Work Readiness of Newly Licensed RNs.

OBJECTIVE: The aim of this study was to examine the work readiness of newly licensed RNs (NLRNs) based on demographics, education, and work experiences. BACKGROUND: Work readiness is the extent to which new graduates possess qualities and competencies associated with workplace success. Work readiness of NLRNs complements their clinical knowledge and skills and has been shown to predict job satisfaction and work engagement. METHODS: Two hundred ninety-seven NLRNs participating in the nurse residency program of a health system in the southeast region of the United States were surveyed using the Work Readiness Scale-Graduate Nurse. RESULTS: Scores on all readiness dimensions were high. Analysis revealed unexpected differences in readiness dimensions based on race, nursing degree, and completion of a nurse externship program. CONCLUSIONS: Work readiness adds to our understanding of factors that can affect the transition of NLRNs into the work setting. Further research is needed to understand how work readiness develops over time, factors that predict work readiness, and its relationship to NLRN retention and other outcomes.

Blood Transfusion Vital Sign Frequency: What Does the Evidence Say?.

Blood transfusion vital sign protocols do not have sufficient evi- dence to mandate surveillance frequency. The purpose of this study was to examine the relationship of vital sign changes to reaction times in an effort to determine best practice for monitoring patients receiving blood products.

The Impact of Shared Governance Over Time in a Small Community Hospital.

OBJECTIVE: This study examined the impact of shared governance (SG) on the professional nursing practice environment of a small community hospital over time. BACKGROUND: Shared governance has been shown to empower nurses in direct patient care to make decisions about their practice and improve job satisfaction. No research has been found that examined the progression of SG over time in a small community hospital. METHODS: Questionnaires pertaining to the professional practice environment, perception of nursing leadership, nurse empowerment, nurse satisfaction, risk of practice errors, and comfort with evidence-based practice were administered to all nurses employed at a 149-bed community hospital in central North Carolina for 5 consecutive years. RESULTS: Results showed that nursing leadership and SG explained 90% of the variance in the nursing professional practice environment. This relationship held true for 5 years. All variables showed continued improvement for 4 years, until year 5 when the organization experienced disruptive change. Even during this year, the results did not return to baseline. CONCLUSIONS: In order to improve the professional practice environment of nurses, hospitals should focus on strong nursing leadership and a sound SG infrastructure.

How effective are hospital adjunct clinical instructors?

BACKGROUND: Within the past several years, an innovative model for collaboration has emerged between schools of nursing and hospitals to increase the enrollment in schools of nursing by utilizing experienced staff nurses as hospital adjunct clinical instructors (HACI). The HACI is temporarily released from typical job duties to serve as a clinical instructor for a group of undergraduate nursing students. AIM: The purpose of this study is to determine if HACIs are as effective as faculty employed by schools of nursing. METHOD: A convenience sample of new graduate nurses participated in the descriptive study. The nurses were asked to evaluate their senior year medical-surgical clinical instructor using Reeve's Instrument to Measure Effectiveness of Clinical Instructors. RESULTS: There was no statistically significant difference in the clinical teaching effectiveness of HACIs and school of nursing faculty. CONCLUSION: This study provides early support for the use of HACIS. However, more studies are needed to validate their effectiveness.

Nurses' perceptions of nurse-physician relationships: medical-surgical vs. intensive care.

UNLABELLED: Effective collaboration between nurses and physicians (RN-MD) is essential in facilitating improved patient care outcomes. A pilot study was conducted among nurses on medical-surgical and intensive care units to identify differences in nurses' perceptions of RN-MD collaborative efforts. INTRODUCTION: Collaboration between nurses and physicians is essential in fostering interdisciplinary relationships. Specialty practice may influence the quality of this collaboration. Effective communication and collegial RN-MD relationships are critical to improved patient outcomes. PURPOSE: The purpose of this study was to identify differences in nurses' perceptions of collaborative efforts between nurses and physicians in medical-surgical (MSUs) units versus intensive care units (ICUs). RESULTS: A descriptive survey methodology was employed. Nurses in three ICUs and eight MSUs within a 975-bed Magnet hospital completed a 25-item Nurse-Physician Relationship survey, used in previous studies on RN-MD communication. The sample (N = 170) consisted of 54% medical-surgical nurses and 46% ICU nurses. No statistically significant differences were found in the demographic variables between the MSU and ICU nurses except for educational degree. A greater percentage of ICU nurses held a bachelor's degree. This study found that although some differences existed in ICU and MSU nurses' perceptions of RN-MD collaboration, there are more similarities between the two areas. Overall, nurses were satisfied with RN-MD relationships, with 75% of ICU and 65% of MSU nurses reporting satisfaction (p = 0.110). MSU nurses were less likely to participate in interdisciplinary rounds than ICU nurses (p < 0.001). ICU nurses were more likely than MSU nurses to report that physicians treat nurses as handmaidens (p = 0.056) and that physicians displayed unprofessional behavior (p = 0.019). CONCLUSIONS: Certain nursing specialty areas are not immune to problems with RN-MD relationships. Rather, all clinical service lines should be concerned with fostering collegiality between nurses and their physician partners.

