An intersectional critique of nursing's efforts at organizing.

Nursing's efforts at organizing in the United States have encompassed various approaches to creating change at a systemic and political level, namely shared governance, professional associations, and nurse unions. The United States is currently experiencing the effects of an authoritarian sociopolitical agenda that has taken aim at our profession's ethic of providing equitable care for all people through legislation that bans gender-affirming care and abortions. Nursing is simultaneously experiencing a crisis of burnout and moral distress, as we navigate the everyday functions of a for-profit healthcare system under the Capitalocene. As we situate ourselves within these policies and practices of late-stage capitalism and an increasingly authoritarian nation-state, we are compelled to think deeply about how nursing is currently organizing ourselves. Our paper will explore the evolution of various forms of organizing through the lens of intersectionality, which offers a framework for considering the ways that power operates, creating a matrix of sociostructural processes that fuel injustice. Intersectionality also compels us to examine whether our organizing has resisted, or perpetuated, a matrix of oppression. We will conclude by offering examples of radical imagining for a future of nursing resistance, where our collective organizing has a greater impact and responsibility for dismantling the status quo to achieve justice and liberation.

The Business Case for Magnet ® Designation : Using Data to Support Strategy.

The Magnet® journey has increased in relevance as the sources of evidence reflect the complex role of the nurse in quality, safety, and the patient care experience. Creating a business case to secure the resources required to embark and travel on the Magnet journey is an essential tool for the chief nurse. Identifying expenses, cost savings or avoidance, and return on investment for nursing services are all important elements of a business case.

Better together: Coalitions committed to advancing health equity.

The Future of Nursing 2020-2030 report identifies coalitions as a driving force for advancing health equity. Five coalitions provided insight into their accomplishments, lessons learned, and role in advancing health equity. The exemplar coalitions included Latinx Advocacy Team and Interdisciplinary Network for COVID-19, Black Coalition Against COVID, Camden Coalition, National Coalition of Ethnic Minority Nurse Associations, and The Future of Nursing: Campaign for Action. While all exemplar coalitions, credited relationship building and partnerships to their success, they used unique strategies for striving to meet their populations' needs, whether the needs arose from COVID-19, racial and/or ethnic disparities, socioeconomic disparities, or other barriers to health. Research and policy implications for coalitions are discussed. Nurses play a critical role in every highlighted coalition and in the national effort to make health and health care more equitable.

Leveraging momentum of 2020-Reflections from an International Conference.

PURPOSE: This Commentary illustrates how innovative clinical and research initiatives highlight the ingenuity and creativity of nursing and midwifery professions thus leveraging the momentum of 2020 that commenced with the Year of the Nurse and Midwife and the Nursing Now Challenge. BACKGROUND: Speakers demonstrated through vision, creativity and policy generation how the world is now in a different place due to COVID-19 and how the global crisis will change and shape the future of health care delivery. EVALUATION: Speakers were invited because of their reputation as international leaders in global health and population. Participants evaluated content and its relevance to research, education and practice in group discussions. KEY ISSUES: The current global crisis determines that the capabilities and capacity of nurses and midwives will become more crucial than ever to the delivery of universal health coverage (UHC) and population health by 2030. CONCLUSIONS: Global leaders and policymakers must seek the knowledge and skills they need to support their work during a global crisis. IMPLICATIONS FOR NURSING MANAGEMENT: Achieving population health and equitable access to health care is dependent on an adequate health workforce.

Building a nursing legacy.

ABSTRACT: A nurse's legacy can be defined in multiple ways. This article describes a project based on a qualitative research study that focused on legacy building in nursing.

Close Collaboration with Parents intervention improves family-centered care in different neonatal unit contexts: a pre-post study.

BACKGROUND: The quality of family-centered care and parental participation in care in neonatal units differ widely across the world. Appropriate education might be an effective way to support medical staff in neonatal units to collaborate with parents and implement family-centered care. The aim of this study was to evaluate the effects of the educational intervention on the quality of family-centered care in eight Finnish neonatal intensive care units from both the staff and parent perspectives. METHODS: A mixed-method pre-post intervention study was conducted in eight neonatal intensive care units in Finland. Data were collected from staff and parents using the Bliss Baby Charter audit tool and semi-structured interviews. RESULTS: The quality of family-centered care, as assessed by staff and parents, increased significantly after the intervention in all eight units. The intervention was able to help staff define and apply elements of family-centered care, such as shared decision making and collaboration between parents and staff. In interviews, staff described that they learned to support and trust the parents' ability to take care of their infant. CONCLUSIONS: The educational intervention increased the quality of family-centered care and enabled mutual partnership between parents and staff. IMPACT: This study shows that the educational intervention for the whole multi-professional staff of the neonatal unit improved the quality of family-centered care. The Close Collaboration with Parents intervention enabled mutual partnership between parents and staff. It also provides evidence that during The Close Collaboration with Parents intervention staff learned to trust the parents' ability to take care of their infant.

