Showing papers in "Journal of Nursing Administration in 2001"
TL;DR: An expanded model of Kanter’s structural empowerment, which specified the relationships among structural and psychological empowerment, job strain, and work satisfaction, provides initial support for an expandedmodel of organizational empowerment and offers a broader understanding of the empowerment process.
Abstract: ObjectiveIn this study, we tested an expanded model of Kanter’s structural empowerment, which specified the relationships among structural and psychological empowerment, job strain, and work satisfactionBackgroundStrategies proposed in Kanter’s empowerment theory have the potential to reduce job st
787 citations
TL;DR: As healthcare institutions face a nursing shortage and a new generation of nurses enter the workforce, consideration of the factors that influence turnover is essential to creating a working environment that retains the nurse.
Abstract: ObjectivesThe purpose of this study was to examine the relationships between work satisfaction, stress, age, cohesion, work schedule, and anticipated turnover in an academic medical center.Background DataNurse turnover is a costly problem that will continue as healthcare faces the impending nursing
498 citations
TL;DR: Controlling for patient acuity, hours of nursing care, and staff mix, units with more experienced nurses had lower medication errors and lower patient fall rates, but adverse occurrence rates onunits with more baccalaureate-prepared nurses were not significantly better.
Abstract: Objective:To describe the relationships between the quality of patient care and the education and experience of the nurses providing that care.Background:There is a call for more nurses with baccalaureate degrees and more experienced nurses to work in hospitals. Previous research studies have examin
273 citations
TL;DR: The author's study provides insight into, and enhances understanding of, recruitment and retention issues for nursing administrators who serve as gatekeepers to the practice orientations and ongoing workplace environments of new nursing graduates.
Abstract: Resources are being spent to develop and implement strategies to attract and retain staff. To further our understanding of work environment factors that affect these issues, the author asked five nurses to reflect on their first 6 months as professional nurses. The author's study provides insight into, and enhances understanding of, recruitment and retention issues for nursing administrators who serve as gatekeepers to the practice orientations and ongoing workplace environments of new nursing graduates.
247 citations
TL;DR: An RN Internship in Pediatrics program for new graduates was brought from vision to reality to facilitate transition of the new graduate nurse to professional registered nurse (RN) and to prepare a beginning level staff nurse who is confident and who provides competent and safe patient care.
Abstract: Faced with a threatened shortage of highly skilled, acute care pediatric nurses, an RN Internship in Pediatrics program for new graduates was brought from vision to reality. Goals of the program were to: 1) facilitate transition of the new graduate nurse to professional registered nurse (RN); 2) prepare a beginning level staff nurse who is confident and who provides competent and safe patient care; and 3) increase the commitment and retention of new graduate nurses within the organization. A 1-year pilot program evaluation demonstrated that the interns who had an average of 8 months of RN experience were comparable or better on all measures than were control group participants who obtained up to 2 years of RN experience. A return on investment of 67.3% was established.
229 citations
TL;DR: In a survey addressing work-related stress, 1,780 registered nurses discussed the many variables affecting their job satisfaction, including: why they chose nursing, patient care issues, nurse manager roles, salaries and benefits, and intent to stay in nursing.
Abstract: In a survey addressing work-related stress, 1,780 registered nurses (RNs) discussed the many variables affecting their job satisfaction, including: why they chose nursing, patient care issues, nurse manager roles, salaries and benefits, and intent to stay in nursing. Their responses may be painful for nursing management to read. Yet, if new candidates are to be attracted and existing RNs retained, satisfaction of RNs with their jobs must be considered.
169 citations
TL;DR: The authors concluded that social networks are important during times of change and uncertainty in the work environment; in other words, a supportive workplace can protect against burnout.
Abstract: As healthcare organizations deal with changes in the external environment, uncertainty in the internal environment is created. The purpose of this study was to explore the relationships among environmental uncertainty, social climate, and burnout among staff nurses. Multiple regression analysis was used to explore relationships among study variables. Perceived environmental uncertainty predicted burnout among staff nurses, although there was no significant relationship between burnout and objective measures of unit activity. The social climate of the workplace was negatively associated with burnout. The authors concluded that social networks are important during times of change and uncertainty in the work environment; in other words, a supportive workplace can protect against burnout.
151 citations
TL;DR: Restructuring in the organization and delivery of patient care and the effects of nursing structure and processes on selected patient outcomes are described and increased registered nurse hours worked per patient/day were associated with lower fall rates and higher patient satisfaction levels with pain management.
