Journal of Nursing Administration最新文献

Objectives: Evaluate the understanding of an Advanced Practice Provider (APP) career ladder designed to promote growth and address salary compression.

Background: APPs are essential to academic medical centers. Targeted ladders may support recruitment, engagement, and retention.

Methods: In 2023, a 4-level APP career ladder was launched at the Northeast Pediatric Health System for nurse practitioners and physician assistants. Pre-post surveys assessed implementation and compensation understanding. A 2-way ANOVA tested pre-postsurvey effects.

Results: Most APPs agreed or strongly agreed that a career ladder clarifies clinical competencies (54% pre vs. 72% post) and provides a development pathway (69% pre vs. 77% post). Knowledge differed by practice location, with outpatient APPs reporting lower knowledge than inpatient peers (P=0.016). Understanding of salary compensation was stable with a small, nonsignificant post increase.

Conclusions: The ladder clarified competencies, supported growth, and recognized APP contributions. Nurse executives should consider implementing competency-based ladders to strengthen this workforce.

Objective: Analyze qualitative baseline data from a randomized controlled trial to identify factors that drive stressors among at-risk nurses and identify their desired actions to improve health/well-being.

Background: Reducing nurse suicide is a national imperative.

Methods: Prospective nurse cohort deemed at-risk of adverse mental health outcomes, including suicidality. Inductive reflexive thematic analysis (n = 466) of survey responses regarding stressors and solutions for positive change.

Results: The nurses' caring identity can cross work/life boundaries and become all-consuming with health consequences. Themes driving stressors include suboptimal work environments, mental/physical health issues, financial insecurity, and unmet relationship and familial obligations. Participant suggestions include transforming workplace culture/resources and providing resources for holistic mental health support and practices, financial planning, and career transitions.

Conclusion: When obligations and expectations exceed capacity, the price of caring results in a deterioration in mental and physical health. Leaders must holistically address these concerns within suicide prevention/well-being programs.

Objective: To explore cross-sector collaboration in complex care transition planning by care coordinators through discussion of a hypothetical practice application and recent research application of social network analysis and relational coordination.

Background: With growing evidence showing the impact of health-related social needs on patient outcomes, funding and regulatory agencies demand care models that link health and social organizations. Programs like medical respite for people experiencing homelessness rely on cross-sector collaboration, the structured alliance of multiple agencies to manage a complex problem unable to be met by one entity, to ensure successful transitions after hospitalization. In cross-sector scenarios, nurse administrators oversee frontline care coordinators, facilitating transitional care plans that can be labor-intensive and require an interorganizational strategy to maneuver and optimize.

Methods: A discussion of social network analysis and relational coordination was applied to a hypothetical hospital care coordinator practice scenario. A recent research application study of a medical respite program and its collaborating cross-sector network (N=15 health/social organizations) through 21 administrative interviews and 41 frontline care coordinator surveys was reviewed. Cross-sector collaboration in the research application study was measured by analysis of the frequency of collaboration between agencies (social network analysis) and the quality of relationships and communication (relational coordination).

Results: Elements and practical application of social network analysis and relational coordination were discussed. Research application results showed that administrative participants were more collaborative than the frontline. All rated relationship quality higher than communication quality. Homeless service and acute care agencies were central actors in the cross-sector network.

Conclusions: The authors describe an innovative way to measure and optimize cross-sector collaboration in teams coordinating complex care transitions. This model could be used by nurse administrators designing or managing cross-sector collaborative programs with community partners receiving patients at high-risk for readmission after hospital discharge, like people experiencing homelessness with multimorbid clinical needs, and adds to the growing literature on an innovative care concept known as cross-sector care coordination.

The National Association of Clinical Nurse Specialists (NACNS) developed a comprehensive toolkit for implementing "Grow your Own" Clinical Nurse Specialist (CNS) programs. The toolkit addresses the critical shortage of CNSs by providing healthcare leaders with practical resources for internal talent development. Implementation examples demonstrate significant returns on investment through cost avoidance and quality improvements. The guide offers a sustainable solution for healthcare organizations facing CNS recruitment challenges while promoting professional advancement opportunities.

This month's Magnet® Perspectives column spotlights recipients of 2025 ANCC Magnet Program® National Magnet Nurse of the Year® (MNOY) awards and the ANCC Magnet Prize®, sponsored by Press Ganey, recognized during the ANCC Magnet and Pathway ConferenceTM in Atlanta, Georgia, October 8-10, 2025. The MNOY awards recognize 5 exceptional clinical nurses in Magnet-designated organizations who demonstrate outstanding contributions in innovation, consultation, leadership, and professional risk-taking. The ANCC Magnet Prize recognizes a Magnet organization whose nursing team spearheaded exemplary achievements, including initiatives in healthcare delivery and research, leading to innovations in patient care services. Press Ganey sponsors the Magnet Prize by providing a $125,000 purse to the organization to further develop and advance its innovative program/project.

