A Qualitative Exploration of Chief Nursing Officer Perspectives on Maintaining Magnet® Designation.

OBJECTIVE: The purpose of this study was to determine chief nursing officer (CNO) perspectives on how to sustain the infrastructure required for successful American Nurses Credentialing Center (ANCC) Magnet® redesignation. BACKGROUND: American Nurses Credentialing Center Magnet designation is a prestigious achievement reflective of years of dedication, innovation, mentoring, and leadership support. As challenging as the initial attainment of Magnet status can be, sustaining the success and becoming redesignated is considered even more difficult by many CNOs. However, there have been no published reports indicating how to be successful in Magnet redesignation. METHOD: A grounded theory qualitative approach was used, and data were collected through telephone interviews with CNOs who had successfully attained at least 1 redesignation. RESULTS: Fourteen CNOs participated; data were organized into 6 themes and 15 subthemes describing the critical elements for Magnet redesignation. CONCLUSION: Relationships among the 6 themes and subthemes are theorized in the form of a wheel with 6 spokes. When "set in motion," the wheel gathers momentum and all of the model elements become coalesced into the organizational ethos.

Description of work processes used by clinical nurse specialists to improve patient outcomes.

BACKGROUND: Advanced practice registered nurses (APRN) are expected to contribute to improved patient outcomes. Traditionally, clinical nurse specialists (CNS) have been the APRN role that led system-level nursing practice initiatives to advance care for specialty populations. Little is known about the work processes used by CNSs to achieve outcomes. PURPOSE: This study identified common processes used by CNSs working in a variety of practice settings and specialties to advance nursing practice and achieve improved clinical outcomes. METHODS: Qualitative descriptive methods were used; a purposeful sample of CNSs with completed system-level projects participated in focus groups. Data were analyzed using standard content analysis process. FINDINGS: CNSs engaged in intricate interactions identified as articulation work involving the management of intersections between people, technology and organizations. This expert work is largely invisible. Self-agency, trust, and influence are a nexus upon which CNS work processes revolve. DISCUSSION: The findings provide insight into CNS work processes, lend credibility to the CNS's leadership abilities, and help explain why the CNS role and practice is often considered invisible and ambiguous.

Nurses' Perceptions of Barriers to Rapid Response System Activation: A Systematic Review.

BACKGROUND: The rapid response system (RRS) was designed to identify and intervene on patients exhibiting clinical deterioration in the non-critical-care setting but is not always effectively activated by nurses, leading to adverse patient outcomes. OBJECTIVES: The objective of this systematic review was to explore nurses' perceived barriers to RRS activation in the acute adult inpatient setting. METHOD: A systematic review was completed utilizing the Preferred Reporting Items for Systematic Reviews and Meta-analysis checklist. Six different search terms were used in the following electronic databases: Academic Search Premier, the Cumulative Index to Nursing and Allied Health Literature, Healthsource: Nursing/Academic Edition, MEDLINE, and PubMed. Limiters applied to search methods included years 2007 to current, full text, scholarly (peer reviewed), and English language. This review was further limited to quantitative studies in the adult inpatient setting. RESULTS: The initial electronic database search yielded 149 articles. After duplicate exclusion, 87 article abstracts were reviewed for inclusion and eligibility, and a total of 8 articles were used for this systematic review. Themes to nurses' perceived barriers to RRS activation include RRS activator-responder interaction, physician influence, nurse education, and nurse experience. DISCUSSION: Nurses play a vital role in patient care by providing continuous surveillance and are the frontline for early detection including prompt intervention should a patient's condition deteriorate. Inconsistent RRS activation has been associated with negative patient outcomes. Exploring nurses' perceived barriers to RRS activation may contribute to interventions that lead to nurses appropriately activating the RRS and potentially decreasing adverse patient outcomes.

The Advanced Practice Clinical Nurse Specialist.

The clinical nurse specialist (CNS), one of the 4 advanced practice registered nurse (APRN) categories, has a unique role to play in contributing to high-quality patient care and system-level change across multiple health care settings. CNS practice requires advanced knowledge and skills, including specialty expertise, the ability to integrate new knowledge and innovation into the system of care, the ability to consult and collaborate with all health professions, and the mentoring of nursing staff to support and fully implement that new knowledge. The purpose of this article was to describe the role of the CNS, explain the background of the CNS role as it relates to APRN practice, provide current CNS workforce statistics, and share opportunities for hospitals and health systems to strategically use CNSs to advance patient and organizational goals.

