Building Leaders for an Equitable and Inclusive Future.

ABSTRACT: The Association for Leadership Science in Nursing (ALSN) 2023 International Conference was held on October 28 to 30 in Birmingham, Alabama, and sponsored by the University of Alabama at Birmingham School of Nursing. ALSN is dedicated to uniting academic and practice leaders to shape leadership science, education in nursing, and the practice of nursing leadership. The theme for the conference was Building Leaders for an Equitable and Inclusive Future. Nurse leaders from the United States, Canada, and Brazil gathered to discuss leadership science.

Academic-Practice Partnership in Research: Meeting the Gold Standard.

Academic-clinical partnerships describe relationships between 2 groups to advance mutual interests, particularly collaboration on research projects. In this column, members of the Association of Leadership Science in Nursing discuss a 10-year partnership between a nurse professor at a southeast university and a nurse scientist at a health system in the southeast United States, reflections on meeting the criterion standard in our research pursuits, and lessons learned.

Leadership Science in Nursing: Creating New Solutions for New Challenges.

The Association for Leadership Science in Nursing (ALSN) November 2022 International Conference was held at the Frances Payne Bolton School of Nursing at Case Western University. ALSN is dedicated to uniting academic and practice leaders to shape leadership science, education in nursing, and the practice of nursing leadership. One hundred fifty-one nurse leaders from the United States, Canada, and Oman gathered to discuss leadership as highlighted in this column.

Transitioning from Nurse-Patient Ratios to Workload Intensity Staffing: What Helps and Hinders the Change.

OBJECTIVE: The aim of this study was to explore the facilitators and barriers in implementing a workload intensity (WI) tool. BACKGROUND: A WI tool was developed to quantify patient needs and more evenly disperse workload among nurses. METHODS: A descriptive phenomenological design was used. Semistructured interviews were conducted with 16 nurses on 5 inpatient units. Questions focused on the factors that helped or hindered the change transition to workload intensity staffing (WIS). RESULTS: WI was perceived as a positive change. Five themes were uncovered as facilitators and barriers to the change: resistance to change, intense workloads, supportive organizational culture, resources/training, and evaluation. CONCLUSIONS: Understanding barriers and facilitators to change is important for successful implementation of WIS. To promote success, leaders should provide support to staff and ensure availability of adequate resources.

The impact of nurse practice environment on patient outcomes and mediation effects of registered nurse outcomes in Middle Eastern acute care hospitals: A cross-sectional study.

AIMS: Examining associations between unit nurse practice environment and four patient outcomes (catheter-associated urinary tract infections [CAUTIs], central line-associated bloodstream infections [CLABSIs], falls, and pressure injuries) and mediation effects of three RN unit workgroup outcomes (job enjoyment, psychological safety, and intent to stay at 1 and 3 years) on these relationships. METHODS: A cross-sectional correlational design, using the National Database of Nursing Quality Indicators® (NDNQI®) unit-level data from 2018 on inpatient units from seven Middle Eastern hospitals. Ninety units were included, where the sample of units for each patient outcome varied (n = 73-90) based on outcome data availability. RESULTS: Higher unit nurse practice environment scores were significantly associated with higher CLABSIs (exp(b) = 8.181, 95 % CI = [2.204, 30.371], p = .002) and lower pressure injuries (exp(b) = 0.153, 95 % CI = [0.032, 0.730], p = .018). However, mediation analysis showed no significant direct effects of unit nurse practice environment on patient outcomes. Mediation analysis showed that nurses' psychological safety-respect significantly mediated the relationship between unit nurse practice environment and CAUTIs (ß = 2.620, p = .013, 95 % bcb CI = [0.837, 5.070]). Nurses' intent to stay at 1-year and psychological safety-respect had significant direct effects (ß = -4.784, p = .017 and ß = 3.073, p = .012, respectively) on CAUTIs. CONCLUSIONS: Nurse practice environment was significantly associated with two patient outcomes and a mediation role of RN outcomes was supported when examining one patient outcome. Future research should examine these relationships in a larger sample for replication. TWEETABLE ABSTRACT: Although nurse practice environment can impact patient outcomes directly, nurse outcomes play a crucial role in mediating this relationship.

