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A Nurse-directed, Early Mobility Initiative for Hospitalized Surgical Patients to Decrease Length of Stay
No full textProblem: Recent staffing shortages at post-acute care facilities create discharge delays placing patients at increased risk for developing complications, contribute to added hospital costs, and overwhelm acute care resources. Initial mobilization of surgical patients by the registered nurse at a centrally located, Midwest community hospital is inconsistent although a hospital-wide nurse-driven mobility protocol exists.
Objective(s): The purpose of this Quality Improvement (QI) project was to increase registered nurse documentation compliance of a reformed mobility leveling system and decrease length of stay (LOS).
Methods: Monthly PDSA cycles evaluated the effectiveness of staff education, nurse documentation, and the Johns Hopkins Highest Level of Mobility (JH-HLM) tool to decrease LOS over a 45-day period. Metrics from each cycle were compared to baseline and previous cycle data, then used in subsequent cycles to achieve the desired outcomes. Challenges included the inability to use the EMR for data collection leading to archaic documentation methods. PDSA cycle one nurse documentation was 62% of the unit’s daily census with an average LOS of 4.26 while cycle two nurse documentation was 69% with an average LOS of 3.79 indicating an increase in nurse documentation and decrease in LOS.
Anticipated Contribution to Practice: Revitalizing an existing mobility protocol using evidence-based mobility measures and ongoing monthly staff education improved patient mobility thereby decreasing length of stay while establishing a sustainable culture of mobility. Additional contributions may include decreased patient complications, hospital costs, discharges to post-acute care facilities, and inappropriate therapy consults
Accelerate: Growing Frontline Nurse Leaders Through a Year Long Innovative Leadership Cohort
No full textAccelerate Program is a year-long, frontline leadership development initiative, aimed at creating a pipeline of future nurse leaders designed and implemented at a large academic medical center. Focus centers on supporting the career advancement and succession planning of informal nurse leaders, enhance and develop nursing leadership competencies, provide innovative leadership development opportunities as well as promoting interprofessional learning and collaboration to achieve effective, impactful outcomes. The first cohort consisted of nurse clinicians from inpatient, procedural, emergency department and ambulatory settings.Curriculum design was guided by The American Organization for Nursing Leadership leader core competencies and was presented by experts from within the health system. Program requirements included manager nomination, full-time employment, no disciplinary action, and previous participation in the organization’s Charge Nurse or Preceptor Program. Accepted participants attended a rigorous yearlong collaborative program with monthly 8-hour sessions covering a range of topics, including: conflict management, financial literacy, communication and interprofessional skills, and the implementation of an evidence-based practice (EBP) project.Pre and post program data was gathered through an investigator developed 360-degree Likert score evaluation in the domains of: leader within, professionalism, communication, healthcare environment, business skills and leadership. Results indicated a significant improvement (6-9%) in all domains. Additionally, 28% of participants were promoted into formal leadership roles during the program.Involvement in the program prepared nurses for navigating the complexities of the nurse manager role while fostering growth and retaining nurse leaders. Anecdotally, participants perceived more confidence in their ability to lead others, conduct quality research projects, and make sound decisions that improve patient outcomes. Additionally, a second cohort is currently underway, and applicants are being nominated for the third cohort. This collaboration has brought together participants who typically wouldn\u27t interact, resulting in the creation of interprofessional EBP projects leading to the implementation of system-wide change initiatives. Further participation in leadership development programs such as Accelerate will continue to foster growth of nurse leaders
Peer-to-Peer Transitional Coaching Program
