Using Structural Empowerment to Improve Outcomes.

In the changing healthcare climate, a robust continuous professional development program is critical to ensure excellent patient care and the best outcomes. It is essential for educators and leaders to understand the factors that enhance the impact of continuous professional development. Organizational leadership must support successful education programs and the ability to provide educational activities. In this month's Magnet® Perspectives, we will review how the Institute of Medicine and Quadruple Aim framework can support structural empowerment through continuous professional development to improve outcomes.

The Role of Nurse Leaders in the Well-being of Clinicians.

This column reviews the concept of humanism in leadership. After surviving a year perceived by many healthcare professionals as the most challenging of a generation, the author reflects on leadership essentials for rebuilding our nursing workforce.

Reflecting on two distinct leadership roles during the pandemic.

ABSTRACT: For more than a year, the COVID-19 pandemic has caused unprecedented stress, anxiety, sadness, and fear, but it has also allowed people to reflect, learn, self-improve, and change. In this article, the author demonstrates how reflective practice enabled her to improve in two distinctly different leadership roles.

Developing Effective Senior Nurse Leaders: The Impact of an Advanced Leadership Initiative.

OBJECTIVE: The aim of this study was to measure structural empowerment (SE) and capture short-term changes in perception for senior nurse leaders before and after a formal development experience. BACKGROUND: The body of literature related to SE in senior nurse leaders is limited. Applying the SE concept to senior levels of nursing leadership provides a vehicle to impact nurse leader retention and ultimately the organization beyond singular units. METHODS: The Advanced Leadership Program (ALP) was designed in collaboration with the American Nurses Association to support personal and professional development for senior nurse leaders. The sample included 28 participants from the United States and the United Kingdom over a 6-month period. RESULTS: The effect of the intervention was seen in the postintervention survey rating SE higher in 5 of 7 domains as compared with the preintervention survey, reduction in overall turnover, and improvements in patient experience scores. Additionally, the participants evaluated the program in top categories, and comments were highly positive around peer support, improved working relationships, and expectations. CONCLUSION: The ALP has shown promise in strengthening SE for senior nurse leaders by supporting leadership skill development, follow-up training, and peer network development.

[Effective interventions enacted by Nurse Managers in daily practice to prevent and/or minimize the missed nursing care: ?ndings from an Italian qualitative study]. / Interventi attuati da infermieri con ruoli manageriali nella pratica quotidiana per prevenire e minimizzare le Missed Nursing Care: risultati di uno studio qualitativo italiano.

INTRODUCTION: Missed Nursing Care is widely recognized as affecting patient safety and healthcare outcomes. Theoretical frameworks, antecedents and consequences have been extensively studied while interventions aimed at preventing the Missed Nursing Care remain little investigated to date. Nurse Managers and Nurse Directors play a main role in promoting interventions at the unit, hospital and at the policy levels. However, few evidences are available to date, thus limiting an evidence-based approach. The aim of this study was to emerge interventions used on a daily basis by Nurse Managers and Directors to prevent and/or minimize Missed Nursing Care. METHODS: A qualitative descriptive study design based upon a positive deviance approach was adopted. Twelve Nurse Managers and Nurse Directors were purposefully selected, working at Hospital, Healthcare Trust or Nursing Home levels, in Italy. Participants were interviewed in two focus group sessions. A thematic analysis of the audio-recorded interviews was performed by two researchers. RESULTS: The following interventions have been reported as effective in preventing and/or minimizing the Missed Nursing Care: (a) Expanding the nursing care capacity; (b) Ensuring the standard of care and an early detection of failures; (c) Monitoring the processes of care; (d) Promoting a shared decision-making; (e) Redesigning the layout of the hospital systems; (f) Promoting a culture towards the Missed Nursing Care prevention, and (g) Realigning the nurse management to the care of patients. DISCUSSION: Several interventions based mainly on process dimension and with preventive intents are daily enacted by Nurse Managers and Directors to prevent and/or minimize Missed Nursing Care. Measuring the effect of these interventions through rigorous studies could help in expanding the evidence available to contrast a phenomenon that threatens patient safety.

