Chief Nursing Research Articles

Delivering inclusive hypertensive care in the prison service.

Morisenuola Ladele, Chief Nurse Fellow, Birmingham Community Healthcare NHS Foundation Trust (Morisenuola.ladele1@nhs.net), was the Gold Award winner in the Nurse of the Year category in the BJN Awards 2024.

The occupational roles of nurses and midwives in the UK: an analysis of the Nursing and Midwifery Council-census England and Wales 2021 data linkage study

ObjectiveThe nursing and midwifery professions are facing challenges to recruitment and retention. Understanding the occupational choices of people registered as nurses and midwives can inform policy as to the potential of initiatives to encourage registrants back to practice. This study thus aims to ascertain the occupational roles taken by nurses and midwives in the UK in 2021 and the drivers behind choosing to work outside of direct clinical practice. ApproachThe Nursing and Midwifery Council (NMC) register contains information on everyone meeting required standards to practice in those professions in England and Wales (currently around 800 thousand people). Registrants must not only complete a course of study for registration but must revalidated every three years. The register has been linked to the 2021 census for England and Wales. The census includes questions ascertaining occupation. Information provided is categorised to provide indication of individuals’ main occupation. These include codes for nursing and for midwifery which provides indication not only to occupation but also to engagement in clinical practice. Analysis uses logistic regression to ascertain how socio-demographics influence engagement in clinical practice or otherwise. Conclusions and ImplicationsData linkage for this study is now completed with the conference being the first time results will be shared. This will be the first time there has been concrete evidence as to nurses and midwives actual occupational roles. A stakeholder group supporting this work includes individuals from Chief Nurses’ Offices to enable findings to feed into policy.

Virtually integrated nursing care: A case study in diffusion of innovations

Bedside nurses are suffering from nurse fatigue owing to excessive workload and work hours. Nurse fatigue results in missed nursing care, which has a direct impact on patient care and safety. Loss of experienced nurses also affects novice nurses, leaving them without strong mentoring. They may suffer from imposter syndrome, which instils self-doubt and limits their professional development, potentially resulting in burnout and attrition. A case study regarding the leadership of the Chief Nursing Officer as aligned with Rogers’ diffusion of innovations theory is presented. There is an initial accumulation of knowledge regarding the innovation, followed by persuasion (through perception of positive attributes to enhance speed of adoption), decision making, actual implementation and confirmation. Use of virtually integrated nursing helped alleviate bedside nurse fatigue by removing overtime hours and reducing workload. The virtually integrated nurses supported the bedside nurses, allowing them additional time in direct patient care, enhancing patient satisfaction and safety. The objective data indicates a decrease in patient fall by over 50 per cent. The integration of virtual nursing reversed the nurse attrition rates. Initial results revealed a 47 per cent reduction in registered nurse turnover. This allowed for retention of experienced nurses, which aids in mentoring novice nurses. The impact of virtually integrated nursing is yet to be completely realised. Based on this case study, the implementation of virtually integrated nursing is possible and beneficial to nursing, patient safety and the bottom line. This innovation had additional positive consequences and led to future considerations regarding continual process improvement and dissemination of knowledge.

Leased clinical faculty model: Bridging gaps in nursing education

In response to the critical Registered Nursing (RN) shortage, John Carroll University, a not-for-profit, private, faith-based university in the Midwest, has developed an academic-practice partnership to bolster its new Bachelor of Science in Nursing (BSN) program. This initiative addresses the challenge of limited clinical faculty. Central to this strategy is a “leased employee agreement” with healthcare partners, which allows the university to employ practicing RNs as part-time clinical instructors. Formulated in collaboration with healthcare Chief Nurse Executives (CNEs), this model enables the seamless integration of hospital-employed RNs into the academic framework as clinical faculty. This model streamlines the onboarding process and enriches student learning experiences by leveraging the practical expertise of active nurses. Initial feedback following its launch in August 2023 has been positive, with students and clinical faculty reporting high levels of satisfaction and quality educational experiences. This approach presents a viable strategy to mitigate faculty shortages in nursing education and underscores the importance of inventive academic-practice partnerships in adapting to the dynamic demands of healthcare training.

