Nurse Manager Engagement: Strategies to Enhance and Maintain Engagement.

OBJECTIVE: This study provided insight into the level of engagement of nurse managers (NMs) and strategies used to achieve and sustain engagement in acute care settings. BACKGROUND: Nurse managers have a significant role in staff satisfaction and unit outcomes and therefore need to be engaged in their work to influence others. Little is known about the level of individual NM engagement and strategies they use to remain engaged. METHODS: A mixed methods approach was used to elicit information about NM engagement. This study used a sample of 47 NMs to measure their level of engagement, and for those achieving scores indicating high levels of engagement, interviews were conducted, and a content analysis was completed to identify themes. RESULTS: Results showed that there were significantly higher levels of NM engagement among those managers who had been practicing as nurse leaders for a longer period and also those who had advanced degrees. Qualitative review revealed the themes of expert communication, autonomy, and influence as the key factors driving NM engagement. CONCLUSIONS: The role of the nurse executive in NM engagement is significant in supporting educational advancement and retention, both of which proved to have an impact on the level of engagement.

Enhancing safety reporting in adult ambulatory oncology with a clinician champion: a practice innovation.

This article examines whether a patient safety "champion" on an ambulatory chemotherapy infusion unit can increase reporting of adverse events and close calls. Reporting rates increased substantially on both intervention and control units. It was accompanied by more reports of medical errors and conditions that worried staff and fewer reports of service quality incidents. The facilitated reporting method described here is a novel approach to incident reporting, complements the spontaneous reporting systems used in hospitals and some ambulatory care settings, and may help to build a safety culture. By identifying errors and worrisome conditions, it may help managers identify problems before they lead to harm.

Patient-reported safety and quality of care in outpatient oncology.

BACKGROUND: Although patients suffer the effects of medical errors and iatrogenic injuries, little is known about their ability to recognize these events in ambulatory specialty care. METHODS: At a Boston cancer center in 2004, 193 adult oncology patients treated on a chemotherapy infusion unit were interviewed by four patient safety liaisons--volunteers recruited from the organization's Adult Patient and Family Advisory Council. RESULTS: Among 193 patients, 83 reported 121 incidents. Investigators classified 2 (1%) adverse events, 4 (2%) close calls, 14 (7%) errors without risk of harm, and 101 (52%) service quality incidents. Respondents reported high staff compliance with safe practices such as identity checking (95%). Examining the most serious described by each of 42 (22%) respondents who reported a recent unsafe experience, investigators classified only one adverse event, 3 close calls, 9 harmless errors, and 27 service quality incidents. DISCUSSION: Patients' perception of unsafe care was surprising, given the same patients' recognition of consistent application of safe practices, such as the use of two forms of identification before performing tests and administering treatments. Many ambulatory oncology patients also reported poor service quality. The relationship between patient perception of safe care, medical injury, and service quality merits further study.

Making patient-centered care come alive: achieving full integration of the patient's perspective.

A patient-centered model of care has profound implications for the way that care is planned, delivered, and evaluated. Although most leaders in healthcare organizations today embrace the basic tenets of a patient-centered philosophy, they often find that moving toward a patient-centered model requires an unanticipated level of commitment and significant adjustments in organizational structures. In this article, the authors describe how patients and families have been integrated into the care delivery model by involving them in planning, decision-making, and improvement processes at all levels of the organization.