Business acumen for nursing leaders: An exploratory qualitative study.

AIM: The aim of this study was to explore the status of and need for business acumen of nurse leaders. BACKGROUND: Health systems globally continue to reform to deliver better care while working within sustainable budgets. However, beyond leadership and management expertise, nurse leaders need strong business acumen to appreciate the complexity of the system. METHOD: Two groups, emerging nurse leaders and established health system leaders, were interviewed for their perspective on four elements related to business acumen. RESULTS: Business in healthcare was defined and therefore valued with variation across both groups. Adequate business education for nurse leaders was considered lacking by both groups. Inconsistent business acumen was seen as a barrier for nursing inclusion at the system level. CONCLUSIONS: Business acumen is a skillset more valuable for the nursing profession than the current educational preparation allows, creating a reputational barrier for nursing's full participation in health system-level leadership, but is considered an opportunity for the future. IMPLICATIONS FOR NURSING MANAGEMENT: Improving the foundation business acumen across the nursing profession will not only raise the profile of nurse leader capability to input and influence across the health system but also improve the wider nursing team's understanding around nurse leader advocacy and decision making.

Business acumen for nursing leaders: A scoping review.

AIM: The aim of this study is to explore the current evidence on business acumen of nurse leaders. BACKGROUND: Health systems across the world are under immense pressure to stay solvent, maintaining services within a defined budget as we recover from the COVID-19 pandemic. Effective nurse leaders not only need to have strong leadership and management skills but also strong business acumen to navigate the complexity of the system. EVALUATION: A scoping review of research was undertaken, using preferred reporting items for systematic reviews and meta-analyses (PRISMA) scoping extension checklist, with 571 studies found across multiple databases, 17 meeting final review eligibility. KEY ISSUES: Findings were noted surrounding three themes: the value of business acumen in nursing, the gaining of business acumen in health care as a nursing leader and the utilizing business acumen as a nurse leader in the health care industry. CONCLUSION: While nursing leadership and management were well researched, limited studies covered the specific focus of business acumen in health care for nurses or broader clinicians. IMPLICATIONS FOR NURSING MANAGEMENT: While evidence points towards business acumen being important for health care leaders in balancing care and cost, inadequate research limits the recognition of these professional capabilities of nurse leaders. Further understanding could inform future policy and curriculum, as well as empower our next generation of clinicians.

Business acumen for nursing leaders, optional or essential in today's health system? A discussion paper.

Background: Over the last number of years, the healthcare system has become more complex in managing increasing costs and outcomes within a defined budget. To be effective through reform, especially moving forward from the COVID-19 pandemic, healthcare leaders, specifically in nursing, have an increased need for business acumen beyond traditional leadership and management principles. Aim: This paper examines the concept of business acumen in the profession of nursing, specifically for managers and higher nurse leaders, establishing whether these skills are optional or essential. Discussion: Nurses learn and develop broad skills in leadership and management, but less specifically about business or the broader system. With a contemporary Australian health system aiming to be more effective, nurses may require a greater level of business acumen to adequately understand the mechanics of business decision making in the system when designing care models, as well as representing the business potential of nursing in balance with clinical outcomes through reform. Conclusion: The modern nurse, in addition to clinical skills, may need a foundational understanding of business evolving throughout their career, to maximise innovative growth across the system, in meeting the healthcare needs of our community now and into the future. Without a foundation level of business acumen and an understanding of the system across the profession, nurses may not be empowered with their full potential of being a strong voice influencing health system reform.

A case study - Implementing a registered nurse professional recognition program across a Queensland hospital and health service.

Ongoing advancement and documentation of professional development is required to maintain nursing registration and competency to practise in Australia and many other countries. All Australian registered nurses are required to undertake a minimum of 20 h of continuing professional development annually and demonstrate competence to practice; this is a criterion for nursing registration. Many health care organisations nationally and internationally develop programs to support such processes, assisting nurses to formally document their ongoing education and commitment to best practice, and clearly demonstrate their ongoing continuing professional development. Such programs align with the MAGNET ® principles of providing structural empowerment, exemplary professional practice and new knowledge, innovations and improvements. This study describes the implementation, evaluation and impact of the registered nurse professional recognition program undertaken by one Hospital and Health Service in South East Queensland using Donabedian's structure, process outcome framework. The registered nurse professional recognition program was implemented to invest in and develop the nursing workforce by providing an opportunity for registered nurses to assess and document their professional skills, knowledge and expertise that are critical to the provision of safe and cost-effective patient and family-centred care.

