Nursing Commons^™

Implementation Plan For Emr And Beyond, Lori Katterhagen

Doctor of Nursing Practice (DNP) Projects

Change is never easy for anyone, but how we implement change can make the difference in how an innovation is accepted. Over the last two years, a small community hospital in California has introduced a new electronic medical record (EMR) to meet the requirements of meaningful use mandated by the Centers for Medicare and Medicaid (CMS) for all hospitals across the United States. EMRs are expected to improve quality in many areas, especially to improve outcomes, while safely reducing costs (U.S. Department of Health & Human Services, 2012). Adoption of EMR’s is not optional, if facilities want to avoid penalties …

Lean Management Principles To The Creation Of Postpartum Hemorrhage Care Bundles, Bethan Faulkner

Doctor of Nursing Practice (DNP) Projects

Postpartum hemorrhage (PPH) is the number one cause of pregnancy-related death in the US. The Maternity local improvement team (LIT), co-led by an Obstetrician and Board Certified Clinical Nurse Specialist found that each month the maternity unit averages 40 PPHs with 1-2 resulting in an emergency. Over a 6-month period, the LIT decreased response time for emergencies significantly. Supply retrieval time decreased by 99.9%, MD response time decreased by 81%, and Family Centered Care increased by 100%. They recently turned their attention to prevention. Given the lack of literature on preventing PPH in postpartum units, the team developed a PPH …

Innovative Approach To New Nurse Residency, Meaningful Use And Health Care Reform, Pamela V. Stanley

Doctor of Nursing Practice (DNP) Projects

The project’s aim was to examine the financial impact of replacing registered nurse (RN) travelers, RN registry and RN overtime with new graduate RNs. Newly graduated RNs are often viewed by hospital administrators as a more costly staffing resource. This project contributes knowledge regarding the potential cost savings with the utilization of a centralized float pool incorporating new graduates. In addition, it contributes a novel idea for reducing organizational costs of implementing an electronic medical record with the utilization of new graduates as super users.

A new graduate program, which incorporated the use of a formal preceptor and mentoring program, …

Improving Value Based Purchasing Through The Implementation Of The Clinical Nurse Leader Role: The Chief Nursing Officer’S Case For Change, Leanne M. Hunstock

Doctor of Nursing Practice (DNP) Projects

The healthcare industry is focused on the implementation of the Affordable Care Act, the payment reform package from Centers for Medicare and Medicaid Services and the development of Accountable Care Organizations. The decisions, behaviors, and practices of medical and clinical staff directly impact patient care, quality, and subsequently cost and reimbursement. The imperative to balance quality and patient safety with cost effectiveness requires a complex orchestration of all the elements of care within the clinical microsystem. A priority is to support and enable bedside nurses’ daily practice, priorities, and decision-making. This can be accomplished through the implementation of the Clinical …

Influencing Change In Healthcare Providers: Communication Strategies For A New Era In Healthcare, Ceonne Raasikh

Doctor of Nursing Practice (DNP) Projects

Effective provider communication is the key to patient engagement. However, many providers are not able to effectively communicate with patients, in part due to low health literacy. Evidence in the literature supports the use of specific strategies aimed at improving communication with patients. The purpose of this quality initiative was to influence providers to adopt new communication strategies with their patients. Pharmacists, nurses and physicians were invited to participate in a free, full-day, educational event. During the event providers were alerted to the issue of health literacy and provided communication strategies to improve patient comprehension and engagement. Following the presentation, …

Perceptions Of A Dedicated Education Unit In The Mississippi Delta, Jacquelyn Felecia Brownlow

Doctoral Projects

The highest health care disparities in the country plague the Mississippi Delta. A weakened economy, minimal access to healthcare and an outdated traditional clinical learning environment place enormous strains on nursing education in this area to provide more nurses. The office of Nursing Workforce reported a 14% to 16% nursing turnover in the Delta compared to the national average of 13.5%. As a result, the health care organization has encountered high nurse turnover, increased staffing shortages, and a decrease in nursing quality indicators. As an effort to improve clinical education and bridge gaps between education and practice, several schools in …

