Collaboration Between Academia and Practice: Interprofessional Crises Leadership and Disaster Management.

An innovative interprofessional disaster preparedness program was designed and implemented through an academic-practice partnership between a large midwestern children's hospital and a community-based state university. This course was part of a constellation of courses developed in response to Presidential Directive (HSPD) 8, a mandate to standardize disaster response training that was issued after the inefficiencies following Hurricane Katrina. A hybrid immersive and didactic approach was used to train senior leadership and frontline clinicians. Included were simulated experiences at the National Center for Medical Readiness, a workshop, and online modules. The program that focused on crisis leadership and disaster management was developed and implemented to serve patient-centered organizations.

A Nurse Transitional Home Visit Following Pediatric Hospitalizations.

By incorporating focused feedback from families and other stakeholders a multidisciplinary team redesigned a single nurse home visit to improve transitions to home for pediatric patients following short-stay, acute care hospitalizations. Refinements to the nurse-led transitional home visit included standardization of teaching focused on condition- and medication-specific concerns, the use of red flags or warning signs to prompt caregiver action, and the provision of reassurance.

Noise Exposure on Pediatric Inpatient Units.

BACKGROUND: Noise is a problem placing registered nurses (RNs) at risk for safety events, decreased job performance, fatigue, irritability, and hearing loss. OBJECTIVE: The purpose of this study is to measure noise levels and sources on pediatric inpatient units as well as to explore the health impact of noise on RNs. METHODS: This was a descriptive nonexperimental study with 65 pediatric RNs from 14 units. Noise (levels, source, location, and activity), heart rate (HR), and stress were measured. Correlations between sound pressure levels (SPLs), HR, and stress were examined. RESULTS: Mean (SD) SPLs were 75.8 (8.9) dBA and were significantly higher than SPLs for patients. Noise was significantly associated with HR but not with time in tachycardia or stress. Primary sources of noise were employee conversations in patient rooms. CONCLUSIONS: On all units, SPLs exceeded protection agency guidelines. Cost-prohibitive structural changes underscore the importance of using behavioral and culture modification to reduce noise.

Excellence and evidence in staffing: a data-driven model for excellence in staffing (2nd edition).

The Patient Protection and Affordable Care Act (PPACA, 2010) and the Institute of Medicine's (IOM, 2011) Future of Nursing report have prompted changes in the U.S. health care system. This has also stimulated a new direction of thinking for the profession of nursing. New payment and priority structures, where value is placed ahead of volume in care, will start to define our health system in new and unknown ways for years. One thing we all know for sure: we cannot afford the same inefficient models and systems of care of yesterday any longer. The Data-Driven Model for Excellence in Staffing was created as the organizing framework to lead the development of best practices for nurse staffing across the continuum through research and innovation. Regardless of the setting, nurses must integrate multiple concepts with the value of professional nursing to create new care and staffing models. Traditional models demonstrate that nurses are a commodity. If the profession is to make any significant changes in nurse staffing, it is through the articulation of the value of our professional practice within the overall health care environment. This position paper is organized around the concepts from the Data-Driven Model for Excellence in Staffing. The main concepts are: Core Concept 1: Users and Patients of Health Care, Core Concept 2: Providers of Health Care, Core Concept 3: Environment of Care, Core Concept 4: Delivery of Care, Core Concept 5: Quality, Safety, and Outcomes of Care. This position paper provides a comprehensive view of those concepts and components, why those concepts and components are important in this new era of nurse staffing, and a 3-year challenge that will push the nursing profession forward in all settings across the care continuum. There are decades of research supporting various changes to nurse staffing. Yet little has been done to move that research into practice and operations. While the primary goal of this position paper is to generate research and innovative thinking about nurse staffing across all health care settings, a second goal is to stimulate additional publications. This includes a goal of at least 20 articles in Nursing Economic$ on best practices in staffing and care models from across the continuum over the next 3 years.

TERN Residency Program: transitioning the experienced registered nurse.

