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Concept: Nurses

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Twenty-four hour nursing care involves shift work including 12-h shifts. England is unusual in deploying a mix of shift patterns. International evidence on the effects of such shifts is growing. A secondary analysis of data collected in England exploring outcomes with 12-h shifts examined the association between shift length, job satisfaction, scheduling flexibility, care quality, patient safety, and care left undone.

Concepts: The Association, Employment, Nursing, Nurse, Shift work, Nurses, Florence Nightingale, Nurse uniform

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To explore how nurses and care-assistants (nursing staff) working in six Flemish nursing homes experience and describe their involvement in grief care.

Concepts: Nursing, Geriatrics, Care of residents, Nurse, Nurses, Florence Nightingale, Nurse uniform, Nursing in the United Kingdom

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AIM: To explore the mechanisms through which nurse practice environment dimensions are associated with job outcomes and nurse-assessed quality of care. Mediating variables tested included nurse work characteristics of workload, social capital, decision latitude, as well as burnout dimensions of emotional exhaustion, depersonalization, and personal accomplishment. BACKGROUND: Acute care hospitals face daily challenges to their efforts to achieve nurse workforce stability, safety, and quality of care. A body of knowledge shows a favourably rated nurse practice environment as an important condition for better nurse and patient outcome variables; however, further research initiatives are imperative for a clear understanding to support and guide the practice community. DESIGN: Cross-sectional survey. METHOD: Grounded on previous empirical findings, a structural equation model designed with valid measurement instruments was tested. The study population was registered acute care nurses (N=1201) in two independent hospitals and one hospital group with six hospitals in Belgium. RESULTS: Nurse practice environment dimensions predicted job outcome variables and nurse ratings of quality of care. Analyses were consistent with features of nurses' work characteristics including perceived workload, decision latitude, and social capital, as well as three dimension of burnout playing mediating roles between nurse practice environment and outcomes. A revised model adjusted using various fit measures explained 52% and 47% of job outcomes and nurse-assessed quality of care, respectively. CONCLUSION: The study refines understanding of the relationship between aspects of nursing practice in order to achieve favourable nursing outcomes and offers important concepts for managers to track in their daily work. The findings of this study indicate that it is important for clinicians and leaders to consider how nurses are involved in decision-making about care processes and tracking outcomes of care and whether they are able to work with physicians, superiors, peers, and subordinates in a trusting environment based on shared values. The involvement of nurse managers at the unit level is especially critical because of associations with nurse work characteristics such as decision latitude and social capital and outcome variables. Further practice and research initiatives to support nurses' involvement in decision-making process and interdisciplinary teamwork are recommended.

Concepts: Game theory, Decision making, Decision theory, Decision making software, Nursing, Nurse, Nurses, Florence Nightingale

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Abstract Aims. To examine the relationship between nursing students' exposure to various forms of incivility in acute care practice settings and their experience of burnout. Background. Given that staff nurses and new nurse graduates are experiencing incivility and burnout in the workplace, it is plausible that nursing students share similar experiences in professional practice settings. Design and sample. A cross-sectional survey design was used to assess Year 4 nursing students' (n=126) perceptions of their experiences of incivility and burnout in the clinical learning environment. Methods. Students completed instruments to assess frequency of uncivil behaviors experienced during the past six months from nursing staff, clinical instructors, and other health professionals in the acute care practice setting and to measure student burnout. Results. Reported incidences of incivility in the practice setting were related to burnout. Higher rates of incivility, particularly from staff nurses, were associated with higher levels of both components of burnout (emotional exhaustion and cynicism).

Concepts: Psychology, Experience, Nursing, Nurse, Nurses, Florence Nightingale, Healthcare occupations, Nurse uniform

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To develop a tool, the Nurses' Empowerment Scale for Intensive Care Unit (ICU) Patients' Families (NESIPF), to help ICU nursing staff assess the empowerment status of patients' families.