Commercial Medical Transportation - The Better Alternative To Air Ambulance, Jime Carlo

Jime Carlo

From a patient's perspective, when there are at least a few days to make arrangements, commercial travel is a viable [and often superior] and cost effective alternative to air ambulance transport. When all the necessary pre-planning, clearances and pre-arranging are done by a third party, and there is a medical escort to navigate the logistics of travel and provide in-flight medical care, the entire transport experience is usually more positive for patients choosing commercial medical transport over a traditional air ambulance.

Re-Cognizing Power In The Culture Of Dementia Care Knowledge, Ryan T. Deforge

Electronic Thesis and Dissertation Repository

In light of increasing system demands, system regulations, and constrained resources, those living and working with dementia in the long-term care sector are vulnerable to oppressive care practices. This is true so long as our understanding of how social power affects the ways in which dementia care knowledge is created, shared, and enacted remains limited. Based on prolonged field observations and on informal and formal interviews with care recipients, family members, and staff, the aim of this critical qualitative research was to examine the culture of dementia care knowledge in two sites: a specialized dementia care unit in a long-term …

The Reality Of Disaster: An Educational Template That Brings Community Into The Classroom, Mary T. Bouchaud Phd, Msn, Cns, Rn, Crrn, Edward H. Jasper Md

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

An Evidence Based Recommendation For The Use Of 5% Human Albumin Vs. Normal Saline With Hypotension Secondary To Hypovolemia In Adult Post Operative Patients, Katherine Anne Marshall

Master of Science in Nursing Evidence-Based Practice Projects

Problem: 5% human albumin is used very frequently in the hospital setting with hypotensive post-surgical patients. There are associated risks with the use of human albumin and it has been shown that normal saline is at least as effective in treating extreme hypotension in this patient population.

Significance: Associated risks that are present with the use of human albumin may be equal to those of the risks of whole blood transfusions. In addition weight gain and fluid retention are complications associated with the use of human albumin versus the use of normal saline. Furthermore, human albumin costs $40.59 more than …

Generational Differences In Empowerment, Professional Practice Environment, Incivility, Authentic Leadership, Job Satisfaction, Engagement And Intent To Leave In Acute Care Nurses, Lisa Marie Haddad

Doctoral Dissertations

Aim. The aim of this study was to examine generational differences among acute care nurses on empowerment, professional practice, authentic leadership, incivility, job satisfaction, engagement and intent to leave the current job.

Background. Empowerment in nursing is a well-studied subject. Perceptions of professional practice environments, authentic leadership and incivility are related to empowerment. An increase in empowerment has been linked to job satisfaction and the likelihood of leaving one’s job or the profession. The nursing shortage forces attention to job satisfaction and keeping the professionals we currently have in the profession. Generational differences exist within different cohorts of nurses and …

Waking Up To Safety: An Examination Of Work Hour Guideline Implementation And Education For Registered Nurses, Bonnie J. Schleder

Ed.D. Dissertations

The link between health care worker fatigue and adverse events is inseparable. Errors made by registered nurses correlated with work duration, overtime and the number of adverse events (Page 2004). To promote patient safety, nurses must remain vigilant. This study determined if work hour guidelines and education regarding safety risks affected nurse work hours, the use of fatigue countermeasures, and patient outcomes. The researcher explored survey data (n=597), actual work hours, patient safety events, and quality outcomes. Data collected demonstrated nurses work hours exceeded recommendations for a safe environment. The introduction of voluntary work guidelines and education did …

Perceptions Of Workplace Bullying Among Practicing Registered Nurses, Crystal Regina Threadgill

Dissertations

Workplace bullying (WPB) is a social and organizational problem. Within the health care arena, employees, particularly registered nurses, are at risk. WPB has several adverse effects and has been cited in the literature as closely associated with burnout and nurses leaving their positions. This quantitative study examined workplace bullying among practicing registered and its relationship with burnout and nurses’ intent to leave their current position.