Core Practice Outcomes for Clinical Nurse Specialists: A Revalidation Study.

Measuring outcomes of clinical nurse specialist (CNS) practice is essential for demonstrating accountability. Literature is limited with respect to the scope of reported CNS outcomes. The National Association of Clinical Nurse Specialists' (NACNS) published listing of CNS outcomes could serve as an outcome measurement framework. Revalidation of these outcomes is an important step in creating a structured outcome measurement approach. The purpose of this descriptive study was to assess CNSs' perceptions of the ongoing validity of NACNS published outcomes. A Web-based survey asked participants to describe, for each of 42 outcomes, the frequency of outcome accountability, importance to practice, and frequency of monitoring. Of the 427 surveys returned, 347 (81%) were included in analysis. Findings demonstrated concordance between identified outcomes and actual CNS practice. When job descriptions included the CNS outcomes, more CNSs reported using the outcomes in practice. Both accountability and importance predicted the monitoring of outcomes (p < .001). This study demonstrated the ongoing validity of NACNS outcomes. Nurse educators must ensure that CNS program curricula are based on the NACNS framework and that successful achievement of program outcomes are congruent with the framework. These outcomes have potential for use as a conceptual framework for guiding future CNS outcome investigations and ongoing monitoring systems. Finally, the findings of this study give voice to CNS practice and provide knowledge about expectations for practice outcomes.

Transforming the nursing profession in Saudi Arabia.

AIM: To discuss the impact of health-care policies and regulations on hospitals' journey towards the Magnet designation in Saudi Arabia. BACKGROUND: Saudi Arabia, like many other countries, faces several challenges in achieving 'the Gold Standard' in nursing practice. Centralised management, the absence of a regulatory professional body, lack of a national benchmarking database and a nursing shortage are all major challenges in advancing nursing practice. KEY ISSUE: The presence of two Magnet-designated hospitals in Saudi Arabia (not affiliated with the Ministry of Health) is an opportunity to explore how this has been achieved within the organisational and professional context. The nursing leaders in the Ministry of Health could be accountable to address the barriers in advancing nursing practice and to raise nursing awareness regarding the adoption of a new culture of excellence. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing managers in the Ministry of Health hospitals are encouraged to assess the hospitals' readiness to apply for Magnet status. Their readiness must include having a high level of nursing satisfaction and low turnover rate, which goes along with assessing cultural and organisational climates to understand the gaps in work environment and driving evidence of readiness toward achieving Magnet status. CONCLUSION: Health-care policies and regulations, both nationally and globally, can result in several challenges to achieving 'the Gold Standard' in nursing practice. These challenges may not be possible to resolve within an organisational level. Collaborative effort and transformational changes are needed to drive the nursing profession toward the best outcomes for our patients and nurses.

Staff nurse perceptions of the Magnet journey.

OBJECTIVE: The objective of this study was to compile a rich description of the phenomenon Magnet journey by registered nurses in clinical settings who provide direct patient care in community healthcare systems recently receiving Magnet designation. BACKGROUND: Evidence supports that Magnet designation leads to improved nursing, patient, and organizational outcomes. Descriptions abound regarding the organizational and cultural transformation during the time leading up to the Magnet designation, commonly referred to as the Magnet journey. There are no published reports regarding the impact of this transformational process on staff nurses. METHODS: Focus groups were conducted at recently designated Magnet hospitals; data were transcribed, reviewed, coded, and themed. The 58 subjects represented various work areas, specialties, and practice sites. RESULTS: Key themes emerged consistent with components of the Magnet model: relationships with leaders, professional accountability, staff voice, Magnet continuum, professional relationships, professional development, and resources/supports. Overall, staff nurses emphasized the positive impact of the transformation that occurred during the journey and the resultant Magnet designation on stakeholders. CONCLUSIONS: Results from this study offer guidance for Magnet project directors, chief nursing officers, managers, advanced practice nurses, and staff nurses involved in or considering the Magnet journey. "Magnet slippage" emerged as a new concept.

Clinical nurse specialist orientation: ready, set, go!

