Calling all nurses-Now is the time to take action on improving the quality of care in nursing homes.

For a number of decades, nurses have raised concerns about nursing-related issues in nursing homes (NH) such as inadequate registered nurse (RN) staffing, insufficient RN and advanced practice registered nurse (APRN) gerontological expertise, and lack of RN leadership competencies. The NASEM Committee on the Quality of Care in Nursing Homes illuminated the long-standing issues and concerns affecting the quality of care in nursing homes and proposed seven goals and associated recommendations intended to achieve the Committee's vision: Nursing home residents receive care in a safe environment that honors their values and preferences, addresses goals of care, promotes equity, and assesses the benefits and risks of care and treatments. This paper outlines concrete and specific actions nurses and nursing organizations can take to ensure the recommendations are implemented.

Reflections on AORN's Progress During My Presidential Term: The Official Voice of Perioperative Nursing

Our strategic goals were: 1. Invest in and transform AORN membership through new programs and initiatives. 2. Reduce financial reliance on Expo through revenue growth and continued development of products, services, and partnerships. 3. Invest in technology and digital innovations to give our members engaging and innovative online education and networking capabilities. 4. Advance AORN's commitment to diversity, equity, and inclusion (DEI). 5. Ensure financial sustainability to safeguard our organization for the next 70 years.

Compassionate, collective or transformational nursing leadership to ensure fundamentals of care are achieved: A new challenge or non-sequitur?

AIMS: This discursive paper draws on three key leadership theories with the aim of outlining how styles of leadership impact the provision of fundamentals of care. DESIGN: Discussion paper. DATA SOURCES: key leadership theories, leadership and fundamentals of care literature. IMPLICATIONS FOR NURSING: The conceptualization of fundamentals of care is viewed through the lens of nursing leadership, and collective, compassionate and transformational leadership theory. The cognitive dissonance that nursing leaders encounter when trying to reconcile organizational, patient and nurses' needs is considered, and the pressure to deliver high-quality fundamentals of care presents a challenge to nurse leaders. CONCLUSION: Leaders must align nursing and patient outcome data to drive forward and prioritize fundamental care. Focusing on key elements of relational leadership styles will ensure a workforce fit to provide fundamental care, which in the current climate must be an organizational and global nursing priority. IMPACT: This discussion attempts to draw together overlapping leadership theories, emphasizes the importance of relational leadership in ensuring the provision of the fundamentals of care and acknowledged the impact of the COVID-19 pandemic on nurses and nursing care, with leadership implications outlined, such as a need for role-modelling, understanding shared values and giving nurses a voice. It will have an impact on nurse leaders, but also on those nurses providing direct care by issuing a challenge for them to confront their own nurse leaders, and to ask that they better resolve competing needs of both the nursing workforce and patients.

Academic nursing leadership: Lessons learned during a pandemic: A qualitative research study.

BACKGROUND: In the wake of the pandemic and faculty shortage, strong academic nurse leaders (ANL) are needed to ensure quality education and professional standards are upheld while preparing future nurses. OBJECTIVES: This team explored experiences and perspectives of ANLs during the pandemic in order to better understand the difficulties they faced, their triumphs and failures, and lessons learned. DESIGN, SETTING AND PARTICIPANTS: This descriptive-exploratory qualitative study captured leadership experiences of 11 academic leaders from a large, urban, Midwestern college of nursing. METHODS: Three focus group sessions were conducted virtually using a structured question guide and content analysis of transcripts. RESULTS: Three themes emerged from analysis: Technology, Time and Change, and Well-being. Content analysis also revealed leadership strategies and "pearls of wisdom" offered by participants. CONCLUSIONS: ANLs faced many challenges during the pandemic that required them to remain steady and present, while practicing regular and effective communication to foster strong relationships. As higher education and healthcare environments develop more complexity and remain constantly changing, leaders must be strategic, emotionally intelligent, and innovative in their roles.

