Quality measures essential to the transformation of the Veterans Health Administration: implications for nurses as co-creators of change.

Health care systems are changing at an unprecedented rate, but few are making the changes in a system affecting nearly 200,000 staff in over 1,100 different sites of service delivery originating from 171 medical centers nationwide, as is the Veterans Health Administration. The issues of change, quality of care, morale and opportunities involved in being a nurse today in a system undergoing this magnitude of change is presented within the framework of the quality of care initiatives that have been launched by VA. The new organization design of VA, emphasizing local decision-making, a description of the multiple quality programs recently introduced and integrative strategies that have been used by the Nursing Strategic Healthcare Group, the VA corporate level policy and nursing programs information center for the country, to support the change process are discussed.

Nursing leaders predict top trends for 2000.

Nursing Management's Editorial Advisory Board predicts the top 10 trends that will impact nurse leaders in 2000. Use them to lead in the new millennium.

How other members of the top management team see the nurse executive.

This study compared how top-level organizational groups within Veterans Affairs Medical Center (VAMC) top management teams perceived nurse executives' participation in strategic decision making. Nurse executives' perceptions of their own involvement in strategic decision making generally agreed with the views of both chiefs of staff and directors. However, the associate director's perceptions of the nurse executive's involvement often differed significantly with those of the nurse. Nurse executives will be better prepared to function effectively within the top management team if they are aware of patterns in how they are perceived by other members.

Decision-making activity and influence of nurse executives in top management teams.

This study assesses the impact on decision-making when introducing the nurse executive into the top management team (TMT) in Veterans Affairs Medical Centers. Results indicate that nurse executives formally elevated to the TMT were no more likely to perceive greater involvement in decision-making than non-TMT nurse executives or nurses informally appointed to the TMT. However, nurse executives in all categories perceived themselves as more involved in strategic decisions than other TMT members.

Quality measures essential to the transformation of the Veterans Health Administration: implications for nurses as co-creators of change.

Health care systems are changing at an unprecedented rate, but few are making the changes in a system affecting nearly 200,000 staff in over 1,100 different sites of service delivery originating from 171 medical centers nationwide, as is the Veterans Health Administration. The issues of change, quality of care, morale and opportunities involved in being a nurse today in a system undergoing this magnitude of change is presented within the framework of the quality of care initiatives that have been launched by VA. The new organization design of VA, emphasizing local decision-making, a description of the multiple quality programs recently introduced and integrative strategies that have been used by the Nursing Strategic Healthcare Group, the VA corporate level policy and nursing programs information center for the country, to support the change process are discussed.

A national model for participative management and policy development.

This article describes the virtual application of an innovative administrative model that addresses national nursing policy issues in the Department of Veterans Affairs. Using a constituency center model of organization, nurse and interdisciplinary experts in the areas of clinical, education, administration, research and informatics are drawn from throughout the country to manage projects that meet the specifications of the national nursing service strategic plan. The impetus for the development of the model, examples products developed and areas of interest explored to date, and an evaluation of the first 18 months of experience are discussed.

A collaborative approach to clinical standards development. Psychiatry and psychiatric nursing in a changing world.

Today's consumers, faced with limited resources, want documented proof of the quality of a product or service. This shift to consumerism has caused health care providers and institutions to carefully examine their practice and move toward the establishment of standards of care in all areas. The authors are recommending a collaborative approach between standards and are advocating the use of the Marker Model as a system to define, organize, integrate, document, and monitor standards in the fields of psychiatry and psychiatric nursing.

Narcotic antagonists. Treatment tool for addiction.

Narcotic antagonists have recently gained attention through research aimed at evaluating both biochemical effects and treatment potential for opiate addiction. Narcotic antagonists are a classification of drugs which block the euphoric (and all other) effects of opiates. Naltrexone is the most promising narcotic antagonist based on ability to produce blockade, length of duration, and relative absence of side effects. The narcotic antagonists offer an adjunctive or alternative method of treatment for opiate addicts based on Wikler's biobehavioral theory of conditioned abstinence. Narcotic antagonists are presently being investigated at seven research centers throughout the United States and may be available for clinical use in the future.