Do Leadership Style, Unit Climate, and Safety Climate Contribute to Safe Medication Practices?

OBJECTIVES: This study aims at: examining if leadership style and unit climate predict safety climate; and testing the direct, indirect, and total effect of leadership style, unit climate, and safety climate on nurses' safe medication practices. BACKGROUND: The Institute of Medicine and nursing scholars propose that safety climate is a prerequisite to safety practices. However, there is limited empirical evidence about factors contributing to the development of safety climate and about the association with nurses' safe medication practices. METHOD: This cross-sectional study used survey data from 246 RNs working in a Magnet® hospital. RESULTS: Leadership style and unit climate predicted 20% to 50% of variance on all safety climate dimensions. Model testing revealed the indirect impact of leadership style and unit climate on nurses' safe medication practices. CONCLUSION: Our hypothesized model explained small amount of the variance on nurses' safe medication practices. This finding suggests that nurses' safe medication practices are influenced by multiple contextual and personal factors that should be further examined.

Assessing Pediatric Nurses' Knowledge About Chemical Flame Retardants.

Chemical flame retardants are routinely applied to children's products and are harmful to their health. Pediatric nurses are in a key position to provide education to caregivers on methods to decrease their children's exposure to these harmful chemicals. However, a critical barrier is the absence of any program to educate nurses about chemical flame retardants. In order to overcome this barrier, we must first assess their knowledge. This article provides key highlights every pediatric nurse should know about chemical flame retardants and reports the results of a knowledge assessment study. PURPOSE: The purpose of this study was to (1) assess pediatric nurses' knowledge of chemical flame retardants, (2) determine what topic areas of chemical flame retardants pediatric nurses lack knowledge in, and (3) determine the best method to educate nurses about chemical flame retardants. DESIGN AND METHODS: A single sample cross-sectional questionnaire design was used. A total sample of 417 advanced practice registered nurses and registered nurses completed an online survey about chemical flame retardants. RESULTS: Pediatric nurses' knowledge of chemical flame retardants was low (M=13.4 out of 51). Articles, webinars, and e-mails were the primary preferred methods for education on the subject identified as a result of the survey. CONCLUSIONS: Pediatric nurses have a large knowledge deficit related to chemical flame retardants. The data collected from this study will help structure future educational formats for pediatric nurses on chemical flame retardants to increase their knowledge.

Nurse's perceptions of their group goal attainment capability and professional autonomy: a pilot study.

AIM: A pilot study to examine staff nurses' perceptions of, and relationships between, group goal attainment capability and professional autonomy. BACKGROUND: A nursing group's capability to employ appropriate nursing interventions leads to improvement in patient outcomes. Nurses' goal attainment capability plays a role in achieving high-quality patient outcomes and may be related to professional autonomy. METHOD: Staff nurses (N = 90) in one community hospital completed the Sieloff-King Assessment of Group Goal Attainment Capability within Organizations and the Nursing Activity Scale instrument. RESULTS: Staff nurses reported high goal attainment capability and high professional autonomy, and a positive significant but weak correlation (r = 0.24, P < 0.05) was found between nurses' perceptions of group goal attainment capability and perceptions of professional autonomy. Three of the eight group goal attainment subscales were positively correlated with professional autonomy including: group leaders' goal attainment capability competency, goals/outcomes competency and goal attainment capability perspective. CONCLUSION: While three subscales of goal attainment capability were significant, the correlations were weak between professional autonomy and group leader's goal attainment competency, goals/outcome competency and goal attainment perspective. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers can play a key role in nurses' group goal attainment capability and perceived professional autonomy.

Turnover intention among hospital-based registered nurses in the Eastern Caribbean.

PURPOSE: Vacancy rates for nurses in the English-speaking Caribbean are estimated at 30% with turnover typically associated with migration. The purpose of this study was to describe the characteristics of hospital-based registered nurses (RNs) in the sub-region, their practice environment and turnover intention in two and five years, respectively, and to determine the relationships among practice environment characteristics and turnover intention. DESIGN: A descriptive correlational design was used with self-reported questionnaires from a convenience sample of 301 RNs working in hospitals in four English speaking Eastern Caribbean countries. Single-item visual analog scales (VAS) were used to measure turnover intention in 2 years and 5 years. The Practice Environment Scale of the Nursing Work Index (PES-NWI) measured the characteristics in the practice environment. FINDINGS: The mean age of the nurses was 32.5 (SD = 6.75) years. Most nurses (58.8%) were single and 91.4% had relatives living abroad. Nurses scored three PES-NWI subscales < 2.5, indicating a less positive practice environment: resource adequacy, nurse participation in hospital affairs, and nurse managers' ability, leadership, and support. The subscale for collegial nurse-physician relations received the best rating (mean = 2.61, SD = .62). For 2-year intention to leave, the mean rating on the 100-mm VAS was 63.2, while that for the 5-year intention to leave was 65.6. No significant correlations were found among four of the five PES-NWI subscales and turnover intention in 2 and 5 years. CONCLUSIONS: The practice environment, while generally unfavorable, is not associated with the nurses' intention to leave their jobs. These findings support the current policy position that calls for managing turnover among nurses. Nursing and health system administrators should assess, plan, and implement workforce policies to slow the outflow of nurses. CLINICAL RELEVANCE: Initiatives to improve the work environment and the delivery of high-quality care are important to RNs in the Eastern Caribbean. Managing the negative impact of continuous outflow of nurses through turnover requires long-term coordinated policy and human resource development and management initiatives to sustain the supply of RNs in the subregion.