Efforts to reduce the length of stay in a low-intensity ICU: Changes in the ICU brought about by collaboration between Certified Nurse Specialists as head nurses and intensivists.

Certified Nurse Specialists (CNS) are advanced practice nurses that often play a role in management. This study aims to investigate whether cooperation between CNSs in the position of Intensive Care Unit (ICU) head nurse and intensivists change the length of stay for ICU patients. A single centered retrospective cohort study design was followed. A multivariable regression analysis was performed to determine whether there is a difference in patients' length of ICU stay for two years before and after CNS as ICU head nurse and an intensivist started collaborating. The patients' diagnosis, age, gender, scheduled/emergency admission, surgical history, length of ICU stay, usage of ventilator, and details of ICU treatment were collected from the institution's electronic medical records. During the study period (April 2015 to March 2019), 3,135 patients were admitted to ICU, with 1,471 in the before collaboration group and 1,664 in the after-collaboration group. Collaboration between the CNS as head nurse and intensivists was significantly associated with shorter length of ICU stay (coefficient -0.03 [95% CI, -0.05-0.01], p < 0.001, t-statistic -3.29). Our main finding illustrates that in low-intensity ICUs, collaboration between CNSs as head nurses and intensivists may reduce patients' length of ICU stay.

Factors influencing adequate and effective clinical supervision for inpatient mental health nurses' personal and professional development: An integrative review.

WHAT IS KNOWN ON THE SUBJECT: CS was developed to give healthcare professionals a space to reflect, problem solve and recognise their own practice. It is different from managerial supervision as it is for the benefit of the individual staff member's personal and professional development firstly, but can potentially benefit the quality of care delivered by the organisation. There have been a range of problems associated with inpatient mental health nurses' engagement in CS and in experiencing the benefits of CS. This is concerning for the delivery of high quality care and the recruitment and retention of inpatient mental health nurses. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE: This paper explores and identifies factors influencing adequate and effective CS for inpatient mental health nurses' personal and professional development. It identifies 6 themes incorporating enablers and barriers for inpatient mental health nurses' CS which lead to practice recommendations for improvement. WHAT ARE THE IMPLICATIONS FOR PRACTICE: This paper advocates a needs analysis to improve access to CS for inpatient mental health nurses. This review specifically adds further knowledge relating to inpatient mental health nurses' engagement with CS which the application of the needs analysis could influence. ABSTRACT: Introduction Clinical supervision (CS) has been recognized as a reflective mechanism in inpatient mental health nursing practice; however, it remains unclear what adequate and effective supervision entails for inpatient mental health nurses. Aim To explore factors which influence adequate and effective clinical supervision for inpatient mental health nurses' personal and professional development. Method Whittemore and Knafl's model for ensuring rigour was utilized. This included stages to address problem identification, literature searching, data evaluation, data analysis and presentation. Seven electronic databases were searched with hand searching/Internet searching. Fourteen retrieved articles were selected and appraised using the Mixed Method Appraisal Tool (MMAT). The data extracted from the papers were analysed thematically. Results The review synthesis resulted in identifying six themes: (a) what makes CS effective; (b) reflection; (c) the facilitation of professional identity and knowledge through CS; (d) participation; (e) knowledge and understanding of CS; and (f) the facilitation of personal awareness and coping. Discussion This review adds further knowledge on the identification of effective CS for inpatient mental health nurses as a defined occupational healthcare group. Implications for practice A suggested needs analysis is presented to improve access to CS options with the aim of promoting effective CS and increased engagement.

The Effectiveness of Charge Nurse Training on Leadership Style and Resiliency.

OBJECTIVE: The study objective was to investigate a charge nurse pilot training program as an effective, evidence-based training modality to improve leadership style and resiliency. BACKGROUND: Leadership is inherent and necessary in the charge nurse role. Little published research about charge nurse leadership training programs exists. METHODS: A pre-post design, with intervention and comparison groups, was conducted at an integrated healthcare system. A random sample of charge nurses was selected to pilot a standardized charge nurse leadership training program including in-person learning to foster leadership skills and nurture resiliency. RESULTS: The sample included 19 control participants and 22 intervention participants. Significant improvement was noted in transformational, transactional, leadership outcomes, and resiliency from preintervention to postintervention for the all subjects. Of the 22 intervention participants, the training elicited higher satisfaction with leadership behavior, followed by effectiveness and their ability to motivate. Charge nurses who attended training had higher resiliency scores pre-post intervention. CONCLUSION: The charge nurse pilot training was an effective program that led to improved leadership style and resiliency.

