Implications of a theoretical framework on stress and burnout for the development of graduate nursing education curricula

This study had two purposes: (a) to develop a theoretical framework integrating and synthesizing findings of prior research regarding stress and burnout among critical care nurses (CCRNs), and (b) to validate the theoretical framework with an empirical study to assure a theory/research based teaching-learning process for graduate courses preparing nursing clinical specialists and administrators.^ The methods used to test the theoretical framework included: (a) adopting instruments with reported validity, (b) conducting a pilot study, (c) revising instruments using results of the pilot study and following concurrence of a panel of experts, and (d) establishing correlations within predetermined parameters. The reliability of the tool was determined through the use of Cronbach's Alpha Coefficient with a resulting range from.68 to.88 for all measures.^ The findings supported all the research hypotheses. Correlations were established at r =.23 for statistically significant alphas at the.01 level and r =.16 for alphas.05. The conclusions indicated three areas of strong correlation among the theoretical variables: (a) work environment stressor antecedents and specific stressor events were correlated significantly with subjective work stress and burnout; (b) subjective work stress (perceived work related stress) was a function of the work environment stressor antecedents and specific stressor events, and (c) emotional exhaustion, the first phase of burnout, was confirmed to be related to stressor antecedents and specific stressor events. This dimension was found to be a function of the work environment stressor antecedents, modified by the individual characteristics of work and non-work related social support, non-work daily stress, and the number of hours worked per week. The implications of the study for nursing graduate curricula, nursing practice and nursing education were discussed. Recommendations for further research were enumerated. ^

The career development of Black female chief nurse executives

This qualitative study was designed to explore the career development of Black female chief nurse executives. Although a small proportion of Black female nurses have achieved positions at the nurse executive level, there remains a paucity of Black female nurse executives in this crucial position which raised the question of what factors contributed to this lack of advancement, but, more important, what factors have contributed to the success of the few who have achieved such level of success in healthcare organizations. The purpose of the study was to explore the career paths of Black female chief nurse executives with a view of understanding the factors which both facilitate and hinder the career development of these leaders in healthcare organizations. The guiding research question was, How do Black female nurse executives in this sample describe their career development? The participants in this study were Black female chief nurse executives located throughout the United States who, for the most part, were raised in segregation with a strong family foundation. To collect data, semistructured telephone interviews were conducted with 10 Black female chief nurse executives throughout the United States. The transcripts from the interviews were transcribed, coded, and analyzed. Using Super’s (1990, 1996), and Gottfredson’s (1981, 1996, 2002, 2005) career development theories and critical race theory (Crenshaw, 1995; Delgado, 2000) as the theoretical framework, the researcher found that the participants’ career development was influenced by (a) strong support system, (b) guidance, (c) influence of diversity, and (d) servant leadership. The findings help us understand the factors that have contributed to their successes as Black chief nurse executives. With the increasingly diverse population and concurrent increasing diversity in nursing and concerns about healthcare disparities, it is imperative that organizations attract, hire, develop, retain, and advance qualified Black nurses. Future studies addressing not only the career development of Black nurses but nurses in general might be informed by the present study’s findings. Recommendations are offered for nursing practice, education, and organizational policy.

The Career Development of Black Female Chief Nurse Executives

This qualitative study was designed to explore the career development of Black female chief nurse executives. Although a small proportion of Black female nurses have achieved positions at the nurse executive level, there remains a paucity of Black female nurse executives in this crucial position which raised the question of what factors contributed to this lack of advancement, but, more important, what factors have contributed to the success of the few who have achieved such level of success in healthcare organizations. The purpose of the study was to explore the career paths of Black female chief nurse executives with a view of understanding the factors which both facilitate and hinder the career development of these leaders in healthcare organizations. The guiding research question was, How do Black female nurse executives in this sample describe their career development? The participants in this study were Black female chief nurse executives located throughout the United States who, for the most part, were raised in segregation with a strong family foundation. To collect data, semistructured telephone interviews were conducted with 10 Black female chief nurse executives throughout the United States. The transcripts from the interviews were transcribed, coded, and analyzed. Using Super’s (1990, 1996), and Gottfredson’s (1981, 1996, 2002, 2005) career development theories and critical race theory (Crenshaw, 1995; Delgado, 2000) as the theoretical framework, the researcher found that the participants’ career development was influenced by (a) strong support system, (b) guidance, (c) influence of diversity, and (d) servant leadership. The findings help us understand the factors that have contributed to their successes as Black chief nurse executives. With the increasingly diverse population and concurrent increasing diversity in nursing and concerns about healthcare disparities, it is imperative that organizations attract, hire, develop, retain, and advance qualified Black nurses. Future studies addressing not only the career development of Black nurses but nurses in general might be informed by the present study’s findings. Recommendations are offered for nursing practice, education, and organizational policy.

