Edna Cadmus

Nurses? Skill Level and Access to Evidence-Based Practice

Integrating evidence-based practice into the culture of an acute care hospital requires assessment, planning, and intervention by nursing leadership. The authors discuss a statewide study that assessed the skill level of nurses in obtaining evidence for their nursing practice, using computers and databases, as well as evaluating the perceived availability of resources in their hospitals to access evidence.

Succession planning: multilevel organizational strategies for the new workforce.

Succession planning for staff and managers starts with a clear vision and strategic plan. It includes hiring, developing, and coaching all employees to meet new competencies. The implementation of succession planning requires commitment, vigilance, and engagement by all members of the nursing department. Partnerships with human resources and the education department are key for success. The author shares one medical centers experience with succession planning and ongoing strategies for success.

Safe patient handling: is your facility ready for a culture change?

C reating a safe patient-handling environment for patients and staff requires a strategic plan, leadership support, and staff engagement. The benefits of creating such an environment far outweigh the financial outlay; yet very few institutions have committed to this change nationally. We present one facility’s experience with developing, implementing, and evaluating a safe patient-handling program.

Factors associated with falls in hospitalized adult patients

INTRODUCTION Despite efforts in hospitals to identify patients at risk for falls and to prevent these incidents, falls among hospitalized patients are not a rare event and continue to be a major health care concern, occurring in approximately 700,000-1,000,000 hospitalized patients per year. PURPOSE The purpose of this study was to examine intrinsic, extrinsic, and workforce factors that contribute to falls among hospitalized adult patients. METHODS A retrospective correlational design was used to examine 160 patients admitted to a medical-surgical unit over the year 2012. Analytical weighting was applied to the study sample to conduct bivariate and multivariate analysis. FINDINGS In multivariate analysis, the variables age, narcotic/sedative use, and overnight shift, significantly predicted the likelihood of a fall during the hospitalization. Cardiovascular disease, neuromusculoskeletal disease, evening shift, the implementation of fall prevention strategies and higher RN to unlicensed assistive personnel staffing ratios decreased the likelihood of a fall during the hospitalization. In addition, patients at high risk for falls using the Hendrich I fall scale were nearly 17% more likely to fall during the hospitalization. CONCLUSIONS Many factors influence the occurrence of a fall in hospitalized patients. Fall risk assessment and the implementation of fall prevention strategies are both effective strategies in the clinical area to identify and decrease the probability of a fall. The presence of the RN is significant in fall prevention in medical-surgical patients.

Measuring first-line nurse manager work: instrument: development and testing.

OBJECTIVE: The objective of this study was to develop and test a 1st-line nurse manager (FLNM) work instrument to measure categories of work and frequency of activities. BACKGROUND: First-line nurse managers have been demonstrated to be key contributors in meeting organizational outcomes and patient and nurse satisfaction. Identifying the work of FLNMs is essential to help in the development of prioritization and sequence. The need for an instrument that can measure and categorize the work of FLNMs is indicated. METHODS: The author-developed instrument was administered as a pilot study to 173 FLNMs in New Jersey. Descriptive statistics were analyzed, and validity and reliability were measured. RESULTS: Content validity was established through 2 focus groups using 10 FLNMs and conducting a survey of 5 chief nursing officers. Reliability was assessed by 13 of 16 FLNM participants using the test/retest method and quantified using percent agreement within a 10-day period. Those items with 70% agreement or more were identified as reliable and retained on the instrument. CONCLUSIONS: The content validity of the instrument is strong; further refinement and testing of the tool are indicated to improve the reliability and generalizability across multiple populations of leaders and settings.

Holding on: Caring for the professional caregiver.

part of a hospital’s mission and is emphasized by many healthcare systems. The Joint Commission has identified improving communication with patients and families on all aspects of care as one of its National Patient Safety Goals. Furthermore, as of October 2012, patient satisfaction scores will comprise 30% of the Hospital Value-Based Purchasing proposed by the Centers for Medicare and Medicaid Services, which may influence the financial circumstances of hospitals. Therefore, good communication with patients and families becomes very important.

Creating a Long-Term Care New Nurse Residency Model

As the impact of health care reform continues to evolve, the movement of patients from acute to post-acute settings will continue to expand. Currently, the turnover and retention of RNs nationally in long-term care is at an all-time high, with a median turnover rate of 50% for RNs. Workforce instability is a prime contributor to poor patient outcomes, increased costs, and a dissatisfied nursing workforce. Therefore, the New Jersey Action Coalition determined that the Institute of Medicines Future of Nursing: Leading Change, Advancing Health recommendation to implement nurse residency programs across settings would be a priority for New Jersey. A 12-month new nurse residency and preceptor program was developed and implemented in long-term care, with 37 new nurses and 37 preceptors. The design and implementation processes are described, as well as lessons learned along the journey. J Contin Educ Nurs. 2016;47(5):234-240.

Entrepreneurship: Assessing the Readiness of the New Jersey APN Workforce

There is an unprecedented opportunity to move advanced practice nurses (APNs) into primary care settings at a steady rate over the next 5 to 8 years. In addition, the opportunity for nurse-owned or nurse-led practices has never been greater. However, many APNs currently work in a structured environment where the employer focuses on the business aspects of the practice and the APN focuses primarily on clinical care. Often APNs are unaware of the entrepreneurial contribution they make to the practice. A Needs Assessment Survey was developed to better understand business and practice management knowledge and skills of APNs in New Jersey. The survey included 14 categories for competency development. Twelve of the 14 categories showed that APNs were at a novice or an advanced beginner level. APNs need to demonstrate their value and take a lead to help solve primary care access issues. This can only be accomplished if APNs are willing to seize the opportunity and overcome barriers and knowledge gaps through both formal and informal education to step out of their traditional positions into more independent roles.