A Multi-hospital Before-After Observational Study Using a Point-Prevalence Approach with an Infusion Safety Intervention Bundle to Reduce Intravenous Medication Administration Errors.

INTRODUCTION: We previously found a high rate of errors in the administration of intravenous medications using smart infusion pumps. OBJECTIVES/DESIGN: An infusion safety intervention bundle was developed in response to the high rate of identified errors. A before-after observational study with a prospective point-prevalence approach was conducted in nine hospitals to measure the preliminary effects of the intervention. MAIN OUTCOME MEASURES: Primary outcome measures were overall errors and medication errors, with the secondary outcome defined as potentially harmful error rates. RESULTS: We assessed a total of 418 patients with 972 medication administrations in the pre-intervention period and 422 patients with 1059 medication administrations in the post-intervention period. The overall error rate fell from 146 to 123 per 100 medication administrations (p < 0.0001), and the medication error rate also decreased from 39 to 29 per 100 medication administrations (p = 0.001). However, there was no significant change in the potentially harmful error rate (from 0.5 to 0.8 per 100 medication administrations, p = 0.37). An intervention component aiming to reduce labeling-not-completed errors was effective in reducing targeted error rates, but other components of the intervention bundle did not show significant improvement in the targeted errors. CONCLUSION: Development and implementation of the intervention bundle was successful at reducing overall and medication error rates, but some errors remained and the potentially harmful error rate did not change. The error-rate reductions were not always correlated with the specific individual interventions. Further investigation is needed to identify the best strategies to reduce the remaining errors. CLINICAL TRIALS REGISTRATION: Registered at ClinicalTrials.gov, identifier: NCT02359734.

Partnership Negotiations: Innovation for Nurse Contract Negotiations During Turbulent Times.

Health care delivery is undergoing rapid change, with frontline nurses at the epicenter. A mind-set requiring innovative collaboration, creativity, flexibility, and openness to new care delivery models is necessary. This article describes an innovative approach to modern world contract negotiations in a 371-bed university-affiliated hospital. The nurses' contract negotiations were scheduled to begin 6 months after a layoff affected nurses and other caregivers. Concurrently, a strike was underway at a hospital in the state with the same union. Contentious negotiations were anticipated. Strategies employed to prepare for negotiations included consultation with a nurse expert, and an agreement between the chief nursing officer and chairman of the Shared Governance Committee to conduct negotiations that would allow for more dialogue between the staff nurse and nursing leadership teams. Sessions opened with a video address by a major health care nurse thought leader who provided an overview of the current health care landscape and future direction of nursing. Joint presentations by staff nurses and nurse leaders on topics of interest were conducted. "Nurses for Nurses" round table sessions took place each day, and valuable work was completed at breakout sessions. Ultimately, the partnership negotiations resulted in a successfully negotiated contract.

A patient-centered longitudinal care plan: vision versus reality.

OBJECTIVE: As healthcare systems and providers move toward meaningful use of electronic health records, longitudinal care plans (LCPs) may provide a means to improve communication and coordination as patients transition across settings. The objective of this study was to determine the current state of communication of LCPs across settings and levels of care. MATERIALS AND METHODS: We conducted surveys and interviews with professionals from emergency departments, acute care hospitals, skilled nursing facilities, and home health agency settings in six regions in the USA. We coded the transcripts according to the Agency for Healthcare Research and Quality (AHRQ) 'Broad Approaches' to care coordination to understand the degree to which current practice meets the definition of an LCP. RESULTS: Participants (n=22) from all settings reported that LCPs do not exist in their current state. We found LCPs in practice, and none of these were shared or reconciled across settings. Moreover, we found wide variation in the types and formats of care plan information that was communicated as patients transitioned. The most common formats, even when care plan information was communicated within the same healthcare system, were paper and fax. DISCUSSION: These findings have implications for data reuse, interoperability, and achieving widespread adoption of LCPs. CONCLUSIONS: The use of LCPs to support care transitions is suboptimal. Strategies are needed to transform the LCP from vision to reality.

Perceptions of empowerment among ED nurses.

