REVIEW OF LITERATURE Prepared for E3 By Debianne Peterman, Ph.D., MSN, RNC-NIC, NE-BC

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1 AUTHOR TITLE SAMPLE PURPOSE/ HYPOTHESES SHARED GOVERNANCE McDowell, J.B., Williams, R,L., Kautz, D.D., Madden, P, Heilig, A., Thompson, A. Shared Governance 10 Years Later Nursing Management, July 2010, pp Review of SG model over the past decade CONCEPTS SG Model 2007 Practical Implementation issues Bylaws of the Quality Councils The Practice Council Bylaws Sample Member Responsibilities Practical Guidelines METHOD/ INSTRUMENT FINDINGS LIMITATIONS EVIDENCE-BASED LEADERSHIP Murphy, B. Evidenced-Based Leadership for Reduced Risk Managing Infection Control, July 2007, pp Article by Studer Group Leadership is something people believe they can provide without standardization. Excellence means making healthcare a better place for employees to work, physicians to practice and patients to receive care. Retention strategies - Behavioral based interviewing - Rounding

2 PROFESSIONAL PORTFOLIO Byrne, M., Schroeter, K, Carter, S., Mower, J. The professional portfolio: An evidence-based assessment method The Journal of Continuing Education in Nursing, 2009, 40(12), Service Recovery This article illustrates how portfolios can be used to assess competence. One specialty nursing certification board s process of creating an EB portfolio for recertification or reactivation of a credential is used as an example. Portfolio provides a method for validating personal accomplishments in an interactive, multidimensional format. Professional portfolios demonstrate reflective critical thinking, lived experiences, narratives, and intrapersonal understanding that illustrate competence. Portfolios provide an indepth, comprehensive, holistic, and relevant way to assess continuing competence. Theory: experiential and reflective learning. Learning is demonstrated by an observed change in behavior. ANCC has an electronic professional portfolio management system Case Study: CCI (Competency and Credentialing Institute) CNOR certification Portfolio Requirements listed Implications for future process improvement: - Application should be short - Use examples - Narrative writing is an acquired skill - Portfolio creation should be a prospective rather than a retrospective process - Ongoing education sessions will need to be put in place NURSING PRACTICE

3 Hendren, R. Nursing s Growing Role HealthLeaders, July 2010, pp Prairie Lakes Hospital Rural SD 81 beds Describe the Nurse Leaders at the evolving role of Bedside nurses. Nurses will assume ever growing roles. Nurse-led primary care will be the norm and APNs will no longer have to justify their role. Went from a task-based / narrow focus to care coordination / broad focus patient care model Nurses are being asked to serve in more strategic roles. Nurses need to become increasingly certified and specialized and be able to demonstrate the use of evidence-based practice as part of our nursing care models. Economic power of nursing. Nurse Residency Programs for GNs supported. Clinical Nurse Leader role. APN role. D Antonio, P., Connolly, C. Wall, B.M., Whelan, J.C., Fairman, J. Histories of nursing: The power and the possibilities Nursing Outlook 2010, 58, Historical perspective of nursing practice. Power and practice Power within Institutions The power of the personal The Power of Politics Nurses are powerful and resourceful, and the illustration of their power stems less from the source of their training program than their ability to work within locations to

4 Power, patients, and the possibilities of context shape their own practices. NURSING WORKFORCE Education is important what most stands out is the nurses ability to capture opportunities to creatively apply their skills, knowledge, and a keen sense of the possibilities. Donelan, K., Buerhaus, P.I., DesRoches, C., Burke, S.P. Health policy thoughtleaders views of the health workforce in an era of health reform Nursing Outlook, 2010, 58, % female 43% male 15% MDs 30% Nurses The purpose of this research was to understand the visibility and salience of the health workforce in general, gain an understanding about the effectiveness of messages concerning the nursing workforce in particular, and to understand why nursing workforce issues do not appear to have gained more traction in national health care policymaking. 3.1 million RNs are employed in the U.S. Survey posed questions about: - Federal health policies - Health workforce supply - Sources of information dissemination - Effective advocacy about nursing workforce issues - Barriers to legislative process Descriptive study The National Survey of Thoughtleaders was administered by mail, telephone, and online to a sample of health workforce and policy thoughtleaders during August 2009 October Overall the projected nursing shortage was seen by a majority of respondents as being more important than each of the other issues inquired about (bioterrorism, financial fraud & abuse, primary care physician shortage). Majority of respondents said that nurses were important to assuring the overall quality of health The importance of the nursing workforce is likely to be heightened if shortages escalate over time against a backdrop of expanded insurance coverage and increasing demand for nurses. Nurses are critical voices on issues of quality and safety in health care. The public trusts nurses honesty and integrity and values the profession. Nurses and nursing professional associations need well-honed messages and they need to master the tools of communication news

