Pressure Injury Prevention in Patients with Prolonged ED Stays Prior to Admission.

PURPOSE: The purpose of this project was to examine whether initiating a standardized pressure injury (PI) assessment and prevention protocol early in adult patients' ED stay reduces hospital-acquired PIs (HAPIs) in those patients admitted from the ED to acute care inpatient medical units. METHODS: A nurse-led evidence-based practice team studied the problem of increasing HAPIs on four acute care inpatient units and found that, among patients who had been admitted to inpatient care from the ED, longer ED boarding times correlated with a higher rate of HAPIs. ED staff and acute care unit nurses collaborated to develop new protocols to prevent HAPIs in the ED, including staff education and standardized assessments and prevention care for at-risk patients. Data collection was performed at three time periods over approximately two and a half years: baseline, intervention, and postintervention. RESULTS: The incidence rate for HAPIs decreased from 3.56 per 1,000 patient-days at baseline to 1.31 per 1,000 patient-days during the intervention period. This reduction was sustained over the next five months, during which the HAPI incidence rate was 1.53 per 1,000 patient-days. IMPLICATIONS: At a time when ED length of stay is difficult to manage and continues to increase, the use of evidence-based interventions and protocols can reduce the rate of PIs in high-risk patients waiting for hospital admission, leading to a reduction in PI rates and overall hospital costs.

Achieving American Nurses Credentialing Center Magnet® Designation With a Virtual Site Visit.

Innovation has enabled organizations to highlight and engage during the COVID -19 pandemic. The use of virtual site visits to assess the organizations 's culture and sustainability of the Magnet components during initial designation and redesignation allows for ongoing support of nursing excellence.

Structured Mentorship and the Nursing Clinical Ladder.

When nursing turnover is greater than the national average, professional development of nursing staff increases job satisfaction and employment retention. One approach that can address the professional development is mentoring. PURPOSE: The evidence-based practice (EBP) project's aim was to determine whether a short-term structured mentorship program led by a clinical nurse specialist increased work engagement among staff nurses within 8 to 10 weeks. DESCRIPTION: The EBP project was implemented on 2 adult acute care inpatient units. Using Wagner's caring mentorship model, a mentorship program using the organization's clinical ladder criteria was established where nurses were able to participate and complete selected professional development activities based on personal interests and perceived strengths. The clinical nurse specialist provided guidance and advice based each participant's identified activity. OUTCOME: Since the completion of the initial pilot, the organization has expanded the mentorship program to include mentorship of nursing leaders as well as staff on the clinical units. With this expansion, the organization has trained an additional 167 mentors and has a consistent 27% overall advancement of nurses on the clinical ladder. In addition, advanced practice registered nurses have implemented mentorship as part of their onboarding practice for advanced practice nursing. CONCLUSION: The EBP project demonstrated that a mentorship program using an established clinical ladder can increase elements of work engagement and satisfaction with the mentor and program among hospital nursing staff. Sustaining and expanding the program can facilitate with increased nursing job satisfaction and employee retention.

Compassion Fatigue and Compassion Satisfaction Among Multisite Multisystem Nurses.

Compassion fatigue is a phenomenon that might affect nurses of all specialties. Compassion fatigue occurrence could be profound and costly. The immediate impact could be disruption of the unit culture. This study investigated the prevalence and individual-level factors associated with compassion fatigue among nurses. An upsurge in patients' complexity today may leave nurses stressed with increasing practice demands and vulnerable to compassion fatigue. If ignored, compassion fatigue may compromise nurses' health and care outcomes. A sample of 1174 nurses from 2 large Southern California health care organizations completed an online survey measuring compassion fatigue, burnout, and compassion satisfaction. Overall, participants scored moderate to average (23-41) on compassion satisfaction, burnout, and compassion satisfaction. Experienced and working nights nurses experienced higher compassion satisfaction levels. Higher compassion fatigue means were associated with new graduates = 29.5, BSN nurses = 27.2, ICU nurses = 27.4, and working 12-hour shift nurses = 26.9, suggesting higher compassion fatigue vulnerability. Nurse leaders and managers can apply this baseline evidence to create tailored programs for specific nursing specialties and inexperienced nurses to tackle compassion fatigue and reduce related unit disorder. Seasoned nurses' perspective can be of value in enhancing those efforts.

Operational Failures Detected by Frontline Acute Care Nurses.

Frontline nurses encounter operational failures (OFs), or breakdowns in system processes, that hinder care, erode quality, and threaten patient safety. Previous research has relied on external observers to identify OFs; nurses have been passive participants in the identification of system failures that impede their ability to deliver safe and effective care. To better understand frontline nurses' direct experiences with OFs in hospitals, we conducted a multi-site study within a national research network to describe the rate and categories of OFs detected by nurses as they provided direct patient care. Data were collected by 774 nurses working in 67 adult and pediatric medical-surgical units in 23 hospitals. Nurses systematically recorded data about OFs encountered during 10 work shifts over a 20-day period. In total, nurses reported 27,298 OFs over 4,497 shifts, a rate of 6.07 OFs per shift. The highest rate of failures occurred in the category of Equipment/Supplies, and the lowest rate occurred in the category of Physical Unit/Layout. No differences in OF rate were detected based on hospital size, teaching status, or unit type. Given the scale of this study, we conclude that OFs are frequent and varied across system processes, and that organizations may readily obtain crucial information about OFs from frontline nurses. Nurses' detection of OFs could provide organizations with rich, real-time information about system operations to improve organizational reliability. © 2017 Wiley Periodicals, Inc.

Enhancing leadership orientation through simulation.

Many novice managers feel unprepared to handle some of the situations that occur as a daily part of their job. It is important to provide an environment through which novice managers can receive training and develop skills in effective communication in complex nursing environments. Simulation-based training can provide a safe, interactive way for new managers to develop their communication and leadership skills. This type of training allows novice managers to increase their confidence and improve their job satisfaction and their management skills.