Connecting the Health Care Workforce with the Patient Experience.

This article is one in a series from Press Ganey-a health care performance improvement organization-that will discuss the many facets of the human experience in health care. Using the latest national data, the series will explore the intersections of safety, reliability, experience, and service, and their impact on engagement, work culture, and nurse-sensitive outcomes. Each installment will be designed as a "deep dive" into the most recent thinking and evidence-based approaches to improvement of the patient experience with a particular focus on practical and implementable tactics in each of the above subject areas.

Supporting the Role Transition of Interim Nurse Managers: Development of an Evidence-Based eManual.

Executive nurse leaders may rely on interim nurse managers (INMs) to fill vacated nurse manager positions open for an extended time. To optimize the INM role for future leadership succession planning, ongoing professional development for this role is critical. The authors describe the use of evidence in the creation of onboarding leadership resources to support the role transition of INMs within a healthcare environment over a 100-day period.

Evolution of an Instrument: Measuring the Nursing Work Environment: A Scoping Review.

Background and Purpose: The Nursing Work Index (NWI) was developed in the 1980s to measure the nursing work environment (NWE). Instruments descended from the NWI continue to measure the NWE today. The purpose of this review was to identify instruments derived from the NWI, examine how they have been used and revised, and evaluate their ability to capture elements of the current work environment. Methods: A scoping literature review. Results: Forty articles were included. Instruments developed from the NWI have been translated into numerous languages and administered to hundreds of thousands of nurses globally. Conclusions: The study of the NWE remains extensive throughout the world. Future research should examine the factorial structure of instrument adaptions and ensure that items are relevant to contemporary nursing practice.

Modernizing Measure of the Nurse Work Environment.

BACKGROUND: Research has established a relationship between favorable nurse work environments and better nurse, patient, and organizational outcomes. However, the instrument most frequently used to measure the nurse work environment, the Practice Environment Scale of the Nursing Work Index (PES-NWI), has not had its items significantly re-evaluated since the 1980s. OBJECTIVE: We sought to examine the psychometric properties of an updated PES-NWI and create an instrument suitable for further testing and refinement to measure the present-day nurse work environment. Specifically, we sought to establish construct, structural, discriminative, and concurrent validity. For reliability, we desired to establish interrater reliability and internal consistency reliability. METHODS: We administered a modified PES-NWI to a national sample of direct-care hospital nurses (n = 818) in the United States. We then assessed the psychometric properties of the instrument. RESULTS: While the modified PES-NWI displayed adequate validity and reliability properties, further testing and refinement of the instrument is necessary. CONCLUSIONS: With this updated measure of the nurse work environment, researchers and hospital leaders can identify modifiable opportunities for improvement in contemporary hospital nurse work environments which may enhance nurse and patient outcomes.

Critical Appraisal of Electronic Surveys: An Integrated Literature Review.

Background and Purpose: Electronic surveys are an essential data collection method in survey research but there are pros and cons. The purpose of this literature review was to understand the advantages and disadvantages of electronic surveys in research. Methods: An integrated literature review was performed. Results: Twenty publications met the criteria and were analyzed. The advantages of electronic surveys include speed, cost, convenience, flexibility, ease of analyses, global reach, reduced errors, and question diversity. The disadvantages of electronic surveys are response outcomes (nonresponse, item-nonresponse/poor completion rates, and careless responding errors) and digital literacy requirements. Conclusions: The advantages of electronic surveys outweigh their disadvantages, but researchers must understand the problems associated with electronic surveys and avoid them.

Individual and Organizational Factors Associated With Nurse Manager Success.

OBJECTIVE: The aim of this study was to synthesize previous findings and provide practical guidance for maximizing nurse manager and nurse performance. BACKGROUND: Two recent studies have linked nurse manager job design factors and individual differences to a variety of valued outcomes, but practical implications remain unclear. METHODS: A large US sample of nurse managers was divided on the basis of nurse and patient outcomes. Various characteristics are compared across the highest and lowest performers. RESULTS: Wider nurse manager span of control is associated with negative outcomes; the availability of support positions does not fully alleviate the consequences of wide spans. Nurse managers with fewer subordinates can effectively manage multiple units. Nurse manager experience is critical for success and cannot be fully replaced by leadership training programs. CONCLUSIONS: Staffing and job design decisions have critical downstream implications. The present research provides guidance for effective staffing and job design.

