Search

Background: Health care executives and policymakers have raised concerns about the adequacy of the US nursing workforce to meet service demands. Workforce concerns have risen given the SARS-CoV-2 pandemic and chronically poor working conditions. There are few recent studies that directly survey nurses on their work plans to inform possible remedies., Methods: In March 2022, 9150 nurses with a Michigan license completed a survey on their plans to leave their current nursing position, reduce their hours, or pursue travel nursing. Another 1224 nurses who left their nursing position within the past 2 years also reported their reasons for departure. Logistic regression models with backward selection procedures estimated the effects of age, workplace concerns, and workplace factors on the intent to leave, hour reduction, pursuit of travel nursing (all within the next year), or departure from practice within the past 2 years., Results: Among practicing nurses surveyed, 39% intended to leave their position in the next year, 28% planned to reduce their clinical hours, and 18% planned to pursue travel nursing. Top-ranked workplace concerns among nurses were adequate staffing, patient safety, and staff safety. The majority of practicing nurses (84%) met the threshold for emotional exhaustion. Consistent factors associated with adverse job outcomes include inadequate staffing and resource adequacy, exhaustion, unfavorable practice environments, and workplace violence events. Frequent use of mandatory overtime was associated with a higher likelihood of departure from the practice in the past 2 years (Odds Ratio 1.72, 95% CI 1.40-2.11)., Conclusions: The factors associated with adverse job outcomes among nurses-intent to leave, reduced clinical hours, travel nursing, or recent departure-consistently align with issues that predated the pandemic. Few nurses cite COVID as the primary cause for their planned or actual departure. To maintain an adequate nursing workforce in the United States, health systems should enact urgent efforts to reduce overtime use, strengthen work environments, implement anti-violence protocols, and ensure adequate staffing to meet patient care needs., Competing Interests: The authors report no conflicts of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Nurse managers have a pivotal role in fostering unit climates supportive of implementing evidence-based practices (EBPs) in care delivery. EBP leadership behaviors and competencies of nurse managers and their impact on practice climates are widely overlooked in implementation science. The purpose of this study was to examine the contributions of nurse manager EBP leadership behaviors and nurse manager EBP competencies in explaining unit climates for EBP implementation in adult medical-surgical units., Methods: A multi-site, multi-unit cross-sectional research design was used to recruit the sample of 24 nurse managers and 553 randomly selected staff nurses from 24 adult medical-surgical units from 7 acute care hospitals in the Northeast and Midwestern USA. Staff nurse perceptions of nurse manager EBP leadership behaviors and unit climates for EBP implementation were measured using the Implementation Leadership Scale and Implementation Climate Scale, respectively. EBP competencies of nurse managers were measured using the Nurse Manager EBP Competency Scale. Participants were emailed a link to an electronic questionnaire and asked to respond within 1 month. The contributions of nurse manager EBP leadership behaviors and competencies in explaining unit climates for EBP implementation were estimated using mixed-effects models controlling for nurse education and years of experience on current unit and accounting for the variability across hospitals and units. Significance level was set at α < .05., Results: Two hundred sixty-four staff nurses and 22 nurse managers were included in the final sample, representing 22 units in 7 hospitals. Nurse manager EBP leadership behaviors (p < .001) and EBP competency (p = .008) explained 52.4% of marginal variance in unit climate for EBP implementation. Leadership behaviors uniquely explained 45.2% variance. The variance accounted for by the random intercepts for hospitals and units (p < .001) and years of nursing experience in current unit (p < .05) were significant but level of nursing education was not., Conclusion: Nurse managers are significantly related to unit climates for EBP implementation primarily through their leadership behaviors. Future implementation studies should consider the leadership of nurse managers in creating climates supportive of EBP implementation.

Many hospitalized smokers do not receive guideline-recommended tobacco treatment, but little is known about the perceptions of inpatient nurses with regard to tobacco treatment. We used a sequential explanatory mixed methods design to help explain the findings of an academic detailing intervention trial on the inpatient medicine units of four Veterans Affairs (VA) hospitals. We surveyed 164 nurses and conducted semistructured interviews in a purposeful sample of 33 nurses with different attitudes toward cessation counseling. Content analysis was used to inductively characterize the issues raised by participants. Emerging themes were categorized using the knowledge-attitudes-behavior framework of guideline adherence. Knowledge-related and attitudinal barriers included perceived lack of skills in cessation counseling and skepticism about the effectiveness of cessation guidelines in hospitalized veterans. Nurses also reported multiple behavioral and organizational barriers to guideline adherence: resistance from patients, insufficient time and resources, the presence of smoking areas on VA premises, and lack of coordination with primary care. VA hospitals should train inpatient staff how to negotiate behavior change, integrate cessation counseling into nurses' workflow, develop alternative referral mechanisms for post-discharge cessation counseling, and adopt hospital policies to promote inpatient abstinence., (Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.)

