The quality of clinician and student quality improvement reports: An analysis of 8 years of submissions.

INTRODUCTION: Many papers reporting on QI projects are not publishable for a variety of reasons. We compared manuscripts submitted as QI reports between June 2014 and June 2016 (prior to publication of the revised Standards for Quality Improvement Reporting Excellence (SQUIRE 2.0) with papers submitted to the American Journal of Nursing between July 2016 and December 2022). The aim was to evaluate any changes in the quality of manuscripts and identify problems that led to rejection; we also compared the quality of students with non-student submissions. METHODS: We conducted a non-randomized descriptive study to evaluate 349 papers submitted as QI project reports between June 2014 and December 2022 using screening templates based on the SQUIRE 2.0 checklist and findings of the INANE Working Group on Student Papers. RESULTS: Manuscripts designated as QI reports accepted for publication increased from 4% during 2014-2016 (T1) to 14% during 2016-2022 (T2); one student submission was accepted. There was a slight decrease in submissions designated as QI that were not QI: 36% of student submissions during T1 and 31% of student submissions during T2. Among clinician submissions, 44% in T1 designated as QI reports were not QI versus 31% submitted during T2. There was a decrease in student submissions that followed the SQUIRE guidelines (36% during T1 to 24% during T2). CONCLUSIONS: Findings demonstrate that by following the SQUIRE 2.0 guidelines, authors submit more complete manuscripts with fewer missing components. However, there are still misconceptions about what constitutes QI versus research and how to report QI initiatives. After comparing the findings from both periods, it is noteworthy that there is essentially the same level of inaccuracy and lack of acceptable manuscripts. CLINICAL RELEVANCE: Sharing findings from QI activities through presentations and publications is a vital way of helping spread the learnings from these projects and improve health care for a wider audience. Clinicians, academicians, and students must understand the elements of the SQUIRE guidelines and ensure that this framework is used for both designing and submitting QI projects for publication.

Nursing Journal Policies on Disclosure and Management of Conflicts of Interest.

PURPOSE: Concerns about conflicts of interest (COIs) in research and health care are well known, but recent reports of authors failing to disclose potential COIs in journal articles threatens the integrity of the scholarly literature. While many nursing journals have published editorials on this topic, review of nursing journal policies on and experiences with COIs has not been reported. The purposes of this study were to examine the extent to which nursing journals have COI policies and require disclosures by authors, peer reviewers, editorial board members, and editors who have a role in journal content decisions. DESIGN: This cohort study addressed top-ranked nursing journal policies about and experiences with COIs in scholarly publications. METHODS: An analysis of COI policies in the instructions for authors of 118 journals listed in the nursing category of Clarivate Analytics Journal Citation Reports was completed in 2019. An electronic survey of the editors was also conducted to determine their awareness and experience with COI policies for their journals. Characteristics of the journals and policies were assessed. Information on polices about COIs for editors and peer reviewers were also reviewed. A content analysis of the policies included assessment of best practices and gaps in requirements. FINDINGS: For the journal policy assessment, 116 journals that publish only in the English language were eligible. The majority (n = 113; 97.4%) of journals had a statement on COI policies for authors, but only 42 (36.2%) had statements for peer reviewers and only 37 (31.9%) had statements for editors. A total of 117 journal editors were sent the survey. One declined to participate, leaving a total of 116 eligible editors; 82 (70.6%) responded and 34 did not respond. Sixty-seven (81.7%) of the 82 editors indicated that their journal had a policy about COIs for authors. Seventy-four editors (63.7%) responded to the question about their journal having a policy about COIs for peer reviewers and editors. Thirty-three (44.5%) of the respondents indicated their journal had a COI policy for peer reviewers, and 29 (39.1%) stated they had a policy for editors. Few editors (n = 7; 9%) indicated that they had encountered problems pertaining to author COIs. CONCLUSIONS: Findings from this study may help promote ethical publication practices through comprehensive policies on disclosure and management of nursing journal authors, peer reviewers, and editors. CLINICAL RELEVANCE: Declarations of potential conflicts of interest promote transparency and allows the consumer of research to take that into consideration when considering the findings of a study.

