Dissertations / Theses on the topic 'Management|Nursing'

As the number of older adults with dementia in nursing facilities grows, so does the need for holistic dementia training for nursing home staff. This curriculum was designed as a training tool for all nursing facility staff in order to provide practical education on how to develop individualized, psychosocial interventions for residents that have dementia. The curriculum is presented in two parts. Part I is a simulation activity and discussion to create empathy among staff members by demonstrating the perspective of an older adult with dementia. Part II is a guided practice activity on how to identify important interests and characteristics of an individual resident and apply this knowledge to create effective interventions. The training is a total of approximately 4 hours and focuses on teaching staff skills that will allow them to continue to target dementia symptoms with psychosocial interventions. The curriculum also includes a trainer’s guide, handouts, and a survey tool for evaluation.

Purpose: It is imperative to assure that health care organizations provide excellent care and create value by improving quality while eliminating unnecessary costs. Lean management is a continuous improvement management plan that uses work flow design to produce improvements in quality, safety, cost and productivity; it has been used in manufacturing, service and, more recently, healthcare industries. This study developed and tested an instrument to measure frontline nurse caregivers' perception of the penetration of lean management in hospitals that report using lean strategies.

Methods: The study consisted of three phases. In Phase 1, using the Delphi technique, an on-line survey of experts (n=10) and a review of the literature identified the domains and subdomains of lean management. Ideas from each domain were formed into items on the Frontline Improvement Thinking (FIT) instrument. The experts also assessed content validity. In Phase 2, nurses assessed the instrument's format, on-line usability of the instrument and content validity. In Phase 3, the instrument was administered to frontline nurses working on units in hospitals that reported using lean methods. Their responses (n= 212) provided the data for assessing the instrument's psychometric properties.

Results: Exploratory factor analysis yielded a scale with 75 items in 12 factors. Three domains were identified: organizational, unit and individual areas of improvement. The 4-factor, 29-item, FIT Unit had the highest reliability (α=.86-0.94; inter-item correlation range=.26-0.63). The 2-factor, 10-item FIT Organization was also acceptable (α=.87 and 0.79, inter-item correlation range=.30-0.72. The FIT Individual had less than desired reliability on one factor (α=.66) but had acceptable reliability on the other six factors (0.75-0.94; inter-item correlation range =.25-0.89). Test-retest reliability estimates were acceptable for the organization and unit based on Pearson's R correlations (0.53-0.77).

Conclusion: In the early stage of development, the FIT instrument proved helpful in describing diffusion of lean management. Sample size and quality proved to be problems, however. Nurses from hospitals with a history of lean quality improvement did not participate in the study and some of the hospitals studied were in the very early phases of lean management. Recommendations include continuing work on measure development by increasing the sample of lean-thinking nurses.

Quality in the healthcare industry has been gaining much importance in the last two decades. Every health professional is carefully trained to provide high quality service. Historically, healthcare providers have done their best in providing honorable service to the public. However, according to the Agency for Healthcare Research & Quality, the healthcare industry reports hospital stays of $375.9 billion in aggregate costs (2010). As a result, the healthcare crisis has demanded improvement in the quality of the healthcare industry. Because nurses are the largest group of healthcare providers in hospitals, they have become a major target for improving healthcare in the hospital setting. Applying Deming's 14 Points can provide a great resource for addressing this issue with a goal to upgrade the quality of the nursing profession. This project was guided by the need to improve the coronary care unit in order to benefit patient outcomes after cardiac surgery.

Leadership in today’s health care system is faced with challenges that require adequate educational training / preparation and practical experience. These challenges are manifested by a constant state of change which adds pressures and additional responsibilities to all health care providers. Adequate training / preparation can make a significant difference in the ability to appropriately and effectively improve and maintain work responsibilities. Historically, management opportunities have been available for adequately trained qualified personnel; however, consistent adequately trained first line nurse managers has not been the case. First line nurse managers are often promoted to their management position as a result of several characteristics; longevity in the nursing profession, exemplary clinical practice, or through a process of seniority, all of which may not be entirely management oriented. The literature states that promotion from nurse to a first line nurse manager position without management training may result in burnout, mistrust among colleagues, lack of respect, lack of leadership, division among departments, and overall poor performance. This study will examine the perceptions about the quality of nurse management training, and the problems encountered when such training does not occur. The study will also provide a basis for a review of the current literature to validate previous studies, provide current studies to include new input, and explore educational training ideas and suggestions addressing training concerns. This quantitative research will survey staff nurses seeking their individual perceptions of the competencies needed for first line nurse managers to be successful in their role. Data provided from staff nurses’ perceptions of the managerial skills and techniques of their current manager will be collected using a survey approach. The data will be used to analyze if there is an absence of needed managerial skills education and resolutions for a better approach. The target population for this study is staff / bedside registered nurses administering first level bedside care for patients in the hospital and/or clinical setting and from this population a sample of registered nurses currently enrolled or have been recently enrolled (within the last two years) in an associate degree to a baccalaureate nursing program.

The American Association of Colleges of Nursing (2016) contends meeting the challenge to transform care will require the successful leadership development, preparation, and role support of the next generation of nurse leaders. Despite the urgency to transform care, meeting the challenge to lead this charge cannot be accomplished without the successful recruitment and retention of Millennial nurses to leadership positions. Identifying the leadership role expectations and support variables that are important to these young managers and creating the milieus that support these views serve to address many pressing succession planning needs.

