A Culture of Inquiry: Practice-Based Knowledge for Nurse Leaders.

A culture of inquiry has not traditionally been associated with nursing leadership. As healthcare evolves, leaders must reevaluate barriers to improving healthcare outcomes. One noted barrier has been a need for more inquisitiveness to innovate. Through an American Organization for Nursing Leadership workgroup, the authors advanced the understanding of a "culture of inquiry," applying a practice-based learning approach for knowledge development. Three recommended foundational elements are psychological safety, building connections, and using design thinking at all organizational levels.

Perceptions of US nurses and nurse leaders on authentic nurse leadership, healthy work environment, intent to leave and nurse well-being during a second pandemic year: A cross sectional study.

AIM: The main aim of this study was to determine the perceptions of clinical nurses and nurse leaders about authentic nurse leadership, work environment, pandemic impact, well-being and intent to leave their position and profession during the second year of the pandemic. BACKGROUND: This research team studied the variables pre-pandemic and in year one of the pandemic. As the pandemic continued, subsequent reports of workforce instability, deteriorating work environment and vulnerable well-being called for an understanding of the current state to inform needed actions by leadership. METHODS: This study is a cross-sectional, descriptive, correlational analysis using national survey data from 1795 US clinical nurses and nurse leaders in the fall of 2021. RESULTS: Pandemic impact was high, authentic nurse leadership was present, healthy work environment was not present and nurse well-being was at-risk and negatively correlated to both healthy work environment and authentic nurse leadership. Within our sample, 61.8% of nurses had no intention to leave their positions, and 82.5% had no intention to leave the profession. Compared with clinical nurses, nurse managers had significantly higher scores on all instruments. CONCLUSIONS: The findings of this study support leadership as positively related to a healthy work environment. Authentic nurse leadership, a healthy work environment and nurse well-being are all critical components of efforts to stabilize the nursing workforce as we recover and rebuild post-pandemic. IMPLICATIONS FOR NURSING MANAGEMENT: This is a call to action for leadership that will serve the goals of retaining nurses, rebuilding work environments and improving well-being.

In the Eye of the Storm: Leadership Lessons From the Front.

New York City (NYC) was in the eye of the COVID-19 pandemic storm in the spring of 2020. Since that time, the country has seen wave after wave of outbreaks and concurrent psychosocial crises. Clinical nurses and nurse leaders delivered extraordinary care with grit, innovation, agility, and resilience. When in the eye of the storm, staff have to feel safe and have a voice even in command-control, adaptive modes. Nurses and nurse leaders have been resilient, and organizations have to play their part in decreasing work burden and creating positive work environments. Non-value-added work as well as barriers to practice should be eliminated permanently. This article describes the many challenges including intensive care unit capacity, staffing, well-being, and lack of visitation, as well as leadership lessons such as the importance of presence, based on the NYC experience of a chief nursing officer in a large academic medical center. These lessons and their implications for our workforce, for public health, and for leadership development and competencies and have taught us how to lead into the future.

Nurses' Intent to Leave their Position and the Profession During the COVID-19 Pandemic.

OBJECTIVE: The aim of this study was to describe the relationships between perceptions of the pandemic impact on clinical nurses' and nurse leaders' intent to leave their current position and the profession and the differences in pandemic impact and intent to leave variables based on background factors. BACKGROUND: There is much discussion and concern about the COVID-19 pandemic impact on nurses' health and the nursing workforce. METHODS: More than 5000 nurses from a national sample participated in a cross-sectional, descriptive study. Participants rated their perceptions of the pandemic impact on their practice and their intent to leave their position and profession. RESULTS: Pandemic impact was rated high overall and was highest in nurses with 25+ years of experience and in managers/directors. Eleven percent of the total sample indicated they intended to leave their position, and 20% were undecided. Nurses who rated pandemic impact at the highest level had higher intent to leave their position. Of the respondents, less than 2% indicated they were leaving the nursing profession, whereas 8% were undecided. CONCLUSIONS: This is the 1st quantitative report of perceived level of pandemic impact on direct care nurses and nurse managers/directors at the time of this writing. The combination of those who intend to leave and those who are uncertain about leaving their positions could cause instability in the workforce if not reversed. Organizational attention to nurse well-being, work environment and staffing is imperative.

