Developing and Evaluating the Effectiveness of a Nursing Leadership Mentoring Pilot Program.

The nurse leader role is a vital role in ensuring quality, safety, and staff retention in the health care setting. A new nurse manager often receives little mentoring support when assuming a new role. Fifteen mentor/mentee pairs were provided with 6 training sessions specifically designed using the Hale Mentoring Up theoretical framework. Surveys and focus groups were conducted at mid- and endpoints. Data were digitally recorded, transcribed verbatim, and loaded into NVivo 12. Two attributes that facilitated a positive mentoring relationship emerged from the qualitative analysis: interpersonal and organizational skills. Interpersonal skills included a mentor-mentee relationship that was built upon trust, flexibility, and learning and development; and organizational skills included building relationships both internally and externally. Furthermore, time was identified as a barrier to mentoring. A mentoring program is a vehicle to help support new nurse leaders through an educational intervention and mentoring support program. The development of a mentoring pilot program helps to strengthen future nursing leadership to support new leaders in their roles.

Nurses Leading Partnership-Driven Transformation to Address the Nursing Shortage.

For various reasons, including the pandemic's toll, many nurses are preparing to exit their roles or leave the profession entirely. Addressing attrition requires health care systems to develop comprehensive workforce strategies to enhance the nursing pipeline. Health care systems must proactively address challenges through innovative workforce solutions using an academic-practice partnership model while incorporating high schools and post-secondary schools. This column will discuss how nurse leaders in a health care system address attrition through academic-practice partnership models, innovative strategies, and outcomes data. [J Contin Educ Nurs. 2023:54(2):53-55.].

Perceptions of Risk, Work, and Lifestyle Changes on Mental Health of Healthcare Workers Amidst the COVID-19 Pandemic.

The COVID-19 outbreak is significantly affecting the mental health of healthcare workers worldwide. This study aims to investigate the mental health outcomes of healthcare workers in a health system located in southeastern US during the first peak of the pandemic and examine the association of specific factors on the mental well-being of healthcare workers. A cross-sectional survey of 388 healthcare workers was conducted. Data were collected using a 79-item questionnaire, which included the Patient Health Questionnaire (PHQ-9) instrument, the 7-item Generalized Anxiety Disorder (GAD-7) instrument, and the 22-item Impact of Event Scale-Revised (IES-R), to assess symptoms of depression, anxiety, and general distress, respectively. Data were analyzed using descriptive, bivariate, and multivariate statistics. Accordingly, 30.1%, 28.7%, and 39.4% of respondents reported depression, anxiety, and distress symptoms, respectively. Younger workers and females reported higher mental symptomologies. We identified significant, nontraditional factors associated with depression and anxiety symptoms among healthcare workers: healthcare procedure change, concern of exposing family to COVID-19, number of missed shifts, and access to psychological resources/services. These findings emphasize the importance of providing the proper training to reduce concerns of exposing family members and psychological interventions to promote mental health well-being for healthcare workers during the stressful COVID-19 pandemic.

Rapid design and implementation of a UVC decontamination room.

With the recent COVID-19 pandemic that has swept the world and the nation, hospitals around the country have experienced shortages in Personal Protective Equipment, specifically N95 filter face-mask respirators (FFRs). This has created the need for facilities to develop sterilization processes to enable reuse of face masks by the health care personnel. Among the various methods of sterilization, UVC light exposure is the easiest to implement given the factors of time, safety, and availability. Face masks and/or other PPE are exposed to UVC light for a specified time to kill any viruses or bacteria that may reside on the surfaces of the masks. A collaborative effort was formed in April of 2020 between Wellstar Health System and Kennesaw State University to (1) setup an appropriate sterilization room at a Wellstar hospital (2) develop the procedural guidelines necessary to ensure quality control and (3) assess employees' perceptions of the N95 FFR decontamination process and efficacy. This paper will first describe the methodology used to validate the layout of the room, which consists of a rudimentary analytical analysis of the UVC photon intensity from bulb-to-mask, computer simulations to determine the lighting power density throughout the room, and experimental measurements to confirm the appropriate energy deposition. This paper will then document the procedures for handling and processing the pre- and post-sterilized masks followed by employee survey findings. It is the hope of the authors that this paper will serve to provide a generic blueprint for hospitals and other organizations to follow if a future need arises for rapid UVC decontamination.