Low-income first time mothers: Effects on advanced practice nurse (APN) follow up telephone calls on maternal and infant health and health care charges

The United States has over 4 million births annually. Currently healthy women with non-complicated deliveries receive little to no routine postpartum support when discharged from the hospital. This is especially problematic if mothers are first time mothers, poor, have language barriers and little to no social support after giving birth. The purpose of this randomized clinical trial was to compare maternal and infant health outcomes, and health care charges between 2 groups of mothers and newborns. A control ( n = 69) group received routine posthospital discharge care. An intervention group (n = 70) received routine posthospital discharge care plus follow up telephone calls by advanced practice nurses (APNs) on days 3,7,14,21,28 and week 8. Both groups were followed for the first 8 weeks posthospital discharge following delivery to examine maternal health outcomes (perceived maternal stress, social support and perceived maternal physical health), infant health outcomes (routine medical follow up visits immunizations, weight gain), morbidity (urgent care visits, emergency room visits, rehospitalizations), health care charges (urgent care visits, emergency room visits, rehospitalizations) in both groups and charges for APN follow up in the intervention group only. Data were analyzed using descriptive statistics and two-sample t-tests. Study findings indicated that intervention group had significantly lower perceived maternal stress, significantly higher rating of perceived maternal health and higher levels of social support and by the end of the 2nd month posthospital discharge compared to control group mothers. Infants in the intervention group had: increased number of immunizations; fewer emergency room visits; and 1 infant rehospitalization compared to 3 infant rehospitalizations in the control group. The intervention groups' health care charges were significantly lower compared to the control group $14,333/$497 vs. $70,834/$1,068. These study results indicate that an intervention of APN follow up telephone calls in this sample of first time low-income culturally diverse mothers was an effective, safe, low cost, easy to apply intervention which improved mothers' and infants' health outcomes and reduced healthcare charges.

The effects of advanced practice nurses (APNs) as intensivists in a surgical intensive care unit (SICU) on patient outcomes, healthcare charges, and apn intensivist services in the SICU

Intensive Care Units (ICUs) account for over 10 percent of all US hospital beds, have over 4.4 million patient admissions yearly, approximately 360,000 deaths, and account for close to 30% of acute care hospital costs. The need for critical care services has increased due to an aging population and medical advances that extend life. The result is efforts to improve patient outcomes, optimize financial performance, and implement models of ICU care that enhance quality of care and reduce health care costs. This retrospective chart review study examined the dose effect of APN Intensivists in a surgical intensive care unit (SICU) on differences in patient outcomes, healthcare charges, SICU length of stay, charges for APN intensivist services, and frequency of APNs special initiatives when the SICU was staffed by differing levels of APN Intensivist staffing over four time periods (T1-T4) between 2009 and 2011. The sample consisted of 816 randomly selected (204 per T1-T4) patient chart data. Study findings indicated reported ventilator associated pneumonia (VAP) rates, ventilator days, catheter days and catheter associated urinary tract infection (CAUTI) rates increased at T4 (when there was the lowest number of APN Intensivists), and there was increased pressure ulcer incidence in first two quarters of T4. There was no statistically significant difference in post-surgical glycemic control (M = 142.84, SD = 40.00), t (223) = 1.40, p = .17, and no statistically significant difference in the SICU length of stay among the time-periods (M = 3.27, SD = 3.32), t (202) = 1.02, p = .31. Charges for APN services increased over the 4 time periods from $11,268 at T1 to $51,727 at T4 when a system to capture APN billing was put into place. The number of new APN initiatives declined in T4 as the number of APN Intensivists declined. Study results suggest a dose effect of APN Intensivists on important patient health outcomes and on the number of APNs initiatives to prevent health complications in the SICU. ^

