Women's power in hospital-based nursing: A critical qualitative study.

AIM: To understand the factors that affect power in hospital-based nursing and reveal how the female gender affects an individual's ability to feel empowered. DESIGN: Critical qualitative research design. METHOD: Semi-structured interviews were conducted with nurses working in inpatient hospital settings in Utah and New Mexico. Data were collected from February to March 2022. Interviews were analysed using thematic analysis. RESULTS: Sixteen participants were interviewed. Six themes were identified from the data, four of which related to nurses' power at work, and two of which specifically related to how gender affects a nurse's ability to use power and feel empowered. These themes include supportive leaders, positive unit culture, successful advocacy, personal factors, societal gender roles and sexism. CONCLUSION: Empowered nurses can revolutionize health care. The themes developed in this study will help nurse leaders and nurses alike increase nurses' ability to use their power and feel empowered in the workplace. IMPACT: Nurse leaders should strive to be supportive of their nurses and build a positive work environment while also providing consistent consequences for sexist actions of staff. Nurses should take opportunities to advocate for their patients, be autonomous and build their knowledge base to improve empowerment. As nurse leaders and nurses alike work together to improve health care, nurse experience, patient and clinical outcomes will be improved. PATIENT OR PUBLIC CONTRIBUTION: The nurses interviewed for this study contributed their experiences and insights during data collection. Some also contributed rigour to the data analysis process by participating in member checking.

Facilitating Organizational Learning in Nursing Teams.

Organizational learning is an effective strategy professional development educators and other nurse leaders can use to improve individual, team, and organizational outcomes. Professional development educators can foster organizational learning by implementing certain actions, called mechanisms, associated with organizational learning. This article highlights five such mechanisms, presents practical examples of each, and suggests evidence-based recommendations professional development educators and nurse leaders can use to better facilitate organizational learning. [J Contin Educ Nurs. 2022;53(8):379-384.].

Contextual factors associated with organizational learning in hospitals: An instrument development study.

AIM: Develop a valid, reliable research instrument to measure contextual factors associated with organizational learning in hospitals. BACKGROUND: A valid, reliable instrument for measuring contextual factors associated with organizational learning is needed so nurse leaders and researchers can improve healthcare by facilitating and studying organizational learning. METHODS: The Organizational Learning in Hospitals model guided development of the Organizational Learning Instrument-Context. Content validity was refined and evaluated through cognitive interviews and expert reviews. The instrument was distributed to direct care nurses in Magnet® hospitals in the United States. Intraclass correlation coefficients validated the use of multilevel analyses. Construct validity was assessed using multilevel confirmatory factor analysis, and coefficient omega was used to assess internal reliability. RESULTS: Participants were 1063 nurses in 120 inpatient units in 11 Magnet® hospitals. Results were as follows: item-level content validity = 0.86-1.0, scale-level content validity = 0.95, intraclass correlation coefficients = 0.171-0.270, coefficient omega = 0.945-0.982 and standardized factors loadings = 0.672-0.964. Model fit statistics were CFI = 0.963, TLI = 0.961 and RMSEA = 0.059. [Correction added on 31 May 2022, after first online publication: In the first line of the 'Results' section, "163 nurses" has been corrected to "1063 nurses" in this version.] CONCLUSIONS: Initial testing indicates the Organizational Learning Instrument-Context has adequate levels of reliability, content validity and construct validity. IMPLICATIONS FOR NURSING MANAGEMENT: Hospital leaders and researchers may begin using this instrument to improve and study contextual factors associated with organizational learning in hospital units.

Developmental stages associated with organizational learning in hospitals: An instrument development study.

