Nursing Home Patient Safety Culture Perceptions Among Licensed Practical Nurses.

BACKGROUND: Licensed practical nurses (LPNs) working in nursing homes are the primary licensed nurses providing care and ensuring patient safety in New Jersey. As such, it is important to understand LPNs' perception of patient safety culture (PSC) and job satisfaction, which may impact resident safety. PURPOSE: To describe the relationship between LPNs' perception of PSC in nursing homes and job satisfaction. METHODS: A cross-sectional study design was used to survey LPNs in New Jersey. RESULTS: LPNs working in nursing homes were less satisfied than LPNs working in other settings, and their perception of PSC was lower than that in 2019 national data report. CONCLUSION: LPNs in nursing homes indicated that PSC needs improvement. Now is an opportune time to implement initiatives to foster a culture of safety in nursing homes.

First Year Outcomes: Program Evaluation of a Statewide Nurse Residency Program.

In New Jersey, a statewide nurse residency program was implemented using an apprenticeship model. The pandemic created disruption to registered nurse residency programs. This included rapid restructuring of program delivery to online methods and a need to adapt curricula to reflect changing practice and guidelines. As a result of the pandemic, new graduates had educational gaps and nurse leaders experienced staffing shortages. First year program outcomes demonstrated a 90% retention of new graduates and financial benefits for organizations participating in the statewide nurse residency program.

Creating a Statewide Nurse Residency: Using an Apprenticeship Model.

The Institute of Medicine recommends residency programs be implemented for new graduates across all settings, yet hospitals have not consistently hardwired this into their organizations. The value proposition is in recruitment, retention, and the conservation of resources. New Jersey's experiences using the US Department of Labor apprenticeship model for nurse residency programs provides a strategy that can be implemented on a statewide basis.

Perceptions of acute care nurse residencies: Perspectives from one state.

AIM: To describe how new nurses transition into practice in acute care settings. BACKGROUND: The Institute of Medicine (2010) landmark report, Future of Nursing: Leading Change, Advancing Health recommends implementing nurse residency programs. However, not all organizations in the state have offered them. Evaluation of the effectiveness of them has been weak. METHOD: A qualitative study using content analysis was conducted. Six focus groups were held 19 educators, 21 nurse residents and 10 chief nursing officers. Co-investigators reviewed the data separately and then met to analyse common categories to gain consensus. RESULTS: Five major categories were identified: pre-residency, program structure, preceptor, resident support and evaluation with additional sub-categories. Although the participants agreed that a residency program was important, the results showed an incongruence between what was needed and what was provided. CONCLUSION: An adequate supply of nurses for the future in health care systems is needed. Addressing transition to practice models can be one strategy that assists with retention of the new graduate. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse leaders need to evaluate the effectiveness of their current nurse residency programs. Standardizing curricula and data collection can improve measurement of outcomes.

Entrepreneurship: Assessing the Readiness of the New Jersey APN Workforce.

There is an unprecedented opportunity to move advanced practice nurses (APNs) into primary care settings at a steady rate over the next 5 to 8 years. In addition, the opportunity for nurse-owned or nurse-led practices has never been greater. However, many APNs currently work in a structured environment where the employer focuses on the business aspects of the practice and the APN focuses primarily on clinical care. Often APNs are unaware of the entrepreneurial contribution they make to the practice. A Needs Assessment Survey was developed to better understand business and practice management knowledge and skills of APNs in New Jersey. The survey included 14 categories for competency development. Twelve of the 14 categories showed that APNs were at a novice or an advanced beginner level. APNs need to demonstrate their value and take a lead to help solve primary care access issues. This can only be accomplished if APNs are willing to seize the opportunity and overcome barriers and knowledge gaps through both formal and informal education to step out of their traditional positions into more independent roles.

Report From the Night Shift: How Administrative Supervisors Achieve Nurse and Patient Safety.

The administrative supervisor role (the nurse leader on the evening or night shift) has been present in hospitals for more than 100 years, but research is just commencing regarding how this leader achieves nurse and patient safety. This focused ethnographic study was conducted in 2 parts. The first part consisted of focus groups with night-shift staff nurses, held at 7 hospitals in the mid-Atlantic region of the United States, with the objective of obtaining the staff nurses' perception of the supervisors' role. The second part consisted of interviews with 30 administrative supervisors, recruited nationally from 20 different states, to explore the supervisors' perspective on practices used to enhance safety. The focus group and interview transcripts were thematically analyzed, using an iterative, comparative method to identify codes and sort for patterns. The findings reveal that administrative supervisors "make it (whatever needs to be done) work" and achieve nurse and patient safety by building trust with the staff, doing rounds, educating, and providing support to the front line team. These shift leaders foster a culture of safety with their relationship-oriented leadership style. By gaining further understanding about the administrative supervisor role, new workflow processes can be explored; specific continuing education programs can be developed; and additional research can be conducted.

Conflict management style, supportive work environments and the experience of work stress in emergency nurses.

