A Nurse-Led Evidence-Based Case for Improving Perioperative Readiness Through AI-Supported Clinical Workflows

Allison Jones

This evidence-based practice case illustrates how nurse leaders applied existing evidence to redesign perioperative readiness workflows to improve patient safety, clinical communication, and operational reliability. Fragmented preoperative data, inconsistent documentation, and manual workflows contribute to perioperative delays and increased cognitive burden for clinicians. Nursing leadership leveraged evidence supporting standardized assessment and workflow redesign to guide a nurse-led practice change supported by an AI-enabled clinical workflow tool.

Guided by the Iowa Model of Evidence-Based Practice and sociotechnical systems theory, nurse leaders collaborated with anesthesia providers, perioperative nurses, information technology partners, and administrative leaders to co-design and implement an evidence-based readiness framework. Implementation strategies included workflow mapping, stakeholder engagement, staff education, phased rollout, and continuous feedback. Barriers such as technology skepticism and workflow variability were addressed through transparent communication and clinician involvement, while facilitators included strong leadership sponsorship and alignment with patient safety priorities.

Outcomes demonstrated meaningful improvements following implementation. Preoperative documentation consistency improved by approximately 40 percent, perioperative delays related to readiness gaps decreased by 20 percent, and clinicians reported improved workflow clarity and reduced cognitive burden. Lessons learned highlighted the importance of visible nursing leadership, early stakeholder engagement, and clear definition of technology’s supportive role in clinical decision making.

Sustainability plans include ongoing leadership oversight, integration of readiness metrics into quality monitoring, continued staff education, and iterative refinement of workflows. This illustrative EBP case reinforces key nursing leadership competencies in evidence translation, change management, and interdisciplinary collaboration, and demonstrates how nurse-led practice change can achieve measurable improvements in patient safety and clinical operations while preserving clinician judgment.

Improving Heart Failure Readmissions Through Structured Nurse Onboarding Education

Lydia Karogo

Background: Heart failure (HF) remains a leading cause of hospital readmission in the United States, with up to 22% of patients readmitted within 30 days (Lawson et al., 2021). An internal evaluation by the heart failure nurse navigator and nurse educators at a heart & vascular acute care hospital identified knowledge gaps among registered nurses (RNs) in HF pathophysiology and disease management plans, contributing to variability in nurse-led HF self-care education practices. A literature review demonstrated strong evidence supporting enhanced nurse-led education interventions as an effective strategy for improving HF education self-care practices and reducing readmissions.

Purpose and objectives: This quality improvement initiative evaluated the impact of a structured HF-focused nurse onboarding education program on nurse knowledge and 30 -day HF readmission rates.

• Improve newly hired nurses' knowledge of HF pathophysiology and disease management plan.
• Enhance nurse-led HF self-care education practices.
• Reduce 30-day HF readmissions.

PICOT: In HF patients admitted at an acute heart and vascular hospital, what is the effect of a structured HF-focused nurse onboarding education program on 30 -day HF readmission rates compared to standard education over the 3-month period?

Methods: The Plan-Do-Study-Act (PDSA) Model for Improvement framework was used to implement a structured HF education program for newly hired RNs. Newly hired nurses were selected as the initial target population due to identified knowledge gaps in HF pathophysiology and disease management, especially among those transitioning from non-cardiac specialties. The program included interdisciplinary delivery of didactic education on HF pathophysiology and HF disease management plan, with anonymized pre- and post-intervention knowledge assessments conducted in accordance with the facility-approved HF Action Plan. Demographic variables, including education, years of RN experience, and prior cardiac experience, were collected. Competency validation of nurses' ability to complete nurse-led HF self-care education was conducted by unit charge nurses using the competency checklist. 30-day readmission data were obtained from Power BI.

The Heart Failure (HF) education curriculum, based on the 2022 AHA/ACC/HFSA HF Guideline (Heidenreich et al.) and the facility’s HF Action Plan, used as a transition self-care tool to prevent readmissions, provided 90-minute classroom sessions including GDMT education and structured self-care teaching strategies. Education was delivered collaboratively by the nurse educators and a board-certified cardiovascular pharmacist to newly hired nurses, with pre- and post-tests administered by the educators and unit-based, real-patient competency assessments validated by charge nurses. Unique identifiers tracked outcomes, and competencies were completed within one month of onboarding, ensuring nurses could provide standardized, evidence-based HF self-care education.

Results and implications: Among participating nurses (n=30), knowledge of HF pathophysiology and disease management plan increased by 28.3% following the intervention, with a large effect size (d=2.08) demonstrating clinical significance. Pre- and post-intervention means were calculated using three-month periods before and after implementation. HF readmissions decreased by 26.3% post-intervention. Matched-month comparisons accounting for seasonal variation demonstrated a 35.3% reduction in mean readmissions. Implementation of a structured HF-focused education onboarding improved nurse knowledge and supported stronger nurse-led HF self-care education practices, with associated reduction in HF readmissions.

Frontline Manager Retention Through Development

Heidi Gilroy

Problem, Background, and Significance:

Nurse managers play a critical role in creating healthy work environments, supporting frontline staff, and advancing organizational outcomes. Many nurses transitioning into management roles report feeling underprepared for the demands of the position. Leadership transitions without structured development increase the risk of turnover, burnout, and inconsistent leader performance, posing significant implications for the organization, the leaders themselves, and the staff that report to them. A quality improvement initiative was undertaken to strengthen leadership preparedness, improve manager retention, and build a sustainable leadership pipeline. Evidence indicates that structured leadership development, mentorship, and succession planning improve managerial competency, retention, and workforce engagement. Studies support that transition-to-leadership programs reduce stress, strengthen confidence, and improve professional satisfaction among new nurse leaders. This evidence informed the design of a multi factorial, internal leadership development model.

Purpose and Project Objectives:

The purpose of this QI project was to increase nurse manager retention by decreasing burnout, enhancing preparedness for leadership transitions, and fulfilling ongoing learning needs of new and experienced nurse leaders. Objectives included:

1. Establish a sustainable leadership pipeline through an Assistant Nurse Manager model
2. Provide structured, ongoing leadership education
3. Improve manager engagement through collaborative professional development structures.

Methods and Implementation:

A multi-component QI approach was used. First, the organization transitioned from a charge nurse model to an ANM model, enabling identification and development of at least 4 potential future leaders per unit. ANMs participated in monthly leadership classes and completed applied leadership projects to build competency. Second, a Manager Development Committee (MDC) was established, composed of all nurse managers. The MDC met regularly to provide fellowship, shared problem solving, leadership education, and peer support. Third, learning needs assessments were conducted twice annually. Managers participated in an interactive workshop to create individualized development plans; progress and needs were reassessed at recurring intervals. Burnout and engagement were evaluated through quarterly employee engagement survey data.

Results and Outcomes:

Within the first year, the organization achieved 100% ANM retention, with two ANMs promoted into manager roles, supporting strong succession outcomes. Manager retention also increased compared to the prior year. Manager engagement was 100% and there was a decrease in manager burnout according to the employee engagement surveys over the course of the year. Qualitative feedback indicated strengthened peer support, increased confidence in leadership skills, and improved perceptions of organizational investment in leadership development.

Implications for Nursing Leadership:

This structured QI approach demonstrates that a multi-factorial leadership development model prioritizing support and professional development for managers can significantly improve retention, engagement, and leadership preparedness. The model provides a framework for nursing leadership succession planning and preparation and can inform best practices for organizations seeking to cultivate resilient and confident nurse leaders.

Reimagining VAT Practice To Improve Throughput And Eliminate CLABSIs

Amber Morandini, Cecilia Mortorano

CVICU leaders identified a critical need to strengthen peripheral IV (PIV) access in their complex patient population to safely deescalate central lines, reduce CLABSI risk, and improve transfer readiness to acute care units. This initiative showcases how targeted vascular access expertise, interdisciplinary collaboration, and redesigned workflows improved PIV success, supported earlier central line removal, and enhanced care progression. Attendees will gain practical strategies, lessons learned, and measurable outcomes demonstrating how optimizing vascular access not only drives CLABSI prevention, but also delivers high-impact improvements in patient throughput—making this a must-see session for quality, safety, and flow leaders.

A Model Linking Workplace Bullying Science to Strengthen Nurse Leader Empowerment Submission Category: Research

JENNIFER HEHL, Laura Dzurec

Problem, Background/Significance, Rationale:

Published study findings suggest that nurse leaders are reticent to confront workplace bullies’ typically confusing and emotionally compelling communications. Yet, when workplace bullying proceeds unaddressed, it disrupts shared goals, open communication, and interpersonal relationships so important to nurses’ work. Workplace bullying constitutes a crisis, one not readily managed, as an extensive literature documents. The investigators reasoned that a model to structure nurse leaders’ insights into bullying might support them in addressing and stemming bullying.

Purpose, Specific Aims, Project Goals or Objectives:

• To develop a model to assist nurse leaders to actively process and confront the chaos that workplace bullying generates.

Methods:

Theoretical Framework. The study was guided by Bronfenbrenner’s most recent model emphasizing that learning occurs during proximal processes, i.e. during increasingly complex, reciprocal, face-to-face interactions that are influenced heavily by each individual’s biological and personal characteristics and that change over time. Study Design. This multi-phased study began with a realist review that grounded development of an evidence-based model describing norm violations embedded in bullies’ sticky stories. Following pilot data collection that supported model revision, a national survey generated data for model testing. Setting. Following IRB approval, we conducted a local pilot and then a national online survey. Sample. Once our model was refined through the pilot work, members of the American Organization for Nursing Leadership were invited to participate via website ad with a link to the study survey. 158 individuals responded to the survey invitation, yielding 89 usable data sets. Study Instrument. Our self-developed instrument incorporated demographics (years and types of nursing leadership experience) as well as custom questions based on our model. Data collection. Redcap software facilitated qualitative and quantitative data collection. Data analysis. Descriptive and thematic analysis.

Results/Outcomes:

The critical review process revealed norm violations as objective features of workplace bullies’ typically false narratives, whether obvious or subtle. Overall, the analyses in the pilot stage validated our initial theory, offering evidence-based/evidence informed data to summarize workplace bullies’ characteristic, affrontive language patterns and the range of listener responses. Nurse leaders in our national survey sample were able to recognize and label norm violations in their shared experiences once they learned about our model. The model helped them think through the effects of bullies’ actions on team members, workplace dynamics and productivity. Study findings support the validity and usability of the model.

Implications:

Even if nurse leaders recognize workplace bullying’s objective features, it remains to be seen if organization administrators will follow up in-kind. The next phase of our work, funded by a chapter of Sigma Theta Tau, is to interview human resources personnel to establish their responses to nurse leaders’ reports of bullying-embedded norm violations as identified in the national study to help us to establish the reliability of the model.

Measuring What Matters: Improving Urine Output Accuracy and Reducing Foley Catheter Use in Hospitalized Adults with CHF

Tara Benline, Samantha Turner, Doug Ferrall

Problem, Background/Significance, Rationale:

Accurate urine output (UOP) measurement is central to assessing fluid balance, renal function, and response to diuretics in hospitalized adults with congestive heart failure (CHF). Incontinent patients are at particular risk for inaccurate or missed UOP, which can prompt default use of indwelling urinary catheters. This increases exposure to catheter‑associated urinary tract infections (CAUTIs), prolongs length of stay (Harding and O’Brien 2025), and adds substantial cost estimated at $7,670–$10,197 per patient (Hollenbeak and Schilling 2018). making it a salient nursing leadership priority for safety, quality, and value‑based care. The project’s rationale is to implement a reliable, minimally invasive method weighing adult incontinence products (IPs) and converting weight differences to volume to strengthen clinical decision‑making while reducing unnecessary catheterization and CAUTI risk. An academic‑practice style partnership within the unit (staff champions, nurse manager, Nursing Professional Development Practitioner, and medical director) provided the structure for appraisal, implementation, and evaluation of this practice change.

Purpose, Specific Aims, Project Goals or Objectives

PICOT Question (QI/EBP): In adult hospitalized patients with episodes of urinary incontinence (P), does measuring UOP by weighing incontinence products (I), compared with standard measurement methods (C), improve the accuracy of UOP measurement and decrease Foley catheter use (O) during hospitalization (T)?

Project Goal: Improve the accuracy and consistency of UOP documentation for incontinent adults receiving diuretics and decrease Foley utilization on the unit.

Objectives:

1. Standardize the IP‑weighing workflow
2. Increase staff competency and adherence
3. Demonstrably reduce Foley days; and
4. Support earlier identification of fluid imbalance and renal dysfunction to inform therapy.

Methods, Collaboration, Implementation and/or Evaluation Plan:

This unit‑level QI pilot leveraged a multidisciplinary team. The nurse manager conducted a cost analysis and procured scales and a mobile weighing cart; the staff nurse champion and Nursing Professional Development Practitioner developed training on proper weighing technique, documentation standards, and conversion from weight to volume. The medical director and nurse manager disseminated a decision‑support algorithm to guide appropriate use. Implementation included staff education, just‑in‑time coaching, compliance monitoring, and feedback loops to address barriers and reinforce adoption. Evaluation focused on

• accuracy/consistency of UOP documentation in the electronic record,
• staff confidence/competency,
• Foley catheter utilization (Foley days), and
• clinical signals of fluid imbalance or renal dysfunction recognized earlier in care.

Results/Outcomes and Implications:

Post‑implementation, nursing documentation of UOP became more accurate and standardized, and nurses reported greater confidence in assessing diuretic response. The unit observed a decline in reliance on indwelling urinary catheters (final Foley‑day metrics to be inserted), aligning with expectations to reduce CAUTI exposure and associated costs. Clinicians cited clearer fluid‑status assessments and earlier recognition of renal risk, which improved interdisciplinary communication and treatment decisions. For nursing leadership, the project demonstrates that a relatively low‑cost, minimally invasive, and staff‑led change can produce meaningful quality and safety gains, while modeling a scalable approach to practice standardization and resource stewardship. Sustainability plans include incorporating the weighing protocol into orientation, ongoing competency checks, and continued manager‑led monitoring of adherence and outcomes.

From Practice to Prevention: Using Simulation to Reduce Falls in Hospitalized Patients at an Academic Medical Center

Jessica DesJardins

Problem/Background/Significance:

Hospital falls remain one of the most prevalent and costly adverse events in hospitalized patients, with up to one million falls annually and 30–50% resulting in injury. Despite established prevention policies, a 29-bed neuro step-down/medical-surgical unit at a Midwest academic medical center consistently exceeded national fall benchmarks. Unit audits identified key gaps, including inconsistent completion of the Johns Hopkins Fall Risk Tool (JHFRT), variable documentation, and lack of standardized fall prevention education. Variation in staff knowledge and practice highlighted the need for a reliable, evidence-based strategy to strengthen frontline nurse competency and reduce fall risk.

Purpose/Aims:

Guided by two PICOT questions—(1) in hospitalized patients, how do best practices compared to current practice affect fall rates, and (2) in registered nurses, how does simulation training compared to lecture-based education affect fall rates—the project aimed to implement simulation-based fall prevention education to improve adherence to evidence-based interventions and decrease inpatient falls and falls with injury. Objectives included designing and implementing a structured simulation program for nursing and ancillary staff, standardizing evidence-based fall prevention practices, and measuring changes in staff compliance and unit fall outcomes following implementation.

Methods/Implementation:

An evidence-based practice framework guided the practice change. Literature supports simulation and structured debriefing as effective educational strategies to enhance clinical judgment and patient safety behaviors. Stakeholders included bedside nurses, nurse leaders, clinical nurse specialists, and educators. Barriers included limited staff ability to step away from direct patient care to participate in simulations and variable unit readiness for change. Facilitators included strong leadership support and proactive coverage of patient assignments, enabling staff to participate in simulations and promoting engagement and adoption of the intervention. Scenario-based simulations were conducted in unoccupied patient rooms and reflected recent unit fall trends and audit findings. Each 5–10 minute session included role-play, identification of high-risk factors, and selection of appropriate fall prevention interventions. Structured debriefing reinforced learning objectives, clarified correct interventions, emphasized consistent use of JHFRT, and provided real-time feedback. A competency checklist validated knowledge and standardized expectations across staff.

Results/Outcomes and Implications:

Simulations were low-cost, feasible, and well-received by staff. Participants reported improved confidence, recognition of practice gaps, and greater ownership of fall prevention. The intervention created a safe environment to practice skills, reinforce evidence-based behaviors, and standardize care. Simulation-based education was implemented in November FY24. Baseline data from FY21–FY23 averaged 32 falls and 10 falls with injury annually. Following implementation, falls decreased to 26 in FY25 and 5 in the first seven months of FY26, while falls with injury decreased to 8 in FY25 and 1 to date in FY26. This represents a sustained downward trend and an approximate 45–60% reduction in both total falls and falls with injury compared to baseline averages. These findings suggest simulation-based education is a feasible, low-cost strategy to improve staff competency and patient safety outcomes.

Substance Use Risk in Middle-Level Nurse Managers: Leadership Roles, Career Stage, and Work Context

Yitong Wang, Karen Foli

Background:

Substance use in the nursing workforce has been widely studied, yet most research has focused on frontline nurses (Foli et al., 2020; Kunyk, 2015; Trinkoff et al., 1998; 2022). In contrast, little is known about substance use risk among middle-level nurse managers. These leaders occupy demanding roles that combine administrative responsibility, clinical oversight, and continuous support of staff. Many work long hours, remain constantly available, and manage staffing and performance under sustained system strain (Labrague et al., 2018; Shirey et al., 2010). Such conditions may increase vulnerability to unhealthy coping behaviors. Despite their central role in workforce stability and care delivery, substance use risk among middle-level nurse managers has received limited empirical attention. Empirical data are needed to clarify risk and protective factors and inform leadership support efforts.

Objectives:

The purpose of this study was to examine alcohol and drug use risk among middle-level nurse managers and to identify individual and workplace characteristics associated with substance use. Specific aims were to:

1. estimate alcohol use and drug use risk among middle-level nurse managers; and
2. examine associations between substance use outcomes and demographic, educational, career-stage, and specialty-related characteristics

The study addressed whether individual and work-related factors were associated with substance use risk among middle-level nurse managers. Findings were intended to inform nursing leadership research and support leadership education and organizational strategies responsive to manager well-being.

Methods:

Using a cross-sectional design, data were drawn from an electronic/online survey administered to middle-level nurse managers across multiple clinical specialties who had continuous responsibility for at least one clinical unit and the ability to complete the survey in English. Participants were recruited through professional nursing organizations, university alumni networks, and social media outreach. The final analytic sample included 234 middle-level nurse managers. The survey assessed alcohol use risk, drug use, and professional characteristics, including education level, career stage, years of RN experience, clinical specialty, and engagement in direct patient care. Binary logistic regression models were used to examine associations between individual and workplace characteristics and substance use outcomes.

Results and Implications:

Among the sample, 13.42% of middle-level nurse managers screened positive for unhealthy alcohol use, and 7.26% reported substantial or severe drug use. Mid- to late-career nurse managers demonstrated higher odds of drug use compared with early-career managers. Master’s-prepared nurse managers had lower odds of unhealthy alcohol use and drug use compared with those prepared at the baccalaureate level. Greater years of RN experience were also associated with lower odds of drug use. Specialty differences were observed, with medical-surgical and pediatric settings associated with higher odds of drug use. These findings identify substance use risk as an important but understudied issue among middle-level nurse managers and highlight education and professional experience as protective factors. Results suggest that leadership support needs may differ by career stage, educational preparation, and work context. This study contributes to nursing leadership research by clarifying patterns of risk and protection among nurse managers and provides evidence to inform leadership education, organizational policy, and future intervention development.

Implementing the QSEN Framework in the First Academic Health care system in the UAE Dubai Health

Abeer Alblooshi

Background:

Quality and safety education for nursing ( QSEN ) provides a structured framework to ensure nurses are competent in delivering safe, high-quality care with rapid health care evolution and growing patient complexity in the United Arab Emirates integrating global best practices into nursing education is essential.

Purpose /Aim:

This paper examines the implementation of the QSEN framework in the First academic health care system Dubai Health nursing education programs in the UAE and evaluates its impact on patient outcomes and Nursing Practice Excellence.

Methods:

A mixed methods evaluation was conducted involving curriculum integration of the six QSEN competencies patient Centered Care, Teamwork and Collaboration, evidence-based practices., quality improvement, Safety and informatics across clinical nursing g education. Teaching strategies included Simulation – based learning, interprofessional team exercises, case-based discussion reflective practice seminars and quality improvement projects embedded within the clinical orientation. Performance assessment data and clinical outcome indicators such as Hospital Acquired Infection, Patient Satisfaction Scores, Incidents reporting rates and Nursing, Preceptors and Nursing Leadership assessments and evaluation surveys were collected from across the system

Results:

Implementation of QSEN competencies led to measurable improvements in both Education and clinical outcomes. Dubai Health Nurses exhibited increased proficiency in patient safety practices, demonstrated through higher simulation performance scores and reduced clinical care errors, interprofessional collaboration activities fostered stronger communication and shared decision reflected in improved teamwork assessment scores. Quality improvement initiatives undertaken by the nurses contributed to measurable process enhancements within the clinical units such as improved documentation accuracy and patient satisfaction metrics showed a positive upward trend aligned with the increased nurses involvement in patient centered care tasks in addition to improvement in nursing attrition rate.

Conclusion:

Successful integration of the QSEN Framework within the UAE first Academic Health care system Nursing education program underscores its value in preparing nurses for Contemporary practices. QSEN competencies not only enriched nurses’ learning experience but also translated it into improved clinical performance and patient care outcomes. these intuitive supports nursing practice excellence by strengthening safety culture, improving care quality and enhancing patient outcomes. The Experience demonstrates the applicability and value of QSEN as a transformative framework for Nursing clinical education in the region

A manager-led coaching program on psychiatric nurses’ confidence in managing patient anxiety during admissions

Siu Shan, Kitty CHAN

Background: Newly graduated psychiatric nurses frequently experience transition shock and reduced confidence when managing patient anxiety during hospital admission. Admission is a critical therapeutic moment in psychiatric care, as patients often present with heightened hospital anxiety characterized by fear, uncertainty, stigma, and emotional distress. Inconsistent communication and limited structured support during this phase may negatively affect patient experience, nurse stress, and workforce retention. In our setting, psychiatric nurse attrition reached 11%, underscoring the need for leadership-driven interventions to strengthen early professional transition.

Purpose: This evidence-based practice (EBP) project evaluated the effectiveness of a ward manager-led coaching program in improving newly graduated psychiatric nurses’ confidence in managing patient anxiety during admission. The guiding PICOT question was: Among newly graduated psychiatric nurses (P), does participation in a manager-led coaching program (I), compared with no structured coaching (C), improve confidence in managing patient anxiety during admission (O)?

Methods: Guided by the Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) Model, a pre–post intervention design was implemented in a 54-bed public psychiatric ward. Eleven nurses with 0–1 year of psychiatric experience participated. The intervention included structured theoretical education on hospital anxiety, real-time admission coaching by the Ward Manager, individualized bedside supervision, and feedback focused on therapeutic communication, anxiety recognition, and ward-specific admission practices. Outcome measures included a structured Confidence Survey (0–10 Likert scale items across competency domains) administered pre- and post-intervention, and a post-intervention satisfaction questionnaire. Paired t-tests were conducted to evaluate changes in confidence.

