Recruitment and retention of professional nurses are crucial issues for hospital departments of nursing. Recognizing the necessity to bridge the gap that persists between nursing education and nursing services, hospitals have designed programs to assist new nurses make the transition to current nursing practice. By helping individuals make the transition to current nursing practice it is hoped that staff nurses will be retained.

Registered Nurse (RN) turnover is costly for hospitals and healthcare facilities. The problem that healthcare administrators face today is their inability to retain nurses for long periods of time and the detrimental effects that come from the lack of retention. The purpose of this quantitative secondary data analysis is to explore the relationship between the retention of RNs and the geographic regions in which they work. The theoretical framework for this study was Barney's concept of viewing people as resources. Deidentified secondary data of RNs was utilized from the Healthforce Center at the University of California San Francisco to probe differences in retention rates between full-time and part-time RNs and the differences in retention rates between new graduate and specialty RNs in California geographic regions. The data was analyzed through descriptive and inferential statistical techniques to perform a t test of independent means. As a result, it was determined that there was no significance in geographic regions in California influencing the retention rates of full and part-time RNs neither was there a significant finding that geographic regions in California influence the retention rates of new graduate RNs or specialty nurses. It was concluded that the retention of RNs is determined by how well they are maintained and managed. A recommendation would be to investigate retention strategies that create longevity among RNs. This study can contribute to positive social change by having a cohesiveness that builds trust and creates a better work environment and positive outcomes for healthcare facilities which will reduce overall cost.

A better understanding of task allocation for the registered nurse (RN) within the scope of the multidisciplinary care team model is required. Patients, healthcare staff, and medical facilities that utilize RNs in multidisciplinary care teams will benefit from improved role identification. A multidisciplinary care team consists of a variety of health care professionals and without role identification, confusion, miscommunication, and negative patient outcomes can occur. A literature review demonstrated that a gap in knowledge existed related to task allocation and role identification of RNs within a multidisciplinary care team. The purpose of this study was to evaluate RNs’ scope of practice within a multidisciplinary care team of an acute care medical center and identify a new theory regarding RNs’ perceptions of their role. A grounded theory approach was used to explore and reveal these perceived role identifications through the lens of the accountability theory. The research questions and the guided interview explored RNs’ self-perceived role identifications that have shaped RNs’ expectations of their scope within the multidisciplinary care team model. The results found nurses to be experts of patient care and that the nursing role has a 24/7 responsibility while being the closest, most personal role to the patient, thus, the RN feels accountable for all the needs to the patient, even if the needs or actions are outside of the nursing assigned role or tasks. From these results emerged a new theory, the perpetual accountability theory. Identified recommendations regarding RNs’ roles and their utilization within the multidisciplinary care teams allow a positive social change of greater success at delivering best practices and optimum patient outcomes.

Preventative care services allow patients to be fully equipped with the knowledge, tools, and other resources to help them discover and treat many diseases and illnesses so that the burden of costs will not fall on patients and their families. Since the passage of the Affordable Care of Act (ACA) by President Barack Obama, the requirement for health insurance coverage has not translated to utilization of preventative care services. The purpose of this study is to determine the motivation for African Americans who have insurance coverage and access to care who are not taking advantage of opportunities for screenings and health education. The health belief model was used to determine how belief and modifying factors influence health decisions. The quantitative study required use of a secondary dataset to determine utilization of preventative care services, insurance affordability, future access to care and understanding of the health care law. The study included testing the statistical significance of these factors among African Americans, White Americans, and Hispanic Americans who participated in the Healthy Americas Survey. Using the program SPSS to process data analyzation and organize output, results reveal that African American participants are concerned about the future ability to access and afford care. With a history of distrust amongst African Americans and the health industry, social implications are for administrators and providers to bridge the gap by offering health education to those in their immediate communities and requesting and implementing feedback from those same individuals.

Most organizational change initiatives fail because managers lack effective change management strategies. The purpose of this single case study was to explore change management strategies that outpatient care facility managers used to positively affect process improvements. The population consisted of 6 managers who completed change initiatives at a military, outpatient medical facility in Texas and 6 of their team members. Data were collected using semistructured interviews and organization documents, then analyzed based on the conceptual framework of Lewin’s change theory. Rowley’s 4-step process for analysis—organizing; getting acquainted with; classifying; coding and interpreting; and presenting and writing up the data—was used to identify 4 major themes through data saturation. From the data analysis, the following strategy themes emerged: building effective teams, establishing the foundation for the change, communicating throughout the change process, and solidifying the change. Managers in the healthcare industry can use the findings of this study as a guide to improve the outcomes of their process improvement initiatives by implementing the strategies provided by the manager participants. Thus, the findings of this study may be used to affect positive social change to improve patients’ quality of healthcare and community healthcare outreach programs through increased efficiencies and reduced expenditures.

Healthcare leaders must establish a just culture to mitigate preventable medical deaths that occur at 250,000 per year, making medical errors the 3rd leading cause of death in the United States. However, there is a gap in knowledge regarding the attributes of nurse manager leadership styles that contribute to promoting a just culture at the unit level. Guided by the full range leadership theory and the just culture model, the purpose of this descriptive correlational study was to determine the relationship between nurse manager transformational, transactional, and laissez-faire leadership styles and unit level just culture perceptions and the differences between staff nurses’ and nurse managers’ perceptions of leadership styles and just culture. The Multifactorial Leadership Questionnaire and the Just Culture Assessment tool were administered to 165 U.S. hospital-based staff nurses and nurse managers. ANOVA revealed a statistically significant difference in the mean just culture scores between transformational, transactional, and/or laissez-faire leadership styles (p < .01). MANOVA outcomes were significant for the difference between the nursing staff’s and nurse managers’ perceptions of nurse managers’ leadership styles (p < .01). This study promotes positive social change identifying transformational and transactional nurse manager leadership skills as a predictor for maintaining a unit level just culture and clarifying the impact of nurse managers’ leadership styles on perceptions of patient safety among frontline nurses and hospital safety. Future research should focus on exploring the relationship between nurse-sensitive patient outcomes such as pressure injuries and hospital-acquired infections along with the unit level just culture and nurse manager leadership styles.