AIMS: To examine the conflict management style that emergency department (ED) nurses use to resolve conflict and to determine whether their style of managing conflict and a supportive work environment affects their experience of work stress. BACKGROUND: Conflict is a common stressor that is encountered as nurses strive to achieve patient satisfaction goals while delivering quality care. How a nurse perceives support may impact work stress levels and how they deal with conflict. METHODS: A correlational design examined the relationship between supportive work environment, and conflict management style and work stress in a sample of 222 ED nurses using the expanded nurse work stress scale; the survey of perceived organisational support; and the Rahim organisational conflict inventory-II. RESULTS: Twenty seven percent of nurses reported elevated levels of work stress. A supportive work environment and avoidant conflict management style were significant predictors of work stress. CONCLUSIONS: Findings suggest that ED nurses' perception of a supportive work environment and their approach to resolving conflict may be related to their experience of work stress. IMPLICATIONS FOR NURSING MANAGEMENT: Providing opportunities for ED nurses in skills training in constructive conflict resolution may help to reduce work stress and to improve the quality of patient care.

Factors associated with falls in hospitalized adult patients.

INTRODUCTION: Despite efforts in hospitals to identify patients at risk for falls and to prevent these incidents, falls among hospitalized patients are not a rare event and continue to be a major health care concern, occurring in approximately 700,000-1,000,000 hospitalized patients per year. PURPOSE: The purpose of this study was to examine intrinsic, extrinsic, and workforce factors that contribute to falls among hospitalized adult patients. METHODS: A retrospective correlational design was used to examine 160 patients admitted to a medical-surgical unit over the year 2012. Analytical weighting was applied to the study sample to conduct bivariate and multivariate analysis. FINDINGS: In multivariate analysis, the variables age, narcotic/sedative use, and overnight shift, significantly predicted the likelihood of a fall during the hospitalization. Cardiovascular disease, neuromusculoskeletal disease, evening shift, the implementation of fall prevention strategies and higher RN to unlicensed assistive personnel staffing ratios decreased the likelihood of a fall during the hospitalization. In addition, patients at high risk for falls using the Hendrich I fall scale were nearly 17% more likely to fall during the hospitalization. CONCLUSIONS: Many factors influence the occurrence of a fall in hospitalized patients. Fall risk assessment and the implementation of fall prevention strategies are both effective strategies in the clinical area to identify and decrease the probability of a fall. The presence of the RN is significant in fall prevention in medical-surgical patients.

Measuring first-line nurse manager work: instrument: development and testing.

OBJECTIVE: The objective of this study was to develop and test a 1st-line nurse manager (FLNM) work instrument to measure categories of work and frequency of activities. BACKGROUND: First-line nurse managers have been demonstrated to be key contributors in meeting organizational outcomes and patient and nurse satisfaction. Identifying the work of FLNMs is essential to help in the development of prioritization and sequence. The need for an instrument that can measure and categorize the work of FLNMs is indicated. METHODS: The author-developed instrument was administered as a pilot study to 173 FLNMs in New Jersey. Descriptive statistics were analyzed, and validity and reliability were measured. RESULTS: Content validity was established through 2 focus groups using 10 FLNMs and conducting a survey of 5 chief nursing officers. Reliability was assessed by 13 of 16 FLNM participants using the test/retest method and quantified using percent agreement within a 10-day period. Those items with 70% agreement or more were identified as reliable and retained on the instrument. CONCLUSIONS: The content validity of the instrument is strong; further refinement and testing of the tool are indicated to improve the reliability and generalizability across multiple populations of leaders and settings.

Pandemic Impact on the Preceptor/New Nurse Dyad.

This qualitative study examined the impact of the pandemic on the preceptor role in out-of-hospital settings, including the preceptor/new nurse working relationship prepandemic and the challenges encountered during the pandemic. On the basis of the study findings, suggestions for adapting preceptor education to address this working relationship in the "new normal" including more preparation for "letting go" of the preceptor/new nurse relationship and the increased use of technology for just-in-time learning for the preceptor are highlighted.

Transition Into Practice: Beyond Hospital Walls.

BACKGROUND: Historically, evidence has shown the importance of nurse residency programs, yet few organizations have implemented them outside of hospital settings. This article shares nurses' experiences and outcomes in an out-of-hospital nurse residency program that transitioned bachelor of science in nursing graduates through an academic-practice partnership. METHOD: A mixed methods design was used that consisted of qualitative interviews (pre- and postresidency) and quantitative surveys (Casey-Fink Graduate Nurse Experience Survey, a job satisfaction survey, and a preceptee evaluation survey). RESULTS: Forty-four nurses participated. Qualitative findings were supported by the quantitative data. Results showed that confidence, competence, job satisfaction, and retention improved with an out-of-hospital residency program. CONCLUSION: Ensuring that every new graduate is afforded a nurse residency should be the goal, regardless of setting, to reduce turnover, ensure workforce stability, and ultimately improve patient outcomes. Academic-practice partnerships can help build resource capacity, especially in these settings, to achieve this goal. [J Contin Educ Nurs. 2023;54(7):327-336.].

Does Public Reporting of Staffing Ratios and Nursing Home Compare Ratings Matter?