Abstract: Objective.Describe restructuring in the organization and delivery of patient care and the effects of nursing structure and processes on selected patient outcomes.Background.Restructuring has been the dominant cost-reduction strategy in acute care hospitals. Changes occurred without a systematic look
151 citations
TL;DR: Nurses with higher level of job strain were found to be significantly more empowered, more committed to the organization, and more satisfied with their work, supporting Karasek’s Demands/Control theory.
Abstract: BackgroundJob strain among staff nurses has become an increasingly important concern in relationship to employee performance and commitment to the organization in current restructured healthcare settings.ObjectivesThe purpose of this study was to test Karasek’s Demands-Control Model of job strain by
146 citations
TL;DR: Nurse-physician collaboration contributed to greater participation in all phases of both caregiving and condition-of-work decisions and the competency of nurse manager leadership did not have a significant effect on phases of participation in both types of decisions.
Abstract: Objectives:To investigate the relations among staff nurses' participation in phases of the decision-making process related to decisions in nursing practice, competencies of nurse manager leadership, and nurse-physician collaboration.Methods:This study is a secondary analysis of the Variations in Nur
94 citations
TL;DR: The authors review the literature related to competence evaluation of practicing nurses and offer recommendations based on the findings to help nurse administrators locate and evaluate existing instruments to assure safe and qualified nursing care.
Abstract: The authors review the literature related to competence evaluation of practicing nurses and offer recommendations based on the findings. Data collection procedures included literature search from major databases. A frame of classification was constructed to assess the methodological soundness of the
TL;DR: A strong significant correlation between nurse report of level of collaboration and satisfaction with decision making was uncovered and this study contributes to the nurse/physician collaboration literature in that it was longitudinal, used a reliable and valid instrument, and surveyed nurses in medical/surgical units as well as the ICU.
Abstract: Objective Finding time to add to nursing knowledge while solving problems in a fast-paced healthcare environment is the ultimate challenge for nurse executives. At one hospital, use of an action research model to measure collaboration in nurse/physician led interdisciplinary teams improved the intervention and the approach to outcome measurement. Background Many hospital nurse executives promote collaborative practice, and yet, innovations introduced to foster collaboration are rarely studied prospectively. The best-known data on collaboration is predominantly from correlational studies. Within the rapidly changing practice setting, action research may be a more legitimate strategy for studying interventions longitudinally. Methods An action research pretest/posttest design using Baggs' Collaboration and Satisfaction About Care Decisions measured collaboration before and after several interventions to improve nurse/physician collaboration. The sample consisted of 87 pretest and 65 posttest registered nurses working on three medical-surgical units and two intensive care units (ICU). Results Collaboration scores in the ICUs were higher than those in previous research, but the posttest indicated no significant difference in either ICU nurse or medical-surgical nurse scores. Higher ICU scores may have been related to the organizational focus on teams. A strong significant correlation between nurse report of level of collaboration and satisfaction with decision making was uncovered. Conclusions This study contributes to the nurse/physician collaboration literature in that it was longitudinal, used a reliable and valid instrument, and surveyed nurses in medical/surgical units as well as the ICU. Some of the difficulties and benefits of research in today's practice setting are illustrated.
TL;DR: Is shared governance still relevant in this era of significant changes in healthcare?
Abstract: Is shared governance still relevant in this era of significant changes in healthcare? Requisites to support nurses and others are more important now than ever before. Shared decision-making is not only relevant, it is essential. The road to empowerment is not easy. Many patterns of organization and relationship must be changed forever through commitment and leadership today.
TL;DR: A 900-hour residency program for senior baccalaureate nursing students to ease their transition into the role of beginning-level staff nurse in an acute-care setting.
Abstract: It takes a relatively long time for new nursing graduates to become oriented and comfortable with work routines on the nursing unit. To address the problem, the authors formed a partnership among three educational programs and three hospitals. This article describes a 900-hour residency program for senior baccalaureate nursing students to ease their transition into the role of beginning-level staff nurse in an acute-care setting. The benefits to the hospitals were decreased orientation time, less turnover in staff (50% at 2 years), and lower recruitment costs.
TL;DR: Leadership that uses complexity principles offers opportunities in the chaotic healthcare environment to focus less on prediction and control and more on fostering relationships and creating conditions in which complex adaptive systems can evolve to produce creative outcomes.
Abstract: The emerging field of complexity science offers an alternative leadership strategy for the chaotic, complex healthcare environment. A survey revealed that healthcare leaders intuitively support principles of complexity science. Leadership that uses complexity principles offers opportunities in the chaotic healthcare environment to focus less on prediction and control and more on fostering relationships and creating conditions in which complex adaptive systems can evolve to produce creative outcomes.
