Beyond Magnet® Designation: Perspectives From Nurse Managers on Factors of Sustainability and High-Performance Programming.

OBJECTIVE: The aim of this study was to identify patterns of high-performing behaviors and nurse manager perceptions of the factors of Magnet® sustainability at a multidesignated Magnet organization. BACKGROUND: The Magnet program recognizes exemplary professional nursing practice and is challenging to achieve and sustain. Only 10% (n = 42) of Magnet hospitals sustained designation for 12 years or longer. This study explored the perspectives of Magnet nurse managers regarding high-performing teams and the sustainability of Magnet designation. METHODS: A qualitative study of nurse managers was conducted at 1 multidesignated Magnet organization (n = 13). Interview responses were analyzed using pattern recognition of Magnet model domains and characteristics of high-performing teams and then related to factors of Magnet sustainability. RESULTS: Transformational leadership is both an essential factor for sustainability and a potential barrier to sustainability of Magnet designation. CONCLUSIONS: Transformational nursing leaders lead high-performing teams and should be in place at all levels as an essential factor in sustaining Magnet redesignation.

Letter-Sound Reading: Teaching Preschool Children Print-to-Sound Processing.

This intervention study investigated the growth of letter sound reading and growth of consonant-vowel-consonant (CVC) word decoding abilities for a representative sample of 41 US children in preschool settings. Specifically, the study evaluated the effectiveness of a 3-step letter-sound teaching intervention in teaching pre-school children to decode, or read, single letters. The study compared a control group, which received the preschool's standard letter-sound instruction, to an intervention group which received a 3-step letter-sound instruction intervention. The children's growth in letter-sound reading and CVC word decoding abilities were assessed at baseline and 2, 4, 6 and 8 weeks. When compared to the control group, the growth of letter-sound reading ability was slightly higher for the intervention group. The rate of increase in letter-sound reading was significantly faster for the intervention group. In both groups, too few children learned to decode any CVC words to allow for analysis. Results of this study support the use of the intervention strategy in preschools for teaching children print-to-sound processing.

Impact of Magnet Culture in Maintaining Quality Outcomes During Periods of Organizational Transition.

Organizational transition presents substantial risk to maintaining quality outcomes. The leadership style and culture present during periods of change and transition empower the frontline staff to react quickly and identify opportunities. The culture of Magnet develops the skill set that enables staff to be leaders in problem solving and identifying creative care delivery approaches. Objectives of this study were to analyze the impact of organizational transition on patient and staff satisfaction, quality, and safety in a Magnet-designated hospital and determine key factors contributing to these outcomes.

The developmental levels in achieving Magnet® designation, part 2.

Magnet® designation has been shown to be a cost-effective strategy resulting in improved patient, staff, and organizational outcomes. Achieving this designation requires an organization to successfully progress through developmental levels on their journey. Part 1 of this article described a 4-level developmental model applied to each of the Magnet components. In part 2, we will discuss a 5-step process and leadership strategies for developing units or departments through the various levels.

The developmental levels in achieving Magnet® designation, part 1.

Magnet® designation has been shown to be a cost-effective strategy resulting in improved patient, staff, and organizational outcomes. Achieving this designation requires an organization to successfully progress through developmental levels on their journey to excellence. Part 1 of this article describes a 4-level developmental model that is applied to each of the Magnet components. Part 2 will discuss a 5-step developmental process and leadership strategies for developing a unit or department through the various levels.

Identification of potential barriers to nurse-sensitive outcome demonstration.

OBJECTIVE: The objective of this study was to determine differences in chief nursing officer, Magnet(®) program director, nurse leader, and direct care RN perspectives of potential barriers to demonstration of nurse-sensitive outcomes. BACKGROUND: The Magnet Recognition Program(®) and other designations are focusing on patient outcomes. No evidence is available addressing barriers to demonstration of nursing outcomes at multiple levels of practice. METHODS: A Likert scale tool was developed and administered to 526 attendees at the 2012 national Magnet conference. Questions related to available resources, benchmarks, outcome demonstration process understanding, perception of value, and competing priorities. RESULTS: Significant perception differences by role were demonstrated related to available resources, competing priorities, and process understanding supporting demonstration of nurse-sensitive outcomes. No significant differences were identified related to benchmarks or perception of process value to the organization. CONCLUSION: This study provides new information demonstrating potential barriers to demonstration of nurse-sensitive outcomes differing by role. Opportunity exists to develop systems and processes to reduce perceived barriers among the nursing workforce.

The influence of goal setting and SmartRoom patient education videos on readmission rate, length of stay, and patient satisfaction in the orthopedic spine population.

The SmartRoom technology, a system now owned by TeleTracking Technologies, aims to transform the delivery of patient care in the inpatient environment. The purpose of this project was to use goal setting and SmartRoom patient education videos to examine whether the videos more effectively engaged patients and their families in their discharge plan and encouraged them to take a more active role in their care while hospitalized. This study used a descriptive design to analyze the effect of goal setting and patient education videos on patient satisfaction at discharge, hospital average length of stay, and 30-day readmission rate in the orthopedic spine surgical care setting. Comparisons were made among three patient groups. No statistically significant difference was found for average length of stay and 30-day readmission across these three groups. However, patient satisfaction with discharge, as measured by the Hospital Consumer Assessment of Health Providers and Systems, revealed an increase in five items regarding discharge with statistically significant differences on two of the five items.

How magnetic are Finnish hospitals measured by transformational leadership and empirical quality outcomes?

