Joanne Disch

Creating a healthy work environment in the midst of organizational change and transition

In the midst of organizational change and transition, the need for a healthy work environment is greater than ever. Leaders may be in a position of leading staff on a journey they would rather not be on. Although there may not be a choice of destination, there are many decisions to be made along the way that will impact the health and quality of the journey. Creation of a healthy work environment does not occur overnight. It requires acknowledgment of the reality of the present environment, clear behavioral expectations and standards, systems, and structures to ensure the organizational changes are enduring and a means to assess continually the health of the work environment. Leaders have an opportunity and a responsibility to structure organizations in such a way that dignity, integrity, honesty, and compassion are preserved.

Diffusing QSEN Competencies Across Schools of Nursing: The AACN/RWJF Faculty Development Institutes

A series of regional Quality and Safety Education for Nurses (QSEN) Faculty Development Institutes were held in 2010 and 2011 to provide nursing faculty with strategies to integrate quality and safety content into their curricula. The interactive coursework focused on the 6 core QSEN competencies. Using a train-the-trainer approach, the QSEN Faculty Development Institute Directors enabled nursing faculty attendees to (a) lead their institutions faculty to incorporate quality and safety content into the curriculum for students; (b) teach and mentor students to deliver high quality and safe patient care; and (c) train other faculty to accomplish these goals. Over 1,100 nursing faculty from across the United States attended the institutes. All types of prelicensure programs were represented including diploma, associate, and baccalaureate degree. In a preinstitute survey, faculty identified multiple opportunities to improve the integration of quality and safety content into curricula including the need for specific content on quality improvement, teamwork and collaboration, and informatics and the need for interprofessional experiences and electronic health record access. Postinstitute evaluations indicated that participants found the content clear, specific, usable, and presented in a format that facilitated thought, reflection, and application. The regional institutes served as a very effective strategy for engaging large numbers of faculty across the country in the QSEN work and for disseminating vital tactics to improve the teaching of quality and safety content.

A Just Culture for Nurses and Nursing Students

This article provides an overview of current safety science related to just cultures, the tracking of errors and near misses, and individual and system responsibilities for promoting safe practice; and applies these principles to schools of nursing.

The Role of the Clinical Nurse Specialist in Creating a Healthy Work Environment

The clinical nurse specialist (CNS) contributes to a healthy work environment through partnerships with the nursing staff, nurse manager, physicians, and other colleagues across the health system. Examples of these partnerships are described in this article, highlighting how the work of the CNS influences the care that patients and families receive, shapes the practice environment, and fosters collegial and respectful relationships among caregivers. The CNS is a pivotal figure in creating an environment where nurses can provide the care that is needed and feel valued for their work. Partnership with a variety of clinicians enables the CNS to influence critical care nursing practice, the intensive care unit team, and the environment in which care is provided.

The role of the chief nurse officer in ensuring patient safety and quality.

Since 1999, dozens of organizations and hundreds of initiatives have emerged to improve the quality and safety of patient care, yet insufficient progress has been made. Attention has turned toward improving senior leadership team effectiveness. The authors describe a national project that examined the role of the senior leadership team in 8 hospitals in promoting quality and safety, with particular focus on the role of the chief nurse officer in this process.

Are we evidence-based when we like the evidence?

Oral caredAlthough nurses routinely report that this is a high priority for adults and children, several studies have shown that oral care is not done routinely and/or consistent with current research or organizational policies. Oral care has been identified as a core component of the Centers for Disease Control and Prevention’s recommended practices for reducing ventilatorassociated pneumonia. Visitation by family membersdSinceMolter’s landmark study in 1979 on family visiting in the intensive care unit (ICU), numerous other studies have supported the practice of open visiting hours, yet restricted visiting hours are still in place inmany organizations, Magnet facilities included.

The Densford Clinical Scholars Program: improving patient care through research partnerships.

The Densford Clinical Scholars Program at the University of Minnesota School of Nursing partners advanced practice nurses and faculty members to design and conduct clinical studies for improving patient care. Benefits have included changes in nursing practice and, on occasion, the practice of other members of the healthcare team; enhanced research skills for clinicians; an enriched professional practice environment; access to clinical facilities for faculty; funding for research; and an expanded network for professional development. The authors describe this innovative partnership.

Developing a Reporting and Tracking Tool for Nursing Student Errors and Near Misses

Little is known about the extent and types of errors and near misses (ENMs) made by nursing students. In nursing schools, the norm has been a culture of blame in which a student, a faculty member, or both are held accountable for ENMs regardless of the source. However, evidence suggests that a failure to track and trend ENMs and learn from them actually increases the likelihood of more ENMs. To help student nurses become competent nurses, educators need systems and structures that allow trending and analysis of ENMs. Key first steps include creating a mechanism for schools to use in reporting nursing-student ENMs and creating a transparent and blame-free culture. In addition, it will be critical to establish a national database to reflect the occurrence and types of ENMs. The database will provide a baseline of information that will guide faculty members in designing interventions to reduce ENMs. This article describes the issues and challenges encountered in creating an occurrence reporting tool, testing the tool, and establishing a national database for tracking and trending ENMs encountered by nursing students. In addition, this article presents an adaptation of the tested occurrence reporting tool that schools can use while a national database is established.

Sense Making and Knowledge Transfer: Capturing the Knowledge and Wisdom of Nursing Leaders

Experienced nurse leaders possess leadership wisdom that must be passed on in thoughtful, systematic ways to younger leaders. Sense making is an intentional process that has been useful in bringing forward a leaders implicit knowledge and wisdom gained over the years. This article examines leadership wisdom, complexity, and knowledge in the context of todays dynamic environment-and offers a concrete example of how the sense-making methodology can work.

Differential effects of professional leaders on health care teams in chronic disease management groups.

Background: Leadership by health care professionals is likely to vary because of differences in the social contexts within which they are situated, socialization processes and societal expectations, education and training, and the way their professions define and operationalize key concepts such as teamwork, collaboration, and partnership. This research examines the effect of the nurse and physician leaders on interdependence and encounter preparedness in chronic disease management practice groups. Purpose: The aim of this study was to examine the effect of complementary leadership by nurses and physicians involved in jointly producing a health care service on care team functioning. Methodology: The design is a retrospective observational study based on survey data. The unit of analysis is heart failure care groups in U.S. Veterans Health Administration medical centers. Survey and administrative data were collected in 2009 from 68 Veterans Health Administration medical centers. Key variables include nurse and physician leadership, interdependence, psychological safety, coordination, and encounter preparedness. Reliability and validity of survey measures were assessed with exploratory factor analysis and Cronbach alphas. Multivariate analyses tested hypotheses. Findings: Professional leadership by nurses and physicians is related to encounter preparedness by different paths. Nurse leadership is associated with greater team interdependence, and interdependence is positively associated with respect. Physician leadership is positively associated with greater psychological safety, respect, and shared goals but is not associated with interdependence. Respect is associated with involvement in learning activities, and shared goals are associated with coordination. Coordination and involvement in learning activities are positively associated with encounter preparedness. Practice Implications: By focusing on increasing interdependence and a constructive climate, nurse and physician leaders have the opportunity to increase care coordination and involvement in learning activities.