The Effectiveness of Charge Nurse Training on Leadership Style and Resiliency.

OBJECTIVE: The study objective was to investigate a charge nurse pilot training program as an effective, evidence-based training modality to improve leadership style and resiliency. BACKGROUND: Leadership is inherent and necessary in the charge nurse role. Little published research about charge nurse leadership training programs exists. METHODS: A pre-post design, with intervention and comparison groups, was conducted at an integrated healthcare system. A random sample of charge nurses was selected to pilot a standardized charge nurse leadership training program including in-person learning to foster leadership skills and nurture resiliency. RESULTS: The sample included 19 control participants and 22 intervention participants. Significant improvement was noted in transformational, transactional, leadership outcomes, and resiliency from preintervention to postintervention for the all subjects. Of the 22 intervention participants, the training elicited higher satisfaction with leadership behavior, followed by effectiveness and their ability to motivate. Charge nurses who attended training had higher resiliency scores pre-post intervention. CONCLUSION: The charge nurse pilot training was an effective program that led to improved leadership style and resiliency.

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.

Clinical Nurse Leader Knowledge Production to Quality Improvement in a Seamless Trajectory: A Participatory Research Approach.

BACKGROUND: Health systems are actively implementing Clinical Nurse Leader (CNL)-integrated care delivery across the United States. PROBLEM: However, the CNL model is a complex health care intervention, making it difficult to generate evidence of effectiveness using traditional research frameworks. APPROACH: Participatory research is a growing alternative to traditional research frameworks, emphasizing partnership with target community members in all phases of research activities. This article describes a system-based participatory study that leveraged academic and practice knowledge to conduct research that was feasible and relevant, and which produced findings that were easily translated into systematic action by the health system. OUTCOMES: Study data were used to produce improvements in the health system's CNL onboarding process, role differentiation, performance, recruitment, and growth plus development. CONCLUSIONS: A participatory approach can be used in future CNL studies, providing a framework for research efforts and potentially speeding up CNL evidence generation and utilization in practice.

Exploring Nurse Manager Support of Evidence-Based Practice: Clinical Nurse Perceptions.

OBJECTIVE: The study identifies what constitutes nurse manager (NM) support and other resources that enable clinical nurses (CNs) to engage in evidence-based practice (EBP). BACKGROUND: Clinical nurses report that NM support enables them to use EBP but what constitutes NM support is still unclear. METHODS: Nurse managers, CNs, and EBP mentors received specialized education and use a team approach for EBP. Data were collected preintervention, mid-intervention, and postintervention from observations, interviews, journaling, and surveys. RESULTS: Results demonstrate how NMs can perform their role responsibilities and still engage CNs to develop a spirit of inquiry, seek answers to their clinical questions using EBP, and advance their clinical performance to improve patient outcomes. Four NM supportive behaviors emerged: cultivating a shared EBP vision, ensuring use of EBP, communicating the value of EBP, and providing resources for EBP. CONCLUSION: Through education and support, NMs describe supportive behaviors necessary for the successful conduction of EBP by CNs.

Organising nursing practice into care models that catalyse quality: A clinical nurse leader case study.

AIMS: To determine the power of a conceptual clinical nurse leader practice model to explain the care model's enactment and trajectory in real world settings. BACKGROUND: How nursing, organised into specific models of care, functions as an organisational strategy for quality is not well specified. Clinical nurse leader integrated care delivery is one emerging model with growing adoption. A recently validated clinical nurse leader practice model conceptualizes the care model's characteristics and hypothesizes their mechanisms of action. METHODS: Pattern matching case study design and mixed methods were used to determine how the care model's constructs were operationalized in one regional United States health system that integrated clinical nurse leaders into their care delivery system in 2010. RESULTS: The findings confirmed the empirical presence of all clinical nurse leader practice model constructs and provided a rich description of how the health system operationalized the constructs in practice. The findings support the hypothesized model pathway from Clinical Nurse Leader structuring to Clinical Nurse Leader practice and outcomes. CONCLUSION: The findings indicate analytic generalizability of the clinical nurse leader practice model. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing practice organised to focus on microsystem care processes can catalyse multidisciplinary engagement with, and consistent enactment of, quality practices. The model has great potential for transferability across diverse health systems.

