Nurse turnover in the Kingdom of Saudi Arabia: An integrative review.

AIM: To appraise and synthesise existing literature on nurse turnover in the Saudi Arabian context. BACKGROUND: Saudi Arabia is notably one of the nations with a health care system that is bombarded by high rates of turnover and turnover intention. Moreover, rapid population growth and the expansion of the health care system increase the demand on registered nurses in the kingdom. EVALUATION: Eleven primary sources were reviewed using Whittemore and Knafl's (Journal of Advanced Nursing, 2005; 52, 546-553) integrative review method. KEY ISSUES: There is variation in the reported turnover rates across the studies. The identified determinants of nurse turnover in the Saudi Arabian context included nurses' demographics, satisfaction, leadership and management, and job-related factors. CONCLUSION: There is a need for more studies that focus on the cost and outcome of nurse turnover and turnover intention in the Saudi Arabian context. IMPLICATIONS FOR NURSING MANAGEMENT: The review highlights the alarming rates of nurse turnover and its determinants in Saudi Arabia. Nurse managers in Saudi Arabia should consider this information, as they make daily assignments.

Nursing Administration Research Priorities: Findings From a Delphi Study.

OBJECTIVE: The aim of this study is to determine the priorities for nursing administration research (NAR) in the United States. BACKGROUND: Previously known as the Council of Graduate Educators in Administrative Nursing, CGEAN provides an avenue for researchers and educators focused on NAR to partner, dialogue, obtain funding resources, and present their findings at a biennial International Nursing Administration Research Conference (INARC). In late 2013, with a goal of building consensus, CGEAN convened an INARC postconference to initiate the process of establishing critical NAR priorities for the future. METHODS: Data from a 3-staged Delphi study were used to identify relevant research topics and determine administrative research priorities. RESULTS: Eight final categories of NAR were determined. CONCLUSIONS: This study found economic valuing of nursing and designing effective future healthcare delivery systems to be high priorities for NAR.

Informatics Competencies in Nursing Management.

This study aimed to identify in scientific literature the informatics competencies required from the nurses to make decision in management process. Through a scoping review, literature databases were searched to find articles published in Portuguese, English, or Spanish, until July 2013. 188 articles were found, and seven were included in this study, published between 1994 and 2011. The studies were written in English (5; 71%), in USA (5; 71%), using experience reports or literature review designs (5; 71%). The informatics competences were categorized according the Technology Informatics Guiding Education Reform (TIGER). The findings highlight gaps in informatics competence to make decisions in the management process--essentially in information management competence.

Roadmap for a participatory research-practice partnership to implement evidence.

BACKGROUND: Our research team has undertaken implementation of evidence in the form of practice guideline recommendations for populations in hospital, community, and long-term care settings with diverse provider and patient populations (people with chronic wounds, e.g., pressure and leg ulcers, heart failure, stroke, diabetes, palliative care, cancer, and maternity care). Translating evidence into clinical practice at the point of care is a complex and often overwhelming challenge for the health system as well as for individual practitioners. PURPOSE: To ensure that best available evidence is integrated into practice, "local evidence" needs to be generated and this process accomplishes a number of things: it focuses all involved on the "same page," identifies important facilitating factors as well as barriers, provides empirical support for planning, and in itself is a key aspect of implementation. In doing this work, we developed a roadmap, the Queen's University Research Roadmap for Knowledge Implementation (QuRKI) that outlines three major phases of linked research and implementation activity: (1) issue identification/clarification; (2) solution building; and (3) implementation, evaluation, and nurturing the change. In this paper, we describe our practical experience as researchers working at point-of-care and how research can be used to facilitate the implementation of evidence. An exemplar is used to illustrate the fluid interplay of research and implementation activities and present the range of supporting research. IMPLICATIONS: QuRKI serves as a guide for researchers in the formation of a strategic alliance with the practice community for undertaking evidence-informed reorganization of care. Using this collaborative approach, researchers play an integral role in focusing on, and using evidence during all discussions. We welcome further evaluation of its usefulness in the field.

