Canadian journal of nursing administration最新文献

Given the fiscal challenges within health care today, nurse administrators, whether acting in the role of client or consultant, must determine the most effective and efficient way to solve problems and achieve goals. The consultation process can be viewed from both the client's and the consultant's perspective. This article is intended to provide a practical approach to addressing the issues within the consultation process. The steps of the consultation process are reviewed. The evolution from solving problems to achieving goals is described. The importance of the use of a screening tool when interviewing prospective consultants is emphasized and an example of a generic screening tool is provided. During the interview, consultants are advised to clearly determine the problem or goal, the outcomes which the client expects, possible barriers and risks, and the philosophical fit between both parties. Nurses practise consultation skills daily and, therefore, consultation is a viable opportunity for self-employment.

Policy and procedure manuals can be cumbersome to keep current and updated. One approach to meet this challenge is by implementing a decentralized system to develop, review, revise and approve policies and procedures. Mechanisms to operationalize such a system involve sharing of responsibility and accountability of specified policies and procedures by various existing committees and development of coordinating systems and support mechanisms. Other key attributes of a decentralized system included collaboration and extensive communication strategies.

This paper describes a process of planned change undertaken by a group of graduate nursing students of the University of Alberta. Their goal, a funded PhD program in Nursing, was realized fourteen months after their initial meeting. The message of their story is a simple yet significant one for all nurses who wish to influence their environment: Using a framework of planned change, a group of people who organize and commit themselves to a clear goal can become impossible to ignore. In the complexities and uncertainties of today's health care system, many nursing leaders wonder how to effectively insert themselves into the changes occurring in their environments. In this paper, the process of planned change is described through the story of one group of nurses who deliberately set out to reach a desired goal: a funded PhD Program in Nursing at the University of Alberta. Fourteen months later on December 21, 1990, a funded PhD Program in Nursing became a reality. In the early 1980's, several nurses attempted to establish doctoral education for nurses in Canada. The need was for nurse researchers and leaders with doctoral qualifications within the Canadian context. By 1986, the collaboration of nursing faculties at the University of Alberta in Edmonton and the University of Calgary was well under way. The work of Dr. Shirley Stinson, Dr. Janetta McPhail, and Dr. Margaret Scott-Wright with their colleagues resulted in academic approval for the first PhD Program in Nursing in Canada, at the University of Alberta in Edmonton. The starting date of the program, however, was subject to the availability of funding. Funding remained elusive for the next three years, and in the fall of 1989, the Nursing Graduate Student Association decided to form a committee to obtain funding for the doctoral nursing program. Nineteen graduate nursing students from the University of Alberta and the University of Calgary banded together to create the "Nursing PhD Program a Reality" group (NPPR). The group used a framework of planned change based on concepts found in the literature on power, politics, and political action.

Research utilization models have not commonly been used in attempts to solve workplace problems using the results of nursing administration research. This paper describes a graduate learning experience in which the Stetler-Marram Research Utilization Model was applied to a fictitious case in nursing administration. In this case, the model was used to develop a research-based intervention to improve job satisfaction in a hospital setting.

The role and structure of the Canadian Health Care System and its facilities are changing rapidly. Regionalization, decentralization, and flattening of hierarchical structures have occurred in governments and institutions. Traditional management roles, including the Vice President/Director of Nursing have been eliminated. There is a need to create a new model of nursing leadership if nurses are to continue to provide quality patient care. This article describes the initiative at Women's College Hospital to meet the expressed needs of nurses by developing a unique nursing role. The development of the chief of nursing practice role is defined within the context of the changing environment and Kanter's theory of empowerment. The position of the chief of nursing practice is a role model for nursing leadership and one that is pivotal for the professional identity of nursing, and for the provision of high quality patient care.

The political, social, economic, and technological forces being experienced within health care today demand that we apply creative models and philosophies for the delivery of nursing services. This paper describes the application of a "Quality Management Model" and presents a "Philosophy of Nursing Quality" that incorporates the elements of quality, cost, caring and nursing in a holistic manner. Application of this Model and Philosophy could provide nurse managers the guidance required to survive the turbulent 90's. In combination, they maximize the potential for success for both the health care recipient and care provider.

This paper presents a model of professional nursing in organizations that provides cohesive direction to the development of patterns that shape how nursing is structured in an organization. Such cohesive direction can foster integration between the practice and the discipline components of nursing. The model can influence the structure of nursing on a macro level within the organization and on a micro level by influencing patterns of nursing care delivery. A set of values, assumptions, dimensions, constructs, principles and propositions have been identified and brought together in this model. As a framework, it can be used to shape the structures and processes that contribute to professional nursing excellence in practice settings.

Theorists tell us that we are smack in the middle of the information age. We cannot help but realize that knowledge is expanding exponentially. The challenge for us as nurses and as nurse leaders is to "keep up", and to do so in a manner which is both efficient and effective. The education of nurses (both basic and ongoing) has historically operated in the pedagogical mode. Nurse learners were expected to be ready and willing to "absorb" whatever the teacher gave out. They were not to demonstrate too much initiative, nor were they held responsible for what or how they learned. Their nursing experience (even when that experience was significant) counted for little. Furthermore, individual nurses have rarely been afforded the opportunity to examine how they learn. Nor have nurse leaders taken into consideration their protegees' preferred learning styles. As a profession, we are very slow to accept and utilize modern principles and practices of learning--principles and practices which we desperately need to cope with the challenges of the information explosion! In undertaking this literature search, I chose to focus on theories of adult and organizational learning, and selected a variety of theories which I believe are timely and relevant to this task.

Technology in the nursing workplace is inevitable but what is not certain is how well these technologies will be initially accepted by nurses. One technological innovation that has appeared in some Canadian hospitals is IV Patient Controlled Analgesia (IV PCA), an innovative technique for pain management, employing the use of a computer-driven pump. Few nursing studies have examined the adoption of technological innovations. This qualitative study examines the incorporation of IV PCA to the nursing workplace and job-related factors that influenced it. A five-phase integration process was identified along with factors impacting on this process. Incorporating IV PCA into nursing practice involved the nurses' judgements of the influence of this innovation on the nurses' comfort with care delivery; the patient/nurse relationship; managing the technology; and the relationship with other health care professionals and patients' family/visitors. Anxiety accompanied the integration process, peaking as IV PCA was introduced to patient care. Findings of this study suggest that actions and decisions initiated by nurse administrators and educators have the potential to influence the successful adoption of this innovation.

This article describes the implementation of unit-based continuous quality improvement approach to quality management and the resultant fostering of autonomy and decision-making among clinical nurses. Restructuring, education and evaluation activities during implementation are described. Nurses in the post-implementation evaluation survey stated that quality of care was improved by unit-based continuous quality improvement. Unit-based continuous quality improvement promotes a high level of clinical nurse involvement as evidenced by quality improvement initiatives and projects completed. Accompanying this involvement, is a system of continuous quality improvement which facilitates patient care improvement.