Beyond Magnet® Designation: Perspectives From Nurse Managers on Factors of Sustainability and High-Performance Programming.

OBJECTIVE: The aim of this study was to identify patterns of high-performing behaviors and nurse manager perceptions of the factors of Magnet® sustainability at a multidesignated Magnet organization. BACKGROUND: The Magnet program recognizes exemplary professional nursing practice and is challenging to achieve and sustain. Only 10% (n = 42) of Magnet hospitals sustained designation for 12 years or longer. This study explored the perspectives of Magnet nurse managers regarding high-performing teams and the sustainability of Magnet designation. METHODS: A qualitative study of nurse managers was conducted at 1 multidesignated Magnet organization (n = 13). Interview responses were analyzed using pattern recognition of Magnet model domains and characteristics of high-performing teams and then related to factors of Magnet sustainability. RESULTS: Transformational leadership is both an essential factor for sustainability and a potential barrier to sustainability of Magnet designation. CONCLUSIONS: Transformational nursing leaders lead high-performing teams and should be in place at all levels as an essential factor in sustaining Magnet redesignation.

The influence of goal setting and SmartRoom patient education videos on readmission rate, length of stay, and patient satisfaction in the orthopedic spine population.

The SmartRoom technology, a system now owned by TeleTracking Technologies, aims to transform the delivery of patient care in the inpatient environment. The purpose of this project was to use goal setting and SmartRoom patient education videos to examine whether the videos more effectively engaged patients and their families in their discharge plan and encouraged them to take a more active role in their care while hospitalized. This study used a descriptive design to analyze the effect of goal setting and patient education videos on patient satisfaction at discharge, hospital average length of stay, and 30-day readmission rate in the orthopedic spine surgical care setting. Comparisons were made among three patient groups. No statistically significant difference was found for average length of stay and 30-day readmission across these three groups. However, patient satisfaction with discharge, as measured by the Hospital Consumer Assessment of Health Providers and Systems, revealed an increase in five items regarding discharge with statistically significant differences on two of the five items.

How magnetic are Finnish hospitals measured by transformational leadership and empirical quality outcomes?

AIM: The overall aim of this study was to examine nurses' and patients' perceptions of the Magnet model components of transformational leadership and empirical quality outcomes in four Finnish hospitals and to determine if the evidence for transformational leadership and empirical quality outcomes is the same or different in the four hospitals. BACKGROUND: This report presents baseline measurements for a longitudinal study of the adaptation of the Magnet model in Finnish hospitals. METHODS: Web-based surveys and mailed questionnaires were used in 2008-2009 to collect data from patients (n = 2566) about their satisfaction with care, and from nursing staff about transformational leadership (n = 1151), job satisfaction (n = 2707) and patient safety culture (n = 925) in the selected hospitals. RESULTS: Awareness of the work of nursing leaders was low. Nurses reported a high level of job satisfaction. Patient safety culture varied considerably between the four hospitals. Patients believed they generally received excellent quality care. CONCLUSIONS: Leadership systems are in transition at the hospitals. Patient safety culture is a complex phenomenon that may be unfamiliar to respondents. The results of the study provide a baseline description to guide the journey toward development of Magnet standards. IMPLICATIONS FOR NURSING MANAGEMENT: Finnish nursing leaders, especially nursing directors, should increase their visibility by working more closely with their staff. They should also pay attention to giving direct feedback about work generally and patient safety issues in particular.

Study of nurse workarounds in a hospital using bar code medication administration system.

This study analyzed registered nurse workarounds in an academic medical center using bar code medication administration technology. Nurse focus groups and a survey were used to determine the frequency and potential causes of workarounds. More than half of the nurses surveyed indicated that they administered medications without scanning the patient or medications during the last shift worked. Benefits of this study include considerations when implementing bar code medication administration technology that may minimize the development of these workarounds in practice.

A relational leadership perspective on unit-level safety climate.

