Integration of Advance Care Planning Into Clinical Practice: A Quality Improvement Project for Leaders.

OBJECTIVE: This quality improvement initiative sought to develop a proactive integrated system approach to advance care planning (ACP) through leadership and colleague engagement. BACKGROUND: Nurse leaders have the capacity to influence the professional competencies of care teams in ACP. Nurse leaders were educated on the importance of ACP, national quality metrics, resources for staff education, and ways to integrate ACP into workflows based on a population management model. METHODS: The project design is a prospective, mixed method design. RESULTS: Nurse leader participants demonstrated a significant increase in knowledge of the importance of ACP and evidence-based models to increase staff engagement and competency. CONCLUSIONS: Study supports nurse leader interventions, promoted engagement of proactive ACP to honor patient choice, and aligns with the mission and vision of one of the largest national Catholic healthcare organizations of being a trusted partner for life.

The Effectiveness of Charge Nurse Training on Leadership Style and Resiliency.

OBJECTIVE: The study objective was to investigate a charge nurse pilot training program as an effective, evidence-based training modality to improve leadership style and resiliency. BACKGROUND: Leadership is inherent and necessary in the charge nurse role. Little published research about charge nurse leadership training programs exists. METHODS: A pre-post design, with intervention and comparison groups, was conducted at an integrated healthcare system. A random sample of charge nurses was selected to pilot a standardized charge nurse leadership training program including in-person learning to foster leadership skills and nurture resiliency. RESULTS: The sample included 19 control participants and 22 intervention participants. Significant improvement was noted in transformational, transactional, leadership outcomes, and resiliency from preintervention to postintervention for the all subjects. Of the 22 intervention participants, the training elicited higher satisfaction with leadership behavior, followed by effectiveness and their ability to motivate. Charge nurses who attended training had higher resiliency scores pre-post intervention. CONCLUSION: The charge nurse pilot training was an effective program that led to improved leadership style and resiliency.

The mindful nurse leader: Advancing executive nurse leadership skills through participation in action learning.

In this second installment of a three-part series on mindfulness, we describe the process of producing video vignettes to illustrate how clinical nurses draw on the power of mindfulness to build their own resiliency while delivering compassionate care.

The mindful nurse leader: Improving processes and outcomes; restoring joy to nursing.

In this first installment of a three-part series on mindfulness, we describe a dynamic project aimed at elevating the importance of mindfulness, compassion, and presence as key competencies for professional nurses across the career span in all healthcare settings.

Strengthening the capacity of nursing leaders through multifaceted professional development initiatives: A mixed method evaluation of the 'Take The Lead' program.

BACKGROUND: Effective nursing leadership is necessary for the delivery of safe, high quality healthcare. Yet experience and research tells us that nursing leaders are commonly unprepared for their roles. Take The Lead (TTL), a large-scale, multifaceted professional development program was initiated in New South Wales, Australia, to strengthen the capacity of Nursing/Midwifery Unit Managers (N/MUMs). The aim of this study was to examine the effects of TTL on job performance, nursing leadership and patient experience. METHODS: Nursing/Midwifery Unit Managers (n = 30) and managers of N/MUMs (n = 30) who had completed the TTL program were interviewed between August and December 2010. The semi-structured interviews included a combination of open-ended questions and questions that required respondents to rate statements using a Likert scale. Data from the open-ended questions were thematically analysed to identify and categorise key concepts. The responses to the Likert items were analysed via descriptive statistics. RESULTS: Nursing/Midwifery Unit Managers' participation in TTL engendered improvements in job performance and leadership skills, as well as some improvement in patients' experiences of care. The program facilitated role clarification and helped foster peer-support and learning networks, which were perceived to provide ongoing professional and personal benefits to participants. CONCLUSIONS: Our study revealed a consensus about the beneficial outcomes of TTL among those involved with the program. It supports the significant and ongoing value of widely implemented, multifaceted nursing leadership development programs and demonstrates that participants value their informal interactions as highly as they do the formal content. These findings have implications for delivery mode of similar professional development programs.

