Building Leaders for an Equitable and Inclusive Future.

ABSTRACT: The Association for Leadership Science in Nursing (ALSN) 2023 International Conference was held on October 28 to 30 in Birmingham, Alabama, and sponsored by the University of Alabama at Birmingham School of Nursing. ALSN is dedicated to uniting academic and practice leaders to shape leadership science, education in nursing, and the practice of nursing leadership. The theme for the conference was Building Leaders for an Equitable and Inclusive Future. Nurse leaders from the United States, Canada, and Brazil gathered to discuss leadership science.

Leadership Science in Nursing: Creating New Solutions for New Challenges.

The Association for Leadership Science in Nursing (ALSN) November 2022 International Conference was held at the Frances Payne Bolton School of Nursing at Case Western University. ALSN is dedicated to uniting academic and practice leaders to shape leadership science, education in nursing, and the practice of nursing leadership. One hundred fifty-one nurse leaders from the United States, Canada, and Oman gathered to discuss leadership as highlighted in this column.

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.

Establishment of Nurse Manager Leadership Competencies to Support Clinicians in Evidence-Based Practice.

OBJECTIVE: This 2-part study was conducted to validate nurse manager (NM) leadership competencies that support clinicians in using evidence-based practice (EBP). BACKGROUND: Numerous studies validate the critical need for NM support among clinicians seeking to engage in EBP. METHODS: In phase 1, a Delphi study was conducted to establish the validity of a set of NM leadership competencies that support EBP. In phase 2, descriptive analyses, tests of significance, and reliability coefficients were used to assess reliability. RESULTS: An expert panel achieved consensus on a set of 22 NM leadership competencies that constitute effective support for EBP. Further quantitative analyses demonstrated excellent levels of internal consistency and overall consistent outcomes across time. CONCLUSION: A valid set of 22 NM leadership competencies with evidence of reliability that successfully support clinicians to engage in EBP in clinical settings was established.

Building the Science to Guide Nursing Administration and Leadership Decision Making.

OBJECTIVE: The aim of this study was to identify the challenges, barriers, and solutions for conducting nursing administration and leadership science (NALS) research. BACKGROUND: Evidence from leadership science should be at the forefront of nurse leaders' decision making. Yet, challenges remain in building the evidence and moving it into nursing administration and leadership practice. METHODS: This study used a Delphi technique with open-ended questions and direct content analysis to evaluate survey responses of members of the Association for Leadership Science in Nursing and American Organization for Nursing Leadership. RESULTS: Open-ended responses were coded to yield super categories and supportive codes for areas with limited evidence to guide leadership practice and the challenges for conducting NALS research. CONCLUSIONS: These findings provide future directions for continuously driving NALS research and for building and leveraging leadership science to support nursing administration decision making.

Association of Hashimoto's Thyroiditis and Burkitt Lymphoma: A Rare Condition to Be Considered.

We present the case of a 72-year-old woman who was diagnosed with Hashimoto's thyroiditis and who developed a low-grade fever, fatigue, and weight loss that prompted to perform a thyroid biopsy to rule out an underlying primary thyroid lymphoma. This case report offers the opportunity to review the association between Hashimoto's thyroiditis and primary thyroid lymphoma. Furthermore, it underlines the importance of considering the diagnosis of lymphoma when a thyroid mass is found in patients with an underlying Hashimoto's disease, as the timely management is essential for survival with this rare thyroid condition.

Boundary Spanning Leadership in Response to the COVID-19 Pandemic: Experience of Nurse Leaders in a Large Integrated Long-term Health Care System.

This article provides insight into the impact of boundary spanning for nurse leaders in a large integrated post-acute health care system in the southeastern part of the United States as they responded (not reacted) to the COVID-19 pandemic that threatened the lives of 2 of society's most vulnerable populations, the elderly and the disabled. Through illustrative examples, the authors describe the 6 strategies of boundary spanning leadership-buffering, reflecting, connecting, mobilizing, weaving, and transforming-that enabled these nurse leaders to respond effectively during this crisis. The literature informs on the merit of situational leadership, as no single type of leadership is right for all circumstances. Today's new novel pandemic served as a powerful catalyst for a group of nurse leaders in a large non-acute network of health care organizations, their colleagues, and other key stakeholders to reframe the boundaries that existed between their organizations and associations, thus enabling them to successfully problem solve together to accomplish several high-stakes goals.

Nurses Taking the Lead: A Look Back to Move Forward.

In recognition of the Year of the Nurse and Midwife, the 2020 annual conference of the Association for Leadership Science in Nursing (ALSN) celebrated A Look Back to Move Forward in recognition of the 50th anniversary of ALSN. The ALSN began as the Council of Graduate Education for Administrative Nursing (CGEAN) in 1970. Today, ALSN maintains the goals of shaping graduate education and research to inform nursing leadership practice.

