Organizational Supports for Nurse Managers in a North American Context: A Scoping Review.

Organizational support for nurse managers (NMs) is not a new phenomenon. However, generally speaking, NMs are not well supported in their roles. This lack of support is burdensome to NMs' role functioning and has impacts on NM recruitment and retention; NM job satisfaction; and outcomes for front-line nurses and patients. There is a gap in the nursing literature as to what supports are currently in place to effectively support NMs. A scoping review (n = 24) focusing on North American healthcare organizations was conducted to examine what organizational supports are currently in place to support NMs and highlight gaps. Arksey and O'Malley's (2005) scoping review framework was used for this review. NM supports are currently lacking; however, they do include orientation to the NM role; competency and professional development; ancillary and clinical support; and support from upper management. The implications for nursing leadership related to organizational supports and gaps in supports for NMs are presented. Healthcare organizations have work to do in order to better support NMs and ensure quality work environments that facilitate the successful functioning of NMs at all stages of their career.

Nurse perspectives in the emergency department: The synergy tool in workload management and work engagement.

AIM: To explore emergency nurses' perceptions of how a nurse-driven patient needs assessment tool, the synergy tool, influenced their workload management. BACKGROUND: Quadruple Aim, particularly the fourth aim of improved staff work experiences, served as the conceptual framework to engage nurses in a participatory action research project. This project took place between 2017 and 2020 in two tertiary care emergency departments in one large Canadian city. METHOD: This study employed a qualitative descriptive component, focus group interviews and nurse comments on two open-ended survey questions. RESULTS: Use of the synergy tool heightened nurses' awareness of patients' holistic care needs. Nurses also stated how patient needs assessment data helped them identify unsafe workloads. CONCLUSIONS: The synergy tool, adapted for emergency department use by nurses, was a means to engage and empower nurses. Patient needs assessment data from the tool identified staffing gaps, resulting in additional nursing staff for both emergency departments. IMPLICATIONS FOR NURSING MANAGEMENT: A focus on patient needs assessment can be an effective way to address nurses' workload concerns.

Surveys conducted pre- and post-implementation of a synergy tool: Giving voice to emergency teams.

AIM: To investigate the impact of a patients' needs assessment (synergy tool) on emergency department nurses' perceptions of quality, safe care delivery and morale. BACKGROUND: The synergy tool provides real-time data on types of patients, their arrival, management and discharge. This tool was introduced to two urban emergency departments in response to government priorities to reduce emergency department wait times and improve patient flow. METHOD: This survey, a component of participatory action research, measures perceptions of 158 nurses pre-introduction and 91 nurses post-introduction of the synergy tool. RESULT: Responses were consistent regarding intent to leave, workload/staffing, spirit at work and quality/safety. One question describing staff as working in 'crisis mode' indicated a significant improvement. CONCLUSION: Critical patient care may be missed during periods of overload, placing patients and staff at risk, leading to an increase in intent to leave. The synergy tool provides an objective means in real time for staff to identify their patients' care needs, assisting management with staffing decisions. Ongoing staff and management communication using tools such as the synergy tool may reduce perceptions of working in 'crisis mode'. IMPLICATIONS FOR NURSING MANAGEMENT: This research suggests that when managers employ a collaborative process and use evidence-based tools and approaches to addressing nurses' workload concerns, nurses' perceptions of working in 'crisis mode' diminish.

Teaching evidence-based nursing practice: A systematic review and convergent qualitative synthesis.

