Nurses Have Names.

This postscript to the issue is a series of reflections by Dorothy Pringle, the previous editor-in-chief, on the contributions Lynn Nagle has made as editor-in-chief of the Canadian Journal of Nursing Leadership over the past 11 years and the richness of the perspectives of the authors of the 18 invited papers. The author also reflects on the contrast between the amount of attention and accolades nurses as care providers have received during the pandemic while having few, if any, nurses emerge as spokespeople or interpreters of the nursing roles and the contributions that nurses have made. Unlike other disciplines and despite their contributions, we have not learned the names of any nursing experts.

Patient and Public Involvement in Identifying Dementia Research Priorities.

OBJECTIVES: To engage persons with dementia, friends, family, caregivers, and health and social care providers to identify and prioritize their questions for research related to living with dementia and prevention, diagnosis, and treatment of dementia. DESIGN: The Canadian Dementia Priority Setting Partnership (PSP) followed James Lind Alliance PSP methods. Results were compared with the World Health Organization research prioritization exercise and the United Kingdom Dementia PSP. SETTING: Canada. PARTICIPANTS: In the first survey, 1,217 individuals and groups from across Canada submitted their questions about dementia. 249 participated in the interim prioritization. For the final prioritization workshop, the 28 participants included persons with dementia, friends, family, caregivers, health and social care providers, Alzheimer Society representatives, and members of an organization representing long-term care home residents. RESULTS: The Canadian Dementia PSP top 10 priorities relate to health, quality of life, societal issues, and dementia care. Five priorities overlap with one or both of the other two prioritization initiatives. CONCLUSION: These results provide researchers and research funding agencies with topics that individuals with personal or professional experience of dementia prioritize, but they are not intended to preclude research into other aspects of dementia.

Development and Psychometric Testing of the Humanistic Nurse-Patient Scale.

Quality of life and well-being of older patients in chronic care facilities is often determined by their relationships with nurses. The authors developed and tested a scale to assess patients' views of what matters most when relating to nurses. Based on the humanistic nursing theory by Paterson and Zderad (1988), 69 items were created and tested with a sample of 40 patients, resulting in refinement of a scale with 24 items. This scale was factor analysed on responses from 249 patients residing in five facilities in Ontario, Canada. The Humanistic Relationship Importance Scale demonstrated strong internal consistency, stability, and reliability with a five-factor solution (α = .87). Construct validity was supported through factual identification. This scale is a valid measure of patients' perspectives of a nurse-patient relationship in chronic care and can be used to measure health professionals' relationships with their older patients and evaluate interventions to enhance relational care.

Exploring nurses' perceptions of collecting and using HOBIC measures to guide clinical practice and improve care.

Ontario's Health Outcomes for Better Information and Care (HOBIC) is designed to help organizations and nurses plan and evaluate care by comparing patient outcomes with historical data on similar cases. Yet, fewer than 15% of patients in a 2010 study were found to have complete admission and discharge data sets. This low utilization rate of HOBIC measures prompted the current qualitative study, in which nurses from three clinical settings in an academic teaching hospital were interviewed to gain their perceptions related to collecting and using HOBIC measures in practice. The objective was to identify factors that promote or impede the collection and use of HOBIC data in clinical practice to improve patient care and outcomes. Analysis of interview results produced four key themes related to (a) use of HOBIC measures to inform patient care, (b) collecting and documenting HOBIC measures, (c) HOBIC as an afterthought and "black hole" and (d) impediments to assessing and documenting HOBIC measures because of language barriers, patients' cognitive status and lack of time. Recommendations to improve uptake include developing, implementing and evaluating a communication and learning plan that promotes HOBIC's values and benefits, and determining how managers and administrators perceive utilization of HOBIC at the clinical unit and organizational levels.

"The potential is unlimited!" Nurse leader perspectives on the integration of HOBIC in Ontario.

Nurse leaders from a sample of acute care and long-term care sites participating in the Health Outcomes for Better Information and Care program in Ontario provided information on their experiences with HOBIC implementation. In addition, they described strategies to enhance successful implementation of the program. Finally, they discussed the potential future uses they envisioned for healthcare settings from the HOBIC data. Organizational benefits, such as data comparability, effective patient care planning and delivery and enhancement of nurses' technology skills were identified. Challenges that were highlighted included attaining buy-in from staff nurses, integration of HOBIC into existing computer systems and the subsequent computer and information technology challenges related to implementing such a program. Additional education and support for nursing staff and management were suggested as approaches for overcoming barriers. This survey demonstrates interest and commitment to HOBIC from many nurse leaders in Ontario and highlights the value that such a program provides for staff nurses in the planning and implementation of care. Nurse leaders in Ontario are keenly aware of the important potential that HOBIC data can provide for high-quality patient care and have identified key factors that need to be considered with the implementation of such a program.

