Building on a previous 1994 study, this descriptive study reflects on the ever-shifting sands of the nurse manager role. This national survey is based on the Katz (1955) conceptual framework of interrelated technical, human and conceptual competencies. An instrument developed by the investigator for determining important nurse manager competencies was validated using an expert panel of AONE nurse manager Fellows. The research used a web-based survey to collect information from hospital nurse managers via a self-administered competency instrument. Eighty one completed the online survey with complete data for a response rate of thirteen percent. Findings suggest the highest self-reported nurse manager competency ratings included effective communication, retention strategies, effective discipline and decision-making. In contrast, the lowest self-reported nurse manager competencies included nursing theory, case management and the research process. The associations of nurse manager competencies with individual and organizational variables were studied. The impact of organizational variables of hospital size and span of control had a medium effect. Magnet status impact was unremarkable. Individual variables of gender, age, education, tenure as an RN, and tenure in current position also did not significantly impact competency ratings. A large and medium effect was noted between tenure in the management role on all the competency ratings within the five constructs. The Chase Nurse Manager Competency Instrument underwent psychometric testing as none had been done since the original 1994 study. The 1994 and the 2010 study data was used to determine reliability and validity assessments with positive results. A crosswalk was also completed between the Chase Instrument and the 2005 AONE Nurse Manager Leadership Collaborative Framework and due to the similarities in the five categories the Chase Instrument was revised to reflect the parallel similar headings support the consistencies between the models. Study findings reveal Nurse managers have to deal with finance and budgeting, patient safety, quality improvement, staff retention, and many other tough topics. They are expected to achieve a blend of clinical and business management with little to no training. Based on the findings the following ten recommendations are provided and include, Provide realistic expectations of the role; Provide a skill assessment and form a plan based on competency development; Provide a structured orientation and development program which includes 30/60/90 day checkpoints; Establish long term mentorship building on the key ingredients of inspiration and role modeling; CNO involvement is critical; Teach Influence; Teach implementation strategies; Create the culture; Invest in Nurse Manager support for Development of Staffing, Financial Acumen and Compliance; Enhance communication skills at every level. Among nursing leadership, the nurse manager role has been identified as critical in the provision of high-performing, effective and efficient care in the patient care delivery setting. This individual is the unit-based CEO responsible for quality, safety, satisfaction and financial performance in alignment with regulatory and accrediting body requirements. Excellence in horizontal and vertical communication is required as this role represents the voice of the direct care nurse at the leadership table as well as the voice of the board of trustees at the unit level.

The purpose of this project was to evaluate the impact of a quality improvement strategy to implement an RN clinical learning and development specialist (CLDS) with the intent to reduce high turnover in novice nurses and low nurse engagement. The CLDS served as expert, role-model, coach, and mentor. Benner'€™s model of novice-to-expert was used as the conceptual framework to monitor progression of nurses mentored by the CLDS. The Institute for Healthcare Improvement model for improvement was reviewed to assess the effectiveness of the CLDS on turnover rates and nurse engagement. At the time of program evaluation, the CLDS role had been operational at the project site for 8 months in inpatient and perioperative service lines. An analysis of turnover rate by headcount of 1510 RNs within the practice environment was completed. The change from the preintervention period to the postintervention period was statistically significantly lower. A nonparametric test to compare the monthly rates was used (z = -2.613; p = .005). To evaluate nurse engagement, the practice environment scale was deployed to all RN nurse residents from 9/2018 through 3/2019. A total of 166 surveys were deployed. There were 86 responses; 62 respondents were RNs with an assigned CLDS. There were no statistically significant differences in the scores between these 2 groups. The social impact of this project is important to share with nursing and operational leadership as an intervention to reduce RN turnover across healthcare settings, specifically in acute care practice areas. The issues of RN turnover and satisfaction with the practice environment are relevant across organization types and settings.

