Robin P. Newhouse

Evidence-based practice: a practical approach to implementation.

Organizations often do not have processes in place to support nurses through a systematic approach for developing and evaluating nursing interventions, protocols, critical pathways, and policies that are derived from scientific evidence. The development of a framework to guide inquiry will have a positive impact on patients. This process may foster a higher level of professional engagement by nurses that may, in the long-term, help improve nurse retention and recruitment. The authors discuss a nursing evidence-based practice model and guidelines that were developed by a team of hospital and academic nurse leaders and is practical and easy to use. This model has been successfully implemented across the department of nursing as a strategic initiative. Results of the implementation have shown that staff nurses can effectively use this model with the help of knowledgeable mentors.

Evaluating an innovative program to improve new nurse graduate socialization into the acute healthcare setting.

ProblemNew nurse graduates experience a stressful role transition into healthcare organizations, with 30% leaving their first job within 1 year and 57% leaving by 2 years of employment. AimThis study tests whether an internship program, Social and Professional Reality Integration for Nurse Graduates (SPRING), improves new nurse graduate retention, sense of belonging, organizational commitment, and anticipated turnover. DesignQuasi-experimental, posttest only, control group design. MethodNew nurse graduates hired by an academic institution that completed SPRING were compared with baseline nurse graduates who did not complete SPRING, using the Organizational Commitment Questionnaire, Modified Hagerty-Patusky Sense of Belonging Instrument, and Anticipated Turnover Scale. Retention was also examined. ResultsAnticipated Turnover was higher for baseline nurses than for 6-month SPRING nurses. Six-month SPRING nurses have lower antecedent sense of belonging than baseline or 12-month SPRING nurses. One-year retention is higher for SPRING new graduates than for non-SPRING new graduates. ConclusionInternship programs for nurse graduates must support the socialization of nurses and their transition into the professional role as well as teach the skills and knowledge needed for competence. This study supports the value of a comprehensive program for new nurse graduates in improving nurse retention and decreasing new nurse graduate intent to leave the organization at 6 months.

Perioperative Nurses and Patient Outcomes—Mortality, Complications, and Length of Stay

THE PURPOSE OF THE STUDY described in this article was to identify the relationship between RN staffing factors in the OR and surgical patient outcomes. THE STUDY ADDRESSED two main questions: whether the level of RN staffing in the OR is related to postoperative complications, mortality, and length of stay (LOS) and whether certification, RN agency use, 24-hour staffing, and the performance of multidisciplinary code drills are related to complications, mortality, and LOS. ACCORDING TO THIS STUDY, selected organizational factors in ORs had a significant influence on patient outcomes.

Exploring Nursing Issues in Rural Hospitals

Objective To explore the impact of legislative, strategic, and organizational changes on nursing in rural hospitals since 1995. Background Rural hospitals have faced decreasing financial margins. This economic pressure is due to multiple reasons, and is a major issue for nurse executives. Nurse executives are responsible for assuring quality of nursing care. Nursing care affects patient outcomes. The impact of legislative, economic, and strategy decisions on nursing in rural hospitals is unknown. Methods A focus group was conducted with 11 nurse executives from rural hospitals who attended the American Organization of Nurse Executives Annual Meeting held on April 20, 2004. Results Themes from the content analysis were grouped into 3 major categories: external environmental (physical isolation, patient population, services needed, legislation), internal organizational (patient acuity, volume, services, technology, financial margin and strategy, staffing, leadership, culture, and resources), and nursing infrastructure (staffing, salary, registered nurse–physician conflict, continuity of care, competency, culture, politics and leadership). Conclusions Nurse executives in rural hospitals face distinctive issues and challenges. Further study of the impact of policy and strategy decisions on rural nursing is needed.

Examining the support for evidence-based nursing practice.