Effectiveness of an Evidence-Based Practice Nurse Mentor Training Program.

BACKGROUND: Multiple reasons are cited for why nurses do not incorporate evidence into clinical practice, including lack of knowledge and skills, training, time, and organizational support. AIMS: To investigate the effectiveness of a mentor training program on mentors' perceptions of knowledge, attitude, skill, and confidence levels, and organizational readiness related to evidence-based practice (EBP) and research utilization; and to investigate the effectiveness of creating a formalized structure to enculturate EBP in order to prepare nurses to incorporate EBP into clinical practice on nurses' perceptions of knowledge, attitude, skill levels, barriers, nursing leadership, and organizational support related to EBP and research utilization. METHODS: A two-group pretest-posttest quasi-experimental, interventional design was used. A convenience sample of 66 mentors and 367 nurses working at a five hospital integrated healthcare system located in the Southeastern United States participated. FINDINGS: Nurse mentors' knowledge, attitude, skill level, and organizational readiness related to EBP, t = -8.64, p < .001, and confidence, t = -6.36, p < .001, improved after training. Nurses' knowledge, attitude, and skill level related to EBP, t = -19.12, p < .001, and barriers to research utilization, t = 20.86, p < .001, EBP work environment t = -20.18, p < .001, and EBP nurse leadership, t = -16.50, p < .001, improved after a formalized structure was implemented. LINKING EVIDENCE TO ACTION: EBP mentors are effective in educating and supporting nurses in evidence-based care. Leaders should use a multifaceted approach to build and sustain EBP, including developing a critical mass of EBP mentors to work with point of care staff.

Medical-surgical nurses' experiences as first responders during deterioration events: a qualitative study.

AIM AND OBJECTIVE: To explore and understand the experiences of medical-surgical nurses as first responders during clinical deterioration events. BACKGROUND: Nurses are key players in identifying and responding to deterioration events to escalate the level of care essential to address specific needs of patients. Delays in recognising signs and symptoms of patient deterioration and activation of Rapid Response Teams have been linked to a lack of nontechnical skills (leadership, teamwork, situational awareness) resulting in increased patient morbidity and mortality. DESIGN: A descriptive, qualitative approach was used. METHODS: A purposive sample of 28 medical-surgical nurses was recruited and interviewed from an integrated healthcare system located in the USA. Interviews were conducted from October 2014-February 2015. Interviews were audio recorded and transcribed verbatim. Transcripts were entered into MaxQDA. The constant comparative method was used for data analysis. RESULTS: Three patterns emerged from the data analysis: Recognising and Responding to the Event, Managing the Event and Challenges Encountered during the Event. From the patterns, seven themes emerged. Themes for pattern one, Recognising and Responding, were early warning signs, continuity in patient care assignments and intuition. Themes for pattern two, Managing the Event, were cognitive, technical and behavioural skills. The theme for pattern three, Challenges Encountered during the Event, was work environment complexity. CONCLUSION: Listening to the stories of medical-surgical nurses provided insight into how they recognised and managed patients experiencing clinical deterioration events. Furthermore, insight into the challenges that medical-surgical nurses encountered in caring for deteriorating patients were identified. RELEVANCE TO CLINICAL PRACTICE: Implication for practice in the areas of continuity of patient assignments, formal clinical deterioration education, work environment and team collaboration and communication was presented.

Clinical Deterioration Leadership Ability Scale: A Psychometric Study.

