Nurse Executives Research Articles

Maureen Swick, RN, MSN, PhD, NEA-BC

Dr. Maureen Swick began her nursing career by earning her associate degree in nursing from Brookdale Community College and BSN from Monmouth University. She has worked as a staff nurse and clinical nurse specialist, and held various leadership positions, including chief nursing officer and chief operating officer. Dr. Swick currently serves as the system chief nurse executive for Inova, the largest not-for-profit health care provider in the Washington, DC, area. Dr. Swick earned her MSN from Columbia University and her PhD from Kennedy Western University. She is a strong nurse advocate and leader, and is committed to transforming the nursing profession. Dr. Swick possesses expertise in optimizing clinical operations, strategic planning, organizational development, critical decision making, and transformational leadership. She has recently developed and implemented a patient-centered care delivery model within the Inova system that was featured by the advisory board in 2014. Dr. Swick served on the American Hospital Association (AHA) board, representing the American Organization of Nurse Executives (AONE) from 2012 to 2014. She is a member of numerous professional organizations, including the American Nurses Association; the American College of Healthcare Executives; AONE, where she served on the Region 2 board of directors for 2 years; and the Organization of Nurse Executives of New Jersey, where she spent 13 years as a board member including president. Dr. Swick brings this wealth of experience in to her new role as president of AONE beginning in 2016. Dr. Swick has been married for 30 years and has 4 children. One of her daughters is an RN, and one of her sons is in school pursuing a career in nursing as well. Her current position is senior vice president, chief nurse executive of Inova Health System.

Keeping the Center: Leadership Resilience Through Shared Learning

In 2015, the American Organization of Nurse Executives (AONE) launched the inaugural Nurse Director Fellowship. The fellowship is a year-long professional development program designed to provide an immersive educational experience for nurse directors. The only program of its kind, the Nurse Director Fellowship strives to support the Institute of Medicine's Future of Nursing report's recommendation to prepare and enable nurses to lead change to advance health. The core curriculum focuses on strengthening leadership, enhancing the ability to lead change, developing innovative strategies for addressing challenges in the health care system, and the need for continued life-long learning to sustain the next generation of successful nurse executives. Experts in health care and other fields, including leadership, influence, and advocacy, offer a robust action learning environment. Diverse, shared learning experiences are utilized to strengthen leadership skills over multiple domains. Throughout sessions, participants are challenged to push boundaries, get out of their comfort zone, and allow themselves to become vulnerable within the group. Through shared learning, they develop leadership resilience to withstand the challenges that lie ahead. In 2015, the American Organization of Nurse Executives (AONE) launched the inaugural Nurse Director Fellowship. The fellowship is a year-long professional development program designed to provide an immersive educational experience for nurse directors. The only program of its kind, the Nurse Director Fellowship strives to support the Institute of Medicine's Future of Nursing report's recommendation to prepare and enable nurses to lead change to advance health. The core curriculum focuses on strengthening leadership, enhancing the ability to lead change, developing innovative strategies for addressing challenges in the health care system, and the need for continued life-long learning to sustain the next generation of successful nurse executives. Experts in health care and other fields, including leadership, influence, and advocacy, offer a robust action learning environment. Diverse, shared learning experiences are utilized to strengthen leadership skills over multiple domains. Throughout sessions, participants are challenged to push boundaries, get out of their comfort zone, and allow themselves to become vulnerable within the group. Through shared learning, they develop leadership resilience to withstand the challenges that lie ahead.

Creative Careers in Retirement: Nurse Executive to Medical Mystery Author

Creative Careers in Retirement: Nurse Executive to Medical Mystery Author

Nurse Manager Competencies Supporting Patient Engagement.

Patient engagement is an important element in transitioning care delivery to achieve population health management goals. Providers are challenged to develop care delivery processes that better engage patients in their life journey across the healthcare continuum. Nurse leaders are central to this process. Building upon the American Organization of Nurse Executives competencies for nurse executives, the nurse manager role requires specific skills to translate the vision of patient engagement into practice.

Patient and Family Engagement Summit: Needed Changes in Clinical Practice.

Patient and family engagement is a strategy to enhance healthcare outcomes through strong clinician-patient partnerships. A new care delivery process, in which the patient is the driver of the healthcare team, is required to achieve optimal health. A summit partially funded by a seed grant from the Robert Wood Johnson Executive Nurse Fellow Alumni Foundation was held with interprofessional colleagues and patient representatives to identify needed clinical competencies and future practice changes. Recommended shifts in the care delivery process included a focus on patient strengths, including the patient as a valued team member, doing care "with me" and not "to me," and considering all entities or providers including the patient, as equal partners.

Peer coaching for nurse managers.

