Chief Nursing Research Articles

Keeping our patients safe

Sam Foster, Chief Nurse, Oxford University Hospitals, looks at research on the impact of nursing team size and composition on patient mortality in hospitals.

Giancarlo Lyle-Edrosolo, DNP, RN, CENP, NEA-BC, FAONL

Giancarlo Lyle-Edrosolo is the Vice President and Chief Nursing Officer of Advocate Christ Medical Center in Oak Lawn, Illinois. He is a first-generation immigrant and was born and raised in the Philippines. Giancarlo has focused his career and professional activities on promoting leadership development, cultivating professional advancement, finding solutions and support for health care worker burnout, and addressing incivility and bullying.

The Global Cardiovascular Nursing Leadership Forum: Promoting Optimal Cardiovascular Health Worldwide.

The Global Cardiovascular Nursing Leadership Forum: Promoting Optimal Cardiovascular Health Worldwide.

Considering changes to education.

Sam Foster, Chief Nurse, Oxford University Hospitals, looks at research commissioned by the Nursing and Midwifery Council into views on changing the standards for pre-registration nursing education programmes.

Automation of health care management system through software

In these modern times, people prefer convenience over traditional methods. This text describes the benefits of implementing a software system in Polyclinic #5. The system enables patients to make online appointments with doctors, eliminating the need to wait in long queues. Additionally, it eliminates the hassle of managing physical medical cards as all records can be accessed digitally. The software also facilitates communication among employees through a chat room and allows for sending reports to the chief physician. For pharmacists, the system provides the ability to check the availability of medicines. Moreover, the software automates tasks, provides schedules for employees, and enables effective management of the team. The system architecture involves subsystems and user access from different devices. Users include the chief physician, doctors, receptionists, nurses, pharmacists, laboratory technicians, and patients. The system development follows an iterative and incremental approach. It concludes with the implementation of off-the-shelf software that simplifies patient appointments, ensures secure medical records, enhances staff communication, and streamlines management and inventory control.

Assessing progress on governance of advanced practice roles

Sam Foster, Chief Nurse, Oxford University Hospitals, considers the issue of governance and quality assurance when it comes to advanced clinical practice.

Impact of practicing servant leadership style among Chief Nursing Officers (CNOs) in nursing organizations

The purpose of this research was to evaluate if the servant leadership style among the hospital's Chief Nursing Officers (CNOs) led to excellent safety grades and higher overall hospital ratings. Is servant leadership style the most suitable? Servant leadership style is concerned with both leadership and service. Current literature does not distinctly demonstrate how the successes or failures of hospitals are associated with their CNO's leadership style. The leadership style of executives in hospitals plays an important role; therefore, it is vital to understand what they practice. This research utilized a previously developed leadership tool for evaluating the leadership styles which was correlated with the data that was obtained from open data base. It was determined that of the total participants fifty percent practiced servant and reported excellent safety and highest hospital ratings. In this exploratory research, those facilities with the CNOs that practiced servant leadership style performed better in the safety and overall rating criteria.

Lived experiences of end-of-life communication among nursing home staff: An interpretive phenomenological study.

To explore and understand lived experiences of end-of-life communication among nursing home staff. Interpretive phenomenological study. In-person, semi-structured, in-depth interviews were conducted from May to August 2021 with 21 nursing home staff members involved in end-of-life communication (four managers, four chief nurses, three chief medical officers, three nurses, three psychologists, two occupational therapists, one chief nurse aide and one nurse aide). Data were analysed by van Manen's hermeneutic approach, which uses the lifeworld existentials of spatiality, corporeality, temporality and relationality to guide reflection on the human experience. Data were reported according to the Consolidated Criteria for Reporting Qualitative Research. Thirteen categories were identified and framed within the four existentials. Regarding spatiality, end-of-life communication took place in a physical, mental, socio-cultural and professional competence space. With regard to corporeality, interviewees reported difficulties in managing their own feelings and those of family caregivers. For temporality, interviewees reported delays in end-of-life communication due to staffing issues and an increase in urgent and temporary relief admissions to nursing homes. To compensate, they tried to assure that all interactions that did take place were of high quality. Finally, with regard to relationality, interviewees lived end-of-life communication through their relationships with family caregivers and colleagues. The supportive role of colleagues was expressed as teamwork, which helped promote reflexivity about how to tailor communication, manage challenging emotions and situations, set aside time for communication, and prepare family caregivers for death. End-of-life communication was an all-encompassing experience for nursing home staff. The supportive role of colleagues was stressed across all existentials, suggesting that teamwork is essential in delivering effective communication at the end-of-life. There was no patient or public contribution to this study, which addresses the experiences of nursing home staff only.

A long-overdue resource to tackle racism.

Sam Foster, Chief Nurse, Oxford University Hospitals, discusses ethnic inequalities among patient groups and the NHS workforce and a resource to raise awareness and help combat racism.

Civility and kindness: not just niceties, but fundamental pillars of quality care.