The surveys utilized were the Negative Acts Questionnaires-Revised (NAQ-R), Maslach Burnout Inventory Survey, Intention to Turnover Scale and a demographic survey. Of the surveys distributed, a total of 185 were returned from one selected hospital …

New Graduate Nurses' Structural Empowerment And Their Experience Of Co-Worker Incivility And Burnout, Pamela Bushell

Electronic Thesis and Dissertation Repository

Burnout among new graduate nurses [NGNs] is a risk to workplace retention and commitment to the nursing profession. With threats of nursing shortages, safeguarding and supporting NGN to maintain workplace allegiance and professional commitment is paramount. Research has highlighted the harmful effects of uncivil working environments and the deleterious effects it can have on working relationships. In this secondary analysis, Kanter’s (1977) theory of structural empowerment was tested using a predictive, non-experimental design in a sample of NGN working in acute care hospitals in Ontario. Two hypothesized models predicted that high levels of structural empowerment and low levels of coworker …

Organizational Strategies For The Adoption Of Electronic Medical Records: Toward An Understanding Of Outcome Variation In Nursing Homes, David B. Lipsky, Ariel C. Avgar, James Ryan Lamare

David B Lipsky

[Excerpt] An important element in president-elect Obama's economic stimulus proposal is his plan to invest a significant proportion of federal dollars in installing electronic medical records (EMR) in U.S. healthcare institutions. In emphasizing the need for EMR, Obama is following the advice of numerous healthcare experts who have pointed out that the healthcare sector lags behind other industries in the use of computer technology. They believe the widespread use of EMR would help reduce medical errors, control the costs of healthcare, and lead to significant improvements in the quality of care Americans receive. In this paper we present preliminary results …

Academic Incivility In Nursing Education, Sherrie Marlow

Nursing Theses and Capstone Projects

A well-documented and growing problem impacting the nursing shortage in the United States is the increasing shortage of qualified nursing faculty. Many factors contribute to the nursing faculty shortage such as retirement, dissatisfaction with the nursing faculty role and low salary compensation (American Association of Colleges of Nursing (AACN), 2005; Allen, 2008; National League of Nursing (NLN), 2010; American Association of Colleges of Nursing (AACN), 2011). Academic incivility has been identified as contributing to nursing faculty role dissatisfaction (Clark & Springer 2010). Academic incivility diminishes the presence of a caring environment, lowers an individual's self-esteem, and negatively impacts the formation …

Retention Of New Graduate Gen Y Nurses, Joyce K. Kutin

Joyce K Kutin RN, MSN, MOL

The purpose of this paper is to review the research of new residency programs on Generation Y retention and the quality implications that influence the organization. General orientation of all nurses upon hire has been the standard practice with preceptoring of senior nurses from the individual units. The process of each unit’s orientation and standards was different without respect to the individual nurse’s experience. Prior to the implementation of the Nurse Residency program for new graduate generation y nurses, the turnover rate within the first year was greater than 50 percent. Health care organizations and their leaders need to anticipate …

The Impact Of The Clinical Nurse Leader/Navigator On Clinical Outcomes And Patient Satisfaction, Diane Smith Raines

UNF Graduate Theses and Dissertations

In an era of value based purchasing and healthcare reform, hospitals face the challenge of delivering high quality care in an environment of diminishing resources. This performance improvement project describes the use of master’s prepared nurses on medical surgical units to improve quality and patient satisfaction. The setting was five medical surgical units in a 200+ bed hospital in the southeastern United States. Declining resources necessitated an increase in the nurse to patient ratios on the units (from 5:1 to 6:1). The project involved the modification of the model of care through the change in nurse/patient ratios and the addition …

Advancing The Future Of Nursing: A Report By The Building Academic Geriatric Nursing, Jennifer L. Bellot, Dana Carthron, Melissa O'Connor, Karen Rose, Casey Shillam, Janet Van Cleave, Amy Vogelsmeier