Peer coaching for nurse managers.

Avoiding Adverse Events Secondary to Opioid-Induced Respiratory Depression: Implications for Nurse Executives and Patient Safety.

Guidelines with recommendations for monitoring type and timing of hospitalized patients for opioid-induced respiratory depression have been published, yet adverse events continue to occur. This study reports on the monitoring practices of 8 hospitals that volunteered to pilot test a Centers for Medicare & Medicaid Services e-quality measure that was under development. Recommendations for nurse executives are provided to support patient safety. Data on monitoring practices were collected retrospectively from the electronic medical records at 8 hospitals on all patients receiving intravenous (IV) opioids for more than 2.5 continuous hours via patient-controlled analgesia (PCA). Analysis included the percentage of patients who were monitored according to specific standards developed by a panel of technical experts with comparisons of naloxone use to monitoring practices. Recommended patient assessments occurred in only 8.3% of the patients. No patients who were assessed at least every 2.5 hours received naloxone. Care for patients receiving IV PCA is lacking in adherence to latest safety standards. Nurse executives must implement structures and processes to promote vigilance with evidence-based monitoring practices.

Aligning Healthcare Safety and Quality Competencies: Quality and Safety Education for Nurses (QSEN), The Joint Commission, and American Nurses Credentialing Center (ANCC) Magnet® Standards Crosswalk

There is little to no improvement in the quality of patient care since the publication of To Err Is Human report in 1999 by the Institute of Medicine. Health care provider education must address quality and patient safety language in order to meet the demands of the 21st century. Academic institutions focus on the quality and safety language as outlined by the Quality and Safety Education for Nurses (QSEN). Conversely, hospitals emphasize competencies and standards as outlined in The Joint Commission accreditation standards and the American Nurses Credentialing Center Magnet® competencies. Nurse leaders need a crosswalk among all 3 standards that can help guide their practice. The crosswalk can help nurse leaders have an increased understanding of the role that QSEN plays in educating a competent and safe nursing workforce.

Engaging Frontline Staff in Performance Improvement: The American Organization of Nurse Executives Implementation of Transforming Care at the Bedside Collaborative

Process improvement stresses the importance of engaging frontline staff in implementing new processes and methods. Yet questions remain on how to incorporate these activities into the workday of hospital staff or how to create and maintain its commitment. In a 15-month American Organization of Nurse Executives collaborative involving frontline medical/surgical staff from 67 hospitals, Transforming Care at the Bedside (TCAB) was evaluated to assess whether participating units successfully implemented recommended change processes, engaged staff, implemented innovations, and generated support from hospital leadership and staff. In a mixed-methods analysis, multiple data sources, including leader surveys, unit staff surveys, administrative data, time study data, and collaborative documents were used. All units reported establishing unit-based teams, of which >90% succeeded in conducting tests of change, with unit staff selecting topics and making decisions on adoption. Fifty-five percent of unit staff reported participating in unit meetings, and 64%, in tests of change. Unit managers reported substantial increase in staff support for the initiative. An average 36 tests of change were conducted per unit, with 46% of tested innovations sustained, and 20% spread to other units. Some 95% of managers and 97% of chief nursing officers believed that the program had made unit staff more likely to initiate change. Among staff, 83% would encourage adoption of the initiative. Given the strong positive assessment of TCAB, evidence of substantial engagement of staff in the work, and the high volume of innovations tested, implemented, and sustained, TCAB appears to be a productive model for organizing and implementing a program of frontline-led improvement.

A Study of Chief Nurse Executives Indicates Low Prioritization of Evidence-Based Practice and Shortcomings in Hospital Performance Metrics Across the United States

Although findings from studies indicate that evidence-based practice (EBP) results in high-quality care, improved patient outcomes, and lower costs, it is not consistently implemented by healthcare systems across the United States and globe. The purpose of this study was to describe: (a) the EBP beliefs and level of EBP implementation by chief nurse executives (CNEs), (b) CNEs' perception of their hospitals' EBP organizational culture, (c) CNEs' top priorities, (d) amount of budget invested in EBP, and (e) hospital performance metrics. A descriptive survey was conducted. Two-hundred-seventy-six CNEs across the United States participated in the survey. Valid and reliable measures included the EBP Beliefs scale, the EBP Implementation scale, and the Organizational Culture and Readiness scale for EBP. The Centers for Medicare and Medicaid Services Core Measures and the National Database of Nursing Quality Indicators (NDNQI) were also collected. Data from this survey revealed that implementation of EBP in the practices of CNEs and their hospitals is relatively low. More than one-third of the hospitals are not meeting NDNQI performance metrics and almost one-third of the hospitals are above national core measures benchmarks, such as falls and pressure ulcers. Although CNEs believe that EBP results in high-quality care, it is ranked as a low priority with little budget allocation. These findings provide a plausible explanation for shortcomings in key hospital performance metrics. To achieve higher healthcare quality and safety along with decreased costs, CNEs and hospital administrators need to invest in providing resources and an evidence-based culture so that clinicians can routinely implement EBP as the foundation of care.