5 MANAGER ROLE Hudson, K. Close the door on crisis management Nursing Management, July 2010, pp Descriptive article defining what a proactive culture looks like and outlining the qualities of proactive leaders. Working within a reactive environment may leave you feeling like you are putting out fires crisis after crisis without control over your work. services and patient safety. Majority of respondents listed budget and cost issues as the major barriers to passage of legislation that would fund increasing capacity of RN education programs. media, research publication, surveys, advertising Lee, H., Cummings, G.G. Factors influencing job satisfaction of front line nurse managers: A systematic review Journal of Nursing Outlines strategies to move toward being a proactive manager and developing a proactive culture. The purpose of this study was to systematically review the research literature that Front line managers are the vital link between senior management and clinical nurses. They influence organizational culture and outcomes for A review of research articles examined the determinants of front line managers job Evidence of significant positive relationships were found between span Organizations may enhance the recruitment, retention, and sustainability of future nursing by

6 Management, 2008, 16, examined the patients and staff so their determinants of job satisfaction and front line nurse ultimately retention is of managers job importance. satisfaction. satisfaction was conducted. of control, organizational support, empowerment and the job satisfaction of front line nurse managers. addressing the factors that influence job satisfaction of front line managers. The review suggests that job satisfaction of front line managers may be improved by addressing span of control and workload, increasing organizational support from supervisor and empowering managers to participate in decisionmaking % return of questionnaires in Study 1 McNeese- Smith, D. Job satisfaction, productivity, and organizational commitment The result of Journal of Nursing Administration, 1995, 25(9), Study 1 was conducted in 2 Seattle hosp.( beds; This article attempts to answer these questions: Times of stress and chaos call for a Conceptual Framework: Kouzes and Posner s model of behaviors. Outstanding behaviors, extrapolated from research of more than Ex post facto / correlational study 11.63% of return questionnaires Generalizability of results is limited by the nonexperimental methodology and by the settings that are all acute-care hospitals. Leadership makes a

7 suburban, nonprofit, community N=471 In 1993 Study 2 was conducted in a large Los Angeles hosp with 553 beds N=18 mgrs and 221 staff style that transforms, creates meaning in the midst of turmoil, and ushers in a better world. Is worth the extra effort? Does it really make a difference? 1300 leaders, are: 1. Challenging he process risk taking, being innovative and change-oriented. 2. Inspiring a shared vision involving others in ideas, interests, and a vision of the possible. 3. Enabling others to act empowering and building teamwork and trust. 4. Modeling the way being role models, setting examples of high standards, and breaking down large tasks into small attainable wins. 5. Encouraging the heart being supportive, caring, and encouraging while recognizing and celebrating accomplishment. These behaviors lead to three outcomes: 1. Job satisfaction 2. Productivity 3. Organizational commitment in Study 2 Statistically significant correlations between the manager s use of behaviors and job satisfaction, productivity, and organizational commitment of the RNs difference to hospital employees, particularly in times of constant change. How managers behave in roles influences nurses and other employees to experience more job satisfaction and more productivity, and increases long-term commitment to the organization.

8 Instruments: The Leadership Practices Inventory for Self (LPI- Self) and Other (LPI Other) The Job-in-General Scale Productivity Scale Akerjordet, K, Severinsson, E. Amendolair, D. Emotionally intelligent nurse : A literature review Journal of Nursing Management, 2008, 16, Emotional intelligence: Essential for developing Purpose: to establish a synthesis of the literature on the theoretical and empirical basis of emotional intelligence and it s linkage to nurse, focusing on subjective wellbeing and professional development. Overview of EI as a concept Organizational Commitment Scale Emotional intelligence has been acknowledged in the literature as supporting nurse that fosters a healthy work environment, creating inspiring relationships based on mutual trust. Nurses who exhibit characteristics of emotional intelligence enhance organizational, staff and patient outcomes. Literature describes EI as critical to the success of Literature search was conducted using international data bases from January 1997 December 2007 Qualitative synthesis of theoretical and empirical articles 4 dimensions of an effective Emotionally intelligent (EI) nurse characterized by selfawareness and supervisory skills highlights positive empowerment processes, creating a favorable work environment characterized by resilience, innovation, and change. EI nurse leaders are behaving in a more authentic and supportive way, fostering a healthy environment as ell as creating a work climate characterized by wisdom, innovation and change. Feelings of freedom and responsibility and of being a respected and trusted team member lead to reciprocal exchange of experiences, knowledge and new ways of thinking. Future research: different methods of study are required to achieve a deeper understanding of EI. Nursing leaders must develop their EI to

