American Organization Of Nurse Executives Research Articles

Leveraging the Value of Nursing

Pamela Austin Thompson, MS, RN, CENP, FAAN, is CEO of the American Organization of Nurse Executives and senior vice president of nursing of the American Hospital Association in Washington, D.C.

The Impact of Health Care Reform Initiatives on Ethical Conflict and Opportunities for Nurses to Improve Quality of Care While Enhancing Their Work Environments

Background: After more than a decade of the nursing profession contending that healthcare reform based almost exclusively on cost cutting was creating an array of serious ethical issues for nurses, healthcare organizations and other providers are now facing increasing demands primarily from payers to demonstrate improvement in both quality of care and patient experience along with continued cost reduction. Research Question: Have efforts by healthcare organizations to comply with these recently imposed requirements influenced the ethical environment faced by nurses and nurse leaders and if so, how? Materials and Methods: Data for assessing the current ethical environment was gathered with a close-ended survey mailed in October 2012 to a random sample of 3000 members of the American Organization of Nurse Executives. Results and Discussion: Statistical analysis of the data and comparison with the findings of a similar study conducted in 2000 indicated that along with five highly rated issues in the earlier study attributed largely to economic constraints imposed by healthcare organizations, the top-10 key ethical issues today included five issues primarily attributable to interprofessional conflict. Conclusion: Given the success of many ongoing efforts aimed at weakening these key sources of ethical conflict that have blocked many proposals to improve the quality of care, opportunities should arise for the nursing profession to more fully achieve its goals of improving the quality of care, safety and patient satisfaction and enhancing nurses’ work environments essential to that effort.

Crossing Our Quality Chasm

The previous CGEAN Perspectives column compared the Baccalaureate Essentials document with American Nurses Credentialing Center (ANCC) and American Organization of Nurse Executives (AONE) certification examination content for nurse managers and concluded that the baccalaureate curriculum lacks the depth of content needed for today's frontline nurse leaders. This article continues the discussion by comparing the Master's Essentials document with ANCC and AONE nurse manager-level certification content to evaluate if a master's graduate education prepares nurses for the competencies of these management roles.

Leader to Honor: Amy E. Brown, MS, RN, NE-BC

Amy Brown began her nursing career at the University of Iowa with a bachelor of science in nursing (BSN) (which included studying in London) and a master of science (MS) in nursing administration from the University of Illinois at Chicago. She chose to start her nursing career at the Mayo Medical Center in Rochester, Minnesota, because of its sterling reputation for patient care quality. The experience of serving on shared-governance councils with such a prestigious and complex health system jumpstarted her interest in leadership as a career. Amy next decided to work as a traveling registered nurse (RN) so she could determine what was so special about Mayo and why there was such a disparity between nursing care environments. Today Amy serves at the Director of Inpatient Surgical Services for Exempla St. Joseph Hospital in Denver, Colorado, and is an affiliate faculty member at Colorado Christian University.

A New Day Dawns For Workforce Redesign

A New Day Dawns For Workforce Redesign

Residency Programs for New Nurse Graduates

The objective of this study was to determine the prevalence of hospital RN residencies and the associated factors. The 2010 Institute of Medicine/Robert Wood Johnson Foundation report, The Future of Nursing: Leading Change, Advancing Health, recommends the adoption of nurse residency programs. Members of the American Organization of Nurse Executives were surveyed, and covariates were identified. We found approximately 36.9% of all hospitals in our study offered a nurse residency in 2011. Associated covariates included not-for-profit status, midsize, and location in the South. Hospitals that offer residency programs were more likely to have other training programs. Findings suggest that residencies have been widely supported even in times of economic recession. It is important to track the expansion of these programs and to initiate research to examine the long-term impacts of residencies on nurse retention and clinical outcomes.

Ramón Lavandero, RN, MA, MSN, FAAN

Ramon Lavandero, RN, MA, MSN, FAAN, is senior director of the American Association of Critical-Care Nurses (AACN) and clinical associate professor at Yale School of Nursing. A native of San Juan, Puerto Rico, he has held clinical, management, and faculty positions at medical centers and academic institutions in the Northeast and Midwest United States. As founding director of the International Leadership Institute at the Honor Society of Nursing, Sigma Theta Tau International, he has consulted on nursing and health care in the Caribbean, Europe, and North and South America. Lavandero has served AACN in volunteer and staff leadership roles since the 1980s, including the team that developed AACN's Standards for Establishing and Sustaining Healthy Work Environments.

