Purpose: To describe the process of designing a new progressive nurse practitioner student clinical evaluation tool based on competencies. Data sources: Selected research articles and professional organization published guidelines. Conclusions: Evaluation of nurse practitioner students' clinical performance is an important and often complex responsibility of faculty. The clinical evaluation tool should reflect the changing expectations associated with particular courses across the curriculum and be based on the competencies identified by the National Organization of Nurse Practitioner Faculties. Collaboration by faculty is the key to development of an accurate and useful clinical evaluation tool. Implications for practice: The progressive nurse practitioner clinical evaluation tool presented here is the result of integrating specific clinical course outcomes and competencies recognized by key nurse practitioner associations.

INTRODUCTION: Nursing practice is continuously evolving in response to global health care need, sociopolitical culture, and advancing medical knowledge necessitating ongoing evaluation of professional practice. The purpose of this state of this science paper was to explore current perceptions of nursing and critique the depth of knowledge specific to nursing practice in the Appalachian region. METHODOLOGY: A review of the literature in multiple databases was conducted to explore perceptions of nursing in Appalachia. RESULTS: Categories of perception included the following: (a) perceptions of nurses and education leaders that practice in the Appalachian region, (b) perceptions of communities of Appalachia and Appalachian health care systems, and (c) perceptions of patients possessing inherent cultural characteristics of the Appalachian region. DISCUSSION: None of the literature specifically addressed perceptions of nursing. Much of the available literature was over 5 years old. A significant deficiency in understanding perceptions of nursing in Appalachia was identified.

Situation awareness and distributed situation awareness are important concepts in critical care, where large interdisciplinary teams must coordinate their activities through information sharing to provide lifesaving treatment to patients. Little is known, however, about how nurses contribute to distributed situation awareness in different types of intensive care settings. The purpose of this study was to explore information sharing by nurses in two intensive care units, with and without interdisciplinary rounds. The method of rapid qualitative inquiry was used, which emphasizes data triangulation and iterative data analysis. In each of two intensive care units studied, four RNs were observed for eight hours each, and the content and characteristics of information sharing were recorded. This was followed by chart reviews to determine the impact of information sharing by nurses on patient care. The results demonstrated that there was little difference in the type of information shared, the pattern of information sharing by nurses in the two units, and the impact that information sharing had on patient care. An important exception, however, was that nurses in the unit without interdisciplinary rounds contacted physicians twice as often as nurses in the unit with interdisciplinary rounds. The results were integrated into a revised model of distributed situation awareness. / Graduate

The Joint Commission (TJC) sets standards to assist healthcare organizations in improving performance. The hospital for which this project was developed did not meet national TJC benchmarks for patient satisfaction and nurse retention. Based on direct observation, discussion with staff, and results of the Multifactorial Leadership Questionnaire given to 39 staff nurses before this project was chosen, evidence suggested that the leadership style of the charge nurses was transactional, which is less effective than transformational leadership (TFL). Framed within the Plan, Do, Study, Act model, the purpose of this quality improvement project was to design an educational curriculum including didactic and competencies on TFL for unit charge nurses. A team approach was used for the project. Incorporating the American Organization of Nurse Executives recommendations on effective leadership, the curriculum encompassed the importance and management of TFL intertwined with the power, motivation, and characteristics of the transformational leader. Competencies governing TFL in practice were a significant part of the curriculum. The curriculum was evaluated by 4 content experts using a 12-item yes or no response for each of the criteria. One of the criteria was answered no in the learning objectives section and the design of the criteria was revised All other criteria were met. A recommendation was made for a change to the evaluation format for the leadership style identification portion of the curriculum. This project has important implications for social change as unit charge nurses strive to act on best practices in leadership, thus positively impacting the well-being and satisfaction of their patients and fellow nurses.

It is estimated that by 2020 there will be 2.8 million long-term care beds in residential facilities, staffed primarily with nursing assistants as the front-line care providers. The American Healthcare Association 2012 staffing survey showed that the median annual turnover rate for nursing assistants in the United States is 51.5%. High rates of turnover are associated not only with poorer quality of care but also with increased costs for facilities. The purpose of this project was to understand characteristics that are associated with long-term employment in the nursing assistant role by describing the personality characteristic of empathy in the nursing assistant population with career longevity. The practice-focused question focused on the level of empathy among nursing assistants in long-term care who have been in their role 3 years or longer. The purposive sample group included 60 nursing assistants from 10 long-term care facilities in New Jersey. Data were collected using the Interpersonal Reactivity Index instrument, which comprises 4, 7-item subscales that consider aspects of the global concept of empathy. The overall findings of this study did not establish a significant relationship between empathy and retention; however, notable shifts in the empathy subscale scores of participants related to gender and length of tenure were noted. The results of this study could promote positive social change by helping administrators select nursing assistants suited to working in long-term care facilities, which may result in lower turnover and improved patient outcomes among the population in long-term care.