9 nurse leaders Nurse Leader, November/December 2003, pp leaders. Developing competencies, including cultivating EI, is essential to meet the newer environment that takes a humanistic approach to achieving health care goals. The more emotionally demanding the work environment, the more the leaders needs EI. Dissonant leaders not in touch with others feelings Resonant Leader: Self-awareness Selfmanagement Social awareness Managing relationships create a climate that allows and encourages the staff to become life-long learners, find passion in their work so they may display compassion to their patients, and quiet the fires that are causing burnout and pushing nurses out of the profession. Cummings, G., Hayduk, L., Estabrooks, C. Mitigating the impact of hospital restructuring on nurses The responsibility of emotionally intelligent Nursing Research, January/February 2005, 54(1), 2-12 N=6526 nurses in acute care hospitals in Alberta, Canada 53% return rate Objective: To develop a theoretical model of the impact of hospital restructuring on nurses and determine the extent to which EI nursing mitigated any of these impacts. Resonant leaders in touch with others feelings A decade of North American hospital restructuring in the 1990 s resulted in the layoff of thousands of nurses, leading to documented negative consequences for both nurses and patients. Nurses who remained employed experienced significant negative physical and emotional health, decreased job satisfaction, and decreased opportunity to provide quality care. Survey The Alberta Nurse Survey of Hospital Characteristics Canadian portion of the International Survey of Hospital Staffing and Organization of Patient Outcomes All nurses felt the impact of restructuring, however, nurses who worked in resonant environments reported fewer negative effects. This would lead to greater satisfaction and more emotional Future research into the mitigation of the consequences of adverse events should be done prospectively, and by using instruments designed to measure the EI of leaders as perceived by followers. Future research should also examine the influence of both the nursing manager s and the senior nursing leader s styles on nurses and on the

10 Freshman, B., Rubino, L. Emotional intelligence: A core competency for Health Care Administrators Overview of EI EI Assessment tools presented The concept of EI as a critical set of management skills is traced through time to its current application for health care administration. EI is defined as proficiencies in intrapersonal and interpersonal skills in the areas of self-awareness, self-regulation, selfmotivation, social awareness, and social skills. resilience with which to provide quality care. nursing work environment. Findings suggest that resonant results in better quality of care by frontline providers. The development of EI management skills is more critical than ever. Medland, J. Stern, M. Coaching as a successful strategy for advancing new manager competency and performance Journal for Nurses in Staff Development, 2009, 25(3), N=7 This article describes a unique approach to advancing the competency of new managers in their formative stages of development. The contributions of EI to effective management are supported by empirical research in the field. Model builds on traditional classroom and on-the-job training by employing the expertise of a dedicated coach. New managers benefit from coaching in ways similar with executives including improved interpersonal skills and performance, effectively making the transition into Descriptive review of the literature and presentation of results from a manager development coaching program conducted at a large academic medical center. Differentiates between coaching and mentoring Outlines the guidelines for selecting the right coach. The first step in cultivating high-quality nursing managers involves the identification of he requisite managerial skills followed by the selection of manager show demonstrate potential in using these skills.

