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PubMed1992

Collaboration in labor relations. A model for success.

Proliferation of bargaining units in currently unionized organizations will create new challenges and complexities for nurse executives. Although the literature abounds with strategies to prevent unionization, little had been presented on establishing and maintaining effective relations with bargaining units. The authors focus on currently unionized nursing practice environments and present a model for facilitating positive, cooperative relations between unions, the nursing profession, and the healthcare organization.

American Nurses' Association↗

PubMed2000

Hospital restructuring: does it adversely affect care and outcomes?

The past decade has witnessed pronounced changes in the organization of United States hospitals, many the direct result of restructuring and re-engineering initiatives intended to decrease costs and increase productivity. Little is known about how these initiatives have affected clinical care and patient outcomes. Using data from a variety of sources, the authors describe initiatives that hospitals undertook during this period, discuss how nurse staffing changed relative to the case mix of patients receiving care, and examine changes in nursing practice environments from 1986 to 1998.

Diagnosis-Related Groups↗

PubMed2004

A practice model for patient safety: the value of the experienced registered nurse.

Creating a culture of patient safety often involves developing nursing care models that effectively use nursing resources. These authors discuss a nursing care model that focuses on the experienced nurses to enhance the use of their expertise. They provide more direct oversight and surveillance for the care given to all patients through leadership, mentoring, and collaborative practice. The experienced nurse is valued as a clinical leader, instrumental to the development of a safe practice environment. Implementation of this model has resulted in dramatic improvements in safety and registered nurse retention.

Clinical Competence↗

PubMed2004

Achieving magnet hospital recognition: chief nurse executives and magnet coordinators tell their stories.

Organizational and management characteristics found in hospitals holding magnet hospital recognition are associated with professional nurse practice environments and positive patient and staff outcomes. However, while we know what works, we need a better understanding of "how to get there.'' The authors report the stories about "how we did it'' told by chief nurse executives and magnet project coordinators from hospitals that have achieved American Nurses Credentialing Center magnet hospital recognition. This article adds to the understanding of how to pursue magnet recognition.

Accreditation↗

PubMed2006

The Densford Clinical Scholars Program: improving patient care through research partnerships.

The Densford Clinical Scholars Program at the University of Minnesota School of Nursing partners advanced practice nurses and faculty members to design and conduct clinical studies for improving patient care. Benefits have included changes in nursing practice and, on occasion, the practice of other members of the healthcare team; enhanced research skills for clinicians; an enriched professional practice environment; access to clinical facilities for faculty; funding for research; and an expanded network for professional development. The authors describe this innovative partnership.

Faculty, Nursing↗

PubMed2002

The chest in profile.

SUMMARY: Radiology has been abounding with technological advances since the chest film first became the mainstay in diagnosing thoracic disease, and yet the conventional chest examination has endured as a front-line tool. The ability to perceive structural alterations is facilitated by a solid foundation in anatomy, which should be easy to achieve in a practice environment in which CT has become so commonplace. Not only is knowledge of anatomic nuances important for analysis of conventional radiographs, but it can only be an asset as multiplanar imaging is increasingly utilized and new modalities are developed over time. Some fundamental anatomic variations are revisited here through correlating the perspective provided by the lateral radiograph with the equally common one provided by routine axial CT images.

Azygos Vein↗

PubMedDate not supplied

Mitigating the impact of hospital restructuring on nurses: the responsibility of emotionally intelligent leadership.

BACKGROUND: A decade of North American hospital restructuring in the 1990s resulted in the layoff of thousands of nurses, leading to documented negative consequences for both nurses and patients. Nurses who remained employed experienced significant negative physical and emotional health, decreased job satisfaction, and decreased opportunity to provide quality care. OBJECTIVE: To develop a theoretical model of the impact of hospital restructuring on nurses and determine the extent to which emotionally intelligent nursing leadership mitigated any of these impacts. METHODS: The sample was drawn from all registered nurses in acute care hospitals in Alberta, Canada, accessed through their professional licensing body (N = 6,526 nurses; 53% response rate). Thirteen leadership competencies (founded on emotional intelligence) were used to create 7 data sets reflecting different leadership styles: 4 resonant, 2 dissonant, and 1 mixed. The theoretical model was then estimated 7 times using structural equation modeling and the seven data sets. RESULTS: Nurses working for resonant leaders reported significantly less emotional exhaustion and psychosomatic symptoms, better emotional health, greater workgroup collaboration and teamwork with physicians, more satisfaction with supervision and their jobs, and fewer unmet patient care needs than did nurses working for dissonant leaders. DISCUSSION: Resonant leadership styles mitigated the impact of hospital restructuring on nurses, while dissonant leadership intensified this impact. These findings have implications for future hospital restructuring, accountabilities of hospital leaders, the achievement of positive patient outcomes, the development of practice environments, the emotional health and well-being of nurses, and ultimately patient care outcomes.

