Chief Nursing Officer Research Articles

Leveraging technology to prepare for a successful Magnet® virtual site visit

Magnet Site Visits are part of the comprehensive review process for organizations seeking the American Nurses Credentialing Center’s (ANCC) prestigious Magnet® recognition for nursing excellence. In 2021, the ANCC’s Magnet Recognition Program® began offering the option for an onsite or Virtual Site Visit (VSV) for domestic and international organizations. These visits are the culmination of years of work that showcase the best in nursing practice and interprofessional collaboration. Chief Nursing Officers (CNOs) and Magnet Program Directors (MPDs) collaborate to strategically plan these visits. This article will describe a Magnet® recognized community hospital’s preparation for a VSV during the height of the COVID-19 pandemic. It will include development of partnerships with Information Technology Specialists, planning and logistics for meetings, development and implementation of a comprehensive education plan, and the overall orchestration of a VSV. Strategies will address the engagement of nurses and leaders amidst the challenges of the COVID-19 pandemic. With strategic planning, effective change management, and the adoption of technology, MPDs may gain confidence to facilitate a Magnet Site Visit virtually or in-person.

Developing a pre-course workbook for advanced practice students in the UK.

British Journal of NursingVol. 32, No. 4 CommentDeveloping a pre-course workbook for advanced practice students in the UKAnna Jones, Colette Henderson, Jonathan Thomas, Angie Banks, Melanie RogersAnna JonesE-mail Address: [email protected]PGT Director for Learning and Teaching, Cardiff University and Deputy Chair Association of Advanced Practice Educators UK (AAPE UK)Search for more papers by this author, Colette HendersonProgramme Lead MSc Advanced Practice, University of Dundee and Chair Scottish Advanced Practice Educators Network (SAPEN)Search for more papers by this author, Jonathan ThomasProgramme Director MSc Advanced Practice, Swansea University and Chair Wales Advanced Practice Educators Network (WAPEN)Search for more papers by this author, Angie BanksProgramme lead MSc Advanced Clinical Practice, Sheffield Hallam UniversitySearch for more papers by this author, Melanie RogersProfessor of Advanced Practice, University of HuddersfieldSearch for more papers by this authorAnna Jones; Colette Henderson; Jonathan Thomas; Angie Banks; Melanie RogersPublished Online:24 Feb 2023https://doi.org/10.12968/bjon.2023.32.4.224AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Department of Health and Social Security. Neighbourhood nursing: a focus for care. Report of the Review of Community Nursing chaired by J Cumberlege. London: HMSO; 10986 Google ScholarDepartment of Health, Social Services and Public Safety. Advanced nursing practice framework. 2016 (revised version of document first published 2014). https://www.health-ni.gov.uk/publications/advanced-nursing-practice-framework (accessed 13 February 2023) Google ScholarGloster A, Leigh J. The knowledge and skills required of advanced level practitioners for accreditation and safe practice. Br J Nurs. 2021;30(3):168-171. https://doi.org/10.12968/bjon.2021.30.3.168 Link, Google ScholarHealth Education England. Multi-professional framework for advanced clinical practice in England. 2017. https://www.hee.nhs.uk/sites/default/files/documents/multi-professionalframeworkforadvancedclinicalpracticeinengland.pdf (accessed 13 February 2023) Google ScholarInternational Council of Nurses. Guidelines on advanced practice nursing. 2020. https://tinyurl.com/5asnjbrx (accessed 14 February 2023) Google ScholarLeary A, MacLaine K, Trevatt P, Radford M, Punshon G. Variation in job titles within the nursing workforce. J Clin Nurs. 2017; 26(23-24): 4945-4950. https://doi.org/10.1111/jocn.13985 Crossref, Medline, Google ScholarNational Leadership and Innovation Agency for Healthcare. Framework for Advanced Nursing, Midwifery and Allied Health Professional Practice in Wales. 2010. https://heiw.nhs.wales/files/weds-introducing-advanced-practice/nliah-advanced-practice-framework/ (accessed 13 February 2023) Google ScholarNHS Education for Scotland. Advanced practice toolkit. 2018. https://www.advancedpractice.scot.nhs.uk (accessed 13 February 2023) Google ScholarPhillips SJ. 30th Annual APRN legislative update: Improving access to healthcare one state at a time. Nurse Pract. 2018;43(1):27-54. doi: https://doi.org/10.1097/01.NPR.0000527569.36428.ed Crossref, Medline, Google ScholarRogers M, Gloster A. Advanced practice nursing in the UK. In: Hassmiller SPulcini J (eds). Advanced practice nursing leadership: a global perspective. Springer; 2020 Crossref, Google ScholarScottish Government. Transforming Nursing Midwifery and Health Professions' (NMaHP) Roles: Paper 2 Advanced Nursing Practice. Chief Nursing Officer Directorate. 2017. https://www.gov.scot/publications/transforming-nursing-midwifery-health-professions-roles-advance-nursing-practice/ (accessed 13 February 2023) Google Scholar FiguresReferencesRelatedDetails 23 February 2023Volume 32Issue 4ISSN (print): 0966-0461ISSN (online): 2052-2819 Metrics History Published online 24 February 2023 Published in print 23 February 2023 Information© MA Healthcare LimitedPDF download

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.