Sam Foster, Chief Nurse, Oxford University Hospitals, reflects on the areas for improvement arising from the latest Kirkup Report, in particular the importance of creating and sustaining kinder, more civil workplaces.

New mandatory training set to transform outcomes for clients with learning disability.

Sam Foster, Chief Nurse, Oxford University Hospitals, reports on an initiative centred on ensuring that staff working with this client group are equipped with the requisite knowledge and skills to provide appropriate care.

Nurses and the doctorate: A mixed study in French health care organizations.

This research aims to understand the place and role of nurses holding a PhD or PhD students (nurse doctor [ND]/nurse doctoral students [NDS]) in health care organizations in France. Worldwide, many nurses are undertaking doctoral studies. France is no exception. However, in France, there is no doctorate dedicated to nursing. The question of ND/NDS integration into health organizations is thus raised in a specific manner. We used a two-stage mixed methodology. The first stage used data from questionnaires that were sent to 165 ND/NDS in France. To contextualize issues raised by these data, we used qualitative methods which comprised 45 semi-structured interviews with nurses, 10 interviews with health managers and chief nurses and 27 h of in situ observations with research coordinators. Seventy-nine participants (47.9% response rate) completed questionnaires. The data showed that work organization in some departments-intensive care units (ICUs), oncology and psychiatry-favoured the development of scientific expertise among nurses. Favourable elements promoting the professional and academic development of ND/NDS included the potential for medical teaching in healthcare services, participation in research projects and, most importantly, medical proximity. Conversely, our data also identified poor visibility and recognition of nursing doctoral courses in French health organizations: A lack of task missions, a lack of suitable posts and poor integration into the nursing profession. Currently, French nurses define their profession as providing direct care to patients and their families-yet this definition fails to consider other important professional elements, such as research. Our study identified how proper ND/NDS integration is important to health care organizations. We identified key organization factors facilitating the integration of ND/NDS, such as participating in research teams and providing research support management. In recent years, the nursing profession has significantly evolved. We are interested in the impact of these changes in work organizations following the development of new scientific skills. Our study investigates all aspects of the nursing profession (teaching, practice, research and organizations). Our study advocates managerial roles, among others, to improve ND and NDS integration into work organizations. We directly observed work organizations that helped develop nursing research. Our study is also aimed at managers who have roles as decision-makers in promoting and facilitating research and nurse researchers.

Redeployment: what have we learnt?

Chief Nurse, Oxford University Hospitals, describes ongoing research into how the redeployment of staff can be improved both for those being redeployed and those making the redeployment decisions.

The Chief Nursing Officer Shared Leadership Model

We highlight the design, implementation, benefits, and challenges of an innovative shared nursing leadership model at the chief nursing officer (CNO) level. At St. John's Health, a 48-bed rural hospital in the Mountain West, 3 qualified, experienced clinical nursing directors were recruited to fill the CNO position. During the first 6 months, the CNOs solidified their leadership and communication styles, negotiated salary and benefits, transitioned into strategic thinking, became members of the administrative team, and maintained their specialty clinical directorships. St. John's Health retained strong nursing leadership talent and enhanced staff engagement, resulting in better staff wages and work–life balance, and continues to improve patient experience scores.

AONL Nurse Leader Competencies: Core Competencies for Nurse Leadership

AONL Nurse Leader Competencies: Core Competencies for Nurse Leadership

Dialysis, Transplantation, and Work: Honoring Original Intent.

<h3>Significance and background</h3> Falls are multifactorial in medical oncology units and are potentiated by an older adult’s response to anxiolytics, opiates and chemotherapy protocols. In addition, the oncology patient is at an increased risk for injury from a fall due to coagulopathy, thrombocytopenia and advanced age. At our National Cancer Institute-designated inpatient cancer treatment centre located in the southeastern USA, 40% of the total discharges are over the age of 65. As part of a comprehensive fall prevention programme, bimonthly individual fall reports have been presented with the Chief Nursing Officer (CNO), nursing directors, nurse managers, physical therapists and front-line providers in attendance. As a result of these case discussions, in some cases, safety recommendations have not been followed by patients and families and identified as an implication in individual falls. Impulsive behaviour was acknowledged only after a fall occurred. A medical oncology unit was targeted for this initiative due to a prolonged length of stay. This patient population receives chemotherapeutic interventions, management of oncological treatment consequences and cancer progression care. <h3>Purpose</h3> The aim of this project was to explore if initiation of a Fall Prevention Agreement between the nursing team and older adults being admitted to medical oncology units would reduce the incidence of falls and the incidence of falls with injury. <h3>Interventional methods</h3> In order to promote patient and family participation in the fall reduction and safety plan, the Fall Risk and Prevention Agreement was introduced upon admission. Using the Morse Fall Scoring system, patient‘s risk for fall was communicated on the Fall Risk and Prevention Agreement. Besides admission, patients were reassessed based on change of status, transfer or after a fall occurs. <h3>Evaluation/findings</h3> Fall and fall injuries rates were compared two-quarters prior to implementation of the fall agreement and eight-quarters post implementation. Falls and fall injuries on the medical oncology unit had an overall reduction of 37% and 58.6%, respectively. <h3>Discussion/implications</h3> A robust fall prevention standard does not ensure care team participation in all elements to reduce fall occurrence. Historically, the Fall Risk and Prevention Agreement had not been initiated on admission. Incorporating patients and families in discussions related to fall risk and prevention is consistent with collaborative communication. The Joint Commission and the Centers for Medicare and Medicaid Services in 2002 encouraged patients and family participation in the acute care experience to promote safety. The medical oncology patient in many cases on admission is identified as ‘moderate’ risk for fall. It is during the course of treatment and an extended length of stay that deconditioning and treatment side effects result in a fall. This patient population often overestimates their abilities and functional status. Engagement with patients and families during the admission process will hopefully communicate the need for a collaborative effort for fall prevention during the hospitalisation. Although this project is limited in data, integrating patients and families into care planning may have a significant impact in reducing falls in the ‘moderate’ risk patient. Additional studies including a multivariate analysis are needed to determine whether supporting evidence links fall reduction to the presence and use of a patient and family agreement.

