Impact of Professional Nursing Practices on Patient/Nurse Outcomes: Testing the Essential Professional Nursing Practices Instrument.

Increasing patient and healthcare system complexity and the need to accurately measure the engagement of clinical nurses (CNs) in holistic, professional nursing practice indicates that an update to the Essentials of Magnetism instrument is needed. The purposes of this research were to critique and weight items, assess the value and psychometric properties of the newly constructed Essential Professional Nursing Practices (EPNP) instrument, and establish relationships between EPNPs and CN job, practice, and nurse-assessed patient satisfaction.

The evolution and development of an instrument to measure essential professional nursing practices.

Nursing continues to evolve from a task-oriented occupation to a holistic professional practice. Increased professionalism requires accurate measurement of care processes and practice. Nursing studies often omit measurement of the relationship between structures in the work environment and processes of care or between processes of care and patient outcomes. Process measurement is integral to understanding and improving nursing practice. This article describes the development of an updated Essentials of Magnetism process measurement instrument for clinical nurses (CNs) practicing on inpatient units in hospitals. It has been renamed Essential Professional Nursing Practices: CN.

Impact of residency programs on professional socialization of newly licensed registered nurses.

Do Nurse Residency Programs (NRPs) reflect the professional socialization process? Residency facilitators in 34 Magnet hospitals completed Residency Program Questionnaires constructed to reflect the goals, themes, components, and strategies of the professional socialization process described in the literature. NRPs in 4 hospitals exemplified the complete two-stage (role transition and role/community integration) process. In 14 hospitals, NRPs were of sufficient length and contained components that reflected the professional socialization process. In 16 hospitals, NRPs exemplified the "becoming" role transition stage. What components are most effective in the professional socialization of new graduate nurses? A total of 907 new and experienced nurses, nurse managers, and educators working on clinical units with confirmed healthy work environments in 20 Magnet hospitals with additional "excellence designations" were interviewed. Components identified as most instrumental were precepted experience, reflective seminars, skill acquisition, reflective practice sessions, evidence-based management projects, and clinical coaching-mentoring sessions. Suggestions for improvement of NRPs are offered.

Components and strategies of nurse residency programs effective in new graduate socialization.

Patient needs and practice conditions demand that clinical nurses in acute care hospitals engage in a unique professional practice role-care and management of clinical situations for multiple patients, simultaneously. Nurse Residency Programs (NRPs) facilitate the integration of newly licensed registered nurses (NLRNs) into this professional practice role through competency development in seven management areas. Purpose of this study was to identify effective components and strategies of NRPs in each area. A sample of 907 nurses in 20 Magnet hospitals with NRPs operative for at least 3 years participated in individual or small group interviews and 82 participant observations. All interviews were digitally recorded, transcribed, and analyzed thematically. Effective strategies were identified for all but one of the seven management areas. Suggestions for improvement in NRPs to better meet NLRN professional socialization needs, patient outcomes, and challenges of the health care system today are offered.

Impact of healthy work environments and multistage nurse residency programs on retention of newly licensed RNs.

The objective of the study was to examine effects of nurse-confirmed healthy unit work environments and multistage nurse residency programs (NRPs) on retention rates of newly licensed RNs (NLRNs). Establishing a culture of retention and healthy clinical nurse practice environments are two major challenges confronting nurse leaders today. Nurse residency programs are a major component of NLRN work environments and have been shown to be effective in abating nurse turnover. Sample for this study consisted of 5,316 new graduates in initial RN roles in 28 Magnet® hospitals. There were no differences in retention rates by education or patient population on clinical unit. NLRN retention rate was higher in community than in academic hospitals. More than half of NLRNs were placed on units with very healthy work environments. Newly licensed RNs on units with work environments needing improvement resigned at a significantly higher rate than did other NLRNs. The quality of clinical unit work environments is the most important factor in NLRN retention.

Development and testing of an organizational job satisfaction tool: increasing precision for strategic improvements.

OBJECTIVE: This article describes the development and testing of a new instrument that measures organizational job satisfaction (OJS). BACKGROUND: Nurse satisfaction includes 2 different types of satisfaction: OJS and professional work satisfaction. To obtain valid results, each type must be measured correctly. METHODS: A metasynthesis of OJS was conducted from 3 sources: nurse satisfaction instruments, attributes present in recruitment advertisements, and nursing comments from a national survey. A cross-walk of these sources provided 17 consistent OJS satisfiers. A survey of 10,000 nurses identified the importance of these satisfiers. RESULTS: Cronbach α for the scale was .85. The satisfiers were grouped into 3 categories: universally important, moderately important, and unimportant. CONCLUSIONS: A synthesis from 3 sources, including identification of important satisfiers, provides validity for the OJS scale. The scale is a reliable and valid tool used to assess and evaluate strategies to improve the nurses' work environment.

Nine structures and leadership practices essential for a magnetic (healthy) work environment.

Improving clinical nurse work environments is a major challenge faced by nurse executives today. To meet this challenge, nurse leaders must implement the "right" structures and best leadership practices so that clinical nurses can engage in the work processes and relationships that are empirically linked to quality patient outcomes. What are these "right" structures and best leadership practices? Meta-analyses of 2 sets of publications were used to identify organizational structures and best leadership practices essential to a healthy work environment, that is, a work environment that enables them to engage in the work processes and relationships needed for quality patient care outcomes. The first set was 12 publications from 7 professional organizations/regulatory bodies that advocated forces, hallmarks, and standards for a healthy work environment. The second set was 18 publications from the Essentials of Magnetism structure-identification studies, in which the aggregated results from 1300 interviews with staff nurse, manager, and physician "experts" were compared with the agency results. Broadening the categories and final aggregation yielded the 9 most important and influential structures essential to a quality work environment. Suggestions for implementing these structures are provided.

