State-of-the-art patient care. The impact of doctorally prepared clinical nurses.

Delivery of state-of-the-art patient care requires new models to foster the development of professional nurses and integrate practice, research, and education. The Chief Nursing Officer of University Hospital/Associate Dean of the College of Nursing at a tertiary health science center positioned doctorally prepared nurses in clinical practice settings to assist in actualizing a vision of state-of-the-art patient care. Strategic targets for performance improvement included building collaboration between the college and hospital, supporting advanced education for nurses, moving the nursing culture from one of co-dependence to one of professionalism, fostering research at the unit level, and capitalizing on the strengths of nurse leaders. Creating an environment where staff nurses use critical thinking skills and access their advanced practice nurse (APN) resources as they do their work has been a win-win-win situation for the patients, the hospital, and the college at the health science center.

Training future leaders of academic medicine: internal programs at three academic health centers.

The authors review the need for internal programs for leadership training at academic health centers and then describe in detail three programs of this type that have operated during the 1990s: (1) the Allegheny Leadership Institute, founded by the Allegheny Health, Education and Research Foundation, Pittsburgh, Pennsylvania; (2) the Physician Executive Management Development Program (PEMDP) of Saint Louis University School of Medicine; and (3) the University of Nebraska Medical Center Leadership Institute. Educational elements common to these programs include having a small class size and participants from many areas of academic medicine and health care, focusing on educational strategies that draw on participants' experiences and training, conducting the training away from the participants' institutions, having short sessions, using faculty from both within and outside the participants' institutions, and creating strategies to reinforce learning. Lessons learned reflect the unique context of each institution; the authors list the major lessons learned by each of the three programs they surveyed (e.g., leaders of the Saint Louis University PEMDP program believe that it is important to help participants implement desired changes in their work areas once they return to work, and are investigating how to do this). The authors conclude with an extensive list of recommendations to optimize the effects of leadership development training carried out in AHCs' internal programs (e.g., "Focus on specific skills that can be learned, and link the learning experiences to real work situations in health care and higher education") and explain why they think internal leadership institutes have at least three distinct advantages over external programs.

A nursing fellowship--building leadership skills.

A postgraduate nursing fellowship helps future nursing leaders deal with constant change, focus on learning and development, think systemically and mobilize resources through team building and goal directedness. An administrative fellowship program helps to develop future leaders, with the skills necessary to assume key positions in health care. Core competencies--leadership criteria, roles of the fellow and preceptor, skills of the fellow and preceptor and fellowship projects--are described.

Layoff survivor sickness. Minimizing the sequelae of organizational transformation.

In 1991, our University Hospital initiated a series of strategic changes designed to increase organizational effectiveness and efficiency, foster a culture of commitment to customer-driven service, and flatten the organizational structure, pushing decision making closer to the point of service. These events, although proactive and positive in their intent, triggered a significant, debilitating response among many members of the nursing staff. The authors discuss the experience of this organization, examines the process of transition and the responses of staff members to change, and provides recommendations for minimizing the sequelae of organizational transformation.

A nursing camp--a multi-agency cooperative effort.

A summer nursing camp for junior and senior high school youth, planned and implemented by a multi-agency advisory group, demonstrates one way to attract future nurses into the profession. To effectively solve the problem of the nurse shortage, the efforts of nurse administrators in education and practice must be coordinated.

A meta-analysis of effects of heparin flush and saline flush: quality and cost implications.

The purpose of this meta-analysis was to estimate the effects of heparin flush and saline flush solutions on maintaining patency, preventing phlebitis, and increasing duration in peripheral heparin locks. The average effect size (d value) across 15 studies with a total sample size of 3,490 was .0573 for patency (clotting). The 95% credibility interval ranged from -.2267 to .3413. The average effect size across 13 studies with a total sample size of 2,356 was -.0757 for phlebitis. The 95% credibility interval ranged from -.2497 to .0983. The average effect size for duration across six samples with a total sample size of 1,960 was -.0550. The 95% credibility interval ranged from -.2424 to .1324. It can be concluded that saline is as effective as heparin in maintaining patency, preventing phlebitis, and increasing duration in peripheral intravenous locks. Quality of care can be enhanced by using saline as the flush solution, thereby eliminating problems associated with anticoagulant effects and drug incompatibilities. In addition, an estimated yearly savings of $109,100,000 to $218,200,000 U.S. health care dollars could be attained.

Occupational health hazards of hospital staff nurses. Part II: Physical, chemical, and biological stressors.

Physical and environmental hazards commonly found in hospitals include slippery floors, electrical hazards, noise, poor lighting, and inadequate ventilation. Describing the extent of musculoskeletal injury in nurses, one survey showed that nurses lost 750,000 working days a year as a result of back pain, which is twice the national average. Most workplace exposures do not result in disease, because either the biohazard is not transmitted by the airborne route or because the agent is present in too low of a dose. The more nurses know about potential occupational health and safety hazards, the more successful they will be in reducing risks, avoiding accidents, and minimizing occupational stressor outcomes.

Occupational health hazards of hospital staff nurses. Part I: Overview and psychosocial stressors.

1. In the health care environment, occupational stressors may be physical, chemical, biological, or psychosocial. 2. Psychosocial stressors include physical and mental overload, job insecurity, role ambiguity, a client population with anxiety or fear, and poorly designed work schedules. 3. Stress can be an occupational hazard because it arises from the environment, and may lead to accidents or injuries. 4. Psychosocial stressors will become increasingly important as the hospital environment demands more of nurses.

Marketing women's health care.

Women's health care is a growing component of the health care business. Developing women's health services can offer hospitals and clinics the opportunity to generate greater revenue and gain the competitive edge. The nurse executive plays a critical role in the development of marketable women's health services.

Nonobstetric surgery during pregnancy.

Women who require nonobstetric surgery during their pregnancy, regardless of the date of gestation, present a complicated and enigmatic clinical picture for the nurse. The clinical picture is challenging by virtue of the existence of pregnancy, compounded by the implications of surgical disease. The impact of surgery on the mother and fetus is described. Information on how the physiologic changes of pregnancy interact with surgical processes and nursing interventions to improve the outcome of surgery are presented.