Results: Mean confidence scores significantly increased from 104.18 (SD = 53.95) pre-intervention to 244.45 (SD = 29.55) post-intervention (p < .001), indicating a substantial improvement in perceived competence. Satisfaction findings were positive: 81.82% perceived the admission procedure as effective in reducing patient anxiety, and 100% reported that the coaching enhanced efficiency and confidence. Participants highlighted the value of personalized feedback and real-time leadership presence during high-stress admissions.

Implications for Nursing Leadership: Manager-led coaching represents a feasible, leadership-driven strategy to strengthen therapeutic communication, support transition-to-practice, and promote patient-centered admission experiences in psychiatric settings. Embedding structured coaching within ward orientation may contribute to improved staff confidence, quality of care, and retention. Future research should evaluate long-term sustainability and patient-level outcomes.

How does education regarding stress reduction technique activities affect PHQ9 and GAP7

Olu Akande

Background:

Depression and anxiety are highly prevalent among individuals receiving home health services and are associated with poor health outcomes, decreased adherence to medical treatment, increased healthcare utilization, and reduced quality of life. In community-based settings, psychological distress often remains underrecognized and undertreated, particularly when care primarily focuses on physical conditions. Evidence supports the effectiveness of non-pharmacologic stress reduction strategies—including mindfulness-based stress reduction (MBSR), deep breathing exercises, grounding techniques, and progressive muscle relaxation—in reducing symptoms of depression and anxiety. However, structured nurse-led educational interventions focused on stress reduction are not routinely integrated into home care practice. Addressing this gap aligns with nursing’s holistic, patient-centered approach and supports national behavioral health priorities aimed at improving access to preventative mental health strategies in vulnerable populations.

Purpose:

Evidence-based project was to evaluate the effectiveness of a structured educational intervention on stress reduction techniques in reducing depression and anxiety symptoms among adult patients receiving home health services. The project sought to determine whether nurse-led education regarding stress reduction activities would significantly improve Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) scores over a two-week period.

Methods:

A pre–post intervention design was implemented at Human Touch Home Care using a convenience sample of 15 adult patients. Participants received a structured educational session delivered by a registered nurse that included instruction and demonstration of mindfulness exercises, diaphragmatic breathing, grounding techniques, and progressive muscle relaxation. Educational materials were provided to reinforce learning and promote independent practice. Depression and anxiety were measured at baseline and two weeks post-intervention using validated self-report instruments: the PHQ-9 and GAD-7. Data were entered and analyzed using SPSS statistical software. Descriptive statistics were calculated to summarize baseline and follow-up scores. Paired t-tests were performed to examine mean differences in pre- and post-intervention scores. Given the small sample size, Wilcoxon signed-rank tests were also conducted to confirm statistical robustness. Data accuracy was ensured through double-entry verification and review by a statistical consultant.

Results:

Statistically significant reductions were observed in both depressive and anxiety symptoms following the intervention. Mean PHQ-9 scores decreased from 10.2 (moderate depression range) at baseline to 6.8 (mild depression range) post-intervention, representing a mean reduction of 3.4 points (p = 0.004). Mean GAD-7 scores decreased from 9.3 (moderate anxiety range) to 5.7 (mild anxiety range), representing a mean reduction of 3.6 points (p = 0.003). Nonparametric Wilcoxon signed-rank tests confirmed statistically significant improvements in both measures (p = 0.001). The majority of participants demonstrated individual score reductions, supporting both statistical and clinical significance.

Conclusions:

Findings indicate that structured stress reduction education delivered by nurses in the home health setting is an effective, low-cost, and feasible intervention for reducing symptoms of depression and anxiety. The intervention demonstrated measurable improvements within a short timeframe, supporting its integration into routine home care practice. Incorporating stress reduction education may enhance holistic patient outcomes, strengthen nursing’s role in behavioral health promotion, and reduce reliance on pharmacologic management. Future research with larger sample sizes and longer follow-up periods is recommended to evaluate sustainability and long-term impact.

A Comparison of Thirst Management Strategies in Patients in the Intensive Care Unit

Kathleen Diatta, Roberta Kaplow

Background: Critically ill patients in the intensive care unit (ICU) report thirst as one of the most distressing symptoms they experience along with pain, dyspnea, anxiety, sleep deprivation, and being in restraints. Despite thirst being identified as a distressing symptom for patients, it is typically not assessed or treated by nurses in the ICU. Strategies to mitigate thirst are essential for quality patient outcomes.

Purpose: The purpose of this study is to compare two protocols to decrease thirst in patients in a medical ICU.

Methods: This study used a cross-sectional descriptive pre-intervention/post-intervention design to evaluate the effectiveness of an alternative oral care protocol as compared with standard/usual oral care on decreasing patients’ level of thirst. Standard oral care in the study ICU consists of moistened mouth sponge swabs and application of lip moisturizer every four hours. The alternative method of oral care entailed use of a 100 mL spray bottle that was filled with cold bottled water stored in an ice bath, sponge swabs, and lip moisturizer. The study enrolled 100 participants in the MICU. Data was collected on each participant for up to five days. However, if a patient was discharged or transferred from the ICU sooner than five days, data collection ended upon ICU discharge.

Results: One hundred patients participated in the study. Fifty were randomized to standard oral care and 50 to the spray bottle group. The biggest difference was on Day 4 when the spray bottle group had lower scores than usual care. There was a significant difference between the 2 groups over the 5 days for both thirst intensity (p<.001) and thirst distress scores (p<.001).

This study compared two groups of ICU patients. One received usual oral care and the other received a mist of cool water from a spray bottle to help mitigate thirst. The data revealed that both groups demonstrated improvement over time. However, the spray bottle group consistently reported decreased thirst intensity and distress levels, especially on Days 4 and 5. These perceptions remained significant even after accounting for medications known to increase thirst.

Conclusions: Both thirst and a dry mouth can be distressing and often go untreated. Only the spray bottle group had meaningful reductions in all three outcomes--the TDS, VAS for thirst intensity, and VAS for distress on Days 4 and 5 compared to usual care. The fact that the usual care did not show the same benefit level suggests that the spray bottle offered tangible relief beyond standard practice.

It is important for nursing staff to assess for thirst in critically ill patients without depending on patients’ reports of thirst. The present study suggests the spray bottle intervention significantly reduced thirst intensity and distress compared to usual care.

Positive Psychology Experience Increases Healthcare Worker Happiness by Seventeen Percent in Randomized Control Trial

Nancy Dunn

For decades, healthcare worker burnout has relentlessly increased. The pandemic exacerbated burnout with reported ranges from 49 to 69%. The research aim was to generate new knowledge on how to improve healthcare workers (HCW) subjective happiness. Studies show improvement in happiness is achievable and can reduce burnout. Emotional recovery from burnout is higher among HCWs who engage in self-care behaviors. The research hypothesis asked “Will HCW who engage in a positive psychology intervention (PPI) improve and sustain happiness?”

This unblinded randomized controlled trial examined the efficacy of a PPI to increase subjective happiness in healthcare workers at a 644-bed community healthcare organization. The intervention included two sequential activities: 1) reading The Happiness Advantage by Shawn Achor, and 2) conducting a 21-day challenge to start and/or improve evidence-based behaviors known to increase happiness.

183 health care workers were randomized into intervention and control arms of the study. The primary outcome measure was the self-reported Subjective Happiness Scale (SHS). Participants consented and submitted baseline data: demographics, use of 8 evidence-based behaviors known to improve happiness, and current happiness using the validated SHS. Intervention subjects (N=93) read The Happiness Advantage by Shawn Achor, then engaged in a 21- day challenge to start and/or improve the 8 behaviors. Control subjects (N=78) were asked to “lead their normal lives” for 6 months. SHS and behaviors were re-measured post challenge and 6 months later for both groups. Intervention subjects were re-measured again at 18 months.

Participants were mostly female (89%), were registered nurses (41%) who worked on the frontline (64%) and primarily on the day shift (79%). Within the intervention group, subjective happiness significantly increased from pretest to posttest (20%); pretest to 6-months after the PPI (17%) and pretest to 18-month follow-up after PPI (14%). Taken together, results show that the intervention group experienced a significant increase in subjective happiness as realized by post-test scores and maintained 85% and 70% of the gains through the 6-month and 18-month follow-up assessments, respectively.

HCW retention is essential for the health and stability of the healthcare environment as more HCWs seek other occupations or retirement. This is an important implication for nurse leaders as the nursing workforce is ever-changing. A recent survey showed that 23% of HCWs (including nurses), are expected to leave their jobs in the immediate future. The healthcare environment needs to address deficiencies in the status quo and provide HCWs with the tools and resources to improve their happiness and overall emotional recovery. This research was a feasibility study that would allow healthcare organizations to strengthen and replicate this research in the future. The efficiency of this PPI allows nurse leaders to implement evidence-based behaviors across multiple interdisciplinary teams and healthcare settings. The SHS is a quick and brief validated survey that enables organizations to obtain baseline and outcome data easily and quickly. The authors encourage healthcare organizations to implement the PPI, as described, as a quality improvement project. Alternatively, replicate the research using this or a modified PPI with a stronger study design.

What Exceptional Nurse Leaders Do Differently: A Qualitative Study of DAISY Nurse Leader Award Recipients

Lucy Leclerc, Monique Bouvier, Sara Patrick, Dinah Steele

Background:

The DAISY Nurse Leader Award recognizes nurse leaders who create environments in which compassionate and extraordinary nursing practice can thrive. While prior research has explored direct-care nurses who have received DAISY recognition, limited empirical work has examined the attributes and behaviors of nurse leaders who receive this distinction. Understanding these leadership characteristics is essential to advancing leadership development, strengthening organizational culture, and improving patient and workforce outcomes.

Purpose:

The purpose of this study was to identify and describe the leadership attributes and behaviors of DAISY Nurse Leader Award recipients through qualitative analysis of nomination narratives.

Methods:

This qualitative study employed a hybrid content–thematic analysis of publicly available DAISY Nurse Leader Award nominations submitted between 2015 and 2024 in the United States. Approximately 3,100 nomination narratives were available for analysis. A random sample of 100 nominations was selected and analyzed iteratively until thematic saturation was achieved. Data were independently coded by multiple researchers using consensus coding to enhance rigor and trustworthiness. Qualitative analysis was intentionally used to preserve narrative context and emotional nuance within the nomination texts. The study was reviewed and approved as exempt by the researchers’ Institutional Review Board.

Results:

Analysis revealed seventeen distinct leadership attributes and behaviors demonstrated by DAISY Nurse Leader Award recipients. These attributes clustered within an emergent inside‑out leadership framework consisting of three spheres of influence:

1. the inner sphere (self), reflecting ethical practice, emotional intelligence, authentic communication, and leading by example
2. the middle sphere (patients, families, teams, and individuals), encompassing advocacy, relational leadership, compassionate presence; change management; meaningful recognition; nurturing inclusivity; mentoring; prioritization of safety; expectations for quality; responsiveness, and innovation
3. the outer sphere (organization, community, and profession), highlighting systems thinking through promotion of professional practice, and broader professional advocacy. Collectively, the findings illustrate how exemplary nurse leaders influence outcomes through consistent alignment of personal values with relational and organizational leadership behaviors.

Conclusions:

This study provides empirical insight into the leadership attributes and behaviors associated with excellence recognized through the DAISY Nurse Leader Award. Findings offer a practical roadmap for nurse leader development and inform leadership education, organizational leadership strategies, and meaningful recognition programs. By illuminating how leadership behaviors ripple outward from self to system, this research contributes to a deeper understanding of leadership practices that foster healthy work environments, professional growth, and high‑quality patient care.

The Re-Integration of LPNs into Acute Care Teams: A Qualitative Exploration of Leadership Views

Susan weaver, Pamela B. de Cordova, Daria Waszak

Background: In response to the critical United States (U.S.) nursing shortage, hospital leaders are reversing a decades-long trend and redesigning care delivery models to re-integrate Licensed Practical Nurses (LPNs) into acute care teams. This strategy mirrors a trend seen in Canada over a decade ago, where similar pressures of rising healthcare demands and nursing shortages prompted new care delivery models. Data from one U.S. state found nearly 50% of hospitals (n = 36) are employing LPNs across various units, including medical-surgical units and EDs.

However, this growing practice is built on a foundation of conflicting research. While some influential studies associate a lower proportion of RNs with negative patient outcomes, other research has found that well-structured RN-LPN teams can improve clinical results, such as reducing medication errors and infections. Therefore, despite the historical precedent and the accelerating trend, the impact of this contemporary wave of LPN integration on both nurse and patient outcomes remains unclear within the U.S. context.

Purpose: The purpose of this study was to explore nurse leaders’ perspectives on the integration of LPNs, specifically the LPN role, job functions, and outcomes in acute care settings in one state.

Methods: For this qualitative descriptive study, nurse leaders were recruited through email invitations from nursing organizations. Semi-structured interviews were conducted to explore their perspectives on LPN integration. Interview transcripts were analyzed using thematic analysis. Respondent validation was performed for credibility.

Interviews were conducted with 18 nurse leaders (directors of nursing and nurse managers) from 16 hospitals, representing a broad geographic distribution across 15 of a single U.S. state’s 21 counties.

Results: Nurse leaders reported integrating LPNs primarily on medical-surgical and emergency department units, largely in response to the RN shortage and a desire to reduce reliance on agency nurses.Thematic analysis yielded seven themes capturing the operational, workforce, and strategic dimensions of LPN integration:

1. consensus on LPN scope of practice except patient assessment
2. transition to team-based nursing models
3. experienced versus new graduate LPNs
4. growing RN workforce
5. strategies to mitigate RN resistance
6. anecdotal comments on nurse and patient outcomes; and
7. the future: LPNs are here to stay.

Conclusion &

Implications: In the changing landscape of U.S. healthcare, amid redesigned care delivery models and projected nursing shortages, this study found that the re-integration of LPNs into acute care presents a dual reality. Nurse leaders clearly value LPNs for their contributions to staffing, direct patient care, and the development of the future nursing pipeline. However, they also identified significant challenges to successful integration, including ambiguity around the LPN's role in patient assessment, the need to manage RN resistance, and the operational shift to team-based nursing. Therefore, the findings suggest that successful LPN integration is not automatic but is contingent on deliberate and thorough preparation. This preparation must include the development of clear policies that align with state scopes of practice for both RNs and LPNs, as well as comprehensive initial and ongoing education for the entire care team to clarify roles and foster collaboration.

Seeing Leadership in Action: A Qualitative Study of Clinical Nurses’ Perceptions of Nurse Leader Visibility

Roberta Kaplow

Background:

Healthcare executive leader’s visibility is often linked to culture, employee engagement, and patient outcomes. However, limited qualitative research explores how clinical nurses perceive this visibility and how it affects their work experience. In healthcare organizations, leaders must relate on a profound level with clinical nurses as the clinical nurses express a desire for caring behaviors from nurse executives. Minor gestures, such as making eye contact, smiling or nodding, have been frequently described as absent or very positive actions. Data of clinical nurses in one study suggest acquaintance with clinical leaders but clinical nurses were not able to name leaders outside of their clinical area. The roles and responsibilities of all executives were ambiguous to clinical nurses.

Methods:

This study used focus groups to answer the study questions. This design was selected for the investigators to obtain a broader understanding of nurses’ perception of executive nurse leadership visibility as little research has been performed to answer this question. Themes were extracted by Copilot of transcribed data.

Results:

There was appreciation of the CNO’s existing visibility. Nurses in 18 of 25 focus groups correctly named the CNO. Staff want structured, reliable rounding rather than rare or crisis-driven visits. Visibility needs to include nights, weekends, and early mornings so all staff feel included. Meaningful check-ins included asking what they need. Transparent, supportive communication is part of perceived visibility. Staff realized that not every ‘wish’ can be granted for a variety of reasons (e.g., finance). They realize that change takes time and request being kept updated as to progress/a timeline for estimated time of completion of a request.

Conclusion Despite efforts to enhance leadership presence, clinical nurses report feeling disconnected from executive leadership. Results of this study offer suggestions of how a CNO can improve staff perceptions of visibility.

Leading Change in Documentation: Factors Shaping Nurses’ Adoption of e-Doc Systems in Hong Kong

Wing Shan Sandy Leung

Electronic documentation (e-Doc) is a central component of Hong Kong’s smart hospital agenda, but its success depends on nurses’ acceptance and sustained use in daily practice. International research suggests electronic records can improve accuracy, accessibility, and communication, yet they may also increase workload and cognitive burden when poorly aligned with clinical workflows or insufficiently supported. In 2023, the Hong Kong Hospital Authority launched a new e-Doc system across public hospitals, and local frontline experience highlighted issues such as device availability, software stability, and training needs. There remains limited empirical evidence on how Hong Kong acute care nurses perceive e-Doc and which factors most strongly shape their intention to recommend it, knowledge that is critical for nursing leadership driving digital transformation.

This study aimed to examine nurses’ perceptions of e-Doc and identify the key predictors of their behavioral intention to recommend its use, using an integrated Technology Acceptance Model (TAM) and Diffusion of Innovations (DOI) framework. Specific objectives were to describe core TAM/DOI constructs (perceived usefulness, ease of use, compatibility, complexity, trialability, observability, relative advantage), explore their relationships with behavioral intention, and derive leadership-focused recommendations for implementation and training strategies.

A descriptive cross-sectional survey was conducted among registered and enrolled nurses working in wards with piloted e-Doc in four Kowloon West Cluster acute hospitals. A self-administered Google Forms questionnaire, adapted from prior studies and refined by three nursing informatics and management experts, included demographic items and 25 Likert-scale questions measuring TAM/DOI constructs and behavioral intention. The finalized instrument showed excellent internal consistency (Cronbach’s alpha 0.93), and 51 valid responses were analyzed using descriptive statistics, Pearson correlations, and stepwise multiple regression.

All major constructs except complexity were significantly positively correlated with behavioral intention, with the strongest correlations observed for relative advantage, observability, and perceived usefulness. Stepwise regression identified relative advantage and observability as the only significant predictors, jointly explaining 82% of the variance in intention to recommend e-Doc. Nurses were more likely to recommend e-Doc when they perceived clear advantages over paper-based documentation (such as improved efficiency, error reduction, communication, and quality of care) and when system use was visible and normalized among peers.

These findings indicate that technical quality alone is insufficient; leadership actions that amplify perceived benefits and social visibility are crucial. Nurse leaders should communicate concrete practice-level gains, promote visible role modelling and recognition of early adopters, and design training around real workflows with on-ward support to build confidence and acceptance. By strategically enhancing perceived relative advantage and observability, nursing leadership can accelerate e-Doc adoption, reduce resistance, and support safer, more efficient documentation and patient care in acute hospital settings.

Designing Environments of Care to Sustain Leaders in High-Intensity Settings

Angelica Walton, Judith Pechacek

High-intensity leadership environments are expanding across sectors, from global governance forums to health systems, crisis response settings, and academic institutions. Leaders in these contexts navigate the sustained complexity of leading through heightened emotional labor, moral burdens, secondary trauma exposure, and compressed decision timelines while being expected to maintain clarity, relational trust, and adaptive problem-solving. Yet organizational systems rarely design and actualize the operational infrastructure that intentionally supports leader regulation, restoration, and collective coherence. Wellbeing is often positioned as an individual responsibility rather than a structural condition of effective leadership. This work advances a nursing-led quality improvement model that reframes leader wellbeing as core performance infrastructure. Drawing from an academic–practice partnership embedded within a global policy forum, the initiative demonstrates how environments of care can be intentionally integrated into operational workflows using human-centered design principles. Rather than adding optional wellness activities, the approach aligns environmental modification, embodied regulation strategies, participatory leadership structures, and collective care agreements directly with leadership performance demands. The model implemented translates theory into actionable system-level strategies and identifies five interdependent domains for leader sustainability: physiological regulation, intentional presence, environmental alignment, relational governance, and collective restoration practices. These domains function not as ancillary supports but as structural conditions that protect cognitive flexibility, mitigate stress-related impairment, and sustain ethical decision-making under pressure. The global forum case exemplar illustrates feasibility, acceptability, and institutional integration of restorative infrastructure within a high-stakes setting. Importantly, dissemination through international publication extended the framework beyond a single context, positioning environments of care as transferable leadership strategy across healthcare organizations, academic governance, crisis operations, and policy systems. This body of work argues that care-centered design is not a peripheral intervention but a measurable leadership performance strategy. Nurse leaders, grounded in relational science and the art of caring, are uniquely prepared to architect these environments across sectors. In an increasingly complex and volatile global landscape, sustainable leadership will depend not only on technical expertise but on intentionally designed conditions that protect human capacity.

The WE CARE Program: Influence on Job Satisfaction and Intent to Leave among Nurses

Aoyjai Montgomery, Joseph Travis, Joyce Stevens, Jennifer Werthman, Ja-Lin Carter, Shea Polancich, Patricia Patrician

As healthcare demands intensify, nurses face escalating workplace stress that affects job satisfaction, retention, and mental health. The work environment not only shapes intent to leave but also influences resilience and the ability to deliver safe, high-quality care. Although numerous interventions address burnout and well-being, evidence remains limited regarding their effectiveness in complex healthcare systems. Prior research has largely examined either organizational factors, such as staffing, workload, and leadership, or individual strategies, including stress management and resilience training. Few studies integrate both approaches, limiting understanding of how structural conditions and psychological resources interact to influence nurse and organizational outcomes.

Specific Aims: This project aimed to

1. evaluate the effectiveness of the Workforce Engagement for Compassionate Advocacy, Resilience, and Empowerment (WE CARE) program, a nurse-led, multifaceted workforce wellness interventions, in improving the work environment, workplace mental health, and nurse outcomes; and
2. examine factors influencing job satisfaction and intent to leave among staff nurses.

Methods: A quasi-experimental one-group pre–post design was used with online surveys. Pre-program data were collected in June 2022 (n = 706). The WE CARE team implemented multifaceted, evidence-based interventions, including Unit Wellness Rounds, resilience education, debriefings, actionable feedback and incivility training, memorial boards, recognition events, and creation of quiet spaces. Interventions were tailored to unit needs. Post-program data were collected in November 2024 (n = 417). Mixed-effects regression models were conducted using R statistical software.

Results and Implications: The WE CARE program was associated with significant improvements in the overall work environment (p < .001), workplace mental health, and nurse outcomes. Well-being increased (p = .003), while compassion fatigue (p < .001), burnout (p < .001), and moral distress (p = .006) decreased. Nurses reported greater recognition (p = .001), increased trust in supervisors and senior leadership (p < .001), and higher perceived organizational support (p < .001). Job satisfaction improved (M = 3.69 vs. 3.49; p = .001; R² = .079), and intent to leave declined from 43.63% to 36.93% (p = .012; R² = .055). Supportive environments, recognition, and leadership trust were positively associated with job satisfaction, whereas burnout and distress increased intent to leave. Trust and organizational support were protective factors. Findings demonstrate the effectiveness of a nurse-led, multifaceted workforce engagement program in improving work environment conditions, mental health, and retention-related outcomes in a real-world setting. The program’s impact led to sustained institutional support beyond the funding period, addressing a critical gap in nurse well-being science by integrating organizational and individual-level strategies.