Healthcare administrators can improve patient care and safety by stimulating nurse engagement as a means of improving internal relationships. The purpose of this case study was to explore engagement strategies that healthcare administrators use to stimulate nurse engagement. Data were collected using semistructured interviews with 4 healthcare administrators in a Missouri hospital setting. The engagement theory informed the conceptual framework of the study. Data were analyzed using Yin's 5-step process that included compiling, disassembling, reassembling, interpreting, and concluding. Analysis revealed 4 major themes: teamwork, nurse and administrator communication, nurse recognition, and nurse empowerment. Strategies were identified through the exploration and analysis of the 4 themes, and the major findings included healthcare administrators increase trust with nurses by forming teams, and administrators who increase communication are more likely to stimulate nurse engagement. The social change implication for this study was that findings of nurse engagement may lead to improved patient care and contribute to a positive patient experience, which benefit patients and their families. Improved patient care may lead to greater faith and credence in medical care benefiting citizens, practitioners, and healthcare administrators.

Murder is not a phenomenon that sits comfortably with the typical image of nurses and yet the number of cases of nurses accused and convicted of murdering patients is mounting. The nursing literature is quiet on the subject and therefore what is generally known on the topic predominantly comes from the media. An analysis of this seemingly unfathomable phenomenon is required to re-consider the problem and understand from new perspectives how and why this is happening. The aim of the study is to provide information for health professionals and organisations that will help them work together to recognise situations in which murder by nurses can occur. The research question is: How do the various discourses surrounding murder committed by nurses on patients in the course of their work shape the definition and treatment of these crimes? A discursive analysis of texts guided by a number of discourse theorists is undertaken to reveal the social construction of murder of patients by nurses. Texts related to the media and professional reporting of over 50 cases of registered nurses, enrolled and licensed nurses and assistants were retrieved from searches of Factiva, CINAHL and MEDLINE between 1980 to 2006. The software program JBI-NOTARI® (Joanna Briggs Institute, 2003b) houses the texts and facilitated analysis. Discursive constructions are reported in four findings chapters and include: the profile of murderous nurses; types of murders; contexts in which murder takes place; factors that aid detection and apprehension; legal processes that guide charges, convictions and punishment; and finally the reactions of the public, the profession, the regulators and the families. The murder of patients by nurses is construed as a combination of extraordinary nurses, extraordinary deeds in ordinary contexts. While members of the nursing profession may not be held accountable for the actions of aberrant nurses who murder there is a responsibility to understand how hospitals and units form crucibles in which murder can take place. The recommendations from this study relate to both practice and research. Practitioners are recommended to critically reflect on structures and processes. / Thesis(Ph.D.)-- School of Population Health and Clinical Practice, 2008

Today patients are more aware of their rights regarding their own care. They are more informed, more engaged and have more and individual requirements, which leads to increased demands for information and participation increases. The Health Act sets out the patients´ right to participation. Participation increases patient satisfaction with care, promotes healing and increases adherence to health care advise. The patient doesn´t always experience participation in their own care to the extent they wish, which suggests that nurse’s does not always succeed in getting the patient involved. The purpose of this study is to describe factors that are important for patient participation in nursing care in a nurse- and patient perspective. Nine research articles were analyzed with qualitative content analysis. The analysis resulted in two themes: health care relationships and communication. Through various acts of nursing care, patients experienced themselves as being seen and confirmed. Patients experienced a sense of security and trust, which is the essence of a trusting relationship, which in turn is the basis for caring and patient participation in their own care. Patient participation requires a sophisticated interaction between nurse and patient, a quest of a safe relationship that can lead the patient to see themselves seen and confirmed.       Keywords: patient participation, nurse-patient relationship, nurse, care

The global nursing shortage created opportunities for registered nurses from less developed countries to improve their working and living conditions through migration to more progressive and affluent nations. In the Philippines, this phenomenon left the country devoid of the much needed health care professionals. In this research study, I described the lived experiences of eleven indigenous Filipino nurses who migrated to the United States. Through the phenomenology approach, I was able to probe into the meaning of the migration as the participants lived through it, approaching it from a humanist perspective and using Abraham Maslow's theory on the hierarchy of needs as the framework. The study was intended to illustrate how the economic, social, and political characteristics of both countries impacted the Filipino nurses' behavior and thought processes while in pursuit of personal goals. Ultimately, this study could be used as a guide in the development of employment and health care policies that are more responsive to the current state of the nursing profession.

