Developing interprofessional collaborative practice competencies in rural primary health care teams.

BACKGROUND: Leaders from a university, Area Health Education Center, and primary care centers (PCCs) collaborated to integrate Interprofessional Collaborative Practice (IPCP) in PCCs. PURPOSE: Describe the facilitators and barriers of IPCP implementation in rural clinics and the impact on decision-making and safety culture. METHODS: The implementation team used engagement strategies to support the development of IPCP. PCC team participants completed surveys measuring collaboration and satisfaction with care decisions and safety culture. Qualitative data were analyzed to describe facilitators and barriers to IPCP. FINDINGS: Significant improvement (p < .035) in the Global Amount of Collaboration made over time. Barriers to IPCP included high turnover, hierarchical culture, lack of role clarity, competing time demands, limited readiness for change, and physical space limitations. Facilitators included structured huddles, alignment of IPCP with organizational goals, and academic-practice partnership. DISCUSSION: Partnering with academic-practice partnerships may facilitate collaboration and team learning as PCCs incorporate IPCP into practice.

Fostering interprofessional collaborative practice in acute care through an academic-practice partnership.

An interprofessional collaborative practice (IPCP) environment was implemented in four inpatient acute care unit accountable care teams (ACT) through an academic-practice partnership. An action research methodology was implemented to empower healthcare professionals and promote ownership and sustainment of the IPCP strategies. Healthcare professionals on the ACT units, students, and faculty engaged in the multi-year project. Interventions included staff engagement exercises and coaching and support of individual ACT unit IPCP strategies and education. Healthcare professional outcome data were collected in the form of participant surveys, measuring collaboration about care decisions and the extent to which professionals engaged in a culture of safety, collected at baseline and 6-month intervals. Healthcare outcome measures of the ACT units were also collected at baseline and 6-month intervals. Students had clinical learning experiences in the IPCP settings and completed post clinical surveys. Implementation of the interventions resulted in a positive trend in the healthcare professionals, although statistical significance was not observed. Student outcome data demonstrated statistically significant positive learning outcomes. Healthcare outcome measures demonstrated a significant decrease in readmissions and an overall decrease in catheter-associated urinary tract infections over time. Other measures were not significantly impacted. In conclusion, an academic - practice partnership can strengthen and support an IPCP environment by allowing healthcare clinicians to be directly involved in the selection and implementation of IPCP strategies and contribute to improved professional, healthcare and student outcomes.

Becoming a nurse faculty leader: Taking risks by being willing to fail.

BACKGROUND: Higher education is undergoing rapid transformation requiring nurse faculty leaders to engage in risk taking. Consequently, what is known about the experience of taking risks? How do leaders decide what constitutes a risk worth taking? How do leaders who take risks tolerate failure? The purpose of this study was to explicate the leadership practices of risk taking in nurse faculty leaders. METHOD: Interpretive phenomenology was used to explore the experience of risk taking among 15 self-identified nurse faculty leaders. Unstructured audio recorded interviews were conducted in which participants described their experiences of taking risks. Transcribed interviews were analyzed by a research team to uncover themes in the narrative data. RESULTS: A theme, willingness to fail, and three subthemes, enacting a culture of experimentation, working hard for success, and learning from failure are reported. CONCLUSION: This study provides practical know-how and an evidence-base to support nurse academic leaders in the practice of risk taking during these challenging times in higher education.

Empowering Nurses to Lead Interprofessional Collaborative Practice Environments Through a Nurse Leadership Institute.

A year-long Nurse Leadership Institute (NLI) for emerging leaders in primary care clinics and acute care environments was developed, implemented, and evaluated. The NLI's goal was to foster empowerment in interprofessional collaborative practice environments for nurses in the three cohorts of NLIs. The NLI was framed around the Five Leadership Practices of modeling the way, inspiring a shared vision, challenging the process, enabling others to act, and encouraging the heart. To create a professional learning environment, foster community, and enhance leadership skills, the Lean In Circle materials developed by Sandberg were adapted for content reorganization and discussion. Minimal literature exists specifically addressing nursing leadership professionals' development based on Sandberg's Circle materials. The findings of the three NLI cohorts reported in this article begin to fill this existing knowledge gap. Participants reported a significant increase in leadership skills. Recommendations for refinement of future NLI offerings are provided. J Contin Educ Nurs. 2018;49(2):61-71.

Becoming a nurse faculty leader: taking risks by doing the right thing.