A Roadmap for Global Acceleration of Genomics Integration Across Nursing.

PURPOSE: The changes needed to accelerate integration of genomics across nursing are complex, with significant challenges faced globally. Common themes lend themselves to a coordinated and collaborative strategic approach to sustained change. We aim to synthesize the outputs of a research program to present a roadmap for nursing leadership to guide integration of genomics across practice. DESIGN: Mixed methods involving a purposive sample of global nursing leaders and nursing organizations in a sustained, highly interactive program. METHODS: Experts in nursing, health care and healthcare services, policy, and leadership were recruited. Online surveys preceded a 3-day residential meeting utilizing participatory methods and techniques to gain consensus on the essential elements of a roadmap to promote genomics integration. FINDINGS: Twenty-three leaders representing 19 countries and seven organizations participated overall. Data on the scope and status of nursing, genomics health care, and resources have been synthesized. Participants identified 117 facilitators to genomics integration across diverse sources. Barriers and priorities identified were mapped to the constructs of the Consolidated Framework for Implementation Research. The roadmap is underpinned by a maturity matrix created by participants to guide and benchmark progress in genomics integration. CONCLUSIONS: Nurse leaders seeking to accelerate change can access practical guidance with the roadmap, underpinned by support through the Global Genomics Nursing Alliance and its strategic priorities. CLINICAL RELEVANCE: Genomics is shaping the future of healthcare, but change is needed for integration across nursing. This practical roadmap, adaptable to local health systems and clinical and educational contexts, is relevant to nurse leaders aiming to accelerate change.

Achieving Health Equity Through Eradicating Structural Racism in the United States: A Call to Action for Nursing Leadership.

PURPOSE: To advocate for strategic actions by U.S. nursing leadership that denote the presence, customs, and implications of racism that has been institutionalized within the structures of U.S. nursing leadership and the profession. ORGANIZING CONSTRUCTS: A racial equity framework is used to examine the barriers to quality health care and equitable health outcomes and to present evidence-based actions to dismantle structural inequities embedded in the nursing profession. METHODS: This article was developed through a comprehensive literature review and synthesis of relevant research, data, peer-reviewed literature, government reports, and organizational guidelines. FINDINGS: A commitment by U.S. nursing leadership to eradicate structural racism in nursing must be made in order to effect sustainable transformative change toward more equitable systems of health care. CONCLUSIONS: This article presents recommendations for nursing leadership in the United States to renew its commitment to quality health care through dismantling structural racism at all levels of direct and systems nursing practice and education, at the bedside, and in the boardrooms. CLINICAL RELEVANCE: Structural racism in nursing and health care also persists globally as a key social determinant of health. Its elimination aligns with international health care and nursing's policy priorities, yet change can only occur when senior leaders clearly understand it as a key barrier to health, and commit to transformative change in how their "systems" work. These recommendations can also be culturally adapted by global nursing for use in antiracism work.

Moral Distress and Intention to Leave the Profession: Lithuanian Nurses in Municipal Hospitals.

