COVID-19 Pandemic Increases in Nurse-Sensitive Quality Indicators.

BACKGROUND: The pandemic profoundly stressed nursing practice and could have thereby affected trends in nurse-sensitive quality indicators (NSIs), measures that detect changes in patient health status directly affected by nursing care. OBJECTIVES: To determine if NSIs have worsened in response to the pandemic and then returned to pre-pandemic levels using data from 2019 through 2022. METHODS: We conducted a cross-sectional descriptive study of annual trends, examining unit data from the National Database of Nursing Quality Indicators (NDNQI) from 2019 through 2022 for five indicators: rates of falls, central line-associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), hospital-acquired pressure injury (HAPI), and ventilator-associated events (VAE). The NDNQI is the largest repository of nursing quality indicators, which are derived from patient-level events, reported at the nursing unit level, and submitted quarterly by over 2,000 member hospitals. Adult medical-surgical or critical care inpatient nursing units with complete data for the 4 years were included, with samples ranging from 456 to 5,818 nursing units in 2,346 hospitals. Analysis of variance was conducted by comparing the 2019 rates to each subsequent year. RESULTS: In decreasing order of prevalence, the mean pre-pandemic rates were 6.58 VAE per 1,000 ventilator days (critical care only), 2.41 HAPI per 1,000 device days, 2.20 falls per 1,000 patient days, 0.96 CAUTI per 1,000 catheter days, and 0.68 CLABSI per 1,000 central line days, for medical-surgical and critical care units combined. The rates for all five nurse-sensitive indicators increased significantly beginning in 2020 and have begun to decline but have not returned to baseline by 2022. The maximum rate was observed in 2020 for falls and 2021 for the remaining indicators. These increases to the maximum ranged from a 12% percent increase in CAUTI to 49% for CLABSI. DISCUSSION: NSIs increased during the pandemic and are now returning to baseline. The pandemic underscored the importance of nursing practice. The pandemic's enduring negative effects on the nursing workforce must be addressed to preserve patient safety.

Supporting the Role Transition of Interim Nurse Managers: Development of an Evidence-Based eManual.

Executive nurse leaders may rely on interim nurse managers (INMs) to fill vacated nurse manager positions open for an extended time. To optimize the INM role for future leadership succession planning, ongoing professional development for this role is critical. The authors describe the use of evidence in the creation of onboarding leadership resources to support the role transition of INMs within a healthcare environment over a 100-day period.

Path Analysis: Interrelationships Between Nurse Manager Competencies, Practice Environment Perceptions, and Frontline Nurses' Intent to Stay.

OBJECTIVE: To examine the correlation between nurse manager (NM) competencies, work environment (Practice Environment Scale of the Nursing Work Index [PES-NWI]), and frontline nurses' intent to stay; the direct effect of NM competency on frontline nurses' intent to stay; and the indirect effect of NM competency on frontline nurses' intent to stay, mediated by PES-NWI. BACKGROUND: PES-NWI and NMs' competency can impact frontline nurses' intent to stay. METHODS: Cross-sectional study with secondary analysis of NM Competency and NDNQI® (National Database of Nursing Quality Indicators®) RN Survey data with path analysis for effects of the model's variables. RESULTS: Positive, weak correlations between NM competencies and frontline nurses' practice environments were found; NM competencies and frontline nurses' intent to stay were not correlated. Paths were NM competency/PES-NWI (ß = 0.20, P = 0.001) and PES-NWI/intent to stay (ß = 0.55, P < 0.001); NM competency/intent to stay was not significant. Indirect effect of NM competency on frontline nurses' intent to stay was mediated through PES-NWI (ß = 0.11, P = 0.002; 95% confidence interval, 0.05-0.17). CONCLUSIONS: Investing in NMs' competency can help create supportive work environments and frontline nurses' intent to stay.

Individual and Organizational Factors Associated With Nurse Manager Success.

OBJECTIVE: The aim of this study was to synthesize previous findings and provide practical guidance for maximizing nurse manager and nurse performance. BACKGROUND: Two recent studies have linked nurse manager job design factors and individual differences to a variety of valued outcomes, but practical implications remain unclear. METHODS: A large US sample of nurse managers was divided on the basis of nurse and patient outcomes. Various characteristics are compared across the highest and lowest performers. RESULTS: Wider nurse manager span of control is associated with negative outcomes; the availability of support positions does not fully alleviate the consequences of wide spans. Nurse managers with fewer subordinates can effectively manage multiple units. Nurse manager experience is critical for success and cannot be fully replaced by leadership training programs. CONCLUSIONS: Staffing and job design decisions have critical downstream implications. The present research provides guidance for effective staffing and job design.

