Influence of hospital Accreditation on professional satisfaction of the nursing team: mixed method study / Influência da Acreditação hospitalar na satisfação profissional da equipe de enfermagem: estudo de método misto / Influencia de la Acreditación hospitalaria en la satisfacción profesional del equipo de enfermería: estudio de método mixto

ABSTRACT Objective: to analyze the influence of Accreditation on the professional satisfaction of nursing workers. Method: multicentric, cross-sectional research, outlined by the sequential explanatory mixed method. In the first preponderant, quantitative step, the validated Brazilian version of the Index of Work Satisfaction was applied to a sample (n = 226) representative of nursing professionals from three hospitals. One hospital was private and certified by Accreditation; another hospital was private and non-certified; and another was public and non-certified. By connection, the second step (qualitative) complemented the quantitative analysis. In this step, interviews (n = 39) were carried out and summarized through the method of Discourse of the Collective Subject. Descriptive and inferential statistical analyses were applied to the quantitative data connected to the qualitative support, as well as a joint presentation of part of the information in a joint display. Results: workers of the certified hospital had a better overall job satisfaction score. There were more statistical associations among workers in private hospitals. The comparison of the three groups investigated in the two steps of the mixed study confirmed Accreditation as a positive factor for professional satisfaction. The public hospital excelled in relation to the certified hospital in terms of salary, job requirements and interaction. Conclusion: Accreditation positively influenced the professional satisfaction of the nursing teams investigated.

RESUMO Objetivo: analisar a influência da Acreditação na satisfação profissional de trabalhadores de enfermagem. Método: pesquisa multicêntrica, transversal, delineada pelo método misto explanatório sequencial. Na primeira etapa preponderante, quantitativa, aplicou-se a versão brasileira validada do Index of Work Satisfaction a uma amostra (n=226) representativa de profissionais de enfermagem de três hospitais. Destes, um era privado e certificado pela Acreditação, e os demais, não certificados, sendo um público e outro privado. Por conexão, a segunda etapa (qualitativa) complementou a fase quantitativa por meio de entrevistas (n=39) que foram sumarizadas pelo Discurso do Sujeito Coletivo. Fez-se análise estatística descritiva e inferencial dos dados quantitativos conectados aos qualitativos de suporte, além de apresentação conjunta de parte das informações em joint display. Resultados: os trabalhadores do hospital certificado apresentaram melhor escore geral de satisfação profissional. Houve mais associações estatísticas entre os trabalhadores dos hospitais privados. A comparação dos três grupos investigados, nas duas fases do estudo misto, ratificou a Acreditação como fator positivo para a satisfação profissional. O hospital público sobressaiu-se em relação ao hospital certificado nas dimensões remuneração, requisitos do trabalho e interação. Conclusão: a Acreditação influenciou positivamente a satisfação profissional das equipes de enfermagem investigadas.

RESUMEN Objetivo: analizar la influencia de la Acreditación en la satisfacción profesional de trabajadores de enfermería. Método: investigación multicéntrica, transversal, delineada por el método mixto explicativo secuencial. En la primera etapa preponderante, cuantitativa, se aplicó la versión brasileña validada del Index of Work Satisfaction a una muestra (n=226) representativa de profesionales de enfermería de tres hospitales. De ellos, uno era privado y certificado por la Acreditación, y los demás eran no certificados, siendo un público y otro privado. Por conexión, la segunda etapa (cualitativa) complementó la fase cuantitativa por medio de entrevistas (n=39) que fueron resumidas por el Discurso del Sujeto Colectivo. Se hizo análisis estadístico descriptivo e inferencial de los datos cuantitativos conectados a los cualitativos de soporte, además de presentación conjunta de parte de las informaciones en joint display. Resultados: los trabajadores del hospital certificado presentaron mejor puntaje general de satisfacción profesional. Hubo más asociaciones estadísticas entre los trabajadores de los hospitales privados. La comparación de los tres grupos investigados, en las dos fases del estudio mixto, ratificó la Acreditación como factor positivo para la satisfacción profesional. El hospital público sobresalió en relación al hospital certificado en las dimensiones remuneración, requisitos del trabajo e interacción. Conclusión: la Acreditación influenció positivamente la satisfacción profesional de los equipos de enfermería investigados.

Nurse turnover in the Kingdom of Saudi Arabia: An integrative review.