No full textHigh nurse turnover is an international concern that exacerbates the nursing shortage, and this shortage impacts patient outcomes, quality of care, patient satisfaction with care and job satisfaction for employees (Bae, 2023; Winter et al., 2020). According to the United States Bureau of Labor Statistic (2023), 193,100 openings for Registered Nurses (RN) are expected each year, over the next decade. In 2023, the national turnover rate for hospital-based nurses was 22.5%, and the RN vacancy rate was 15.7% (NSI Nursing Solutions Inc., 2023). Even more alarming is the suggestion that first year registered nurse turnover within hospitals, far exceed all other tenure categories (NSI Nursing Solutions, Inc., 2023). According to NSI Nursing Solutions Inc. (2023), 32.8% of nurses who left their hospital-based organization, did so within one year. A study in South Korea, suggests similar findings with additional information stating that 20.1% of newly hired nurses left their position within six months, compared to 6.3% who left between seven and twelve months (Kim & Kim, 2021). Retention is an organization’s ability to maintain staff employment within the organization. Retention of new graduate nurses in practice is imperative to reduce the gap between experienced nurses leaving the profession and hospitals’ ability to provide safe and effective patient care.The purpose of this project is to review retention outcomes for new graduate nurses who participate in an interventional peer coaching program within an acute care organization. Coaching improves clinical performance, well-being, peer-relationships, collaboration, engagement, career development and socialization (Costeira et al., 2022; DeGrazia et al., 2021; Wagoner-Duncan & Tinsley, 2023). Coaching also fosters communication and encourages knowledge sharing between coach and participants (Costeira et al., 2022; DeGrazia et al., 2021; Richardson et al., 2023; Rosen et al., 2022). Chahbounia and Gantare’s (2023) study suggests that a coaching program can reduce stress and burnout in nurses. Investigators suggest that coaching increases use of organizational resources and connectedness which in turn improves self-care practices, stress management and retention for both coach and the nurse receiving coaching (Chahbounia & Gantare, 2023; Costeira et al., 2022; Rosen et al., 2022). Coaching and mentoring are identified within the literature, as having high potential to reduce new graduate nurse turnover
Implementation of a Dementia-Specific Advance Care Planning Tool: A Quality Improvement Pilot
No full textPurpose: There are 55 million cases of dementia worldwide and the cost of care for these individuals is estimated to rise to $2 trillion by 2030. Dementia-specific Advance Care Planning (ACP) can help to reduce the burdens of providing care to those diagnosed with dementia. This study sought to determine if the implementation of a dementia-specific ACP tool increases knowledge and decision-maker confidence, as well as decrease inappropriate healthcare utilization rates.Method: At a Program for All-Inclusive Care for the Elderly (PACE), individuals diagnosed with a cognitive deficit (CD) and their surrogate decision-maker (SDM) were recruited as dyads to participate in an ACP pilot progam. A dementia-specific ACP tool was implemented. Knowledge of dementia was assessed for both members of the dyad and SDM confidence regarding their role as decision-maker. Chart review was used to obtain emergency department and inpatient admission healthcare utilization rates. Non-parametric analytics were utilized to analyze the data.Results: Participants with CD showed no statistical significant improvement in knowledge dementia scores. SDMs showed statistically significant improvement in knowledge and confidence. The healthcare utilization rate decreased by five visits.Conclusion: Findings suggest that individuals with CD and SDMs do not understand the terminality of a dementia diagnosis. SDMs do not know what kind of care their loved one would want at end-of-life. Dementia-specific ACP should be implemented with all individuals with CD and their SDMs, soon after diagnosis
Mitigating Fast Turnover Rates of the Internationally Educated US RNs
No full textIntroduction: The nursing shortage in the United States is a significant and ongoing challenge for the healthcare system. Internationally educated nurses (IEN) make up a substantial portion of the nursing workforce in many countries including United States to help address nursing shortages. But IENs often face unique challenges related to cultural differences, language barriers, and professional practice variations which can affect their successful integration and retention. This quality improvement project developed, implemented, and evaluated a comprehensive orientation program to reduce turn-over rates in IENs.Methods: Databases such as PubMed, Scopus, Joanna Briggs, and CINAHL were used to search for evidence. The keywords were internationally educated nurses, retention, and turn-over. Based on the evidence reviewed, the intervention that was implemented was a comprehensive orientation program incorporating cultural adaptation, clinical skills enhancement, emotional support and professional coaching. The intervention started last January 2023 and consisted of a week of orientation program tailored to the specific needs of IENs.Results: The orientation program resulted in a notable increase in retention rate among IENs from 65.4% in 2022 to 93.3% in 2023.Discussion: The tailored orientation program proved to be an effective strategy for increasing retention rate among IENs. By addressing the unique challenges faced by the nurses, the program enhanced their integration and retention within the healthcare workforce. Continued refinement and expansion of such programs are recommended to sustain and build upon these positive outcomes