PSYCHOMETRIC PROPERTIES OF THE NURSE MANAGER COMPETENCY INSTRUMENT FOR RESEARCH.

Background and Purpose: Competent nurse managers (NM) are essential to create safe and healthy work environments and support frontline nurses. Measuring NM competence with a valid and reliable instrument is critical in research. We assessed the psychometric properties of the Nurse Manager Competency Instrument for Research (NMCIR). Methods: Item analysis, internal consistency analysis, and confirmatory factor analysis were performed with a sample of 594 NMs. Results: The NMCIR showed high internal consistency. The 26 items were loaded on ten factors with a good overall fit, supporting the hypothesized factor structure. However, the findings showed poor discriminant validity. Conclusion: The NMCIR demonstrates sound psychometric properties for use in studies of NM competence. Further evaluation of the NMCIR is recommended to improve discriminant validity.

Relationships among nurse managers' job design, work environment, and nurse and patient outcomes.

The importance of nurse managers' practice environments in affecting outcomes for direct care nurses and patients has been well-researched. Nonetheless, much remains to be learned about the determinants of the nurse manager practice environment. In this study, 541 US nurse managers' survey responses were matched to unit-level aggregate data of their subordinates' responses on the National Database of Nursing Quality Indicators. A model relating job design and experience to the nurse manager's practice environment and direct care nurse (i.e., job satisfaction, intent to stay, and joy and meaning in work) and patient outcomes (i.e., nurse-reported quality of care and missed nursing care) was evaluated through multilevel path analysis. Nurse manager span of control, support staff, and experience influence nurse managers' perceptions of their practice environment and nurse and patient outcomes. Although support staff can offset some negative effects of wide spans of control, it does not fully compensate for wide spans. Thus, nurse manager job design factors and experience relate to nurse manager practice environments and valued downstream outcomes. The present research emphasizes the importance of a positive nurse manager practice environment and provides guidance for nurse manager hiring and job design decisions.

Measuring the Work Environment: The Voice of the Staff Nurse.

OBJECTIVE: The aims of this study were to obtain direct care hospital nurse input on the relevance of the Practice Environment Scale of the Nursing Work Index (PES-NWI) and to determine whether additional items are needed to measure the contemporary nursing work environment (NWE). BACKGROUND: Instruments accurately measuring the NWE are essential due to the NWE's association with nurse, patient, and organizational outcomes. However, the most frequently used instrument for measuring the NWE has not been scrutinized by today's practicing direct care nurses to ensure its current relevancy. METHODS: Researchers administered a survey with a modified PES-NWI and open-ended questions to a national sample of direct care hospital nurses. RESULTS: Three items from the PES-NWI may be suitable for removal, and additional items may be added to accurately measure the current NWE. CONCLUSION: Most PES-NWI items remain relevant for modern nursing practice. However, some revisions could enable greater precision in measuring the current NWE.

Initial evaluation of a Doctor of Nursing Practice - Executive track program: The development of a three-year process to implement the new AACN Essentials.

The Essentials: Core Competencies for Professional Nursing Education, published by the American Association of Colleges of Nursing, call for a competency-based curriculum to support the seamless transition from education to practice. The introduction of these new core competencies threaded across two levels of sub-competencies (entry-level practice; advanced practice) requires new pedagogy and is prompting curriculum evaluation processes across the country. The experiences of nursing faculty teaching in an online, post-master's Doctor of Nursing Practice Executive track program are discussed, including lessons learned. A three-year, incremental plan to guide the assessment, revision, and evaluation of nursing curriculum is presented and remaining questions discussed.

The Impact of Generation on Nurse Manager Job Satisfaction.