OBJECTIVE: Public reporting is a policy to improve quality and increase data transparency. The objective was to examine the association between publicly available staffing ratios and the Five-Star Quality Ratings from Nursing Home Compare over time. DESIGN: Panel data analysis. SETTING AND PARTICIPANTS: About 146 nursing homes with complete quarterly data in New Jersey between January 1, 2012, and December 31, 2019. METHODS: Using data from the State of New Jersey Department of Health and Nursing Home Compare, staff-to-resident ratios were trended for registered nurses, licensed practical nurses, and certified nursing assistants by shift and over time. Panel data analysis was used to test the association between the ratios and the ratings. RESULTS: Compared to 2012, staffing ratios improved slightly for licensed practical nurses but not for registered nurses or certified nursing assistants in 2019 (P < .001). The number of residents assigned doubled at night for all personnel. During the day and evening shifts, registered nurse staffing was significantly associated with the Nursing Home Compare staffing rating (P < .01) but not the overall rating. CONCLUSIONS AND IMPLICATIONS: Decreasing the number of residents assigned to a registered nurse in NHs results in an increase in staffing ratings. Mandatory public reporting holds nursing homes accountable for quality outcomes but does not improve staffing ratios. Quality resident care is the cumulative result of multiple measures inclusive of staffing; therefore, administrators should continue to focus on improving quality in NHs, which may improve staffing ratios across shifts.

Preceptor Criteria Revisited.

BACKGROUND: Preceptor selection criteria based on demographic data has been shown to yield inconsistent degrees of success in the role. The purpose of this mixed-methods study was to determine if preceptors with different levels of innovativeness identified different benefits and challenges when implementing the preceptor role. METHOD: A mixed-methods study was conducted using online surveys to determine each participants' individual level of innovativeness. Interviews were conducted with preceptors from each innovator category to identify benefits and challenges in implementing the preceptor role. RESULTS: Preceptors who scored lower in innovativeness identified challenges that were not discussed by preceptors who scored higher in innovativeness. Conversely, preceptors who scored higher in innovativeness identified benefits that were not common to preceptors with lower levels of innovativeness. CONCLUSION: Opportunities for nurse educators and facility nurse leaders were presented to meet the diverse needs of the preceptor and provide for more consistent implementation of the preceptor role. [J Contin Educ Nurs. 2020;51(9):425-432.].

Nurses' skill level and access to evidence-based practice.

Integrating evidence-based practice into the culture of an acute care hospital requires assessment, planning, and intervention by nursing leadership. The authors discuss a statewide study that assessed the skill level of nurses in obtaining evidence for their nursing practice, using computers and databases, as well as evaluating the perceived availability of resources in their hospitals to access evidence.

Long-Term Care Nurse Residency Program: Evaluation of New Nurse Experiences and Lessons Learned.

Transitioning to long-term care environments presents a significant challenge for new nurses and their directors of nursing. The complexity of this environment, instability of the workforce, and the lack of support structures frequently affect a new nurse's decision not to apply to long-term care, but to look for positions in acute care hospitals. To address these issues, a long-term care new nurse residency program was developed, implemented, and evaluated in New Jersey through the work of the New Jersey Action Coalition. The purpose of this study was to determine the effects of the residency program on new nurses' confidence, competence, retention, job satisfaction, and perceptions of organizational safety. J Contin Educ Nurs. 2017;48(10):474-484.

Creating a Long-Term Care New Nurse Residency Model.

As the impact of health care reform continues to evolve, the movement of patients from acute to post-acute settings will continue to expand. Currently, the turnover and retention of RNs nationally in long-term care is at an all-time high, with a median turnover rate of 50% for RNs. Workforce instability is a prime contributor to poor patient outcomes, increased costs, and a dissatisfied nursing workforce. Therefore, the New Jersey Action Coalition determined that the Institute of Medicine's Future of Nursing: Leading Change, Advancing Health recommendation to implement nurse residency programs across settings would be a priority for New Jersey. A 12-month new nurse residency and preceptor program was developed and implemented in long-term care, with 37 new nurses and 37 preceptors. The design and implementation processes are described, as well as lessons learned along the journey. J Contin Educ Nurs. 2016;47(5):234-240.

The Impact of the Nursing Practice Environment on Missed Nursing Care.

OBJECTIVES: Missed nursing care is an emerging problem negatively impacting patient outcomes. There are gaps in our knowledge of factors associated with missed nursing care. The aim of this study was to determine the relationship between the nursing practice environment and missed nursing care in acute care hospitals. METHODS: This is a secondary analysis of cross sectional data from a survey of over 7.000 nurses from 70 hospitals on workplace and process of care. Ordinary least squares and multiple regression models were constructed to examine the relationship between the nursing practice environment and missed nursing care while controlling for characteristics of nurses and hospitals. RESULTS: Nurses missed delivering a significant amount of necessary patient care (10-27%). Inadequate staffing and inadequate resources were the practice environment factors most strongly associated with missed nursing care events. CONCLUSIONS: This multi-site study examined the risk and risk factors associated with missed nursing care. Improvements targeting modifiable risk factors may reduce the risk of missed nursing care.