A Narrative Analysis of Nurses' Experiences With Meaning and Joy in Nursing Practice.

Health care transformation is guided by the triple aim of improving health, enhancing the patient experience, and reducing costs. Experts have recommended the addition of a fourth aim, improving the experience of providing care. They advise that achievement of the triple aim will only be possible if we create the conditions where health care workers can find meaning and joy in their work. Nurses' experiences with meaning and joy in their practice have not been well described. In an effort to fill this knowledge gap, nurses across the nation recently participated in a qualitative study to share their experiences with meaning and joy in their nursing practice. The study utilized a narrative inquiry approach with a lens of appreciation to elicit and interpret nurses' stories. The stories, recorded and archived in StoryCorps, provided rich insight into meaning and joy in nursing practice. The study captured contemporary themes that crossed practice settings and generations across the United States. Four themes emerged from the analysis, including: fulfilling purpose-"I am a nurse"; meaningful connection; impact-the wow factor; and the practice environment. The practice environment theme included 3 subthemes: teams work, leaders model the way, and opportunities to learn and grow. The themes are described and illustrated with participant quotes. The study findings build on published evidence related to meaning in nursing practice and our conceptual understanding of joy. Results align with recommendations for defining and focusing on the fourth aim: To improve the practice experiences of nurses so they can more fully contribute to achieving both the triple aim in health care and their own well-being. Specific implications for leaders and supportive practice environments are discussed.

Shared Governance: The Role of Buy-in in Bringing About Change.

The term buy-in can be found in almost any article considering individuals' participation in an initiative. At the time of this writing, a Google search of buy-in resulted in 10.5 billion hits. The term buy-in seems intuitive, yet many healthcare organizations struggle to implement and sustain initiatives that depend on nursing buy-in and involvement. The purpose of this article is to identify prerequisites to buy-in and factors that facilitate buy-in which, when cultivated, may positively influence nurse engagement. In this article, the authors discuss the concept of buy-in, identify prerequisites for buy-in, consider factors to enhance buy-in, and present scenarios of what happens when buy-in happens, when it almost happens, and when it fails. They also consider future directions to facilitate buy-in by nursing staff members.

Virtual nursing grand rounds and shared governance: how innovation and empowerment are transforming nursing practice at Thanh Nhan Hospital, Hanoi, Vietnam.

The Vietnam Nurse Project has been operating in Hanoi since 2007. Its primary purpose is to improve nursing education through curriculum development, faculty development, and the introduction of a more student-centric teaching and learning environment. The Virtual Nursing Grand Rounds component of the project is an academic-practice partnership between the Vietnam Nurse Project at the University of San Francisco School of Nursing and Health Professions and the Thanh Nhan Hospital intensive care unit. Its goal is to improve nursing practice in the Thanh Nhan Hospital intensive care unit. The Virtual Nursing Grand Rounds is a fully interactive real-time synchronous computer technology-assisted point-to-point program that provides ongoing evidence-based staff development and consultative services.

Leading an international nursing partnership: the Vietnam Nurse Project.

This article describes an international partnership between a US university in San Francisco, California, and a nursing school in Hanoi, Vietnam. The focus of the project is nursing education and practice. All successful partnerships require a great deal of trust, care, nurturing, and determination. However, regardless of the resources available, the first order of business must be to build trust and confidence between the players.

Diffusion of innovation: the leaders' role in creating the organizational context for evidence-based practice.

Successfully leading change represents one of the most, if not the most, challenging aspects of a leader's role. The traditional top-down command and control structures and processes present in healthcare institutions and nursing are the enemies of effective change. Transitioning from traditional structures to structures that are more of a partnership between point-of-service staff and administrators is the foundation for creating an evidence-based practice culture.