Nurse-driven programs to improve patient outcomes: transforming care at the bedside, integrated nurse leadership program, and the clinical scene investigator academy.

As the national quality agenda continues to be a key driver in healthcare, more programs are being developed to teach staff nurses how to lead quality change projects. Nurses are in a unique position to do this work; however, they may lack project management and leadership skills to do so. The authors provide a content analysis that compares and contrasts 3 such programs.

Planning and creating a new bi-state nursing workforce center through unique partnerships.

Multiple strategies are needed to address the complex issues related to the nursing shortage. It is not enough to focus on increasing the number of students in the pipeline unless this is met with complimentary work to improve the professional practice environments of nursing staff. In addition, nurse-driven improvement projects that address specific patient and organizational outcomes will elevate the role of nurses from trusted professional to quality agents. The authors describe a partnership that has launched a new type of workforce center with core missions to create work environment improvements and point-of-care change led by staff nurses.

Developing measures of pediatric nursing quality.

Recent research has highlighted the impact of nursing care on patient outcomes. The link to staffing has also been documented for selected conditions. To date, efforts to establish nurse-sensitive measures have focused largely on adults. This article describes the project undertaken to select and pilot 2 pediatric indicators of nursing quality care to be included in an ongoing national benchmarking program.

Redesigning the health care system of the future.

The models outlined above represent alternative constructs for examining factors that may or may not influence human health in a positive manner. If the economic framework seems more theoretical than actionable, consider an alternative framework that has been advanced by the American Hospital Association and described in Table I. Regardless of the framework adopted, work to improve the health care system and its financing will be hard, irrespective of whether incremental or wholesale changes are made. What is important, however, is that a thoughtful approach be taken and the trade-offs of each decision carefully weighted. The health of the population of the state and the country depend on it.

Comparing variations in labor costs for two vs. one full-time nurse manager.

Labor costs for two versus one full-time nurse manager were compared. Results revealed reductions in nursing costs per patient day. These results suggest that innovative models may hold promise as organizations struggle to retain nurses and decrease costs.

An infrastructure for organizational support of research.

Nurses are well suited to develop, implement, and disseminate research initiatives. However, most nurses need assistance to translate the idea behind the initiative into reality. This process requires resources and support. The authors outline one organization's infrastructure by which support is provided. Collaboration between a hospital-based research team and bedside nurses has produced a successful, funded program of research that has led to dissemination of findings.

Analysis of the nursing workforce crisis: a call to action.

In our integrative review of reports on the health care workforce shortage, we examined 15 reports that focused primarily on nursing and were conducted by various stakeholders. We studied these reports objectively, identifying problems and solutions as described by the authors, which we then categorized by theme. We found problems at both the national and institutional levels and noted that the reports contained similar problem and solution "themes." Yet we also found gaps between these-some problems had no solutions and some solutions didn't address any of the suggested problems. Gaps occurred among problems and solutions listed in the following theme categories: demand, health care economics, workforce planning, research and data support, and technology. Despite the urgent need, we still lack a national strategy designed to avert the nursing shortage. This review may provide a foundation for such a plan.We present the results of our analysis and our recommendations to the federal government and national organizations, to institutions, and to nurses. These recommendations don't provide a comprehensive strategy for averting the nursing shortage, but they do offer a basis upon which one may be created.

Using standard desk-top tools to monitor medical error rates.

Many experts believe it is time to do something about the high number of medical errors and adverse events highlighted in the recent IOM report. This article examines how front line managers can use a valuable quality improvement/assurance tool--the statistical process control chart--to track and analyze medical error rates. It includes a step-by-step guide to the creation and interpretation of a demonstration chart, discusses potential barriers to the use of statistical process control charts, and suggests ways to overcome those barriers.