Nursing management最新文献

Background: Health care workers continue to experience persistent stress, anxiety, and burnout, despite recent declines from pandemic-era peaks. Animal-assisted activity (AAA) has shown promise in improving psychological well-being, but research specific to health care workers remains limited.

Purpose: To evaluate the effect of a baby-kangaroo AAA intervention on staff anxiety levels during Nurses Week and National Hospital Week.

Methods: As part of a quality improvement project, staff voluntarily completed a two-question survey immediately before and after holding and petting a baby kangaroo. Anxiety was measured using a validated one-item, 5-point Likert-type scale. Role-based demographic data were collected, and paired t tests were used to analyze pre- and postintervention differences.

Results: A total of 324 staff completed the presurvey and 251 completed the postsurvey. All three role groups-RN/LPN, clinical non-RN/LPN, and nonclinical staff-showed statistically significant reductions in anxiety (all P < .0001). The overall mean anxiety decrease across 251 paired responses was 0.906 (SD = 0.64).

Conclusions: A brief, informal AAA encounter involving a baby kangaroo significantly reduced self-reported anxiety among health care workers. Findings support the integration of AAA as a meaningful well-being intervention and highlight the opportunity for nurse leaders to champion similar programs that promote staff emotional health and engagement.

Background: Workplace violence (WPV) in healthcare settings is a growing concern, with rates significantly higher than in other industries. WPV negatively impacts staff well-being, job satisfaction, and patient care quality.

Purpose: This initiative aimed to reduce WPV incidents and improve staff safety and reporting practices at a large Level 1 trauma center in North Texas.

Methods: Using the Plan-Do-Check-Act (PDCA) framework, an interprofessional team implemented a comprehensive WPV prevention program. Strategies included staff education, standardized reporting, use of the Brøset Violence Checklist (BVC), personal duress alarms, signage, and development of an escalation pathway. Data were tracked via a dashboard and shared governance committees.

Results: Reported WPV events increased from 128 in Q3 2022 to 215 in Q4 2023, reflecting improved awareness and reporting. Public safety involvement rose from 77 to 108 events. Employee engagement scores improved, RN vacancy rates decreased from 17.59% to 8.54%, and staff reported feeling empowered to escalate concerns.

Conclusions: A structured, multidisciplinary approach to WPV prevention enhanced staff safety, reporting, and engagement. Ongoing efforts include advanced de-escalation training, behavioral emergency response teams, and system-level enhancements.

Background: Nursing professional governance (NPG) promotes shared decision-making and is a Magnet® expectation, yet inconsistent tools and fragmented education can decrease council effectiveness.

Purpose: The purpose of this project was to standardize tools and education to improve role clarity, engagement, and council health across a large academic medical center.

Methods: This quality improvement project used iterative Plan-Do-Study-Act cycles from June 2023-July 2024. Interventions included redesigned council charters and agendas, slides created for enhanced communication, a centralized SharePoint site, a formal NPG orientation, an electronic feedback form, and a governance-specific email inbox. Council health was measured using the Hess Council Health Survey (CHS) at baseline and two post-intervention time points.

Results: Baseline CHS results identified gaps in education, role expectations, time-dedication strategies, and pathways for non-member input. Postintervention improvements were observed in: agreement that new members received formal education (40.9% to 57.3%), availability of strategies to dedicate time (50% to 76.1%), clarity of expectations (63.6% to 83.3%), and opportunities for non-member input (46.3% to 61.1%). Although some gains declined at later follow-up, most remained above baseline.

Conclusions: Standardizing governance tools and providing structured education improved engagement and role clarity; ongoing reinforcement is needed to sustain gains.

Background: Nurse work environment (NWE) is a well-established predictor of nurse and patient outcomes. However, limited research has examined the individual contributions of NWE domains to nurse outcomes.

Purpose: This study aimed to identify which subscales of the Practice Environment Scale (PES) most strongly influence nurse outcomes: retention, job enjoyment, respect and recognition, and missed nursing care.

Methods: A cross-sectional analysis was conducted using 2024 National Database of Nursing Quality Indicators® RN Survey data from 1789 inpatient units across 221 hospitals. NWE was measured using PES subscales, and nurse outcomes were assessed via standardized instruments. Structural equation modeling evaluated direct effects of PES domains on outcomes.

Results: All PES subscales were significantly associated with nurse outcomes ( P < .05). Staffing and resource adequacy had the strongest effects on retention (β = 0.44), job enjoyment (β = 0.61), and reduced missed care (β = -0.87). Nurse manager leadership and support also significantly predicted retention and respect and recognition. Nurse participation in hospital affairs primarily influenced respect and recognition, whereas nurse-physician interaction showed weaker associations.

Conclusions: Adequate staffing and strong nurse manager leadership are critical to nurse retention and satisfaction. Targeted improvements in these domains may enhance workforce stability and care quality.

Background: Pediatric inpatient nursing faces increasing workforce strain, care complexity, and change saturation. Although virtual nursing has emerged as a care model redesign to support direct care teams and enhance patient and family experiences, the existing literature primarily reflects adult or outpatient settings. Evidence describing implementation, role integration, and change management approaches specific to pediatric inpatient virtual nursing remains limited.

Purpose: To describe the nurse-led implementation of a pediatric inpatient virtual nursing model and identify practical change management strategies to support successful integration.

Methods: A descriptive case study examined the phased implementation of an inpatient virtual nursing program at a freestanding academic children's hospital. Leadership strategies, staff engagement approaches, workflow integration efforts, and frontline feedback were analyzed using Plan-Do-Study-Act cycles.

Results: Initial implementation was challenged by change saturation, role ambiguity, and limited frontline ownership. Reframing virtual nursing as a team-based care model, applying Kotter's change framework, and engaging interdisciplinary staff with codesign, improved acceptance, clarified role boundaries, and reduced resistance.

Conclusions: Successful pediatric inpatient virtual nursing integration requires intentional change management, nurse-led leadership, and phased implementation. Centering people before platforms and engaging frontline teams are essential for sustainable care model redesign.