Team-based primary care is an innovative care delivery model that has the potential to improve access to comprehensive, coordinated, and high-quality patient care. It is understood that in order for primary care teams to work effectively, health care providers must work across disciplinary boundaries and develop strong relationships that enable them to coordinate their roles and expertise. This research investigated how health care providers make use of different team structures (i.e., tools) to manage their interdependent work, enabling them to deliver team-based primary care. This research also examined how team structures influence the intra-team relationships important for coordinating care. By exploring the different ways primary care teams enact team structures, this research identifies ways primary care teams use team structures differently to address the needs of patients and coordinate team-based care. In-person interviews were conducted at 7 primary care clinics participating in a population health management program in a southeastern city in the United States. Research participants from various health care disciplines (e.g., medicine, nursing, social work) were asked to describe their experiences delivering team-based primary care. Interviews were recorded, transcribed, and analyzed. Data were analyzed using a constant comparative approach in order to investigate how different team structures were used to address the needs of patients and the challenges of delivering team-based primary care. The data suggested that primary care teams enact structures in different ways. In some teams, huddles were used to anticipate the specific needs of patients and coordinating care, referrals occurred via warm handoffs with co-located providers, and protocols were used to facilitate collaborative problem-solving. In other clinics, huddles were focused on clinic operations, referrals were performed using traditional methods (e.g., phone calls), and protocols were used to guide task delegation. Participants in some clinics described how team huddles were used to leverage high-quality relationships by fostering respectful interactions between team members. More research is needed to determine whether the use of patient-focused huddles, warm handoffs, and protocols that initiate problem-solving is associated with better patient outcomes, particularly for patient populations with complex medical and non-medical needs.

Research indicates that the current teacher shortage is in part due to stress and burnout. A topic that has not been examined is beginning expatriate English medium teachers (EMTs) with 5 years or less of teaching experience in the United Arab Emirates and the relationship between using individualized, self-initiated wellness paradigms and stress, job burnout, and intent to leave the teaching profession. The transactional model of stress and coping, Maslach's multidimensional theory of burnout, and the health promotion model were used to evaluate the moderating effects of the EMTs' burnout and stress levels on their wellness and intent to leave. In a quantitative, correlational design, multiple linear and moderated multiple regression were used to analyze data from a sample of 165 EMTs employed in schools in the United Arab Emirates. Results indicated that spiritual growth was a significant, negative predictor of intent to leave. EMTs' burnout and stress levels did not have a moderating effect on spiritual growth and intent to leave. There was a significant, positive relationship between emotional exhaustion, personal accomplishment, and intent to leave. These results can foster positive social change by bringing awareness to the stress and burnout that EMTs experience and by proposing that administrators, stakeholders, and school district personnel provide coping mechanisms for teachers to deal with stress, burnout, and intent to leave.

Changes in reimbursement make it imperative for nurse managers to develop tools and methods to assist them to stay within budget. Disparity between planned staffing and required staffing often requires supplemental staffing and overtime. In addition, many states are now mandating staffing committees to demonstrate effective staff planning. This retrospective quantitative study developed an empirical method for building nursing unit staffing plans through the incorporation of patient acuity and patient turnover as adjustments towards planning nursing workload. The theoretical framework used to guide this study was structural contingency theory (SCT). Patient turnover was measured by Unit Activity Index (UAI). Patient acuity was measured using case mix index (CMI). Nursing workload was measured as hours per patient day (HPPD). The adjustment to HPPD was made through the derivation of a weight factor based on UAI and CMI. The study consisted of fourteen medical, surgical, and mixed medical-surgical units within a large academic healthcare center. Data from 3 fiscal years were used. This study found that there were significant, but generally weak correlations between UAI and CMI and HPPD. The method of deriving a weight factor for adjusting HPPD was not as important as the decision-making relative to when to adjust planned HPPD. In addition, the measure of unit activity index was simplified which will assist researchers to more easily calculate patient turnover. As a result of this study, nurse managers and will be better able to adjust and predict HPPD in cases where benchmarking has been problematic. Data-driven adjustments to HPPD based on UAI and CMI will assist the nurse manager to plan and budget resources more effectively.

While systemic lupus erythematosus (SLE) has been traditionally viewed as a woman's disease, SLE impacts men as well. Although most research on SLE has concentrated on how it affected women, little is known about how it impacts men. The purpose of this phenomenological study was to examine how men who live with SLE perceive its psychological impact. Using the lens of the biopsychological theory, common themes were examined pertaining to how men with SLE perceive the impact that SLE has on their cognitive and emotional functioning. Data were collected via interviews with 9 men with SLE, and the data were analyzed using thematic analysis to determine common themes. The following common themes emerged: reflections on life before SLE, changes in interpersonal relationships, changes in intimate relationships, changes in self-concept, and changes in perspective about living with lupus. These themes suggest that, in order to improve the quality of life for patients living with SLE, it is not enough to address the physical symptoms; it is necessary to address the cognitive and emotional impacts of the disease process as well. Implications for positive social change of this research study include providing a greater level of understanding of the psychological impact of SLE on men as a resource for professional therapists and psychologists who are trying to find information that would be beneficial for their male SLE clients. Additional potential implications for positive social change include providing information for families and caregivers of those men with SLE, and how the disease impacts them from a psychological standpoint.