Enculturation of professional contract nurses: a concept analysis

The concept enculturation, an essential component of integration into the work arrangement of professional contract nurses, also known as travel nurses, is analyzed. These registered nurses are contracted by hospitals through health care staffing service firms, for temporary work assignments. The work of travel RNs involves frequent recurring episodes of integration to health care teams at hospitals throughout the nation. Rodgers Evolutionary Method (Rodgers & Knafl, 2000) is applied to analyze the concept of enculturation, leading to a pragmatic perspective on its meaning and utility. This work may contribute new knowledge applicable to future nursing research.     

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. To reframe the nursing practice into an economic equation that captures the cost, quality, and service, a paradigm shift in thinking is needed in order to assess work redesign. Nursing productivity must be evaluated in terms of value-added care, a vision that goes beyond direct care activities and includes team collaboration, physician rounding, increased RN-to-aide communication, and patient centeredness; all of which are crucial to the nurse's role and the patient's well-being. The science of appropriating staffing depends on assessment and implementation of systematic changes best illustrated through a "systems theory" framework. A throughput transformation is required to create process changes with input elements (number of front-line nurses) in order to increase time spent in value-added care and to decrease waste activities with an improvement in efficiency, quality, and service. The purpose of this pilot study was two-fold: (a) to gain an understanding of how much time RNs spent in value-added care, and (b) whether increasing the combined level of RNs and unlicensed assistive personnel increased the amount of time spent in value-added care compared to time spent in necessary tasks and waste.     

A magnetic strategy for new graduate nurses

With the shortfall of nurses, more health care organizations are actively recruiting new graduate nurses. To translate active recruitment to successful retention, however, these newest nurses need support to make the adjustment from the security of a protected academic environment to the demands of a professional nursing career. Nursing turnover occurs when their role transition is unsuccessful. A unique model implemented in 2003 transformed new graduate nurses into confident staff nurses in an acute care setting. The insights gained and the investments required for a "magnetic" strategy to make new graduate nurses successful new staff nurses who stay with the organization are revealed.     

Evolution of the chronic care role of the registered nurse in primary care

High-quality, accessible, and efficient primary care is needed as the U.S. health care system undergoes significant change. Advancing the role of registered nurses in the primary care setting is important to the solution. A large academic health center implemented five initiatives to improve the care of chronically ill patients through the expanded role of RNs in the context of the health care team. Role evolution of nurses in the pilots required some continuing education and some additional nursing support to release the pilot nurses from their usual duties. These strategies allowed the nurses to apply interventions that enhanced the coordination of care and promoted patient self-management skills. Some short-term improvements in health status were realized and barriers to self-care were identified and resolved.     

Outcomes of a career planning and development program for registered nurses

The impact of a career planning and development program (CPDP) for registered nurses (RNs) on nurse and system outcomes was examined. The CPDP was effective as participants were able to create a career vision and individualized career plan.     

Meeting Magnet research evidence-based practice expectations through hospital-based research centers

Hospital-based nursing research centers can create the structures and processes needed to promote and sustain research and evidence-based practice (EBP) and assist in the monitoring of care delivery outcomes. At the University of Rochester Medical Center, New York, a highly successful nursing research center has succeeded in creating a Magnet environment that incorporates research and EBP into strategic planning, individual employee performance review, and organizational processes. Support of a hospital-based research center can provide the foundation for an infrastructure that supports achievement of Magnet designation research and EBP criteria. The costs pertain primarily to the staff required to develop and manage the center and the educational programs offered through it. Based on the experience at this center, administrators should plan 3-5 years before significant impact is seen in terms of numbers of consultations performed and tangible increases in staff and leadership participation in research and EBP initiatives.     

The California Nurse Mentor Project: every nurse deserves a mentor

In the rush to fill positions, newly hired and transitioning RNs are increasingly put into demanding roles without adequate clinical or organizational preparation. One approach that has shown promising preliminary success in enhancing nursing job satisfaction and increasing long-term retention is the use of trained nurse mentors who are paired with newly hired or new graduate nurses to provide ongoing support, guidance, and assistance. The California Nurse Mentor Project was a 3-year pilot project whose goal was to create a replicable program designed to improve the quality, sensitivity, and effectiveness of patient care through enhanced retention of nurses, including multicultural, multilingual, and male nurses. The pilot implementation of the California Nurse Mentor project has been extremely successful. Attrition rates are lower for nurses who are enrolled in the program than those who did not. Both mentors and mentees report that the program has impacted several areas, including their job satisfaction and professional confidence. Preceptor training, according to participant feedback, shows lasting effects on their pedagogy even a year after attending the training.     

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.     

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.     

