On-the-Go Strategies to Enhance Resilience and Self-Care: Using Technology to Create Healthy Work Cultures.

Professional burnout is a significant occupational hazard resulting in lower job commitment, poor patient outcomes, reduced performance, lower job satisfaction, and frequent absenteeism. Models exist that provide guidance in addressing burnout, improving resiliency, and well-being. Advancing evidence-based, multidisciplinary solutions to improve patient care by caring for the caregiver is the cornerstone to increasing resiliency, well-being, empathy, and gratitude. Developing resilience in health care includes a wide array of technological methods to facilitate well-being. Digital journaling, mood tracking, meditation apps, habit tracking, lifestyle apps, and wearable technology are strategies to deal with stress and compassion fatigue.

National Practices Regarding Doctor of Nursing Practice (DNP) Projects.

BACKGROUND: AACN published a clarifying document in 2015 to guide Doctor of Nursing Practice (DNP) programs' DNP Scholarly Projects. This publication provided specific and general guidance; however, areas of inconsistent interpretation remained. The variability of best practices for DNP projects sparked the idea for a national survey to explore how projects are being carried out and to determine if the varied approaches align with AACN's 2015 recommendations. OBJECTIVE: This nationwide study's purpose was to describe DNP Scholarly Project processes and to determine alignment with AACN's 2015 DNP project recommendations. METHODS: A descriptive survey was deployed to DNP programs across the country. RESULTS: National DNP project practices were identified as well as gaps in alignment with AACN recommendations. CONCLUSIONS AND IMPLICATIONS FOR NURSING: The results of this study provided a national snapshot of how DNP programs are executing DNP projects. Rich dialogue and ongoing exploration about DNP project best practices continue because of this work.

DNP Team Projects: A Reflection of Team Science.

BACKGROUND: Concern has been raised related to the rigor of DNP team projects due to the potential lack of individual opportunity for growth. However, team science, the scientific collaboration conducted by more than one individual in an interdependent fashion, is becoming standard practice for scientific inquiry and dissemination. DNP team projects provide an opportunity to demonstrate competencies related to collaboration, communication, organization, planning, reliability, accountability and acknowledgement of other opinions, expertise, and contributions. Faculty working with student teams may encounter challenges related to team dynamics and individual student evaluation. Thoughtful application of team science principles can assist in minimizing these challenges. METHOD: The purpose of this paper is to describe two school's combined experiences and lessons learned in application of team science to DNP team projects. CONCLUSION: When undertaken with an informed and organized approach, DNP team projects are an ideal strategy to enhance collaborative skills and position nurse leaders to positively impact health outcomes.

Nursing Knowledge in the Doctor of Nursing Practice Curriculum.

The goal of Doctor of Nursing Practice (DNP) education is to prepare advanced practice nurse leaders for the practice setting. Accordingly, it is imperative that DNP education is grounded in nursing theoretical knowledge. The purpose of this project was to examine the presence of nursing theoretical knowledge within DNP programs across the United States. A retrospective approach was used to review publicly available information on the webpages of a sample of DNP programs accredited by the Commission on Collegiate Nursing Education (CCNE) to determine if nursing theoretical knowledge guided DNP programs. Demographic information was also collected. A sample of 100 CCNE accredited programs revealed a lack of nursing theoretical knowledge visible within DNP programs. It is unclear how DNPs are being prepared to be practice leaders guided by nursing theoretical knowledge. Nursing leaders must develop policies to assure that nursing knowledge is core in DNP programs.

Storytelling to Capture the Health Care Perspective of People Who Are Homeless.

Utilizing a hermeneutic philosophical approach, the researchers explored the perceptions and experiences of people who are homeless in Mobile, Alabama, receiving health care and interacting with health care providers. Using the voice of the participants, discussions among the researchers, and supporting literature reinforcing key concepts, a framework was created illustrating the lived experience. The following themes were identified: social determinants of health, compromised systems, professionalism, dehumanization, engagement, and downward trajectory. The experiences described and themes identified indicate a breakdown in therapeutic relationships between homeless individuals and health care providers, contributing to the continuing destabilization common in this population.

Leadership's Impact on Quality, Outcomes, and Costs.

In the move to increase effectiveness in valued-based organizational cultures, mindfulness leaders are charged to create environments that foster curiosity and creativity in uncertain times. Mindfulness increases situational awareness and improved communication enhances a culture of safety and better patient outcomes. Mindfulness leadership matters, providing effective ways to communicate and collaborate with others. Results matter, increasing the ability to sustain improvement through increased awareness, and enhancing healthy work environments and joy in the workplace. This article provides useful tools, strategies, and tips for mindful leaders and facilitates greater impact on improved patient and employee outcomes.

Advancing the clinical nurse leader model through academic-practice-policy partnership.

