Dissertations / Theses on the topic 'Nurse Staff'

America's health care industry is in a state of crisis. Nursing administrators are in the position to facilitate change in institutions. One aspect of nursing which has remained constant is high turnover rates. The high turnover rates have been linked to job dissatisfaction. One method of reducing turnover is to provide greater job satisfaction to staff nurses. Job satisfaction has been connected with management style (Lucas, 1991; Price & Mueller, 1981; Volk & Lucas, 1991).This study described the impact of head nurse management style on staff nurse job satisfaction. Likert's (1967) System 4 management theory was utilized as the framework in the study. All staff nurses and head nurses from three Central Indiana hospitals were given the opportunity to participate in the study. Participants completed two questionnaires, one from Price and Mueller's (1981) work on turnover to determine job satisfaction and one from Likert and Likert's (1976) work to determine management style.Data analysis was conducted to describe any variations between staff nurse experience of head nurse management style and staff nurse job satisfaction. Differences between head nurse and staff nurse description of management style were also examined. There were no identified risks as participation was voluntary and did not affect the employment status of any individual.Results of the study demonstrated agreement with previous research findings. When management style is closer to participative (system 4), greater job satisfaction is expressed. Recommendations are to provide management training and training in communication and self-awareness for head nurses, and to form unit based committees designed to achieve greater staff input in decisions affecting the unit functioning.Benefits of the study include identification of the management style which leads to improved staff nurse job satisfaction. Equipping nurse administrators with information regarding desirable management style to employ for staff nurses to experience greater job satisfaction, and training present managers in that management style are also possible benefits from the study.
School of Nursing

The Bureau of Labor Statistics projected a shortage of registered nurses (RNs) growing to an estimated 581,500 by the year 2025 (an increase of 22 percent since 2008). Recent economical downturns have found many healthcare organizations experiencing a positive effect with the stabilization of nursing turnover. Once the economy begins to recover, however, experts predict the profession of nursing will still face the largest shortage in history according to projections by the American Nurses Association. Because lack of job satisfaction is a precursor to resignation, additional research regarding the identification of interventions that increase RN job satisfaction may result in retaining professionally qualified and prepared staff. This study proposed to identify through focus groups, staff nurse perceptions of nurse manager behaviors that influence RN staff nurse job satisfaction. A sample of 28 RNs, each participating in one of five focus groups, answered questions related to satisfaction with nurse manager behaviors. The investigator used qualitative content analysis to identify patterns within and across focus group data.

Major findings of the study resulted in the identification of two conceptual categories (manager behaviors supportive of RNs and RN's perceived disconnect of work issues from the manager's role) and three major themes related to supportive behaviors (communication, respect, and feeling cared for). The results suggest the following as staff nurse preferences for nurse manager behaviors: open and honest communication that involves listening, consistency, and confidentiality; an increased level of respect including fairness and recognition of a job well done; and the sense of feeling cared for as when a manager meets individual needs and supports staff as professionals. The investigator compared the categories and themes to previous tools used in healthcare, which indicate the need for further item and/or tool development as well as further research regarding RNs' perceived disconnect of work issues from the manager's role.

This project study addressed the problem of frequent turnover of nurse managers at a Northeastern community hospital. The lack of retention of nurse managers has led to attenuated support for the nursing staff who continued to hold the front line in patient care. The purpose of this qualitative bounded case study was to explore nurse managers' experiences with turnover in order to identify strategies for enhancing retention. Work empowerment and servant leadership theories served as the frameworks for the study. Research questions focused on nurse managers' perceptions of empowerment and servant leadership characteristics that were important in decisions to assume and remain in a management/leadership role. Data collection included audio-recorded interviews with seven current or past full-time nurse managers, and observation of three of the participants at a leadership meeting. Interview transcripts were open coded and thematically analyzed. Observation data were categorized according to empowerment and servant leadership characteristics. Five themes were identified that related to research questions: struggling in management transition, seeking opportunity for transformation, being committed but powerless, embarking unprepared on an unplanned journey, and having the presence to lead others by serving. The findings of this study guided development of a 12-month program for new nurse managers that integrated characteristics of servant leadership to empower leaders and others. These contributions may promote positive social change by preparing new nurse managers for their role and developing their skills to become successful nurse managers.

Duties performed by staff Registered Nurses (RNs), and Nurse Managers (NMs) require a different skill set to be effective. Nursing leadership is responsible for guiding staff RNs in providing quality, effective, and cost-efficient care. Incompetent leadership may lead to decreased retention and negative patient outcomes. Quality nursing leadership positively influences professional development of staff RNs and patient care. A literature review exposed a gap in leadership training that assists new NMs to function independently and efficiently. The purpose of this original basic qualitative study, which employed Husserl and Heidegger’s approach of phenomenology, was to explore the experiences of staff RNs who transitioned into the NM role within the last five years and practice in either a small rural hospital or large urban medical center in southeastern North Carolina. Semi-structured interviews using open-ended questions were utilized to collect rich, contextual data until data saturation occurred. Open and axial coding of the data, documented in a code/theme frequency table, facilitated the discovery of central themes within the data including: the benefit of having performed managerial duties while in a staff RN role; leadership training to introduced a broader view of NM responsibilities and techniques needed to accomplish these duties; and a dedicated mentor who provided intimate guidance during the transition. The evidence from this study aligns with the published literature regarding the transition from a staff RN role into a NM role and supports making a proposal to the hospital’s administration for a systems-oriented NM training opportunity such as a 90-day nursing leadership orientation that included formal classes on budgeting, common human resource management issues, and how to evaluate staff. This formalized training, in concert with one-on-one mentoring with experienced NM, would ensure a smoother transition from the staff RN role into the NM role and would produce more efficient, more satisfied nursing leadership professionals who are more inclined to stay with the organization that helped their career growth.

Horizontal violence is a reality for many staff nurses; it has been recognized as an issue across the nursing profession for more than three decades, and yet there is very little interventional research on how nurse leaders can, and should, address the problem. This study has assessed the research evidence obtained using the Rapid Evidence Analysis (REA) method. What can be concluded from this analysis is that leaders should use tools such as authentic leadership, education of horizontal violence and cognitive behavioral rehearsal training to influence the presence of horizontal violence among staff nurses. Due to the limited number of studies, and methodologies used in those studies, further interventional research is needed to strengthen the science.