Examining the knowledge level of nurses regarding aseptic non touch technique in nurses: a cross-sectional study

BackgroundHealthcare-associated infections (HAIs) are important indicators of healthcare quality. The aseptic non touch technique (ANTT), a standardised aseptic technique, is a crucial preventative measure against HAIs. However, there is insufficient evidence currently available regarding ANTT awareness and proficiency among nurses. This study aimed to investigate the status of ANTT proficiency in a cohort of nurses and analyse the associated risk factors, with the ultimate goal of providing a reference for promoting the application of ANTT in clinical practice.MethodsThe study population was sampled from nurses working in a tertiary hospital in Zhejiang Province, China, in January 2024. A cross-sectional survey was conducted using a self-designed questionnaire to assess ANTT knowledge. Multivariate linear regression analysis was used to analyse the risk factors influencing ANTT knowledge in nurses.ResultsA total of 458 nurses were included in this study. The cohort had an overall score of 49.7% correct responses on the ANTT knowledge questionnaire, with a mean score of 12.4 ± 2.4 out of 25, and 30.1% of the nurses felt that they did not need training related to ANTT. Multivariate linear regression analysis indicated that professional title, educational level, and the need for ANTT training were independently associated with ANTT knowledge in nurses. Nurses with Master’s degrees and associated chief nurses were observed to have higher levels of ANTT knowledge compared to the rest.ConclusionsANTT knowledge is insufficient among nurses in China, and its importance is not widely recognised. Continuous efforts are required to strengthen this knowledge. Constructing sustained, multiform, and stratified training programmes may represent an effective method to strengthen ANTT knowledge among nurses and promote its clinical use.

Leading through the COVID-19 pandemic: Experiences of UK Executive Nurse Directors.

To explore the challenges experienced by Executive Nurse Directors during the COVID-19 pandemic, and to inform future nursing leadership strategies. A qualitative research project involving interviews with 21 Executive Nurse Directors from England and Wales. Participants were purposively sampled and recruited through Chief Nursing Officers and nursing leadership networks. Semi-structured interviews were conducted and recorded online via Teams. Braun and Clarke's approach to thematic reflexive analysis was applied to data analysis. Executive Nurse Directors played a critical role during the COVID-19 pandemic. Six themes are explored: tensions, and adaptive response to personal leadership styles; uncertainty and support at the board level; responding to national political decision-making; the personal and emotional impact of the role and the sources of effective support; the voice and public profile of nursing; lessons learnt and strategies for future leadership development. Enablers of decision-making included effective multidisciplinary working, freedom from normal organizational constraints, support for innovation, and the development of stronger bonds with colleagues. Barriers to decision-making included limited knowledge of the virus and its impact and lack of guidance, particularly at a national level. Priorities, strategies and actions for recovery include recognizing the emotional impact of being in a high-level decision-making role, protecting staff from burnout and understanding the long-term implications of pandemic work for nurse leaders. Future strategies for nursing leadership during public health, national and global emergencies are recommended. This study contributes to the literature exploring the Executive Nurse Director role and their experiences of leading through the COVID-19 pandemic, and identifies priorities, strategies and actions for recovery and learning for the future of senior leadership. The study adhered to the Consolidated Criteria for Reporting Qualitative Research. No patient or public contribution.

Time spent on activities that can be delegated and reasons for not delegating among acute care nurses: A mixed-methods study.

