The role of healthcare leaders in implementing equitable clinical academic pathways for nurses: An integrative review.

AIM: To identify and synthesize empirical evidence on the role of healthcare leaders in the development of equitable clinical academic pathways for nurses. DESIGN: Integrative literature review. DATA SOURCES: Literature was searched using CINAHL, PubMed, ProQuest and Google Scholar databases. REVIEW METHODS: A total of 114 eligible articles published between 2010 and2022 were screened, 16 papers were selected. RESULTS: Results highlighted the need for consistent national, regional, and organizational policy approaches to developing clinical academic careers for nurses. Government health departments and National Health boards must focus on increasing engagement in research and evidence-based nursing practice for high-quality patient care. Discriminatory practices and attitudes were identified as barriers. Discrimination due to gender was evident, while the impact of race, ethnicity, and other social categories of identity are under-researched. Educational leaders must unravel misconceptions about research, highlighting its relevance to patient care and bedside nurses' work. Academic leaders together with executive nurses, research funders and professional nursing bodies must create appropriately remunerated career structures. Transformative approaches are required to develop the clinical academic nurse role and understand its value in clinical practice. CONCLUSION: Multiple elements exist within complex systems that healthcare leaders can navigate collaboratively to develop and implement clinical nurse academic roles. This requires vision, acknowledgement of the value of nursing research and the importance of evidence-based research infrastructures. IMPACT: Findings highlight the collaborative role of healthcare leaders as critical to the success of critical academic careers for nurses. This review can inform those still to formalize this innovative role for nurses. REPORTING METHOD: The review complies with the PRISMA guidelines for reporting systematic reviews. This paper contributes evidence about the healthcare leader's role in developing clinical academic pathways for nurses to the wider global clinical community. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution was included in this review.

Going the extra mile for patients: Service-oriented high-performance work systems drive nurses' job crafting and extra-role service behaviour.

AIM: This study intends to investigate whether, how and when service-oriented high-performance work systems (SHPWSs) drive nurses' extra-role service behaviour. DESIGN: This was a quantitative cross-sectional study conducted with matched nurse-patient participants. METHOD: We tested hypotheses using data from 284 nurses and their matched 566 patients. The data were collected in 2019. We conducted a set of hierarchical regression analyses to test our hypotheses. RESULTS: The results showed that SHPWSs have a positive impact on job crafting, which, in turn, mediates the link between SHPWSs and extra-role service behaviours. Additionally, the influence of professional identification moderates these relationships. Specifically, SHPWSs are significantly and positively associated with job crafting among highly professionally identified nurses. The indirect effect is significantly positive when nurses strongly identify with their profession but not significant when their professional identification is low. CONCLUSION: The results indicated that SHPWSs can elicit job crafting among higher professional identifiers, which further increases extra-role service behaviours towards patients. IMPACT: Our research emphasizes the significance of HRM themes in the healthcare service industry and their direct impact on healthcare personnel. Shifting from a management-centric to an individual-centric perspective, we focus on the proactive role of nurses. Furthermore, this study enhances the understanding of the boundary conditions for the effectiveness of SHPWSs. PATIENT OR PUBLIC CONTRIBUTION: Nurses and their mated patients from a Chinese hospital contributed to this study by completing the survey.

Nurses' experiences of competence in lifestyle counselling with adult patients in healthcare settings: A qualitative systematic literature review.