BACKGROUND: The benefits that ensue evidence-based nursing practice (EBNP) in health care settings have been globally communicated to the nurses. However, the current clinical activities surrounding EBNP demand the involvement of nursing schools to accelerate this practice. OBJECTIVES: The purpose of this study was to synthesize, describe, and explore the evidence available to teach EBNP to undergraduate student nurses, so the students can continue to integrate EBNP in clinical settings upon becoming professional nurses. DESIGN: Systematic review with convergent qualitative synthesis. DATA SOURCES: Five electronic databases were searched; CINAHL, MEDLINE, EMBASE, ERIC, and Web of Science Core Collection. REVIEW METHODS: This study followed the guidelines for writing systematic reviews by the Joanna Briggs Institute. RESULTS: Two themes were generated; educational strategies, and EBNP knowledge and implementation. The latter theme had six sub-themes of timing, duration, content, delivery method, context, and prerequisites while the former theme had four sub-themes of knowledge acquisition, EBNP use and research utilization, collaborative teaching, and barriers and facilitators. CONCLUSION: Well-designed educational strategies have a positive impact on students' EBNP knowledge and skills. These strategies are well suited for promoting EBNP implementation in clinical settings when students qualify as nurses.

Using the Synergy Tool to Determine Regina Emergency Department Staffing Needs.

This article describes a three-year project between nurse researchers, the Saskatchewan Health Authority, the provincial nurses' union and nurses and leadership from two Regina tertiary care emergency departments. The purpose of the project was to create staffing guidelines based on patients' priority care needs. A patient needs assessment tool - the synergy tool - was used to categorize patients' acuity and dependency needs. Staffing guidelines were developed to match patients' needs to nurses' years of experience and classification. Staffing guidelines based on patient needs were compared to guidelines determined by operational budgets. The identified staffing gaps resulted in nurse hires for both emergency departments.

Teaching evidence-based nursing practice to student nurses in developing countries: strategies for novice nurse educators.

Introduction Globally, Evidence based nursing practice (EBNP) is becoming an expected norm for nursing practice. The small-scale activities surrounding this practice in African countries indicate a need for better approaches to enhance EBNP. One of these approaches is strengthening nursing education through EBNP education. Objectives The purpose of this paper is to provide strategies to African novice nurse educators to teach EBNP, with the ultimate goal of promoting it in clinical settings when the student nurses enter professional practice. Methods This is a discussion paper based on the results of a systematic review. Results In this paper, the authors create an understanding of EBNP, describe the state of nursing education in Africa, and propose the EBNP content to be taught as well as how to teach it. Conclusions Emphasis is on educational strategies that create student engagement, promote critical thinking, unite clinical and classroom settings, and are cost-effective within the context of Africa.

Conceptualizing the Role of a Strategist for Outreach and Indigenous Engagement to Lead Recruitment and Retention of Indigenous Students.

A number of universities have introduced Indigenous student-specific programming to improve recruitment. These programs target the needs of Indigenous students and often impart a sense of comfort or belonging that may be more difficult to obtain in a mainstream program. The University of Saskatchewan, College of Nursing, implemented a Learn Where You Live delivery model that challenged the university community to think differently about outreach and engagement. This is best described by redefining distance such that student services and supports would no longer be localized to a main campus but redesigned for distribution across the province. Sustaining this model meant the College leadership had to find new ways to support faculty to engage in teaching and learning opportunities that would be context relevant and aid student recruitment and retention. The new position of Strategist for Outreach and Indigenous Engagement was created to lead opportunities for faculty and staff to gain knowledge and expertise in policy development, negotiation and implementation for success in the distributed delivery model. The framework of Two-Eyed Seeing was adapted to guide the introduction and ongoing implementation (Bartlett et al. 2012).

Reshaping Policies to Achieve a Strategic Plan for Indigenous Engagement in Nursing Education.

Canadian universities are developing strategies to address the Truth and Reconciliation Commission (TRC) Calls to Action. There has been much attention paid to the positivist, individualistic and Eurocentric foundations of nursing and its educational curricula, but limited focus on assessing organizational structures or engaging with stakeholders. Without both approaches, the success of new initiatives may be limited. The College of Nursing at the University of Saskatchewan implemented a "Learn Where You Live" model that demonstrated a sense of place by providing access and opportunity in rural, remote and northern regions of the province. Key to this initiative was the creation of the position of Strategist for Outreach and Indigenous Engagement, whose role it is to develop strategic initiatives designed to interpret and influence socio-political and policy-level system changes. This paper shares how adding a political scientist to nursing education created an interprofessional team by introducing new ways of thinking and being that have cultural relevance and understanding for a sustainable future.