PURPOSE: The purpose of this study was to describe the level of moral distress experienced by nurses, situations that most often caused moral distress, and the intentions of the nurses to leave the profession. METHODS: A descriptive, cross-sectional, correlational design was applied in this study. Registered nurses were recruited from five large, urban Lithuanian municipal hospitals representing the five administrative regions in Lithuania. Among the 2,560 registered nurses, from all unit types and specialities (surgical, therapeutic, and intensive care), working in the five participating hospitals, 900 were randomly selected to be recruited for the study. Of the 900 surveys distributed, 612 questionnaires were completed, for a response rate of 68%. Depending on the hospital, the response rate ranged from 61% to 81%. Moral distress was measured using the Moral Distress Scale-Revised (MDS-R). The MDS-R is designed to measure nurses' experiences of moral distress in 21 clinical situations. Each of the 21 items is scored using a Likert scale (0-4) in two dimensions: how often the situation arises (frequency) and how disturbing the situation is when it occurs (intensity). On the Likert scale, 0 correlates to situations that have never been experienced, and 4 correlates to situations that have occurred very often. RESULTS: Among the 612 participants, 206 (32.3%) nurses reported a low level of moral distress (mean score 1.09); 208 (33.9%) a moderate level of distress (mean score 2.53), and 207 (33.8%) a high level of distress (mean score 3.0). The most commonly experienced situations that resulted in moral distress were as follows: "Carrying out physician's orders for what I consider to be unnecessary tests and treatments" (mean score 1.66); "Follow the family's wishes to continue life support even though I believe it is not in the best interest of the patient" (mean score 1.31); and "Follow the physician's request not to discuss the patient's prognosis with the patient or family" (mean score 1.26). Nurses who had a high moral distress level were three times more likely to consider leaving their position compared with respondents who had a medium or low moral distress level (8.7% and 2.9%, respectively; p < .05). CONCLUSIONS: Our findings provide evidence on the association between moral distress and intention to leave the profession. Situations that may lead health professionals to be in moral distress seem to be mainly related to the unethical work environment. CLINICAL RELEVANCE: The findings of this study reported that moral distress plays a role in both personal and organizational consequences, including negative emotional impacts upon employees.

Applying Complexity Science as a DNP Quantum Leader.

As Doctor of Nursing Practice (DNP) students and graduates begin to apply new knowledge in real-life situations, they are transforming their organizations. The impact of DNP projects is noted by measurable outcomes in diverse settings. This article presents 4 unique clinical/organizational examples of DNP projects. The authors have identified an application of complexity science and leadership theory in their practice changes. In addition, they share their thoughts and feelings as emerging leaders.

The case for "structural missingness:" A critical discourse of missed care.

Stimulated by our conversations at the 2018 International Philosophy of Nursing Society Conference and our shared interests, the coauthors present an argument for augmenting the broader discussion of "missed care" with our synthesized concept called structural missingness. We take the problem of missed care to be largely grounded on a particular economic construction of the healthcare system within an era of what some are calling the Capitalocene, capturing the pervasive influence of capitalism on nature, humanity and the world order. Our perspective is that of the United States, however, extrapolations can be made to the social and healthcare systems in other countries. We are concerned with the underlying conditions that structurally reify inequality and ultimately undermine nursing practice. To situate the discussion, we briefly review existing literature on the contextualization of missed care. We understand contemporary circumstances of missed care as a function of the neoliberalization of healthcare, including the idea of nursing as a commodity. From this, we discuss the implications of missed care, which forms the basis of our critique. Synthesizing the term "structural missingness, we locate a moral imperative in the professional and disciplinary commitments of nursing to consider who and what have been left out. This moral imperative for the nursing profession, along with other social and health related professions, underscores our obligation to be involved in uncovering inequities and conceptualizing upstream solutions for structural missingness.

A vision for nursing in Pakistan: is the change we need possible?

Adnan Yaqoob, Assistant Professor, Lahore School of Nursing, The University of Lahore, sets out his vision for the future of nursing in Pakistan.

What if the bully is the manager?

Bullying can occur at all levels of nursing, and anyone could be targeted. This article offers strategies to identify bullying behaviors and discusses the prevalence of incivility in the nursing profession with a focus on vertical violence.

[The discipline of nursing : Knowledge, teaching, and care] / Les sciences infirmières : savoir, enseignement et soin.

In recent years, professional skills and the nursing profession in France have undergone major transformations. These have included the recognition of advanced nursing practice and its implementation in 2018, and the creation by the National Council of Universities in 2019 of a “Nursing” section (n° 92), which has paved the way for the development of research and teaching in nursing in an academic environment in France.To support these transformations, the Association de recherche en soins infirmiers (Arsi) (Nursing Research Association) has for several years been organizing seminars and symposia. The seminar “The discipline of nursing : Knowledge, teaching, and care,” held on November 16, 2019 in Paris, was a continuation of those organized in 2014 and 2016.This seminar focused on the acquisition of nursing knowledge, in particular through the analysis of clinical situations using two middle-range theories : comfort and symptom management.The first part of this article describes the objectives and the working methodology of the seminar. The second part provides a recap of the theoretical foundations, while the third and final part presents the results of what the workshops participants produced.