TL;DR: Using the Q method, the authors were able to identify different, unique viewpoints concerning employee needs among the study population, as well as commonly shared views that can aid in the design of more effective strategies aimed at fulfilling the needs of an organization’s staff to increase their satisfaction.
Abstract: As yet another nursing shortage faces the country, the issue of the satisfaction of nurses again becomes of critical concern to nursing managers in the interest of staff retention. The authors describe the use of the statistical technique Q methodology to assess the needs of nurses and other medical staff at a level one, tertiary care emergency department in the United States. Using the Q method, the authors were able to identify different, unique viewpoints concerning employee needs among the study population, as well as commonly shared views. This level of detail, not obtainable using more traditional statistical techniques, can aid in the design of more effective strategies aimed at fulfilling the needs of an organization's staff to increase their satisfaction.
TL;DR: This article synthesizes research conducted during the past 5 years that quantifies what separates superior leaders from average leaders, including emotional intelligence and its link to performance.
Abstract: Effective leadership is one of the most elusive keys to organizational success yet it is a key ingredient to making any organization work. Leadership is also changing in nature. Our current faster, more flexible, flatter organizations face intense competition and require dynamic leadership. This article synthesizes research conducted during the past 5 years that quantifies what separates superior leaders from average leaders. Although this research originated from a study of top global nonhealthcare organizations, it relates to the nursing profession. The author discusses key elements of the research, including emotional intelligence and its link to performance.
TL;DR: Estimates of the increase in RN expenditures required by this mandate, by hospital size and for regions of California are provided.
Abstract: In 1999, California passed the first legislation in the United States to establish minimum staffing levels in hospitals for registered nurses (RNs) and licensed vocational nurses. The author provides estimates of the increase in RN expenditures required by this mandate, by hospital size and for regions of California. Issues related to the implementation of minimum ratios also are discussed. Attention must be paid to other staffing regulations, special concerns of rural hospitals, the possibility that minimum ratios result in lower RN staffing, and the effect of the nursing shortage on the ability of hospitals to meet requirements.
TL;DR: The Net Generation persona and its work-related skills and values are explored and implications are posed in this article for nurse administrators.
Abstract: The Net Generation is the digitally-savvy generation born between the years of 1980 and 1999. People born during this time are predicted to seek careers in the helping professions, be open to job stability and working in organizations, and intolerant of coworkers and leaders who are not technically competent. The Net Generation persona and its work-related skills and values are explored and implications are posed in this article for nurse administrators.
TL;DR: The results suggest that empowerment provides an excellent way of enhancing organizational attitudes for both men and women.
Abstract: Kanter argues that empowerment has many positive consequences Not only do empowered employees work more effectively, but they are more likely to express positive attitudes toward their organization Although support for Kanter's model has been found in several studies of nurses, these studies have not explored the possibility of gender differences Do men in nursing have the same access as women do to structures that lead to empowerment? Moreover, do men and women react differently to empowerment? To answer these questions, we sampled 412 nurses (195 men; 217 women) about their access to empowerment structures and their trust and commitment to their organization We found no support for the suggestion that male nurses are less empowered because of their "token" status Also, we found that the model predicted the responses of men and women equally Our results suggest that empowerment provides an excellent way of enhancing organizational attitudes for both men and women
TL;DR: A unit level study was conducted to investigate the influence of governance type on organizational culture, nurse work satisfaction, nurse retention, and patient satisfaction.
Abstract: Given our dynamic healthcare marketplace, it is imperative to examine the context in which nurses function. A unit level study was conducted to investigate the influence of governance type on organizational culture, nurse work satisfaction, nurse retention, and patient satisfaction. The results of the study will be of value to nurse executives wanting to redesign the context for nursing service to improve outcomes, including nurse and patient satisfaction.
TL;DR: This pilot study examined rural nurses' perceptions of CAH conversion and found information can be used by nursing administrators and educators to prepare nurses to work in CAHs that are located in more remote areas of the United States.
Abstract: Critical Access Hospitals (CAHs) are a recent federal initiative to address the fiscal concerns of small rural hospitals and improve access to healthcare for rural residents. A national effort exists to examine the outcomes of this federal initiative, but there is a paucity of information about nursing in CAHs. This pilot study, using survey techniques, examined rural nurses' perceptions of CAH conversion. The authors discuss the authorizing legislation, Medicare Rural Hospital Flexibility Program (MRHFP), and highlight survey findings on nurses' perceptions about hospitals that converted to CAH status. The information can be used by nursing administrators and educators to prepare nurses to work in CAHs that are located in more remote areas of the United States.
TL;DR: The results support assertions that Medicare per episode reimbursement should be higher for rural than for urban home health patients, with urban patients being healthier than rural patients.