Risk taking is a key aspect of academic leadership essential to meeting the challenges and opportunities in higher education. What are the practices of risk taking in nurse faculty leaders? This interpretive phenomenological study examines the experience and meaning of risk taking among nurse leaders. The theme of doing the right thing is brought forth through in-depth hermeneutic analysis of 14 individual interviews and two focus group narratives. The practice of doing the right thing is propelled and captured by leaders through a sense professional responsibility, visioning the future, and being true to self and follow one's core values. This study develops an evidence base for incorporating ways of doing the right thing in leadership development activities at a time when there is tremendous need for highly effective leaders in academic settings. Examining the practices of doing the right thing as a part of leadership development lays a foundation for building the next generation of nursing leaders prepared to navigate the ever-changing and complex academic and health care environments.

Urban stream syndrome in a small, lightly developed watershed: a statistical analysis of water chemistry parameters, land use patterns, and natural sources.

The relationships among land use patterns, geology, soil, and major solute concentrations in stream water for eight tributaries of the Kayaderosseras Creek watershed in Saratoga County, NY, were investigated using Pearson correlation coefficients and multivariate regression analysis. Sub-watersheds corresponding to each sampling site were delineated, and land use patterns were determined for each of the eight sub-watersheds using GIS. Four land use categories (urban development, agriculture, forests, and wetlands) constituted more than 99 % of the land in the sub-watersheds. Eleven water chemistry parameters were highly and positively correlated with each other and urban development. Multivariate regression models indicated urban development was the most powerful predictor for the same eleven parameters (conductivity, TN, TP, NO[Formula: see text], Cl(-), HCO(-)3, SO9(2-)4, Na(+), K(+), Ca(2+), and Mg(2+)). Adjusted R(2) values, ranging from 19 to 91 %, indicated that these models explained an average of 64 % of the variance in these 11 parameters across the samples and 70 % when Mg(2+) was omitted. The more common R (2), ranging from 29 to 92 %, averaged 68 % for these 11 parameters and 72 % when Mg(2+) was omitted. Water quality improved most with forest coverage in stream watersheds. The strong associations between water quality variables and urban development indicated an urban source for these 11 water quality parameters at all eight sampling sites was likely, suggesting that urban stream syndrome can be detected even on a relatively small scale in a lightly developed area. Possible urban sources of Ca(2+) and HCO(-)3 are suggested.

Becoming a nurse faculty leader: doing your homework to minimize risk taking.

Risk taking is an important aspect of academic leadership; yet, how does taking risks shape leadership development, and what are the practices of risk taking in nurse faculty leaders? This interpretative phenomenological study examines the meaning and experience of risk taking among formal and informal nurse faculty leaders. The theme of doing your homework is generated through in-depth hermeneutic analysis of 14 interview texts and 2 focus group narratives. The practice of doing one's homework is captured in weighing costs and benefits, learning the context, and cultivating relationships. This study develops an evidence base for incorporating ways of doing one's homework into leadership development activities at a time when there is a tremendous need for nurse leaders in academic settings. Examining the practices of doing one's homework to minimize risk as a part of leadership development provides a foundation for cultivating nurse leaders who, in turn, are able to support and build leadership capacity in others.

Creating tomorrow's leaders and innovators through an RN-to-bachelor of science in nursing consortium curricular model.

The critical need to increase the number of baccalaureate-prepared RNs to improve the safety and quality of patient care in today's complex health care system is a pressing issue in health care. One part of the solution lies in the attainment of higher education of RNs prepared at the associate and diploma levels who make up the majority of the nursing workforce in the United States today. The Indiana University Schools of Nursing located throughout the state of Indiana collaborated to create a statewide RN-to-bachelor of science in nursing curriculum that is flexible, innovative, and meaningful. The plan focuses on the strengths and unique learning needs of returning RN students. Specifically, this curriculum offers year-round online courses in 7-week terms, which allows students to enter and exit the program within 1 year, and a curriculum with more choices and fewer constraints than is typical for baccalaureate nursing degrees. This learner-centered plan fully incorporates the American Association of Colleges of Nursing Essentials for Baccalaureate Education (2009) throughout the curriculum. It is conveniently delivered online, takes into account and gives credit for students' previous learning and work experience, and allows the students to pursue nursing specialty knowledge for college credit. Working together as a consortium to achieve these goals across an entire state with 8 regional campuses required focused attention on the concerns and strengths of all the stakeholders and successful implementation of effective communication strategies.