Building a nursing research fellowship in a community hospital

Often, registered nurses feel that they are using "evidence" to guide practice, but in reality the sources of evidence are not based on research. The nursing leadership team at Northwest Community Hospital was committed to integrating evidence-based practice and nursing research into the clinical setting for RNs at all levels of the organization. The scope of the fellowship program enabled direct care RNs to receive protected release time for a 12-month period to develop a research proposal, implement the study, and disseminate the findings. The Nursing Research Fellowship Program was successful from the perspective of the Magnet appraisers who recognized the program as a Magnet exemplar, the chief executive officer, the CNE, members of the nursing leadership team, professional colleagues, the fellows and partners, and registered nurses at all levels in the organization. Nursing research is now part of the professional nursing culture.     

Journey to Magnet: cost vs. benefits

As hospitals and health systems strive to be an "Employer of Choice", one important goal for their nursing leaders has been the decision to embark on their journey of becoming a designated Magnet facility. Approximately 12 months ago, conversations with a few chief nursing executives uncovered a hot topic concerning the achievement/designation of Magnet status and specifically its cost benefits. With more and more hospitals obtaining Magnet status, these nurse leaders did not know how other organizations felt about their journey including outcomes and were very interested in learning more details about their colleagues' experiences.     

Partnership to build research capacity

Today's nursing leaders are setting the stage for the next evolution--bringing together skilled clinicians and administrators with peers in education to create new approaches to leading the profession forward. Partnerships share goals, common purpose, mutual respect, willingness to negotiate and compromise, informed participation, information giving, and shared decision making. The shared practice academia effort between a public university and a private health care system situated in the island state of Hawai'i is described. The medical center and school of nursing pursued individual strategic efforts to build research capacity and used the opportunity to fund academic practice research projects. The mutual need and recognition of the high stakes involved, in concert with stable, committed leaders at all levels, were key to the early success of their efforts. Through the formal research partnership mechanism, a discrete focus was created for efforts and used to move to tactical, operational, and interpersonal integration in this relationship.     

Resourcing evidence-based practice in ambulatory care nursing

Ambulatory care nurses may benefit from not only developing knowledge and skills in evidence-based practice (EBP), but also in identifying and providing sufficient resources for EBP to be implemented and sustained. Organizations should select one of the five conceptual models available in the literature to guide development and implementation of EBP. Costs of implementing and sustaining EBP include expert consultation, facilitators, staff time, informatician time, and data management. Benefits of EBP include improvements in patient care quality and safety, as well as regulatory compliance and risk management. Resources supporting EBP include professional literature available via the Internet and databases or agencies, such as ARHQ, professional organizations, and funding through grants.     

Politics, economics, and nursing shortages: a critical look at United States government policies

The economic concept that the independent actions of buyers and sellers tend to move the market toward equilibrium where there is no shortage or surplus is basic in the classic and current literature of economics. The problem with subsidies is that nurses who receive subsidized educations are able to provide nursing services for less compensation because they paid less or nothing for their educations. Subsidies may be politically appealing, but they override market forces of supply and demand. The demand for nurses and nursing instructors can be met and maintained for generations to come with policies that expand roles and reimbursement for APNs and encourage the nurse and nursing instructor labor markets to correct themselves by providing fair compensation under Magnet status working conditions. Politics and policies meant to correct the nursing shortage should focus less on how to reduce the cost of producing nurses, and more on how to afford to compensate nurses with wages and benefits that achieve market equilibrium.     

Conceptual frameworks used in funded nursing health services research projects

Theories not only suggest ideas for research, but they provide order and logic to an investigation and limit the number and type of variables to be considered to a reasonable few. Although relatively little health services research is done within nursing, there is a growing appreciation of the need for knowledge related to the use, costs, quality, delivery, organization, financing, and outcomes of health care and how nursing practice influences these variables. Conceptual frameworks used by investigators in funded grants from the Agency for Healthcare Research and Quality show that workforce-related health services research of nursing phenomena is based on a wide variety of conceptual models, many of the investigator's own invention. Ultimately, there may emerge new theories or conceptual frameworks that combine clinical, organizational, financial, and outcome variables from the unique perspective of nursing. Such conceptualizations will guide future researchers and add coherence to the body of health services research into nursing issues.     

Using a spreadsheet/table template for economic value added analysis

Translating clinical research into practical applications that are cost effective has received significant attention as staff nurses attempt to expand new knowledge into an already complex daily workflow. spreadsheet/table template created in a word processing format can assist with setting up and carrying out the analysis of costs for comparing different approaches to routine activities. By encouraging nurses to take the initiative to examine parts of everyday nursing practice with an eye to cost analysis, significant contributions can be made to maximizing the bottom line.     

Hospital staff shortage: the role of the competitiveness of pay of different groups of nursing staff on staff shortage

Shortages of nursing staff in OECD countries have been a preoccupation for policy makers. Shortages of staff may be the consequence of uncompetitive pay. In the private sector, employers in different regions can offer different pay rates to reflect local amenities and cost of living. Hospitals in the UK however cannot set the pay for their employees, and as a result they might therefore incur staff shortages. Moreover, occupational groups do not operate in isolation. Shortages of staff may also be the consequence of the competitiveness of pay of an alternative group of staff. This is investigated using two distinct groups of nursing staff: assistant nurses (ANs) and registered nurses (RNs) working in English hospitals in 2003–2005 using national-level data sets. We find that an increase by 10% of the pay competitiveness of RNs decreases the shortage of both the RNs and of ANs by 0.6% and 0.4%, respectively.     