Leadership Practices as Perceived by Emergency Nurses During the COVID-19 Pandemic: The Role of Structural and Psychological Empowerment.

INTRODUCTION: To our knowledge, no studies have explored leadership practices in relation to structural and psychological empowerment among nurses during COVID-19. Therefore, the purpose of this study was to examine those relationships in Jordanian nurses working in emergency departments during the COVID-19 pandemic. METHODS: A descriptive, correlational cross-sectional design was used in this study. The participants were emergency nurses working at 3 large hospitals in Jordan. The participants were surveyed via an online questionnaire between September 2021 and January 2022. A total of 3 valid scales were included in the questionnaire to assess the nurses' clinical leadership practices in relation to perceived structural and psychological empowerment. RESULTS: A total of 193 emergency nurses were surveyed, of which 116 participants (60.1%) were male, and their average age was 29.64 (SD 4.74) years. Nurses had a moderate level of clinical leadership practices 12.50 (SD 1.65), moderate level of perceived structural empowerment 3.67 (SD 0.44), and a high-moderate level of perceived psychological empowerment 5.96 (SD 0.65). Clinical leadership practices were shown to have a significant positive relationship with structural (r = 0.65; P < .01) and psychological (r = 0.74; P < .01) empowerment. Predictors of clinical leadership practices of the Jordanian emergency nurses during COVID-19 were ranked in order of significance; structural and psychological empowerments were the highest significant predictors. However, patient to nurse ratio (>6 patients/nurse) was the lowest significant predictor. DISCUSSION: Although structural and psychological empowerments play a pivotal role in predicting the leadership practices of the emergency nurses in Jordan, the nurses should enhance their leadership style for better management and effective communication during critical situations such as pandemics.

Moral distress and moral injury and their interplay as a challenge for leadership and management: The case of Croatia.

AIM: We aim to investigate the interplay between moral distress and moral injury among nurses working in palliative and oncology wards and to assess its impact on nursing leadership. BACKGROUND: The past 2 years have been particularly challenging for nurses and nursing leaders in Croatia. The coronavirus disease pandemic and the subsequent earthquakes in the country significantly impacted the work of nurses. Moral distress has been well-known to nursing professionals, but recent studies warn about cofounding it with moral injury and their possible intercorrelation, deserving more attention from an empirical perspective. METHODS: We conducted quantitative cross-sectional research in palliative and oncology wards in 11 Croatian health care facilities on 162 nurses, using a questionnaire and paper/pencil method over 6 months (1 January 2021 to 1 July 2021). The questionnaire consisted of three parts: sociodemographic data, a Measure of moral distress for health care professionals and Moral injury symptoms scale for health care professionals. The research protocol was approved by the Ethics committee of the Catholic University of Croatia under no. 1-21-04. RESULTS: The findings of our study demonstrated that the current average levels of moral distress might be characterized as low, but the moral injury symptoms are severe. The results of our study bring interesting novel insights, such as the strong correlation between moral distress and moral injury, but also in terms of nurses' decision to leave or consider leaving their position. The nurses who experience higher levels of moral distress experience severe symptoms of moral injury, while nurses who score higher in moral distress and moral injury have left, considered or consider leaving their positions. CONCLUSIONS: This study highlighted the need to pay attention to the emerging phenomenon of moral injury that has been unaddressed and overshadowed by moral distress, their intercorrelation, and the importance of addressing them timely and adequately within health care organizations with their leadership and management. IMPLICATIONS FOR NURSING MANAGEMENT: These findings provide a significant insight that may assist nursing managers and leaders to act and respond in time to develop various prevention and mitigation measures and help resolve situations leading to moral distress or moral injury.

Virtue ethics in health care teams; its time has come: Review of the nursing virtue ethics literature.