The nursing profession is tasked with identifying and evaluating models of care with potential to add value to health care delivery. In consideration of this goal, we describe the Clinical Nurse Leader (CNL) initiative and the activities of a national-level CNL research collaborative. The CNL initiative, launched by the American Association of Colleges of Nursing in collaboration with education and healthcare leaders, has delineated CNL education curriculum and practice competencies, and fostered the creation of academic-practice-policy partnerships to pilot CNL integration into frontline nursing care delivery. The partnership has evolved into an Agency for Healthcare Research and Quality affiliate practice-based research network, the CNL Research Collaborative, which links research, policy, education, and practice stakeholders to advance the CNL evidence base. We summarize foundational CNLRC research to explain CNL practice, quantify CNL effectiveness, and bring clarity to how CNLs can be implemented to consistently influence care, quality, and safety.

EBP Design and Translation: Teaching How to Begin a Scholarly Practice Project.

This column shares the best evidence-based strategies and innovative ideas on how to facilitate the learning and implementation of EBP principles and processes by clinicians as well as nursing and interprofessional students. Guidelines for submission are available at https://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1741-6787.

Developing the Clinical Nurse Leader Survey Instrument: A Modified Delphi Study.

Clinical nurse leader (CNL)-integrated care delivery is an emerging nursing model, with growing adoption in diverse health systems. To generate a robust evidence base for this promising nursing model, it is necessary to measure CNL practice to explicitly link it to observed quality and safety outcome improvements. This study used a modified Delphi approach with an expert CNL panel to develop and test the face, content, and construct validity of the CNL Practice Survey instrument.

A regional consortium for doctor of nursing practice education: Integrating improvement science into the curriculum.

The DNP curriculum prepares the graduate for evidence informed improvement translation through coursework integrating improvement, safety, and translation sciences. Innovative leadership skills are necessary to lead inter-professional unit-based and health system opportunities. Equipping the DNP with the necessary skills and competencies to accomplish any type of improvement translation requires exposure to the tools and techniques of these sciences with an emphasis in didactic content. With a foundational knowledge of the principles for improvement, translation and application will follow. It is imperative theoretical underpinnings of translational science are taught, and that the students be expected to apply these concepts in "real word" circumstances. Thus, the DNP student is afforded opportunities during their DNP program to participate in a "learning lab" for evidence informed improvement translation. In essence, the courses within the program are designed to allow conversion from theory into practice.

Applying the PDSA Framework to Examine the Use of the Clinical Nurse Leader to Evaluate Pressure Ulcer Reporting.

The clinical nurse leader (CNL) role has been cited as an effective strategy for improving care at the microsystem level. The purpose of this article is to describe the use of the CNL role in an academic medical center for evaluating pressure ulcer reporting. The Plan-Do-Study-Act cycle was used as the methodological framework for the study. The CNL assessment of pressure ulcers resulted in a 21% to 50% decrease in the number of hospital-acquired pressure ulcers reported in a 3-month time period. The CNL role has potential for improving the validity and reliability of pressure ulcer reporting.

Operational Failures Detected by Frontline Acute Care Nurses.

Frontline nurses encounter operational failures (OFs), or breakdowns in system processes, that hinder care, erode quality, and threaten patient safety. Previous research has relied on external observers to identify OFs; nurses have been passive participants in the identification of system failures that impede their ability to deliver safe and effective care. To better understand frontline nurses' direct experiences with OFs in hospitals, we conducted a multi-site study within a national research network to describe the rate and categories of OFs detected by nurses as they provided direct patient care. Data were collected by 774 nurses working in 67 adult and pediatric medical-surgical units in 23 hospitals. Nurses systematically recorded data about OFs encountered during 10 work shifts over a 20-day period. In total, nurses reported 27,298 OFs over 4,497 shifts, a rate of 6.07 OFs per shift. The highest rate of failures occurred in the category of Equipment/Supplies, and the lowest rate occurred in the category of Physical Unit/Layout. No differences in OF rate were detected based on hospital size, teaching status, or unit type. Given the scale of this study, we conclude that OFs are frequent and varied across system processes, and that organizations may readily obtain crucial information about OFs from frontline nurses. Nurses' detection of OFs could provide organizations with rich, real-time information about system operations to improve organizational reliability. © 2017 Wiley Periodicals, Inc.

Consolidating the Academic End of a Community-Based Participatory Research Venture to Address Health Disparities.

Although there is strong support for community engagement and community-based participatory research (CBPR) from public health entities, medical organizations, and major grant-funding institutions, such endeavors often face challenges within academic institutions. Fostering the interest, skills, and partnerships to undertake participatory research projects and truly impact the community requires an interdisciplinary team with the competencies and values to engage in this type of research. Discussed in this article is how a CBPR-focused team evolved at a southern university, with emphasis on the activities that supported group identity, contributed to its evolution, and positioned the group to speak with authority in promoting CBPR as a tool for addressing health disparities.