AIMS AND OBJECTIVES: To identify and synthesise nurses' experiences of competence in lifestyle counselling with adult patients in healthcare settings. BACKGROUND: Modifiable lifestyle risk behaviours contribute to an increased prevalence of chronic diseases worldwide. Lifestyle counselling is part of nurses' role which enables them to make a significant contribution to patients' long-term health in various healthcare contexts, but requires particular competence. DESIGN: Qualitative systematic literature review and meta-aggregation. METHOD: The review was guided by Joanna Briggs Institute's methodology for conducting synthesis of qualitative studies. PRISMA-checklist guided the review process. Relevant original studies were search from databases (CINAHL, PubMed, Scopus, Medic and Psych Articles, Ebscho Open Dissertations and Web of Science). After researcher consensus was reached and quality of the studies evaluated, 20 studies were subjected to meta-aggregation. RESULTS: From 20 studies meeting the inclusion criteria, 75 findings were extracted and categorised into 13 groups based on their meaning, resulting in the identification of 5 synthesised findings for competence description: Supporting healthy lifestyle adherence, creating interactive and patient-centred counselling situations, acquiring competence through clinical experience and continuous self-improvement, collaborating with other professionals and patients, planning lifestyle counselling and managing work across various stages of the patient's disease care path. CONCLUSION: The review provides an evidence base that can be used to support nurses' competence in lifestyle counselling when working with adult patients in healthcare settings. Lifestyle counselling competence is a complex and rather abstract phenomenon. The review identified, analysed and synthesised the evidence derived from nurses' experience which shows that lifestyle counselling competence is a multidimensional entity which relates to many other competencies within nurses' work. IMPLICATIONS FOR THE PROFESSION: Recognising the competencies of nurses in lifestyle counselling for adult patients can stimulate nurses' motivation. The acquisition of these competencies can have a positive impact on patients' lives and their health. PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution. IMPACT: The research may enhance nurses' competence in lifestyle counselling, leading to improved health outcomes, better adherence to recommendations and overall well-being. It may also drive the development of interventions, improving healthcare delivery in lifestyle counselling. REPORTING METHOD: The review was undertaken and reported using the PRISMA guidelines. PROTOCOL REGISTRATION: Blinded for the review.

Women's experiences with opting out of cervical cancer screening and the role of the nurse in the women's decision-making process.

AIM: To explore Danish women's experiences with opting out of cervical cancer screening and the role of the nurse in the women's decision-making process. DESIGN: A qualitative study using semi-structured, individual interviews with a phenomenological-hermeneutic approach. METHODS: Interviews were conducted with 13 women with experience in opting out of cervical cancer screening. Women were recruited through a public flyer and interviewed virtually or by phone. The interviews were analysed using the theory of interpretation from Paul Ricoeur and consisted of three levels: naïve reading, structural analysis, and critical discussion and analysis. The present study adheres to the COREQ guidelines. RESULTS: The women experience various personal causes for opting out of cervical cancer screening, such as low accessibility of screening appointments, discomfort during the smear test, fear of being sick, and insufficient information about the relevance of screening to the individual woman. The perceived disadvantages of screening outweighed their perceived advantages. The women's experiences did not include the role of the nurse in the procedures and knowledge sharing related to cervical cancer screening. However, nurses were described as having good communicative and relational qualifications relevant to being involved in cervical cancer screening. CONCLUSION: It was challenging for the women to weigh the advantages and disadvantages of cervical cancer screening and thus to make an informed decision about participation. They expressed a need for more information on which to base their decision. This places nurses in a much needed, yet unexplored, role of identifying and lowering potential personal barriers that may outweigh the women's perceived benefits of participating in screening. IMPLICATION FOR THE PROFESSION AND/OR PATIENT CARE: Nurses should play a more active role in cervical cancer screening such as improving general knowledge and facilitating two-way communication about its relevance. REPORTING METHOD: The present study adheres to the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Restoring Psychiatric Mental Health APRN Roles: A Report of Innovations in Workforce Development Design Supported by Salutogenic Solutions and an Enduring Educational Frame, Part One.

BACKGROUND: The change from a clinical nurse specialist to nurse practitioner model has significantly affected graduate education and practice because of emphasis on the dominant biomedical prescriber role, marginalizing the nurse-psychotherapy and consultation-liaison roles fundamental to quality psychiatric advanced practice nursing practice. AIM/METHOD: We report on a four-year Workforce Development Project supported by an academic-practice partnership to restore formation and skill building of the marginalized roles. Part One focuses on program design, the curriculum for nine specialty courses, and the teaching and learning community approach that promotes engagement, faculty commitment, and preceptor recruitment and retention; the creative faculty staffing model is described. RESULTS: The educational frame described includes highlights of teaching/learning strategies drawn from the history of professional formation curriculum rooted in salutogenesis and belonging science, existentialism, solution-focused therapy, modeling and role modeling theory, and Peplau's Interpersonal Relations . CONCLUSION: There is significant interest and commitment to learning the nurse-psychotherapist and consultation-liaison roles.