AIM: To summarize and evaluate the nursing virtue ethics literature, examine how virtue ethics has been applied to health care teams, offer a new framework to guide understanding and development of virtuous health care teams and offer recommendations to nurse leaders. BACKGROUND: With the unprecedented levels of incivility and turnover in the post-COVID-19 world, virtue ethics may provide an innovative approach for nursing leaders working to rebuild healthy practice environments. EVALUATION: An integrative review yielded articles from eight databases using PRISMA guidelines. Level of evidence and quality were assessed using the Johns Hopkins tools. KEY ISSUES: Virtue ethics has been of interest to the health care community predominantly as a concept. Most articles focused on debating whether virtue ethics belongs in nursing. Virtue ethics offers a creative strategy for leaders to attract and retain nurses. CONCLUSION: There is a dearth of research on virtue ethics and nursing. One study empirically uncovered and validated a framework for virtue ethics in health care teams. IMPLICATIONS FOR NURSING MANAGEMENT: To rebuild strong health care teams, nurse leaders can model virtue ethics using an empirically derived framework while coaching their teams to do the same. Doing so holds the promise of reengaging staff and rebuilding healthy practice environments.

UK nurses' and midwives' experiences of healthful leadership practices during the COVID-19 pandemic: A rapid realist review.

AIM: We aim to explore healthful leadership practices in nursing and midwifery evident within the COVID-19 pandemic in the United Kingdom, the contextual facilitators, barriers and outcomes. BACKGROUND: Globally, the health and care sectors are under pressure and despite nurses and other professionals, demonstrating resilience and resourcefulness in the COVID-19 pandemic; this has negatively impacted on their health and wellbeing and on patient care. EVALUATION: Two searches were conducted in July 2021 and December 2021. Inclusion/exclusion criteria were identified to refine the search, including papers written since the beginning of the pandemic in 2020. A total of 38 papers were included principally from the United States and United Kingdom. Ten were research papers; the others were commentaries, opinion pieces and editorials. MS Teams literature repository was created. A unique critical appraisal tool was devised to capture contexts, mechanisms and outcomes whilst reflecting more standardized tools, that is, the Critical Appraisal Skills Programme and the Authority, Accuracy, Coverage, Objectivity and Date tool for reviewing grey literature to refine the search further. KEY ISSUES: Six tentative theories of healthful leadership emerged from the literature around leadership strategies, which are relational, being visible and present; being open and engaging; caring for self and others; embodying values; being prepared and preparing others; and using available information and support. Contextual factors that enable healthful leadership practices are in the main, created by leaders' values, attributes and style. The literature suggests that leaders who embody values of compassion, empathy, courage and authenticity create conditions for positive and healthful relations between leaders and others. Nurse and midwives' voices are however absent from the literature in this review. CONCLUSION: Current available literature would suggest healthful leadership practices are not prioritized by nurse leaders. Perspectives of nurses' and midwives' about the impact of such practices on their wellbeing is also missing. Tentative theories are offered as a means of identifying healthful leadership strategies, the context that enable these and potential outcomes for nurses and midwives. These will be explored in phase two of this study. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse leaders must be adequately prepared to create working environments that support nurses' and midwives' wellbeing, so that they may be able to provide high-quality care. Ensuring a supportive organizational culture, which embodies the values of healthfulness, may help to mitigate the impact of the COVID-19 pandemic on nurses' and midwives' wellbeing in the immediate aftermath and going forward.

Preparing BSN students for a new workplace: Experiences in a COVID-19 designated unit as an RN extender.