OBJECTIVE: This study compared nursing staff perceptions of safety climate in clinical units characterized by high and low ratings of leader-member exchange (LMX) and explored characteristics that might account for differences. BACKGROUND: Frontline nursing leaders' actions are critical to ensure patient safety. Specific leadership behaviors to achieve this goal are underexamined. The LMX perspective has shown promise in nonhealthcare settings as a means to explain safety climate perceptions. METHODS: Cross-sectional survey of staff (n = 711) and unit directors from 34 inpatient units in an academic medical center was conducted. RESULTS: Significant differences were found between high and low LMX scoring units on supervisor safety expectations, organizational learning-continuous improvement, total communication, feedback and communication about errors, and nonpunitive response to errors. CONCLUSION: The LMX perspective can be used to identify differences in perceptions of safety climate among nursing staff. Future studies are needed to identify strategies to improve staff safety attitudes and behaviors.

A curriculum designed to decrease barriers related to scholarly writing by staff nurses.

Demonstrating professional development outcomes, such as scholarly publication, is critical as nurse leaders guide organizations seeking recognition as centers of excellence. However, personal and situational barriers often prevent staff nurses from achieving scholarly publication. This project tested a workshop and mentoring approach to decrease publication barriers with staff nurses in 2 community hospitals. Self-efficacy principles guided the curriculum that resulted in a statistically significant improvement in staff nurse perception of successful scholarly publication endeavors.

Blueprint for design: creating models that direct change.

The need for healthcare system change is overwhelming: broken systems, an inadequate workforce, patient safety failures, and lack of access to healthcare are but a few of the significant problems confronting healthcare today. Most people agree that things need to change, but they are not sure on what to change or how to change them. A well-developed model can serve as the currency for that change. By considering the evidence of what has worked well in the past and marrying that with what the future will require, we can create a strong sustainable model for professional practice. The authors explore that evidence and discuss the structure, process, and outcomes that should be considered in designing care delivery models for the future.

Failure to rescue: a literature review.

Rapid response teams have been advocated as an intervention to reduce failure to rescue events. Such teams can improve nurse autonomy and control to rescue patients deteriorating in a medical surgical setting. The purpose of this review is to enhance nurse executives' understanding of failure to rescue as a nurse sensitive outcome, tested interventions, and implications for future research. The emergence of failure to rescue as an outcome measure will be initially discussed. Research regarding the relationship between failure to rescue and registered nurse staffing as well as research examining the potential to reduce failure-to-rescue events will be explored.

A road map for creating a Magnet work environment.

OBJECTIVE: The authors examine the relationship between working environment and the developmental level of the workforce, against the backdrop of the American Nurses Credentialing Center Magnet Recognition Program, to provide a road map for creating a positive work environment. BACKGROUND: With the daily demands on nurse managers, there is a need to identify focused strategies to achieve a Magnetized, high-performing work environment. METHODS: The American Nursing Association Magnet survey was administered to nurses at a large healthcare system. Patient units at each hospital were categorized as reactive, responsive, proactive, or high performing. Similar categories of units across all 6 hospitals were analyzed. Analysis of variance was performed on each Force of Magnetism by developmental level. RESULTS: Mean scores measuring the Forces of Magnetism were statistically significant between reactive and responsive units. Likewise, mean scores between responsive and proactive units were also statistically significant. Between reactive and responsive units, there were 3 statistically significant forces of Magnetism: organizational structure, management style, and interdisciplinary relations. These are labeled primary priority forces. Between responsive and proactive units, there were 6 statistically significant forces of Magnetism labeled secondary priority forces: policies and programs; professional models of care; quality of care; consultation and resources; autonomy; and interdisciplinary relations. CONCLUSIONS: Nursing staff perceive the "Magnetism" of the work environment differently, depending on the developmental level of the unit. Nurse managers with reactive units should focus on the 3 Forces of Magnetism identified as the primary priority forces, in order to help develop their unit to the next level of responsive. Once a responsive level has been achieved, the next 6 forces should be addressed.

Investment in the future: a 3-level approach for developing the healthcare leaders of tomorrow.

