharge ward during the SARS-CoV-2 pandemic: an effective way to increase patient turnover when human resources are scarce. Infez Med 2020; 28:539-544. [PMID: 33257628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
During the SARS-CoV-2 pandemic, the province of Brescia (Italy) had a significant number of COVID-19 cases, which led to a subversion of the ordinary structure of the university hospital ASST Spedali Civili, driven by the need to hospitalize as many patients as possible in a narrow period of time. At the peak of the epidemic, a rapid hospitalization discharge area, the Discharge Ward (DW), was set up with the aim of facilitating the rapid turnover of patients in the wards where the most severe patients had to be hospitalized. The organization and activities carried out are described in the results of this reproducible experience during epidemic events.
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Affiliation(s)
- Filippo Castelnuovo
- Division of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili, Brescia, Italy
| | | | - Graziella Cristini
- Division of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili, Brescia, Italy
| | - Verena Crosato
- Division of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili, Brescia, Italy
| | - Francesca Pennati
- Division of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili, Brescia, Italy
| | - Giulia Renisi
- Division of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili, Brescia, Italy
| | - Ilaria Izzo
- Division of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili, Brescia, Italy
| | - Giuseppe Paraninfo
- Division of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili, Brescia, Italy
| | - Evelyn Van Hauwermeiren
- Division of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili, Brescia, Italy
| | - Francesco Castelli
- Division of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili, Brescia, Italy
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Underwood F, Dickinson L, O'Keeffe K, George B. Strengthening quality assurance by implementing an evidence-based revision of a ward accreditation programme. Nurs Manag (Harrow) 2020; 27:35-40. [PMID: 32929896 DOI: 10.7748/nm.2020.e1957] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2020] [Indexed: 06/11/2023]
Abstract
Ward accreditation is fundamental in contemporary healthcare delivery. One NHS trust in southwest England that had been placed in special measures introduced a ward accreditation programme - known as the ASPIRE programme - but the trust's senior nursing leadership team raised concerns about the level of quality assurance provided. Therefore, the trust revised its newly created ward accreditation programme, referring to the evidence base to re-evaluate the metrics used for assessment. Five new elements, including direct registered nurse care time and ward climate, were introduced in the accreditation process. The revision improved confidence in the quality assurance provided by the programme, which became central to the trust's overall improvement plans.
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Affiliation(s)
- Frazer Underwood
- The Knowledge Spa, South West Clinical School, Royal Cornwall Hospitals NHS Trust, Truro, England
| | | | - Kim O'Keeffe
- Midwifery and allied health professionals, Royal Cornwall Hospitals NHS Trust, Truro, England
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Olofinbiyi OB, Dube M, Mhlongo EM. A perception survey on the roles of nurses during triage in a selected public hospital in Kwazulu-Natal Province, South Africa. Pan Afr Med J 2020; 37:9. [PMID: 32983327 PMCID: PMC7501752 DOI: 10.11604/pamj.2020.37.9.22211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 04/03/2020] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION triage is gradually becoming an autonomous nursing role essential to patients' safety and the efficient delivery of emergency care. The increased need for more holistic and advanced care during triage makes the role of nurses during triage highly indispensable. However, several studies have shown that nurse-led triage has been so successful over the years in most African countries and in other developing countries. South African Triage Scale (SATS) is an example of triage tool that was designed in such a way that the lowest cadre nurse can successfully implement. The success recorded by this tool made most African countries and some other developing countries adopt the tool. The study was designed to explore the roles of nurses during triage in a selected public hospital in KwaZulu-Natal province. METHODS this study utilized a quantitative approach, in which a non-experimental survey involving convenience sampling technique was chosen as the most suitable sampling technique for the study. Recognition-primed decision model formed the framework of the study. Ethical clearance was obtained from University of KwaZulu-Natal Ethics Review Board and ethics principles were observed during the study. RESULTS the result of the study indicated that majority (100%) of the respondents perceived that nurses have lots of roles to perform during triage. They further unveiled that it is highly paramount for nurses to manage the waiting room and control overcrowding in the unit. CONCLUSION the study draws on the need for qualified and experienced nurses to be in charge of these roles in order to reduce the mortality and morbidity rates that usually occur during triage administration.
