Driving Organizational Change From the Bedside: The AACN Clinical Scene Investigator Academy.

BACKGROUND: Staff nurses are pivotal in leading change related to quality improvement efforts, although many lack skills to steer change from the bedside. The American Association of Critical-Care Nurses (AACN) staff nurse leadership program, Clinical Scene Investigator (CSI) Academy, teaches and empowers staff nurses in leadership skills and change concepts to translate evidence into practice affecting patient outcomes. OBJECTIVES: To describe the curriculum of the AACN CSI Academy that provides staff nurses with the leadership skills required to create unit-based change projects that positively impact patient/family outcomes. METHODS: The curriculum of the Academy included leadership topics, communication, change concepts, quality improvement methods, project management, and data management and analysis. Each team of participants collected project data to show improvements in patient care. The program evaluation used many data sources to assess the program effectiveness, relating to the professional growth of the participant nurses. The participants assessed project patient outcomes, sustainability, and spread. RESULTS: The first cohort of CSI participants included 164 direct care nurses from 42 hospitals in 6 cities. They rated the Academy highly in the program evaluation, and they reported that the Academy contributed to their professional development. The individual hospital quality improvement projects resulted in positive patient and estimated fiscal outcomes that were generally sustained 1 year after the program. CONCLUSION: With the skills, tools, and support obtained from participation in the CSI Academy, staff nurses can make substantial contributions to their organizations in clinical and possibly fiscal outcomes.

The clinical scene investigator academy: the power of staff nurses improving patient and organizational outcomes.

Nurses are in a key position to have an impact on the national quality agenda. However, many lack the quality and safety methods to lead this work. The Clinical Scene Investigator Academy provided 23 nurses from 7 regional hospitals with the knowledge and support necessary to implement nurse-led quality improvement projects. Not only did each Clinical Scene Investigator project improve patient and/or staff outcomes but 3 such projects also had a significant economic impact.

Developing and testing a clinical information system evaluation tool: prioritizing modifications through end-user input.

OBJECTIVE: The objectives were to develop and validate the Information System Evaluation Tool (ISET), use feedback to modify the institution's clinical information system (CIS), and determine the modifications' success. BACKGROUND: The ability of a CIS to increase patient safety and care quality is dependent on its systems and processes. A survey was needed to provide the specificity necessary to make meaningful system improvements. METHODS: The ISET was pilot tested and revised before being administered before implementation of the CIS. It was administered at 2 times after implementation. The ISET was revised after analysis of the results, and comparisons were made between the times. RESULTS: The ISET is a valid and reliable instrument. Perceptions of the CIS initially decreased, but had significantly improved by 16 months after implementation. CONCLUSIONS: End-users must be convinced that the CIS supports their practice and improves care for adoption to be successful. The ISET measures these perceptions and highlights areas for improvement.

Development and testing of an organizational job satisfaction tool: increasing precision for strategic improvements.

OBJECTIVE: This article describes the development and testing of a new instrument that measures organizational job satisfaction (OJS). BACKGROUND: Nurse satisfaction includes 2 different types of satisfaction: OJS and professional work satisfaction. To obtain valid results, each type must be measured correctly. METHODS: A metasynthesis of OJS was conducted from 3 sources: nurse satisfaction instruments, attributes present in recruitment advertisements, and nursing comments from a national survey. A cross-walk of these sources provided 17 consistent OJS satisfiers. A survey of 10,000 nurses identified the importance of these satisfiers. RESULTS: Cronbach α for the scale was .85. The satisfiers were grouped into 3 categories: universally important, moderately important, and unimportant. CONCLUSIONS: A synthesis from 3 sources, including identification of important satisfiers, provides validity for the OJS scale. The scale is a reliable and valid tool used to assess and evaluate strategies to improve the nurses' work environment.

Nurse-driven programs to improve patient outcomes: transforming care at the bedside, integrated nurse leadership program, and the clinical scene investigator academy.

As the national quality agenda continues to be a key driver in healthcare, more programs are being developed to teach staff nurses how to lead quality change projects. Nurses are in a unique position to do this work; however, they may lack project management and leadership skills to do so. The authors provide a content analysis that compares and contrasts 3 such programs.

Planning and creating a new bi-state nursing workforce center through unique partnerships.