11 the manager role, and successful work-life integration. Redman, R.W. Sellgren, S., Ekvall, G., Tomson, G. Leadership succession planning: An evidence-based approach for managing the future The Journal of Nursing Administration, 2006, 36(6), Leadership styles in nursing management: Preferred and perceived Journal of Nursing Management, 2006, 14, N=77 nurse managers N=770 nurses (10 each reporting to the 77 managers) Large Outlines the need for a nursing succession plan. To explore nursing regarding what nurse managers and subordinates see as important and to explore subordinates opinions of their nurse manager s performance in Coaching is emerging as an essential tool for new manager development. Leadership succession planning is a key business strategy to help organizational leaders deal effectively with the future. Evidence from industry provides a variety of best practices that can ensure that a pipeline of leaders will be available when they are needed. The manager s style can be fundamental for subordinates acceptance of change and in motivating them to achieve stated visions and goals and high quality of care. Descriptive Correlational Questionnaire to assess preferred behavior in 3 dimensions: Change Production Outlined key elements in effective succession planning. Statistically significant differences in opinions of preferred between managers and subordinates, especially related to production Leadership succession planning is an essential business strategy that stands to benefit healthcare organizations in general and nursing in particular. Preparing a deep talent pool of future nursing leaders for healthcare will contribute both to the successful performance of healthcare organizations and to the quality of patient care services they deliver. Questionnaires have limitations. This study demonstrates that subordinates wish nurse managers to be more distinct about demands in relation to work. Some managers

12 Sellgren, S.F., Ekvall, G., Tomson, G. Ward, K. Leadership behavior of nurse managers in relation to job satisfaction and work climate Journal of Nursing Management, 2006, 16, A vision for tomorrow: Transformational nursing leaders Nursing Outlook, May/June 2002, 50, university hospital - Stockholm N=770 nurses Large university hospital - Stockholm reality. This study examines how nurse managers behavior relates to job satisfaction and work climate N=8 Provide a picture of principles and values as practiced by transformational The nursing shortage is a challenge for managers all over the world. Leadership is a core element of management and it is important to elucidate behavior in order to increase knowledge about attracting and retaining talented staff. ROL: 8 major attributes of transformational leaders: Self-knowledge Authenticity Expertise Vision Employee/ relation orientations Correlational 3 questionnaires that assessed perceived behavior, creative work climate and job satisfaction. Qualitative Interviews with 8 transform. leaders and relation orientation. Subordinates prefer managers with more clearly expressed behavior than managers themselves prefer and demonstrate. Subordinates with a manager perceived as super have the highest rates on job satisfaction. Correlation between and creative work environment is stronger than between and job satisfaction. All of the trans. Leaders interviewed strive for excellence, value integrity, possess a vague profile. Future research should study the role of in relation to working climate, staff satisfaction and turnover. A manager s ability to lead has a major effect on work climate. Nurse managers must work on developing their behavior towards being an all-round leader that cares about people, is concerned about productivity and can handle change. The knowledge gained from the interviews with transformational nursing leaders can provide insight into the future of nursing

13 ACADEMIC MEDICAL CENTERS nursing leaders. Flexibility Shared Charisma Ability to inspire and motivate others Conducted by mail, in-person, shape their environment for success, demonstrate perseverance, attempt to improve the lives of others. Possess a genuine love for people, motivate others with inspiration, invent the future, and share the path toward selfdiscovery.. Transformational has the power to produce future generations of successful leaders who, in concert with others, have the ability to create effective solutions to some of the profession s most pressing issues Simone, J.V. Understanding academic medical centers: Simone s maxims Editorial Shader, K., Broome, M.E., Broome, C.D., West, M.E., Nash, M. Clinical Cancer Research, 1999, 5, Factors influencing satisfaction and anticipated turnover for nurses in an academic medical center Journal of Nursing Administration, 31(4), nurse managers 241 staff nurses 908-bed university hospital (12 units surveyed) Purpose: examine the relationships between work satisfaction, stress, age, cohesion, work schedule, and anticipated turnover in an academic medical center. Nurse turnover is a costly problem that will continue as healthcare faces the impending nursing shortage, a new generation of nurses enter the workforce, and incentives provided to nurses to work for institutions increase. Cross-sectional survey Questionnaires: The Index of Work Satisfaction The Job Stress Scale Byrne Group Cohesion Scale The more job stress, the lower group cohesion, he lower work satisfaction, and the higher the anticipated turnover. As healthcare institutions face a nursing shortage and a new generation of nurses enter the workforce, consideration of the factor that influence turnover is essential to creating a working environment that retains the nurse.

14 Anticipated Turnover Scale

Baptist Health Nurse Leader Competency Model

Baptist Health Nurse Leader Competency Model Strategic Visionary Systems Thinking Quality Care and Performance Improvement Fiscal and Management Excellence Management of Self and Others 1 - Strategic,