Linking HOBIC measures with length of stay and alternate levels of care: implications for nurse leaders in their efforts to improve patient flow and quality of care.

Integral to understanding and leveraging performance data to monitor and drive quality improvement (QI) efforts to enhance patient care is a partnership between researchers (who generate data) and nurse executives (who lead QI efforts). In Canada, evidence-based, nursing-sensitive patient outcome data are included in the Health Outcomes for Better Information and Care (HOBIC) initiative. A descriptive study was undertaken to examine the relationships and predictive abilities of HOBIC measures with length of stay (LOS) and alternate levels of care (ALC) measures. Specifically, we were interested in determining (a) whether relationships among the HOBIC measures exist and (b) whether any of the HOBIC measures are associated with, and could subsequently be used to predict, the patient and the destination to which he or she is discharged (ALC). Our interest in understanding these relationships and predictive abilities was both research driven and practice driven, with the intent eventually to use study findings to target clinical practice and data feedback strategies. To address the two research aims, this study employed both descriptive and inferential statistical approaches with multiple analytic approaches. Study results suggest that many of the HOBIC measures are related, with a higher score in one measure corresponding to a higher score in another measure. The exception is the therapeutic self-care (TSC) measure, in which higher scores on other HOBIC measures were correlated with lower TSC scores. Associations were also found with the predictive ability of certain HOBIC measures on LOS and ALC. Our study findings call for nurse leaders to emphasize the importance to clinical nurses on hospital units of focusing their efforts on assisting patients in managing their fatigue and dyspnoea effectively; increasing their ability to engage in activities of daily living, functional status and therapeutic self-care; and preventing or minimizing pressure ulcers and falls in acute care patients. In turn, these efforts may decrease patients' LOS.

Welcome intrusions: an interpretive phenomenological study of TB nurses' relational work.

BACKGROUND: Nurse-client relationships are valued in descriptions of public health practice and require consideration as work involving knowledge, skill, and personal engagement. Even so, in public health, they are largely taken-for-granted, particularly in the area of tuberculosis (TB). Instead, TB nursing is often structured by a population focus, which at times challenges individually focused relationship ideals. PURPOSE AND DESIGN: This paper describes an interpretive phenomenological study which was undertaken to understand the nature of TB nurses' relational work. METHODS: Data were collected over an eight month period through observations of usual nurse-client visits and semi-structured interviews. SETTING AND PARTICIPANTS: The study took place in the TB program of a public health department of a large multicultural Canadian city with nine nurses and 24 clients. RESULTS: The phrase 'welcome intrusions' represents the nature of relational work and along with three key themes, 'getting through the door', 'doing TB but more than that', and 'beyond a professional', speaks to the central tension in this relational work: balancing its dual surveillance-care focus. CONCLUSIONS: Together these themes emphasize the importance of nurses' skill of involvement in two key domains of TB nursing practice: providing comfort and being watchful.

Expanding nurses' scope of practice.

On April 9, 2009, the government of British Columbia announced that it was expanding the scope of practice of registered nurses, midwives and naturopathic physicians in the province. From now on, RNs will be able to independently provide a broader range of health services including suturing, tuberculosis screening and managing labour in hospital when the primary care provider is absent. Registered nurses working triage will now be able to immediately order diagnostic ultrasounds and X-rays. Additionally, registered nurses will be able to dispense or administer prescription medications in urgent situations including severe allergic reaction, drug overdose, post-partum bleeding and for communicable disease prevention and management. (British Columbia 2009) It is important to point out that it is RNs, not nurse practitioners, who will have these additional capacities.

Standardizing nursing information in Canada for inclusion in electronic health records: C-HOBIC.

