Nursing Leadership Team Research Articles

The Clinical Nurse Leader and Rural Hospital Safety and Quality

Rural healthcare organizations face significant challenges when implementing quality and safety initiatives due to limited human and financial resources. The Clinical Nurse Leader (CNL), a new nursing role developed to address the quality and safety concerns of healthcare organizations and providers, may prove to be an exceptionally valuable member of the rural nursing leadership team. Educationally prepared to assume nine roles (expert generalist clinician, outcomes manager, advocate, healthcare team leader, information manager, educator, member of a profession, and life-long learner) the CNL is well prepared to function as a valuable member of the rural health care team. Through the use of the microsystem assessment process, the CNL can lead quality and safety initiatives specific to meet the unique needs of rural health care organizations, providers, and patients.

Practice and experience of the establishment of nurse team leaders in the hierarchical management

Objective To explore the feasibility of the establishment of nurse team leaders in the hierarchical management. Methods Eight nurses were assigned as nurse team leaders in eight surgeon wards. To ensure the quality of nursing, we established the hierarchical management mode of Head nurse-nurse team leader -primary nurse, made the nurse team leader or monitor take charge of the secondary nursing quality control networks, and brought the nurse quality control work forward. Results The patient' s satisfaction to nursing service increased significantly after nurse team leader system. Conclusions The hierarchical management reflects a patient-centered philosophy, makes full use of nursing staff at all levels, and it is beneficial to arrangt human resource and talent cultivation, it can make the implementation of the hierarchical management better and promote the nursing professional development. Key words: Head nurse-nurse team leader; Hierarchical management

Engaging the Nursing Workforce: A Hospital's Approach to Linking Best Practices with Positive Outcomes

The nursing leadership team at Northwest Texas Healthcare System (NWTHS), a 489-bed, for-profit organization, introduced a comprehensive process to engage the nursing workforce in response to a 2-year period of flat scores during the 2006–2007 annual Gallup Employee Engagement survey. In addition, our nursing engagement scores were lower than all other departmental scores for the facility, the parent corporation's scores, and comparable institutions that use the Gallup survey. As a result of this trend, we implemented a variety of strategies to improve the engagement of the nursing workforce. The process includes using the facility's employee opinion survey to isolate the problems, building initiatives at the unit and executive level, and holding the process together through individual manager accountability.

Data-Driven Systems for RN Autonomy

In early 2005, as the nursing leadership team began to develop final action plans for our Magnet™ application, it became evident to us that we had concerns with our nursing staff's recognition of their professional role responsibilities. Staff appeared to be focused on tasks at hand and less focused on coordinating care based on patient needs. We also heard from our physician colleagues that staff nurses were not always able to articulate a concise report in terms of recognizing changes in a patient's medical condition. The nursing staff appeared to lack a true understanding of their professional responsibilities, first, as a registered nurse (RN) as required by legal scope of practice and second, based on their professional role status. In addition, they lacked understanding of how to translate their professional role into everyday practice. Furthermore, we realized that, as a nursing organization, we had not created an environment of expectation regarding professional RN role performance.

O papel do enfermeiro no contexto hospitalar: a visão de profissionais de saúde

This study attempts to analyze the conceptions surrounding nursing hospital work from the viewpoint of a multiprofessional health care team. The data for this qualitative study resulted from the application of semi-structured interviews, and Thematic Analysis was used for data treatment. Eight health care professionals from a multidisciplinary team in a philanthropic hospital in southern Brazil participated in the study. The results were presented based on four thematic units: relevance of the nurse role in the hospital context, the nursing team leader, the nursing connection element, and nursing action. The performance of the nurse, within the viewpoint of the health care team is revealed through relationships and is pointed to as a communication link among the health care team. The managerial function was that which was most specifically perceived among the research subjects, principally for relationships and interconnections that are established in a care system.

Keeping Up

Information management is a required competency for nurse executives, both for current and future practice. This article describes the chief nursing executive's role in information technology, presents suggestions for maintaining information technology competency, and shares how one hospital devised a simple tool to make information more usable for the nursing leadership team.

