A fragmented patient safety concept: the structure and culture of safety management in health care

The uniform and visible commitment to safety management is a cultural and structural change that health care organizations have not typically attempted. Committee structures are just one example of how culture drives structure in managing health care safety. The question is: "Are we interested in making nonpatient safety programs as well understood and as culturally significant as patient safety programs?" Models exist to institutionalize safety management in health care. We need only look to the JCAHO or OSHA and other high-hazard industry models for examples of safety management. Change requires a focus on safety, not occupational safety or patient safety, but just safety. In health care, safety would be a key characteristic of organizational culture. The organizational expectation is then that all employees will work safely and practice safety. Employees will apply safe practices when handling chemicals, in lifting, and when giving medications. Only when safety imbues the work and decisions of each employee in this way will the highest level of safety be attained.     

What role can nurse leaders play in reducing the incidence of pressure sores?

Pressure sores have plagued the nursing profession for many years as a major health care problem in terms of a patient's suffering and financial cost. Pressure sores are increasingly common in hospitalized patients in the United States with a 63% increase from 1993 to 2003. The nurse leader is accountable for the occurrence of pressure sores, a nurse-sensitive indicator, by a scorecard which is benchmarked against other facilities. The nurse leader must take a systematic approach in the prevention of pressure sores, with the strategy being consistent and motivating to the staff in order to improve patient outcome. The chief nursing officer, the unit manager, and the bedside nurse must all collaborate to prevent tissue injury in patients at risk for developing pressure sores and to promote wound healing in patients with existing breakdown.     

Nurses as implementers of organizational culture

Drawing from both theory and case-study data, the role of nurse leaders in implementing constructive organizational cultures is discussed. Constructive cultures create high-performance work environments, increasing both employee and patient satisfaction, and ultimately affecting economic performance. Nursing administrators aspiring to implement a constructive culture should emphasize people-centered values through a collective mission, strategic human resource management practices, and a patient service-oriented philosophy. Furthermore, constructive organizational cultures create successful high-performance work environments when nurses have positive colleague interactions and approach tasks in a manner that helps them experience self-actualization, while at the same time achieving organizational goals.     

TIQ (Technical IQ)--a survival skill for the new millennium

Managing in the new technocracy of the new millennium will be challenging but also much more exciting than the work we do now. Twenty years ago, nurse managers weren't held accountable for the level of knowledge about financial outcomes that is expected now. The same will be true for technology. With electronic medical records, innovations in medical treatments, and the impact of the information and technologic revolution on the entire world, the interface between technology assessment, operationalizing technology, and continually upgrading staff to know what the implications of the technology revolution are will be imperative for success. That means that we must influence schools of nursing to include technology in their content now, and to help us prepare this generation of health care leaders to take a full seat at the leadership table to manage these complexities in the future. The success of the leader of the future will be measured by that person's ability to integrate the very complex issues of patient care and technology in a way that makes sense for patients, the organization, and the staff who will be working in a very complex environment. The leader's TIQ will be as important as other intelligences in the next 20 years.     

Overcoming barriers to patient safety

Creating a culture of patient safety is a critical goal of all patient care unit staff. An analysis of the key barriers to patient safety on a typical inpatient unit in an acute care hospital (unclear unit values), the fear of punishment for errors, the lack of systematic analysis of mistakes, the complexity of the nurses' work, and inadequate teamwork are presented. Nine practices to overcome these barriers and achieve patient safety are discussed.     

Moving toward zero: the leader's mandate

Converting to a culture that strives for perfection and accepts no less than zero defects is the work of leadership in health care today. Some cultures are made up of people who believe that average is good enough. The challenge of the leader is to break up those beliefs and embed new models of "Yes We Can." The leader must communicate four very effective messages that must go along with the passion for the work: (a) evidence and "best practice" data trump local, opinion-based beliefs; (b) morphing from an internal view of best practice to a national/international view of practices within and outside health care; (c) transparency; and (d) KISS: "Keep It Simple, Stupid.'     

Nursing overtime: why, how much, and under what working conditions?

To provide the best care to patients, the physical wellness of nursing staff is essential. Current evidence indicates long work hours can lead to adverse nurse and patient outcomes. To provide quality and safe patient care, both staff nurses and nurse managers need to recognize the adverse effects of overtime, whether it is mandatory or voluntary. Results of this study showed overtime was not used more when there was an increase in nursing shortages. Further, overtime was not used to control shortages; rather, understaffing was an underlying condition of the nursing practice, at least in the study sample. Thus, efforts must be made not only to prevent nurses from working long hours, but also to resolve the problem of understaffing in order to retain qualified nurses in hospitals.     