The Critical Role of Leadership: Building an Effective Team to Improve Wellness Outcomes among Nurses

Aoyjai Montgomery, Jill Stewart, Dana Morson, Ja-Lin Carter, Joseph Travis, Cindy Blackburn, Jacqueline Westbrook, Toni Beam, Patricia Patrician

The COVID-19 pandemic intensified a longstanding crisis in nurse well-being. Burnout, moral distress, and compassion fatigue have reached alarming levels across the nursing workforce, contributing to turnover, reduced quality of care, and threats to patient safety. Despite broad acknowledgment of this problem, many organizational responses lack the structural integrity needed to produce lasting change. Wellness programs are often implemented as temporary initiatives and are underfunded, disconnected from operations, and insufficiently led. In 2022, nursing leaders and research faculty at UAB created the WE CARE program (Workplace Engagement for Compassionate Advocacy, Resiliency, and Empowerment) with HRSA funding to address this gap. The program was designed not only to deliver evidence-based wellness content but to model how leadership structure enables program success. Drawing on safety science and organizational behavior, the WE CARE team was built on five pillars: hardwiring, champion selection, lived experience, decentralized governance, and data-driven decision-making. A Nurse Wellness Manager was co-located within the existing hospital Wellness Office, lending role authority and integration. Five NPDSs, selected for their COVID-era frontline experience and personal familiarity with burnout, served as wellness champions embedded across hospital divisions. Their autonomy to innovate and adapt interventions without management interference was central to program agility and frontline engagement. A direct reporting line from the NWM to the Chief Nursing Officer ensured that survey data translated into executive action. Over two years, the WE CARE team achieved extraordinary reach: more than 17,000 wellness rounds, 2,209 new employee touchpoints, over 400 Community Resiliency Model training participants, and a nurse-developed podcast with 500+ subscribers. Outcomes across all six wellness domains improved between pre- and post-surveys, with notable decreases in distress (60.1% to 44.7%), burnout (51.9% to 38.6%), and compassion fatigue indicators (down by more than half). The program concluded with all NPDS positions transitioned to permanent hospital funding which evidence that wellness had been institutionalized, not merely piloted. The WE CARE program demonstrates that improving nurse well-being at scale is achievable when leaders apply evidence not only to what interventions are delivered, but how programs are structured, governed, and sustained. This presentation offers nurse leaders and administrators a replicable, evidence-based model for building wellness infrastructure that outlasts grant funding and becomes part of the organizational fabric.

Improving Hospital Flow Through Nurse‑Led DKA Reallocation: Standardizing IMCU Management to Reduce ICU Demand

Jessika Casey, Andrea Stumme

Hospitals across Arizona continue to experience ICU capacity strain fueled by high acuity admissions and prolonged emergency department (ED) boarding. At our medical center, clinically stable patients with diabetic ketoacidosis (DKA) were routinely admitted to the ICU regardless of acuity, consuming critical care resources and delaying placement for patients who truly required ICU level interventions. Evidence based guidelines consistently demonstrate that many patients with uncomplicated DKA can be safely managed in intermediate level care when supported by frequent assessments, telemetry monitoring, and structured insulin titration. Local data confirmed that most DKA admissions did not require ICU specific interventions, creating a compelling rationale for a quality improvement initiative to realign patient placement with actual care needs. The purpose of this initiative was to redesign the DKA care pathway by transitioning eligible patients to the Intermediate Care Unit (IMCU) using a standardized, evidence based protocol. The project focused on three primary aims: optimizing resource utilization by reducing unnecessary ICU admissions, supporting nursing practice through targeted education and clear escalation criteria, and improving hospital throughput by increasing ICU availability and decreasing ED boarding. A PICOT question guided the process: In clinically stable adult patients with DKA (P), does management in an IMCU using a standardized DKA protocol (I), compared with routine ICU admission (C), result in safe outcomes and reduced ICU utilization (O)? A multidisciplinary team, including IMCU and ICU nursing leadership, educators, physicians, pharmacy, and quality, collaborated to establish inclusion and exclusion criteria, define escalation pathways, and standardize workflow components. Plan Do Study Act (PDSA) cycles were used to test and refine processes such as lab timing, communication expectations, and documentation tools. IMCU nurses completed structured education on DKA pathophysiology, insulin titration, electrolyte management, and identification of early deterioration. Competency reinforcement included quick reference materials, and immediate access to escalation support. Outcome measures included ICU admissions avoided, need for escalation to ICU after IMCU admission, hypoglycemic events, length of stay, readmissions, and nurse reported confidence. Data collection utilized EHR reports, structured chart audits, unit logs, and brief post encounter surveys. Across the 18 month implementation period, all eligible DKA patients managed in the IMCU met safety benchmarks: no escalations to the ICU and no hypoglycemic events were recorded. Length of stay and 30 day readmissions remained stable compared with baseline. The pathway saved 22 ICU admissions, directly preserving critical care capacity for higher acuity patients. IMCU nurses reported increased confidence in insulin titration, electrolyte management, and early deterioration recognition, supported by standardized tools and clear escalation pathways. Adherence audits demonstrated consistent use of inclusion and exclusion criteria, reinforcing workflow reliability. This nurse led initiative demonstrates that evidence based DKA management in the IMCU can maintain safety while improving resource utilization and system flow. Targeted training, structured decision supports, and reliable escalation pathways strengthened IMCU capability and enhanced hospital flexibility. This model provides a scalable framework for nursing leadership to optimize capacity, advance clinical practice, and expand the safe use of intermediate level care for conditions traditionally defaulted to ICU management.

From Variation to Consistency: Stroke Champions Strengthening ICU Competency and Documentation Practice

Jessika Casey, Taylor Steger, Matthew Henry

In a Primary Stroke Center ICU, time and clarity matter. Before this project, we saw what many units see: documentation for post thrombolytic patients wasn’t always consistent; NIHSS scores weren’t fully captured, required vital sign intervals after TNK/tPA could drift, and when numbers went sideways, the steps for intervening and notifying the provider weren’t always charted. None of this came from a lack of caring; it came from the reality of high acuity shifts, competing priorities, and constantly evolving stroke standards. We built a simple answer that fit real ICU life: a nurse led Stroke Champion model that puts a skilled peer at the bedside, standard tools in everyone’s hands, and a steady rhythm of case review and quick teach backs to keep us aligned. Our aim was straightforward: tighten documentation reliability, raise staff confidence with stroke protocols, and reduce variation in those first 24 hours after thrombolytic therapy. Using Plan–Do–Study–Act cycles, ICU education and the Stroke Program led the work with support from nursing leadership and volunteer bedside nurses who stepped up as Champions. Champions completed focused training (core measures, thrombolytic pathways, NIHSS accuracy, BP targets, adverse event recognition, and documentation standards) and carried easy, usable tools: pocket prompts, checklists, and escalation cues. Champions were present during Code Strokes and available throughout the first day post TNK/tPA. Every month, we review cases together, looking at where the charting fell short, and did brief micro teaches to close those gaps right away. We tracked what mattered. Our primary measures were documentation compliance: complete NIHSS scoring, on time vital sign frequency, and clear documentation of interventions with timely provider notification when values were out of range. We also measured nurse confidence in three domains (NIHSS, monitoring/targets, documentation clarity) with brief Likert scale surveys, and we captured comments about how the tools and workflow felt in practice. Data came from consecutive pre/post chart audits, EHR supported reviews, Champion utilization logs, and short post encounter surveys; January was excluded because there were no TNK cases. After the program launchedr, audits showed both an overall increase and better consistency across required documentation elements. Nurses reported feeling more grounded during high stakes moments: confidence scores rose by 1.95 points (on a 1–5 scale) across all three domains. Comments matched the numbers: nurses felt more prepared to care for stroke patients, more confident in their charting, and comfortable serving as a resource when colleagues had stroke questions. Just as important, the daily feel on the unit changed. With a Champion at the elbow and a short set of prompts to fall back on, the cognitive load eased and the care looked the same from patient to patient, shift to shift. This is the kind of change nurses can sustain. Keep the tools short, keep the feedback loop tight, and keep expertise on the unit. The Stroke Champion model gives leaders a practical way to hardwire stroke core measures, build confidence where it counts, and create reliable ICU stroke care without adding noise.

Standardizing the CVOR‑to‑ICU Landing: Nurse‑Led Collaboration to Shorten Extubation Times After Cardiac Surgery

Jessika Casey, Kalina Lowe

Timely extubation after cardiac surgery depends as much on a predictable operating room–to–ICU “landing” as it does on patient physiology. Internal reviews at our ICU showed that delays were frequently driven by workflow variation: room readiness, monitor connection, role clarity, and handoff content-rather than clinical instability. Recognizing that early extubation (≤6 hours) is a widely tracked quality benchmark in cardiac programs and a core element of enhanced recovery pathways, we launched a nurse led quality improvement (QI) initiative to standardize the transition and reduce “wheels out to extubation” times. The Society of Thoracic Surgeons has reported ≤6 hour extubation as a routine performance metric for two decades, and contemporary reviews link fast track extubation with shorter ICU/hospital length of stay and fewer ventilator related complications when applied with prudent criteria. Using iterative Plan–Do–Study–Act cycles, ICU clinical education led a multidisciplinary team (CVOR/ICU nursing, anesthesia, surgery, respiratory therapy, intensivists) to implement a concise readiness checklist, explicit role assignments, and a structured bedside handoff script. Primary outcome was time from wheels out of the OR to extubation; process measures were checklist and handoff adherence; balancing measures included reintubation, and ICU length of stay; outcomes consistent with fast track literature. Data was pulled from EHR time stamps, manual audits, and protocol logs, then trended monthly with targeted micro teaching. This approach aligns with evidence that standardized OR to ICU handoffs improve handoff completeness, teamwork, and early post op processes Across the first two quarters post implementation, 96 patients were managed on protocol (3 off protocol). Average wheels out to extubation time decreased from 4:20 to 4:10, moving the service closer to the ≤6 hour benchmark and our local goal of <4 hours. Night shift improved from 4:45 to 4:17; a day shift spike in April (6:12) resolved with focused feedback, and June produced the best overall performance (Day 2:46, Night 4:04, Average 3:18). Qualitative feedback from CVOR/ICU teams described smoother landings and clearer expectations; at a Network CV Collaborative review, 4/4 surgeons reported satisfaction with the ICU landing process. These results are directionally consistent with multicenter and guideline oriented literature showing that earlier, criteria driven extubation can reduce resource use without compromising safety and that structured handoffs strengthen reliability during high risk transitions For nursing leadership, the implications are pragmatic and scalable: keep the playbook short (readiness checklist, roles, script), pair monthly data review with just in time teaching, and embed prompts into orientation and documentation to hardwire consistency. This nurse led bundle offers a transferable framework for other time directed ICU transitions where speed, safety, and shared mental models drive outcomes.

Preparing Prelicensure Nurses to Evaluate AI in Health System Operations: An Academic–Practice Experiential Pilot

Miranda Hawks, Monique Bouvier

Artificial intelligence is increasingly integrated into health system operations in documentation processes, workforce management, patient engagement platforms, and clinical decision support. As these technologies expand across healthcare environments, nurses will be expected to engage in evaluating their implications for workflow, safety, and equity. Despite this growing expectation, prelicensure nursing education has not consistently provided structured opportunities for students to examine how artificial intelligence functions within healthcare systems or how nurses can contribute to responsible implementation. Without early exposure to these operational contexts, nurses may enter practice with limited preparation to participate in system-level discussions related to emerging technologies. Academic–practice partnerships provide a promising pathway for addressing this preparation gap by connecting nursing education with health system environments where technological change is actively occurring.

This academic–practice partnership between Emory University’s Nell Hodgson Woodruff School of Nursing and Emory Healthcare implemented an experiential artificial intelligence and digital health learning track for prelicensure Master of Nursing students. The purpose of this initiative was to strengthen students’ capacity to evaluate artificial intelligence tools used within health systems and to develop early leadership skills related to technology implementation and governance in healthcare environments.

Faculty members partnered with leaders from Emory Healthcare to design and implement the experiential learning track within a 12-week extracurricular AI and Digital Health Enrichment Pilot. Students examined artificial intelligence applications within health system operations and participated in structured learning activities that included stakeholder mapping, evaluation of workflow implications, and guided reflection on issues related to patient safety, equity, and system integration. The design of the learning experience was informed by Kolb’s Experiential Learning Cycle and Schön’s Reflective Practitioner framework. Students engaged with both academic mentors and health system collaborators and produced structured analyses describing operational considerations associated with artificial intelligence systems.

Preliminary observations suggest that students developed increased comfort engaging in discussions related to artificial intelligence in healthcare settings and demonstrated emerging ability to identify operational considerations associated with digital tools including workflow implications and potential areas of bias. Health system collaborators noted that student analyses highlighted perspectives related to nursing workflow and system implementation considerations. Formal evaluation of student reflections and partner feedback will be completed in May 2026.

Early experiences from this partnership suggest that structured exposure to health system technologies may support the development of digital health leadership capacity among prelicensure nursing students. Academic–practice collaborations may provide a feasible model for introducing artificial intelligence literacy and systems-level reasoning within nursing education. Preparing nurses to critically examine emerging technologies may strengthen the profession’s ability to participate in technology governance, implementation decisions, and ethical oversight as artificial intelligence becomes increasingly integrated into healthcare delivery.

Enhancing Telehealth Engagement to Improve Hypertension Outcomes in African American Rural Veterans; HNV, A Quality Improvement Initiative.

Injoh Esther Njung Baya

Enhancing Telehealth Engagement to Improve Hypertension Outcomes in African American Rural Veterans: A Quality Improvement Initiative.

Dr. Esther Njung Baya, DNP, FNP-C, BSN, RN VA Quality Scholar (VAQS) NP Fellow Ralph H. Johnson VAMC She/hers/her Principal Investigator

Background:

African American rural Veterans experience a disproportionate burden of hypertension and face barriers to chronic disease management, including limited access to clinic appointments and underutilization of existing telehealth services.

Purpose:

This quality improvement (QI) initiative aims to enhance telehealth engagement and improve hypertension outcomes among African American rural Veterans with Stage 2 hypertension receiving care at a rural community-based outpatient clinic using evidence-based interventions.

Method: Using the Plan-Do-Study-Act (PDSA) framework, four interventions are being implemented:

1. Veteran-centered education on telehealth modalities,
2. secure messaging and smartphone reminders to reinforce adherence to phone appointments and blood pressure monitoring,
3. expanded use of remote patient monitoring (RPM) devices, and
4. nurse-led follow-up to support engagement and troubleshoot technology barriers. Telehealth equipment includes the Medtronic Commander Flex CD390 home BP monitor, Cognosante tablet hub/modem, Medtronic Interactive Voice Response (IVR) system, and a standard BP cuff. Approximately 30 Veterans have been enrolled and baseline assessment made. Outcome measures include telehealth engagement rates, phone appointment adherence, systolic/diastolic blood pressure trends, patient satisfaction, and percentage of Veterans actively using RPM devices.

Results:

Implementation is ongoing. Early observations indicate increased awareness of telehealth tools and rising RPM enrollment among participating Veterans. Full pre/post analyses of engagement, blood pressure, and patient satisfaction will be completed as additional data accrue.

Keywords: Telehealth; Remote Patient Monitoring (RPM); Hypertension; African American Veterans; Quality Improvement

Organizational culture of patient safety in the operating room: a cross-sectional study

Vivian Schutz, Cintia Fassarella, Gabriel Teixeira Cavalcante, Rosilene Alves Teixeira, Soraia Cristina de Abreu Pereira, Danielle Mendoca Henrique, Flavia Giron Carmerini, Nivea Pita Gomes de Oliveira, Tallita Mello Delphino

Background:

Maintaining a safe climate in operating rooms (ORs) is a persistent challenge for health systems, particularly as anesthetic surgical procedures become increasingly complex and the risk of adverse events rises in these high acuity environments. The OR requires rapid decision making, interdisciplinary coordination, and the integration of advanced technologies, all of which heighten vulnerability to communication failures, reduced situational awareness, and weakened team cohesion. These factors directly influence patient safety and the reliability of perioperative care. Strengthening OR safety culture is therefore essential for reducing preventable harm and supporting high reliability performance. This study sought to answer the research question: How is the safety climate perceived by surgical teams in two university surgical centers, and what differences exist between safety climate domains according to age and length of professional experience?

Purpose:

To evaluate the safety climate in two university surgical centers using a validated safety climate assessment instrument.

Objectives:

Specific aims were to:

• Analyze differences in safety climate domain scores among surgical team members (nurses, surgeons, anesthesiologists, and technicians).
• Examine variations in safety climate perceptions according to years of professional experience.
• Assess whether safety climate perceptions differ across age groups among operating room personnel.

Methods:

This cross sectional, analytical study with a quantitative approach was conducted in accordance with STROBE guidelines. The research was carried out in two public university surgical centers in Rio de Janeiro, Brazil. Sample size calculation was performed using Epi Info version 5.5.9 with a 95% confidence level. The final sample included 289 professionals—144 from Hospital A (HA) and 145 from Hospital B (HB)—all of whom worked in the operating room with direct or indirect patient interaction and a minimum workload of 20 hours per week. Data were collected using the Safety Attitudes Questionnaire – Operating Room Version (SAQ OR) between February 2021 and July 2022. After ethical approval, participants completed printed questionnaires individually, with an average response time of 10 minutes. Data analysis included descriptive statistics, analysis of variance (ANOVA), and linear regression using R software version 4.2.1.

Results:

The mean global SAQ OR score was 60.97 in HA and 59.71 in HB, indicating a neutral safety climate in both institutions. The domain “Communication in the surgical environment” received the highest positive scores (77.91 in HA and 76.83 in HB). Statistically significant differences among professional groups were identified in the domains “Working conditions” (p = 0.003) and “Perception of work performance” (p = 0.035). Professional experience was significantly associated with the “Perception of stress” domain (p = 0.004). Age demonstrated a dual association: each additional year corresponded to a 0.29 point reduction in “Communication in the surgical environment” and a 0.27 point increase in “Perception of performance at work.” These findings highlight how demographic and experiential factors shape safety climate perceptions.

Mindful Creative Arts Intervention to Support Stress Reduction Among ICU Nurses: A Quality Improvement Project

Kelsey Zwang

Nurse stress is a pervasive issue in healthcare, contributing to burnout, absenteeism, presenteeism, medical errors, and decreased patient safety. ICU nurses are particularly vulnerable due to high patient acuity, staffing shortages, and emotionally demanding clinical care. At a large academic healthcare system on the West Coast, the Press Ganey Culture of Safety Survey identified nurse stress as a key opportunity area, particularly in the coronary care ICU, where staff reported unreasonable levels of job stress. Evidence from peer-reviewed studies supports mindfulness-based interventions and creative arts–based strategies as effective for reducing perceived stress, enhancing self-efficacy, and promoting emotional processing among healthcare professionals (Ho et al., 2021; Moss et al., 2022; Zhang et al., 2024; Depret et al., 2020; Reed et al., 2020). The strength of evidence is moderate to strong: randomized controlled trials and quasi-experimental studies consistently demonstrate reductions in stress and improvements in coping skills among nursing staff following structured mindfulness or creative arts programs. Systematic reviews and meta-analyses further support the efficacy of these interventions across healthcare settings. This evidence supports implementing a QI initiative to address workplace stress, improve nurse well-being, and positively impact patient outcomes.

Purpose, Specific Aims, Project Goals/Objectives:

The QI project aimed to implement a mindful creative arts station in the ICU to reduce nurse stress. The primary objective was to decrease perceived stress levels among ICU nurses using the validated Perceived Stress Scale–12 (PSS-12). Secondary goals included evaluating process measures such as staff engagement, feasibility, and perceptions of benefit to inform sustainability and potential unit expansion. Methods, Collaboration, Implementation, and Evaluation: The project utilized the Plan-Do-Study-Act (PDSA) cycle to guide implementation. Stakeholders included ICU nurses, unit leadership, infection prevention, and environmental services. Barriers such as limited time and physical space were addressed by integrating self-directed, low-intensity creative activities during breaks and configuring a mobile, accessible station. The PSS-12 survey measured pre- and post-intervention stress levels, while process metrics tracked engagement, supply usage, and staff feedback via Qualtrics and Microsoft Outlook.

Results/Outcomes and Implications:

Pre-intervention PSS-12 scores (n=31) indicated moderate to high stress; post-intervention scores (n=30) showed slight increases in helplessness but improvements in self-efficacy. Qualitative feedback revealed staff perceived the station as relaxing, therapeutic, and socially engaging, suggesting meaningful benefits despite environmental stressors. Younger and mid-career nurses reported the highest stress levels. No workflow disruptions occurred, and engagement was highest among staff who accessed the station consistently. The project demonstrates that low-cost, accessible creative arts interventions are feasible and valued in high-acuity units. Sustainability is supported through unit leadership ownership, ongoing supply management, and integration into regular breaks, with potential expansion across hospital units.

Finding Belonging and Balance While Influencing Nurse Retention: Nurse Managers Juggling It All

Jill Whade

BACKGROUND: National registered nurse (RN) turnover remains a persistent challenge, with recent rates at 16.4%, carrying substantial financial implications for healthcare organizations. Nurse manager (NM) turnover, reported at 9.5%, presents even greater risks due to the high cost of recruitment and the critical role NMs play in shaping clinical nurses’ intent to stay. Previous research identifies unit leadership as a primary driver of clinical nurse retention, underscoring the importance of understanding the experiences and motivations of NMs themselves.

PURPOSE: This study aimed to examine the factors influencing nurse managers’ intent to stay and to explore how nurse manager experiences, values, and workplace conditions shape the retention and engagement of clinical nurses.

METHODS: A qualitative, descriptive design was used. Twenty nurse managers participated in voluntary, anonymous, one-hour interviews. Interview data were analyzed to identify themes reflecting influences on NM intent to stay and perceived impacts on clinical nurse retention.

RESULTS: Five primary themes emerged:

1. Supportive Relationships,
2. Organizational Alignment,
3. Professional Growth & Flexibility,
4. Practical Considerations, and
5. Work–Life Balance. NMs emphasized that strong leadership support networks—including directors, executives, peers, and shared governance partners—were central to their retention. Participants described the role as complex, demanding significant emotional and operational bandwidth while navigating salary compression, competing priorities, and broad spans of control. Despite challenges, NMs cited alignment with organizational values and opportunities for growth as key reasons for remaining in their roles. Clinical nurses reinforced these themes, identifying visible leadership, flexibility, engagement in decision-making, recognition, and responsiveness to concerns as essential factors influencing their own retention.

Implications:

This study highlights the essential role of nurse manager well being, support, and professional alignment in strengthening both NM retention and clinical nurse stability. As organizations face ongoing workforce challenges, prioritizing NM support structures is critical. Findings demonstrate that when NMs feel valued, supported, and aligned with organizational culture, they exhibit a greater commitment to their roles and are equipped to foster healthy, engaged clinical environments. The five themes identified—supportive relationships, organizational alignment, professional growth and flexibility, practical considerations, and work–life balance—represent actionable areas where healthcare leaders can invest resources and strategic effort. Leadership behaviors, such as providing meaningful recognition, modeling work–life balance, ensuring realistic expectations, and addressing span of accountability, have direct implications for both NM and clinical nurse retention. NMs who feel empowered and supported are more capable of cultivating trust, visibility, fairness, and recognition among their teams—factors known to enhance clinical nurse engagement and intent to stay. Ultimately, strengthening the NM role is a pathway to improving patient outcomes, reducing turnover costs, and fostering resilient, thriving nursing teams. Healthcare organizations must embrace proactive, intentional strategies that reinforce NM well being and leadership capacity as essential components of workforce stability and cultural excellence.

