The importance of nurse residency programs is addressed in the literature; however, a review of residency program outcomes and effectiveness is needed. Guided by Roy's adaptation model and Deming's plan-do-check-act model, the purpose of this quality improvement project was to assess the current state of a longstanding critical care nurse residency program in meeting organizational goals and objectives and to recommend modifications to the program related to external factors, internal challenges, and educational deficits of nurses entering the program. A review of the evidence-based literature and feedback from focus groups of leadership stakeholders were used to develop recommendations for residency program improvement. Using qualitative analysis of the focus group data, three common themes emerged related to external factors: financial resources, patient acuity, and generational differences that influence nurse satisfaction with the residency program. Three additional themes emerged related to organizational barriers to satisfaction with the program: preceptor availability and development, limited training hours due to productivity standards, and leader time to support novice nurses. Reality shock when starting to practice in the high acuity critical care area was the most frequently reported educational deficit among new nurses. Recommendations for program improvement included obtaining feedback from residency program participants and preceptors, initiating preceptor development pathways, reinstituting a dedicated cost center for nurse residents' training, and using competency assessment tools to customize training plans for residency program participants. This project has the potential for social change by increasing job satisfaction and retention of new nurses and improving health outcomes in critical care patients.

Abstract The number of internationally educated nurses (IENs) in Ontario is growing. Given the predicted nursing shortage due to an aging nursing workforce and a short supply of nursing graduates, this trend will probably continue as international recruitment to meet nursing demands in Canada continues. Current Canadian research that examines IENs’ experience as they integrate into their workplaces is scarce. With an increasingly diverse Canadian and patient population due to rising immigration trends, a workforce that addresses the needs of the diverse patient population is valuable. Therefore an in-depth understanding of IENs’ experience, their contribution to nursing practice, and their distinct role in promoting health care access to Canada’s diverse population is necessary. A qualitative study using descriptive phenomenology was used to explore the integration experiences of eleven IENs within the Ontario, Canada health care system. Interviews were conducted to examine their experience of integrating into Canadian work settings. Thematic analysis informed by a descriptive phenomenological lens was used to uncover the essence of the IEN’s integration experience. The findings are categorized into five major themes including: Relationship with colleagues; Professional knowledge and experience; Organizational practices and work environment; Cross-cultural and linguistic competence; and IENs as an asset to nursing and patient care. These findings were nested within an overarching theme of resilience and an intrinsic motivation to establish their credibility as competent nurses. These findings highlight IENs’ unique integration experiences, and contribute to Canadian literature in the field, especially in terms of an understanding of IENs’ unique contribution to nursing in Canada. Implications and recommendations for nursing with regards to practice, education, research, and administration are presented.

Thesis (M.S.)--University of Michigan, 1992.

Thesis (M.S.)--University of Michigan, 1992.

Bakgrund: Inom hälso-och sjukvården har samarbete vuxit fram som en organisationsform. Kunskap om hur vårdpersonal uppfattar samarbete är värdefullt för en fortsatt utveckling av organisationen och för att säkra god vård. Syfte: Syftet med denna studie var att undersöka undersköterskans, anestesisjuksköterskans och operationssjuksköterskans uppfattning av samarbetet på operationssalen samt vilka främjande och hindrande faktorer som påverkade samarbetet. Metod: Som metod valdes en deskriptiv design med kvantitativa data. Ett frågeformulär har använts för att uppnå syftet med studien. Frågeformuläret har inspirerats av "The Operating Room Management Attitudes Questionnaire". Totalt 38 frågeformulär med medföljande informationsbrev delades ut till 12 operationssjuksköterskor, 13 anestesisjuksköterskor och 13 undersköterskor. Personalen informerades om studien muntligen på en arbetsplatsträff (APT). Resultat: Resultatet visade att de främjande faktorerna för ett fungerande samarbetet är god kommunikation, personkemi, kompetens, teamträning, checklista och konstruktiv kritik. De hindrande faktorerna för ett fungerande samarbete som framkom i resultatet var att det inte gavs tid för reflexion, bristande resurser gällande personal och utrusning samt trång arbetsmiljö. Konklusion: Om kommunikationen fungerar mellan professionerna samt att tid ges för reflexion främjas i sin tur samarbetet och patientsäkerheten vilket minskar vårdskador. / Background: Cooperation as a form of organisation has become more and more important within the health services.Knowledge of how health professionals perceive cooperation is valuable for the further development of the organization and to ensure good care. Aim: The purpose of this study was to investigate an assistant nurse's, nurse's anesthetist and surgical nurse's the perception of cooperation in the operating room, as well as the promotion and prevention factors affecting cooperation. Method: The method was a descriptive design with quantitative data. A questionnaire was used in order to achieve the purpuse of the study.The questionnaire is inspired by "The Operating Room Management Attitudes Questionnaire". A total of 38 questionnaires with an accompanying information letter was distributed to 12 surgical nurses, 13 nurse anesthetists and 13 assistant nurses. The staff were informed about the study orally in a department meeting. Results: The results showed that the promoting factors for an effective collaboration is good communication, personal chemistry, expertise, teamtraining, checklist and constructive criticism. The disincentives for a functional cooperation that emerged in the result, was that there was no time for reflection, a lack of staff resources, shortage of equipment and cramped working conditions. Conclusion: A well functioning communication between professions, where time for reflection is given encouriging cooperation, which in turn promotes patient safety and thereby reduces preventable harm.

