Impact of Evidence-Based Charge Nurse Education on Charge Nurse Skills and Nurse-Specific Metrics.

OBJECTIVE: This research study was designed to analyze the impact of an evidence-based charge nurse (CN) education program on novice and experienced CNs' self-confidence and satisfaction with the role, skill competencies, and nursing metrics. BACKGROUND: Charge nurses are critical to effective daily unit operations. However, executive nursing leadership found that unit performance varied by CN despite experience. METHODS: University faculty partnering with nurse leaders developed an evidence-based CN education program including a series of classes, coaching in skills and role responsibilities by nurse leaders, and evaluation of skills competencies before and after the CN education program. RESULTS: The CN program was associated with significant positive changes in CN performance, nurse-specific metrics, hospital-acquired events, and patient satisfaction. CONCLUSIONS: Interventions targeting frontline leaders positively impact CN performance.

Relationship of Nurse-Led Education Interventions to Liver Transplant Early Readmission.

INTRODUCTION: Early hospital readmission following liver transplantation is associated with lower survival and worse long-term graft function. Language, cultural practices, and health literacy influence patient understanding of posttransplant care education. Complex medication regimes, changes in metabolism and nutrition absorption, and infection/rejection further complicate the prevention of readmission. PURPOSE: The purpose of this study was to compare the 30-day readmissions of single-organ liver transplant recipients for 1-year prior and 1-year following the implementation of nurse-led education. The study examined the demographics, clinical characteristics, and 30-day readmissions of 35 liver transplant recipients who participated in the newly designed nurse-led education and 51 liver transplant recipients who experienced the prior post-liver transplant education. DESIGN: A single-center, correlational study with a convenience sample was conducted at a Hispanic-serving South Texas hospital. The new education intervention maintained the standard education and added twice-daily mutual patient-focused goal setting between the nurse and the recipient that aligned with readiness for discharge activities/goals, structured education using abbreviated handouts written at a second-grade level available in both English and Spanish, and the use of repetition through multimodal methods. RESULTS: The odds for 30-day readmissions the year prior to the nurse-led patient education intervention were 2.088 times greater than the year following the implementation. Thirty-day readmissions were reduced by 16.3% from the 2017 cohort to the 2018 cohort. DISCUSSION: Understanding unique risk factors facilitates structured patient education which can be individualized to the patient and caregiver including collaborative nurse-patient goals.

Human Trafficking Victim Identification, Assessment, and Intervention Strategies in South Texas Emergency Departments.

INTRODUCTION: Human-trafficking victims seek assistance for health issues in emergency departments. This point of contact provides an opportunity for screening and identification of the victim's situation, enabling intervention. METHODS: This descriptive research study was designed to identify whether a standard protocol is currently used to identify, assess, and intervene for human-trafficking victims in 47 south Texas counties. ED leaders were surveyed using a sequential set of strategies including online, e-mail, and/or phone surveys to identify the methods used in emergency departments screening for adult and child human-trafficking victims. RESULTS: Researchers surveyed 99 emergency departments in south Texas, which includes 21 counties bordering Mexico. Twenty-seven ED leaders responded (27.3%). Despite being located in an area with high rates of human trafficking, these leaders stated that few trafficking victims were identified in 2017. Eleven (40.7%) of the responding emergency departments specifically screened adults for human trafficking, and 10 (37.0%) specifically screened children for human trafficking. A variety of methods were used by each of these emergency departments to identify human-trafficking victims. DISCUSSION: The failure to recognize human-trafficking victims prevents assessment of the victim's status and further delays referral to appropriate resources. Barriers to screening for human trafficking included lack of awareness of the human-trafficking experience, need for clinical education related to evidence-based protocols, and need for validated screening instruments and standardization of processes that promote action and provide victim assistance.

Building a Practice-Focused Academic-Practice Partnership.

A practice-focused academic-practice partnership merging the strengths and resources of 2 faith-based community organizations built evidence-based practice, nursing research, and innovative nursing programs. The unique partnership emphasizing quality care and patient outcomes resulted in hospital-acquired infection reduction, interventional research reducing readmissions, clinical redesign, increased percentage of bachelor's degree-prepared nurses, and dissemination through publication and presentation. Key elements to partnership success were shared mission and vision, program oversight, strong contract, and annual plans with specific measurable outcomes.

Cultural and Generational Considerations in RN Retention.