Practice patterns of licensed practical nurses in North Carolina.

In the United States, state laws develop basic practices to define the scopes of practice for registered nurses and licensed practical nurses (LPNs). The purpose of the study was to describe the actual practice patterns of LPNs working in North Carolina. The results of the study convey an unfavorable pattern regarding LPN scope of practice. Indications are that a paradigm shift might be required in order to reverse the pattern of overpractice by LPNs.

Effects of yoga on anxiety and depression for high risk mothers on hospital bedrest.

BACKGROUND: and purpose: In recent years, yoga practitioners have joined forces with medical programs to approach patients' well-being holistically. This study is a randomized controlled trial to assess the effects of a specialized adapted yoga program on anxiety and depression for high-risk expectant mothers on bedrest in a hospital setting. MATERIALS AND METHODS: Seventy-nine pregnant subjects on physician ordered hospitalized bedrest were randomized into two groups: receiving biweekly yoga sessions (intervention group) or receiving no yoga (control group). Data collection tool was the Hospital Anxiety and Depression Scale (HADS) to assess outcomes after delivery. RESULTS: Yoga, even as little as three sessions, showed significant impact in reducing anxiety and depression high-risk pregnant women on hospitalized bedrest. Perceived anxiety and depression overall scores were lower in the intervention group than in the control group (p < 0.001). CONCLUSION: Results demonstrated that yoga is an effective intervention to decrease anxiety and depression in high-risk antepartum women on hospitalized bedrest.

North Carolina wound nurses examine heel pressure ulcers.

PURPOSE: Heels are the second most common location for pressure ulcers, and their prevalence is increasing. The purpose of this multisite research project was to describe physical characteristics and medical history of patients experiencing heel pressure ulcers (PUs). SUBJECTS AND SETTING: The settings for this study were different healthcare settings (acute care, long-term care, and homecare) in North Carolina and Virginia, where member WOC nurses perform consultative services for patients with heel ulcers. Patients older than 18 years with a heel PU were included in the study. METHODS: A data collection tool was developed by the authors. Participating members of the NC WOC Nurses Group identified 84 participants. Descriptive statistics were used to summarize the data by using proportions, means, standard deviations, and ranges. RESULTS: Over half of the population had a palpable pedal pulse. Full-thickness PUs were found in 45% of the sample while 19% had suspected deep tissue loss. Subjects tended to be elderly and have low nutritional markers, high body mass index, multiple comorbid conditions such as diabetes mellitus, systemic infection, end-stage renal disease and peripheral arterial disease, as well as low Braden Scale scores. CONCLUSION: The study revealed important factors specific to heel PUs including advanced age, malnutrition, high body mass index, and multiple comorbid conditions. Further research is needed to further refine our knowledge of our factors associated with an increase likelihood of heel PUs. Our findings also point out the need for a tool specific for the evaluation of heel PU risk.

Factors affecting quality of life in persons on hemodialysis.

The purpose of this cross-sectional, correlational study was to describe the quality of life (QOL) in persons with end stage renal disease and explore factors that may affect QOL. Biologicalfunction, symptoms,function, general health perception, and characteristics of the individual and environment explained 61% of the variability in overall QOL. Only anxiety, depression, and general health perception significantly contributed to QOL QOL may be better predicted from psychological factors than physiological factors.

Research and quality improvement: different processes, different evidence.

Two sources commonly used for evidence-based practice include research findings and quality improvement (QI) reports. However, they often are implemented improperly. It is important for nurses to distinguish between research and QI. A tool for making such a distinction is presented.

Fatigue in African American women on hemodialysis.

The purpose of this study was to examine factors associated with fatigue in African American women with end stage renal disease. Twenty-seven of 36 women in the sample were fatigued. Correlations were found with mood disorder and fatigue (p < .001), social support and uremic malnutrition (p = .003), and anemia and fatigue (p = .012) and mood disorder (p = .039). Anemia, uremic malnutrition, mood disorder, and social support explained 38% of variance in fatigue scores (F = 4.768 [4, 31]; p = .004). Future studies testing interventions that mitigate fatigue are warranted.

