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Results for “Professional Autonomy”

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PubMed2006

Relating outcomes to excellent nursing practice.

Healthcare professionals must find ways to accelerate the diffusion of knowledge within their organizations. Although nurses have extraordinary access to patient care data, they may underestimate their roles as data managers and innovators of change, and relinquish control of data to others. The authors discuss how nurses at an acute psychiatric hospital collect and report their own data to show the direct relationship between outcomes and excellence in nursing practice. Knowledge that is gained through practice is shared to inspire and sustain needed changes.

Clinical Nursing Research↗
PubMedDate not supplied

Evolution of the American Nurses Association's position on health insurance for the aged: 1933-1965.

In 1958, the American Nurses Association (ANA) formally endorsed federal health insurance for the aged, a position contrary to that of organized medicine and hospitals. Understanding how ANA's organizational culture and position on health policy evolved was the purpose of this research. ANA documents from 1933 until passage of Medicare legislation in 1965 and interviews with four contemporary nursing executives of that period were analyzed. Powerful professional and economic external forces and internal divisions limited ANA's ability to influence health policy. Ultimately ANA's cultural values of caring and professional autonomy enabled dedicated leaders to build support, national alliances, and recognition for nursing.

Aged↗
PubMedDate not supplied

Measuring nursing governance.

BACKGROUND: Despite outcomes studies measuring such variables as job satisfaction, autonomy, professionalism, turnover, leadership styles, and more recently, cost-effectiveness, no consistent relationships have been established between shared governance models and outcomes. OBJECTIVES: To define and develop an instrument to measure the governance of hospital-based nurses. METHODS: The 88-item Index of Professional Nursing Governance (IPNG) was developed to measure professional nursing governance of hospital-based nurses. Psychometric properties were tested with 1,162 registered nurses from 10 hospitals. RESULTS: Content validity after item generation was .95, using Popham's average congruency procedure. Six factors explained 42% of the variance with subscale intercorrelations between .43 and .67. All subscales had a high degree of internal consistency (alphas .87 to .91); test-retest reliability was .77. Construct validity testing showed that scores between shared governance and traditionally governed hospitals were significantly different. A correlation was found between scores on the IPNG and the Hague and Aiken Index of Centralization. CONCLUSIONS: The results of this study support the validity of the 88-item IPNG as a reliable instrument for measuring the distribution of professional nursing governance of hospitals.

Adult↗
PubMedDate not supplied

Variations in nursing practice environments: relation to staffing and hospital characteristics.

BACKGROUND: While improvements in nursing practice environments are considered essential to address the nursing shortage, relatively little is known about the nursing practice environments in most hospitals. OBJECTIVES: The objectives of this study are to describe variations in nursing practice environments across hospitals and to examine their associations to hospital bed size, community size, teaching intensity, and nurse staffing levels. METHODS: The research design was cross-sectional analyses of nurse survey and administrative data for 156 Pennsylvania hospitals from 1999. For comparative reference, nurse survey data from earlier years from two small samples of nursing magnet hospitals were analyzed. The nursing practice environment was measured by the Practice Environment Scale of the Nursing Work Index (PES-NWI). RESULTS: Nursing practice environments varied greatly among the hospitals studied. The nursing practice environments of the small samples of magnet hospitals were superior to those of the Pennsylvania sample. About 17% of the hospitals in the Pennsylvania sample had favorable practice environments. Pennsylvania hospitals with better practice environments had higher RN-to-bed ratios. Practice environment differences were not associated with hospital bed size or community size. Hospitals with a modest teaching level had less favorable environments. DISCUSSION: Considerable variation exists in the quality of hospital nursing practice environments. Five out of six hospitals are targets for improvement. Favorable nursing practice environments can be achieved in a wide variety of hospital settings.

Acute Disease↗
PubMedDate not supplied

Testing the relationship between job stress and satisfaction in correctional nurses.

BACKGROUND: Correctional nurses function in a high stress environment due to the nature of their clients and the primacy of environmental security. Job stress and satisfaction are theorized relational concepts that influence intent to stay and turnover as described in the anticipated turnover model. An increased understanding of the nature and sources of stress and satisfaction provides necessary information about correctional nursing. OBJECTIVE: To (a) replicate an earlier study of correctional nurses to determine whether similar findings could be duplicated in a study of prison nurses from another state and (b) test the concepts of stress and satisfaction as represented in the anticipated turnover model. METHODS: Using the Index of Work Satisfaction and the Nurse Stress Index, a correlational mail survey was designed to assess job stress and satisfaction among 454 nurses in a northeastern state prison system. RESULTS: Overall stress scores were not significantly different from the original study despite differences in demographic characteristics. Highest to lowest mean scores on actual sources of satisfaction include physician-nurse interaction, autonomy, professional status, task requirements, organizational policies, and pay. Satisfaction scores were significantly higher in the original study. An inverse relationship exists between job stress and satisfaction among correctional nurses. Job stress was a significant predictor of job satisfaction, supporting the theorized conceptual relationship between job stress and job satisfaction as described in the anticipated turnover model. DISCUSSION: Stress levels and the top two sources of stress were essentially the same for both groups of correctional nurses. Sources of satisfaction are ranked similarly but subscale and overall scores indicate that the nurses in the replication study were more dissatisfied. Findings validate the theoretical proposition in the anticipated turnover model that job stress is a major predictor variable in explaining job satisfaction.

Female↗
PubMed2000

Surviving the proving ground: lessons in change from NP pioneers.

