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.

Transforming Shared Governance: Toward Professional Governance for Nursing.

For more than 40 years, shared governance has supported structural empowerment and engaged nurses in their practice. Although progress has been made in advancing nursing ownership of practice through shared governance, mature nursing autonomy has yet to be achieved. It is time to evolve to professional governance, emphasizing accountability, professional obligation, collateral relationships, and decision making. Nurse leaders are provided with historical context and recommendations for effectively leading professional governance in an empowering work culture.

Leveraging Technology to Sustain Extraordinary Care: A Qualitative Analysis of Meaningful Nurse Recognition.

OBJECTIVE: Meaningful recognition of nurses submitted by patients and families using interactive patient care (IPC) technology was analyzed using artificial intelligence (AI) to identify the themes and behaviors associated with extraordinary nursing. BACKGROUND: Meaningful recognition positively impacts nursing and organizational outcomes. The use of AI techniques such as natural language processing and machine learning to identify and describe behaviors impacting patient experiences is an emerging science. METHODS: Nurse recognition comments were collected from a convenience sample of 3 organizations via an IPC inpatient platform and analyzed using the AI techniques of natural language processing, machine learning, sentiment analytics, and corollary dictionaries based on rules of linguistics. RESULTS: The top theme of nursing recognition comments was courtesy and respect with the behaviors of empathy/compassion, helpfulness, kindness, attentiveness, and emotional comfort. The theme of skills/knowledge was the 2nd most common, with the behaviors of being professional, knowledgeable, keeping track, competence, dedication, and being thorough. CONCLUSIONS: AI techniques for qualitative analysis of comments collected through IPC reveal nurse themes and behaviors most meaningful to patients and their family members. Nurses can advance the science of AI and guide its evolution so that nurse caring behaviors associated with establishing human connections that positively influence patient and family experience are accurately represented.

Leadership Practices and Engagement Among Magnet® Hospital Chief Nursing Officers.

OBJECTIVE: Describe the relationship between leadership practices and engagement of chief nursing officers (CNOs) in Magnet® organizations. BACKGROUND: Transformational leadership practices and CNO engagement are vital in influencing nursing practice. METHODS: Magnet hospital CNOs were invited to participate in a quantitative descriptive study via an online survey published in 2 newsletters. RESULTS: The CNOs rated their leadership practices high across all dimensions; the top leadership practice of Magnet CNOs was enabling others to act. There was a strong positive correlation between the vigor of engagement and the challenge the process leadership practice. CONCLUSION: This is the 1st study of Magnet CNOs transformational leadership practices and their work engagement and therefore adds to our understanding of the important characteristics to build future leadership development programs for nurse leaders at the executive level. Particularly noteworthy for the development of future nurse executives is the strong link between vigor and challenging the process.

Leveraging Technology to Increase Patient and Family Engagement and Improve Outcomes.

Engaging persons in their health care influences the quality of care and improves patient safety, health outcomes, and the patient experience. Emerging technology is enabling patients to be more fully engaged in their care. At the same time, the rapid emergence of these solutions is impacting nursing professional practice, workflows, and care delivery models across the continuum. Faced with a sustained and continued technology explosion, nurse executives are uniquely positioned to lead care transformation that leverages technology to engage patients at the point of care, redefine nursing practice, and improve empirical outcomes.

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.

The Center for Nursing Excellence: A Health System Model for Intentional Improvement and Innovation.

An innovative Center for Nursing Excellence model that supports structural empowerment and the achievement of exemplary nursing, patient, and organizational outcomes was implemented in 2 separate health systems in the western United States. Formal leadership roles for nursing practice, research, professional education, and Magnet® continual readiness are aligned to ensure that Magnet designation is attained and maintained in system hospitals.

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.

Shared Governance and Work Engagement in Emergency Nurses.

INTRODUCTION: Lack of work engagement in emergency nurses has been linked to increased job turnover, burnout, and lack of job satisfaction. Shared governance is a vehicle that can be used by emergency nursing leaders to increase work engagement among emergency nurses. Research is lacking about the relationship between perceptions of shared governance and work engagement in emergency nurses. In this study we examined the relationship between ED nurses' perceptions of shared governance and work engagement. METHODS: A descriptive correlation design was used with a convenience sample of 43 emergency nurses recruited through the ENA Web site. Participants completed a demographic questionnaire, the Index of Professional Nursing Governance Tool, and the Utrecht Work Engagement Scale. RESULTS: The mean total work engagement score indicated average engagement (M = 4.4, standard deviation = 1.2). A significant positive relationship was found between shared governance and work engagement, indicating that as perceptions of shared governance increase, work engagement increases (r (41) = 0.62, P < .001). DISCUSSION: The study provides beginning evidence on the relationship of shared governance and work engagement in emergency nurses. Understanding the relationship between perceptions of shared governance and work engagement in emergency nurses may assist emergency nursing leaders in developing and testing interventions to enhance it.

The Relationship of Clinical Nurses' Perceptions of Structural and Psychological Empowerment and Engagement on Their Unit.

OBJECTIVE: The purpose of this study was to describe relationships between structural empowerment, psychological empowerment, and engagement among clinical nurses. BACKGROUND: Empowerment and engagement are key drivers of retention and quality in healthcare. Creating an empowering culture and an engaged staff supports initiatives that are essential for positive work environments. METHODS: A survey of 280 nurses in a national conference was conducted using the Conditions of Work Effectiveness, Psychological Empowerment Instrument, and the Utrecht Work Engagement Scale. Pearson correlation coefficients and multiple regression analysis were used to determine relationships between demographic data and study variables. RESULTS: Overall, nurses had high perceptions of structural empowerment and psychological empowerment and were moderately engaged. Also, significant positive relationships were found between the key study variables. CONCLUSIONS: Results show positive correlations between empowerment and perceived engagement among clinical nurses.