Objective: The aim of this study was to determine interventions recommended by nurses working in rural America to promote wellness in the workplace.

Background: Over the last decade, persistent nursing shortage and an unprecedented post-pandemic period challenged health care systems. There is limited literature addressing these challenges from the perspective of nurses in rural America.

Methods: The longitudinal, qualitative study used focus groups to understand the nurses' recommended interventions. Clinical nurses (n=14), nurse leaders (n=17), and advanced practice nurses (n=12) from tertiary and rural settings participated in the first focus group session. Clinical nurses (n=11), nurse leaders (n=13), and advanced practice nurses (n=9) participated in the second focus group session.

Results: The participants prioritized wellness interventions that could impact nurses in their role and work setting across the United States. Recommended unique interventions aligning with role and work setting are provided by the authors.

Conclusions: Study findings provide organizational leaders with interventions to explore that may have a positive impact on nurse wellness in their health care systems. Future research is recommended to investigate the effects of these interventions on nurses' wellness.

Professional advancement models (PAM) for advanced practice providers enhance recognition and engagement by rewarding academic excellence. This manuscript outlines the sustainability of a PAM at a pediatric medical center, highlighting integration into professional governance and performance management. Design flexibility has ensured relevance amid shifting organizational priorities. The PAM demonstrates return on investment through improved recognition, engagement, and retention, while serving as a career map that strengthens leadership's ability to guide academic career development.

Objective: The purpose of this study was to assess the prevalence and severity of post-traumatic stress (PTS) symptoms among intensive care unit (ICU) nurses and examine correlations with other psychological outcomes. A secondary purpose was to assess the feasibility of an evidence-based treatment for PTS in this population.

Background: PTS may contribute to psychological distress, trouble sleeping, and high turnover.

Methods: ICU nurses completed measures of PTS, self-compassion, anxiety symptoms, insomnia, and depressive symptoms. Participants with high levels of PTS were offered a trauma intervention.

Results: PTS, depression, anxiety, and insomnia were present in 28% to 41% of participants. High PTS symptoms were correlated with high anxiety (r=0.476, P=0.011) and depression (r=0.416, P=0.018). High depressive symptoms correlated with high anxiety (P=0.422, P=0.023), PTS (r=0.416, P=0.018), insomnia (r=0.562, P=0.001), and the likelihood of leaving their position or the profession of nursing (r=0.485, P=0.008). None of the 11 participants who were offered the intervention accepted it.

Conclusions: Interventions to address PTS are needed in ICU settings; however, barriers to acceptance must be addressed. ICU nurses should be involved in all phases of intervention development, implementation, and evaluation.

Background: Psychological safety, leadership support, and organizational climate frequently limit the primary nurses' voice behavior. Nurses then tend to remain silent when assessing the possible risks associated with vocalizing concerns (voice behavior). Research predominantly confirms a top-down structure between leadership and voice behavior from clinical nurses, with less research on the mechanism of upward management. This study aimed to validate the mediating role of workplace upward networking between affective leadership and the voice behaviors of clinical nurses.

Methods: This study was a cross-sectional survey, using purposeful sampling to select 639 nurses from all primary hospitals in Hangzhou. Measurement tools included the demographic information questionnaire, affective leadership scale, voice behavior scale, and workplace upward networking scale.

Results: The relationship between affective leadership and voice behavior mediated by upward networking in the workplace was confirmed. Affective leadership affected workplace upward networking, with an explained variation of 37%. Affective leadership and workplace upward networking affected voice behavior, with an explained variation of 61%.

Conclusions: This study provides support for a nursing management model in primary care, emphasizing the cultivation of affective leadership behaviors and style and the enhancement of upward management strategies to foster clinical nurses voicing concerns to management about safety issues or ideas for innovation.

The evolution of nursing leadership educational preparation, compared with current nurse executive board certifications, highlights redundancies and insufficient differentiation based on level of academic preparation. Emphasizing outcomes associated with doctoral preparation and the American Association of Colleges of Nursing (AACN) essentials, the authors propose establishing a doctoral-level certification pathway. This recommendation aligns nurse executive certification with the transition of many advanced practice registered nurse (APRN) programs to the Doctor of Nursing Practice (DNP) as the terminal practice degree, leading to advanced specialty certification, and supports national calls for doctoral education for nurses who hold organization-wide or system-level leadership positions.