The frontline clinical manager identifying direct reports' level of practice.

Patricia Benner applied the Dreyfus Model of Skill Acquisition to describe and interpret skill acquisition and clinical judgment in nursing practice. Operational definitions for the 5 levels of her original Novice to Expert Theory were used by the study participants in a large Midwestern pediatric hospital to self-identify their level of practice. The frontline clinical managers of these direct care registered nurses (RNs) used the same tool to rate their direct reports. The aim of this portion of a larger study was to determine if the clinical manager's perception of their direct reports was the same as that of the RNs. The results of this study are being used by one study unit's clinical managers as the basis for implementing the Hersey and Blanchard Situational Leadership Model. The clinical managers work with their direct reports depending on the level of practice and the details of the task to be performed. One example is creating therapeutic relationships with each other and with families to ensure a safe environment for all.

Transforming Care at the Bedside (TCAB): enhancing direct care and value-added care.

AIM: The purpose of this study was to examine the effectiveness of a Transforming Care at the Bedside initiative from a unit perspective. BACKGROUND: Improving patient outcomes and nurses' work environments are the goals of Transforming Care at the Bedside. Transforming Care at the Bedside creates programs of change originating at the point of care and directly promoting engagement of nurses to transform work processes and quality of care on medical-surgical units. METHODS: This descriptive comparative study draws on multiple data sources from two nursing units: a Transforming Care at the Bedside unit where staff tested, adopted and implemented improvement ideas, and a control unit where staff continued traditional practices. Change theory provided the framework for the study. RESULTS: Direct care and value-added care increased on Transforming Care at the Bedside unit compared with the control unit. Transforming Care at the Bedside unit decreased in incidental overtime. Nurses reported that the process challenged old ways of thinking and increased nursing innovations. Hourly rounding, bedside reporting and the use of pain boards were seen as positive innovations. CONCLUSIONS: Evidence supported the value-added dimension of the Transforming Care at the Bedside process at the unit level. IMPLICATIONS FOR NURSING MANAGEMENT: Nurses recognized the significance of their input into processes of change. Transformational leadership and frontline projects provide a vehicle for innovation through application of human capital.

"Change can be good": unit perspectives on transforming care at the bedside.

BACKGROUND: How do nurses commit to effecting change, the kind of change that will transform both care received and the caregiver? This was the mission of Transforming Care at the Bedside, the 2003 initiative sponsored by the Robert Wood Johnson Foundation and the Institute of Healthcare Improvement. OBSERVATIONS AND OBJECTIVES: This analysis reflects processes and context of unit change through Transforming Care at the Bedside. Organizational leadership includes engagement in change. SUBJECTS AND METHODS: Descriptions of change process were solicited from stakeholder interviews and focus groups to evaluate and make recommendations for the future. RESULTS AND CONCLUSIONS: Stakeholders recognized that "Change can be good!" Reflection and strategic evaluation strengthen planning for sustainability supporting staff engagement and transformational leadership in an academic health science setting.

Combining creativity and community partnership in mental health clinical experiences.

Lack of parity for mental health treatment, coupled with the trend toward more community-based care, has challenged nurse faculty to identify quality, creative psychiatric clinical sites. The purpose of this article is to educate nurse faculty on practical, creative ways to identify nontraditional community psychiatric clinical experiences. Service learning, community partnerships, and group interaction are emphasized. Literature regarding recent health care initiatives and widely accepted criteria for quality nursing education are discussed as foundations for creating alternative mental health clinical experiences. The authors' experiences implementing these concepts are discussed. Community partnerships and alternative clinical sites/experiences benefit students, faculty, institutions, and the community.

Inactive nurses: a source for alleviating the nursing shortage?

OBJECTIVE: This study seeks to provide an understanding of why inactive registered nurses chose to become inactive and what they would require for them to return to nursing. BACKGROUND: In 2000, a shortage of 110,000 (6%) registered nurses existed in the United States. If the current trends continue, the shortage is projected to grow to 29% by 2020. One solution to the nursing shortage may be attracting nurses with inactive licenses back into employment. METHODS: This study used a quantitative, cross-sectional survey design. Data analysis included descriptive and inferential statistics. RESULTS: Inactive nurses (N = 428) younger than 60 years in 1 Southern state were surveyed. A major portion (27.6%) of these nurses left nursing because of a conflict between parenting duties and scheduling requirements (13.5%) at work and indicated that they would return to nursing if given the opportunity to work part-time, especially if shifts were flexible and shorter. CONCLUSION: Although the group of registered nurses younger than 60 years do not constitute a large percentage of nurses in this country, they are a potential source of alleviating, to some extent, the critical nursing shortage. Employers can encourage many of these nurses to return to work by providing more flexible work schedules, including part-time and shorter shifts, as well as decreased workloads.