Abstract The number of internationally educated nurses (IENs) in Ontario is growing. Given the predicted nursing shortage due to an aging nursing workforce and a short supply of nursing graduates, this trend will probably continue as international recruitment to meet nursing demands in Canada continues. Current Canadian research that examines IENs’ experience as they integrate into their workplaces is scarce. With an increasingly diverse Canadian and patient population due to rising immigration trends, a workforce that addresses the needs of the diverse patient population is valuable. Therefore an in-depth understanding of IENs’ experience, their contribution to nursing practice, and their distinct role in promoting health care access to Canada’s diverse population is necessary. A qualitative study using descriptive phenomenology was used to explore the integration experiences of eleven IENs within the Ontario, Canada health care system. Interviews were conducted to examine their experience of integrating into Canadian work settings. Thematic analysis informed by a descriptive phenomenological lens was used to uncover the essence of the IEN’s integration experience. The findings are categorized into five major themes including: Relationship with colleagues; Professional knowledge and experience; Organizational practices and work environment; Cross-cultural and linguistic competence; and IENs as an asset to nursing and patient care. These findings were nested within an overarching theme of resilience and an intrinsic motivation to establish their credibility as competent nurses. These findings highlight IENs’ unique integration experiences, and contribute to Canadian literature in the field, especially in terms of an understanding of IENs’ unique contribution to nursing in Canada. Implications and recommendations for nursing with regards to practice, education, research, and administration are presented.

In 2010, the Patient Protection and Affordable Healthcare Act (PPACA) implemented changes to reduce healthcare spending that incorporated Centers for Medicare and Medicaid (CMS) incentive programs to reduce 30-day readmission rates in seniors with heart failure. This project includes a policy and procedure for private practice using a nurse practitioner navigator (NPN) led multidisciplinary team (MDT) for the patient-centered medical home (PCMH) to improve communication between hospitals and PCMH to decrease readmission rates in seniors with heart failure (HF). This practice change will provide an implementation and evaluation plan along with plans for future expansion. Meetings were held twice weekly along with the use of Skype when team members were unavailable. A literature review explored methods to improve communication between hospitals and PCHM to reduce readmission rates. Thirty-two peer-reviewed articles were identified in a search of CINAHL and ProQuest Nursing and Allied Health Source databases that served as the primary pool of evidence used for this project, supplemented by context considerations provided by the project team. Evaluating the evidence based research provided support for this project using a NPN led MDT to reduce readmission rates. Coleman's transition of care (TOC) model was used as a framework for both the policy and procedure to integrate patient, provider, and environmental contexts, support health care policy changes, and reduce health care spending. This scholarly project supports the role of DNPs as leaders in the medical field working to translate existing evidence into policy and practice and lead interdisciplinary health care teams.

No description available.

Indiana University-Purdue University Indianapolis (IUPUI) / The Bureau of Labor Statistics projected a shortage of registered nurses (RNs) growing to an estimated 581,500 by the year 2025 (an increase of 22 percent since 2008). Recent economical downturns have found many healthcare organizations experiencing a positive effect with the stabilization of nursing turnover. Once the economy begins to recover, however, experts predict the profession of nursing will still face the largest shortage in history according to projections by the American Nurses Association. Because lack of job satisfaction is a precursor to resignation, additional research regarding the identification of interventions that increase RN job satisfaction may result in retaining professionally qualified and prepared staff. This study proposed to identify through focus groups, staff nurse perceptions of nurse manager behaviors that influence RN staff nurse job satisfaction. A sample of 28 RNs, each participating in one of five focus groups, answered questions related to satisfaction with nurse manager behaviors. The investigator used qualitative content analysis to identify patterns within and across focus group data. Major findings of the study resulted in the identification of two conceptual categories (manager behaviors supportive of RNs and RN’s perceived disconnect of work issues from the manager’s role) and three major themes related to supportive behaviors (communication, respect, and feeling cared for). The results suggest the following as staff nurse preferences for nurse manager behaviors: open and honest communication that involves listening, consistency, and confidentiality; an increased level of respect including fairness and recognition of a job well done; and the sense of feeling cared for as when a manager meets individual needs and supports staff as professionals. The investigator compared the categories and themes to previous tools used in healthcare, which indicate the need for further item and/or tool development as well as further research regarding RNs’ perceived disconnect of work issues from the manager’s role.