Positive effects of electronic patient records on three clinical activities

Purpose To investigate the effects of a fully functional electronic patient record (EPR) system on clinicians’ work during team conferences, ward rounds, and nursing handovers. Method In collaboration with clinicians an EPR system was configured for a stroke unit and in trial use for 5 days, 24 h a day. During the trial period the EPR system was used by all clinicians at the stroke unit and it replaced all paper records. The EPR system simulated a fully integrated clinical-process EPR where the clinicians experienced the system as if all transactions were IT supported. Such systems are not to be expected to be in operational use in Denmark until at least 2 years from now. The EPR system was evaluated with respect to its effects on clinicians’ mental workload, overview, and need for exchanging information. Effects were measured by comparing the use of electronic records with the use of paper records prior to the trial period. The data comprise measurements from 11 team conferences, 7 ward rounds, and 10 nursing handovers. Results During team conferences the clinicians experienced a reduction on five of six subscales of mental workload, and the physicians experienced an overall reduction in mental workload. The physician in charge also experienced increased clarity about the importance of and responsibilities for work tasks, and reduced mental workload during ward rounds. During nursing handovers the nurses experienced fewer missing pieces of information and fewer messages to pass on after the handover. Further, the status of the nursing plans for each patient was clearer for all nurses at the nursing handovers except the nurse team leader, who experienced less clarity about the status of the plans. Conclusion The clinicians experienced positive effects of electronic records over paper records for the three clinical activities involved in the evaluation. This is important in its own right and likely to affect clinicians’ acceptance of EPR systems, their command of their work, and consequently the attainment of ‘downstream’ effects on patient outcomes.

Using the discrete choice experimental design to investigate decision-making about pressure ulcer prevention by community nurses

This study investigates the preferences of senior community nurses who work as district nurse team leaders in selecting preventive care plans for elderly people at high risk of pressure ulcer formation. The discrete choice experiment (DCE) technique was used. Focus group work produced the following five attributes of nurse decision-making: 'ease of care plan management', 'impact of care plan on patient's lifestyle', 'speed of obtaining the equipment', 'affordability', 'evidence-based practice'. These were incorporated into a self-administered questionnaire, posted to 102 nurses from two integrated acute/community NHS Trusts in Wales. A response rate of 55% was achieved. Respondents were asked to rate the importance of the selected attributes on a 5-point scale. They rated 'evidence-based practice', 'impact of care plan on patient's lifestyle', 'ease of care plan management' and 'speed of obtaining the equipment' highly, whereas 'affordability' was of less importance. However, regression analysis, which is part of the DCE technique, produced a somewhat different picture, with 'impact' being least and 'affordability' most statistically significant. The reasons for this apparent anomaly are discussed and the paper concludes that the DCE approach is capable of yielding important information, which is not produced by simple rating exercises. Such information is potentially of value in the context of modernisation and service configuration.

Lessons Learned When Magnet Designation Is Not Received

Magnet designation is the highest level of acknowledgement accorded healthcare organizations in recognition of professional nursing care. After our nursing leadership team attended a Magnet conference in 1998, we were inspired, and so was our staff. In 2004, we submitted our documentation and were notified that it met the criteria, and our site visit was scheduled. We did not receive Magnet designation, but we viewed our experience as an opportunity to learn. The authors describe how a disappointing outcome was turned into an experience of great learning and transformation.

Do our HCAs need job descriptions as well as contracts?

I am a practice nursing team leader and have been asked to manage two health care assistants (HCAs). Although they have been with the practice for some time and have contracts of employment, I've noticed that they do not have job descriptions. Do I need to provide them with one and, if so, what should it cover?

Building the capacity for evidence-based clinical nursing leadership: the role of executive co-coaching and group clinical supervision for quality patient services

