The DNP Graduate and the Potential to Advance Nursing: An Interview With Thought Leader Michael Bleich, PhD, RN, FAAN, by Carol Bradley, MSN, RN, FAONL.

This column is an interview of Michael Bleich PhD, RN, FAAN and focuses on the current state of DNP education. As a thought leader in nursing education, Michael shares his views on the state of DNP nursing education and the opportunity it provides to transform health care through nursing.

A mixed-methods exploration of nurse loneliness and burnout during COVID-19.

AIM: This study investigated the phenomenon of nurse loneliness as a potential contributor to burnout. BACKGROUND: Nurse wellbeing is critical for safe and efficient healthcare delivery. However, evidence indicates nurses' wellbeing is at risk. The levels of burnout, the most commonly measured symptom of suboptimal wellbeing, are rising and may relate to a largely unexplored phenomenon: loneliness. METHODS: A mixed-methods approach was used to investigate burnout and loneliness in direct-care nurses in four diverse hospitals in the midwestern and southeastern United States. Burnout and loneliness were measured, prevalence was estimated, and correlation was examined. Interpretive descriptive inquiry and analysis was used to develop a richer understanding of nurse loneliness in the context of burnout. While this study did not explicitly explore the impact of the global pandemic, data was collected in late 2021 and early 2022, during the Delta variant wave. RESULTS: In the study population (n = 117), rates of burnout are high and positively correlate with loneliness. Qualitative interviews (n = 11) revealed that nurses feel unseen, emotionally detached from their work, and dehumanized. However, social connection with peers is protective and nurses still report a strong sense of devotion to the profession and solidarity with peers. CONCLUSIONS: This study offers insight into nurse loneliness, highlighting the importance of social connectedness to improve nurse wellbeing.

A Quality Improvement Approach to Violence Reduction: Standardizing the Risk Identification Process.

BACKGROUND: The impact of aggressive and violent behaviors directed toward staff in psychiatric facilities has layers of implications tied to recruitment and retention, cost, quality and safety. LOCAL PROBLEM: Increased patient aggressive behaviors contributed to staff dissatisfaction and high turnover rates, triggering an analysis of current aggression management approaches. METHODS: The Plan-Do-Study-Act quality improvement method was used for this project. INTERVENTIONS: The Dynamic Appraisal of Situational Aggression (DASA) risk assessment tool was implemented. RESULTS: Daily aggression risk identification increased by 69%, and aggressive incidents toward staff and patients decreased by 64% and 28%, respectively, when the tool was completed more consistently. Surveys revealed acceptance of the tool by nurses. CONCLUSIONS: Quality improvement statistical tools supported evidence-based strategies. A risk for aggression assessment laid the foundations for implementing strategies for reducing aggression and violence.

Stakeholder Perspectives on Implementation of Smart Speakers for Aging in Place in Low-Income Senior Housing: A Qualitative Study.

In the current study, a smart speakers-based system (Amazon® Echo Dot device, a safety pendant, and facility tailored functionalities) for supporting aging in place was implemented in one low-income senior housing property. We aimed to explore perceived benefits, concerns, and expectations about this system among three stakeholder groups (older adults, housing staff, and technology developers) to identify facilitators of and barriers to system implementation. A qualitative analysis of individual interviews using inductive coding methods was performed to identify emerging themes. All stakeholder groups perceived smart speakers as valuable for convenience in daily living and safety. Older adults and system developers identified user difficulty with setting up functions they wanted to use, suggesting the need for user-centered technology support. There were differences in priorities for smart speaker use among three stakeholder groups. This work contributes to the identification of factors affecting smart speaker adoption and use among low-income older adults who often have limited technology experience and support. [Journal of Gerontological Nursing, 48(10), 33-39.].

The Langston Center for Innovation in Quality and Safety: A Moderating Variable in Humanizing Disruptive Innovation.

Disruptive innovations may serve both good and ill causes. This means that disruption can stimulate positive outcomes or tip people and organizations into chaos. The Langston Center for Innovation in Quality and Safety plays a moderating role by ensuring that innovations consider the upstream and downstream consequences potentiated by change initiatives characterized by a rapid implementation cycle. Drawing on change management and implementation science approaches, human factor variables are intentionally considered to generate acceptance of substantive disruptions.

Job and Role Transitions: The Pathway to Career Evolution.

