Nursing practice leaders' perspectives on continuing challenges related to the Doctor of Nursing Practice Degree.

In 2020, deans from top-ranked nursing schools authored a Nursing Outlook article titled, "Doctor of Nursing Practice (DNP) Degree in the United States: Reflecting, Readjusting, and Getting Back on Track." In 2022, the American Association of Colleges of Nursing published the report, "State of the Doctor of Nursing Practice Education."- Both have been critical to advancing national discussions on the implementation of a universal DNP practiceentry standard in nursing. This paper, written by Chief Nursing Officers from top-ranked academic medical centers, reports on perspectives from practice settings/employers regarding issues raised by educators and deans in those documents. Barriers to acceptance of the DNP degree in practice include a lack of degree standardization, a need for DNP outcomes data, and a desire for a clearer return on investment for the DNP degree among graduates and employers.

A Qualitative Descriptive Study of Nurse Manager Decision-Making Associated With RN Hiring.

OBJECTIVE: To explore the practices and self-confidence of nurse manager (NM) decision-making related to evaluating RN hiring needs. BACKGROUND: Evidence-based hiring strategies to sustain workforce stability were identified as a gap in the literature. Locally, inconsistencies in the method that NMs use to determine how many RNs to hire and at what frequency to hire them were observed, posing a threat to strategic workforce planning. METHODS: Using a mixed-methods, qualitative descriptive design, researchers used in-depth interviews and surveys to assess current practices and NM confidence related to evaluating hiring needs. RESULTS: The overarching theme among the 10 participants was false confidence. Subthemes reflected the dissonance in confidence and high variability in the hiring process. NM stress, time spent, and confidence were not correlated with years' experience. CONCLUSIONS: NMs experience stress, spend excessive time, and use varying approaches to evaluate hiring needs. Years of managerial experience are unrelated to practical skills or level of confidence in hiring decision-making.

Health System Redesign of Cardiac Monitoring Oversight to Optimize Alarm Management, Safety, and Staff Engagement.

OBJECTIVE: The purpose of this quality improvement project was to improve health system patient safety by creating a cardiac monitoring structure aligned with national standards. BACKGROUND: Excessive alarms pose patient safety threats and are often false or clinically insignificant. The Joint Commission identified reduction of nonactionable alarms as a National Patient Safety Goal. METHODS: The conversion to structured monitoring occurred in 4 phases: 1) defining health system monitoring structure and processes; 2) co-create sessions; 3) implementation and impact analysis; and 4) ongoing evaluation and optimization. RESULTS: Twenty-two clinical units participated. At the conclusion of phase 4, total 30-day alarm rates decreased by 74% at the academic hospital and by 92% and 95% at the community hospitals and were sustained for 12 months. CONCLUSIONS: Decreasing alarm frequency can be safely achieved in academic and community hospitals by creating a system-wide monitoring infrastructure and standardized processes that engage interdisciplinary teams.

Moving nursing innovation to prime time through the use of creative partnerships.

Nurses are well-positioned to solve many problems in healthcare through engagement in innovation. Support from healthcare organizations to facilitate creative partnerships may accelerate nurses' ability to innovate and improve job satisfaction. The value of creative partnerships is rooted in the diversity of experiences and skillsets of each project team member. While nurses may be content experts and key stakeholders, they often lack experience with project management, information technology, product development, and other important skills. We describe the use of co-creation approaches in creative partnerships with diverse stakeholders to enhance the ability of nurse-led project teams to build valuable and sustainable products or services.

Evaluation of a proactive hiring model to achieve workforce stability in the intensive care unit.

AIM: The purpose was to evaluate an innovative Prospective Hiring Equation to determine registered nurse hiring needs. BACKGROUND: The American Organization for Nursing Leadership identifies human resource management as a competency for nurse managers, yet calculations to determine when and how many registered nurses to hire are not readily available. METHODS: We implemented an educational intervention to teach nurse mangers the Prospective Hiring Equation. We evaluated the processes (adoption and confidence) and outcomes (vacancy rates) using a pre-evaluation/postevaluation design in a single cohort of nurse managers (n = 9). We used a statistical process control chart to depict mean differences in vacancy rate at baseline and 6-month postimplementation. RESULTS: Participants (n = 9) were on average 43 years' old, female, and had 2.94 (SD = 2.66) years' of nurse manager experience. Following implementation of the intervention, the combined vacancy rates of the intensive care units improved by 11.8% (SD = 7), and use of agency nurses decreased by 42.5% (premedian = 7.2, interquartile ratio = 3.6, 10.8; postmedian = 1.8, interquartile ratio 0.9, 8.55). CONCLUSIONS: The Prospective Hiring Equation may be a useful tool to improve nurse managers human resource management competencies. IMPLICATIONS FOR NURSING MANAGEMENT: The Prospective Hiring Equation may help nurse managers improve accuracy when evaluating hiring needs.

The Implementation of a Structured Nursing Leadership Development Program for Succession Planning in a Health System.

