Susan R. Lacey

Know staff's "intent to stay"

Traditional measures of nursing workloadare inadequate. Opportunities exist to furthersubstantiate issues surrounding workload per-ception and employment satisfaction, such asmanager or peer support. Measuring theseelements may help to efficiently identify fac-tors triggering negative nursing perceptionsrelated to workload.Study participantsData were collected from a 241-bed pediatricfacility that serves as a regional referral center.Participants were a convenience sample ofpediatric registered nurses. Data were collect-ed from 879 participants over 2001 to 2002 onall shifts, including weekends. A trained clini-cal research coordinator (CRC) monitored alldata collection.Participants received a packet that includedthe Individual Workload Perception Scale(IWPS), a demographic sheet, and the enroll-ment script in lieu of a consent form asinstructed by the governing InstitutionalReview Board. To avoid the introduction ofbias, the CRC was allowed to only rereaditems, not interpret them. Participant timeburden was approximately 15 minutes.The original IWPS was a 46-item instru-ment, measured using a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree).Prior to factor analysis, content validity wasdetermined by three nurse executives and twoexperts in the field of measurement psycho-metric analysis.Manager support questions considerednurses’ perceptions of the extent to whichsupervisors or managers provide support andserve as a resource to the workgroup. Thissupport can take many forms, and a nursemanager who is clinically competent andavailable may rarely need to provide directnursing care as long as nurses believe thissupport exists. A nurse manager who is empa-thetic toward others about workload issuesand appears to work hard at filling open posi-tions will also positively influence workloadperception.Peer support evaluated the extent to whichthere’s cohesion and teamwork within theworkgroup. There are a number of factors inthe current nursing work environment whichmay influence this perception. First, turnovernationally is greater than 20% in many hospi-tals.

Enhancing the Work Environment of Staff Nurses Using Targeted Interventions of Support

Nurse executives continue to search for ways to support their staff nurses through enhancing their work environment to promote professional practice environments. Given that not all hospitals have the intensive resources necessary to pursue Magnet Recognition certification or the Texas Nurses Associations Texas Nurse-Friendly Hospital program designation, this does not prohibit them from pursuing specific components adapted for their own institution. The authors discuss 3 programs to enhance the work environment through increased professional practice. The rationale for these programs, preimplementation and postimplementation are explained.

Secondary Analysis of Merged American Hospital Association Data and U.S. Census Data: Beginning to Understand the Supply–Demand Chain in Pediatric Inpatient Care

Much attention has been focused on how the nursing shortage will impact the growing number of aging Americans. This study was conducted as a first step in understanding nursing supply relative to potential pediatric demand using merged data from the American Hospital Associations annual survey and Census data by state from the year 2000. Findings indicate that there is tremendous variability among reporting states related to estimated pediatric nurses (registered nurse full-time equivalents), potential pediatric demand (persons from birth to 18 years), and allocated pediatric beds. Future research will examine how this supply-demand chain impacts clinical and cost outcomes for pediatric patients.

Transparency in Healthcare Transformation or an Illusion

A dialogue on the concept of transparency by nurse administrators highlights specifics in the hospital setting. The authors of this column present exemplars from practice and issues related to safety, cost and the importance of data specific to nursing practice. The need for collaboration between service and academe is emphasized.

Planning and creating a new bi-state nursing workforce center through unique partnerships.

Multiple strategies are needed to address the complex issues related to the nursing shortage. It is not enough to focus on increasing the number of students in the pipeline unless this is met with complimentary work to improve the professional practice environments of nursing staff. In addition, nurse-driven improvement projects that address specific patient and organizational outcomes will elevate the role of nurses from trusted professional to quality agents. The authors describe a partnership that has launched a new type of workforce center with core missions to create work environment improvements and point-of-care change led by staff nurses.