Engaging Frontline Staff in Performance Improvement: The American Organization of Nurse Executives Implementation of Transforming Care at the Bedside Collaborative.

Background: Process improvement stresses the importance of engaging frontline staff in implementing new processes and methods. Yet questions remain on how to incorporate these activities into the workday of hospital staff or how to create and maintain its commitment. In a 15-month American Organization of Nurse Executives collaborative involving frontline medical/surgical staff from 67 hospitals, Transforming Care at the Bedside (TCAB) was evaluated to assess whether participating units successfully implemented recommended change processes, engaged staff, implemented innovations, and generated support from hospital leadership and staff.

The coordinator role for a nursing online graduate practicum.

Although graduate students in nursing are adult learners and expert clinicians, they are often novices in the roles they seek upon graduation. Practicum experiences help students bridge the gap between theory learned in course work and beginning practice at the master's level. However, finding practica for online nursing graduate students at great distances is often a challenge.

Healthcare Team Vitality Instrument (HTVI): developing a tool assessing healthcare team functioning.

Aim: This paper is a report of a study conducted to refine, shorten and validate the Healthcare Team Vitality Instrument.

Background: The Healthcare Team Vitality Instrument was developed to assess team vitality of nurses as well as other licensed and unlicensed personnel working as part of healthcare teams in inpatient hospital units. This instrument was necessary for two reasons.

Evaluation of a nurse practitioner-led care management model in reducing inpatient drug utilization and cost.

The aim of this research was to evaluate the economic impact of a collaborative nurse practitioner (NP) care management model on the use of pharmaceutical resources, with a focus on antibiotics, among general medicine inpatients. Although studies have shown the effectiveness of care management by NPs, especially as reflected on length of stay and hospital cost, little is known about their impact on drug cost. The researchers utilized pharmaceutical claims data of 1,200 subjects who participated in the Multidisciplinary, Physician, and Nurse Practitioner Study from 2000 to 2004 to assess the effect of the NP-led care management model on drug utilization outcomes.

Value-added care: a paradigm shift in patient care delivery.

Spiraling costs in health care have placed hospitals in a constant state of transition. As a result, nursing practice is now influenced by numerous factors and has remained in a continuous state of flux. Multiple changes within the last 2 decades in nurse/patient ratio and blend of front-line nurses are examples of this transition.

Achieving magnet redesignation: a framework for cultural change.

Magnet recognition is the highest award that the ANCC bestows on an institution and exemplifies a hospital's accomplishments in providing commitment, support, and resources for nursing excellence throughout the organization. Magnet hospitals attain their status based on structure and outcome criteria known as the 14 Forces of Magnetism. The authors discuss one hospital's journey and the outstanding models integrated in their organization that paved the way for their first award, followed by their journey toward redesignation.

The relationship between the volume and type of transforming care at the bedside innovations and changes in nurse vitality.

Through an initiative called Transforming Care at the Bedside (TCAB), the Robert Wood Johnson Foundation and the Institute for Healthcare Improvement have created an innovative bottom-up framework for redesigning the work environment on medical-surgical units. The specific purpose of this study, conducted by the University of California Los Angeles/RAND evaluation team, was to examine the number of innovations tested and the association of the volume of tests made and changes in a summary measurement of self-reported vitality at the 13 participating hospitals. The findings of this evaluation yielded several important implications for nurse leaders.

Spreading nursing unit innovation in large hospital systems.

Healthcare administrators increasingly face the challenge of how to spread innovation throughout their organizations. The authors present the results of an evaluation of the efforts of 3 major hospital systems to internally disseminate nursing unit change among medical-surgical units. The findings show that all 3 organizations carefully planned, coordinated, and implemented a spread process; none left dissemination to chance.

Value-added care: a new way of assessing nursing staffing ratios and workload variability.

Objective: To thoroughly understand the implications of California regulatory staffing ratios on nursing units, the present study examines the relative amounts of time allocated to workload activities among registered nurses.

Background: Nursing is a synergistic, intuitive process and may not be capable of being translated into minimum patient-to-nurse ratios that work across an entire region or state. A fundamental step in evaluating the appropriateness of prescribed ratios lies in assessing how registered nurses spend their time while caring for patients.

