Critical care nurse leaders' moral distress: A qualitative descriptive study.

BACKGROUND: Unit-based critical care nurse leaders (UBCCNL) play a role in exemplifying ethical leadership, addressing moral distress, and mitigating contributing factors to moral distress on their units. Despite several studies examining the experience of moral distress by bedside nurses, knowledge is limited regarding the UBCCNL's experience. RESEARCH AIM: The aim of this study was to gain a deeper understanding of the lived experiences of Alabama UBCCNLs regarding how they experience, cope with, and address moral distress. RESEARCH DESIGN: A qualitative descriptive design and inductive thematic analysis guided the investigation. A screening and demographics questionnaire and a semi-structured interview protocol were the tools of data collection. PARTICIPANT AND RESEARCH CONTEXT: Data were collected from 10 UBCCNLs from seven hospitals across the state of Alabama from February to July 2023. ETHICAL CONSIDERATIONS: This study was approved by the Institutional Review Board at the University of Alabama in Huntsville. Informed consent was obtained from participants prior to data collection. FINDINGS: UBCCNLs experience moral distress frequently due to a variety of systemic and organizational barriers. Feelings of powerlessness tended to precipitate moral distress among UBCCNLs. Despite moral distress resulting in increased advocacy and empathy, UBCCNLs may experience a variety of negative responses resulting from moral distress. UBCCNLs may utilize internal and external mechanisms to cope with and address moral distress. CONCLUSIONS: The UBCCNL's experience of moral distress is not dissimilar from bedside staff; albeit, moral distress does occur as a result of the responsibilities of leadership and the associated systemic barriers that UBCCNLs are privier to. When organizations allocate resources for addressing moral distress, they should be convenient to leaders and staff. The UBCCNL perspective should be considered in the development of future moral distress measurement tools and interventions. Future research exploring the relationship between empathy and moral distress among nurse leaders is needed.

Critical care nurse leaders addressing moral distress: A qualitative study.

BACKGROUND: Moral distress (MD) occurs when clinicians are constrained from taking what they believe to be ethically appropriate actions. When unattended, MD may result in moral injury and/or suffering. Literature surrounding how unit-based critical care nurse leaders address MD in practice is limited. AIM: The aim of this study was to explore how ICU nurse leaders recognize and address MD among their staff. STUDY DESIGN: Qualitative descriptive with inductive thematic analysis. RESULTS: Five ICU nurse leaders participated in a one-time individual interview. Interview results suggest that (1) ICU nurse leaders can recognize and address MD among their staff and (2) nurse leaders experience MD themselves, which may be exacerbated by their leadership role and responsibilities. CONCLUSIONS: Further research is needed to develop interventions aimed at addressing MD among nurse leaders and equipping nurse leaders with the skills to identify and address MD within their staff and themselves. RELEVANCE TO CLINICAL PRACTICE: MD is an unavoidable phenomenon ICU nurse leaders are challenged with addressing in their day-to-day practice. As leaders, recognizing and addressing MD is a necessary task relating to mitigating burnout and turnover and addressing well-being among staff within the ICU.

Exploring Nurses' Perceptions of Specialty Certification.

BACKGROUND: The strategic nursing plan for a large Midwestern health care system includes achievement of the American Nurses Credentialing Center's Magnet® recognition for all their hospitals. This study explored the barriers to and perceived value of certification among nurses employed by the same health care system across eight facilities in a metropolitan region. One of these facilities holds Magnet® recognition. METHOD: Subjects were recruited by direct email to collect demographic data and complete a barrier to certification survey and the Perceived Value of Certification Tool-12. RESULTS: There were statistically significant differences in the perception that lack of institutional support is a barrier to certification both in aggregate and when comparing the Magnet® hospital with the others. CONCLUSION: As an initial exploration into barriers and perceived value, this study provides data for this health care system to plan strategies to promote certification. This study also serves as an exemplar for other organizations considering evaluation of certification barriers and value among their nursing staff. [J Contin Educ Nurs. 2023;54(12):567-573.].

Moral distress among nurse leaders: A qualitative systematic review.

Moral distress (MD) is well-documented within the nursing literature and occurs when constraints prevent a correct course of action from being implemented. The measured frequency of MD has increased among nurses over recent years, especially since the COVID-19 Pandemic. MD is less understood among nurse leaders than other populations of nurses. A qualitative systematic review was conducted with the aim to synthesize the experiences of MD among nurse leaders. This review involved a search of three databases (Medline, CINAHL, and APA PsychINFO) which resulted in the retrieval of 303 articles. PRISMA review criteria guided authors during the article review and selection process. Following the review, six articles were identified meeting review criteria and quality was assessed using the Critical Appraisal Skills Programme (CASP) Checklist for qualitative studies. No ethical review was required for this systematic review. The six studies included in this review originated from the United States, Brazil, Turkey, and Iran. Leadership roles ranged from unit-based leadership to executive leadership. Assigned quality scores based upon CASP criteria ranged from 6 to 9 (moderate to high quality). Three analytical themes emerged from the synthesis: (1) moral distress is consuming; (2) constrained by the system; and (3) adapt to overcome. The unique contributors of MD among nurse leaders include the leadership role itself and challenges navigating moral situations as they arise. The nurse leader perspective should be considered in the development of future MD interventions.

Strategic Planning: Moving From Plan to Implementation.