AIM: To appraise and synthesise existing literature on nurse turnover in the Saudi Arabian context. BACKGROUND: Saudi Arabia is notably one of the nations with a health care system that is bombarded by high rates of turnover and turnover intention. Moreover, rapid population growth and the expansion of the health care system increase the demand on registered nurses in the kingdom. EVALUATION: Eleven primary sources were reviewed using Whittemore and Knafl's (Journal of Advanced Nursing, 2005; 52, 546-553) integrative review method. KEY ISSUES: There is variation in the reported turnover rates across the studies. The identified determinants of nurse turnover in the Saudi Arabian context included nurses' demographics, satisfaction, leadership and management, and job-related factors. CONCLUSION: There is a need for more studies that focus on the cost and outcome of nurse turnover and turnover intention in the Saudi Arabian context. IMPLICATIONS FOR NURSING MANAGEMENT: The review highlights the alarming rates of nurse turnover and its determinants in Saudi Arabia. Nurse managers in Saudi Arabia should consider this information, as they make daily assignments.

Nursing Administration Research Priorities: Findings From a Delphi Study.

OBJECTIVE: The aim of this study is to determine the priorities for nursing administration research (NAR) in the United States. BACKGROUND: Previously known as the Council of Graduate Educators in Administrative Nursing, CGEAN provides an avenue for researchers and educators focused on NAR to partner, dialogue, obtain funding resources, and present their findings at a biennial International Nursing Administration Research Conference (INARC). In late 2013, with a goal of building consensus, CGEAN convened an INARC postconference to initiate the process of establishing critical NAR priorities for the future. METHODS: Data from a 3-staged Delphi study were used to identify relevant research topics and determine administrative research priorities. RESULTS: Eight final categories of NAR were determined. CONCLUSIONS: This study found economic valuing of nursing and designing effective future healthcare delivery systems to be high priorities for NAR.

A theory-based approach to nursing shared governance.

BACKGROUND: The discipline of nursing uses a general definition of shared governance. The discipline's lack of a specified theory with precepts and propositions contributes to persistent barriers in progress toward building evidence-based knowledge through systematic study. PURPOSE: The purposes of this article were to describe the development and elements of a program theory approach for nursing shared governance implementation and to recommend further testing. METHOD: Five studies using multiple methods are described using a structured framework. The studies led to the use of Lipsey's method of theory development for program implementation to develop a theory for shared governance for nursing. DISCUSSION: Nine competencies were verified to define nursing practice council effectiveness. Other findings reveal that nurse empowerment results from alignment between the competencies of self- directed work teams and the competencies of organizational leaders. Implementation of GEMS theory based nursing shared governance can advance goals at the individual, unit, department, and organization level. CONCLUSION: Advancing professional nursing practice requires that nursing concepts are systematically studied and then formalized for implementation. This article describes the development of a theoretical foundation for the systematic study and implementation of nursing shared governance.

Starting a national conversation: the Institute of Medicine workshop on the future directions of credentialing research in nursing.

In this month's column, the director of research for the American Nurses Credentialing Center discusses outcomes of the Institute of Medicine Workshop on Credentialing Research in Nursing.

Nursing administration research: an evolving science.

The nature and focus of nursing administrative research have evolved over time. Recently, the research agenda has primarily reflected the national health policy agenda. Although nursing research has traditionally been dominated by clinical interests, nursing administrative research has historically addressed the interface of reimbursement, quality, and care delivery systems. This article traces the evolution of nursing administrative research to answer questions relevant to scope, practice, and policy and suggests future directions.

Leading change to create a healthy and satisfying work environment.

Nurse executives must take a leadership role in creating a healthy work environment for nurses and all disciplines. Engaging in partnerships and empowering clinical nurses to construct the solutions to barriers that may stand in the way of the goal of a satisfied and healthy workforce are important strategies toward success. This publication outlines many projects a 3-time Magnet-designated academic hospital has implemented, working with our shared leadership councils, to meet the standards for a healthy work environment. These initiatives, from the unit to the hospital level, included standardizing a culture change of uninterrupted meal breaks, the creation of intensive care unit Zen rooms, strategies to better manage increased patient volumes, best practices for facility design, enhancing physician-nurse relations, and a hospital wellness program. Data were benchmarked against national nurse and employee surveys to compare progress and report outcomes. Two important nursing organization structures that have contributed to the success of a healthy and satisfied nursing work environment include UEXCEL, a longstanding clinical nurse professional practice program, and the hospital's 11-year participation in the University HealthSystem Consortium/American Association of Colleges of Nursing National Post-Baccalaureate Nurse Residency Program. A highly engaged, well-educated, and committed nursing workforce, nurtured by a strong leadership team, has created a positive work environment characterized by low turnover and high retention.

The Research to Action Project: Applied Workplace Solutions for Nurses.

The number of new nurses entering the profession has increased, but the need to retain nurses in the profession continues to be a critical priority. The consequences of the nursing shortage are reflected in continued high levels of overtime, absenteeism and turnover. The Canadian Federation of Nurses Unions (CFNU), in partnership with the Canadian Nurses Association, the Canadian Healthcare Association and the Dietitians of Canada, initiated the project Research to Action: Applied Workplace Solutions for Nurses (RTA). The RTA initiative comprised research-based pilot projects, implemented in 10 jurisdictions across the country, that aimed to improve workplaces and increase the retention and recruitment of nurses. Unions, employers, governments, universities and professional associations came together in an unprecedented show of collaboration. Lessons and knowledge were shared among the projects, which were evaluated for their viability in other jurisdictions and professions. The pilots led to increased leadership, engagement and professional development, and decreased overtime, absenteeism and turnover.