Organizational Safety Climate and Job Enjoyment in Hospital Surgical Teams With and Without Crew Resource Management Training.

OBJECTIVE: The association between organizational safety climate (OSC) and job enjoyment (JE) for team members in surgical units in 2 hospitals was investigated. The treatment hospital received airline industry-based crew resource management (CRM) training, and the comparison hospital did not. BACKGROUND: Strong OSC has been positively associated with healthy hospital work environments and was expected to also be associated with employee job enjoyment. METHODS: Two hundred sixty-two surgical personnel responded to surveys about OSC and JE. RESULTS: The effects of OSC on JE did not depend on having CRM training. However, OSC and JE scores were higher in the treatment hospital, and the main effect of OSC and JE scores in the treatment hospital was highly significant (P < 0.001), with higher safety climate scores associated with higher JE. CONCLUSIONS: A strong OSC is important to employee job enjoyment. Nurse leaders should promote measures to strengthen the OSC in their surgical services departments.

Can Nurses Self-Assess Fatigue?: Implications for Nurse Leaders.

OBJECTIVE: The aims of this study were to describe nurses' self-perceptions of fatigue and to examine nurses' acceptance of specific fatigue countermeasures. BACKGROUND: The work of nurses places them at a high risk of fatigue. Evidence suggests 75% to 80% of nurses in the United States experience high levels of fatigue. METHODS: This descriptive, cross-sectional correlational study surveyed 279 nurses. RESULTS: Results suggest that almost half of nurses (46%) are not able to accurately self-assess fatigue. Nurses expressed acceptance of several workplace fatigue reduction strategies. CONCLUSIONS: It may be unrealistic to expect nurses to self-assess fatigue levels and make decisions about their ability to safely provide patient care. Reliable methods for assessing fatigue in the workplace are needed. Several strategies exist that may be used to alleviate fatigue, and many were acceptable to nurses. Nurse leaders are well positioned to implement changes that impact the occurrence of nurse fatigue and thereby the quality of patient care.

Reinventing the Delivery of Care in a New Women and Children's Center Using an Integrated Lean Model.

This article describes one heath system's creation of a new women's health hospital using an innovative model integrating patient care delivery, Lean building design, and Lean integrated project methodology. The article describes a 5-year journey detailing the innovative process that guided the planning and implementation of the new care delivery model, as well as employee and leader roles, employee behavior and engagement, and key insights and lessons learned that will benefit nurse leaders.

Exploring the Association Between Organizational Safety Climate, Failure to Rescue, and Mortality in Inpatient Surgical Units.

OBJECTIVE: To examine the association between organizational safety climate (OSC), in-hospital mortality (IM), and failure to rescue (FTR) in 2 hospitals, 1 with and 1 without crew-resource-management training. BACKGROUND: OSC is 1 of the most important organizational factors that promotes safety at work; however, there is a lack of research examining the relationship between OSC and patient deaths in hospitals. METHODS: We utilized a matched 2-group comparison of surgical patients and surveyed surgical staff to assess the relationship between OSC, FTR, and IM. RESULTS: The OSC assessment was completed by 261 surgical team members. A total of 1764 patients had at least 1 FTR complication; however, there was no association between OSC with FTR or IM for either hospital. CONCLUSIONS: Nurse leaders should remain vigilant in building work teams with strong hospital safety climates. More research is needed to explore the relationship between OSC and patient outcomes.

Failure to rescue and 30-day in-hospital mortality in hospitals with and without crew-resource-management safety training.

