Driving Organizational Change From the Bedside: The AACN Clinical Scene Investigator Academy.

BACKGROUND: Staff nurses are pivotal in leading change related to quality improvement efforts, although many lack skills to steer change from the bedside. The American Association of Critical-Care Nurses (AACN) staff nurse leadership program, Clinical Scene Investigator (CSI) Academy, teaches and empowers staff nurses in leadership skills and change concepts to translate evidence into practice affecting patient outcomes. OBJECTIVES: To describe the curriculum of the AACN CSI Academy that provides staff nurses with the leadership skills required to create unit-based change projects that positively impact patient/family outcomes. METHODS: The curriculum of the Academy included leadership topics, communication, change concepts, quality improvement methods, project management, and data management and analysis. Each team of participants collected project data to show improvements in patient care. The program evaluation used many data sources to assess the program effectiveness, relating to the professional growth of the participant nurses. The participants assessed project patient outcomes, sustainability, and spread. RESULTS: The first cohort of CSI participants included 164 direct care nurses from 42 hospitals in 6 cities. They rated the Academy highly in the program evaluation, and they reported that the Academy contributed to their professional development. The individual hospital quality improvement projects resulted in positive patient and estimated fiscal outcomes that were generally sustained 1 year after the program. CONCLUSION: With the skills, tools, and support obtained from participation in the CSI Academy, staff nurses can make substantial contributions to their organizations in clinical and possibly fiscal outcomes.

From the Team to the Table: Nursing Societies and Health Care Organizational Ethics.

Health care work is interprofessional work. Nurses and physicians, members of the professions whose close collaboration is foundational to health care delivery, continue to be educated separately in most academic institutions. Their work also is organized in ways that challenge interprofessional collaboration. Understanding workplace realities faced by nurses and physicians, separately and jointly, is a starting place for exploring how to support ethically sound interprofessional work. In this essay, we look most closely at the work of nurses and physicians who care for seriously ill hospitalized patients, a patient population closely associated with ethical challenges.

Critical care nurse work environments 2013: a status report.

BACKGROUND: The health of critical care nurse work environments has been shown to affect patient care outcomes as well as the job satisfaction and retention of registered nurses. The American Association of Critical-Care Nurses (AACN) Critical Care Nurse Work Environment Survey was first conducted in 2006 following the release of the AACN Standards for Establishing and Sustaining a Healthy Work Environment and was conducted again in 2008. This article reports the results of the third AACN Critical Care Nurse Work Environment Survey conducted in 2013. OBJECTIVE: To evaluate the current state of critical care nurse work environments. METHODS: A total of 8444 AACN members and constituents responded to an online survey. RESULTS: The overall health of critical care nurses' work environments has declined since 2008, as have nurses' perceptions of the quality of care. Respondents rated their overall work environment and factors associated with healthy work environments including quality of patient care, staffing, communication and collaboration, respect, physical and mental safety, moral distress, nursing leadership, support for certification and continuing education, meaningful recognition, job satisfaction, and career plans. Although some factors improved, declines in any factors are a concern. CONCLUSIONS: An increasing body of evidence has shown relationships between healthy nurse work environments and patient outcomes. The results of this 2013 survey identified areas in which the health of critical care nurse work environments needs attention and care, requiring the relentless true collaboration of everyone involved.

Critical care staff nurses: empowerment, certification, and intent to leave.

BACKGROUND: Certification is a voluntary process that is used to recognize specialized knowledge and skills. Little research has been focused on staff nurses with specialty certification. OBJECTIVE: To determine if perceptions of empowerment and intent to leave the position and the profession differed among staff nurses who were certified by the American Association of Critical-Care Nurses, nurses certified by other certifying organizations, and nurses who were not certified. METHODS: A comparative descriptive study was used to analyze the results of a 2007 to 2008 Web-based survey of members of the association. Data were available on 4268 staff nurses. RESULTS: Total empowerment scores and intent to leave either the position or the profession did not differ between nurses who were certified and those who were not. However, perceptions of informal power, opportunity, and support did differ between the 2 groups. CONCLUSIONS: The differences between nurses who were certified and those who were not may be related to variables other than certification. Further research and theoretical model testing is needed to determine the value of certification.

Certification, empowerment, and intent to leave current position and the profession among critical care nurses.

BACKGROUND: This study was based on the American Association of Critical-Care Nurses' (AACNs') interest in determining the value and influence of specialty certification. OBJECTIVES: To examine relationships between AACN specialty certification and empowerment, and, secondarily, to examine these variables as related to intent to leave the current position and the nursing profession. METHODS: AACN members were asked to participate in a Web-based survey; 6589 AACN members completed the surveys. RESULTS: Perceptions of empowerment differed significantly among nurses certified by AACN and nurses without such certification. Additional analyses revealed significant differences in empowerment related to position, education, salary, ethnicity, sex, intent to leave the current position, and intent to leave the profession. Forty-one percent of the participants indicated intent to leave their current position in the next year; only 6.9% indicated their intent to leave the profession in the next year. Intent to leave current position differed significantly according to age, sex, years of experience, ethnicity, educational level, and certification. CONCLUSIONS: The value of specialty certification and the importance of empowerment among critical care nurses are affirmed. The next step in the continued journey toward increasing retention of critical care nurses, and thereby improving patient care, is to evaluate existing programs focused on retention and identify needed enhancements.