Using a Virtual Escape Room to Teach About Blood Transfusion Reactions
No full textThe highest preventable risk of blood transfusion error resulting in adverse events is due to human error. Nurses are required to know how to safely administer blood while also being able to recognize and manage adverse transfusion reactions. New graduate nurses are expected to have the ability to administer blood products safely. It is up to nurse educators to equip nursing students with the skills and knowledge to perform this procedure. Escape rooms are increasingly popular in educational settings. They provide a motivating and engaging atmosphere for learning while enhancing students’ critical thinking skills, time management, teamwork, and communication skills. They are easily adaptable to a variety of topics. Escape rooms could also help with better knowledge retention leading to safer patient care
Characteristics of the United States Acute Care Nurse Practitioners’ Work Environment, 2012 to 2022
No full textBackground: Acute care comprises a significant amount of health care, with over 35 million hospitalizations in the United States annually.1 As the population ages and comorbidities and chronic illness increase, demand for hospital care is forecasted to grow.2 To meet the demand for acute care, clinicians, healthcare organizations, and policymakers are calling for increased nurse practitioner (NP) utilization in hospital care.3,4Significance: Acute care NPs practice across clinical specialties and assume diverse roles providing high-quality, interdisciplinary hospital care.3,5,6 Despite demand for NPs in hospital care, barriers, including organizational regulations and state scope-of-practice restrictions, limit full implementation of their roles.7-9 These restrictions constrain the effectiveness of NPs by decreasing their capacity to contribute to care, fueling access to care problems, and increasing the cost of care.10Purpose: The purpose of this study was to examine changes in the acute care NP work environment in the decade after formalizing the role in nursing policy.11Methods: Using a repeated cross-sectional design and data from the National Sample Survey of Nurse Practitioners (2012) and the National Sample Survey of Registered Nurses (2018, 2022), the analysis included NPs certified in pediatric or adult acute care NP roles. Examining work environment characteristics measured in all three surveys, we perform descriptive statistics to summarize data distributions and trends. All analyses accounted for the complex survey design and weighting used to generate national workforce estimates.Results: The majority (≥85%) of acute care NPs were satisfied with their jobs. However, there were gaps in the full attainment of acute care NP role implementation. Despite working in hospitals, less than one-third of acute care NPs had hospital admitting privileges or managed their own panel of patients. Only three out of five acute care NPs billed for their care. Some report they were not fully practicing to their scope (11.3-18.9%), and their skills were not fully utilized (11.7-23.3%).Implications: Acute care NPs identified persistent opportunities to improve the work environment and remove practice restrictions that constrain their effectiveness. Future work should include advocacy to remove practice barriers and evaluation of policy interventions intended to improve the work environment of acute care NPs and meet the growing demand for care
The Effects of Eliminating Idiomatic American English From High-Stakes Nursing Examinations
No full textBackground: In the United States, English for Speakers of Other Languages (ESOL) health care providers are important to the nursing workforce but often face challenges when taking the NCLEX-RN examination. This study evaluated the effects of removing slang and words with multiple meanings from high-stakes examination questions.
Method: This study used a quantitative, experimental posttest-only control group design and included a convenience sample of 169 nursing students from a college in southern Florida.
Results: Nursing students per-formed significantly better on the experimental (M = 79.9 [7.48]) than on the control examination (M = 75.08 [10.51]), t(151.8) = 2.973, p = .003. Students with low language acculturation scores achieved significantly higher scores on the experimental (M = 81.48 [SD = 6.05]) versus the control examinations (M = 72.21 [10.09]), t(60.9) = 4.975, p = .001.
Conclusion: Modifying examination questions linguistically can help ESOL nursing students perform better and aid examination creators to design bias-free tests. [J Nurs Educ. 2024;63(12):XXX-XXX.
