Nurse leaders' views on clinical ladders as a strategy in professional development

AIM: To investigate nurse leaders' views on clinical ladders as a strategy in professional development of nursing. BACKGROUND: Hospitals worldwide have implemented clinical ladders to boost professional development and improve quality of patient care. At ward level good leadership is vital in creating a learning environment and using nurses' new competence. METHOD: The design was explorative and data were collected in focus groups with 19 nurse leaders at the ward level and 24 executive nurse leaders at hospitals with several years of experience with clinical ladders. RESULTS: Most nurse leaders did not think strategically in promoting clinical ladders at the organizational level. Nurse leaders who considered clinical ladders a tool in developing nursing quality found motivational work challenging and rewarding. Not all nurse leaders managed to utilize clinical specialists' new competence. CONCLUSION: Further investigation into nurse leaders' actions as strategic managers of development and use of nurses' competence is warranted. Implications for nursing management It is important that managers see the close connection between professional development of individuals and development of quality and high standard in the ward. A prerequisite is therefore to engage in the strategic planning of competence at all levels of decision in the organization.     

Predictors of nurses' perceptions of barriers to research utilization

AIM: To identify predictors of nurses' self-reported barriers to using research findings in clinical practice. BACKGROUND: Several studies have shown that nurses perceive barriers to research utilization but to our knowledge predictors of nurses perceptions of barriers to research utilization have not been identified before. METHODS: Three questionnaires were answered by 833 nurses: the Barriers Scale, the Quality Work Competence questionnaire and a questionnaire including questions on professional issues. RESULTS: Dissatisfaction with support from immediate superiors for participating in research and/or development projects, having no academic degree and unclear and unrealistic workplace goals were identified as factors increasing the risk of perceiving barriers to the use of research findings in clinical practice. CONCLUSIONS: The results imply that head nurses, nursing managers and other health care leaders should create strategies for supporting nurses' professional development and possibilities to implement research findings in clinical practice. IMPLICATIONS FOR NURSING MANAGEMENT: To support research utilization and evidence-based care health care leaders, head nurses and nurse managers should create clear and realistic goals for the work place including demands on evidence-based care. It is also important for head nurses and nurse managers to create strategies for supporting nurses' professional development and possibilities to implement research findings in clinical practice.     

The value of specialty nursing certification

The American Board of Nursing Specialties (ABNS) undertook a national study to validate nurses' perceptions, values, and behaviors related to certification. A Web-based survey was developed and disseminated to certified nurses, noncertified nurses, and nurse managers. Of the 11,427 respondents, 8,615 (75%) identified themselves as certified nurses, and 2,812 (25%) were noncertified nurses. Of these, 1,608 respondents (14%) held the position of Nurse Manager. Using the Perceived Value of Certification Tool (PVCT), certified and noncertified nurses showed a high level of agreement with the value statements on certified practice. Nurse Managers bolstered these perceptions with their correspondingly high rate of agreement on the certification value statements. Additionally, the study examined barriers and challenges to certification, incentives to certification, the impact of certification on lost workdays and nurse retention. This study took an important step in furthering understanding of nursing certification and the implications for health care organizations, nursing certification boards, and certified and noncertified nurses.     

Managers' duty to maintain good workplace communications skills

Communication is a fundamental element of care at every level of nursing practice. It is important, therefore, for nurse managers to create environments that promote and encourage good communication, and help nurses to develop their communication skills formally and informally. This article discusses the effects of communication on the quality of care. It examines nurses' professional duty to maintain good communication skills and how managers can help them do this. It also discusses nurse managers' communication skills in the context of leadership style, conflict resolution and self-awareness. Finally, it considers the notion of shared governance as good practice.     

Role discrepancy: is it a common problem among nurses?