AIM: To develop and test the Organizational Learning Instrument: Development Stages instrument, a measure of hospital units' readiness to engage in organizational learning. DESIGN: Cognitive interviewing, expert review and a quantitative, cross-sectional survey. METHODS: Item development was informed by previous research on organizational learning. Content validity was assessed and strengthened using cycles of cognitive interviewing and expert review. The resulting instrument was distributed by email to all nurses providing direct patient care in inpatient units in 11 Magnet® hospitals. Data were collected in 2018. Intraclass correlations, using hospital unit as the grouping variable, indicated the need to use multilevel methods to analyse the survey data. Thus, coefficient omega and multilevel confirmatory factor analysis were used to estimate the instrument's reliability and construct validity, respectively. RESULTS: The Organizational Learning Instrument: Development Stages is a 35-item survey comprised of four scales: Identity & Ownership, Team & Respect, Accountability & Support and Reliability & Sustainability. The expert review yielded scale-level content validity scores from 0.90 to 1.0 and item-level content validity scores from 0.86 to 1.0. Survey participants were 1212 nurses, working in 99 inpatient units, across 11 Magnet® hospitals. Intraclass correlations ranged from 0.113 to 0.158. Coefficient omega reliability for the four scales was 0.981-0.993. Standardized factor loadings for the 35 items were 0.699-0.961, with acceptable model fit statistics (comparative fit index = 0.980, Tucker-Lewis Fit Index = 0.979, and root mean squared error of approximation = 0.060). CONCLUSIONS: These results indicate the instrument meets or exceeds generally accepted criteria for content validity, reliability and construct validity instrument, and is suitable for further use and testing. IMPACT: Nurse administrators, managers and researchers now have a valid, reliable instrument to better foster and study organizational learning in hospital units. Advances in organizational learning are expected to improve a variety of patient, staff and organizational outcomes in hospital units.

Mechanisms of organisational learning in hospitals: An instrument development study.

AIM: To develop a valid, reliable research instrument to measure mechanisms associated with organisational learning in hospitals. BACKGROUND: A valid, reliable instrument for measuring mechanisms of organisational learning would enable nurse leaders and researchers to improve health care through facilitation and study of organisational learning. METHODS: The Organizational Learning in Hospitals model was used as a framework to develop the Organizational Learning Instrument-Mechanisms. Cognitive interviews and expert reviews were used to refine and evaluate item-level and scale-level content validity. The instrument was distributed by email to a random sample of nurses working in inpatient hospitals in Utah (n = 1253). Confirmatory factor analysis was used to assess construct validity, and coefficient alpha was used to assess internal reliability. RESULTS: Item-level content validity scores were .88 to 1.0, and scale-level content validity was .98 (maximum score = 1.0). Standardized factor loadings were .539-.956, with model fit statistics as follows: comparative fit index (CFI) = .975, Tucker-Lewis index (TLI) = .973 and root mean square error of approximation (RMSEA) = .059. Coefficient alpha scores were .77-.95 for the instrument's five factors. CONCLUSIONS: Initial testing indicates the Organizational Learning Instrument-Mechanisms has adequate levels of reliability, content validity and construct validity. IMPLICATIONS FOR NURSING MANAGEMENT: Hospital leaders and researchers may begin using this instrument to improve and study the mechanisms of organisational learning in hospital units.

Organizational learning during COVID-19: A qualitative study of nurses' experiences.

AIM: The aim of this study is to test the validity of the Organizational Learning in Hospitals model in the context of the COVID-19 pandemic. BACKGROUND: Organizational learning is especially crucial in circumstances of intense, complex, enduring change, as with the COVID-19 pandemic. Nurse managers need additional guidance for fostering organizational learning under such circumstances. The Organizational Learning in Hospitals model may be a helpful resource but requires additional validation. METHODS: Semi-structured interviews were conducted to gather 19 nurses' first-hand experiences of organizational learning during the COVID-19 pandemic. Data were analysed using deductive thematic analysis. RESULTS: Nurses' experiences of organizational learning generally aligned with the tenets of the model. Specifically, effective organizational learning occurred when the contextual factors and mechanisms portrayed in the model converged. Model and contrary cases illustrate this phenomenon. CONCLUSIONS: This study validates and adds context to the model. It offers practical examples of the contextual factors and mechanisms of organizational learning. Leaders can use the model to guide their efforts to foster organizational learning. IMPLICATIONS FOR NURSING MANAGEMENT: This study reaffirms the importance of nurse leaders' central role in organizational learning. Nurse leaders can use the Organizational Learning in Hospitals model, and the practical examples provided, to foster organizational learning during challenging times.

Building the Science to Guide Nursing Administration and Leadership Decision Making.

OBJECTIVE: The aim of this study was to identify the challenges, barriers, and solutions for conducting nursing administration and leadership science (NALS) research. BACKGROUND: Evidence from leadership science should be at the forefront of nurse leaders' decision making. Yet, challenges remain in building the evidence and moving it into nursing administration and leadership practice. METHODS: This study used a Delphi technique with open-ended questions and direct content analysis to evaluate survey responses of members of the Association for Leadership Science in Nursing and American Organization for Nursing Leadership. RESULTS: Open-ended responses were coded to yield super categories and supportive codes for areas with limited evidence to guide leadership practice and the challenges for conducting NALS research. CONCLUSIONS: These findings provide future directions for continuously driving NALS research and for building and leveraging leadership science to support nursing administration decision making.