College of Nursing Faculty Papers & Presentations

In the United States, the number of older adults will double during the next 25 years (United States Census Bureau, 2008). This dramatic demographic shift is changing the landscape of health care practice as more people live longer with multiple chronic conditions. To better prepare nurses to care for this future population, the John A. Hartford Foundation partnered with the American Academy of Nursing in 2000 to launch the Building Academic Geriatric Nursing Capacity (BAGNC) program. Since that time, 251 scholarships and fellowships have been awarded to nurses to advance geriatric nursing education, research, and practice. In 2009, …

The Economic Benefits Of Increased Levels Of Nursing Care In The Hospital Setting, Diane E. Twigg, Elizabeth Geelhoed, Alexandra Bremner, Christine M. Duffield

Research outputs 2013

Aim: To assess the economic impact of increased nursing hours of care on health outcomes in adult teaching hospitals in Perth, Western Australia. Background: Advancing technology and increased availability of treatment interventions are increasing demand for health care while the downturn in world economies has increased demand for greater efficiency. Nurse managers must balance nurse staffing to optimize care and provide efficiencies. Design: This longitudinal study involved the retrospective analysis of a cohort of multi-day stay patients admitted to adult teaching hospitals. Methods: Hospital morbidity and staffing data from September 2000 until June 2004, obtained in 2010 from a previous …

The Effect Of Coaching On Nurse Manager Leadership Of Unit Based Performance Improvement: Exploratory Case Studies, Cynthia A. Baxter

DNP Projects

The nurse manager role has experienced an explosion of responsibilities and expectations over the last decade. As a result, competency and skill acquisition for the successful nurse manager has become the focus of many nurse managers, nurse executives, researchers and organizations. The three manuscripts contained in this final capstone report will explore the acquisition of nurse manager competency, propose coaching as a methodology for acceleration and improvement of nurse manager skill acquisition and describe the results of three case studies using coaching as an intervention to improve the performance improvement skill acquisition of nurse managers.

Nursing Leadership Team Orientation Program, Sheryl Capelle

Theses and Graduate Projects

Nursing is a dynamic profession. Throughout the history of nursing, leaders have emerged. Some leaders have joined a nursing leadership team to provide care and support to the unit staff and patients. Developing a highly functioning leadership team comes through having a well-developed orientation plan. The nursing leadership team must learn, their roles and expectations from each other. This project explains nursing leadership teams and discusses the development of a new orientation program for the nursing leadership team. A conceptual model of a puzzle is used to describe how nursing leaders bring the ptzzle pieces of leading, caring and relationships …

The Effects Of A Care Delivery Model Change On Nursing Staff And Patient Satisfaction, Kathleen Gier

Nursing Theses and Capstone Projects

Hospitals across the nation are faced with the challenge of providing high-quality, cost-effective patient care. The purpose of the research study, The Effects of a Care Delivery Model Change on Nursing Staff and Patient Satisfaction, was to examine the impact of implementing a team-approach care delivery model on defined outcomes of staff satisfaction and patient satisfaction. A quasi-experimental design study was utilized to examine the effects of implementing a team-approach care delivery model on a 33-bed Medical-Surgical unit. Prior to and after implementation of the new care delivery model, data were collected regarding patient and staff satisfaction. All nursing and …

Medication Safety: Improving Faculty Knowledge And Confidence, Sharon S. Cherry

Nursing Theses and Capstone Projects

The purpose of this capstone project was to increase knowledge and confidence among nursing faculty assisting pre-licensure nursing students with the medication administration process. The project administrator designed a one day Safe Medication Practices seminar that included a Medication Administration Toolkit to increase knowledge and confidence in faculty members about safety and efficiency in giving medications with multiple students on any clinical day. This toolkit included high-fidelity simulation medication scenario case examples as a teaching pedagogy, as well as other teaching strategies to utilize in the clinical environment. Bandura's Social Learning theory provided the framework for this capstone project. The …