Leadership-organizational culture relationship in nursing units of acute care hospitals

The phenomena of leadership and organizational culture (OC) has been defined as the driving forces in the success or failure of an organization. Today, nurse managers must demonstrate leadership behaviors or styles that are appropriate for the constantly changing, complex, and turbulent health care delivery system. In this study, researchers explored the relationship between nurse managers' leadership styles and OC of nursing units within an acute care hospital that had achieved excellent organizational performance as demonstrated by a consistent increase in patient satisfaction ratings. The data from this study support that transformational and transactional contingent reward leaderships as nurse manager leadership styles that are associated with nursing unit OC that have the ability to balance the dynamics of flexibility and stability within their nursing units and are essential for maintaining organizational effectiveness. It is essential for first-line nursing leaders to acquire knowledge and skills on organizational cultural competence.     

Management training effects on nurse manager leadership behavior

Costly organization-based leadership/management development training gives little evidence that such training affects long-term changes in nurse manager leader style adaptability in meeting situations and staff needs.     

趣味相投能带来创新吗？领导幽默一致性对团队创新的影响

领导幽默作为一种新兴的领导行为方式，其对创新的促进作用已经得到相关文献证实。然而，以往研究大都关注下属对领导者幽默的评价，而忽视了领导者对自身幽默的评价。基于互动仪式链理论和资源保存理论，分析领导自评领导幽默与团队他评领导幽默的一致性对团队创新的影响及其作用机制。应用多项式回归与响应面分析技术，对174个团队的领导和团队成员配对样本数据进行分析。研究发现：相比“低自评—低他评”的情形,在“高自评—高他评”情形下,团队创新水平更高；相比“高自评—低他评”的情形，在“低自评—高他评”情形下，团队创新水平更高；领导幽默一致性能够通过团队凝聚力影响团队创新。最后，结合研究结论对领导如何恰当地表达幽默以促进团队创新提出对策建议。     

How can nurses help patients work more effectively with nurses to improve the safety of patient care?

The literature seems quite clear that patients still regard the nurse as the principal link between the technical and interpersonal aspects of their care. The often-discussed medical error crisis tends to create in the patient mistrust of all care providers. The health care industry is driving towards a system that requires patients to be self-reliant in managing their care, without allowing for factual limitations in patient capability, ability, and interest in such an enterprise. Unfortunately for the overworked, understaffed nurse, patients still look to them to provide quality compassionate care without the patient having to police them. Health care providers have been mandated to provide assessment and intervention for pain management. It was mandated because we as health care professionals failed to perform this vital function in a consistent, quality manner. It did add to the workload of the nurse. However, if done properly, it is a valuable communication tool for the nurse and the patient to comfortably discuss pain and its management--the interpersonal part of care.     

领导者过度授权对员工创新行为的“负担”机制研究

员工创新行为是组织赢得竞争优势的核心源泉,已有研究发现领导者授权对员工创新行为具有积极影响,但是,领导者授权是一把“双刃剑”,授权过度会成为员工“负担”。在界定领导者过度授权的基础上,基于资源保存理论,纳入员工角色压力和情绪耗竭两个因素,通过对多渠道获取的1 204份问卷进行抽样获得758份领导者过度授权问卷数据,采用层次回归和Process中介效应检验法,实证探讨领导者过度授权对员工创新行为的“负担”机制。结果表明,领导者过度授权会增加员工角色压力,在高角色压力下员工会产生情绪耗竭,出于资源保存的考虑而减少角色外行为,最终抑制员工创新行为。     

世界遗产“文化自然之旅”与中国 文化景观之贡献

从最近ICOMOS大会世界遗产热点“文化自然之旅”着眼，回溯世界遗产的文化与自然保护发展历程的主要节点，厘清自然文化之旅的历史脉络，助益遗产保护者透彻理解今天国际文件的背景及其重要性，指出文化与自然的融合是国际社会一直努力的方向，中国“天人合一”的文化景观，尤其是中国风景名胜区对世界遗产自然和文化的融合具有重大的价值，应该成为国际“文化自然之旅”的引领者。     

Computerized physician order entry: a prescription for patient safety

Clinician adoption of CPOE/CDS solutions is crucial to helping caregivers reduce medical errors and enhance patient safety. The LeapFrog Group CPOE/CDS report can be a helpful guide, but as clinicians concerned about the quality of health care and the well-being of our patients, we must play an active role in the successful adoption of these solutions by: 1. Making sure that your institution is committed to having the appropriate people involved in the entire process, including nurse leaders. 2. Selecting a vendor that has the knowledge and clearly understands the importance of implementing this type of system. 3. Ensuring that your organization is selecting a system that actually meets the criteria defined by the LeapFrog Group.     