Measuring the Work Environment: The Voice of the Staff Nurse.

OBJECTIVE: The aims of this study were to obtain direct care hospital nurse input on the relevance of the Practice Environment Scale of the Nursing Work Index (PES-NWI) and to determine whether additional items are needed to measure the contemporary nursing work environment (NWE). BACKGROUND: Instruments accurately measuring the NWE are essential due to the NWE's association with nurse, patient, and organizational outcomes. However, the most frequently used instrument for measuring the NWE has not been scrutinized by today's practicing direct care nurses to ensure its current relevancy. METHODS: Researchers administered a survey with a modified PES-NWI and open-ended questions to a national sample of direct care hospital nurses. RESULTS: Three items from the PES-NWI may be suitable for removal, and additional items may be added to accurately measure the current NWE. CONCLUSION: Most PES-NWI items remain relevant for modern nursing practice. However, some revisions could enable greater precision in measuring the current NWE.

Relationships among nurse managers' job design, work environment, and nurse and patient outcomes.

The importance of nurse managers' practice environments in affecting outcomes for direct care nurses and patients has been well-researched. Nonetheless, much remains to be learned about the determinants of the nurse manager practice environment. In this study, 541 US nurse managers' survey responses were matched to unit-level aggregate data of their subordinates' responses on the National Database of Nursing Quality Indicators. A model relating job design and experience to the nurse manager's practice environment and direct care nurse (i.e., job satisfaction, intent to stay, and joy and meaning in work) and patient outcomes (i.e., nurse-reported quality of care and missed nursing care) was evaluated through multilevel path analysis. Nurse manager span of control, support staff, and experience influence nurse managers' perceptions of their practice environment and nurse and patient outcomes. Although support staff can offset some negative effects of wide spans of control, it does not fully compensate for wide spans. Thus, nurse manager job design factors and experience relate to nurse manager practice environments and valued downstream outcomes. The present research emphasizes the importance of a positive nurse manager practice environment and provides guidance for nurse manager hiring and job design decisions.

Building Nurse Manager Well-being by Reducing Healthcare System Demands.

The National Academies of Medicine consensus study committee reported that US healthcare workers experience high levels of burnout resulting from external pressures on the healthcare system and the organization of work. Nurse managers are especially susceptible to burnout. This column provides evidence-based strategies to improve the work environment, reduce the burden of job demands, and promote well-being among nurse managers.

A Survey of Interim Nurse Managers to Understand the Role and the Impact on Nurse and Patient Outcomes.

OBJECTIVE: The aim of this study was to describe the current state of the interim manager (IM) role and the impact of the role on job performance. BACKGROUND: Interim managers provide leadership during organizational change, yet little is known about the role and its impact on outcomes. METHODS: An electronic survey was completed by 179 IMs working in acute care hospitals. Instruments included the Nurse Manager Practice Environment Scale, Decision Involvement Scale, Subjective Stress Scale, Maslach Burnout Inventory, and Brief Resilience Scale. RESULTS: The average tenure for IMs was 10 months. Despite moderately high levels of stress and exhaustion, IMs were resilient, positively viewed their work environment, and perceived their job performance as positively impacting nurse and patient outcomes. Interim managers were generally satisfied in their roles and likely to pursue nursing leadership as a career. CONCLUSION: Interim managers desire permanent leadership opportunities providing a pool for replacing exiting nurse managers. Support is needed to be successful.

Advancing Nursing Leadership Science Through an Innovative Research-Practice Partnership.

ABSTRACT: The Association for Leadership Science in Nursing and American Organization for Nursing Leadership Foundation have formed a new research-practice collaborative. The collaborative allows for a synergistic approach to the advancement of leadership science. This article discusses the impetus for the collaborative, its structure, and how its synergy of research and practice expertise provides immense opportunity for robust, practice-relevant research.

The Impact of Generation on Nurse Manager Job Satisfaction.

OBJECTIVE: The aim of this study was to determine the effects of generational membership on nurse managers' (NMs') perception of their practice environment and job satisfaction using the Nurse Manager Practice Environment Scale (NMPES). BACKGROUND: Boomers, Generation Xers, and millennials make up the NM workforce. Each has specific perceptions and expectations for their practice environment and job satisfaction. Little is known about these differences. METHODS: A secondary analysis of NM survey data was conducted using descriptive statistics and multiple regression to identify the impact of generation on NMs' perception of their practice environment and satisfaction. RESULTS: Generational membership did not significantly impact NMPES or job satisfaction scores, but the practice environment was a strong predictor of these outcomes. CONCLUSION: Generational membership did not impact NMs' satisfaction for this sample, but the practice environment did. Further research is needed to examine additional factors that influence NM satisfaction and retention.

