The Level of Political Astuteness in Nursing Leaders: A Baseline Assessment.

OBJECTIVE: To assess the baseline knowledge of nursing leaders regarding political advocacy and healthcare policy. BACKGROUND: Although there has been considerable attention to the need for nurses' involvement in health policy, there has not been a prior assessment of the political astuteness of nursing leaders. METHODS: Researchers analyzed self-reported data from 101 nursing leaders collected via electronic survey from American Organization for Nursing Leadership members. Descriptive, correlational analysis of data assessing political astuteness and background information was completed. RESULTS: Half of the nurse leader participants demonstrated slight political astuteness. Nurse executives, including those in chief nursing officer, chief nurse executive, and vice president positions, had higher levels of political astuteness than those in nurse director and manager positions. CONCLUSION: Nursing leaders have beginning levels of political astuteness. Formal education is recommended to increase the knowledge base of nurse leaders in the areas of understanding the political and legislative process and the skills needed to advocate regarding healthcare policy, thus increasing their level of political astuteness.

Facilitators of and Barriers to the Therapeutic Nurse-Patient Relationship: Perceptions From Psychiatric Mental Health Nurses.

BACKGROUND: The therapeutic relationship serves as a cornerstone in psychiatric mental health nursing practice, providing a basis for implementing various interventions. AIMS: This study aimed to explore the perspectives of psychiatric mental health nurses regarding factors that facilitate and impede the therapeutic nurse-patient relationship. METHODS: A descriptive study was conducted among psychiatric mental health nurses employed at two community psychiatric hospitals in the northeast area of the United States. A list of facilitators and barriers was developed based on an extensive literature review and subsequently validated by three experts in the field of psychiatric mental health nursing. Participants rated these factors on a 10-point scale. RESULTS: The study included 74 registered nurses from two psychiatric hospitals, yielding a 24% response rate. The highest-ranked facilitator was awareness that the relationship enables collaborative goal setting with patients. The most significant barrier was insufficient time due to administrative tasks. CONCLUSIONS: This study highlights the importance of understanding facilitators and barriers in the therapeutic nurse-patient relationship. Replicating the study nationally on a larger scale among psychiatric mental health nurses is recommended.

Individual and Work-Related Characteristics Associated with COVID-19 Vaccination Status among Ohio Nurses.

Uptake of the COVID-19 vaccine by nurses lags behind that of other health care professionals with minimal empirical evidence to understand this phenomenon. In this secondary analysis, we examined nurses' individual and work-related characteristics and their association with COVID-19 vaccination status. Alumni of three Ohio nursing colleges and members of a professional organization were invited to complete questionnaires from June through August 2021. Logistic regression models were used to evaluate associations between nurse characteristics and vaccination status. Among 844 respondents, 754 (80.30%) had received at least one dose of the vaccine. Older age, having a bachelor's degree or higher, and working in critical care were associated with vaccination. Providing direct care for COVID-19 patients in the last 7 days and a higher perception of one's work being affected by COVID-19 were significantly associated with being vaccinated, whereas prior COVID-19 infection was inversely associated with vaccination status. Our findings suggest that COVID-19 vaccine uptake among nurses is influenced by a host of factors related to virus knowledge, beliefs, and risk perceptions. Awareness of these factors can aid the development of interventions to increase nurses' acceptance of vaccines.

Eating Disorders: Identification and Management in General Medical and Psychiatric Settings.

OBJECTIVE: Eating disorders (EDs) are serious, complex illnesses with both behavioral and physical health features. EDs have high rates of medical and psychiatric morbidity, and a 6% mortality rate, the highest of any mental illness. Early detection of EDs offers the best opportunity for recovery; yet, estimates are that as few as one in 10 individuals with an ED receive treatment. The purpose of this article is to provide an ED identification and management overview for inpatient nurse clinicians in general psychiatric and medical settings, helping to facilitate timely recognition and care. METHOD: An overview of ED diagnostic criteria and two evidence-based ED tools are introduced for consideration. RESULTS: Opportunities to identify and help manage an ED are numerous. Most individuals with an ED make several health care visits in either medical or psychiatric settings without ever being screened for an ED. General ED screening and assessment tool familiarization can facilitate a treatment trajectory for these patients, improve overall quality of life, and may potentially result in a life-saving intervention for this often-deadly cluster of medical and psychiatric disorders. CONCLUSION: Screening and assessment in general clinical settings, identifying patients with undiagnosed EDs, beginning basic treatment plans, and referrals for appropriate follow-up care, have the potential to reduce ED recidivism and related health care costs. Simultaneously, and most important, long-term outcomes for patients with EDs may improve.