A nurse's use of evidence-based practice (EBP) is imperative if the goal is for quality and safe care that is safe. Patient quality care is directly correlated to the degree to which hospital nurses are active participants in decision making. Nurses possess the skills that should promote their presence in decision-making forums using evidence-based strategies. Both evidence-based practice (EBP) and participatory Shared Governance Models, independently, have been found to promote improved patient outcomes (Kramer & Schmalenberg, 2004). Shared governance models include formal councils that address recruitment and retention, policy and procedure development, professional practice challenges, quality improvement initiatives and research opportunities. A nurses' Decisional Involvement (DI) and participation in a Shared Governance Council (SGC) may serve as a venue to best utilize Evidenced-Based Practice (EBP) skills with the overall goal of improving care outcomes.

The aim of this research was to determine the relationship of staff nurse engagement, DI and its impact on participation in a SGC and the relationship to EBP. A quantitative non-experimental correlational, on-line survey design was utilized. A total of 156 staff nurses from two (2) Magnet^® recognized hospitals in the Northeastern region of the United States was studied.

Results revealed a significant positive relationship between participation in a SGC and staff nurse engagement, actual DI, age, years of experience and professional certification. Additionally, nurses that participated in a SGC had a significantly higher self-reported EBP implementation. Exploratory logistic analysis revealed EBP implementation, staff nurse engagement, full time work status and participation in IDRs were significant predictors of participation in a SGC. A multiple regression analysis resulted in EBP belief, staff nurse engagement, and participation in a SGC explaining 34.5% of the variability of predicting EBP implementation. The findings give beginning support to the importance of creating an infrastructure that fosters staff nurse engagement and participation in a SGC to promote EBP implementation.

The purpose of this study was to identify what registered nurses employed in hospitals perceived to be important to their nursing practice. Staff nurse opinions were analyzed to explore similarities and differences between demonstration and comparison sits, and demonstration sties over time, during early implementation of the Differentiated Group Professional Practice (DGPP) model. An exploratory/descriptive design was used to analyze the content of written responses to one open-ended question. Nurses on the demonstration units expressed fewer responses related to administrative and nursing management support and more responses related to lack of recognition from nursing management, continuing education, pay related to responsibility, non-nursing tasks, and group cohesion. Results supported the conceptual framework of the DGPP model. Additional categories revealed by the analysis included administration, education, interdepartmental communication, job alternatives, nursing management, physical environment, and staffing.

Despite medical technology and research advances postpartum hemorrhages (PPH) continue to be a leading cause of morbidity and mortality for pregnant women, even in developed countries. One possible explanation for PPHs continuing to be a leading cause of maternal death is inconsistent recognition and timely treatment of women experiencing a PPH. This doctor of nursing practice project attempts to improve labor and delivery nurse knowledge through an educational intervention which will contribute to rapid identification and treatment of PPH. Knowledge change was demonstrated though change in pretest and posttest scores. The educational information and process was guided by adult learning theory and content was based on current research and evidence-based practice guidelines on PPH. Ninety six participants were assessed using a PPH pretest posttest design. The tests consisted of 15 questions. Correct scores were added and a percent correct score was calculated. The data demonstrated that 63% of the participants passed the pretest with an 80% or higher and 90% of the participants passed the posttest with an 80% or higher. The difference was statistically significant, indicating there was an increase in knowledge after the educational materials were presented. This DNP project contributes to social change by ensuring women receive excellent and timely PPH care by nurses who have a strong understanding of PPH and can apply that knowledge through rapid identification and treatment.

Leadership in today’s health care system is faced with challenges that require adequate educational training / preparation and practical experience. These challenges are manifested by a constant state of change which adds pressures and additional responsibilities to all health care providers. Adequate training / preparation can make a significant difference in the ability to appropriately and effectively improve and maintain work responsibilities. Historically, management opportunities have been available for adequately trained qualified personnel; however, consistent adequately trained first line nurse managers has not been the case. First line nurse managers are often promoted to their management position as a result of several characteristics; longevity in the nursing profession, exemplary clinical practice, or through a process of seniority, all of which may not be entirely management oriented. The literature states that promotion from nurse to a first line nurse manager position without management training may result in burnout, mistrust among colleagues, lack of respect, lack of leadership, division among departments, and overall poor performance. This study will examine the perceptions about the quality of nurse management training, and the problems encountered when such training does not occur. The study will also provide a basis for a review of the current literature to validate previous studies, provide current studies to include new input, and explore educational training ideas and suggestions addressing training concerns. This quantitative research will survey staff nurses seeking their individual perceptions of the competencies needed for first line nurse managers to be successful in their role. Data provided from staff nurses’ perceptions of the managerial skills and techniques of their current manager will be collected using a survey approach. The data will be used to analyze if there is an absence of needed managerial skills education and resolutions for a better approach. The target population for this study is staff / bedside registered nurses administering first level bedside care for patients in the hospital and/or clinical setting and from this population a sample of registered nurses currently enrolled or have been recently enrolled (within the last two years) in an associate degree to a baccalaureate nursing program.