One pediatric hospital addressed the challenges of registered nurses (RNs) transitioning to new roles by developing a year-long residency for experienced RNs, whether newly hired or transitioning to another role within the hospital. The evidence-based program's goal is for the participant to demonstrate effective decision-making skills, applying principles into his or her practice at the point of care. Objectives of the program are measured using pre/post tool and through the use of reflective journaling. The article provides a framework to develop an experienced RN residency program that supports transition from competent to proficient in a new work environment.

"On the scene": Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.

Cincinnati Children's Hospital Medical Center is transforming the way it cares for its patients by building a sophisticated model that focuses on accountable care across the continuum. As nurses from different parts of the organization, we act as change agents to develop an integrated structure built around the patient's needs, from prevention to self-management. We demonstrate how organizational structure, fluid staffing, professional practice, and healthy behaviors operationally catalyze the continuum of care, and how we utilize self-management, community-based programs, and care integration to change the outcome for our patients and families. While care coordination is taking on many forms in medical centers around the world, Cincinnati Children's is proud and passionate about sharing its best practices along the way.

The frontline clinical manager identifying direct reports' level of practice.

Patricia Benner applied the Dreyfus Model of Skill Acquisition to describe and interpret skill acquisition and clinical judgment in nursing practice. Operational definitions for the 5 levels of her original Novice to Expert Theory were used by the study participants in a large Midwestern pediatric hospital to self-identify their level of practice. The frontline clinical managers of these direct care registered nurses (RNs) used the same tool to rate their direct reports. The aim of this portion of a larger study was to determine if the clinical manager's perception of their direct reports was the same as that of the RNs. The results of this study are being used by one study unit's clinical managers as the basis for implementing the Hersey and Blanchard Situational Leadership Model. The clinical managers work with their direct reports depending on the level of practice and the details of the task to be performed. One example is creating therapeutic relationships with each other and with families to ensure a safe environment for all.

Enhancing shared governance for interdisciplinary practice.

Cincinnati Children's Hospital Medical Center has a strong history of embracing staff empowerment and shared decision making. Shared governance for nursing was implemented in 1989; a separate allied health structure was created in 1999. The two operated in parallel with few occasions for interface, and with little collaboration. With the beginning of the medical center's efforts to pursue perfect patient care in 2002, there was a marked increase in the frequency of interprofessional initiatives and collaborations in the organization. By 2005, this increase in collaborative practice precipitated discussions questioning the purpose and efficiency of two separate structures. Over the next two years, planning ensued to merge these structures to better reflect the current interprofessional reality. The enhanced shared governance structure at Cincinnati Children's was launched in 2008. Each discipline now governs its own practice, but as patient care issues overlap, there is a structure in place to resolve patient issues that cross disciplines. The new Patient Care Governance Council includes physician and family representatives.

The impact of dedicated medication nurses on the medication administration error rate: a randomized controlled trial.

BACKGROUND: Concerns about hospital medication safety mount as the pace of new drug releases accelerates. METHODS: We performed a randomized study at 2 hospitals (A and B) to examine whether the medication administration error rate could be decreased by having "dedicated" nurses focus exclusively on administering drugs. "Medication nurses," after receiving a brief review course on safe medication use, were responsible solely for drug delivery for up to 18 patients each. "General nurses," who did not attend the course, provided comprehensive care, including drug delivery, for 6 patients each. A direct observation technique was used to record drug errors, process-variation errors, and total errors. RESULTS: At both hospitals combined, the total error rate was 15.7% for medication nurses and 14.9% for general nurses (P<.84). Comparing hospitals, the total error rate for medication nurses at hospital B was significantly higher than it was at hospital A (19.7% vs 11.2%; P<.04). At hospital A, there was a significantly lower error rate for medication nurses than for general nurses in the surgical units (P<.01) but no significant differences in total errors comparing nurse types in the medical units (P<.77). CONCLUSIONS: This trial suggests that use of dedicated medication nurses does not reduce medication error rates. However, subgroup analysis indicates that medication nurses might be useful in some settings. The differences in findings at the 2 hospitals and their differences in medication-use processes reinforce the concept that medication errors are usually related to systems design issues.