How nurse preceptors provide help to new nurses influences perceived relationship quality.

BACKGROUND: In many hospitals, newly-hired registered nurses (RNs) enter into preceptorships, where they are paired with more experienced nurse preceptors who are responsible for ensuring effective transition to practice. Although high-quality relationships between preceptors and newly-hired nurses facilitate nurses' learning and integration into their medical institutions, preceptors have little guidance for what tactics develop such relationships. OBJECTIVES: To investigate whether the type of help provided by preceptors (i.e., autonomous or dependent help) influences preceptees' evaluations of relationship quality and psychological safety with their preceptor. Furthermore, we investigate the role of instrumental support and emotional support as explanatory mechanisms. DESIGN/SETTINGS/PARTICIPANTS/METHODS: Convenience sampling was used to collect data via a cross-sectional survey of 217 in-patient RNs hired between June 2016 and May 2018 to a magnet hospital within the Southwestern United States. Recently hired nurses evaluated their preceptor's help-giving tendencies, and reported on their perceived support, relationship quality and feelings of psychological safety with their preceptor. RESULTS: Dependent help was positively related to instrumental support. Conversely, autonomous help was positively related to both relationship quality and psychological safety, and these relationships were partially mediated by perceived instrumental support and emotional support. CONCLUSION: Findings illustrate the multiple benefits of autonomous help for encouraging high-quality relationships between preceptors and preceptees. This study identifies autonomous help-giving as a useful tactic for nurse preceptors (or other organizational insiders, such as mentors or supervisors) to establish high-quality relationships with recently hired nurses.

Perioperative Care of Patients Diagnosed With Twin-to-Twin Transfusion Syndrome Undergoing Laparoscopic-Assisted Fetoscopic Placental Laser Photocoagulation.

Twin-to-twin transfusion syndrome (TTTS) is a condition that results in unbalanced blood flow between two fetuses. Patients diagnosed with TTTS can experience maternal or fetal morbidity and mortality. Depending on the severity of TTTS, laser ablation of placental anastomoses may be the most effective treatment. The preferred treatment method requires percutaneous entry to the uterus; however, some patient circumstances (eg, placenta location) require a laparoscopic-assisted procedure. During the preoperative appointments, clinicians assess the condition of the fetuses and patients may participate in genetic counseling. Intraoperative care involves an interdisciplinary team that may include a pediatric general surgeon, maternal-fetal medicine specialists, an RN circulator, a scrub person, and an anesthesia professional. Perioperative nurses should have knowledge of the pathophysiology of TTTS, including its natural progression. They also should understand preoperative and intraoperative patient care requirements to provide safe and effective care for patients undergoing laparoscopic-assisted fetoscopic placental laser photocoagulation procedures.

Bedside Usability Surveys: Adding Authentic User Detail to the Assessment.

Errors in healthcare are a leading cause of death in the United States. Equipment usability and user interfaces remain an area not fully elucidated. Infusion pumps play a vital role in care delivery, often essential for critical therapies. While pump function is comparatively simple, their programming, configuration, and form provide opportunity for error. Our purpose was to assess qualities nurses identified as important to pump operation by electronic survey. A self-developed usability survey was distributed to a random sample of 500 nurses, stratified by unit type and employed at the large academic quaternary care hospital. The overall response rate was 48% (n = 240). Descriptive and inferential statistics describe the responses and represent more than 5500 weekly infusions. Nurses described confident use of the system with some differences by unit type. Ninety percent of respondents indicated they have omitted use of the dose error reduction system, which should raise safety concerns. Users reported issues with the user interface and error prevention systems. Qualitative items elicited suggestions for improving aspects of the pump. Employing a usability survey in a clinical area proved to be a simple, inexpensive way to gather more information on the use and potential improvements of infusion pumps.

On-the-job and off-the-job embeddedness differentially influence relationships between informal job search and turnover.

Whereas informal job search (i.e., using personal contacts for job search) is positively associated with the receipt of job offers, research has yet to consider the extent to which informal job search translates into current employees' turnover decisions or to investigate factors that may restrain (or facilitate) the translation of informal job search into turnover decisions. In this study, we propose that on-the-job and off-the-job embeddedness play distinct roles in strengthening or weakening the positive relationship between informal job search and turnover intentions and behavior. We assert that on-the-job embeddedness reduces the likelihood that informal job search translates into turnover decisions, whereas off-the-job embeddedness strengthens the positive association between informal job search and turnover decisions. We tested these hypotheses across two samples of employed nurses. Although results were mixed, we found evidence that on-the-job embeddedness dampened the positive relationships of informal job search with turnover intentions and behaviors, whereas off-the-job embeddedness facilitated the positive relationships between informal job search and turnover decisions. Taken together, findings suggest that on-the-job and off-the-job embeddedness influence informal job search processes differently. We discuss the implications of these findings for how organizations manage employees' informal job search activities as well as how researchers approach the study of job embeddedness. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Is There Light? Well It Depends--A Grounded Theory Study of Nurses, Lighting, and Medication Administration.