Victoria L. Rich, PhD, RN, FAAN

Victoria L. Rich, PhD, RN, FAAN, is the chief nurse executive and associate executive director at the University of Pennsylvania Medical Center and associate professor of nursing administration at the University of Pennsylvania School of Nursing. She is recognized for her leadership in healthcare, business, and nursing education, most notably for her pioneering work in patient safety and cultural diversity. She has developed numerous patient safety initiatives for healthcare systems, both nationally and internationally. Her experiential knowledge enabled her to develop a model for creating a risk-reduction culture in healthcare through the process of systemic mindfulness. As a result of her leadership and commitment to diversity concerns, she received the 2013 Prism Diversity Award by the American Organization of Nurse Executives.

‘Crucial Conversations’ in the Workplace

Offering nurses a framework for discussing—and resolving— incidents of lateral violence. This is the second article in a series on leadership, coordinated by the American Organization of Nurse Executives (AONE), highlighting how nurses are leading change efforts in hospitals. It describes work done in conjunction with the AONE's Care Innovation and Transformation initiative, which provides leadership development and educational opportunities to nurse managers and staff aimed at supporting nurses at the point of care in making changes to improve the quality and safety of patient care.

Michelle Janney, PhD, RN, NEA-BC

Michelle Janney, PhD, RN, NEA-BC

Partnering for Change

Nurse leaders and telemetry unit staff work together to change the way nurses conduct shift report. This is the first article in a new series on leadership, coordinated by the American Organization of Nurse Executives (AONE), highlighting how nurses are leading change efforts in hospitals. It describes work done in conjunction with the AONE's Care Innovation and Transformation initiative, which provides leadership development and educational opportunities to nurse managers and staff aimed at supporting nurses at the point of care in making changes to improve the quality and safety of patient care.

The Nurse Manager

Change in today's health care landscape is a daily, if not hourly, reality. The nurse manager must have strong leadership skills to navigate through change with a focus on the patient and the provision of safe and reliable care. The historical term for those leading change is "change agent." In this article, the authors introduce the idea of a change coach, building on the nurse manager foundational skill of coaching and weaving this concept into the manager's role in change. A change coach uses the coaching behaviors including guidance, facilitation, and inspiration to inspire others toward change, altering human capabilities, and supporting and influencing others toward change. An exemplar of the nurse manager's role as a change coach in practice is provided using American Organization of Nurse Executives' Care Innovation and Transformation initiative. It is the agile manager that is able to successfully move between the roles of change agent and change coach to continuously transform the environment and how care is delivered.

Leadership Imperative

Healthy workplace practice environments are essential to keeping patients safe. The American Organization of Nurse Executives (AONE) identifies the creation and maintenance of healthful practice environments as an essential role for nurse leaders. In this article, we profile exemplars of nurse leaders who have integrated elements of the AONE Principles and Elements of a Healthful Practice Work Environment in their executive practices.

The American Organization of Nurse Executives System CNE Task Force

Health care is a complex industry, consequently requiring a diverse group of health care executives leading initiatives for efficiency and effectiveness in patient care delivery. Value-based purchasing and pay for performance are at the top of the list for indicators of success, and many hospitals are merging into health care systems. The role of the system chief nurse executive is an evolving role to lead health care systems in clinical, operational, patient safety, and patient satisfaction processes and outcomes. The American Organization of Nurse Executives, being the voice for nursing leadership, convened a group of system chief nurse executives to address the role, function, and competencies needed for this significant and emerging role in health care. This article describes the role statement and system chief nurse executive competencies needed for success in the role. In addition, the next steps for addressing the needs of this group will be outlined in this article.

The Future of Nursing

This bimonthly department, sponsored by the American Organization of Nurse Executives (AONE), presents information to assist nurse leaders in shaping the future of healthcare through creative and innovative leadership. The strategic priorities of AONE anchor the editorial content. They reflect contemporary healthcare and nursing practice issues that challenge nurse executives as they strive to meet the needs of patients.

