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In this paper, the authors describe one of the signature programs launched through the Marian K. Shaughnessy Nurse Leadership Academy, the post-doctoral system-level executive nursing education program. This program was directly linked to the core focus of the Shaughnessy Nurse Leadership Academy. The program design, speakers, and outcomes are presented along with lessons learned, including the value and power of philanthropy, and the need for flexibility in both scheduling and implementation during a pandemic.

Nurses who aspire to lead a professional nursing organization can significantly influence the future of the nursing profession. This article describes 4 essential responsibilities required in a board leadership position as identified by a group of nurse leaders who have each served as the board president of a national or international professional nursing organization.

In this article, there is a discussion focused on three contemporary nursing topics: leadership, followership, and academic-practice partnerships. These comments are framed within the context of the current healthcare system transformation. There is a focus on why each of these topics is relevant to the nursing profession in leading change and advancing health. Finally, there is a description about the interdependence of leadership and followership and the significance these hold for the interdependence between nursing education and nursing practice.

VISION AND MISSION The Indiana University Nurse Learning Partnership (IUNLP) was initially conceived 5 years ago and consists of leaders from the Indiana University School of Nursing, a National League for Nursing Center for Excellence in Nursing Education, and the Department of Nursing at the Indiana University Health (IUH) Academic Health Center (AHC), made up of 3 Magnet-designated hospitals. The formal partnership, led by Dean Marion E. Broome and Executive Vice President and Chief Nurse Executive Linda Q. Everett, began in 2009 when leaders in both settings recognized that although individual collaborations were occurring in both arenas, there was no formalized, intentional structure at the leadership level to bring resources to bear and create a synergistic environment for students, nurses, and nurse leaders at the school and hospital system. Inspired by the Carnegie Report1 on transforming nursing education, leaders from both settings met for a retreat in summer 2010, where the IUNLP model was formalized to better communicate intentions to all constituencies (Figure 1). The mission of this intentional academic–practice partnership is to demonstrate the value nursing brings to improving the health of the community. At the heart of this initiative lies a shared culture where practice and academic partners share a

Redesign of the current healthcare system is essential. Despite advanced biomedical knowledge, the United States continues to experience wide variation in healthcare quality and outcomes, and unprecedented healthcare costs. 1,2 With healthcare spending expected to reach 20% of the nation's gross domestic product by 2015, 1 most understand and support the need for health system reform that includes accountable care organizations.

By the year 2020, as hospitals morph into entirely different kinds of service providers, nurses too will look altogether different. Those with the capacity to embrace disruptive innovation, along with all the unknowns that accompany it, will be successful at guiding their organizations into the future. Nurse executives must act now to build nursing cultures capable of massive and transformational change--change that will alter the way patient care is perceived, delivered, and evaluated. One hospital system is using a Think Tank approach to pilot demonstration projects that aim to maximize the role of the registered nurse and redefine expectations around patient care delivery. Early work indicates that new thinking combined with "permission to fail" from nursing leadership is essential to success. Lean Six Sigma principles and creativity tools from inside and outside of health care are being adopted with promising results. Exemplars show that by creating a sense of urgency around a big opportunity, this health care system is developing change initiatives that are literally transforming culture.

Academic-practice partnerships are an important mechanism to strengthen nursing practice and help nurses become well positioned to lead change and advance health. Through implementing such partnerships, both academic institutions and practice settings will formally address the recommendations of the Institute of Medicine Future of Nursing Committee. Effective partnerships will create systems for nurses to achieve educational and career advancement, prepare nurses of the future to practice and lead, provide mechanisms for lifelong learning, and provide a structure for nurse residency programs. This paper details the work of the American Association of Colleges of Nursing-American Organization of Nurse Executives Task Force on Academic-Practice Partnerships that has identified hallmarks of successful partnership and produced tools and shared exemplars to assist nursing leaders in developing and sustaining partnerships for the future.

Eighty percent of medical error are attributed to human factors. Human factors experts suggest the least explored factor in patient errors is attention, specifically, situation awareness. The purpose of this article was to analyze the concept of situation awareness using a hybrid concept analysis. The experience of situation awareness among nurses was elicited during the fieldwork phase through semistructured interviews. Content and relational analyses yielded 9 themes: perception, comprehension, projection, knowledge and expertise, cognitive overload, interruption management, task management, instantaneous learning, and cognitive stacking. A conceptual definition of situation awareness emerged along with recommendations for application in nursing.