Caregiver burnout is an issue for health care organizations, negatively influencing cost, engagement, and workforce stability. Nurse residency programs are intended to address the gap in practice between academia and clinical practice and provide social support during this transitional time. Self-care education can positively affect novice acute care nurses' transition into their new professional role while building connections with the health care organization during the first year of employment. The purpose of this project was to develop a staff educational module to address the nursing practice problem of evidence-based self-care education within a nurse residency curriculum at the doctoral site. The practice focus question for this project was can evidence-based staff development project be developed identifying self-care strategies for novice acute care nurses within a nurse residency program. Orem's theory of self-care, which highlights the importance of taking time to care for self as integral to human functioning, and Watson's caring theory, which emphasizes the loving care of self as a vital prerequisite for caring for others, were the theoretical frameworks. This module was developed based on existing peer-reviewed journals, national organizations' position statements, white papers, and expert opinion and was synthesized using Melynk's hierarchy of evidence for intervention studies tool. This module was developed and shared with doctoral site stakeholders. The recommendation was to integrate this educational product into the existing nurse residency program. The positive implications this project has for the nursing profession include improved well-being and job satisfaction for the novice acute care nurses and potential long-term effects on organizational cost related to turnover

An acute care practice site reported 75% turnover of novice nurse practitioners (NPs), which indicated a gap in the transition from student to practitioner within the first year of clinical practice. This gap can leave novice NPs unprepared to manage patients effectively and contribute to high turnover. The practice-focused question addressed whether an evidence-based staff development program for novice NPs at an acute care site could be developed. The purpose of this project was to create a framework based on evidence to transition novice NPs successfully into practice. Benner's skill-acquisition in-nursing theory informed this project. Evidence was obtained by searching electronic databases, reviewing professional organization websites, and consulting with experts. The search revealed journal articles, best-practice guidelines, and useful insights from experts. The Elkins literature review matrix was used to organize, summarize, and weigh the evidence. A summary of consultations with experts was used. Commonalities within the evidence included guided clinical experiences and nonclinical activities such as (a) formal didactic sessions, (b) professional development, and (c) quality improvement. Outcomes include recommendations for a 12-month postgraduate development program framework and educational content. Recommendations were also provided for formative and summative evaluations. The implications of this project for social change include effective preparation of novice NPs and stabilization of the NP workforce at the project site.

Nursing is the largest health care profession in the United States, and health care organizations rely heavily on the services of registered nurses to provide quality care to patients. Unfortunately, the nursing shortage makes it critical for health-care leaders to identify potential issues that may be influencing nurses to leave the nursing profession and to develop solutions for retaining nurses in the nursing profession. The purpose of this qualitative case study was to explore the perceptions of three groups of RNs in an acute-care hospital setting regarding perceived issues that might influence nurses? intentions to leave the nursing profession and possible solutions to mitigate these issues. The three groups of nurses were (a) staff nurses with less than 5 years of nursing experience, (b) staff nurses with 5 or more years of nursing experience, and (c) nurse managers in the acute-care hospital setting. Exploring the perceptions of nurses was a practical means of seeking a better understanding of the lived experiences of staff nurses and managers to understand the issue of nurse retention in an acute-care hospital setting. Data were collected using a structured questionnaire that included demographic and open-ended, in-depth interview questions. Results indicated the importance of staff nurses and nurse managers? perceptions of issues influencing nurses to leave or remain in the nursing profession and perceived solutions to the issues and the need for further research to explore how different groups of nurses perceive different issues influencing their intent to leave the nursing profession.

Nurses play a vital role in the delivery of healthcare services. Yet, the World Health Organisation and World Bank predict a shortfall of over seven million nurses by 2030, affirming the persistence of the global nurse shortage phenomenon. The literature identifies several reasons for nurse shortages, with the most salient being the challenge to retain nurses. The literature points to transformational leadership as the panacea for managing retention but fails to account for how an individual nurse manager’s leadership behaviours enable the navigation of the complex systems in healthcare to achieve positive outcomes. This qualitative study applies the Concept of the Rhizome to provide a non-linear but holistic approach, in a field of study dominated by linear perspectives, to understand how retention of the nursing workforce is influenced by the leadership behaviours of the nurse manager. Interviews with nurse managers (n=24) and other stakeholders (n=57), conducted in Australia and Seychelles, affirm the link between leadership behaviours and retention. Through reflective storytelling, this study showed that the identity of nurse managers, shaped by various cultures inside and outside the work environment, determined their behaviours. This research found enabling leadership is underscored by the harnessing of a paradox mindset, which is posited as the way forward for managing retention in the healthcare sector. Nurse managers influenced the work environment through positive deviant behaviours and taking on a multiplicity of roles. They weaved between positive leadership styles and activities to develop positive strategies, intentionally confronting challenges to find redress with positive resolve. These findings have important implications for Positive Organisational Scholarship in Healthcare. Furthermore, this study endorses leadership development focussing on navigating the paradox and tensions within healthcare, as a useful support for nurse managers to cope with tensions in this challenging work environment to influence retention of nurses within the system. Key Words: enabling leadership, paradox navigators, positive deviance, Positive Organisational Scholarship in Healthcare (POSH), nurse managers, staff retention

This dissertation presents a quantitative study of the attitudes of staff nurse preceptors toward nursing students with learning disabilities. There are an increased number of nursing students with learning disabilities. These students may have additional challenges in clinical settings, particularly if clinical settings do not understand or support their educational needs. Stigma exists towards people with learning disabilities, and it is unclear if staff nurse preceptors are accepting of nursing students with learning disabilities and willing to serve as a preceptor.

Attitude was measured with the following four constructs developed for this study: perceived levels of preceptor preparedness, level of confidence in implementation of preceptor role, preceptor beliefs of student potential, and agreement with the provision of reasonable accommodations. These constructs were developed through a review of the literature and found to best represent the dynamic relationship between the preceptor and the preceptee.

This study analyzed data from an electronic survey to examine the preceptor's attitudes towards learners with learning disabilities and their willingness to serve in the preceptor role for students with learning disabilities. Preceptor's familiarity with learning disabilities, knowledge of issues related to learning disabilities, and their concerns regarding nursing students and new graduate nurses with learning disabilities were assessed. The preceptor's familiarity with learning disabilities and knowledge of issues related to learning disabilities were low, and their concerns were high. However their attitudes were mixed. Preceptors reported that they were not well prepared and had low levels of confidence in their ability to support and accommodate those with learning disabilities. However, they had strong beliefs in the potential of both nursing students and new graduate nurses with learning disabilities, and they had high levels of agreement that reasonable accommodations should be provided.

The preceptors indicated a high willingness to serve in the role of preceptor for both nursing students and new graduate nurses with learning disabilities. Attitudes toward new graduate nurses with learning disabilities were slightly more positive than the attitudes toward nursing students with learning disabilities, and willingness to precept was higher for new graduate nurses than nursing students. The conclusions of this research are that preceptors are accepting and willing to take on the challenge of precepting nursing students with learning disabilities, however they need information and support from their institutions and nurse educators.