The clinical competency of practicing and nonpracticing faculty of associate degree schools of nursing

This study assesses and describes the perception of clinical competency and the relationship to clinical practice of full-time nursing faculty in the associate degree nursing programs in the state of Florida. The study was developed around one major hypothesis and four research questions. The Hygiene-Motivators Theory proposed by Herzberg, Mausner, and Snyderman (1959) provided the conceptual framework to explain factors that would motivate a person to expand workload and maintain job satisfaction.^ Data were collected from the 244 faculty members teaching full-time at the 15 associate degree schools of nursing accredited by the National League for Nursing in the state of Florida. A total of 186 faculty (76%) responded and 175 (72%) cases were used for data analysis.^ Two instruments were modified and combined for the investigation. The instruments were the Faculty Perception of Practice Questionnaire (Parascenzo, 1983) and a three-part Attributes Deemed Necessary for Faculty to Proclaim Clinical Competency (Smith, 1991) scale. Computer analyses employing descriptive and inferential statistics were performed.^ The findings revealed that faculty were closely divided as to practice activities with more faculty nonpracticing than practicing. Factors identified as impediments to increased clinical practice were identified as teaching load and personal/family responsibilities that lead to a lack of time and lack of opportunity. Those faculty who practice did so as moonlighters in positions that would not require advanced training. Both the practicing and nonpracticing faculty reported a high level of satisfaction with their activities as a means of maintaining clinical practice. While both groups reported a high level of expertise, those practicing faculty perceived themselves to be more clinically competent on the attributes of knowledge, skills, and on the total attribute scale. It was further revealed that perception of competency declined with the length of time spent out of practice. There was no difference in the two groups on the attributes of values/attitude. ^

The Effects of Advanced Practice Nurses (APNs) as Intensivists in a Surgical Intensive Care Unit (SICU) on Patient Outcomes, Healthcare Charges, and APN Intensivist Services in the SICU

Intensive Care Units (ICUs) account for over 10 percent of all US hospital beds, have over 4.4 million patient admissions yearly, approximately 360,000 deaths, and account for close to 30% of acute care hospital costs. The need for critical care services has increased due to an aging population and medical advances that extend life. The result is efforts to improve patient outcomes, optimize financial performance, and implement models of ICU care that enhance quality of care and reduce health care costs. This retrospective chart review study examined the dose effect of APN Intensivists in a surgical intensive care unit (SICU) on differences in patient outcomes, healthcare charges, SICU length of stay, charges for APN intensivist services, and frequency of APNs special initiatives when the SICU was staffed by differing levels of APN Intensivist staffing over four time periods (T1-T4) between 2009 and 2011. The sample consisted of 816 randomly selected (204 per T1-T4) patient chart data. Study findings indicated reported ventilator associated pneumonia (VAP) rates, ventilator days, catheter days and catheter associated urinary tract infection (CAUTI) rates increased at T4 (when there was the lowest number of APN Intensivists), and there was increased pressure ulcer incidence in first two quarters of T4. There was no statistically significant difference in post-surgical glycemic control (M = 142.84, SD= 40.00), t (223) = 1.40, p = .17, and no statistically significant difference in the SICU length of stay among the time-periods (M= 3.27, SD = 3.32), t (202) = 1.02, p= .31. Charges for APN services increased over the 4 time periods from $11,268 at T1 to $51,727 at T4 when a system to capture APN billing was put into place. The number of new APN initiatives declined in T4 as the number of APN Intensivists declined. Study results suggest a dose effect of APN Intensivists on important patient health outcomes and on the number of APNs initiatives to prevent health complications in the SICU.