Transformational leadership practices of nurse leaders in professional nursing associations.

OBJECTIVE: This study describes the transformational leadership (TL) practices of nurse leaders in professional nursing associations (PNAs). BACKGROUND: Professional nursing associations are vehicles to provide educational opportunities for nurses as well as leadership opportunities for members. Little has been published about the leadership practices of PNA members. METHOD: E-mail surveys of 448 nurse leaders in PNAs were conducted in 2013 using the Leadership Practices Inventory (LPI). RESULTS: The top 2 TL practices of these nurse leaders were enabling others to act and encouraging the heart. Respondents with more leadership training reported higher TL practices. CONCLUSION: This is the 1st study to describe TL practices of nurse leaders in PNAs. Results of this study show that nurse leaders of PNAs emulate practices of TL. Transformational leaders can mobilize and direct association members in reaching shared values, objectives, and outcomes. Understanding TL practices of nurse leaders in PNAs are important to the future of nursing in order to enable nurses to lead change and advance health through these organizations.

Structural empowerment and the nursing practice environment in Magnet® organizations.

OBJECTIVE: The aim of this study was to describe the characteristics of shared governance and its relationship with nursing practice environments in Magnet® organizations. BACKGROUND: Structural empowerment is a core Magnet model component illustrated through shared governance. A paucity of literature exists describing it and its relationship to the nursing practice environment in Magnet organizations. METHODS: E-mail surveys of Magnet chief nursing officers and leaders of their organization's nursing practice council were conducted using the Index of Professional Nursing Governance (IPNG) and the nursing Work Index-Revised (NWI-R). RESULTS: In Magnet organizations, the primary governance distribution is shared governance, with most subscales in the IPNG within the shared governance range. Total and subscale scores on the NWI-R ranged from 1.35 to 1.48, with significant, positive correlation between total IPNG score and total NWI-R score (r = 0.416, P < .001), as well as the NWI-R and IPNG subscales. CONCLUSIONS: This study provides new evidence that demonstrates the positive relationship between shared governance and the nursing practice environment in Magnet organizations.

Nurse practitioner/physician collaborative practice: an integrative model for professional peer review.

As chief nursing officers partner with physician colleagues to create collaborative models of practice across the care continuum, the role of peer review in achieving quality outcomes cannot be overlooked. This article describes how an integrated healthcare system approached the creation of a unique integrative model for physician/nurse practitioner peer review.

Nursing professional attire: probing patient preferences to inform implementation.

OBJECTIVE: The aim of this study was to increase understanding of patient perceptions of nursing professional image, appearance, and identification to inform implementation of professional clinical attire. BACKGROUND: There is growing evidence of patient preference for and organizational implementation of professional clinical attire. METHODS: A total of 350 randomly selected inpatients were surveyed using the professional image and patient preferences survey prior to a revision of the dress code for nursing. RESULTS: Patients gave high scores for nursing image, appearance, and identification, with no support for color-coded uniforms. CONCLUSIONS: Organizations should assess patient perceptions before implementation of a dress code for nursing.

Transformational leadership practices of chief nursing officers in Magnet® organizations.

OBJECTIVE: This study describes the transformational leadership practices of Magnet® chief nursing officers (CNOs). BACKGROUND: It is believed that transformational leadership practices influence quality and are integral to Magnet designation. METHODS: E-mail surveys of 384 Magnet CNOs were conducted in 2011 using the leadership practices inventory (LPI). RESULTS: Enabling others to act and modeling the way are top practices of Magnet CNOs. Those 60 years or older and those with doctorate degrees scored significantly higher in inspiring a shared vision and challenging the process. There was a significant positive relationship between total years as a CNO and inspiring a shared vision and between total scores on the LPI and number of beds in the organization. CONCLUSIONS: As CNOs gain experience and education, they exhibit more transformational leadership characteristics. Magnet organizations should take steps to retain CNOs and support their development and advancement.

Implementing Institute of Medicine Future of Nursing recommendations: a model for transforming nurse practitioner privileges.

The Institute of Medicine Future of Nursing report created a sense of urgency to remove barriers preventing advanced practice RNs from practicing to their full scope of practice. With the chief nursing officer as catalyst for change, this article describes a collaborative model and process that resulted in expanded clinical privileges for nurse practitioners in an integrated healthcare system.

Transformational leadership: visibility, accessibility, and communication.

The chief nursing officer of a Magnet® organization is a dynamic, transformational leader who develops and communicates a strong vision for nursing excellence and creates a foundation for exemplary nursing practice and excellent patient care. Transformational leadership is a core component of the Magnet Model®. The 3rd subcomponent--visibility, accessibility, and communication--is the focus of this article.

Transformational leadership practices of chief nursing officers in Magnet® organizations.

OBJECTIVE: This study describes the transformational leadership practices of Magnet® chief nursing officers (CNOs). BACKGROUND: It is believed that transformational leadership practices influence quality and are integral to Magnet designation. METHODS: E-mail surveys of 384 Magnet CNOs were conducted in 2011 using the leadership practices inventory (LPI). RESULTS: Enabling others to act and modeling the way are top practices of Magnet CNOs. Those 60 years or older and those with doctorate degrees scored significantly higher in inspiring a shared vision and challenging the process. There was a significant positive relationship between total years as a CNO and inspiring a shared vision and between total scores on the LPI and number of beds in the organization. CONCLUSIONS: As CNOs gain experience and education, they exhibit more transformational leadership characteristics. Magnet organizations should take steps to retain CNOs and support their development and advancement.