Role of the Chief Nurse Officer in Ensuring Person- and Family-Centered Care.

Person- and family-centered care (PFCC) is a philosophy that has been espoused for decades and yet is rarely embedded in health care organizations. Difficulties dispelling the numerous myths about what PFCC is, as well as daunting challenges to designing and implementing it, have hindered progress. The chief nurse officer is well-positioned to assume organizational leadership in successfully navigating this effort. This article provides 9 specific steps a chief nurse officer should take to create a culture, with supportive systems and an environment, to ensure authentic PFCC.

Newly Licensed RN Retention: Hospital and Nurse Characteristics.

OBJECTIVES: The aims of this study were to examine the relationship between 1-year retention of newly licensed RNs (NLRNs) employed in hospitals and personal and hospital characteristics, and determine which characteristics had the most influence. METHODS: A secondary analysis of data collected in a study of transition to practice was used to describe the retention of 1464 NLRNs employed by 97 hospitals in 3 states. Hospitals varied in size, location (urban and rural), Magnet® designation, and university affiliation. The NLRNs also varied in education, age, race, gender, and experience. RESULTS: The overall retention rate at 1 year was 83%. Retention of NLRNs was higher in urban areas and in Magnet hospitals. The only personal characteristic that affected retention was age, with younger nurses more likely to stay. CONCLUSION: Hospital characteristics had a larger effect on NLRN retention than personal characteristics. Hospitals in rural areas have a particular challenge in retaining NLRNs.

Development and Psychometric Analysis of a Nurses' Attitudes and Skills Safety Scale: Initial Results.

Health care organizations have incorporated updated safety principles in the analysis of errors and in norms and standards. Yet no research exists that assesses bedside nurses' perceived skills or attitudes toward updated safety concepts. The aims of this study were to develop a scale assessing nurses' perceived skills and attitudes toward updated safety concepts, determine content validity, and examine internal consistency of the scale and subscales. Understanding nurses' perceived skills and attitudes about safety concepts can be used in targeting strategies to enhance their safety practices.

Nurses' Perceived Skills and Attitudes About Updated Safety Concepts: Impact on Medication Administration Errors and Practices.

Approximately a quarter of medication errors in the hospital occur at the administration phase, which is solely under the purview of the bedside nurse. The purpose of this study was to assess bedside nurses' perceived skills and attitudes about updated safety concepts and examine their impact on medication administration errors and adherence to safe medication administration practices. Findings support the premise that medication administration errors result from an interplay among system-, unit-, and nurse-level factors.

Preceptor Support in Hospital Transition to Practice Programs.

OBJECTIVE: The aim of this study was to describe newly licensed RN (NLRN) preceptorships and the effects on competency and retention. BACKGROUND: Preceptors are widely used, but little is known about the benefit from the perspective of the NLRN or about the models of the relationships. The National Council of State Boards of Nursing added questions about the preceptor experience in a study of transition-to-practice programs. METHODS: Hospitals were coded as having high or low preceptor support in regard to scheduling NLRN on the same shifts as their preceptors, assignment sharing, and preceptor release time and a low number of preceptors per preceptee. RESULTS: Half of the 82 hospitals were classified as high, and half as low preceptor support. NLRNs and their preceptors in high-support hospitals evaluated the preceptor experience and NLRN competence higher. In addition, NLRN retention was higher in the high-support hospitals. CONCLUSIONS: To improve NLRN competence and retention, preceptors should have adequate time with each NLRN, share shift and patient assignments, and have few preceptees assigned to each preceptor concurrently.

Honorary and ghost authorship in nursing publications.

