Rebecca S. Miltner

Nurturing charge nurses for future leadership roles.

Charge nurses are untapped leadership resources that can be groomed for future advanced leadership positions in healthcare organizations. The purpose of this study was to understand the development needs for the charge nurse role. This study demonstrates they receive little or no training for assuming positions of leadership and offers suggestions for enhancement of preparation.

Interprofessional Education in Action: The VA Quality Scholars Fellowship Program

Although there are many examples of interprofessional education activities that focus on quality and safety, few include longitudinal experiences of teams working together over time. One exception is the Veterans Affairs Quality Scholars (VAQS) fellowship program. This article describes the integration of interprofessional education into the VAQS fellowship program, offers 2 examples of interprofessional projects conducted by the fellows, and discusses the VAQS program as a model for others to consider in developing interprofessional training programs in safety and quality improvement.

The Practice Environment Scale of the Nursing Work Index: An updated review and recommendations for use

OBJECTIVES The Practice Environment Scale of the Nursing Work Index (PES-NWI) is an instrument, which measures the nursing practice environment - defined as factors that enhance or attenuate a nurses ability to practice nursing skillfully and deliver high quality care. The purpose of this paper is to provide an updated review of the Practice Environment Scale of the Nursing Work Indexs use to date and provide recommendations that may be helpful to nursing leaders and researchers who plan to use this instrument. DESIGN A narrative review of quantitative studies. DATA SOURCES PubMed, EMBASE, and the Cumulative Index to Nursing & Allied Health Literature were searched to identify relevant literature using the search terms, Practice Environment Scale of the Nursing Work Index and PES-NWI. REVIEW METHODS Studies were included if they were published in English between 2010 and 2016 and focused on the relationship between the Practice Environment Scale of the Nursing Work Index and patient, nurse, or organizational outcomes. Data extraction focused on the reported survey scores and the significance and strength of the reported associations. RESULTS Forty-six articles, from 28 countries, were included in this review. The majority reported significant findings between the nursing practice environment and outcomes. Although some modifications have been made, the instrument has remained primarily unchanged since its development. Most often, the scores regarding staffing and resource adequacy remained the lowest. CONCLUSION The frequency of use of this instrument has remained high. Many researchers advocate for a move beyond the study of the connection between the Practice Environment Scale and nurse, patient, and organizational outcomes. Research should shift toward identifying interventions that improve the environment in which nurses practice and determining if changing the environment results in improved care quality.

The future of quality improvement research

Presentation The history of quality improvement research (QIR) demonstrates the large growth in improvement activities from early quality assessment and small area variation work through the adoption of industrial quality improvement methods in healthcare operations to the recent opportunities inherent in the Affordable Care Act of 2010. But after 40 years of development, significant growth in these scholarly activities has not produced comparable growth in insights, practical guidance, or progress toward better care. Five challenges influence the trajectory of improvement work and implementation science. The first challenge relates to the innovations and evidence base to improve healthcare. The focus of innovation and research in improvement has been on strategies, facilities and systems that are leaders in performance and quality improvement – the organizational equivalents of healthy white males. This makes differentiation and generalizability to the range of organizational settings difficult. A concerted effort must be made to focus on research conducted within, and with relevance to, the broader practice environment. The second challenge includes multiple logistical barriers such as access to study sites, the limited funding opportunities for QIR, and the lack of consistent IRB guidance and interpretation of regulations. Underlying these barriers is a considerable lack of clarity surrounding the nature of QIR relative to other types of health research. With the exception of the recent statement on cluster randomized trials by the Ottawa Ethics of Cluster Randomized Trials Consensus Group (2012)[1], the absence of consistent guidelines for QIR poses challenges for researchers trying to obtain local IRB review as well as investigators competing with others using more traditional research methods during the grant review process. QIR researchers need to embrace the IRB process and develop explicit, consensus-based guidance to facilitate more consistent reviews at the funding and IRB stages. The third challenge includes the professional differences that stem from the diversity of academic disciplines and types of institutions from which people involved in this work emerge. The concepts and definitions arising from diverse disciplinary roots make it difficult to achieve progress and move forward collectively. These factors pose barriers to the scholarly QIR community and, more importantly, contribute to confusion and decreased credibility among external stakeholders and scientists in the more traditional fields of study surrounding QIR. Lack of consensus and clarity impede the advance of this science because researchers cannot explain the work consistently to funding agencies, editorial review boards and other stakeholders. The fourth challenge is the need to strengthen the theoretical foundations for this work. There is an urgent need to assess whether we have the right theories, too many theories or simply a lack of guidance in using theories to build the science of improvement. The weak theoretical basis for QIR contributes to the fifth and final challenge to the future, which is advancing the science through robust and appropriate research approaches, designs and methods. The field has failed to reach consensus about the major research questions and goals for QIR, and continues to debate the appropriate methods for improvement and implementation work. Different views regarding the value and need for various research approaches and methods for conducting QIR limits the production of practical and effective insights and tools for researchers, clinicians, organizations, and policy decision makers.

Organisational strategies to implement hospital pressure ulcer prevention programmes: findings from a national survey.