This study explored the experience of being a Millennial nurse manager, seeking to understand how these young nurse managers make meaning of their lived experience. This was a qualitative interpretative phenomenological research study. Three theoretical perspectives contributed ideologies that framed this inquiry: Ray’s (1989) theory of bureaucratic caring, generational cohort theory (Strauss & Howe, 1991), and authentic leadership theory (Avolio & Gardner, 2005). A purposeful targeted national sample of 25 Millennial nurse managers with a minimum of one year of nurse manager experience in the role participated in audio-recorded telephone interviews. Content analysis identified seven themes: Coming into the Role, Learning as I Go, Having the Support of My Director, Making an Impact, Helping Staff Succeed, Managing Change, and Trying to Stay Balanced.

Findings from this study suggest Millennial nurse managers gauge role success and satisfaction in relation to their perceived levels of support and development and their ability to master role expectations. Additional findings suggest adequate succession planning for the nurse manager role remains challenged by the lack of formal mandated requisites for the role.

The nurse manager role as it stands varies significantly among organizational settings regarding responsibilities, mechanisms of support, number of direct reports, and span of control. Recommendations included the need to address the nurse manager role, academic requisites, and developmental variances in practice. Additionally, re-evaluating the organizational responsibility to the leadership development of these young nurse leaders is recommended to ensure their retention and success in the role.

The specific problem under study results from the growth of multinational workforces in U.S. hospitals and the gap in the literature explaining how the presence of these workforces impacts hospital leadership, decision-making, and financial performance. The purpose of this qualitative embedded multi-case study was to discover and describe hospital nursing leader’s beliefs from their experiences about how having employees from multiple national cultures affects nursing leadership, decision-making, and departmental financial performance in the hospital. The challenge faced by many hospitals is that the U.S. workforce is becoming culturally diverse as the global workforce increases its geographical mobility. The current research was important because results revealed nurse leaders’ beliefs about a link between the cultural dimensions of a multinational workforce and the decision-making, financial performance, and patient care within a hospital nursing department. The sample included eight nursing leaders from seven hospitals where the workforces are multinational and culturally diverse. The cultural dimensions by Hofstede were used to study the impact of a multinational workforce on the organizational practices of a nursing department in a hospital setting. Results revealed nine core themes, expected from the literature, and two emerging themes provided answers to the research questions. The nine core themes were Hofstede’s cultural dimensions, workforce values, nursing organization impact, immigration/migration, nursing leadership, nursing workforce, organization culture, change, and develop multicultural organization attributes. The two emerging themes were familismo (family loyalty influences multinational workforce decision making) and hospital refusal to hire multicultural nurses whose national culture conflict with the organization’s culture.

The current study focused is on the underrepresentation of registered nurses in hospital CEO positions. There are several existential gaps in chief executive officer (CEO) leadership in the United States. The gender gap in CEO positions across all sectors demonstrates that females represent 31% of CEO positions in the United States. However, females represented only 12% of hospital CEOs in 2007 (Plant, 2008). In 2016, females represented 36% of hospital CEOs. Nevertheless, a far greater gap exists as registered nurses represented 2.5% of hospital CEOs in 2007 (Plant, 2008), and 3.0% of hospital CEOs in 2016. The chronic underrepresentation of registered nurses (RNs) is irrespective of education, experience preparation, knowledge, attitude, skills, and habits as RN executives aspiring to become hospital CEOs often have more education and experience than their non-registered nurse counterparts have. The sample for the current qualitative grounded theory study had 30 participants including 10 RN executives currently employed and holding the title of hospital CEO, 10 non-RN executives currently employed holding the title of hospital CEO, and 10 decision-makers who have authority over the hospital CEO candidate selection process. The current study employed grounded theory method to develop a substantive grounded theory of why the phenomenon of the underrepresentation of registered nurses in hospital CEO positions exists. The substantive grounded theory developed in the study might help decision-makers involved in the hospital CEO selection process adjust their selection strategies so they evaluate hospital CEO candidates equitably. Registered nurses aspiring to become hospital CEOs might also benefit from the study by altering their career development strategies so the decision-makers perceive them as qualified candidates for the position of hospital CEO.

The purpose of this exploratory qualitative study was to identify experiences or barriers that arise during the first year as Certified Registered Nurse Anesthetists (CRNAs) transition into management and; if these shared experiences can prepare future CRNA managers by providing insight into what knowledge, skills, and abilities are necessary to ensure a smooth and successful career transition.

A representative sample by email and Facebook (FB) elicited 18 phone interviews of current and past Certified Registered Nurse Anesthetist (CRNA) managers. One interviewer asked 16 questions: seven demographic and nine open-ended. Survey information was (1) transcribed, (2) reviewed and de-identified, and (3) coded for content and classical analysis by two experienced independent coders. A coding tree was developed by coders after independent and random assessment of codes with an IRR (0.93). NVivo 11 software was used to assist with analysis of codes.

CRNA participants (66%) had less than five years of CRNA management experience, and 61% had no previous management experience or education before accepting their first role as a CRNA manager. An incidental finding, 83% of participants were reluctant managers and 76% of CRNA managers devoted greater than 50% of their time to performing clinical duties over managerial duties. Two resources that CRNA participants agreed were helpful resources during transition included: mentors (83%) and previous education or experiences (44%), especially in business, finance, or management. The skills CRNA participants believed were important during transition included people skills (56%), financial knowledge (33%), and communication (28%).

CRNA managers are more likely to be reluctant managers that may be relatively new in the role, and with no previous management experience or education. Recommendations for new CRNA managers during transition included; mastering “people skills,” either through relationship management or communication skills. Derailment may be avoided if new managers consider the results of this investigation.