Preparing future nursing leaders to be successful is important because many current leaders will retire in large numbers in the future. A structured nursing leadership development program utilizing the Essentials of Nurse Manager Orientation online program provided future nursing leaders with content aligned with nursing leadership competencies. Paired with assigned mentors and monthly leadership sessions, the participants increased their perception of leadership competence.

Policy to practice: increased family presence and the impact on patient- and family-centered care adoption.

OBJECTIVE: This quality improvement study introduced 24/7 family presence and measured its impact in 3 categories; perceptions, complaints, and patient experience scores. This article offers insight for leaders into the 1st phase of patient- and family-centered care (PFCC) adoption. BACKGROUND: Family presence improves patient safety and satisfaction; however, 70% of US healthcare organizations maintain restrictive visitation policies. METHODS: We surveyed nursing staff 6 months postinnovation to determine staff knowledge, implementation practices, and perceived challenges to implementation. We surveyed system leaders regarding PFCC transformation and trended formal complaints and patient experience scores after family presence innovation. RESULTS: Findings provide insight for leaders into family presence policy adherence challenges experienced by staff. Leaders perceived significant transformation toward PFCC adoption postinnovation. Complaints increased postinnovation, and patient experience scores demonstrated positive trends. CONCLUSIONS: We gained insight regarding challenges to policy adherence and identified next steps for leaders in the transformation toward PFCC adoption.

Evaluation of the use of bar-code medication administration in nursing practice using an evidence-based checklist.

The goal of this project was to determine whether the use of bar-code medication administration complied with current evidence as to how it should be used. Using an evidence-based checklist, we performed a gap analysis on bar-code medication administration (BCMA) in an acute care setting. Compliance with current evidence was identified through observation and unstructured nurse interviews. Based on findings from the initial gap analysis, quality improvement initiatives were implemented followed by a reassessment to identify possible improvement of the identified gaps. Initially, there was 72% compliance with current evidence-based practices using BCMA. After implementation of initial quality improvement initiatives targeting 3 of 9 areas with deficits in compliance, compliance was found to be 81%. The evidence-based checklist was helpful in identifying gaps in current performance and opportunities for improvement with BCMA.

Isolated central nervous system relapse of chronic myeloid leukemia after allogeneic hematopoietic stem cell transplantation.

BACKGROUND: This case report highlights the relevance of quantifying the BCR-ABL gene in cerebrospinal fluid of patients with suspected relapse of chronic myeloid leukemia in the central nervous system. CASE PRESENTATION: We report on a female patient with isolated central nervous system relapse of chronic myeloid leukemia (CML) during peripheral remission after allogeneic hematopoietic stem cell transplantation. The patient showed a progressive cognitive decline as the main symptom. MRI revealed a hydrocephalus and an increase in cell count in the cerebrospinal fluid (CSF) with around 50% immature blasts in the differential count. A highly elevated BCR-ABL/ ABL ratio was detected in the CSF, whilst the ratio for peripheral blood and bone marrow was not altered. On treatment of the malresorptive hydrocephalus with shunt surgery, the patient showed an initial cognitive improvement, followed by a secondary deterioration. At this time, the cranial MRI showed leukemic infiltration of lateral ventricles walls. Hence, intrathecal administration of cytarabine, methotrexate, and dexamethasone was initiated, which caused a significant decrease of cells in the CSF. Soon after, the patient demonstrated significant cognitive improvement with a good participation in daily activities. At a later time point, after the patient had lost the major molecular response of CML, therapy with dasatinib was initiated. In a further follow-up, the patient was neurologically and hematologically stable. CONCLUSIONS: In patients with treated CML, the rare case of an isolated CNS blast crisis has to be taken into account if neurological symptoms evolve. The analysis of BCR-ABL in the CSF is a further option for the reliable detection of primary isolated relapse of CML in these patients.

An academic-health service partnership in nursing: lessons from the field.

PURPOSE: To describe the development of an academic-health services partnership undertaken to improve use of evidence in clinical practice. APPROACH: Academic health science schools and health service settings share common elements of their missions: to educate, participate in research, and excel in healthcare delivery, but differences in the business models, incentives, and approaches to problem solving can lead to differences in priorities. Thus, academic and health service settings do not naturally align their leadership structures or work processes. We established a common commitment to accelerate the appropriate use of evidence in clinical practice and created an organizational structure to optimize opportunities for partnering that would leverage shared resources to achieve our goal. FINDINGS: A jointly governed and funded institute integrated existing activities from the academic and service sectors. Additional resources included clinical staff and student training and mentoring, a pilot research grant-funding program, and support to access existing data. Emergent developments include an appreciation for a wider range of investigative methodologies and cross-disciplinary teams with skills to integrate research in daily practice and improve patient outcomes. CONCLUSIONS: By developing an integrated leadership structure and commitment to shared goals, we developed a framework for integrating academic and health service resources, leveraging additional resources, and forming a mutually beneficial partnership to improve clinical outcomes for patients. CLINICAL RELEVANCE: Structurally integrated academic-health service partnerships result in improved evidence-based patient care delivery and in a stronger foundation for generating new clinical knowledge, thus improving patient outcomes.

Evaluation of an evidence-based, nurse-driven checklist to prevent hospital-acquired catheter-associated urinary tract infections in intensive care units.

