Patricia Cornett

Sustaining the pivotal organizational outcome: magnet recognition

parsons m.l. & cornett p.a. (2011) Journal of Nursing Management19, 277–286 Sustaining the pivotal organizational outcome: magnet recognition Aim  To identify the facilitators and barriers for health-care organizations to sustain Magnet Recognition, the exemplar of a professional practice environment and quality care. Background  Recognition as a Magnet Hospital is the gold standard for acknowledging excellence in nursing. However, limited evidence exists to inform nursing management practices for sustainability. Method  This qualitative study was conducted using a national convenience sample of 15 Chief Nursing Officers of Magnet Recognized hospitals in the USA. Results  Key macrosystem facilitators included executive management and leadership themes about quality, people, education, and the nurse executive’s commitment and intent. Barriers were executive management turnover and financial challenges. Infrastructure supports and resources for empowerment and quality and unit leadership practices were found to be essential for quality outcomes. The key theme at the microsystem level was moving nursing practice to managing outcomes from tasks; barriers were challenges with unit management turnover and development. Conclusions  Multiple factors at system levels were found to contribute to sustainability. Further research is needed on the concept of sustainability. Implications for nursing management  The findings contribute to executives’ armamentarium to inform management practice for the design of evidenced based organizational systems and programs for nursing excellence.

Team behavioral norms: a shared vision for a healthy patient care workplace.

Leaders are bombarded with healthy workplace articles and advice. This article outlines a strategy for laying the foundation for healthy patient care workplaces at the pivotal unit level. This process facilitates the nursing unit staff to create and implement a shared vision for staff working relationships. Fourteen acute care hospital units, all participants in a healthy workplace intervention, were selected for this analysis because they chose team behavioral norms as a top priority to begin to implement their vision for a desired future for their units, a healthy workplace. These units developed specific team behavioral norms for their expectations of each other. The findings revealed 3 major norm themes and attributes: norms for effective communication, positive attitude, and accountability. Attributes of each norm are described to assist nurses to positively influence their core unit work culture.

Building organizational capacity for a healthy work environment through role-based professional practice

The professional practice of registered nurses (RNs) and their professional role competence are key variables that have an impact on quality and patient safety. Organizations in which RNs practice must have the capacity to fully support the professional role of those RNs in exercising their legitimate power derived through nurse licensing laws and professional standards and ethics. The interplay of individual RN practice and organizational practice, and measurement thereof, are the essence of organizational capacity. Two models are discussed that tie together the attributes of healthy workplace environments and provide the structure to guide and sustain organizational capacity.

Does Research Training During Residency Promote Scholarship and Influence Career Choice? A Cross-Sectional Analysis of a 10-Year Cohort of the UCSF–PRIME Internal Medicine Residency Program

ABSTRACT Problem: The Association of Program Directors in Internal Medicine, the Accreditation Council for Graduate Medical Education, the Alliance for Academic Internal Medicine, and the Carnegie Foundation report on medical education recommend creating individualized learning pathways during medical training so that learners can experience broader professional roles beyond patient care. Little data exist to support the success of these specialized pathways in graduate medical education. Intervention: We present the 10-year experience of the Primary Care Medicine Education (PRIME) track, a clinical-outcomes research pathway for internal medicine residents at the University of California San Francisco (UCSF). We hypothesized that participation in an individualized learning track, PRIME, would lead to a greater likelihood of publishing research from residency and accessing adequate career mentorship and would be influential on subsequent alumni careers. Context: We performed a cross-sectional survey of internal medicine residency alumni from UCSF who graduated in 2001 through 2010. We compared responses of PRIME and non-PRIME categorical alumni. We used Pearsons chi-square and Students t test to compare PRIME and non-PRIME alumni on categorical and continuous variables. Outcome: Sixty-six percent (211/319) of alumni responded to the survey. A higher percentage of PRIME alumni published residency research projects compared to non-PRIME alumni (64% vs. 40%; p = .002). The number of PRIME alumni identifying research as their primary career role was not significantly different from non-PRIME internal medicine residency graduates (35% of PRIME vs. 29% non-PRIME). Process measures that could explain these findings include adequate access to mentors (M 4.4 for PRIME vs. 3.6 for non-PRIME alumni, p < .001, on a 5-point Likert scale) and agreeing that mentoring relationships affected career choice (M 4.2 for PRIME vs. 3.7 for categorical alumni, p = .001). Finally, 63% of PRIME alumni agreed that their research experience during residency influenced their subsequent career choice versus 46% of non-PRIME alumni (p = .023). Lessons Learned: Our results support the concept that providing residents with an individualized learning pathway focusing on clinical outcomes research during residency enables them to successfully publish manuscripts and access mentorship, and may influence subsequent career choice. Implementation of individualized residency program tracks that nurture academic interests along with clinical skills can support career development within medicine residency programs.