This project study addressed the lack of formal preparation encountered by novice nurse educators within a nursing program located in the southeastern region of North Carolina. This problem is significant at both the local and national levels because expert clinicians are needed to fill nurse educator vacancies that have led to qualified students being denied admission to nursing programs. A qualitative case study research design was employed to explore the perceptions of novice nurse educators in one nursing program transitioning from clinical nursing practice to the nurse educator role. The theoretical framework to guide this study was Benner's novice to expert model that outlines the journey of how novice nurse educators transition into an educator role. Guiding research questions focused on understanding the motives, challenges, positives experiences, and perceptions of support that novice nurse educators encountered during transition from clinical practice to academia. Purposeful sampling was used to recruit 7 novice nurse educators within an associate degree nursing program. Data collection included interviews with novice nurse educators, review of a 2012 self-study report, and demographic characteristics of participants. Interviews were transcribed verbatim, coded, and analyzed to identify themes. Five themes were identified: (a) work is always with you, (b) teaching in the dark, (c) making a difference, (d) a shoulder to lean on, and (e) more structure/mentoring. Findings indicated the need for a mentorship/orientation program, which was developed to assist in role transition for novice nurse educators. Implications could contribute to a positive social change by helping clinicians to transition effectively to meet society's need for qualified nurse educators.

The high rate of voluntary employee turnover in nursing has forced business leaders to search for strategies that reduce voluntary employee turnover. The purpose of this single case study was to explore strategies nurse managers used to reduce registered nurse voluntary turnover. Face-to-face semistructured interviews were conducted with 5 nurse managers in the San Antonio, Texas area. The conceptual framework included Herzberg's 2-factor theory and Maslow's hierarchy of needs theory. Data analysis included Yin's 5-step process: (a) compiling the data, (b) disassembling the data into common codes, (c) reassembling the data into themes, (d) interpreting their meaning, and (e) reporting the themes. Member checking and methodological triangulation increased the trustworthiness of interpretations. The interpretations were then triangulated with new themes derived from nurse managers, policies, and procedures. The resulting major themes were job satisfaction, employee compensation, advancement, reward and recognition, and open effective communication. The implications for social change include (a) keeping families together, (b) employing more workers, (c) reducing unemployment, (d) stabilizing communities, (e) helping increase the economy, and (f) improving human and social conditions outside of the workplace. Findings from this study will provide positive social implications including the potential to decrease voluntary employee turnover in businesses, thus contributing to the retention of skilled employees, reducing unemployment, and decreasing revenue losses.

Research has shown that job satisfaction influences retention of nurses, and policies focused on nursing satisfaction are more beneficial for retaining new nurses than adjusting work hours and wages. The prophecy job fit predictor is a quality improvement initiative designed to identify where a nurse should be assigned based on behavior, clinical capabilities, and personality assessment. The practice-focused question for this project focused on whether satisfaction rates of recently graduated registered nurses were influenced by their unit placement. The conceptual frameworks that guided this project were the plan, do, study, and act method and Herzberg's 2-factor theory. Data were obtained from surveying a cohort of 54 graduate nurses in 3 hospital locations in 6 specialty units. Results obtained using 1-way ANOVA and a Likert scale showed that graduate nurse satisfaction rates increased when assigned to their best fit unit: prophecy job fit 58.33% with a mean score of 3.34 (Hospital A), prophecy job fit 20% with a mean score of 3.1 (Hospital B), prophecy job fit 33.33% with a mean score of 3.1 (Hospital C). The results showed that the prophecy job fit predictor during nursing orientation can guide nurses into the appropriate specialty unit and increase nursing satisfaction. The implications of these findings for positive social change in nursing practice include the benefits of using the prophecy job fit predictor when assigning graduate nurses to their hospital setting to address the nursing shortage.

An expectation of the nurse preceptor role includes the ability to evaluate, deliver feedback, and coach new graduate nurses. A gap in nurse preceptors' communication skills can affect the safety-related behaviors and quality of care provided by new graduate nurses, thus affecting patient outcomes. To bridge this gap, robust training on delivering feedback and coaching is needed for preceptors. The purpose of this staff education project was to develop and validate 5 communication simulation scenarios for preceptor training. Mezirow's transformative learning theory and the National League for Nurses-Jeffries simulation theory were used to guide the project. A panel of nurse leaders served as subject-matter experts who evaluated each simulation scenario and individual components using a Likert-style scoring method. Lynn's model for validation was used to determine the validity of individual components and overall scenarios. Each component and scenario scored 0.83 or higher according to Lynn's model and was deemed valid. The panel members recommended that the components and scenarios be integrated into the preceptor-training program at the project site. Incorporating the validated scenarios into a preceptor-training program might allow nurse preceptors the opportunity to practice effective communication skills in a simulation setting. Implications for positive social change include professional development for preceptors, effective training for new graduate nurses, and improved outcomes for patients.

There are numerous factors that influence a nurse manager's job satisfaction and intention to remain in a job. The purpose of this project was to evaluate whether a formal mentorship program for nurse managers impacted job satisfaction and intention to remain in a job. A pilot program was developed and 15 nurse managers from 2 hospitals in the Pacific Northwest participated in a 6-month mentorship program. The program was guided by mentorship enactment theory and Kouzes and Posner's exemplary leadership framework. Using the Leadership Profile Inventory (LPI) and the Nurse Manager Practice Environment Scale (NMPES), job satisfaction, intention to stay in a job, and transformational leadership behaviors were measured before and after the program. Results were analyzed using a paired samples t test. There were statistically significant differences between the preprogram LPI scores (M= 212.27, SD=37.8) and postprogram scores (M=232.47, SD= 25.28); t (14) = -2.83, p =.013. There were also statistically significant differences between the preprogram NMPES Subscale 3: Culture of Generativity (M= 23.20, SD= 4.65) and postprogram scores (M= 26.20, SD= 4.74); t (14) = -2.40, p=.032. The results demonstrated a significant increase in job satisfaction, intention to stay, and transformational leadership behaviors. Implementation of this pilot program supported positive social change through reduced nurse manager turnover, resulting in a reduction of healthcare spending on replacement costs in addition to improved patient outcomes.