An organizational approach to improve staff resiliency and wellness during the COVID-19 pandemic.

Healthcare worker burnout is a well-established phenomenon known to affect an individual's mental state, and has been shown to be diminished amongst individuals with higher levels of resilience. From a leadership perspective, practices that drive and inspire others to demonstrate resilience and surpass their own expectations fosters a resilient culture and allows employees to view adversity as an opportunity while knowing that support is omnipresent. In this paper, we describe and evaluate the outcomes of a virtual organizational intervention during the COVID-19 pandemic aimed to reduce healthcare staff burnout, and improve their levels of resilience, well-being, and self-compassion. Participants reported the workshops were relevant and provided strategies for wellness that were easy to incorporate into their daily routine. By nurturing one's own personal well-being through resiliency strategies learned in this educational series, staff can enact strategies to care for themselves, which in turn can contribute to organizational wide healthy work environments, improved health system outcomes, and enhanced patient care.

Insights from staff nurses and managers on unit-specific nursing performance dashboards: a qualitative study.

INTRODUCTION: Performance data can be used to monitor and guide interventions aimed at improving the quality and safety of patient care. To use performance data effectively, nurses need to understand how to interpret and use data in meaningful ways to guide practice. Dashboards are interactive computerised tools that display performance data. In one large, urban teaching hospital in Toronto, Canada, unit-specific dashboards were implemented across the organisation. METHODS: A qualitative study was undertaken to explore the perceptions and experiences of front-line nurses and managers associated with the implementation of a unit-level dashboard. Six units were selected to participate in the study. Data were analysed using a directed content analysis approach. RESULTS: The sample included 56 study participants, including 51 front-line nurses and 5 unit managers. Three key themes emerged around nurses' and unit managers' perspectives on the implementation of unit-specific dashboards. Nurses and managers described that the Care Utilising Evidence dashboard was a visual tool that displayed data on the impact of the nursing care provided to patients. This tool also was used by the nurses and managers to keep track of processes of care and patient outcomes and experiences at a unit level. Further, nurses were able to use performance data to identify quality care improvements specific to their unit. CONCLUSIONS: The results highlight how unit-specific dashboards are being used to monitor performance and drive quality improvement efforts from the perspectives of nurses and unit managers. In practice, nurse leaders may consider investing in dashboards as a quality improvement strategy to optimise the use of performance data at their organisations.

Patients' views on bedside nursing handover: creating a space to connect.

A study was undertaken to explore patients' experiences and perceptions associated with implementation of bedside nursing handover. Interviews were conducted with patients and analyzed using a directed content analysis. Three themes emerged through which patients described their experience with bedside nursing handover as follows: (1) creating a space for personal connection; (2) "bumping up to speed"; and (3) varying preferences. Health care leaders and nurses can use study findings to tailor strategies to engage patients, taking into account their preferences, in bedside nursing handover.

Enablers and barriers to implementing bedside reporting: insights from nurses.

As part of efforts to improve patient safety, quality of care and patient- and family-centred care, there is a growing interest in moving away from traditional taped nursing reports or reporting at the nursing station to reporting at the bedside. Although a body of knowledge exists regarding what nurses view as benefits and challenges experienced in nurse-to-nurse bedside reporting, less is known about the perceptions of nurses who have experienced this change in reporting practice on their unit. In this context, a qualitative study using semi-structured interviews was undertaken to explore nurses' perceptions of a newly implemented nurse-to-nurse bedside reporting practice at one acute care hospital. A total of 43 interviews were conducted on four units with seven nurses from respirology, 10 from obstetrics and gynecology, 10 from nephrology and 16 from general surgery. Data were analyzed using a directed content analysis approach. Three themes emerged that captured nurses' perceptions of the implementation of nurse-to-nurse bedside reporting: (a) being supported to change and embrace bedside reporting, (b) maintaining confidentiality and respecting patients' preferences and (c) experiencing challenges with bedside reporting. Our findings provide insight for other organizations in their efforts to change reporting practices. Specifically, there is a need for multi-pronged initiatives including leadership support, educational opportunities and ongoing monitoring and feedback mechanisms. Future research is required to examine how enablers can be leveraged and barriers mitigated or removed to ensure successful implementation and sustainability of nurse-to-nurse bedside reporting.

Implementing an organization-wide quality improvement initiative: insights from project leads, managers, and frontline nurses.

With the movement to advance quality care and improve health care outcomes, organizations have increasingly implemented quality improvement (QI) initiatives to meet these requirements. Key to implementation success is the multilevel involvement of frontline clinicians and leadership. To explore the perceptions and experiences of frontline nurses, project leads, and managers associated with an organization-wide initiative aimed at engaging nurses in quality improvement work. To address the aims of this study, a qualitative research approach was used. Two focus groups were conducted with a total of 13 nurse participants, and individual interviews were done with 10 managers and 6 project leads. Emergent themes from the interview data included the following: improving care in a networked approach; driving QI and having a sense of pride; and overcoming challenges. Specifically, our findings elucidate the value of communities of practice and ongoing mentorship for nurses as key strategies to acquire and apply QI knowledge to a QI project on their respective units. Key challenges emerged including workload and time constraints, as well as resistance to change from staff. Our study findings suggest that leaders need to provide learning opportunities and protected time for frontline nurses to participate in QI projects.

