Ada Sue Hinshaw

Innovative Retention Strategies for Nursing Staff

The creation of innovative retention strategies will be a major focus for nursing administration as a shortage of nurses recurs and turnover of staff becomes a problem. A recent study provides information on which to formulate retention strategies. The findings suggest that retention strategies, to be effective, need to be targeted specifically to particular conditions of the nursing staff, e.g., educational preparation and the clinical service on which staff are functioning. The authors outline their research findings and the innovative strategies that have been constructed.

NURSING STAFF TURNOVER, STRESS AND SATISFACTION: MODELS, MEASURES, AND MANAGEMENT

Staff turnover, stress, and satisfaction are continual problems plaguing the delivery of health care and, specifically, nursing care. Numerous investigations have been conducted to identify the major phenomena pertaining to these concerns. Models have been constructed and tested specifying the relationships among staff stress, satisfaction, other predictive factors, and voluntary/involuntary turnover. Traditionally, turnover has been the focus of research endeavors, while the other factors have been investigated in terms of their impact on it (Mobley, Griffeth, Hand, & Meglino, 1979).

A Blueprint for Genomic Nursing Science

PURPOSE This article reports on recommendations arising from an invitational workshop series held at the National Institutes of Health for the purposes of identifying critical genomics problems important to the health of the public that can be addressed through nursing science. The overall purpose of the Genomic Nursing State of the Science Initiative is to establish a nursing research blueprint based on gaps in the evidence and expert evaluation of the current state of the science and through public comment. ORGANIZING CONSTRUCTS A Genomic Nursing State of the Science Advisory Panel was convened in 2012 to develop the nursing research blueprint. The Advisory Panel, which met via two webinars and two in-person meetings, considered existing evidence from evidence reviews, testimony from key stakeholder groups, presentations from experts in research synthesis, and public comment. FINDINGS The genomic nursing science blueprint arising from the Genomic Nursing State of Science Advisory Panel focuses on biologic plausibility studies as well as interventions likely to improve a variety of outcomes (e.g., clinical, economic, environmental). It also includes all care settings and diverse populations. The focus is on (a) the client, defined as person, family, community, or population; (b) the context, targeting informatics support systems, capacity building, education, and environmental influences; and (c) cross-cutting themes. It was agreed that building capacity to measure the impact of nursing actions on costs, quality, and outcomes of patient care is a strategic and scientific priority if findings are to be synthesized and aggregated to inform practice and policy. CONCLUSIONS The genomic nursing science blueprint provides the framework for furthering genomic nursing science to improve health outcomes. This blueprint is an independent recommendation of the Advisory Panel with input from the public and is not a policy statement of the National Institutes of Health or the federal government. CLINICAL RELEVANCE This genomic nursing science blueprint targets research to build the evidence base to inform integration of genomics into nursing practice and regulation (such as nursing licensure requirements, institutional accreditation, and academic nursing school accreditation).

Navigating the perfect storm: balancing a culture of safety with workforce challenges.

Balancing the development of cultures of safety with nursing workforce challenges is similar to navigating the perfect storm. The perfect storm is characterized as a tempest of extreme intensity that happens rarely, maybe once every 100 years, as a result of multiple factors that end in a situation worse than people have ever seen. Such a storm is currently evident when attempting to ensure patient safety while being confronted with a shortage of nurses and nursing faculty unlike any other shortage experienced in over a number of decades. Based on research, the threats to patient safety from healthcare system and health professional errors have become of paramount concern. The prevention of such errors is the focus of healthcare organizations as they create cultures of safety. A major aspect of cultures of safety is nurses with their many roles in caring for patients and families, especially the constant surveillance they provide, which often prevents complications and deaths secondary to failure to rescue. However, providing such surveillance requires adequate numbers of well-prepared nurses in attendance. The perfect storm is created because of the existence of a steadily worsening shortage of nurses and nursing faculty. Multiple factors have converged to develop and sustain such a shortage. A blueprint for healthcare organizations is proposed, with examples of numerous innovative strategies that are being developed and studied for handling the major challenges posed by this perfect storm.

Nursing Science: The Challenge to Develop Knowledge:

The development of knowledge for nursing poses an exciting, scholarly adventure for the professions scientists. A series of challenges are involved: the challenge to develop the substantive content needed for practice within nursings disciplinary perspective, the challenge to sus tain excellence in the developing science base and in the preparation of nurse researchers, and the challenge of disseminating stable, appropri ate research results to the professions clinicians and to the public. Nursing is entering into a new era, moving from the stage of establishing structures to support nursing research and building the cadre of scien tists needed to conduct investigations, to the stage of focusing on the identification and study of the phenomena which comprise the body of knowledge needed for practice. A number of directions or priorities for nursing research are evident for the future. The questions of concern are how to centralize nursings scientific endeavors and resources as well as prepare researchers who are on the cutting edge or frontiers of science, and what strategies can be used to facilitate excellence in these efforts. The dilemma of transferring research findings into practice in a timely but scientifically appropriate manner requires a partnership be tween practitioners and researchers. Both are committed to making clinical decisions based on accurate, relevant information. Such re search based practice requires a merger of the talents and expertise of those providing practice and those developing the knowledge base for the profession.

Strategies for Initiating a Research Program

A hospital-based nursing research program should improve patient care by producing data critical to administrative and clinical decisions. This article describes one successful nursing research program from conception to implementation. It provides nursing administrators with insight into the practical aspects of building a research program and emphasizes that such a program is essential to any hospital committed to a belief in the value of research to nursing practice.

Problems In Doing Research

Last issue, this column spoke to the need to insure consistency between the three basic models in every research project; i.e., the theoretical model, the design model, and the analysis model. While the concept of “insuring consistency” seems straightforward, the actual real world assessment of consistency is not easy. Theoretical substruction is one assessment technique for tracking consistency among the three models in a research project’. Theoretical substruction is defined as an assessment or critique process that systematically abstracts from the verbal, theoretical explanation of a research report, its major concepts, and propositions (relationships between concepts) and shows them in a pictorial structure. In other words, a pictorial framework is built from the verbal explanation of the theory underlying the research.

Theoretical model testing to identify personality variables effecting preventive behaviors.

To test the preventive behavior model, the impact of perceived barriers and benefits and health value orientations on two health care activities (smoking and exercise) was examined. Data from 76 subjects who had taken part in a health screening program were analyzed using regression analysis. A reduced empirical model for exercise resulted, explaining 46% of the variance. However, only one variable that accounted for 7% of the variance was significant in explaining smoking behavior. Significant personality variables in the exercise model provide clues toward understanding psychological factors that may be operating to influence an individuals participation in health care activities.

Research challenges and programs for practice settings.

Several types of research programs can be developed in service settings. These can be categorized according to whether research is conducted, utilized, or facilitated. The challenges of integrating research into the clinical setting threads through each type of program. Several of the major challenges and strategies will be considered in this article. In addition, several types of research programs will be discussed, especially in terms of their policy implications.

Nursing resources and the delivery of patient care: the National Center for Nursing Research Perspective.

The nursing shortage has preoccupied nurse executives with daily crises about how to provide adequate staff resources to assure quality care and how best to plan for the future. This major societal concern affects all settings--but most particularly hospitals. The National Center for Nursing Research (NCNR) has been actively assessing this situation and has begun several targeted initiatives. Nurse executives have a vital role in this evolving research priority area focused on nursing resources and its effect on quality of care.