ALSN 2021 Conference: Nursing Science for Leadership in the New Decade.

The Association for Leadership Science in Nursing's 2021 conference provided an opportunity to further enhance professional understanding of the difficulties facing nurse leaders as the COVID-19 pandemic continues to create unimaginable challenges. Presentations provided evidence in support of courageous caring leadership interventions.

The influence of nurse manager competency on practice environment, missed nursing care, and patient care quality: A cross-sectional study of nurse managers in U.S. hospitals.

AIMS: Identify and examine drivers of nurse manager competency and high-quality practice environments. BACKGROUND: Nurse managers are a key predictor of positive professional practice environments, which are, in turn, associated with nurse, patient, and organisational outcomes. However, little work has examined the factors that contribute to nurse manager competency. METHODS: Nurse managers completed online surveys, which were matched to unit-level aggregate data of their subordinate direct care nurses' responses on the National Database of Nursing Quality Indicators. This resulted in a final sample of 541 nurse managers across 47 U.S. hospitals. Multilevel path analysis was utilized to assess a model of the antecedents and consequences of nurse manager competency. RESULTS: Nurse manager competency and practice environments were predictive of missed nursing care and nurse-reported quality of care. Nurse manager experience was found to have twice the effect on competency as advanced education. CONCLUSIONS: Nurse manager competency and its downstream effects are achieved through nurse manager experience and advanced education. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse manager competency yields better practice environments and nursing care. Considering the influence of experience, careful attention should be paid to the competency development process of more novice nurse managers.

Factors That Influence Millennial Generation Nurses' Intention to Stay: An Integrated Literature Review.

OBJECTIVE: To synthesize literature exploring the expectations of millennial nurses and factors that influence their retention. BACKGROUND: Long-anticipated nursing shortages are happening nationwide in part from boomer retirements. These supply issues are expected to worsen because of an aging population who will require complex healthcare going forward. Millennial nurse turnovers, however, represent the biggest threat to supply. METHODS: This extensive literature review was conducted following published guidelines. Thirteen publications regarding millennials' expectations of work were analyzed. RESULTS: Millennials expect strong leadership, advancement opportunities, alignment of organizational and personal values, good coworker relationships, healthy work-life balance, recognition, and cutting-edge technology. CONCLUSIONS: Millennials have specific expectations for work, and they will leave if these go unmet. Findings from this review provide valuable insight into this generation of nurses to help leaders create appropriate retention strategies. The limited literature on this topic highlights the need for more research.

Nurses Taking the Lead: A Look Back to Move Forward.

In recognition of the Year of the Nurse and Midwife, the 2020 annual conference of the Association for Leadership Science in Nursing (ALSN) celebrated A Look Back to Move Forward in recognition of the 50th anniversary of ALSN. The ALSN began as the Council of Graduate Education for Administrative Nursing (CGEAN) in 1970. Today, ALSN maintains the goals of shaping graduate education and research to inform nursing leadership practice.

Areas of satisfaction and challenges to success of mid-career nurse scientists in academia.

BACKGROUND: Mid-career nurse scientists in academia face many challenges that can lead to burnout and exiting the profession. Finding ways to increase satisfaction and support will help retain these critical faculty in research positions. PURPOSE: Describe areas of satisfaction and challenges to success in the faculty role for mid-career nurse scientists in academia. METHOD: Cross-sectional, descriptive. A total of 65 self-identified mid-career nurse scientists completed an online survey. FINDINGS: Mid-career nurse scientists were most satisfied with their role at their organization, least satisfied with time for research and opportunities to receive mentoring. They felt moderately supported by colleagues and deans, least supported by their ADR. Differences in satisfaction among nurse scientists in different levels of research institutions were noted. DISCUSSION: Challenges to success in mid-career nurse scientists exist. Loss of nurse scientists at mid-career threatens to undermine the knowledge base of the individuals who mentor the next generation of scientists. The discipline must support mid-career scientists in their efforts to be successful in research.

The perceived reality and environment of the mid-career nurse scientist.