Transformational leadership practices of chief nursing officers in Magnet® organizations.

OBJECTIVE: This study describes the transformational leadership practices of Magnet® chief nursing officers (CNOs). BACKGROUND: It is believed that transformational leadership practices influence quality and are integral to Magnet designation. METHODS: E-mail surveys of 384 Magnet CNOs were conducted in 2011 using the leadership practices inventory (LPI). RESULTS: Enabling others to act and modeling the way are top practices of Magnet CNOs. Those 60 years or older and those with doctorate degrees scored significantly higher in inspiring a shared vision and challenging the process. There was a significant positive relationship between total years as a CNO and inspiring a shared vision and between total scores on the LPI and number of beds in the organization. CONCLUSIONS: As CNOs gain experience and education, they exhibit more transformational leadership characteristics. Magnet organizations should take steps to retain CNOs and support their development and advancement.

Transformational leadership practices of chief nursing officers in Magnet® organizations.

OBJECTIVE: This study describes the transformational leadership practices of Magnet® chief nursing officers (CNOs). BACKGROUND: It is believed that transformational leadership practices influence quality and are integral to Magnet designation. METHODS: E-mail surveys of 384 Magnet CNOs were conducted in 2011 using the leadership practices inventory (LPI). RESULTS: Enabling others to act and modeling the way are top practices of Magnet CNOs. Those 60 years or older and those with doctorate degrees scored significantly higher in inspiring a shared vision and challenging the process. There was a significant positive relationship between total years as a CNO and inspiring a shared vision and between total scores on the LPI and number of beds in the organization. CONCLUSIONS: As CNOs gain experience and education, they exhibit more transformational leadership characteristics. Magnet organizations should take steps to retain CNOs and support their development and advancement.

Expanded adult day program as a transition option from hospital to home.

This article describes a pilot program for provision of postacute care (PAC) in an established adult day program. Demographic, clinical, utilization, and satisfaction data were abstracted retrospectively from program records; postdischarge readmission and emergency department visit data were obtained from the electronic health record. Comparative data were obtained from the health records of patients who were offered but declined the adult day program. Between 2005 and 2008, 78 patients requiring PAC were approached by the RN coordinator; 33 selected the adult day program, and 45 selected alternative destinations. The majority of patients had a neurological diagnosis, most commonly stroke. Participants and their family caregivers were highly satisfied with the program. The 30-day readmission rate for adult day program participants was significantly lower than that for nonparticipants. An expanded adult day program may represent a viable Transitional Care Model for selected patients and a feasible alternative to skilled nursing facility and home health care for PAC.

Relationship between staff nurse involvement in organizational structures and perception of empowerment.

Work structures that empower nurses contribute to a healthy work environment yet there are few studies that have looked at the relationship between nurse participation in formal work structures and their perception of empowerment. Nurses involved in power-sharing activities demonstrate a greater commitment to the organization and have improved job satisfaction. To measure the perception of structural empowerment by nurses and examine the relationship between staff registered nurse participation in organizational structures and perceived structural empowerment. A descriptive correlational survey design was used to measure staff nurses' perception of structural empowerment, using the Conditions of Work Effectiveness Questionnaire-II (CWEQ-II). A purposive sample of staff registered nurses (N = 122) at a large Veterans Affairs urban teaching hospital was recruited to complete an online survey. The response rate was 33%. Nurses perceived a moderate amount of structural empowerment and a greater sense of empowerment in the areas of opportunity, support, and collaboration on the CWEQ-II. The total mean score for the CWEQ-II (M = 18.50, SD = 3.63) indicated a moderate amount of perceived structural empowerment. Of the 4 CWEQ-II subscales, opportunity (M = 3.78, SD = 0.87) was moderately high. Resources (M = 3.04, SD = 0.72) and support (M = 2.92, SD = 0.94) were rated as moderate, and participants rated information moderately low (M = 2.75, SD = 0.88). On 2 scales that measured sources of organizational power, informal power was moderately high (M = 3.37, SD = 0.79) compared with formal power (M = 2.64, SD = 0.81), which scored moderately low. In comparing nurses who participated in councils with those who did not, there were no significant differences in their total or subscale scores on the CWEQ-II. Of those who did participate in councils (n = 48, 39.3%), the number of council meetings nurses attended correlated significantly with support (r = 0.37, P = .009). The percentage of time council members communicated information to their peers at the unit level correlated positively with informal power (r = 0.30, P = .04). Organizational structures that provide opportunities for nurses to participate in professional matters that are important to them support empowerment that is essential for a healthy work environment.

Nurse administrators: leading environmental change.

