Nursing Administration

The Evolution of Ambulatory Care Nursing: A Compelling Conversation In this month's Magnet Perspectives column, guest author Kathleen Martinez, MSN, RN, CPN, joins Rebecca Graystone, MS, MBA, RN, NE-BC, for an in-depth look at the explosive growth of ambulatory care nursing over the past decade. The authors take a deep dive into multiple factors contributing to this rapid evolution, the role of the Magnet Recognition Program® in accelerating and supporting ambulatory care and the nurses who provide it, and the prospects for continued growth in the decade ahead.

Origin and Outcomes of Acute Care Nurse Practitioner Practice Acute care nurse practitioners (NPs) are educated, clinically trained, and board certified to care for acutely and critically ill patients, largely in hospital settings. Acute care NPs can positively impact patient care outcomes and are often added to acute care teams to drive optimal, reliable, efficient, and safe care, often referred to as "high value" care.

Strategies for Success in Regulatory Readiness This article describes the formation of a Regulatory Advisory Council to address regulatory preparedness. The council used quality improvement methods to address data and findings from previous mock surveys and created 2 categories of work, an environment of care and clinical standards group, with checklists and work streams to improve organizational success with regulatory readiness.

A Place for the Professional Introduction in Practice This article describes a survey exploring the use of professional introductions by nurses.

Exploring the Association Between Organizational Safety Climate, Failure to Rescue, and Mortality in Inpatient Surgical Units OBJECTIVE To examine the association between organizational safety climate (OSC), in-hospital mortality (IM), and failure to rescue (FTR) in 2 hospitals, 1 with and 1 without crew-resource-management training. BACKGROUND OSC is 1 of the most important organizational factors that promotes safety at work; however, there is a lack of research examining the relationship between OSC and patient deaths in hospitals. METHODS We utilized a matched 2-group comparison of surgical patients and surveyed surgical staff to assess the relationship between OSC, FTR, and IM. RESULTS The OSC assessment was completed by 261 surgical team members. A total of 1764 patients had at least 1 FTR complication; however, there was no association between OSC with FTR or IM for either hospital. CONCLUSIONS Nurse leaders should remain vigilant in building work teams with strong hospital safety climates. More research is needed to explore the relationship between OSC and patient outcomes.

Evaluation of a Bed Reaggregation Initiative at an Urban Academic Medical Center BACKGROUND Hospital flow disruptions have been linked to treatment delays, longer length of stay (LOS), poor patient outcomes, and overburdened staff leading to disengagement. OBJECTIVE This project was designed to evaluate and determine if the bed reaggregation was successful at meeting its goals. METHODS Donabedian's framework guided the following evaluation points: 1) patient placement accuracy, 2) LOS variance, 3) emergency department (ED) boarding times, 4) hospital bypass hours, 5) operational declination rates, 6) patient satisfaction, and 7) RN engagement. Data were analyzed using pre-post percent change and χ2 analysis. RESULTS Primary placement of patients, LOS variance, and operational declinations improved. Hours on bypass and ED boarding times were not reduced. RN engagement scores varied widely with significant decreases on 2 of the reaggregated units. Patient satisfaction scores varied, but overall did not decrease. CONCLUSION Further consideration is needed for improving hospital bypass, ED boarding times, and RN engagement.

An Exploration of Characteristics and Behavioral Traits of DAISY Honorees and Nominees: A Qualitative Study BACKGROUND In the literature, an abundance of stories exist describing patient situations and caregiver actions, but only 2 studies were identified that outline DAISY honorees' actions and behavioral characteristics. OBJECTIVE This study utilized patient nomination data and DAISY honoree insight to identify and gain better understanding of the characteristics and behavioral traits of DAISY nurses. METHODS A grounded theory approach and purposive sample were used in this study, which was conducted in 2 phases using 2 different data sets. In phase 1, the NarrativeDx AI platform generated insights from DAISY nomination comments. In phase 2, a survey was administered to DAISY honorees collecting descriptive data that were analyzed in SPSS, whereas insights on DAISY nurses were collected via open-ended responses and analyzed using NVivo software. RESULTS Three themes emerged in phase 1 from DAISY nomination data: caring, knowledge/skills, and reliability. A total of 37 DAISY honorees participated in phase 2. Most participants were bachelor's degree–prepared and worked day shift in the emergency department, critical care units, or medical-surgical units; some entered leadership roles post award, and 34% cited nursing as a 2nd career. Four themes emerged from their open-ended responses: engaging in care, environment of care, dedicated to care, and competence of care. Subthemes emerged in both analyses. CONCLUSIONS The essence of caring was noted continuously in both nomination and honoree data. Further research aimed at discovering the characteristics and behaviors of DAISY honorees is recommended as examination of these factors may provide a deeper understanding of this exemplary group of nurses. Insights could be incorporated into training and practice programs aimed at increasing patient and nursing satisfaction.

Development of a Mobile Hospital for Disaster Relief Mobile supplemental hospitals were an important asset to community response in preparing for the recent pandemic. MED-1 is a Mobile Emergency Department that has adapted and evolved to the changing needs of communities in times of disaster and nondisaster. An overview of the asset (MED-1), the operations, and use is provided to demonstrate how mobile supplemental hospitals can effectively meet a range of healthcare needs. Innovative utilization of MED-1 has secured its future as an effective resource averaging 100 days of deployment per year.

Joy and Meaning in Nurse Manager Practice: A Narrative Analysis Nurse managers are an integral part of the healthcare system and have powerful influence at the point of service. The experience of joy and meaning in the work of healthcare contributes to achievement of positive outcomes. This study aimed to learn how nurse managers described joy and meaning in their practice. Results included 5 themes: to mentor and be mentored, to focus on the patient, to create and cultivate environments, to be optimistic, and to be empowered by leaders. The themes are described and illustrated with participant quotes. Specific implications for organizations and leaders are discussed.

Four Years Later: Examining Nurse Perceptions of Electronic Documentation Over Time OBJECTIVE To examine changes in registered nurse (RN) perceptions of electronic documentation over a 4-year period. BACKGROUND The investigators previously reported differences in RN perceptions prior to and 1 year after adoption of a comprehensive electronic health record (EHR). METHODS Investigators repeated the study 4 years after adoption, using the Nurses' Perceptions of Electronic Documentation tool and interviews with a subset of RNs. RESULTS Nurses scored higher on ease of use domain and lower on concern about the EHR domain and showed no difference on the impacts of the EHR domain. Interviews revealed that 4 years later, some aspects of documentation were easier; the tool was comprehensive, but not without risk, and nurses remained ambivalent about the EHR. CONCLUSIONS Use of EHR technology impacts nursing work. It is important to understand how nurses' perceptions change over time. This study gives nursing leaders insight into adoption and acceptance of an EHR.

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