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Affiliation(s)
| | - Makhosazane Dube
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, South Africa
| | - Euphemia Mbali Mhlongo
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, South Africa
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Rodriguez-Yu V, Cruz A, Ruiz J, Pickering C. Empowering nurses to achieve excellence: A VA hospital's journey to Pathway to Excellence® designation. Nurs Manag (Harrow) 2020; 51:28-35. [PMID: 32868739 DOI: 10.1097/01.numa.0000669060.81304.ce] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Valerie Rodriguez-Yu
- At Audie L. Murphy Memorial Veterans Hospital in San Antonio, Tex., Valerie Rodriguez-Yu is the associate director, patient care services/nurse executive; Amy Cruz is the nursing excellence coordinator; Judith Ruiz is a quality assurance nurse, patient care services; and Carolyn Pickering is a nurse scientist
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34
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Huckaby S. Making the Case: The Use of Lean Six Sigma Methodologies to Improve Staffing in an Acute Hemodialysis Department. Nephrol Nurs J 2020; 47:457-460. [PMID: 33107718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Making a business case to match staffing-to-patient care needs sometimes requires new approaches. Partnering with departments outside of nursing proved successful in one acute hemodialysis department. Working with Lean Six Sigma teammates to define our workflow processes and utilizing the resulting data led to developing a business case, which gained the department 2.5 additional full-time equivalent registered nurses. A staffing template was created to evaluate ongoing patient volumes against current staffing. This staffing template can be used by any hemodialysis unit to aid in determining ongoing staffing requirements.
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Deerhake AM, O'Brien TR. Intradisciplinary Nursing Communication Post Hospital Merger: A Quality Improvement Project Using Online Communities of Practice in the Intensive Care Unit. Comput Inform Nurs 2020; 39:48-54. [PMID: 33417316 DOI: 10.1097/cin.0000000000000657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
After hospital mergers, unit work environments are at risk of being unhealthy due to poor intradisciplinary two-way communication in times of change. This quality improvement project explored the impact a 4-week, social-media-based, intradisciplinary communication strategy had on a postmerger intensive care unit work environment. The sample (N = 14) included 11 bedside nurses and three administrative nurses working in a 22-bed southwestern US ICU. The participants took part in a Facebook closed-group community of practice called Nurse to Nurse, with a total of 25.9% participation rate. Eleven participants completed the pre-Nurse to Nurse survey, a 20.4% completion rate, while eight participants completed the post-Nurse to Nurse survey, a 14.8% completion rate. After the conclusion of Nurse to Nurse, the overall mean skilled communication survey score increased to 3.79, a 1.6% improvement. Question 14, which measured zero-tolerance behavior perception, exhibited a mean of 2.3% improvement, boosting this metric to excellent status. Utilization data revealed 68 comments posted within Nurse to Nurse implementation, with 56 showing horizontal communication (73.5%) and 24 displaying vertical communication (26.5%). A total of 217 bedside nurse views (81.3%) and 50 administrative nurse views (18.7%) were noted. Nurse to Nurse, an online communication-focused community of practice, enhanced communication among bedside and administrative nurses working in a postmerger intensive care unit setting.
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36
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Gab Allah AR, Elshrief HA, Ageiz MH. Developing Strategy: A Guide For Nurse Managers to Manage Nursing Staff's Work-related Problems. Asian Nurs Res (Korean Soc Nurs Sci) 2020; 14:178-187. [PMID: 32693032 PMCID: PMC7368158 DOI: 10.1016/j.anr.2020.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 06/25/2020] [Accepted: 07/14/2020] [Indexed: 11/25/2022] Open
Abstract
PURPOSE The purpose of this study was to assess nursing staff's work-related problems as perceived by their managers and thereafter develop strategies that would serve as a guide for nurse managers to manage these problems. METHODS A descriptive research design was used. The participants included in the study consisted of the following two groups: Group 1-a convenience sample of 150 first-line managers working at three different hospitals; and Group 2-a panel of experts for the Delphi technique, selected using the Snowball sampling technique. Tools for data collection included the following: Tool 1-questionnaire about nursing staff's problems; Tool 2-Delphi technique to develop strategies for managing nursing staff's problems; and Tool 3-opinionnaire format. RESULTS The recruited first nurse managers were of the opinion that job stress, work overload, conflict, workplace violence, poor performance, staff turnover, demotivation, lack of empowerment, and staff absenteeism were among the common problems faced by staff nurses at work. CONCLUSION From the expert panelists' perspectives, the newly developed strategy in this study was considered valid; the researchers recommend the strategy developed in this study to be universalized in different health care settings and used as a guide for nurse managers.