Multiple strategies are needed to address the complex issues related to the nursing shortage. It is not enough to focus on increasing the number of students in the pipeline unless this is met with complimentary work to improve the professional practice environments of nursing staff. In addition, nurse-driven improvement projects that address specific patient and organizational outcomes will elevate the role of nurses from trusted professional to quality agents. The authors describe a partnership that has launched a new type of workforce center with core missions to create work environment improvements and point-of-care change led by staff nurses.

Nursing: key to quality improvement.

Nurses and effective nursing care contribute to quality patient outcomes. This article explains in detail the importance of nursing care in the quality agenda and explores the existing gaps in this field of science. Key stakeholders and groups that advocate and focus on specific quality agendas within the field of pediatrics are briefly described. Pediatric health care uses a multidisciplinary model of delivery; each discipline uses specific domains of knowledge and interventions, making it difficult to separate them when evaluating patient outcomes. Much work needs to be conducted using health services research approaches that link and partition the overall and combined contribution of discipline-specific providers.

Differences between pediatric registered nurses' perception of organizational support, intent to stay, workload, and overall satisfaction, and years employed as a nurse in magnet and non-magnet pediatric hospitals: implications for administrators.

Much is understood about the issues that nurses believe impact their work environment and how Magnet hospitals have better organizational and patient outcomes. The majority of these large-scale studies have not included large numbers of nurses who care for children. In addition, we know little about how nurses perceive their work environment as their years in nursing increase. This study used a secondary analysis of survey responses from pediatric staff nurses to determine (1) whether there were differences in nurses' perceptions of organizational support, workload, intent to stay, and overall satisfaction within Magnet and non-Magnet hospitals, and (2) whether there were differences in these responses as the years in nursing increased. Findings indicate that Magnet nurses perceive a better work environment than do nurses from non-Magnet hospitals, and that for nurses in their first year as a nurse and for those nurses who have been a nurse for 15 years or longer believe their work environment is more supportive. The implications for nurse administrators include finding ways to keep new nurses engaged and satisfied after that initial "honeymoon" feeling about their new profession as well as providing further evidence of the value Magnet provides an institution.

Enhancing the work environment of staff nurses using targeted interventions of support.

Nurse executives continue to search for ways to support their staff nurses through enhancing their work environment to promote professional practice environments. Given that not all hospitals have the intensive resources necessary to pursue Magnet Recognition certification or the Texas Nurses Association's Texas Nurse-Friendly Hospital program designation, this does not prohibit them from pursuing specific components adapted for their own institution. The authors discuss 3 programs to enhance the work environment through increased professional practice. The rationale for these programs, preimplementation and postimplementation are explained.

Secondary analysis of merged American Hospital Association data and U.S. Census data: beginning to understand the supply-demand chain in pediatric inpatient care.

Much attention has been focused on how the nursing shortage will impact the growing number of aging Americans. This study was conducted as a first step in understanding nursing supply relative to potential pediatric demand using merged data from the American Hospital Association's annual survey and Census data by state from the year 2000. Findings indicate that there is tremendous variability among reporting states related to estimated pediatric nurses (registered nurse full-time equivalents), potential pediatric demand (persons from birth to 18 years), and allocated pediatric beds. Future research will examine how this supply-demand chain impacts clinical and cost outcomes for pediatric patients.

Differentiating the workplace needs of nurses by academic preparation and years in nursing.

Questions surrounding the optimal level of academic preparation for nurses entering the workforce appear to be nearing consensus. However, in most organizations, the existing nursing workforce includes nurses of various ages, amounts of experience, and levels of academic preparation. All nurses serve an important role in caring for patients. The objective of this study was to determine if differences in work environment perceptions exist for nurses with different levels of academic preparation but similar years of experience in nursing. Mean values of work environment perceptions were compared between associate degree nurses and bachelor of science nurses with equivalent years in clinical practice using univariate statistics. Bachelor of science nurses reported similar or more positive work environment perceptions across all levels of professional experience as compared with associate degree nurses. The largest difference in perceptions between the two groups was seen in nurses with more than 15 years of professional experience. In this group, bachelor of science nurses reported more positive perceptions of peer support, unit support, workload, and overall nursing satisfaction. Intent to stay was not different between the groups considered. The results of this study suggest that efforts to expand nurses' access to baccalaureate programs may have positive implications for professional nursing and the work environment.