Don't forget our charge nurses

In response to the nursing shortage, many health care organizations are utilizing a team approach to nursing care delivery. Although, the role of the charge nurse in these changing nursing care delivery models is a pivotal one to the effective and safe management of patient care units, many receive no leadership training. An educational program that hundreds of charge nurses have attended over the past 2 years is described. Strategies that organizations should consider when planning their own training are shared.     

California regional registered nurse workforce forecast

OBJECTIVE: To forecast the shortage of registered nurses (RNs) of the 24 Primary Metropolitan Statistical Areas (PMSA) and Metropolitan Statistical Areas (MSA) in California. BACKGROUND: A nursing shortage prevails nationally and is most serious in the state of California. Successful interventions in the alleviation of the RN shortage will require effective resource allocation and academic program development in various regions throughout the state. While various published studies have focused on nursing workforce development at the state and even regional levels, there are no studies focused on identifying RN shortages at the PMSA or MSA (P/MSA) level. In this report, a forecasting model is developed to systematically analyze the future supply and demand of the RN workforce within each California P/MSA. METHODS: Using accessible public databases, forecasting models were constructed to project the demand and supply of RN jobs in California P/MSAs. In the demand model, population age and size were used as determinants of regionally required RN jobs. In the RN jobs (supply) model, a region's supply of RNs was the net sum of factors increasing and decreasing the regional presence of RN jobs, including RN graduations, migration, and aging of the RN workforce. The combination of these supply and demand models was used to produce regional RN shortage forecasts for future years. RESULTS: Almost all regions exhibited growing shortages by 2020 at rates ranging from 3% to 600%. Using a modified version of the grading rubric of the California Regional Registered Nurse Workforce Report Card (Lin, Lee, Juraschek, & Jones, 2006), only two regions will receive a grade above "C" in 2020. The number of "F" grades will grow to nine. CONCLUSIONS: California has the lowest RN ratio in the United States (Fletcher, Guzley, Barnhill, & Philhour, 2004; Health Resources and Services Administration, 2004a) and this RN workforce forecasting model shows that over the next 15 years, the majority of P/MSAs in California will have increasing RN shortages. This analysis has significant policy implications including the need to create specific plans to mitigate the effect of the California shortage.     

Can Human Capital Theory Explain why Nurses are so Poorly Paid?

This paper uses Australian Census data to examine the earnings of female professionals. Comparisons are made between Registered Nurses (RNs), Teachers, Social Professionals, Health Professionals and Business Professionals. Wage decompositions show that RNs earn significantly less than other female Professionals and that the observed differentials can not be explained by differences in human capital endowments. The evidence presented is strongly suggestive of monopsonist or oligopsonist power in the setting of nurse wages – with a manifestation being persistent labour market disequilibrium. Changing the relative reward structure for nurses may help address the on-going nursing 'shortage' in Australia, although further research in this area is called for.     

Nurses who do not nurse: factors that predict non-nursing work in the U.S. registered nursing labor market

Registered nurses (RNs) who work outside of nursing have seldom been examined. This aim of this study was to compare the 122,178 (4%) of RNs who are employed outside of nursing to those who work in nursing jobs in terms of sociodemographic, market, and political variables to determine if these groups are substantively different from one another. Using a logit regression model, wages were a significant predictor of working outside of nursing for unmarried nurses but not for married nurses. Married and unmarried male nurses were more likely to work outside of nursing. Baccalaureate education, children under age 6, higher family income, and years since graduation increased the odds of working outside of nursing for married nurses. Ultimately, identifying characteristics on which these groups differ may inform future policy directions that could target nurses who may leave nursing at a time when retention efforts might be effective to alter their trajectory away from the profession.     

Nursing is the room rate

Shrinking dollars increase the need for health care stakeholders to clearly understand nursing's worth. For nursing to assure an adequate investment in nurses, it needs to articulate its value drivers. Nursing revenue offers a data source that reflects stakeholder choices and patient needs. The daily nursing billing supports hospital payment and provides cost data, important for hospital financial decision making. This revenue is a tangible asset reflecting nursing value and can be used to justify an investment in the profession. Nursing leadership can use this daily nursing charge data to monitor and measure the impact of efficiencies related to patient care.     

Registered nurses: the impact of wages on labour force participation and hours worked – are wages an effective mechanism for addressing RN shortages with evidence from 1960 to 2008?

