BSN Preparation for RNs: The Time Is Now!

Some nurse executives and academic nurse leaders believe that the issue of educational entry into professional nursing practice is an "old" issue. Nursing is the only healthcare profession that still does not require the minimum of a baccalaureate degree (BSN). It is time for nurse leaders to act: eliminate the multiple educational levels and require a minimum BSN degree for professional nurse practice.

Implementing a Nurse Manager Profile to Improve Unit Performance.

Nurse managers face significant pressures in the rapidly changing healthcare environment. Staying current with multiple sources of data, including reports that detail institutional and unit performance outcomes, is particularly challenging. A Nurse Manager Customized Profile was developed at a western academic hospital to provide a 1-page visual of pertinent data to help managers and director supervisors focus coaching to improve unit performance. Use of the Decisional Involvement Scale provided new insights into measuring manager performance.

Part 2: Evaluation and outcomes of an evidence-based facility design project.

Based on the work of a TCAB facility design team at an academic hospital (part 1), an evaluation project was implemented to measure RN work environment perceptions, work activity sampling, and steps walked on 6 units moving into a new acute care pavilion. Pre and post data reported significant nurse satisfaction post move with the new work environment. Workflow sampling data did not reflect significant changes; the pedometer device used to measure nurse steps proved unreliable. Project evaluation data are reported.

Part 1: Evidence-based facility design using Transforming Care at the Bedside principles.

An academic hospital used Transforming Care at the Bedside (TCAB) principles as the framework for generating evidence-based recommendations for the design of an expansion of the current hospital. The interdisciplinary team used the table of evidence-based data to advocate for a patient- and family-centered, safe, and positive work environment. A nurse project manager acted as liaison between the TCAB design team, architects, and facilities and design consultants. Part 2 of this series describes project evaluation outcomes.

Longitudinal charge nurse leadership development and evaluation.

OBJECTIVE: The study's aim was to examine longitudinal outcomes of a leadership program for permanent and relief charge nurse from 1996 to 2012 using action research and Kouzes and Posner's The Leadership Challenge conceptual frameworks. BACKGROUND: Charge nurses hold significant oversight of patient safety, quality, and team functioning. This study contributes knowledge regarding charge nurse leadership and organization outcomes associated with these essential roles over time. METHODS: Data were collected over 6 time periods using Kouzes and Posner's The Leadership Practices Inventory (LPI) and internally developed action research tools. Surveys were aligned with leadership and work environment changes to examine outcomes. RESULTS: Charge nurse leadership LPI mean ratings improved. Relief charge nurses reached similar LPI outcomes by 2012, with no statistical differences in mean or domain scores. Action research methods facilitated executive decision making during change processes. Demographics shifted with younger charge nurses with less practice experience serving as charge nurses in the most recent years. CONCLUSIONS: Charge nurse leadership reported significant gains despite institutional changes and uneven delivery of educational interventions.

Mapping the organization: a bibliometric analysis of nurses' contributions to the literature.

OBJECTIVE: The aim of this study was to map an academic hospital's nursing contributions to the literature using bibliometric methods. BACKGROUND: Nurse executives continue to search for ways to share knowledge gained in the clinical setting. Manuscripts from clinical nurses must increase to advance the science of nursing practice and nursing administration. METHODS: A search of electronic databases and curriculum vitae provided bibliographic data for University of Colorado Hospital (UCH) nurses from 1990 to 2012. Bibliometric techniques were used for publication counts and citation analysis. A review of the infrastructure supporting scholarly work was undertaken. RESULTS: A total of 191 journal articles, 9 books, 103 book chapters, 5 manuals, and 46 manual chapters were published by UCH nurses. Author productivity steadily increased. Citation analysis indicated that the works published were used by others. The h-index for UCH authors was 25. The hospital culture, interdisciplinary practice, and the role of the research nurse scientists had an impact on study results.

Leading change to create a healthy and satisfying work environment.