Implementação de um modelo de supervisão clínica em enfermagem - modelo safecare / Implementation of a nursing clinical supervision model - SAFECARE model

The actual context, marked by the high cost of health care associated with technological advances, the increase in the workload of health professionals and the aging of the population with multiple chronic diseases. There are concerns raised by health organizations regarding the quality of care, with emphasis on actions aimed to the continuous quality improvement. The effects of clinical supervision on quality of care defined as a target area by the World Health Organization are a key aspect in improving quality. The literature shows that there is no model of nursing clinical supervision capable to respond to the actual context needs. The objective of this exploratory, descriptive and longitudinal study was to implement a contextualized nursing clinical supervision model, SafeCare model, in order to identify the contributions of its implementation in the indicators sensitive to nursing clinical supervision. The study was conducted in the surgery department of a health care institution and the nurses of the surgery department composed the sample. With this article we intend to disseminate the results of the implementation of the SafeCare model and to prove that the implementation of a contextualized Nursing clinical supervision model based on nurses' needs, SafeCare Model, has contributed to obtaining higher quality and safer care for clients

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Evidence based practice as an indicator of clinical supervision in nursing in context of ambulatory surgery / A prática baseada na evidência como indicador da supervisão clínica em enfermagem no contexto de cirurgia de ambulatório

Clinical supervision and evidence-based practice in nursing should be understood as complementary and indissociable as they go hand in hand towards the same objectives. Therefore, the supervising process, should boost the evidence-based practice in order to promote better nursing care. The purpose of this study is to evaluate nurse's predisposition to incorporate evidence-based practice into their care and to identify barriers to its application with the purpose of propose contributions for the implementation of a nursing clinical supervision model that encourages the use of the best evidence available into the daily practice. The study is integrated into the research project "SAFECARE - Supervisão Clínica para a segurança e qualidade dos cuidados". It was developed an exploratory-descriptive study in an ambulatory surgery unit of a University Hospital in Porto, Portugal. It had a target population of 59 nurses, and it was used the "Evidence-Based Practice Questionnaire" as a method of collecting data. From the 49 questionnaires collected, we find that the subscale "Practices" has an average score of 4.89, the subscale "Attitudes" 5.36 and the subscale "knowledge/skills and competences" 5.08. These results showed that nurses have a low use of evidence-based practice when compared with the level of knowledge, skills and competences shown, although they seem to have a positive attitude towards this subject. These results can be partially explained by the overburden felt by the nurses, which identified the lack of time and motivation, but also inappropriate training and scarcity of team meetings and proper tools in the workplace as barriers

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Clinical supervision: analysis of postoperative pain evaluation in the ambulatory surgery setting / Supervisão clínica: análise da avaliação da dor pós-operatória em cirurgia de ambulatório

Clinical supervision, as a formal process of monitoring professional practice, aims to improve decision-making to contribute to safety and quality of care through reflection processes and analysis of clinical practice. This study aimed to compare the postoperative pain evaluation and clinical recording procedures performed by nursing staff and clinical supervisors in ambulatory surgery patients.The study was integrated into the research project "SAFECARE". It was developed a descriptive cross-sectional quantitative study in an ambulatory surgery unit of a University Hospital in Oporto, Portugal. The study population was the nursing staff with an intentional non-probabilistic sampling method. A questionnaire was constructed and evaluation of postoperative pain, patient clinical and demographic variables was included. This instrument was applied in 116 patients matched by 12 surgical specialties. Results were compared between nursing staff, clinical supervisors and electronic nursing records. Patients had an average age of 48.6 years, being mostly female. Regarding pain evaluation, the scale most used by nurses (62.1%) and clinical supervisors (67.2%) was the "Numerical Scale". Postoperative pain evaluation scores ranged from 0 to 7, with score 0 (no pain) presenting more frequently by nurses, electronic nursing records and clinical supervisors. 34.5% of results were not documented in electronic nursing records. These findings support the importance of an intervention of clinical supervision in the indicator "pain" for the outpatient surgery setting. Local protocols of clinical supervision practice would contribute to improve postoperative pain evaluation, as well as standardization and optimization of nursing records, thus ensuring quality care