Information technology, nurse staffing, and patient needs

As health care organizations increasingly adopt health information technology, time-sensitive data that track patients' requirements for nursing care and nurses' responsiveness to these needs might be available to support evidence-based nurse staffing decisions. care information technologies available in hospitals and on nursing units may provide valuable sources of information that can be translated into usable data. In this study, the usefulness of electronic data obtained from a nurse tracking call light system as a source of information for quality measurement was explored. The findings point to what might be under-utilization of existing health information technology to track patients' needs and nurses' responsiveness, patient census, and patient movements. The authors recommend health information technology be used less as support for other organizational systems and more as an administrative resource that can allow nurse executives to be more actively engaged within and across nursing environments.     

Working with nurse educators' collective wisdom: implications for recruitment and retention

Very few studies have been undertaken to consider the impact of nurse education environments on faculty retention and recruitment at a time when numbers of nursing faculty are falling to significantly low levels. The purpose of this article is to deconstruct nurse educators' experience, illuminate what nurse educators think is important to a quality work environment, and offer some critical questions that lead to the potential for change. The findings of this study suggest recruitment and retention of nurse educators are best addressed by a critical reexamination of organizations. Paying attention to what nurse educators believe is a quality work environment is a starting point for the process of deconstruction and reconstruction. This study contains compelling information that speaks to nurse educators' experience in what they believe is important in their workplace.     

The AACN Synergy Model for Patient Care: a nursing model as a Force of Magnetism

One of the 14 Forces of Magnetism requires a health care organization to have a professional model of care. The eligibility requirements stipulate that this model must be utilized throughout the health care system and that the same philosophy must be used throughout the system. The American Association of Critical-Care Nurses Synergy Model for Patient Care describes nursing practice based on eight patient characteristics, and also describes eight nurse competencies. The core concept of the model is that the needs or characteristics of patients and families influence and drive the characteristics or competencies of nurses. Synergy results when the needs and characteristics of a patient, clinical unit, or system are matched with a nurse's competencies. The synergy model is an excellent framework to organize the work of patient care throughout the health care system. It can be used and applied in various ways and provides a comprehensive framework for assuring success in building a philosophy that supports the Forces of Magnetism.     

A balancing act: managing your personal and professional life--Part II

Managing your personal and professional life is a lifelong balancing act due to situations that arise in the course of expected and unexpected normal life events. Identifying and dealing with these issues in your own life will likely make you a stronger leader in the eyes of your employees who often struggle with similar issues. Acknowledging these struggles among your employees can help create community in work teams, which ultimately translates into retention. Advocating for work life policies in your organization will transform personal compassion into organizational culture and, ultimately, into corporate policy.     

知识型员工工作自主性对建言行为的影响

基于工作特征模型理论和自我决定理论,考察了中国组织情境下工作自主性对员工建言行为的影响,检验了员工归属感的中介作用与领导正直度的调节作用。对收集到的224份有效样本进行了层次回归分析,研究结果表明：①工作自主性与员工建言行为显著正相关;②员工归属感在工作自主性与员工建言之间的关系中起完全中介作用;③领导正直度对工作自主性与员工归属感和员工建言之间的关系有显著的弱化效应,并且员工归属感完全中介工作自主性与领导正直度间交互作用对员工建言行为的影响。     

Through the eyes of gratitude

There are complex considerations at play when deciding what nurse should work with which patient. During the course of a relationship between a patient and a nurse, or a nurse and a patient's family, remarkable and life-changing interactions can occur. The relationship between Patrick Barnes, his family, and the nurses who cared for them, was the inspiration for the creation of the DAISY Foundation. The DAISY Award focuses attention on the specific behaviors administrators want to encourage to bring the organization's vision and values to life. DAISY stories, presented publicly, uplift all who hear them. We can all learn a lot from the Barnes family story by remembering the power of compassion, the power of gratitude, and the power of recognition.