Research to Action: an evaluation.

The evaluation of the Research to Action project was conducted using an Outcome Mapping (OM) methodology (Earl et al. 2001) with a mixed-methods, repeat survey (before/after) study design. This design uses concurrent measurement of process and outcome indicators at baseline and follow-up. The RTA project proved effective at improving work environments and thereby promoting the retention and recruitment of nurses. Nurses involved in the RTA initiatives had a higher perception of leadership and support in their units, improved job satisfaction, increased empowerment and occupational commitment, and a greater intention to stay on the job.The pilot projects were most successful when there were clearly stated objectives, buy-in from nurses, support from the steering committee and management, and adequate communication among stakeholders. Committed coordination and leadership, both locally and nationally, were central to success.Considerable evidence has documented the challenges facing Canada's nursing human resources and their workplaces, such as high levels of turnover, excessive use of overtime and persistent shortages. There is a growing imperative to translate this research into action, and much of the available evidence presents viable policy alternatives for consideration. For example, a recent national synthesis report (Maddalena and Crupi 2008) recommended that, in consultation with stakeholders, processes should be put in place to share knowledge and best practices in nursing management, practice, staffing models and innovations in workplace health and well-being.Nurses across the country report a desire to be more involved in decisions affecting them and their patients (Wortsman and Janowitz 2006). A recent study on the shortage of registered nurses in Canada (Tomblin Murphy et al. 2009) highlighted the need for collaboration among governments, employers, unions and other stakeholders to improve working conditions for nurses. Another report notes the potential benefits of reduced turnover among nurses, the cost of which has been identified as a major burden on the Canadian healthcare system (O'Brien-Pallas et al. 2010). One of the goals of the pan-Canadian framework for health human resources (HHR) planning adopted by the Federal/Provincial/Territorial Advisory Committee on Health Delivery and Human Resources is to enhance all jurisdictions' capacity to build and maintain a sustainable workforce in healthy, safe work environments (ACHDHR 2005).Within this context, Health Canada's Office of Nursing Policy provided funding to the Canadian Federation of Nurses Unions (CFNU) and partner agencies in October 2008 to develop pilot projects across the country aimed at improving nurse retention and recruitment through various workplace improvement schemes. Each of the provincial partners contributed funds, in-kind support or both to the projects. The initiative was entitled Research to Action: Applied Workplace Solutions for Nurses (RTA). A national steering committee including representation from unions, governments and employers, each pilot project, CFNU and its national partners ­ the Canadian Nurses Association, the Canadian Healthcare Association and the Dietitians of Canada ­ was formed to oversee the development of 10 pilot projects. There was one project in each of Newfoundland and Labrador, Nova Scotia, New Brunswick, Prince Edward Island, Ontario, Manitoba, Saskatchewan, Alberta, British Columbia and Nunavut. The pilot projects, led by their own steering committees, focused on various aspects of nursing practice identified as particularly relevant to each jurisdiction, with a specific emphasis on improving the work life of nurses and transforming research knowledge into practice. The goals of the RTA initiative were to promote high-quality workplace environments, improve the retention and recruitment of nurses (RNs and LPNs), enhance the quality of patient care and engage stakeholders in collaborative partnerships. The first project began in May 2009 and the last project was completed in March 2011.

Practices for caring in nursing: Brazilian research groups.

BACKGROUND: The present study considers the production of knowledge and the interactions in the environment of research and their relationships in the system of caring in nursing and health. AIM: To elaborate a theoretical model of the organization of the practices used for caring, based on the experiences made by the research groups of administration and management in nursing, in Brazil. METHODS: The study is based on grounded theory. Twelve leaders of research groups, working as professors in public universities in the south and the south-east of Brazil, distributed in sample groups, were interviewed. FINDINGS: The core phenomenon 'research groups of administration and management in nursing: arrangements and interactions in the system of caring in nursing' was derived from the categories: conceptual bases and contexts of the research groups; experiencing interactions in the research groups; functionality of the research groups; and outputs of the research groups. The research groups are integrated in the system of caring in nursing. CONCLUSIONS: The activities of the Brazilian administration and management in nursing research groups are process oriented and in a process of constant renovation, socially relevant, operate in a complex scenario and contribute to the advancement of the organizations of the system of caring in nursing through strengthening the connection among academia, service and community.

