Differentiating nursing leadership and management competencies.

As the foundation of evaluating content for nursing leadership and administration courses, leadership and management competencies were identified from a literature review of 140 articles published between 2000-2004. Similarities and differences among the competencies were assessed. A large intersection of common competencies was discovered, indicating a lack of discrimination between leadership and management competencies. Arguably, this fusion ignores the different purposes served by leadership and management. Alternately, the convergence of leadership and management competencies might reflect that traditional distinctions have narrowed. Nevertheless, ambiguity persists regarding essential leadership and management competencies and the way they are reflected in nursing curricula. If concerns about the work environment are to be remedied for patients and staff, nurse educators are urged to act quickly to identify requisite competencies and better align course content with them. This will better prepare nurse administrators to succeed in their arduous work.

Barriers and enablers to changing organizational culture in nursing homes.

PURPOSE: To discuss the barriers and enablers of changing organizational culture in 3 nursing homes undergoing a culture change initiative, and suggest actions for program enhancement. METHODS: Interview data with staff (n = 64) and families (n = 14) from 3 culture-change facilities in a larger mixed-methods pilot study were used to identify barriers and enablers. FINDINGS: The 3 sites ranged from 120 to 139 beds and did not differ in staff characteristics. Barriers included exclusion of nurses from culture-change activities, perceived corporate emphasis on regulatory compliance and the "bottom line," and high turnover of administrators and caregivers. Enablers included a critical mass of "change champions," shared values and goals, resident/family participation, and empowerment at the facility level. RECOMMENDATIONS: Involve all levels of staff, residents, and community in culture-change activities. Align incentives and rewards with the new values. Empower individual homes to make decisions at the facility level. Work with corporate partners to enable rapid translation and implementation of recommendations based on the findings.

The relationship between nurse staffing and patient outcomes.

OBJECTIVES: To examine the association between in-hospital mortality and four nurse staffing variables-the ratio of total nursing staff to patients, the proportion of RNs to total nursing staff, the mean years of RN experience, and the percentage of nurses with bachelor of science in nursing degrees. BACKGROUND: Studies suggest that nurse staffing changes affect patient and organizational outcomes, but the impact of nurse staffing on patient outcomes has not been studied sufficiently and the results of the previous studies are equivocal. Additionally, the studies of the relationship between nurse staffing and patient outcomes or the impact of nurse staffing on patient outcomes had not been previously examined in Thailand. METHODS: A retrospective, cross-sectional, observational research design was employed to study the research questions. Data of 2531 patients admitted to seven medical units and 10 surgical units of a 2300-bed university hospital in Thailand was used. All data of patients admitted to this hospital with four common groups of principal diagnoses (diseases of the heart, malignant neoplasms [cancer of all forms], hypertension and cerebrovascular diseases, and pneumonia and other diseases of the lung) was extracted from patient charts and discharge summaries in the calendar year 1999. Nurse staffing variables for each nursing unit in 1999 came from nursing service department databases. Multivariate logistic regression was used to determine the relationship between nurse staffing variables and in-hospital mortality. RESULTS: The findings of this study revealed that the ratio of total nurse staffing to patients was significantly related to in-hospital mortality in both partial and marginal analyses, controlling for patient characteristics. In addition, the ratio of total nursing staff to patients was found to be the best predictor of in-hospital mortality among the four nurse staffing variables, controlling for patient characteristics. The study did not find any significant relationship between in-hospital mortality and three nurse staffing variables (the proportion of RNs to total nursing staff, the mean years of RN experience, and the percentage of bachelor degree prepared nurses) probably due to the low variation of these variables across nursing units or because they may have correlated with other variables. CONCLUSIONS: The findings of this study add to our understanding of the importance of nurse staffing and its relationship to the patient outcome of hospital mortality. Further, the findings also provide information for hospital and nursing administrators to use when restructuring the clinical workforce, revising hospital policies, or making contractual decisions on behalf of nursing and public beneficiaries.