An individual's career trajectory evolves with each job and role transition. Over time, job/role experiences trigger choices as to whether to stay in a particular job setting or role. Reflective questions guide the process of deciding whether and when it is time to transition. Considerations include role fit with lifestyle expectations, need for advanced knowledge and formal education, and readiness for upward or lateral movement. Using a framework modeled after the work of Bolman and Deal, this article presents 4 lenses to guide a careerist's readiness and need for change: human resource, structural, political, and symbolic factors. Each lens is introduced to reinforce a holistic approach to key triggers and considerations in career change. The summary culminates with how to foster a joy-filled career.

Mitigating Knowledge Loss: A Strategic Imperative for Nurse Leaders.

With the aging of the nursing workforce and expected retirement of large numbers of experienced nurses in the next decade, mitigating the impact that lost knowledge will have on organizational performance and patient outcomes is critical. The authors raise awareness of the problem, summarize observations procured from hospital nurse executive regarding approaches for knowledge transfer through workforce development, and pose proactive strategies for nurse leaders who can provide direction to offset the issue before it becomes a crisis.

International Perspectives in Leadership Development: Part I.

In this first part of a two-part series, leadership development perspectives are shared from interviews and experiences gained while visiting Taiwan and China. Each country has a distinctive culture and needs, yet both are rapidly rising to strengthen the leadership capacity of nurses and are increasingly a source of advances in global leadership and organizational science.

Leadership and brilliant mistakes.

Professional development educators work fervently to model best practices and appropriate ways of being successful within health care organizations. However, mistakes are made and happen at every level and are part of organizational life. Innovation requires risk, and risk means that mistakes will happen. The anatomy of the mistake is presented and, when appropriate, celebrated.

Defining moments in leadership character development.

Critical moments in life define one's character and clarify true values. Reflective leadership is espoused as an important practice for transformational leaders. Professional development educators can help surface and explore defining moments, strengthen leadership behavior with defining moments as a catalyst for change, and create safe spaces for leaders to expand their leadership capacity.

Leadership needs assessment.

Documenting a leadership needs assessment is complex. One approach is through developing a central aim, followed by the competencies needed to lead the organization, others, and self. By adding contextual factors, an actionable leadership development plan evolves.

Patient-Centered Leadership.

Patient-centered care has garnered new attention, as it is linked to health system reimbursement. The background for patient-centered care has evolved from a rich history of evidence, indicating that the patient experience matters. This article addresses the history of patient-centered care and the evidence supporting patient-centered leadership.

Teasing leadership development out of clinical scenarios.

Staff development professionals increasingly use clinical simulation, case studies, and nonsimulated, real-time clinical performance for strengthening clinical judgment and corresponding action when training clinicians. Leadership competencies can also be strengthened and reinforced during these educational opportunities. Through debriefing and peer evaluation, clinical scenarios are rich with leadership development opportunities.

Hot topics for leadership development.

Three areas stand out from a health systems perspective that should be on the development agenda for all leaders. These topics include population health, predictive analytics, and supply chain management. Together, these topics address access, quality, and cost management.

Identifying volition-driven leaders.

Professional development educators have access to health care practitioners at the onset of and throughout their employment. The educator-learner relationship presents an opportunity for educators to distinguish highly motivated individuals from those with the attribute known as volition. Motivation and volition are differentiated in this article.

Developing positive deviants as change agents.

In nearly every quagmire, one or more individuals surpass the issue being faced. Knowledge gained from these positive deviants-who fall outside the norm-leads to a six-step approach to problem solving that is fundamentally different than reductionistic approaches. Professional development educators can train leaders to this technique.

The jester of leadership.

Innovation can be stifled in hierarchical organizations, filled with traditions and rules. One organization created space for an individual whose position required stimulating professionals through scenarios and storytelling, being a disruptive force for keeping the spiritual and innovative health resiliency of its workforce alive. This role is described.

Rankism in nursing and health care.

Professional development educators can frame their practice by understanding rankism from an organizational development framework. Forms and functions of rankism are presented with reference to the work of Robert Fuller.

Leading with simplicity.

The clinical requirements to deliver safe quality care to patients and the human interactions between and among professional disciplines and agencies are extremely complex. Leaders transform complexity into simplicity. Ten laws of simplicity provide a framework for improving care delivery.

Developing leaders as systems thinkers-part III.

This article concludes a three-part series on developing leaders to function as systems thinkers. Part I differentiated between systematic and systems thinking and action, and part II elucidated competencies needed to develop and influence systems. The emphasis now shifts. Professional development educators are often expected to instruct individuals in multiple types of data collection, ranging from quality improvement to program evaluation metrics. The focus of this column is on collecting and using systems data.