AONE Helps Hospitals Improve Care Through a 2nd Transforming Care at the Bedside Effort

This bimonthly department, sponsored by the American Organization of Nurse Executives (AONE), presents information to assist nurse leaders in shaping the future of healthcare through creative and innovative leadership. The strategic priorities of AONE anchor the editorial content. They reflect contemporary healthcare and nursing practice issues that challenge nurse executives as they strive to meet the needs of patients.

The Organizational Transformative Power of Nurse Residency Programs

Residency programs for newly licensed registered nurses (NLRNs) have been strongly advocated by the Institute of Medicine, American Organization of Nurse Executives, and other professional organizations. Their cost-effectiveness as well as their impact on NLRN retention, job and practice satisfaction, improved performance, and reduction in environmental reality shock has been demonstrated. This qualitative study sought answers to the question: what people, components, processes and activities of Nurse Residency Programs (NRPs), and the work environment are instrumental in the transition and integration of NLRNs into the professional practice role and into professional communities? In the course of interviewing 907 nurses-NLRNs, experienced nurses, managers, and educators-practicing on clinical units with confirmed "very healthy work environments" in 20 Magnet hospitals, it became evident that not only did NRPs positively impact the professional socialization of NLRNs, they led to transformative changes in the organization and in the practice of other health care professionals. The organizational transformative changes described by the interviewees are presented for each of the 7 major challenges identified by NLRNs-delegation, prioritization, managing patient care delivery, autonomous decision-making, collaboration with other disciplines, constructive conflict resolution, and utilizing feedback to restore self-confidence. If it can be demonstrated that these transformative changes stimulated by NRPs also lead to improved patient outcomes, NRPs may be the most significant organization transformation instituted by nurse leaders in recent years.

Laura J. Caramanica, PhD, RN, CENP, FACHE

Laura Caramanica is the chief nursing officer (CNO) for WellStar Kennestone Hospital, a 633-bed flagship tertiary care facility of WellStar Health System. She is a member of the senior administrative team and as such is involved in the system-wide initiatives in collaboration and partnership with the system CNO and other organizational-based CNOs. She is also responsible for directing clinical nursing practice to achieve the highest quality of patient care and foster a "best of class" clinical practice environment. Caramanica develops and articulates a vision for nursing and patient care services by translating strategic goals into tactical plans for nursing and other clinical areas.

Learning How to Dance: Courageous Followership: A CNO Case Study

Chief nursing officers (CNOs) are described as the primary architects of nursing practice and patient care environments. They are the common voice for nursing in healthcare organizations and require a specific set of executive competencies. 1 The American Organization of Nurse Executives developed a set of CNO competencies that focus on four core areas: communication and relationship management, professionalism, business skills and principles, and knowledge of healthcare environment. 2 CNO effectiveness depends on the kind of relationships they create in their organization between leaders and followers. Developing good followership relationships that build on motivation rather than control is important. A balance of power between leaders and followers creates a culture of trust and openness.

Interdisciplinary teamwork in hospitals: A review and practical recommendations for improvement

Recognizing the importance of teamwork in hospitals, senior leadership from the American College of Physician Executives (ACPE), the American Hospital Association (AHA), the American Organization of Nurse Executives (AONE), and the Society of Hospital Medicine (SHM) established the High Performance Teams and the Hospital of the Future project. This collaborative learning effort aims to redesign care delivery to provide optimal value to hospitalized patients. With input from members of this initiative, we prepared this report which reviews the literature related to teamwork in hospitals. Teamwork is critically important to provide safe and effective hospital care. Hospitals with high teamwork ratings experience higher patient satisfaction, higher nurse retention, and lower hospital costs. Elements of effective teamwork have been defined and provide a framework for assessment and improvement efforts in hospitals. Measurement of teamwork is essential to understand baseline performance, and to demonstrate the utility of resources invested to enhance it and the subsequent impact on patient care. Interventions designed to improve teamwork in hospitals include localization of physicians, daily goals of care forms and checklists, teamwork training, and interdisciplinary rounds. Though additional research is needed to evaluate the impact on patient outcomes, these interventions consistently result in improved teamwork knowledge, ratings of teamwork climate, and better understanding of patients' plans of care. The optimal approach is implementation of a combination of interventions, with adaptations to fit unique clinical settings and local culture.