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.

A theory-based approach to nursing shared governance.

BACKGROUND: The discipline of nursing uses a general definition of shared governance. The discipline's lack of a specified theory with precepts and propositions contributes to persistent barriers in progress toward building evidence-based knowledge through systematic study. PURPOSE: The purposes of this article were to describe the development and elements of a program theory approach for nursing shared governance implementation and to recommend further testing. METHOD: Five studies using multiple methods are described using a structured framework. The studies led to the use of Lipsey's method of theory development for program implementation to develop a theory for shared governance for nursing. DISCUSSION: Nine competencies were verified to define nursing practice council effectiveness. Other findings reveal that nurse empowerment results from alignment between the competencies of self- directed work teams and the competencies of organizational leaders. Implementation of GEMS theory based nursing shared governance can advance goals at the individual, unit, department, and organization level. CONCLUSION: Advancing professional nursing practice requires that nursing concepts are systematically studied and then formalized for implementation. This article describes the development of a theoretical foundation for the systematic study and implementation of nursing shared governance.

Starting a national conversation: the Institute of Medicine workshop on the future directions of credentialing research in nursing.

In this month's column, the director of research for the American Nurses Credentialing Center discusses outcomes of the Institute of Medicine Workshop on Credentialing Research in Nursing.

Nursing administration research: an evolving science.

The nature and focus of nursing administrative research have evolved over time. Recently, the research agenda has primarily reflected the national health policy agenda. Although nursing research has traditionally been dominated by clinical interests, nursing administrative research has historically addressed the interface of reimbursement, quality, and care delivery systems. This article traces the evolution of nursing administrative research to answer questions relevant to scope, practice, and policy and suggests future directions.

Leading change to create a healthy and satisfying work environment.

Nurse executives must take a leadership role in creating a healthy work environment for nurses and all disciplines. Engaging in partnerships and empowering clinical nurses to construct the solutions to barriers that may stand in the way of the goal of a satisfied and healthy workforce are important strategies toward success. This publication outlines many projects a 3-time Magnet-designated academic hospital has implemented, working with our shared leadership councils, to meet the standards for a healthy work environment. These initiatives, from the unit to the hospital level, included standardizing a culture change of uninterrupted meal breaks, the creation of intensive care unit Zen rooms, strategies to better manage increased patient volumes, best practices for facility design, enhancing physician-nurse relations, and a hospital wellness program. Data were benchmarked against national nurse and employee surveys to compare progress and report outcomes. Two important nursing organization structures that have contributed to the success of a healthy and satisfied nursing work environment include UEXCEL, a longstanding clinical nurse professional practice program, and the hospital's 11-year participation in the University HealthSystem Consortium/American Association of Colleges of Nursing National Post-Baccalaureate Nurse Residency Program. A highly engaged, well-educated, and committed nursing workforce, nurtured by a strong leadership team, has created a positive work environment characterized by low turnover and high retention.

Practices for caring in nursing: Brazilian research groups.

BACKGROUND: The present study considers the production of knowledge and the interactions in the environment of research and their relationships in the system of caring in nursing and health. AIM: To elaborate a theoretical model of the organization of the practices used for caring, based on the experiences made by the research groups of administration and management in nursing, in Brazil. METHODS: The study is based on grounded theory. Twelve leaders of research groups, working as professors in public universities in the south and the south-east of Brazil, distributed in sample groups, were interviewed. FINDINGS: The core phenomenon 'research groups of administration and management in nursing: arrangements and interactions in the system of caring in nursing' was derived from the categories: conceptual bases and contexts of the research groups; experiencing interactions in the research groups; functionality of the research groups; and outputs of the research groups. The research groups are integrated in the system of caring in nursing. CONCLUSIONS: The activities of the Brazilian administration and management in nursing research groups are process oriented and in a process of constant renovation, socially relevant, operate in a complex scenario and contribute to the advancement of the organizations of the system of caring in nursing through strengthening the connection among academia, service and community.

Towards evidence-based management: creating an informative database of nursing-sensitive indicators.

PURPOSE: The purpose of this paper is to describe the creation, evolution, and implementation of a database of nursing-sensitive and potentially nursing-sensitive indicators, the Military Nursing Outcomes Database (MilNOD). It discusses data quality, utility, and lessons learned. DESIGN/METHODS: Prospective data collected each shift include direct staff hours by levels (i.e., registered nurse, other licensed and unlicensed providers), staff categories (i.e., military, civilian, contract, and reservist), patient census, acuity, and admissions, discharges, and transfers. Retrospective adverse event data (falls, medication errors, and needle-stick injuries) were collected from existing records. Annual patient satisfaction, nurse work environment, and pressure ulcer and restraint prevalence surveys were conducted. FINDINGS AND CONCLUSIONS: The MilNOD contains shift level data from 56 units in 13 military hospitals and is used to target areas for managerial and clinical performance improvement. This methodology can be modified for use in other healthcare systems. CLINICAL RELEVANCE: As standard tools for evidence-based management, databases such as MilNOD allow nurse leaders to track the status of nursing and adverse events in their facilities.

