Test-Retest Reliability of the Verran Professional Governance Scale©.

Background and Purpose: Stability testing, conducted using a test-retest protocol, measures an instrument's reliability by evaluating the consistency of participant responses to survey questions with repeated testing within a short interval. No studies have measured the stability of the Verran Professional Governance Scale© (VPGS). The purpose of this study was to evaluate the test-retest reliability of the VPGS. Methods: Volunteers from a parent study using the VPGS were sent a link to a retest version of the survey 14 days after taking the initial survey with a reminder email sent 5 days after the first request. Item-level and subscale comparisons were made between participants' initial and retest responses using intraclass correlation coefficients (ICCs) applying a two-way random-effects model. Results: VPGS subscales had ICC scores of 0.71 for decision-making, 0.73 for collateral relationships, and 0.86 for professional obligation. Conclusions: Findings suggest that the VPGS demonstrates test-retest reliability. Future research should evaluate the instrument's responsiveness.

The Relationship Between Practice Environment Variables and Nurse Manager Perceptions of Workplace Mistreatment to Identify Factors Amenable to Change.

OBJECTIVE: To examine the relationships between practice environment factors and nurse manager (NM) perceptions of workplace mistreatment (WPM). BACKGROUND: NMs have a unique perspective of business operations and care delivery and can offer insight into how WPM manifests in clinical settings at the leadership level. METHODS: Researchers used a cross-sectional correlational design using a nonexperimental causal technique. A convenience sample of 139 NMs completed a survey regarding their perceptions of organizational change, the practice environment, and WPM. RESULTS: NMs reported experiencing incivility (98%) and bullying (90%). Approximately 20% variance explained mistreatment by relationships with supervisors and budgeted resources ( F4,134 = 9.16, P = 0.000). CONCLUSIONS: Modifiable factors can be identified to prevent or reduce WPM.

The Verran Professional Governance Scale: Confirmatory and Exploratory Analysis.

This article describes psychometric testing and refinement of the Verran Professional Governance Scale (VPGS), which measures behaviors associated with professional governance. Phase 1 reduced the items on the scale based on floor and ceiling effects and redundancy of items. Phase 2 examined structural construct validity using exploratory (EFA) and confirmatory factor analysis (CFA). The final 22-item instrument demonstrates satisfactory internal consistencies and fit indices and significant positive correlation between the VPGS, job satisfaction, and control over nursing practice.

Beyond Burnout and Resilience: The Disillusionment Phase of COVID-19.

In caring for patients during the COVID-19 pandemic, nurses are experiencing a crisis of emotional highs and lows that will have lasting implications for their professional and personal well-being. As a result, much attention has been focused on nurse burnout, but the range of nurses' experiences is more nuanced, complicated, and profound. With the recognition that the nursing workforce was already experiencing burnout before the pandemic, this article explores how individuals respond to disasters and the detrimental effects of the repeated surges of critically ill patients, which have led nurses to experience an extended period of disillusionment that includes secondary traumatic stress, cumulative grief, and moral distress. This article describes the range of psychological responses to the COVID-19 pandemic so that nurse leaders can better identify resources and interventions to support nurses.

Strategic Planning for a Very Different Nursing Workforce.

The COVID-19 pandemic amplified and intensified dramatic changes already emerging within the nursing workforce. This article examines and extrapolates from current trends to enable nurse leaders to prepare for the future nursing workforce and practice environment. Suggestions for strategic planning including imaging and prioritizing from a set of options for achieving a desired future state are offered. Strategic planning focusing on the wise use of nursing expertise and creating a positive professional practice environment can support the transition from the current crisis to a more resilient health care system supported by the full utilization of the knowledge and skills of registered nurses.

Stigma: A Barrier in Supporting Nurse Well-Being During the Pandemic.

Public media and the nursing literature are replete with data and anecdotal stories evidencing the overwhelming impact to nurses' well-being during the COVID-19 pandemic. Although many organizations have rallied and are providing robust services to support nurses through the pandemic, stigma (negative perceptions, attitudes, and discrimination) about mental health support is contributing to nurses' reluctance to use the many resources available to them. This article outlines strategies for reducing the stigma and eliminating the barriers associated with obtaining the mental and emotional well-being support and services that nurses need and deserve.