Spiritual needs and spiritual support preferences of people with end-stage heart failure and their carers: implications for nurse managers.

BACKGROUND: Spiritual care is an important element of holistic care but has received little attention within palliative care in end-stage heart failure. AIMS: To identify the spiritual needs and spiritual support preferences of end-stage heart failure patients/carers and to develop spiritual support guidelines locally. METHOD: Semi-structured interviews (totalling 47) at 3-monthly intervals up to 1 year with 16 end-stage heart failure patients/carers. Focus group/consultation with stakeholders. RESULTS: Participants were struggling with spiritual/existential concerns alongside the physical and emotional challenges of their illness. These related to: love/belonging; hope; coping; meaning/purpose; faith/belief; and the future. As a patient's condition deteriorated, the emphasis shifted from 'fighting' the illness to making the most of the time left. Spiritual concerns could have been addressed by: having someone to talk to; supporting carers; and staff showing sensitivity/taking care to foster hope. A spiritual support home visiting service would be valued. CONCLUSIONS: Our sample experienced significant spiritual needs and would have welcomed spiritual care within the palliative care package. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers could play a key role in developing this service and in leading further research to evaluate the provision of such a service in terms of its value to patients and other benefits including improved quality of life, spiritual wellbeing, reduced loneliness/isolation and a possible reduction in hospital admissions.

The clinical nurse leader: prepared for an era of healthcare reform.

PROBLEM: Passage of the 2010 Patient Protection and Affordable Care Act will require change in the healthcare systems. The clinical nurse leader must be prepared to lead and shape the changing environment to achieve maximum outcomes for patients and families. Movement toward integrated care delivery across the care continuum, the transition of the Centers for Medicare & Medicaid Services to a value-based funding model, and accountability for high-quality, cost-effective care are just some of the drivers of this new integrated healthcare system. IMPLICATIONS: Reimbursement models that reward those health systems that are able to meet benchmark performance standards will result in major shifts in how health systems operate. Expertise in care coordination across the healthcare continuum is essential for maximum reimbursement. Payment for value instead of volume delivered is a major reimbursement transition coming to the acute care setting, necessitating increased attention to mining data necessary to capture quality patient outcomes for maximum reimbursement. CONCLUSIONS: The clinical nurse leader is ideally suited to function within these integrated systems of the future, and possesses the skills needed to assist healthcare systems to meet this challenge.

Use of a simulated administrative decision-making exercise in an online master's Nursing Administration course.

To simulate the type of ethical and informed decision making required of today's nurse executives, a unique role-playing exercise was developed in a graduate Nursing Administration course. This exercise included evidence-based information about the safety issues inherent in 12-hour nursing shifts. It then explored the decision-making process that a nurse executive would follow to weigh the conflicting concerns of safety and staff satisfaction. A blog format was used for a role-playing exercise in which students were assigned various roles, and the assignment was designed to mimic a roundtable discussion. The final step was to assume the role of the chief nurse executive and make a decision regarding the ethical dilemma of staff satisfaction versus evidence-based safety concerns. Students demonstrated an understanding of acknowledging input from others, as well as the ability to synthesize points on a difficult question.

Nurse Executives' Perceptions of the Executive Training for Research Application (EXTRA) Program.