Nurse competencies for transitions of care: Implications for education and practice.

Although there are a number of transitions of care initiatives that address specific needs as patients move across healthcare settings, adverse events still occur during handoffs. Transitions of care create periods of vulnerability for populations with complex needs that include communication gaps, medication changes, and poorly coordinated treatment plans, often without involving patients and their families. This paper outlines what nurses need to know to provide for safe transitions of care across the healthcare continuum. The theoretical basis for transitions of care at the macro level, examples of nurse-led models for transitions of care, and key activities and implications for nursing education and practice are described. A holistic framework for effective transitions of care across healthcare settings can guide nursing educators in the development of specific nursing competencies for transitions of care.

Organizational Support for Nurse Manager Role Transition and Onboarding: Strategies for Success.

OBJECTIVE: The aim of this study was to provide guidance on supportive nurse manager role transition practices. BACKGROUND: The nurse manager role is increasingly more complex and the workforce is increasingly less experienced. Wide variation in nurse manager role transition exists among organizations. Nurse managers are commonly hired without requisite knowledge and are expected to learn through experience. METHODS: A mixed-methods approach was used to identify current and ideal organizational practices supporting the role transition of novice nurse managers. RESULTS: Effective role transition of new nurse managers begins with human resource policies that encourage graduate preparation for nurse managers. A supportive transition program includes didactic education for knowledge development and coaching of novice nurse managers in the application of new knowledge to clinical practice experiences. Rigorous program evaluation is recommended for sustainability. CONCLUSION: Nurse managers are the linchpins of organizations. Organizational leaders need to support their role transition for the success of the organization.

Disruptive Innovation: Impact for Practice, Policy, and Academia.

The 2019 Association for Leadership Science in Nursing International Conference, Disruptive Innovation, was held in Los Angeles, California, with attendees from 30 US states, Canada, Brazil, and China. Presenters discussed the need for nurse leaders to advocate for health equity, lead evidence-based innovation, how robots and other technology are generating disruptive innovations in healthcare, and building strong academic-practice partnerships to address nursing workforce challenges. This article will report on these important insights.

A Concept Analysis of Transitions of Care for Population Health.

BACKGROUND: Compelling evidence indicates that gaps in quality, safety, and experiences occur when patients encounter transitions across the care continuum. Differences in the organization of healthcare services as well as disparities in health across the globe, may have a unique impact on processes associated with transitions of care for client populations. PURPOSE: Increased attention to the concept of transitions of care has resulted in disparate meanings and lack of clarity about its nature. Therefore, the purpose of this manuscript is to address this knowledge gap by analyzing the concept of transitions of care at the population level. METHODOLOGY: To address the knowledge gap of what constitutes transitions of care at the population level, a concept analysis was done guided by the methodology of Walker and Avant. A comprehensive search of the literature yielded a small but relevant number of publications. RESULTS: This analysis identified four defining attributes, together with antecedents and consequences of transitions of care at the macro-system level of healthcare. A synthesized definition of transitions of care was developed. IMPLICATIONS FOR PRACTICE: This analysis provides conceptual clarity for the concept of transitions of care at the macro-system level of care. It can be used to guide the development of a middle-range theory to inform clinical practice and health policy.

Leveraging the Power of Board Leadership in Professional Nursing Organizations.

Nurses who aspire to lead a professional nursing organization can significantly influence the future of the nursing profession. This article describes 4 essential responsibilities required in a board leadership position as identified by a group of nurse leaders who have each served as the board president of a national or international professional nursing organization.

Grassroots to Global: The Future of Nursing Leadership.

The 2018 International Nursing Administration Research Conference, Grassroots to Global, was held in Atlanta, Georgia, with attendees from 38 US states, Canada, and China. Presenters discussed the need for nurse leaders to be prepared to partner with those inside and outside of healthcare to create innovative, interprofessional care delivery models; advocate for advancements in technology to address healthcare access shortages; and lead new areas of research that can drive policy change to support nurse leaders in long-term care and the essential role of the nurse manager in creating optimal practice environments for quality outcomes. This article will report on these important insights.

Connecting Communities: The Development of an International Partnership.

Addressing health inequities and the social determinants of health for all people of the world is a primary goal of the World Health Organization. This article describes how a "Connecting Communities educational program" enabled nurse leaders from academic institutions from different sides of the globe to develop a reciprocal relationship of mutual interest around the topics of the nursing role in population health and care delivery. Grant funding resulted in the sharing of knowledge, expertise, and experiences directed toward encouraging the development of nurses as global citizens, with a broader view on what influences health and well-being. This initiative demonstrates how nurses can contribute to the improvement of world health and address the social determinants of health while practicing locally but thinking and contributing globally.