AIM: The overall aim of this study was to examine nurses' and patients' perceptions of the Magnet model components of transformational leadership and empirical quality outcomes in four Finnish hospitals and to determine if the evidence for transformational leadership and empirical quality outcomes is the same or different in the four hospitals. BACKGROUND: This report presents baseline measurements for a longitudinal study of the adaptation of the Magnet model in Finnish hospitals. METHODS: Web-based surveys and mailed questionnaires were used in 2008-2009 to collect data from patients (n = 2566) about their satisfaction with care, and from nursing staff about transformational leadership (n = 1151), job satisfaction (n = 2707) and patient safety culture (n = 925) in the selected hospitals. RESULTS: Awareness of the work of nursing leaders was low. Nurses reported a high level of job satisfaction. Patient safety culture varied considerably between the four hospitals. Patients believed they generally received excellent quality care. CONCLUSIONS: Leadership systems are in transition at the hospitals. Patient safety culture is a complex phenomenon that may be unfamiliar to respondents. The results of the study provide a baseline description to guide the journey toward development of Magnet standards. IMPLICATIONS FOR NURSING MANAGEMENT: Finnish nursing leaders, especially nursing directors, should increase their visibility by working more closely with their staff. They should also pay attention to giving direct feedback about work generally and patient safety issues in particular.

Utilizing complexity science to drive practice change through patient- and family-centered care.

Complexity science applied through a 6-step patient- and family-centered care methodology provides a practical framework for achieving meaningful change in organizations. This approach was used to improve the preoperative preparation experience of patients undergoing total joint arthroplasty in an orthopedic specialty hospital.

Study of nurse workarounds in a hospital using bar code medication administration system.

This study analyzed registered nurse workarounds in an academic medical center using bar code medication administration technology. Nurse focus groups and a survey were used to determine the frequency and potential causes of workarounds. More than half of the nurses surveyed indicated that they administered medications without scanning the patient or medications during the last shift worked. Benefits of this study include considerations when implementing bar code medication administration technology that may minimize the development of these workarounds in practice.

A relational leadership perspective on unit-level safety climate.

OBJECTIVE: This study compared nursing staff perceptions of safety climate in clinical units characterized by high and low ratings of leader-member exchange (LMX) and explored characteristics that might account for differences. BACKGROUND: Frontline nursing leaders' actions are critical to ensure patient safety. Specific leadership behaviors to achieve this goal are underexamined. The LMX perspective has shown promise in nonhealthcare settings as a means to explain safety climate perceptions. METHODS: Cross-sectional survey of staff (n = 711) and unit directors from 34 inpatient units in an academic medical center was conducted. RESULTS: Significant differences were found between high and low LMX scoring units on supervisor safety expectations, organizational learning-continuous improvement, total communication, feedback and communication about errors, and nonpunitive response to errors. CONCLUSION: The LMX perspective can be used to identify differences in perceptions of safety climate among nursing staff. Future studies are needed to identify strategies to improve staff safety attitudes and behaviors.

Nurse manager leadership development: leveraging the evidence and system-level support.

The complexities of healthcare demand new leadership approaches to achieve organizational goals while developing and sustaining healthy work environments. The nurse manager is the defining role, crucial to achievement of workplace outcomes. Preparing nurses for this dynamic, complex role is often dependent on didactic education or on-the-job training that falls short of true leadership development. The authors describe an innovative approach to the development of successful nursing leaders across an integrated healthcare system.

A curriculum designed to decrease barriers related to scholarly writing by staff nurses.

Demonstrating professional development outcomes, such as scholarly publication, is critical as nurse leaders guide organizations seeking recognition as centers of excellence. However, personal and situational barriers often prevent staff nurses from achieving scholarly publication. This project tested a workshop and mentoring approach to decrease publication barriers with staff nurses in 2 community hospitals. Self-efficacy principles guided the curriculum that resulted in a statistically significant improvement in staff nurse perception of successful scholarly publication endeavors.

Magnet recognition program: the next generation.

Twenty-five years ago, the foundation of the Magnet Recognition Program was established. Magnet designation has served as the hallmark of excellence for nursing practice, and research has demonstrated a profound impact on nursing practice and patient care. The purpose of this article was to forecast the direction of the Magnet Recognition Program. The authors discussed the results of a multivariate structural analysis of the forces of magnet and the subsequent future model for Magnet.

Blueprint for design: creating models that direct change.

The need for healthcare system change is overwhelming: broken systems, an inadequate workforce, patient safety failures, and lack of access to healthcare are but a few of the significant problems confronting healthcare today. Most people agree that things need to change, but they are not sure on what to change or how to change them. A well-developed model can serve as the currency for that change. By considering the evidence of what has worked well in the past and marrying that with what the future will require, we can create a strong sustainable model for professional practice. The authors explore that evidence and discuss the structure, process, and outcomes that should be considered in designing care delivery models for the future.

Failure to rescue: a literature review.

Rapid response teams have been advocated as an intervention to reduce failure to rescue events. Such teams can improve nurse autonomy and control to rescue patients deteriorating in a medical surgical setting. The purpose of this review is to enhance nurse executives' understanding of failure to rescue as a nurse sensitive outcome, tested interventions, and implications for future research. The emergence of failure to rescue as an outcome measure will be initially discussed. Research regarding the relationship between failure to rescue and registered nurse staffing as well as research examining the potential to reduce failure-to-rescue events will be explored.