The primary purpose of this study was to identify the way in which two groups, staff nurses and nurse administrators/managers, each conceptualize the ideal and actual role of the registered nurse practicing at the bedside. Data was examined in order to identify similarities and differences in the opinions of the two groups. A questionnaire with 35 items/situations using a Likert scale was developed. Items/situations were worded to conform to a five-point response format ranging from strongly agree to strongly disagree. The role conception items/situations were designed to measure the respondent's perceptions of what the role should be and perceptions of what actually exists in the practice of the nurse role. The sample of 300 non-management nurses was randomly selected using 50 percent of the professional nurses from each unit. Nurse administrators/managers comprised a smaller number than non-managers, therefore, the questionnaire was given to this entire group. Noteworthy findings of the study include that (a) staff nurses and nurse administrators/managers agreed in their perception of what comprises the actual professional role of the nurse practicing at the bedside, (b) both groups also agreed in their perception of what comprises the ideal professional role of the staff nurse practicing at the bedside, (c) the staff nurses and nurse administrators/managers agreed in their perception of what comprised the actual bureaucratic role of the nurse practicing at the bedside, (d) the groups agreed in their perceptions of what comprised the ideal bureaucratic role of the nurse practicing at the bedside, and (e) there is a significant difference between the ideal and actual role conceptions within both the bureaucratic and professional concepts. Simply stated, the respondents of this study do not believe that nursing is being practiced the way nursing should be practiced. Implications of the study are presented and discussed, and recommendations for further study are provided.

Individuals with heart failure (HF) are often readmitted within 30 days of discharge from the hospital. Telehealth has been developed to help manage HF during this critical period. However, association of telehealth with improved HF outcomes is still unclear. There is a need to identify the patients who benefit most from telehealth and explore factors that work in conjunction with telehealth to improve HF outcomes. Therefore the purpose of this study was to explore the patient characteristic factors that impact health status and healthcare utilization outcomes of patients with HF who use telehealth in a homecare setting. A descriptive, correlational study design using retrospective chart review was employed. The sample comprised Medicare patients admitted to a New England homecare agency, with HF as a diagnosis and had used telehealth from 2008 to 2010. OASIS and electronic documentation at the homecare agency served as data sources. Descriptive statistics, logistic and multiple regression analysis were used to analyze association of patient demographic, psychosocial status, and disease characteristics with HF outcomes of patients on telehealth. The sample size was 403, of whom 70% were over 75 years of age, 55% were female, and 94% were Caucasian. Number of nursing contacts ranged 1 to 26 with a median value of 10. There were 118 (29.3%) all-cause readmissions, 76 cardiac-related hospitalizations (18.9%), 17 cases with mortality (4.2%) and 52 (12.7%) abrupt terminations of telehealth. For patients with HF on telehealth, patient characteristics such as: anxiety, high number of medications, acute cardiac events, musculoskeletal, psychiatric and anemia type of co-morbidity were associated with high nursing utilization patterns; dyspnea, high number of medications, obesity, ACEI/ARB and beta-blockers were associated with hospitalizations; and renal, psychiatric and cancer type of co-morbidities and female gender were associated with unplanned termination of telehealth. Abrupt termination of telehealth was also found to be correlated with hospitalizations. The findings of this study contribute to our understanding of healthcare utilization by patients with heart failure on telehealth.

<p> This grounded theory study describes how Nurse Practitioners (NPs) provided care to Aboriginal people in British Columbia and proposed a theoretical foundation to guide NPs interactions with Aboriginal people in providing healthcare. This study first explored NPs work with Aboriginal people. Through analysis of interview responses, insight was gained into how NPs provide care to Aboriginal people. Fourteen NPs who worked with Aboriginal people in British Columbia for at least one year during the past five years were interviewed. After each interview data were manually coded for concepts and categories from which to build theory. Memos were written for further clarity and participants were asked to verify whether or not identified concepts and categories worked, fit, and were relevant and modifiable as new data arose. The theory, Engaging Mutually, identified core categories of Initializing Engagement, Sympathetic Mutuality, and Therapeutic Enlightenment as being connected and working together to help provide effective health care. Engaging Mutually was identified as relevant to the theories of oppression, motivational expectancy, social justice, social cognitive, cultural competency, and Watson&rsquo;s caring theory. The significance of this study was to assist NPs to gain a better understanding of how to work with Aboriginal people to improve their health. This study contributes to research, theory, leadership, and nursing and NP practice. Engaging Mutually may assist NPs and other health care providers to develop appropriate health care practices when working with Aboriginal people and potentially with people from other cultures.</p>

