Developing a Nursing Workload Intensity Staffing Model: Evaluating the Perceptions of Nurses and the Effect on Nursing-Sensitive Indicators.

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.

Leaders Benefit From Organizational Membership: Perspectives From the United States and Canada.

This article explores the value of nurse leader membership in professional organizations in the United States and Canada. Benefits include the sharing of scholarly information, enlarging networks, and professional development.

Building Leaders for an Equitable and Inclusive Future.

The Association for Leadership Science in Nursing (ALSN) 2023 International Conference was held on October 28 to 30 in Birmingham, Alabama, and sponsored by the University of Alabama at Birmingham School of Nursing. ALSN is dedicated to uniting academic and practice leaders to shape leadership science, education in nursing, and the practice of nursing leadership. The theme for the conference was Building Leaders for an Equitable and Inclusive Future.

Academic-Practice Partnership in Research: Meeting the Gold Standard.

Academic-clinical partnerships describe relationships between 2 groups to advance mutual interests, particularly collaboration on research projects. In this column, members of the Association of Leadership Science in Nursing discuss a 10-year partnership between a nurse professor at a southeast university and a nurse scientist at a health system in the southeast United States, reflections on meeting the criterion standard in our research pursuits, and lessons learned.

Leadership Science in Nursing: Creating New Solutions for New Challenges.

The Association for Leadership Science in Nursing (ALSN) November 2022 International Conference was held at the Frances Payne Bolton School of Nursing at Case Western University. ALSN is dedicated to uniting academic and practice leaders to shape leadership science, education in nursing, and the practice of nursing leadership. One hundred fifty-one nurse leaders from the United States, Canada, and Oman gathered to discuss leadership as highlighted in this column.

The impact of nurse practice environment on patient outcomes and mediation effects of registered nurse outcomes in Middle Eastern acute care hospitals: A cross-sectional study.

Aims: Examining associations between unit nurse practice environment and four patient outcomes (catheter-associated urinary tract infections [CAUTIs], central line-associated bloodstream infections [CLABSIs], falls, and pressure injuries) and mediation effects of three RN unit workgroup outcomes (job enjoyment, psychological safety, and intent to stay at 1 and 3 years) on these relationships.

Methods: A cross-sectional correlational design, using the National Database of Nursing Quality Indicators® (NDNQI®) unit-level data from 2018 on inpatient units from seven Middle Eastern hospitals. Ninety units were included, where the sample of units for each patient outcome varied (n = 73-90) based on outcome data availability.

Transitioning from Nurse-Patient Ratios to Workload Intensity Staffing: What Helps and Hinders the Change.

Objective: The aim of this study was to explore the facilitators and barriers in implementing a workload intensity (WI) tool.

Background: A WI tool was developed to quantify patient needs and more evenly disperse workload among nurses.

Methods: A descriptive phenomenological design was used.

Organizational Safety Climate and Job Enjoyment in Hospital Surgical Teams With and Without Crew Resource Management Training.

Objective: The association between organizational safety climate (OSC) and job enjoyment (JE) for team members in surgical units in 2 hospitals was investigated. The treatment hospital received airline industry-based crew resource management (CRM) training, and the comparison hospital did not.

Background: Strong OSC has been positively associated with healthy hospital work environments and was expected to also be associated with employee job enjoyment.

Reinventing the Delivery of Care in a New Women and Children's Center Using an Integrated Lean Model.

This article describes one heath system's creation of a new women's health hospital using an innovative model integrating patient care delivery, Lean building design, and Lean integrated project methodology. The article describes a 5-year journey detailing the innovative process that guided the planning and implementation of the new care delivery model, as well as employee and leader roles, employee behavior and engagement, and key insights and lessons learned that will benefit nurse leaders.

Exploring the Association Between Organizational Safety Climate, Failure to Rescue, and Mortality in Inpatient Surgical Units.

Objective: To examine the association between organizational safety climate (OSC), in-hospital mortality (IM), and failure to rescue (FTR) in 2 hospitals, 1 with and 1 without crew-resource-management training.

Background: OSC is 1 of the most important organizational factors that promotes safety at work; however, there is a lack of research examining the relationship between OSC and patient deaths in hospitals.

Methods: We utilized a matched 2-group comparison of surgical patients and surveyed surgical staff to assess the relationship between OSC, FTR, and IM.

Failure to rescue and 30-day in-hospital mortality in hospitals with and without crew-resource-management safety training.

Failure to rescue (FTR) occurs when a clinician is unable to save a hospitalized patient's life when they experience a complication that was not present on admission. Research suggests that a focus on patient safety, including implementing airline-industry-based-crew-resource management (CRM) training, can improve patient outcomes, however, the effects of CRM on FTR are unknown. This study examined FTR and 30-day in-hospital mortality (IM) outcomes in two hospitals to determine if differences existed in the treatment hospital (received CRM training) and the comparison hospital (did not receive CRM training).