Increasing competition, health care complexity, threats to quality, and rapidly changing environments confront nurse practitioners (NPs) as they enter the new millennium. If NPs are to strengthen their positions as health care providers and continue to make a lasting contribution, they must exhibit proficiency in creating and managing change. Lessons gleaned from those who pioneered the NP role can provide the wisdom needed to address contemporary role challenges. The purpose of this study was to identify the strategies employed by NP pioneers who contributed to role survival and growth. This article provides a discussion of the change strategies utilized by NP pioneers and highlights their relevance to current practice issues.

Adaptation, Psychological↗
PubMed1996

Profession building in the new health care system.

To further the goals of greater legitimacy and power, it is necessary for nursing to abandon many of the profession building strategies it has pursued in the past. We describe the traditional framework for profession building in nursing and some reasons it is no longer effective. In contrast, a contemporary framework for profession building in nursing is presented. Because nursing, like other complex adaptive systems, is strongly anchored by its past trajectory, it will require considerable energy and resources to make the transition.

Health Care Reform↗
PubMed2002

Nurse practitioner: reflecting on the future.

The role of the nurse practitioner was first conceptualized in the late 1960s. Today, there are approximately 70,000 nurse practitioners in practice, they receive third-party insurance reimbursements, and they are in many specialty practices, as well as working in primary care practices promoting health and disease prevention. In the future, economics will shape our health care industry, placing a greater demand for nurse practitioners in this trillion-dollar marketplace. This article explores the evolving role of the nurse practitioner in education, practice, and research to meet the challenges of the health care needs into the 21st century.

Forecasting↗
PubMedDate not supplied

Rebuilding a professional practice model. The return of role-based practice accountability.

There is no patient care without clinical practice. To improve the quality of health care, organizations must build a finely tuned and resilient clinical enterprise, one founded on clear role accountability and decision authority within the team. The author views scope of practice and professional standards as the foundation for practice accountability and decision authority. A case is made that an interdisciplinary, professional practice model is an appropriate delivery model in today's health care environment; a model that places the professional role in its rightful place as decision maker and supports the role's inherent accountability to evaluate and monitor practice performance. The importance of measuring professional practice performance is seen as a key link toward better understanding ways to reduce error and ensure patient safety.

Decision Making, Organizational↗
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

Growing our future nursing leaders.

The need for strong nursing leadership to meet the future challenges of the healthcare delivery system is widely acknowledged, yet many of today's nursing leaders express concern about a lack of interest in leadership among their younger nurses. This article reports on a qualitative research study that involved focus groups with 48 younger nurses under the age of 40 who were not currently in formal leadership positions. Using a ConCensus process, participants were asked questions to identify and prioritize the factors that influence their decisions to accept or reject nursing leadership positions. In this study, participants did see a potential in the nursing leadership role to make a difference for both patients and staff. Adequate compensation for the role and true decision-making power were factors of concern for younger nurses. Feedback from current leaders about nursing leadership positions is not positive. Strategies that current nursing leaders will need to consider to encourage interest in nursing leadership will be discussed.

Adult↗
PubMedDate not supplied

Impact of management development on nurse retention.

PURPOSE: Nurse retention is essential to maintain quality healthcare organizations. In an effort to mitigate the loss of nurse managers, a management education program was created for new and transitioning nurse managers that included scholarships for nurses from long-term and rural acute care settings. Program evaluation was based upon the outcomes of anticipated turnover and employee satisfaction. DESIGN AND METHODS: Using a preprogram and postprogram evaluation, the Index of Work Satisfaction (IWS) and the Anticipated Turnover Scale (ATS) were used to survey participants. Descriptive statistics as well as Wilcoxon statistics for group comparisons were used for analysis. FINDINGS: ATS scores were significantly reduced (P < .05) for all program participants. Further analysis of scholarship recipients indicated that the management program significantly increased their intent to stay (P < .08) in their current positions. However, because of a large rate of attrition, findings can only be considered preliminary. CONCLUSIONS: While the high level of attrition among the scholarship recipients is disappointing, potential attendance barriers are discussed, particularly from long-term care settings. Management development programs may improve the satisfaction and retention of critically needed managers and enhance development of future nursing leaders.

Adult↗
PubMedDate not supplied

From Tele-ed to Telehealth: the need for IT ubiquity in nursing.

Although numerous studies have shown that information technology (IT) improves care, makes the workplace better for clinicians, and reduces costs, healthcare-especially nursing-has been slow to adopt it for a variety of reasons. However, because of a worsening nursing shortage, couples with increasing healthcare costs and administrative overhead, nursing demands that IT become not only common, but pervasive, playing a role in every aspect of nursing, from recruitment and education, to patient care. This article will examine the several potential applications of IT to nursing and their benefits, challenges to widespread IT adoption, and the importance of IT ubiquity to the very viability of the profession.

Attitude of Health Personnel↗
PubMedDate not supplied

Reaping benefits from intellectual capital.

The wealth and value of organizations are increasingly based on intellectual capital. Although acquiring talented individuals and investing in employee learning adds value to the organization, reaping the benefits of intellectual capital involves translating the wisdom of employees into reusable and sustained actions. This requires a culture that creates employee commitment, encourages learning, fosters sharing, and involves employees in decision making. An infrastructure to recognize and embed promising and best practices through social networks, evidence-based practice, customization of innovations, and use of information technology results in increased productivity, stronger financial performance, better patient outcomes, and greater employee and customer satisfaction.

Attitude of Health Personnel↗