AIM: This paper reports a study of nurses' perceptions of the differences between ideal and actual nursing roles, how these perceptions differ according to length of experience and the factors that might contribute to these perceived differences. BACKGROUND: The literature suggests that nurses tend to experience role discrepancy or a mismatch between their ideal and actual roles. Although it has been assumed that experienced nurses perceive less role discrepancy than inexperienced nurses, either because the former adjust themselves to their actual practice or because they have the expertise to improve their practice, this assumption has not been tested. METHODS: A survey design was used and the data were collected in 2003. Selected items from the Jefferson Survey of Attitudes Toward Physician-Nurse Inventory and the Staff Nurse Role Conception Inventory were administered to 216 Registered Nurses in Victoria, Australia to measure their perceptions of ideal and actual nursing roles. Data were analysed using a t-test and regression analysis. RESULTS: Nurses with more clinical experience rated their ideal and actual nursing roles more positively than those with less experience. However, the results showed that both groups of nurses experienced the same degree of role discrepancy. Both groups perceived strong role discrepancy in the areas of organizational decision-making and provision of patient education. Experienced nurses also perceived moderate role discrepancy in developing nursing care plans and in the freedom to initiate referrals. CONCLUSIONS: Role discrepancy cannot be resolved by having more clinical experience. While clinical experience enhances nurses' conceptions of their ideal roles, it can also lead to role discrepancy if there are organizational barriers that prevent nurses from engaging in their ideal roles. It is important to find a way whereby nurses can actualize their ideal views of practice in the current healthcare environment.     

Confirming mentorship

BACKGROUND: Mentorship is related to nurses' success in nursing practice linked to professionalism, nursing quality improvement and self-confidence. AIM: To elucidate mentorship of recently registered nurses' view of themselves with regard to their development of nursing competencies by means of the Sympathy-Acceptance-Understanding-Competence (SAUC) model for confirming mentorship. METHODS: Questionnaires, personal interviews and focus group interviews were used for evaluation 2 years after the completion of a year of mentorship, the subjects being eight nurses. FINDINGS: The study showed that novice nurses evaluated their mentors as confirming, which is understood as a key factor for novice nurses' positively reinforced self-relation (perception of themselves) and self-knowledge linked to improved competencies in nursing practice such as more secure and motivated to nurse (S-phase), increased capacity to verbalize nursing situations (A-phase) and to reflect upon and evaluate patient situations based on patients' unique identities as individuals (U-phase), and improved abilities to support patients' own resources as individuals from a more holistic view and to establish collaboration with other professionals. CONCLUSION: Mentorship enabled novice nurses to nurse in a more reflective and holistic way, and their positively reinforced self-relation may be understood as a crucial ingredient for maintaining quality standards in nursing in the future.     

Achieving consensus about pain content for child branch curricula

AIM: The aim of the study was to identify nurse educators' and nurse managers' perceptions of the educational needs of children's nurses in relation to pain management. RATIONALE: Children continue to suffer unnecessary pain during hospitalization. This has been attributed, in part, to inadequate education among paediatric nurses with a number of studies demonstrating that nursing curricula need re-evaluating with respect to the content relating to pain management. In order to equip nurses to manage pain within clinical practice nurse education needs to provide them with the knowledge and skills required. It is apparent that nurse education is currently failing students in this regard. In order to evaluate nursing curricula with respect to pain management it is necessary for there to be a degree of consensus, among paediatric nurses, regarding appropriate content. METHODOLOGY: A two-round Delphi study was used to ascertain the appropriate pain content for pre-registration child branch courses. When undertaking a Delphi study a number of 'experts' in the field are identified, who complete a series of questionnaires. The first round is used to generate ideas, which are reconsidered in subsequent rounds (Hicks 1999, Reid 1988). Following analysis of the responses to each questionnaire anonymous feedback is sent to the respondents together with the next questionnaire (Walker 1994). Participants were either senior nurse educators or senior nurse managers. RESULTS: Positive correlations were found within the two groups as well as between the educators' and managers' rankings for the 14 categories identified. CONCLUSIONS: The results of this study suggest that nurse educators and nurse managers have similar views about the pain management knowledge they would expect a newly qualified child branch nurse to have. The list of appropriate pain content derived from the results of this study provides a useful tool with which to evaluate the content of child branch curricula.     

Leadership styles of Finnish nurse managers and factors influencing it

Aim  The purpose of the present study was to explore nurse managers' perceptions of their leadership styles and factors influencing it.
Background  It is a challenge for nurse managers to retain nurses in hospitals and to ensure a high quality of care in nursing practice. Leadership style is an important part of leadership. Knowledge concerning nurse managers' resonant and non-resonant leadership styles provides nurse managers with tools to reflect on their own leadership style.
Method  Open-ended, tape-recorded interviews were conducted with 13 nurse managers from five Finnish hospitals and two long-term care facilities. The data were analysed using qualitative content analysis.
Results  Five categories of leadership style were discerned: visionary, coaching, affiliate, democratic, commanding. Factors that influence leadership style were identified: earlier superiors, values, information, cooperation, employees and education.
Conclusions  The results of this study show that Finnish nurse managers use both resonant and non-resonant leadership styles.
Implications for nursing management  The findings of this study show that nurse managers use a variety of leadership styles. The study demonstrates the importance of knowledge about leadership styles and factors influencing it among nurse managers providing future leadership and management education.     

