Psychiatric Nurses' Lived Experiences of Workplace Violence in Acute Care Psychiatric Units in Western Canada.

Workplace violence directed at nurses in healthcare settings is a common occurrence across the globe resulting in negative nurse and organizational implications that may impact the quality of care provided. Psychiatric nurses working on acute care psychiatric units are at an increased risk and are frequently subjected to patients' violent and aggressive behaviors. These implications pose significant threats to the nurses' emotional, physical, and psychological health. Efforts to reduce workplace violence on acute care psychiatric units requires an examination of psychiatric nurses' lived experiences. A qualitative descriptive phenomenological inquiry was conducted using semi-structured interviews with 10 registered psychiatric nurses within a Western Canada health region to explore their lived experiences of patient-to-nurse workplace violence. The findings of this study highlight the implications of workplace violence and substantiates the urgent need to improve the safety on acute care psychiatric units.

Using the Synergy Tool to Determine Regina Emergency Department Staffing Needs.

This article describes a three-year project between nurse researchers, the Saskatchewan Health Authority, the provincial nurses' union and nurses and leadership from two Regina tertiary care emergency departments. The purpose of the project was to create staffing guidelines based on patients' priority care needs. A patient needs assessment tool - the synergy tool - was used to categorize patients' acuity and dependency needs. Staffing guidelines were developed to match patients' needs to nurses' years of experience and classification. Staffing guidelines based on patient needs were compared to guidelines determined by operational budgets. The identified staffing gaps resulted in nurse hires for both emergency departments.

Nurse managers implementing the lean management system: A qualitative study in Western Canada.

AIM: This study explores the perceptions and experiences of nurse managers involved in implementing the Lean management system in a Western Canadian province. BACKGROUND: The provincial government of Saskatchewan, Canada, implemented a multimillion-dollar investment in the Lean management system to transform health care delivery by reducing waste and increasing efficiency of processes and outcomes. METHODS: This qualitative exploratory study employed semi-structured interviews with 14 nurse managers in urban and rural health regions in one Canadian province. RESULTS: Six themes outline the difficulties nurse managers experienced in juggling role responsibilities alongside a poorly implemented change system with scarce resources. CONCLUSION: The results showed tensions in the implementation of a Lean model adapted in the context of health care organisations. The expectations for nurse managers to be pivotal players in the implementation of transformative health care practices that promote and sustain strategies to reduce waste, improve coordination and increase patient safety require investment in leadership development. IMPLICATIONS FOR NURSING MANAGEMENT: Lean management systems significantly impact the roles of nurse managers who require adequate resources and training to successfully adapt. The results of this study may be used for more effective support mechanisms for nurse managers.

The Role of Nurse Leaders in Advancing Carer Communication Needs across Transitions of Care: A Call to Action.

This paper focuses on the central role of senior nurse leaders in advancing organizational resources and support for communication between healthcare providers and carers that influences patient and carer outcomes during the transition from hospital to the community. A Think Tank (Lobchuk 2012) funded by the Canadian Institutes of Health Research (CIHR) gathered interdisciplinary and intersectoral stakeholders from local, national and international levels to develop a Family Carer Communication Research Collaboration. Workshop stakeholders addressed critical challenges in meeting communication needs of carers as partners with clinicians in promoting safe care for the elderly, chronically or seriously ill or disabled individuals in the community. Key priority areas identified the need to uncover nurse leader perspectives at the system, nurse leader, healthcare provider and patient levels where communication with carers occurs. The overarching outcome from the workshop focuses on the need for nurse leaders to advocate for patients and their families in meeting carer communication needs. The authors' "call to action" requires commitment and investment from nurse leaders in the critical juncture of healthcare delivery to strengthen communication between healthcare providers and carers that influence patient and carer outcomes in seamless transitions of care.

Empirical and pragmatic adequacy of grounded theory: Advancing nurse empowerment theory for nurses' practice.

AIMS AND OBJECTIVE: To draw on the findings of a grounded theory study aimed at exploring how power is exercised in nurse-manager relationships in the hospital setting, this paper examines the empirical and pragmatic adequacy of grounded theory as a methodology to advance the concept of empowerment in the area of nursing leadership and management. BACKGROUND: The evidence on staff nurse empowerment has highlighted the magnitude of individual and organisational outcomes, but has not fully explicated the micro-level processes underlying how power is exercised, shared or created within the nurse-manager relationship. Although grounded theory is a widely adopted nursing research methodology, it remains less used in nursing leadership because of the dominance of quantitative approaches to research. Grounded theory methodology provides the empirical and pragmatic relevance to inform nursing practice and policy. Grounded theory is a relevant qualitative approach to use in leadership research as it provides a fine and detailed analysis of the process underlying complexity and bureaucracy. DESIGN: Discursive paper. METHOD: A critical examination of the empirical and pragmatic relevance of grounded theory by (Corbin & Strauss, , ) as a method for analysing and solving problems in nurses' practice is provided. CONCLUSIONS: This paper provides evidence to support the empirical and pragmatic adequacy of grounded theory methodology. Although the application of the ontological, epistemological and methodological assumptions of grounded theory is challenging, this methodology is useful to address real-life problems in nursing practice by developing theoretical explanations of nurse empowerment, or lack thereof, in the workplace. RELEVANCE TO CLINICAL PRACTICE: Grounded theory represents a relevant methodology to inform nursing leadership research. Grounded theory is anchored in the reality of practice. The strength of grounded theory is to provide results that can be readily applied to clinical practice and policy as they arise from problems that affect practice and that are meaningful to nurses.

Impact of Role Stressors on the Health of Nurse Managers: A Western Canadian Context.