Assessing nursing staffing ratios: variability in workload intensity.

In 2004, California became the first state to implement specific nurse-to-patient ratios for all hospitals. These mandated enactments have caused significant controversy among health care professionals as well as nursing unions and professional organizations. Supporters of minimum nurse-to-patient ratios cite patient care quality, safety, and outcomes, whereas critics point to the lack of solid data and the use of a universally standardized acuity tool.

The magnet designation process: a qualitative approach using Donabedian's conceptual framework.

Twelve nurse leaders and 12 registered nurses from 2 hospitals were interviewed to gain an understanding on the process for preparing for magnet designation. These leaders and nurses provided insight into whether a cultural shift within the organization was occurring while striving for magnet designation and the level of staff nurses' engagement during the process. Donabedian's framework provided the conceptual context for this study.

Recruitment and retention strategies: a Magnet hospital prevention model.

The national health care system is facing another significant nursing shortage, particularly in the acute inpatient setting. Magnet organizations have enabled professional nurses to be autonomous and empowered, and to do for patients what they know should be done in a manner consistent with professional standards. This philosophy of nursing excellence is crucial for attracting and retaining clinical nurses, as well as vital for enhancing job satisfaction and longevity--a key strategy in surviving the nursing shortage.

What constitutes effective leadership? Perceptions of magnet and nonmagnet nurse leaders.

Magnet hospitals, so named because of their ability to attract and retain nurses, have been operating for nearly 20 years. Although research on their success, particularly related to job satisfaction and retention of nurses, is available, research on magnet nurse leader effectiveness has been limited to the pivotal role the nurse leader plays in supporting a magnet culture. To enhance the research groundwork in magnet hospitals and nursing leadership, 16 nurse leaders from magnet and nonmagnet hospitals were interviewed.

The interrelationship of organizational characteristics of magnet hospitals, nursing leadership, and nursing job satisfaction.

This study examined whether magnet hospitals continue to provide higher levels of job satisfaction and empowerment among nurses when compared with non-magnet hospitals. Also studied at both types of hospitals was whether job satisfaction discrepancy was interlinked with leadership effectiveness and support of professional nursing practice. Nurses employed at magnet hospitals experienced higher levels of empowerment and job satisfaction due to greater access to work empowerment structures.

Nurse leaders' perceptions of what compromises successful leadership in today's acute inpatient environment.

The purpose of this study was to gain an understanding of nurse leaders' perceptions of both the value of their roles in today's health care setting and their beliefs about how power and gender interface with role worth. Support for the theoretical significance of this research stemmed from Kanter's Structural Theory of Organizational Behavior. Four leaders were recruited at the executive level and 12 at the director/managerial level.

What's the attraction to Magnet hospitals? Unlimited opportunity, resources, and autonomy draw nurses to these empowering facilities.

Here, review study results that find nurses employed at Magnet hospitals experience enhanced job satisfaction due to greater access to empowerment structures within their practice setting.

What constitutes successful nurse leadership?: A qualitative approach utilizing Kanter's theory of organizational behavior.

What constitutes successful leadership in today's healthcare environment and what are the principal components of an organization that supports the role of the nurse leader? To answer these questions, 16 nurse leaders from four acute care hospitals were interviewed for their perception of leadership traits that are effective in the inpatient hospital setting and types of organizational infrastructures that create conditions for job effectiveness. Kanter's theory of organizational behavior provided the conceptual framework for this study. Leadership effectiveness is linked to having access to opportunity, resources, information, and formal and informal power in the work setting.

Assessing differences in job satisfaction of nurses in magnet and nonmagnet hospitals.

Is there a difference in the level of job satisfaction among clinical nurses employed at magnet versus nonmagnet hospitals, and is it linked to nurse executive leadership? To answer these questions, 305 clinical nurses employed at magnet and nonmagnet hospitals rated their perceptions of job satisfaction while 16 leaders from the same hospitals were interviewed for their perception of their role in healthcare. The author discusses that differences in job satisfaction scores were linked to greater visibility and responsiveness by magnet nurse leaders; better support of clinical nurse autonomous decision-making by magnet nurse leaders; and greater support of a professional nursing climate at magnet hospitals as evidenced by adequate staffing in the workforce.