Agency nursing work in acute care settings: perceptions of hospital nursing managers and agency nurse providers

There is a paucity of research in investigating agency nursing work from the perspectives of hospital nursing managers and agency nurse providers. This exploratory paper examines the hospital nursing managers' and agency nurse providers' perceptions and experiences of agency nursing work. Individual, in-depth interviews were conducted with three agency nurse providers and eight hospital nursing managers. Because of the lack of previous research in this area, an exploratory, semi-structured interviewing technique was deemed appropriate. Three major themes emerged from interview data: planning for ward allocation, communication and professionalism. In planning for ward allocation, hospital managers were primarily concerned with maintaining adequate numbers of nursing staff in the ward settings. A major concern for agency nurse providers was inappropriate allocation of temporary staff. Communication was valued in different ways. While hospital managers focused on communication between the agency nurse and other permanent members of the health care team, agency providers were concerned with exchanges between agencies and hospital organizations, and between the agencies and agency nurses. For both groups, responsibility for professional development and the status of agency nursing as a career choice for graduate and experienced nurses were the focal aspects for consideration. A limitation of this study is the small number of individual interviews conducted with hospital nursing managers and agency nurse providers. Nevertheless, the findings represent the views of 11 individuals in senior managerial roles. The findings reinforce the need to enhance collaboration between hospitals and nursing agencies, and to examine how divergent views of agency nursing work could be reconciled--with the aim of providing quality patient care.     

Effects of Case Management on the Nursing Context-Perceived Quality of Care, Work Satisfaction, and Control Over Practice

Purpose: To examine in 1995 the effects of case management on the context of nursing practice-perceived quality of care delivered, work satisfaction, and control over nursing practice-rather than the commonly studied effect on fiscal outcomes.
Design: Prospective quasi-experimental. Sampled were nurses on four units at one community hospital where patients with DRG 107 (Coronary Artery Bypass Graft, with no cardiac catheterization) were traditionally hospitalized.
Methods: Registered nurses on these units completed quality of care, satisfaction, and practice-control scales before and 1 year after implementation.
Findings: Significant positive differences were found in several aspects of perceived quality of care for both staff nurses and case managers, with specific increases found in nurses' perceived ability to develop relationships with patients, ability to be therapeutic, and support for good care from the institutional structure and administration. A significant decrease in nurses' satisfaction with their pay and other rewards as well as respect from colleagues was found. Case managers were found to have significantly increased perceptions of control over their practice.
Conclusions: Case management was found to have a primarily positive effect on nurses-staff and case managers alike. There were significant increases in several aspects of the nurses' perceptions of the quality of care delivered. Additionally, case managers were more satisfied with the administration, the respect they received, and their pay and rewards in the institution. Most strikingly, case managers perceived themselves to have more control over their practice. Some negative effects of the program were a decrease in satisfaction with the pay and rewards by the staff who were not case managers.     

Competence profiles of recently registered nurses working in intensive and emergency settings

BACKGROUND: Preceptorship is an essential method of supporting nurse competence, guaranteeing high quality care and increasing job satisfaction. AIM: To describe recently registered nurses' perceptions of their competence level, and to identify factors influencing these perceptions. METHOD: The survey was conducted by using Meretoja's Nurse Competence Scale. The sample comprised 235 registered nurses working in intensive and emergency settings. The data were analysed by using statistical methods. RESULTS: Nurses' self-assessed competence level ranged from moderate to good. A statistically significant association was seen between competence level and age, length of current work experience and the frequency of using competencies. CONCLUSIONS: The results shed useful light on the educational needs of nurses and provide important clues for the development of preceptorship programmes. The Nurse Competence Scale proved to be a reliable and valid instrument in assessing the competence of recently registered nurses. Implications for nursing management We recommend that management strategies be developed to enhance and support positive learning environments for competence development. We recommend preceptorship programmes based on systematic competence assessments made by nurses themselves, their preceptors and managers.     