Leadership of the nurse: an integrative literature review / Liderança do enfermeiro: uma revisão integrativa da literatura / Liderazgo del enfermero: una revisión integradora de la literatura

This Integrative Literature Review, sought to evidence and discuss the main characteristics of the concept of leadership and of the nurse leader, as well as their contributions to the practice of nursing and health from nursing scientific publications indexed in the database Medical Literature Analysis and Retrieval System Online (MEDLINE) and published between 1998 and 2008. Following the inclusion criteria, a total of 36 studies were selected for analysis, of these 89 percent (33 articles) were published in foreign journals and 11 percent (3) published in national journals. The profiles of nursing leaders encountered were the authentic and the authoritative, with the leadership evidenced as an organizational tool that combines communication, interpersonal relationships, planning, the commitment to success and the resolvability of conflicts. Education is presented as fundamental for the formation of leaders, relating directly the valorization of academic titles with the improvement of this competence.

Trata-se de revisão integrativa da literatura, que buscou evidenciar e discutir as principais características do conceito de liderança e do enfermeiro líder, bem como suas contribuições para a prática em enfermagem e saúde, a partir de publicações científicas de enfermagem indexadas na base de dados Medical Literature and Retrivial System on Line (MEDLINE), entre 1998 e 2008. Seguindo os critérios de inclusão, totalizaram-se 36 estudos selecionados para análise, dos quais 89 por cento (33 artigos) foram publicados em periódicos estrangeiros e 11 por cento (3) publicados em periódicos nacionais. Os perfis de enfermeiros líderes encontrados foram o autoritário e o autêntico, sendo a liderança evidenciada como ferramenta organizacional que articula comunicação, relações interpessoais, planejamento, o compromisso com o êxito e a resolutividade de conflitos. A educação apresenta-se como fundamental para a formação de líderes, relacionando diretamente a valorização da titulação acadêmica ao aperfeiçoamento dessa competência.

Se trata de una Revisión Integradora de la literatura, que buscó evidenciar y discutir las principales características del concepto de liderazgo y del enfermero líder, así como sus contribuciones para la práctica en enfermería y salud, a partir de publicaciones científicas de enfermería indexadas en la base de datos Medical Literature and Retrivial System on Line (MEDLINE) entre 1998 y 2008. Siguiendo los criterios de inclusión, se totalizó 36 estudios seleccionados para análisis, de los cuales 89 por ciento (33 artículos) fueron publicados en periódicos extranjeros y 11 por ciento (3) publicados en periódicos nacionales. Los perfiles de enfermeros líderes encontrados fueron el autoritario y el auténtico, siendo el liderazgo evidenciado como una herramienta organizacional que articula comunicación, relaciones interpersonales, planificación, el compromiso con el éxito y la resolutividad de conflictos. La educación se presenta como fundamental para la formación de líderes, relacionando directamente la valorización de la titulación académica con el perfeccionamiento de esa competencia.

Towards evidence-based management: creating an informative database of nursing-sensitive indicators.

PURPOSE: The purpose of this paper is to describe the creation, evolution, and implementation of a database of nursing-sensitive and potentially nursing-sensitive indicators, the Military Nursing Outcomes Database (MilNOD). It discusses data quality, utility, and lessons learned. DESIGN/METHODS: Prospective data collected each shift include direct staff hours by levels (i.e., registered nurse, other licensed and unlicensed providers), staff categories (i.e., military, civilian, contract, and reservist), patient census, acuity, and admissions, discharges, and transfers. Retrospective adverse event data (falls, medication errors, and needle-stick injuries) were collected from existing records. Annual patient satisfaction, nurse work environment, and pressure ulcer and restraint prevalence surveys were conducted. FINDINGS AND CONCLUSIONS: The MilNOD contains shift level data from 56 units in 13 military hospitals and is used to target areas for managerial and clinical performance improvement. This methodology can be modified for use in other healthcare systems. CLINICAL RELEVANCE: As standard tools for evidence-based management, databases such as MilNOD allow nurse leaders to track the status of nursing and adverse events in their facilities.

Economic theory and nursing administration research--is this a good combination?

TOPIC: Economic theory is used to describe and explain decision making in the context of scarce resources. PURPOSE: This paper presents two applications of economic theory to the delivery of nursing services in acute care hospitals and evaluates its usefulness in guiding nursing administration research. SOURCES OF INFORMATION: The description of economic theory and the proposed applications for nursing are based on current nursing, healthcare, and economic literature. Evaluation of the potential usefulness of economic theory in guiding nursing administration research is based on the criteria of significance and testability as described by Fawcett and Downs. CONCLUSIONS: While economic theory can be very useful in explaining how decisions about nursing time allocation and nursing care production are made, it will not address the issue of how they should be made. Normative theories and ethical frameworks also must be incorporated in the decision-making process around these issues. Economic theory and nursing administration are a good fit when balanced with the values and goals of nursing.