The general aims of this article were to facilitate primary care nurses (District Nurse Team Leaders) to link management and leadership theories with clinical practice and to improve the quality of the service provided to their patients. The specific aim was to identify, create and evaluate effective processes for collaborative working so that the nurses' capacity for clinical decision-making could be improved. This article, part of a doctoral study on Clinical Leadership in Nursing, has wider application in the workplace of the future where professional standards based on collaboration will be more critical in a world of work that will be increasingly complex and uncertain. This article heralds the type of research and development activities that the nursing and midwifery professions should give premier attention to, particularly given the recent developments within the National Health Service in the United Kingdom. The implications of: Agenda for Change, the Knowledge and Skills Framework, 'Our Health, Our Care, Our Say' and the recent proposals from the article 'Modernising Nursing Career', to name but a few, are the key influences impacting on and demanding new ways of clinical supervision for nurses and midwives to improve the quality of patient management and services. The overall approach was based on an action research using a collaborative enquiry within a case study. This was facilitated by a process of executive co-coaching for focused group clinical supervision sessions involving six district nurses as co-researchers and two professional doctoral candidates as the main researchers. The enquiry conducted over a period of two and a half years used evidence-based management and leadership interventions to assist the participants to develop 'actionable knowledge'. Group clinical supervision was not practised in this study as a form of 'therapy' but as a focus for the development of actionable knowledge, knowledge needed for effective clinical management and leadership in the workplace. 1. Management and leadership interventions and approaches have significantly influenced the participants' capacity to improve the quality of services provided to their patients. 2. Using various techniques, tools, methods and frameworks presented at the sessions increased participants' confidence to perform. 3. A structured approach like the Clinical Nursing Leadership Learning and Action Process (CLINLAP) model makes implementing change more practical and manageable within a turbulent care environment. The process of Stakeholder Mapping and Management made getting agreement to do things differently much easier. Generally it is clear that many nurses and midwives, according to the participants, have to carry out management and leadership activities in their day-to-day practice. The traditional boundary between the private, the public and the voluntary sector management is increasingly becoming blurred. It is conclusive that the district nurses on this innovative programme demonstrated how they were making sense of patterns from the past, planning for the future and facilitating the clinical nursing leadership processes today to improve quality patient services tomorrow. Their improved capacity to manage change and lead people was demonstrated, for example, through their questioning attitudes about the dominance of general practitioners. They did this, for example, by initiating and leading case conferences with the multi-disciplinary teams. It became evident from this study that to use group clinical supervision with an executive co-coaching approach for the implementation and to sustain quality service demand that 'good nursing' is accepted as being synonymous with 'good management'. This is the future of 'new nursing'.

A revision of a job evaluation system

This paper reports a revision of the United Kingdom's National Health Service Job Evaluation System and tests the revised system in eight clinical nursing management jobs in four Turkish hospitals. A job evaluation system was developed in the United Kingdom in 2003-2004. Most studies have focused on how the whole system will be implemented in a health organization. No study investigating proficiency of the system in terms of factors and their level definitions was found. The factors Knowledge, Training and experience and Working conditions were divided into five factors: Knowledge, Experience, Education, Environmental conditions and Hazards. To test the revised system, all the nursing management jobs in four hospitals were evaluated using a factor-based questionnaire including nurses' demographic information and 19 variables. The questionnaire was distributed to 57 supervisor nurses in 31 clinics at four hospitals in one Turkish city in 2005. All the questionnaires were analysed to evaluate the jobs. The job scores change depending on clinical conditions. Although the score range in the National Health Service Job Evaluation system has been determined as 405-465 points (band VI) for Nurse team leader and 469-536 points (band VII) for Nurse team manager jobs, the job scores in the present study were 363 (band V) - 557 points (band VIIIa) and 379 (band V) - 586 points (band VIIIa) respectively. Although this exploratory study was limited to four hospitals in one city in Turkey, the results indicated that two new jobs would be identified in the National Health Service system to match the jobs in the intensive care and emergency units.

Island-hopping the way to success

Marie O'sullivan has, literally, come a long way from Dublin where she was raised. Via training and a staff nurse job in Belfast, through a job in Guernsey, onto midwifery and practice nursing in central Scotland, through further training in district nursing, she is now a community nurse team leader in Orkney, and recent recipient of a prestigious Health Foundation Leaders for Change award.

Partnership working by default: district nurses and care home staff providing care for older people

Older people residents in care homes that only offer residential care rely on primary health care services for medical and nursing needs. Research has investigated the demands that care homes staff and residents make on general practice, but not the involvement of other members of the primary health care team. This paper describes two consecutive studies completed in 2001 and 2003 that involved focus groups and survey methods of enquiry conducted in two settings: an England shire and inner London. The research questions that both studies had in common were (1) What is the contribution of district nursing and other primary care services to care homes that do not have on-site nursing provision? (2) What strategies promote participation and collaboration between residents, care home staff and NHS primary care nursing staff? and (3) What are the current obstacles and aids to effective partnership working and learning? A total of 74 community-based nurses and care home managers and staff took part in 10 focus groups, while 124 care home managers (73% of the 171 surveyed) and 113 district nurse team leaders (80% of the 142 surveyed) participated in the surveys. Findings from both studies demonstrated that nurses were the most frequent NHS professional visiting care homes. Although care home managers and district nurses believed that they had a good working relationship, they had differing expectations of what the nursing contribution should be and how personal and nursing care were defined. This influenced the range of services that older people had access to and the amount of training and support care home staff received from district nurses and the extent to which they were able to develop collaborative and reciprocal patterns of working. Findings indicate that there is a need for community-based nursing services to adopt a more strategic approach that ensures older people in care homes can access the services they are entitled to and receive equivalent health care to older people who live in their own homes.

