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INTRODUCTION: The ongoing COVID-19 pandemic substantially affects health care workers from multiple disciplines, including nurses, physicians, therapists, and first responders. The aims of this study were to 1) explore and describe the experiences of health care workers and first responders working with individuals with COVID-19 infection, and 2) identify the support and strategies that were helpful during their experience. METHODS: A qualitative descriptive study was conducted via online video interviews of 29 health care workers and first responders who agreed to be contacted for an interview. Thematic analysis resulted in three themes and corresponding subthemes. RESULTS: The three overriding themes were 1) experiencing vulnerability, 2) suffering loss and grief, and 3) coping with vulnerability. A sense of vulnerability and high levels of stress were described and affected participants during their professional work as health care workers and first responders as well as their roles in their homes and communities. DISCUSSION AND CONCLUSION: The findings indicate the need for effective measures to assist health care workers and first responders to minimize the negative consequences of persistent and severe stress and vulnerability as they care for individuals with COVID-19 and their families.

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AIM: To explore how relational coordination, known to enhance quality and efficiency outcomes for patients and hospitals, impacts direct care nurse outcomes such as burnout, work engagement, and job satisfaction, addressing the "Quadruple Aim," to improve the experience of providing care. BACKGROUND: Hospitals are complex organizations in which multiple providers work interdependently, under conditions of uncertainty and time constraints, to deliver safe quality care despite differences in specialization, training, and status. Relational coordination-communicating and relating for the purpose of task integration-is known to improve quality, safety, and efficiency under these conditions, but less is known about its impact on the well-being of direct care providers themselves. METHODS: Surveys measuring relational coordination among nurses and other types of providers as well as job-related outcomes in 5 acute care community hospitals were completed by direct care RNs. RESULTS: Relational coordination was significantly related to increased job satisfaction, increased work engagement, and reduced burnout. CONCLUSIONS: Relational coordination contributes to the well-being of direct care nurses, addressing the Quadruple Aim by improving the experience of providing care.

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The aim of the study reported in this article was to investigate staff nurses' perceptions and experiences about structural empowerment and perceptions regarding the extent to which structural empowerment supports safe quality patient care. To address the complex needs of patients, staff nurse involvement in clinical and organizational decision-making processes within interdisciplinary care settings is crucial. A qualitative study was conducted using individual semi-structured interviews of 11 staff nurses assigned to medical or surgical units in a 600-bed university hospital in Belgium. During the study period, the hospital was going through an organizational transformation process to move from a classic hierarchical and departmental organizational structure to one that was flat and interdisciplinary. Staff nurses reported experiencing structural empowerment and they were willing to be involved in decision-making processes primarily about patient care within the context of their practice unit. However, participants were not always fully aware of the challenges and the effect of empowerment on their daily practice, the quality of care and patient safety. Ongoing hospital change initiatives supported staff nurses' involvement in decision-making processes for certain matters but for some decisions, a classic hierarchical and departmental process still remained. Nurses perceived relatively high work demands and at times viewed empowerment as presenting additional. Staff nurses recognized the opportunities structural empowerment provided within their daily practice. Nurse managers and unit climate were seen as crucial for success while lack of time and perceived work demands were viewed as barriers to empowerment.

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OBJECTIVE: The objective of this study was to investigate the impact of The Productive Ward-Releasing Time to Care™ program implemented in a hospital transformation process on nurse perception related to practice environment, burnout, quality of care, and job outcomes. BACKGROUND: To address the continuously evolving complex challenges of patient care, high-performance nursing care is necessary. METHODS: A longitudinal survey design was used to conduct a study in a 600-bed acute care university hospital with 3 measurement periods: T0: base line in 2006, T1 in 2011, and T2 in 2013. As part of the hospital transformation process, the productive ward program was introduced between T1 and T2. RESULTS: Relevant impact on nurse-physician relations, nurse management, hospital management-organizational support, nurse-reported quality of care, and job outcomes were identified. CONCLUSION: Hospital strategies and policies should be aligned with daily practices so that engaged and committed staff can promote excellent outcomes.

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This department highlights nursing leaders who have demonstrated a commitment to nursing leadership in research, practice, policy, education and theory. This interview profiles Donna Sullivan Havens, PhD, RN, FAAN, professor, The University of North Carolina at Chapel Hill.

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OBJECTIVES: The objectives of this study were to develop and test a scale designed to describe and assess nurse managers' practice environments. BACKGROUND: Creating practice environments supporting workers at all levels is critical to achieving excellent patient, staff, and organizational outcomes. Scales are available to assess staff nurses' practice environment; however, no comparable scale for nurse managers exists. METHODS: A cross-sectional design using an electronic survey was administered to nurse managers in 25 hospitals in 9 health systems from 6 states. RESULTS: Exploratory factor analysis with a varimax rotation produced a final solution of 44 items loading in 8 domains. Cronbach's α's ranged from .72 to .97. Mean scores ranged from 3.92 to 4.99 on a 6-point Likert scale. CONCLUSIONS: The scale demonstrated adequate psychometric properties and warrants further use and testing. Understanding the nurse manager practice environment may reveal insights to guide opportunities to improve organizational performance.