Aim: To build on previous British Columbia Nursing Leadership Institute (BC NLI) evaluative research by analyzing the perceptions of staff nurses and identifying whether they have seen any behavior differences in their first-line leaders during the one year period following their leaders’ participation in a formal leadership development program. Background: The healthcare system is absorbed with many demands and complexities that are challenging every aspect of the system. To be able to shift away from the current path, the system requires committed and effective nurse leaders that play a fundamental role in healthcare and its necessary system transformations. To assist nurses to become effective leaders it is essential that organizations recognize the role of structured leadership development education, such as the BC NLI, in shaping nurse leaders who have the potential to impact patient, workplace, staff, and organization outcomes. The BC NLI is a collaborative initiative designed to support first-line nurse leaders by employing an empowerment framework. Methods: Staff nurses working with first-line nurse leaders who attended the BC NLI between 2008–2009 were included in one of ten focus group sessions that took place one year after their leaders took part in the institute. A qualitative approach of inductive thematic analysis was utilized to conduct a secondary analysis of the staff focus group data and derive code categories and themes. Results: The BC NLI focus group participants showed support for their first-line leaders. They recognized that leaders face many organizational challenges, possess transformational and transactional qualities, and play a key role in the workplace environment. The importance of organizational support and formal leadership development education were identified as key parts of the leaders’ leadership development. Participants reinforced their support for leadership development education, such as the BC NLI, by attributing their leaders’ growth to their participation in the programme. However, some BC NLI focus group participants also expressed their hesitation regarding the possibility of external factors, such as prior experience, having possible influence on leadership development. Conclusion: This study provides evidence that formal leadership development, such as the BC NLI, is vital for the development of first-line nurse leaders.

Preceptorships are an indispensable part of undergraduate clinical education and are prevalent among schools of nursing. However, there is wide interpretation and implementation of preceptorships which leaves many facets of the preceptor role poorly understood. Research has suggested preceptors experience several benefits from serving; however, the role has also been described as one leading to overload, conflict, and burnout. There is a lack of studies exploring preceptor role functions from the perspective of those who serve in it. The purpose of this qualitative study was to explore staff nurse experiences as preceptors to undergraduate, pre-licensure nursing students with emphasis on the RN’s perceptions of the role, specifically the preparation for, support in, and understanding of what the role entails. Focus groups were used to collect data. Transcripts were analyzed using conventional content analysis. Findings suggest that the primary role function is Protector, with Socializer and Teacher as secondary role functions. Preceptors in this study described a strong empathetic drive to protect students from negative experiences, to protect patients from harm, to protect their own professional identities, and to protect the nature of the nursing profession. Within each role function, there are specific behaviors in which the preceptor engages to varying degrees depending on the needs of the individual student. Findings have implications for continued development of the preceptor role.

Caring relationships established between nurse managers and staff nurses promote positive work environments. However, research about staff nurses’ perceptions of nurse manager caring behaviors is limited. A 94-item Caring Assessment Tool-Administration (CAT-adm^©) was developed to measure staff nurses’ perceptions of nurse managers’ caring behaviors; however, it lacked robust psychometric testing. This study was undertaken to establish the CAT-adm^© survey as a reliable and valid tool to measure staff nurses’ perceptions of nurse managers’ caring behaviors.

The Quality-Caring Model^® (QCM^®) served as the theoretical framework. Specific aims were to 1) evaluate construct validity of the CAT-adm^© survey by describing factors that account for variance in staff nurses' perceptions of nurse manager caring, 2) estimate internal consistency, and 3) conduct item reduction analysis. Four research questions were: 1) Will the factor structure of observed data fit an 8-factor solution? 2) What is the internal consistency reliability of the CAT- adm^©? 3) What items can be reduced while maintaining an acceptable factor structure? and 4) What are staff nurses’ perceptions of nurse manager caring behaviors?

A cross-sectional descriptive design was used. A sample of 703 staff nurses from Midwestern, Midatlantic and Southern Regions of the U.S. completed the CAT-adm^© survey electronically. Analysis included Confirmatory Factor Analysis (CFA), Exploratory Factor Analysis (EFA), univariate analysis, and descriptive statistics. CFA did not support an 8-factor solution. EFA supported a two-factor solution and demonstrated significant shared variance between the two factors. This shared variance supported a one-factor solution that could conceptually be labeled Caring Behaviors. Random selection reduced the scale to 25-items while maintaining a Cronbach’s Alpha of .98. Using the new 25-item scale, the composite score mean of staff nurses’ perceptions of nurse manager caring behaviors indicated a moderately high level of caring. Suggestions for nursing administration, nurse manager practice, leadership, education and for future research were given.

The new 25-item CAT-adm^© survey has acceptable reliability and validity. The 25-item CAT-adm^© survey provides hospital administrators, nurse managers, and researchers with an instrument to collect valuable information about the caring behaviors used by nurse managers in relationship with staff nurses.

Numerous studies have been done in the area of nurse scheduling, since this is a complex area with a lot of aspects that has to be taken into account. An interesting but little studied subject is how the requirements for the scheduling affect the possibility to construct a feasible schedule, or how the requirements affect the quality of the schedule. Of special interest is the effect of the composition of the workforce and of the change in scheduling rules. What is missing is results showing which composition and changes that are possible, and if so what is needed to be able to follow through with them. The changes tested in our simulation study are changes that is up for discussion at many wards in Sweden today, with topics such as split shifts and high part-time work percentages within the staff. In order to simulate various scheduling requirements and changes, an integer linear model for creating nurse schedules is developed. The results provide some insight into the dependence between scheduling requirements and the resulting schedules. In particular our simulation results indicate that there is an inherent conflict between high part-time work percentages and split or long work shifts. Our results can be used as a basis for future research on these topics in the area of nurse scheduling.

