A practical approach to establishing a critical care outreach service: An expert panel research design.

BACKGROUND: For over two decades, nurse-led critical care outreach services have improved the recognition, response, and management of deteriorating patients in general hospital wards, yet variation in terms, design, implementation, and evaluation of such services continue. For those establishing a critical care outreach service, these factors make the literature difficult to interpret and translate to the real-world setting. AIM: The aim of this study was to provide a practical approach to establishing a critical care outreach service in the hospital setting. METHOD: An international expert panel of clinicians, managers, and academics with experience in implementing, developing, operationalising, educating, and evaluating critical care outreach services collaborated to synthesise evidence, experience, and clinical judgment to develop a practical approach for those establishing a critical care outreach service. A rapid review of the literature identified publications relevant to the study. A modified Delphi technique was used to achieve expert panel consensus particularly in areas where insufficient published literature or ambiguities existed. FINDINGS: There were 502 publications sourced from the rapid review, of which 104 were relevant and reviewed. Using the modified Delphi technique, the expert panel identified five key components needed to establish a critical care outreach service: (i) approaches to service delivery, (ii) education and training, (iii) organisational engagement, (iv) clinical governance, and (v) monitoring and evaluation. CONCLUSION: An expert panel research design successfully synthesised evidence, experience, and clinical judgement to provide a practical approach for those establishing a critical care outreach service. This method of research will likely be valuable in other areas of practice where terms are used interchangeably, and the literature is diverse and lacking a single approach to practice.

Business acumen for nursing leaders: An exploratory qualitative study.

AIM: The aim of this study was to explore the status of and need for business acumen of nurse leaders. BACKGROUND: Health systems globally continue to reform to deliver better care while working within sustainable budgets. However, beyond leadership and management expertise, nurse leaders need strong business acumen to appreciate the complexity of the system. METHOD: Two groups, emerging nurse leaders and established health system leaders, were interviewed for their perspective on four elements related to business acumen. RESULTS: Business in healthcare was defined and therefore valued with variation across both groups. Adequate business education for nurse leaders was considered lacking by both groups. Inconsistent business acumen was seen as a barrier for nursing inclusion at the system level. CONCLUSIONS: Business acumen is a skillset more valuable for the nursing profession than the current educational preparation allows, creating a reputational barrier for nursing's full participation in health system-level leadership, but is considered an opportunity for the future. IMPLICATIONS FOR NURSING MANAGEMENT: Improving the foundation business acumen across the nursing profession will not only raise the profile of nurse leader capability to input and influence across the health system but also improve the wider nursing team's understanding around nurse leader advocacy and decision making.

Business acumen for nursing leaders: A scoping review.

AIM: The aim of this study is to explore the current evidence on business acumen of nurse leaders. BACKGROUND: Health systems across the world are under immense pressure to stay solvent, maintaining services within a defined budget as we recover from the COVID-19 pandemic. Effective nurse leaders not only need to have strong leadership and management skills but also strong business acumen to navigate the complexity of the system. EVALUATION: A scoping review of research was undertaken, using preferred reporting items for systematic reviews and meta-analyses (PRISMA) scoping extension checklist, with 571 studies found across multiple databases, 17 meeting final review eligibility. KEY ISSUES: Findings were noted surrounding three themes: the value of business acumen in nursing, the gaining of business acumen in health care as a nursing leader and the utilizing business acumen as a nurse leader in the health care industry. CONCLUSION: While nursing leadership and management were well researched, limited studies covered the specific focus of business acumen in health care for nurses or broader clinicians. IMPLICATIONS FOR NURSING MANAGEMENT: While evidence points towards business acumen being important for health care leaders in balancing care and cost, inadequate research limits the recognition of these professional capabilities of nurse leaders. Further understanding could inform future policy and curriculum, as well as empower our next generation of clinicians.

Business acumen for nursing leaders, optional or essential in today's health system? A discussion paper.

Background: Over the last number of years, the healthcare system has become more complex in managing increasing costs and outcomes within a defined budget. To be effective through reform, especially moving forward from the COVID-19 pandemic, healthcare leaders, specifically in nursing, have an increased need for business acumen beyond traditional leadership and management principles. Aim: This paper examines the concept of business acumen in the profession of nursing, specifically for managers and higher nurse leaders, establishing whether these skills are optional or essential. Discussion: Nurses learn and develop broad skills in leadership and management, but less specifically about business or the broader system. With a contemporary Australian health system aiming to be more effective, nurses may require a greater level of business acumen to adequately understand the mechanics of business decision making in the system when designing care models, as well as representing the business potential of nursing in balance with clinical outcomes through reform. Conclusion: The modern nurse, in addition to clinical skills, may need a foundational understanding of business evolving throughout their career, to maximise innovative growth across the system, in meeting the healthcare needs of our community now and into the future. Without a foundation level of business acumen and an understanding of the system across the profession, nurses may not be empowered with their full potential of being a strong voice influencing health system reform.

The Crucial Role of Nurses and Social Workers in Initiating End-of-Life Communication to Reduce Overtreatment in the Midst of the COVID-19 Pandemic.

The large scale and rapid spread of the current COVID-19 pandemic has changed the way hospitals and other health services operate. Opportunities for patient-centered decision-making at the end of life are being jeopardized by a scarcity of health system resources. In response, the traditional doctor-initiated advanced care planning (ACP) for critical illness may also need to be readjusted. We propose nurse-led and allied health-led ACP discussions to ensure patient and family inclusion and understanding of the disease prognosis, prevention of overtreatment, and potential outcomes in crisis times. We highlight known barriers and list enablers, long-term and short-term opportunities to assist in the culture change.

Nurse practitioner succession planning: forward thinking or just an after-thought?

This paper examines the concept of backfill and succession planning for an elite speciality nursing group, nurse practitioners. Nurse practitioners work in many public, private, inpatient and outpatient settings across the country. This discussion is relevant to all practicing nurse practitioners, but especially those with their own specific patient group. A nurse practitioner is an elite nursing specialist with specific speciality skills. While present, nurse practitioners can be most effective at holistically managing their patient group. However, if an endorsed nurse practitioner is no longer present, for a short or long interval, their specific skills and abilities cannot be easily substituted or replaced in the short term. This potential compromise in patient care can be detrimental to the developing reputation of the role of the nurse practitioner. In order to address the shortage of specifically skilled nurse practitioners across the country in all specialties, there is a need to forward plan and consider contingencies for succession in the event of short- or long-term absences from the clinical environment. Succession planning is the key to patient safety and the successful implementation of the role of the nurse practitioner.

Emergency nurse as hospital clinical team coordinator--shining a light into the night.

BACKGROUND: The Clinical Team Coordinator (CTC) is a senior experienced nurse from the Emergency Department (ED) that provides an after-hours clinical supervision and liaison service for the entire hospital. The role guides and supports nursing and junior medical staff regarding clinical and hospital procedures, protocols and individual patient problems and assists with clinical issues on the wards such as patient assessment and management. METHOD: Following a qualitative evaluation of the CTC role in 2009, the scope of activity and impact on clinical services after hours was established through shift data collation and analysis during the calendar year 2011. RESULTS: In 2011, the CTC was directly involved with 18,165 occasions of care across the evening and night shift periods, with only one third of these calls requiring Resident Medical Officer (RMO) attention. The CTC role reviews patients, provides support and advice, facilitates impromptu education and learning, as well as assists nursing and medical staff with difficult and complex clinical tasks. CONCLUSION: Senior clinical nursing support from the CTC has been well received from nursing and medical staff and the role is now a permanently established in the hospital.