Moral Injury, Nurse Well-being, and Resilience Among Nurses Practicing During the COVID-19 Pandemic.

OBJECTIVE: The aim of this study was to determine relationships between moral injury (MI), well-being, and resilience among staff nurses and nurse leaders practicing during the COVID-19 (coronavirus disease 2019) pandemic. BACKGROUND: Attention to MI among health professionals, including nurses, increased in 2021, particularly related to the pandemic. Few studies examined MI, well-being, and resilience; even fewer provided implications for leadership/management. METHODS: The sample included 676 RNs practicing in Ohio. The electronic survey included assessments of MI, well-being, and resilience distributed via the Ohio Nurses Association and the schools of nursing alumni Listservs. RESULTS: There was a significant association between MI and negative well-being and negative association between MI and resilience. Differences were observed between staff nurses and leaders. CONCLUSIONS: This is the first study relating MI, resilience, and well-bring among nurses and nurse leaders during the pandemic. There is a need for additional research to further our understanding about nurses' health and well-being during the pandemic and beyond.

Perceptions of US nurses and nurse leaders on authentic nurse leadership, healthy work environment, intent to leave and nurse well-being during a second pandemic year: A cross sectional study.

AIM: The main aim of this study was to determine the perceptions of clinical nurses and nurse leaders about authentic nurse leadership, work environment, pandemic impact, well-being and intent to leave their position and profession during the second year of the pandemic. BACKGROUND: This research team studied the variables pre-pandemic and in year one of the pandemic. As the pandemic continued, subsequent reports of workforce instability, deteriorating work environment and vulnerable well-being called for an understanding of the current state to inform needed actions by leadership. METHODS: This study is a cross-sectional, descriptive, correlational analysis using national survey data from 1795 US clinical nurses and nurse leaders in the fall of 2021. RESULTS: Pandemic impact was high, authentic nurse leadership was present, healthy work environment was not present and nurse well-being was at-risk and negatively correlated to both healthy work environment and authentic nurse leadership. Within our sample, 61.8% of nurses had no intention to leave their positions, and 82.5% had no intention to leave the profession. Compared with clinical nurses, nurse managers had significantly higher scores on all instruments. CONCLUSIONS: The findings of this study support leadership as positively related to a healthy work environment. Authentic nurse leadership, a healthy work environment and nurse well-being are all critical components of efforts to stabilize the nursing workforce as we recover and rebuild post-pandemic. IMPLICATIONS FOR NURSING MANAGEMENT: This is a call to action for leadership that will serve the goals of retaining nurses, rebuilding work environments and improving well-being.

Nurses' Intent to Leave their Position and the Profession During the COVID-19 Pandemic.

OBJECTIVE: The aim of this study was to describe the relationships between perceptions of the pandemic impact on clinical nurses' and nurse leaders' intent to leave their current position and the profession and the differences in pandemic impact and intent to leave variables based on background factors. BACKGROUND: There is much discussion and concern about the COVID-19 pandemic impact on nurses' health and the nursing workforce. METHODS: More than 5000 nurses from a national sample participated in a cross-sectional, descriptive study. Participants rated their perceptions of the pandemic impact on their practice and their intent to leave their position and profession. RESULTS: Pandemic impact was rated high overall and was highest in nurses with 25+ years of experience and in managers/directors. Eleven percent of the total sample indicated they intended to leave their position, and 20% were undecided. Nurses who rated pandemic impact at the highest level had higher intent to leave their position. Of the respondents, less than 2% indicated they were leaving the nursing profession, whereas 8% were undecided. CONCLUSIONS: This is the 1st quantitative report of perceived level of pandemic impact on direct care nurses and nurse managers/directors at the time of this writing. The combination of those who intend to leave and those who are uncertain about leaving their positions could cause instability in the workforce if not reversed. Organizational attention to nurse well-being, work environment and staffing is imperative.

Perceptions of Authentic Nurse Leadership and Work Environment and the Pandemic Impact for Nurse Leaders and Clinical Nurses.