OBJECTIVE: The aim of this study was to identify evolving cultural and generational factors influencing nurse retention. BACKGROUND: Multigenerational/culturally diverse workforces challenge the nurse leader's understanding of nurse satisfaction. METHODS: A survey was designed to identify the RN's career intentions, desired leadership traits, and practice environment appraisal. RESULTS: While generally satisfied with their current position, generational differences in the average number of years nurses intend to stay at their current employer exist with Millennials anticipating staying 3.03 years; Generation X, 5.83 years; and Boomers, 8.25 years. Perceived inability to meet patient needs, which varied by generation, was significantly related to nurse satisfaction (P < .01). Factors identified by the nurses that may improve retention, regardless of generation, were pay, staffing, and nursing leadership support. Preferred leader traits varied by generation and ethnicity. Hispanic nurses value hardworking, honest leaders, whereas non-Hispanic nurses value dependability. CONCLUSION: Nurse leaders must individualize efforts to retain an ethnically diverse and multigenerational nursing workforce.

Impact of Population Differences: Post-Kidney Transplant Readmissions.

Early hospital readmissions after kidney transplantation are common and considered an indicator of healthcare quality. The purpose of this study was to identify and describe the risk factors for and causes of 30-day readmission post-kidney transplant for adults in a predominantly Hispanic Southern Texas population in comparison to the United States kidney transplant population and published research. A single-center, descriptive, retrospective study of adult kidney transplant recipients readmitted to a hospital in southern Texas was conducted. Results indicated that this population had lower education levels, a greater percentage of Spanish-speaking patients, and a high number of patients with either or both diabetes mellitus and hypertension, necessitating the development of additional methods of increasing understanding and adherence to restrictions, requirements, and medication regimes.

Improving Vaccination Rates in Adults With Type 2 Diabetes in a Family Practice Setting Through the Use of Evidence-Based Interventions.

BACKGROUND: Adults with diabetes are at increased susceptibility to infectious disease because of hyperglycemia, poor glucose control, and decreased immunity. Diabetes is the seventh leading cause of death in Texas and the United States. OBJECTIVE: The purpose of this evidence-based quality improvement project was to implement processes to facilitate providers' adherence to immunization guidelines for adults with type 2 diabetes mellitus. METHOD: A protocol was created for a family practice clinic using the Four Pillars Transformation Program. Interventions included immunization standing orders, vaccine needs screening, patient education, electronic medical record alerts, an appointed immunization champion, and quality improvement meetings. RESULTS: Ten weeks post project implementation, the increased screening and education resulted in 64% of the eligible patients being vaccinated with pneumococcal polysaccharide vaccine 23, 86% pneumococcal conjugate vaccine, 89% tetanus, and 54% herpes zoster. CONCLUSIONS: The results indicate that formal printed education on diabetes and vaccines increased vaccine uptake in eligible patients by 76%. IMPLICATIONS FOR NURSING: The Four Pillars Transformation Program allows each practice the ability to modify and select interventions best suited to the practice needs, making it a feasible tool for any clinic.

An initiative to improve primary prevention of cardiovascular disease in adults with type II diabetes based on the ACC/AHA (2013) and ADA (2016) guidelines.

PURPOSE: This project was designed to increase family practice clinicians' adherence to the American College of Cardiology/American Heart Association (2013) and American Diabetes Association (ADA, 2016) clinical practice guidelines for the prevention of cardiovascular disease (CVD) in 40- to 75-year-old adults with type II diabetes (DMII) through interactive education, an electronic alert, and quality improvement sessions on the treatment and management of cholesterol in a family practice primary care setting. DATA SOURCES: A pre- and postretrospective chart review of 159 charts from a family practice clinic was conducted. Included in the chart review were 40- to 75-year-olds with a diagnosis of DMII. CONCLUSIONS: Three outcomes were analyzed. Assessment of Atherosclerotic Cardiovascular Disease risk score increased from 0% to 76.7% (X2 (1, 159) = 93.46, p < .001), diet and exercise counseling documentation increased from 85% to 100%, and statin therapy application increased from 55.1% to 72.2% (X2 (1, 159) = 11.55, p = .003) in eligible adults 40-75 years-old with DMII. IMPLICATIONS FOR PRACTICE: This initiative helps to build the body of evidence regarding useful interventions to improve primary prevention of CVD by improving clinician adherence to the clinical care guidelines for 40- to 75-year-old adults with DMII.

Mock Institutional Review Board: Promoting Analytical and Reasoning Skills in Research Ethics.

Although it is critical that nurses possess ethical reasoning skills for research, there is limited information on effective strategies to develop these skills in graduate health care students. A research study analyzing educational interventions including the effect of online human subjects training followed by a mock institutional review board simulation demonstrated that knowledge acquisition is not enough to acquire the ethical reasoning skills needed to implement health care research. Situational context is also needed to envision the application of ethical principles.

Developing Policies and Protocols in the Age of Evidence-Based Practice.