This thesis investigates how individual student nurses construct a body of knowledge that is appropriate and able to support or underpin their practical experiences in the early part of their undergraduate pre-registration nursing programme. It is an exploration of how contemporary nursing students link theory, that is fit for purpose, with the art and skills that are pre-requisite for competent nursing practice. The study is written from the perspective of a senior academic and perceived gatekeeper of professional nursing standards, and uses personal and professional writing to illustrate the ontological stance adopted. Working with the core concepts introduced by Bernstein (1975), Von Glasersfeld (1989), Mezirow et al (2000) inter alia, an emergent research methodology is employed. A questionnaire is used to confirm that the Higher Education Institution where the research was conducted was typical in the UK at the time; web logs (blogs) are used to explore the individual experiences of ten student nurses; and this is supplemented by interviews, naturally occurring and other data to illuminate, extend and contextualise the findings. The findings underpin the construction of a recursive model that links heads, hands and hearts with a central focus on viable knowledge, this being the knowledge that guides practice. The contribution of this study to practice relates to the recognition that knowledge must be presented and transmitted in a viable fashion with practice being maintained as pivotal to the educational process, and the recommendations of the study for curriculum design and delivery reflect this. The research concludes that viable knowledge that is dependent upon the centrality of practice in nurse education should become the defining attribute of the nurse of the future.

At the time of this study (2009) the role of the nurse practitioner (NP) was new to the province of British Columbia (BC). The provincial government gave the responsibility for implementing the role to health authorities. Managers of health authorities, many of whom were unfamiliar with the role, were responsible for identifying the need for the NP role, determining how the NP would function, and gaining team members’ acceptance for the new role. The purpose of the study was to explain the process of NP role implementation as it was occurring and to identify factors that could enhance the implementation process. An explanatory, single case study with embedded units of analysis was used. Three primary health care (PHC) settings in one health authority in BC were purposively selected. Data sources included semi-structured interviews with participants (n=16) and key documents. Propositions and a conceptual framework developed from the review of the literature guided the study. Key components of the framework were the concepts of intention, involvement and acceptance. The results demonstrate the complexity of implementing the NP role in settings unfamiliar with it. The findings suggest that early in the implementation process and after the NP was hired, team members needed to clarify intentions for the role and they looked to senior health authority managers for assistance. Acceptance of the NP was facilitated by team members’ prior knowledge of either the role or the individual NP. Community health care providers needed to be involved in the implementation process and their acceptance developed as they gained knowledge and understanding of the role. Although relatively new in their roles, NPs were enacting, to some degree, all competencies of the role, as defined by College of Registered Nurses of BC. The findings suggest that the interconnectedness of the concepts of intention, involvement and acceptance influences the implementation process and how the NP is able to function in the setting. Without any one of the three concepts not only is implementation difficult, but it is also challenging for the NP to fulfill role expectations. Implications for research, policy, practice and education are discussed. / case study research

As nursing leaders, nurse managers are critical to the future of the healthcare system, as well as the nursing profession. Becoming a new manager or leader requires considerable development (Conners, Dunn, Devine, & Osterman, 2007); however, there is limited literature that focuses on the development of the nurse manager (Cadmus & Johansen, 2012). The purpose of this study was to explore the development of self-efficacy in nursing leaders, specifically new nurse managers. Albert Bandura’s (1997) self-efficacy theory was used to guide this study. Qualitative content analysis was used to analyze the data. Two themes emerged from the data, describing experiences of self-efficacy, and the development of self-efficacy. A positive connection between experiencing a mentoring relationship and perceived self-efficacy emerged from the data. The findings of this study provide healthcare stakeholders an in-depth understanding of the importance of mentoring and it outcomes related to the development of self-efficacy in new nurse managers.

Thesis (Ph.D.)--Duquesne University, 2007. / Title from document title page. Abstract included in electronic submission form. Includes bibliographical references (p. 84-94).