Managing the difficult employee: A reframed perspective

All nurse managers deal with difficult employees during their careers. Such employees engage in negative social interdependence, and the ensuing negative conflict they create affect team performance effectiveness, job satisfaction, and turnover intention. This state of affairs is the antithesis of professional practice and healthy workplace environments, where constructive conflict exists. By reframing the difficult employee behavior in a professional practice framework, the necessary prosocial actions of positive interdependence become clear. When role-based professional RNs are supported by managers who value shared leadership and create professional practice environments, positive social interdependence can flourish and negative social interdependence of difficult employees will not.

Foreword. Healthy workplaces in acute care hospitals.

This entire issue of Critical Care Nursing Quarterly focuses on healthy workplaces in acute care hospitals. A social-ecological framework guides the choice of articles for the issue. An ecological framework recognizes the interplay between human beings and the socioenvironment in producing health and quality of life. Therefore, a comprehensive perspective requires that we look beyond the currently accepted definitions and policy statements for the creation of healthy work environments. Shirey shares her research findings on authentic leadership, culture, and healthy workplaces, and Cornett and O’Rourke describe the essentiality of professional nursing practice in a healthy workplace. Ethics guides leaders and facilitators in working with groups to create the kind of workplace in which nurses want to work and an innovative framework for ethics in participatory action research is fully depicted. A surgical trauma ICU healthy workplace case study is described and improvements for quality of care and unit operations are discussed. Nurse behaviors for healthy infection control practices are incorporated into the healthy workplace rubric and are critical for nurse and patient health and well-being. Teamwork’s role in patient safety and healthy workplaces is described in detail by Clark. Furthermore, facility design, a key component of a healthy workplace, a place that promotes quality of care and a positive engaged staff, is promulgated by Stichler. As issue editors, it is our hope that you, the reader, will find these articles stimulating and informative as you in your nursing role strive to promote healthy workplaces for all.

Putting Schemas to the Test: An Exercise in Clinical Reasoning

A 70-year-old previously healthy man presented to the emergency department with 6 weeks of fatigue, fevers, and chills. He had abdominal fullness, early satiety, and 20-pound weight loss over the preceding 8 months. He did not have headache, night sweats, cough, dyspnea, diarrhea, dysuria, or rash. His family noticed yellowing of his skin and eyes over the previous week. He had immigrated from Vietnam to the USA 30 years prior. He lived in Northern California and had traveled to Minnesota 1month earlier. He previously worked as a landscaper and had been retired for 10 years. He denied tobacco, alcohol, or recreational drug use.

Problematic communications during 2016 fellowship recruitment in internal medicine

ABSTRACT Some internal medicine residency program directors have expressed concerns that their third-year residents may have been subjected to inappropriate communication during the 2016 fellowship recruitment season. The authors sought to study applicants’ interpersonal communication experiences with fellowship programs. Many respondents indicated that they had been asked questions that would constitute violations of the National Residency Matching Program (NRMP) Communications Code of Conduct agreement, including how they plan to rank specific programs. Moreover, female respondents were more likely to have been asked questions during interview experiences about other programs to which they applied, and about their family plans. Post-interview communication policies were not made clear to most applicants. These results suggest ongoing challenges for the internal medicine community to improve communication with applicants and uniform compliance with the NRMP communications code of conduct during the fellowship recruitment process.

Severe piperacillin–tazobactam‐induced hemolysis in a cystic fibrosis patient

Piperacillin–tazobactam is one of the most common causes of drug‐induced immune hemolytic anemia (DIIHA) and is frequently utilized, especially in patients with cystic fibrosis (CF). Here, we report a case of life‐threatening piperacillin–tazobactam‐associated DIIHA in a 30‐year‐old woman with CF and propose management recommendations for piperacillin–tazobactam‐associated DIIHA in CF patients.

Sustaining the pivotal organizational outcome

parsons m.l. & cornett p.a. (2011) Journal of Nursing Management19, 277–286 Sustaining the pivotal organizational outcome: magnet recognition Aim  To identify the facilitators and barriers for health-care organizations to sustain Magnet Recognition, the exemplar of a professional practice environment and quality care. Background  Recognition as a Magnet Hospital is the gold standard for acknowledging excellence in nursing. However, limited evidence exists to inform nursing management practices for sustainability. Method  This qualitative study was conducted using a national convenience sample of 15 Chief Nursing Officers of Magnet Recognized hospitals in the USA. Results  Key macrosystem facilitators included executive management and leadership themes about quality, people, education, and the nurse executive’s commitment and intent. Barriers were executive management turnover and financial challenges. Infrastructure supports and resources for empowerment and quality and unit leadership practices were found to be essential for quality outcomes. The key theme at the microsystem level was moving nursing practice to managing outcomes from tasks; barriers were challenges with unit management turnover and development. Conclusions  Multiple factors at system levels were found to contribute to sustainability. Further research is needed on the concept of sustainability. Implications for nursing management  The findings contribute to executives’ armamentarium to inform management practice for the design of evidenced based organizational systems and programs for nursing excellence.