The Big Data Revolution: Opportunities for Chief Nurse Executives

Informatics competency adoption is a recognized issue across nursing roles in digital health practice settings. Further, it has been suggested that the health system's inability to reap the promised benefits of electronic health/patient records is, in part, a manifestation of inadequate development of informatics competency by chief nurse executives (CNEs) and other clinicians (Amendola 2008; Simpson 2013). This paper will focus on CNE informatics competency and nursing knowledge development as it pertains to the Big Data revolution. With the paper's aim of showing how CNEs armed with informatics competency can harness the full potential of Big Data offering new opportunities for nursing knowledge development in their clinical transformation roles as eHealth project sponsors. It is proposed that informatics-savvy CNEs are the new transformational leaders of the digital age who will have the advantage to successfully advocate for nurses in leading 21st-century health systems. Also, transformational CNEs armed with informatics competency will position nurses and the nursing profession to achieve its future vision, where nurses are perceived by patients and professionals alike as knowledge workers, providing the leadership essential for safe, quality care and demonstrating nursing's unique contributions to fiscal health through clinically relevant, evidence-based practices (McBride 2005b).

To Our Readers

Process improvement stresses the importance of engaging frontline staff in implementing new processes and methods. Yet questions remain on how to incorporate these activities into the workday of hospital staff or how to create and maintain its commitment. In a 15-month American Organization of Nurse Executives collaborative involving frontline medical/surgical staff from 67 hospitals, Transforming Care at the Bedside (TCAB) was evaluated to assess whether participating units successfully implemented recommended change processes, engaged staff, implemented innovations, and generated support from hospital leadership and staff.In a mixed-methods analysis, multiple data sources, including leader surveys, unit staff surveys, administrative data, time study data, and collaborative documents were used.All units reported establishing unit-based teams, of which > 90% succeeded in conducting tests of change, with unit staff selecting topics and making decisions on adoption. Fifty-five percent of unit staff reported participating in unit meetings, and 64%, in tests of change. Unit managers reported substantial increase in staff support for the initiative. An average 36 tests of change were conducted per unit, with 46% of tested innovations sustained, and 20% spread to other units. Some 95% of managers and 97% of chief nursing officers believed that the program had made unit staff more likely to initiate change. Among staff, 83% would encourage adoption of the initiative.Given the strong positive assessment of TCAB, evidence of substantial engagement of staff in the work, and the high volume of innovations tested, implemented, and sustained, TCAB appears to be a productive model for organizing and implementing a program of frontline-led improvement.

Nurse Executive Leadership During Organizational Mergers.

The recent growth in hospital mergers and the resultant mergers of nursing service departments (NSDs) have produced a need for chief nursing officers (CNOs) to be aware of implications and anticipated dynamic changes. This article addresses the major issues raised by mergers for NSDs and presents an operational step-by-step checklist for CNOs.

Leadership Skills: New Nurse to Nurse Executive

Nursing careers are plentiful! Today’s nurses have the ability to move through hospital systems, outpatient surgery centers and clinics, educational systems, government health care, community health settings, and multiple advanced practice nursing specialties. Leadership opportunities are also abundant with the ever-changing health care system. Regardless of the chosen path, leadership skills remain essential to your success. From novice to expert, mentorship is vital. Leadership role models remain pivotal to future success as a nursing leader. Identifying potential leaders, even amongst novice nurses, guide gifted individuals to graduate education and beyond. As well, identification and guidance of individuals provide strong motivation to gain new knowledge and glean skills consistent with strong nursing leadership. Nursing careers are plentiful! Today’s nurses have the ability to move through hospital systems, outpatient surgery centers and clinics, educational systems, government health care, community health settings, and multiple advanced practice nursing specialties. Leadership opportunities are also abundant with the ever-changing health care system. Regardless of the chosen path, leadership skills remain essential to your success. From novice to expert, mentorship is vital. Leadership role models remain pivotal to future success as a nursing leader. Identifying potential leaders, even amongst novice nurses, guide gifted individuals to graduate education and beyond. As well, identification and guidance of individuals provide strong motivation to gain new knowledge and glean skills consistent with strong nursing leadership.