AIM To describe the presence and operationalisation of organisational strategies to support implementation of pressure ulcer prevention programmes across acute care hospitals in a large, integrated health-care system. BACKGROUND Comprehensive pressure ulcer programmes include nursing interventions such as use of a risk assessment tool and organisational strategies such as policies and performance monitoring to embed these interventions into routine care. The current literature provides little detail about strategies used to implement pressure ulcer prevention programmes. METHODS Data were collected by an e-mail survey to all chief nursing officers in Veterans Health Administration acute care hospitals. Descriptive and bivariate statistics were used to summarise survey responses and evaluate relationships between some variables. RESULTS Organisational strategies that support implementation of a pressure ulcer prevention programme (policy, committee, staff education, wound care specialists, and use of performance data) were reported at high levels. Considerable variations were noted in how these strategies were operationalised within individual hospitals. CONCLUSION Organisational strategies to support implementation of pressure ulcer preventive programmes are often not optimally operationalised to achieve consistent, sustainable performance. IMPLICATIONS FOR NURSING MANAGEMENT The results of the present study highlight the role and influence of nurse leaders on pressure ulcer prevention program implementation.

Identifying Patterns in Implementation of Hospital Pressure Ulcer Prevention Programs: A Multisite Qualitative Study.

PURPOSE: To describe the presence or absence of key components of hospital pressure ulcer (PU) prevention programs in 6 acute care hospitals. DESIGN: Multisite comparative case study. SUBJECTS AND SETTING: Using purposeful selection based on PU rates (high vs low) and hospital size, 6 hospitals within the Veterans Health Administration health care system were invited to participate. Key informant interviews (n = 48) were conducted in each of the 6 participating hospitals among individuals playing key roles in PU prevention: senior nursing leadership (n = 9), nurse manager (n = 7), wound care specialist (n = 6), frontline RNs (n = 26). METHODS: Qualitative data were collected during face-to-face, semistructured interviews. Interview protocols were tailored to each interviewees role with a core set of common questions covering 3 major content areas: (1) practice environment (eg, policies and wound care specialists), (2) current prevention practices (eg, conduct of PU risk assessment and skin inspection), and (3) barriers to PU prevention. We conducted structured coding of 5 key components of PU prevention programs and cross-case analysis to identify patterns in operationalization and implementation of program components across hospitals based on facility size and PU rates (low vs high). RESULTS: All hospitals had implemented all PU prevention program components. Component operationalization varied considerably across hospitals. Wound care specialists were integral to the operationalization of the 4 other program components examined; however, staffing levels and work assignments of wound care specialists varied widely. Patterns emerged among hospitals with low and high PU rates with respect to wound care specialist staffing, data monitoring, and staff education. CONCLUSION: We found hospital-level variations in PU prevention programs. Wound care specialist staffing may represent a potential point of leverage in achieving other PU program components, particularly performance monitoring and staff education.

Caring for America's Veterans: The Power of Academic-Practice Partnership.

Veterans receive care across the entire health system. Therefore, the workforce needs knowledge and awareness of whether patients are Veterans and the impact of their military service on their physical and mental health. Recent reports of limitations in access for Veterans seeking health care have highlighted this need across all health care settings. Academic-practice partnerships are one mechanism to align the need for improved health care services within the Veteran population while advancing nursing practice in the Veterans Health Administration and surrounding communities. The key to strong partnerships and sustained collaboration is shared goals, mutual trust and respect, the development of formal relationships, and support of senior leadership that fosters the joint vision and mission to improve nursing care for Veterans. This article describes the evolving partnership between one Veterans Health Administration Medical Center and a School of Nursing, which aligned strategic goals across both organizations to increase the capacity and capability of services provided to Veterans.

Promoting a Strategic Approach to Clinical Nurse Leader Practice Integration.

The Office of Nursing Services of the Department of Veterans Affairs (VA) piloted implementation of the clinical nurse leader (CNL) into the care delivery model and established a strategic goal in 2011 to implement the CNL role across the VA health care system. The VA Office of Nursing Services CNL Implementation and Evaluation (CNL I&E) Service was created as one mechanism to facilitate that goal in response to a need identified by facility nurse executives for consultative support for CNL practice integration. This article discusses strategies employed by the CNL I&E consultative team to help facility-level nursing leadership integrate CNLs into practice. Measures of success include steady growth in CNL practice capacity as well as positive feedback from nurse executives about the value of consultative engagement. Future steps to better integrate CNL practice into the VA include consolidation of lessons learned, collaboration to strengthen the evidence base for CNL practice, and further exploration of the transformational potential of CNL practice across the care continuum.

Professional development needs of nurse managers.

BACKGROUND Nurse managers have a key role in creating positive work environments where safe, high-quality care is consistently provided. This requires a broad range of skills to be successful within todays complex health care environment; however, managers are frequently selected based on their clinical expertise and are offered little formal preparation for this leadership role. METHOD We conducted three focus groups with 20 nurse managers to understand their professional development needs. Transcripts were analyzed using conventional content analysis. RESULTS Three themes emerged: Managing Versus Leading, Gaining a Voice, and Garnering Support. Managers focused on daily tasks, such as matching staffing to patient needs. However, the data suggested gaps in foundational management skills, such as understanding organizational behavior, use of data to make decisions, and refined problem-solving skills. CONCLUSION Professional development activities focusing on higher level leadership competencies could assist managers to be more successful in this challenging, but critical, role.

A Team Approach to Enhance Scholarship Among Honors Students in Nursing [Innovation Center]

AbstractHonors programs within schools of nursing have the potential to enhance young nurses’ interest in developing programs of research early in their careers and can thus contribute to the successful development of nursing knowledge. Such programs also provide opportunities to enhance knowledge and skill in leadership and teamwork at a critical time during the development of their professional nurse identity. This article presents the successful approach one organization took when revising its honors program to meet the current needs of students, society, and the profession.