Karen S. Cox

Nurse Manager Support: What Is It? Structures and Practices That Promote It

Professional nursing organizations identify nurse manager (NM) support of staff nurses as an essential component of a productive, healthy work environment. Role behaviors that constitute this support must be identified by staff nurses. In this mixed-method study, supportive role behaviors were identified by 2382 staff nurses who completed the investigator-developed Nurse Manager Support Scale. In addition, semistructured interviews were conducted with 446 staff nurses, managers, and physicians from 101 clinical units in 8 Magnet hospitals in which staff nurses had previously confirmed excellent nurse manager support. Through individual and focus group interviews with NM and chief nurse executives in the 8 participating hospitals, the organizational structures and practices that enabled NM to be supportive to staff were determined. The 9 most supportive role behaviors cited by interviewees were as follows: is approachable and safe, cares, “walks the talk,” motivates development of self-confidence, gives genuine feedback, provides adequate and competent staffing, “watches our back,” promotes group cohesion and teamwork, and resolves conflicts constructively. Supporting structures and programs identified by managers and leaders include the following: “support from the top,” peer group support, educational programs and training sessions, a “lived” culture, secretarial or administrative assistant support, private office space, and computer classes and seminars.

Structures and Practices Enabling Staff Nurses to Control Their Practice

This mixed-methods study uses interviews, participant observations, and the CWEQII empowerment tool to identify structures and attributes of structures that promote control over nursing practice (CNP). Nearly 3,000 staff nurses completed the Essentials of Magnetism (EOM), an instrument that measures CNP, one of the eight staff nurse-identified essential attributes of a productive work environment. Strategic sampling is used to identify 101 high CNP-scoring clinical units in 8 high-EOM scoring magnet hospitals. In addition to 446 staff nurses, managers, and physicians on these high-scoring units, chief nursing officers, chief operating officers, and representatives from other professional departments are interviewed; participant observations are made of all unit/departmental/hospital council and interdisciplinary meetings held during a 4 to 6 day site visit. Structures and components of viable shared governance structures that enabled CNP are identified through constant comparative analysis of interviews and observations, and through analysis of quantitative measures.

Walk the Talk: Promoting Control of Nursing Practice and a Patient-Centered Culture

at the unit level unless parallel sanction and endorsement for these activities exist at the organizational level. After clarifying and illustrating the walk-the-talk metaphor and the constructs control of nursing practice and shared governance, we present the results of research that pertain to control of nursing practice and a patient-centered culture. We then suggest ways in which clinical nurses can operationalize the walk aspect of the talk, the values and beliefs inherent in control of nursing practice and a patient-centered culture.

An infrastructure for organizational support of research.

Nurses are well suited to develop, implement, and disseminate research initiatives. However, most nurses need assistance to translate the idea behind the initiative into reality. This process requires resources and support. The authors outline one organization’s infrastructure by which support is provided. Collaboration between a hospital-based research team and bedside nurses has produced a successful, funded program of research that has led to dissemination of findings.

Hospital Leadership Recognizes Need to Create Partnerships to Treat Consequences of Poverty

In this paper, two senior administrative leaders at a tertiary care childrens hospital explain why they decided to partner with a community organization in order to better fulfill the hospital mission.

Transparency in Healthcare Transformation or an Illusion

A dialogue on the concept of transparency by nurse administrators highlights specifics in the hospital setting. The authors of this column present exemplars from practice and issues related to safety, cost and the importance of data specific to nursing practice. The need for collaboration between service and academe is emphasized.

