Journal of Nursing Administration最新文献

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.

Objective: The aim was to describe the factors leading to, and explore the coping strategies and the consequences of, nurse manager presenteeism.

Background: Presenteeism, or presence at work while not fully performing, is prevalent among direct-care nurses, yet no studies have explored nurse manager presenteeism.

Methods: This study used a convergent mixed-methods design with 1:1 interviews, a demographic questionnaire, mental/physical health and work situation questions, and the Job Stress-Related Presenteeism Scale (JSPS). Participants included 14 nurse managers from 3 hospitals in Central Pennsylvania.

Findings: Quantitative results reveal participants' physical and mental health, results of the JSPS, and inferences between presenteeism and health/demographic items. The overarching qualitative theme was the cyclic nature of presenteeism. Work demands and other contributing factors, like illness and personal factors, contribute to presenteeism, which leads to adverse consequences. The consequences lead to more work demands and can lead the nurse manager to consider leaving a job or the profession. The cycle can be broken by protective factors, coping mechanisms, and support. Mixed-methods results revealed convergence among the quantitative and qualitative results.

Conclusions: Executive leaders must help nurse managers break the cycle of nurse manager presenteeism. Nurse managers need fewer work demands and more support to improve their performance at work.

Frontline nursing leaders who foster compassionate and innovative healthcare settings improve nurse engagement, patient outcomes, and workplace culture. These leaders play a crucial role in advancing healthcare by highlighting the need to recognize and support these essential professionals.

Objective: To explore a workload intensity staffing (WIS) model's effect on nurse and patient outcomes.

Background: Little is known about the relationship between WIS and nurse and patient outcomes.

Methods: A point-based workload intensity tool was developed and implemented to determine the level of care for adult inpatients. Before and after implementation, nurses provided feedback on staffing practices. Rates for catheter-associated urinary tract infections (CAUTIs), central line-associated bloodstream infections (CLABSI), and patient fall rates were collected.

Results: Nurses indicated that patients were equally distributed among nurses (pre-score mean [M] = 3.7 vs post M = 3.6, P = 0.609) and that patient work intensity was incorporated into patient assignments (pre M = 3.4 vs post M = 3.5, P = 0.717). A significant negative trend was revealed for patient falls per 1000 patient-days (b = -0.063, P = 0.010) with fewer falls post-WIS implementation and a significant decrease in falls with injury (b = -0.085, P = 0.002). There was no significant difference in CAUTI and CLABSI rates for pre- versus post-WIS and WIS implementation.

Conclusions: Although these initial results are promising, more research is needed on WIS and nurse and patient outcomes.

Since the American Organization for Nursing Leadership (AONL) Foundation for Nursing Leadership Research and Education began awarding grants for nursing leadership research in 2003, more than $500,000 has funded research supporting nurse leaders of all levels. This column discusses several studies that leaders of all levels, but most especially the senior leaders, chief nurse executives, and others, may find useful. Publications from these studies are ongoing, and readers will be able to access links to published articles on the AONL Foundation's website.

The American Nurses Credentialing Center's Magnet Recognition Program® is the premier international acknowledgment of nursing excellence in healthcare organizations today. More than 35 years of research continues to support a host of benefits from improved nurse engagement to better patient outcomes. Despite this elite track record, however, myths persist about what is required to earn the coveted credential. In this month's Magnet®Perspectives, we tackle some of the biggest misconceptions out there and explore how organizations can use the Magnet framework as a guide and support to create a culture of excellence in 3 key areas: staffing models, education and certification, and engagement.

Objective: This quality improvement project aimed to reduce central line bacteremias (central line-associated bloodstream infections [CLABSIs]) in a neonatal ICU (NICU) to a CLABSI rate of zero using a clinical nurse specialist (CNS)-led neonatal peripherally inserted central catheter (PICC) team.

Background: The NICU at the study site was experiencing more than twice the National Healthcare Safety Network average CLABSI rate at 2.2 per 1000 line-days with an estimated cost of $2 072 806 to the organization.

Methods: In early 2009, the CNS guided the unit from on-demand PICC placement to a dedicated team of PICC certified nurses who assumed total care of PICC line insertion and maintenance. The project used a continual, rapid cycle quality improvement model to incorporate the current evidence-based practices.

Results: The CNS-led PICC team has maintained a zero CLABSI rate for 9 years with only 1 CLABSI since June 2022.

Conclusions: The adoption of a CNS-led PICC team was instrumental in achieving a zero CLABSI rate over a prolonged period.

Nurse resilience took a hard hit during the COVID-19 pandemic and is showing signs of stabilization. Nationally, nurse leaders ask for guidance to better support frontline nurses. We conducted a review of literature to identify interventions to improve nurse resilience. This article presents a review and critique of individual-, team-, and system-level interventions to support frontline nurses. Nurse leaders are encouraged to implement systematic strategies to help frontline nurses disconnect from work.

Objective: The purpose of this study was to assess the association of educational level, work experience, and other demographic factors with the perceived impact of nurse practitioner role effectiveness.

Background: Nurse practitioners (NPs) bring value by impacting patient and organizational outcomes in multiple ways. Employers report difficulties differentiating between how MSN- versus DNP-educated NPs affect patient and organizational outcomes.

Methods: A cross-sectional descriptive survey design was used in this study that included demographic variables, productivity information, and variables related to perceived organizational outcome impacts.

Results: Participants included 128 NPs with an average of 9.5 years of experience as an NP. Years of practice as an NP was correlated with age. Educational preparation (MSN or DNP) was significantly correlated with overall perceived organizational outcomes and with specific outcomes.

Conclusions: Based on the results of this study, hiring DNP-prepared NPs is expected to bring a return-on-investment value for organizations.