Donna Sullivan Havens

Global Use of the Practice Environment Scale of the Nursing Work Index

Background:Although the Practice Environment Scale of the Nursing Work Index has been endorsed as a gauge of the quality of the nursing practice environment by several organizations in the United States promoting healthcare quality, there is no literature describing its use in different practice settings and countries. Objective:The purpose of this study was to inform research by describing the modifications and use of the scale in a variety of practice settings and countries. Methods:The Cumulative Index to Nursing and Allied Health Literature and the PubMed databases were searched for the years 2002-2010 to identify 37 research reports published since 2002 describing use, modification, and scoring variations in different practice settings and countries. Results:The scale was modified for 10 practice settings in five countries and translated into three languages. Composite scores ranged from 2.48 to 3.17 (on a 1-4 scale). The Staffing and Resource Adequacy subscale most often scored lowest. A new Nursing Information Technology subscale has been developed. New scoring methods to identify the favorability of practice environments are described. Over time, the nature of the research conducted using the measure has changed. Overall, most publications report significant associations between scale scores and multiple nurse, patient, and organizational outcomes. Discussion:Scale use is growing across different clinical settings and countries. Recommendations for future research use include reducing scale length, using consistent scoring methods, considering the impact of various modifications on the basis of cultural and clinical setting nuances, and using the measure in longitudinal and intervention research designs.

Relational coordination among nurses and other providers: impact on the quality of patient care

AIM The present study examined nurse reports of relational coordination between nurses and other providers and the impact of relational coordination on patient care quality. BACKGROUND While communication between providers has been traditionally considered important to improve quality, relational coordination extends this view, emphasising the value of high-quality relationships exemplified by shared goals, shared knowledge and mutual respect; and high-quality communication that is timely, frequent, accurate and problem-solving. METHODS Direct care registered nurses (RNs) (n=747) completed surveys to assess relational coordination across five provider functions and six types of patient care units. Nurses also reported perceptions about patient care quality. RESULTS In all analyses, relational coordination between nurses and other providers was significantly related to overall quality, in the expected directions. As relational coordination increased, nurses reported decreases in adverse events such as hospital-acquired infections and medication errors. CONCLUSIONS Enhancing relational coordination between nurses and other providers is central to improving the quality of patient care. IMPLICATIONS FOR NURSE MANAGERS AND NEW KNOWLEDGE: The emerging theory of relational coordination provides a useful new research-based framework for managers to use to improve provider relationships, communication and the quality of care.

Improving nursing practice and patient care : Building capacity with appreciative inquiry

Appreciative inquiry is a philosophy and methodology for promoting positive organizational change. Nursing leaders at 6 community hospitals are partnering with the authors on a project that uses appreciative inquiry to improve communication and collaboration, to increase nurse involvement in decision making, and to enhance cultural awareness and sensitivity. In this article, the authors describe appreciative inquiry, how hospitals are using it, and the initial lessons learned.

Chief nursing officer retention and turnover: a crisis brewing? Results of a national survey.

Anecdotal evidence suggests growing concerns about chief nursing officer (CNO) dissatisfaction, intent to leave, and turnover. However, little evidence documents the magnitude of the problem or whether CNO turnover requires direct action. This article reports the results from the first phase of a three-phase study examining CNO turnover and retention in U.S. hospitals. CNOs were invited to complete an online survey to gather data about their experiences with turnover and to identify CNO retention issues. Our sample includes responses from 622 CNOs employed in hospitals and healthcare systems across the United States. Approximately 38 percent of the respondents reported having left a CNO position-13 percent within two years before the survey and 25 percent within five years before the survey. Of these, approximately one-quarter had been asked to resign, had been terminated, or had lost their jobs involuntarily. When asked about the context of their departure, a high percentage reported leaving their position to pursue another CNO position (50 percent) or for career advancement (30 percent); approximately 26 percent reported leaving because of conflicts with the chief executive officer. Of great concern is the finding that approximately 62 percent of respondents anticipate making a job change in less than five years, slightly more than one-quarter for retirement. Respondents clearly indicated that CNO turnover is a problem that requires attention. The knowledge gained from this study can be used by healthcare leaders to develop strategies and policies aimed at recruiting and retaining CNOs and easing the transition for CNOs and others in the organization when CNO turnover does

The influence of interpersonal relationships on nurse managers' work engagement and proactive work behavior

OBJECTIVE: This study tested the effects of interpersonal relationships on nurse managers’ work engagement and proactive work behavior. BACKGROUND: An engaged workforce may help healthcare organizations improve performance. In healthcare, nurse managers are responsible for creating motivating work environments. They also need to be engaged, yet little is known about what influences nurse managers’ performance. METHODS: A self-administered electronic survey was used to collect data from 323 nurse managers working in acute care hospitals. Instruments included the Relational Coordination Scale, Utrecht Work Engagement Scale, and Proactive Work Behavior Scale. RESULTS: Interpersonal relationships with nurse administrators were most predictive of nurse managers’ work engagement. Interpersonal relationships with physicians were most predictive of nurse managers’ proactive work behavior. CONCLUSION: Organizational cultures that foster quality interpersonal relationships will support the job performance of nurse managers.