Reimagine Health Care Leadership, Challenges and Opportunities in the 21st Century.

PURPOSE: This paper spotlights human capital management, digital technology, and costs control as issues that healthcare leaders will face in redesigning the health care ecosystem in the 21st century. DESIGN: The paper was designed to highlight the attributes that make effective leaders. It addresses how nursing leadership can take a lead to redesign the 21st Century health care system, supported by case examples. METHODS: An expansive literature review was done using MEDLINE, SAGE, Google Scholar, and University of California San Diego Library Catalogs. The selections criteria include recent publications in English within and outside the healthcare industry. FINDINGS: Health leadership is viewed as paramount to productivity, capacity and meeting new challenges. CONCLUSIONS: Effective nursing leadership in a healthcare organization correlates with staff job satisfaction, retention, turnover and quality of care. Nursing leadership development must be supported by appropriate level of educational preparedness, and requisite set of competencies and skills.

Shared Vision in Nursing: An Evolutionary Concept Analysis Revealing Dualities Within the Profession.

Shared vision has been used by the nursing community for over 20 years, but this concept and its language are not presented consistently. At its most basic level, shared vision consists of identifying what a group wants to create. The main objective of this study is to provide a concept analysis of shared vision from an evolutionary nursing perspective within health care organizations. Forty-eight nursing journal articles from 1989 to 2016 were included in the analysis. The concept is presented within the nursing literature as a process or an outcome relying on top-down or bottom-up approaches to defining the future of care. Nurses are central and active in visioning while patients and families are passive recipients. Leaders have an important role to play in shared vision.

Artificial intelligence: Essentials for nursing.

Artificial intelligence (AI) is a transformational technology that will affect all healthcare providers. This article offers an overview of basic AI concepts and the role of nurses in embracing this technology in healthcare settings.

Mentoring millennials for nursing leadership.

As baby boomers continue to retire and millennials become the leading generation in the nursing workforce, nurse leaders must promote professional development and leadership opportunities for millennials moving forward. This article describes challenges and opportunities across the multigenerational nursing workforce along with suggestions on how to remove barriers and align with millennial nurses to provide meaningful mentorship and promote understanding and a positive work environment.

[Patients and caregivers experience on Nursing in Italy: scoping review]. / L'infermieristica in Italia attraverso l'esperienza di pazienti e caregivers: scoping review.

INTRODUCTION: Comparison of the state of nursing in Italy with other countries has shown that theory development in Italian nursing remains quite undeveloped. Theory development in Italian nursing will need to consider local cultural and professional aspects, specific to the Italian practice context, by drawing on known health needs, experiences and nursing approa- ches. The aim of this investigation was to map current knowledge related to nursing in Italy, based on the experiences of patients, families and communities, to provide a basis on which nursing theories could be developed. METHODS: Scoping Review was selected as the best method for this knowledge mapping. Fawcett's nursing metaparadigm was chosen as a broad guide and means by which the litera- ture analysis could be structured. RESULTS: Twenty-two studies were retained and examined in this analysis, including contexts relating to acute care, chronic conditions, as well as emergency and home care services. We defined themes in line with the nursing metaparadigm. Although these definitions are partial, referring only to certain contexts specific to some aspects of nursing care, the original contributions of this investigation provides an important starting point for theory development in Italian nursing, based on the Italian context. CONCLUSION: Strong and credible theory development, that can be readily adapted to practice, requires a rigorous analysis of the points of view of all actors involved in the nursing care process.

Reflections on a methodology for analyzing professional practice and its possible use in nursing.

In order for nursing work not to become mechanistic, the team needs to develop a critical eye to its knowledge, its know-how and its know-to-be. The training of nursing professionals from a critical and reflective perspective motivated this study, which was based on the theoretical reference and the experience of the authors with use of the analytical methodology of the Groupe Entraînement de Analyze de Situations Éducatives (Training Group to Analyze Educational Situations) professional practice. This methodology aims to analyze professional situations in a group with the presence of a facilitator. The objective is to analyze the contributions of the Groupe Entraînement de Analyze de Situations Éducatives to train reflective professionals in nursing. The steps, rules of operation and the role of the participants are explained in order to promote a safe environment for all, enabling group members to develop hypotheses to understand the situation and develop analysis and reflection skills. It is concluded that this methodology offers the opportunity to open a space for reflective thinking, respecting the different roles and times intended for the speech of each participant, building their professional identity.