Academic nursing programs were impacted by the onset of the pandemic with the challenges of social distancing, detecting, and controlling the spread of the virus. Many traditionally campus-based, face-to-face programs transitioned quickly to include virtual activities for classes, laboratories, and clinical experiences for students. Initially direct patient care clinical activities came to a halt due to concerns for student safety and overwhelming numbers of COVID-19 cases stressing health system resources. However, as COVID-19 cases began to rise and hospitals struggled with staffing shortages, it became necessary to explore how nursing students could contribute to relieving the staffing burden while obtaining critical education as RN Extenders. Students that participated in the RN Extender program were seniors entering the nursing workforce within the next two months. Significant student screening and preparation was provided to support students serving as RN Extenders in COVID-19 units. The prior working relationships and personal contact between academic and practice leaders, a sense of equal participation, clear and realistic expectations of the benefits and responsibilities of each group were crucial. Building ongoing and frequent opportunities for formal and informal communication among all stakeholders was vital and the major contributor to the success of this program.

Diverse Leadership Needed for a Changing World

In this changing world, nurse leaders must step up and improve structural racism, social determinants of health, and health inequities. Nurse leaders must not wait at the gate to be change agents but have the vision, understanding, clarity, and agility to serve on all types of boards and lead change.

Social Isolation and Nursing Leadership in Long-Term Care: Moving Forward After COVID-19.

Nursing leaders have a responsibility to promote and facilitate social engagement and connectedness to mitigate social isolation in long-term care (LTC). The COVID-19 pandemic has emphasized longstanding problems in LTC facilities, such as staff mix, workload, and support. The pandemic has shed light on the severe deleterious effect of social isolation and the critical importance of maintaining social engagement and connectedness, especially in times of crisis or major change. Staff education and ongoing support cannot be overemphasized. Critical nursing leadership and interdisciplinary collaboration engaging all team members are essential in operationalizing nonpharmacological approaches that foster the well-being of residents with dementia.

Integrating Climate Change in the Curriculum: Using Instructional Design Methods to Create an Educational Innovation for Nurse Practitioners in a Doctor of Nursing Practice Program

An applied epidemiology course for doctor of nursing practice students was revised to include a module on the impact of climate change on population health. The Analyze, Design, Develop, Implement, and Evaluate (ADDIE) model of instructional design is a gold standard framework for creating course content and guided the module development. A nurse content expert discussed the environmental impacts of climate change on health using literature, actual clinical scenarios, and the application of epidemiologic data. Topics included safeguarding workers and vulnerable populations within the context of the coronavirus disease 2019 pandemic. Students posted reflections on their understanding of module content in response to structured prompts electronically in the learning management system for review by the faculty. Faculty evaluation of responses identified the need to further develop and integrate environmental epidemiology and climate change content more fully within the doctor of nursing practice curriculum.

International Council of Nurses' Global Nursing Leadership Institute: Responding to the pandemic.

BACKGROUND: In 2020, the SARS-CoV-2 pandemic forced the redesign of the International Council of Nurses' (ICN) Global Nursing Leadership Institute (GNLI) that heretofore had included an intensive, week-long residential experience in Geneva, Switzerland. AIM: This paper describes the development, implementation, challenges and preliminary outcomes of an approach that regionalized GNLI and delivered it online, while preserving some cross-regional connections among participants. RESULTS: A virtual approach to a global policy leadership programme cannot replace the richness of an intensive, concentrated residential one, but the redesign of GNLI has given ICN, its member national nursing associations and individual nurse leaders previously unexplored opportunities for networking and collaboration aligned with the six WHO regions, and for cross-region networking and discussions of global issues. CONCLUSION AND IMPLICATIONS FOR NURSING AND/OR HEALTH POLICY: The SARS-CoV-2 pandemic has highlighted the need for nursing leadership in policy and practice. A virtual approach to leadership development can increase the reach of programmes that seek to build nursing's capacity to advance health-promoting policies in workplaces, organizations and nations.

A study of Indiana University Health's spirit of inquiry and innovation during COVID.