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Reflexões acerca do exercício da supervisão de enfermagem no enfrentamento da covid-19 / Reflections about the exercise of nursing supervision in covid-19 confrontation / Reflexiones sobre el ejercicio de la supervisión de enfermería para hacer frente a covid-19

Introdução: Responder crescentes demandas por cuidado, no contexto atual de pandemia, exige readequar o trabalho, com práticas assertivas relativas à assistência e gerência de enfermagem. A supervisão de enfermagem, em enfoque educativo e colaborativo, tem potencial para promover transformações necessárias na equipe para implementação de assistência segura e em tempo oportuno. Objetivo: Refletir teoricamente acerca de contribuições da supervisão de enfermagem no enfrentamento da COVID-19. Materiais e Métodos: Estudo reflexivo, embasado na formulação discursiva sobre a supervisão de enfermagem, organizado nas seções: Contextualização da temática, aspectos gerais da pandemia COVID-19, Gerenciamento e Supervisão de Enfermagem na atenção hospitalar, Supervisão de Enfermagem no enfrentamento dos desafios da pandemia e Considerações finais. Resultados: A pandemia agravou o contexto de prática de enfermagem, que requer mobilizar conhecimentos e informações para dimensionar recursos diversos e planejar ações, para favorecer o cuidado e reduzir riscos de danos para o paciente, comunidade e profissionais de saúde. Evidencia-se relevância de competências e instrumentos gerenciais que favoreçam o trabalho do enfermeiro. Destaca-se a supervisão de enfermagem para abordar continuamente medidas e intervenções usuais, de enfoque gerencial e assistencial, readequadas para o contexto da pandemia, em perspectiva educativa da equipe. Conclusões: A supervisão de enfermagem é capaz de intervir na dinâmica da prática hospitalar, promover capacitação e adesão às recomendações atuais de procedimentos que minimizem o contágio pela COVID-19. Seu potencial impulsiona transformações, com ações que qualificam a equipe no seu cenário de prática profissional, para melhores resultados para o paciente, para a equipe e a instituição.(AU)

Introduction: Responding to growing demands for care, in the current pandemic context, requires readjusting the work, with as sertive practices related to nursing care and management. Nursing supervision, in an educational and collaborative approach, has the potential to promote necessary changes in the team to implement safe and timely assistance. Objective: Theoretically reflect on the contributions of nursing supervision in confronting with COVID-19. Materials and Method: Reflective study, based on the discursive formulation on nursing supervision, organized in the sections: Contextualization of the theme, general aspects of the pandemic COVID-19, Nursing Management and Supervision in hospital care, Nursing Supervision in facing the challenges of the pandemic and Final considerations. Results: The pandemic has aggravated the context of nursing practice, which requires mobilizing knowledge and information to dimension various resources and plan actions, to favor care and reduce risks of harm to the patient, community and health professionals. The relevance of managerial skills and instruments that favor the work of nurses is evident. Nursing supervision stands out in order to continually address usual measures and interventions, with a managerial and care focus, adapted to the context of the pandemic, in the educational perspective of the team. Conclusions: Nursing supervision is able to intervene in the dynamics of hospital practice, promote training and adhere to current recommendations for procedures that minimize contagion by COVID-19. Its potential drives transformations, with actions that qualify the team in its professional practice scenario, for better results for the patient, the team and the institution.(AU)