Introduction: The focus on acute care, time pressure, and lack of resources hamper the implementation of smoking cessation guidelines in the emergency department (ED). The purpose of this study was to determine whether an emergency nurse- initiated intervention based on the 5A's (Ask-Advise-Assess-Assist-Arrange) framework improves quit rates., Methods: We conducted a pre-post implementation trial in 789 adult smokers who presented to two EDs in Iowa between August 13, 2008 and August 4, 2010. The intervention focused on improving delivery of the 5A's by ED nurses and physicians using academic detailing, charting/reminder tools, and group feedback. Performance of ED cessation counseling was measured using a 5A's composite score (ranging from 0 to 5). Smoking status was assessed by telephone interview at 3- and 6-month follow-up (with biochemical confirmation in those participants who reported abstinence at 6-month follow-up)., Results: Based on data from 650 smokers who completed the post-ED interview, there was a significant improvement in the mean 5A's composite score for emergency nurses during the intervention period at both hospitals combined (1.51 vs. 0.88, difference = 0.63, 95% confidence interval [CI] [0.41, 0.85]). At 6-month follow-up, 7-day point prevalence abstinence (PPA) was 6.8 and 5.1% in intervention and preintervention periods, respectively (adjusted odds ratio [OR] = 1.7, 95% CI [0.99, 2.9])., Conclusions: It is feasible to improve the delivery of brief smoking cessation counseling by ED staff. The observed improvements in performance of cessation counseling, however, did not translate into statistically significant improvements in cessation rates. Further improvements in the effectiveness of ED cessation interventions are needed.

Background: Fall prevention programs for hospitalized patients have had limited success, and the effect of programs on decreasing total falls and fall-related injuries is still inconclusive. This exploratory multi-hospital study examined the unique contribution of call light response time to predicting total fall rates and injurious fall rates in inpatient acute care settings. The conceptual model was based on Donabedian's framework of structure, process, and health-care outcomes. The covariates included the hospital, unit type, total nursing hours per patient-day (HPPDs), percentage of the total nursing HPPDs supplied by registered nurses, percentage of patients aged 65 years or older, average case mix index, percentage of patients with altered mental status, percentage of patients with hearing problems, and call light use rate per patient-day., Methods: We analyzed data from 28 units from 4 Michigan hospitals, using archived data and chart reviews from January 2004 to May 2009. The patient care unit-month, defined as data aggregated by month for each patient care unit, was the unit of analysis (N = 1063). Hierarchical multiple regression analyses were used., Results: Faster call light response time was associated with lower total fall and injurious fall rates. Units with a higher call light use rate had lower total fall and injurious fall rates. A higher percentage of productive nursing hours provided by registered nurses was associated with lower total fall and injurious fall rates. A higher percentage of patients with altered mental status was associated with a higher total fall rate but not a higher injurious fall rate. Units with a higher percentage of patients aged 65 years or older had lower injurious fall rates., Conclusions: Faster call light response time appeared to contribute to lower total fall and injurious fall rates, after controlling for the covariates. For practical relevance, hospital and nursing executives should consider strategizing fall and injurious fall prevention efforts by aiming for a decrease in staff response time to call lights. Monitoring call light response time on a regular basis is recommended and could be incorporated into evidence-based practice guidelines for fall prevention.

Background: Development and dissemination of evidence-based practice (EBP) guidelines are important first steps, but without active translation efforts, they do little to promote knowledge uptake by direct care providers. In order to close the gap between discovery and use of knowledge, efforts should focus on methods to speed translation of research findings into practice., Aim: To facilitate this process, the National Nursing Practice Network (NNPN) was established to provide participating health care organizations with access to resources, information, opportunities for learning and knowledge transfer, and legitimacy and credibility with internal and external stakeholders., Approach: Designed as a practice collaborative learning network, the NNPN uses an interactive learning approach by valuing and learning from the experiences of members and encouraging active participation through conferences, teleconferencing, and use of an interactive member Web site. Use of a network of acute care sites to increase the uptake of EBP is based on social network theory; the NNPN is a network of acute care hospitals through which data, information, knowledge, practices, and behaviors flow., Discussion and Conclusion: The use of a collaborative nursing network provides an innovative way to address the difficulty of implementing and sustaining EBP in organizations and also for maximizing resources and knowledge. Early evaluation data are promising. This approach is offered as one possible method of moving use of EBP in nursing forward.

The purpose of this study was to examine the unique contribution of the nursing intervention pain management on length of stay (LOS) for 568 older patients hospitalized for hip procedures. Propensity-score-adjusted analysis was used to determine the effect of pain management on LOS. The LOS for hospitalizations that received pain management was 0.78 day longer than that for hospitalizations that did not receive pain management. Other variables that were predictors of LOS included several context-of-care variables (e.g., time spent in the intensive care unit, registered nurse skill mix, etc.), number of medical procedures and unique medications, and several other nursing interventions., (Copyright 2010 Elsevier Inc. All rights reserved.)