Stroke Survivors\u27 and Family Caregivers\u27 Perceptions of Depressive Symptoms After Stroke
No full textThe American Psychiatric Association designates the unique relationship between depression and stroke listing it as a medical condition that are is the source of depressive symptoms.1 Poststroke depression (PSD) is a frequently occurring complication of stroke and is associated with adverse outcomes with an estimated prevalence of 27%.2 Prior research has found stroke survivors with PSD experience worse functional recovery than those without PSD.3Caregiver depression influences stroke recovery and is specifically associated with higher risk 6-month mortality of stroke survivors with moderate to severe stroke.4Researchers have noted partners of stroke survivors face greater risk for caregiver burden, depressive symptoms and anxiety when taking on the stroke caregiver role due to abrupt change in family dynamics.5The purpose in Phase I (n=64) of this mixed methods study was to examine the relationship between stroke disability, caregiver burden, distance from stroke center, prior history of depression and depressive symptoms after stroke. In Phase II (n=6 stroke survivors; n=9 stroke caregivers) in 1:1 interview, researchers sought the first hand perspectives of stroke survivors and their caregivers regarding their perceptions of depressive symptoms of PSD and the experience of PSD. PI was influenced to develop study’s Phase II by University of California San Francisco Symptom Management Theory, a middle range theory depicting symptom management as a multidimensional process.6Phase I results which noted a significant mean difference in depression scores between stroke caregivers who are spouse/significant other and stroke caregivers who are other family member (p-value of 0.0397) and also a significant mean difference in depression scores between stroke caregivers with prior history of depression and stroke caregivers who do not have prior history of depression (p-value = 0.025). Phase II findings validated and illuminated significant Phase I results.
This study contributes to nursing science regarding the experience of post stroke depression in both stroke survivors and stroke caregivers and stroke caregiver burden specifically how male vs female caregivers operationalize their caregiver role. Future research should explore gender differences in perceptions of caregiving for stroke survivors and caregivers. Further nursing implications include focused clinical assessment of depression in stroke survivors and caregivers
Evaluation of Learning Experiences of New Graduate Nurses at a Teaching Hospital in Nigeria
No full textINTRODUCTION: A successful nursing career depends on the senior professional colleagues’ assistance for new graduates to master professional skills during internship programme. This study examined the working relationships between new graduates and senior nurses; level of guidance with mastering practical skills and socialization into the hospital roles. Three null hypotheses were formulated for statistical analyses to provide empirical evidence.
METHOD: This involved descriptive design and Focus Group Discussion (FGD). The target population were 52 nurses that were currently on internship programme in the hospital and all of them were included as sample for the inferential study while six outspoken among them were selected through purposive sampling for the FGD. Structured questionnaire with Content Validity Index .86 and test-retest reliability of .82 served as instrument for quantitative data and a written guide to collect data for FGD. Descriptive data and hypotheses were analysed using percentages and one sample t-test respectively with decision rule taken at .05 level of significance.
RESULTS: From 52 graduate nurses sampled, 50 (96%) provided data used for analyses. About 50.6% reported cordial relationship; 41.3% approved of the professional guidance received and 53.2% agreed that socialization into hospital roles was given to them by the senior colleagues. The working relationships between new graduate nurses and senior colleagues was statistically and significantly cordial with total mean greater than the expected (t=10.794; p=000\u3c.05); guidance on practical nursing skills they receive was significantly higher than expected mean level (t=8.518; p=.000\u3c.05) and socialization into hospital roles was statistically and significantly higher than average (4.477 ≤ t ≤ 23.738; p=.000\u3c.05). Thematic analyses of FGD revealed three main themes: fair collaborative work relationships; fair Mentor-Mentee relationships and learners seeking for improved information sharing.
RECOMMENDATIONS: Training of the preceptors should be more intensive and extended to include other nursing staff who work in the hospital and participate in assisting the new graduate nurses during the period of internship so as to ensure their full transition as hospital staff. Similar study is required to involve nurse preceptors and senior nurses who mentor the students to assess the factors that may limit effective and efficient mentoring of the new graduate nurses on internship programme