BACKGROUND AND PURPOSE: Assessing nurses' perceived leadership abilities during clinical deterioration provides a starting point for designing educational interventions to support leadership improvement. The study purpose was to provide psychometric testing of the Clinical Deterioration Leadership Ability Scale (CDLAS). METHODS: The psychometric properties and factor structure of the CDLAS was examined. RESULTS: Factor analysis determined a 1-factor structure (eigenvalues 5.783). Construct validity was supported by a significant difference between experienced (M = 3.48, SD = .57) and less experienced nurses (M = 3.27, SD = .68; t(146) = -2.00, p = .047). Acceptable levels of internal consistency reliability were found (.93, .95, and .94). CONCLUSION: The CDLAS has demonstrated acceptable validity and reliability. Further testing is needed in diverse populations and establishment of test-retest reliability.

Validation of a Predictive Model to Identify Patients at High Risk for Hospital Readmission.

BACKGROUND: Hospital readmission is an adverse patient outcome that is serious, common, and costly. For hospitals, identifying patients at risk for hospital readmission is a priority to reduce costs and improve care. PURPOSE: The purposes were to validate a predictive algorithm to identify patients at a high risk for preventable hospital readmission within 30 days after discharge and determine if additional risk factors enhance readmission predictability. METHODS: A retrospective study was conducted on a randomized sample of 598 patients discharged from a Southeast community hospital. Data were collected from the organization's database and manually abstracted from the electronic medical record using a structured tool. Two separate logistic regression models were fit for the probability of readmission within 30 days after discharge. The first model used the LACE index as the predictor variable, and the second model used the LACE index with additional risk factors. The two models were compared to determine if additional risk factors increased the model's predictive ability. RESULTS: The results indicate both models have reasonable prognostic capability. The LACE index with additional risk factors did little to improve prognostication, while adding to the model's complexity. CONCLUSION: Findings support the use of the LACE index as a practical tool to identify patients at risk for readmission.

The Effects of Guided Imagery on Patients Being Weaned from Mechanical Ventilation.

The study purpose was to assess the effects of guided imagery on sedation levels, sedative and analgesic volume consumption, and physiological responses of patients being weaned from mechanical ventilation. Forty-two patients were selected from two community acute care hospitals. One hospital served as the comparison group and provided routine care (no intervention) while the other hospital provided the guided imagery intervention. The intervention included two sessions, each lasting 60 minutes, offered during morning weaning trials from mechanical ventilation. Measurements were recorded in groups at baseline and 30- and 60-minute intervals and included vital signs and Richmond Agitation-Sedation Scale (RASS) score. Sedative and analgesic medication volume consumption were recorded 24 hours prior to and after the intervention. The guided imagery group had significantly improved RASS scores and reduced sedative and analgesic volume consumption. During the second session, oxygen saturation levels significantly improved compared to the comparison group. Guided imagery group had 4.88 less days requiring mechanical ventilation and 1.4 reduction in hospital length of stay compared to the comparison group. Guided imagery may be complementary and alternative medicine (CAM) intervention to provide during mechanical ventilation weaning trials.

Original Research: Implementation of an Early Mobility Program in an ICU.

OBJECTIVE: Research is needed to determine the feasibility of implementing a dedicated ICU mobility team in community hospital settings. The purpose of this study was to assess, in one such hospital, four nurse-sensitive quality-of-care outcomes (falls, ventilator-associated events, pressure ulcers, and catheter-associated urinary tract infections [CAUTIs]), as well as hospital costs, sedation and delirium measures, and functional outcomes by comparing ICU patients who received physical therapy from a dedicated mobility team with ICU patients who received routine care. METHODS: We conducted a retrospective longitudinal study at a community acute care hospital; patients were randomly assigned to intervention or routine care groups. The mobility team screened patients Monday through Friday using a mobility algorithm to determine eligibility for participation in each early mobility session. Based on their strength, balance, hemodynamic stability, and ability to participate in early mobility activities, patients advanced through four progressively difficult phases of mobility. Data were collected and analyzed after patients were discharged from the hospital. RESULTS: The 66 patients who received the mobility intervention had significantly fewer falls, ventilator-associated events, pressure ulcers, and CAUTIs than the 66 patients in the routine care group. The mobility group also had lower hospital costs, fewer delirium days, lower sedation levels, and improved functional independence compared with the routine care group. Patients in the mobility group got out of bed on 2.5 more days than patients in the routine care group. There were also no adverse events in the mobility group. CONCLUSIONS: It is feasible for a community hospital to create and implement a dedicated ICU mobility team. Early mobilization of ICU patients contributed to fewer delirium days and improved patient outcomes, sedation levels, and functional status.