Thesis (Ph.D. in Nursing) -- University of Colorado Denver, 2007.
Typescript. Includes bibliographical references (leaves 93-101). Free to UCD affiliates. Online version available via ProQuest Digital Dissertations;

Healthcare management is an industry where skill sets are incremental, and Registered Nurses (RNs) must gain their clinical skills before they develop their management skills. Professional training for management-bound RNs seldom comprises more than a few disjointed days or weeklong development seminars, which is valuable but inadequate. The purpose of this original basic qualitative study, which employed Husserl and Heidegger’s approach of phenomenology, was to explore the lived experiences of staff RNs who transitioned into the Clinical Nursing Supervisor (Nurse Manager) role within a small rural community hospital in North Carolina. Semi-structured interviews using open-ended questions were utilized to collect rich, contextual data until data saturation occurred. Open and axial coding of the data, documented in a code/theme frequency table, facilitated the discovery of central themes within the data including: a lack of orientation to the new role; inconsistent expectations of the new role; the benefits of a formal program or structured orientation for the new role, and a need to focus the hospital administration on formal leadership orientation and succession planning. The evidence from this original basic qualitative study aligns with the published literature regarding the transition from a staff RN role into a nursing leadership role and supports making a proposal to the hospital’s administration for a systems-oriented Clinical Nursing Supervisor training opportunity such as a 90-day nursing leadership orientation that included formal classes on budgeting, common human resource management issues, and how to evaluate staff. This formalized training, in concert with one-on-one mentoring with experienced Clinical Nursing Supervisors, would ensure a smoother transition from the staff RN role into a Clinical Nursing Supervisor role and would produce more efficient, more satisfied nursing leadership professionals who are more inclined to stay with the organization that helped their career growth.

Background The ward sister/manager figure has traditionally been considered the ward based clinical leader. This role has evolved over time in response to professional and political demands; despite or because of this, reports of role ambiguity exist and the ward sister/manager position has become increasingly difficult to recruit to, with nurses arguably looking to roles perceived to have greater influence and status, but less onerous managerial responsibility. Understanding the nature of this role and the factors that may impact upon the transition from staff nurse to ward sister/manager is of great significance. The gaps in understanding related to development in preparation for and in the early stages of this role, led to this research, with the aim of understanding the experience of the transition and the impact of organisation factors, and whether they facilitate or hinder the process of transition for this group of nurses. Study design A case study approach consisting of interviews and documentary analysis was undertaken in one metropolitan National Health Service hospital, underpinned by a critical realist approach. The case study comprised interviews with six nurses, repeated over time with three of those nurses, who had recently participated in a leadership development programme and key informants who were senior practitioners within the organisation or who were recommended by participants, in combination with strategy and policy scrutiny and website analysis. Ritchie and Spencer’s Framework approach was used to support the management and subsequent analysis of the data. Findings The ward sister/manager role was identified as a vital role, but the managerial components of the role served as a significant disincentive to participants. Participants required support from significant role models during the transition process, although the degree of support, both required and available, varied. Motivating factors and the sense of job satisfaction were essential for developing a sense of self-fulfilment. A range of support mechanisms were present and utilised across the organisation but these appeared disparate and the lack of a unifying vision for nursing services was apparent. Contribution to knowledge Developing into the ward sister/manager role involves a significant transition that has not previously been acknowledged. Job satisfaction in the ward sister/manager role is significantly affected by organisational factors, as well as individual factors. The organisation itself contributes to the role legitimacy of this role.

Translating research into practice takes 10 to 20 years or more. Evidence-based practice (EBP) integration remains at 10% to 20%, despite recommendations requiring EBP-guided decisions. Up to 30% decreases in health care system spending, improved quality outcomes, and increased staff satisfaction result from EBP integration. Nurse leaders, who rate quality and safety as the highest priority but EBP as the lowest, are accountable for EBP enculturation; a desire to support bedside registered nurses in EBP exists, yet this EBP use knowledge gap supersedes this goal. The purpose of this project was to provide an EBP education program introducing the use of evidence to guide nursing practice. The project question addressed whether an education program for staff nurses on introduction to EBP would increase nursing staff perception of the value of EBP and their interest in implementing EBP. Knowles's theory of adult learning and the nursing process guided this project. The 36 participants completed the16-question EBP Beliefs Scale before and after the education program on introduction to EBP. Results from the paired samples t tests showed there was a significant difference in each response on the survey, indicating an increased understanding of the fundamental value of EBP, as well as the participant's individual ability to implement EBP within clinical practice. The limited findings contribute to the existing body of knowledge, while positive social change implications include resolving public health and safety issues, reversing fiscal irresponsibility, and overcoming resistance to change, which is at the heart of implementing and enculturating EBP.

Thesis (Ph.D. in Nursing) -- University of Colorado Denver, 2008.
Typescript. Includes bibliographical references (leaves 113-132). Free to UCD Anschutz Medical Campus. Online version available via ProQuest Digital Dissertations;