Among the numerous challenges facing healthcare leaders is the paucity of well-prepared, effective managers. Cuts in recent years have reduced "bench strength," and the demands of managing in a complex industry are significant. The authors describe a 3-level leadership development program created at the University of Pittsburgh Medical Center to meet this challenge. Leadership gaps, content for each level, and outcomes are discussed.

An evidence-based model for enriching academic nursing leadership.

The challenge of developing contemporary nurse leaders for today and tomorrow is compounded not only by the faculty shortage but also by limited faculty expertise in healthcare administration. The authors describe an effective academic-service partnership designed to ground future nursing leaders in the knowledge, skills, and abilities essential for success.

Driving improvement in patient care: lessons from Toyota.

Nurses today are attempting to do more with less while grappling with faulty error-prone systems that do not focus on patients at the point of care. This struggle occurs against a backdrop of rising national concern over the incidence of medical errors in healthcare. In an effort to create greater value with scarce resources and fix broken systems that compromise quality care, UPMC Health System is beginning to master and implement the Toyota Production System (TPS)--a method of managing people engaged in work that emphasizes frequent rapid problem solving and work redesign that has become the global archetype for productivity and performance. The authors discuss the rationale for applying TPS to healthcare and implementation of the system through the development of "learning unit" model lines and initial outcomes, such as dramatic reductions in the number of missing medications and thousands of hours and dollars saved as a result of TPS-driven changes. Tracking data further suggest that TPS, with sufficient staff preparation and involvement, has the potential for continuous, lasting, and accelerated improvement in patient care.

The transformational model for professional practice: a system integration focus.

Healthcare organizations face the increasingly difficult challenge of providing services that are of high quality, reasonable cost, and easy accessibility for their constituents. Mergers and acquisitions are one strategy for accomplishing this, but in doing so it is critical to have a "road map" to create an integrated system, rather than merely a consortium of hospitals. The University of Pittsburgh Medical Center has successfully created an integrated healthcare system of 19 hospitals. The authors describe the professional practice model used as a framework for success in integrating patient care.

The impact of staffing on patient outcomes across specialty units.

OBJECTIVE: Determine the relationships between nursing staffing and specific nurse-sensitive outcomes (central line blood-associated infection, pressure ulcer, fall, medication error, and restraint application duration rates) across specialty units (cardiac and noncardiac intensive care, cardiac and noncardiac intermediate care, and medical-surgical). BACKGROUND: A number of hospital-level studies have demonstrated that lower staffing levels are associated with higher adverse patient outcomes. However, insufficient insight into unit-level staffing relationships is available. Further unit-level inquiry is necessary to fully explicate the relationships between staffing and outcomes and to provide assistance to nurse administrators as they seek to develop blueprints for staffing plans that are linked to quality outcomes. METHODS: Secondary analysis of prospective, observational data from 95 patient care units (cardiac intensive care, n = 15; noncardiac intensive care, n = 7; cardiac intermediate care, n = 18; noncardiac intermediate care, n = 12, and medical-surgical, n = 43) across 10 acute care hospitals. RESULTS: No statistically significant relationships were found between central line infection and pressure ulcer rates and staffing across specialty units. Significant inverse relationships were present between staffing and falls in cardiac intensive care, medication errors in both cardiac and noncardiac intensive care units, and restraint rates in the medical-surgical units. CONCLUSIONS: Results from this study suggest that the impact of staffing on outcomes is highly variable across specialty units; however, when present, the relationships are inversely related with lower staffing levels, resulting in higher rates of all outcomes.

Measuring nurse-sensitive patient outcomes across specialty units.

In efforts to quantify the quality of care delivered to patients within their systems, nursing administrators are being called on to both privately and publicly report nursing-sensitive outcomes for their institutions. Accurate reporting with appropriate patient population or risk adjustment is essential if the reported outcomes are to provide meaningful data to consumers and providers. At present there are no effective mechanisms available that can sufficiently adjust nursing-sensitive outcomes to assure reliable reporting. This study suggests that specialty unit classification may be one method by which nursing-sensitive outcomes can be accurately reported.