Prior to evidence-based practice, policies and procedures were reviewed annually or even triennially to ensure that they reflected current practice and demonstrated adherence to regulatory standards. With the publication of the Institute of Medicine report, a shift to operationalization of best evidence practices, formal statements, and frameworks for care has gained increased importance. Processes for policy and protocol development and revision are now based on the inclusion of best evidence, clinician expertise, and patient values or preference. Policies and protocols are now updated when new evidence justifies a revision and are designed to share the most recent evidence and facilitate staff adherence to new practices. This article describes the essential practices for policy and protocol development, including leadership support, team commitment, identification of current resources, recognition of current practices, development of the policy and protocol to logically flow with nursing practices, effective dissemination methods, and evaluation and sustainability practices. J Contin Nurs Educ. 2017;48(2):87-92.

The DNP project: Quandaries for nursing scholars.

BACKGROUND: In the evolving Doctor of Nursing Practice (DNP) movement, there continues to be a lack of agreement about the final scholarly project. PURPOSE: This study identifies and describes the faculty practices and challenges related to the DNP project across the United States. METHODS: In a descriptive research study, 90 DNP program directors responded to an online survey describing the environment of the DNP program with emphasis on the final scholarly project. DISCUSSION: According to the respondents, 87% of faculty are somewhat or very dissatisfied with the DNP project. Elements that may contribute to the dissatisfaction are the reported lack of faculty knowledge of evidence-based practice and quality improvement, lack of consensus on the DNP project, lack of faculty resources for DNP projects, challenges with clinical sites for the DNP project, and students' scholarly writing skills. CONCLUSION: It is imperative to have academic/practice faculty oriented to DNP concepts; achieve consensus on the project title, type, depth, and outcomes; and have an ongoing dialog regarding DNP project design, execution, and challenges. Project implementation models need to be appropriate for the escalating DNP enrollment. Program support related to institutional review board relationships, student writing and statistical skills, and program-practice site partnerships are needed.

A Unique Approach to Dissemination of Evidence-Based Protocols: A Successful CAUTI Reduction Pilot.

A unique approach to disseminate an evidence-based protocol for urinary catheter management was led by a staff-driven catheter-associated urinary tract infection (CAUTI) reduction team in one hospital. The nurseeducators, faculty from a local university, and the facility's clinical nurse leader mentored the team. As an approachto reduce CAUTIs in the transplant care and intensive care units, the team developed an interdisciplinary CAUTIEducation Fair, which provided a safe, nonthreateningenvironment to unlearn prior behaviors and showcompetency in new evidence-based ones.

Leading and managing an intergenerational workforce.

Focus group discussions with four generations of staff nurses identified five themes that participants believed must be addressed in order to make the current work environment a desirable place to conduct their careers as nurses. These themes are: transitioning from student to nurse, managing difficult staffing conditions, maintaining morale, dealing with safety matters, and building relationships that enhance teamwork. Manager challenges are discussed in relation to each theme and suggested leadership strategies are offered.

Retention priorities for the intergenerational nurse workforce.

TOPIC: Retention of senior, Gen-X, and Millennial nurses is influenced by manager interactions and efforts to create a satisfying work experience. PURPOSE: The purpose of this project was a generational assessment of job satisfaction, work environment, and desired characteristics of managers in an effort to improve nurse retention. SAMPLE AND METHODS: Data from staff nurses at 22 southern hospitals collected by online survey included measures of job satisfaction and perceptions of safety, the Nurse Manager Desired Traits survey, and the Nursing Work Index-Revised. FINDINGS: The satisfaction with work environment scores for the whole group (n = 1,773) were high. Subscale scores showed highest satisfaction with nurse/physician relationships; lowest was nurse control of practice. A specific satisfaction question showed the younger nurses were less satisfied than those over age 40. Nurse safety concerns were expressed by 40% of the sample. One third of Millennial nurses plan to leave their job within the next 2 years. Over two thirds plan to be gone within the next 5 years. Especially alarming is the fact that 61% of the nurse group stated they plan to leave their current jobs within 10 years. RECOMMENDATIONS: (a) Create model managers; (b) empower staff nurse councils; (c) stabilize staffing; (d) revamp incentives; and (e) focus on safety.

What nurses want: the nurse incentives project.

Today's nurse executives are struggling with leadership challenges of managing the multigenerational workforce, financial imperatives to deliver better care for lower costs, and competition to provide the optimal work environment to retain nurses. The purpose of the Nurse Incentives Project was to determine satisfaction with current employment incentives and potential managerial actions which might decrease or delay turnover by registered nurses. This study spawned recommendations regarding the role of incentives in designing an environment where benefits and perks will be seen as incentives to stay and thrive in the current nursing workplace. The results show that nurses know what they want. Attention to generational priorities and flexible benefits programs may help to create the cohesive work environment that nurses seek. Investment into creating delivery arenas where satisfied nurses are caring for satisfied patients is a worthwhile goal.