Restoring Psychiatric Mental Health APRN Roles: A Report of Innovations in Workforce Development Design Supported by Salutogenic Solutions and an Enduring Educational Frame, Part Two.

BACKGROUND: The change from clinical nurse specialist to nurse practitioner model with emphasis on the biomedical prescriber role significantly affected graduate education/practice. AIM/METHOD: This article reports solutions, lessons learned, and insights from faculty in a four-year Workforce Development Project supported by an academic-practice partnership. Lessons learned that are shared as administrative and clinical practice insights include use of experiential learning platform and interaction process recordings, confirmation of the state of nurse psychotherapy blocks to clinical placements, movement toward a salutogenic psychosocial nursing process, changing student evaluation language of preceptors, and implementation of an Advanced Practice Nursing model for clinical supervision. RESULTS: The educational hypothesis that in-person experiential learning in a workshop format with live simulations is critical to the professional development of psychiatric mental health advanced practice nursing is supported. Resistance to the cultural change operationalized through the curriculum is described. Five student reflections exemplify progress made as a result of this program. CONCLUSION: This program with its enduring educational frame was an opportunity to regain a historical momentum as nurse leaders in mental health care. There is significant interest and commitment to learning the nurse-psychotherapist and consultation-liaison roles.

Juggling multiple roles: Navigating challenges and uncertainties in nursing practice, education, and research during wartime in Israel.

The events of October 7, 2023, marked a turning point for Israel, plunging the nation into a state of existential dread and uncertainty due to an ongoing conflict. The nursing profession is multifaceted and can encompass simultaneously diverse roles within various settings, including direct patient care, education, and research. In regular times, there is a delicate balance between mastering these three roles. Yet, in times of war, there is a threat to this balance. The manuscript highlights the personal, unique struggles of nursing doctoral students balancing clinical duties, teaching responsibilities, and research commitments during a war. The authors reflect on their experiences and challenges related to clinical-professional, academic, and personal dimensions as doctoral students. The manuscript highlights the connection between significant events and the resilience and determination among nursing doctoral students and future generations of academics. It provides recommendations to help attenuate the additional stresses experienced by nurses during war. These interventions will not mitigate the complexity and challenges of juggling our multiple professional roles. However, the awareness of these challenges can lead to growth and achievement in patient care, professional and personal development, and academic excellence.

The relationship between managerial coaching and role ambiguity among nurses in the military health system.

Managerial coaching may be an effective strategy to reduce role ambiguity among nurses. Although the benefits of coaching relationships have been demonstrated outside of nursing, there is a lack of evidence about this career development relationship in nursing. A cross-sectional design was used to determine the relationship between managerial coaching and role ambiguity among military and civilian nurses who work in the Military Health System (MHS). Nurses who worked at a large academic medical center in San Antonio, Texas were asked to participate by completing a survey to examine the variables of interest. Among the 382 nurses that responded, perceived role ambiguity was low and managerial coaching was seldom perceived from first-line supervisors. However, there was a significant negative relationship between managerial coaching and role ambiguity. This study provides foundational knowledge about the relationship between managerial coaching and role ambiguity for nurses working in the MHS.

Factors Influencing the impact of nurse practitioners' clinical autonomy: a self determining perspective.

