Nursing Administration Quarterly最新文献

Leading professionals require a different set of skills from those used for most employee work groups. This article reviews the reasons why nursing professionals need different leadership capacity and what some of those changes might be.

In 2019, the National Academy of Science identified clinician burnout as a growing public health concern. The COVID-19 pandemic has only compounded this crisis and transformed it into an escalating fracture within the US health care system. Concurrently evolving with this emergency is a rise in the number of nurses who intend to leave the profession. Frontline nurse leaders are the lynchpin in ensuring health care systems function. These leaders have accountability over patient care and clinician well-being. Focused efforts must address clinician burnout. However, without addressing the well-being of frontline nurse leaders, the fault line in our health care system becomes a vast chasm. Recently, published literature began to emerge describing and addressing frontline clinician burnout. Unfortunately, only a few, if any, address issues related to leaders. The aim of this qualitative case study research was to explore and discover general themes in system chief nurse executive leadership practices that support, mentor, develop, and retain nurse leaders as a basis for future research. Three major themes were identified for future study and exploration: enhancing leadership development programs; improving leader work environments; and focusing on leader well-being and support. Further research is needed to evaluate the effectiveness of these themes.

Health care is a highly competitive environment where managers must compete for finite resources. The Centers for Medicare & Medicaid Services-directed reimbursement models such as value-based purchasing and pay-for-performance heavily focused on quality improvement and nursing excellence are having a major impact on financial reimbursement for health care services in the United States. As such, nurse leaders must function in a business-focused environment where decisions regarding resource allocation are driven by quantifiable data, the potential return on investment, and the organization's ability to provide quality patient care in an efficient manner. It is imperative for nurse leaders to recognize the financial impact of potential additional revenue streams, as well as avoidable costs. Nurse leaders must also be skilled at translating the return on investment for nursing-centric programs and initiatives, often hidden in anecdotal terms and cost avoidance rather than revenue generation, to ensure appropriate resource allocation and budgetary assumptions. This article uses a case study framed within the business case to review a structured approach to operationalizing nursing-centric programs and highlights key strategies for success.

The COVID-19 pandemic presented staffing challenges in providing care during the surge of critically ill patients. This qualitative descriptive study was conducted to obtain an understanding of clinical nurses' perspective of staffing in units during the first wave of the pandemic. Eighteen focus groups were conducted with registered nurses who worked on intensive care, telemetry, or medical-surgical units at 9 acute care hospitals. The focus group transcripts were thematically analyzed to identify codes and themes. The overarching theme was staffing, a bit of a mess, which sums up the general perception of nurses during the initial phase of the pandemic. The following additional themes underscore the overarching theme: challenging physical work environment; supplementing the frontline: buddies, helpers, runners, agency, and travel nurses; nurses do everything; getting through as a team; and emotional toll. Nurse leaders can utilize these findings to guide staffing decisions today and in the future, such as ensuring nurses are oriented to their deployed unit, keeping team members together when reassigned, and striving for consistency with staffing. Learning from the experience of clinical nurses who worked during this unprecedented time will assist in improving nurse and patient outcomes.

The Practice Environment Scale of the Nursing Work Index, a widely used practice environment instrument, does not measure vital coworker interrelations. Team virtuousness measures coworker interrelations, yet the literature lacks a comprehensive instrument built from a theoretical foundation that captures the structure. This study sought to develop a comprehensive measure of team virtuousness built from Aquinas' Virtue Ethics Theory that captures the underlying structure. Subjects included nursing unit staff and master of business administration (MBA) students. A total of 114 items were generated and administered to MBA students. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were run on randomly split halves. Based on analyses, 33 items were subsequently administered to nursing unit staff. EFA and CFA were repeated on randomly split halves; CFA item loadings replicated EFA. Three components emerged from the MBA student data: integrity, α = .96; group benevolence, α = .70; and excellence, α = .91. Two components emerged from the nursing unit data: wisdom, α = .97; and excellence, α = .94. Team virtuousness varied significantly among units and correlated significantly with engagement. The two component instrument, named the Perceived Trustworthiness Indicator, is a comprehensive measure of team virtuousness built from a theoretical framework that captures the underlying structure, demonstrates adequate reliability and validity, and measures coworker interrelations on nursing units. Forgiveness and relational and inner harmony emerged as elements of team virtuousness, broadening understanding.

