Journal of Nursing Administration最新文献

Objective: The aim of this study was to analyze medication-related nursing medical malpractice cases to gain insights regarding how malpractice risk can be reduced.

Background: The criminal prosecution and verdict of nurse RaDonda Vaught focused attention on the potential medicolegal risk for nurses related to medications.

Methods: Medication-related medical malpractice cases involving nurses were obtained from a national database. Various attributes of these cases were examined, including contributing factors, injury severity, and case outcomes.

Results: Authors identified 231 nursing medication-related medical malpractice cases closed from 2017 to 2021. The most frequent adverse events involved medication administration. Not following policies or protocols was the most common contributing factor. Opioids and epinephrine were the medications most frequently involved in the cases. Indemnity payments were made in 56.3% of the cases, with an average indemnity payment of $366 002.

Conclusions: Nursing medication-related medical malpractice cases are relatively uncommon, which may reassure nurses regarding medicolegal risk. Medications and contributing factors involved in the cases suggest patient safety interventions including education related to policies, procedures, and protocols.

Objective: The aim of this study was to explore factors related to a travel nurse completing or extending an assignment or leaving before the end of an assignment.

Background: Hospitals use various options for staffing shortages. One option is to contract with travel nurses. The recent increase in travel nurse utilization, coupled with the need to retain permanent staff and see a return on investment, requires an understanding of factors driving travel nurse decision-making.

Methods: This qualitative research used semistructured interviews and a survey with prepandemic-postpandemic participants that comprised travel nurses from 2 urban academic centers.

Results: Three themes emerged from the interview data: flexibility, support, and conditions.

Conclusions: Travel nurses report they will stay in an assignment if they feel supported and have flexibility and if the location is desirable. Matching institutional needs with travel nurse experience and assignment expectations can create a mutually beneficial experience for the institution, agency, and the travel nurse.

Background: Moral distress is the inability to do the right thing due to imposed constraints.

Objective: Explore the presence of moral distress among nurses.

Methods: A quantitative, exploratory, cross-sectional study at a level 1 trauma center using the Measure of Moral Distress for Healthcare Professionals (MMD-HP).

Results: Ninety-seven nurses completed the MMD-HP. The top 3 items contributing to moral distress included inadequate staffing, inadequate resources, and lack of administrative support. Nurses who considered leaving had more moral distress. Moral distress explained 28.5% of the variance associated with nurses' "intent to leave" and "primary unit" ( P < 0.001). Moral distress for nurses 40 to 49 years of age was higher compared with nurses 50 years or older.

Conclusions: Moral distress involved deficiencies in staffing, resources, and administrative support. Research should explore interventions to mitigate moral distress among nurses by promoting safe staffing levels, the provision of adequate resources, and increased administrative support.

Objective: To translate the Verran Professional Governance Scale© (VPGS©) into Swedish, adapt it to the Swedish context, and validate it.

Background: Magnet ® -recognized hospitals have proven successful in reversing negative trends regarding nursing shortage. A change in organizational and management structures is required, and professional governance is fundamental. However, in a Swedish context, there are no validated instruments to measure professional governance.

Methods: The instrument was translated from English to Swedish and synthesized into a unified version. It was back translated, discussed in an expert panel, and pilot tested with cognitive interviews of nurses.

Results: A new Swedish version of the VPGS© was developed. The expert group reached a consensus, and the scale-level Content Validity Index value shows high relevance. Some words and sentences were revised, and an introduction was added.

Conclusions: The study generated a Swedish version of the VPGS©, which can be used to measure nurses' perceptions of professional governance behaviors.

Objectives: To explore and make recommendations to implement direct billing and reimbursement models for nursing care in the United States.

Background: Nurses make up the largest group of healthcare professionals and within hospitals, nurses represent approximately a quarter of all resources and associated costs of patient care. This care is mostly hidden in daily room and board charges.

Methods: The authors surveyed the recent and historical literature related to costing and billing for nursing care. These results were synthesized and led to the recommendation of several new models to cost, bill, and pay for nursing care provided by nurses who are not currently billing for their services.

Results: Two basic billing models are proposed: the 1st is to remove nursing care out of the current daily room or facility-based charges and allocate nursing care time provided to each patient during each day of stay. The 2nd is to expand existing Current Procedural Terminology codes to bill for specific activities and interventions by nurses in all settings where nursing care is delivered.

Conclusions: It is feasible to implement the proposed methods to identify patient-level nursing intensity, cost, services, and interventions provided by individual nurses in all healthcare settings.

Clinical peer review is a strategy that engages nurses in elevating not only the safety of patients but also their influence on practice. There is little guidance in the literature about how to operationalize peer review in a way that promotes just culture. In a postpandemic era, where nurse engagement and retention are low, this article describes how to implement and measure the impact of clinical peer review on practice trends and empower nurses to influence system-wide change.

Objective: To propose practical hypotheses on audit and feedback that support the effectiveness with nurses.

Background: Audit and feedback interventions have been mainly studied with physicians; however, the processes have been practiced by nurses for years. Nurses' response may differ from that of physicians and other healthcare disciplines because of their roles, power, and the configuration of nursing activities.

Methods: A comparative analysis of the Clinical Performance Feedback Intervention Theory was conducted using nursing-specific empirical data from: 1) a mixed-methods systematic review and 2) a pilot study of audit and feedback with a team of primary care nurses.

Results: Researchers hypothesize that audit and feedback interventions are more effective when: 1) feedback emphasizes how it relates to the relational aspect of nursing; 2) indicators are measured and reported at team level; and 3) feedback is provided in a way that highlights benefits to nurses' practice, such as the potential to reduce workload.

Conclusion: These proposed hypotheses provide concrete guidance to researchers and managers for an effective use of audit and feedback as a quality improvement strategy with nurses.

This project aimed to evaluate the DNP projects at an academic medical center, assess the sustainability of DNP final projects, and explore potential opportunities to enhance the organizational review processes. The organization's graduate student review committee reviewed DNP projects implemented at the organization over the last 8 years. The sustainability of projects was less than anticipated. Recommendations are provided to enhance the DNP project approval process and improve strategies for sustainability.

Due to shifting priorities and unforeseen challenges, nurse leaders often lack sufficient time and resources to systematically review and appraise the available literature in search of the best evidence to guide decisions. A nurse-led rapid review service can produce accelerated knowledge synthesis and contextualized translation of evidence in a resource-efficient manner. This article describes a nurse-led rapid review service implemented at a large academic medical center and provides a reproducible process to guide other healthcare organizations in developing similar programs.

Traditional staffing models rely on the productivity metric of hours per patient day, lacking the ability to adequately capture the nursing workload. Acuity-based staffing considers the patient population's acuity for appropriate nursing workload. Using process improvement methodology, a pediatric ICU transitioned to an acuity-based staffing model resulting in an 11.3% ( P < 0.05) reduction in the acuity per nursing assignment and a decrease in reportable safety events by 61.3% ( P < 0.05).