OBJECTIVE: The aim of this study was to determine the pandemic impact on the relationship between nurses' perception of the authentic nurse leadership (ANL) of their manager and their perception of the work environment. BACKGROUND: Both ANL and healthy work environment (HWE) contribute to staff and patient outcomes. Our 1st study of these 2 variables revealed a positive relationship. Will this be upheld in a pandemic year? METHODS: More than 5000 nurses from a national sample participated in a cross-sectional, correlational, descriptive study using the Authentic Nurse Leadership Questionnaire, the Critical Elements of a Healthy Work Environment Scale, and a pandemic impact on practice question. RESULTS: Overall, nurses perceived ANL and HWE were present despite a high level of pandemic impact; however, when clinical nurses were separated from managers/directors, HWE was not present for frontline nurses. The moderate correlation of ANL and HWE was replicated in this larger study. CONCLUSIONS: This is the 2nd study of the positive relationship between ANL and HWE using these models, supporting ANL as an essential standard of a HWE. ANL was present for clinical nurses in a pandemic year signaling that nurse leaders rose to meet frontline leadership needs. HWE was present overall, but not for clinical nurses. Leadership is essential to work environments and outcomes especially in times of crisis and significant change.

Caffeine and high energy drink use and knowledge by nurses in three countries.

AIM: The purpose of this study was to examine nurses' use and knowledge of caffeine and high energy drinks (HED) in three countries. METHODS: Nurses in each country completed a survey on caffeine and HED use and knowledge. RESULTS: In a sample of 182 nurses, caffeine use was high with 92% of nurses in Korea, 90.8% in Italy and 88.1% in the United States (US) having at least one cup of coffee a day while 64% of Koreans and 11.9% of those in the US had at least one HED per day. In Korea 68% of nurses (Italy 63.1% and 35.8% US) had at least one cup of caffeinated tea per day. Most agreed there is a need to educate nurses about HED, which contain high amounts of caffeine. Over half of nurses in Korea (58%) and the US (56.7%) said their colleagues consume HED at work. CONCLUSION: Findings of this study indicate many nurses are consuming caffeine at work and there is a need for education. It is unclear how caffeine affects nurses' clinical performance, which raises the issue of patient safety. Further research is needed regarding safe amounts of caffeine while nurses are on the job as well as an understanding of how HED additives may affect the well-being and clinical care of nurses.

Giving while grieving: Racism-related stress and psychological resilience in Black/African American registered nurses.

BACKGROUND: Studies have found race-related stress psychologically and physiologically harms members of stigmatized racial groups. However, the stressor is racism, not race. PURPOSE: This study examined the relationship between racism-related stress and psychological resilience in Black/African American nurses. METHOD: This study used a cross-sectional, quantitative, correlational design with two instruments, an investigator-developed demographic questionnaire and a convenience sample. FINDINGS: Participants perceived they have low psychological resilience in stressful situations. With racism-related stress, in particular, participants perceived they are affected by both lived and vicarious racism - ruminating over past occurrences, and expecting/worrying that racism will happen to them or other Black/African American people. There was a significant positive correlation between participants' perceived psychological resilience, their ability to assess the nature of the racism-related stressor and their ability to mitigate its harmful effects by identifying and utilizing their coping resources. There was a negative correlation between racism-related stress and psychological resilience. DISCUSSION: There is a need for continued research on racism-related stress among Black/African American nurses. Further, healthcare organizations, advisably through their diversity, equity and inclusion (DEI) programs, must develop systemic approaches to meeting the unique needs of the Black/African American workforce.

Narrative Nursing: Empowering Nurse Leaders.

Narrative Nursing is a form of storytelling that is used as an intervention with nurses to empower them to share their profound experiences in the nurse-patient relationship. Nurses participating in the Narrative Nursing workshops each share an individual encounter that was meaningful in their own nursing career. The shared experience serves to acclaim the power of nurses as leaders at the point of care and nurse leaders mentoring others. Four stories of nurse leadership are included in this article, 2 from clinical nurses providing care at the bedside and 2 from nurses in leadership roles. Participants in Narrative Nursing describe the workshops as inspirational, affirming, and empowering of the essence of professional nursing. Leadership lessons learned from the Narrative Nursing experiences thus far are included as are plans for future work to inspire all nurses at all levels of leadership. The future work includes embedding the intervention within relationship-based leadership theories.

Clinical Nurses' Perceptions of Authentic Nurse Leadership and Healthy Work Environment.