Nursing students can help support evidence-based practice on clinical nursing units

AIMS: A research study was designed to explore whether research utilization projects underwent by student nurses could have an impact on nursing practice on clinical nursing units. BACKGROUND: The use of evidence-based practice is becoming essential for nursing managers and nursing staff, but there are many barriers to implementing research findings in practice. Student nurses can be used to assist when staff nurses do not have time during the work day. METHODS: Baccalaureate nursing students completed a research utilization project during their final comprehensive clinical experience. Telephonic interviews were conducted with the students' preceptors 5 months after the students' clinical experience, to obtain their perceptions of the impact of the student project on the nurses' knowledge and practice. RESULTS: The staff nurse preceptors reported the projects were well received with the primary impact of the projects being to educate the nursing staff and patients and thus improve the level of nursing practice on the clinical units. CONCLUSIONS: Student research utilization projects are one way to save time for staff nurses and increase their awareness of current research findings.     

Leadership: the key to quality outcomes

Nurse executives are charged with creating a workforce that provides quality care in a creative and cost-effective manner. Style of leadership determines how nurse executives relate to their professional nurses and ultimately how successful their health care institutions will be. The practice-based theory of nursing leadership called the Integrated Leadership Practice Model can be practiced by nurse executives to promote employee satisfaction, assure that quality care is provided based on standards and competencies, and promote an organizational culture committed to quality. This article proposes the application of integrated leadership to the practice of nurse executives and demonstrates how they can foster and support this model for nursing leadership within their nurse managers.     

The influence of nursing leadership on nurse performance: a systematic literature review

brady germain p. & cummings g.g. (2010) Journal of Nursing Management 18, 425–439
The influence of nursing leadership on nurse performance: a systematic literature review Aim The aim was to explore leadership factors that influence nurse performance and particularly, the role that nursing leadership behaviors play in nurses’ perceptions of performance motivation. Background Nurse performance is vital to quality patient care outcomes and nursing leadership behaviors have been linked to nurse performance. Evaluations A review of research articles that examined the factors that nurses perceived as influencing their motivation and performance was conducted. Eight studies were included in the final analysis. Key issues Nurses’ perceptions of factors that affect their motivation and ability to perform were grouped into five categories using content analysis: autonomy, work relationships, resource accessibility, nurse factors, and leadership practices. Nursing leadership behaviors were found to influence both nurses’ motivations directly and indirectly via other factors. Conclusion The review suggests that nurse performance may be improved by addressing nurse autonomy, relationships among nurses, their colleagues and leaders, and resource accessibility. Implications for nursing management Nursing managers and leaders may enhance their nurses’ performance by understanding and addressing the factors that affect their ability and motivation to perform.     

儿科门诊护士静脉穿刺情况调查及对策

目的 了解儿科门诊护士静脉穿刺情况及其工作满意度。方法 采用自行设计的无记名选择型问卷调查，内容包括门诊患儿静脉穿刺术成功率、静脉穿刺术失败时患儿家属对该护士的态度情况、护士对儿科门诊工作的满意度情况和护患沟通情况4方面。结果 门诊患儿静脉穿刺一次成功率90．30％；穿刺术失败时，75．26％的患儿家属不能谅解护士，甚至有17．52％的家属责骂或殴打护士；护士经常处于精神紧张状态，心理压力大，对工作的满意度不高；仍有25．88％的护士在穿刺过程中未能做好与患儿沟通。结论 长久下来，会影响护士的身心健康，也会降低护理质量。因此，加强护理管理，提高护士的综合素质，改善护士的工作环境，进一步完善有关的规章制度和法律法规显得相当重要.     

Do we really understand how to retain nurses?

AIM: To compare views of nurse executives with those of nurses who have left the profession on the importance of retention strategies. BACKGROUND: Although much has been written about nursing turnover, there continues to be dissonance among decision makers as to why nurses leave the profession and what the most crucial issues are for retention. METHOD: Factor analysis was undertaken to compare responses of nurse executives with those of nurses employed outside of nursing. RESULTS: Contract requirements represented the greatest discrepancy, 1.07, followed by legal and employer issues, 1.02; worklife/homelife balance, 0.91; external values and beliefs about nursing, 0.75; and professional practice, 0.29. CONCLUSIONS: A disparity exists between perceptions of nurse executives and those of nurses who have left the profession as to which issues are most critical in retention. We suggest that nurse executives ensure sufficient organizational support for nursing unit managers who are more likely to understand methods of retaining nurses at the clinical interface.