Understanding the Cures Act Information Blocking Rule in cancer care: a mixed methods exploration of patient and clinician perspectives and recommendations for policy makers.

BACKGROUND: The 21st Century Cures Act Interoperability and Information Blocking Rule was created to increase patient access to health information. This federally mandated policy has been met with praise and concern. However, little is known about patient and clinician opinions of this policy within cancer care. METHODS: We conducted a convergent parallel mixed methods study to understand patient and clinician reactions to the Information Blocking Rule in cancer care and what they would like policy makers to consider. Twenty-nine patients and 29 clinicians completed interviews and surveys. Inductive thematic analysis was used to analyze the interviews. Interview and survey data were analyzed separately, then linked to generate a full interpretation of the results. RESULTS: Overall, patients felt more positive about the policy than clinicians. Patients wanted policy makers to understand that patients are unique, and they want to individualize their preferences for receiving health information with their clinicians. Clinicians highlighted the uniqueness of cancer care, due to the highly sensitive information that is shared. Both patients and clinicians were concerned about the impact on clinician workload and stress. Both expressed an urgent need for tailoring implementation of the policy to avoid unintended harm and distress for patients. CONCLUSIONS: Our findings provide suggestions for optimizing the implementation of this policy in cancer care. Dissemination strategies to better inform the public about the policy and improve clinician understanding and support are recommended. Patients who have serious illness or diagnoses such as cancer and their clinicians should be included when developing and enacting policies that could have a significant impact on their well-being. Patients with cancer and their cancer care teams want the ability to tailor information release based on individual preferences and goals. Understanding how to tailor implementation of the Information Blocking Rule is essential for retaining its benefits and minimizing unintended harm for patients with cancer.

Leadership Science in Nursing: Creating New Solutions for New Challenges.

The Association for Leadership Science in Nursing (ALSN) November 2022 International Conference was held at the Frances Payne Bolton School of Nursing at Case Western University. ALSN is dedicated to uniting academic and practice leaders to shape leadership science, education in nursing, and the practice of nursing leadership. One hundred fifty-one nurse leaders from the United States, Canada, and Oman gathered to discuss leadership as highlighted in this column.

Managing safety in perioperative settings: Strategies of meso-level nurse leaders.

BACKGROUND: Perioperative nursing units are described as one of the most challenging practice environments, characterized by a distinct hierarchal culture and rapid pace. These dynamics create challenges for creating a culture of safety, where meso-level nurse leaders (MLNLs) must operate in the space between the micro level of direct patient care and the macro-level administrative priorities. PURPOSE: Guided by complexity leadership theory, we sought to understand the strategies MLNLs used to facilitate a culture of safety in perioperative settings. METHODOLOGY: A qualitative descriptive study with semistructured interviews was conducted. Inductive thematic analysis was used to analyze content from the interviews, and several techniques (audit trail, reflexivity, peer debriefing) were used to ensure rigor. RESULTS: Seventeen MLNLs completed an interview, and analysis identified four strategies that MLNLs reported to foster safety as meso-leaders in perioperative environments: (a) recognizing the unique perioperative management environment, (b) learning not to take interactions personally, (c) developing "super meso-level nurse leader" skills, and (d) appealing to policies and patient safety. CONCLUSION: Perioperative environments require MLNLs to use multifaceted strategies to keep the peace among many stakeholders and foster patient safety. PRACTICE IMPLICATIONS: Our study shows how clear organizational policies and procedures can serve as a vital tool-moving attention away from a feeling of individual "policing" and toward joint discussion about shared patient safety goals-and ultimately support MLNLs in challenging perioperative work environments. Perioperative environments create unique challenges, and organizations should consider perioperative-specific leadership training to prepare MLNLs for these roles.

Implementation Science for the Practice-Oriented Nurse Leader.

Senior nurse leaders are accountable for improving patient outcomes efficiently and cost-effectively. Nurse leaders often find heterogeneous patient outcomes across comparable nursing units in the same enterprise, presenting a challenge for nurse leaders tasked with making system-wide quality improvements. Implementation science (IS) offers a promising new approach to guide nurse leaders in understanding why certain implementation efforts meet with success or failure and the barriers faced in making practice changes. Knowledge of IS builds upon evidenced-based practice and quality improvement knowledge, adding to the armamentarium of tools at nurse leaders' disposal for improving nursing and patient outcomes. In this article, we demystify IS, differentiate it from evidence-based practice and quality improvement, describe IS concepts every nurse leader should be familiar with, and outline nurse leaders' role in building IS in their organizations.