Introducción: Responder a las crecientes demandas de atención, en el contexto actual de pandemia, requiere reajustar el trabajo, con prácticas asertivas relacionadas con la atención y el manejo de enfermería. La supervisión de enfermería, en un enfoque educativo y colaborativo, tiene el potencial de promover los cambios necesarios en el equipo para la implementación de asistencia segura. Objetivo: Reflejar teóricamente sobre las contribuciones de la supervisión de enfermería para hacer frente a COVID-19. Materiales y Métodos: Estudio reflexivo, basado en la formulación discursiva sobre supervisión de enfermería, organizado en las secciones: Contextualización del tema, aspectos generales de la pandemia COVID-19, Gestión y supervisión de enfermería en la atención hospitalaria, Supervisión de enfermería para enfrentar los desafíos de la pandemia y Consideraciones finales. Resultados: La pandemia ha agravado el contexto de la práctica de enfermería, que requiere movilizar el conocimiento y la información para dimensionar diferentes recursos y planificar acciones, favorecer la atención y reducir los riesgos de daño para el paciente, la comunidad y los profesionales de la salud. La relevancia de las habilidades e instrumentos gerenciales que favorecen el trabajo de las enfermeras es evidente. La supervisión de enfermería se destaca para abordar continuamente las medidas e intervenciones habituales, con un enfoque de gestión y atención, adaptado al contexto de la pandemia, en la perspectiva educativa del equipo. Conclusiónes: La supervisión de enfermería puede intervenir en la dinámica de la práctica hospitalaria, promover la capacitación y cumplir con las recomendaciones actuales de procedimientos que minimizan el contagio por COVID-19. Su potencial impulsa transformaciones, con accio...(AU)

'It's the relationship you develop with them': emotional intelligence in nurse leadership. A qualitative study.

AIM: to investigate emotional intelligence (EI) and its relationship to nursing leadership. BACKGROUND: strong, effective leadership is core to organisational competency and significantly influences care quality. EI is the ability to understand one's own feelings and to assess and respond to the feelings of others. It is linked to self-awareness, self-management, social awareness and social skills, all of which are vital in leadership roles. However, insufficient research explores EI in nursing leadership from the perspective of nurse leaders. DESIGN: a qualitative study employed interpretive phenomenological analysis methods, using a purposive sample of band 7 sisters/charge nurses/team managers (n=5) from one Welsh health board. Semistructured interviews were recorded and analysed in four stages. FINDINGS: four clusters of themes were identified, each with two to three subthemes. These were: sensing others-the empathetic leader; experiencing the affected sense of self; strategies employed to build the team; and reading the flux of the organisation. CONCLUSION: although the nurse leaders were unfamiliar with the concept of EI, their narratives reflected some core values of EI. However, significant barriers around time, pressure and staffing levels impeded their potential to use EI to become more effective leaders. Nurse leaders should harness the power of emotions to influence others to achieve excellent care.

Enhancing the quality of clinical supervision in nursing practice.

Clinical supervision has been an aspect of nursing practice in various forms for several years; however, it remains challenging to ensure its widespread implementation across healthcare organisations. There is an increasingly evident need for formalised support in nurses' busy practice settings, so it is important to improve the quality of clinical supervision in healthcare. This will also assist nurses in providing evidence of their continuing professional development as part of revalidation. This article provides an overview of clinical supervision, outlining its features and functions in healthcare practice. It includes three case studies related to group clinical supervision, discussing how this was implemented in each case and the various methods of group-working that were used.

Outpatient parenteral antimicrobial therapy (OPAT) in Christchurch: 18 years on.