OBJECTIVE: We know that human vision has limitations, medication administration is a high-risk activity, and some nurses work in environments that do not meet recommended lighting standards. The goal of this study was to inform safe medication administration practices and add evidence for establishing guidelines for lighting decisions by understanding registered nurses' (RNs') decision making about lighting during medication administration. METHODS: Grounded theory methodology was followed (n = 16). Theoretical sampling was used to ensure that participants represented a variety of backgrounds and hospital settings. Results were validated by three expert researchers. Two of the researchers had significant expertise in medication administration errors. RESULTS: Data analysis culminated in the substantive theory It Depends. This theory describes a process of frequently automatic decision making about lighting, whose aspects include assessing variation, balancing safety and healing, and RN bias. All RNs expressed concerns about perceived risks in relation to lighting, but had difficulty describing how they confirmed when the correct decision about lighting was made. CONCLUSIONS: Nurses are often unaware of their reasons for lighting decisions, and there is a need for education and other measures to increase the likelihood that lighting decisions that enhance patient safety are made by nurses.

Light for nurses' work in the 21st century: a review of lighting, human vision limitations, and medication administration.

A literature review was conducted to determine the state of the science related to medication errors and light. The limited literature is discussed in relationship to human vision and light needs. Little systematic action has been taken to increase nurses' awareness of the connection between lighting and potential medication errors. Implications for nursing practice and research about light conditions are provided. Interventions from other industries may aid nursing in making decisions about light conditions.

Tubing misconnections: normalization of deviance.

BACKGROUND: Accidental connection of an enteral system to an intravenous (IV) system frequently results in the death of the patient. Misconnections are commonly attributed to the presence of universal connectors found in the majority of patient care tubing systems. Universal connectors allow for tubing misconnections between physiologically incompatible systems. METHODS: The purpose of this review of case studies of tubing misconnections and of current expert recommendations for safe tubing connections was to answer the following questions: In tubing connections that have the potential for misconnections between enteral and IV tubing, what are the threats to safety? What are patient outcomes following misconnections between enteral and IV tubing? What are the current recommendations for preventing misconnections between enteral and IV tubing? Following an extensive literature search and guided by 2 models of threats and errors, the authors analyzed case studies and expert opinions to identify technical, organizational, and human errors; patient-related threats; patient outcomes; and recommendations. RESULTS: A total of 116 case studies were found in 34 publications. Each involved misconnections of tubes carrying feedings, intended for enteral routes, to IV lines. Overwhelmingly, the recommendations were for redesign to eliminate universal connectors and prevent misconnections. Other recommendations were made, but the analysis indicates they would not prevent all misconnections. CONCLUSIONS: This review of the published case studies and current expert recommendations supports a redesign of connectors to ensure incompatibility between enteral and IV systems. Despite the cumulative evidence, little progress has been made to safeguard patients from tubing misconnections.

Cause-and-effect mapping of critical events.

Health care errors are routinely reported in the scientific and public press and have become a major concern for most Americans. In learning to identify and analyze errors health care can develop some of the skills of a learning organization, including the concept of systems thinking. Modern experts in improving quality have been working in other high-risk industries since the 1920s making structured organizational changes through various frameworks for quality methods including continuous quality improvement and total quality management. When using these tools, it is important to understand systems thinking and the concept of processes within organization. Within these frameworks of improvement, several tools can be used in the analysis of errors. This article introduces a robust tool with a broad analytical view consistent with systems thinking, called CauseMapping (ThinkReliability, Houston, TX, USA), which can be used to systematically analyze the process and the problem at the same time.

Threading needles in the dark: the effect of the physical work environment on nursing practice.

Frequently, the most critical calculations, considerations, and preparations for patient care and medication administration are made in noisy, dimly lit, and chaotic areas of the nursing unit. Healthcare has begun to recognize the impact of the physical work environment plays in the ability of humans to perform reliably and safely. This article reviews the draft guidelines recently released by the United States Pharmacopeia for public comment for the physical environment to promote safe medication administration.

Reexamining fatigue: implications for nursing practice.

A growing body of scientific evidence demonstrates negative effects of fatigue on human performance. Nursing practice encompasses many tasks that require optimal performance. Fatigue can be the result of a multitude of contributing causes. Nurses and nursing leaders must be aware of the causes and effects of fatigue and ensure that its impact is considered where staffing and patient safety intersect.

Tubing misconnections--a systems failure with human factors: lessons for nursing practice.

In a neonatal unit, an experienced nurse inadvertently connected a feeding tube to an intravenous catheter. An analysis of this error, including the historical perspective, reveals that this threat to safety has been documented since 1972. Implications for nursing practice include the redesign of systems to accommodate human factors science and a change in health care's view of vigilance.