Using a Delphi Method to Identify Human Factors Contributing to Nursing Errors.

PURPOSE: The purpose of this study was to identify human factors associated with nursing errors. DESIGN: Using a Delphi technique, this study used feedback from a panel of nurse experts (n = 25) on an initial qualitative survey questionnaire followed by summarizing the results with feedback and confirmation. METHODS: Synthesized factors regarding causes of errors were incorporated into a quantitative Likert-type scale, and the original expert panel participants were queried a second time to validate responses. FINDINGS: The list identified 24 items as most common causes of nursing errors, including swamping and errors made by others that nurses are expected to recognize and fix. The responses provided a consensus top 10 errors list based on means with heavy workload and fatigue at the top of the list. CONCLUSIONS: The use of the Delphi survey established consensus and developed a platform upon which future study of nursing errors can evolve as a link to future solutions. This list of human factors in nursing errors should serve to stimulate dialogue among nurses about how to prevent errors and improve outcomes. CLINICAL RELEVANCE: Human and system failures have been the subject of an abundance of research, yet nursing errors continue to occur.

Hospital nurses' perceptions of human factors contributing to nursing errors.

OBJECTIVE: The aim of this study is to understand the human factors associated with hospital errors to provide a framework to discuss why errors occur. BACKGROUND: Patient safety in hospitals has been a major focus in healthcare for the past 15 years. Errors still occur at an alarming rate. METHODS: A cross-sectional survey of 393 hospital-based registered nurses provided perceptions of 24 items relating to human errors in hospitals. Errors were assessed for likelihood, intervenability, importance, and common occurrence. RESULTS: Data revealed 4 themes that explained 55% of the variance in likelihood to cause an error: loss of focus, unhealthy environment, interpersonal deficits, and overwhelmed. Feeling swamped was most important but was not seen as intervenable. CONCLUSION: Managers must provide a way for nurses to feel empowered to intervene on error situations they believe are most likely, common, and important.

Using a strengths model to build an on-line nursing education program.

The on-line environment is the new frontier for academia struggling to define its place in the evolving economy. A concern is how to engage students who maximize their on-line experience and graduate in a timely manner. A strengths model was used as the basis for development of an on-line doctoral nursing program. Upon entering the program, students were given a strengths assessment that focused both students and faculty on the positive attributes students were bringing to their doctoral studies. A positive feedback methodology using on-line discussions in each course was used to support the identified strengths. The optimal picture of a successful entering doctoral student appears to be a person whose top five strengths are learner, achiever, input, connectedness and responsibility. A strengths model promotes a positive learning environment and supports a teacher-learner dynamic where faculty members are encouraged to focus on the students' strengths rather than their challenges.

Evaluation of a Collaborative Care Model for Hospitalized Patients.

The current lack of collaborative care is contributing to higher mortality rates and longer hospital stays in the United States. A method for improving collaboration among health professionals for patients with congestive heart failure, the Clinical Integration Model (CIM), was implemented. The CIM utilized a process tool called the CareGraph to prioritize care for the interdisciplinary team. The CareGraph was used to focus communication and treatment strategies of health professionals on the patient rather than the discipline or specific task. Hospitals who used the collaborative model demonstrated shorter lengths of stay and cost per case.

Leading and managing an intergenerational workforce.

Focus group discussions with four generations of staff nurses identified five themes that participants believed must be addressed in order to make the current work environment a desirable place to conduct their careers as nurses. These themes are: transitioning from student to nurse, managing difficult staffing conditions, maintaining morale, dealing with safety matters, and building relationships that enhance teamwork. Manager challenges are discussed in relation to each theme and suggested leadership strategies are offered.

Retention priorities for the intergenerational nurse workforce.

TOPIC: Retention of senior, Gen-X, and Millennial nurses is influenced by manager interactions and efforts to create a satisfying work experience. PURPOSE: The purpose of this project was a generational assessment of job satisfaction, work environment, and desired characteristics of managers in an effort to improve nurse retention. SAMPLE AND METHODS: Data from staff nurses at 22 southern hospitals collected by online survey included measures of job satisfaction and perceptions of safety, the Nurse Manager Desired Traits survey, and the Nursing Work Index-Revised. FINDINGS: The satisfaction with work environment scores for the whole group (n = 1,773) were high. Subscale scores showed highest satisfaction with nurse/physician relationships; lowest was nurse control of practice. A specific satisfaction question showed the younger nurses were less satisfied than those over age 40. Nurse safety concerns were expressed by 40% of the sample. One third of Millennial nurses plan to leave their job within the next 2 years. Over two thirds plan to be gone within the next 5 years. Especially alarming is the fact that 61% of the nurse group stated they plan to leave their current jobs within 10 years. RECOMMENDATIONS: (a) Create model managers; (b) empower staff nurse councils; (c) stabilize staffing; (d) revamp incentives; and (e) focus on safety.

What nurses want: the nurse incentives project.

Today's nurse executives are struggling with leadership challenges of managing the multigenerational workforce, financial imperatives to deliver better care for lower costs, and competition to provide the optimal work environment to retain nurses. The purpose of the Nurse Incentives Project was to determine satisfaction with current employment incentives and potential managerial actions which might decrease or delay turnover by registered nurses. This study spawned recommendations regarding the role of incentives in designing an environment where benefits and perks will be seen as incentives to stay and thrive in the current nursing workplace. The results show that nurses know what they want. Attention to generational priorities and flexible benefits programs may help to create the cohesive work environment that nurses seek. Investment into creating delivery arenas where satisfied nurses are caring for satisfied patients is a worthwhile goal.

Salvation or damnation: deconstructing nursing's aspirations to professional status.

AIM: This paper will deconstruct the rationale(s) for aspiring to professional status in nursing. BACKGROUND: It is argued that 'transformative nursing leaders' must transition from operational to strategic aspects, such as considering the question of whether or not nursing should move towards professional status. METHOD: This paper examines documented outcomes arising out of professional status and considers whether or not these are contrary to the central tenets of nursing's underpinning philosophy and practice axioms. The outcomes scrutinized are: compensation, respect and recognition, political influence and clout, the consumer movement and the gender issue. FINDINGS: A carte blanche aspiration for professional status is irreconcilable with some of nursing's central tenets. However, there are benefits that nurses should pursue. CONCLUSION: Aspiring to professional status by adopting the normative orthodoxies and dominant discourse of our medical colleagues actually serves to reinforce and maintain nurses in a mostly subservient role. IMPLICATIONS FOR NURSING MANAGEMENT: In place of adopting the gendered views of professional status, nurses and clients might be better served by the creation of a parallel discourse; one where the central and underpinning values of nurses and clients are seen as equal, though different to the values of the current dominant discourse.

Motivating an intergenerational workforce: scenarios for success.

Although much has been written about the challenge of having four generations in the workplace simultaneously, problems of conflict, misunderstanding, and divisiveness continue. This article provides a snapshot of each generation as context. A series of scenarios based on Maslow's Hierarchy of Needs are then presented with insights into how each generation might approach the situation, along with hints for successfully managing toward positive outcomes. The expected outcome is a technique for each generation to look at workplace situations from all perspectives.