Routine implementation and sustainability of evidence-based practices (EBPs) into health care is often the most difficult stage in the change process. Despite major advances in implementation science and quality improvement, a persistent 13- to 15-year research-to-practice gap remains. Nurse leaders may benefit from tools to support implementation that are based on scientific evidence and can be readily integrated into complex health care settings. This article describes development and evaluation of an evidence-based implementation and sustainability toolkit used by health care clinicians seeking to implement EBPs. For this project, implementation science and EBP experts created initial iterations of the toolkit based on Rogers' change theory, the Advancing Research through Close Collaboration (ARCC) model, and phases and strategies from implementation science. Face validity and end-user feedback were obtained after piloting the tool with health care clinicians participating in immersive EBP sessions. The toolkit was then modified, with subsequent content validity and usability evaluations conducted among implementation science experts and health care clinicians. This article presents the newly updated Fuld Institute Evidence-based Implementation and Sustainability Toolkit for health care settings. Nurse leaders seeking to implement EBPs may benefit from an evidence-based toolkit to provide a science-informed approach to implementation and sustainability of practice changes.

Nursing is a highly stressful and demanding profession that can negatively affect mental health, as shown by nurses' high rate of depression. Furthermore, Black nurses may experience additional stress due to race-based discrimination in the work environment. This research aimed to examine depression, experiences of race-based discrimination at work, and occupational stress among Black nurses. To better understand associations between these factors, we conducted multiple linear regression analyses to assess whether (1) past-year or lifetime experiences of race-based discrimination at work and occupational stress predicted depressive symptoms; and (2) controlling for depressive symptoms, past-year and lifetime experiences of race-based discrimination at work predicted occupational stress in a cohort of Black registered nurses. All analyses controlled for years of nursing experience, primary nursing practice position, work setting, and work shift. The results indicated that both past-year and lifetime experiences of race-based discrimination on the job were significant predictors of occupational stress. However, experiences of race-based discrimination at work and occupational stress were not significant predictors of depression. The results of the research highlighted the predictive effect of race-based discrimination on occupational stress in Black registered nurses. This evidence can inform the development of organizational and leadership strategies to improve the well-being of Black nurses in the workplace.

The purpose of this article is to review Chickering and Gamson's principles of good practice in teaching and to illustrate their applicability to nursing online education delivery. An additional purpose is to present examples of teaching methods used by faculty to promote engagement in online education courses during the pandemic. The original 7 best practices in education, including ( a ) encourages contact between students and faculty, ( b ) develops reciprocity and cooperation among students, ( c ) uses active learning techniques, ( d ) gives prompt feedback, ( e ) emphasizes time on task, ( f ) communicates high expectations, and ( g ) respects diverse talents and ways of learning, remain evidence-based guidelines today. The authors recommend the addition of 2 new best practices: ( a ) incorporating assignment flexibility to meet student learning preferences; and ( b ) applying learning to real-life situations. Having evidence-based guidelines for supporting the role of a teacher in the online learning setting is of paramount importance.

Nurses and nurse leaders directing clinical organizations can elevate scholarly inquiry by employing a PhD-prepared hospital-based nurse scientist (HBNS). This individual will shape the culture of clinical inquiry, leading and driving efforts to close the gap between knowledge and practice. As the nursing workforce struggles to recover from the COVID-19 pandemic, now more than ever, collaborations between HBNSs and nurse leaders are essential to explore and test new nursing care delivery systems. Given the national shortage in the PhD-prepared nurse scientist talent pool, attracting and hiring the right candidate is critical. The purpose of this article is to provide practical recommendations for nurse leaders to introduce an HBNS into an organization as an important building block for nursing science and improved clinical practice. The role of the HBNS has evolved in tandem with increased education in the nursing workforce, evidence-based practice, and the explosion of implementation science. Before recruiting an HBNS, the organization must create a job description that outlines responsibilities, paying attention to the HBNS position within the organizational structure. Additionally, leaders must consider the candidate's characteristics for interacting with clinical staff. The senior nursing leadership team must recognize and appreciate the HBNS as a scholar and advisor.