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Affiliation(s)
- Amal Refaat Gab Allah
- Nursing Administration Department, Faculty of Nursing, Menoufia University, Menoufia Governorate, Egypt
| | - Hayam Ahmed Elshrief
- Nursing Administration Department, Faculty of Nursing, Menoufia University, Menoufia Governorate, Egypt
| | - Marwa Hassan Ageiz
- Nursing Administration Department, Faculty of Nursing, Menoufia University, Menoufia Governorate, Egypt.
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37
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Ye L, Yang S, Liu C. Infection prevention and control in nursing severe coronavirus disease (COVID-19) patients during the pandemic. Crit Care 2020; 24:338. [PMID: 32532324 PMCID: PMC7291182 DOI: 10.1186/s13054-020-03076-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 06/08/2020] [Indexed: 12/19/2022] Open
Affiliation(s)
- Lei Ye
- Department of Critical Care Medicine, Zhejiang Hospital, 12 Lingyin Road, Hangzhou, 310013, China
| | - Shulan Yang
- Department of Nursing, Zhejiang Hospital, 12 Lingyin Road, Hangzhou, 310013, China.
| | - Caixia Liu
- Department of Nursing, Zhejiang Hospital, 12 Lingyin Road, Hangzhou, 310013, China
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38
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Cunningham K, Deringer P, McCormick K. Building a hospital-specific nursing practice resource site: Achievable and essential. Nurs Manag (Harrow) 2020; 51:13-16. [PMID: 32472855 DOI: 10.1097/01.numa.0000662700.20449.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Kimberly Cunningham
- At St. Luke's Hospital in Bethlehem, Pa., Kimberly Cunningham is an education specialist, Peter Deringer is a nursing professional practice coordinator, and Kelly McCormick is a cancer support services clinical education specialist
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Kester KM. A multifaceted approach to tackling nurse turnover. Nurs Manag (Harrow) 2020; 51:22-28. [PMID: 32472856 DOI: 10.1097/01.numa.0000662652.32499.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Kelly M Kester
- Kelly M. Kester is the heart services clinical operations director at Duke University Hospital in Durham, N.C
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40
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Abstract
BACKGROUND Magnet hospitals are recognized for nursing excellence and high-value patient outcomes, yet little is known about which and when hospitals pursue Magnet recognition. Concurrently, hospital systems are becoming a more prominent feature of the U.S. health care landscape. PURPOSE The aim of the study was to examine Magnet adoption among hospital systems over time. APPROACH Using American Hospital Association surveys (1998-2012), we characterized the proportion of Magnet hospitals belonging to systems. We used hospital level fixed-effects regressions to capture changes in a given system hospital's Magnet status over time in relation to a variety of conditions, including prior Magnet adoption by system affiliates and nonaffiliates in local and geographically distant markets and whether these relationships varied by degree of system centralization. RESULTS The proportion of Magnet hospitals belonging to a system is increasing. Prior Magnet adoption by a hospital within the local market was associated with an increased likelihood of a given system hospital becoming Magnet, but the effect was larger if there was prior adoption by affiliates (7.4% higher likelihood) versus nonaffiliates (2.7% higher likelihood). Prior adoption by affiliates and nonaffiliates in geographically distant markets had a lesser effect. Hospitals belonging to centralized systems were more reactive to Magnet adoption of nonaffiliate hospitals as compared with those in decentralized systems. CONCLUSIONS Hospital systems take an organizational perspective toward Magnet adoption, whereby more system affiliates achieve Magnet recognition over time. PRACTICE IMPLICATIONS The findings are relevant to health care and nursing administrators and policymakers interested in the diffusion of an empirically supported organizational innovation associated with quality outcomes, particularly in a time of increasing hospital consolidation and system expansion. We identify factors associated with Magnet adoption across system hospitals and demonstrate the importance of considering diffusion of organizational innovations in relation to system centralization. We suggest that decentralized system hospitals may be missing potential benefits of such organizational innovations.
