Nurse practitioners (NPs) and physician assistants (PAs) have long been part of the care model at our institution. Over the years, however, we have demonstrated a preference for NPs based on the belief that they can better meet our patients' needs. A recent evaluation of our care model led us to question these preferential hiring practices. After carefully examining NP and PA education and licensure requirements, scope of practice, and roles at our institution, we concluded that similarities between the roles far outweighed the differences and that our preferential hiring practices should be replaced by an individualized approach, in which advanced practice positions are filled by whichever candidate best meets the role requirements. This inclusive and analytic approach may be a useful model for other nurse leaders considering the NP/PA question.

OBJECTIVE::

The objective of this study was to determine the utility and feasibility of using data from a nurse call system equipped with radiofrequency identification data (RFID) to measure nursing time spent in patient rooms.

BACKGROUND::

Increasing the amount of time nurses spend with hospitalized patients has become a focus after several studies demonstrating that nurses spend most of their time in nondirect care activities rather than delivering patient care. Measurement of nursing time spent in direct care often involves labor-intensive time and motion studies, making frequent or continuous monitoring impractical.

METHODS::

Mixed methods were used for this descriptive study. We used 30 days of data from an RFID nurse call system collected on 1 unit in a community hospital to examine nurses time spent in patient rooms. Descriptive statistics were applied to calculate this percentage by role and shift. Data technologists were surveyed to assess how practical the access of data would be in a hospital setting for use in monitoring nursing time spent in patient rooms.

RESULTS::

The system captured 7393 staff hours. Of that time, 7% did not reflect actual patient care time, so these were eliminated from further analysis. The remaining 6880 hours represented 91% of expected worked time. RNs and nursing assistants spent 33% to 36% of their time in patient rooms, presumably providing direct care.

CONCLUSIONS::

Radiofrequency identification data technology was found to provide feasible and accurate means for capturing and evaluating nursing time spent in patient rooms. Depending on the outcomes per unit, leaders should work with staff to maximize patient care time.

: This study investigated the perceptions of nursing hostility and job satisfaction of new RNs, comparing the working settings of Magnet® and non-Magnet hospitals.: An online survey of new graduate RNs was conducted using the Negative Acts Questionnaire-Revised, the McCloskey/Mueller Satisfaction Survey, the Casey-Fink Graduate Nurse Experience Survey, and a demographic questionnaire.: Findings indicated that RNs of Magnet and non-Magnet facilities experienced similar hostility and job satisfaction results. Magnet nurses (n = 226) perceived nursing hostility significantly different than non-Magnet nurses (n = 939); however, both groups reported a global perception of nursing hostility as new RNs.: Based on this study's findings, greater consideration should be placed on orientation/residency programs, collaborative partnerships between academia and service, zero tolerance for behaviors undermining culture safety, and addressing nursing hostility.

: The objectives of this study were to explore the perceptions of hospital-based staff nurses regarding their involvement in decision making and to gain an understanding of the ways nurses would like to be involved in decision making.: How nurses want to be involved and the extent to which hospital-based staff nurses are involved in formal and informal structures for decision making remain unknown.: Stratified cluster random sampling was used to identify hospitals to participate in the study. Staff nurses and chief nursing officers (CNOs) from 10 hospitals in Colorado were invited to participate in this qualitative descriptive study informed by grounded theory. Focus groups with staff nurses and individual interviews with CNOs were also conducted.: Safe quality patient care was threaded throughout discussions among the staff nurses and CNOs.: Staff nurses viewed involvement in decision making through the lens of an egalitarian process, whereas administration viewed involvement as soliciting input but making decisions unilaterally.

: The objective of this study was to develop a reliable and valid checklist for documenting team and collaborative behaviors occurring during multidisciplinary bedside rounds.: Teamwork and collaboration are important for providing high-quality patient care, yet there are no objective means of evaluating the occurrence of team and collaborative behaviors during bedside rounds.: A checklist was developed and tested on 3 general medical units. Items on the checklist were derived from the literature and our medical center's patient-family-centered values.: The final version of the checklist was determined to be reliable, valid, and easy to use in the clinical setting.: Clinicians, administrators, and investigators are encouraged to use and/or modify this checklist for use in their setting. Further research identifying instruments to objectively measure teamwork and collaboration is needed.

Missed nursing care refers to omission of standard required nursing care of patients in acute care hospitals. The objective of this study was to compare the amounts and reasons of missed nursing care, the level of nurse staffing, and job satisfaction between the United States and Lebanon. Several studies in the United States have shown that a significant amount of care is being missed. This study is designed to determine if Lebanon is experiencing a similar phenomenon and what reasons are given for missing nursing care. Findings support that a substantial amount of nursing care is missed in Lebanon, although less than that in the United States (t = 11.53, P < .001), that nurses in Lebanon were less satisfied with being a nurse than are nurses in the United States, and there was no difference in the identification of staffing resources as a reason for missed care in the 2 countries.

: A qualitative design was used to decipher the viewpoints of nurse managers about communication trends associated with their leadership roles and unit subcultures.: Disruptive behaviors such as poor communication and inadequate teamwork have been associated with patient harm and deficient workplace cultures. However, few studies have focused on nurse managers' perceptions of communication and a healthy workplace.: A descriptive qualitative study was conducted using 12 in-depth interviews of 6 nurse managers to better understand communication patterns of managers. Analysis identified 5 themes and 13 subthemes.: Workplace processes were identified that either promoted or hindered managers' abilities to set a positive tone and to stay connected to their staff, ensuring effective communication while meeting multiple unit and institutional challenges.: Findings can be used to strengthen communication practices, obviate communication disconnects, and ensure a healthy workplace.

This study uses the qualitatively developed Adams Influence Model© (AIM) and concepts from the psychometrically validated Revised Professional Practice Environment scale to guide the development of the Leadership Influence Over Professional Practice Environments Scale. Nurse executives and others can use this scale individually or in conjunction with instruments targeting staff or patient perceptions of their influence as part of health services research, leadership development, and professional practice environment enhancement strategy.

This interview, conducted by the editor, is the 1st in a series of interviews of emerging nurse scientists highlighting the department author, Jeffrey M. Adams, PhD, RN, director of the Center for Innovations in Care Delivery and Connell Nursing Research Scholar at Massachusetts General Hospital.

In this month's column, the executive director of the American Nurses Credentialing Center® provides a perspective on the importance of nursing research and the creation of a supportive culture. Magnet® organizations promote a culture of inquiry in leading to new knowledge, innovations, and improvements.