Setting the Research Agenda for Nursing Administration and Leadership Science: A Delphi Study.

OBJECTIVE: The aim of this study was to identify and prioritize research topics for nursing administration and leadership science. BACKGROUND: Nursing administration and leadership research priorities should provide a framework for building the science needed to inform practice. METHODS: The Association for Leadership Science in Nursing (ALSN) and American Organization for Nursing Leadership (AONL) Foundation (AONL-F) for Nursing Leadership and Education collaborated on a Delphi study. Initial input on research priority items were received from ALSN and AONL members. National experts participated in a 3-round Delphi study. RESULTS: Top-ranked priorities included: 1) nurses' health, well-being, resiliency, and safety in the workplace; 2) developing and managing a nursing workforce to meet current and future healthcare needs; 3) healthy work/practice environments for direct care nurses; 4) healthy work/ practice environments for nurse leaders; 5) quantification of nursing's value across the healthcare delivery system; and 6) nurse leader development and essential competencies. CONCLUSIONS: Researchers and funders should use these priorities to guide future studies.

Filling the Knowledge Gap for Nurse Leaders: Next Steps Following COVID-19.

The purpose of this article is to share gaps in knowledge and research related to pandemic management identified by nurse leaders during the COVID-19 pandemic. As part of a larger Delphi study, nurse leaders responded to an open-ended question about gaps in research they saw as important following the pandemic. Responses were analyzed using directed content analysis. Results are presented as 4 supercategories: Organizational leadership preparedness, adaptive leadership in crisis, innovations in care delivery, and health, well-being, and resilience.

Pre-licensure nursing students' experiences of psychological safety: A qualitative descriptive study.

BACKGROUND: Organizational learning is essential for consistently providing safe, efficient, high-quality patient care. Psychological safety is foundational for organizational learning. For pre-licensure nursing students psychological safety is crucial for both their learning and patient safety. Understanding pre-licensure nursing students' experiences of psychological safety can guide efforts to cultivate clinical environments conducive to learning and excellent patient care. OBJECTIVES: The objective of this study was to gain insight into pre-licensure nursing students' first-hand experiences with psychological safety in clinical settings. DESIGN: A qualitative, descriptive design was used for this study. SETTINGS: Participants were recruited from 12 different nursing programs across eight states. PARTICIPANTS: A total of 26 pre-licensure nursing students participated in this study. Included were students who had completed at least one clinical rotation, but had not yet obtained licensure as a registered nurse. METHOD: Semi-structured interviews were conducted via telephone. Interviews were analyzed using a constant comparative approach to thematic analysis. RESULTS: Four primary themes emerged from the data, two of which had sub-themes: 1) Feeling Self-Conscious, with the sub-themes Expecting Expectations and Interpreting Feedback; 2) Engaging; 3) Learning and Performing; and 4) Moving Forward, with the sub-themes Using Coping Strategies and Developing Confidence. CONCLUSIONS: This study reinforces the importance of psychological safety for nursing students' learning and for patient safety. Feeling psychologically safe allowed students to engage in the clinical setting, to learn from their experiences, and to perform their very best. With these insights, faculty and clinical preceptors can cultivate effective learning environments where patients can also receive safe, high-quality patient care.

Organizational Learning and Motivation in Certified Nurse Aides: A Qualitative Study.

Organizational learning is linked to improved outcomes in health care settings. In long-term care facilities, the unique position and expertise of certified nurse aides (CNAs) are crucial for excellent resident care, thus is it important to understand their sources of motivation. However, CNA motivation has not been adequately studied. The current qualitative descriptive study explored sources and implications of CNA motivation, particularly as it relates to engaging in organizational learning. Twenty-four CNAs working in a state Veteran's home were interviewed. CNAs described their sources of motivation as: I'm a Natural Caregiver, Support From Administration, Working as a Team, Love for Residents, and Self-Care. When motivated, CNAs had more positive attitudes about their work, a higher level of engagement with residents, a stronger drive to accomplish extra tasks, and less desire to quit. Engaging CNAs in organizational learning may provide an opportunity to motivate CNAs and optimize their unique position and expertise to improve resident care. [Research in Gerontological Nursing, 14(5), 255-263.].