Nursing Bedside Dysphagia Screen: Is it Valid?

Screening for dysphagia on stroke patient admissions in a timely manner, with early risk identification, and implementation of appropriate oral intake measures is a priority to reduce negative patient outcomes. Containing patient and facility costs, along with reducing length of stay, is a priority for all healthcare institutions. To ensure the provision of care at our facility was consistent with these priorities, we reviewed our processes and looked for opportunities for improvement. Assuring we had a reliable and valid nursing bedside screening tool for dysphagia was identified as a priority. We designed a study to answer the questions of validity and reliability. The findings suggest that our facility-developed Nursing Bedside Dysphagia Screen is a valid and reliable tool to help identify patients with stroke who are at risk for aspiration pneumonia.

Consistent charge nurses improve teamwork.

Team perception on a medical-surgical department improved after the implementation of a dedicated charge nurse staffing strategy.

Hospital to home: a transition program for frail older adults.

PURPOSE OF STUDY: This study describes a social-worker navigator transitional care model for at-risk seniors being discharged from hospital to home. The model is designed to prevent rehospitalizations so as to improve quality of life and patient outcomes. This model is different from others with its focus on the psychosocial aspects of care transitions, medical needs, and individualized needs with the provision of nonreimbursable services. PRIMARY PRACTICE SETTING: Care begins in the acute care hospital or inpatient rehabilitation facility and continues in the postdischarge home environment. Participants are connected to community services to support their independent living at home. METHODOLOGY AND SAMPLE: Case managers, physicians, or others refer potential participants to the navigator. Criteria for inclusion include the following: age 65 years or older, Medicare and/or Medicaid recipient, living in the same county as the hospital, and having at least 2 of a list of 11 criteria that predict readmission. After the participant agrees to enroll, the navigator recommends in-home services at discharge. Within the first 72 hr, the navigator makes a home visit to evaluate the home environment, assess medical management, and make referrals for other services. Follow-up phone calls and other home visits are made by the navigator during the participant's enrollment, which is from 30 days to 4 months. RESULTS: Hospital readmissions were decreased by 61% for this high-risk population. Cost savings by preventing readmissions correlated to a cost savings of $628,202 per year. The 36-Item Short-Form Health Survey showed statistically significant improvements in quality-of-life scores for both physical and mental health summary scales and for all 8 subscales (p < .004). Almost all (99%) of respondents were satisfied with the overall Hospital to Home program. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: The results of this study demonstrate the importance of extending social support and health education into the home after discharge from the hospital. Access to immediate in-home care services such as transportation, housekeeping, laundry, and light meal preparation allows patients not to experience gaps in care that could result in a readmission. The assigned navigator reinforces medical management and connects participants to appropriate community resources in order to remain safe at home.

Building an engaged and certified nursing workforce.

Professional certification has been linked to positive patient, system, and nurse outcomes. However, certification rates among nurses remain low. Using tenets from employee engagement theory, we designed strategies to fully engage nurses within our nursing division to pursue certification. After 1 year, certification rates more than doubled in our cardiac departments.

Clinical nurse specialist practice domains and evidence-based practice competencies: a matrix of influence.

PURPOSE: The purpose of this article is to describe master's-level evidence-based practice (EBP) competencies as determined by a national consensus panel and present an EBP matrix that illustrates the influence that the clinical nurse specialist (CNS) practice can have on driving EBP change. BACKGROUND: Evidence-based practice is a growing and necessary paradigm for nursing care. The ACE Star Model conceptualizes the knowledge transformation that must occur in an EBP environment as 5 distinct points: discovery, summary, translation, integration, and evaluation. Master's-level EBP competencies based on these 5 steps were established by a national consensus panel. The CNS's practice can be organized around 5 domains: expert practitioner, researcher, consultant, educator, and leader. The master's-level EBP competencies can be transposed on a crosswalk of the ACE Star Model and the 5 CNS practice domains to form a matrix representing the influence that CNSs can have over the EBP process. IMPLICATIONS: Each competency falls well within the practice domains of the CNS, making the CNS an ideal person to lead the EBP movement forward, providing tangible outcomes to further demonstrate the need for the CNS role.

The Patient Self-determination Act: has it reached the end of its life?

The Patient Self-determination Act requires that patients be informed in writing of their right to accept or refuse treatment and the right to an advance directive. For the past 15 years, hospitals have been providing these written materials, yet advance directives are still not adequately directing end-of-life care. Barriers and facilitators to implementation of this law are discussed, as well as the role of nursing management in meeting its true intent.