Path Analysis: Interrelationships Between Nurse Manager Competencies, Practice Environment Perceptions, and Frontline Nurses' Intent to Stay.

OBJECTIVE: To examine the correlation between nurse manager (NM) competencies, work environment (Practice Environment Scale of the Nursing Work Index [PES-NWI]), and frontline nurses' intent to stay; the direct effect of NM competency on frontline nurses' intent to stay; and the indirect effect of NM competency on frontline nurses' intent to stay, mediated by PES-NWI. BACKGROUND: PES-NWI and NMs' competency can impact frontline nurses' intent to stay. METHODS: Cross-sectional study with secondary analysis of NM Competency and NDNQI® (National Database of Nursing Quality Indicators®) RN Survey data with path analysis for effects of the model's variables. RESULTS: Positive, weak correlations between NM competencies and frontline nurses' practice environments were found; NM competencies and frontline nurses' intent to stay were not correlated. Paths were NM competency/PES-NWI (ß = 0.20, P = 0.001) and PES-NWI/intent to stay (ß = 0.55, P < 0.001); NM competency/intent to stay was not significant. Indirect effect of NM competency on frontline nurses' intent to stay was mediated through PES-NWI (ß = 0.11, P = 0.002; 95% confidence interval, 0.05-0.17). CONCLUSIONS: Investing in NMs' competency can help create supportive work environments and frontline nurses' intent to stay.

COVID-19 Pandemic Increases in Nurse-Sensitive Quality Indicators.

BACKGROUND: The pandemic profoundly stressed nursing practice and could have thereby affected trends in nurse-sensitive quality indicators (NSIs), measures that detect changes in patient health status directly affected by nursing care. OBJECTIVES: To determine if NSIs have worsened in response to the pandemic and then returned to pre-pandemic levels using data from 2019 through 2022. METHODS: We conducted a cross-sectional descriptive study of annual trends, examining unit data from the National Database of Nursing Quality Indicators (NDNQI) from 2019 through 2022 for five indicators: rates of falls, central line-associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), hospital-acquired pressure injury (HAPI), and ventilator-associated events (VAE). The NDNQI is the largest repository of nursing quality indicators, which are derived from patient-level events, reported at the nursing unit level, and submitted quarterly by over 2,000 member hospitals. Adult medical-surgical or critical care inpatient nursing units with complete data for the 4 years were included, with samples ranging from 456 to 5,818 nursing units in 2,346 hospitals. Analysis of variance was conducted by comparing the 2019 rates to each subsequent year. RESULTS: In decreasing order of prevalence, the mean pre-pandemic rates were 6.58 VAE per 1,000 ventilator days (critical care only), 2.41 HAPI per 1,000 device days, 2.20 falls per 1,000 patient days, 0.96 CAUTI per 1,000 catheter days, and 0.68 CLABSI per 1,000 central line days, for medical-surgical and critical care units combined. The rates for all five nurse-sensitive indicators increased significantly beginning in 2020 and have begun to decline but have not returned to baseline by 2022. The maximum rate was observed in 2020 for falls and 2021 for the remaining indicators. These increases to the maximum ranged from a 12% percent increase in CAUTI to 49% for CLABSI. DISCUSSION: NSIs increased during the pandemic and are now returning to baseline. The pandemic underscored the importance of nursing practice. The pandemic's enduring negative effects on the nursing workforce must be addressed to preserve patient safety.

Connecting the Health Care Workforce with the Patient Experience.

This article is one in a series from Press Ganey-a health care performance improvement organization-that will discuss the many facets of the human experience in health care. Using the latest national data, the series will explore the intersections of safety, reliability, experience, and service, and their impact on engagement, work culture, and nurse-sensitive outcomes. Each installment will be designed as a "deep dive" into the most recent thinking and evidence-based approaches to improvement of the patient experience with a particular focus on practical and implementable tactics in each of the above subject areas.

Individual and Organizational Factors Associated With Nurse Manager Success.

OBJECTIVE: The aim of this study was to synthesize previous findings and provide practical guidance for maximizing nurse manager and nurse performance. BACKGROUND: Two recent studies have linked nurse manager job design factors and individual differences to a variety of valued outcomes, but practical implications remain unclear. METHODS: A large US sample of nurse managers was divided on the basis of nurse and patient outcomes. Various characteristics are compared across the highest and lowest performers. RESULTS: Wider nurse manager span of control is associated with negative outcomes; the availability of support positions does not fully alleviate the consequences of wide spans. Nurse managers with fewer subordinates can effectively manage multiple units. Nurse manager experience is critical for success and cannot be fully replaced by leadership training programs. CONCLUSIONS: Staffing and job design decisions have critical downstream implications. The present research provides guidance for effective staffing and job design.

PSYCHOMETRIC PROPERTIES OF THE NURSE MANAGER COMPETENCY INSTRUMENT FOR RESEARCH.