A Tale of Two Concepts: Integrating Implementation Leadership and Evidence-Based Practice Sustainment

Francis Saint Clair, Mary Dolanski

Title

A Tale of Two Concepts: Integrating Implementation Leadership and Evidence-Based Practice Sustainment

Background:

The Institute of Medicine's report "Crossing the Quality Chasm" (2001) identified that care grounded in the best available scientific knowledge is essential to improving healthcare quality and safety. This report led to a focus on evidence-based practice (EBP). Although significant effort and resources have been invested in implementing EBPs, sustained clinical workflow integration remains variable across organizations. Implementation science has increasingly emphasized sustainment as a critical outcome for achieving long-term quality improvement and meaningful population-level impact. In nursing, sustainment has been associated with organizational stakeholder engagement, structured communication, knowledge sharing, ongoing education, resource allocation, evaluation and monitoring systems, and alignment with governance and policy structures. These processes suggest that sustainment requires active reinforcement and organizational integration rather than passive continuation of practice.

Purpose:

The purpose of this presentation is to synthesize implementation science and nursing sustainment literature to explore how implementation-focused leadership behaviors may influence long-term EBP sustainment in nursing settings.

Methods:

A focused conceptual synthesis of contemporary implementation leadership and nursing sustainment literature was conducted. Foundational work on the Implementation Leadership Scale (ILS) and subsequent empirical studies examining associations between implementation leadership behaviors and implementation climate or implementation outcomes were reviewed. Nursing literature addressing the determinants of EBP sustainment and the organizational mechanisms supporting the continued use of best practices was also examined. Findings from these parallel bodies of literature were integrated to develop a conceptual model linking implementation leadership behaviors with sustainment processes in nursing contexts.

Results:

Literature in Implementation Science demonstrates that higher implementation leadership scores are associated with stronger implementation climates. Strong implementation climate means shared perceptions that EBP use is expected, supported, and rewarded. In acute care settings, studies have shown that frontline nurse manager implementation leadership behaviors were linked to more positive unit implementation climates. In other sectors, implementation leadership was associated with improved implementation climate and greater fidelity to complex EBPs through climate-mediated pathways. Leadership development strategies such as the Leadership and Organizational Change for Implementation (LOCI) intervention research has shown that strengthening implementation leadership behaviors improves organizational conditions and provider engagement in implementation processes. Nursing sustainment literature identifies mechanisms influenced by leaders, including feedback and monitoring, stakeholder engagement, resource provision, education, communication, and policy integration, as critical to sustained EBP use. However, these mechanisms have not been explicitly integrated with implementation leadership theory.

Conclusions:

While implementation leadership has been associated with improved implementation conditions and provider engagement, its relationship to long-term EBP sustainment in nursing contexts remains insufficiently examined. This synthesis proposes a conceptual integration model that links implementation-focused leadership behaviors to organizational sustainment mechanisms. Bridging these literatures highlights the need for empirical investigation of how implementation leadership behaviors may influence sustained EBP delivery and routinization in nursing practice.

A Randomized Control Trial Examining Virtual Reality for Reducing Stress and Burnout and Enhancing Resilience and Work Engagement Among Nurse Managers.

Esther Chipps, Stephanie Justice

Background: Nurse managers (NMs) face unprecedented workplace stress, with burnout rates ranging from 30% to 80%. While mindfulness interventions demonstrate effectiveness for healthcare workers, NMs' demanding schedules limit participation in traditional programs. Virtual reality (VR) technology offers an innovative solution by providing immersive, on-demand mindfulness experiences adaptable to unpredictable workdays.

Purpose: This study evaluated the effects of an eight-week VR mindfulness intervention on perceived stress, burnout, resilience, and work engagement among NMs at an academic medical center.

Methods: A randomized waitlist control pilot study was conducted from February–July 2025. Thirty-eight NMs were randomized 1:1 to intervention or control groups. Intervention participants used Meta Quest 2 headsets with TRIPP® software, completing 10–12 minute mindfulness sessions three times weekly for eight weeks. Validated instruments measured outcomes at baseline and post-intervention: Perceived Stress Scale-10, Maslach Burnout Inventory, Connor-Davidson Resilience Scale-10, and Utrecht Work Engagement Scale-9. Data analysis included Hedge's g effect sizes and linear regression.

Results: The intervention group demonstrated significant improvements across all outcomes compared to controls. Participants showed decreased perceived stress (g=-1.140) and burnout (emotional exhaustion g=-0.536; depersonalization g=-0.565; personal accomplishment g=0.651), alongside increased resilience (g=0.679) and work engagement (total g=0.96). Linear regression confirmed the intervention significantly predicted improvement across all measures (p<.02).

Conclusions: VR mindfulness interventions effectively reduce stress and burnout while improving resilience and work engagement in NMs. This scalable, technology-enabled approach offers healthcare organizations an evidence-based strategy to support nursing leadership well-being and workforce sustainability.

Nurse Manager Workload and Practice Environments Before and After the COVID-19 Pandemic: A Sequential Explanatory Mixed-Methods Study

Esther Chipps

Background: Nurse managers (NMs) are critical leaders whose work influences care quality, workforce stability, and organizational performance. Even prior to the COVID 19 pandemic, the NM role was characterized by high workload and broad spans of control. The pandemic further expanded NM responsibilities; however, limited empirical evidence has examined whether these changes persisted post pandemic or how sustained role expansion affects leadership sustainability.

Purpose: To analyze changes in NM responsibilities before and after the COVID 19 pandemic and examine relationships among role expansion, practice environment, job satisfaction, and intent to leave.

Methods: A three phase sequential explanatory mixed methods design was used. Phase I established content validity of the Nurse Manager Responsibilities Tool (NMRT). Phase II surveyed 166 U.S. NMs to quantify pre and post pandemic responsibilities and assess practice environment, job satisfaction, and intent to leave. Phase III used qualitative interviews to contextualize and refine quantitative findings.

Results: Time spent on NM responsibilities increased across all categories post pandemic, particularly administrative operations, clinical operations, meetings, quality activities, and tasks outside the traditional NM role. Although practice environment perceptions were generally positive, nearly one third of NMs were undecided about remaining in their role. Qualitative findings revealed persistent pandemic related responsibilities, including organizational policy management, staff wellness support, engagement, mentoring, and professional development. Integration of findings validated and expanded the NMRT.

Conclusions and Implications: This study advances nursing leadership science by empirically demonstrating post pandemic role creep and highlighting invisible work as sustained features of NM practice. Findings support the need for leadership role redesign, workload redistribution, and educational preparation focused on sustainable nurse manager leadership models.

A Model for Nursing Leadership and Health System Science

Esther Chipps, Maria Lindell Joseph, Hussein Tahan

Background and Significance Nursing leadership plays a pivotal role in shaping healthcare systems, workforce outcomes, quality, equity, and policy; however, it has historically lacked articulation as a distinct scientific discipline. The Nursing Leadership and Health Systems Science Model (NLHSSM) was developed to address this gap by providing a unified framework that integrates leadership practice, education, research, innovation, and policy.

Study Purpose The purpose of this qualitative study was to verify and refine the NLHSSM through systematic input from experienced nurse leaders and to strengthen its scientific foundation and practical application.

Methods:

Using a qualitative descriptive study design, individual semi structured interviews were conducted with 12 national nurse leaders representing service, education, research, and policy sectors. Participants reviewed the visual model and accompanying narrative and provided feedback regarding relevance, clarity, conceptual alignment, omissions, and real world applicability. Data were analyzed using constant comparative methods, and participant feedback and exemplars were incorporated into iterative refinements of the model.

Results/Conclusions Findings supported nursing leadership as a distinct scientific discipline grounded in interdisciplinary science, systems thinking, and empirical inquiry. Participants validated the model’s applicability across health system delivery, leadership education, research priority setting, digital innovation, and policy advocacy. Overall, results indicate that the NLHSSM provides a robust framework to advance nursing leadership science, guide research agendas, inform leadership education, and strengthen professional identity. This work contributes to the ongoing development of evidence based, outcomes driven nursing leadership practice across complex health systems.

A Multi-Component Wellness Program To Promote Self-Leadership and Wellness

Lindsay Morris, Mary Dolansky, Madaline Witort

Nursing students and faculty face significant academic and clinical demands that contribute to high levels of stress and burnout. Developing self-leadership skills that foster self-awareness and resilience may help individuals navigate these challenges more effectively. However, wellness initiatives that intentionally integrate self-leadership development within healthcare education remain limited. To address this gap, the Marian K. Shaughnessy Nurse Leadership Academy (MKSNLA) at the Frances Payne Bolton School of Nursing at Case Western Reserve University developed a multi-component wellness-based self-leadership initiative to support leadership development and well-being among healthcare students and faculty in an interprofessional educational environment.

The purpose of this initiative was to implement and evaluate a three-part wellness-based self-leadership program within an academic healthcare setting. Specifically, the project aimed to:

1. evaluate the feasibility and perceived impact of the BeWell: Flourishing in Self-Leadership program for nursing faculty,
2. implement interprofessional yoga sessions designed to promote mindfulness and leadership reflection among healthcare students and faculty, and
3. assess the impact of a brief classroom mindfulness intervention on nursing students’ stress and confidence in navigating challenges.

This initiative was implemented at the MKSNLA within the Health Education Campus between 2023 and 2025. Three wellness-based self-leadership initiatives were introduced: the BeWell: Flourishing in Self-Leadership faculty program, interprofessional yoga classes, and a classroom mindfulness intervention. The BeWell program consisted of a four-week asynchronous mini-series with video modules and reflective exercises. Interprofessional yoga sessions were offered weekly to students and faculty across healthcare disciplines. The mindfulness intervention consisted of a five-minute guided meditation delivered at the beginning of nursing classes. Pre- and post-session surveys were distributed via Qualtrics to assess perceived stress, self-leadership confidence, and perceived professional development benefits. Descriptive statistics and qualitative feedback were used to evaluate participant perceptions of feasibility and impact.

Across the three initiatives, participants reported outcomes related to self-leadership development, stress management, and professional growth. Faculty participating in the BeWell program reported increased awareness of self-leadership practices and greater confidence in implementing wellness strategies. Participants in the interprofessional yoga initiative reported relaxation, improved focus, and perceived benefits for professional and leadership development. Following the classroom mindfulness intervention, nursing students reported moderate to high confidence in navigating challenges, and 65% indicated that additional mindfulness sessions would be beneficial.

Creating Affective Events: Pet Therapy as a Nurse Residency Program Component

Cheryl Smith-Miller

Transitioning from nursing student to practicing professional is a critical adjustment period for newly licensed registered nurses (NLRNs). Although structured residency programs are designed to ease this transition many NLRNs continue to experience high stress, emotional fatigue isolation, anxiety, and uncertainty. These discomforting states highlight the need for innovative strategies that promote early-career nurses’ well-being. Canine-assisted interventions (CAIs) present one such option.

Recent research identifies CAI as an evidence-informed approach in reducing stress and anxiety, improving emotional well-being, mood, and enhancing social connection among healthcare providers. However, no studies have yet explored the integration of CAIs into nurse residency programs or their influence on well-being during the critical first year of practice. This gap in the literature underscores the need to examine CIAs’ potential for offering meaningful emotional and psychological support to NLRNs. Guided by affective events theory, this study aimed to examine the influence of a CAI among nurse residency participants’ emotional states and its effectiveness as an affective event.

MENTORSHIP, MENTOR BEHAVIORS, AND NURSE WELL-BEING

Jasmine Mitchell

Nurses, at the forefront of healthcare, serve as leaders in sustaining human health and represent the largest component of the healthcare system, but the physical and mental pressure of working in acute care hospitals and increased workplace stressors negatively impact well-being (Si et al., 2023). Interventions aimed at improving low levels of well-being are vital to sustain the nursing profession (Ding et al., 2022; Zhang et al., 2024). The literature indicates mentorship may enhance well-being; however, the direct relationship between mentorship and well-being has not been addressed. A cross-sectional survey of registered nurses working in acute care hospitals employed statistical methods including independent samples t -tests, regression analyses, correlations, and one-way analysis of variance to examine the relationships between mentorship, mentor behaviors and attributes, demographic variables, and well-being. A total of 255 survey participants were included in the study. Sample demographics were recorded using a demographic details form. A mentorship assessment determined those participants that had been mentored and those that had not, as well as whether or not those that were mentored had a current mentor or not. Mentor behaviors and attributes were recorded with the Mentor Behavior Scale (MBS) (Brodeur et al., 2015). Levels of well-being were measured with the short version of the Psychological General Well-Being Index (PGWB-S) (Grossi et al., 2006). The analysis demonstrated that nurses experience moderate distress on average (M = 71.37, SD = 20.16), while 32.9% are severely distressed. Nurses who had a current mentor made up 19.2% of the sample. These mentees’ perception that a good understanding of the changes that would be good for them had been established with their mentor was positively correlated with positive well-being (rho = .45, p < .001). The mentee’s perception that their mentor understands their needs, worries, and problems was positively correlated with self-control and feelings of emotional stability (rho = .33, p < .005). The mentee’s perception that when meeting, their mentor talks less than they do was also positively correlated with self-control (rho = .38, p < .005). Good reliability of the PGWB-S and the MBS and four subscales was demonstrated with Cronbach’s alphas above 0.70.

From Inception to Implementation: Development of the ALSN International Ambassador Program

Jihane Frangieh Jihane Frangieh, Mary Dolansky, Kim Crawford, Kay Kennedy, Edmund J. Walsh, Cindy Zellefrow

Problem/Purpose:

As nursing leadership continues to expand across global health systems, professional organizations must develop intentional mechanisms to support international engagement, knowledge exchange, and leadership collaboration. The Association for Leadership Science in Nursing (ALSN) recognized the need to strengthen its global reach and ensure that membership and leadership initiatives are relevant and accessible to nurse leaders worldwide. In response, the ALSN International Ambassador Program was conceptualized to promote international membership, facilitate dialogue among global nurse leaders, and foster collaborative opportunities in leadership, education, research, and practice.

Objectives:

The objectives of this initiative were to

1. establish a structured international ambassador program to increase global engagement and representation within ALSN,
2. create a platform for discussion of shared challenges and innovations in nursing leadership and education across countries, and
3. support mutually beneficial collaborations among nurse leaders in practice and academia.

Implementation:

The program was initiated by a team of ALSN nurse leaders who identified the opportunity to expand ALSN’s international presence. Program inception involved defining the vision, goals, and guiding principles for global engagement. Over the first year, several development activities were implemented to engage international nurse leaders and foster collaboration. These activities included conducting two focus groups to assess needs and priorities, hosting monthly virtual café meetings for discussion and networking, organizing a virtual conference to share best practices and innovations, and developing a common international leadership agenda to guide ongoing collaboration. Additional structural steps included establishing ambassador roles and expectations, designing the application and selection process, and creating communication strategies to connect ambassadors with ALSN leadership and membership activities. The program aligns with the ethical responsibility of advancing global nursing leadership outlined in the American Nurses Association Code of Ethics, emphasizing promotion of nursing knowledge and collaboration across international boundaries.

Evaluations/Lessons Learned:

The inaugural year of the ALSN International Ambassador Program generated tangible engagement and early indicators of impact. Implemented activities fostered enthusiasm among international members, strengthened connections between ambassadors and ALSN leadership, and established a clear framework for collaboration in leadership science. Lessons learned highlight the value of structured engagement opportunities, consistent communication, and co-created leadership initiatives in cultivating meaningful global partnerships.

Implications:

The ALSN International Ambassador Program demonstrates a strategic, replicable approach to expanding global engagement within professional nursing organizations, fostering international dialogue, and advancing leadership science, education, research, and practice.

Association between nurse staffing and door-to-diuretic time in acture decompensated heart failure

Alaina Tellson, Dillon Dzikowicz

Purpose (What): To evaluate how RN staffing ratios and skill mix influence key emergency department (ED) outcomes, including left without being seen (LWBS), left before evaluation completion (LBEC), left against medical advice (LAMA), and inpatient boarding and time to be seen in waiting room. Relevance/Significance (Why): EDs face increasing crowding, higher acuity, and rising demands for timely care. Elevated rates of LWBS, LBEC, LAMA, and midnight boarding signal delayed or fragmented care and threaten accreditation and reimbursement readiness. Understanding how staffing patterns shape these outcomes is critical for evidence-based workforce planning and Magnet-level performance. Strategy/Implementation/Methods (How): We extracted daily ED performance metrics from an Upstate NY Magnet-designated hospital, including LWBS, LBEC, LAMA, and boarding and waiting-room time. These operational metrics were paired with daily nurse-staffing counts spanning a pre-pandemic six-year period:1/1/2013 to 12/31/2019. We assessed RN-to-Patient Ratio (overall visits/registered nurse) and RN skill mix (RN/sum of direct care staff). We standardized factors, assessed multicollinearity (VIF<5, Condition Index <5), and then used a negative binomial model for each outcome controlling for overall visits, overall admissions, day of the week, year, and season. All analyses were completed in SPSS with significance set at p< 0.05. Evaluation/Outcomes/Results (So what): Across 2,556 days, the ED recorded 10,455 LWBS (1.3%),15,824 LBEC (2.0%), and 2,373 LAMA (0.3%). LWBS rose 28% per standard deviation (SD) increase in the RN-to-patient ratio (p<.001) and 10% with higher overall visits (p=.002). LBEC fell 22% with SD increase in the RN-to-patient ratio (p<.001) but rose 46% with overall visits (p<.001). LAMA increased 22% with higher RN-to-patient ratio (p<.001) and 15% with SD increase in skill mix (p=.003). Operationally, adding 1 RN per 12 added patients/day reduces LWBS by 12%, LBEC by 10%, and LAMA by 10%. Conclusions/Implications (And now): ED outcomes are highly sensitive to RN staffing and volume. Improved RN ratios reduce early departures, whereas rising volume increases risk. Scaling RN staffing to demand, using a benchmark of one RN per 12 added patients, can enhance safety, throughput, and overall ED performance.

Comparing heart failure outcomes across hospital settings within an integrated healthcare system

Alaina Tellson, Dillion Dzikowicz

Introduction / Significance: Heart failure (HF) remains a leading cause of hospitalization and mortality. Health outcomes may vary depending on the type of hospital—rural, community, or academic—but limited data exist comparing these settings within integrated systems. This study fills a critical gap by evaluating whether hospital context influences HF outcomes and identifying context-specific care disparities.

Methods: A retrospective cohort study of adult HF patients discharged from hospitals within a large healthcare system during 2013-2019. Hospitals were categorized as academic (n=2), community (n=8), or critical access hospitals (n=2) based on system designations. Data including demographics, comorbidities, length of stay (LOS), and in‑hospital mortality from the electronic health record (EHR). Multilevel logistic and linear regression models adjusted for patient-level covariates (age, sex, race/ethnicity, Get With The Guidelines-Heart Failure (GWTG-HF) risk score, Charlson Comorbidity Index) and hospital clustering. Pairwise comparisons between settings were performed with significance set at p<0.05. All analyses were completed in R (version 4.5.0).

Results: In total, our database contained 19,433 heart failure patients from 12 hospitals. Compared to patients treated at academic centers, patients at community hospitals had similar odds of in-hospital death (OR = 1.34, 95% CI [0.54, 3.21], p = .53), as did those treated at critical access hospitals (OR = 2.35, 95% CI [0.76, 6.91], p = .14). No significant differences were observed between community and critical access hospitals (p = .43). Mortality risk was higher among patients identified as White (p = .003) or of other racial backgrounds (p < .001), and lower among Hispanic patients (p = .008). Increased comorbidity burden (p = .003) and higher GWTG-HF scores (p < .001) were also associated with greater odds of in-hospital mortality. Patients treated at academic centers had significantly longer average hospital stays (adjusted mean = 7.32 days) compared to those treated at community hospitals (5.61 days; p = .002) and critical access hospitals (5.07 days; p = .001). No significant difference in length of stay was observed between community and critical access hospitals (p = .54). Longer hospital stays were also associated with older age (p < .001), greater comorbidity burden (p = .007), and higher GWTG-HF scores (p < .001).

Conclusion: In this large, integrated healthcare system, hospital type was not significantly associated with in-hospital mortality among patients hospitalized for heart failure after adjusting for clinical and demographic factors. However, significant differences in length of stay were observed, with academic centers demonstrating longer hospitalizations. These findings suggest that while mortality risk may be consistent across hospital settings within an integrated system, resource utilization patterns differ and may reflect differences in care delivery models, patient complexity, or institutional practices. Future work should explore the drivers of these variations and their impact on long-term outcomes and health system efficiency.

Leveraging Academic-Practice Partnerships to Advance Nursing Excellence

Judith Pechacek, Andrea Leszko

Abstract: Leveraging Academic-Practice Partnerships to Advance Nursing Excellence Session Objectives 1. Identify cross-sector challenges and the role of nursing collaboration in driving change. 2. Explore strategies to leverage professional strengths for actionable solutions. 3. Define specific methods to integrate nursing expertise across care, education, and research.

Problem Background and Significance: In an era defined by critical workforce shortages, escalating clinical complexity, and persistent health inequities, the traditional silos between academic institutions and healthcare systems are no longer sustainable. As a nursing professor and a hospital administrator, we recognize that academic-practice partnerships (APPs) have evolved from optional affiliations into strategic imperatives. While these collaborations are designed to accelerate evidence translation and leadership development, they often face "false starts" due to cultural friction, high turnover, and misaligned organizational priorities. The rationale for our partnership—a collaboration between the University of Minnesota School of Nursing and the Minneapolis VA Health Care System (VAHCS)—is rooted in the belief that integrating the diverse voices of frontline staff, researchers, and executives is the only way to bridge the gap between theory and bedside application.

Purpose: The “VA-SoN Collaboratory” was established to move beyond standard affiliation agreements. Our purpose is to operationalize a shared vision through formal governance, co-funded roles, and integrated research pipelines. By fostering bidirectional leadership, we aim to build a robust nursing infrastructure that improves community health outcomes and cultivates the next generation of nurse leaders.

Methods: Successful partnerships do not happen by accident; they require intentional design. Our framework utilizes four essential building blocks:

• Defined Roles: Creating role clarity to navigate complex institutional boundaries.
• Structured Processes: Implementing frequent touchpoints and joint action plans.
• Relationship-Building: Prioritizing longitudinal trust to measure long-term impact.
• Mutually Beneficial Goals: Ensuring win-win outcomes for both the university and the medical center.

We utilize Memoranda of Understanding (MOUs), joint faculty appointments, and shared governance models to anchor these efforts in accountability and implementation science.

Results and Implications: The Collaboratory model has yielded measurable success. To date, we have supported jointly funded programs, including the VA Quality Scholars (VAQS) Fellowship, NP residencies, and RN-to-Practice (RNTTP) tracks. We have successfully embedded DNP and PhD projects directly into the VA’s clinical infrastructure, increasing practicum placements and establishing a pipeline of APRN affiliate faculty.

Conclusion: To sustain these gains, healthcare organizations must view these partnerships as essential leadership infrastructure. By elevating bedside nurses as drivers of research and curriculum, we ensure that medical advancements are translated into frontline care. This model positions nursing as the central engine for health system transformation.

Reducing CLABSI's Through CHG Bathing Education and Virtual Reality Communication Training

Sarah Bender, Jacalyn Buck, Teri Chenot, Todd Tussing

Background: CLABSIs represent a persistent and largely preventable patient safety challenge. While evidence‑based CLABSI prevention bundles are widely adopted, their effectiveness depends on reliable execution of each element. Daily CHG bathing is a critical maintenance practice; however, patient refusal and inconsistent nurse follow‑up communication can undermine bundle fidelity. At a National Cancer Institute–designated comprehensive cancer center, audit data revealed strong adherence to most bundle components, yet CHG bathing compliance remained below organizational targets, highlighting a leadership opportunity to address behavioral and communication barriers rather than technical skill deficits alone.