BACKGROUND: COVID-19 has required nursing innovations to meet patient care needs not previously encountered. PURPOSE: The purpose of this study was to describe nursing innovations conceived, implemented, and desired during the first COVID-19 surge. METHODS: The investigators invited registered nurses employed across 16 Midwest hospitals (6,207) to complete the survey. Respondents provided demographics and written descriptions of innovations they conceived, witnessed, and desired. Investigators analyzed text responses using standard content analytic procedures and summarized quantitative demographics using percentages. FINDINGS: Nurses reported seven types of innovations that would (a) improve personal protective equipment (PPE), (b) limit the need to repeatedly don and doff PPE, (c) ensure safer practice, (d) conserve and access supplies, (e) provide patient and family education and support, (f) make team member communication more efficient, and (g) improve peer support. DISCUSSION: Nurses are in a unique position to generate innovative solutions to meet patient care needs under adverse and rapidly changing situations.

Digital transformation in community nursing.

Digital transformation has been making its mark on organisations in healthcare and beyond over the last few years, with no signs of stopping. In the NHS, much of the focus has been on acute services until recently, but this focus is now shifting towards community services, with Sussex Community Foundation Trust (SCFT) being named as the first community Digital Aspirant Trust by NHSx. This article explores what digital transformation is and uses SCFT's experiences to illustrate how this can provide benefits for community nurses. It considers what the future of digital transformation might look like and how clinicians can help to ensure patients remain central to any change.

Core competencies and challenges among nurses transitioning into positions of leadership - a Caribbean perspective.

PURPOSE: Nurses are a significant part of the professional workforce, but leaders may be promoted without the requisite competencies. This study aims to explore the perspectives of nurse managers about the core competencies necessary for promotion as leaders in health. DESIGN/METHODOLOGY/APPROACH: This was a mixed-methods study that targeted nurses (N = 126) who were promoted in four Caribbean countries over the past five years. A 30-item questionnaire was used for quantitative data collection and analyzed using SPSS version 25. Interviews yielded the qualitative data, which were analyzed using open coding and thematic analysis. Ethical approvals were received from ethics committees at the university and country level. FINDINGS: Most participants were female (n = 112), had 15 or more years' experience (n = 71) and an associate degree/diploma in nursing (n = 62). Leadership was the most important competency required of nurse leaders in spite of their position within the organization, followed by team building and motivation. Challenges to the transitioning into leadership positions included the prevailing culture and a lack of a systematic approach to building capacity in leadership. There was also between-group statistical significance, as determined by one-way ANOVA for delegation, motivation and leadership as core competencies based on occupations roles. RESEARCH LIMITATIONS/IMPLICATIONS: Notwithstanding the importance of the findings from this research, there were some limitations. While the researchers considered implementing this study in eight Caribbean countries, approvals were received for only four countries. This will affect the ability to generalize the findings to the wider Caribbean countries. One of the strengths of this research was the use of mixed methods for data collection. However, the qualitative component of the findings may be limited by the number of focus groups conducted, notwithstanding the richness of the data collected. PRACTICAL IMPLICATIONS: The findings can be used as a framework from which the health system in developing countries can begin to examine practical solutions to developing 21st century leadership competencies in nursing. While there may be remanence of the colonial past in the way systems function, the complexity of health systems requires leadership that is rooted in competence that is multidimensional. ORIGINALITY/VALUE: This paper provides an important contribution to the literature on leadership and competencies from the perspective of low- to middle-income resource settings. The qualitative component of the research added richness to the nuances and understanding of the phenomenon of competencies for nurse leaders.

'The office of disaster management' nurse managers' experiences during COVID-19: A qualitative interview study using thematic analysis.