Background and Purpose: Competent nurse managers (NM) are essential to create safe and healthy work environments and support frontline nurses. Measuring NM competence with a valid and reliable instrument is critical in research. We assessed the psychometric properties of the Nurse Manager Competency Instrument for Research (NMCIR). Methods: Item analysis, internal consistency analysis, and confirmatory factor analysis were performed with a sample of 594 NMs. Results: The NMCIR showed high internal consistency. The 26 items were loaded on ten factors with a good overall fit, supporting the hypothesized factor structure. However, the findings showed poor discriminant validity. Conclusion: The NMCIR demonstrates sound psychometric properties for use in studies of NM competence. Further evaluation of the NMCIR is recommended to improve discriminant validity.

Relationships among nurse managers' job design, work environment, and nurse and patient outcomes.

The importance of nurse managers' practice environments in affecting outcomes for direct care nurses and patients has been well-researched. Nonetheless, much remains to be learned about the determinants of the nurse manager practice environment. In this study, 541 US nurse managers' survey responses were matched to unit-level aggregate data of their subordinates' responses on the National Database of Nursing Quality Indicators. A model relating job design and experience to the nurse manager's practice environment and direct care nurse (i.e., job satisfaction, intent to stay, and joy and meaning in work) and patient outcomes (i.e., nurse-reported quality of care and missed nursing care) was evaluated through multilevel path analysis. Nurse manager span of control, support staff, and experience influence nurse managers' perceptions of their practice environment and nurse and patient outcomes. Although support staff can offset some negative effects of wide spans of control, it does not fully compensate for wide spans. Thus, nurse manager job design factors and experience relate to nurse manager practice environments and valued downstream outcomes. The present research emphasizes the importance of a positive nurse manager practice environment and provides guidance for nurse manager hiring and job design decisions.

The influence of nurse manager competency on practice environment, missed nursing care, and patient care quality: A cross-sectional study of nurse managers in U.S. hospitals.

AIMS: Identify and examine drivers of nurse manager competency and high-quality practice environments. BACKGROUND: Nurse managers are a key predictor of positive professional practice environments, which are, in turn, associated with nurse, patient, and organisational outcomes. However, little work has examined the factors that contribute to nurse manager competency. METHODS: Nurse managers completed online surveys, which were matched to unit-level aggregate data of their subordinate direct care nurses' responses on the National Database of Nursing Quality Indicators. This resulted in a final sample of 541 nurse managers across 47 U.S. hospitals. Multilevel path analysis was utilized to assess a model of the antecedents and consequences of nurse manager competency. RESULTS: Nurse manager competency and practice environments were predictive of missed nursing care and nurse-reported quality of care. Nurse manager experience was found to have twice the effect on competency as advanced education. CONCLUSIONS: Nurse manager competency and its downstream effects are achieved through nurse manager experience and advanced education. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse manager competency yields better practice environments and nursing care. Considering the influence of experience, careful attention should be paid to the competency development process of more novice nurse managers.

Advancing Nursing Leadership Science Through an Innovative Research-Practice Partnership.

ABSTRACT: The Association for Leadership Science in Nursing and American Organization for Nursing Leadership Foundation have formed a new research-practice collaborative. The collaborative allows for a synergistic approach to the advancement of leadership science. This article discusses the impetus for the collaborative, its structure, and how its synergy of research and practice expertise provides immense opportunity for robust, practice-relevant research.

Building Nurse Manager Well-being by Reducing Healthcare System Demands.

The National Academies of Medicine consensus study committee reported that US healthcare workers experience high levels of burnout resulting from external pressures on the healthcare system and the organization of work. Nurse managers are especially susceptible to burnout. This column provides evidence-based strategies to improve the work environment, reduce the burden of job demands, and promote well-being among nurse managers.

Nurse Leader Competencies: Today and Tomorrow.

The coronavirus-2019 (COVID-19) pandemic has resulted in turbulent times challenging nurse leaders to adopt, adapt, and develop new leadership competencies to navigate current and future challenges. In never-imagined approaches, nurse leaders have responded to a different type of crisis management. In this new era, nursing leadership will need competencies to reshape the future of nursing and nurses' role in caring for patients, families, and promotion of healthy communities along with a focus on reducing health disparities. The pandemic has drawn critical focus on the health and well-being needs of nurses. The American Organization for Nursing Leadership and the Association for Leadership Science in Nursing have offered insights of nursing leadership competencies critical for practice and education in shaping the future.

A Complexity-Informed Model to Guide Nurse Manager Practice.