<p> Medication administration is an important task performed daily by nurses and is one of the key aspects of safe patient care. The multiple and varied roles of nurses, complexity of workplace, chaotic and technical nature of the work environment may result in cognitive overload that may overwhelm nurses, which may possibly lead to medication errors. All medication errors committed are considered serious events but some may consequently be harmful to patients. Research indicates that when medication errors occur the concern is usually for the patients involved in the incident. However, making a medication administration error has a lasting effect on the nurse as well as the patient (Schelbred &amp; Nord, 2007; Treiber &amp; Jones, 2010).</p><p> This study examined what it was like to make a medication error for eight registered nurses through in-depth and focused face to face interview using the descriptive phenomenological approach rooted in the philosophical tradition of Husserl. Two interviews were carried out with each participant and the research data were generated from a total of sixteen interviews and field notes. The transcripts were analyzed using the seven-step methodological guidelines developed by Colaizzi for data interpretation to understand the meaning of the nurses lived experiences of making medication errors.</p><p> Five theme categories emerged: Immediate <i>Impact: Psychological and Physical Reactions; Multiple Causes within Chaos: Cognitive Dimensions; Embedded Challenges: Healthcare Setting; Organizational Culture: Within the Place/Within the Person; Dynamics of Reflection: Looking Forward</i>. The essential structure of the phenomenon of making a medication administration error included the realization that a profound experience had happened to them. This resulted in physical and emotional upheavals, a threatened professional status, with low self-esteem and confidence. An overwhelming workload, a stressful work environment and ill-treatment by peers were descriptions of the cause of the errors. Nurses did offer ways to improve the system but felt their concerns were often not valued. Implications for nursing practice to improve patient outcomes, and for nursing education, to radically change the teaching of medication administration were formulated.</p>

<p> Racial disparity continues to be a struggle in America. The main purpose of this project was to determine whether there is a relationship between race and the acquisition of health insurance in adult residents of California who are younger than 65 years old. Through secondary data gathering, analysis of an existing racial disparity in health care insurance acquisition was accomplished. The results of the project indicate that a relationship exists between race and health insurance acquisition, thereby promoting an opportunity to determine hindering factors and discuss recommendations that can help to alleviate them. Multiple factors that influence the acquisition of health insurance among residents in California have been cited. Some of these factors such as affordability and immigration status are more relevant in the Latino racial group compared to the others. The awareness of this relationship promotes implications towards a legislative focus on the underserved populations and a development of action plans and public policies that can aid in acquisition of health insurance for all.</p>

<p> Medical errors cost the United States&rsquo; healthcare system approximately $19.1 billion annually. A failure to communicate or speak up is said to be a contributing factor. The purpose of this quantitative correlational study was to examine the relationship between managerial responsiveness, managerial approachability, and prosocial voice among acute-care registered nurses (RNs) from a Greater Northwest facility. The participants were 108 acute-care RNs. Instrumentation included the Supervisor as a Voice Manager developed by Saunders, Sheppard, Knight, and Roth (1992) to measure managerial responsiveness and managerial approachability. Prosocial voice was measured using Van Dyne and LePine&rsquo;s (1998) Prosocial Voice Scale. The relationship between managerial approachability and prosocial voice was positively correlated (<i>p</i> = .001). A positive relationship (<i>p</i> = 0.001) between the linear combination gender, education, years of experience within current acute-care facility, managerial responsiveness and managerial approachability and the RN&rsquo;s use of prosocial voice was found and accounted for 20.0% of the variance in the prosocial voice score. An unexpected serendipitous finding occurred when applying a backward elimination regression to three variables: managerial approachability, managerial responsiveness, and prosocial voice. RNs use of prosocial voice was positively correlated with the RN&rsquo;s level in the organization (<i>p</i> =.01), the RN&rsquo;s perception of managerial approachability (<i>p</i> = .001) while negatively correlated with the RN&rsquo;s perception of managerial responsiveness score ( <i> p</i> = .05). This research adds to current prosocial voice literature and expands the research on managerial approachability and managerial responsiveness. Future research recommendations were identified.</p>

<p> The purpose of this exploratory qualitative study was to identify experiences or barriers that arise during the first year as Certified Registered Nurse Anesthetists (CRNAs) transition into management and; if these shared experiences can prepare future CRNA managers by providing insight into what knowledge, skills, and abilities are necessary to ensure a smooth and successful career transition. </p><p> A representative sample by email and Facebook (FB) elicited 18 phone interviews of current and past Certified Registered Nurse Anesthetist (CRNA) managers. One interviewer asked 16 questions: seven demographic and nine open-ended. Survey information was (1) transcribed, (2) reviewed and de-identified, and (3) coded for content and classical analysis by two experienced independent coders. A coding tree was developed by coders after independent and random assessment of codes with an IRR (0.93). NVivo 11 software was used to assist with analysis of codes. </p><p> CRNA participants (66%) had less than five years of CRNA management experience, and 61% had no previous management experience or education before accepting their first role as a CRNA manager. An incidental finding, 83% of participants were reluctant managers and 76% of CRNA managers devoted greater than 50% of their time to performing clinical duties over managerial duties. Two resources that CRNA participants agreed were helpful resources during transition included: mentors (83%) and previous education or experiences (44%), especially in business, finance, or management. The skills CRNA participants believed were important during transition included people skills (56%), financial knowledge (33%), and communication (28%). </p><p> CRNA managers are more likely to be reluctant managers that may be relatively new in the role, and with no previous management experience or education. Recommendations for new CRNA managers during transition included; mastering &ldquo;people skills,&rdquo; either through relationship management or communication skills. Derailment may be avoided if new managers consider the results of this investigation.</p><p>