The Effect of Leadership Interventions on Staff Nurse Job Enjoyment and Leadership Perception.

Nurse managers (NMs) influence retention and job satisfaction, although many facilities lack NM training programs. A program examined staff nurse perceptions after their NMs participated in leadership training. NMs with limited training may find it more challenging to positively affect their nurses' job satisfaction and retention.

Nurses' Participation in Clinical and Administrative Decisions in Different Types of Hospital Units.

Objective: This study explored the types of decisions and differences in decision making that nurses made in different types of hospital units.

Background: The relationship between nurses' participation in decision making and the different types of hospital units where they work is not well understood.

Methods: Nurses' participation in decision making was explored using the Participation in Decision Activities Questionnaire.

Nurses to Their Nurse Leaders: We Need Your Help After a Failure to Rescue Patient Death.

The purpose of this study was to describe nurses' needs and how they are being met and not met after caring for surgical patients who died after a failure to rescue (FTR). A qualitative, phenomenologic approach was used for the interview and analysis framework. Methods to ensure rigor and trustworthiness were incorporated into the design.

Nurses' Experiences With Patients Who Die From Failure to Rescue After Surgery.

Purpose: To describe the lived experiences of hospital nurses caring for surgical patients who died from failure to rescue (FTR).

Design: A qualitative phenomenologic approach was used. Methods to ensure rigor and trustworthiness were incorporated into the design.

Leading in the Healthcare Vortex.

The 2016 International Nursing Administration Research Conference, Leading in a Healthcare Vortex, was held in Orlando, Florida. The program drew 116 attendees with representation from Canada and Brazil. Participants from practice, education, and research discussed leadership in our turbulent healthcare climate, which are highlighted in this column.

Interdisciplinary Shared Governance in Ambulatory Care: One Health System's Journey.

The implementation of shared governance structures in acute care has illustrated the positive relationship between shared decision making and nurse empowerment and positive nurse and patient outcomes. Little is known, however, about interdisciplinary shared governance, and even less is known about shared governance in ambulatory care. This article details one health system's experience with the implementation of an interdisciplinary shared governance structure in ambulatory care over a 4-year period.

Preparing BSN Students for Population-Focused Nursing Care.

A baccalaureate nursing program in central North Carolina, in partnership with a local homeless shelter and community clinic, serves a vulnerable, underserved population while helping students gain hands-on experience in population-focused nursing. Students assess health needs, issues in access to care, and other health challenges using health assessment tools, surveys, and one-on-one dialogue. They then prioritize the top three health challenges and issues for the population and plan and implement educational sessions.

The relationship between work complexity and nurses' participation in decision making in hospitals.

Objective: The aim of this study is to examine the relationship between work complexity and nurses' participation in decision making in hospital nursing units.

Background: Increasing nurses' participation in decision making has been used as a way to manage work complexity; however, the work of nurses in acute care hospitals has become highly complex, and strategies used to manage this complexity have not been fully explored.

Methods: The relationship between work complexity and nurse participation in decision making was examined using data from the Outcomes Research in Nursing Administration project.

Organizational effects on patient satisfaction in hospital medical-surgical units.

Objective: The purpose of this study was to examine the relationships between hospital context, nursing unit structure, and patient characteristics and patients' satisfaction with nursing care in hospitals.

Background: Although patient satisfaction has been widely researched, our understanding of the relationship between hospital context and nursing unit structure and their impact on patient satisfaction is limited.

Methods: The data source for this study was the Outcomes Research in Nursing Administration Project, a multisite organizational study conducted to investigate relationships among nurse staffing, organizational context and structure, and patient outcomes.

Organizational influences on patient perceptions of symptom management.

We tested a theoretical model of the relationships of hospital context, nursing unit structure, and patient characteristics to patients' perceptions of the extent to which nurses met their expectations for management of troubling symptoms. In our sample of 2,720 patients randomly selected from 278 nursing units in 143 hospitals, we found that patient age was positively associated with patients' perceptions of symptom management. The proportion of registered nurses as caregivers on the unit was not a significant predictor of symptom management, but better work conditions on the unit (nurses' autonomy, participation in decision-making, and collaboration with other disciplines [relational coordination]) significantly contributed to patients' perceptions of better symptom management.

Does safety climate moderate the influence of staffing adequacy and work conditions on nurse injuries?

Problem: Hospital nurses have one of the highest work-related injury rates in the United States. Yet, approaches to improving employee safety have generally focused on attempts to modify individual behavior through enforced compliance with safety rules and mandatory participation in safety training. We examined a theoretical model that investigated the impact on nurse injuries (back injuries and needlesticks) of critical structural variables (staffing adequacy, work engagement, and work conditions) and further tested whether safety climate moderated these effects.