AIM: The purpose of this study was to understand the experiences of nurse managers during the COVID-19 pandemic. BACKGROUND: There is a growing body of knowledge about the experiences of clinical nurses during COVID-19. However, there is less evidence about the experiences of nurse managers during the pandemic. METHODS: Eight nurse managers, from acute care and outpatient settings, completed semistructured interviews about how their roles had changed during the pandemic, how they felt about these changes, and what had gone well or been difficult. Each participant was interviewed once, for 20-60 min. We used thematic analysis methods to analyse the interview transcripts. FINDINGS: Nurse managers had to coordinate care in a context of uncertainty and guidance that changed frequently. Participants found that their roles and responsibilities either expanded to include more duties, or they were asked to take on a completely new role, with no orientation or training. Nurse managers were expected to provide support to their staff and patients, but did not necessarily receive support themselves. Participants were expected to plan simultaneously for care during the pandemic and for a return to normal working conditions. These factors contributed to challenging and difficult participant experiences of managing during COVID-19. CONCLUSION: Nurse managers' experiences during COVID-19 are influenced by changes to their roles and the support they received. Nurse managers continue to support high-quality care despite working a difficult context. IMPLICATIONS FOR NURSING MANAGEMENT: Where possible, nurse managers can be supported to extend their roles or receive additional education and support if they are required to take on new responsibilities. Nurse managers require support in order to be a resource for their staff.

A blueprint for nursing innovation centers.

BACKGROUND: The interest in and demand for healthcare innovation has heightened amid the COVID-19 pandemic. Organizations are challenged to balance the goals of daily operations with innovation to stay relevant and compete in the marketplace. Innovation is critical for not only the success and sustainability of organizations, but the well-being of the faculty, staff, and clients they serve. PURPOSE: In this article, we present an overview of several Nursing Innovation Centers in the United States as well as examples of colleges without formal innovation centers but who are addressing innovation in their programs. METHODS: We examined the subjective experience of nursing innovation in seven colleges of nursing using semi-structured intervieweds and thematic analysis. FINDINGS: We discuss four themes for creating an innovation center or innovation focus and six themes important for sustainability and impact. In addition, we provide a working model for these themes and provide lessons learned along with trends and recommendations for the future. DISCUSSION: This information provides guidance and a framework for academic and practice organizations aspiring to create opportunities for innovation to flourish in their institutions. We also encourage leadership to critically evaluate and address biases in faculty hiring, research evaluation, publication practices, educational opportunities and mentoring to overcome the diversity innovation paradox.

Examining effective communication in nursing practice during COVID-19: A large-scale qualitative study.

AIM: The aim of this study was to conduct a primary examination of the qualitative communication experiences of nurses during the first wave of the COVID-19 pandemic in the United States. BACKGROUND: Ambiguity in ever-evolving knowledge on how to provide care during COVID-19. Remaining safe has created a sense of urgency, which has in turn created the need for organizations to quickly alter their operational plans and protocols to support measures that increase capacity and establish a culture of safe care and clear communication. However, no known study has described communication in nursing practice during COVID-19. METHODS: Utilizing qualitative descriptive methodology, semi-structured interviews were conducted with 100 nurse participants from May to September 2020 and recorded for thematic analysis. The consolidated criteria for reporting qualitative studies (COREQ), a 32-item checklist, were used to ensure detailed and comprehensive reporting of this qualitative study protocol. FINDINGS: Study participants shared descriptions of how effective communication positively impacted patient care and nursing practice experiences during the first wave of the COVID-19 pandemic. The thematic network analyses identified the importance of effective communication across three levels: (1) organizational leadership, (2) unit leadership and (3) nurse-to-nurse communication. Within this structure, three organizing themes, essential to effective communication, were described including (a) presence, (b) education and (c) emotional support. CONCLUSION: Examining existing crisis communication policies and procedures across healthcare organizations is imperative to maintain highly relevant, innovative, and data-driven policies and strategies that are fundamental to preserving quality patient care and supporting optimal nursing practice. IMPLICATIONS FOR NURSING POLICY AND HEALTH POLICY: Effective communication is critical to support nurses through extended periods of crisis. COVID-19 represents a unique contemporary challenge to the nursing workforce given the high stress and prolonged strain it has created for both human and healthcare supply resources. There is value in nurses' presence at local, unit level and organizational leadership levels to convey critical information that directly informs leadership decision-making during unprecedented emergencies such as the COVID-19 pandemic.