Creating a Work Environment Conducive to Organizational Learning.

Through organizational learning, health care teams can consistently provide excellent patient care in a complex and changing environment. Nurse managers, educators, and other leaders can facilitate organizational learning within their teams by promoting certain contextual factors in the clinical work environment. This article provides an overview of contextual factors associated with organizational learning, includes practice-based examples of these factors, and offers evidence-based recommendations for creating a learning-focused work environment. [J Contin Educ Nurs. 2021;52(6):281-285.].

Sustaining Exemplary Practice: Leading Through the Lens of Organizational Learning.

Nurse leaders must be proficient at fostering organizational learning within their teams and throughout their companies. Organizational learning can be achieved by creating a culture conducive to learning, integrating learning practices into the team's routines, and leveraging the impact of learning by cultivating a strong, vibrant institutional memory. Authors describe the concept of organizational learning, provide strategies for fostering a culture where organizational learning thrives, and underscore the nurse leaders' role in leading organizations to achieve and sustain exemplary practice.

Nurses' experiences of Organisational learning: A qualitative descriptive study.

AIM: To explore the validity of and expand upon a model of organisational learning in hospitals. BACKGROUND: Organisational learning is a positive change in an organisation's collective knowledge, cognition and/or action, leading to improved hospital performance. A current model offers an evidence-based, theoretical representation of organisational learning in hospitals, yet the intricacies of organisational learning in clinical practice are not fully understood. Additional guidance is needed to effectively foster and study organisational learning. METHOD: Semi-structured interviews were used to gather 15 first-hand experiences of organisational learning from 14 nurses. Data were analysed via deductive thematic analysis. RESULTS: Organisational learning was more effective when aligned closely with the model and less effective when alignment was poor. The nurses' experiences illustrate relationships among elements of the model and underscore the importance of leadership and psychological safety in organisational learning. CONCLUSION: This study helps validate the model and offers new insights into organisational learning. Additional research is needed to explore the role of leadership and psychological safety in organisational learning. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers can use the Organisational Learning in Hospitals model to evaluate organisational learning. Nurse managers have the opportunity to develop effective leadership practices designed to cultivate psychological safety within their teams.

New graduate registered nurses' experiences with psychological safety.

AIM: The purpose of this study was to gain insight into new graduate registered nurses' experiences with psychological safety. BACKGROUND: Organizational learning allows acute care hospitals to consistently provide high-quality patient care. Psychological safety is critical for organizational learning. New graduate nurses in particular need to feel psychologically safe as they transition into professional nursing practice. Understanding new graduate registered nurses' experiences of psychological safety can guide leaders and others to create work environments that foster psychological safety and organizational learning. METHOD: Semi-structured interviews were conducted with 13 newly graduated registered nurses working in inpatient hospital settings. Interviews were analyzed using thematic analysis. RESULTS: Four primary themes featured prominently in the new graduate nurses' experiences of psychological safety: building credibility, making personal connections, feeling supported and seeking safety. CONCLUSION: Understanding these themes will help nursing education programmes, nurse managers, nurse colleagues and new graduate registered nurses foster psychological safety and create environments conducive to organisational learning. IMPLICATIONS FOR NURSING MANAGEMENT: All members of the health care team involved in the new graduate registered nurses' transition to practice have a role in fostering psychological safety. Additional research is needed to better understand psychological safety and how to foster it.

Disruptive Innovation: Impact for Practice, Policy, and Academia.

The 2019 Association for Leadership Science in Nursing International Conference, Disruptive Innovation, was held in Los Angeles, California, with attendees from 30 US states, Canada, Brazil, and China. Presenters discussed the need for nurse leaders to advocate for health equity, lead evidence-based innovation, how robots and other technology are generating disruptive innovations in healthcare, and building strong academic-practice partnerships to address nursing workforce challenges. This article will report on these important insights.

Organizational learning in hospitals: A realist review.