BACKGROUND: Nurses' perceptions of empowerment have been linked to a number of variables in the hospital workplace, including job satisfaction, autonomy, and work effectiveness. Yet there have been no previous studies of perceptions of empowerment specifically among emergency department (ED) nurses. METHODS: Registered nurses (RNs) employed in the EDs of 6 hospitals in a major health care system in the eastern United States were surveyed regarding their perceptions of empowerment. Of the 240 RNs eligible to participate, there were 167 usable surveys. RESULTS: There was a moderate level of empowerment among the RNs who participated, consistent with the level of empowerment reported in several other studies of staff nurses and nurses in other positions. DISCUSSION: The moderate level of empowerment in this sample may be attributed to the many opportunities for RN involvement in the hospitals within this health care system. Nurse leaders can initiate programs focused on enhancing RN perceptions of empowerment. In addition, there is a need for further research among RNs with different specialty preparation.

Registered nurse job satisfaction and satisfaction with the professional practice model.

AIMS: This paper describes the initial assessment of job satisfaction and satisfaction with the professional practice environment of registered nurses working on units where a professional practice model was implemented and the relationship between these two variables. BACKGROUND: The nursing shortage has been linked to overall job satisfaction and specifically to nurses' satisfaction with the professional practice environment. Initiatives to increase retention and recruitment and decrease turnover have been linked to work satisfaction among nurses. METHODS: A descriptive, cross-sectional design was used with participants (N = 101) from four patient care units; this represented a 55% response rate. RESULTS: The nurses were moderately satisfied with the professional practice environment but had overall low job satisfaction. There was a significant negative relationship between overall work satisfaction and satisfaction with the professional practice environment (P < 0.0001). CONCLUSIONS: The introduction of the professional practice model may have raised awareness of the components of job satisfaction that were not being met. Thus, the nurses may have become more knowledgeable about the potential needs in these areas. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers and leaders must recognize that job satisfaction consists of many dimensions, and each of these dimensions is important to nurse retention. Implementation of a professional practice model may heighten awareness of the missing components within a practice environment and lead to decreased overall satisfaction. A broader understanding of characteristics associated with increased satisfaction may aid in development of organizational change necessary to retain and attract nurses.

Shared governance and empowerment in registered nurses working in a hospital setting.

Empowerment of registered nurses through professional practice models inclusive of shared governance has been proposed as essential to improve quality patient care, contain costs, and retain nursing staff. The purpose of this study was to determine the relationship between perceptions of governance and empowerment among nurses working in acute care hospital units in which a shared governance model had been in place for 6 to 12 months. The 158 nurses who participated perceived themselves to be moderately empowered and in an early implementation stage of shared governance. There was a statistically significant positive relationship between perceptions of shared governance and empowerment. Recommendations for professional practice and future research are included.

Effect of a geriatric nurse education program on the knowledge, attitudes, and certification of hospital nurses.

Although nurses are the primary care providers for hospitalized and vulnerable older adults living in the community, they are generally not prepared in geriatric care. This study examined the effect of a 21-hour nursing education program on nurses' knowledge and attitudes regarding care of older adults and the geriatric nursing certification of the participants. The program was offered to 92 nurses in three cohorts over a 1-year period. Participants completed pre- and posttest measures of geriatric knowledge and attitudes. Significant differences were found between pretest and posttest knowledge and attitudes. Program evaluation and success in achieving certification in gerontological nursing also indicated a positive effect of the program.

A leadership initiative to improve communication and enhance safety.

The EMPOWER project was a collaborative effort to promote a culture of patient safety at Danbury Hospital through an interdisciplinary leadership-driven communication program. The "EMPOWER" component includes Educating and Mentoring Paraprofessionals On Ways to Enhance Reporting of changes in patient status. Specifically, the EMPOWER program was designed to prepare paraprofessional staff (PPS) to communicate changes in patient status using SBAR (situation, background, assessment, recommendations) structured communication. The specific project goals included (a) translation of SBAR structured communication methods for use with PPS, (b) reduction of cultural and educational barriers to interdisciplinary communication, and (c) examination of the effect of the EMPOWER intervention on the PPS communication practices and perceptions of the patient safety culture. Results of the project indicate a change in the use of SBAR throughout the institution, with particular improvement in communication from PPS to professional staff.

Phase 2 of the EMPOWER project: enhancing communication for paraprofessionals.

