Fellow Designations of Interest to Nurse Leaders.

Achieving fellow designation is commonly a career goal for nurse leaders. The path to achievement can be confusing, and once a goal is set, choosing the right designation is important. This column outlines the background of fellow designation, clarifies differences between fellow designation and other career advancement options, and presents ideas for consideration by nurse leaders as they pursue career advancement through fellow designation.

Global nurse leader perspectives on health systems and workforce challenges.

AIM: As part of the 2011 annual American Organization of Nurse Executives conference held in San Diego, California, a session was presented that focused on nursing workforce and health systems challenges from a global perspective. This article includes content addressed during the session representing nurse leader perspectives from the UK, Singapore and the USA. BACKGROUND: Recent events in global economic markets have highlighted the interdependence of countries. There is now a global focus on health-care costs and quality as government leaders struggle to reduce budgets and remain solvent. EVALUATION: Finding solutions to these complex problems requires that nurse leaders adopt more of a world view and network with one another as they look for best practices and creative strategies. KEY ISSUES: Nursing leadership challenges such as staffing, competency development, ageing populations, reduced health-care funding and maintaining quality are now common global problems. CONCLUSION: There is a need for innovation in nursing practice to accommodate the enormous challenges facing nursing's future. IMPLICATIONS FOR NURSING MANAGEMENT: Opportunities on an international scale for nurse leaders to have dialogue and network, such as the conference presentation discussed in this article, will become increasingly more important to facilitate the development of innovative leadership strategies.

Using portfolios to introduce the clinical nurse leader to the job market.

Development of a portfolio is an effective strategy used by clinical nurse leaders (CNLs) to inform prospective employers of their specialized skills in quality improvement, patient safety, error prevention, and teamwork. The portfolio provides evidence of competence relative to the role of clinician, outcomes manager, client advocate, educator, information manager, systems analyst/risk anticipator, team manager, healthcare professional, and lifelong learner. This article describes the CNL portfolio developed by experts from the University of Tennessee Health Science Center and Methodist LeBonheur Healthcare. Examples of portfolio documents generated throughout the master's entry CNL curriculum are provided, along with student experiences using the portfolio in the employment interview process.

Transforming nursing workflow, part 2: the impact of technology on nurse activities.

OBJECTIVE: To assess the impact of new technology on nurse workflow, nurses at 2 hospitals were observed before and after implementation of an electronic medication charting system. In part 1 (September 2010 issue), we discussed the chaotic nature of nurse activities and its implications on transforming workflow. BACKGROUND: Numerous studies have documented the impact of technology on performance and satisfaction, but technology's impact on the frequency, duration, and pattern of activities is less understood. These patterns are important to the development of new care models. METHODS: Observers shadowed nurses at 2 hospitals before and after the implementation of an electronic medication charting system. A total of 196 hours of observation was recorded at one site, and 185 hours at the other site. RESULTS: Analysis of variance revealed a number of significant differences in the time spent on a variety of activities, but the duration and frequency of nurse activities were not drastically altered by the additional technology. CONCLUSIONS: Computer use increased; however, the impact was evenly distributed among other activities. More importantly, time with patients and verbal communication remained unchanged as nurses seemed to incorporate the new requirements into their normal routine.

Transforming nursing workflow, part 1: the chaotic nature of nurse activities.

OBJECTIVE: To quantitatively measure workflow and computer use, the activities of 27 medical-surgical RNs were recorded through direct observation. BACKGROUND: Previous studies have shown how nurses spend their time but have not documented the pattern, duration, or frequency of activities. The absence of this information is problematic for leaders charged with improving performance and staff development. METHODS: Observers recorded nurse activities and location in real time using predefined lists. More than 98 hours of observations were recorded. RESULTS: Assessment, charting, and communicating were the most frequent activities, consuming 18.1%, 9.9%, and 11.8% of nurse time, respectively. The duration of 40% of the activities was less than 10 seconds. Timelines revealed that nurses constantly switch activities and locations in a seemingly random pattern. CONCLUSION: The results indicate that there is little "flow" in nurse workflow. The chaotic pace implies that nurses rarely complete an activity before switching to another. The opportunity to use critical thinking and engage in planning care is severely limited under these circumstances. The implications for cognition and role transformation are discussed. Part 2 of this research explores the impact of new technology on nurse activities and workflow.

Designing a patient care model with relevance to the cultural setting.

Healthcare leaders are challenged to develop new approaches to care that better serve populations and use valuable resources in more effective and efficient ways. The authors discuss a model of care under development at Sidra Medical and Research Center, Qatar, with emphasis on how to translate the best available evidence in a way that is applicable and meaningful for the cultural setting. Strategies that nurse leaders can call upon to engage their team members' cultural intelligence during the planning and design of new processes of care are also discussed.