The Relationship between Nursing Leadership and Patient Readmission Rate: A Systematic Review.

BACKGROUND: Nurse leaders play a fundamental role in improving patient quality care delivery, thus improving patient clinical outcomes. PURPOSE: This systematic review examined the knowledge to date of nursing leadership on reducing patient readmission rates. METHODS: A literature review was conducted using seven electronic databases: Medline Ovid, PubMed, Cumulative Index to Nursing and Allied Health (CINAHL) Plus, Emerald, PsycINFO, ABI/INFORM collection, and EBSCO, with the addition of references for relevant papers reviewed. FINDINGS: The search resulted in a total of 15 articles. Findings revealed that leadership practices of nurses have an impact on reducing patient readmission rates. CONCLUSIONS: The results suggest a need for further rigorous studies investigating the mechanism of how nursing leadership relates to patient readmission rates and how to translate this into practice across diverse cultures.

Factors influencing nurses' willingness to lead.

AIM: To identify factors influencing nurses' willingness to lead. BACKGROUND: Given the ageing workforce and the projected retirement of nurse leaders, there is a concern about nursing leadership shortages in the next decade. Several studies have shown that nurses are not interested in pursuing leadership positions, but studies investigating nurses' willingness to lead and related predictors remain limited. METHODS: A workforce survey of 1,201 direct-care nurses was conducted in Oregon. Logistic regression modelling was used to identify factors influencing the likelihood of nurses' willingness to lead. RESULTS: Fifty-three percent of nurses were willing to pursue leadership roles. Years of experience, job burnout, the perception of the work environment, adequacy of leadership preparation, and the amount of salary and compensation were significant predictors of nurses' willingness to lead. CONCLUSION: Increasing nurses' participation in hospital affairs and providing adequate leadership preparation, parts of the work environment, prior to engaging them in leadership roles is recommended to improve their attitudes about leading. IMPLICATIONS FOR NURSING MANAGEMENT: Recruitment of future nursing leaders should not be based solely on demographics such as age and gender. Rather, recruiters should focus on creating more favourable work environments in which to lead.

Psychometric analysis of the leadership environment scale (LENS): Outcome from the Oregon research initiative on the organisation of nursing (ORION).

AIM: The purpose of this study was to establish the psychometric properties of the new 16-item leadership environment scale. BACKGROUND: The leadership environment scale was based on complexity science concepts relevant to complex adaptive health care systems. METHODS: A workforce survey of direct-care nurses was conducted (n = 1,443) in Oregon. Confirmatory factor analysis, exploratory factor analysis, concordant validity test and reliability tests were conducted to establish the structure and internal consistency of the leadership environment scale. RESULTS: Confirmatory factor analysis indices approached acceptable thresholds of fit with a single factor solution. Exploratory factor analysis showed improved fit with a two-factor model solution; the factors were labelled 'influencing relationships' and 'interdependent system supports'. Moderate to strong convergent validity was observed between the leadership environment scale/subscales and both the nursing workforce index and the safety organising scale. Reliability of the leadership environment scale and subscales was strong, with all alphas ≥.85. CONCLUSIONS: The leadership environment scale is structurally sound and reliable. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing management can employ adaptive complexity leadership attributes, measure their influence on the leadership environment, subsequently modify system supports and relationships and improve the quality of health care systems. The leadership environment scale is an innovative fit to complex adaptive systems and how nurses act as leaders within these systems.

An approach to shorten time to infarct artery patency in patients with ST-segment elevation myocardial infarction.

We developed a regional strategy to decrease the time to percutaneous coronary intervention (PCI) for patients with acute ST-segment elevation myocardial infarction (STEMI). Protocols were created for paramedics and referring hospitals to identify and directly triage all patients with STEMI to a single PCI center. Time to PCI reperfusion and in-hospital mortality were assessed in 233 consecutive patients with STEMI. Ninety-minute initial hospital door-to-patent infarct artery was achieved in 58.3% of paramedic-diagnosed and directly triaged patients compared with 37.5% of "walk-ins" to the PCI hospital and with only 5.2% of those transferred from another hospital emergency department (ED; p <0.001). Overall in-hospital mortality was 2.1%, 0% in paramedic identified patients, and 0% in those walk-ins to the PCI hospital ED compared with 4.3% for those transferred from a referring hospital ED (p = 0.007). Paramedic diagnosis of STEMI and direct triage to a prealerted interventional hospital for primary PCI was associated with a high percentage of patients achieving <90-minute infarct artery patency. Substantial delays remained for those who presented initially to a non-PCI hospital ED despite the expedited protocol. In conclusion, this observational study suggests that wider use of paramedic electrocardiographic STEMI diagnosis and direct triage to a prealerted PCI hospital catheterization team may help improve outcomes of patients with STEMI.