The Magnet view: celebrating the Magnet way

The Annual ANCC Magnet Conferences provide an atmosphere of learning, celebration, and recognition. At the 11th Annual Conference in 2007, those attending could choose from a variety of programs, visit exhibits, watch film clips from different organizations, view art displays, connect with 4,700 others and most of all, celebrate. Capturing the culture of this celebration and channeling the energy of nurses into creating solutions and a new view of nursing are vital to our recruitment and retention efforts.     

The Magnet view: pursuing ANCC Magnet recognition as a system or individual organization

Systems comprising more than one organization at some point think about whether or not to pursue Magnet recognition for each individual organization or as a system. There are several considerations when making this decision in each of the Model Components for the Magnet Recognition Program. Magnet recognition is not a checklist of achievements, but rather an enculturation of values, standards, vision, commitment, and pride. It is important to remember that each organization is different and is at a different place in their development at any one time. Making the decision to pursue system Magnet recognition should consider all important factors since if one organization in the system doesn't make the grade, the system is not Magnet recognized.     

An economic analysis of patient simulators clinical training in nursing education

Patient simulators have become widely used in medical education including increasing use in nursing education. Research suggests their usefulness in developing nursing competence. Little research to date, however, has examined the financial feasibility of the use of patient simulators as an educational tool. The extent to which a simulation lab comprising six Laerdal SimMan high-fidelity patient simulators and a staff of nurse educators is a financially feasible alternative to classroom-based education is examined.     

End-of-life care in nursing homes: the high cost of staff turnover

Nursing home staff turnover results in high cost--both economic and personal--and has a negative impact on the quality of care provided to residents at the end of life. Reducing staff turnover in nursing homes would benefit both the cost to the U.S. health care system, and, most importantly, the care residents receive in the vulnerable period leading to death. There is rising pressure on nursing homes to improve their palliative and end-of-life care practices and reduce transfers to hospital for situations and conditions that can be safely managed on site. Nursing care staff deserve an investment in the specific training necessary for them to give the highest quality care to dying residents. This training should be multifaceted and include the physiological, psychological, spiritual, interpersonal, and cultural (including ethnic) aspects of dying. Empowerment with these necessary knowledge, skills, and attitudes will not only result in better care for residents but likely also will reduce the burnout and frustration staff experience in caring for residents near death.     

Predicting nurses' organizational and professional identification: the effect of nursing roles, professional autonomy, and supportive communication

Recruiting and retaining qualified nursing staff is of growing importance to today's hospital and nurse leaders. Findings from a survey completed by 190 RNs at a major teaching hospital revealed that nursing roles, professional autonomy, and supportive communication were differentially related to the nurses' organizational and professional identification. Professional autonomy was by far the strongest predictor of nurse identification, followed by manager and co-worker support. Co-worker support and traditional nursing roles predicted nurse professional identification, but neither traditional nor collaborative roles predicted nurses' identification with their organization. Communication strategies intended to help executives retain qualified nursing staff are presented.     

Graduate nurse perceptions of the work experience

Findings from a longitudinal study on the perceptions of the work environment and job satisfaction for new graduate nurses in the first 18 months of employment at a Magnet Midwestern urban academic pediatric medical center are described. The findings indicated that orientation assisted the new graduate to become confident in his/her clinical competence and work management. By 18 months, the new graduate felt satisfied with access to resources and the ability to participate in professional development opportunities. The results suggest that the new graduate nurse's career adjustment extends beyond mastering clinical skills and includes a lifestyle adjustment to a profession that requires service 24 hours a day, 7 days a week.     

Analyzing fluctuating unit census for timely staffing intervention

A computer information system, which can provide cost-saving measures useful in adequately allocating nursing staff in the face of decreasing patient stays, increasing patient admissions and discharges, and the unexpected transfers surrounding busy nursing units, is explored.     

A consortium approach to nursing staff development

Within a consortium framework, four teaching hospitals have developed a curriculum for nursing staff development. Since 1980, the institutions have realized significant savings. The courses provide networking and integration of new research and facilitate technological transfer. Other institutions may also find a collaborative approach beneficial.     

Managing people or places?

Based upon a growing body of nursing research, emphasizing the management of the work environment is more likely to lead to strong individual and organizational performance than focusing on individual performance. In several studies, individual variables among staff such as age, experience, and tenure were less predictive of their perceptions of an organization than were variables in the work environment.     

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 effectiveness: how do you measure up?

The purpose of this article is to provide leaders with a tool to collect accurate data of subordinate's perceptions. Leaders in the nursing profession must feel comfortable and be encouraged to seek the opinion of the staff they serve. Without actively seeking the feedback of subordinates there is no opportunity for personal growth and insight. So, while asking for staff feedback can be a "daring adventure" for any leader, leading staff who do not want to follow will result in an organization of "nothing" in today's health care arena.     

Improving patient care by making small sustainable changes: a cardiac telemetry unit's experience

With the introduction of each new drug, technology, and regulation, the processes of care become more complicated, creating an elaborate set of procedures connecting various hospital units and departments. Using methods of Adaptive Design and the Toyota Production System, a nursing unit redesigned work systems to achieve sustainable improvements in productivity, staff and patient satisfaction, and quality outcomes. The first hurdle of redesign was identifying problems, to which staff had become so accustomed with various work arounds that they had trouble seeing the process bottlenecks. Once the staff identified problems, they assumed they could solve the problem because they assumed they knew the causes. Utilizing root cause analysis, asking, "why, why, why," was essential to unearthing the true cause of a problem. Similarly, identifying solutions that were simple and low cost was an essential step in problem solving. Adopting new procedures and sustaining the commitment to identify and signal problems was a last and critical step toward realizing improvement, requiring a manager to function as "teacher/coach" rather than "fixer/firefighter".