BACKGROUND: To improve the overall quality and effectiveness of the Canadian health care system through better decisions supported by research-based evidence (RBE), the Canadian Health Services Research Foundation (CHSRF) and partners have created the Executive Training for Research Application (EXTRA) program. OBJECTIVES: To evaluate how nurse executive fellows perceive changes in their levels of knowledge of RBE and in their level of use of RBE following participation in the EXTRA program. METHODS: Nurse executives in the first four cohorts of the program (2004-2007) completed a survey during their 2-year fellowship period. RESULTS: Statistically significant improvements were observed regarding nurse executives' perceived knowledge and use of RBE. According to the participants, the EXTRA fellowship contributes to their role and function in their organization by providing tools, learning, and access to resources and networking, which contributes to their credibility, leadership, and knowledge transfer skills. CONCLUSIONS: The EXTRA program has been structured to reduce barriers and to enhance the facilitators found in the literature on the implementation of evidence-based practices (EBP) in health care settings. Overall, nurse executives perceived that the benefits of participating in the EXTRA program were both individual and organizational.

Innovation in transformative nursing leadership: nursing informatics competencies and roles.

In a recent brief to the Canadian Nurses Association's National Expert Commission on the Health of Our Nation, the Academy of Canadian Executive Nurses (ACEN) discussed leadership needs in the Canadian healthcare system, and promoted the pivotal role of nursing executives in transforming Canada's healthcare system into an integrated patient-centric system. Included among several recommendations was the need to develop innovative leadership competencies that enable nurse leaders to lead and advance transformative health system change. This paper focuses on an emerging "avant-garde executive leadership competency" recommended for today's health leaders to guide health system transformation. Specifically, this competency is articulated as "state of the art communication and technology savvy," and it implies linkages between nursing informatics competencies and transformational leadership roles for nurse executive. The authors of this paper propose that distinct nursing informatics competencies are required to augment traditional executive skills to support transformational outcomes of safe, integrated, high-quality care delivery through knowledge-driven care. International trends involving nursing informatics competencies and the evolution of new corporate informatics roles, such as chief nursing informatics officers (CNIOs), are demonstrating value and advanced transformational leadership as nursing executive roles that are informed by clinical data.

Nurse manager leadership development: leveraging the evidence and system-level support.

The complexities of healthcare demand new leadership approaches to achieve organizational goals while developing and sustaining healthy work environments. The nurse manager is the defining role, crucial to achievement of workplace outcomes. Preparing nurses for this dynamic, complex role is often dependent on didactic education or on-the-job training that falls short of true leadership development. The authors describe an innovative approach to the development of successful nursing leaders across an integrated healthcare system.

Nurse entrepreneurs' attitudes to management, their adoption of the manager's role and managerial assertiveness.

AIM: This study explores the attitudes of Finnish nurse entrepreneurs to management, their adoption of the manager's role, managerial assertiveness, development and training needs in management and associated factors. METHODS: The research was conducted as part of a questionnaire survey among 335 entrepreneurs with different educational backgrounds. The sample for the study reported here consisted of those respondents who had a registered nurse degree. The data were analysed using SPSS statistical software. RESULTS: Nurse entrepreneurs took a positive attitude towards management, but there were obvious shortcomings in their adoption of the manager's role. They also showed a lack of managerial assertiveness. Half of the respondents had development needs and one-third had training needs in relation to management. CONCLUSIONS: Nurses who are planning to start up in business should have earlier leadership experience and should attend some form of management training. IMPLICATIONS FOR NURSING MANAGEMENT: The provision of care and nursing services is increasingly taking place in the private sector. This study contributes to our understanding of the managerial role of nurse entrepreneurs in this new environment.

Promoting leadership and management in Australian general practice nursing: what will it take?

AIM: This paper outlines the current state of Australian practice nursing, describes the context of general practice and establishes the importance of promoting leadership and management in this setting. BACKGROUND: Australian general practice nurses have emerged as key stakeholders in primary health care. However, their role in leadership and management has been largely invisible. The reasons for this are multifactorial, including the delay to establish a strong professional organization, their negative power relationships with general medical practitioners, limited nursing leadership and poorly defined roles. To date, the impetus for practice nurse growth has been largely external to the nursing profession. Growth has been driven by the increasing burden of chronic disease and workforce shortages. This has further weakened the control of nurse leaders over the development of the specialty. CONCLUSIONS: The Australian practice nurse role is at a crossroads. While the practice nurse role is a viable force to improve health outcomes, the growing strength of the practice nurse challenges traditional professional roles and practice patterns. IMPLICATIONS FOR NURSING MANAGEMENT: There is an urgent need to develop practice nurse leaders and managers to not only embrace the challenges of Australian general practice from an operational perspective, but also undertake a clinical leadership role. As clinical leaders, these nurses will need to develop a culture that not only optimizes health outcomes but also advances the status of the nursing profession.