Failure to rescue (FTR) occurs when a clinician is unable to save a hospitalized patient's life when they experience a complication that was not present on admission. Research suggests that a focus on patient safety, including implementing airline-industry-based-crew-resource management (CRM) training, can improve patient outcomes, however, the effects of CRM on FTR are unknown. This study examined FTR and 30-day in-hospital mortality (IM) outcomes in two hospitals to determine if differences existed in the treatment hospital (received CRM training) and the comparison hospital (did not receive CRM training). Researchers expected there would be lower rates of FTR and IM in the treatment hospital than the comparison hospital. The study utilized a matched two-group comparison, cross-sectional quasi-experimental design. Over 10,000 patients (n = 10,823) comprised the study with 1,764 having at least one FTR complication. Adjusted odds of FTR were 2.9% higher for treatment versus comparison but these results did not reach significance. The adjusted odds of IM were 0.4% higher for treatment versus comparison but not significantly higher. Although the reasons for our findings remain unclear, previous researchers also found that CRM training improved staff outcomes but unexpectedly did not improve patient outcomes. CRM training may best be used to target changes in staff behaviors and improvement in staff outcomes. Refresher CRM training may be needed to prevent drifting back into longstanding behaviors. Reductions in FTR and patients with IM outcomes may require more comprehensive, multipronged interventions in addition to CRM training.

The Effect of Leadership Interventions on Staff Nurse Job Enjoyment and Leadership Perception.

Nurse managers (NMs) influence retention and job satisfaction, although many facilities lack NM training programs. A program examined staff nurse perceptions after their NMs participated in leadership training. NMs with limited training may find it more challenging to positively affect their nurses' job satisfaction and retention. This program evaluation suggests that nurse executive investment in and support of the NM role yield positive benefits for the NM leader and their staff.

Nurses' Participation in Clinical and Administrative Decisions in Different Types of Hospital Units.

OBJECTIVE: This study explored the types of decisions and differences in decision making that nurses made in different types of hospital units. BACKGROUND: The relationship between nurses' participation in decision making and the different types of hospital units where they work is not well understood. METHODS: Nurses' participation in decision making was explored using the Participation in Decision Activities Questionnaire. The final sample included 307 nurses in 24 nursing units in 6 hospitals. RESULTS: Nurses overall participated more in clinical than administrative decisions, and there were significant differences based on unit type. Critical care nurses had the highest and general care units the lowest levels of participation in decision making. CONCLUSIONS: Nurses in critical care units participated in higher amounts and at higher levels of clinical decisions overall than either intermediate or general care units. Nurse leaders should determine barriers to decision making in general care units and explore mechanisms to increase participation by clinical nurses.

Enhancing Systems Thinking for Undergraduate Nursing Students Using Friday Night at the ER.

BACKGROUND: The complexity of health care systems requires cooperation between system stakeholders, structures, and functions. Nurses need an understanding of systems thinking to work effectively in this complex environment. METHOD: Nurse educators used the Friday Night at the ER simulation game with undergraduate nursing students to simulate complex problem solving and assess their learning. RESULTS: Students had significantly higher scores on the Systems Thinking Scale and reported increased self-perceived proficiency with the quality improvement Quality and Safety Education for Nurses competency after participating in the game. CONCLUSION: Nurse educators should consider incorporating complex problem-solving exercises, such as Friday Night at the ER, into their undergraduate curriculum to challenge and strengthen students' critical and systems thinking. Hospital nurse educators should also consider this intervention to assist practicing nurses in bolstering their critical and systems thinking. [J Nurs Educ. 2018;57(11):687-689.].

Nurses to Their Nurse Leaders: We Need Your Help After a Failure to Rescue Patient Death.

The purpose of this study was to describe nurses' needs and how they are being met and not met after caring for surgical patients who died after a failure to rescue (FTR). A qualitative, phenomenologic approach was used for the interview and analysis framework. Methods to ensure rigor and trustworthiness were incorporated into the design. The investigator conducted semistructured 1:1 interviews with 14 nurses. Data were analyzed using Colaizzi's methods. Four themes were identified: (1) coping mechanisms are important; (2) immediate peer and supervisor feedback and support are needed for successful coping; (3) subsequent supervisor support is crucial to moving on; and (4) nurses desire both immediate support and subsequent follow-up from their nurse leaders after every FTR death. Nurses' needs after experiencing an FTR patient death across multiple practice areas and specialties were remarkably similar and clearly identified and articulated. Coping mechanisms vary and are not uniformly effective across different groups. Although most nurses in this study received support from their peers after the FTR event, many nurses did not receive the feedback and support that they needed from their nurse leaders. Immediate nurse leader support and follow-up debriefings should be mandatory after patient FTR deaths. Developing an understanding of nurses' needs after experiencing an FTR event can assist nurse leaders to better support nurses who experience FTR deaths. Insight into the environment surrounding FTR deaths also provides a foundation for future research aimed at improving patient safety and quality through an improved working environment for nurses.