Purpose: The purpose of this evidence‑based quality improvement initiative was to reduce CLABSI risk by strengthening CHG bathing compliance through a leadership‑supported, nurse‑driven intervention that combined targeted education, structured communication training, and innovative virtual reality (VR) simulation. The initiative aimed to increase CHG compliance, decrease CHG refusal, increase nurse self‑efficacy and ultimately decrease CLABSI rates.

Methods: This initiative was implemented on a 24‑bed mixed‑acuity acute leukemia unit within an academic medical center. Multiple leadership and implementation frameworks guided the work, including DMAIC for process improvement, Lewin’s Change Model for change management, the Iowa Model of Evidence‑Based Practice, and the Crucial Conversations framework. A multidisciplinary leadership coalition collaborated throughout planning, implementation, and evaluation. Registered nurses completed a computer‑based learning module focused on CHG bathing and crucial conversations framework. Education was reinforced through an immersive VR simulation that allowed nurses to practice difficult patient conversations in a psychologically safe environment. Outcome measures included CLABSI rates, while process measures included CHG bathing compliance, CHG refusal rates, and nurse self‑efficacy assessed using the General Self‑Efficacy Scale.

Results: Following implementation, CHG bathing compliance increased by 20.75%, exceeding the organizational goal of 90%, while CHG refusal rates decreased by 64.2%. Documentation reliability improved, with an 81% reduction in undocumented CHG bathing events. In the three months post‑implementation, the unit experienced two months with zero CLABSIs and one month with a single CLABSI event, demonstrating a favorable trend. Nurse self‑efficacy scores increased by 9% immediately following the intervention, with partial retention at three months. Audit findings indicated improved nurse follow‑up after patient refusal, reflecting sustained behavior change supported by leadership engagement and real‑time feedback.

This initiative demonstrates how nurse leaders can leverage innovative educational technologies and structured communication frameworks to address complex, behavior‑dependent quality challenges. Integrating VR simulation into professional development strengthened frontline confidence, supported consistent practice, and aligned workforce capability with organizational safety goals. These findings contribute to nursing leadership science by illustrating a scalable, low‑cost strategy to enhance nurse engagement, quantify nursing’s impact on outcomes, and sustain evidence‑based practice in high‑risk clinical environments.

Examining the Impact of Geographic Clustering of Nursing Care Assignments on Nursing and Patient Outcomes: A Mixed Methods Study

Amy Knupp, Esther Chipps

Background / Significance Structural differences in nursing unit floor designs have the potential to influence staff workflow, patient experience, quality outcomes, and safety. Evidence supports the use of geographical clustering (GC), a model that assigns nurses to patients located in close proximity, to streamline workflow, decrease steps taken, and increase visibility of assigned rooms and patients. Despite literature suggesting GC has an impact on staff and patient outcomes, a lack of experimental studies exist to support these findings. This study offers an innovative approach in redesigning nurse-patient assignments to focus on nursing workflow, patient safety, and satisfaction.

Purpose / Study Aims The primary aims were to 1a.) to compare GC to standard nurse-patient assignments and 1b.) to determine the impact of GC on staff efficiency, staff workload, and missed care, as well as responsiveness, emergency response team (ERT) activations, patient falls, patient hospital acquired pressure injuries (HAPIs), and patient satisfaction. A secondary aim was to describe staff members’ experiences working on the unit with GC.

Research Design: This research study used a mixed methods design. Phase 1 utilized a quasi-experimental design to capture pre and post quantitative data. Phase 2 employed focus groups to gather qualitative data related to staff satisfaction.

Sample: The target sample was the registered nurse (RN) and patient care assistant staff on both the intervention and the control units.

Setting: Two medical surgical units, with similar physical layouts and patient acuity levels, within an academic medical center were utilized for this study.

Intervention: Geographically clustered nursing care assignments were made each shift by the charge RNs in consultation with the nursing unit leadership on the intervention unit. The intervention took place over four months and was then discontinued.

Data collection: Staff efficiency data was collected using a step counting device worn by volunteer nursing staff members. Responsiveness data was accessed from the call-light system and reported the number of minutes it took a staff member to turn the call light off once they entered the patient room. ERT activation, patient fall, and patient HAPI data were obtained from the nursing unit and/or hospital quality scorecard, and patient satisfaction data was retrieved from the monthly patient satisfaction report. Staff workload was measured using the NASA Task Load Index tool and missed care was measured using the Revised MISSCARE Survey – Part A. Focus groups assessed staff members’ experiences with the GC model.

Data Analysis: Because the response rate / final sample size was low, descriptive statistics were used to summarize and report the differences in the pre-post quantitative data. Focus group transcripts were independently reviewed by members of the research team and consensus was established regarding the identified themes.

Results / Implications There is some indication that GC has an impact on efficiency, workload, missed care, responsiveness, falls, ERT activations, HAPIs, and patient satisfaction, however, larger studies incorporating structured implementation science strategies are warranted.

Addressing Unequal Group Representation Using Propensity Score Weighting

Angela Pascale, Melora Ferren

Background:

Many nursing research studies use comparative designs to examine differences in continuous measures across groups defined by interventions, exposures, or organizational characteristics. One analytic challenge in these studies arises when the groups being compared are unevenly represented, resulting in substantial differences in sample size across groups. When one group contains substantially fewer observations than others, meaningful statistical comparisons across groups using traditional methods become more difficult.

Objective:

Demonstrate how propensity score weighting can be applied to improve comparability in unbalanced categorical groups using applied nursing research examples.

Methods:

Propensity score weighting (PSW) offers an alternative analytic strategy for strengthening comparability in unbalanced group comparisons by assigning weights based on the estimated probability of group membership given observed characteristics. When comparing two groups, binomial propensity score models can be used to generate weights; for analyses involving three or more groups, multinomial models may be required.

This methods application is illustrated using an in press study examining nursing-sensitive outcomes across three ANCC hospital designation categories (Magnet, PTE, and non ANCC). In this example, multinomial propensity scores were estimated using hospital characteristics, and weights were applied prior to estimating group differences. A second example—using binomial weighting from a published study comparing hospitals with and without PTE designation—demonstrates how PSW can adjust comparisons when only two groups are evaluated. Together, these examples highlight practical approaches for implementing PSW in nursing research.

Results:

Traditional statistical approaches such as t-tests and ANOVA provide initial comparisons of mean differences across categorical groups. However, when group sizes are uneven, these comparisons may not fully account for differences between groups. In these situations, propensity score weighting can be used to improve comparability between groups.

In a three-group example, comparisons of nursing-sensitive measures, including fall rates, CLABSI rates, CAUTI rates, and HAPI prevalence, across three hospital designation groups were initially evaluated using ANOVA (Pascale, In Press). These analyses identified several statistically significant differences in nursing-sensitive measures across designation groups. Multinomial propensity score weighting was subsequently applied to address unequal group representation across hospital designation groups. After applying propensity score weighting, some differences identified in the initial ANOVA analyses were no longer observed, while others remained statistically significant. In a two-group context example, a recently published study examining PTE designation and patient satisfaction illustrates the use of binomial propensity score weighting to estimate adjusted differences in patient satisfaction between hospitals with and without PTE designation (Yu et al., 2025). These illustrations underscore the analytic value of propensity score weighting in addressing unequal representation.

Conclusions:

Propensity score weighting provides a useful analytic approach for examining differences across categorical groups when sample sizes are uneven. By reducing bias introduced by unequal representation, propensity score weighting enhances the rigor and interpretability of nursing leadership and organizational research. As comparative analyses remain central to evaluating nursing-sensitive outcomes, propensity score weighting provides an essential analytic tool for generating more accurate and meaningful insights.

Strengthening Financial Stewardship and Operational Performance Through a Structured Nurse Manager Development Program

Elizabeth McNulty

Nurse managers are responsible for the day to management of patient care units including overseeing the patient care needs, care provided, quality metrics, staffing and the professional development of the staff. Hospital leaders need to understand the competencies required of nurse managers in order to develop effective nurse leaders. A 2021 literature review found 392 competencies for nurse managers in the literature. The second most frequent cited competency was finance. However, many nurses are promoted to management positions after demonstrating clinical excellence and strong communication skills and often lack formal education in financial management. Personnel costs make up the largest portion of hospital budgets, and nurse managers are typically responsible for managing these resources. Therefore, financial competence of nurse managers is crucial for a hospital’s overall success. From mid‑2024 through 2025, a 265‑bed suburban community hospital experienced substantial turnover in nursing leadership, including the retirement of the long-standing Chief Nursing Officer and two nursing directors. By 2025, approximately 75% of nurse leaders were new to their roles, with several being novice managers. Although quality outcomes remained stable, staffing‑related performance metrics declined. The productivity index (PI) dropped, while overtime, on‑call use, agency utilization, and Protests of Assignment (POA) from nurses and patient care assistants increased. A learning needs assessment (LNA) of nurse leaders identified key development gaps in driving accountability, evidence‑based practice, and financial stewardship. Strengthening nurse managers’ understanding of FTEs, budgeting, scheduling, and variance explanation emerged as a priority to improve the financial success of the hospital. A targeted competency‑based education and strengthened departmental support was implemented to improve the financial stewardship and operational effectiveness of nurse managers. Formal monthly education for director and managers explored role clarity among nursing leadership, communication, accountability, self-awareness, emotional intelligence and team building. Novice nurse managers and supervisors participated in additional monthly working sessions to understand staffing plans, the collective bargaining agreements in place, FTEs, and position controls. Daily staffing huddles were expanded from once a day to three times per day. Monthly operating reviews, actioning planning, clinical staffing and leadership meetings were restructured and infused with data. As a result, the PI improved from 0.92 to an average of 1.002 over six months and remains steady. POAs decreased by 87% in the same time period. By utilizing position controls, nurse managers better understood their budgeted FTEs and use of overtime and agency staff decreased as full time positions were filled. Additional results were seen in a decrease in RN turnover and an increase in retention. A structured, competency‑based leadership development program combined with the use of data to strengthen operational oversight improved the financial competence and staffing performance among nurse managers. This approach may support other organizations facing rapid leadership turnover or onboarding novice nurse leaders.

Evidence for Targeted Health Promotion Interventions: Exploring the Impact of Age and Disease Status on Healthy Lifestyle Beliefs in Hong Kong

ALICE Yuk-yu Cheng

Evidence for Targeted Health Promotion Interventions: Exploring the Impact of Age and Disease Status on Healthy Lifestyle Beliefs in Hong Kong

Background:

Population aging and chronic disease burden challenge global healthcare systems, requiring age-sensitive health promotion strategies. Health perceptions vary across the lifespan due to cognitive, social, and physiological development, affecting how health messages resonate with different age groups. In Hong Kong, the coexistence of Humorism with Western healthcare approaches and Traditional Chinese Medicine (TCM) among the Chinese adults suggests distinct patterns of health beliefs and lifestyle-related behaviors. The territory's healthcare transformation from tertiary to primary care aligns with global preventive healthcare trends, underscoring the need for culturally sensitive, age-appropriate interventions within this pluralistic medical context.

Objectives:

This study examined differences in healthy lifestyle beliefs between individuals with and without pre-existing medical conditions across different age groups in Hong Kong residents; and the moderating effect of age on the relationship between medical disease status and healthy lifestyle beliefs.

Methodology A cross-sectional survey was conducted during a community health promotion campaign in Ma On Shan district, Hong Kong. A convenience sample of 231 campaign participants completed a validated Healthy Lifestyle Beliefs Scale (HLBS).

Healthy Lifestyle Beliefs were assessed using the Healthy Lifestyle Beliefs Scale (Melnyk, 2003), a validated 16-item self-report instrument measuring beliefs about maintaining healthy lifestyle practices, including emotional regulation and health maintenance. Participants rated each item using a 5-point Likert scale (1 = strongly disagree, 5 = strongly agree). Multiple regression and hierarchical regression analyses assessed the effects of medical disease status, age groups, and their interaction on healthy lifestyle beliefs.

Results:

Middle-aged adults without existing medical conditions demonstrated the highest healthy lifestyle belief scores. Medical disease status was associated with significantly decreased belief scores (β = -6.07, p < 0.001). Age-related differences emerged, with teenagers and elderly participants without medical conditions reporting lower beliefs than middle-aged adults. A significant interaction between medical disease status and age was observed for elderly participants (β = 4.56, p = 0.045), indicating attenuated negative effects of disease on beliefs in this group.

Conclusions:

Age and medical disease status demonstrate independent and interactive associations with healthy lifestyle beliefs among Hong Kong residents. These findings provide empirical support for implementing targeted, age-stratified, and disease-sensitive health promotion interventions that accommodate the diverse needs of populations across the life course. Clinically, healthcare providers should adopt tailored counseling frameworks responsive to patients' age and disease profiles, adjusting communication approaches and intervention intensity accordingly to enhance engagement, optimize health behavior modification, and ultimately improve population-level health outcomes.

Building Research Capacity for Innovative Pediatric Nursing Science through a Collaborative Academic-Clinical Research Partnership

Lindsey Patton, James DeMasi, Renee Manworren, Tammy Webb

Background: Building research capacity in health systems for nurses is a priority for obtaining ANCC Magnet Designation and advancing the nursing profession. Clinical nurses and the healthcare system are an excellent context for carrying out high-quality research where nurses with research skills connect directly to patient care. However, challenges include lack of infrastructure, nursing research competency, navigating research processes, and optimizing funding potential. Literature highlights building research capacity is a multifaceted endeavor, requiring the development of strong relationships, clear roles, supportive leadership, and dedicated structures. Academic-clinical partnerships are a key strategy for increasing nursing research capacity by formalizing mutual vision and goals. In pediatric settings, these partnerships are particularly vital given the complexity of care and the need for specialized research competencies.

Purpose/Aims: This academic-clinical partnership, launched in February 2022 between a pediatric health system and a public R1 Nursing School, designed to strengthen pediatric research capacity through collaborative engagement of nurse scientists and clinical nurses. This partnership focused on two primary aims: 1) advancing pediatric outcomes via innovative pain research, and 2) expanding research opportunities by providing nurse faculty with access to research sites, diverse pediatric populations, and interdisciplinary clinical collaborators. This partnership emphasizes the mutual benefit of capacity-building efforts, elevating research competencies and infrastructure within both the practice and academic settings and fostering a sustainable culture of clinical inquiry and evidence-based innovation.

Methods/Approach: To build research capacity, the chief nurse executive and director for nursing excellence collaboratively developed a formal research affiliation agreement with the School of Nursing’s dean and director of research. This agreement aimed to streamline the partnerships' shared vision, strategic goals, and facilitate operational alignment. Directors of research from both institutions held strategic meetings to identify immediate opportunities and infrastructure requirements. At the clinical site, efforts centered on creating research credentialing, overseeing PhD students' activities, and onboarding federally funded projects. At the University, infrastructure priorities included aligning PhD students to relevant studies, financial support at clinical sites, and formalizing funding agreements.

Results: Over four years, the partnership launched four research studies, one with internal funding and three federally funded studies. Twelve clinical nurses from the healthcare system have served as site primary or co-investigators, and three PhD students and two nursing faculty were credentialed and integrated into research processes at the clinical site. Three nursing faculty advanced their research programs through direct collaboration. The partnership secured a total of $98,761 in research funding, with an additional $75,000 committed for 2026. As recruitment efforts increase, ongoing evaluation will track dissemination efforts and improvements in pediatric pain outcomes.

Implications for Practice: By actively engaging nurse leaders in the development and implementation of collaborative strategies, the initiative demonstrated how leadership principles of a shared vision, mentoring, and strategic alignment, can drive successful academic-clinical partnerships. A collaborative partnership evolves over time and advances the capability and capacity to accelerate new nursing knowledge and innovation, yielding a new pathway for chief nursing officers and nursing school deans to realize the full research potential of the faculty and practicing nurses.

Professional Identity and Global Leadership Partnerships with International Ambassadors: A Focus Group

Kimberley Crawford, Jihane Franjieh, Kay Kennedy, Edmund Walsh, Cindy Zellefrow, Mary Dolansky

Problem Understanding the desire for international nurses’ engagement in leadership roles across academia, practice, research, and professional development is crucial to developing partnerships to advance leadership education, practice, and research. Nurse leaders from the Association for Leadership Science in Nursing (ALSN) sought to explore nursing leadership practices and insights from other countries and to identify both the opportunities available and the desired opportunities for future collaboration.

Purpose:

We conducted a focus group to inquire about leadership aspirations across multiple countries and to explore ways to increase collaboration in ALSN to advance nursing leadership science through education, practice, and research. The research questions Three research questions were asked: What are the issues in leadership that you face in your country around nursing leadership in education, practice, and research? What are some mutually beneficial collaboration opportunities in leadership, education, research, and practice that we can partner with? Finally, what types of content and experiences would be valuable for you in a webinar format?

Methods:

Participants were recruited via email from the list of 11 International Ambassadors for ALSN. Each represented a different country outside the United States. Participants were divided into two groups to ensure that everyone had time to speak during the 75-minute meeting. Each group had two facilitators, and the focus groups were conducted simultaneously on two different Zoom calls. Transcripts were provided via Zoom and then checked for accuracy and deidentified. Then, a thematic analysis (Braun & Clarke, 2006) was conducted by the four nurse leaders who conducted the groups, using a six-phase framework: familiarization with the data, generating initial codes, searching for themes, reviewing themes, defining and naming themes, and producing the report.

Results:

Seven ambassadors participated in the focus groups. Each participant represented one of the following countries: Canada, Italy, Lebanon, the Philippines, Thailand, Taiwan, and the Czech Republic. Four themes emerged:

1. Leadership competency Development is widely prioritized but conceptually undefined,
2. Workforce, structural, and contextual constraints limit leadership research capacity,
3. Global collaboration is needed to advance leadership frameworks, and
4. Leadership as a driver of professional identity and recognition in nursing. These themes provide a background to global leadership collaboration, which will be addressed to ensure successful partnerships. A second focus group will be conducted to highlight motivation, benefits, and resources needed to partner with ALSN globally.

Use of LiDAR Technology to Mitigate Falls and Falls with Injury

Polly Willis, Roberta Kaplow, Shawane Neptune

Background: Patient falls in hospitals is a significant problem and is the most common adverse event reported. In the United States, up to 1 million falls are reported annually. An average of $14,000 is spent on each fall. Annual cost estimation is as high as $34 billion.8 Falls led to approximately 250,000 injuries and up to 11,000 deaths. Up to 25% of falls result in injury. Since 2019, patient falls has been the leading sentinel event evaluated.

Aim: The purpose of determine if use of LiDAR technology decreases the incidence of falls and falls with injury. Meathods: This study used a descriptive pre- post-comparison design. The following procedures were performed in this study. LiDAR technology was installed in patient rooms to assist with monitoring patients and prevent falls and falls with injury. Nurses were taught how to interpret the information being provided by the LiDAR technology by the company representative or designee. The study investigators monitored the falls and falls with injury from incident reports and sought input from the Falls Improvement Team leaders to identify patients who have sustained a fall or fall with injury during the study period. Incidence rates and number of falls and falls with injury that occurred within the study period (6 months) were evaluated and compared to baseline data.

Results: Following installation of the LiDAR technology, the incidence of falls and falls with injury decreased by 44.4%.

Harnessing Social Media Insights and Team Science for a Digitally Connected Nursing Workforce

Heather Nelson-Brantley, Joy Parchment, Cori Heier, Mary Anne Schultz, Martha Grubaugh, Fred Neis, Christopher Hickman

Nurses’ job decision making is being reshaped by a multigenerational workforce with evolving expectations for work–life balance, digital communication, and employment flexibility. Our national study—the first to examine this issue at scale—revealed that nearly one third of nurses intended to leave their position within one year despite generally high job satisfaction, underscoring a complex workforce landscape. Distinct differences in social media use across age, role, and employment type further highlight the need for nurse leaders to strategically engage on digital platforms to support communication, recruitment, and retention. Yet nursing leadership science has not fully leveraged artificial intelligence to analyze large scale public discourse and translate it into actionable insights. This study addresses that gap through a team science approach integrating nursing leadership researchers and data engineers using mixed methods computational social science to examine nurses’ lived experiences and job decision-making at scale.

The study’s objective was to equip nurse leaders with data driven strategies for connecting with, attracting, and retaining a diverse workforce. Aim 1 involved capturing and characterizing how nurses use social media when making job decisions. Using natural language processing, we extracted and modeled more than one million posts across a three year period, producing, to our knowledge, the first national, unfiltered evidence of workforce sentiment patterns spanning the mid pandemic through post pandemic era. Aim 2, currently underway, builds on these findings to develop an action guide for nurse leaders grounded in the Social Media Engagement framework.

Guided by this framework, we employed large scale digital ethnography, algorithmic text filtering with human in the loop validation to extract and classify posts from Reddit, X, YouTube, Instagram, Facebook, and TikTok. Iterative refinements improved precision in identifying self identified nurses and work related content. Rule based filtering, regular expression logic, and BERT based embedding exploration enabled characterization of themes related to retention, intent to leave, and workplace conditions. Ethical safeguards ensured use of publicly accessible data only, with removal of identifying information.

To date, more than one million posts have been extracted and processed using custom Python pipelines for large scale deduplication, cleaning, and classification. Analyses that would require thousands of hours of human labor are now completed in roughly 40 hours, providing near real time visibility into workforce experiences at unprecedented scale. This work was completed on a modest budget under $10,000 (excluding salaries), demonstrating the feasibility and cost efficiency of AI enabled team science. By integrating nursing leadership and data engineering expertise, the study advances methodological innovation in the field and generates actionable insights unattainable through traditional research approaches.

This presentation will describe these methods, share preliminary thematic findings, and discuss implications for leveraging AI driven, team science approaches to strengthen nurse leader communication, engagement, and workforce stability in a rapidly digitizing healthcare environment.

Faith-Based Community Engagement to Improve Breast Cancer Screening Intentions Among African-American Women Ages 40-50 in Underserved Commu

Zenobia Frazier

Breast cancer remains a leading cause of cancer-related mortality among women in the United States, with African American women experiencing disproportionately higher mortality despite having a lower overall incidence compared with White women. African American women aged 40–50 are also more likely to develop aggressive breast cancer subtypes, including triple-negative breast cancer, making early detection through mammography essential for improving outcomes. Barriers such as limited access to culturally relevant health education, socioeconomic challenges, and mistrust of healthcare systems contribute to disparities in screening utilization and delayed diagnosis.

Faith-based organizations serve as trusted institutions within many African American communities and represent an important setting for nurse leaders to implement culturally responsive health promotion strategies. Leveraging these trusted community networks provides an opportunity to address social determinants of health and improve preventive screening behaviors among underserved populations.

This quality improvement project evaluated the effectiveness of a nurse-led, faith-based breast cancer education intervention designed to increase mammography screening knowledge, beliefs, and screening intention among African American women aged 40–50 in underserved communities of faith. Guided by Pender’s Health Promotion Model and the Health Belief Model, the intervention addressed perceived susceptibility, perceived benefits, and perceived barriers to mammography screening through culturally relevant educational sessions delivered in collaboration with local faith leaders.

A quantitative pre–post design was used to assess changes in participant knowledge, screening beliefs, and intention to obtain a mammogram following the intervention. Results demonstrated clinically significant improvements in breast cancer knowledge and screening beliefs. Screening intention increased by 14% following the intervention, suggesting that culturally relevant education delivered within trusted community settings can positively influence preventive health behaviors.