To describe the activities nurses perceived to be delegable to other staff (delegable activities) in order to estimate the time nurses spend on delegable activities and explore nurses' reasons for not delegating these activities. Mixed-methods explanatory sequential. In total, 236 nurses from 27 medical and surgical wards of five hospitals in northern Italy completed a web-based survey during a single shift between June and July 2022. Minutes spent on delegable activities, staff member to whom participants could have delegated and reason(s) for not delegating were reported. Chief nurses provided specific wards' characteristics using a paper-and-pencil questionnaire. Twenty semi-structured interviews were conducted to explore delegable activities and reasons for not delegating. Quantitative and qualitative results were merged using joint displays. Participants spent approximately one-quarter of their time performing delegable activities, mainly delegable to nurse aides or nurse clerks, and performed due to a lack/shortage of staff or their concurrent participation in other activities. Participants recognized that activities requiring clinical assessment and decision-making skills cannot be delegated, whereas technical activities and indirect care should be delegated. Organizational, structural and cultural factors, as well as patient characteristics, available staff and experience affected delegation, leading nurses to perform delegable activities to ensure patient care. Nurses spend a considerable part of their time on delegable activities due to a lack of staff or support services and suboptimal organization, which could be addressed by optimal staff management, but also to the complexity of the contexts, including individual and cultural factors that should be addressed through policy interventions. This study estimates the time nurses spend on delegable activities in acute care settings. Our findings highlighted the reasons that sustain the decision not to delegate that policymakers, healthcare managers, and nurse educators should consider to promote nurses' delegation skills. MMR checklist. None.

The CMO and the Chief Nursing Officer: Creating Synergy

The Chief Nursing Officer and the Chief Medical Officer are responsible for the oversight of clinical outcomes within a complex and rapidly changing environment. Much attention has been paid to the interplay between these strategic executive roles. As the two chief clinical officers, they need to create synergy to realize the imperative of exemplary care delivery. While a great deal of evidence supports a partnership model of leadership, attainment remains elusive for many CMOs and CNOs.

The Uncharted Path: Understanding the Gap Between Chief Nursing Officers and CEO Roles in Healthcare

The Uncharted Path: Understanding the Gap Between Chief Nursing Officers and CEO Roles in Healthcare

Analysis of the Relationship Between Job, Life Satisfaction and Teamwork Attitudes of Intensive Care Nurses Working in a Turkish Public Hospital

Objective: The aim of this study was to determine the relationship between work, life satisfaction levels, and teamwork attitudes of intensive care nurses who work in a public hospital in Turkey.
 
 Methods: This was a descriptive and correlational study. The sample consisted of nurses working in intensive care units. Tools used to collect data were the “Sociodemographic Question Form,” “Nurse Job Satisfaction Scale” “Life Satisfaction Scale” and “Teamwork Attitudes Questionnaire” were used to collect the data.
 
 Results: A total of 217 nurses participated. In the study were a mean age of 35.32 ± 7.70. Most, 78.2% of the participants (n=170) were female, 65.90% (n=143) were graduates, 67.70% (n=147) were married, and 62.7% (n=136) had children. In this study, the LSS, NJSS, and T-TAQ scores for Intensive Care Nurses (ICNs) were determined to be 14.21 ± 4.28, 84.34 ± 16.71, and 99.11 ± 21.48, respectively. The respondents reported moderate and high scores on all three scales, and these scores positively correlated at the same time.
 
 Conclusion: In this study, which explores the interrelationships among these three distinct domains, is unusual in this regard. There was a positive correlation between the scores on the LSS, NJSS and T-TAQ in this study. It was determined that there was a positive relationship between LSS, NJSS and T-TAQ. Each scale score affects the scores of other scales. In our study, it can be said that ICNs' job satisfaction, life satisfaction and teamwork attitude levels are at medium level and above. Academicians, chief nurses, institution managers, and health system managers play important roles in the satisfaction of nurses whose satisfaction level is high.

Determining the Leadership Order of the Clinically Responsible Nurse Working in a University Hospital