Catheter-associated urinary tract infections account for 40% of all health care-associated infections. An evidence-based, nurse-driven daily checklist for initiation and continuance of urinary catheters was implemented in 5 adult intensive care units. Measures of compliance, provider satisfaction, and clinical outcomes were recorded. Compliance with the checklist was 50 to 100%: catheter-associated urinary tract infections decreased from 2.88 to 1.46 per 1000 catheter days and catheter days decreased in 2 intensive care units.

The Power of Two:: One Academic-Practice Partnership's Response to Coronavirus Disease 2019 (COVID-19).

Academic-practice partnerships are necessary for strengthening nursing practice, robust and relevant academic programs, and advancing health care. The purpose of this paper is to describe how a strong academic-practice partnership shaped our response to the coronavirus disease 2019 (COVID-19) pandemic. During this unprecedented time, existing relationships between the health system and school of nursing were quickly leveraged to provide mutually beneficial relief, opportunities, and support. Initiatives described in this paper demonstrate how powerful a concentrated academic-practice partnership can be in transforming the nursing profession. Moving forward, it will be crucial for schools to build partnerships with appropriate organizations that have a vested interest in preparing nurses for the future.

An innovative DNP post-doctorate program to improve quality improvement and implementation science skills.

BACKGROUND: Doctor of Nursing Practice programs prepare nurse leaders for unique roles to address healthcare needs across the quality spectrum. However, additional mentoring and training in implementation science and analytical skills is needed to effectively lead system-wide quality initiatives. PURPOSE: The purpose of this article is to describe the planning, implementation, and evaluation of an innovative post-doctoral DNP Quality Implementation Scholars Program developed through an academic-practice partnership to address this need. PROJECT METHOD: Throughout the one year post-doctoral program, we evaluated student experiences qualitatively using focus groups and quantitatively using standardized course and instructor surveys to assess overall programmatic goals. Program outcomes were evaluated from the perspective of the academic-practice partnership planning committee through a Qualtrics© survey. FINDINGS: Strengths of the program included the in-depth mentoring by faculty and relationships built across the larger health system. Both scholars and the planning team noted that the system-wide project implemented by the scholars was relevant, timely, and quality-focused. CONCLUSIONS: This innovative DNP post-doctoral program leveraged the skill-sets of DNP-prepared nurse leaders to lead system-wide quality improvement initiatives tailored specifically to healthcare organizations.

Priorities and challenges of health system chief nursing executives: insights for nursing educators.

The health system chief nursing executive (CNE) is responsible for providing high-quality, service-oriented nursing care; delivering such care with disciplined cost management; leading and developing a group of nursing executives and managers at the facility level to establish nursing professional development programs and to build and maintain an effective supply of nurses; and advocating nurses and patients. This article provides insight into the strategies and priorities of large health system CNEs in balancing their obligations to their health systems, to patients and their families, and to the nurses they lead. It is hoped that these insights will provide perspectives that will support the ability of nursing educators to meet their own obligations to their schools of nursing, the faculty and students they represent, and to the profession. These insights will also set a context for further dialogue between two very important groups of nursing leaders-nursing executives and nursing educators.

Test-Retest Reliability of the Genetics and Genomics in Nursing Practice Survey Instrument.

BACKGROUND AND PURPOSE: Assessment of nursing genomic competency is critical given increasing genomic applications to health care. The study aims were to determine the test-retest reliability of the Genetics and Genomics in Nursing Practice Survey (GGNPS), which measures this competency, and to revise the survey accordingly. METHODS: Registered nurses (n = 232) working at 2 Magnet-designated hospitals participating in a multiinstitutional genomic competency study completed the GGNPS. Cohen's kappa and weighted kappa were used to measure the agreement of item responses between Time 1 and Time 2. Survey items were revised based on the results. RESULTS: Mean agreement for the instrument was 0.407 (range = 0.150-1.000). Moderate agreement or higher was achieved in 39% of the items. CONCLUSIONS: GGNPS test-retest reliability was not optimal, and the instrument was refined based on the study findings. Further testing of the revised instrument is planned to assess the instrument performance.

EC as PIE: five criteria for executing a successful DNP final project.

The goal of doctor of nursing practice (DNP) programs should be to produce nurses that are uniquely prepared to bridge the gap between the discovery of new knowledge and the scholarship of translation, application, and integration of this new knowledge in practice (American Association of Colleges of Nursing [AACN], 2006). However, there is concern over the variability in DNP programs and expected outcomes. The aim of this article is to describe a 5-point system of evaluation to determine whether a DNP final project meets the outcomes of the AACN Essentials of Doctoral Education in Advanced Nursing Practice (2006) in a comprehensive and rigorous way. In brief, the five criteria that must be met are represented by the acronym EC as PIE (E = Enhances; C = Culmination; P = Partnerships; I = Implements; E = Evaluates). Each criterion must be present and come together to form one complete "pie" representing evidence-based practice that is robust and innovative, culminating in a rigorous doctoral level DNP final project. In addition, we provide detailed examples of how these standards are currently being successfully implemented and discuss additional possibilities.