Registered nurses (RNs) are critical producers and coordinators of patient care in acute and non-acute settings (Needleman et al. 2011). The Affordable Care Act coupled with an ageing population, are increasing demand for health care and, in turn, RNs. Numbering 3 million, RNs comprise the largest professional occupation in health care. Therefore, the labour force participation and hours worked are of keen interest to stakeholders and policymakers. Rising demand may exacerbate nursing shortages and have important effects on costs. We estimate the impact of wages on participation and hours worked as a possible policy tool to increase nursing supply. In 2008, the RN wage had a positive and significant effect on participation and a small positive but only marginally significant effect on hours worked given participation. The latter elasticity for married females (single females) was 0.11 (0.33). Therefore, the elasticity of hours worked with respect to the nurse wage is and unlikely to have an important effect on the participation rates or hours worked of currently trained female RNs. Consequently, wage increases are unlikely to be an effective policy to increase the labour supply among the currently licensed RNs and will not relieve any short-term nursing shortage.     

The potential imposition of wage controls on nurses: a threat to nurses, patients, and hospitals

When there are shortages of RNs, hospitals and health care organizations in competitive nurse labor markets respond by increasing wages: some hospitals will respond faster and some will offer higher wages than others. The wage increase brings about two important short and long-run outcomes that, together, will increase the supply of RNs in the labor market. Because wage controls prevent the flexibility of wages to adjust, they can cause a shortage to develop when the demand for RNs is increasing (as in the 1970s), and wage controls will lengthen the duration of a shortage once it has begun. The impacts of prolonged RN shortages are multifaceted and destructive to nurses, patients, and hospitals. Looking ahead over the next 15 years when the demand for RNs is expected to grow by roughly 3% per year and the supply of RNs by much less than that, a new nursing shortage is projected to develop and reach a deficit of 285,000 RNs by 2020. The worst thing that could happen to the nursing profession would be to impose wage controls on nurses as this would prevent the needed short and long-run labor supply responses from developing and thereby eliminate the shortage.     

When nursing takes ownership of financial outcomes: achieving exceptional financial performance through leadership, strategy, and execution

With nurses and unlicensed supportive personnel composing the greatest percentage of the workforce at any hospital, it is not surprising nursing leadership plays an increasing role in the attainment of financial goals. The nursing leadership team at one academic medical center reduced costs by more than $10 million over 4 years while outperforming national benchmarks on nurse-sensitive quality indicators. The most critical success factor in attaining exceptional financial performance is a personal and collective accountability to achieving outcomes. Whether it is financial improvement, advancing patient safety, or ensuring a highly engaged workforce, success will not be attained without thoughtful, focused leadership. The accountability model ensures there is a culture built around financial performance where nurses and leaders think and act, on a daily basis, in a manner necessary to understand opportunities, find answers, and overcome obstacles. While structures, processes, and tools may serve as the means to achieve a target, it is leadership's responsibility to set the right goal and motivate others.     

The language of business: a key nurse executive competency

The ability to interpret fiscal data pertaining to patient outcomes, human resources, customer satisfaction, and financial positions is a vital evidenced-based nurse executive competency. The ability of nurse leaders to influence and contribute in health system executive decision making requires fluency in accounting, "the language of business." After examining challenges faced by nurse executives, faculty at the Loewenberg School of Nursing at the University of Memphis integrated intensive accounting education into a new executive MSN program. Woven throughout the management accounting course is the concept that accounting data must be relevant and accurate for use by organization decision makers. Evidence-based decision making is emphasized when teaching planning and control activities. In addition, fluency in accounting is enhanced which leads to greater skill in patient and nursing advocacy. As competency in management accounting increases through the semester, executive MSN students are encouraged to apply cost accounting course content to their practice settings and to analyze how planning or control activities improve quality outcomes.     

知识权力视角下悖论式领导对研发团队创新的作用及影响机制研究

结合领导力、知识管理及创新相关理论，基于中国情境构建并检验链接悖论式领导与团队创新关系的理论模型，从知识—权力转化视角探讨悖论式领导对团队创新的作用机制及边界条件。研究得出，悖论式领导对创新团队的知识权力集中度有显著正向影响，进而通过知识创造、知识整合等阶段性过程作用于团队创新；在领导权力与知识权力的转化及承接过程中，高竞争性价值观会提升悖论式领导对知识权力集中度的作用，低竞争性价值观会削弱悖论式领导对知识权力集中度的作用。     

Awareness and perceptions of the Johnson & Johnson Campaign for Nursing's Future: views from nursing students, RNs, and CNOs

Johnson & Johnson launched the Campaign in February 2002. Data from surveys of nursing students, RNs, and CNOs reflect a high level of awareness of several key elements of the Campaign--advertisements, recruitment materials, the discovernursing.com Web site, and regional "Promise of Nursing" fundraising events. The J & J Campaign for Nursing's Future represents the largest involvement of the private corporate sector, and through this initiative we are learning new and innovative ways to examine the challenges confronting the nursing workforce and develop actions to help resolve them.