This study aims to determine the leadership orientations of clinical chief nurses. In the descriptive study, the G-Power 3.1.9.4 program was used to calculate the sample size and the number of people planned to be included in the study was calculated as 50 with 5% error and 95% power. In this direction, all (50) clinical nurses working in a university hospital between 10.05.2023 and 30.05.2023 will form the study sample group. The data of the study will be collected from individuals with a socio-demographic "Leadership Orientation Questionnaire" prepared by the researchers. 84.6% of the participants were female and 15.4% were male. While 89.7% of the participants are married, 10.3% are single. While 56.4% of them are graduates, 43.6% of them are undergraduates. 46.2% of the participants have been in management for 0-5 years, 28.2% for 10 years and above, and 25.6% for 5-10 years. While the participants' human-oriented leadership behavior score average was 7.79, the minimum score was 3 and the maximum score was 12. While the task-oriented behavior average score was 12.62, the minimum score was 4 and the maximum score was 19. While the leadership orientation total score average was 20.41, the minimum score was 7, and the maximum score was 27. As a result of this study, there is no significant difference between the sub-dimensions of the leadership orientation scale and age, gender, marital status, educational status, duration of work in the profession, and management process. Therefore, extra pieces of training should be planned for responsible nurses, taking into account clinical leadership. There are few studies on this subject in the literature. It is recommended to increase the studies.

England's Chief Nursing Officer 7Ps: a new nursing framework

Penny Harrison explores a new nursing framework, launched in November 2023, colloquially termed the ‘7Ps’

Listen to the voices of nurses: the role of community chief nurses and registered nurses in the provision of care for older people in Sweden during the COVID-19 pandemic – a cross-sectional study

BackgroundDuring the pandemic in Sweden, the aim was to protect older people, especially those among them who were sick, frail and vulnerable in residential care facilities. A ban was put on visits at all residential care facilities in March 2020 to prevent the spread of infection among the older people. This study aims to describe the experiences of Community Chief Nurses and Registered Nurses who provided medical and nursing care for older people in residential care facilities and home care during the first wave of the COVID-19 pandemic, and to examine factors associated with the quality of care.MethodsThe study has a mixed method cross-sectional design (STROBE). Data were collected using a web-based survey that comprised two questionnaires, for Community Chief Nurses and Registered Nurses developed for the study. Data were analysed using descriptive statistics and logistic regression models, as well as qualitative content analyses.ResultsThe majority of Community Chief Nurses reported adequate opportunities to work with management to handle the COVID-19 pandemic. The Registered Nurses reported that the quality of care, as well as the person’s safety, was negatively affected during the pandemic. Factors associated with good care were as follows: information-sharing; ability to comply with hygiene practices; competence in how to care for older persons with COVID-19; a physician at bedside assessing their health; and support from frontline managers.ConclusionThe study highlights crucial facets that care organizations must address to enhance their readiness for future pandemics or disasters, ensuring the security and well-being of the older people.

Expanding the role of the cath lab nurse and inspiring others.

Ghazala Yasin, Divisional Chief Nurse, Ashford and St Peter's Hospitals NHS Foundation Trust, formerly Cardiology Nurse Consultant, Buckinghamshire Healthcare NHS Trust (ghazala.yasin@nhs.net) was the winner of the Gold Award in the Cardiovascular Nurse of the Year Category in the BJN Awards 2023.

The role of the nurse leader in nursing personnel management processes

All specialists whose professional activities involve communicating with people, in addition to a high level of knowledge and skills, must also have some special personalit y traits. Chief and senior nurses must be leaders. Target. Identification of obvious and hidden leaders among nurse managers and determination of their role in the processes of managing nursing personnel. Results. Information on the management activities of chief and senior nurses was analyzed; the main leadership characteristics of heads of nursing services, the essence of leadership style, leadership potential, and the ability to delegate authority were studied; the problems in the management activities of heads of nursing services were found; obvious and hidden leaders among nurse leaders were identified. Conclusion. It is the head of the organization, who is a leader by nature and by his/her actions and at the same time is able to effectively manage his/her subordinates, that achieves high results and achievements of the service s/he leads.

Operationalizing the Vision: Collaboration With the Chief Nursing Officer.

Operationalizing the Vision: Collaboration With the Chief Nursing Officer.

A renewed focus on school nursing

Sallyann Sutton shares the Chief Nursing Officer's recent announcement on school nursing and discusses the importance of clearly articulating the role and changes to practice.

Developing Leaders and Fighting Burnout: An Interview With Sharon Pappas.