Alberta↗

PubMed1998

Achieving magnet status.

Creating and maintaining a professional practice environment that ensures quality patient outcomes continues to be a challenge in a cost-constrained health care environment. The ability to be recognized for excellence by nursing colleagues is made possible by the Magnet Nursing Services Recognition Program. This article will describe the application preparation, site visit, and evaluation experience of Robert Wood Johnson University Hospital.

American Nurses' Association↗

PubMedDate not supplied

Competency: an essential component of caring in nursing.

Providing online e-learning for nurses significantly reduces medical errors by providing "just-in-time" reference and device training. Offering continuing education 24/7 assures continued competency in an ever-changing practice environment while fostering professional development and career mobility.

Career Mobility↗

PubMedDate not supplied

The opportunities of stewardship.

Nurse leadership involves stewardship. In the healthcare system, it will mobilize around true integration across provider settings and new models of care delivery that are driven by the changing needs of consumers while also tending to the fiscal soundness of the system. For the profession, the focus will be on refining the roles, creating positive and healthy practice environments, and upgrading regulation and standards to support the future work of the nurse. In stewardship of the self, nurse leadership will develop a sound cadre of future nurse leaders, engage in continual learning, and role model balance.

Delivery of Health Care↗

PubMedDate not supplied

Hospital restructuring and nursing leadership: a journey from research question to research program.

The 1990s brought new fiscal realities to healthcare, leading to nursing job loss estimates in tens of thousands following widespread hospital restructuring to manage costs and improve efficiency. This research aimed at examining (a) how multiple episodes of hospital restructuring leading to layoff of nurses affected nurses who remained employed and (b) whether and how nursing leadership mitigated or intensified the negative effects of hospital restructuring on nurses. This dissertation comprised 3 empirical studies leading to 5 publications. The first study was a systematic literature review; the second and third used structural equation modeling to develop and test theoretical models addressing nursing practice environments and effects of hospital restructuring on nurses. The combined findings in this dissertation illustrate that hospital restructuring had significant negative physical/emotional health effects on nurses who remained employed. Nurses who worked for resonant (emotionally intelligent) leadership reported positive health and well-being, and opportunities to provide quality patient care. Nurses who worked for dissonant leadership reported greater negative effects of hospital restructuring. These findings led to a beginning theory of relational energy--a mechanism of mitigation whereby resonant nursing leaders invest energy into collaborative relationships with nurses, thereby positively influencing health and well-being, and, ultimately, outcomes for patients.

Alberta↗

PubMedDate not supplied

Methodologic trends in the healthcare professions: portfolio assessment.

Earlier article have presented the importance of developing programs of assessment designed to measure knowledge and abilities basic to community-focused healthcare practice. In the field of assessment, considerable attention recently has been given to what has come to be called "alternative assessment" methods. Alternative assessment formats offer the possibility to more accurately assess a range of abilities, such as critical thinking, problem solving, and clinical decision making, that are fundamental to community-based nursing practice. The authors present one such alternative assessment method--portfolio assessment--and discuss its application to the measurement of student performance in a community-focused practice environment.

Clinical Competence↗

PubMedDate not supplied

A meaningful clinical experience in home healthcare for associate degree graduate nurses.

Associate degree nursing (ADN) students need exposure to community-based clinical settings to prepare them for changing practice environments. In response to that need, a discrete, clinically-focused, home healthcare course was developed and offered to recent ADN graduate nurses. Emphasis was placed on active participation of the client and family in care giving activities. Students were involved in teaching and demonstration, coordination of resources, and relevant referrals. Appropriate documentation with a focus on Medicare reimbursement issues was included.

Clinical Competence↗

PubMed2001

Managed care's attempts to capture aesthetic surgery.