Background: According to the Australian Bureau of Statistics (2013) falls and medication errors in hospitals are among the first twenty leading causes of death. Research on the relationship between nurse staffing, patient falls, and medication errors are limited. Even scarcer are studies that examine this relationship on a nursing shift by shift and ward by ward basis, and no research exists on shift overlap periods and adverse patient outcomes. Objective: This study examined whether there was a relationship between hospital inpatient falls and medication errors and nurse staffing on a shift by shift and ward by ward basis, including an analysis of patient characteristics and the severity of incidents. Research Design: Multinomial logistic regression models were used. Data were collected using a secondary analysis of two existing databases: Advanced Incident Management System (AIMS) database and the nursing staff roster database (RoSTAR) over two years (January 2011 to December 2012). The Kane framework of nurse staffing was used to guide the current study. Setting: The study was conducted in three adult tertiary teaching hospitals in Perth, Western Australia. Participants: Reports of 7,558 incidents that occurred during the study period from 76 nursing wards and wards (4,677 medical, 2,209 surgical, and 672 critical care wards incidents), and 320,009 nursing shift records in three hospitals, were examined. Measures: The occurrence and severity of shift-level inpatient falls and medication errors were measured as dependent variables. Independent variables included nursing staff skill-mix, staff experience, and actual nursing hours. Control variables were shift, ward type, and hospital. Results: This study supports the importance of RN staffing levels in improving patient outcomes. However, it also shows that the relationship between nurse staffing and patient outcomes can be affected by different factors such as patient characteristics, nurse characteristics, and ward type. The number of total clinical incident reports decreased by 7.4% from 2011 to 2012. Falls declined by 4.6% and medication errors declined by 10.8%. The average age of patients who fell or had medication errors was 56.3 years (range of 15 to 100 years) but was more common in patients over 65 years old (57.3%). The number of incidents was highest during the morning shift, less during the evening and lowest during the night shift (28.4%, 27.2%, and 21.8% respectively). Notably, 22.6% of total incidents were reported during the overlap period (13:00 pm to 15:29 pm) which is only two and a half hours. Medical wards had the highest incident records followed by surgical wards; fewer incidents occurred in critical care wards (61.9%, 29.2%, and 8.9% respectively). More registered nurses and more experienced staff on the shift were both associated with fewer falls and medication error incidents, as well as less severe injuries. An increase in the actual nursing hours was associated with fewer medication errors but not fewer fall incidents. However, an increase in in the actual nursing hours was associated with less severe falls but not less severe medication errors. Conclusion: Overall, the fall and medication error incidents in three Perth hospitals decreased over the study period. However, the large variation in the incidents at both the shift and the ward level indicated room for improvement related to fall and medication error prevention. A relationship was identified between both more RNs and more experienced nurses in attendance and fewer incidents and less severe injuries. Further studies are necessary to identify prevention strategies for hospital falls and medication errors in the overlap period. Immediate consideration of the number of incidents that occurred during the overlap period is required. It is necessary to improve communication and teamwork among staff. Actions should be taken to review, implement and evaluate policies and procedures.

The purpose of this study was to determine if shared governance systems result in an increased perception of autonomy for staff nurses. The population for this study included all registered nurses providing inpatient care at two mid-sized community hospitals in the Midwest, who were not identified as supervisors, managers or executives. The convenience sample was obtained from those completing and returning a distributed survey. The sample was 146 staff nurses from each organization. Only responses from nurses with more than one year experience at the current facility were included in the study. , One hospital had a shared governance system in place. The other hospital had a traditional organizational system.The theoretical framework for the study was the Neuman Systems Model (1989). Staff nurse autonomy was measured by the Nursing Activity Scale (Schutzenhofer, 1987). Management characteristics were measured by the Profile of Organizational Characteristics (Liken, 1978). Also administered was a brief demographic data questionnaire (Schutzenhofer & Musser, 1994).Each hospital provided the researcher with access to participant mailboxes of those registered nurses providing inpatient care and not in management or executive roles Surveys were placed in each mailbox, and drop boxes were made available in unit classrooms in one hospital, and in nursing administration in the other hospital. A reminder notice was placed in each participant mailbox one week after initial survey distribution. Drop boxes were retrieved by the researcher one week following the reminder notice distribution. Study participants were informed about the study by cover letter and invited to participate. Participation was strictly voluntary. Data was available only to the investigator and only group data were reported without reference to individual participants. Participant responses were completely anonymous. Questionnaires were printed on two different colors of paper in order to distinguish between hospitals. No code numbers or other identifying marks were placed on any of the questionnaires. The study provided information on which to base management decisions regarding nursing governance arrangements.
School of Nursing

Thesis advisor: Barbara E. Wolfe
Patient quality outcomes in the United States (U.S.) healthcare system are largely stagnant or making minimal improvements, resulting in unnecessary morbidity, mortality, and costs (AHRQ, 2012 National Healthcare Quality Report). As the US implements the 2010 Patient Protection and Affordability Act, there is fiscal pressure to attain and sustain significant improvements to patient quality outcomes. This necessitates an understanding of how the processes and structures of care influence patient quality outcomes (Donabedian, 1966) in a complex care environment. To begin addressing this gap, this investigation examined the influence of unit-level authentic leadership (AL) and structural empowerment (SE) on staff nurse decisional involvement (DI) and patient quality outcomes on general care units in the acute-care hospital setting. This study used a cross-sectional survey design. Participants were staff nurses working on 105 general care units across eleven US hospitals. The surveys measured staff nurse perceptions of AL, SE, and DI at the care unit level. The patient quality outcomes of interest were falls with injury, hospital acquired pressure ulcers and patient satisfaction. Care unit level AL and SE had a significant influence on actual staff nurse DI (p = .002 and < .001, respectively) and the degree of dissonance between actual and preferred DI (p < .001). AL and SE had a significant inverse relationship with patient falls with injury (p = .017 and .028, respectively), yet a positive relationship with HAPU rates (p = .051 and .026, respectively). While AL did not have a significant relationship with any of the three patient satisfaction metrics, a significant positive relationship with SE was found (p = .002, .001, and .002, respectively). There was no support for a relationship between actual staff nurse DI and any of the patient quality outcomes. This study extends previous research in this area in that it is the first to examine actual patient quality outcomes at the care unit level. These findings provide support for the unique contributions to patient quality outcomes at the care unit level, indicating the need to develop AL among front-line nurse managers and SE in nurse work environments
Thesis (PhD) — Boston College, 2015
Submitted to: Boston College. Connell School of Nursing
Discipline: Nursing

Thesis (Ph.D. in Nursing) -- University of Colorado Denver, 2007.
Typescript. Includes bibliographical references (leaves 176-188). Free to UCD affiliates. Online version available via ProQuest Digital Dissertations;

Using a staff development approach, this doctor of nursing practice project addressed the preparation of nurses who serve in the role of mentors. Developed and carried out in an American Nurses Credentialing Center Magnet-designated hospital, the primary aim of the project was to develop and implement a staff education program for mentors focusing on best-practice strategies for mentoring new nurses. The secondary purpose was to conduct a literature review on evidence-based practice strategies for mentoring new nurses. This project was guided by Knowles' adult learning theory and Benner's novice to expert model. A 2-hour education program was attended by 16 registered nurses, including 2 assistant nurse managers, 12 clinical nurses, and 2 unit-educators. A program evaluation was completed showing 2 RNs indicating interest in initiating a unit-based mentorship program. Two nursing units reported current mentorship programs already in place. Evaluation results were summarized and reported to the education council chair. Improvements in knowledge scores on mentorship was ascertained from the results of a posttest that were higher (average score of 83.125%) than the scores noted on the pretest (average score of 70%). Potential implications of the project include improving the morale of mentors who would be well equipped through organized mentorship education programs with tools for preparing, training, and developing new nurses. The findings of this project have the potential to positively influence social change by assisting in achieving higher nurse retention rates leading to improved patient outcomes.