Successful organizations depend on strategic thinkers who understand strategic planning and strategic management. These strategic leaders can proactively manage the constant environmental changes to position their organizations for a competitive advantage and avoid acting in a reactive and defensive manner. However, while organizations are often adept at developing extensive strategic plans, implementation of the plan is often poor or without a definitive strategy. This article addresses key strategies for successful implementation of changes to bring about sustainable cultural change in an organization to meet the organization's overall strategic goals, specifically through the use of implementation science.

Creating a Business Case for Success.

Health care is a highly competitive environment where managers must compete for finite resources. The Centers for Medicare & Medicaid Services-directed reimbursement models such as value-based purchasing and pay-for-performance heavily focused on quality improvement and nursing excellence are having a major impact on financial reimbursement for health care services in the United States. As such, nurse leaders must function in a business-focused environment where decisions regarding resource allocation are driven by quantifiable data, the potential return on investment, and the organization's ability to provide quality patient care in an efficient manner. It is imperative for nurse leaders to recognize the financial impact of potential additional revenue streams, as well as avoidable costs. Nurse leaders must also be skilled at translating the return on investment for nursing-centric programs and initiatives, often hidden in anecdotal terms and cost avoidance rather than revenue generation, to ensure appropriate resource allocation and budgetary assumptions. This article uses a case study framed within the business case to review a structured approach to operationalizing nursing-centric programs and highlights key strategies for success.

AACN Essentials as the Conceptual Thread of Nursing Education.

In March 2021, the American Association of Colleges of Nursing (AACN) endorsed and published a report that included a reenvisioned framework for nursing education. This report introduced innovative and bold ideas for transforming nursing education and pedagogy from a concept-based model to a competency-based model of nursing education. This new model of nursing education establishes a core set of expectations and standards of competency-based nursing curricula common to all nursing educational programs moving forward. Before this transformative change can occur, nurse educators must first understand what is expected of them before they can adapt current nursing curricula to meet the future needs of our communities and employers. This article will dissect the Re-envisioned Essentials and provide the reader with new terminology introduced by the Essentials document, as well as the core expectations and standards established by the AACN for future nursing education and curricula. With this new understanding, we will introduce and discuss strategies supporting the transitional process of moving from concept-based educational models to competency-based models using a think-backward approach to change that begins with an alignment of program-level learning outcomes with national standards and working backwards to build assessments.

Anatomy of a Business Case.

A business case plan (BCP) provides a structured framework for evidence-based, transparent business decisions. It is an essential tool that when written well will provide you with the means to translate the cost and benefits of nursing practice proposals, often related in anecdotal terms, into quantifiable, evidence-based terms outlining return on investment and business advantages of investing in nursing initiatives. The BCP should include an analysis of the problem and associated needs, the proposed solutions with options, goals for success, implementation, and evaluation plans, as well as a risk-adjusted cost-benefit analysis. It contains the necessary information to allow decision makers to make well-informed decisions regarding resource allocation. As clinical experts seeking to compete for finite resources in the health care arena, nursing leadership must bridge the language gap between nursing and business finance. This article outlines the required elements of the BCP to provide you with a practical working definition of each element to support your future initiatives in the business of health care improvement.

Interpreting Organizational-Level Financial Statements.

An organization's financial statements reflect their financial well-being and determine their ability to meet the health care needs of the citizens in their community. It is imperative that nursing leadership recognize the key components of an organization's annual consolidated financial statements, the balance sheet and income statement, and know how to interpret them to provide efficient, high-quality health care and to be successful in their role as nurse leaders. This article provides exemplars of these key documents with detailed instructions for the interpretation and understanding of the organization's financial statements, which will enable the reader to accurately and adeptly interpret their own organization's financial statements, as well as the statements from other organizations.

Improving Quality With Emergency Department Throughput in a Critical Access Hospital.

OBJECTIVE: The study objective was to determine the impact of specific measures to reduce the length of stay (LOS) in an emergency department (ED) in a critical access hospital (CAH). BACKGROUND: Despite mandates to reduce bottlenecks by increasing throughput, many EDs are not successful. Strategies available to larger hospitals may not be feasible for resource-limited CAHs. METHODS: Interventions were implemented to decrease ED LOS in a rural CAH. Through retrospective chart reviews from time periods both preimplementation and postimplementation, the LOS was determined and compared using 2-sample t tests. RESULTS: Significant decreases were found between the groups in mean LOS times, as well as specific time intervals within the overall LOS time for nursing-centric activities and incidence of patients leaving prior to treatment completion. CONCLUSIONS: A significant decrease in LOS resulted from numerous actions taken to improve patient flow. Results may be used to enhance patient flow and decrease LOS in other CAHs, improving quality and access to care.

Technology acceptance among physicians: a new take on TAM.

The proliferation of information technology has been a revolutionary force that has increased efficiency and effectiveness in many industries. However, health care organizations, particularly physician practices, are noticeably lagging in the adoption of such technologies. This article provides a systematic review of the literature on physician acceptance of information technology. An overview of the technology acceptance model (TAM) is discussed, and a modified version of this model is proposed. Finally, ideas for testing this new model in a physician setting are presented. By providing a better understanding of physician technology acceptance, this model will inform health care managers about barriers that make physicians hesitant to embrace new technologies designed to increase efficiency and improve quality in a health care setting.