Diversity Practices for Hiring the New Graduate Nurse.

A multistep selection process was established to assist in securing top talent while achieving diversity objectives for a nurse residency program. The selection process incorporated objective scoring tools, diverse panel interviews, unconscious bias training, and standardized interview questions to decrease unconscious and implicit bias. As a result, the entry-level nursing workforce has become more diversified by race, gender, age, and academic training.

Exploring nurse beliefs and perceived readiness for system wide integration of evidence based practice in a large pediatric health care system.

PURPOSE: Evidence-based practice (EBP) within healthcare leads to improved patient outcomes, high-quality care, job satisfaction, reduced turnover, professional autonomy, and validates nursing practice. Although a plethora of research focuses on implementing EBP, there has been little attention on assessing organizational readiness for integration. The primary aims of this study were to explore nursing beliefs and attitudes about EBP and explore the culture and readiness among pediatric nurses for system-wide integration of EBP. DESIGN AND METHODS: This study was a quantitative, cross-sectional survey-based study conducted at a large pediatric health system. RESULTS: Overall pediatric nurses had a mean score of 61.78 ± 9.32 on the EBPB (n = 396). Results of the EBPB Scale and OCRSIEP showed no statistical difference between nursing roles EBPB scores; however, nursing leaders had higher scores than any other nursing role. The OCRSIEP had a mean score of 84.98 ± 19.53 (n = 388). CONCLUSIONS: Findings suggest that pediatric nurses believe that EBP results in the best clinical care for patients and can improve clinical care, but they lack the skills and time necessary to engage in the process. This study found that increasing awareness of EBP resources and developing EBP competencies may assist pediatric nurse leaders with EBP integration into daily practice. PRACTICE IMPLICATIONS: Increasing visibility and competencies of EBP may positively impact organizational readiness by increasing confidence needed to remove identified barriers and engrain EBP in the organization's culture.

Implementing a Watcher Program to Improve Timeliness of Recognition of Deterioration in Hospitalized Children.

PURPOSE: Early recognition and response to clinical deterioration is critical to patient safety. Failures or delays in recognition and response often manifest as emergency transfers to the intensive care unit (ICU). We describe implementation of a program to improve recognition and response to clinical deterioration within the pediatric inpatient acute care setting (i.e., medical-surgical, hematology-oncology, and intermediate care units). DESIGN AND METHODS: We assembled an inter-professional team including nurses, physicians, and hospital leaders to evaluate preventable patient harm events associated with failures in identifying and responding to clinical deterioration and resultant emergency transfers to the intensive care unit (ICU). We evaluated an existing situational awareness framework incorporating principles of high-reliability organizations, refined the framework utilizing internal event analyses data, and subsequently implemented a program reducing emergency transfers. RESULTS: Emergency transfers to the ICU from acute care settings decreased by more than 70%, and to date, this improvement has sustained. Nurses report increased satisfaction and empowerment to proactively escalate their concerns, respond to changes in a patient's condition, and reduce uncertainty about the plan of care. CONCLUSIONS: The program has enhanced situational awareness, reduced emergency transfers, and fostered a culture of accountability and collaboration in alignment with the organizational core value of safety. PRACTICE IMPLICATIONS: Developing a reliable system to support the healthcare team in recognizing and responding to clinical deterioration reduces the risk of care delays. Applying situational awareness to other high-risk situations, additional areas for program expansion were identified, to include emergency department admissions and behavioral health patients.

Taking the Fall for Kids: A Journey to Reducing Pediatric Falls.

PURPOSE: To reduce harm related to pediatric falls, a quality improvement project was conducted at a children's hospital. DESIGN AND METHODS: An interprofessional team designed and implemented evidence-based interventions to align with the hospital's journey to reduce patient harm. These interventions included selection and implementation of a fall risk assessment tool, implementation of fall bundle elements, and implementation of fall prevention education to patients and families. Surveys, audits, and rate of falls were used to evaluate the project. RESULTS: Fall bundle compliance increased from 27% to 88% and there were zero patient falls in five out of the six months after implementation a comprehensive pediatric fall prevention program. CONCLUSIONS: Implementing pediatric-specific, evidence-based interventions can help to reduce patient falls. There was a substantial increase in fall bundle compliance and a decrease in falls and falls with injury. PRACTICE IMPLICATIONS: Engagement and empowerment of clinical nurses in the quality improvement process design and implementation can substantially improve patient outcomes and patient safety while reducing harm. Future research is needed to determine factors that promote enhanced reporting needed to determine the true incidence of patient falls in pediatric inpatient and outpatient settings.

The Emotional Cost of Caring for Others: One Pediatric Hospital's Journey to Reduce Compassion Fatigue.

OBJECTIVE: This study examined the prevalence of compassion fatigue and life stress of pediatric nurses. BACKGROUND: Distressing patient situations over time may affect nurses' professional quality of life and result in compassion fatigue. If not addressed, compassion fatigue may have personal and organizational consequences. METHODS: Using a descriptive, correlational design, a convenience sample of 268 nurses completed a web-based survey. RESULTS: High compassion satisfaction and moderate to low burnout and secondary traumatic stress were described by 49% of participants. Education was statistically associated with burnout and secondary traumatic stress. Life stress scores were significantly associated with age, experience, organizational tenure, and professional engagement. Narrative commentary yielded 5 themes: staffing, recognition, boundaries, expectations, and hopelessness. Organizational initiatives to prevent or mitigate compassion fatigue focused on awareness, balance, and connections. CONCLUSIONS: Nurses are negatively impacted by the emotional cost of caring. Future studies need to identify interventions to minimize compassion fatigue.

The Impact of Nurse Residency Programs on Patient Quality and Safety Outcomes: A Review of the Literature.

Schools of nursing are struggling to prepare registered nurses to practice in today's complex healthcare settings. Nurse residency programs are a good solution to support the transition to practice. Nursing education leaders must be informed of the nursing quality and safety outcomes of nurse residency programs. This literature review provides insight and evaluation of the evidence related to the impact of nurse residency programs with substantial evidence of nurse outcomes and minimal patient outcomes.

Career Mapping for Professional Development and Succession Planning.

Career mapping facilitates professional development of nurses by education specialists and nurse managers. On the basis of national Nursing Professional Development Scope and Standards, our education and professional development framework supports the organization's professional practice model and provides a foundation for the professional career map. This article describes development, implementation, and evaluation of the professional career map for nurses at a large children's hospital to support achievement of the nursing strategic goals for succession planning and professional development.