Nurses are challenged with ethical problems on a daily basis, yet when they are students, nurses may have never had an opportunity to explore the complexities of how ethics will influence every facet of their nursing practice. This article describes how a large health care system, through collaboration between academic and clinical partners, developed a nurse ethicist role to serve both the patient care environment and students in academic programs. The nurse ethicist is charged with creating and sustaining programs in ethics and nursing ethics education with the goal of improving the capacity of nurses to manage the ethical issues inherent in the care of patients in a contemporary, technology-driven health care system. The Program in Nursing Ethics includes staff education, consultation and support, and research. The addition to the faculty of a nurse ethicist who is active in clinical ethics consultation has strengthened the baccalaureate nursing curriculum by providing an instructor who creates and shares a clear vision for how ethics is central to quality nursing care. This article describes the central role of a nurse ethicist in promoting ethical nursing practice.

Evidence-based practice (EBP) is the conscientious and judicious use of current best evidence, in conjunction with clinical expertise and patient values, to guide health care decisions (Sackett et al. 2000). When EBPs are effectively implemented, patient outcomes improve and resource use declines (Newman et al. 2000; Titler 2008). Effects of translating research into practice (TRIP) interventions have varying results, thereby requiring further study (Jones et al. 2004; Feldman et al. 2005; McDonald et al. 2005; Murtaugh et al. 2005; Fihn 2006; Kochevar and Yano 2006; Wensing, Wollersheim, and Grol 2006). The study reported here expands the knowledge about translation by testing a multifaceted TRIP intervention to improve acute pain management practices for older adults hospitalized with a hip fracture. Several factors stimulated our interest in undertaking this study. First, there is a wealth of research evidence on acute pain management, but elders do not receive adequate pain management during hospitalization (APS 2003; Morrison et al. 2003a; Titler et al. 2003). Second, fractured hips account for over 225,000 hospitalizations annually for Medicare recipients ≥65 years and are projected to double by the year 2040 (Hall and Owings 2002). This is a significant population of older adults likely to have pain. Third, managing acute pain in elders with hip fracture contributes to earlier ambulation and less adverse outcomes (Morrison et al. 2003b; Herrick et al. 2004). Under assessment and treatment of acute pain in older adults is troublesome given that research demonstrates better patient outcomes and reduced resource use with optimal pain management. Results of a multisite, randomized experimental trial to test the effectiveness of a multifaceted TRIP intervention designed to promote adoption of evidence-based (EB) acute pain management practices for older patients hospitalized with a hip fracture are reported here. Specifically, we hypothesized that following implementation of the TRIP intervention, (1) nurse's and physician's adoption of EB acute pain management practices for older adults will be greater in the experimental (E) versus the comparison (C) group, (2) nurse and physician barriers to use of EB acute pain management practices in older adults would be lower in the E versus C group, and (3) mean pain intensity of patients will be lower in the E versus C group. The cost analysis of the TRIP intervention (a fourth study aim) is reported elsewhere (Brooks et al. in press).

Implementing evidence into healthcare practice is essential to maximize the benefits of research and billions of dollars spent generating new knowledge. Implementation science is the investigation of methods, interventions (strategies), and variables to influence adoption of evidence-based healthcare practices by individuals and organizations to improve clinical and operational decision making, and includes testing the effectiveness of interventions to promote and sustain use of evidence-based healthcare practices. Estabrooks and her research team are to be applauded not only for the excellent contributions to the understanding of research utilization but also for setting forth a series of articles to stimulate thinking and comments across national boundaries and lines of inquiry. Described here are the implications for implementation science with regard to conceptual frameworks, measurement issues, and research designs, stimulated by the papers of the Estabrooks investigative team set forth in this special issue.

A nurse's uniform influences perceptions about nursing practice and thus contributes significantly to the overall image of a nurse. A nurse's uniform also can represent the brand of an organization, the tangible and intangible attributes that distinguish an organization from its competitors. The rebranding of a major health care system provided a unique opportunity to refine the "image of nurses" within the organization. This article describes the planning, evidence gathering, and implementation of a major initiative to promote professional nursing practice.

Prior research has found that safety organizing behaviors of registered nurses (RNs) positively impact patient safety. However, little research exists on how engaging in safety organizing affects caregivers.While we know that organizational processes can have divergent effects on organizational and employee outcomes, little research exists on the effects of pursuing highly reliable performance through safety organizing on caregivers. Specifically, we examined whether, and the conditions under which, safety organizing affects RN emotional exhaustion and nursing unit turnover rates.Subjects included 1352 RNs in 50 intensive care, internal medicine, labor, and surgery nursing units in 3 Midwestern acute-care hospitals who completed questionnaires between August and December 2011 and 50 Nurse Managers from the units who completed questionnaires in December 2012.Cross-sectional analyses of RN emotional exhaustion linked to survey data on safety organizing and hospital incident reporting system data on adverse event rates for the year before survey administration. Cross-sectional analysis of unit-level RN turnover rates for the year following the administration of the survey linked to survey data on safety organizing.Multilevel regression analysis indicated that safety organizing was negatively associated with RN emotional exhaustion on units with higher rates of adverse events and positively associated with RN emotional exhaustion with lower rates of adverse events. Tobit regression analyses indicated that safety organizing was associated with lower unit level of turnover rates over time.Safety organizing is beneficial to caregivers in multiple ways, especially on nursing units with high levels of adverse events and over time.