The force behind the call for evidence-based management is often a belief that managers can be more effective if they are informed by logic and evidence and are relentless in their search for knowledge from internal and external sources. This force is shadowed by a concern that healthcare managers make strategic decisions based on low levels of evidence. The awareness that evidence-based medicine results in better care drives the education of healthcare administrators. The benefits of evidencebased practice (EBP), however, not only applies to medicine but to nursing as well. The link between nursing care and quality outcomes is unmistakable, but nursing’s future in quality movement is dependent on the commitment of nurse leaders to incorporate evidence into all areas of nursing practice. Enabling EBP is a goal of many nurse executives within healthcare organizations. A number of standards drive this aspiration and include evidence-based nursing practice as an essential component of a quality environment. Nurses need information to make appropriate practice decisions, yet they do not perceive that they are prepared or given the adequate resources to do so. Nurse executives allocate these resources to the work environment, providing the essential infrastructure for EBP and establishing the appropriate level of human and material resources (such as mentors, processes, and evidence sources). This requires a strategic approach to planning and budgeting. A strategic approach will require an understanding of the benefits of creating an infrastructure before the examination of associated cost. This article examines the evidence on the effect of evidencebased nursing practice on patient and nurse outcomes in healthcare organizations.

Selecting measures for safety and quality improvement initiatives.

In this department, hot topics in nursing outcomes, research, and evidence-based practice and their practical implications for nursing leaders in diverse healthcare settings are highlighted. Content includes evidence-based projects and decision making, locating measurement tools for quality improvement and safety projects, using outcome measures to evaluate quality, practice implications of administrative research, and exemplars of projects that demonstrate innovative approaches to organizational problems. The focus of this article is on locating and selecting measures for safety and quality improvement initiatives.

Enhancing a professional environment in the organized delivery system: Lessons in building trust for the nurse administrator

Objective: To examine the level of system integration and determine if a relationship exists between the level of nursing development and system integration. Data Source/Study Setting: Primary data was collected from Nurse Administrators in Maryland acute care hospitals in December 1999. Study Design: A survey of Maryland nurse administrators was conducted utilizing three tools. The Perceived Systemness and Integration Measure was used to measure the level of integration within the system or network. The level of professional practice development was measured utilizing a Likert-scale tool designed by the researchers based on the Transformational Model for Professional Practice in Health Care Organizations. A narrative response questionnaire was included to determine mechanisms in place to promote professional practice and clinical integration. Findings: The level of system integration was moderate in all domains: Functional (3.35), Physician-System (2.88), and Clinical (3.14). Significant correlations were found between Transformational Leadership and Culture (.539, p < .05), Strategic Planning (.514, p < .05), and Resource Allocation (.505,p < .05). No significant relationship was found between the level of clinical integration and the development of nursing. Conclusions: The level of clinical integration was moderate. Few mechanisms to enhance clinical integration exist across the delivery system. Nurse executives need to promote structure and processes to enhance the development of nursing in integrated systems and networks.

Collaborative synergy: practice and academic partnerships in evidence-based practice.

In this department, Dr Newhouse highlights hot topics in nursing outcomes, research, and evidence-based practice relevant to the nurse administrator. The goal is to discuss the practical implications for nurse leaders in diverse healthcare settings. Content includes evidence-based projects and decision making, locating measurement tools for quality improvement and safety projects, using outcome measures to evaluate quality, practice implications of administrative research, and exemplars of projects that demonstrate innovative approaches to organizational problems. This column describes potential collaborations in evidence-based practice between clinical settings and colleges or universities.

Expert opinion: Challenges and opportunities for academic and organizational partnership in evidence-based nursing practice

At a national conference, students and faculty voiced a concern that they encounter clinical sites in which preceptors, nurses, or nurse leaders are not receptive to hearing or reviewing evidence when practice questions emerged. This presents an issue for nurse executives as they strive to promote evidence-based practice in their organizations. Experts provide a valuable source of evidence to guide strategies to address and resolve administrative and clinical practice questions. Three evidence-based practice experts, Drs Colleen Goode, Cheryl Stetler, and Marita Titler, were interviewed to provide guidance for faculty, students, and nursing leaders in organizations that provide a clinical site for nursing students. Suggestions include strategies to enhance the organizational evidence-based practice culture, providing leadership support, using evidence-based practice as an opportunity for self-development for nurse leaders, and formation of faculty and academic-practice collaborative partnerships.

Perioperative nurses and patient outcomes: Mortality, complications, and length of stay

The purpose of the study described in this article was to identify the relationship between RN staffing factors in the OR and surgical patient outcomes. The study addressed two main questions: whether the level of RN staffing in the OR is related to postoperative complications, mortality, and length of stay (LOS) and whether certification, RN agency use, 24-hour staffing, and the performance of multi-disciplinary code drills are related to complication mortality, and LOS. According to this study, selected organizational factors in ORs had a significant influence on patient outcomes.