Mary Crabtree Tonges

Running the vicious cycle backward and other systems solutions to nursing problems.

Peter Senges book, The Fifth Discipline: The Art and Practice of the Learning Organization, is a business bestseller. The fifth discipline refers to systems thinking, a conceptual framework for making the full pattern of complex, interrelated actions clearer and helping people see how to change them. This article summarizes selected key concepts from Senges work and explains how nurse executives can use systems thinking to gain a deeper understanding of the forces operating in recurrent situations and identify opportunities for leverage to benefit patients, staff, and healthcare organizations.

Translating Caring Theory Across the Continuum From Inpatient to Ambulatory Care

While theory-based practice is a Magnet® characteristic, translating theories to practice remains challenging. As a result, theory-guided practice remains an ideal rather than a realized goal in many organizations. This article provides an overview of a research-derived caring theory, a translational model for theory-driven practice, implementation of a delivery model designed to translate theory across the acute and ambulatory care continuum, and resulting outcomes in oncology clinics and the emergency department.

Amplifying nursing's voice through a staff-management partnership.

Recommendations to decrease the nursing shortage often identify the need to strengthen nurses’ autonomy and control in hospitals but do not describe specific mechanisms to accomplish this goal. The Nurse Practices Committee provides a forum for staff nurses and nurse executives at Robert Wood Johnson University Hospital to jointly make decisions about resource allocation. Committee members agree that this work has strengthened relationships by fostering mutual understanding, respect, and trust. As a result, nursing management and staff partners can advocate for patients and nurses with a single, more powerful voice.

Implementing the ten-step monitoring and evaluation process in nursing practice.

Implementation of the ten-step monitoring and evaluation process as recommended by the Joint Commission leads to the development of a program that meets the requirements of the quality assurance standard. The Professional Practice Program at Robert Wood Johnson University Hospital (New Brunswick, New Jersey) demonstrates the application of this process within the Nursing Division. A conceptual model of nursing practice based on nursing diagnosis provides the framework for the program. Responsibility for the system belongs to the professional nursing staff through the election of unit-based representatives.