Effectively and Efficiently Reengineering the Nursing Work Environment by Applying a Conceptual Framework for Nurse Retention.

The nursing shortage that is upon us is the result of a confluence of factors, some simple and some complex. Legacy solutions are not working. Recovery from the current situation involves examining and reshaping the nursing work environment. Creative and innovative solutions are being developed and tested. The call for addressing the work environment is surfacing in the literature, yet methods for doing so in an orderly, progressive manner have been elusive. To solve complex problems, structure helps lead to clear thinking. This work presents a conceptual framework for nurse retention derived from concept analysis of initiatives with empirical outcomes for intent to stay, intent to leave, turnover, and retention. It layers in 2 simple theorists and presents an intuitive, understandable model to guide strategic planning and decision making. The Framework has been used for several applications, one of which is a unit-based action planning method that is systematic, cyclic, and uses data relevant to specific unit culture. Improvements occurred in retention and engagement metrics, work effectiveness scores, and cost. Nurse managers extol the process's simplicity and ease of use, and the role the Framework plays in shaping the way they think about nurse retention.

The Role of Relationship-Based Care in Developing Empathy Through Vulnerability: Visual Cues for Conversation and Change.

Empathy is a word that is showing up in conversations across health-care organizations as we explore how to establish relationships with our patients to improve quality of care. According to researcher Brene' Brown, empathy is a connection with the heart, and cannot be expressed without touching our own vulnerability. In an increasingly complex and demanding health-care environment, with patient volumes and acuities impacting workflow and prioritization, it is important to explore vulnerability not only as a concept present in patient populations and our individual experiences as health-care professionals, but also as an unspoken and changing element in the entire clinical milieu. In a health-care world where focus is necessarily placed on quantitative metrics and outcomes, addressing concepts such as vulnerability can create a real challenge. Fear is an inherent by-product of vulnerability. As an aid to conversation and culture revision, this article presents a series of diagrams showing how focusing on the three relationships of Relationship-Based Care (RBC) (care for self, care for colleagues, and care for patients and families) can help shrink the fear associated with vulnerability. Fear initiates and perpetuates protective behaviors to keep us from feeling the uncertainty of vulnerability; those behaviors work against the development and nurturing of the RBC relationships. The three relationships of RBC provide a structure with which to explore vulnerability, allowing their principles and practices to help us open our hearts and lead us to the empathy we seek when serving our patients, ourselves, and each other.

DNP Preparation in Supporting Critical Skills for Magnet® Program Directors.

Magnet® organizations are required to identify a Magnet program director (MPD), who plays a critical role in attaining and maintaining Magnet designation. The evidence is sparse related to qualifications or recommended educational levels of those assuming an MPD role. In this article, the author discusses how one of the DNP Essentials, clinical scholarship and the use of analytical methods for evidence-based practice, is reported to prepare nurses for the MPD role.

Does a Doctor of Nursing Practice Degree Provide Preparation for Assuming a Magnet Program Director Role?

One of the blueprints used by health care organizations for attaining and sustaining nursing excellence is the American Nurses' Credentialing Center's (ANCC) Magnet designation. The ANCC requires organizations to identify a Magnet program director (MPD), who serves as the contact and communication point through the process of application, designation, and maintenance of the credential. The MPD role is complex, has a wide variety of necessary skills and competencies, and can be challenging and overwhelming to undertake. Literature reveals no guidelines nor recommendations regarding educational preparation for assuming the role. Chief nursing officers (CNOs) support "program director" as a potential employment option for doctor of nursing practice (DNP) graduates. Given the complexity of the MPD, would DNP education provide elements that would help new MPDs prepare for the position? The purpose of this project was to determine if MPDs recommend concepts within DNP program Essentials as preparation for their roles. A mixed methods design was used, with qualitative data obtained from a focus group and quantitative, nonexperimental data obtained through a cross-sectional survey. Data were collected from current MPDs. The concepts of DNP Essentials presented in the survey were all recommended as preparation for the MPD role, making DNP education a relevant option.

New graduate survey: factors that influence new nurses' selection of first clinical position.

AIM: The aim was to survey nurses with 2 to 3 years' experience to determine what factors were involved in the choice of their first nursing position and if they were still in that position. BACKGROUND: A false sense that the nursing shortage has ended has occurred with nurses delaying retirement until the economy improves. However, the turnover rate still shows 26% of registered nurses leaving their first hospital position within 2 years. METHODS: New graduate nurses were surveyed to determine if nursing was what they expected, what led them to their first position, if they were still in their first position, and factors that may have influenced these decisions. The 159 respondents also commented on their intent to stay and gave free-text responses. RESULTS: Significant difference was found between the current unit worked with both the unit wanted while in nursing school and the unit wanted upon graduation. Positive and negative narrative comments shed light on factors influencing intent to stay. CONCLUSION: Nurses are concerned with ability to deliver safe care, supportive management, and teamwork. IMPLICATIONS FOR NURSING MANAGEMENT: Recommendations were made for nursing management in creating an environment of continued learning and teamwork to support new graduate nurses.