Field Hospital Boston Hope: Defining Culture During Uncertainty.

As hospitals across the world realized their surge capacity would not be enough to care for patients with coronavirus disease-2019 (COVID-19) infection, an urgent need to open field hospitals prevailed. In this article the authors describe the implementation process of opening a Boston field hospital including the development of a culture unique to this crisis and the local community needs. Through first-person accounts, readers will learn (1) about Boston Hope, (2) how leaders managed and collaborated, (3) how the close proximity of the care environment impacted decision-making and management style, and (4) the characteristics of leaders under pressure as observed by the team.

The Value of Nursing Research.

Innovations in patient care, nursing, and the practice environment are hallmarks of organizations receiving American Nurses Credentialing Center (ANCC) Magnet Recognition. In this month's "Magnet Perspectives" column, the chair and vice-chair of ANCC's Commission on Magnet Recognition examine the growing importance of nursing research on patient care and outcomes and the role of Magnet hospitals as research pacesetters for the nursing profession. The authors discuss the critical difference between research and evidence-based practice, why both are important, and how organizations can develop the structures and processes to inspire and advance a robust culture of clinical inquiry.

Development and Psychometric Evaluation of the Professional Practice Work Environment Inventory.

OBJECTIVE: The purpose is to examine the psychometric properties of the professional practice work environment inventory (PPWEI). BACKGROUND: Derived from the Professional Practice Environment (PPE) and the Revised PPE scales, the PPWEI was designed to measure 8 components of the PPE that can be used to assist nurse administrators in decision-making. METHODS: A psychometric evaluation was undertaken with 874 nurses who were providing direct care to patients at the Massachusetts General Hospital and who provided no missing data on the newly developed 72-item PPWEI. RESULTS: Cronbach's α internal consistency reliability of the total score was .93, with 61 items having factor loadings more than .50, the factor loading cutoff used to define the component subscales. Principal component analyses with varimax rotation and Kaiser normalization demonstrated 8 components, explaining 64.6% of variance. Cronbach's α reliability coefficients of the PPWEI subscales ranged from .82 to .93. CONCLUSION: The multidimensional PPWEI is a psychometrically sound measure of several components of the PPE in the acute care setting and sufficiently reliable and valid for use as independent subscales in healthcare research.

Development and psychometric evaluation of the patient care associates' work environment scale.

OBJECTIVE: The purpose of this study is to examine the psychometric properties of the Patient Care Associates' Work Environment Scale (PCA-WES). BACKGROUND: Few studies exist examining patient care associates (PCAs) working in acute care settings, and no instruments are available to examine the impact of the work environment on their practice. METHODS: A psychometric evaluation using a nonprobability purposive sample of 390 PCAs was undertaken. RESULTS: Cronbach's α internal consistency reliability of the total score was .95. Principal components analysis with varimax rotation and Kaiser normalization identified 5 components that accounted for 57.2% of variance and confirmed the original theoretical structure. The resulting 35-item scale had subscale Cronbach's α reliability estimates that ranged from .84 to .93. CONCLUSIONS: The multidimensional PCA-WES is a psychometrically sound measure of 5 components of the PCA practice environment in the acute care setting and is sufficiently reliable and valid for use as independent subscales in healthcare research.

Promoting a culture of international professional practice for nursing through a twinning relationship.

This article illustrates the impact of a twinning relationship between the nursing services of Huashan Hospital, Fudan University (HH), in Shanghai, China, and of Massachusetts General Hospital (MGH) in Boston, Massachusetts. Through twinning, the healthcare leaders and nursing staff at HH learned key concepts, skills, and methods from their MGH colleagues, enhancing the role, presence, and overall impact of nursing in their organization. Strategies to advance a nursing leadership development agenda included establishing twinning relationships and immersing nurse leaders into each other's practice arena via nurse visitation exchanges. This collaborative effort, although only 3 years old, begins the process of modeling twinning for replication among nurses and across organizations internationally. Improvements in nursing care delivery and patient care at both organizations are attributed to this project.

Partnering and leadership: core requirements for developing a dedicated education unit.

Preparing new nurses to practice independently and provide safe and effective care has always been a priority for nurse leaders in academe and service but is becoming more of a challenge as patient acuity intensifies and care systems become more complex. Recent reports by the Carnegie Foundation and by the Institute of Medicine and RWJF call for nurse leaders to improve how nurses are prepared and educated by reducing the gap between classroom and clinical teaching and making better use of resources and partnerships available in the community. The development of a dedicated education unit is one strategy to address this gap.

Pandemic Care Through Collaboration: Lessons From a COVID-19 Field Hospital.

During the surge of Coronavirus Disease 2019 (COVID-19) infections in March and April 2020, many skilled-nursing facilities in the Boston area closed to COVID-19 post-acute admissions because of infection control concerns and staffing shortages. Local government and health care leaders collaborated to establish a 1000-bed field hospital for patients with COVID-19, with 500 respite beds for the undomiciled and 500 post-acute care (PAC) beds within 9 days. The PAC hospital provided care for 394 patients over 7 weeks, from April 10 to June 2, 2020. In this report, we describe our implementation strategy, including organization structure, admissions criteria, and clinical services. Partnership with government, military, and local health care organizations was essential for logistical and medical support. In addition, dynamic workflows necessitated clear communication pathways, clinical operations expertise, and highly adaptable staff.

A systematic approach to baseline assessment of nursing documentation and enterprise-wide prioritization for electronic conversion.

An important challenge associated with making the transition from paper to electronic documentation systems is achieving consensus regarding priorities for electronic conversion across diverse groups. In our work we focus on applying a systematic approach to evaluating the baseline state of nursing documentation across a large healthcare system and establishing a unified vision for electronic conversion. A review of the current state of nursing documentation across PHS was conducted using structured tools. Data from this assessment was employed to facilitate an evidence-based approach to decision-making regarding conversion to electronic documentation at local and PHS levels. In this paper we present highlights of the assessment process and the outcomes of this multi-site collaboration.

Caring for patients while respecting their privacy: renewing our commitment.

In 1996, HIPAA or the Health Insurance Portability and Accountability Act (HIPAA) was enacted into law. This law has had a significant impact on the health care industry including the need for numerous changes in the way we communicate with our patients, their families, and with each other. This law provides rights to patients and safeguards for employees. It affects everyone in a health care setting. Since the days in which the Nightingale Pledge was written, nursing has stressed the importance of confidentiality regarding all patient matters. The current Code of Ethics for Nurses ANA, 2001) is clear in intent and meaning as it relates to the nurse's role in promoting and advocating for patient's rights related to privacy and confidentiality. For nurses, HIPAA is an endorsement of our previously articulated responsibility to our patients. The purpose of this article is to remind nurses of the importance of keeping patient information private. This reminder will come first as HIPAA is reviewed and the implications of this Act for nurses is discussed. The reminder will also come as challenges to maintaining privacy and strategies for promoting privacy are presented.