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Affiliation(s)
- Karen B Lasater
- Karen B. Lasater, PhD, RN, is Postdoctoral Fellow, Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia. E-mail: . Michael R. Richards, MD, PhD, MPH, is Assistant Professor, Department of Health Policy, Vanderbilt University, Nashville, Tennessee. Nikila B. Dandapani, BA, is Research Assistant, Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia. Lawton R. Burns, PhD, MBA, is Professor and Director, Wharton Center for Health Management and Economics, University of Pennsylvania, Philadelphia. Matthew D. McHugh, PhD, JD, RN, MPH, CRNP, FAAN, is Associate Professor and Associate Director, Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia
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Palese A, Ambrosi E, Guarnier A, Barelli P, Zambiasi P, Allegrini E, Bazoli L, Casson P, Marin M, Padovan M, Picogna M, Taddia P, Salmaso D, Chiari P, Frison T, Marognolli O, Canzan F, Grassetti L, Saiani L. [Nursing outcomes in medical wards (ESAMED Study): the results of a multicenter longitudinal study]. Assist Inferm Ric 2020; 39:35-46. [PMID: 32458829 DOI: 10.1702/3371.33475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
. Factors associated to patients' outcomes in medical units: lessons learnt from an Italian multicentric longitudinal study design (ESAMED study). INTRODUCTION Research on nursing outcomes attempted to identify the associated factors, however, with mainly retrospective or descriptive studies. In 2011, an Italian network was established and a multicentric longitudinal study aimed at exploring factors associated with nursing outcomes among in-hospital medical patients was started. AIMS To summarise (a) how the research project was originated, (b) which patients have been involved, variables and instruments used, (c) the main findings, and (d) the lessons learnt. METHOD 12 acute medical units from 11 Italian hospitals were involved. A consecutive sample was adopted: on a daily basis, data has been collected at the (a) patient; (b) nursing care, and (c) hospital levels. RESULTS The effect of the variability in the amount of nursing care and skill mix in medical units was explored on the following outcomes: (a) hospital-acquired functional dependence, (b) prevalence and incidence of (i) episodes of hyperactive delirium, (ii) avoidable pressure ulcers; (iii) peripheral venous catheter phlebitis; (c) dissatisfaction with the nursing care; and (d) in-hospital mortality; 1464 out of 2082 eligible patients were involved. The frequency and reasons of Missed Nursing Care (MNC), as well as the presence of family caregivers at the bedside were also measured. CONCLUSIONS The study confirmed that (a) the amount of nursing care provided by graduate nurses improves patient outcomes; (b) a skill mix in favour of nursing aides, negatively impacts on patients' outcomes; and (c) a higher frequency of MNC threatens patient outcomes.