Abstract: OBJECTIVE The study purpose was to determine if health status differed between rural versus urban home health patients and to identify if locale was a significant predictor of home health direct care time. BACKGROUND Implemented in October 2000, the Medicare home health prospective payment system (PPS) made only temporary allowance for differences in cost of delivering home health services in rural versus urban environments. However, past research documented differences in health status and service utilization between rural and urban home health patients. METHODS Data were collected retrospectively on a convenience sample of 2,788 patient episodes of care. Patient health status was measured using items form the Outcome Assessment and Information Set (OASIS). Obtained from itinerary records, direct care time was the time clinicians spent in the home. RESULTS The results showed significant differences in rural versus urban patients health status, with urban patients being healthier than rural patients. Consistent with poorer health status, rural patients received more RN direct care time. Other study factors being equal, living in a rural locale increased total direct care time by 150 minutes over living in an urban environment. CONCLUSIONS Given the poorer health status and increased time requirements for rural patients, the results support assertions that Medicare per episode reimbursement should be higher for rural than for urban home health patients.
TL;DR: An informal study was conducted to explore the relationship between telephone nursing quality indicators-assessment, critical thinking, use of protocols, and continuity of care-found in documentation and nursing-sensitive patient outcomes.
Abstract: As a growing specialty, telephone nursing practice requires definition, standardization, and identification of quality indicators and nursing-sensitive outcomes. An informal study was conducted to explore the relationship between telephone nursing quality indicators-assessment, critical thinking, use of protocols, and continuity of care-found in documentation and nursing-sensitive patient outcomes. Findings provide insight into the telephone process of care and application of critical thinking reflected in documentation and greater understanding of the complexity of telephone nursing practice and integration of care and outcomes.
TL;DR: Strategic efforts to recruit and retain nurses are underway, with a focus on nurturing interest among young people and increasing opportunities to stimulate their interest, to increase the supply of appropriately prepared professional nurses.
Abstract: A severe shortage of nurses is being experienced nationally and globally. In South Florida, one of the most severely impacted regions in the world, a group of healthcare organizations, educational institutions, and nursing organizations formed the Nursing Shortage Consortium to combat the nursing shortage. Strategic efforts to recruit and retain nurses are underway, with a focus on nurturing interest among young people and increasing opportunities to stimulate their interest, to increase the supply of appropriately prepared professional nurses.
TL;DR: The authors describe an organization’s success in creating a process, which aligned nurses and senior management in the creation of a desired future state by the selection of key interventions to enhance nurse satisfaction and loyalty, and ultimately retention.
Abstract: The authors describe an organization’s success in creating a process, which aligned nurses and senior management in the creation of a desired future state. The environment is one of high census, nurse shortage, and two union organizing efforts. The outcome is a significant investment in this organization’s future by the selection of key interventions to enhance nurse satisfaction and loyalty, and ultimately retention.
TL;DR: The experiences of frail elders in a community case management program within a managed care setting, and perceptions of the case manager’s ability to help navigate that system, are described.
Abstract: Capitated payment systems have forced healthcare providers to explore new methods of care delivery for frail, older clients who consume a disproportionate amount of time and resources. The authors describe the experiences of frail elders in a community case management program within a managed care setting. The experiences of living with frailty in a changing healthcare system, and perceptions of the case manager's ability to help navigate that system, are described. This article presents the benefits of community case management toward client goals of safety, support, and control.
TL;DR: Although it was determined that data regarding the ANA quality indicators could be collected from five acute-care inpatient units at one medical center that is part of a multisite managed care system, a variety of unanticipated findings emerged.
Abstract: Realizing the importance of linking nursing's contribution to quality patient care, a pilot study was conducted to determine whether data regarding the quality indicators proposed by the American Nurses' Association (ANA) could be collected from five acute-care inpatient units at one medical center that is part of a multisite managed care system. Although it was determined that data regarding the ANA quality indicators could be collected at the study site, a variety of unanticipated findings emerged. These findings reflect both discrepancies and congruities between how the investigative team expected the ANA indicators to operate versus what was actually experienced. The lessons learned while collecting ANA indicator data are shared to assist future users and to advance the evolution of the ANA indicators.
TL;DR: An approach to assist nursing leaders in systemic analysis of operational structure is presented here and helps leaders to identify structural inadequacies that limit operational performance.
Abstract: A healthcare landscape characterized by cost pressures, advancing technologies, staffing shortages, and increasing regulation is the norm for nursing leaders. High performance in these environments requires effective operational structures. These structures must respond to change while maintaining operational stability. An approach to assist nursing leaders in systemic analysis of operational structure is presented here. The approach helps leaders to identify structural inadequacies that limit operational performance.