Mary Krugman

The graduate nurse experience.

Graduate nurses experience stress transitioning from student to practicing professional nurse, moving from a familiar educational environment into the workforce, where expectations are to rapidly function as a competent nurse. This study identified the stresses and challenges experienced by cohorts of graduate nurses working in 6 acute care hospitals, during specific timed data periods, to better understand factors that may influence graduate nurse retention. Results report graduate nurses do not feel skilled, comfortable, and confident for as long as 1 year after being hired, highlighting the need for healthcare organizations to provide extended orientation and support programs to facilitate successful entry into practice.

The Graduate Nurse Experience: Qualitative Residency Program Outcomes

Graduate nurses experience role conflict and stress as they begin practice in work environments of high complexity, nurse shortages, and expectations to become competent rapidly. The authors report outcomes from a study that evaluated qualitative responses to the Casey-Fink Graduate Nurse Experience Survey administered to graduate nurse residents in the University HealthSystem Consortium/American Association of Colleges of Nursing postbaccalaureate nurse residency program at 12 academic hospital sites. Qualitative analysis provided sufficient evidence to convert specific open-ended questions on the Casey-Fink Graduate Nurse Experience Survey instrument to a quantitative format for ease of administration and analysis.

Evaluating the Impact of Computerized Clinical Documentation

A computerized system for care planning and documentation of patient care was initiated at a western teaching hospital, using the framework of Nursing Interventions Classification and Nursing Outcomes Classification standardized languages. The software integrates care planning and documentation, and includes both order entry as well as a charting application. Prior to initiating the project, a study was conducted to evaluate staff attitude toward computerization, time needed for documentation, and comprehensiveness of charting entries. Data from staff surveys, observations, and chart audits conducted pre- and post–computer project implementation demonstrated that the staff attitudes toward computers were less positive, the time required for charting was unchanged, and there were improvements in how completely the nurses documented charting elements.

Excellence through evidence: securing collegial/collaborative nurse-physician relationships, part 2.

Multiple nurse-physician (RNMD) relationships coexist on hospital units; collegial and collaborative (C/C) relationships positively impact, more than others, patient outcomes. The goal of this multisite evidence-based management practice initiative was to identify structures that enable C/C RNMD relationships. In part 1, the authors discuss the methodology and selection of the sample of 141 physicians, managers, and staff nurses from 44 clinical units in 5 hospitals that had previously demonstrated extensive C/C RNMD relationships. These 141 experts were interviewed to identify structures enabling C/C RNMD relationships. Part 1 presents the structures that enable C/C RNMD relationships as described and tested in the literature, as well as a description of the characteristics of the clinical units, experts, and C/C RNMD relationships found in this study. In part 2, the structures identified by the experts as needed for securing C/C RNMD relationships will be presented, along with suggestions for attainment.

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.

The National Post-baccalaureate Gradua te Nurse Residency Program: A Model for Excellence in Transition to Practice

The Chief Nursing Officers (CNOs) of the University HealthSystems Consortium (UHC) of Academic Hospitals desired to increase the numbers of baccalaureate graduate nurses hired by their facilities and provide a more consistent, uniform transition into practice for these graduate nurses. A partnership between the UHC CNOs and the American Association of Colleges of Nursing (AACN) led to establishing a National Post-Baccalaureate Graduate Nurse Residency Program. The structure, curriculum, and outcomes measures were developed and the program was implemented, with growth from six original pilot sites to 34 academic hospitals. Outcomes from the first year of program operation at these six sites show a high rate of retention, decreased stress by graduate nurses over time, improved organization and prioritization of care, and increased satisfaction in the first year of practice.

Charge nurse leadership development and evaluation.

Objective To describe the development and evaluation of a permanent charge nurse role and report outcomes of this leadership model over 4 years. Background A permanent charge nurse role was developed to improve continuity of care and develop emerging nurse leaders. An evaluation model was constructed to measure program outcomes. Kouzes and Posner’s Leadership Model served as the theoretical framework. Methods The permanent charge nurse role was developed, training planned, and the evaluation framework established. Measurements included two survey instruments, an investigator-developed End-of-Shift Report, and institutional patient satisfaction data. Survey instruments included Kouzes and Posner’s Leadership Practice Inventory (LPI), concurrently measuring self (charge) and other (staff) perceptions of charge leadership. The McClosky Mueller Satisfaction Scale (MMSS) measured charge and staff nurse job satisfaction. Data were collected at baseline, post-implementation, and additional time periods. Results Charge RNs reported significantly more favorable perceptions of leadership abilities than staff. The Shift Report successfully tracked both system and charge management issues. Patient satisfaction data did not yield data due to vendor changes. Job satisfaction results showed charge nurses reported higher satisfaction with schedule, praise and recognition, control and responsibility, than staff nurses. Conclusions Using data to evaluate charge nurse leadership guides continued program improvements.

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.

A clinical advancement program: evaluating 10 years of progressive change.

OBJECTIVE To report the evolution of a clinical advancement program, UEXCEL, at a western teaching hospital and the outcomes associated with evaluation over time. BACKGROUND The clinical ladder program was initiated in 1989 to provide a professional framework for developing, evaluating, and promoting registered nurses. The program is derived from Benners Novice to Expert model. Over a 10-year period, the program has undergone three significant revisions. Program evaluation data have been used to guide institutional change. METHODS Structure and progression of program development and change are outlined. Evaluation data were collected using a 23-item clinical ladder satisfaction scale developed by Strzelecki. Data were collected in 1993, 1994, 1996, and 1998 using standard survey methods after institutional review board approval. Subjects were registered nurses holding clinical positions at the University of Colorado Hospital. Data were trended across units and time periods and were compared with other institutional evaluation data sets. RESULTS Improvement in nurse satisfaction with the UEXCEL program has been steady and incremental, after low baseline measurement. Satisfaction has improved after each program revision. A significant demographic variable over time is the correlation between higher registered nurse education and program satisfaction. Human resources issues are reported with data results. CONCLUSIONS Sustaining a clinical advancement program represents a challenge in the current health-care environment. Institutional commitment, staff involvement in revisions, and activities to improve professional nurse development are critical strategies so progress can be achieved.