Research priorities for nursing professional development: a modified e-Delphi study.

In 2010, the National Nursing Staff Development Organization Research Committee identified the need to delineate research priorities for nursing professional development (NPD). A Delphi study with 13 experts in NPD resulted in the identification of 24 priorities for the next 5 years. These priorities provide the future direction for NPD research and funding.

Estimating nursing intensity and direct cost using the nurse-patient assignment.

BACKGROUND: This study examines the feasibility of using the nurse-patient assignment (NPA) to calculate direct nursing hours and costs for each inpatient-day. The NPA data are collected at every hospital and therefore represent a readily available information source that can establish the intensity and economic value of nursing care at US hospitals. METHOD: Direct nursing care hours for each patient were collected twice a day using an existing nursing intensity database at a single university hospital between January 2004 and June 2005 for a total of 11,582 patient-days. Nursing intensity was also calculated for each shift using the NPA. Mean unit and hospital nursing hours were calculated and compared with the direct nursing care hours using ordinary least squares regression. RESULTS: For the day shift, the NPA estimate explained 77.2% (r2 = 0.772) of the variance of patient-level nursing intensity. Unit and hospital mean estimates of nursing intensity had lower r of 0.574 and 0.456, respectively. The night-shift NPA, unit, and hospital r2 estimates were 0.824, 0.633, and 0.579, respectively. CONCLUSION: The use of the NPA can provide a robust and easy method to calculate nursing intensity for individual patients using assignment data available in nearly all care settings. The NPA estimate can be used to allocate direct nursing time and costs for each patient within the hospital billing system and can also be used in pay-for-performance or for benchmarking nursing intensity within and across hospitals.

Promoting leadership: the development of a nurse executive team in an acute hospital trust.

AIM: The purpose of this study was to evaluate how an executive nursing team, within an acute hospital trust in the south of England, developed their leadership characteristics through the use of a professional development programme. BACKGROUND: This paper offers an insight into how this team worked together to clarify their views of their new role and how the role would be enacted. METHOD: A questionnaire using quantitative and qualitative measures was used to explore the group's leadership style and evaluate the professional development programme. FINDINGS: The findings show how the development programme worked and what clarity it afforded the group in terms of their leadership style. Group work, building on the findings, helped them define their particular characteristics, skills and leadership ability and what further work was needed to demonstrate this. CONCLUSIONS: The issues raised, such as team-working, mutual purpose and personal development, are discussed in terms of their function within an integrated executive team with vision and goals. IMPLICATIONS FOR NURSING MANAGEMENT: In ensuring that the nursing service has positive purpose, direction and goals, there needs to be a strategic approach to corporate development; otherwise, nursing will struggle to lead itself within a fast changing health care system.

Measuring and accounting for the intensity of nursing care: is it worthwhile?

In June 2007, the Robert Wood Johnson Foundation sponsored a conference titled "The Economics of Nursing: Paying for Quality Nursing Care." The second topic at the conference was "the appropriateness and feasibility of measuring and accounting for the intensity of nursing care." Drs. Welton and Sermeus presented papers on that topic. This response to those papers focuses on why the hospital industry has not always accounted for and measured nursing intensity. Then it asks, "Why do we want more accurate information about nursing resources used by different patients?" It is not sufficient to say the data regarding nursing costs are not accurate. Nor is it sufficient to say that we now can improve the accuracy of the data. To move forward in this area, we need to develop compelling evidence and arguments that indicate that nursing-cost data of greater accuracy have a benefit that will exceed the costs of that data collection.

The Warrington workload tool: determining its use in one trust.

With recent advances in chronic disease management and with earlier discharge from the acute sector, it has become increasingly important for district nurses to monitor and evidence their increasing workload, to monitor demand and capacity. The district nursing service in the author's trust has employed an adaptation of the Warrington workload tool, over several years, to demonstrate and evidence their workload. However, many dispute the accuracy of such tools. This audit set out to discover how accurately the tool was being calculated. The findings have cast doubt on the tool's accurate completion and highlighted an ongoing training need to ensure improvement in its use. The tool is to be further supported with the inclusion of a caseload profiling tool to provide qualitative evidence of the service that the nurses now provide. It was also identified that the service needs evidence that their resource needs are met in response to workload tool data to ensure the tool continues to be used in a proactive manner.