OBJECTIVE: A qualitative exploratory inquiry was used to understand nurse managers' (NMs') perceptions of their role stressors, coping strategies, and self-health related outcomes as a result of frequent exposure to stressful situations in their role. BACKGROUND: Strong nursing leadership is required for desirable staff, patient, and organizational outcomes. A stressed NM will negatively influence staff nurse satisfaction and retention, patient outcomes, and organizational performance. Stress can affect NMs' mental and physical heath, leading to job dissatisfaction and turnover. METHODS: A qualitative exploratory inquiry was conducted using semistructured interviews with 23 NMs and 1 focus group interview. RESULTS: Findings suggest that coping strategies may be inadequate, given the intensity and demands of the manager role, and could negatively impact NMs' long-term health. CONCLUSIONS: Senior nurse leaders can significantly impact the health and productivity of NMs by minimizing the adverse effects of role stress and foster a positive work environment.

Process of seeking connectivity: social relations of power between staff nurses and nurse managers.

This study explored the process of how power is exercised in nurse-manager relationships in the hospital setting, to better understand what fosters and constrains staff nurse empowerment. Semi-structured interviews and participant observations were conducted with 26 participants in a hospital in Western Canada. Seeking connectivity was the basic social process in which nurses strive to connect with their manager to create a workable partnership in the provision of high-quality patient care while responding to the demands of the organizational context. The overarching finding was that the manager plays a critical role in modifying the work environment for nurses and, as such, nurses seek connection with their manager. Findings revealed two patterns within the process of seeking connectivity: (a) in the absence of a meaningful engagement with the manager, power was held over nurses through institutional patterns of behaviour and practices, and nurses employed a variety of resistance strategies; (b) when managers provided guidance and engaged nurses as co-collaborators, power was shared and nurses were able to influence patient outcomes positively. The results of this study support Laschinger's program of research on nurse empowerment from an organizational perspective, and advance nurse empowerment from a critical perspective.

Nurse managers' work stressors and coping experiences: unravelling the evidence.

This pilot study explored (a) front-line nurse managers' stressor experiences and (b) coping strategies used in order to respond to the myriad of challenges and demands of their role. The nurse managers who participated indicated that limited resources, ever-increasing challenges and work expectations contributed to the stressors they experience. Coping responses included support, cognitive, personal and social strategies, but findings indicated managers still lacked the ability to cope effectively. Managers faced considerable job stress and conflicting demands, often caught between focusing on staff relations and organizational productivity. Equipping managers with appropriate preparation and support may make the role of nurse manager more attractive and facilitate succession planning. These findings will assist senior nurse leaders in formulating directives for appropriate structures and processes in advancing a multidimensional approach to support managers. Resolving this issue is critical for creating reasonable and realistic work expectations for nurse managers and for supporting the pivotal role that managers play to achieve organizational outcomes while preserving their personal health and well-being.

The power behind empowerment for staff nurses: using Foucault's concepts.

The concept of staff nurse empowerment is often evoked in dialogue concerning the nature of nurses' practice in improving their work environments. Nurse empowerment has been the subject of vigorous discussion in healthcare settings, and has been researched largely through an organizational perspective. In this paper, nurse empowerment is analyzed by drawing upon a critical science approach as an alternative theoretical lens. Power is integral to empowerment, and occurs in the context of relations of power. The author uses the ideas of Michel Foucault to address the different ways in which power relations shape nurses' experiences in the workplace. Foucault conceptualizes power as a form of power that envelops staff nurses and nurse managers and, more specifically, as a set of disciplinary techniques. Rather than discussing power solely as a repressive force, Foucault identifies the productive aspects of power. His analysis of where power resides suggests a thought-provoking approach to staff nurse empowerment that has the potential to change nurses' practice through points of resistance, and thus has implications for improving the quality of nurses' work life.

Setting the climate for evidence-based nursing practice: what is the leader's role?

Nurses are being challenged today to justify their practice. Many clinical and policy decisions in nursing are based upon isolated, ritualistic and unsystematic forms of clinical practice. The growing movement towards establishing evidence-based nursing practice (EBNP) is situated in a systematic appraisal of the best evidence available. Nurse leaders have an obligation to cultivate sound clinical and economic practices leading to quality patient care and positive work life environments for nurses.

Perceptions of first-line nurse managers. What competencies are needed to fulfill this role?

First-line nurse managers have experienced an unprecedented shift in their roles and responsibilities as a result of health care reform. Consequently, there is a need to identify competencies required of first-line nurse managers in a changing health care environment. A descriptive, exploratory study of nurse managers in a western Canadian province was conducted using a combined quantitative and qualitative approach. The research instrument was comprised of three parts: a questionnaire that grouped five categories of competencies (technical, human, conceptual, leadership, and financial management); demographic data; and a critical incident technique that allowed the subjects to elaborate on a specific incident in their practice when they "performed at their best" as a manager. Findings revealed that nurse managers' need for knowledge and understanding was greater than their ability to implement managerial competencies. The exploration of competencies of first-line nurse managers has implications for curriculum development in leadership and management courses in nursing programs, as well as managerial development in health care agencies. Results will assist educators and administrators in addressing the changing needs of current and future nurse managers.

Lessons learned in developing and delivering Web-based graduate courses: a faculty perspective.

The increased demand for graduate distance education by RNs create many challenges for nurse educators. This article describes the trials and tribulations of developing and delivering two Web-based graduate nursing courses at a western Canadian university. The authors describe the background and rationale for developing Web-based courses, the relevant literature, and the lessons learned in planning and delivering these courses.