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Acute-care rural hospitals comprise 41% of US community hospitals, yet little is known about the quality of nursing practice environments (PEs) in these settings. Thus, there is little evidence for rural nurse leaders to access in organizing nursing practice to support quality staff and patient outcomes. The Practice Environment Scale of the Nursing Work Index (PES-NWI) has not been tested with a rural nurse sample and the literature does not provide reference scores for this group. This article presents findings to support the PES-NWI as a measure to describe rural acute-care nurse PEs and provides reference values for nurse leaders to use to implement evidence based nursing practice.

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BACKGROUND: Although the Practice Environment Scale of the Nursing Work Index has been endorsed as a gauge of the quality of the nursing practice environment by several organizations in the United States promoting healthcare quality, there is no literature describing its use in different practice settings and countries. OBJECTIVE: The purpose of this study was to inform research by describing the modifications and use of the scale in a variety of practice settings and countries. METHODS: The Cumulative Index to Nursing and Allied Health Literature and the PubMed databases were searched for the years 2002-2010 to identify 37 research reports published since 2002 describing use, modification, and scoring variations in different practice settings and countries. RESULTS: The scale was modified for 10 practice settings in five countries and translated into three languages. Composite scores ranged from 2.48 to 3.17 (on a 1-4 scale). The Staffing and Resource Adequacy subscale most often scored lowest. A new Nursing Information Technology subscale has been developed. New scoring methods to identify the favorability of practice environments are described. Over time, the nature of the research conducted using the measure has changed. Overall, most publications report significant associations between scale scores and multiple nurse, patient, and organizational outcomes. DISCUSSION: Scale use is growing across different clinical settings and countries. Recommendations for future research use include reducing scale length, using consistent scoring methods, considering the impact of various modifications on the basis of cultural and clinical setting nuances, and using the measure in longitudinal and intervention research designs.

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Chief nursing officers (CNOs) develop environments in which quality patient care is delivered and nurses enjoy professional practice. Because of the growing turbulence in this vital role, the American Organization of Nurse Executives conducted a study to examine CNO turnover as described in interviews with CNOs and healthcare recruiters to inform the development of strategies to improve CNO recruitment and retention and ease transition for those who turn over. The authors present the findings from this research and describe American Organization of Nurse Executives' initiatives to address the identified needs.

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Appreciative inquiry is a philosophy and methodology for promoting positive organizational change. Nursing leaders at 6 community hospitals are partnering with the authors on a project that uses appreciative inquiry to improve communication and collaboration, to increase nurse involvement in decision making, and to enhance cultural awareness and sensitivity. In this article, the authors describe appreciative inquiry, how hospitals are using it, and the initial lessons learned.

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BACKGROUND: For decades, enhancing staff nurse decisional involvement in matters of nursing practice and patient care has been identified as a long-term strategy to improve the quality of the nursing work environment and the safety and quality of patient care. OBJECTIVE: To describe psychometric assessments of the Decisional Involvement Scale (DIS), a diagnostic and evaluative measure of nurse decisional involvement. METHODS: A series of assessments were conducted to evaluate the psychometric performance of the scale. Content validity was assessed by experts in the field. Descriptive statistics were used to examine the use and performance of the scale. The contrasted groups approach was used to assess construct validity. Item analysis was used to explore evidence of the internal consistency of items and subscales across multiple samples. Structural modeling was used to conduct a confirmatory factor analysis using data from two independent samples of staff registered nurses (RNs; n = 849 and 650). RESULTS: Acceptable content validity indexes (CVIs) were independently generated by three content experts. Construct validity was supported, as hypothesized; nurses working on professional practice units scored significantly higher for all items when compared to nurses working on units without professional practice models in place. Internal consistency (coefficient alpha) was high and nearly identical for the total measure and all subscales across the two independent nurse samples. Six subscales were identified using factor analysis, and these were confirmed by structural modeling. CONCLUSION: Psychometric findings support that the DIS is a valid and reliable measure of staff nurse decisional involvement.

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Organizational and management characteristics found in hospitals holding magnet hospital recognition are associated with professional nurse practice environments and positive patient and staff outcomes. However, while we know what works, we need a better understanding of "how to get there.'' The authors report the stories about "how we did it'' told by chief nurse executives and magnet project coordinators from hospitals that have achieved American Nurses Credentialing Center magnet hospital recognition. This article adds to the understanding of how to pursue magnet recognition.

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An integrative literature review was conducted to investigate studies on adverse events reported in medical, health services, and nursing literature. The review was guided by the method proposed by Jackson (1980) and Ganong (1987). Three questions shaped the review: (a) What terms are used to denote adverse events? (b) What purposes drive adverse events research? and (c) What data sources are used to study adverse events? Adverse events was the dominant term, the study of adverse events as an outcome variable was the prevailing research purpose, and monitoring or screening the patient clinical record and self-reported incidents by health care professionals were the main data sources. Future research is recommended to conceptualize and study adverse events.

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Key organizations and new legislation are promoting staff nurse involvement in decisions about nursing practice and patient care as a long-term strategy to improve the culture of the work environment. The authors discuss the Decisional Involvement Scale (DIS), a multipurpose measure that can be used as a diagnostic tool, an organizational development strategy, and an evaluative instrument. In addition, support to substantiate the DIS as a valid and reliable measure is summarized.

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