Evidence is building about the impact of environmental contaminants on patients and health care providers. The nurse administrator has a professional responsibility to provide leadership in assuring that the health care organization does not have a negative impact on health. This article presents critical environmental health concerns and an overview of the nursing profession efforts to improve the environment, which includes development of the American Nurses Association's Principles of Environmental Health for Nursing Practice with Implementation Strategies. An example is provided as to how the nurse administrator can use Appreciative Inquiry to harness the nurses collaborative energy for an environmentally healthy organization.

Validity testing the Outcomes and Assessment Information Set (OASIS).

This study evaluated the criterion validity of the Outcome and Assessment Instrument Set (OASIS) items that measure activities of daily living (ADLs), instrumental activities of daily living (IADLs), cognitive functioning, and depression. A convenience sample of patients (n = 203) from five home care agencies participated in the study. Patient OASIS items were compared to data collected using gold standard instruments. Correlations range from .44 to .69 for ADLs and .20 to .68 for IADLs. A correlation of .62 was found for cognitive functioning while correlations for depressive symptoms are .36 and .26. OASIS ADLs and cognitive status items are sufficiently valid, but the OASIS depression item is not sufficiently sensitive to the prevalence of these conditions.

Nurses' perception of their manager's leadership style and unit climate: are there generational differences?

AIM: To describe and compare how nurses representing four age cohorts perceive their manager's leadership style and unit climate. BACKGROUND: The current workforce consists of nurses representing four generational cohorts. Nursing literature suggests that nurses from each age cohort think, behave and approach work differently. Limited empirical evidence, however, exists about how nurses from each age cohort perceive two aspects of their work environment: their managers' leadership style and unit climate. METHOD: This cross-sectional, descriptive survey was conducted using a convenience sample of 475 registered nurses working in different inpatient units in three community non-magnet hospitals. RESULTS AND CONCLUSION: Only nurses from Boomer and Gen-Xers had sufficient representation to be included in the data analysis. Nurses from the two main age cohorts did not differ in their perceptions of their manager's leadership style. Significant differences were found in two unit climate dimensions. The Gen-Xers had a less favourable perception of their unit climate related to warmth and belonging and administrative support. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse manager's might reflect on how they interact with different age cohorts; and to involve nurses from various age cohorts in the development of policies to create a flexible work environment.

Risk factors for hospitalization among Medicare home care patients.

This study determined factors associated with an increased risk of ending Medicare home health care because of hospitalization and examined specific types of and reasons for hospitalization. Sample members (N = 922) were followed from admission to discharge as they received home care from Ohio Medicare-certified home care agencies between December 1999 and March 2002. Potential patient-level risk factors were predisposing, enabling, or need variables, and an agency-level variable denoting hospital affiliation or free-standing status was examined as a second-level risk factor. Among those hospitalized (18.3%), more than 80.0% experienced emergency hospitalizations, mostly for acute exacerbations of chronic diseases. Statistically significant risk factors for hospitalization included dyspnea severity, functional disability level, skin or wound problems, diabetes, case mix score, and guarded rehabilitation prognosis. Home care agencies might reduce hospitalizations by using clinical prognosis as a key resource for team communication and by helping patients and families anticipate potential acute exacerbations of chronic diseases and manage these events at home.

Exercise of autonomous home care practice: the relationship with nurse characteristics.

This study examined how the value of autonomy is reflected in home healthcare agencies' practice models and how staff registered nurse (RN) characteristics (education, experience, certification) relate to the RNs' perception of their ability to exercise autonomous practice: control over practice decisions (clinical autonomy) and control over practice setting decisions (organizational autonomy). RNs (N = 82) from 11 agencies were found to have more control over practice decisions than practice setting decisions. No significant relationship was found between RN characteristics of education, RN experience, home healthcare experience, and specialty certification.

Home health services research.

This chapter reviews 69 published research reports of home health care from a health services perspective by nurse researchers and researchers from other disciplines. Reports were identified through searches of the National Library of Medicine (MEDLINE), and the Cumulative Index to Nursing and Allied Health Literature and Social Sciences Citation Index using the following search terms: home health care, health services research, and elders. Within the major areas identified, the following additional terms were specified: resource use and outcomes. Reports were included if published between 1995 and 2001, used samples age 65 and older, performed in the U.S., and published in English. Studies of all types were included. The key findings follow: (a) Most studies were a theoretical. If a theoretical model was used, it was most often the Andersen Behavioral Model. (b) Few conclusions can be drawn about resource use--increasing age and higher severity of health related problems are associated with higher numbers of home visits. The variety of measures of resource use and the study approaches (large national data sets versus single or several agency samples) limits the ability to draw conclusions on resource use. (c) There is a growing body of evidence on rehospitalization of home health care patients which indicates rehospitalization is prevalent but largely not predictable. (d) Patient outcomes research is inconclusive at this point, primarily because there are few studies that examine patient outcomes using a consistent set of measures. The main recommendations are: to study rehospitalization using a more profile-based approach to determine visit patterns that may be effective, to further specify the kinds of outcomes that may be achieved as a result of home health care and which patients might be expected to achieve positive outcomes, and to examine the integration of home health care with the broader community-based services.