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.

Excellence and evidence in staffing: a data-driven model for excellence in staffing (2nd edition).

The Patient Protection and Affordable Care Act (PPACA, 2010) and the Institute of Medicine's (IOM, 2011) Future of Nursing report have prompted changes in the U.S. health care system. This has also stimulated a new direction of thinking for the profession of nursing. New payment and priority structures, where value is placed ahead of volume in care, will start to define our health system in new and unknown ways for years. One thing we all know for sure: we cannot afford the same inefficient models and systems of care of yesterday any longer. The Data-Driven Model for Excellence in Staffing was created as the organizing framework to lead the development of best practices for nurse staffing across the continuum through research and innovation. Regardless of the setting, nurses must integrate multiple concepts with the value of professional nursing to create new care and staffing models. Traditional models demonstrate that nurses are a commodity. If the profession is to make any significant changes in nurse staffing, it is through the articulation of the value of our professional practice within the overall health care environment. This position paper is organized around the concepts from the Data-Driven Model for Excellence in Staffing. The main concepts are: Core Concept 1: Users and Patients of Health Care, Core Concept 2: Providers of Health Care, Core Concept 3: Environment of Care, Core Concept 4: Delivery of Care, Core Concept 5: Quality, Safety, and Outcomes of Care. This position paper provides a comprehensive view of those concepts and components, why those concepts and components are important in this new era of nurse staffing, and a 3-year challenge that will push the nursing profession forward in all settings across the care continuum. There are decades of research supporting various changes to nurse staffing. Yet little has been done to move that research into practice and operations. While the primary goal of this position paper is to generate research and innovative thinking about nurse staffing across all health care settings, a second goal is to stimulate additional publications. This includes a goal of at least 20 articles in Nursing Economic$ on best practices in staffing and care models from across the continuum over the next 3 years.

Embarking on accountable care: preparing for the second curve.

With the advent of the Affordable Care Act, new models of care are underway. Health care experts agree that to improve care, there will need to be improved partnerships across the care continuum, finally eliminating silos of care and services. WellStar Health System, a large health care system in the southeastern part of the United States, is demonstrating its early adoption of integration and the new rules of engagement. These rules will fundamentally change the course of how to provide health care and lead the way for a more accountable-based model of care delivery. This article describes the anticipated and successful preliminary outcomes achieved in the first year of this system's demonstration project in the Medicare Shared Savings Program or "Medicare ACO." WellStar Health System began with a focus on addressing the needs of the heart failure patient. In an effort to achieve the triple aim of improving access, reducing cost, and improving outcomes, the system designed a dedicated inpatient heart failure unit. This unit operates with a new and sustainable structure that actually links the interdisciplinary and multiple providers of care across the care continuum. In doing so, a significant improvement in achieving patient's compliance with care treatment and a reduction in hospital readmissions have been achieved.

Evaluation of an evidence-based practice initiative: outcomes, strengths and limitations of a retrospective, conceptually-based approach.

BACKGROUND AND PURPOSE: Making evidence-based practice (EBP) a sustained reality is a difficult endeavor. This relates, among other factors, to lack of sufficient research upon which to base implementation efforts. Alternative sources of evidence therefore need to be considered, particularly where organizational level EBP is the goal. In this article a brief evaluation of a service-based initiative with the aim of obtaining insights regarding multiple types and levels of EBP-related outcomes is described. METHODS: A structured, retrospective improvement evaluation was conducted. Semi-structured interviews and available documents were chosen to obtain information regarding outcomes, perceived spread of reported individual changes, and factors related to the degree of progress. Underlying the method is an evaluation model that shows a progressive set of EBP outcomes at both individual and group levels. FINDINGS: Evaluative results, although limited by several factors, provided credible and sufficient internal evidence for this organization's leadership team to build upon past efforts and refine their approach to integrating research utilization (RU) throughout the department of nursing. For example, the evaluation indicated a set of RU outcomes at the individual nurse level not previously considered and also indicated limitations and challenges to full achievement of initial project-related goals. DISCUSSION AND IMPLICATIONS: The evaluation provided suggestive internal evidence regarding potential benefits of one component of a long-term, valued EBP initiative. However, the evaluation also raised questions regarding structural aspects of this initiative; identified barriers to progress; provided information for dialogue and planning; and highlighted future needs for a proactive, systematic evaluation and a documented trail of data related to all EBP program goals. For those in settings with similar characteristics and aims that have not built in such a prospective evaluation for EBP initiatives, this evaluative project can be assessed for its applicability.