Defining what evidence is, linking it to patient outcomes, and making it relevant to practice: insight from clinical nurses.

BACKGROUND/RATIONALE: Factors that impede or enable successful evidence based practice for nurses in their daily work is well documented. Less known is how nurses define evidence in their daily clinical practice and how this knowledge can inform strategies to enhance evidence based patient care and outcomes. AIMS/METHODS: A qualitative study was undertaken to explore nurses' perceptions of what constitutes evidence as part of EBP and how applicable evidence is to their daily practice. A qualitative design using semi-structured interviews was employed for this study. Data were analyzed using directed content analysis. RESULTS: The following four key themes emerged: viewing evidence as research based and a proven practice; linking evidence to patient outcomes; basing evidence on experience; and making evidence relevant to practice. IMPLICATIONS: Study findings point to having accessible, practical tools to make evidence credible and relevant for nurses tailored to their clinical contexts.

The value of bedside shift reporting enhancing nurse surveillance, accountability, and patient safety.

A study was undertaken to explore nurses' experiences and perceptions associated with implementation of bedside nurse-to-nurse shift handoff reporting. Interviews were conducted with nurses and analyzed using directed content analysis. Two themes emerged that illustrated the value of bedside shift reporting. These themes included clarifying information and intercepting errors and visualizing patients and prioritizing care. Nurse leaders can leverage study findings in their efforts to embed nurse-to-nurse bedside shift reporting in their respective organizations.

Quality nursing care and opportunities for improvement: insights from patients and family members.

A study was undertaken to delineate patients' and families' experiences and perceptions associated with their nurse-patient therapeutic relationships and nursing care. Data were analyzed using a directed content analysis approach. Two key themes emerged: patients and family members described primarily receiving excellent nursing care and to a lesser extent substandard care. Study findings have implications for nurse leaders to enhance nurses' therapeutic relationships with patients and family members and patient-centered care within their organizations.

Investing in nursing research in practice settings: a blueprint for building capacity.

Engaging clinical nurses in practice-based research is a cornerstone of professional nursing practice and a critical element in the delivery of high-quality patient care. Practising staff nurses are well suited to identify the phenomena and issues that are clinically relevant and appropriate for research. In response to the need to invest in and build capacity in nursing research, hospitals have developed creative approaches to spark interest in nursing research and to equip clinical nurses with research competencies. This paper outlines a Canadian hospital's efforts to build research capacity as a key strategy to foster efficacious, safe and cost-effective patient care practices. Within a multi-pronged framework, several strategies are described that collectively resulted in enhanced research and knowledge translation productivity aimed at improving the delivery of safe and high-quality patient care.

Comparison of nurse workload approaches.

BACKGROUND: For hospitals in the United States, the number of patients who lie in beds at midnight is considered to be the standard indicator of nursing workload; relatively little attention is given to the total number of patients cared for in a 24-hour day. Staffing decisions are related to cost of care. Such decisions are made on a per-shift basis, calculating hours per patient day (HPPD) based upon midnight census provides little decision-making support about variable staffing needs over a 24-hour period. The discrepancy between nurse managers' staffing based on real-time patient needs and financial analysts looking only at units of service captured at midnight clearly speaks to the need for a new metric of measurement. OBJECTIVE: To describe the variations in nursing workload across two medical units using a comparison of intra-day census recommendations for staffing and those projected based on the midnight census alone. METHODS: Data were retrieved from a primary data set that included: (1) the number of patients lying in beds at four different times during a 24-hour period: 06.00, 14.00, 22.00 hours and at midnight; (2) projected nursing hours needed based on the numbers of patients lying in beds at different times during the 24-hour period; and (3) the number of projected nursing hours needed for the numbers of patients lying in bed and those who were admitted and discharged in an 8-hour period of time. RESULTS: Statistically significant increases in 06.00 hour patient counts were found with statistically lower patient counts at both 14.00 and 22.00 hours compared with the midnight census alone. Nursing hour projections per day did not show any significance when projected based on intra day vs. midnight census alone. Statistically significant increases in nursing hour projections were seen on all three shifts when admissions and discharges and the nursing workload associated with those procedures were calculated. CONCLUSIONS: Findings suggest that the midnight census alone may well not be the most precise measure to predict nursing workload or to cost out nursing care. To accurately capture the realities of a 24-hour nursing workload, the nursing work associated with patient admissions and discharges has to be a part of the equation. IMPLICATIONS FOR NURSING MANAGEMENT: The tradition of using the midnight census to budget 24 hours of nursing services in the hospital setting does not capture the totality of nursing workload. A model that costs out direct nursing care in the hospital and ultimately bills separately for that care is needed to reflect the realities of hospital nursing workload.