Bonnie Mowinski Jennings

Characteristics of nurses and hospital work environments that foster satisfaction and clinical expertise.

ObjectiveThe purpose of this aspect of a larger study was to describe characteristics of nurses and their work environment at two military hospitals. BackgroundFew studies have explored characteristics among nurses who practice in military hospitals. There is reason to believe that differences exist between nurses who work in military and civilian hospitals, some of which are required educational level, leadership experience, officer status, and career development opportunities. MethodsA descriptive design was used to address how military and civilian nurses who work in military hospitals describe their autonomy, control over practice, nurse-physician collaboration, and clinical expertise and what relationships exist among these variables. ResultsScores on autonomy, control over practice, and nurse-physician relationships all were above midpoint for all respondents as a group, indicating positive work environments in both of the military hospitals studied. Scores from the clinical expertise instrument were well above midpoint, indicating a desirable level of clinical expertise. These findings all reflect favorably on the military hospital work environment. Conclusions/ImplicationsThis information will help to make a case for instituting or preserving those nursing processes that are effective and for identifying and working to change nursing processes that are not effective. Nurses will benefit by having a more collaborative work environment.

The Content and Context of Change of Shift Report on Medical and Surgical Units

Objective: This study was conducted to describe the current content and context of change of shift report (CoSR) on medical and surgical units and explore whether nurses use computerized support during the CoSR process. Background: Change of shift report is a commonly occurring handoff that could contribute to gaps in care. Methods: Bedside, face-to-face, and audiotaped CoSRs were audiotaped and observed on 7 medical and surgical units in 3 acute care facilities in the Western United States. Results: Conventional content analysis revealed 4 themes: the Dance of Report, Just the Facts, Professional Nursing Practice, and Lightening the Load. Observations exposed the lack of content structure, high noise levels, interruptions, and no use of electronic health records in these facilities as a part of the report process. Conclusion: Improvements to CoSR include determining a consistent and tailored structure for report, evaluating types of report suitable for particular units, reducing interruptions and noise, and determining content amenable to computerization.

The Nurse’s Medication Day

The medication administration stage of the medication-use process is especially vulnerable to error because errors are least likely to be caught before reaching the patient. Medication administration, however, remains poorly understood. In this article we describe medication administration as observed in an ethnographic study conducted on one medical unit and one surgical unit. A central finding was that medication administration entailed a complex mixture of varied and often competing demands that temporally structured the nurses’ entire workday. Articulation work was evident in time management strategies nurses used to handle demands from institutional policies, technical devices, patients, the physical environment, and the medications themselves. The average number of doses of medication per patient was more than double the number policy groups have indicated. Medication administration is not simply the giving of drugs, nor does it have clearly defined temporal boundaries. Because of its inseparability from other nurses’ work, medication administration inherently entails interruption, thereby calling into question the current emphasis on reducing interruptions as a tactic to decrease medication errors.

Patient outcomes research: seizing the opportunity.

Nurses must take a proactive role in patient outcomes research. Because the patient, not disease, has always been the focus of nursing, nurses are sensitized to the rich but complicated context in which patient outcomes research will be conducted. Nurse researchers are experienced in using complex research models, dealing with ambiguous concepts, grappling with difficult measurement issues, and subscribing to methodological pluralism. These skills are important to success with patient outcomes research. In this article, the opportunities and challenges posed to nurses by patient outcomes research will be addressed. One of the benefits will be a stronger knowledge base for clinical practice and hence patient care.

A critical analysis of hardiness.

Hardiness is a construct with widespread appeal to nurse researchers. Of 97 papers reviewed, 35 were written by nurses. Because of its popularity, there is a pressing need to analyze hardiness carefully. This critical analysis of hardines describes Kobasas work as the foundation of hardiness research, provides a review of hardiness in the nursing literature, and recommends future hardiness research.

What Really Matters to Healthcare Consumers

Consumer satisfaction with healthcare is an important quality and outcome indicator. Satisfaction may be at the crux of survival for healthcare delivery systems because it creates the competitive edge in healthcare. To better understand patient satisfaction by examining consumer healthcare experiences and expectations, a study was conducted. An important concept identified in the data, MY CARE, refers to a constellation of quality healthcare features that were wished for by all participants and realized by only some of them. The features of MY CARE offer lessons for all healthcare leaders to use when making improvements in care delivery systems—improvements that could create a more patient-centered healthcare system and boost patient satisfaction.

Turning Over Patient Turnover: An Ethnographic Study of Admissions, Discharges, and Transfers

The impact on nursing work of patient turnover (admissions, discharges, and transfers) became evident in an ethnographic study of turbulence. The patient turnover data were generated from extensive observations, 21 formal interviews, and a year of admission and discharge records on one medical and one surgical unit. Timing of turnover events on the two units differed, but on both units admissions typically interrupted workflow more than did discharges, clustered admissions were more disruptive than staggered admissions, and patient turnover during change of shift was more disruptive than during medication administration. Understanding the complexity of patient turnover will elucidate the work involved and improve the evidence base for nurse staffing, a key determinant of quality and safety of care.

Outcomes: Two Directions—Research and Management

Outcomes research took hold in the late 1980s. Because of the rising costs of health care, policymakers demanded an objective analysis of treatments and interventions as demonstrated by cost-effective patient outcomes. More recently, outcomes management programs have surfaced. In contrast to outcomes research, which is concerned with effectiveness, outcomes management is concerned with efficiency. Therefore, this one concept, outcomes, has moved in two related but different directions. Understanding outcomes from both the research and management perspectives is a challenge facing the nursing profession.

A provocative look at performance measurement.

A fascinating web of issues can be spun from the notion of performance measurement. After a brief discussion about the background of performance measurement, this article puts performance measurement into a fresh light by examining three major issues: the concept of quality and its application to performance measurement, the power of the patient and the transition of focus to customers within health care organizations, and deliberations about data and concomitant implications for information systems of the future.

The Language of Outcomes

Outcomes are a topic of great interest. Their potential is considerable as a mechanism to evaluate quality, improve effectiveness, and link practice to professional accountability. Greater clarity and precision in the use of outcomes terminology will allow this potential to be realized. This article identifies the current confusion in outcomes terminology, begins an outcomes lexicon, and issues a call to action for further clarification in the language of outcomes.