Health visiting and community matrons: progress in partnership.

Since primary care services face their biggest challenges in the reorganisation of the NHS, a major theme for future service delivery is the effective management of clients with long-term conditions. Nationally, PCTs are committed to preparing experienced, senior nurses as community matrons, who will lead integrated health and social care for people with multiple long-term conditions and reduce hospital admissions. This paper discusses how health visitors can influence and support the development of local long-term condition services and the importance of health visitors working with community matrons to share their experiences and skills for the benefit of both patients and professionals.

Addressing spiritual leadership: an organizational model.

The Joint Commission requires health systems to address spiritual care. Research indicates that spirituality is associated with better physical, psychological, and social health and that culturally diverse populations and individuals at end-of-life often request spiritual care. The authors report the results of a consensus conference of 21 executives representing 10 large faith-based health systems who discussed the input, process, and outcomes of a corporate model for spiritual leadership. Specific initiatives are highlighted.

Should nurses be leaders of integrated health care?

AIM(S): To examine the role of nurses within integrated health care. BACKGROUND: Healthcare planners are overly concerned with the treatment of diseases and insufficiently focused on social cohesion vertical rather than horizontal integration of healthcare effort. These domains need to be better connected, to avoid medicalization of social problems and socialisation of medical problems. EVALUATION: Published literature, related to theories of whole system integration. *When conceptualizing whole system integration it helps to consider research insights to be snapshots of more complex stories-in-evolution, and change to be the result of ongoing community dance where multiple players adapt their steps to each other. *One image that helps to conceptualize integration is that of a railway network. Railway tracks and multiple journeys are equally needed; each requiring a different approach for success. *Traditional nursing values make nurses more attuned to the issues of combined vertical and horizontal integration than medical colleagues. CONCLUSION(S): Nurses should lead integration at the interface between horizontal and vertical activities. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing managers and universities should support the development of nurses as leaders of whole system integration, in partnership with local healthcare organizations.

The whole story.

Community matrons have a dual role in the care of people with long-term conditions: nursing and co-ordination. The aim is to manage patient care so that hospital admissions can be reduced, especially those that result from a crisis. Community matrons make detailed assessments of their patients' health and social care needs. They work across traditional boundaries, such as secondary care and social services. Medication management is part of their remit. Patients are visited and reviewed regularly.

Clinical leadership in contemporary clinical practice: implications for nursing in Australia.

BACKGROUND: Leadership in the clinical practice environment is important to ensure both optimal patient outcomes and successive generations of motivated and enthusiastic clinicians. AIM: The present paper seeks to define and describe clinical leadership and identify the facilitators and barriers to clinical leadership. We also describe strategies to develop clinical leaders in Australia. Key drivers to the development of nursing leaders are strategies that recognize and value clinical expertise. These include models of care that highlight the importance of the nursing role; evidence-based practice and measurement of clinical outcomes; strategies to empower clinicians and mechanisms to ensure participation in clinical decision-making. KEY ISSUES: Significant barriers to clinical leadership are organizational structures that preclude nurses from clinical decision making; the national shortage of nurses; fiscal constraints; absence of well evaluated models of care and trends towards less skilled clinicians. CONCLUSIONS: Systematic, strategic initiatives are required to nurture and develop clinical leaders. These strategies need to be collegial collaborations between the academic and health care sectors in order to provide a united voice for advancing the nursing profession.