Patient-Family Centered Advisory Council For The Emergency Department, Kelly Sanocki

Theses and Graduate Projects

Issues such as overcrowding and long wait times in the ED cause an increase in patient frustration and dissatisfaction, which may lower hospital satisfaction scores,, and reimbursement. This project proposes the implementation of a Patient-Family Advisory Council (PFAC) in the Emergency Department (ED) setting in a large urban hospital. The addition of a PFAC will offer patients and family members a voice in their care, as they work collaboratively with various healthcare providers to improve patient care, patient safety, and overall satisfaction. The addition of Watson's Caring theory will serve as the theoretical framework for the PFAC since it is …

Who Do You Think You Are? And Who Would You Like To Become?, Sandra Koeller

Theses and Graduate Projects

Ultimately -y goal would be to enhance staff satisfaction to the point of better retention of nursing assistants on my floor. I thought this would also assist in improving RN satisfaction, as there would be solid, reliable assistive staff on the floor. Research of the literature shows staff retention has a direct impact on patient satisfaction as well. The constant cycle of replacing staff is costly to the organization and diminishes satisfaction to all staff as they become trapped in the endless cycle of training new staff in. Patient quality of care suffers, as newly trained staff needs time to …

Floattng Through Uncharted Waters, Amanda Moscatelli

Theses and Graduate Projects

The act of floating or flexible staffing is a cost effective way to maintain nursing staffing levels through times of shortages and surplus. While the financial and patient care benefits are abundant, the culture of floating tends to be negative. Nurses cite difficulty adapting to a changed environment, caring for different patient populations, and working with different staff members as the most difficult and anxiety provoking aspects of floating. Although nurses at a large Midwest medical center frequently float across a number of nursing units, they receive no formal education on the practice of floating. Introduction of an online floating …

Developing Ambulatory Care Registered Nurse Competencies For Care Coordination And Transition Management, Sheila Haas, Beth Ann Swan, Traci Haynes

College of Nursing Faculty Papers & Presentations

The need for care coordination and management of transitions between Patient-Centered Medical Home providers, outpatient and community settings, including the Accountable Care Organization is often overlooked, episodic, and accountability for coordinating care and managing transitions between providers and services is lacking.

Nurse Manager Caring And Workplace Bullying In Nursing : The Relationship Between Staff Nurses' Perceptions Of Nurse Manager Caring Behaviors And Their Perception Of Exposure To Workplace Bullying Within Multiple Healthcare Settings, Lynda Diana Olender

Seton Hall University Dissertations and Theses (ETDs)

This study examined the relationship between staff nurses’ perception of nurse manager caring behaviors and their perceived exposure to workplace bullying within multiple healthcare settings. It was based on the theoretical position that caring promotes reciprocal caring and healing for each other and for the larger universe as informed by Watson’s theory of human caring (1979, 2006, 2008). Results indicated a statistically significant, negative, linear relationship between the CFS-CM and the NAQ-R (r = -.534, p < .001), meaning that as staff nurses’ perceptions of their nurse manager caring increased, their perception of exposure to negative acts (meeting the definition of workplace bullying) significantly decreased. The sample consisted of primarily older, more experienced, staff nurses who worked 10 years or longer within their work environment. Data analysis also revealed that staff nurses who were females and those who worked in Medical/Surgical settings were significantly more likely to perceive their managers as caring (p < .05 respectively) and that a high workload significantly influenced the staff nurses perception of exposure to workplace bullying (p < .05). In view of the predicted nursing shortages as baby-boomer nurses retire at the same time the demand for health care is rising (AACN, 2009), these findings highlight the importance of caring leadership for the health and availability of nurses at the bedside, and may lead to shifting work priorities for nurse managers. Study findings may also foster the design and implementation of a caring curriculum and caring competencies applicable for the nurse managers’ role either within nursing academic or clinical settings.