Transitioning to Nurse Leadership Roles in Nontraditional Settings.

The COVID-19 pandemic prompted many people, nurses included, to re-evaluate their professional and personal priorities and goals. Nurse leaders have the opportunity to draw on their portfolio of experiences, strengths, insights, and accomplishments and apply them to alternative non-hospital-based leadership roles that are less well known but in just as high demand. This article describes how nurse leaders can align their experience and expertise with their personal and career goals as they explore career opportunities in nontraditional settings.

Building Community Well-being by Leveraging the Economic Impact of Health Systems.

Local communities face systematically deepening disparities in economic, health, and well-being outcomes. Nurses are increasingly leading initiatives to positively impact the social determinants of health in local communities. This article describes how to use the enormous economic impact of hospitals and health systems as anchor institutions embedded in local communities. By leveraging the everyday business practices of hospitals and health systems, such as hiring, purchasing, and investing, nurses can help to transform the economic and consequent health well-being of socioeconomically disadvantaged individuals and neighborhoods. Hiring, purchasing, and investing in nearby neighborhoods build community wealth through both gainful employment and subsequent recirculation of money locally. Improving the economic viability of the local community positively impacts concomitant social determinants of health. Nurses, with their experience and expertise in collaboration and communication with diverse stakeholder and with their high ranking as the most trusted profession, are natural leaders to build community networks and partnerships that promote community transformation for well-being.

Professional Governance Scale: Instrument Development and Content Validity Testing.

Instrument development and content validity testing resulted in a new instrument to measure the relatively new concept of professional governance. Professional governance is defined as the accountability, professional obligation, collateral relationships and decision making of a professional, foundational to autonomous practice and achievement of exemplary empirical outcomes. Fourteen experts with subject matter expertise either in measurement development or in creating professional practice environments assessed the validity of the proposed items and the instrument. The resulting Professional Governance Scale consisted of 75 items that adequately covered all attributes and their characteristics and had a Relevancy Mean Individual Content Validity Index of 95.

Evolution of Structural Empowerment: Moving From Shared to Professional Governance.

OBJECTIVE: The aim of this study is to describe the maturation of the concept of shared governance to professional governance as a framework for structural empowerment. BACKGROUND: An analysis of the literature and concept clarification of structural empowerment and shared governance demonstrate that the concept and attributes of shared governance have evolved toward professional governance. METHODS: A comprehensive, deductive literature review and concept clarification of structural empowerment, shared governance, and related constructs was completed. RESULTS: The concept and practice of shared governance has matured to a concept of professional governance with the attributes of accountability, professional obligation, collateral relationships, and effective decision-making.

A usability evaluation exploring the design of American Nurses Association state web sites.

National leaders are calling for opportunities to facilitate the Future of Nursing. Opportunities can be encouraged through state nurses association Web sites, which are part of the American Nurses Association, that are well designed, with appropriate content, and in a language professional nurses understand. The American Nurses Association and constituent state nurses associations provide information about nursing practice, ethics, credentialing, and health on Web sites. We conducted usability evaluations to determine compliance with heuristic and ethical principles for Web site design. We purposefully sampled 27 nursing association Web sites and used 68 heuristic and ethical criteria to perform systematic usability assessments of nurse association Web sites. Web site analysis included seven double experts who were all RNs trained in usability analysis. The extent to which heuristic and ethical criteria were met ranged widely from one state that met 0% of the criteria for "help and documentation" to states that met greater than 92% of criteria for "visibility of system status" and "aesthetic and minimalist design." Suggested improvements are simple yet make an impact on a first-time visitor's impression of the Web site. For example, adding internal navigation and tracking features and providing more details about the application process through help and frequently asked question documentation would facilitate better use. Improved usability will improve effectiveness, efficiency, and consumer satisfaction with these Web sites.

The Influence of Quality Improvement Efforts on Patient Outcomes And Nursing Work: A Perspective from Chief Nursing Officers at Three Large Health Systems.