Objective: To determine the impact of patient characteristics, clinical conditions, hospital unit characteristics, and health care interventions on hospital cost of patients with heart failure., Data Sources/study Setting: Data for this study were part of a larger study that used electronic clinical data repositories from an 843-bed, academic medical center in the Midwest., Study Design: This retrospective, exploratory study used existing administrative and clinical data from 1,435 hospitalizations of 1,075 patients 60 years of age or older. A cost model was tested using generalized estimating equations (GEE) analysis., Data Collection/extraction Methods: Electronic databases used in this study were the medical record abstract, the financial data repository, the pharmacy repository; and the Nursing Information System repository. Data repositories were merged at the patient level into a relational database and housed on an SQL server., Principal Findings: The model accounted for 88 percent of the variability in hospital costs for heart failure patients 60 years of age and older. The majority of variables that were associated with hospital cost were provider interventions. Each medical procedure increased cost by $623, each unique medication increased cost by $179, and the addition of each nursing intervention increased cost by $289. One medication and several nursing interventions were associated with lower cost. Nurse staffing below the average and residing on 2-4 units increased hospital cost., Conclusions: The model and data analysis techniques used here provide an innovative and useful methodology to describe and quantify significant health care processes and their impact on cost per hospitalization. The findings indicate the importance of conducting research using existing clinical data in health care.

Purpose: The purpose of this study was to determine the cost of one nursing treatment, surveillance, for older, hospitalized adults at risk for falling., Design: An observational study using information from data repositories at one Midwestern tertiary hospital. The inclusion criteria included patients age>60 years, admitted to the hospital between July 1, 1998 and June 31, 2002, at risk for falls or received the nursing treatment of fall prevention., Methods: Data came from clinical and administrative data repositories that included Nursing Interventions Classification (NIC). The nursing treatment of interest was surveillance and total hospital cost associated with surveillance was the dependent variable. Propensity-score analysis and generalized estimating equations (GEE) were used as methods to analyze the data. Independent variables related to patient characteristics, clinical conditions, nurse staffing, medical treatments, pharmaceutical treatments, and other nursing treatments were controlled for statistically., Findings: The total median cost per hospitalization was $9,274 for this sample. The median cost was different (p=0.050) for patients who received high versus low surveillance. High surveillance delivery cost $191 more per hospitalization than did low surveillance delivery., Conclusion: Propensity scores were applied to determine the cost of surveillance among hospitalized adults at risk for falls in this observational study. The findings show the effect of high surveillance delivery on total hospital cost compared to low surveillance delivery and provides an example of a useful method of determining cost of nursing care rather than including it in the room rate. More studies are needed to determine the effects of nursing treatments on cost and other patient outcomes in order for nurses to provide cost-effective care. Propensity scores were a useful method for determining the effect of nursing surveillance on hospital cost in this observational study., Clinical Relevance: The results of this study along with possible clinical benefits would indicate that frequent nursing surveillance is important and might support the need for additional nursing staff to deliver frequent surveillance.

Internet technology holds potential as a valuable educational tool, but several challenges continue to impede its use. This article describes the use of a web-based course to educate staff nurses regarding evidence-based acute pain management practices for older adults. Specific areas highlighted include: the steps involved in creating the web-based course; the materials and support required to disseminate the course; the challenges encountered in promoting use of the course; and responses to and evaluations of the course. The authors' experiences provide knowledge to assist other healthcare professionals on the use of a web-based course to educate staff nurses.

Implementing evidence-based practice is a complex but valued process that requires support for nurses to make it a reality in care delivery. To address this, an Evidence-Based Practice Staff Nurse Internship was developed at the University of Iowa Hospitals and Clinics in the United States., Program Overview: The objective of this internship is to promote use of evidence by staff nurses to improve patient outcomes. Through a competitive application process, six nurses are accepted in each cohort. The program provides didactic content and dedicated work time on topics interns select (e.g., family pet visitation, sedation management, bowel sounds assessment, guided imagery, family transition to pediatric floor). Interns receive paid clinical release time for participating., Roles and Responsibilities: Teams include the staff nurse, the nurse manager, and an advanced practice nurse. Responsibilities for each step are assigned to the person with the appropriate expertise., Evaluation: Interns report understanding the process, appreciate the opportunity for professional growth, and report their objectives are being met. Participants evaluated the program very positively and also provided recommendations for revision (e.g., revising class content). The program resulted in improved quality of care such as increased patient and family satisfaction, decreased length of stay, and cost savings., Implications: Programs that support practitioners through the evidence-based practice process are needed for use in a variety of settings internationally. This unique program supports staff nurses in making evidence-based practice a reality for their work and patients and might be transferable across settings.