Managed care organizations recently have attempted to add aesthetic surgery to their line of available services. To better understand the challenges posed by these actions, all members of the American Society for Aesthetic Plastic Surgery were surveyed about managed care overtures to aesthetic plastic surgeons, their responses, and the likely responses of their patients. The goal was to examine both the supplier and consumer ends of the aesthetic surgery market to determine the likely effects of managed care's attempts to capture aesthetic surgery. A total of 632 plastic surgeons returned the surveys (response rate, 54.5 percent). Twenty-two percent reported being approached by managed care organizations about joining a panel of aesthetic surgeons. Approximately one-quarter of the plastic surgeons said they would participate in aesthetic surgery panels developed by managed care organizations. Characteristics significantly associated with willingness to participate were solo practice structure, a low percentage of practice revenues from aesthetic surgery, and a very competitive practice environment. Plastic surgeons believed that their colleagues would be even more willing to acquiesce to managed care aesthetic surgery; more than one-third said that 25 to 50 percent of their colleagues would join, and nearly one-third thought that more than half would participate. Plastic surgeons believed that many of their patients would also participate in managed care aesthetic surgery. Twenty-four percent thought that more than half of their patients would choose an aesthetic surgeon through their managed care organization if that organization developed a network for aesthetic surgery. This figure increased to almost 40 percent if the organization would deny coverage for complications resulting from nonpanel surgeons, and to 41 percent if the organization would offer price discounts. This survey shows that most plastic surgeons are against managed care aesthetic surgery. But it also shows that some plastic surgeons will participate, and that most plastic surgeons think many of their colleagues and patients will do likewise. This means that managed care organizations have the potential to make inroads in aesthetic surgery on both the supplier and consumer ends of the market. To prevent managed care from capturing aesthetic surgery, plastic surgeons must anticipate the likely business strategy of managed care. To this end, they must understand the steps involved in the creation of a new service business and offer organized countermeasures against each of them.

Attitude of Health Personnel↗

PubMed1988

Doctoring: the philosophic milieu.

To understand fully a physician's role in society, and to deal successfully with the current sense of crisis, the medical profession must evolve a world-view that appropriately relates a physician to the patient, to the practice environment, to the base of knowledge, and to the physician's own sense of self. Such a world-view would be multilevel and interdisciplinary, and would be based on interactions and adaptations of physicians to life systems. Medicine's world-view must provide a philosophic milieu intérieur that leads to a proper equilibrium between medicine's technologic skills and its humanistic concerns.

Adaptation, Psychological↗

PubMed1981

Firefighters' reaction to alarm, an ECG and heart rate study.

Firemen's reaction to alarm was investigated with a pulse rate and ECG analysis. The frame of reference was the psychophysiological alarm reaction and its relation to psychosomatic diseases. ECG and pulse rate measurements were recorded continuously from 22 first-string firemen. According to an exercise stress test, the subjects were healthy, but not more fit than a sedentary population. High pulse rates occurred during the alarm due to vigorous movement to the trucks. No anticipatory pulse rate rise occurred as the firemen approached the fire. Non-pathological ECG deviations were found 13 subjects although no abnormalities were found in the same subjects during exercise test. Different firefighting practices, environment, selection, and training might explain the differences between the findings of the present investigation and those of other recent studies.

Adult↗

PubMed1998

Managing congestive heart failure at home.

The hospital readmission rate and associated cost of treating patients with heart failure continues to escalate. Hospitals now regard home care as an alternative to institutional care for mthe long-term management of heart failure. Heart failure management programs are becoming increasing popular in home care as home health agencies strive to meet the demands of the Medicare managed-care environment. Practice standards such as those of the Agency for Health Care Policy and Research (AHCPR), form a basis by which home health agencies can develop, implement, and evaluate their program. Heart failure management continues to improve with advances made toward decreasing morbidity and mortality. The cardiac home care nurse assumes a pivotal role in the management of these complex patients.

Community Health Nursing↗

PubMed2002

Incisional refractive surgery.

The use of incisional refractive surgery has become limited due to the widespread use of the excimer laser to correct myopia, hyperopia and astigmatism. Laser in situ keratomileusis and photorefractive keratectomy have proven to be much more accurate and predictable in correcting refractive error. This has made some forms of incisional refractive surgery practically obsolete. Radial keratotomy should not be considered a primary refractive procedure in the modern world, as RK has become "RKhaic". There are still indications for incisional refractive surgery in cataract and post-surgical patients for the treatment of astigmatism. However, with the advent of the toric intraocular lens and the use of LASIK in such aforementioned patients, these indications for incisional surgery will likely become more limited. In this review, we go over the past history of incisional refractive surgery and also report the current uses and advancements of this technique in today's practice environment.

Astigmatism↗