Measuring staff nurse decisional involvement: The Decisional Involvement Scale

Key organizations and new legislation are promoting staff nurse involvement in decisions about nursing practice and patient care as a long-term strategy to improve the culture of the work environment. The authors discuss the Decisional Involvement Scale (DIS), a multipurpose measure that can be used as a diagnostic tool, an organizational development strategy, and an evaluative instrument. In addition, support to substantiate the DIS as a valid and reliable measure is summarized.&NA; Key organizations and new legislation are promoting staff nurse involvement in decisions about nursing practice and patient care as a long‐term strategy to improve the culture of the work environment. The authors discuss the Decisional Involvement Scale (DIS), a multipurpose measure that can be used as a diagnostic tool, an organizational development strategy, and an evaluative instrument. In addition, support to substantiate the DIS as a valid and reliable measure is summarized.

Achieving magnet hospital recognition: chief nurse executives and magnet coordinators tell their stories.

Organizational and management characteristics found in hospitals holding magnet hospital recognition are associated with professional nurse practice environments and positive patient and staff outcomes. However, while we know what works, we need a better understanding of “how to get there.” The authors report the stories about “how we did it” told by chief nurse executives and magnet project coordinators from hospitals that have achieved American Nurses Credentialing Center magnet hospital recognition. This article adds to the understanding of how to pursue magnet recognition.

The Magnet Nursing Services Recognition Program: a comparison of two groups of magnet hospitals.

The Magnet Nursing Services Recognition Program: A Comparison of Two Groups of Magnet Hospitals Linda Aiken;Donna Havens;Douglas Sloane; JONA: The Journal of Nursing Administration

The Staff Nurse Decisional Involvement Scale: Report of Psychometric Assessments

Background: For decades, enhancing staff nurse decisional involvement in matters of nursing practice and patient care has been identified as a long-term strategy to improve the quality of the nursing work environment and the safety and quality of patient care. Objective: To describe psychometric assessments of the Decisional Involvement Scale (DIS), a diagnostic and evaluative measure of nurse decisional involvement. Methods: A series of assessments were conducted to evaluate the psychometric performance of the scale. Content validity was assessed by experts in the field. Descriptive statistics were used to examine the use and performance of the scale. The contrasted groups approach was used to assess construct validity. Item analysis was used to explore evidence of the internal consistency of items and subscales across multiple samples. Structural modeling was used to conduct a confirmatory factor analysis using data from two independent samples of staff registered nurses (RNs; n = 849 and 650). Results: Acceptable content validity indexes (CVIs) were independently generated by three content experts. Construct validity was supported, as hypothesized; nurses working on professional practice units scored significantly higher for all items when compared to nurses working on units without professional practice models in place. Internal consistency (coefficient alpha) was high and nearly identical for the total measure and all subscales across the two independent nurse samples. Six subscales were identified using factor analysis, and these were confirmed by structural modeling. Conclusion: Psychometric findings support that the DIS is a valid and reliable measure of staff nurse decisional involvement.

The Productive Ward program™: a longitudinal multilevel study of nurse perceived practice environment, burnout, and nurse-reported quality of care and job outcomes.

Objective: The objective of this study was to investigate the impact of The Productive Ward–Releasing Time to Care™ program implemented in a hospital transformation process on nurse perception related to practice environment, burnout, quality of care, and job outcomes. Background: To address the continuously evolving complex challenges of patient care, high-performance nursing care is necessary. Methods: A longitudinal survey design was used to conduct a study in a 600-bed acute care university hospital with 3 measurement periods: T0: base line in 2006, T1 in 2011, and T2 in 2013. As part of the hospital transformation process, the productive ward program was introduced between T1 and T2. Results: Relevant impact on nurse-physician relations, nurse management, hospital management-organizational support, nurse-reported quality of care, and job outcomes were identified. Conclusion: Hospital strategies and policies should be aligned with daily practices so that engaged and committed staff can promote excellent outcomes.