Journal of Nursing Administration最新文献

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).

Developing the skills and behaviors needed for nurses to lead in professional governance has long been a priority at the American Organization for Nursing Leadership (AONL). The annual AONL Professional Governance Leadership Conference is an important part of advancing nursing professional governance, convening nurses in all roles to discuss professional governance concepts and leadership practices. AONL has produced publications and podcasts exploring the professional governance foundations, roles, and behaviors, available on its website. This article discusses AONL's partnership in the development of a new book, Professional Governance for Nursing: The Framework for Accountability, Engagement, and Excellence, edited by AONL faculty and former staff.

Objective: The aim of this study was to examine the relationship between nurse practitioner (NP) organizational climate and the implementation of full practice authority (FPA) for NPs.

Background: In 2021, Massachusetts passed FPA for NPs. Most NPs did not experience changes to their practice. It is unknown whether NP organizational climate impacts implementation of FPA.

Methods: A Web-based survey was distributed to NPs in Massachusetts.

Results: Response rate was 50.3% (N = 147). Practice remained unchanged for most. Organizations with more favorable climates experienced more rapid implementation of FPA, resulting in improved efficiency (P = 0.049) and timeliness (P = 0.007) of care. Nurse practitioners outside hospital systems were more likely to report favorable organizational climates and positive change to their practice after FPA.

Conclusions: Organizations that facilitate implementation of FPA are likely to experience improvement in efficiency and timeliness of patient care. Nursing leadership, especially within hospital-based organizations, can help achieve these benefits by improving the organizational climate for NPs.

It is imperative to support the next generation of nurses and nurse leaders facing the challenges of our complex health systems. A formal mentoring program provides a structure that allows nurses to have a relationship that promotes ongoing counsel, career development, and a myriad of other benefits with another nurse or other healthcare professionals. The 2023 Magnet® Application Manual requires organizations to implement and use mentoring and succession planning programs under the transformational leadership standard. Adopting and sustaining effective and meaningful mentoring and succession planning activities and programs promote an environment of inclusion and professional development. In addition to formal mentoring programs, the importance of informal mentoring relationships can have a lasting impact on nurses along their nursing journey.

Efficient and effective meetings are critical for busy health care leaders who are often juggling multiple demands on their time. Creating a shared sense of purpose post COVID and having engagement with all leaders are critical to a department's success. This improvement project offers leaders direction on thinking through meeting redesign.