AIM: Outpatient parenteral antimicrobial therapy (OPAT) has become an established option for management infections requiring intravenous therapy. As the uptake of OPAT has increased, the clinical governance has changed and is now managed via virtual clinics and increased use of district nurses in addition to specialist outpatient review. The aim of this study was to report the characteristics, diagnoses, treatment and outcomes of patients managed by the service over 12 months in 2015/6 and compared these features with those of patients treated with OPAT in 1999. METHODS: Cases for 2015/6 were identified from the OPAT service database which records prospectively all information on diagnosis, antibiotic choice and duration of treatment, complications and requirement for review by the ID physicians and OPAT nurses prospectively. The outcomes, complications and readmissions were found by reviewing computerised records of Christchurch Hospital. All results were entered into a Microsoft® Excel database for analysis. Statistical analyses were performed using OpenEpi software. Data for 1999 was taken from an earlier publication. RESULTS: OPAT treatment in 12 months from 1 July 2015 was administered 407 times to 385 patients, which represented a 2.7 times increase in treatment courses than in 1999. The median age was 55 years in 1999 and 61 in 2015/6. There was a substantial increase in the proportion of bone and joint, abdominal and urinary tract infections but a fall in cellulitis and soft tissue infection. The number and proportion of patients treated with broad spectrum agents including piperacillin + tazobactam, ceftriaxone and carbapenems increased from 1% in 1999 to 20% in 2015/6. Unplanned readmission to hospital increased from 15 (10%) in 1999 to 62 patients (15%) in 2015/6. The most common reason for readmission in 2015/6 was for ongoing symptoms or progression of the infection requiring OPAT. Eight patients (2%) required readmission from adverse reactions to antimicrobial therapy. Two patients on palliative care died while on OPAT and 35 (9%) within 12 months of the index admission. CONCLUSION: OPAT use has increased and is used to treat patients with comorbidities, who are older, and with a different case-mix than 1999. Safety has not been compromised but the risk of treatment failure has increased. A better understanding of the reasons for treatment failure would improve patient selection and management with OPAT.

Delineation of the Nursing Supervisor Role: A Pilot Study.

OBJECTIVE: The purpose of this study was to describe a sample of nursing supervisors and their work. BACKGROUND: The role of the nursing supervisor is not well understood. The supervisor population is poorly defined, as are their ideal academic preparation and work activities. METHODS: This study followed the American Nurses Credentialing Center® framework for role delineation studies. A convenience sample of 50 nursing supervisors from New Jersey was recruited to complete an online survey including demographic data and prioritization of work activities. RESULTS: Participants represented a homogeneous and aging workforce with diverse professional preparation. Exploratory factor analysis revealed 6 categories of nurse supervisor work including administrative presence, leadership liaison, patient safety and experience, patient care advocacy, throughput, and external response. Work activities were prioritized. CONCLUSIONS: Nurse supervisors prioritized responding to emergencies above all other responsibilities. This study should be replicated in a nationwide sample of nurse supervisors.

Intersectionality and Critical Realism: A Philosophical Framework for Advancing Nursing Leadership.

This article presents intersectionality theory with critical realism as a philosophical framework for studying nursing leadership. In response to gaps in the current leadership literature, the aim is to develop an approach that addresses how the multiple social positions nurses hold can create an intersecting matrix of oppression that impacts on their opportunities to develop as leaders. The result is a theoretical foundation, which can inform the methodological framework of future studies. Providing evidence by which a reader can judge the merits of a chosen methodology, it sets the case for integrating intersectionality with critical realism for studying nursing leadership.

Nursing leadership and health policy: everybody's business.

We all know great leadership when we see it. Outstanding nurse leaders, guided by a moral compass, simultaneously see the big picture and the consequences at micro level. While policy and politics determine health and nursing practice, most nurses just want to get on with their day job. They carry out decisions made by others but have little say in them, and weak influence or status, although they are increasingly knowledgeable and skilled. In settings where policy decisions are made - parliaments, governments, and boardrooms - nurse leaders are often neither heard nor heeded. This is starting to change. The global Nursing Now campaign is working with the International Council of Nurses, and the World Health Organization, to create and strengthen strategic nursing leadership, as modelled by the International Council of Nurses' Global Nursing Leadership Institute. A new window of opportunity is opening, with the bicentennial of Florence Nightingale's birth in 2020. Now is the moment!

Grassroots to Global: The Future of Nursing Leadership.

The 2018 International Nursing Administration Research Conference, Grassroots to Global, was held in Atlanta, Georgia, with attendees from 38 US states, Canada, and China. Presenters discussed the need for nurse leaders to be prepared to partner with those inside and outside of healthcare to create innovative, interprofessional care delivery models; advocate for advancements in technology to address healthcare access shortages; and lead new areas of research that can drive policy change to support nurse leaders in long-term care and the essential role of the nurse manager in creating optimal practice environments for quality outcomes. This article will report on these important insights.