Factors affecting frontline workers' satisfaction with supervision.

Objective. This research was guided by a stress and support model to examine the effects of frontline workers' background characteristics, personal stressors, job-related stressors, and workplace support on satisfaction with supervision. Method. Survey data were collected from 644 workers in 49 long-term-care settings that employed them. Regression analysis were used to determine the effects of worker level and then Hierarchical Linear Modeling (HLM) and organizational factors on the outcome. Results. Although all four variable categories made significant contributions to explaining satisfaction with supervision, the most powerful were personal stressors and job-related stressors. Results from HLM analysis showed frontline workers in nursing homes and those employed in for-profit organizations had lower levels of satisfaction with supervision. Discussion. Findings suggest organizational interventions to address workers' financial and health issues and management practices such as better training programs and peer mentoring could enhance workers' satisfaction with supervision.

Roadmap for success: The 10-step nursing strategic plan.

This bimonthly department, sponsored by the American Organization of Nurse Executives (AONE), presents information to assist nurse leaders in shaping the future of healthcare through creative and innovative leadership. The strategic priorities of AONE anchor the editorial content. They reflect contemporary healthcare and nursing practice issues that challenge nurse executives as they strive to meet the needs of patients. In this article, the author presents a simple yet highly effective 10-step approach to strategic planning that can be completed in any nursing organization. The 10-step process provides a roadmap for the future of nursing.

Getting real on evidence-based staffing.

Getting your arms around the topic of evidence-based staffing is not simple. There is no central place where one can turn to understand what evidence-based staffing is, what is necessary to adopt it, and how to measure its effectiveness. Organizing the evidence into usable resources and tools that can provide the guidance and experience needed to successfully operationalize evidence-based staffing is perhaps our biggest barrier. It was against this backdrop that a model for evidence-based staffing was developed through a national collaborative effort. While change is never easy, it is feasible that letting go of the gross inefficiencies, habits, traditions, policies, and practices that will be replaced by evidence-based staffing will not be so hard. With the movement grounded in science and guided by experience and wisdom, it seems safe to assume that we can get there quickly.

Academic leadership in nursing: legitimating the discipline in contested spaces.

AIM: To investigate the potential of recent conceptual developments in the sociology of education for conceptualising academic leadership in nursing. BACKGROUND: During an investigation into the current status and future trajectory of academic nursing in Ireland, academic leadership emerged as a major concern for respondents. METHOD: The languages of legitimation of academic leaders were elicited in in-depth interviews and analysed as expressions of underlying legitimation principles. RESULTS: The concept of legitimation principles provides a way of thinking about how academic nursing is positioned in the health and higher education sectors, how its leaders construct its identity, practices and purposes, and clarifies the proper focus and goals of academic leadership in nursing. CONCLUSIONS: Academic leadership is concerned with legitimating the discipline of nursing as an autonomous, coherent and distinctive professional and academic endeavour. This legitimacy must be secured in academic, clinical and wider contexts in which academic nursing is viewed with ambivalence; leaders must take account of the impact of nursing history on the current status and future trajectory of the discipline. IMPLICATIONS FOR NURSING LEADERSHIP: The analytic tools facilitate a better understanding of the internal and external conditions under which academic nursing will flourish, or wither, in contemporary higher education.

Shared governance as vertical alignment of nursing group power and nurse practice council effectiveness.

AIM(S): This study validates an instrument for measuring the effectiveness of nursing practice councils and offers a framework for measuring and understanding shared governance. BACKGROUND: Empowerment results from the vertical alignment of nursing group power with nursing unit power practices. The field lacks an instrument for measuring nurses' practice of power. METHOD(S): Two studies (n1 = 119; n2 = 248) are used to validate the Nursing Practice Council effectiveness scale (NPCes). RESULTS: NPCes is a valid and reliable index of nursing practice council effectiveness. This study suggests specific diagnostic tools to understand two levels for actualized power, one at the group or departmental level and one at the unit level. CONCLUSION(S): NPCes and the Sieloff-King Assessment of Group Power within Organizations (SKAGPO) can be used together to improve examination of shared governance. Examining group power as well as unit-level practices may give a more complete view of barriers to nurse empowerment. IMPLICATIONS FOR NURSING MANAGEMENT: Changing nursing power and practices in an organization may be made more effective by engaging and monitoring vertical alignment of strategies fostering power competencies among nurse leaders and simultaneously supporting nursing practice councils as a means of exercising nurse authority at the unit level.

Developing, testing and applying instruments for measuring rising dependency-acuity's impact on ward staffing and quality.