The nursing process and its application in intensive care at Rio de Janeiro as a support to the development of an electronic patient record

This study aims at evaluating the utilization of the nursing process in intensive care units in the metropolitan area of Rio de Janeiro, in order to identify the potential conditions for the deployment of a computerized system in those units. Interviews with 27 nursing team leaders were performed in the period from January to July 2003. The interviews revealed that: the nursing process was not fully implemented and not systematically including the nursing diagnostic stage; 13 units had nursing prescription forms, but only 11 released them; and, 5 units used some type of computerized information system. From the forms so obtained, 128 different nursing actions were identified with high variability of use and no existence of standards for data recording. In this scenario, it can be concluded that the conditions for a computerized system for the nursing process are not adequate.

District nurse involvement in providing palliative care to older people in residential care homes.

Although less than 15% of older people in care homes die of a terminal disease such as cancer, many more die following a period of slow deterioration. In the UK, residents of care homes receive their nursing care from primary healthcare providers. This article reports on a study that describes how district nurses and care home managers define their responsibilities when caring for residents who are dying. The findings presented are from a detailed survey of 89 district nurse team leaders and 96 care home managers. District nurses were the most frequent health professionals visiting care homes, but less than half reported involvement in palliative care. The differing priorities and perceptions of participants regarding what constituted nursing and personal care influenced older people's access to palliative care services. Furthermore, the organization of care and the stability of the care home workforce affected participants' ability to establish ongoing supportive working relationships. It is argued that unless there is an organizational review of current practice, older people will continue to have unequal access to generalist and specialist palliative care.

Take control of your meetings

Jennifer Percival helps a nurse team leader regain control of a business meeting

Coaching: An essential leadership skill for the advanced practice nurse

Leadership in the 21st century requires that individuals lead in creative ways that enhance and support their employees' growth, development, and performance. Employees have reported that they need to feel respected and valued. As a member of the nursing leadership team, the advanced practice nurse (APN) is on the front line, involved with staff on a daily basis, and able to coach staff in a variety of different situations. Using coaching as a leadership skill assists the APN in making a significant contribution to the health care field and to employee growth and development. Copyright © 2001 by W.B. Saunders Company

The team survey: a tool for health care team development.

The aim of this study was to validate a psychometric tool, the team survey, in a health care setting with a range of teams from a Large National Health Service (NHS) Trust. The team survey was developed by Millward and Ramsay (1998) to measure the team dimensions identified in the cognitive-motivational model of team effectiveness (Millward & Purvis 1998). The team dimensions are team potency, team identification, Shared Mental Models and team meta-cognitions. The psychometric properties of the tool as a reliable and valid predictor of team effectiveness was assessed by way of a survey of 10 teams (comprising 124 members in all) located on different premises, within a large NHS Trust. Team size ranged between 5 and 19 members, with average team size being 10 members. Two independent ratings of 'effectiveness' were made for each team. Factor and multiple regression analyses were employed to identify the most powerful predictors of health care team effectiveness from a cognitive and motivational perspective. The results suggest that the team survey is psychometrically robust within a health care setting. It is concluded that the tool has a potentially key role in informing and evaluating team development initiatives in support of the work of practice development nurses and nursing team leaders.

Enhancing psychiatric nursing practice: role of an advanced practice nurse.

In response to demands for alternative health models that deliver cost-effective quality care, one large Midwestern medical center implemented a change in their nursing practice model. The change involved the introduction of unit-based nursing leadership teams that included advanced practice nurses (APNs). This article reports the findings from an investigation that employed a case study design to evaluate the process and outcomes of integrating an APN on a psychiatric unit with experienced nurses. Data collection methods included a nursing survey (n = 34), interviews with nine randomly selected nurses, and two multidisciplinary open forums. Consistent with the staff nurses' survey ratings of important advanced practice role functions, responses from the nursing interviews and open forums suggested nurses' professional development to be the most positive outcome. Role confusion was identified as a negative outcome. Recommendations for improved integration and use of APNs in today's psychiatric health environments were identified.