BACKGROUND: Both novice and experienced clinical nurse specialists (CNSs) need a consistent orientation to ensure that all in the role have the same knowledge base from an agreed upon set of role expectations. PURPOSE: The purpose of this article was to describe an orientation process using the 3 spheres of CNS practice as the framework for a CNS competency validation tool that can be used in all practice specialties and settings. Additionally, the roles of CNS preceptor and CNS mentor are delineated. CONCLUSIONS: The orientation tool based on the spheres of influence provides a thorough and consistent orientation for CNSs and may also be used as an educational tool for leadership and other staff regarding the CNS role.

The role of the CNS in achieving and maintaining Magnet status.

OBJECTIVE: The purpose of this study was to describe the role of clinical nurse specialists (CNSs) in achieving and maintaining Magnet designation. BACKGROUND: Anecdotal evidence indicates that CNSs are effective in helping hospitals achieve Magnet designation. However, there is no empirical evidence to support these statements. METHODS: Using an anonymous descriptive survey design, surveys were sent to chief nursing officers from Magnet facilities. Information collected included facility descriptions, presence and employment patterns of CNSs, and CNS importance in relation to the Forces of Magnetism. RESULTS: Clinical nurse specialists were employed in 87% of the facilities. Of those, 88% indicated that CNSs were important in achieving Magnet status, and 92% indicated that CNSs were important in maintaining Magnet status. The Force of Magnetism related to consultation and resources was perceived as most influenced by CNSs. CONCLUSION: Most Magnet hospitals employed CNSs. They were perceived as important in achieving and maintaining Magnet status.

Student stakeholders impact redesign for management practicum.

Healthcare educators are continually challenged to respond to societal needs as they engage in the dynamic and ongoing process of curriculum redesign. The expectations of a group of stakeholders in the process, our students, were obtained through a survey process over time and led to change in the management and leadership practicum. The authors describe the survey process and its outcomes.

Management curriculum redesign: integrating customer expectations for new leaders.

Tumultuous and dynamic changes in the healthcare environment have resulted in unprecedented stresses and challenges for both nursing education and nursing practice. It is essential that nursing education curricula reflect the rapidly changing technologies and dramatically expanding knowledge and changes in the practice environment and incorporate theory, science, professional standards, and consumer/service input. The authors describe a redesigned undergraduate management curriculum.

Leading and succeeding in outcomes management.

An effective OM program offers the best in clinical care, efficiency, and use of organizational resources and results in overall satisfaction for health care consumers, payers, and providers. Although challenges abound in today's health care environment, a strong interdisciplinary team with the appropriate resources and supports and led by a skilled outcomes manager will succeed. Such a team will also develop as other needs and opportunities exist in the future.

Decision support systems to manage outcomes.

It is essential that outcomes are evaluated and actions are taken to resolve problematic decision support issues. Many organizations are planning a transition to clinical information systems that will have data repositories and integrated databases within their systems. These transitions take years to complete, and systems must be put into place to collect data and report outcomes during the interim period. Careful and strategic planning is important so that the most effective use of existing technology and the most appropriate systems are implemented to manage outcomes. Multidisciplinary teams that use the most efficient technologic approaches will best meet the challenge to provide the most cost-effective care with the best quality outcomes.

Outcomes management. A role for everyone.

In summary, many persons have an impact on the outcomes of care and services, although some are more directly involved in day-to-day clinical care; whereas others are in support roles more removed from the clinical area. To manage outcomes effectively and ensure quality care, key stakeholders must be active participants, and an infrastructure must be in place to support the entire effort.

Patient satisfaction measurement: current issues and implications.

Healthcare consumers are demanding excellence in care and services from care providers, and payors are following in their expectations. Demonstration of quality outcomes and consumer satisfaction with services are now a priority and the primary competitive edge in healthcare. Hospitals and healthcare systems that invest in programs to determine how patients evaluate their experiences will have valuable information to make transformational changes in care delivery and services. The purpose of this article is to present an overview of consumer/patient satisfaction instruments, satisfaction measurement issues, research instruments, and commonly used vendor patient satisfaction survey programs.

Patient satisfaction measurement: current issues and implications.

Healthcare consumers are demanding excellence in care and services from care providers, and payors are following in their expectations. Demonstration of quality outcomes and consumer satisfaction with services are now a priority and the primary competitive edge in healthcare. Hospitals and healthcare systems that invest in programs to determine how patients evaluate their experiences will have valuable information to make transformational changes in care delivery and services. The purpose of this article is to present an overview of consumer/patient satisfaction instruments, satisfaction measurement issues, research instruments, and commonly used vendor patient satisfaction survey programs.