OBJECTIVE: The aim of this study was to determine the effects of generational membership on nurse managers' (NMs') perception of their practice environment and job satisfaction using the Nurse Manager Practice Environment Scale (NMPES). BACKGROUND: Boomers, Generation Xers, and millennials make up the NM workforce. Each has specific perceptions and expectations for their practice environment and job satisfaction. Little is known about these differences. METHODS: A secondary analysis of NM survey data was conducted using descriptive statistics and multiple regression to identify the impact of generation on NMs' perception of their practice environment and satisfaction. RESULTS: Generational membership did not significantly impact NMPES or job satisfaction scores, but the practice environment was a strong predictor of these outcomes. CONCLUSION: Generational membership did not impact NMs' satisfaction for this sample, but the practice environment did. Further research is needed to examine additional factors that influence NM satisfaction and retention.

The influence of nurse manager competency on practice environment, missed nursing care, and patient care quality: A cross-sectional study of nurse managers in U.S. hospitals.

AIMS: Identify and examine drivers of nurse manager competency and high-quality practice environments. BACKGROUND: Nurse managers are a key predictor of positive professional practice environments, which are, in turn, associated with nurse, patient, and organisational outcomes. However, little work has examined the factors that contribute to nurse manager competency. METHODS: Nurse managers completed online surveys, which were matched to unit-level aggregate data of their subordinate direct care nurses' responses on the National Database of Nursing Quality Indicators. This resulted in a final sample of 541 nurse managers across 47 U.S. hospitals. Multilevel path analysis was utilized to assess a model of the antecedents and consequences of nurse manager competency. RESULTS: Nurse manager competency and practice environments were predictive of missed nursing care and nurse-reported quality of care. Nurse manager experience was found to have twice the effect on competency as advanced education. CONCLUSIONS: Nurse manager competency and its downstream effects are achieved through nurse manager experience and advanced education. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse manager competency yields better practice environments and nursing care. Considering the influence of experience, careful attention should be paid to the competency development process of more novice nurse managers.

Advancing Nursing Leadership Science Through an Innovative Research-Practice Partnership.

ABSTRACT: The Association for Leadership Science in Nursing and American Organization for Nursing Leadership Foundation have formed a new research-practice collaborative. The collaborative allows for a synergistic approach to the advancement of leadership science. This article discusses the impetus for the collaborative, its structure, and how its synergy of research and practice expertise provides immense opportunity for robust, practice-relevant research.

Building Nurse Manager Well-being by Reducing Healthcare System Demands.

The National Academies of Medicine consensus study committee reported that US healthcare workers experience high levels of burnout resulting from external pressures on the healthcare system and the organization of work. Nurse managers are especially susceptible to burnout. This column provides evidence-based strategies to improve the work environment, reduce the burden of job demands, and promote well-being among nurse managers.

ALSN 2021 Conference: Nursing Science for Leadership in the New Decade.

The Association for Leadership Science in Nursing's 2021 conference provided an opportunity to further enhance professional understanding of the difficulties facing nurse leaders as the COVID-19 pandemic continues to create unimaginable challenges. Presentations provided evidence in support of courageous caring leadership interventions.

A Survey of Interim Nurse Managers to Understand the Role and the Impact on Nurse and Patient Outcomes.

OBJECTIVE: The aim of this study was to describe the current state of the interim manager (IM) role and the impact of the role on job performance. BACKGROUND: Interim managers provide leadership during organizational change, yet little is known about the role and its impact on outcomes. METHODS: An electronic survey was completed by 179 IMs working in acute care hospitals. Instruments included the Nurse Manager Practice Environment Scale, Decision Involvement Scale, Subjective Stress Scale, Maslach Burnout Inventory, and Brief Resilience Scale. RESULTS: The average tenure for IMs was 10 months. Despite moderately high levels of stress and exhaustion, IMs were resilient, positively viewed their work environment, and perceived their job performance as positively impacting nurse and patient outcomes. Interim managers were generally satisfied in their roles and likely to pursue nursing leadership as a career. CONCLUSION: Interim managers desire permanent leadership opportunities providing a pool for replacing exiting nurse managers. Support is needed to be successful.