Advancing Nursing Leadership Science Through an Innovative Research-Practice Partnership.

ABSTRACT: The Association for Leadership Science in Nursing and American Organization for Nursing Leadership Foundation have formed a new research-practice collaborative. The collaborative allows for a synergistic approach to the advancement of leadership science. This article discusses the impetus for the collaborative, its structure, and how its synergy of research and practice expertise provides immense opportunity for robust, practice-relevant research.

Building the Science to Guide Nursing Administration and Leadership Decision Making.

OBJECTIVE: The aim of this study was to identify the challenges, barriers, and solutions for conducting nursing administration and leadership science (NALS) research. BACKGROUND: Evidence from leadership science should be at the forefront of nurse leaders' decision making. Yet, challenges remain in building the evidence and moving it into nursing administration and leadership practice. METHODS: This study used a Delphi technique with open-ended questions and direct content analysis to evaluate survey responses of members of the Association for Leadership Science in Nursing and American Organization for Nursing Leadership. RESULTS: Open-ended responses were coded to yield super categories and supportive codes for areas with limited evidence to guide leadership practice and the challenges for conducting NALS research. CONCLUSIONS: These findings provide future directions for continuously driving NALS research and for building and leveraging leadership science to support nursing administration decision making.

Implementation Science and Nursing Leadership: Improving the Adoption and Sustainability of Evidence-Based Practice.

Increasingly, nurse executives are embracing evidence-based practice (EBP). Yet, it takes 17 years to move only 14% of research evidence into practice. Implementation science (IS) aims to reduce this gap through the study of factors that influence dissemination, adoption, implementation, and sustainability of evidence-based interventions. Nurse leaders aiming for EBP must be well equipped to support IS. This article introduces IS, leadership competencies essential for supporting implementation research and practice, and preparing an IS-ready workforce.

Nurses Taking the Lead: A Look Back to Move Forward.

In recognition of the Year of the Nurse and Midwife, the 2020 annual conference of the Association for Leadership Science in Nursing (ALSN) celebrated A Look Back to Move Forward in recognition of the 50th anniversary of ALSN. The ALSN began as the Council of Graduate Education for Administrative Nursing (CGEAN) in 1970. Today, ALSN maintains the goals of shaping graduate education and research to inform nursing leadership practice.

Setting the Research Agenda for Nursing Administration and Leadership Science: A Delphi Study.

OBJECTIVE: The aim of this study was to identify and prioritize research topics for nursing administration and leadership science. BACKGROUND: Nursing administration and leadership research priorities should provide a framework for building the science needed to inform practice. METHODS: The Association for Leadership Science in Nursing (ALSN) and American Organization for Nursing Leadership (AONL) Foundation (AONL-F) for Nursing Leadership and Education collaborated on a Delphi study. Initial input on research priority items were received from ALSN and AONL members. National experts participated in a 3-round Delphi study. RESULTS: Top-ranked priorities included: 1) nurses' health, well-being, resiliency, and safety in the workplace; 2) developing and managing a nursing workforce to meet current and future healthcare needs; 3) healthy work/practice environments for direct care nurses; 4) healthy work/ practice environments for nurse leaders; 5) quantification of nursing's value across the healthcare delivery system; and 6) nurse leader development and essential competencies. CONCLUSIONS: Researchers and funders should use these priorities to guide future studies.

Using Implementation Science to Further the Adoption and Implementation of Advance Care Planning in Rural Primary Care.