Measuring nursing workload in neonatal intensive care.

AIM: To determine if a suitable method of measuring nursing workload could be developed in neonatal intensive care units (NICUs). BACKGROUND: Nursing is a multifunctioning activity and previous methods measuring the demand for nurses do not put enough emphasis on the individual capabilities. The reporting of NICU activity has traditionally been related to bed occupancy and the number of infants requiring ventilator support. A classification system based on activity, hours of care and nursing staff ratios has been used; however, it does not consider the clinical ability of the individual nurses. METHODS: A 5-month prospective study was undertaken in which nurses in two NICUs scored their patients' level of dependency and professional assessment of the level of intensity of care required by the infants in each shift. In addition, serial measures of severity of illness scores for each patient were collected. KEY ISSUES: The study identified methods of measuring workload that consider the individual nurse's ability and contributing organizational factors. We found that the estimates of nursing hours using the two traditional dependency measures did not match the current practice or take into account the skill of the nurses. A method in which the nurses indicated the intensity of nursing care required by their patients was suitable one for capturing their individual capabilities. System factors were also found to contribute to the nursing workload. CONCLUSIONS: It is not sufficient to use patient acuity or severity of illness alone. Other factors such as the nurse's assessment of the intensity of care required and the organizational factors are important components of workload estimates.

A span of control tool for clinical managers.

During the second half of the 1990s, healthcare in Canada experienced significant downsizing and reform. One of the consequences of these reorganizations has been a reduction in the number of clinical managers and a significant increase in their span of control, to the point that often their abilities to fulfil their role as clinical managers are hindered (Altaffer 1998; Counsell et al. 2001; Pabst 1993). The first-line manager plays a critical role in the delivery of healthcare, in particular, within nursing services. Therefore, providing support for the professional practice of clinical managers should become a priority.

The costs of nurse turnover, part 2: application of the Nursing Turnover Cost Calculation Methodology.

This is the second article in a 2-part series focusing on nurse turnover and its costs. Part 1 (December 2004) described nurse turnover costs within the context of human capital theory, and using human resource accounting methods, presented the updated Nursing Turnover Cost Calculation Methodology. Part 2 presents an application of this method in an acute care setting and the estimated costs of nurse turnover that were derived. Administrators and researchers can use these methods and cost information to build a business case for nurse retention.

Measuring nursing power within organizations.

PURPOSE: To describe the Sieloff-King Assessment of Departmental Power (SKADP) instrument and the psychometric evaluation of both the SKADP and its revision: the Sieloff-King Assessment of Group Power within Organizations (SKAGPO) instrument. DESIGN: A survey of 357 chief nurse executives in the United States to psychometrically evaluate the SKAGPO. METHODS: Psychometric evaluation of the SKAGPO included: (a) internal consistency reliability using Cronbach's alpha coefficient, split-half with the equal-length Spearman Brown Correction Formula, and item analysis; (b) concurrent criterion-related validity; and (c) factor analysis. FINDINGS: Cronbach's alpha coefficient for the SKAGPO was .92. Subscales' alphas ranged from .63 to .88. Item-total correlations ranged from .24 to .68, with an average item-total correlation of .48 (n = 334). Concurrent criterion-related validity was supported. CONCLUSIONS: The SKAGPO and the related subscales showed initial reliability and validity.

Measuring staff nurse decisional involvement: the Decisional Involvement Scale.

Key organizations and new legislation are promoting staff nurse involvement in decisions about nursing practice and patient care as a long-term strategy to improve the culture of the work environment. The authors discuss the Decisional Involvement Scale (DIS), a multipurpose measure that can be used as a diagnostic tool, an organizational development strategy, and an evaluative instrument. In addition, support to substantiate the DIS as a valid and reliable measure is summarized.