Starting Now: Implementing the Healthy Work Environment Standards Is More Important Than Ever

Starting Now: Implementing the Healthy Work Environment Standards Is More Important Than Ever

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.

Work family conflict, family work conflicts and work-related quality of life: The effect of rotating versus fixed shifts.

This study examined the difference between rotating and fixed shift schedules on work-family conflict, family-work conflict and work-related quality of life. There is a lack of evidence regarding the effect of rotating shifts on work-family conflict, family-work conflict and work-related quality of life among nurses. A cross-sectional design was used to conduct this study. Data were collected from 216 nurses using the Work and Family Conflict Scale and Work-Related Quality of Life. Bivariate correlations and independent samples t-tests were performed. The results of the current study were reported using the STROBE checklist. Bivariate correlations showed that work-related family quality of life is negatively associated with work-family and family-work conflicts. The mean differences between the two groups (rotating and fixed shifts) were significant for all three variables: work-family conflicts, family-work conflicts and work-related quality of life. Rotating shifts are associated with an increased risk of experiencing work-family and family-work conflicts and decreasing their quality of working life, which may adversely affect the quality of care provided. The effect of shift types on nurses and how rotating shifts have more severe consequences on nurses should be considered. Nurse managers are encouraged to use the findings of this study to mitigate the risk of any work-family or family-work conflicts and improve nurses' work-related quality of life. The chief nursing officers at the data collection settings facilitated direct contact with potential participants and data collection.

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.

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.

Joy Peters, DNP, RN, MSN, MBA, NEA-BC

Joy Peters's inspiration to join the profession of nursing came from the influences of her father as well as the tragic passing of her sister from a car accident. She saw firsthand how the nurses who cared for her sister, as well as for them as a family, impacted her through the kindness, compassion, and support they provided to them as a family unit. She had several mentors who shaped her professionally, guiding her to a path of nursing leadership. She has a passion for patients and is an advocate for patient experience. She led her organization to achieve prestigious ANCC Magnet Recognition®, which they were able to navigate during the pandemic which is even more inspiring. Joy is currently the chief nursing officer (CNO) for both Jefferson Hospital as well as Canonsburg Hospital part of the Allegheny Health Network in Pittsburgh, Pennsylvania.

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.

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.

Reducing Indwelling Urinary Catheter Utilization Results in Reduction of Associated Urinary Tract Infections

<h3>Background</h3> Catheter Associated Urinary tract infections (CAUTIs) are the fifth most common type of healthcare-associated infection (HAI), resulting in increased morbidity/mortality. The most important risk factor for developing a CAUTI is prolonged use of indwelling urinary catheters (IUCs). One of the strategies to prevent a CAUTI is to reduce IUC utilization. During the 12-month period from July 2019 through June 2020, the CAUTI Standard Infection Ratio (SIR) for our Medical Center was 1.86 with 21 observed cases. The Standard Utilization Ratio (SUR) was 0.89. <h3>Methods</h3> A Plan Do Study Act (PDSA) cycle was used in this performance improvement project. In order to address high CAUTI incidences, a multi-disciplinary performance improvement task force composed of nursing directors, physicians, infection prevention, and the supply chain was initiated in August 2020. The Chief Medical Officer, Chief Nursing Officer and Chief Operating Officer highlighted the gravity of the situation at every team meeting. One action taken was the initiation of the "Holy Moley Remove That Foley" campaign. The purpose of the campaign was to review appropriateness of IUCs during daily multi-disciplinary rounds using "IUC appropriateness checklist" and complete the "IUC insertion checklist" prior each IUC insertion house-wide including the Emergency Department. Bladder scans were encouraged to assess for retention and to follow a nurse driven protocol to use external urinary devices. The hospital's education department provided education and ongoing competency evaluations during this campaign. <h3>Results</h3> The actions above resulted in SIR of 0.58, SUR of 0.71 and 7 incidences during July 2020 through June 2021. This is a statistically significant SIR reduction with two-tailed t test, p value of 0.0049. <h3>Conclusions</h3> By engaging a multi-disciplinary team that includes non-nursing departments, a significant reduction in CAUTIs was achieved. This project highlights that the involvement of several disciplines is needed to prevent HAIs.

A vision for nursing research.

Sam Foster, Chief Nurse, Oxford University Hospitals, considers the challenges for institutions in picking up the Chief Nursing Officer's strategy for nursing involvement in research.

Working together to promote and celebrate the diversity of nursing.