This project highlights the critical role of nurse leadership in advancing health equity through community-engaged practice and innovative population health strategies. By partnering with faith communities, nurse leaders can leverage trusted relationships to deliver culturally responsive health promotion interventions that address structural barriers to preventive care. Faith-based health initiatives represent a promising and sustainable strategy for improving breast cancer screening participation and reducing disparities in cancer outcomes among underserved populations.

An Exploration of DNP-Prepared Nurses’ Attainment of Leadership Competencies Using a Qualitative Approach

Linda Cole, Lisa Thomas, Karen Fowler, Teresa Welch, Jeannie Corey

The rapid expansion of Doctor of Nursing Practice (DNP) programs has increased expectations for leadership development among DNP-prepared nurses, particularly in alignment with the American Organization for Nursing Leadership (AONL) Nurse Leader Core Competencies. While doctoral education is intended to advance leadership capacity beyond master’s-level preparation, the extent to which DNP graduates perceive exposure to and attainment of these competencies remains unclear. Existing literature suggests that DNP preparation may enhance leadership credibility, systems-level thinking, and quality improvement impact; however, variation in educational approaches and limited national qualitative data reveal persistent gaps in understanding how leadership competencies are developed, translated into practice, and valued by DNP-prepared nurses.

This qualitative descriptive study, grounded in Transformational Leadership theory, explored DNP-prepared nurses’ perceptions of their exposure to and attainment of the AONL Nurse Leader Core Competencies during their DNP education. A purposive national sample of DNP-prepared nurses who graduated within the past one to five years participated in semi-structured, one-on-one virtual interviews guided by the AONL competency framework. Interviews were audio-recorded, transcribed verbatim, and analyzed using Braun and Clarke’s six-phase thematic analysis, incorporating both deductive coding aligned with AONL domains and inductive identification of emergent themes. Methodological rigor was ensured through member checking, peer debriefing, reflexive journaling, and maintenance of an audit trail.

Data analysis is ongoing, with early themes beginning to emerge. Anticipated findings include identification of perceived strengths and gaps in leadership competency development, as well as educational strategies within DNP programs that most effectively support leadership readiness and application in professional practice. These findings are expected to inform academic and practice partnerships, guide refinement of DNP curricula, and strengthen leadership development outcomes across healthcare systems as the population of DNP-prepared nurses continues to grow.

Longitudinal Associations Between RN Agency Staffing and Patient Fall Rates Across U.S. Hospitals, 2019–2024

Melora Ferren

Problem Hospitals have relied on RN agency staffing to stabilize the workforce amid labor volatility. Nurse leaders assume that temporary staffing provides needed capacity without compromising patient safety; however, longitudinal evidence to evaluate this assumption is limited. Patient falls remain among the most frequent and costly hospital adverse events, affecting outcomes. CNOs must balance labor costs, safety, reliability, and workforce strategy; therefore, understanding how agency staffing relates to patient outcomes is essential.

Purpose:

Examine longitudinal associations between RN agency staffing and patient fall rates in inpatient units from 2019–2024. Aims

1. Describe national trends in RN agency use, RN staffing levels, and fall rates.
2. Determine whether RN agency use predicts fall rates after adjusting for staffing intensity and hospital structural characteristics.
3. Assess variation in fall-rates across hospitals and units.

Methods:

A longitudinal secondary analysis was conducted using data from adult medical-surgical and stepdown units participating in NDNQI between 2019-2024. Units were included if they contributed at least one quarter of data per year on fall rates, RN hours per patient day (RNHPPD), and agency RN use. The final sample included 4,291 units from 883 hospitals. The primary predictor was the percentage of RN hours supplied by agency staff. The outcome was falls per 1,000 patient days, winsorized at the 5th and 95th percentiles. Covariates included RNHPPD, bed size, teaching status, and Magnet designation. Linear mixed-effects models were used to estimate associations, with random intercepts for hospitals and units and random slopes for time at the unit level to account for clustering and longitudinal trajectories. Model selection was guided by AIC, BIC, and likelihood ratio tests. A sensitivity analysis was performed using a complete-case subset (n = 2,537 units).

Results:

RN agency use rose from 3.18% to a peak of 12.28% before declining to 8.67% in 2024. Fall rates decreased over the study period (2.56 to 2.47 per 1,000 patient days). Baseline fall rates varied across units and hospitals. Higher RN agency use was associated with significantly higher fall rates (β = 0.004, 95% CI [0.002, 0.005]). Higher RNHPPD was associated with lower fall rates (β = –0.04, 95% CI [–0.049, –0.028]). Magnet hospitals had substantially lower fall rates than non-Magnet hospitals (β = –0.38, 95% CI [–0.472, –0.281]). Fall rates declined over time and findings were consistent in sensitivity analyses.

Although national fall rates improved, greater reliance on agency RNs remained a significant and meaningful predictor of increased fall risk. Workforce composition appears to function as a structural mechanism through which workforce strategy influences patient safety. For CNOs, agency staffing should be monitored as a strategic safety exposure, not solely a labor-cost variable. Leaders should consider:

• integrating agency utilization into safety and workforce dashboards,
• evaluating safety-adjusted returns on staffing investments,
• strengthening onboarding and integration of temporary staff
• using longitudinal staffing–outcome analytics to identify units at highest risk.

This study provides the largest multi-year national evidence to date linking agency use to patient safety outcomes, positioning staffing composition as a measurable and actionable leadership lever.

Implementing an Intercultural Journal Club for Graduate Nursing Leadership Students

Shelly Luger, Helen Ewing, Rebecca Davis, Augustine Ndaimani

Two private universities, one in the Midwestern United States and the other in Rwanda Africa, formed an intentional and reciprocal partnership to collaborate on graduate nursing leadership programing emphasizing global health, leadership, and advanced level nursing. Both institutions offer graduate nursing programs with a leadership focus, and although students are geographically dispersed, they share common goals of degree completion and advancing their professional identity as nurse leaders. These shared aims created an opportunity for structured intercultural dialogue. In response, faculty partners launched a graduate, international, virtual intercultural journal club (JC) in fall 2025 to provide a platform for academic dialogue and cross-cultural exchange among graduate nursing students from both institutions. While journal clubs are frequently incorporated in undergraduate education, there is limited evidence regarding their impact with graduate intercultural nursing students, particularly in virtual, international contexts. The purpose of this project is to describe and evaluate the implementation of this intercultural JC within an international graduate nursing partnership and to explore its influence on leadership development, communication, and sense of global nursing community. Guided by Sigma’s Global Nursing Leadership Competency Framework, three faculty, collaboratively selected articles that integrate nursing leadership and cultural exchange. Bi- monthly virtual sessions were scheduled to align with both academic calendars and account for time zone differences. Invitations were extended to graduate students enrolled in nursing leadership courses, and articles from nursing leadership journals were distributed with structured discussion questions. During sessions, articles and questions served as initial prompts; as students gained confidence, dialogue expanded beyond the literature to topics such as recruitment strategies to manage limited nursing staffing in their respective countries. To date, participation has included up to twenty-six students and faculty participants from the Rwandan and U.S. universities with representation from the United States, Haiti, Ghana, Sierra Leone, Rwanda, Malawi, Nigeria and Liberia. Evaluation data are being collected using a post-session form employing a five-point Likert scale to assess students’ perceptions of dialogue quality, engagement, communication, and overall value of the JC. Descriptive and qualitative analyses of findings from these and subsequent sessions will be completed and available at the time of the conference. Preliminary observations suggest that the intercultural JC may foster intellectual engagement, bridge the research–practice gap, and create a sense of community across borders while providing a flexible, virtual format that reduces geographical barriers. The primary goals are to promote dialogue, enhance community engagement, and develop effective communication across diverse cultural settings, with the expectation that ongoing JCs will catalyze a global network of nurse leaders committed to advancing leadership, scholarship, and impact. Anticipated implications include offering an adaptable model for integrating global leadership competencies into graduate nursing curricula, informing the design of intentional, reciprocal academic partnerships, and contributing to the emerging literature on virtual, intercultural educational strategies in graduate nursing education.

Are Future Nurse Leaders Prepared for Quality Accountability? Findings From a National Survey of Quality Measure Education in U.S. Nursing Programs

Alexis Wells, Danielle Walker

Healthcare systems increasingly rely on quality measures to evaluate performance, guide reimbursement, and improve outcomes in value based care environments. Nurses play a critical role in implementing and influencing these measures at the point of care and are increasingly expected to participate in quality improvement initiatives and performance accountability efforts. Despite these expectations, little is known about how nurses are prepared during professional education to understand and engage with the quality measures that shape healthcare delivery. Quality measure education is not standardized across nursing curricula, and limited preparation may hinder clinicians’ ability to participate fully in quality improvement initiatives or contribute to system level performance goals. This gap between expectations for quality accountability and educational preparation may influence nurses’ readiness to lead quality improvement and patient safety initiatives. Understanding the current landscape of quality measure education in nursing programs is essential to strengthening the leadership capacity of the future nursing workforce and supporting improved healthcare quality and patient outcomes. The purpose of this study was to examine the extent and depth of quality measure education in accredited nursing programs in the United States. Specifically, the study sought to develop and validate a survey instrument capable of assessing curricular coverage of quality measure education and to describe how nursing programs prepare students to understand and engage with quality measures. A multi phase instrument development and national survey design were used. The Quality Education and Standards Training – Preparing for Quality Measure Performance (QUEST PQMP) instrument was developed to assess curricular coverage and depth of quality measure education in nursing programs. Instrument development included expert face validity with quality measure specialists and content validity evaluation with experienced faculty to ensure clarity, relevance, and alignment with curricular practices. Following validation, a cross sectional survey of accredited U.S. nursing programs was conducted. Survey items assessed the presence of quality measure education, types of measures taught, instructional approaches, and cognitive rigor using Hess’s Cognitive Rigor Matrix and Webb’s Depth of Knowledge framework. Descriptive and comparative analyses were used to evaluate responses. Findings revealed notable variability in the presence and depth of quality measure education across nursing programs. Many programs indicated that instruction was limited or inconsistently integrated within the curriculum. When quality measures were included, instruction most often emphasized introductory awareness rather than deeper conceptual understanding of how measures influence clinical decision making, healthcare system performance, and patient outcomes. Few programs reported teaching quality measures at higher levels of cognitive rigor that promote application, analysis, or evaluation. These findings suggest that many nursing graduates may enter practice with limited preparation to engage fully in quality measurement and performance initiatives central to modern healthcare systems. Strengthening quality measure education in nursing curricula may enhance nurses’ readiness to exercise frontline leadership in quality improvement and performance accountability while supporting interdisciplinary collaboration and improved patient outcomes. Findings from this study provide national insight to inform leadership driven strategies for integrating quality measure education into nursing programs and strengthening workforce readiness for healthcare quality improvement.

Integration of Nursing Leadership Rounds in Mobility Improvement Efforts for Pre and Post Liver Transplant Patients

Floricel Guillermo, Melanie Donovan, Jennifer Do, Christine Kiamzon, Edna Sarino

Chronic results of cirrhosis and post-transplant complications affect Length of Stay (LOS) and extensive physical rehabilitation, limiting safe placement when discharged. Metabolic disorders in patients with advanced liver cirrhosis contribute to significant muscle wasting. While pending liver transplantation, patients frequently become physically weaker and deconditioned. After transplantation, patients remain physically hindered. While inpatient rehabilitation has shown to improve patients’ mobility, a trend of patients with low functioning mobility was still evident in our complex population.

To address the problem, many mobility efforts were applied through the years. This approach required a multidisciplinary effort. The 28-bed medical surgical liver transplant unit implemented a gym program in 2014 run by physical and occupational therapists. In addition to a progressive mobility standard of care where nurses drive mobility goals during daily rounds, the multidisciplinary team identifies post-transplant patients who meet criteria to start the gym program. Nursing staff balance clinical care along with getting patients ready for the gym twice a day. In the 24-bed Transplant Surgical Intensive Care Unit (ICU), mobility champions developed a liver service mobility progression pathway based on the Bedside Mobility Assessment Tool (BMAT) levels. Specialty beds were provided, and restorative care assistants (RCA) were employed as adjuncts to nursing care focusing on advancing patient mobility. The literature on change management states that leaders who increase effective communication strategies and visibility are more successful in diffusing best practices. Health care organizations that have been effectively improving quality indicators have leaders who accomplish change by having specific goals to improve communication such as discussing barriers and communicating directly with staff who may encounter barriers to change. We then initiated mobility nursing leadership rounding in partnership with RCAs and frontline ICU staff. It was established that walking rounds once a week with the RCAs would be conducted. The group consists of nursing managers from the liver ICU, liver medical surgical unit, RCAs, and frontline nurses. During rounds, the group would discuss each patient’s mobility status, analyze the next steps to progress mobility, barriers, and determine whether the mobility plan put in place were effective. It also gave us the opportunity to identify patients in advance who may fit the gym criteria when transferred to the floor and patients who are severely debilitated that need more support. In a brief time since leadership rounding in the ICU was integrated in June 2025, we have made a positive impact. Cultivating this initiative resulted in significant drop in ICU LOS and an increase of dispositions to home or rehabilitation facilities. RCAs daily productivity improved from seeing 6-8 patients to 10-12 daily. Frontline nurses are engaged and initiative-taking with patient’s mobility needs. Before rounds, the average ICU LOS for liver transplant patients discharged to rehab was 12 days in Q1-Q2 2025. In Q3-Q4, it is down 62% from 6.2 days. Patients discharged home saw a 37% reduction in ICU LOS, averaging 4.15 days in the last quarter. The gym program remains strong with 4 daily patients.

Empowered by Purpose: Advancing Clinical Nurse Research Through Strategic Vision

Judy Badia, Mariamma Joseph

Problem: A robust nursing research infrastructure is critical for advancing inquiry, supporting nurse led studies, and fostering interdisciplinary collaboration and aligns with the Magnet Model for enhancing evidence-based practice, professional development, and the integration of research into high-quality patient care. Despite education many nurses do not feel prepared to embark on nursing research, Structured programs are challenged by competing priorities, time, work over load, and knowledge.

Purpose:

The purpose of this presentation is to provide a practical roadmap for developing and sustaining a comprehensive nursing research infrastructure that supports the advancement of nursing knowledge and evidence-based practice. The presentation will highlight key structural, organizational, and cultural elements needed to build a strong research environment within healthcare.. Emphasis will be placed on strategies that enable nurses at all levels to engage in research and scholarly activities, including mentorship, leadership support, and dedicated resources. Additionally, the session will explore how interdisciplinary collaboration among nurses, physicians, and allied health professionals can strengthen innovation and accelerate the translation of research into clinical practice. Approaches to fostering professional growth through research training, mentorship, and dissemination opportunities will also be discussed. Overall, the presentation aims to offer scalable strategies that help organizations cultivate a sustainable culture of inquiry and integrate research as a core component of nursing practice and professional development.

Methods:

A structured, multi-phase approach was used to guide the process. First, an organizational assessment was conducted to evaluate existing research capacity, resources, and barriers to nurse-led scholarship. Stakeholder engagement included nursing leadership, clinical nurses, academic partners, and interdisciplinary collaborators to identify priorities and opportunities for growth. Based on the assessment findings, a framework for nursing research infrastructure was developed that incorporated leadership support, mentorship programs, research education, and access to methodological and statistical resources. Key strategies included establishing a nursing research council, creating tiered mentorship models for novice and experienced researchers, and integrating research training and protected time for scholarly activities.

Implementation strategies focused on interdisciplinary collaboration, and providing structured pathways for project development, dissemination, and translation into practice. Program outcomes were evaluated using metrics such as nurse participation in research activities, project development, scholarly dissemination, and integration of findings into clinical practice. Structures and resources to support nurses for external dissemination were also developed. Lessons learned and best practices are presented to inform scalable and sustainable approaches to strengthening nursing research capacity.

Results:

As a result of these infrastructure-building efforts, the Nursing Research Fellowship has demonstrated measurable growth and productivity. The program is currently hosting its third cohort, with a total of 17 fellows enrolled across cohorts to date. Participation in the fellowship has led to a range of scholarly outputs, including five peer-reviewed publications, ten podium presentations, and thirty-six poster presentations at regional and national external conferences. These outcomes reflect increased engagement of clinical nurses in research dissemination and scholarly inquiry. In addition, the organization successfully launched its first Nursing Research Day, designed to showcase ongoing projects, celebrate scholarly achievements, and foster a culture of inquiry across the nursing division.

Breaking the Sitter Cycle: A Smarter Approach to Patient Safety

Kirstie Toussaint

Hospitalized patients aged 65 and older face elevated safety risks from medication effects, increased LOS, altered mental status, and other complications. Traditionally, patient care technicians (PCTs) provide constant bedside observation (CO), straining nursing resources. At our urban academic medical center, clinical teams reported inadequate PCT support due to frequent CO reassignments, consuming hundreds of thousands in premium overtime annually. One PCT was assigned per CO patient—far exceeding staffing standards. Non-pharmacologic interventions were inconsistently implemented, and virtual constant observation (VCO) technology operated at 100% capacity with waitlists, preventing CO downgrading. Unchecked CO drives unsustainable labor costs, erodes staff satisfaction, and limits flexibility. As a NICHE Exemplar and CMS Age-Friendly health system, we embedded evidence-based frameworks—VCO literature, NICHE best practices, and the Age-Friendly 4Ms (What Matters, Medications, Mentation, Mobility)—into a scalable, nurse-driven solution.

PICOT Question: In hospitalized adults requiring observation (P), does a nurse-driven four-tier model incorporating VCO and Age-Friendly 4Ms (I), compared to traditional 1:1 CO (C), reduce CO utilization, premium overtime, and floating hours (O) over eight months (T)?

Objectives:

1. reduce CO through a standardized decision algorithm
2. optimize VCO to free cameras for higher-acuity patients
3. decrease overtime and floating while returning PCTs to direct care; and
4. maintain or improve safety metrics, including fall rates, restraint use, and physician-ordered 1:1 precautions.

Using a Plan-Do-Study-Act (PDSA) framework, an interdisciplinary team sponsored by the VP of Nursing reviewed policies and literature in March 2025, establishing scope across acute, ICU, and adult units. Performance indicators included CO per shift, VCO per shift, premium overtime, and floating hours; balancing metrics included fall rates, restraint use, and adverse events. A four-tier nurse-driven observation decision tree was designed: Level 1 (frequent safety checks), Level 2 (VCO), Level 3 (close-grouped observation), and Level 4 (1:1 CO), with non-pharmacologic interventions—delirium prevention bundles, integrative health, and violence risk care plans—embedded at each level. The 4Ms Framework guided clinical assessment. A phased rollout began in July 2025 across medical-surgical, ICU, and rehabilitation units, including shared governance input, introductory videos, and two months of unit-based training. Nurse administrators conducted 24/7 reassessments every eight hours with bedside RNs and PCTs. A VCO de-escalation protocol freed cameras for higher-acuity patients. In-person CO decreased by 21% and VCO census by 17%, freeing cameras for emergency department expansion. Premium overtime declined by 21% from baseline. PCTs returned to direct patient care, and a 0.5% reduction in floating hours improved staff satisfaction and break relief. Hospital-wide fall rates decreased by 6%, with no adverse changes in 1:1 precautions or restraint use. All outcomes were achieved with zero new FTEs or capital investment, demonstrating that standardized protocols and leadership accountability can optimize safety while improving resource use. Nurse administrators developed enhanced leadership competencies through bedside rounds, and staff reported greater confidence selecting observation levels. Next steps include expansion to psychiatry and rehabilitation, EMR alignment, and LOS analysis for subacute patients. This model offers a fiscally responsible, scalable, evidence-based framework for nursing leaders pursuing CMS quality reporting standards.

Strengthening Nursing Leadership Through Positive Practice Environments: Impact of an Intervention Program in Primary Health Care

Vivian Schutz, Soraia Cristina de Abreu Pereira, Eduardo Jose Ferreira dos Santos, Rosilene Alves Ferreira, Cintia Silva Fassarella, Olga Maria Pimenta Lopes Ribeiro

ABSTRACT

Background: Healthy nursing practice environments are increasingly recognized as fundamental for sustaining the nursing workforce, strengthening leadership, and improving patient safety. Evidence consistently demonstrates that supportive work environments contribute to better professional satisfaction, improved teamwork, and enhanced quality of care. Despite this knowledge, many healthcare organizations still struggle to implement structured initiatives aimed at improving the conditions in which nurses practice. Primary health care settings present specific challenges related to workload, coordination of care, and multidisciplinary collaboration. Leadership strategies that actively engage nurses in reflecting on and improving their work environments may represent an effective pathway to strengthen safety culture and organizational performance.

Purpose: This study evaluated the impact of the Program to Promote Positive Nursing Practice Environments (PPAPEP) on nurses’ perceptions of their work environment and attitudes toward patient safety in primary health care units. The objectives were to: assess whether the intervention improved nurses’ perceptions of the nursing practice environment and to examine potential changes in perceptions related to patient safety climate.

Methods: A randomized, controlled, parallel-group clinical trial was conducted in primary health care units in northern Portugal between September 2024 and April 2025. Forty-eight nurses were randomly assigned to either an intervention group (n=24) or a control group (n=24). The intervention consisted of a structured program designed to stimulate reflection, discussion, and learning about the characteristics of positive nursing practice environments. The program included six weekly sessions that addressed key dimensions such as leadership support, professional participation, communication processes, and organizational factors influencing nursing practice. Data were collected at baseline, immediately after the intervention, and at a three-month follow-up. Two validated instruments were used to assess

outcomes: the Scale for the Environments Evaluation of Professional Nursing Practice – Shortened Version (SEE-NP) and the Safety Attitudes Questionnaire – Short Form (SAQ-SF). Statistical analyses included descriptive statistics, group comparisons, and repeated measures analysis to evaluate changes over time.

Outcomes and Implications: Nurses who participated in the program reported improvements in their perceptions of the nursing practice environment, particularly in dimensions related to organizational support, teamwork, and communication. Although improvements were observed immediately after the intervention, a slight decline was noted at follow-up, suggesting that sustained organizational commitment may be necessary to maintain long-term change. No statistically significant differences were found in patient safety attitudes between groups. However, consistent positive associations were observed between perceptions of the work environment and safety climate measures across all time points. The PPAPEP program demonstrated potential to improve nurses’ perceptions of their practice environments in primary health care. Findings reinforce the close relationship between supportive work environments and safety culture. For nursing leaders, targeted organizational interventions may represent a promising strategy to strengthen practice environments, support workforce well-being, and promote safer care delivery.

Learning Objectives:

• Explain the relationship between nursing practice environments and patient safety culture in primary health care settings.
• Describe leadership strategies and organizational interventions that can support the development of positive nursing practice environments.