AIM: To explore factors that influence the impact of nurse practitioners' clinical autonomy with a self-determining perspective. BACKGROUND: Worldwide, there is a significant demand for healthcare professionals such as the nurse practitioner in meeting some healthcare needs across patients' lifespans. Factors influencing nurse practitioners clinical autonomy can impact the full utilisation of the role in practice. INTRODUCTION: Limited evidence exists that describes or researches nurse practitioner clinical autonomy. Instead, there is a focus in the literature on strategic debates, role confusion and nurse practitioners reporting the straddling between nursing, allied heath professionals and medicine in the provision of healthcare services. DESIGN: A cross-sectional study design was used in a purposive sample in a national sample of nurse practitioners in Ireland across a full range of healthcare settings. Additionally, the survey included open comments sections to capture qualitative comments by the nurse practitioners themselves. METHODS: Self-determination theory is rooted in an organismic dialectical stance. This study used a convenience sample of n = 148 from a total sample of n = 448 (33%) of the population. The Dempster Practice Behavioural Scale and an initially validated advanced nursing practice clinical autonomy scale were used. Open comments were analysed by thematic analysis. STROBE Standards guidelines for cross-sectional studies were followed, and COREQ guidelines were followed for writing qualitative research. RESULTS: The study findings demonstrated that the more clinical experience the nurse practitioner had, the higher their levels of clinical autonomy. The previous length of nursing experience did not impact nurse practitioner clinical autonomy levels. However, average experience of nurse practitioner' in this study was 3-10 years. No significant differences existed between the reported gender, nurse practitioners' clinical autonomy and decision-making. 1:40 female and 1:9 male nurse practitioners undertook a doctorate or PhD-level education. No advanced nurse practitioner identified as non-binary. Gender and organisational culture considerations can influence nurse practitioners clinical autonomy. IMPLICATIONS FOR NURSING AND HEALTH POLICY: This study highlights intrinsic motivators that support nurse practitioners in providing innovative healthcare: competence, relatedness and clinical autonomy. Countries credentialing, regulations professional standards and healthcare policy positively influence nurse practitioner clinical autonomy. Nurse practitioners' clinical autonomy is championed when health policy and organisational stakeholders intrinsically collaborate. A disconnect between health policy organisational culture extrinsically influences lower levels of nurse practitioners' clinical autonomy. CONCLUSION: The findings underline the positive impact of nurse practitioner clinical autonomy. A recommendation of this study is to continue to measure impact of clinical autonomy and develop nurse practitioners' self-determination strategies around the role and integrity of their levels of intrinsic clinical autonomy.

Clinical decision-making processes among graduate nurses, specialist nurses and nurse practitioners A collaborative international study.

AIM: To explore clinical decision-making by comparing the processes used by three groups of nurses in the emergency departments of three hospitals: in Norway, Finland and Ireland. BACKGROUND: Clinical decision-making in an emergency department environment is a complex process often occurring in times of crisis. It is an important aspect contributing to the quality of care. However, empirical research is limited regarding the decision-making process in different nursing roles. METHODS: In accordance with the consolidated criteria for reporting qualitative research, a qualitative and observational study was conducted to explore clinical decision-making by comparing the processes used by three groups of nurses in the emergency departments of three hospitals: in Norway, Finland and Ireland. Six Registered Nurses, six Nurse Specialists and six Nurse Practitioners were observed. A total of 40 hours of observation was made at each setting according to a structured observation guideline, followed by clarifying questions. The data material was analysed by means of a qualitative manifest and latent content analysis. RESULTS: Three themes arose: acting in accordance with routines, previous experience and intuition; considering patient experience; and facilitating new alternatives based on critical thinking. The Registered Nurses mainly used the first approach, the Nurse Specialists used the first and the second approaches, and the Nurse Practitioners used all three approaches. CONCLUSIONS: The results highlight the differences in decision-making processes between these groups. Nurse Practitioners were the only group that facilitated and evaluated new alternatives using their clinical autonomy, such as stepping up and making independent and collaborative decision-making. IMPLICATION: The results can be used in countries developing advanced practice nursing education and defining their scope of practice to inform stakeholders.

Trainee district nurses' understanding and perceptions of the palliative care key worker role: a qualitative study.