PURPOSE: The purposes of this study were to (a) assess the prevalence of articles with honorary authors and ghost authors in 10 leading peer-reviewed nursing journals between 2010 to 2012; (b) compare the results to prevalence reported by authors of articles published in high-impact medical journals; and (c) assess the experiences of editors in the International Academy of Nursing Editors with honorary and guest authorship. METHODS: Corresponding authors of articles published in 10 nursing journals between 2010 and 2012 were invited to complete an online survey about the contributions of coauthors to see if the International Committee of Medical Journal Editors () criteria for authorship were met. Additionally, members of the International Academy of Nursing Editors were invited to complete an online survey about their experiences in identifying honorary or ghost authors in articles submitted for publication. FINDINGS: The prevalence of articles published in 10 nursing journals with honorary authors was 42%, and the prevalence of ghost authorship was 27.6%. This is a greater prevalence than what has been reported among medical journals. Qualitative data yielded five themes: lack of awareness around the rules for authorship; acknowledged need for debate, discussion, and promotion of ethical practice; knowingly tolerating, and sometimes deliberately promoting, transgressions in practice; power relations and expectations; and avoiding scrutiny. Among the 60 respondents to the editor survey, 22 (36.7%) reported identifying honorary authors and 13 (21.7%) reported ghost authors among papers submitted to their publications. CONCLUSIONS: Inappropriate authorship is a significant problem among scholarly nursing publications. RELEVANCE: If nursing scholarship is to maintain integrity and be considered trustworthy, and if publications are to be a factor in professional advancement, editors, nursing leaders, and faculty need to disseminate and adhere to ethical authorship practices.

Mandate for care.

MUCH HAS been written on the need to move to a more patient- and family-centred system of healthcare delivery. Recognised steps that nursing staff can take to design patient-centred care delivery models include, for example, unrestricted visiting for family members, hourly rounding and having open medical record policies.

A Reflection on Claire Fagin.

Honoring the life and work of this visionary leader.

Applying Principles of a Fair and Just Culture to a Student Scenario.

BACKGROUND: This article reviews national efforts toward promoting fair and just cultures in schools of nursing. A real-life vignette in which a nursing student made a medication error is presented, and the nursing program contacted the nursing regulatory body for advice on how to handle the situation. METHOD: A framework was used to analyze the causes of the error. Commentary is offered regarding how applying the principles of a fair and just culture could improve student performance and advance the school's culture to reflect one that was fair and just. RESULTS: A fair and just culture requires a commitment of all leaders and faculty within a school of nursing. Administrators and faculty must recognize that errors are part of the learning process, that errors can be minimized but not eliminated, and that learning can occur from each incident to prevent similar occurrences in the future. CONCLUSION: Academic leaders must engage faculty, staff, and students in a dialogue about the principles of a fair and just culture to develop a tailored plan of action. [J Nurs Educ. 2023;62(3):139-145.].

Facilitating a Culture of Evidence-Based Practice and Quality Improvement Excellence: Streamlining Processes to Improve Care.

This article defines evidence-based practice (EBP) and quality improvement (QI) and examines the positive impact on patient care when they are in place, as well as the barriers to their implementation. An effective tool, Ovid Synthesis, was created to enable clinicians and administrators to streamline the processes for EBP and QI, provide oversight on the initiatives underway, and enable clinical educators to help nursing staff develop the necessary competencies and successfully execute their EBP and/or QI projects.

Teaching the culture of safety.

Although a healthcare culture of safety has been a practice priority for many years, there has been less attention to incorporating culture of safety content into the education of healthcare professionals. Students need to become knowledgeable about system vulnerabilities and understand how knowledge, skills, and attitudes promoting utilization of safety science will lead to safer care for patients and families. Learning about both patient safety and system vulnerabilities needs to begin in pre-licensure programs and become an integral part of learning in all phases of nursing education and practice. In this article the author will begin by reviewing the essential elements of a culture of safety and considering what students need to know about a culture of safety. She will describe activities that promote safety, high reliability organizations, and external drivers of safety, and conclude by offering strategies for integrating a culture of safety into the curriculum.

QSEN in an Amazon World.