Elevating Nursing Practice Through EHR Order Set Standardization: A Governance-Driven Quality Initiative

Donna Wellbaum, Stesha Selsky, Ida Anderson

Here's a single cohesive 500-word abstract narrative:

At UCLA Health, a five-hospital academic health system with 290 outpatient locations, a review of CareConnect (Epic) order sets revealed a problem many health systems recognize but few formally address. Over time, nursing order sets had accumulated duplicate orders, out-of-scope directives, and task structures never designed to carry clinical accountability. Without governance criteria to distinguish clinically necessary EHR support from tasks that displace professional judgment, the EHR quietly shifted from a tool that supports nursing practice to one that defines it. The implicit message to nurses became: if it isn't in the EHR, it doesn't need to happen. Standard nursing care items outside the task queue were at risk of not being completed, compromising patient safety and undermining professional practice. This pattern does not emerge through any single decision but develops gradually and without intent, making it particularly difficult to detect and address without a deliberate governance response. The evidence base supporting this work is grounded in nursing informatics literature consistently linking EHR cognitive burden to reduced nurse autonomy, diminished documentation quality, and erosion of clinical reasoning visibility in the medical record. Magnet standards further reinforce that EHR configuration should reflect and amplify nursing's professional contribution rather than obscure it. Despite this evidence, published EHR governance frameworks rarely address the professional practice implications of nursing order architecture at a systemic level. UCLA Health's response was both structural and philosophical. A formal Orders Management Workgroup was established under Nursing Informatics and Professional Governance, convening monthly with clinical content leads, EHR build teams, operational nursing leaders, and CNS subject matter experts. Using A3 methodology, root cause analysis confirmed that the absence of consistent criteria for EHR task creation had gradually transferred accountability for routine nursing care from the nurse to the system. The team codified guiding principles to address this directly: that standards of nursing care belong in clinical guidelines and protocols, not individual EHR orders, and that EHR tasks should be reserved for safety-critical workflows rather than serving as reminders for foundational practice that nurses are educated, licensed, and accountable to perform. This distinction between tasks that add genuine clinical value and those that substitute for nursing competency represents the innovative core of this initiative. The initiative is currently underway with outcomes tracking in progress, including number of orders retired or reclassified, nurse workflow impact feedback, and documentation quality indicators. Sustainability is embedded through ongoing Professional Governance review, standard operating procedures for future nursing order development, and integration into nursing orientation and continuing education. Nurse leaders attending this session will leave with a replicable governance framework for evaluating nursing orders against scope of practice criteria, guiding principles for determining when EHR task support is appropriate, and a workgroup structure applicable regardless of health system size. This work offers a principled, sustainable alternative to reactive order set cleanup and is relevant to any organization striving to ensure the EHR remains a tool that elevates, rather than replaces, professional nursing practice.

NARRATE Together: An Evidence-based Story-Telling Intervention to Promote Certified Nursing Assistant’s Work Engagement with Nurse Leaders.

Cheryl Bradas, Joyce J. Fitzpatrick, Mary A. Dolansky, Charissa Duffy, Michael Lehtonen, Sineenat Waraphok

Background:

Due to the increasing number of older Americans, the demand for long-term care is on the rise. However, the high rate of clinician burnout and subsequent turnover is a significant problem, with around 44% of nursing homes experiencing moderate staffing shortages and 32% experiencing high shortages, limiting resident accessibility to long-term care for those in greatest need. Unfortunately, there is a relative dearth of evidence-based interventions that have effectively addressed the organizational and individual-level factors that impact burnout in long-term care facilities. The NARRATE (Nurturing Multi-Level Adaptation through Reflection, Resilience, And Team Engagement) intervention is designed to enhance relational partnerships between frontline nursing staff and organizational leaders. Narrative nursing, a form of storytelling and reflection, allows frontline caregivers and organizational leaders to share experiences and lessons learned, strengthening collective values and goals.

Purpose:

To describe context-specific factors that contribute to burnout in a long-term care setting and refine NARRATE for front-line caregivers and organizational leaders.

Specific Aims:

1.To identify and adapt the key components for the NARRATE intervention and to address individual and organizational-level factors that contribute to clinician burnout in a long-term care setting. 2.Explore the most effective approach to delivering the NARRATE intervention to clinicians in a long-term care setting. 3.Understand how organizational leaders can leverage the NARRATE intervention to drive positive organizational transformation to address the individual and organizational level factors that influence clinician burnout in a long-term care setting.

Methods:

The project was conducted at a long-term care facility that had not implemented any formal organizational interventions to address clinician burnout. Letters of support were obtained from the CNO, the Executive Director, and the CEO/President. Data collection involved audio-recording interviews followed by verbatim transcription of the recordings. Data were managed and analyzed using NVivo 15. Thematic analysis, guided by Braun and Clarke’s framework, was performed to identify patterns, themes, and variations in participants’ responses. Preliminary findings were shared with participants to validate interpretations and ensure that their perspectives were accurately represented in the analysis.

Results:

19 CNAs and 6 Nurse Leaders completed interviews. Key findings revealed four primary themes. Theme 1: Staff turnover: challenges and existing supportive responses; Theme 2: Factors contributing to the pre-implementation of NARRATE success; Theme 3: Challenges to the pre-implementation of NARRATE; and Theme 4: Ways to improve the applicability of NARRATE in this setting. Across both groups, main themes were similar, while some variation was observed in categories and subcategories. Overall, the most appealing component across groups was storytelling. Findings provided valuable insights into the complex interplay of individual and organizational factors contributing to nurse burnout in the long-term care facility. The participatory engagement of frontline providers and organizational leaders in refining NARRATE enabled the project team to address potential barriers and other impediments that may affect the acceptability, feasibility, and efficacy of the proposed multi-level intervention. Future work includes a pilot study comparing a long-term care unit implementing NARRATE, with a unit that has not.

: Human Centered Leadership in Healthcare and Its Influence on Nurse Leader Well Being, Leadership Practice, and Workforce Outcomes: A Longitudinal Mixed Methods Study

Jessica Phillips, Kelley Anderson, Lucy Leclerc, Kimberly Lewis, Araceli Nunez, Xiaoqian (Jane) Liu, Leslie Hualde

Nurse leaders face escalating workforce instability driven by staffing shortages, rising patient acuity, and sustained performance pressures. Burnout and turnover intention among nurses and nurse leaders threaten organizational stability and patient outcomes, yet empirical evaluation of nursing derived, relational leadership frameworks remains limited. This prospective, longitudinal mixed methods study examined the influence of the Human Centered Leadership in Healthcare (HCL HC) Essentials Program on nurse leaders’ leadership behaviors, professional quality of life, and turnover intention, as well as corresponding outcomes among their direct reports. Specific aims were to examine changes in leadership behaviors, professional quality of life, retention, and turnover intention among nurse leaders and direct reports and to describe nurse leaders’ experiences integrating HCL HC principles into practice. The study was conducted at a large, multisite academic medical center using a quasi experimental pretest–posttest design. Quantitative data were collected at baseline, post intervention, and at 6 and 12 month follow up from 37 nurse leaders and 41 direct reports using validated measures of leadership behaviors (HCL HC Assessment), professional quality of life (ProQOL 5), and turnover intention (TIS 6). Quantitative analyses included descriptive statistics and paired comparisons; qualitative data were generated through appreciative inquiry and analyzed thematically. Across most outcomes, leadership behaviors, professional quality of life, and turnover intention remained stable over time for both groups. Nurse leaders demonstrated consistently low to moderate turnover intention and a near significant reduction in burnout. Among direct reports, a statistically significant improvement was observed in the HCL HC Upholder domain, reflecting enhanced perceptions of ethical, values aligned leadership. Findings suggest that in complex, real world healthcare settings, leadership development may be reflected not only in measurable improvement but also in stabilization of key workforce indicators. Relational, nursing derived leadership frameworks such as HCL HC may support ethical leadership practice and leader well being and warrant further multisite investigation to advance leadership science in nursing.

The Relationships Between Clinical Education Resource Nurse Utilization, Psychological Capital and Perceptions of Conditions of Work Effectiveness in First Year Nurses

Martha Grubaugh, Maureen Varty, Megan Coe, Jamie Cox

Background: The academic-practice gap for newly licensed nurses (NLN) continues to widen due to increasing patient complexity and time needed to achieve clinical competence. NLNs face numerous challenges upon entry into practice, and they experience transition shock which can last beyond their first year of practice. NLNs commonly still feel unsure of their ability to practice independently after orientations and formal nurse residency programs. Additional interventions are needed beyond residency programs to foster confidence, retention, and job satisfaction for this important faction of the nursing workforce The Clinical Education Resource Nurse (CERN) role was developed to provide intra-shift support for NLNs during their first year of practice, offering real-time education, mentorship and overall moral support, ensuring advocacy for both NLNs and their patients. CERNs are experienced nurses who are hired to work 12-hour shifts and staff shifts with less resources (i.e., night shifts and weekends). They aim to create an environment that ensures NLNs have consistent educational resources, real-time decision support, and guidance on navigating difficult or new clinical situations.

Purpose: The purpose of this study was to test Laschinger’s Expanded Workplace Empowerment Model by proposing that the CERN role increases NLN’s access to resources and support. By having access to CERNs for guidance, NLNs may have increased psychological capital (PsyCap), improved perceptions of conditions for workplace effectives (PCWE), and ultimately, increased job satisfaction. PsyCap is a multidimensional concept which refers to an individual’s level of belief that they can influence their own well-being. PCWE refers to one’s beliefs on how well their work environment supports them to be successful. To date, no research has directly examined how the CERN role relates to important NLN workforce outcomes. If there is a positive relationship between how often NLNs utilize CERNS, PsyCap, PCWE, and job satisfaction, then it would emphasize the need to focus more research on the CERN roles.

Methods: A cross-sectional survey of NLNs during their first 8-12 months of practice was administered at a large hospital across 17 acute care units after receiving Institutional Review Board approval. The Psychological Capital Questionnaire and the Conditions for Work Effectiveness Questionnaire were used to measure PsyCap and PCWE, respectively. Job satisfaction was measured using a single item. CERN utilization was measured by calculating a proportion for shifts where a NLN requested CERN support during the first 12 months of their role. CERN routinely document all NLN requests for CERN assistance and NLN names requesting support. Descriptive statistics and linear regressions will be used to analyze the data.

Results: Data collection and analysis is ongoing, with expected completion by the conference date.

Conclusions: Currently, there is a lack of research about intra-shift support roles such as CERNs. If a correlation does exist between CERN utilization and important NLN outcomes, it would support further interventional research to examine the return on investment of this role. Future research could provide insight into whether the CERNs should be implemented as a part of transition to practice programs and could provide support beyond the first year.

Building Safety: A Pyramid Approach to Falls Prevention

Felcy Tauro, Ezra Hoover

Purpose: To decrease the incidence of patient falls with injury to below the benchmark using an innovative falls prevention pyramid.

Background: Patient falls with injury are a significant concern in hospitals due to their impact on patient safety, costs, and quality of care. Falls also have an emotional and psychological impact on patients. Patient falls are the second most common cause of death related to accidental injury. Falls can also cause reduced mobility, and increased costs. Injuries include fractures and head

injuries, which can be life-threatening.

Methods: A pre-post-intervention design was used. A 3-step pyramid was developed. Steps

included patient assessment of risk using an evidence-based program, staff education, and implementation of evidence-based prevention strategies. Staff were taught how to perform an accurate assessment of fall risk using all the required components of the program. Education on fall risk management occurred twice daily during staff huddles. Fall prevention audit tips were posted on the unit huddle board. Prevention strategies included use of signage in each patient room, bed alarms, and floor mats for moderate-and high-risk patients. Falls champions conducted audits to evaluate adherence with the bundle elements.

Results: In Quarter 1, 2023, a complex medical cardiac unit had an incidence of 1.01 falls with injury per 1000 patient days, which was above our target. Following implementation of the fall prevention pyramid, our unit has outperformed the benchmark the subsequent eight quarters. In the past four of eight quarters, there were no falls with injury on our unit. Further, our unit had a 64.3% reduction in overall falls (without injury) since implementation of the fall pyramid.

Conclusions: Our recommendations extend beyond the fall prevention bundle. Ongoing support, communication, and collaboration are necessary to ensure a culture of safety.

Reframing Women's Perceptions of Advanced Cardiovascular Therapy: Integrating George Kelly's Personal Construct Theory and Jean Watson's Human Caring Science

Dr. Vanessa Pugh

Problem and Purpose: The problem addressed in the study was that despite advances in therapy for cardiovascular disease, women were not benefiting from advanced therapies for their cardiovascular disease when compared to their male counterparts. Women are not taking advantage of advanced therapies such as LVADs, implantable biventricular devices, cardiac resynchronization devices, heart transplants, coronary artery bypass grafts, and heart valve replacements. In addition, women were also less likely to receive cardiac resynchronization therapy, which uses a biventricular pacemaker or an implantable cardioverter defibrillator, and when compared to men, women are three times less likely to receive a defibrillator. The study sought to answer what are the perceptions of women who chose a conservative therapy instead of an advanced therapy for their cardiac disease? For nursing leaders, the study addressed the lack of processes and policies in place to help decrease health care disparity, decrease health care costs, reduce morbidity, disability, and mortality, and improve outcomes for women with cardiovascular disease. Design and Method: George Kelly’s Personal Construct Theory and Jean Watson’s Theory of Human Caring served as the theoretical framework. George Kelly’s theory explains how perceptions shape decisions, and Jean Watson’s theory enables nurse leaders to create a supportive practice environment that ensures high-quality, empathetic care to support women in their decision-making. The data analysis plan included semi-structured interviews with open-ended interview questions. NVIVO software was used for transcription in addition to manual transcription and coding of the transcripts. 20 participants, aged 18 and older, were recruited using social media platforms and the snowballing technique. Inclusion criteria were women diagnosed with a cardiovascular disease. There was no specific inclusion or exclusion of ethnic or racial groups. Exclusion criteria were women with genetic heart defects because care is typically structured for these patients.

Results: Three primary themes emerged: perceptions of conservative therapy, perceptions of advanced therapy, and experiences influencing treatment perceptions. Guided by George Kelly’s theory, the findings suggest that women’s perceptions of their illness and treatment options significantly influenced decision-making. Despite worsening symptoms, many women continued to choose conservative therapy, and advanced therapies were not recommended by clinicians, contributing to poorer outcomes. Financial barriers, lack of insurance, and limited caregiver support were key factors influencing decisions. Participants perceived advanced therapies as unaffordable and impractical, reinforcing conservative choices. Perceived socioeconomic bias and limited access to care further contributed to delays in treatment. Patient–provider relationships played a critical role; inadequate communication and lack of education regarding disease and treatment options reduced the likelihood of pursuing advanced therapies. Emotional responses, including fear and anxiety, also influenced decisions. These findings contribute to nursing leadership by highlighting the impact of patient perceptions and social determinants on treatment disparities. Implications for nursing leadership include promoting equitable access, improving communication, and supporting timely referrals. Leadership education should emphasize health equity and patient-centered communication, while future research should focus on interventions to reduce disparities in advanced cardiovascular therapy utilization.

The Role “Sense of Belonging” Plays in the Recruitment and Retention of Millennial and Gen Z Nursing Staff: Implications for Nurse Leaders.

Todd Tussing, Brett Hagenbuch, Hunter Jefferis, Nechelle Marlowe, Jacalyn Buck

Today’s health care organizations are experiencing high staff turnover and large volume of vacancies of nursing positions. Two generations are in the retirement range (Baby Boomers and Gen X) leaving the Millennials and Gen Z generations to fill the gap. Nurse Leaders must understand the generational characteristics of these two younger generational cohorts to retain them once they have on-boarded into their teams. One highly valued work characteristic identified for Millennials and Gen Zs is to have a “sense of belonging” within their work environment. Additionally, some literature uses the term “Workplace Spirituality” to refer to a culture which provides a team member a sense of meaningful work, sense of community with coworkers, and alignment with organizational values. Nurse leaders who cultivate an environment to enhance a sense of belonging or workplace spirituality in order recruit and retain Millennials and Gen Z members of their nursing teams. The purpose of this EBP review is to identify and the relationship that a “sense of belonging” has on staff workplace satisfaction and intent to leave and to illuminate interventions nursing leaders can employee to foster such an environment to decrease intent to leave among team members. A search of the evidence was conducted and revealed that a sense of belonging/Workplace Spirituality has a positive effect on work satisfaction and decreases intent to leave. Results of the search revealed that younger generational cohorts (millennials and Gen Z) prefer a work setting that matches their purpose in life and provides them a sense of belonging which translates over to an increase in work satisfaction. Increasing work satisfaction decreases the intent to leave which can impact staffing within nursing teams and patient outcomes. Three critical care units at an AMC incorporated EBP interventions including community-based team projects, off-work social events, cultural themed events, and mentorship for professional development. Post-implementation, results demonstrated a positive effect. Nurse leaders should foster an environment that increases communication, fosters trust, decreases bullying behavior, increases team bonding to increase a sense of Workplace Spirituality to increase retention of nursing staff.

Advancing Nursing Workforce Strategy Through a Tiered Academic Partnership Model

Chris Denman, Caitlin McVey

The persistent imbalance between the supply and demand of registered nurses intensifies pressure on nursing leaders to find innovative solutions to strengthen the nursing workforce and reduce new graduate nurses’ (NGNs) time to independent practice. Academic nursing programs rely on clinical placements to develop students’ nursing skills and application of knowledge. While this model satisfies academic requirements, many NGNs still report feeling unprepared to independently deliver safe and effective patient care. Nurse residency programs help ease this transition, yet evidence shows they do not fully meet NGNs’ needs nor consistently reduce first‑year turnover. These challenges underscore the need for more strategically aligned academic–practice partnerships.

Nursing leaders at a large not‑for‑profit health system in Southeast Texas closely examined their partnership with over 200 academic programs. This evaluation revealed significant variation in placement processes, administrative inefficiencies, and limited visibility into workforce priorities. The absence of a standardized framework resulted in misalignment between student placements, hiring needs, onboarding processes, and long‑term workforce goals, while also increasing the burden on staff nurses supporting students in clinical settings. Nursing leaders recognized the opportunity to more strategically align workforce goals and develop practice-ready nurses, within a new academic partnership model.

As nursing workforce challenges intensify, health systems and academic partners must collaborate to develop innovative strategies to enhance skill attainment, improve transition to practice, and strengthen the supply of competent, confident nurses. The purpose of this initiative was to create a scalable academic partnership model to enhance strategic alignment between academic nursing programs and hospitals.

To address these challenges, health system nursing leaders collaborated with hiring managers, educators, talent acquisition teams, student placement coordinators, and nursing school deans and program directors to develop the Tiered Academic Partnership Model (TAPM). This evidence-informed model was designed to flexibly support academic institutions of all sizes and aligns with the AACN-AONL guiding principles on academic-practice partnerships. This 3-tiered model defines highly aligned strategic partnerships, enhanced partnerships, and standard academic affiliation agreements. TAPM streamlines the student-to-employee pathway, standardizes placement processes, improves student experience, reduces administrative burden, and creates a more personalized transition to practice for NGNs.

The new TAPM model provides a framework to develop outcomes-driven partnerships, emphasizing clinical readiness, conversion to hire, and return on investment for nursing programs and health systems. Initial outcomes following implementation have been promising. Initial student-to-new-hire conversion rates increased by up to 80%, ranging between 90%-100% for Tier 1 partners and 70%-80% for Tier 2 partners. New graduate RN orientation hours are more personalized and efficient as evidenced by a four-week reduction in orientation time. The model has also supported improved campus coordination, streamlined clinical placement processes, and increased NGN retention rates by 8%. Hiring leaders reported NGNs from Tier 1 partners exhibit better alignment with the hospital culture, familiarity with the hospital policies, and understanding of role expectations. The TAPM offers a scalable, strategic approach for health systems seeking to optimize clinical placements and enhance practice readiness. Ultimately, this model supports a more sustainable workforce while improving satisfaction for both staff and students.

Evaluating the Usability of eTemplates for Enhancing Electronic Documentation Practices in Family Nurse Practitioner Students

Kenadee Canada, Seungman Kim

Electronic health record (EHR) documentation training is essential for advanced practice providers (APPs), as informatics competency is required to effectively use health information technology (HIT) to improve timeliness, communication, and disease surveillance. However, limited training opportunities contribute to EHR usability challenges and increased documentation burden, leading to workflow inefficiencies, errors, delays in care, provider burnout, and increased risk of adverse patient outcomes and organizational financial loss. A gap exists in structured health information technology tools to support clinical documentation training in APP graduate programs, resulting in disrupted learning and reduced readiness for transition to practice. Additionally, limited research exists on the development and utility of electronic documentation tools in advanced practice education. This project addressed the lack of educational resources for electronic documentation during clinical preceptorship among Family Nurse Practitioner (FNP) students at a single public university in Texas. The purpose of this study was to evaluate FNP student perceptions of usability when using eTemplates, a structured electronic documentation tool developed in a SOAP note format, to support learning of documentation practices that influence workflow efficiency and transition-to-practice readiness. The aim was for 50% of participants to achieve mean perceived usefulness (PU) and perceived ease of use (PEOU) scores ≥5.0 on a 7-point Likert scale using the Technology Acceptance Model (TAM1). This study used a program implementation and evaluation design with a pilot feasibility, descriptive approach. Eligible participants were FNP students in their second or final term during clinical preceptorship (September 2025–March 2026). The eTemplates tool and supporting resources were distributed via Google Drive. Data were collected using anonymous Qualtrics pre- and post-surveys. Quantitative data were analyzed using descriptive statistics, and qualitative responses were analyzed using thematic analysis. Primary outcomes included PU and PEOU measured using a modified TAM1 framework. Secondary measures included baseline comfort, response rate, and qualitative feedback. Baseline comfort with electronic documentation (n=7) was moderate (mean = 3.57/5). Six students participated; four completed the post-survey (qualitative n=2). Mean PU (4.58) and PEOU (4.67) exceeded the midpoint, indicating generally favorable usability perceptions. However, variability suggested differences in engagement, and the project aim was not achieved. Qualitative findings indicated the tool supported structured documentation, but some participants perceived it as exceeding learning needs at the time of introduction, reported limited use, and preferred individualized workflows. Implementation was feasible but limited by small sample size, voluntary participation, descriptive analysis, and variable tool use. Earlier introduction, structured orientation, and integration into coursework are recommended to support adoption. eTemplates demonstrate potential to enhance clinical reasoning, standardize documentation, improve informatics competency, and support transition to practice. At the system level, structured documentation tools may improve workflow efficiency, reduce documentation burden, support provider retention, and contribute to cost savings through improved productivity and decreased onboarding and training demands. Overall, eTemplates address a critical gap in advanced practice education with potential for scalability through curriculum integration and formal platform development, future research, and positive global healthcare impact by advancing APP documentation standards that improve training, workforce readiness, patient outcomes, and organizational efficiency.

Measuring What Matters: Leadership Development Outcomes for Executive Nurse Leaders!

Joyce Batcheller, Joy Parchment, Patricia Yoder-Wise

Executive nurse leaders (ENLs), including new and aspiring chief nursing officers, operate amid mounting pressures: cost containment, workforce shortages, well being concerns, and the demand for innovative care models, all against a backdrop of shortened executive tenure and high turnover intent. A targeted executive leadership development program was evaluated using a cross-sectional mixed methods design guided by the CLIR framework (Courage, Learning, Innovation, Relationships) to understand how such preparation influences ENLs’ effectiveness, attitudes, and career trajectories. Following IRB approval, alumni who attended the program from 2014–2022 completed a 54 item online survey consisting of Likert items, demographics, write in questions, and four open-ended questions from April–October 2023. Descriptive statistics were used to summarize quantitative data. For qualitative responses, manual coding and thematic analysis were conducted using a large language model, and all codes and themes were independently validated by the research team to achieve consensus.

Forty four ENLs from urban, rural, and suburban acute care settings across the United States participated; most were White (80%), aged 51–60 (54%), doctoral prepared (63%), and had 7–10 years in role (32%). Post program outcomes were notable: improved C suite communication (75%), strategic plan development (80%), promotions (64%), and expanded responsibilities (60%), with 93% crediting the program for significant leadership growth. Leaders described tangible improvements in executive presence, strategic thinking, and decision making that benefited their teams and organizations. Attitudinal shifts included greater readiness to lead well being and resilience initiatives (>80%), stronger use of purposeful communication (97%), and sustained feelings of respect (95%), value (82%), and organizational engagement (78%).