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Affiliation(s)
- Marky Medeiros
- Marky Medeiros is a cultures of excellence consultant at Creative Health Care Management in Minneapolis, Minn., and adjunct faculty at Nebraska Methodist College's MSN program in Omaha, Neb
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Affiliation(s)
- Sharon Cox
- Founder and Principal Consultant, Cox & Associates, Brentwood, Tenn
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Chambers JB, Parkin D, Rimington H, Subbiah S, Campbell B, Demetrescu C, Hayes A, Rajani R. Specialist valve clinic in a cardiac centre: 10-year experience. Open Heart 2020; 7:e001262. [PMID: 32399252 PMCID: PMC7204551 DOI: 10.1136/openhrt-2020-001262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 03/12/2020] [Accepted: 03/16/2020] [Indexed: 11/06/2022] Open
Abstract
Aims Guidelines recommend specialist valve clinics as best practice for the assessment and conservative management of patients with heart valve disease. However, there is little guidance on how to set up and organise a clinic. The aim of this study is to describe a clinic run by a multidisciplinary team consisting of cardiologists, physiologist/scientists and a nurse. Methods The clinical and organisational aims of the clinic, inclusion and exclusion criteria, and links with other services are described. The methods of training non-clinical staff are detailed. Data were prospectively entered onto a database and the study consisted of an analysis of the clinical characteristics and outcomes of all patients seen between 1 January 2009 and 31 December 2018. Results There were 2126 new patients and 9522 visits in the 10-year period. The mean age was 64.8 and 55% were male. Of the visits, 3587 (38%) were to the cardiologists, 4092 (43%) to the physiologist/scientists and 1843 (19%) to the nurse. The outcomes from the cardiologist clinics were cardiology follow-up in 460 (30%), referral for surgery in 354 (23%), referral to the physiologist/scientist clinic in 412 (27%) or to the nurse clinic in 65 (4.3%) and discharge in 230 (15%). The cardiologist needed to see 6% from the nurse clinic and 10% from the physiologist/scientist clinic, while advice alone was sufficient in 10% and 9%. Conclusion A multidisciplinary specialist valve clinic is feasible and sustainable in the long term.
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Affiliation(s)
| | | | | | | | | | | | - Anna Hayes
- Guy's and St Thomas' Hospital, London, UK
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Thomas-Hawkins C, Flynn L, Dillon J. Registered Nurse Staffing, Workload, and Nursing Care Left Undone, and Their Relationships to Patient Safety in Hemodialysis Units. Nephrol Nurs J 2020; 47:133-142. [PMID: 32343087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Patient safety is an important foundation of high-quality care. Yet little is known regarding the effects of nursing indicators on patient safety in dialysis units. The purpose of this study was to examine interrelationships among registered nurse (RN) staffing, workload, nursing care left undone, and patient safety outcomes in hemodialysis settings. The sample consisted of 104 staff nurses who worked in hemodialysis facilities and completed a mailed survey. Low RN staffing, high RN workloads, and RN nursing care left undone were significantly associated with unsafe patient shift change periods and low safety ratings. Care left undone was an indirect pathway through which low RN staffing and high workloads impacted safety. Patient safety in hemodialysis units can be enhanced by ensuring adequate RN staffing and reasonable RN workloads, as well as redesigning responsibilities so RNs can complete necessary care activities.
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Affiliation(s)
- Charlotte Thomas-Hawkins
- Associate Professor and Interim Associate Dean, Nursing Science Division, Rutgers University School of Nursing, New Brunswick, NJ
- member of ANNA's South Jersey Chapter
| | - Linda Flynn
- Interim Dean and Professor, Rutgers University School of Nursing, New Brunswick, NJ
| | - Jennifer Dillon
- PhD Candidate, Rutgers University School of Nursing, New Brunswick, NJ
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Grugnetti AM, Caruso R, Scognamiglio D, Monti MC, Garofalo C, Monti MC, Meles MO, Arrigoni C. Effects of Implementing Standardized Organizational Interventions on Drug Therapy Management (DTM): A Quasi-Experimental Study. G Ital Med Lav Ergon 2020; 42:48-54. [PMID: 32614533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 01/31/2020] [Indexed: 06/11/2023]
Abstract
Background. Interruptions occurring during the drug preparation and administration have a documented effect on patients' safety. However, literature has paid little attention to show how the introduction of a set of standardized organizational interventions, based on the combination of the current evidence, could reduce the number of interruptions occurring during drug therapy management. For this reason, this study used the most recent evidence to combine a set of standardized organizational interventions, and it was aimed to assess the effect of those interventions on the number of interruptions occurring during drug therapy management (Hypothesis a) and the overall duration of the therapy administration (Hypothesis b). Methods. A quasi-experimental study was performed, using pre- and a post- organizational implementation data collections in a single Italian center. The data collections were related to the interruptions and 40 shifts were randomly selected for both pre- and post-phase, respectively on December 2016 and February 2017. The standardized organizational interventions were implemented using the current evidence on this topic. Results. The standardized organizational interventions decreased the interruptions in the post-implementation phase, but those had not an effect on the duration of the therapy administration. Conclusions. This study represented an updated evidence, which describes the effect of a standardized and evidence-based set of organisational interventions' implementation on drug therapy management. Our results suggest a number of hints for managers and future researches. Managers should keep into account the usefulness of those interventions, while future researches with experimental designs are needed to provide harder evidence on this topic.