We can't respond to patient complaints using the one-size-fits-all approach.

Sam Foster, Chief Nurse, Oxford University Hospitals, outlines how concerns with implementing NHS-wide processes highlighted in a recent study are in line what many executive staff are encountering in practice.

The experience of moral distress by chief nurse officers during the COVID-19 pandemic: A descriptive phenomenological study.

AimThe aim of this study is to explore the moral distress experiences of nurse officers during the COVID‐19 pandemic.BackgroundMoral distress has emerged as a challenge for nurses ad nurse leaders, revealing the need for health professionals and health care managers to examine, understand and deal with moral distress un Nurse leaders.MethodsIt is a descriptive phenomenological study that used content analysis.ResultsThirteen chief/assistant nurse officers were interviewed, and four themes were identified: being a manager in the pandemic, situations that cause moral distress, effects of moral distress and factors that reduce moral distress.ConclusionFaced with various expectations, such as the management of unusual and uncertain processes, and the management of the psychological responses of both employees and themselves, chief nurse officers struggled significantly to maintain their moral integrity and experienced moral distress during the COVID‐19 pandemic.Implications for Nursing ManagementExtraordinary situations such as pandemics have factors that led to moral distress for a Chief Nursing Officer (CNO). Health care systems in which nurse managers are excluded from decision‐making processes have a traditional hierarchical structure that ignores CNOs professional autonomy, contributing to the development of moral distress. Therefore, CNOs should engage in self‐reflection to recognize their own moral distress experiences, examine the existing health system to identify the factors that cause moral distress and take actions to implement changes to eliminate these factors. To cope with moral distress, CNOs should also improve their communication skills, team collaboration skills and the use of scientific knowledge and take responsibility in their managerial role.

Using restorative practice in health care.

Sam Foster, Chief Nurse, Oxford University Hospitals, considers whether the principles of restorative practice can help in the process of dealing with the aftermath of patient safety incidents.

Predominantly practiced leadership styles of Chief Nursing Officers in healthcare organizations

The objective of this research was twofold. 1) To identify which leadership style is predominant in magnet and non-magnet hospitals and 2) To determine if the servant leadership style was more suitable in the healthcare environments than transformational leadership style? There were ten (n = 10) voluntary participants recruited from various acute care hospitals in the Tri-state area (New York, New Jersey, and Pennsylvania). In some instances, these participants were interprofessional who managed multiple key units of the organization i.e., nursing and operations. Forty percent (n = 4) participants worked in a magnet setting; whereas, sixty percent (n = 6) participants worked in a non-magnet facility. All participants were either Chief Nursing Officers (CNO) or Chief Nursing Executives (CNE) for this research. A qualitative study design was utilized for this research. A leadership research tool was developed for this study. The data collection consisted of pre-interview questionnaires as well as a 60 min virtual interview with each participant individually. The virtual interview was conducted using a combination of direct and open-ended questions with the participants. The data were analyzed using a thematic approach post-interview. The ultimate response rate for this study was 100%. Fifty percent (n = 5) participants believed that they practiced servant leadership style and the remaining fifty percent (n = 5) believed that they practiced transformational leadership style; however, post-interview, it was determined that forty percent (n = 4) practiced transformational, while thirty percent (n = 3) practiced servant leadership, twenty percent (n = 2) practiced situational leadership, and ten percent (n = 1) practiced visionary leadership style. Thirty percent (n = 3) participants believed that the servant; whereas, seventy percent (n = 7) believed that the transformational leadership style was most beneficial for magnet hospitals . On the other hand, sixty percent (n = 6) of participants believed that the servant and forty percent (n = 4) believed that the transformational leadership style was most beneficial for non-magnet hospitals. Furthermore, eighty percent (n = 8) participants believed that the servant leadership style was best for any healthcare organization . This research finding demonstrated that transformational, servant, and situational leadership styles were predominantly being practiced among the participants. In summary, participants believed that transformational for magnet and servant for non-magnet hospitals were the best-suited leadership styles.