Moving Forward Into the Future: Nurses and Nurse Leaders at Leading US Public Health System Implementing Foundational Transformation to Advance Health Equity.

The nation's largest public health care system, New York City Health + Hospitals (NYC H + H), is engaged in a fundamental transformation of its nursing culture, actualizing many of the recommendations in the National Academies, The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. NYC H + H and its more than 9600+ nurses and 970+ social workers share a common public health mission, vision, and values to deliver essential health care services to the most vulnerable and disadvantaged members of society, regardless of ethnicity, culture, creed, gender, age, sexual orientation, income, immigration, or insurance status. This mission dovetails with all of the recommendations in the Future of Nursing report. Systemwide implementation of these recommendations is proceeding, with some programs further advanced than others. This article highlights the system's diversity, equity, and inclusion initiatives; nursing professional development; collaboration with academic partners; labor contract provisions to support recruitment and retention campaigns; technological advances to remove barriers to patient care; and nurse residency program and professional-shared governance implementation. NYC H + H safeguards 1.4 million patients annually, caring for 1 in every 6 New Yorkers through 11 essential hospitals, 5 post-acute care facilities, more than 70 community centers, and correctional health services in city jails.

Nursing Leadership at Nation's Leading Public Health System Addressing Health Equity and Social Determinants of Health at the Administrative Level and at the Bedside.

New York City Health + Hospitals (NYC H + H) is the largest public health care system in the United States, safeguarding 1.4 million patients annually, caring for 1 in every 6 New Yorkers through 11 essential hospitals, 5 post-acute care facilities, more than 70 community centers, and correctional health services in city jails. The 9600+ nurses and 970+ social workers represent the largest segment of the system's 40 000 employees, charged with delivering essential health care services to the most vulnerable and disadvantaged members of society, regardless of ethnicity, culture, creed, gender, age, sexual orientation, income, immigration, or insurance status. NYC H + H is in the process of reinventing nursing culture with a renewed focus on achieving true nursing excellence, emphasizing professional evidence-based best practices and a compassionate care delivery model, putting nurses in the forefront of all efforts to address the social determinants of health and the devastating consequences of health disparities. Systemwide implementation of foundational transformation is positioning nursing in the vanguard of the system's commitment to equity and diversity in the workplace, recognizing unconscious bias, calling out bigotry, and rooting out systemic racism, all key recommendations in the National Academies, The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity.

Staffing Up For The Surge: Expanding The New York City Public Hospital Workforce During The COVID-19 Pandemic.

Confronted with the coronavirus disease 2019 (COVID-19) pandemic, New York City Health + Hospitals, the city's public health care system, rapidly expanded capacity across its eleven acute care hospitals and three new field hospitals. To meet the unprecedented demand for patient care, NYC Health + Hospitals redeployed staff to the areas of greatest need and redesigned recruiting, onboarding, and training processes. The hospital system engaged private staffing agencies, partnered with the Department of Defense, and recruited volunteers throughout the country. A centralized onboarding team created a single-source portal for medical care providers requiring credentialing and established new staff positions to increase efficiency. Using new educational tools focused on COVID-19 content, the hospital system trained twenty thousand staff members, including nearly nine thousand nurses, within a two-month period. Creation of multidisciplinary teams, frequent enterprisewide communication, willingness to shift direction in response to changing needs, and innovative use of technology were the key factors that enabled the hospital system to meet its goals.

Critical Care And Emergency Department Response At The Epicenter Of The COVID-19 Pandemic.

New York City has emerged as the global epicenter for the coronavirus disease 2019 (COVID-19) pandemic. The city's public health system, New York City Health + Hospitals, has been key to the city's response because its vulnerable patient population is disproportionately affected by the disease. As the number of cases rose in the city, NYC Health + Hospitals carried out plans to greatly expand critical care capacity. Primary intensive care unit (ICU) spaces were identified and upgraded as needed, and new ICU spaces were created in emergency departments, procedural areas, and other inpatient units. Patients were transferred between hospitals to reduce strain. Critical care staffing was supplemented by temporary recruits, volunteers, and Department of Defense medical personnel. Supplies needed to deliver critical care were monitored closely and replenished to prevent interruptions. An emergency department action team was formed to ensure that the experience of front-line providers was informing network-level decisions. The steps taken by NYC Health + Hospitals greatly expanded its capacity to provide critical care during an unprecedented surge of COVID-19 cases in NYC. These steps, along with lessons learned, could inform preparations for other health systems during a primary or secondary surge of cases.

Measuring workload of nurses on a neurosurgical care unit.

AIM OF THE STUDY: The aim of this study was to create a model of workload that could be used to manage workload and increase satisfaction of workload for nurses on a neuroscience care unit. BACKGROUND: No study was found that delineated a model of workload that could be used to manage or improve satisfaction with workload for a neuroscience care unit at either the individual nurse or unit level. METHODS: Staff, management, and a researcher collaboratively developed a model to examine workload on a neuroscience care unit. Forty-three independent variables of workload and the dependent variable of satisfaction with workload were studied over 28 days using stepwise regression. Stepwise regression is appropriate for model building. Criteria to enter any independent variable into a regression equation included correlating with the dependent variable of satisfaction with workload, validation of central tendency assumptions, and good data fit using residual diagnostics. RESULTS: Independent variables of workload that explained the variance of satisfaction with workload included time (15.9%), undelegated work (4.0%), number of isolation patients (2.9%), individual employees (2.1%), number of patients (1.3%), and number of postoperative neurosurgical patients (1.1%). On the unit level, satisfaction with workload was predicted by time (42.5%) and the number of nurses on duty (7.7%). CONCLUSIONS: Satisfaction with workload as reported by staff nurses is predicted by both individual- and unit-level factors of workload. Staff input is crucial to the development of a model of workload on clinical specialty units like neuroscience care. Staff nurses identify key variables, otherwise overlooked, affecting workload and satisfaction and satisfaction with workload. IMPLICATIONS FOR NURSING MANAGEMENT: It is vital to develop unit-specific models of workload and consider both individual- and unit-level factors. Such models have potential for deeper research into both management and increasing satisfaction of workload at the level of clinical specialty/unit.