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Affiliation(s)
- Anna Maria Grugnetti
- IRCCS Policlinic San Matteo Foundation and Department of Public Health, Experimental and Forensic Medicine, Section of Hygiene, University of Pavia, Italy
| | - Rosario Caruso
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Domenico Scognamiglio
- Azienda Socio Sanitaria Territoriale (ASST), Unità Operativa di Chirurgia, Lodi, Italy
| | - Maria Cristina Monti
- Department of Public Health, Experimental and Forensic Medicine, Unit of Clinical Biostatistic and Epidemiology, University of Pavia, Italy
| | - Cinzia Garofalo
- Azienda Socio Sanitaria Territoriale (ASST), Unità Operativa di Chirurgia, Lodi, Italy
| | - Maria Cristina Monti
- Azienda Socio Sanitaria Territoriale (ASST), Unità Operativa di Chirurgia, Lodi, Italy
| | - Mauro Oreste Meles
- Azienda Socio Sanitaria Territoriale (ASST), Unità Operativa di Chirurgia, Lodi, Italy
| | - Cristina Arrigoni
- Department of Public Health, Experimental and Forensic Medicine, Unit of Hygiene, University of Pavia, Italy
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Monsees E, Goldman J, Vogelsmeier A, Popejoy L. Nurses as antimicrobial stewards: Recognition, confidence, and organizational factors across nine hospitals. Am J Infect Control 2020; 48:239-245. [PMID: 31926758 DOI: 10.1016/j.ajic.2019.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 11/27/2019] [Accepted: 12/01/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND There are national calls to engage nurses as antimicrobial stewards, but it is unknown how patient safety culture influences nurses' antimicrobial stewardship (AS) involvement. METHODS Cross-sectional survey to determine bedside nurses' recognition and performance confidence in AS. Nine hospitals ranged in size from 42 to 562 beds serving pediatric and adult populations in 2 different metropolitan areas. Composite scores for nursing practices, performance confidence, and organizational factors were developed and correlated. Analysis of variance (ANOVA) with Tukey HSD post-hoc tests and nonparametric (Kruskal-Wallis) tests with Bonferroni adjusted P values for multiple comparisons were used to evaluate differences by clinical unit and years of clinical experience. Free text comments were categorized by theme. RESULTS A total of 558 nurses participated (13% response rate). A significant positive association rs = 0.454, P < .001 was found between nurses' beliefs about nursing practices that contribute to AS processes and their confidence to perform. Ninety one nurses provided comments with 50 statements indicating the primary barrier to stewardship were organizational factors including perceived lack of a safety culture. CONCLUSIONS Nurses identified a professional role in AS processes, though safety culture inhibited their involvement. These findings can help enhance the inclusion of nurses in AS efforts.
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Affiliation(s)
- Elizabeth Monsees
- Division of Infectious Diseases, Children's Mercy Hospital, Patient Care Services Research, Kansas City, MO.
| | - Jennifer Goldman
- Division of Infectious Diseases, Children's Mercy Hospital, Kansas City, MO
| | - Amy Vogelsmeier
- Sinclair School of Nursing, University of Missouri, Columbia, MO
| | - Lori Popejoy
- Sinclair School of Nursing, University of Missouri, Columbia, MO
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Abstract
OBJECTIVE construct and test a proposal to measure the qualitative dimension of nursing workload; identify the workload cut-off point and its indicator as predictors of the good and optimal nursing care product score. METHOD this is a descriptive study conducted in four inpatient units and four intensive care units of a Brazilian teaching hospital, considering 308 evaluations performed by 19 nurses. Four measurement instruments were used: three to assess the care demand in relation to nursing and the other to classify the care product delivered at the end of the shift. The workload was calculated and its indicator was constructed. RESULTS a weak and inverse correlation was found between the care product score, workload and the workload indicator and the workload indicator in the units and moderate and inverse between Nursing care planning and Care needs assistance with the number of hospitalized patients. CONCLUSION it is possible to associate workload and its indicator with the care product. Nursing workload ≤ 173 hours (24 hours) and indicator ≤ 12.3 hours / professional were associated with a higher probability of obtaining a "good" and "optimal" score in the care product in the inpatient units.