BACKGROUND: The district nurse is identified as a keyworker in community based palliative care. However, a dearth of research exists on trainees' views and understanding of adopting the role upon qualification. AIMS: The aim of this study was to explore the understanding and perceptions of district nurse trainees in relation to the palliative care key worker role. METHODS: Data was gathered via online semi-structured interviews (n=10) and the results were analysed using a thematic model. FINDINGS: The four evolving themes included: understanding of the palliative care key worker role scope and function; the level of preparation for the role; a juggling act and embedding the role in practice. CONCLUSION: The themes highlighted various drivers and barriers that reflect a degree of incongruence with policy and practice. Recommendations to standardise the palliative care key worker role, underpinned by formal preparation and clearly defined responsibilities may enhance future development and implementation of the role.

[The new nursing professions in psychiatry: One man's dream, another man's nightmare?] / Les nouvelles professions infirmières en psychiatrie, rêve des uns, cauchemar des autres ?

The deployment of case management and advanced nursing practice is shaking up the roles of the various professionals on mental health teams, and the usual organization of care in psychiatry. These changes can be perceived as either positive or worrying, depending on each individual's role and position. For the past 3 years, the mobile teams of the Centre rive gauche cluster at Le Vinatier hospital have been organized according to the principles of Flexible Assertive Community Treatment, and include an advanced practice nurse (APN) on their staff. The roles of the case manager and the APN have been rethought. A number of measures have facilitated the implementation of these new functions.

[Psychiatric care teams: taking care and forgetting about it]. / Les équipes de soins en psychiatrie ou prendre soin à s'en oublier.

The psychiatric care team offers comprehensive, personalized support, raising public awareness, promoting mental equilibrium and combating stigmatization. Its role includes collaboration, communication, designing adapted treatment plans and creating a climate of trust to influence the quality of care. In this way, she contributes to a more inclusive and caring society. As such, her own state of well-being deserves special attention. However, they often work in a highly degraded ecosystem that can be likened to psychiatry in a war zone.

[The care team, from roots to new challenges]. / L'équipe soignante, des racines aux nouveaux défis.

The team is a fundamental and structuring dimension of care, founded on the principles of complementarity, interdependence, and shared objectives and responsibilities towards the patient. As a result of the pandemic and the rationalization of public hospitals, teams are faced with changes in the role of supervisors and the arrival of new figures such as advanced practice nurses. While these changes can bring new dynamism and questioning of practices, they can also be destabilizing. The institution must preserve the role of the team and its members.

Patient-Centered Nursing for the Christ-Centered Nurse.

ABSTRACT: Patient-centered care (PCC), a term coined decades ago, is a key but challenging focus of nursing practice. The history, development, and current dialogue about PCC along with biblical perspectives on caregiving, wisdom, and discernment help nurses who follow Christ to offer compassionate PCC. Strategies are proposed for meaningfully engaging patients and families as active participants in healthcare. The Christian nurse can best provide consistent, effective PCC by remaining Christ-centered.

Experiences and perspectives of nurses infected with COVID-19: A qualitative systematic review and meta-synthesis.

This qualitative systematic review aims to comprehensively understand the experiences and perspectives of nurses infected with COVID-19, addressing a significant gap in the current literature. Following the JBI meta-synthesis approach, a rigorous search was conducted across nine electronic databases and references until January 16, 2023. Seventeen eligible studies underwent quality assessment using the JBI critical checklist. Data were synthesized using standardized tools, and the ConQual tool evaluated confidence in the findings. Seven key findings emerged, providing valuable insights into emotional experiences, adaptation to COVID-19 challenges, influence of support systems, coping strategies, posttraumatic growth perceptions, and effects on professional identity and career advancement. The findings highlight emotional toll, adaptive strategies, and professional implications for nurses. Moreover, they emphasize the importance of support systems, coping mechanisms, and posttraumatic growth in promoting nurses' well-being and resilience. These insights have practical implications for targeted interventions and support mechanisms to enhance infected nurses' well-being and improve healthcare outcomes.

Perceptions of public health nursing Team Leaders (TLs) and Team Supervisors (TSs) on nurse's development in Fiji.