The evaluation of nurse navigators in chronic and complex care.

AIM: With increasing age and chronicity in populations, the need to reduce the costs of care while enhancing quality and hospital avoidance, is important. Nurse-led co-ordination is one such model of care that supports this approach. The aim of this research was to assess the impact that newly appointed Navigators have on service provision; social and economic impact; nurses' professional quality of life and compassion fatigue; and analysis of the change that has occurred to models of care and service delivery. DESIGN: A concurrent mixed-method approach was selected to address the research aims. METHODS: The research project was funded in July 2018 and will conclude in December 2020. Several cohorts will be studied including; patients assigned to a navigator, patients not assigned to a navigator, family members of patients assigned a navigator; and a sample sized estimated at 140 navigators. DISCUSSION: This study provides a comprehensive international longitudinal and mixed method framework for evaluating the impact of nurse navigators on quality of care outcomes for patients with chronic conditions. IMPACT-WHAT PROBLEM WILL THE STUDY ADDRESS?: Even with specialty focused co-ordinated care, patients get lost in the system, increasing the incidence of non-compliance and exacerbation of condition. Navigators work with patients across service boundaries allowing for care that is patient responsive, and permitting variables in clinical, social and practical elements of care to be addressed in a timely manner. This novel nurse-led approach, supports hospital avoidance and patient self-management, while encouraging expansion and opportunity for the nursing and midwifery workforce.

Impact of MAGNET hospital designation on nursing culture: an integrative review.

BACKGROUND: Organisational culture is a critical part of a positive and productive working environment and often presents as an area of ongoing development. The MAGNET recognition program awards recognition to organisations that have positive organisational cultures that meet the standards and criteria. However, the broad impact of MAGNET on hospital culture outside of America remains unclear. OBJECTIVE: In this study, we explore the impact of MAGNET designation on organisational culture within the nursing context. METHODS: An integrative literature review was performed using a systematic search of Medline (Ovid), Embase (Elsevier) and the Cumulative Index to Nursing and Allied Health Literature (CINAHL Ebsco) databases and a combination of subject headings and key words for organizational culture, organizational change and MAGNET hospital, as well as reference chaining was conducted. Using a constant comparative process key categories, themes and subthemes emerged. RESULTS: Twenty-nine key studies were identified and were evaluated utilising two study quality appraisal tools; National Health and Medical Research Council (NH&MRC) levels of evidence and the Polit and Beck critical appraisal tool. Three key categories emerged from the data: (1) nurse practice environment; (2) structure and process models; (3) measurement scales. A key finding was that MAGNET designation appears to enhance organisational culture for nurses and the framework used to introduce MAGNET helps to empower nurses to direct organisational culture in their facility. Conclusion and Implications for Nursing and Health Policy: MAGNET appears to have a positive impact on organisational culture, particularly for nurses. However, lack of standardised evaluation tools used to assess organisational culture associated with MAGNET designation limits comparability of the studies. Generally, the quality of evidence used to develop recommendations was poor to very poor. More, well designed studies undertaken outside of the USA are required. Impact Statement: An in-depth integrative review exploring the impact of MAGNET designation on organisational culture has not been undertaken. In this paper, we have used an integrative review methodology to identify, examine, thematically group and critically evaluate published literature around the impact of MAGNET designation on organisational culture within designated hospitals.

Decision-making under pressure: medical errors in uncertain and dynamic environments.