Bakgrund: En specialistsjuksköterska inom akutsjukvård med inriktning mot ambulans- och/eller intensivvård hanterar hjärtstopp enligt algoritmen för avancerad hjärtlung-räddning och verkar i komplexa situationer såväl prehospitalt som intrahospitalt, där krav ställs på specialistsjuksköterskan att kunna tolka tillstånd, hantera avancerad utrustning och läkemedel samt ställs inför etiska och komplexa situationer.  Syfte: Att belysa specialistsjuksköterskors erfarenheter av att delta vid hjärtstopp  Metod: Kvalitativ metod med deskriptiv ansats. Intervjuerna genomfördes med en semistrukturerad frågeguide, vilket gav möjlighet för följdfrågor. Tio deltagare intervjuades och intervjuerna analyserades med hjälp av kvalitatitv innehållsanalys av Graneheim & Lundman (2004).  Resultat: Studiens resultat presenteras i två kategorier. Den fokuserade experten samt Människan med behov för återhämtning och reflektion. Arbetet som specialistsjuksköterska inom akutsjukvård med inriktning mot ambulans- och/eller intensivvård ger deltagarna upplevelser som påverkar dem i både yrket och privat. Förberedelser att hantera situationerna sker i form av utbildning i avancerad hjärtlung-räddning men också erfarenheter av att delta vid hjärtstopp är viktiga för att utvecklas i yrkesrollen och hantera utrustningen som finns tillhanda för hjärtstopp. För att kunna hantera upplevelserna krävs, förutom stödinsatser av arbetsgivaren i form av debriefing, även informellt stöd av kollegor samt personliga copingstrategier. Konklusion: Arbetet som specialistsjuksköterska kräver avancerade kunskaper och förberedelser i form av utbildning, hantering av medicinteknisk utrustning men även upplevda erfarenheter, för att kunna formas i sin yrkesroll. Att genomföra formella debriefingar, använda kollegialt stöd och egna copingstrategier gör att specialistsjuksköterskor hanterar exponeringen av att möta patienter med hjärtstillestånd till en hanterbar situation. Dock anser en del av specialistsjuksköterskorna att det finns brister som kan förbättras vad gäller utbildning för att hantera hjärtstopp. / Background: A specialist nurse in emergency care with focus on prehospital- and/or intensive care manages algoritms for cardiac arrests and are active in complex situations, both pre- and intrahospital, were the specialist nurses have demands on them to interpret conditions, manage advanced equipment and drugs and are encountered to ethical and complex situations.  Purpose: To enlighten the experiences of specialist nurses when managing cardiac arrests, the complexity that sorrounds the situation whenever a patient is in cardiac arrest, could give the specialist nurse tools to better understand and cope with that type of emergency situations and increase safety in their professional role Method: Qualitative method with a descriptive approach. The interviews were conducted through a semi-structured interview guide. Ten participants were interviewed and the interviews were transcribed and analyzed according to qualitative content analysis by Graneheim & Lundman (2004). Result: The result of the study is presented in two categories, the focused expert and the person with need for recovery and reflection, with seven sub categories belonging to the categories. Working as a specialist nurse within emergency care with focus on prehospital- and/or intensive care and taking care of patients in cardiac arrest give the participants in this study experiences that affect them both professionally and private. Preparation to manage cardiac arrests involve training in advanced cardiopulmonary resusciation but also experiences of participating during cardiac arrests are important to evolve in their professional role and manage the equipment that are being used for cardiac arrests. To be able to manage the experiences they need to accept supportive measures from their employer and informal measures such as peer-support and personal coping strategies.  Conclusion: The role of being a specialist nurse in emergency with focus on prehospital  and/or intensive care demands advanced knowledge and preparations through education, managing medical technology equipment and lived experiences, in order to be shaped in their professional role. By conducting formal debriefings, use peer-support and their own coping strategies the specialist nurse manage to cope with exposure of meeting patients in cardiac arrest. However, some of the specialist nurses considers there should be room for improvement regarding their education to manage cardiac arrests.