Nurse manager practice is a broad concept that reflects the defined role responsibilities and the manner in which nurse managers perform their role. The outcome of nurse manager practice is commonly known as their job performance. The job performance of nurse managers reflects their effectiveness and is assessed by organizational, staff, and patient outcomes. There is strong evidence that nurse managers with relational leadership styles are the key drivers of positive practice environments and job satisfaction among nurses. Concluding that the solution to positive environments and satisfied nurses rests solely on the leadership style of the nurse manager seems logical; however, it ignores the role of the larger organizational context. This article applies a complexity lens to understand nurse manager practice and other organizational factors influencing job performance. The evidence developed thus far yielded the identification of dimensions of the organizational context that support nurse manager practice and nurse manager job performance. Additional research is needed to identify the essential ingredients to support nurse manager practice. Organizational success depends on developing synergy among the administrative, adaptive, and enabling leadership functions of organizations.

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.

Interprofessional Education: Advancing Team Science to Create Collaborative Safety Cultures.

The Institute of Medicine called for all health professionals to be educated in interprofessional teams. Accreditation bodies governing education of health professions responded by creating standards for interprofessional education (IPE) activities. Educators teaching in health professional programs implemented a variety of IPE activities, yet rigorous evaluation of IPE on interprofessional practice and patient outcomes is limited. The authors review the progress of IPE, introduce new trends in IPE, and identify the methods needed to evaluate IPE effectiveness.

The Influence of the Practice Environment on Nurse Managers' Job Satisfaction and Intent to Leave.

OBJECTIVE: The aim of this study was to explore the influence of the practice environment on nurse managers' (NMs') job satisfaction and intent to leave. BACKGROUND: Nurse managers are a ready pool of talent to fill impending strategic leadership vacancies. Job satisfaction as an NM is a deciding factor for senior leadership aspirations. METHODS: This study used a secondary analysis of 2012 survey data of 355 NMs. The Nurse Manager Practice Environment Scale was used to identify organizational features that influence NMs' job satisfaction and intent to leave. RESULTS: Mean (SD) job satisfaction was 4.5 (1.1) on a 6-point scale. Mean (SD) intent to leave was 5.0 (2.1) on a scale ranging from 3 to 9. The Nurse Manager Practice Environment Scale was a significant predictor of both job satisfaction and intent to leave. CONCLUSIONS: Features of the organizational context can be modified to improve job satisfaction and reduce intent to leave among NMs.

Application of CGEAN's Research Priorities: PhD, DNP Scholarship.

The Accountable Care Act of 2010 is stimulating rapid transformations of healthcare systems. The shift from a focus on providing healthcare in a closed system to improving the health of communities demands rapid innovation by nurse leaders. Nurse leaders prepared at the doctorate of nursing practice level and PhD-prepared nursing health services researchers are needed to develop and evaluate best practices as they emerge. This column expands on the findings from CGEAN's Delphi study.

Nursing Administration Research Priorities: Findings From a Delphi Study.

OBJECTIVE: The aim of this study is to determine the priorities for nursing administration research (NAR) in the United States. BACKGROUND: Previously known as the Council of Graduate Educators in Administrative Nursing, CGEAN provides an avenue for researchers and educators focused on NAR to partner, dialogue, obtain funding resources, and present their findings at a biennial International Nursing Administration Research Conference (INARC). In late 2013, with a goal of building consensus, CGEAN convened an INARC postconference to initiate the process of establishing critical NAR priorities for the future. METHODS: Data from a 3-staged Delphi study were used to identify relevant research topics and determine administrative research priorities. RESULTS: Eight final categories of NAR were determined. CONCLUSIONS: This study found economic valuing of nursing and designing effective future healthcare delivery systems to be high priorities for NAR.

Achieving 80% BSN by 2020: Chief Nurse Executive Role and ANCC Influence.

OBJECTIVES: The aim of this study was to understand current education level of hospital nurses and strategies used by Kentucky's chief nurse executives (CNEs) to encourage academic progression in their RN workforce. BACKGROUND: The Institute of Medicine and American Nurses Credentialing Center called for 80% of RNs to be educated with a minimum of a BSN. CNEs have a key role in achieving that goal. METHODS: An electronic survey was administered in fall 2013. Fifty-two Kentucky CNEs responded. RESULTS: No hospitals in Kentucky met the BSN target. Sixty-two percent of CNEs planned to achieve 80% BSN nurses by 2020. Teaching status, hiring preferences, goals for increasing percentage of BSN nurses, and processes to facilitate advancement of nurses prepared at the associate degree level were associated with pursuit or achievement of Pathway to Excellence® or Magnet® designation. In addition to policies to support increasing educational levels, incentives offered included tuition reimbursement, career advancement, time off, and academic partnerships. CONCLUSION: Increasing the proportion of BSN-prepared nurses should be a priority for CNEs. Strategies to facilitate that goal are explored. From these data, a large number of CNEs (38%) do not have a goal to achieve the recommended levels of BSN nurses. Further education and support in the rural hospitals in Kentucky are indicated to support this recommendation.