Psychometric testing of the clinical nurse leader staff satisfaction instrument.

BACKGROUND AND PURPOSE: Patient care is changing rapidly with increased complexity of care, patient volumes, and financial constraints with rising health care costs and limited reimbursements. In response, the clinical nurse leader (CNL) role was developed. No appropriate instrument exists to measure staff satisfaction with the CNL role. This study describes the development and testing of an instrument designed to measure staff satisfaction with implementation of the CNL role. METHODS: The psychometric properties and factor structure of the Clinical Nurse Leader Staff Satisfaction (CNLSS) instrument was examined. RESULTS: A 2-factor solution was discovered for the CNLSS. Cronbach's alpha coefficients were acceptable for the subscales and instrument. CONCLUSION: The CNLSS is a valid and reliable instrument. Future research should focus on establishing test-retest reliability and construct validity.

Psychometric properties of the Clinical Decision-Making Self-Confidence Scale.

BACKGROUND AND PURPOSE: Nurses' self-confidence in handling acute patient deterioration events may influence decision-making capabilities and implementation of lifesaving interventions during such events. The study purpose is to provide further psychometric testing of the Clinical Decision-Making Self-Confidence Scale (CDMSCS). METHODS: The psychometric properties and factor structure of the CDMSCS was examined. RESULTS: A two-factor solution was discovered for the CDMSCS. Construct validity was further supported by statistically significant differences between registered nurses and nursing students' self-confidence level in handling deterioration events. Cronbach's alpha coefficients were acceptable for the subscales and instrument. CONCLUSION: The CDMSCS is a valid and reliable instrument. Future studies should focus on establishing test-retest reliability and to determine factor loadings of subscale items to retain or delete cross-loading items.

Medical-surgical nurses' perceived self-confidence and leadership abilities as first responders in acute patient deterioration events.

AIMS AND OBJECTIVES: To explore and understand medical-surgical nurses' perceived self-confidence and leadership abilities as first responders in recognising and responding to clinical deterioration prior to the arrival of an emergency response team. BACKGROUND: Patients are admitted to hospitals with multiple, complex health issues who are more likely to experience clinical deterioration. The majority of clinical deterioration events occur on medical-surgical units, and medical-surgical nurses are frequently the first healthcare professionals to identify signs and symptoms of clinical deterioration and initiate life-saving interventions. DESIGN: A prospective, cross-sectional, descriptive quantitative design using a survey method was used. METHODS: Nurses were recruited from an integrated healthcare system located in the south-east United States. Nurses completed a demographic, a self-confidence and a leadership ability questionnaire. RESULTS: One hundred and forty-eight nurses participated in the study. Nurses felt moderately self-confident in recognising, assessing and intervening during clinical deterioration events. In addition, nurses felt moderately comfortable performing leadership skills prior to the arrival of an emergency response team. A significant, positive relationship was found between perceived self-confidence and leadership abilities. Age and certification status were significant predictors of nurses' leadership ability. CONCLUSION: Although nurses felt moderately self-confident and comfortable with executing leadership abilities, improvement is needed to ensure nurses are competent in recognising patients' deterioration cues and making sound decisions in taking appropriate, timely actions to rescue patients. Further strategies need to be developed to increase nurses' self-confidence and execution of leadership abilities in handling deterioration events for positive patient outcomes. RELEVANCE TO CLINICAL PRACTICE: Educational provisions should focus on various clinical deterioration events to build nurses' self-confidence and leadership abilities in handling clinical deterioration. Nurses should obtain national certification to increase their knowledge and clinical reasoning skills.