ABSTRACT: Quality and Safety Education for Nurses (QSEN) was launched in 2005 as a national nursing initiative aimed at preparing nurses with the competencies needed to continuously improve the quality and safety of the health care they provide. The six QSEN competencies-and the knowledge, skills, and attitudes that each entails-have served as a basis for significant curricular revision, more enlightened professional practice, relevant research, and health care system improvements. Since the launch of QSEN, new technologies have emerged, the range of care sites has broadened, new practice roles have emerged, and patients and families have become more active health care consumers. This article highlights these changes, considers Amazon as a powerful contemporary social force, examines the company's core values, and considers their relevancy to the six QSEN competencies. Essential new literacies and cognitive capacities are also identified. Lastly, the authors outline steps nurses can take to incorporate the QSEN competencies, along with the literacies and capacities, into their practice and organizations. Doing so is vital to delivering safe, high-quality care in this rapidly changing health care climate, and will enable nurses to claim their leadership and thrive professionally in an Amazon world.

Innovative collaborations: a case study for academic owned nursing practice.

PURPOSE: Academic service partnerships are critical for schools of nursing to maintain credibility regarding their missions of education, research, service, and practice. METHODS: In this paper, we describe a case study of a ten year program, the Living Independently For Elders (LIFE) Program at the University of Pennsylvania School of Nursing that has provided community-based long-term care to high-risk older adults. FINDINGS: Quality of care and financial outcomes were met with nurse faculty engagement, administrative commitment, and integration of business practices. CONCLUSIONS: As a result, high risk older adults receive care in their communities rather than nursing homes, and the school- owned and -operated program is a nationally recognized innovative nursing model of care. CLINICAL RELEVANCE: Strategies are described that can be used globally as more schools of nursing embrace and strengthen service partnerships.

Promoting evidence-based practice and translational research.

Evidence-based practice (EBP) is an evolutionary step in the nursing model of excellence in professional practice at the Hospital of the University of Pennsylvania. A healthcare culture focused on excellence and world-class patient care requires that nursing research and EBP are integrated into the professional practice model and nursing care delivery. To achieve this, it requires the development of staff expertise, time allocation for staff to participate in scholarly activities, resources that support EBP and research, and expert consultants in EBP and nursing translational research. This article describes the systems and structures in place to provide staff with resources in order to translate research and deliver EBP and the multiple initiatives in disseminating evidence to the point of care.

Quality and safety education for advanced nursing practice.

The Quality and Safety Education for Nurses (QSEN) project is a national initiative to transform nursing education to integrate quality and safety competencies. This article describes a two-year process to generate educational objectives related to quality and safety competency development in graduate programs that prepare advanced practice nurses in clinical roles. Knowledge, skills, and attitudes for each of 6 competencies are proposed to stimulate development of teaching strategies in programs preparing the next generation of advanced practice nurses.

Nursing practice and work environment issues in the 21st century: a leadership challenge.

A leadership conference titled "Have Patient Safety and the Workforce Shortage Created the Perfect Storm?" was held in honor of Dr. Ada Sue Hinshaw, who was ending her tenure as dean of the University of Michigan School of Nursing. A morning panel on the preferred future for practice featured plenary speaker Dr. Linda Burnes Bolton and participating panelists Dr. Sanjay Saint, Dr. Jane Barnsteiner, and Dr. Joanne Disch. Each speaker presented a unique yet complementary perspective, with several common themes permeating the morning's presentations. For example, all of the speakers mentioned how important interprofessional collaboration is to promoting patient safety. The themes can be categorized broadly as nursing practice and work environment issues, with subthemes of interprofessional communication and collaboration, systems solutions to patient safety problems, and future directions in nursing education. A synopsis of comments made during the morning practice panel and empirical support for the themes and subthemes identified by panelists are provided in this article.

Quality and nursing: moving from a concept to a core competency.

The growing focus on providing high-quality care suggests that nurses' involvement in quality activities is likely to increase in coming years. By actively participating in the improvement of health care, nurses benefit their patients and stimulate joy in work.