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Affiliation(s)
| | - Marcia Galan Perroca
- Faculdade de Medicina de São José do Rio Preto, Departamento de Enfermagem Especializada, São José do Rio Preto, SP, Brazil
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Duffield C, Twigg D, Roche M, Williams A, Wise S. Uncovering the Disconnect Between Nursing Workforce Policy Intentions, Implementation, and Outcomes: Lessons Learned From the Addition of a Nursing Assistant Role. Policy Polit Nurs Pract 2019; 20:228-238. [PMID: 31615328 DOI: 10.1177/1527154419877571] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The use of nursing assistants has increased across health systems in the past 20 years, to alleviate licensed nurses' workload and to meet rising health care demands at lower costs. Evidence suggests that, when used as a substitute for licensed nurses, assistants are associated with poorer patient and nurse outcomes. Our multimethods study evaluated the impact of a policy to add nursing assistants to existing nurse staffing in Western Australia's public hospitals, on a range of outcomes. In this article, we draw the metainferences from previously published quantitative data and unpublished qualitative interview data. A longitudinal analysis of patient records found significantly higher rates adverse patient outcomes on wards that introduced nursing assistants compared with wards that did not. These findings are explained with ward-level data that show nursing assistants were added to wards with preexisting workload and staffing problems and that those problems persisted despite the additional resources. There were also problems integrating assistants into the nursing team, due to ad hoc role assignments and variability in assistants' knowledge and skills. The disconnect between policy intention and outcomes reflects a top-down approach to role implementation where assistants were presented as a solution to nurses' workload problems, without an understanding of the causes of those problems. We conclude that policy makers and managers must better understand individual care environments to ensure any new roles are properly tailored to patient and staff needs. Further, standardized training and accreditation for nursing assistant roles would reduce the supervisory burden on licensed nurses.
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Affiliation(s)
- Christine Duffield
- Nursing and Health Services Management, Faculty of Health, University of Technology Sydney, Australia
- School of Nursing and Midwifery, Edith Cowan University, Australia
| | - Di Twigg
- School of Nursing and Midwifery, Edith Cowan University, Australia
| | - Michael Roche
- Health Services Management and Mental Health Nursing, Faculty of Health, University of Technology Sydney, Australia
| | - Anne Williams
- College of Science, Health, Engineering and Education, Murdoch University, Western Australia
| | - Sarah Wise
- Centre for Health Economics Research and Evaluation, UTS Business School, University of Technology Sydney, Australia
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Robinson J, Gelling L. Nurses+QI=better hospital performance? A critical review of the literature. Nurs Manag (Harrow) 2019; 26:22-28. [PMID: 31468826 DOI: 10.7748/nm.2019.e1858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2019] [Indexed: 11/09/2022]
Abstract
NHS regulators, such as NHS Improvement and the Care Quality Commission, promote staff involvement in quality improvement (QI), while national nursing leaders and the Nursing and Midwifery Council advocate nurses' involvement in improving services. This article critically explores the evidence base for a national nursing strategy to involve nurses in QI using a literature review. A thematic analysis shows that nurse involvement in QI has several positive outcomes, which are also included in the NHS Improvement's Single Oversight Framework for NHS Providers. The article concludes that nurse involvement in QI helps improve hospital performance.
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Affiliation(s)
- Jane Robinson
- Nursing Directorate, NHS England and NHS Improvement, London, England
| | - Leslie Gelling
- Faculty of Health Social Care and Education, Anglia Ruskin University, Cambridge, England
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