Quality and performance improvement initiatives are driving significant changes in the United States healthcare system. In anticipation of the full implementation of national health reform over the next several years, the pace of these changes has been increasing. The goals of these quality initiatives mirror the National Quality Strategy's three aims which developed out of the Institute for Healthcare Improvement's triple aim of improving the patient care experience, improving the population's health, and reducing healthcare costs. Projects are underway across the United States to achieve these aims. In this article, Chief Nursing Officers of three of the nation's largest healthcare systems, the Department of Veterans Affairs, Kaiser Permanente, and Ascension Health, have outlined their organizations' quality and performance improvement initiatives. Their forward-thinking projects broadly address several aspects of healthcare, including reduction of hospital-acquired conditions, patient engagement, and the integration of mobile technologies and other informatics solutions to improve clinical workflows and increase registered nurses' access to knowledge resources. The article then offers a brief analysis and conclusion of these three exemplars. The projects span the information systems life cycle: some are well established and continuing to improve, others have been recently implemented, and still others planned for implementation in the near future.

Exploring influential nurse executive leadership: an interview with Marla Weston.

This department highlights nursing leaders who have demonstrated the ability to inspire and lead change. This competency is seen in the ability to create, structure, and implement organizational, local, national, and international change through strategic visioning, risk taking, and effective communication. This, the fourth in a series of interviews, profiles the experiences of ANA Chief Executive Officer Marla Weston, PhD, RN.

Managing and facilitating innovation and nurse satisfaction.

Behaviors and actions that foster innovation are complementary to those associated with managing and facilitating nurse satisfaction. These include creating an organizational climate that encourages the generation, sharing, and implementation of new ideas; managing with the skills to hire and retain competent and creative individuals; and establishing the infrastructure and processes to recognize and embed best and promising practices into the organization. The ability to innovate and to manage and facilitate nurse satisfaction is a necessary competency for organizational success.

Validity of instruments for measuring autonomy and control over nursing practice.

PURPOSE: To review the psychometric properties and evaluate the estimates of validity of commonly used instruments to measure autonomy and control over nursing practice. DESIGN: Literature review and evaluation of psychometric properties. METHODS: Nursing research reports published in English in peer-reviewed journals between 1990 and 2007 were examined. Psychometric properties and the actual instrument were reviewed to determine validity for measuring autonomy and control over nursing practice. FINDINGS AND CONCLUSIONS: Instruments used to measure autonomy and control over nursing practice are frequently imprecise or inaccurate for measuring the concept of interest. Valid instruments are available to allow measurement of the concepts of clinical autonomy, work autonomy, and control over nursing practice. Clear definitions and valid measures are helpful when communicating and synthesizing nursing knowledge concerning these concepts. CLINICAL RELEVANCE: Evaluating the validity of instruments for measuring clinical autonomy, work autonomy, and control over nursing practice can be helpful when organizing and synthesizing the literature related to these concepts, so that strategies to improve professional practice environments becomes more clear.

Health care leadership academy: a statewide collaboration to enhance nursing leadership competencies.

Competency in leadership skills is necessary to manage in the current chaotic health care environment and proactively participate in the creation of a better environment. Although interest in pursuing a career in health care is growing, lack of leadership competence contributes to employee frustration and dissatisfaction, which directly and indirectly impacts the supply of health care workers. To addressthe lack of leadership competence and its disturbing consequences, the Arizona nursing community designed a model for nursing leadership and created a partnership to provide a high-quality, affordable leadership education program focused on enhancing the leadership competencies of frontline nursing supervisors.

Defining control over nursing practice and autonomy.

Control over nursing practice and autonomy describe how nurses influence decisions about their practice. Both have been associated with professional practice environments that result in nurse satisfaction and quality patient outcomes. The terms are often commingled and confused, which limits their applicability in practice and research. The author clarifies the concepts of control over nursing practice and autonomy as they relate to decision making in nursing, which provides a foundation for their application in practice and research.

Reaping benefits from intellectual capital.

The wealth and value of organizations are increasingly based on intellectual capital. Although acquiring talented individuals and investing in employee learning adds value to the organization, reaping the benefits of intellectual capital involves translating the wisdom of employees into reusable and sustained actions. This requires a culture that creates employee commitment, encourages learning, fosters sharing, and involves employees in decision making. An infrastructure to recognize and embed promising and best practices through social networks, evidence-based practice, customization of innovations, and use of information technology results in increased productivity, stronger financial performance, better patient outcomes, and greater employee and customer satisfaction.