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The aim of this study was to explore the facilitators and barriers in implementing a workload intensity (WI) tool.A WI tool was developed to quantify patient needs and more evenly disperse workload among nurses.A descriptive phenomenological design was used. Semistructured interviews were conducted with 16 nurses on 5 inpatient units. Questions focused on the factors that helped or hindered the change transition to workload intensity staffing (WIS).WI was perceived as a positive change. Five themes were uncovered as facilitators and barriers to the change: resistance to change, intense workloads, supportive organizational culture, resources/training, and evaluation.Understanding barriers and facilitators to change is important for successful implementation of WIS. To promote success, leaders should provide support to staff and ensure availability of adequate resources.

OBJECTIVE The association between organizational safety climate (OSC) and job enjoyment (JE) for team members in surgical units in 2 hospitals was investigated. The treatment hospital received airline industry-based crew resource management (CRM) training, and the comparison hospital did not. BACKGROUND Strong OSC has been positively associated with healthy hospital work environments and was expected to also be associated with employee job enjoyment. METHODS Two hundred sixty-two surgical personnel responded to surveys about OSC and JE. RESULTS The effects of OSC on JE did not depend on having CRM training. However, OSC and JE scores were higher in the treatment hospital, and the main effect of OSC and JE scores in the treatment hospital was highly significant (P < 0.001), with higher safety climate scores associated with higher JE. CONCLUSIONS A strong OSC is important to employee job enjoyment. Nurse leaders should promote measures to strengthen the OSC in their surgical services departments.

Effective nursing leadership positively impacts quality outcomes and organizational performance. This study is the first known to examine the impact of implementing structured nursing leadership rounds on staff satisfaction with leadership. Positive accomplishments included improved scores on 2 domains of the practice environment scale (PES) throughout the children’s hospital after leader rounding was established; however, unit-level survey results varied in statistical significance. The study was conducted during a time of significant nursing leadership changes throughout the children’s hospital. Additional studies with stable nursing leadership teams are needed to further examine the impact of structured rounding on nurses’ satisfaction with leadership.

Failure to rescue (FTR) occurs when a clinician is unable to save a hospitalized patient's life when they experience a complication that was not present on admission. Research suggests that a focus on patient safety, including implementing airline-industry-based-crew-resource management (CRM) training, can improve patient outcomes, however, the effects of CRM on FTR are unknown. This study examined FTR and 30-day in-hospital mortality (IM) outcomes in two hospitals to determine if differences existed in the treatment hospital (received CRM training) and the comparison hospital (did not receive CRM training). Researchers expected there would be lower rates of FTR and IM in the treatment hospital than the comparison hospital. The study utilized a matched two-group comparison, cross-sectional quasi-experimental design. Over 10,000 patients (n = 10,823) comprised the study with 1,764 having at least one FTR complication. Adjusted odds of FTR were 2.9% higher for treatment versus comparison but these results did not reach significance. The adjusted odds of IM were 0.4% higher for treatment versus comparison but not significantly higher. Although the reasons for our findings remain unclear, previous researchers also found that CRM training improved staff outcomes but unexpectedly did not improve patient outcomes. CRM training may best be used to target changes in staff behaviors and improvement in staff outcomes. Refresher CRM training may be needed to prevent drifting back into longstanding behaviors. Reductions in FTR and patients with IM outcomes may require more comprehensive, multipronged interventions in addition to CRM training.

Nurse managers (NMs) influence retention and job satisfaction, although many facilities lack NM training programs. A program examined staff nurse perceptions after their NMs participated in leadership training. NMs with limited training may find it more challenging to positively affect their nurses' job satisfaction and retention. This program evaluation suggests that nurse executive investment in and support of the NM role yield positive benefits for the NM leader and their staff.

This article describes one heath system's creation of a new women's health hospital using an innovative model integrating patient care delivery, Lean building design, and Lean integrated project methodology. The article describes a 5-year journey detailing the innovative process that guided the planning and implementation of the new care delivery model, as well as employee and leader roles, employee behavior and engagement, and key insights and lessons learned that will benefit nurse leaders.

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.

Purpose To describe the lived experiences of hospital nurses caring for surgical patients who died from failure to rescue (FTR). Design A qualitative phenomenologic approach was used. Methods to ensure rigor and trustworthiness were incorporated into the design. Methods The investigator conducted one-on-one semistructured interviews with 14 nurses, and data were analyzed using Colaizzi's methods. Findings Six themes were identified: (a) the environment surrounding the FTR was unexpected; (b) FTR was unexpected but not preventable; (c) nurses were emotionally ill-prepared for the FTR; (d) nurse outcomes are different in unexpected versus expected death; (e) nurses' roles as protectors are important; and (f) FTR effects future nursing practice. Conclusions Nurses' reactions after an FTR surgical death may be different when there is no identified nursing error contributing to the event. There may be key differences between deaths that are simply unexpected and those that involve FTR. The importance of mentoring junior nurses in protective surveillance skills is vital. Clinical Relevance Developing an understanding of nurses' experiences with FTR can assist nurse leaders to better support nurses who experience FTR deaths. Insight into the environment surrounding FTR deaths provides a foundation for future research aimed at improving patient safety and quality through an improved working environment for nurses.