Perceptions of Authentic Nurse Leadership and Work Environment and the Pandemic Impact for Nurse Leaders and Clinical Nurses.

OBJECTIVE: The aim of this study was to determine the pandemic impact on the relationship between nurses' perception of the authentic nurse leadership (ANL) of their manager and their perception of the work environment. BACKGROUND: Both ANL and healthy work environment (HWE) contribute to staff and patient outcomes. Our 1st study of these 2 variables revealed a positive relationship. Will this be upheld in a pandemic year? METHODS: More than 5000 nurses from a national sample participated in a cross-sectional, correlational, descriptive study using the Authentic Nurse Leadership Questionnaire, the Critical Elements of a Healthy Work Environment Scale, and a pandemic impact on practice question. RESULTS: Overall, nurses perceived ANL and HWE were present despite a high level of pandemic impact; however, when clinical nurses were separated from managers/directors, HWE was not present for frontline nurses. The moderate correlation of ANL and HWE was replicated in this larger study. CONCLUSIONS: This is the 2nd study of the positive relationship between ANL and HWE using these models, supporting ANL as an essential standard of a HWE. ANL was present for clinical nurses in a pandemic year signaling that nurse leaders rose to meet frontline leadership needs. HWE was present overall, but not for clinical nurses. Leadership is essential to work environments and outcomes especially in times of crisis and significant change.

Clinical Nurses' Perceptions of Authentic Nurse Leadership and Healthy Work Environment.

OBJECTIVE: The aim of this study was to determine the relationship between clinical nurses' perception of the authentic nurse leadership of their manager and their perception of the work environment on their unit. BACKGROUND: Authentic leadership (AL) and healthy work environments contribute to staff engagement and improved patient outcomes. There is limited research linking these 2 variables. METHODS: Two hundred fifty-four clinical nurses at a national conference participated in a cross-sectional, correlational, descriptive study using the Authentic Nurse Leadership Questionnaire and the Critical Elements of a Healthy Work Environment Survey. RESULTS: Overall, nurses rated the authentic nurse leadership of their manager as present most of the time and agreed their work environment was healthy. There was a moderate correlation between AL and healthy work environment. Background variables were not significantly related to nurses' perceptions of the authentic nurse leadership of their manager or their work environment. CONCLUSIONS: This is the 1st study using these authentic nurse leadership and healthy work environment frameworks. In this novel nursing model of AL, caring is an attribute that was valued by frontline nurses. This is a call to action for leadership development at every level using AL principles and for the improvement of lagging domains in nursing work environments, both critically needed during challenging healthcare times and for the ultimate purpose of improving patient and workforce outcomes.

Impact of Hearing Loss on Patient Falls in the Inpatient Setting.

INTRODUCTION: The objectives of this study were to investigate an association between the risk of patient falls and self-reported hearing loss and to examine whether self-reported hearing loss with versus without hearing aids predicts patient falls in an inpatient setting. METHODS: This retrospective cohort analysis was conducted in 2018 in a large, urban, academic medical center. Participants included unique inpatients (N=52,805) of adults aged >18 years between February 1, 2017, and February 1, 2018. Outcome measures were falls in the inpatient setting and hearing loss with versus without hearing aids as predictors for patient falls. RESULTS: Self-reported hearing loss was associated with falls in the inpatient setting (OR=1.74, 95% CI=1.46, 2.07, p<1.43 × 10-9). Among patients with hearing impairment, a lack of hearing aids increased the risk for falls in the inpatient setting (OR=2.70, 95% CI=1.64, 4.69, p<1.41 × 10-5). After accounting for the risk of fall using the Morse Fall Scale (which does not include hearing impairment) and controlling for age and sex, patients with hearing loss and no hearing aids were significantly more likely to fall (OR=2.44, 95% CI=1.002, 5.654, p<0.042), but patients with hearing loss who did have hearing aids were not significantly more likely to fall (p<0.889). Hearing loss together with the Morse Fall Scale better predicted falls than the Morse Fall Scale alone (p<0.017). CONCLUSIONS: In the inpatient setting, there was a positive association between hearing loss and falls. However, among patients with hearing loss, only those without hearing aids were significantly more likely to fall, accounting for the Morse Fall Scale score and demographics characteristics. These findings support adding hearing loss as a modifiable risk factor in risk assessment tools for falls and exploring the use of amplification devices as an intervention.