The purpose of this qualitative study was to explore the meaning of the phrase "image of the nurse" in the context of the desired brand experience of assurance.A brand is a promise that lives in the minds of consumers. Nurses play a key role in delivering on the brand promise of a hospital.Using focus groups, the authors applied a deductive approach to generate data. Discussion transcripts were analyzed by establishing codes and identifying themes.The most frequent comment from participants was that for nurses to communicate assurance, they must 1st be clean, well groomed, and understated in overall appearance. Nurse behaviors that reassure patients include being present with patients, helping patients know what to expect, and demonstrating a consistent team approach.Overall appearance and behaviors define the image of nurses and contribute significantly to the brand of assurance.

The UIHC Department of Nursing is nationally known for its work on use of research to improve patient care. This reputation is attributable to staff members who continue to question "how can we improve practice?" or "what does the latest evidence tell us about this patient problem?" and to administrators who support, value, and reward EBP. The revisions made in the original Iowa Model are based on suggestions from staff at UIHC and other practitioners across the country who have implemented the model. We value their feedback and have set forth this revised model for evaluation and adoption by others.

Experimental multisite studies are needed to test adoption interventions that promote use of evidence-based guidelines in critical care practice. A research model (see Fig. 2) based on Rogers' diffusion of innovation model provides a conceptual guide for selecting interventions to test in translational research studies. Studies should address the four major areas of innovation adoption: (1) characteristics of the guideline, (2) users of the guideline, (3) methods of communicating the guideline, and (4) the social system in which it is being adopted. It is imperative that researchers study which interventions are most effective in promoting use of critical care evidence-based practices by nurses and physicians and how the social system of critical care environments affects adoption of such practices. Without this empiric knowledge, health care systems have little guidance in how to most effectively promote adoption of scientific evidence to improve care of critically ill patients.

In a pay-for-performance environment, implementing and sustaining evidence-based practice (EBP) is no longer a luxury but a necessity. A critical driving force for EBP is that our communities—the people we serve—expect to receive care based on the best available evidence. Transformational nursing leadership is required to create an infrastructure that influences organizational factors, processes and expectations, thus enabling the sustainability of EBP. The American Nurses Credentialing Center and the American Organization of Nurse Executives provide a framework for nursing leaders to consider when designing EBP implementation structures. This exemplar illustrates nursing leadership competencies with regard to implementation and sustainability of EBP within a multihospital system.

A computer information system, which can provide cost-saving measures useful in adequately allocating nursing staff in the face of decreasing patient stays, increasing patient admissions and discharges, and the unexpected transfers surrounding busy nursing units, is explored.

Few topics can ignite passionate debate like a change in registered nurse (RN) uniform color. Anyone in nursing who has been through such a change can tell you that it's a daunting task, fraught with emotion that can ultimately distract nurses from the important work of patient care.

This article examines acute pain management practices for patients 65 years of age and older who were hospitalized during 1999 for hip fracture. Data were collected from the medical records of patients (N = 709) admitted to 12 hospitals in the Midwest and from questionnaires on pain practices completed by nurses (N = 172) caring for these patients. The major variables examined were (1). pharmacological and nonpharmacological treatments for acute pain in hospitalized elders, (2). nurses' perceived stage of adoption for avoiding meperidine use and for administering analgesics around-the-clock, and (3). nurses' perceived barriers to optimal treatment of acute pain in elders. Acetaminophen was the most frequently administered analgesic, but administered doses were far less than the maximum daily recommended dose. More than one third (39%) of the nurses reported that they always avoided the use of meperidine, and over half reporting avoiding its use sometimes. However, the majority of patients (56.8%) received at least one dose of meperidine, even though evidence suggests that other analgesic agents are more appropriate for treatment of acute pain in elders. Only 27% of patients received patient-controlled analgesia, and only 22.3% of patients received around-the-clock administration during the first 24 hours after admission of analgesics that had been ordered on a prn basis. The majority of nurses were aware that around-the-clock administration of analgesics was preferable, but only 33.7% were persuaded (believed) that this method should be used. Intramuscular injection was used for 52.2% of patients, even though this route is not recommended for older adults. The most frequently used nonpharmacological intervention was repositioning, followed by use of pressure relief devices and cold application. Nurses reported difficulty contacting physicians and difficulty communicating with them about type and/or dose of analgesics as the greatest barriers to pain management. Findings from this multi-site study show that active and focused "translation" interventions are needed to promote adoption of evidence-based acute pain management practices by health care providers.