BACKGROUND/PURPOSE: A qualitative study was designed to explore facilitators and barriers to success from the perspectives of self-identified mid-career nurse scientists. METHODS: Data were collected from 84 respondents using open-ended items as part of an electronic survey of self-identified mid-career nurse scientists who were members of regional nursing research societies. DISCUSSION/CONCLUSION: Two main themes emerged: "Perceived Realities" and "What's Needed to Achieve Career Success." Mid-career nurse scientists experience both joy from teaching and research roles and dissatisfaction with research support; difficulty balancing heavy teaching workload, administrative responsibilities, and research, and ineffective mentoring. Based on the challenges in their environment, respondents identified numerous ways to enhance career success including (1) increasing or enhancing release time for research activities, (2) formal infrastructure to support research activities, and (3) targeted, effective mentoring by senior scientists.

Factors that influence nurse manager job satisfaction: An integrated literature review.

AIMS AND OBJECTIVES: To understand factors that influence nurse manager job satisfaction. BACKGROUND: Nurse managers influence patient care, staff retention and health care initiatives, yet poor retention and recruiting outcomes threaten the supply of managers. Research regarding staff nurse job satisfaction and retention is substantial, but far less is known about these same areas for nurse managers. EVALUATIONS: Electronic databases were systematically searched to find studies regarding nurse manager job satisfaction. Articles were selected using professional guidelines and set criteria. Fourteen peer-reviewed publications were included in this review. Major themes were extracted and synthesized. KEY ISSUES: Findings from this review indicate that nurse manager job satisfaction is influenced by workloads, organisational support, nurse manager-supervisor relationships and the quality of their training and competency. CONCLUSIONS: This review found overwhelming workloads, inadequate resources, poor supervisor relationships and insufficient training to be commonplace for nurse managers. To improve satisfaction and retention, institutions must cultivate practice environments that promote healthy workloads, strong interorganisational relationships, professional growth and success of their nurse managers. IMPLICATIONS FOR NURSING MANAGEMENT: Findings from this study reveal areas for improvement that health care institutions and senior nursing leadership can use to transform practice environments, increase nurse managers' job satisfaction and entice them to stay.

Nurse Leader Competencies: Today and Tomorrow.

The coronavirus-2019 (COVID-19) pandemic has resulted in turbulent times challenging nurse leaders to adopt, adapt, and develop new leadership competencies to navigate current and future challenges. In never-imagined approaches, nurse leaders have responded to a different type of crisis management. In this new era, nursing leadership will need competencies to reshape the future of nursing and nurses' role in caring for patients, families, and promotion of healthy communities along with a focus on reducing health disparities. The pandemic has drawn critical focus on the health and well-being needs of nurses. The American Organization for Nursing Leadership and the Association for Leadership Science in Nursing have offered insights of nursing leadership competencies critical for practice and education in shaping the future.

Organizational Support for Nurse Manager Role Transition and Onboarding: Strategies for Success.

OBJECTIVE: The aim of this study was to provide guidance on supportive nurse manager role transition practices. BACKGROUND: The nurse manager role is increasingly more complex and the workforce is increasingly less experienced. Wide variation in nurse manager role transition exists among organizations. Nurse managers are commonly hired without requisite knowledge and are expected to learn through experience. METHODS: A mixed-methods approach was used to identify current and ideal organizational practices supporting the role transition of novice nurse managers. RESULTS: Effective role transition of new nurse managers begins with human resource policies that encourage graduate preparation for nurse managers. A supportive transition program includes didactic education for knowledge development and coaching of novice nurse managers in the application of new knowledge to clinical practice experiences. Rigorous program evaluation is recommended for sustainability. CONCLUSION: Nurse managers are the linchpins of organizations. Organizational leaders need to support their role transition for the success of the organization.

A Complexity-Informed Model to Guide Nurse Manager Practice.

Nurse manager practice is a broad concept that reflects the defined role responsibilities and the manner in which nurse managers perform their role. The outcome of nurse manager practice is commonly known as their job performance. The job performance of nurse managers reflects their effectiveness and is assessed by organizational, staff, and patient outcomes. There is strong evidence that nurse managers with relational leadership styles are the key drivers of positive practice environments and job satisfaction among nurses. Concluding that the solution to positive environments and satisfied nurses rests solely on the leadership style of the nurse manager seems logical; however, it ignores the role of the larger organizational context. This article applies a complexity lens to understand nurse manager practice and other organizational factors influencing job performance. The evidence developed thus far yielded the identification of dimensions of the organizational context that support nurse manager practice and nurse manager job performance. Additional research is needed to identify the essential ingredients to support nurse manager practice. Organizational success depends on developing synergy among the administrative, adaptive, and enabling leadership functions of organizations.