Incentives and procedures effective in increasing survey participation of professional nurses in hospitals.

Positive patient and nurse outcomes depend upon improved clinical nurse work environments. Improvements can be confirmed through environmental surveys that have sufficient participation to yield accurate data. Professional clinical nurses in hospitals face a unique work complexity that inhibits survey participation. What procedures/incentives are effective in increasing survey participation? Are procedures/incentives effective with non-nurses applicable to nurses? These questions were answered through a focused literature review, a case-study analysis of procedures and incentives used by M.D. Anderson Cancer Center that resulted in a 93% response rate on an environmental Web-based survey, operational data from environmental surveys administered to staff nurses in 286 hospitals nationally and internationally, and an e-mail survey of nurse leaders/managers in 7 strategically selected hospital units. Incentives effective with nurse populations differed from those of non-nurse populations in several areas. Benchmarking and gap analysis-assessment, comparison to internal or external referents, introduction of needed improvements, and reassessment-are best leadership/management practices and are essential elements of the research and quality improvement efforts characteristic of Magnet hospitals. As the use of surveys for quality improvement and workforce management increases, nurse leaders need to know what procedures and incentives encourage response rates large enough to produce valid, representative data.

Nurse-physician relationships in hospitals: 20,000 nurses tell their story.

"Good" relationships between nurses and physicians are important to high-quality patient care. Five different types of nurse-physician relationships exist on clinical units. What are the differences in the nurse-physician climate between magnet and comparison hospitals? What are the organizational structures and best leadership practices that help nurses develop collegial and collaborative relationships with physicians?

Accurate assessment of clinical nurses' work environments: response rate needed.

Improvement of hospital unit work environments is key to quality patient care, productivity, nurse retention, and job satisfaction. Accurate measurement of such environments is necessary prior to introduction and evaluation of improvement structures and strategies. Characteristics and attributes of work environments are group level phenomena. Accurate assessment of these phenomena requires survey response rates of sufficient size to ensure sample representativeness and data that can reliably be aggregated to group level. What is the sufficient response rate? This question was answered through psychometric testing of five random samples from the population of 23 M.D. Anderson Cancer Center clinical units that had 100% response rates on an environmental survey. Response rates of 40% or more had acceptable psychometric properties for unit-specific scales.

Structures and practices enabling staff nurses to control their practice.

This mixed-methods study uses interviews, participant observations, and the CWEQII empowerment tool to identify structures and attributes of structures that promote control over nursing practice (CNP). Nearly 3,000 staff nurses completed the Essentials of Magnetism (EOM), an instrument that measures CNP, one of the eight staff nurse-identified essential attributes of a productive work environment. Strategic sampling is used to identify 101 high CNP-scoring clinical units in 8 high-EOM scoring magnet hospitals. In addition to 446 staff nurses, managers, and physicians on these high-scoring units, chief nursing officers, chief operating officers, and representatives from other professional departments are interviewed; participant observations are made of all unit/departmental/hospital council and interdisciplinary meetings held during a 4 to 6 day site visit. Structures and components of viable shared governance structures that enabled CNP are identified through constant comparative analysis of interviews and observations, and through analysis of quantitative measures.

Essentials of a productive nurse work environment.

BACKGROUND: Staff nurse work environments must be improved. To do so, their quality must be measured. The Essential of Magnetism (EOM) tool measures eight characteristics of a productive and satisfying work environment identified by staff nurses in magnet hospitals as essential to quality patient care. The EOM items are based on grounded theory and are used to measure attributes of the work environment as functional processes. The EOMII is a revision of two of the subscales of the EOM. OBJECTIVES: To test the hypotheses that staff nurses in hospitals designated as having excellent work environments (Magnet) will score significantly higher on the EOMII and on two outcome indicators than will their counterparts in Comparison hospitals. Additional aims include establishing the psychometric properties of the EOMII; updating the National Magnet Hospital Profile; ascertaining relationships between nurse attribute, work, and contextual variables and the characteristics of a productive work environment; and investigating the relationship between the magnet structure, care processes and relationships and two single-item indicators, overall job satisfaction, and nurse-assessed quality of patient care. METHODS: This was a secondary analysis of aggregated data from 10,514 staff nurses in 34 hospitals who completed the EOMII and the two outcome indicators. RESULTS: The EOMII is a valid and reliable measure of the quality of work environment from a staff nurse perspective. The hypotheses were confirmed. There are differences in essentials and outcome variables by (a) context-nurses in magnet hospitals report the most productive work environment; (b) education-master's prepared nurses report the most favorable environments; (c) experience-the most inexperienced and the most experienced report the most satisfying, productive environments; and (d) clinical unit-medical and surgical specialty and outpatient units report the healthiest work environments. DISCUSSION: The primacy of magnet designation as a contextual variable indicating a quality work environment was affirmed. A larger percentage of magnet hospitals meet the magnet profile now than in 2003. Item analysis of the EOMII subscales provides guidance on how to improve the unit work environment. Suggestions are made for additional study and research.