BACKGROUND: Nurse team leaders are responsible for contributing to managing the quality of service delivery and facility output of their nurses to ensure there is a high quality of care delivered by the health system. This study aimed to explore the perceptions of public health nursing Team Leaders (TLs) and public health nursing Team Supervisors (TSs) on nurses' development in Fiji. METHODS: A qualitative study was used to gather information using in-depth phone interviews among TLs and TSs comprising Chief Midwifery Nursing Officer (CMNO), Director of Nursing (DON), Sub-divisional Nursing Managers (SDNMs), acting SDNMs and Nursing Manager (NM) at Central health division in Fiji. The data was collected through semi-structured open-ended questionnaires and were audio recorded. The data was analyzed using manual thematic analysis process. RESULTS: The study comprised of 26 participants, which included 10 TSs and 16 TLs. Four themes were identified for the results amongst TSs and TLs: ethical development; professional development; psychological development; and recommendations. However, nine sub- themes were identified for TSs and eight sub-themes were identified for the result amongst TLs. CONCLUSION: This study highlighted that TLs and TSs elaborated on the need for the ethical, professional, psychological development, nursing development and also on the importance of policies and guidelines. Professional ethics should be integrated into the Continuous Profession Development (CPD) points that are used to renew yearly nursing licenses as well as exposing the need for having competencies on professional ethics in nurses' logbooks. Further research is needed to determine the in-depth barriers.

Nurses' Perspectives of Their Impact While Serving on Boards.

OBJECTIVE: The study objective was to identify nurses' perceptions of their impact while serving on boards. BACKGROUND: Nurse leaders serving as voting board members are key experts for board effectiveness and may be associated with stronger performing organizations. Extant research indicates that nurse leaders are qualified for board service; however, no research explores the impact of nurses on boards. METHODS: We conducted an exploratory qualitative study by interviewing 20 nurses serving on boards. Hermeneutic analysis of the data resulted in 1 overarching pattern and 7 traversing themes. RESULTS: Nurses who serve on boards reported leveraging expert knowledge of healthcare and caring wisdom to influence strategic thinking to meet stakeholder needs. CONCLUSION: Nurses promote effective board governance by ensuring that the perspectives and needs of all stakeholders are represented in board processes. We recommend health-related organization executives and board leaders appoint nurses as voting members of their governing boards.

Forever Changed: RNs Speak of their COVID-19 Experiences through a System-Wide Nursing Web Site.

A COVID19RNStories website allowed RNs in this integrated health system to "tell their stories" during the recent pandemic. From April to August 2020, approximately 100 items were posted with 4 themes emerging. COVID19RNStories had no preconceived hypotheses or specific questions to answer: RNs shared whatever they felt was relevant to their experiences. This approach provided real-time information on issues and concerns of RNs during the 1st wave of COVID-19. This article discusses the identified themes with recommendations for nursing leaders to support staff during the pandemic and future unexpected emergency situations.

Nurse preceptors' perceptions of benefits, rewards, support, and commitment to the preceptor role in a new preceptorship program.

BACKGROUND: Nurse preceptorship is a new concept emerging in the Iranian health care system. The purpose of this research was to assess preceptor nurses' perceived benefits, rewards, support, and commitment to the role in a new nurse preceptorship program in Iran and to examine the relationships between these concepts. METHODS: A descriptive correlational study was employed, and using total population sampling method, 45 preceptor nurses were recruited from a tertiary referral teaching hospital in Iran. Data were collected using the Preceptor's Perception of Benefits and Rewards Scale, the Preceptor's Perception of Support Scale, and the Commitment to the Preceptor Role Scale. Descriptive statistics and correlational analysis were used to analyse data. RESULTS: Preceptors' commitment to their role was positively and moderately associated with their perceived benefits and rewards (r = 0.503, p = 0.001) and perceived support (r = 0.430, p = 0.003). None of the examined demographic and practice variables showed statistically significant association with commitment to the preceptor role. CONCLUSIONS: Commitment to the preceptor role was associated with benefits, rewards and support that preceptor nurses perceive in relation to their role. To optimise the effectiveness of nurse preceptorship programs, benefits, rewards, recognition, and support should be integral to planning of these programs.