Objective This paper provides a narrative overview of the literature concerning clinical decision-making processes when staff come under pressure, particularly in uncertain, dynamic and emergency situations. Methods Studies between 1980 and 2015 were analysed using a six-phase thematic analysis framework to achieve an in-depth understanding of the complex origins of medical errors that occur when people and systems are under pressure and how work pressure affects clinical performance and patient outcomes. Literature searches were conducted using a Summons Search Service platform; search criteria included a variety of methodologies, resulting in the identification of 95 papers relevant to the present review. Results Six themes emerged in the present narrative review using thematic analysis: organisational systems, workload, time pressure, teamwork, individual human factors and case complexity. This analysis highlights that clinical outcomes in emergency situations are the result of a variety of interconnecting factors. These factors may affect the ability of clinical staff in emergency situations to provide quality, safe care in a timely manner. Conclusions The challenge for researchers is to build the body of knowledge concerning the safe management of patients, particularly where clinicians are working under pressure. This understanding is important for developing pathways that optimise clinical decision making in uncertain and dynamic environments. What is known about the topic? Emergency departments (EDs) are characterised by high complexity, high throughput and greater uncertainty compared with routine hospital wards or out-patient situations, and the ED is therefore prone to unpredictable workflows and non-replicable conditions when presented with unique and complex cases. What does this paper add? Clinical decision making can be affected by pressures with complex origins, including organisational systems, workload, time constraints, teamwork, human factors and case complexity. Interactions between these factors at different levels of the decision-making process can increase the complexity of problems and the resulting decisions to be made. What are the implications for practitioners? The findings of the present study provide further evidence that consideration of medical errors should be seen primarily from a 'whole-of-system' perspective rather than as being primarily the responsibility of individuals. Although there are strategies in place in healthcare organisations to eliminate errors, they still occur. In order to achieve a better understanding of medical errors in clinical practice in times of uncertainty, it is necessary to identify how diverse pressures can affect clinical decisions, and how these interact to influence clinical outcomes.

Secondhand Smoke Exposure and Smoke-free Policy in Philadelphia Public Housing.

OBJECTIVES: Multi-unit housing environments remain significant sources of secondhand smoke (SHS) exposure, especially for vulnerable populations in subsidized housing. In Philadelphia, the largest US housing authority to implement smoke-free policies, we measured baseline resident smoking-related behaviors and attitudes, and longitudinal exposures to airborne nicotine, during policy development and implementation. METHODS: In 4 communities, we collected data in 2013, 2014, and 2016, before and after introduction of comprehensive smoke-free policies, interviewing persons in 172 households, and monitoring air-borne nicotine in non-smoking homes and public areas. Average nicotine level differences across years were estimated with multi-level models. RESULTS: Fifty-six percent of respondents smoked. Only 37% of households were smoke-free, with another 41% restricting smoking by area or time of day. The number of locations with detectable nicotine did not differ before and after policy implementation, with approximately 20% of non-smoking homes and 70%-80% of public areas having detectable nicotine. However, public area nicotine levels were lower in 2016, after policy implementation, than in 2013 and 2014 (-0.19 µg/m3, p = .03). CONCLUSIONS: Findings suggest that initial policy implementation was associated with reduced SHS exposure in Philadelphia. As HUD strengthens smoke-free policies, SHS monitoring can be useful to educate stakeholders and build support for policy enforcement.

The journey of discovering compassionate listening.

This article presents the concept of "compassionate listening" in critical life moments to gain insight into the process of listening with compassion. This insight evolved through a process of layered reflection using a series of texts, particularly stories that captured critical moments in working with people who were facing crisis situations or who were dying. Writing and reflecting on these stories enabled me to identify how I engaged with patients and their loved ones as a palliative care nurse specialist. I was able to explore how compassionate listening could be used to ascertain their needs, particularly when they were unable or unsure of how to proceed.

Transformational leadership and shared governance: an action study.

AIMS: The present study demonstrates the practical relevance of the concepts of transformational leadership as a Director of Nursing working with structure (shared governance) and active processes, informed by action research, to achieve the incremental breakthroughs associated with culture change in nursing. BACKGROUND: Responding to the context of a decade of health reforms in a New Zealand tertiary hospital, the leadership challenge, as a Director of Nursing, was to find ways of transforming the nursing workforce. How could nursing evolve from a relatively disempowered position within the organization (impact of the reforms) and reshape to achieve effectiveness within the new organizational culture? METHODS: Interwoven with transformational leadership are action processes progressively moving forward through cycles of reconnaissance, planning, implementation and evaluation. The principles of shared governance 'partnership', 'equity', 'accountability' and 'ownership' underpin and work synchronically with the active processes in advancing the effectiveness of nursing. It is leadership for and in action. This study is descriptive and exploratory overall, and more specifically it uses reflective practice and self-reporting as methods. RESULTS: The outcomes of transformational leadership are evident in a confident, competent and committed nursing workforce which embraces continuous learning and expresses a professional respect for each other. CONCLUSIONS: The practical inter-weaving of the concepts of transformational leadership, shared governance and action processes provide a framework for sustainable change processes both at a unit and organizational level. IMPLICATIONS FOR NURSING MANAGEMENT: It is the interplay between the three concepts that generates a process of creative innovation, questioning and challenging existing structures to try and reach a new level of excellence through the participation and valuing of nurses and nursing practice.