This year has been particularly challenging for nurses around the world. As the commemorations take place for International Nurses Day on 12 May, the Chief Nursing Officer for Scotland and Chief Nursing Officer for Wales share their priorities and hopes for the coming year.

Development Practices in Senior Nursing and Midwifery Leadership: Pathways to Improvement in South Pacific Health Policy.

The Pacific Islands countries consist of thousands of isolated islands with a combined population of over 10 million people. It is a heterogeneous and diverse region culturally, linguistically economically and politically. Health challenges are considerable and healthcare systems are often overstretched. Framed in the context of the World Health Organisation's strategic directions and policy priorities, this paper describes an account of collaboration across these countries to develop leadership skills in the nursing and midwifery professions. It outlines lessons for nursing leadership, healthcare policy development and the valuable role of Government Chief Nursing and Midwifery Officers. The South Pacific Chief Nursing and Midwifery Officers Alliance (SPCNMOA) is a cooperative partnership, which was formed to improve the quality of healthcare in the region. It acts as an enabler to promote leadership skills and provide a safe space for learning, developing policy and the sharing of good practice. Through mentorship programs, international meetings and strong relationship-building, the SPCNMOA has strengthened partnerships within the region and improved community health services in even the most remote areas. By strengthening leadership and collaboration, these health professionals are now recognised by key policy makers as knowledgeable experts who have a legitimate role in guiding policy development, changing practice and delivering health policy improvements at local, country and international levels.

Nursing Leadership in Rural Hospitals: A Competency Needs Assessment

Purpose: Assess competence and competency needs of nursing leadership in rural hospitals located in the Alabama Black Belt Region. Determine the preferred method of continuing education to meet those identified competency needs. Sample: A purposeful sample of registered nurses currently working in leadership roles identified by the Chief Nursing Officer as nurse manager or nursing directors in a participating rural hospital within the Alabama Black Belt Region. Method: A pilot study using descriptive statistical analysis to assess competency needs of nursing leadership and preferred method of educational delivery through email survey and Likert-style questions. For purposes of recruitment, Chief Nursing Officers were personally introduced to the purpose and design of the study and asked to distribute the email survey to their staff. Descriptive statistics analysis was used to examine role preparation and experience of nurse managers and mean self-rated competency scores. Bivariate correlations were examined exploring relationships between nurse manager experience, education, and competency. Findings: Statistically significant at p=0.031, participants with &lt;5 years of experience reported non-proficiency in their knowledge of quality improvement strategies and non-proficiency in their ability to lead multi-generational work teams as compared to those with &gt; 5 years of experience who reported proficiency, p=0.026. Conclusions: In an environment where constant change and quality drive organizational success, nurse leaders with &lt; 5 years of experience are not proficient in managing multi-generational work teams or in understanding or managing focused quality improvement strategies to monitor, analyze, and improve the quality of patient care processes to improve the healthcare outcomes in an organization. Realizing that more than 50% of the current nursing leadership has &lt; 5 years of experience these findings would suggest that leading and managing, striving for clinical excellence in a diverse workforce would be difficult if not impossible to achieve. Keywords: Rural Hospital, Competency, Leadership, Needs Assessment, Nurse Manager DOI: https://doi.org/10.14574/ojrnhc.v22i1.701

Encouraging and Facilitating Research Opportunities for Advanced Practice Registered Nurses: The Role of the Chief Nursing Officer.

This month's column highlights the value contribution of advanced practice registered nurses (APRNs) to research and the importance of chief nursing officer development of health system infrastructure to engage APRNs in research.

Chief Nursing Officers: Their COVID-19 Experience.

The purpose of this study was to describe the experience of chief nursing officers (CNOs), including leadership strategies that they developed as they encountered the administrative challenges posed by COVID-19. The COVID-19 pandemic required CNOs to make difficult decisions and to support nursing staff as they cared for critically ill and dying patients, and therefore, they experienced intense stress during a pandemic of a highly infectious disease. Understanding the challenges that CNOs faced in this crisis will help hospitals and CNOs to better prepare for the future. Using a descriptive qualitative approach, we conducted interviews with 9 CNOs from hospitals across the United States. The goal of the interviews was to develop an understanding of the difficulties that these CNOs encountered during the COVID-19 pandemic and their emotional response to the challenging situations. Themes of frustration, heartbreak, and feeling overwhelmed, exhausted, and helpless were revealed. In addition, pride in being a nurse was expressed. Themes revealed in this study suggested intentional leadership strategies that would be useful in future healthcare crises.

Erik Martin, DNP, RN, CENP

Erik Martin, DNP, RN, CENP

The Roles Chief Nursing Officers Play in the Provision of In-Service Education in Hospitals with Fewer Than 300 Beds

The Roles Chief Nursing Officers Play in the Provision of In-Service Education in Hospitals with Fewer Than 300 Beds