The Canadian Health Outcomes for Better Information and Care (C-HOBIC) project introduced systematic use of standardized clinical nursing terminology for patient assessments. Implemented so far in three Canadian provinces, C-HOBIC comprises an innovative model for large-scale capture of standardized nursing-sensitive clinical outcomes data within electronic health records (EHRs). To support this activity, nursing assessment and outcomes concepts were mapped to the International Classification for Nursing Practice (ICNP(R)). By comparing serial data on a patient across multiple time points, the C-HOBIC model can generate nursing-sensitive patient outcome reports. A principle benefit of the C-HOBIC model is that it provides nurses with information critical to planning for and evaluating patient care. Inclusion of nursing information in either provincial databases or EHRs in three Canadian provinces promotes continuity of patient care across sectors of the healthcare systems in those provinces and also facilitates aggregation and analysis by administrators and policy makers. The C-HOBIC model provides standardized, consistent, interoperable clinical information that reflects nursing practice throughout the Canadian healthcare System.

From the Editor-in-Chief: leadership for the information age: the time for action is now.

Dr. Lynn Nagle, the Senior Nursing Advisor for Canada Health Infoway, writes the column on nursing informatics for this journal. She and I have both been involved in the development and now the implementation of HOBIC (Health Outcomes for Better Information and Care), a province-wide initiative funded by the Ontario Ministry of Health and Long-Term Care: I am the executive lead and Lynn is the informatics lead. HOBIC seeks to bring online functionality to nurses that supports systematic assessment of patients on eight outcomes upon admission and discharge in acute care, chronic hospital care, long-term care and home care, and quarterly for people in residential settings. There is strong research evidence that nurses make a difference in how well patients do on these outcomes. Nurses can now access the results of their assessments online throughout a patient's stay, compare them to other patients of similar age or gender and begin to set benchmarks for improving these outcomes. Unit managers and chief nursing officers receive an array of monthly reports on the admission and discharge status of patients - information that can also be reviewed on the basis of gender and age group. HOBIC will be a critical component of the electronic health record when it is wholly adopted throughout Ontario.

Alert--return of 1990s healthcare reform.

Remember the 1990s? In case you don't, there was a major recession and hospitals found themselves squeezed for funds. A movement called "healthcare reform" was instituted across Canada to reduce costs and balance budgets. Nurses bore the brunt of the so-called reforms, which resulted in * merging of hospitals and loss of nursing positions; * elimination of nurse managers' positions and expansion of the span of control of those who remained, so that they found themselves managing two to four units and responsible for 100 to 200 nurses; * elimination of RN positions and substitution of licensed practical nurses or non-regulated workers; * replacing full-time RN positions with part-time positions without fringe benefits; * absence of nursing positions for new graduates and nurses who had been displaced, driving them to seek employment in the United States (the majority did not return to Canada); * collapse of the applicant pool to schools of nursing, which took a decade to rebound to pre-reform days (the drop in graduates over several years during this period is in part responsible for the shortage of nurses today); * dramatic loss of job satisfaction by nurses, which has still not recovered; and * a prevalent sense that nurses were disposable and mattered little in the broad healthcare system.

Effects of leadership and span of control on nurses' job satisfaction and patient satisfaction.

BACKGROUND: Hospital restructuring has resulted in nurse managers' having direct responsibility for a greatly expanded number of units and staff. However, very little research has examined the impact of these larger spans of control on nurse and patient outcomes. OBJECTIVE: This study examined the relationships between leadership style, span of control, nurses' job satisfaction and patient satisfaction, as well as the moderating effect of span of control on the relationship between leadership style and the two outcomes. METHODS: The study was conducted at seven teaching and community hospitals with a sample of 51 units, 41 nurse managers, 717 nurses and 680 patients. Data analyses included multiple regression and hierarchical linear modelling. RESULTS: The study findings provided support for the theoretical relationships among leadership style, span of control, nurse job satisfaction and patient satisfaction. In addition, the results showed that higher spans of control decreased the positive effects of transformational and transactional leadership styles on job satisfaction and patient satisfaction, and increased the negative effects of management by exception and laissez-faire leadership styles on job satisfaction. DISCUSSION: Leadership matters, and certain leadership styles, particularly transformational, are better than others. Span of control also matters: the wider the span, the lower the nurses' job satisfaction and patient satisfaction. However, as spans of control increase in size, no leadership style, even transformational, can overcome the negative effects.

From the editor-in-chief; it's time to recognize good things.

It's time to celebrate some of the very good things that are happening for nursing and for nurses.