Critical conversation: toxic stress in children living in poverty

On October 27, 2017, the American Academy of Nursing President and Executive Vice President/Chief Operating Officer Children’s Mercy Kansas City Karen Cox, PhD, RN, FAAN, convened a critical conversation on Toxic Stress in Children Living in Poverty. An invitation-only event, the critical conversation was launched in response to the Robert Wood Johnson Foundation’s Culture of Health working group that met in 2016 on eliminating childhood poverty. Among the approximately 100 participants who assembled at the National Press Club, Washington, DC, were representatives of 33 organizations and 15 universities including First Focus, the Child Welfare League of America, Zero to Three, the Association for the Education of Young Children, the Campaign for Grade-Level Reading, National Association of Social Workers, and the Coalition to Stop Gun Violence. Two panels of experts discussed with participants Framing the Problem and Innovative Strategies for Preventing Toxic Stress in Children. Speakers included James Anderst, MD, MSCI, Professor of Pediatrics, University of Missouri-Kansas City School of Medicine, Children’s Mercy Kansas City; Cara Baldari, JD, Senior Policy Director, First Focus; Deborah Gross, DNSc, RN, FAAN, Academy Edge Runner (The Chicago Parent Program) and Professor, Johns Hopkins University; Sandee McClowry, PhD, RN, FAAN, Academy Edge Runner (INSIGHTS into Children’s Temperament) and Professor, New York University; Andrew Racine, MD, PhD, Professor, College of Medicine,Montefiore Health System; Joe Reardon, JD,President and CEO, Kansas City Chamber of Commerce and former Mayor, Kansas City, Kansas; AnneTurner-Henson, DSN, RN, FAAN, Professor, School of Nursing, University of Alabama at Birmingham; and JulieWillemsVan Dijk, PhD,RN,FAAN,Senior Scientist and Director of the County Health Rankings & Roadmaps Program. This critical conversation shined a spotlight on the Academy’s background work to date as a leader in making the challenge of toxic stress in children a national priority. “We all need to be active participants and leaders in helping our nation support policies that can build economically viable, thriving communities that are places where health is promoted,” said past Academy President Diana Mason in her message on looking upstream in which toxic stress in childhood, nutrition, and violence were identified as factors to be addressed (Mason, 2014). Further, Mason and Karen Cox discussed, in a subsequent president’s message, the prevalence of adverse childhood events (ACEs) and the impact of toxic stress on brain architecture. “The science, then, allows us to think about addressing poverty in a different light,” they concluded, urging an analysis of policies that may reduce toxic stress and the development of new partnerships to enhance commitment across sectors to this work (Mason & Cox, 2014). The Academy also hosted a policy dialogue on toxic stress in children during its annual policy conference in 2014 to focus attention on the determinants of health and implications for children and adolescents. Further, the Academy published the policy brief Urgent action needed to reduce exposure to toxic stress in pregnant women and young children, calling attention to the issue that child exposure to toxic stress begins prenatally (Gross, Beeber, DeSocio, & Brennaman, 2016). Importantly, the Academy recognizes nurse innovators by designating them as Edge Runners. Several Edge Runners’ models of care are designed to reduce the effects of toxic stress. These are just a few examples:

Driving Organizational Change From the Bedside: The AACN Clinical Scene Investigator Academy

Background Staff nurses are pivotal in leading change related to quality improvement efforts, although many lack skills to steer change from the bedside. The American Association of Critical‐Care Nurses (AACN) staff nurse leadership program, Clinical Scene Investigator (CSI) Academy, teaches and empowers staff nurses in leadership skills and change concepts to translate evidence into practice affecting patient outcomes. Objectives To describe the curriculum of the AACN CSI Academy that provides staff nurses with the leadership skills required to create unit‐based change projects that positively impact patient/family outcomes. Methods The curriculum of the Academy included leadership topics, communication, change concepts, quality improvement methods, project management, and data management and analysis. Each team of participants collected project data to show improvements in patient care. The program evaluation used many data sources to assess the program effectiveness, relating to the professional growth of the participant nurses. The participants assessed project patient outcomes, sustainability, and spread. Results The first cohort of CSI participants included 164 direct care nurses from 42 hospitals in 6 cities. They rated the Academy highly in the program evaluation, and they reported that the Academy contributed to their professional development. The individual hospital quality improvement projects resulted in positive patient and estimated fiscal outcomes that were generally sustained 1 year after the program. Conclusion With the skills, tools, and support obtained from participation in the CSI Academy, staff nurses can make substantial contributions to their organizations in clinical and possibly fiscal outcomes.