Nurse executives must take a leadership role in creating a healthy work environment for nurses and all disciplines. Engaging in partnerships and empowering clinical nurses to construct the solutions to barriers that may stand in the way of the goal of a satisfied and healthy workforce are important strategies toward success. This publication outlines many projects a 3-time Magnet-designated academic hospital has implemented, working with our shared leadership councils, to meet the standards for a healthy work environment. These initiatives, from the unit to the hospital level, included standardizing a culture change of uninterrupted meal breaks, the creation of intensive care unit Zen rooms, strategies to better manage increased patient volumes, best practices for facility design, enhancing physician-nurse relations, and a hospital wellness program. Data were benchmarked against national nurse and employee surveys to compare progress and report outcomes. Two important nursing organization structures that have contributed to the success of a healthy and satisfied nursing work environment include UEXCEL, a longstanding clinical nurse professional practice program, and the hospital's 11-year participation in the University HealthSystem Consortium/American Association of Colleges of Nursing National Post-Baccalaureate Nurse Residency Program. A highly engaged, well-educated, and committed nursing workforce, nurtured by a strong leadership team, has created a positive work environment characterized by low turnover and high retention.

Professional development research literature from 1996 to 2006: an integrative review.

An integrative review of the professional development research literature, spanning the years 1996 to 2006, was conducted by the National Nurses in Staff Development Organization Research Committee at the request of the organization's Board of Directors. Rigorous research criteria were used to evaluate 949 publications. Results determined that 8 studies met the research criteria. Outcomes are reported and recommendations are suggested for advancement of research in the field.

The Colorado Patient-Centered Interprofessional Evidence-Based Practice Model: a framework for transformation.

BACKGROUND: Evidence-based practice (EBP) models provide a framework to guide organizations and their clinicians to implement evidence-based policies, protocols, and guidelines. A historical review of evidence-based models is presented. The revised Colorado Patient-Centered Interprofessional EBP Model supports use of research evidence and nonresearch evidence and adopts a patient-centered approach to EBP. AIM: The purpose of this article is to present a framework that can be used to transform an organization and foster the use of evidence by interdisciplinary team members. APPROACH: An evidence-based intervention to decrease catheter associated urinary tract infections (CAUTI) is presented to show how the model is operationalized. The EBP model is supported by the five steps that clinicians should use as they identify a clinical problem, gather the evidence, and move the evidence into practice. Ideas for dissemination of new models to clinicians throughout the organization are presented.

The graduate nurse experience: qualitative residency program outcomes.

Graduate nurses experience role conflict and stress as they begin practice in work environments of high complexity, nurse shortages, and expectations to become competent rapidly. The authors report outcomes from a study that evaluated qualitative responses to the Casey-Fink Graduate Nurse Experience Survey administered to graduate nurse residents in the University HealthSystem Consortium/American Association of Colleges of Nursing postbaccalaureate nurse residency program at 12 academic hospital sites. Qualitative analysis provided sufficient evidence to convert specific open-ended questions on the Casey-Fink Graduate Nurse Experience Survey instrument to a quantitative format for ease of administration and analysis.

Structures and practices enabling staff nurses to control their practice.

This mixed-methods study uses interviews, participant observations, and the CWEQII empowerment tool to identify structures and attributes of structures that promote control over nursing practice (CNP). Nearly 3,000 staff nurses completed the Essentials of Magnetism (EOM), an instrument that measures CNP, one of the eight staff nurse-identified essential attributes of a productive work environment. Strategic sampling is used to identify 101 high CNP-scoring clinical units in 8 high-EOM scoring magnet hospitals. In addition to 446 staff nurses, managers, and physicians on these high-scoring units, chief nursing officers, chief operating officers, and representatives from other professional departments are interviewed; participant observations are made of all unit/departmental/hospital council and interdisciplinary meetings held during a 4 to 6 day site visit. Structures and components of viable shared governance structures that enabled CNP are identified through constant comparative analysis of interviews and observations, and through analysis of quantitative measures.

Evidence-based multidisciplinary practice: improving the safety and standards of male bladder catheterization.

A series of nursing care variances related to the procedure of catheterizing male patients stimulated an evidence-based practice project designed to define best practice for the technique of inserting male catheters. Results indicate current nursing knowledge may be inadequate.

Advancing medical-surgical nursing practice: improving management of the changing patient condition.

Higher patient acuities and more novice nurses on medical-surgical units have Educators focused on achieving positive outcomes with changes in patient condition. An educational program was developed to enhance nurses' knowledge, skill, and confidence in assessing hemodynamics, recognizing early signs of instability, and administering vasoactive medications. The program was successful with significant knowledge improvement as well as an increased use of the Medical Emergency Team while maintaining a low number of code calls.