This column describes a project that was implemented to enhance the communication skills of hospital paraprofessional staff. One of the primary goals was to enhance the communication between paraprofessional (nursing assistants) and professional (nurses and physicians) staff.

The EMPOWER project: an initiative to educate and mentor paraprofessional staff.

This column describes a new program designed to enhance patient safety by teaching paraprofessional staff (PPS) how to communicate changes in patient status to professional staff. Phase 1 of the project included assessment of PPS perceptions of the patient safety culture at the hospital through survey and focus group discussions. Results from Phase 1 and plans for Phase 2 are described.

A leadership initiative to improve paraprofessional communication of changes in patient status.

As hospitals around the globe make the transition from paper to electronic communication and documentation systems, there is a need for examining the role that electronic and non-electronic systems play in promoting effective and safe communication practices between all members of the health care team. We report here the strategies we have adopted to integrate a structured communication framework into the clinical workflow of paraprofessional providers as a means to support safe practices, to promote teamwork and to provide a key foundation for implementation of electronic clinical documentation.

Medication administration process assessment: applying lessons learned from commercial aviation.

Medication administration is a major safety issue for patients and providers. The authors describe a commercial aviation-based system safety assessment conducted on the medication administration process for a community teaching hospital in the northeast United States. Processes on 2 medical units and 1 surgical unit were assessed. A sampling of qualitative outcomes is presented in a risk prioritization framework, along with practical recommendations predicated on the valuable lessons learned in commercial aviation.

The relationship between nurses' perceptions of empowerment and patient satisfaction.

PURPOSE: This study aims to explore the relationship between nurses' perceptions of empowerment and patient satisfaction using Kanter's theory as adapted by Laschinger and others. RESEARCH QUESTION: Is there a positive relationship between nurses' perceptions of empowerment and patient satisfaction? METHOD: A descriptive correlational design was used. Instruments used were the Conditions of Work Effectiveness Questionnaire II, which measures nurse empowerment, and the Press Ganey Associates Patient Satisfaction Surveys, which measures patient satisfaction. RESULTS/CONCLUSIONS: Significant relationships were found between nurses' perceptions of empowerment and access to information, opportunity, support, and resources. A significant positive correlation was found between nurses' perceptions of empowerment and patient satisfaction (r = .052; p < .05). Limitations of this study are presented, as well as recommendations for future research.

Differences in perceptions of empowerment among nationally certified and noncertified nurses.

OBJECTIVE: To examine the difference in perceptions of empowerment between nurses who were nationally certified and those who were not. BACKGROUND: Nurses are encouraged to obtain certification in their specialty. The focus of most nursing research on certification has been on motivation to acquire certification and perceived benefits of certification. Research related to empowerment indicates that access to empowerment structures results in achievement and success. METHODS: This descriptive comparative study used the Conditions of Work Effectiveness II Questionnaire to measure registered nurses' perceptions of empowerment. Certification status was recorded on the demographic section of the questionnaire. RESULTS: Significant differences were noted in empowerment scores for certified and noncertified nurses as measured by the Conditions of Work Effectiveness II Questionnaire. Findings suggest that nurses who are certified have higher perceptions of empowerment. Certification may increase nurses' perceptions of empowerment and therefore improve work effectiveness. CONCLUSION: Certified nurses in this study had increased access to job-related power and opportunity structures. Certification provides recognition of the nurses' knowledge and expertise in the specialty area which in turn is empowering. Organizations that support and recognize this achievement may experience improved turnover and retention rates.

The clinical partnership as strategic alliance.

The purpose of this article is to describe a renewed partnership between a collegiate school of nursing and a community hospital. Universities and hospitals are searching for creative solutions to increase the number of registered nurses available to meet the demand for nursing care. An affiliation agreement had been in existence for many years, but health care system imperatives made it necessary to redesign the partnership between nursing education and nursing service. The model used to develop this new partnership is based on the work done in the field of management and is in the form of a strategic alliance. The success of a strategic alliance depends on two key factors: the relationship between partners and partnership performance. Identified outcomes show that this partnership is helping to meet the increasing demand for nursing care by building student capacity, satisfying mutual needs of faculty and clinical staff, and removing economic barriers. This article describes the development of the strategic alliance, its current status, and strategies for the future.