This year, Sharon Pappas, PhD, RN, NEA-BC, FAAN, Chief Nurse Executive (CNE) at Emory Healthcare (EHC), Atlanta, Georgia, received the American Organization for Nursing Leadership (AONL) prestigious Lifetime Achievement Award, which honors an AONL member recognized by the nursing community as a significant leader in the nursing profession and who has served AONL in an important leadership capacity. As CNE of Georgia's largest healthcare system, she leads and supports a Magnet® nursing culture across EHC, with the goal of achieving Magnet designation for the entire EHC system. Dr Pappas was commended for her leadership in leading the EHC incident command during COVID-19 where she focused on providing exceptional patient care and supporting clinical nurses caring for critically ill patients.

P08 Preventing and managing urinary tract infections: using thematic analysis to explore interventions and strategies implemented by NHS commissioning organizations in English primary care, 2017–22

Abstract Objectives To identify and explore strategies, interventions and activities used by English Clinical Commissioning Groups (CCGs) to improve prevention and management of urinary tract infections (UTIs) from 2017–22. Methods Online questionnaires were sent to primary care chief nurses and medicines optimization leads via regional infection prevention control (IPC) and antimicrobial stewardship (AMS) leads August–September 2022. Qualitative data were mapped to the Theoretical Domains Framework. Results Response rate was 14.1% (56/397 participants approached), with representation from 29.2% (31/106) English CCGs. Respondents provided 201 examples of UTI interventions. Themes identified included: (i) populations and settings; (ii) aspects of UTI targeted; (iii) types and functions of interventions and activities; (iv) resources, tools and policies; and (v) implementation strategies. Education and training were the most used type of intervention, while changing the environment to facilitate ideal behaviours was the least used intervention type. Most interventions targeted general practice staff and patients accessing primary care, followed by care home staff and residents and their families. The most used success measures included reduction in antibiotic prescribing (54.5%, 97/178 intervention examples); positive feedback from stakeholders (42.1%, 75/178); and increased adherence to national diagnostic guidelines (32.6%, 58/178). However, 48.8% (20/41) stated their team’s UTI activities had not been evaluated, indicating that success was determined using informal data or perceived outcomes. Barriers to implementation of UTI interventions included: lack of resources and time; low staff engagement, inaccurate data due to lack of clinical coding; inconsistent systems and processes; and lack of dedicated roles. Facilitators to implementation included: availability of tools; financial incentives; multidisciplinary collaboration; sharing of information; staff motivation; embedding resources into systems; digitalization; and dedicated roles. Conclusions Multidisciplinary teams and cross-sector collaboration are key facilitators for implementation of UTI interventions. Although some teams are already using robust success measures, there is a need to improve how interventions are evaluated to inform resource allocation and planning. Education and training interventions should address or leverage the barriers and facilitators identified, including clinical coding skills, embedding resources and tools into existing systems and auditing adherence to diagnostic and antibiotic prescribing guidance. There may be missed opportunities for intervention types that are less widely used e.g. changing environmental factors.

Exploration of System Chief Nurse Executive's Leadership Practices to Support, Mentor, Develop, and Retain Nurse Leaders.

In 2019, the National Academy of Science identified clinician burnout as a growing public health concern. The COVID-19 pandemic has only compounded this crisis and transformed it into an escalating fracture within the US health care system. Concurrently evolving with this emergency is a rise in the number of nurses who intend to leave the profession. Frontline nurse leaders are the lynchpin in ensuring health care systems function. These leaders have accountability over patient care and clinician well-being. Focused efforts must address clinician burnout. However, without addressing the well-being of frontline nurse leaders, the fault line in our health care system becomes a vast chasm. Recently, published literature began to emerge describing and addressing frontline clinician burnout. Unfortunately, only a few, if any, address issues related to leaders. The aim of this qualitative case study research was to explore and discover general themes in system chief nurse executive leadership practices that support, mentor, develop, and retain nurse leaders as a basis for future research. Three major themes were identified for future study and exploration: enhancing leadership development programs; improving leader work environments; and focusing on leader well-being and support. Further research is needed to evaluate the effectiveness of these themes.