Background: The complexity of health care systems requires cooperation between system stakeholders, structures, and functions. Nurses need an understanding of systems thinking to work effectively in this complex environment. Method: Nurse educators used the Friday Night at the ER simulation game with undergraduate nursing students to simulate complex problem solving and assess their learning. Results: Students had significantly higher scores on the Systems Thinking Scale and reported increased self-perceived proficiency with the quality improvement Quality and Safety Education for Nurses competency after participating in the game. Conclusion: Nurse educators should consider incorporating complex problem-solving exercises, such as Friday Night at the ER, into their undergraduate curriculum to challenge and strengthen students' critical and systems thinking. Hospital nurse educators should also consider this intervention to assist practicing nurses in bolstering their critical and systems thinking. [ J Nurs Educ. 2018;57(11):687–689.]

The implementation of shared governance structures in acute care has illustrated the positive relationship between shared decision making and nurse empowerment and positive nurse and patient outcomes. Little is known, however, about interdisciplinary shared governance, and even less is known about shared governance in ambulatory care. This article details one health system's experience with the implementation of an interdisciplinary shared governance structure in ambulatory care over a 4-year period. The authors report lessons learned, positive health system outcomes that resulted including improved communication, better preparedness for accreditation visits, improved assessment of fall risk, and a streamlined documentation system. Also discussed are mechanisms to enhance sustainability of the structure and discussion of future opportunities and challenges.

Objective This study explored the types of decisions and differences in decision making that nurses made in different types of hospital units. Background The relationship between nurses' participation in decision making and the different types of hospital units where they work is not well understood. Methods Nurses' participation in decision making was explored using the Participation in Decision Activities Questionnaire. The final sample included 307 nurses in 24 nursing units in 6 hospitals. Results Nurses overall participated more in clinical than administrative decisions, and there were significant differences based on unit type. Critical care nurses had the highest and general care units the lowest levels of participation in decision making. Conclusions Nurses in critical care units participated in higher amounts and at higher levels of clinical decisions overall than either intermediate or general care units. Nurse leaders should determine barriers to decision making in general care units and explore mechanisms to increase participation by clinical nurses.

OBJECTIVE: The aim of this study is to examine the relationship between work complexity and nurses’ participation in decision making in hospital nursing units. BACKGROUND: Increasing nurses’ participation in decision making has been used as a way to manage work complexity; however, the work of nurses in acute care hospitals has become highly complex, and strategies used to manage this complexity have not been fully explored. METHODS: The relationship between work complexity and nurse participation in decision making was examined using data from the Outcomes Research in Nursing Administration project. The sample included 3,718 RNs in 278 medical-surgical units in 143 hospitals. RESULTS: When work complexity increased, nurses’ participation in decision making decreased. CONCLUSIONS: When nurses have limited input into decision making, the information available to the care team may be incomplete. Barriers to nurses’ participation in decision making should be explored and interventions developed so that nurses may be full participants in decision making affecting both patients and the work environment.

The purpose of this study was to describe nurses' needs and how they are being met and not met after caring for surgical patients who died after a failure to rescue (FTR). A qualitative, phenomenologic approach was used for the interview and analysis framework. Methods to ensure rigor and trustworthiness were incorporated into the design. The investigator conducted semistructured 1:1 interviews with 14 nurses. Data were analyzed using Colaizzi's methods. Four themes were identified: (1) coping mechanisms are important; (2) immediate peer and supervisor feedback and support are needed for successful coping; (3) subsequent supervisor support is crucial to moving on; and (4) nurses desire both immediate support and subsequent follow-up from their nurse leaders after every FTR death. Nurses' needs after experiencing an FTR patient death across multiple practice areas and specialties were remarkably similar and clearly identified and articulated. Coping mechanisms vary and are not uniformly effective across different groups. Although most nurses in this study received support from their peers after the FTR event, many nurses did not receive the feedback and support that they needed from their nurse leaders. Immediate nurse leader support and follow-up debriefings should be mandatory after patient FTR deaths. Developing an understanding of nurses' needs after experiencing an FTR event can assist nurse leaders to better support nurses who experience FTR deaths. Insight into the environment surrounding FTR deaths also provides a foundation for future research aimed at improving patient safety and quality through an improved working environment for nurses.

The 2016 International Nursing Administration Research Conference, Leading in a Healthcare Vortex, was held in Orlando, Florida. The program drew 116 attendees with representation from Canada and Brazil. Participants from practice, education, and research discussed leadership in our turbulent healthcare climate, which are highlighted in this column. The conference was dedicated to the memory of Dr Heather S. Laschinger in recognition of her distinguished research legacy of empowering nursing work environments and mentorship of prominent nursing administration researchers.