Background and significance: Nurses' job dissatisfaction is associated with negative nursing and patient outcomes. One of the most powerful reasons for nurses to stay in an organisation is satisfaction with leadership. However, nurses are frequently promoted to leadership positions without appropriate preparation for the role. Although a number of leadership programs have been described, none have been tested for effectiveness, using a randomised control trial methodology. Aims: The aims of this research were to develop an evidence based leadership program and to test its effectiveness on nurse unit managers' (NUMs') and nursing staff's (NS's) job satisfaction, and on the leader behaviour scores of nurse unit managers. Methods: First, the study used a comprehensive literature review to examine the evidence on job satisfaction, leadership and front-line manager competencies. From this evidence a summary of leadership practices was developed to construct a two component leadership model. The components of this model were then combined with the evidence distilled from previous leadership development programs to develop a Leadership Development Program (LDP). This evidence integrated the program's design, its contents, teaching strategies and learning environment. Central to the LDP were the evidence-based leadership practices associated with increasing nurses' job satisfaction. A randomised controlled trial (RCT) design was employed for this research to test the effectiveness of the LDP. A RCT is one of the most powerful tools of research and the use of this method makes this study unique, as a RCT has never been used previously to evaluate any leadership program for front-line nurse managers. Thirty-nine consenting nurse unit managers from a large tertiary hospital were randomly allocated to receive either the leadership program or only the program's written information about leadership. Demographic baseline data were collected from participants in the NUM groups and the nursing staff who reported to them. Validated questionnaires measuring job satisfaction and leader behaviours were administered at baseline, at three months after the commencement of the intervention and at six months after the commencement of the intervention, to the nurse unit managers and to the NS. Independent and paired t-tests were used to analyse continuous outcome variables and Chi Square tests were used for categorical data. Results: The study found that the nurse unit managers' overall job satisfaction score was higher at 3-months (p = 0.016) and at 6-months p = 0.027) post commencement of the intervention in the intervention group compared with the control group. Similarly, at 3-months testing, mean scores in the intervention group were higher in five of the six "positive" sub-categories of the leader behaviour scale when compared to the control group. There was a significant difference in one sub-category; effectiveness, p = 0.015. No differences were observed in leadership behaviour scores between groups by 6-months post commencement of the intervention. Over time, at three month and six month testing there were significant increases in four transformational leader behaviour scores and in one positive transactional leader behaviour scores in the intervention group. Over time at 3-month testing, there were significant increases in the three leader behaviour outcome scores, however at 6-months testing; only one of these leader behaviour outcome scores remained significantly increased. Job satisfaction scores were not significantly increased between the NS groups at three months and at six months post commencement of the intervention. However, over time within the intervention group at 6-month testing there was a significant increase in job satisfaction scores of NS. There were no significant increases in NUM leader behaviour scores in the intervention group, as rated by the nursing staff who reported to them. Over time, at 3-month testing, NS rated nurse unit managers' leader behaviour scores significantly lower in two leader behaviours and two leader behaviour outcome scores. At 6-month testing, over time, one leader behaviour score was rated significantly lower and the nontransactional leader behaviour was rated significantly higher. Discussion: The study represents the first attempt to test the effectiveness of a leadership development program (LDP) for nurse unit managers using a RCT. The program's design, contents, teaching strategies and learning environment were based on a summary of the literature. The overall improvement in role satisfaction was sustained for at least 6-months post intervention. The study's results may reflect the program's evidence-based approach to developing the LDP, which increased the nurse unit managers' confidence in their role and thereby their job satisfaction. Two other factors possibly contributed to nurse unit managers' increased job satisfaction scores. These are: the program's teaching strategies, which included the involvement of the executive nursing team of the hospital, and the fact that the LDP provided recognition of the importance of the NUM role within the hospital. Consequently, participating in the program may have led to nurse unit managers feeling valued and rewarded for their service; hence more satisfied. Leadership behaviours remaining unchanged between groups at the 6 months data collection time may relate to the LDP needing to be conducted for a longer time period. This is suggested because within the intervention group, over time, at 3 and 6 months there were significant increases in self-reported leader behaviours. The lack of significant changes in leader behaviour scores between groups may equally signify that leader behaviours require different interventions to achieve change. Nursing staff results suggest that the LDP's design needs to consider involving NS in the program's aims and progress from the outset. It is also possible that by including regular feedback from NS to the nurse unit managers during the LDP that NS's job satisfaction and their perception of nurse unit managers' leader behaviours may alter. Conclusion/Implications: This study highlights the value of providing an evidence-based leadership program to nurse unit managers to increase their job satisfaction. The evidence based leadership program increased job satisfaction but its effect on leadership behaviour was only seen over time. Further research is required to test interventions which attempt to change leader behaviours. Also further research on NS' job satisfaction is required to test the indirect effects of LDP on NS whose nurse unit managers participate in LDPs.

