Karen S. Hill

Work satisfaction, intent to stay, desires of nurses, and financial knowledge among bedside and advanced practice nurses.

Objective: To better understand factors that may contribute to retention of experienced nurses, a study examined differences and relationships among work satisfaction, intent to stay in the nursing profession, and financial knowledge of retirement consequences related to income between clinical bedside nurses (CBNs) and advanced practice nurses (APNs) and described the importance of 7 workforce desires of nurses. Background: Overall, nurses are not informed regarding the financial implications of transitioning from the workforce into retirement. In addition, little is known about the workforce desires and intent to stay among experienced nurses. Methods: A cross-sectional, descriptive, comparative design was used. Data were collected from a convenience sample (n = 176) of CBNs employed by a 371-bed, acute care, Magnet®-designated hospital, who worked in telemetry and medical-surgical care, and APNs employed by the hospital or employed by a credentialed physicians within the facility in a variety of care settings and roles. Results: Findings from the Work Satisfaction and Intent to Stay scales suggest that relationships in the workplace are important. Data related to the 7 workforce desire questions show that nurses in this organization support the characteristics of caring in the work environment as identified by Watson. The financial knowledge of the consequences of retirement related to income was low among both groups but slightly higher for the APNs. Conclusions: Implications of this study for nurse leaders include the importance of strengthening relationships among nursing colleagues and between the nurse and the supervisor particularly in the constructs of caring. Data support a need for increased education about finances and retirement for RNs in the workplace.

Mitigating Knowledge Loss: A Strategic Imperative for Nurse Leaders.

With the aging of the nursing workforce and expected retirement of large numbers of experienced nurses in the next decade, mitigating the impact that lost knowledge will have on organizational performance and patient outcomes is critical. The authors raise awareness of the problem, summarize observations procured from hospital nurse executive regarding approaches for knowledge transfer through workforce development, and pose proactive strategies for nurse leaders who can provide direction to offset the issue before it becomes a crisis.

Defy the decades with multigenerational teams.

Identify techniques for relating to staff members of any age.

Nursing and the Aging Workforce: Myths and Reality, What Do We Really Know?

Not unlike the general population, the population of nurses is aging. This trend is problematic for the nursing workforce in the light of a predicted shortage yet the extent of the effect of the aging population is unknown. What should individuals older than 45 years know to mitigate the effects of aging both physically and professionally? This article describes the magnitude of the aging nursing workforce issue, explores the myths and realities related to the aging process, discusses evidence-based strategies supporting healthy aging and retention of experienced nurses in one Magnet hospital, and introduces recommendations for further study.

Transforming Practice Through Publication: A Community Hospital Approach to the Creation of a Research-Intensive Environment.

Publication of 28 data-based articles in peer-reviewed journals over a 4-year period is the result of a commitment to conducting and publishing research at a 383-bed Magnet®-redesignated community hospital. The research-intensive environment in nursing at this institution supports publication as the desired outcome of all projects. The provision of appropriate resources, the development of 2 models to guide the conduct of research and nursing leadership that encourages and supports research activities enables nurses to submit manuscripts describing their work. Steps taken to support the publication of findings can be adapted for other practice settings.

A failure of leadership.

On February 24, 2008, the Centers for Medicare and Medicaid Services withdrew certification for inpatient reimbursement to the Haywood Regional Medical Center (HRMC) in Clyde, North Carolina. The precipitating event was an inspection in late January by state officials finding pervasive medical errors and concluded that the hospital was in imminent jeopardy for patient safety. A few days later, 3 additional payers including Blue Cross and Blue Shield withdrew payment for inpatient care. In the ensuing days, the chief executive officer, the chief nursing executive, and chairman of the board of the hospital resigned. The leader of a consultant team attempting to recertify the hospital summarized the situation as a significant leadership failure. In an article in the local Smokey Mountain News, interviews with present and former HRMC nurses indicated that they felt that nursing care was not valued and the overbearing emphasis on controlling costs led to a high rate of regular staff resigning for other jobs. Open positions were filled with contract or traveler nurses. On June 6, 2006, findings from a survey conducted at HRMC found substantial deficiencies in nurse staffing. In particular, the report cited several nurses informing supervisors of dangerous staffing conditions in the intensive care unit. Haywood Regional Medical Center is the sole hospital in Haywood County and its third largest employer. Physicians scrambled to save their practices in the aftermath of the hospital losing Medicare payment by seeking admitting privileges in hospitals in adjacent counties. The overall impact of the lack of reimbursement for Medicare and Medicaid inpatient services will profoundly affect this rural community for many years. The sober lesson is the lack of communication with the nursing staff at HRMC and the apparent assumption by senior executives that nurses were a commodity. The reported lack of response by senior management to critical concerns raised by both nurses and physicians is difficult to comprehend in today’s environment of collaboration. The key question that any nurse manager or nurse executive should ask is as follows: could this happen at my hospital? As a nurse leader, just reading a few key documents (see reference list) will give you a very uncomfortable feeling. Although it is easy to retrospectively diagnose organizational ills, there are some personal and leadership lessons from this situation that can be applied to nurse executives facing organizational challenges.

Development of leadership competencies as a team.

Creating positive change to move a leadership team forward in a learning environment was a challenge for senior executives. The author describes an organized approach to leadership competency development for both nursing and nonnursing department directors and senior administrative staff members. The project was based on a 360-degree assessment group composite analysis and was implemented during a 12-month period. Prioritization of leadership development occurred as a result of this effort within the facility strategic plan, and intradepartmental communication dramatically improved.

Volunteerism: Another Path to Leadership Skills

This department highlights nursing leaders who have demonstrated the ability to inspire and lead change. This competency is seen in the ability to create, structure, and implement organizational change through strategic vision, risk taking, and effective communication. Each article showcases a project of a nurse leader who demonstrates change in a variety of environments, ranging from acute care hospitals to home care and alternative practice settings. Included are several ‘‘lessons learned’’ applicable to multiple settings that provide insight for other nurses in executive practice.

Predatory publishing: what nurse executives need to know.

Editors attending the 2014 meeting of the International Academy of Nursing Editors have coalesced to provide information to our readers regarding a recent trend in the publishing world, predatory publishing.

Evidence Supporting Excellence

The 2012 Magnet Conference, held in Los Angeles, California, on October 10 to 12, 2012, highlighted programs, projects, and research supporting environments of nursing excellence. I have selected 11 presentation abstracts to present in this special section profiling some unique projects from a variety of practice settings. Congratulations to all the writing teams who participated in these unique initiatives.