Concepts: Psychometrics, Nursing, Nurse, Nurses, Florence Nightingale, Nurse uniform, Nursing in the United Kingdom

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Background Vanderbilt University Hospital’s original rapid response team included a critical care charge nurse and a respiratory therapist. A frequently identified barrier to care was the time delay between arrival of the rapid response team and arrival of the primary health care team. Objective To assess the impact of adding an acute care nurse practitioner to the rapid response team. Methods Acute care nurse practitioners were added to surgical and medical rapid response teams in January 2011 to diagnose and order treatments on rapid response calls. Results In 2011, the new teams responded to 898 calls, averaging 31.8 minutes per call. The most frequent diagnoses were respiratory distress (18%), postoperative pain (13%), hypotension (12%), and tachyarrhythmia (10%). The teams facilitated 360 transfers to intensive care and provided 3056 diagnostic and therapeutic interventions. Communication with the primary team was documented on 97% of the calls. Opportunities for process improvement were identified on 18% of the calls. After implementation, charge nurses were surveyed, with 96% expressing high satisfaction associated with enhanced service and quality. Conclusions Teams led by nurse practitioners provide diagnostic expertise and treatment, facilitation of transfers, team communication, and education.

Concepts: Medicine, Pulmonology, Diagnosis, Therapy, Nurse, Nurses, Healthcare occupations, Vanderbilt University

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Patient classification systems (PCSs) are commonly used in nursing units to assess how many nursing care hours are needed to care for patients. These systems then provide staffing and nurse-patient assignment recommendations for a given patient census based on these acuity scores. Our hypothesis is that such systems do not accurately capture workload and we conduct an experiment to test this hypothesis. Specifically, we conducted a survey study to capture nurses' perception of workload in an inpatient unit. 45 nurses from an oncology and surgery unit completed the survey and rated the impact of patient acuity indicators on their perceived workload using a six-point Likert scale. From these ratings we can calculate a workload score for an individual nurse given a set of patient acuity indicators. The approach offers optimization models (prescriptive analytics), which use patient acuity indicators from a commercial PCS as well as a survey-based nurse workload score. The models assigns patients to nurses by distributing acuity scores from the PCS and survey-based perceived workload in a balanced way. Numerical results suggest that the proposed nurse-patient assignment models achieve a balanced assignment and lower overall survey-based perceived workload compared to the assignment based solely on acuity scores from the PCS. This results in an improvement of perceived workload that is upwards of five percent.

Concepts: Patient, Psychometrics, Nursing, Nurse, Likert scale, Nurses, Florence Nightingale, Conducting

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Therapeutic hypothermia has become a widely accepted intervention that is improving neurological outcomes following return of spontaneous circulation after cardiac arrest. This intervention is highly complex but infrequently used, and prompt implementation of the many steps involved, especially achieving the target body temperature, can be difficult. A checklist was introduced to guide nurses in implementing the therapeutic hypothermia protocol during the different phases of the intervention (initiation, maintenance, rewarming, and normothermia) in an intensive care unit. An interprofessional committee began by developing the protocol, a template for an order set, and a shivering algorithm. At first, implementation of the protocol was inconsistent, and a lack of clarity and urgency in managing patients during the different phases of the protocol was apparent. The nursing checklist has provided all of the intensive care nurses with an easy-to-follow reference to facilitate compliance with the required steps in the protocol for therapeutic hypothermia. Observations of practice and feedback from nursing staff in all units confirm the utility of the checklist. Use of the checklist has helped reduce the time from admission to the unit to reaching the target temperature and the time from admission to continuous electroencephalographic monitoring in the cardiac intensive care unit. Evaluation of patients' outcomes as related to compliance with the protocol interventions is ongoing.

Concepts: Cardiac arrest, Thermoregulation, Hypothermia, Therapeutic hypothermia, Nursing, Nurse, Nurses, Florence Nightingale

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NASN recently developed a Framework for 21st-Century School Nursing Practice (Framework) to guide school nursing activities. The principles and components of the Framework can be used as a guide in achieving high-quality school nurse practice. The purpose of this article is to share how school nurses can use the Framework in their daily practice, invite nurses to identify one new way the Framework can be used in your practice this school year, and implement and evaluate the change.

Concepts: Nursing, Nurse, Nurses, Florence Nightingale, Nursing specialties, Nurse uniform, School nursing, Nursing in the United Kingdom

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Caring is the core and essence of the nursing profession. Nurse educators, are in a key position to role model for perspective nurses the role of caring while including caring as a vital component in a nursing curriculum.

Concepts: Education, Sociology, Nursing, Nurse, Nurses, Florence Nightingale, Nurse uniform, Nursing in the United Kingdom