PURPOSE: This paper aims to explains how relatively simple nurse staffing formulas from "best practice" ward dependency-acuity data can be used for nursing workforce planning and development. DESIGN/METHODOLOGY/APPROACH: The paper combines literature, detailed ward surveys, workshop and expert group/stakeholder information to generate and test care levels/nurse multipliers for setting ward establishments. FINDINGS: The paper finds that professional-judgement based ward staffing can be abandoned, while complex acuity-quality, timed-task and regression-based nurse staffing algorithms for setting ward establishments may be unnecessary since the new multipliers, underpinned by robust validity and reliability testing, seem to be remarkably accurate nurse-staffing determiners at a fraction of the cost. RESEARCH LIMITATIONS/IMPLICATIONS: As care levels and multipliers stand they are suitable only for UK National Health Service acute wards. Primary care, mental health, learning disability and other specialist group care levels and multipliers need developing. PRACTICAL IMPLICATIONS: Users, at a minimum, can adopt care level data and multiplier staffing recommendations for benchmarking purposes. Ultimately, the algorithms can be used to: adjust ward establishments according to workload; or set staffing for new, inpatient services. ORIGINALITY/VALUE: The paper offers a simple system for assessing patients' nursing needs and setting ward staffing accordingly.

Nurses' perception of their manager's leadership style and unit climate: are there generational differences?

AIM: To describe and compare how nurses representing four age cohorts perceive their manager's leadership style and unit climate. BACKGROUND: The current workforce consists of nurses representing four generational cohorts. Nursing literature suggests that nurses from each age cohort think, behave and approach work differently. Limited empirical evidence, however, exists about how nurses from each age cohort perceive two aspects of their work environment: their managers' leadership style and unit climate. METHOD: This cross-sectional, descriptive survey was conducted using a convenience sample of 475 registered nurses working in different inpatient units in three community non-magnet hospitals. RESULTS AND CONCLUSION: Only nurses from Boomer and Gen-Xers had sufficient representation to be included in the data analysis. Nurses from the two main age cohorts did not differ in their perceptions of their manager's leadership style. Significant differences were found in two unit climate dimensions. The Gen-Xers had a less favourable perception of their unit climate related to warmth and belonging and administrative support. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse manager's might reflect on how they interact with different age cohorts; and to involve nurses from various age cohorts in the development of policies to create a flexible work environment.

Nurse staffing levels revisited: a consideration of key issues in nurse staffing levels and skill mix research.

AIM: This paper revisits the published evidence relating to how nurse staffing levels impact on patient, nurse and service outcomes and considers the implications of this body of research for nurse managers in their quest to determine optimum nursing numbers. BACKGROUND: Within the context of the recognized global nursing shortage and particular local pressures within international health services, questions of appropriate nurse staffing levels and skill mix are once again becoming increasingly important. It would seem that the determination of optimum nurse staffing levels and skill mix is a central issue in relation to health service governance, service user involvement, as well as in the recruitment, retention and well-being of nursing staff across the service sectors. METHODS: A review of published evidence was carried out, applying key principles of the systematic method, in order to facilitate the identification of current factors and issues in nurse staffing levels research. The review did not seek to address a specific research question. The search covered 10 years from 1998 to 2008 and identified more than 500 relevant papers, giving a wide international perspective. KEY ISSUES: The majority of research in the field relates to the acute service sector and there are considerable similarities in issues that transcend international boundaries. Much of the research focuses on the impact on patients and nurses of 'poor' nurse staffing levels. More recent studies have explored the impact of nurse staffing levels on the service organization itself. However, while there may be an association between models of nurse staffing and outcomes, there is insufficient evidence to establish a causal relationship between these factors. In this context it is perhaps time to reconsider how nursing outcomes are defined and measured. IMPLICATIONS FOR NURSING MANAGEMENT AND CONCLUSION: Nurse managers, commissioners of services and workforce planners need to be cognisant of key issues and analyses in the consideration of nurse staffing levels. Not least of these is the need for a healthy degree of caution regarding the supposed objectivity, scientific basis, or evidence base, for rational calculation of optimum nurse staffing levels.

Economic evaluation of nursing practices: a review of literature.

BACKGROUND: The importance of cost-effectiveness of nursing practices and its influence on prioritizations has been discussed in literature. It is, however, unclear to what extent health economic analysis has been used in the area of nursing. AIM: The aim of this paper was to investigate how studies of nursing practices apply economic evaluations. METHODS: A literature review was conducted that included studies through August 2007. The search was performed using Medline, CINAHL, PsycINFO, Econlit, DARE, HTA, NHS EED, Cochrane reviews and clinical trials with a search term connected to nursing and health economics. Protocols were used in the screening procedure and the result is reported in a descriptive form. RESULTS: The search identified 115 studies published between 1984 and August 2007. Studies were found in the following nursing practices: provision of support and treatment (n = 17); assessing suffering/well-being (n = 1); preventing or treating ill health (n = 53); and organization of individual care (n = 44). In 22% of all studies, the authors explicitly presented the health economic method used. In 25% of all studies, the perspective of the economic analysis was explicitly stated and a large variability in cost was considered in the analysis. In 82 studies, the authors reported cost-effective intervention. CONCLUSIONS: Although economic evaluation of nursing practice has increased, it is still a rather small area. According to the items elucidated in this study, further methodological improvement is needed to evaluate the economics of nursing.