PURPOSE: To analyze the literature on advance care planning (ACP) in primary care through the lens of implementation science, with a focus on implications for rural settings. DESIGN: Scoping review of the literature. METHODS: The Cumulative Index of Nursing and Allied Health Literature (CINAHL), Medline, PsycINFO, and the Psychology and Behavioral Sciences Collection databases were searched for studies related to ACP adoption and implementation in primary care. The Theoretical Domains Framework was used to map the literature to 14 determinants that serve as barriers or facilitators to ACP. The Conceptual Model of Evidence-Based Practice Implementation in Public Service Sectors was used to analyze the stage of implementation for each of the included studies. FINDINGS: Four steps to ACP were specified: identification, conversation, documentation, and follow-up. Determinants were identified for each step, but studies largely focused on the conversation step. Professional role and identity, environmental context and resources, and emotion were the most frequently cited determinants in initiating conversations. The identification step was largely determined by behavioral regulation. For documenting ACP, environmental context and resource determinants were most prevalent. In the few studies that addressed follow-up, providers expressed a desire for electronic reminders as a behavioral regulator to follow-up. CONCLUSIONS: While ACP has been shown to have patient, family, and societal benefits, its uptake in primary care has been minimal. Because ACP is a complex process that is highly context dependent, implementation science is critical to inform its successful adoption and implementation. Smaller healthcare networks, adaptable professional roles, trusted relationships, and tight-knit community might be important facilitators of ACP in rural primary care. CLINICAL RELEVANCE: Findings from this study can be used to accelerate ACP implementation in rural primary care.

Magnet® and Pathway to Excellence®: Focusing on Research and Evidence-Based Practice.

Healthcare organizations seeking to achieve or maintain Magnet or Pathway to Excellence designation are increasingly challenged to demonstrate how nurses are leading or are engaged in research and evidence-based practice. This article describes common barriers to and effective strategies for developing a culture of research and evidence-based practice, with recommendations for Magnet- and Pathway-seeking organizations.

The Effect of an Evidence-Based Practice Education and Mentoring Program on Increasing Knowledge, Practice, and Attitudes Toward Evidence-Based Practice in a Rural Critical Access Hospital.

OBJECTIVE: The aim of this study was to determine the effect of an evidence-based practice (EBP) education and mentoring program on the knowledge, practice, and attitudes toward EBP among staff nurses and clinicians in a rural critical access hospital. BACKGROUND: While rural nurses value EBP, they often have more limited resources to engage in EBP activities compared with urban-based nurses. METHODS: Direct care nurses and clinicians participated in a 5-month EBP education and mentoring program following the Iowa Model Revised: Evidence-Based Practice to Promote Excellence in Health Care. The Evidence-Based Practice Questionnaire was used to assess pretest-posttest knowledge, practice, and attitudes toward EBP. RESULTS: Knowledge and practice of EBP increased significantly (P = .008 and P = .015, respectively) after the EBP education and mentoring intervention. Attitudes toward EBP also increased, although the increase was not statistically significant (P = .106). CONCLUSIONS: Education and mentoring of healthcare clinicians in rural settings are crucial to the translation of evidence-based research into practice to improve patient outcomes.

Disruptive Innovation: Impact for Practice, Policy, and Academia.

The 2019 Association for Leadership Science in Nursing International Conference, Disruptive Innovation, was held in Los Angeles, California, with attendees from 30 US states, Canada, Brazil, and China. Presenters discussed the need for nurse leaders to advocate for health equity, lead evidence-based innovation, how robots and other technology are generating disruptive innovations in healthcare, and building strong academic-practice partnerships to address nursing workforce challenges. This article will report on these important insights.

Exploring nurses' perceptions of nurse managers' communicative relationships that encourage nurses' decisions to buy-in to initiatives that enhance patients' experiences with care.

AIM: To explore nurses' perceptions of nurse managers' (NMs') communicative relationships that encourage nurses' decisions to buy-in to organisational initiatives to enhance patients' experiences with care (PEC). BACKGROUND: The role of the nurse to patient experience is well established, yet little is known about how the communicative relationship between manager and nurse relates to nurse buy-in to PEC initiatives. METHOD: An exploratory qualitative descriptive study was conducted with 15 nurses from two inpatient medical-surgical units in a large acute care hospital using semi-structured interviews. RESULTS: Three themes were identified. The communicative relationship was developed and strengthened through the manager's: (a) multimodal approach to communicating and influencing, (b) engaging and supporting staff and (c) promoting staff-led decision-making. CONCLUSIONS: Nurses in our study who reported having a strong communicative relationship with their NM perceived that this relationship encouraged their buy-in and engagement in PEC initiatives. IMPLICATIONS FOR NURSING MANAGEMENT: An assessment of the communication between the frontline NM and his or her team is important for understanding why initiatives to support PEC are or are not yielding desired results.