This article describes a comprehensive partnership between a college of nursing and its corresponding department of nursing services. The Nursing Collaboratory was created to provide an infrastructure for the generation, dissemination, and application of knowledge to improve nursing practice and patient outcomes. In addition to creative problem solving, the Collaboratory serves as an "incubator" of ideas and innovation, engaging nursing staff, faculty, and students in the development of new products and services to enhance nursing education and practice. J Prof Nurs 17:114-120, 2001.

Nurse leaders are frequently called upon to deal with challenging and distressing human resource (HR) issues. Throughout my career, some of my most critical learning opportunities have been HR-related. What I’ve learned is that it’s easy to talk the talk of “do the right thing for the patients always,” but it takes a true leader and principled individual to walk the walk each day. One HR crisis in particular literally rocked me to my personal core. Under my watch, a nursing practice issue surfaced that required swift and deliberate action, including the termination of well-intentioned leaders and nursing board sanctions for several RNs. Timing compounded the issue: A very public and important announcement about nursing practice was set to take place, and the fallout from the terminations and sanctions prompted disgruntled staff to consider a remonstrative demonstration at a ceremonial event. My leadership style and my decision-making practice were publicly called into question. Even though regulatory compliance, legal, and HR departments were in agreement with the corrective actions being taken, I was a primary target for complaints that escalated to include all of hospital administration. Drama built over a series of weeks, while the nursing ceremony loomed large. On the day of the ceremony, I was emotionally drained. I hadn’t slept well for weeks, and it was taking a physical toll. A colleague and friend recognized that I was near implosion and took me aside to say, “Stop. It’s time to take care of you. You have to get out of here and clear your head. If you don’t take care of you, you can’t continue to lead this department.” Truer words had never been spoken. But as a nurse is wont to do, I had a million reasons why I couldn’t just step away, even briefly. Thankfully, my colleague and friend prevailed, and after the ceremony (no demonstration occurred— whew!), I packed a bag and my dog and went on a short RV vacation with my husband. The woods and time away had never been more therapeutic. I needed to care for myself and renew. In retrospect, I can clearly see the steps that exacerbated my stress and anxiety. What I’ve learned over time is that failure to care for yourself makes any bad situation worse. If you’re not taking time off, getting away, and focusing on something other than work, you’re doing yourself a disservice and ultimately setting yourself up for failure. Another friend and colleague, Dan Pesut from the Indiana University School of Nursing, recently spoke to a retreat of my nursing leadership team and tackled this very issue. He suggested that it is way too easy to get caught up in day-to-day trials and tribulations that can trip up the best of us and leave us wondering, “What the heck am I doing here?” But we can all get back to purpose by asking, “What am I truly trying to accomplish? Why am I really here?” The answer for me is always the same: the patients. I am here for the patients, who make the work worthwhile. Even as an executive, I feel that I can make a difference in their lives by supporting nurses and working with them to make a meaningful difference in the care patients receive. To take the best care of patients, we have to first take care of ourselves. Only that will allow us to live a good life—living where we belong, with the people we love, doing the right work, on purpose. For me, that is nursing in a nutshell: good work, good people, right reasons. As you strive to meet goals related to patient satisfaction and patient expectations, ask yourself what matters most. And then do something for yourself to help you get there.

Hospitalization and treatment for hip fracture and elective hip replacement surgery are increasing as the number of elderly increases and with new surgical breakthroughs. Little research has been conducted on the interventions and other variables that impact cost of care; no research has been published that includes the impact of nursing care on hospital cost. To explain the cost of hospital care that includes nursing interventions for an older patient population hospitalized for a hip fracture and/or related procedure. An effectiveness research model composed of patient characteristics, clinical conditions, nursing unit characteristics, medical, pharmacy, and nursing interventions related to the outcome of hospital cost was tested using GEE analysis. The analysis included 195 variables systematically reduced to 71 that were then examined in a sample of 568 hospitalizations (n = 523 patients, > or = 60 years old) admitted for treatment of a hip fracture or elective hip procedure over a 4-year period. Data were obtained retrospectively from nine clinical and administrative data repositories from one tertiary care hospital. The best predictors of increased hospital cost were the nursing intervention of Tube Care, the level of RN staffing below the unit's average, total number of medical procedures, total number of different medications, and low levels of the nursing intervention of Surgical Preparation. More RN hours per patient day and some nursing interventions were associated with reduced cost. The study demonstrates the importance of conducting effectiveness research in nursing. Some nursing interventions were associated with increased cost and some with decreased cost, but when compared with medical and pharmacy interventions, fewer nursing interventions were associated with increased cost. Inadequate RN staffing raised cost whereas increased RN staffing was associated with lower costs.