Bakgrund: Patientsäkerheten äventyras inom hälso- och sjukvården och en av tio patienter drabbas av vårdskada som hade kunnat kringgås om adekvata omvårdnadsåtgärder vidtagits. All vård- och omsorgspersonal har ett gemensamt ansvar att bidra till god och säker vård och det är sjuksköterskan som har det fulla omvårdnadsansvaret för patienterna. Genom patientsäkerhetslagen och sjuksköterskans sex kärnkompetenser skall sjuksköterskan främja patientsäkerheten. Syfte: Syftet var att belysa sjuksköterskans uppfattning av patientsäkerhet relaterat till bemanningen av sjuksköterskor. Metod: En allmän litteraturstudie med en induktiv innehållsanalys genomfördes. Resultat: Studien är grundad på 10 vetenskapliga artiklar som ledde fram till fyra kategorier; tiden påverkar patientsäkerheten, sjuksköterskornas kompetens påverkar patientsäkerheten, arbetsmiljö påverkar patientsäkerheten och sjuksköterskans hälsa påverkas av bristande patientsäkerhet. I resultatet framkom det att sjuksköterskans uppfattning är att patientsäkerheten är bristfällig och är relaterad till underbemanning av sjuksköterskor. Sjuksköterskorna uppfattar tiden som en stor påverkbar faktor till utebliven omvårdnad som resulterar i sämre patientsäkerhet. Konklusion: Det krävs att sjuksköterskebemanningen är fulltalig och att sjuksköterskor känner sig trygga i sitt arbete för att bedriva god patientsäkerhet. Mer forskning behövs inom området för att genomföra en förändring för att stärka patientsäkerheten.
Background: Patient safety is jeopardizing healthcare, one in ten patients suffering due to medical errors could have been avoided if the appropriate actions had been taken. All nursing staff have a shared responsibility to contribute to proper and safe care but it is the nurses who have full responsibility over the patients. Patient safety should be promoted through the patient safety law and the nurse’s six core qualifications. Purpose: The aim was to understand the nurse’s perception of patient safety related to the number of nursing staff. Method: A literature review with an inductive approach was performed. Results: The study is based on ten scientific articles which led to four categories: time affect’s patient safety, the competence of the nurse affects patient safety, work environment affect patient safety and the health of the nurse is affected by defective patient safety. It was found in the result that the nurse’s perception of patient safety is adverse in the context of staffing. The nurse’s perceived time as a major contributing factor to absent care that resulted in poorer patient safety. Conclusion: It is necessary that the appropriate number of nursing staff is present during care. The staff needs to feel safe and secure in their work in order to offer good patient safety. More research is needed in this area to enable a change in patient safety.

Magister Curationis - MCur
The South African health care system shifted the focus of treating psychiatric disorders from institutional care level mental health services to facilitate this process of integration into the Primary Health Care (PHC) settings. All the provinces were thus engaged in improving mental health care services at community level by providing training for professional nurses in mental health at PHC settings. Consequently, mental health nursing has also changed considerably by shifting the focus of mental health care to the primary care level. It is however, suggested that the current revolving door syndrome experienced at psychiatric institutions was partly due to inadequate community-based psychiatric services. It was also suggested that the attitudes and knowledge of health professionals towards mental illness has a major impact on service delivery, treatment and outcome of mental illness. The aim of this research study was to assess the attitude of nursing staff working at a Community Health Centre (CHC) towards the mental health care user. A CHC was chosen that renders 24 hour services. The inclusive sample included all the different categories of nurses permanently employed at this CHC. The Attitude Scale for Mental Illness questionnaire was used to collect the data. Descriptive statistics: means, median and standard deviations were calculated for the following variables: separatism; stereotyping; restrictiveness; benevolence; pessimistic prediction and stigmatization. In conclusion it can be said that the nursing staff with more experience irrespective of category of nurse has less of a stereotyping attitude towards mental illness. The longer the nurse worked at the setting and irrespective of their nursing qualification the more positive their attitude towards the MHCU became.

During the past years in Sweden, there has been a lack of staff within the nursing profession. Due to that the employer may demand more of the employee than what usually is requested. This scenario can lead to work-related stress. What happens when the employer forces the staff to work so that the patient safety and that the registered nurse’s certification is put at risk? The purpose of the essay is to investigate what professional certification means within healthcare, what the legal value is in the certificate, and what the consequences can be with a management that does not observe stressors. The method being used is the legal dogmatic method together with a sociology perspective. Certification professions guarantee a specific qualification and knowledge provided for the profession. Abuse of this can lead to recall of the certification. The employers’ management is strong. Also, because of the nurse’s special liability relationship with the patient, it is almost impossible to abstain from the work one is being assigned. This relatively small opportunity to affect their working situation can lead to stress due to powerlessness. It is hard for employees to claim stress as a factor for a negative event to occur. Staff management can be identified as a system error which trigger a stressor and because of that patient safety and the certification is put at risk. But, management is a very important part of Swedish labour law and should preferably not be touched. National and international actors work for that through notice, routines and technical facilities build a safety system against human faults and for patient safety to be guaranteed. But, management is identified to be the most critical system error.

Because of the expense associated with hospital admissions, the use of observation status has grown. One of the most consistently measured outcomes in observation is the patient length of stay (LOS). Research supports the positive impact that nurse practitioners (NP) have on LOS when added to other service lines that could be applied to observation. Banner Desert Medical Center (BDMC) is currently attempting to decrease their observation LOS. Adding acute care nurse practitioners (ACNP) to the care delivery model is a potential intervention. The purpose of this project was to develop an executive summary to inform staff of current evidence that supports the addition of ACNPs to observation. Then, via a survey, the project aimed to determine the level of staff support by identifying the Transtheoretical Model of Change (TTM) Stage of Change and to recommend appropriate stage-matched interventions for staff based on TTM processes of change. The 10 Likert scale survey questions were adapted from two validated TTM surveys. The final question asked for the pros and cons of the intervention to determine the Decisional Balance (DB). The registered nurse (RN) cohort demonstrated consistently strong support for the proposed intervention with an average mean response of 6.57 on affirmative questions and a correspondingly low average mean of 2.2 on negative questions. When compared to the RN cohort, the physician cohort had lower mean responses with an average of 4.29 on every affirmative, a higher average mean response of 3.85 on the negatively worded questions. The DB for RNs was 19 pros to two cons. The DB for physicians was eight cons to three pros. These finding reflect that nurses are in the Preparation Stage of Change and are ready to move forward with adding ACNPs. An appropriate stage-matched intervention for registered nurses would be the development of change teams. In contrast, the physician cohort is in the Precontemplation stage and is not ready to proceed with adding ACNPs. Appropriate stage-matched interventions for physicians would include facilitating consciousness-raising activities such as an open forum to communicating information about the proposed change and to explore concerns and questions regarding the intervention.