The research relationship in narrative enquiry.

Background Many nurse researchers have embraced narrative methods because of the power of the stories they produce. Narrative enquiry relies on stories for data. Stories are the tools with which people build a sense of their experience of the world and the vehicle by which they share that sense with others. In narrative research, it is essential to follow themes beyond individual stories through to analysis at the social level. The researcher must understand the significance of the narrative for others and for society. Narrative lends itself particularly well to studies of changes in a society and societal groups. Aim To define and describe approaches to narrative enquiry, address their uses and usefulness, and identify potential issues. Discussion Narrative methods require the development of trust. Researchers and participants must understand their roles as well as the processes and intent of the research. While narrative approaches provide powerful stories through which issues can be understood, they must be approached with careful consideration of the power imbalance in the relationship, the vulnerability of the participant and the potential misuse of empathy in influencing outcomes. Conclusion Narrative enquiry provides powerful data to answer important research questions meaningfully. Researchers using narrative enquiry must be mindful of the power of the bond formed in the sharing of stories and not encourage participants to share more than they intend. Implications for practice Nurse researchers need to understand their role as researcher in their relationships with participants and view the powerful stories they are told as a way of answering research questions, not as a call to engage therapeutically to solve problems.

Qualities of exemplary nurse leaders: perspectives of frontline nurses.

AIM:  This paper reports on a study that looked at the characteristics of exemplary nurse leaders in times of change from the perspective of frontline nurses. BACKGROUND:  Large-scale changes in the health care system and their associated challenges have highlighted the need for strong leadership at the front line. METHODS:  In-depth personal interviews with open-ended questions were the primary means of data collection. The study identified and explored six frontline nurses' perceptions of the qualities of nursing leaders through qualitative content analysis. This study was validated by results from the current literature. RESULTS:  The frontline nurses described several common characteristics of exemplary nurse leaders, including: a passion for nursing; a sense of optimism; the ability to form personal connections with their staff; excellent role modelling and mentorship; and the ability to manage crisis while guided by a set of moral principles. All of these characteristics pervade the current literature regarding frontline nurses' perspectives on nurse leaders. CONCLUSION:  This study identified characteristics of nurse leaders that allowed them to effectively assist and support frontline nurses in the clinical setting. IMPLICATIONS FOR NURSING MANAGEMENT:  The findings are of significance to leaders in the health care system and in the nursing profession who are in a position to foster development of leaders to mentor and encourage frontline nurses.

The meanings older adolescents attach to spirituality.

PURPOSE: The purpose of this study was to explore the details of the experiences and meanings that adolescents associate with spirituality. DESIGN AND METHODS: This exploratory qualitative study used focus group discussions to uncover the experiences of 22 adolescents ages 16-19 years from two midwestern Canadian high schools. RESULTS: Three themes emerged: understandings of spirituality, the influence of spirituality on wellness, and the moderating influences of spirituality. PRACTICE IMPLICATIONS: The unique stories and experiences of this study's participants provide nurses with some possible starting points and ideas for dialogue related to spirituality with their adolescent clients.

Exploring adolescent views of body image: the influence of media.

The purpose of this article is to present findings from two parallel qualitative studies that used focus groups to explore adolescent views of psychological wellness and healthy bodies. Nine focus groups were held with 46 adolescents aged 16-19 years from two Mid-Western Canadian high schools. Both studies were designed with an interpretive humanist perspective and then a 6-step thematic approach was used to analyze the data. Common themes emerging in the focus group discussions in both studies included the negative impact of media on adolescent body image and pressure to conform to the Western views of physical appearance. These findings illustrate the need for nurses to understand the influence of the media on adolescents' views of their body image and to incorporate protocols for assessment, education, and counseling of adolescents on the healthy usage of media into their pediatric clinical practice. Through consistent participation in the development and implementation of health policies, nurses play a critical role in supporting adolescents to develop healthy views of body image.