Nurses' Experiences With Patients Who Die From Failure to Rescue After Surgery.

PURPOSE: To describe the lived experiences of hospital nurses caring for surgical patients who died from failure to rescue (FTR). DESIGN: A qualitative phenomenologic approach was used. Methods to ensure rigor and trustworthiness were incorporated into the design. METHODS: The investigator conducted one-on-one semistructured interviews with 14 nurses, and data were analyzed using Colaizzi's methods. FINDINGS: Six themes were identified: (a) the environment surrounding the FTR was unexpected; (b) FTR was unexpected but not preventable; (c) nurses were emotionally ill-prepared for the FTR; (d) nurse outcomes are different in unexpected versus expected death; (e) nurses' roles as protectors are important; and (f) FTR effects future nursing practice. CONCLUSIONS: Nurses' reactions after an FTR surgical death may be different when there is no identified nursing error contributing to the event. There may be key differences between deaths that are simply unexpected and those that involve FTR. The importance of mentoring junior nurses in protective surveillance skills is vital. CLINICAL RELEVANCE: Developing an understanding of nurses' experiences with FTR can assist nurse leaders to better support nurses who experience FTR deaths. Insight into the environment surrounding FTR deaths provides a foundation for future research aimed at improving patient safety and quality through an improved working environment for nurses.

Leading in the Healthcare Vortex.

The 2016 International Nursing Administration Research Conference, Leading in a Healthcare Vortex, was held in Orlando, Florida. The program drew 116 attendees with representation from Canada and Brazil. Participants from practice, education, and research discussed leadership in our turbulent healthcare climate, which are highlighted in this column. The conference was dedicated to the memory of Dr Heather S. Laschinger in recognition of her distinguished research legacy of empowering nursing work environments and mentorship of prominent nursing administration researchers.

Interdisciplinary Shared Governance in Ambulatory Care: One Health System's Journey.

The implementation of shared governance structures in acute care has illustrated the positive relationship between shared decision making and nurse empowerment and positive nurse and patient outcomes. Little is known, however, about interdisciplinary shared governance, and even less is known about shared governance in ambulatory care. This article details one health system's experience with the implementation of an interdisciplinary shared governance structure in ambulatory care over a 4-year period. The authors report lessons learned, positive health system outcomes that resulted including improved communication, better preparedness for accreditation visits, improved assessment of fall risk, and a streamlined documentation system. Also discussed are mechanisms to enhance sustainability of the structure and discussion of future opportunities and challenges.

Preparing BSN Students for Population-Focused Nursing Care.

A baccalaureate nursing program in central North Carolina, in partnership with a local homeless shelter and community clinic, serves a vulnerable, underserved population while helping students gain hands-on experience in population-focused nursing. Students assess health needs, issues in access to care, and other health challenges using health assessment tools, surveys, and one-on-one dialogue. They then prioritize the top three health challenges and issues for the population and plan and implement educational sessions. After this experience, students report greater understanding of the concepts of community health and are able to apply them in practice. It is recommended that others considering this approach collect data to document the effectiveness of services to the population served and for funding of such initiatives.

The relationship between work complexity and nurses' participation in decision making in hospitals.

OBJECTIVE: The aim of this study is to examine the relationship between work complexity and nurses' participation in decision making in hospital nursing units. BACKGROUND: Increasing nurses' participation in decision making has been used as a way to manage work complexity; however, the work of nurses in acute care hospitals has become highly complex, and strategies used to manage this complexity have not been fully explored. METHODS: The relationship between work complexity and nurse participation in decision making was examined using data from the Outcomes Research in Nursing Administration project. The sample included 3,718 RNs in 278 medical-surgical units in 143 hospitals. RESULTS: When work complexity increased, nurses' participation in decision making decreased. CONCLUSIONS: When nurses have limited input into decision making, the information available to the care team may be incomplete. Barriers to nurses' participation in decision making should be explored and interventions developed so that nurses may be full participants in decision making affecting both patients and the work environment.