Roxane Spitzer, PhD, RN, MBA, MA, FAAN

It is my privilege to interview a great nurse leader, mentor and colleague; Dr. Roxane Spitzer. Dr. Spitzer has had a long and stellar career leaving her "footprint" on the profession of nursing and healthcare administration. She has mentored many nurses as they progressed on their career track. I know you will enjoy hearing about her and hearing from her leadership journey as she answers my interview questions.

The ICN-Burdett Global Nursing Leadership Institute Creates Outstanding World Class Nurse Executives

In order for nurse executives to excel in this century as leaders, they have to be global citizens and have a passion for caring for the world’s populations. As global citizens, nurse executives must have certain competencies that are global in nature such as external awareness, policy development and political skills, influence and negotiation, to name a few. Nurse executives who are globally aware understand how external factors affect the world, the nation, the organization and its future from a political, economic, social and health perspective. Nurse executives with a global lens are informed on international and national laws, policies and priorities and they use this information for planning purposes, policy development, and decision-making. These nurse executives are oriented to client and population needs; they develop superb skills in global environmental scanning and analysis and are abreast of all aspects of political, economic, and social trends worldwide. They also know how to build and maintain networks, coalitions, and alliances. Nurse executives who are global citizens are masters in creating and maintaining networks. Simply put, nurse executives who are global citizens are strategic thinkers and planners who shape, lead, and sustain global health, education, and social policies. They are outstanding policy developers and politically astute. These nurse leaders are at the top of their game and highly sought out for their expertise, not only in their nations, but also by a variety of organizations and key stakeholders worldwide. In order for nurse executives to excel in this century as leaders, they have to be global citizens and have a passion for caring for the world’s populations. As global citizens, nurse executives must have certain competencies that are global in nature such as external awareness, policy development and political skills, influence and negotiation, to name a few. Nurse executives who are globally aware understand how external factors affect the world, the nation, the organization and its future from a political, economic, social and health perspective. Nurse executives with a global lens are informed on international and national laws, policies and priorities and they use this information for planning purposes, policy development, and decision-making. These nurse executives are oriented to client and population needs; they develop superb skills in global environmental scanning and analysis and are abreast of all aspects of political, economic, and social trends worldwide. They also know how to build and maintain networks, coalitions, and alliances. Nurse executives who are global citizens are masters in creating and maintaining networks. Simply put, nurse executives who are global citizens are strategic thinkers and planners who shape, lead, and sustain global health, education, and social policies. They are outstanding policy developers and politically astute. These nurse leaders are at the top of their game and highly sought out for their expertise, not only in their nations, but also by a variety of organizations and key stakeholders worldwide.

Creating Supportive Environments and Thriving in a Volatile, Uncertain, Complex, and Ambiguous World.

Nurse executives (NEs) are operating in a volatile, uncertain, complex, and ambiguous world. NEs must create supportive environments that promote staff empowerment, resilience, and alignment, to ensure organizational success. In addition, NEs need to be transparent and create a culture of partnership with their staff. The ability of NEs to create and sustain this environment is vital in supporting teams to successfully navigate in today's healthcare environment.

Shared Governance and Rapid Response Teams Beyond Clinical Practice: The Nurse Executive Advisory Cabinet

Nurses have continuously met challenges and adapted to change within an environment that is in constant flux. Given the need to transform care models and systems to respond to healthcare reform while balancing the quality and cost equation, nurses are working within a rule- and policy-imposing structure that profoundly affects their level of control over nursing practice (CONP) and engagement. Nurses are challenged to work in an environment in which the pressure to add value, optimize resources, and decrease expenses is moving at a faster pace than the work to transform the clinical delivery model and workflow. Consequently, this may result in a decreased sense of autonomy and overall CONP, augmenting the case for change. This sense of urgency, the need to find new solutions to old problems, presents an opportunity to creatively re-engage nurses in a greater breadth (i.e., type and level of involvement) of decision making and influence over practice and the context in which care is delivered.

What Does It Mean to Be Part of a System? The Role of the Chief Nurse Executive and Shared Governance

As the healthcare system landscape continues to evolve toward more integrated care, a trend of consolidating hospitals into larger systems continues. The systems are more than the traditional hospital-centric structures, as acute care becomes just 1 component in a larger system that includes ambulatory care, acute and post-acute care, chronic disease, end-of-life management, and all structures inbetween. 1

Designing Tomorrow: Rewriting the Nurse Executive Script for an Emerging Stage.

As nurse executives (NEs), we are aware of our emerging, expanding roles as single settings, whether hospitals, clinics, or other entities, are morphing into components of whole systems. We are challenged to focus appropriate attention inward to ensure that nursing is positioned to lead while extending ourselves outward, to participate in shaping new systems. This month, we will shine the spotlight on these transitions, identifying some of the triumphs and challenges, in a conversation with Donna King, an NE with Advocate Health Care in Illinois.