AIM: To establish a middle-range theory of organizational learning in hospitals. DESIGN: A realist review of the literature, conducted according to established standards for realist and meta-narrative evidence syntheses. Middle-range theory development was performed according to Smith and Liehr's recommendations. DATA SOURCES: Two comprehensive scientific databases and six discipline-focused databases spanning health care, life sciences, business, sociology, and psychology were searched from inception to 12 May 2016. REVIEW METHODS: Citations meeting the inclusion criteria were appraised using the Mixed Methods Appraisal Tool. Data extraction was guided by a focus on the contextual factors, mechanisms, and outcomes associated with organizational learning. RESULTS: The initial search yielded 2,332 citations, 147 of which were ultimately included in the review. The included citations were generally of high quality. Reviewed evidence indicates certain aspects of organizational context can be conducive to mechanisms of organizational learning, leading to a range of positive organizational outcomes. CONCLUSION: This review updates and expands on a previous review of the literature on organizational learning in hospitals, refines the concept of organizational learning in hospitals, and provides a middle-range theory of organizational learning in hospitals. IMPACT: This updated review provides a strong evidence base for future work on the topic of organizational learning in hospitals. The refined concept of organizational learning makes it possible to develop reliable, valid research instruments that better reflect of the full scope of organizational learning. Finally, the middle-range theory guides researchers and clinical leaders as they advance the science and practice of organizational learning.

Organisational learning in hospitals: A concept analysis.

AIM: To provide a clear definition and description of organisational learning in hospitals. BACKGROUND: Organisational learning is a promising strategy nurse managers, and leaders can use to improve organisational performance. A clear definition and description of organisational learning is necessary to advance theory, research and practice in this field. METHODS: Walker & Avant's method was used to conduct a concept analysis of organisational learning in hospitals. Data sources included 147 empirical studies, 16 review articles, three dictionary entries and three book chapters. RESULTS: Organisational learning occurs when experiences are translated into positive changes in the organisation's collective knowledge, cognition and actions. Organisational context plays a key role in the learning process. Other manifestations of the concept are identified. CONCLUSIONS: This concept analysis provides a clear definition of organisational learning and a description of its defining attributes, antecedents, empirical referents and consequences. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers and leaders can improve patient and organisational outcomes by creating an environment conducive to translating experiences into organisational learning. Further research is needed to continue advancing the science of organisational learning in hospitals.

The learning history: A research method to advance the science and practice of organizational learning in healthcare.

AIMS: This paper presents a discussion of the learning history research method, including a description of how to conduct a learning history. Suggested applications of the method in research and clinical practice are also provided. BACKGROUND: Organizational learning has been linked to improved clinical performance and other positive outcomes in healthcare. Yet, the theoretical guidance available to researchers and clinical leaders who study and strive to foster organizational learning is sparse. Studying how organizational learning occurs in the healthcare context is a critical step toward addressing this knowledge gap. The learning history, a participatory research method, is specifically designed for studying the organizational learning process. Thus, it is precisely suited for the work of developing a theoretical foundation for organizational learning in healthcare. DESIGN: Discussion paper. DATA SOURCES: This discussion paper is based on relevant literature and the authors' experiences conducting learning histories. IMPLICATIONS FOR NURSING: Researchers can use learning histories to develop a better understanding of and a theoretical foundation for organizational learning in healthcare. Leaders in clinical practice can use learning histories to foster learning and improvement in their organizations. CONCLUSION: Learning histories are a promising approach to advancing the science and practice of organizational learning.

Organizational learning in a college of nursing: A learning history.

BACKGROUND: College of nursing leaders can foster organizational learning as a means of achieving their desired organizational outcomes. Organizational learning has not previously been studied in colleges of nursing, leaving college administrators and faculty little guidance as they strive to improve outcomes in their own colleges. OBJECTIVES: The purpose of this study was to discover new insights related to organizational learning in a college of nursing. DESIGN: The learning history method was used to document and describe organizational learning in a college of nursing. SETTING: This study was conducted with a college of nursing situated in a private, religious-based university in the western United States. PARTICIPANTS: Six stakeholders and 16 individuals familiar with the college's history were purposively recruited for this study. Participants included college administrators, faculty, students, alumni, and individuals with university-level responsibilities related to the college. METHODS: Semi-structured interviews and college artifacts were used to gather data. Data was reviewed and themes identified through a process called "distillation." FINDINGS: The college's vision, "Learning the Healer's Art" provides purpose and motivation within the college. Four themes provide additional insight into how the college established a learning culture and fosters behavior conducive to organizational learning: (1) Character and Quality, (2) Long-Term Perspective, (3) Collaborative Leadership and Adaptation, and (4) Mentoring. CONCLUSION: College of nursing leaders can foster organizational learning and pursue improvement within their colleges. Recommended actions include developing a shared vision for the college, building a cadre of qualified faculty and students who have strong personal character, maintaining a long-term perspective, using a collaborative approach to leadership and adaptation, and facilitating mentoring.