OBJECTIVE: The aim of this study was to determine the relationship between clinical nurses' perception of the authentic nurse leadership of their manager and their perception of the work environment on their unit. BACKGROUND: Authentic leadership (AL) and healthy work environments contribute to staff engagement and improved patient outcomes. There is limited research linking these 2 variables. METHODS: Two hundred fifty-four clinical nurses at a national conference participated in a cross-sectional, correlational, descriptive study using the Authentic Nurse Leadership Questionnaire and the Critical Elements of a Healthy Work Environment Survey. RESULTS: Overall, nurses rated the authentic nurse leadership of their manager as present most of the time and agreed their work environment was healthy. There was a moderate correlation between AL and healthy work environment. Background variables were not significantly related to nurses' perceptions of the authentic nurse leadership of their manager or their work environment. CONCLUSIONS: This is the 1st study using these authentic nurse leadership and healthy work environment frameworks. In this novel nursing model of AL, caring is an attribute that was valued by frontline nurses. This is a call to action for leadership development at every level using AL principles and for the improvement of lagging domains in nursing work environments, both critically needed during challenging healthcare times and for the ultimate purpose of improving patient and workforce outcomes.

Postpartum glucose screening among women with gestational diabetes.

OBJECTIVE: (1) Determine the rate of completion of glucose screening for diabetes in the postpartum period for women who had gestational diabetes mellitus, and (2) compare the rates of follow up glucose screening among women who had A1GDM or A2GDM 4-12 weeks postoartum. DESIGN: A retrospective comparative study. SETTING: An academic hospital in an urban community. PARTICIPANTS: One hundred and seventy-five women with gestational diabetes who gave birth between January 2012 and September 2015. METHODS: The electronic medical record was reviewed to confirm diagnosis of gestational diabetes at 24-28 weeks and completion of 4-12 weeks postpartum glucose screening. All consecutive women meeting eligibility criteria were included. RESULTS: The rate of postpartum glucose screening was 38.9%. There were 22 (31.0%) women with A1GDM and 46 (44.2%) women with A2GDM who had postpartum glucose screening (χ2 = 3.12, p = 0.08). CONCLUSIONS: The type of GDM, did not affect the rate of follow-up for postpartum glucose screening. Strategies need to be developed to improve postpartum screening rates in women with gestational diabetes.

An Exploratory Study of a 3-Minute Mindfulness Intervention on Compassion Fatigue in Nurses.

This study shows that breathing mindfully for 3 minutes over a period of 4 weeks, positively affects compassion fatigue in nurses. A nonrandomized, pre/postintervention study was conducted using a 3-minute attentional breathing intervention. Thirty-two nurses participated over 4 weeks. The intervention demonstrated statistically significant reductions in compassion fatigue measures.

Levels of Innovativeness Among Nurse Leaders in Acute Care Hospitals.

OBJECTIVE: The purposes of the study were to describe levels of innovativeness in nurse executives, clinical directors, and nurse managers in acute care settings in the United States and to compare innovativeness between the groups. BACKGROUND: Nurse leaders must navigate the complex ever-changing landscape of healthcare. New strategies are necessary for managing resources and improving patient outcomes. METHODS: A survey was posted in the American Organization of Nurse Executives newsletter using the Scales for Measurement of Innovativeness to measure innovativeness. The sample included 137 nurse leaders in executive and management positions in acute care settings. RESULTS: The largest percentage of nurse leaders across all leadership roles fell into the innovativeness category of early majority. Of the total sample, only 2 individuals were categorized as innovators, and only 15 as early adopters. Fifty-one individuals were early majority; 49 were in the late majority; and 20 individuals were at the lowest category of innovativeness, that of laggards. Both nurse executives and clinical directors had significantly higher levels of innovativeness compared with nurse managers. Graduate-level education and certification were not associated with higher levels of innovativeness. CONCLUSIONS: Understanding the levels and components of innovativeness may assist nurse leaders to affect change in themselves and their organizations.

Current State of International Clinical Experiences in US Prelicensure Nursing Programs.

