Eileen Sporing

The relationship of nurse staffing, skill mix, and Magnet recognition to institutional volume and mortality for congenital heart surgery.

Objective: The aim of this study was to examine the relationship of nurse staffing, skill mix, and Magnet® recognition to institutional volume and mortality for congenital heart surgery at childrens hospitals. Background: Little is known about how nurse staffing, skill mix, and Magnet recognition influence outcomes in childrens hospitals. Methods: Cases of congenital heart surgery were identified from the 2005-2006 Pediatric Health Information System Database using International Classification of Diseases, Ninth Revision, Clinical Modification codes. The National Association of Childrens Hospitals and Related Institution database was used for staffing data and verified by chief nursing officers; Magnet recognition was obtained from the American Nurses Credentialing Center Web site. Relationships among nursing characteristics, volume, and mortality were examined. Results: Among children undergoing congenital heart surgery at major childrens hospitals, there was marked variation in intensive care unit (ICU) nursing hours per patient day (14.96-32.31). Variation in ICU nursing skill mix was less extreme (80%-100%); 20 hospitals had 100% registered nurse staffing in ICUs. There was a significant difference in median nursing skill mix between Magnet and non-Magnet hospitals (P = .02). None of the nursing characteristics was associated with mortality. However, higher nursing worked hours was significantly associated with higher volume (rs = 0.39, P = .027). Hospital volume was significantly associated with risk-adjusted mortality. Conclusion: Nursing characteristics varied in ICUs in childrens hospitals treating congenital heart surgery but were not associated with mortality. There was a significant relationship between ICU nursing worked hours and institutional volume. Nursing skill mix was lower in Magnet hospitals.

Exemplary Professional Practice Through Nurse Peer Review

The development and execution of a nurse peer review program to evaluate nursing practice associated with significant adverse events has resulted in systemic changes. Descriptive analyses were conducted for 23 peer-reviewed cases involving 41 RNs and 2 advanced practice nurses from 14 specialties over a 4-year period. Thematic analysis revealed four common event categories: assessment and monitoring, team communication, skin integrity, and vascular access. This approach demonstrates the impact of professional nurse accountability for improving the quality of care and may serve as an exemplar for professional practice.

Collaboration among nurse executives in complex environments: fostering administrative best practice.

In the past decade, many healthcare institutions have formed new partnerships, alliances, and networks. Collaboration among chief nursing officers and other leaders from affiliating institutions is essential to the success of these new organizational structures. The authors explore the nature of the collaboration among chief nursing officers and senior nurse leaders at 5 Harvard-affiliated teaching hospitals that provide cancer care. In particular, this article examines how collaborative relationships have been fostered and highlights the challenges, benefits, and outcomes of successful cross-institutional collaboration.

A nursing career lattice pilot program to promote racial/ethnic diversity in the nursing workforce.

The nursing career lattice program (NCLP) at Children’s Hospital Boston has provided employees with social, educational, and financial assistance as they begin or advance their nursing careers. At the conclusion of a pilot phase, 35% of employees in the NCLP were enrolled in nursing school and 15% completed nursing school. The NCLP exemplifies how a workforce diversity initiative can lead to outcomes that support and sustain a culture rich in diversity and perpetuate excellence in nursing in one organization.