Turning Health Systems Data Into Actionable Information.

Health systems produce vast amounts of complex, multidimensional data. Health systems nurse leaders, informaticians, and nurse researchers must partner to turn these data into actionable information to drive quality clinical outcomes. The authors review health systems in the era of big data, identify opportunities for health systems-nursing research partnerships, and introduce emerging approaches to data science education in nursing.

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.

Interprofessional Education: Advancing Team Science to Create Collaborative Safety Cultures.

The Institute of Medicine called for all health professionals to be educated in interprofessional teams. Accreditation bodies governing education of health professions responded by creating standards for interprofessional education (IPE) activities. Educators teaching in health professional programs implemented a variety of IPE activities, yet rigorous evaluation of IPE on interprofessional practice and patient outcomes is limited. The authors review the progress of IPE, introduce new trends in IPE, and identify the methods needed to evaluate IPE effectiveness.

Characteristics of the Nursing Practice Environment Associated With Lower Unit-Level RN Turnover.

OBJECTIVE: The aim of this study is to examine characteristics of the nursing practice environment associated with lower RN turnover. BACKGROUND: Identifying characteristics of the practice environment that contribute to lower RN turnover is important for meeting the national quality strategy priority of reducing healthcare costs. METHODS: Data from 1002 adult care units in 162 National Database of Nursing Quality Indicators participating hospitals were analyzed using multivariate linear regression. The Practice Environment Scale of the Nursing Work Index was used to measure practice environment characteristics. RN turnover was measured at the unit level. RESULTS: Nursing units with higher overall ratings of the nursing practice environment had lower rates of RN turnover. Units with higher RN perceived staffing and resource adequacy experienced significantly lower RN turnover. CONCLUSIONS: Unit managers and hospital administrators should consider RN perception of staffing and resource adequacy and the overall practice environment when developing targeted strategies for decreasing RN turnover.

Leading Change: A Case Study of the First Independent Critical-Access Hospital to Achieve Magnet® Designation.

OBJECTIVE: The aim of this study was to understand how nurses in a 25-bed critical-access hospital (CAH) led change to become the 1st to achieve Magnet®. BACKGROUND: Approximately 21% of the US population lives in rural areas served by CAHs. Rural nurse executives are particularly challenged with limited resources. METHODS: Staff nurses, nurse managers, interprofessional care providers, the chief nursing officer, and board of directors (n = 27) were interviewed. Observations of hospital units and administrative meetings were done, and hospital reports were analyzed. RESULTS: Nine themes emerged to support a conceptual model of leading change. The CAH spent 3 years of its 6-year journey establishing organizational readiness. Nurses overcame complex challenges by balancing operational support and fostering relationships. The Magnet journey led to significantly improved nurse and patient outcomes. A new organizational culture centered on shared governance, evidence-based practice, and higher education emerged. CONCLUSIONS: The journey to Magnet leads to improved nurse, patient, and organization outcomes.

Leading change: a concept analysis.

AIM: To report an analysis of the concept of leading change. BACKGROUND: Nurses have been called to lead change to advance the health of individuals, populations, and systems. Conceptual clarity about leading change in the context of nursing and healthcare systems provides an empirical direction for future research and theory development that can advance the science of leadership studies in nursing. DESIGN: Concept analysis. DATA SOURCES: CINAHL, PubMed, PsycINFO, Psychology and Behavioral Sciences Collection, Health Business Elite and Business Source Premier databases were searched using the terms: leading change, transformation, reform, leadership and change. Literature published in English from 2001 - 2015 in the fields of nursing, medicine, organizational studies, business, education, psychology or sociology were included. METHODS: Walker and Avant's method was used to identify descriptions, antecedents, consequences and empirical referents of the concept. Model, related and contrary cases were developed. RESULTS: Five defining attributes of leading change were identified: (a) individual and collective leadership; (b) operational support; (c) fostering relationships; (d) organizational learning; and (e) balance. Antecedents were external or internal driving forces and organizational readiness. The consequences of leading change included improved organizational performance and outcomes and new organizational culture and values. CONCLUSION: A theoretical definition and conceptual model of leading change were developed. Future studies that use and test the model may contribute to the refinement of a middle-range theory to advance nursing leadership research and education. From this, empirically derived interventions that prepare and enable nurses to lead change to advance health may be realized.