AIM: The study purpose was to describe current international clinical experience (ICE) practices in RN prelicensure programs in the United States. BACKGROUND: There is interest in ICE to fulfill the goal of preparing global citizens; however, lack of evidence on developing, implementing, and evaluating best practices for ICE limits the enactment of this approach. METHOD: An electronic survey was completed by 900 deans and/or directors of diploma, associate, bachelor's, accelerated bachelor's, and master's-entry RN prelicensure programs. RESULTS: Respondents (n = 241, 27 percent) indicated their programs included ICE. Across programs, ICE occurred most often in community health courses. The predominant reason for offering ICE was alignment with the institutional mission and vision. CONCLUSION: Wide variability exists in methods used to implement ICE for credit toward the nursing major. There is a need to continue to assess and disseminate best practices in implementing ICE to accomplish the goal of global health engagement.

The relationship of body mass index (BMI) to job performance, absenteeism and risk of eating disorder among hospital-based nurses.

Obesity has been linked to job absenteeism and decreased job performance. Additionally, shift work may be related to abnormal eating in nurses. This study examines the relationship between body mass index, job performance, absenteeism, and eating disorder risk among nurses. Registered Nurses (n = 63) participated in a survey that included the Work Limitations Questionnaire and the Eating Attitudes Test. Most participants were either overweight or obese. Significant correlations were noted between body mass index and job performance, and body mass index and risk of eating disorders. An understanding of how increased body mass index can affect a nurse's job performance and wellness warrants continued attention from the nursing profession.

Use of puppets to teach resourcefulness skills to women who self-injure: An exploratory study.

BACKGROUND: Self-injurious behavior (SIB), when frequent and repetitive, can lead to risk behaviors resulting in accidental or intentional suicide. Psychoeducation about resourcefulness can be critical to interrupt the cycle of self-injury. Therapeutic puppetry provides a safe and secure vehicle for expressing feelings without fear of retaliation. OBJECTIVES: Determine the outcome of a resourcefulness psychoeducation program, utilizing hand puppets as a teaching tool, on the measure of resourcefulness for adult women who self-injure. METHODS: A psychoeducation program, utilizing hand puppets as a teaching tool, was offered to women during psychiatric hospitalization. Participants completed the Resourcefulness Scale (RS) pre and post intervention. A program evaluation to determine the effectiveness of hand puppets was completed. Acceptability and feasibility of the program was evaluated. RESULTS: Sixteen participants completed the program. Results showed a statistically insignificant increase in scores. The program evaluation revealed agreement that resourcefulness learning was accomplished. Participants reported that hand puppets were helpful in practicing resourcefulness skills. Majority of participants recommended continuation of the program.

Leadership Practices and Engagement Among Magnet® Hospital Chief Nursing Officers.

OBJECTIVE: Describe the relationship between leadership practices and engagement of chief nursing officers (CNOs) in Magnet® organizations. BACKGROUND: Transformational leadership practices and CNO engagement are vital in influencing nursing practice. METHODS: Magnet hospital CNOs were invited to participate in a quantitative descriptive study via an online survey published in 2 newsletters. RESULTS: The CNOs rated their leadership practices high across all dimensions; the top leadership practice of Magnet CNOs was enabling others to act. There was a strong positive correlation between the vigor of engagement and the challenge the process leadership practice. CONCLUSION: This is the 1st study of Magnet CNOs transformational leadership practices and their work engagement and therefore adds to our understanding of the important characteristics to build future leadership development programs for nurse leaders at the executive level. Particularly noteworthy for the development of future nurse executives is the strong link between vigor and challenging the process.

Staff Nurses' Perceptions of Their Nurse Managers' Transformational Leadership Behaviors and Their Own Structural Empowerment.

OBJECTIVE: The aim of this study was to investigate staff nurses' perception of their nurse managers' transformational leadership behaviors and their own structural empowerment. BACKGROUND: Transformational leadership behaviors in nurse managers have been linked to increased staff nurse satisfaction and decreased turnover and burnout. Perception of nurse managers' leadership behaviors by staff nurses and the relationship to the staff nurses' structural empowerment is important to advance our understanding of the leadership role of nurse managers. METHODS: A descriptive correlational design was used to examine the relationship between staff nurses' perception of their nurse managers' transformational leadership behaviors and their own structural empowerment. Staff nurses at a conference were offered an opportunity to participate in the study. RESULTS: The transformational leadership behaviors of nurse managers were moderately correlated to staff nurses' structural empowerment. Transactional leadership behaviors were associated with staff nurses' structural empowerment to a lesser degree. CONCLUSION: Nurses who perceived their nurse managers as demonstrating transformational leadership behaviors experienced higher structural empowerment.