<p> The current study focused is on the underrepresentation of registered nurses in hospital CEO positions. There are several existential gaps in chief executive officer (CEO) leadership in the United States. The gender gap in CEO positions across all sectors demonstrates that females represent 31% of CEO positions in the United States. However, females represented only 12% of hospital CEOs in 2007 (Plant, 2008). In 2016, females represented 36% of hospital CEOs. Nevertheless, a far greater gap exists as registered nurses represented 2.5% of hospital CEOs in 2007 (Plant, 2008), and 3.0% of hospital CEOs in 2016. The chronic underrepresentation of registered nurses (RNs) is irrespective of education, experience preparation, knowledge, attitude, skills, and habits as RN executives aspiring to become hospital CEOs often have more education and experience than their non-registered nurse counterparts have. The sample for the current qualitative grounded theory study had 30 participants including 10 RN executives currently employed and holding the title of hospital CEO, 10 non-RN executives currently employed holding the title of hospital CEO, and 10 decision-makers who have authority over the hospital CEO candidate selection process. The current study employed grounded theory method to develop a substantive grounded theory of why the phenomenon of the underrepresentation of registered nurses in hospital CEO positions exists. The substantive grounded theory developed in the study might help decision-makers involved in the hospital CEO selection process adjust their selection strategies so they evaluate hospital CEO candidates equitably. Registered nurses aspiring to become hospital CEOs might also benefit from the study by altering their career development strategies so the decision-makers perceive them as qualified candidates for the position of hospital CEO.</p><p>

This study uses a descriptive survey design to describe and examine the relationship among school nurses' level of education, years of experience, knowledge of asthma and identification of the school nurse's level of proficiency based on Benner's (1984) model of Novice to Expert. A convenience sample of school nurses employed in public schools within the state of Massachusetts with an RN degree (registered nurse) were sampled. The demographic data revealed that of the 325 participants who participated in the study, the majority of school nurses were female ranging in age from 40 to 50 (M = 47.0). The majority of nurses had a bachelor's degree in nursing and were employed in the nursing profession on an average of twenty-two years and in school nursing for ten years. Since the majority of the school nurses did not have a master's degree, they were not certified by a national certifying body. The majority of participants indicated that they had received certification through the Board of Education in Massachusetts. Most school nurses worked full time in a public school and were responsible for between six hundred and a thousand students. The majority of nurses indicated that they did not have a school-based clinic on site, nor did they have a school-based health center or clinic to refer students. There was little variability among sample characteristics with school nurses employed in Massachusetts being a fairly homogenous group. Those surveyed were sent a packet containing four questionnaires including one on demographics, as well as an asthma questionnaire, a questionnaire assessing chronic health problems in the schools, and a self-reporting questionnaire based on Benner's (1984) model. Further results of this study revealed that the majority of the school nurses had an average to above average knowledge of asthma. The three most common interventions performed by school nurses as well as non medical personnel for those students with chronic illness are nebulizations, inhalers, and peak flow meters. Based on the self-report model of Benner's (1984), these same nurses viewed themselves as expert in their level of practice. Mezirow's Adult Learning Theory as well as Benner's (1984) model of Novice to Expert were used to support the nurses level of practice based on experience, intuition and a constellation of meaning schemes developed from previous exemplars. Results of the study indicated that although the nurses surveyed were expert in their knowledge of basic nursing concepts, none had advanced practice level courses in advanced health assessment or clinical decision making in order to effectively manage the complexities of chronic illness such as ADHD, diabetes, and epilepsy, as well as asthma, the most common chronic illness in schools today.

<p> Caring is a complex phenomenon that has been described and linked to several other concepts such as competence, compassion, presence, intention, interconnectedness, detachment, coping, trust, reassurance, empathy, and advocacy. The significance of exploring the patients&rsquo; lived experience of caring can provide a framework for achieving the benchmarks evaluated during a hospitalization by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). The higher the scores on the patients surveys provide better the feedback on the HCAHPS, which in turns increases the funding received from Centers for Medicare and Medicaid Services (CMS). The HCAHPS are one measure used to calculate incentive payments with the Value-Based Purchasing program being the other measure. This hermeneutic phenomenological study was to explore the patients&rsquo; lived experience of caring during a minimum of a two night stay in the hospital. Watson&rsquo;s caring theory was the guiding framework of this study to illuminate caring, and building relationships between the nurse and the patient. Fifteen adult patients over eighteen years of age who were hospitalized for a minimum of a two-night stay were interviewed in their private occupancy room. Following the data analysis using Van Kaam&rsquo;s methods and NVivo software, two themes emerged: (1) being helped by someone who demonstrates presence and (2) being helped by someone with competence. Based on data analysis, patients expect their caregivers to demonstrate presence; this involves being available to meet their needs and providing care with competence knowing how to perform the skills and performing with proficiency. </p>