Persistent challenges remained prominent. Quantitatively and qualitatively, leaders pointed to union dynamics (52% no current activity; 43% concerned about future involvement), financial pressures, workforce instability (recruitment/retention; 24/7 staffing), skill gaps among new graduates, and intensified interdisciplinary tensions. Issues of workplace violence were widespread (73%), most often perpetrated by patients, families, or visitors; DEI concerns persisted, with 34% reporting offensive behaviors, 47% perceived limited inclusivity, and 20% reporting discrimination. Psychological safety and trust surfaced as practical mitigation strategies.

Support and growth behaviors were common: 84% sought mentorship, 43% reported intentional self care and reflective practice, and organizations frequently supported graduate education (64%) and certification (61%). Achievements ranged from promotions and advanced degrees to publications, organizational recognition, induction into a national nursing academy, and visible progress in authentic leadership and boundary setting. A crosswalk with AONL nurse leader core competencies suggested observable program effects in multiple domains, indicating that structured development can strengthen essential executive capabilities.

Together, findings associate ENL specific leadership development with meaningful improvements in strategic capacity, presence, communication, and career progression, while also illuminating persistent system-level pressures that shape leaders’ experiences. Health systems can translate these insights into action by sustaining ENL focused development, formalizing mentorship and protected time for reflection, advancing DEI and violence prevention strategies, and partnering with academia to close readiness gaps. Future research should extend this work through multi site, longitudinal designs that quantify organizational returns (retention, quality, and financial performance) and refine measures of competencies in executive practice.

Exploring Teamwork Between Virtual and Bedside Nurses: A Grounded Theory Study

Caitlin McVey Weinheimer, Carina Katigbak, Eduardo Salas, Maja Djukic

Advancing technologies and the use of telehealth have expanded in hospitals to include telenursing. In hospitals, telenursing offers new opportunities, where virtual nurses serve as an extension of bedside nurses to reduce administrative burdens and support patient care. Telenursing introduces a unique teamwork dynamic where virtual and bedside nurses work together as a remote team to provide patient care. While research has been done on teamwork in healthcare and virtual teamwork outside of healthcare, research on virtual nursing teamwork between bedside and virtual nurses in the hospital setting is limited. Addressing this knowledge gap is critical to ensure positive patient and nursing workforce outcomes in hospital-based telenursing settings.

The primary aim of this study was to develop a grounded theory that explains teamwork between virtual and bedside nurses in the hospital setting. Studying the mechanisms of teamwork integration between virtual and bedside nurses is critical to ensuring positive patient and nursing workforce outcomes in hospital-based telenursing settings.

Researchers used the Constructivist Grounded Theory (CGT) methodology for this study. Participants included virtual nurses, bedside nurses, and nurse leaders who work within a virtual nursing care model to provide care to hospitalized patients in the United States. Participants were recruited using purposive and snowball sampling methods. Participants provided consent and were offered an electronic gift card as an incentive for their participation. The data collection and analysis processes were iterative, and additional theoretical sampling questions were added between interview rounds, in accordance with the CGT methodology. Researchers collected data through one-on-one virtual interviews, which were recorded and transcribed. Sampling continued until thematic saturation was reached across and within categories. The researchers validated the resulting theory against the raw data, existing theoretical frameworks, and with member checking to increase rigor and trustworthiness.

Twenty-two nurses participated in the study. The core category, Bridging Distance in Teamwork, conceptualizes teamwork between virtual and bedside nurses. This theory includes six interrelated categories and 19 properties:

1. Integrating Workflows (aligning technology and workflows, needing shared situational awareness, understanding role context, and leaders championing virtual nursing),
2. Working Interdependently (contributing to workload relief and care quality, being receptive to support, providing a safety net, and adapting),
3. Humanizing (knowing one another, extending grace, and cultivating rapport),
4. Orchestrating Effective Communication (closing communication loops, tailoring communication, and communicating intentionally),
5. Exercising Trust (recognizing clinical credibility and demonstrating reliability over time), and
6. Cultivating Remote Cohesion (actively engaging across roles, expressing mutual respect and appreciation, and holding a shared mindset).

This research fills a gap in the published literature and contributes to nursing knowledge by outlining the theory of bridging distance in teamwork between virtual and bedside nurses. Although many teamwork variables aligned with the published literature, this study identified five new variables critical to bridging the distance in teamwork, including

1. Humanizing,
2. Extending Grace,
3. Being Receptive to Support,
4. Actively Engaging Across Roles, and
5. Expressing Mutual Respect and Appreciation.

Applied Shared Decision Approach to Implement CDC CAUTI Guidelines To Achieve Zero Harm In Liver Transplant Surgical Unit

Christine Kiamzon, Erin Colantuono, Floricel Guillermo, Edna Sarino

Catheter Associated Urinary Tract Infections (CAUTIs) remain a significant concern in healthcare, worsening length of stay, morbidity and mortality and financial consequences. An estimated 70% of CAUTIs are preventable, yet one of the most frequently reported hospital acquired infections (HAIs). Regulatory agencies scrutinize HAIs, withhold reimbursement and promote adoption of strategies for early catheter removal. Indications for indwelling catheter (IDC) use in this unit included urinary retention, accurate urinary output measurement, hematuria and postoperative use of epidurals. Despite best practice guidelines, there remain barriers to early indwelling urinary catheter discontinuation. Enhancing daily nurse rounds and providing nurses and nurse practitioners with leadership driven establishment of a targeted guideline to address these common barriers reduced catheter days and achieved 35 consecutive months of Zero Harm no CAUTI. Ongoing leadership oversight and collaboration resulted in the development of pathway targeted at common indications for catheter use and their barriers to early removal, while fostering shared decision-making amongst nurse and providers.

Strengthening Nurse Leader Dyads and Retention Through Role Clarity, Job Crafting, and AI‑Enhanced Connection Conversations

Kimberly Cross, Lindsay Duphiney, Diana Roth

This mixed‑methods project evaluated two integrated strategies designed to strengthen nurse leader effectiveness and improve workforce stability at an urban academic medical center:

1. a role‑clarity and job‑crafting intervention for Nurse Director (ND)–Assistant Nurse Director (AND) dyads, and
2. standardized, AI‑enhanced Connection Conversations to strengthen leader presence, trust, and retention.

The AND role was introduced in 2023 to reduce turnover and large span of control, but early implementation lacked standardized responsibilities and delegation standards, contributing to role ambiguity and inconsistent dyad functioning. Concurrently, variability across the organization in Connection Conversations, which are routine leader and staff dialogues intended to build connection and identify support needs with staff, limited the leader's dyad impact on engagement and retention.

A role‑clarity toolkit was co‑designed with NDs and ANDs through focus groups and implemented over one month. Pre/post surveys using validated Role Ambiguity and Conflict Scales were administered, and staff engagement, turnover, and patient‑experience metrics were reviewed. In parallel, Lean methods were used to standardize the cadence and structure of Connection Conversations. Leaders used an AI‑enabled scribe to document conversations in real time, populate structured templates, and generate automated follow‑up lists. Summaries were centrally stored, and AI‑driven quarterly thematic analysis identified patterns across units.

Findings demonstrated modest declines in dyad role ambiguity, with meaningful improvements in clarity of responsibilities, communication workflows, and delegation standards. These improvements aligned with upward trends in staff engagement and patient‑experience indicators. Qualitative themes underscored ongoing ambiguity and workflow barriers but highlighted the benefits of improved role delineation, better onboarding, and more structured dyad communication.

Units using AI‑enhanced Connection Conversations experienced a turnover decrease from 6.5% to 3.5%. Staff reported more genuine, personalized interactions, and leaders found the AI tools improved their presence and follow‑through. AI‑generated documentation increased consistency, and automated follow‑up lists strengthened accountability. Quarterly theme reviews surfaced operational challenges and education needs, prompting targeted improvements.

Together, these findings illustrate that integrating formal role delineation with structured, AI‑supported Connection Conversations offers a scalable model for strengthening nursing leadership, elevating staff voice, and enhancing workforce stability in complex healthcare environments.

Authentic Leadership and Turnover Intentions Among Long-Term Care Nurses in Ontario, Canada: A Structural Equation Modeling Study

Edmund Walsh, Carol Wong, Kimberley Jackson, Emily Richard, Joan Finegan

Canada’s aging population is placing increasing pressure on long-term care facilities, with growing demand for beds and RNs and RPNs. These facilities face multiple challenges, including rising resident acuity, staffing shortages, and nurse turnover. Nurse turnover has been associated with negative resident outcomes, including declines in activities of daily living and a higher prevalence of falls. Given recruitment and retention challenges in long-term care, it is important to explore strategies that may help address turnover intentions.

Relational leadership has been identified as a factor influencing outcomes for nurses, patients, and organizations. Authentic leadership has received growing attention in the nursing literature and has been associated with positive work environment and workforce outcomes. However, most research has been conducted in acute care, and little is known about these relationships in long-term care.

The study explored relationships among managers’ authentic leadership, structural empowerment, emotional exhaustion, cynicism, job satisfaction, and turnover intentions in RNs and RPNs working in Ontario long-term care facilities. It was hypothesized that managers’ authentic leadership would be associated with higher structural empowerment, lower emotional exhaustion and cynicism, higher job satisfaction, and lower turnover intentions.

The theoretical framework for this study was authentic leadership theory. A nonexperimental, correlational, cross-sectional survey design was used. Random samples of 1,500 RNs and 1,500 RPNs were drawn from the College of Nurses of Ontario. Inclusion criteria were: RN or RPN licensed in Ontario; employed as a staff nurse in an Ontario long-term care facility; and English proficiency.

Validated instruments included the Authentic Leadership Questionnaire, Conditions for Work Effectiveness Questionnaire–II, Maslach Burnout Inventory, Job Diagnostic Survey, and Measure of Turnover Intentions, along with a demographic questionnaire.

Ethics approval was obtained from the institutional research ethics board. Data were collected through an online survey using email addresses provided by the College. Invitations were sent in November 2025 with reminders after one and two weeks. Participants received a letter of information and consent and could enter a draw to win one of 50 Amazon gift cards.

The sample size was 262 (response rate = 8.85%). SPSS was used for descriptive and inferential analyses. Mplus was used to assess the measurement and structural models using the MLR estimator.

The structural model demonstrated acceptable fit. Managers’ authentic leadership was positively associated with structural empowerment, and structural empowerment was associated with lower emotional exhaustion and cynicism. Emotional exhaustion was associated with higher cynicism. Cynicism was associated with lower job satisfaction, and job satisfaction was associated with lower turnover intentions.

While authentic leadership has been widely studied in nursing over the past 15 years, this study provides early evidence of authentic leadership in long-term care facilities and among RPNs. This contributes to leadership science by extending this work to a setting requiring attention to support a sustainable nursing workforce.

Continued research in this setting is needed to support evidence-informed hiring, training, and evaluation of nurse managers. The findings suggest further research among nurses in long-term care is needed to support the design and testing of authentic leadership development programs.

DNP Projects in Clinical Settings: The need for a new way forward

Rebecca Lash, Jennifer Baird

Problem: The emergence of the Doctor of Nursing Practice (DNP) degree has created a pathway for advanced educational attainment in nursing. The rapid growth of these programs has, however, had downstream effects for clinical settings, which are charged with supporting the development and implementation of DNP students’ scholarly projects. Evidence on this topic continues to coalesce around common themes, including wide variability in the design and scope of these projects and the amount of support available to students as they navigate elements of the project process.1-9 Although evidence is largely descriptive, these papers highlight the unclear return on investment for clinical settings due to accelerated timelines, limited scope, and poor sustainability frequently associated with DNP projects. Our organization has seen similar issues with DNP project rigor and implementation challenges.

Implementation:

The purpose of this quality improvement project was to standardize the DNP student project development process within our pediatric hospital to create clear expectations about the requirements for each student and ensure alignment between project topics and organizational priorities. Using an A3 problem-solving framework and with sponsorship from nursing leaders, the Nurse Scientist and a Professional Development Associate collaborated to redesign the DNP student experience. We gathered key informants, including recent graduates, current students, and project mentors, to understand the current state and envision a future-state process. We created a new DNP student project application and onboarding requirements, established key milestones of the project process, and established a DNP project advisory group to facilitate review/endorsement of project proposals.

Evaluation: DNP students now have a roadmap for project completion, clear expectations about milestones and a project support team. Since launching on July 1, 2024, 95% of DNP students (n= 19) have adhered to the new process. As of March 2026, there are currently 12 active and 8 completed DNP students. However, of the projects completed, only one (5%) has demonstrated a sustainable practice change. As a result of the new process, we have been able to identify substantial issues with the current project process, including a misalignment of incentives between organizations and schools. This misalignment results in projects that lack rigor, are unsustainable or lack utility for the organization as they are frequently too small scale and implemented on unrealistic timelines. We have found that students are not mastering the skills around which curricula are anchored and require substantial organizational support during project implementation. Critically, we have not been able to substantiate that students are better equipped for advanced roles than when they entered the program.

Lessons Learned: Creation of a standardized DNP student project process has enabled our organization to more effectively support students despite significant variability in scholarly project requirements among DNP academic programs. However, the return on investment for the organization to support these projects remains unclear. The next steps of this ongoing work will be to restructure current academic partnerships to ensure the interests of the organization and patient populations are considered, with a vision to create value for both the student and the clinical setting.

Reimagining Discharge Follow‑Up: A Digital Solution That Reduces Calls and Elevates Care

Ashley Holzgraefe, Sarah Richmond

Problem/Background: Effective post‑discharge follow‑up is essential to safe care transitions, patient engagement, and prevention of avoidable readmissions. Despite its importance, traditional nurse‑led discharge follow‑up processes are often inefficient and unsustainable, characterized by low patient answer rates, repeated call attempts, inconsistent outreach, and limited clinical context to guide triage. These challenges contribute to increased nursing workload, decreased staff satisfaction, and missed opportunities to address patient needs early. Nursing leadership is uniquely positioned to lead innovative, data‑driven solutions that improve both patient and staff outcomes.

Purpose:

The purpose of this quality improvement initiative was to evaluate whether Healix—an automated, Epic‑integrated discharge follow‑up survey—could increase patient engagement, reduce unnecessary nursing follow‑up calls, improve preparedness for required outreach, and enhance staff satisfaction.

Methods:

Guided by evidence‑based transition‑of‑care principles and nursing leadership engagement strategies, an interdisciplinary team of nurse leaders, bedside nurses, informatics specialists, and quality partners designed and implemented Healix on a high‑volume medical observation unit. Patients received an automated follow‑up survey via text or email based on documented communication preference. Survey questions addressed symptoms, medication concerns, discharge instruction clarity, and free‑text questions. Results routed into a dedicated Epic report reviewed twice daily by nursing staff to determine the need for follow‑up. Outreach calls were limited to patients reporting worsening symptoms or unresolved concerns. Quality improvement evaluation focused on engagement rates, nursing call volume, types of patient‑reported issues, and staff experience using descriptive analysis.

Results:

From January 19 to February 28, 2026, 105 of 319 discharged patients (32.9%) completed the Healix survey, representing a significant increase compared to the unit’s historical 12.7% Medallia response rate. Of respondents, 83.8% (88/105) did not require follow‑up calls, resulting in a 28% reduction in total nursing call volume. Actionable insights were captured, with 10% of patients reporting medication questions and 10% reporting discharge instruction questions. Staff feedback was unanimously positive; 100% of staff respondents reported increased efficiency, improved preparedness, and greater satisfaction compared to traditional “cold calls.” No workflow disruptions occurred during implementation. Conclusions and Implications: Healix demonstrates a feasible, scalable, and leadership‑driven quality improvement solution that enhances patient engagement while reducing nursing workload. By enabling targeted, data‑informed follow‑up, this initiative supports safer care transitions, improves staff experience, and highlights the critical role of nursing leadership in advancing innovative, sustainable care delivery models.

Nurse Leadership in Action: Implementation of an Innovative Restorative Care Assistant Role to Enhance Progressive Mobility in High-Acuity Liver Transplant Patients

Melanie Donovan, Christine Kiamzon, Jennifer Do

Patients with chronic liver cirrhosis suffer from sarcopenia, frailty and malnutrition due to the sequelae and complications of the disease. Patients with liver failure commonly exhibit muscle atrophy, contractures, severe fluid overload and edema, all of which limit range of motion and strength. Patients before and after transplant have extensive hospitalizations resulting in severe debilitation, resulting long length of stay, significant emotional and psychological impact, and ongoing skilled nursing and rehabilitation care beyond discharge. Between 2010-2015, this liver service ICU and ward noted concerning trends in discharge barriers to the home setting, resulting in an increase length of stay post-transplant, and financial burden of insurance denial for inpatient stay. These challenges resulted in an increase of disposition to long term care facilities and skilled nursing facilities. Significant impacts such as these called for additional resources and protocols focused on progressive mobility in this population. Backed by physician support, nurse leaders added the role of the restorative care assistant as an adjunct to nursing and physical therapy. Nurse leaders designed and developed the goals for the role, a job description, identified required trainings and skill checklists, and established daily workflows to meet the needs of patients in the ward and ICU settings. Additionally, nurse leaders designed the documentation template in the electronic medical record (EMR) and report tools for patient overview. Nurse leaders and RCAs met at regular intervals to evaluate the evolving needs of the patient population, nursing staff, and unit culture as the interdisciplinary team embraced progressive mobility as a common goal. The restorative care assistant role has proven to significantly improved patient outcomes that are invaluable. Since the inception of the RCA role in the inpatient setting, data in 2016-2020 compared to 2021-2024, showed a 56.8% reduction of discharges to skilled nursing facilities and a 56.5% reduction of discharges to long term care facilities. Instead, patients demonstrated increased mobility tolerance to qualify for insurance approvals to acute rehabilitation facilities (ARF), resulting in a 79% increase of discharges to ARF.

Implementation of Ultrasound-Guided Peripheral IV Insertion for Patients with Difficult Intravenous Access

Carla Di Bartolomeo

First-attempt success to start peripheral intravenous (IV) lines can be challenging. At the project site, there was no standardized process to support successful first-attempt IV placement, so an evidence-based solution was pursued. The purpose of this quality improvement project was to determine if the implementation of the Emergency Nurses Association’s (ENA) Clinical Practice Guideline (CPG): Difficult Intravenous Access, screening for difficult IV access and ultrasound-guided IVs, would impact successful first-attempt IV access among adult patients. The project was piloted over 12 weeks in an urban District of Columbia advanced urgent care facility. Ida Jean Orlando’s deliberative nursing process theory and W. Edwards Deming’s plan-do-study-act model provided the scientific foundations. The total sample size was 1522, with n = 1,079 in the comparative group and n = 443 in the implementation group. Data were extracted from the electronic health record and the Comprehensive Difficult Intravenous Access (C-DIVA) screening tool form. A chi-square test demonstrated a statistically significant improvement in first-attempt IV success, X2 (1, N = 1,522) = 55.76, p = .001. Clinical significance was supported by a 19.1% increase in first-attempt success. Based on these results, the implementation of the ENA CPG: Difficult Intravenous Access using ultrasound-guided IV placement may improve first-attempt IV success in this population. Recommendations include continuing the intervention at the project site and disseminating the findings. Keywords: difficult intravenous access, ultrasound-guided IV access, W. Edwards Deming’s plan-do-study-act model, Emergency Nurses Association's Clinical Practice Guideline: Difficult Intravenous Access, Ida Jean Orlando’s deliberative nursing process theory, ultrasound-guided peripheral intravenous insertion, quality improvement.

From Service to Leadership: An Experiential Global Health Model for Developing Nurse Leaders and Advancing Workforce Capacity

Faith Adole

Abstract: Traditional nursing leadership development pathways often emphasize formal education and advancement within healthcare organizations, with limited focus on experiential, mentorship-driven learning. This creates a gap in preparing nurses to develop leadership competencies, professional identity, and adaptability needed to address complex healthcare challenges across diverse settings. Evidence supports experiential learning and mentorship as effective approaches for leadership development; however, structured models integrating these elements within global and community-based contexts remain limited.

This evidence-based practice project describes and evaluates an experiential, mentorship-driven leadership development model embedded within a global health organization. Guided by Experiential Learning Theory and principles of Transformational Leadership, the model engages nurses through clinical outreach, community-based initiatives, and workforce development programs across multiple settings.

Participants enter as volunteer nurses engaged in clinical and community-based care or as volunteer ambassadors and are supported through mentorship, leadership exposure, and progressive responsibility. Leadership opportunities include program coordination, clinical education, community engagement, and international mission leadership. Key stakeholders include nurse participants, organizational leaders, and global health partners. Facilitators include mentorship, real-world application, and leadership encouragement, while barriers include variability in resources and the absence of a formalized leadership curriculum.

Leadership progression was observed among participants. Six nurses advanced from clinical and community-based volunteer roles into formal nursing and programmatic leadership positions, including director-level leadership, clinical education, and international mission leadership. Two participants founded independent nonprofit organizations, and two received national recognition through the DAISY Award for Advancing Health Equity. Sustained engagement was demonstrated, with four of six participants remaining active for three to five years.

Key themes included leadership identity formation, increased professional confidence, and sustained commitment to service. Participants also expanded their professional roles through public speaking, mentorship, and engagement in global health scholarship.

This model demonstrates a promising, scalable approach to nurse leadership development through experiential learning and mentorship. Findings highlight the potential to formalize and replicate this approach to strengthen leadership pipelines, enhance workforce capacity, and advance health equity across global and local healthcare systems.

From Variation to Reliability: Leveraging Quality Improvement Methodologies to Improve Veteran Retinopathy Screening

Leslie DuBois, Susan Diem, Judith Pechacek

Diabetic retinopathy is a leading cause of preventable vision loss, making diabetic eye screening a national priority within the Veterans Health Administration (VHA). Despite quality improvement (QI) efforts, screening rates remain stagnant. In FY25, the national VHA rate reached 77%, with the Minneapolis VA Health Care System (MVAHCS) at 73%. As of March 2026, challenges persist, underscoring the need to shift from attributing gaps to patient behavior toward building high reliability systems.

Led by a Family Nurse Practitioner (FNP) in the Quality Post Doctoral Fellowship, this initiative applies QI methodology and nursing leadership to redesign the diabetic eye exam pathway. Evidence shows that adherence to diabetic eye screening depends on reliable workflows, coordinated access, and well designed systems. These findings support using structured QI tools—such as Ishikawa diagrams, workflow mapping, empathy mapping, and service delivery tables—to identify contributors to missed screenings. Nursing leadership is positioned to guide redesign efforts, strengthen system reliability, and reduce preventable complications.

The overall purpose of this project is to lead a system level redesign that improves diabetic eye exam completion rates. The first phase of this project and aim is to illuminate system contributors using QI methodologies embedded in the Model for Improvement (MFI) and define, measure, analyze, improve, control (DMAIC) framework. Project objectives are:

1. Define the current system state using DMAIC and MFI tools
2. Map multiple access pathways across referral, scheduling, and imaging stages; and
3. Diagnose system contributors to missed screenings.

The first phase employed a multimodal QI approach, including:

• Ishikawa diagramming: Categorized root causes and integrated veteran insights
• Process mapping: Visualized current state of consults, referrals, and imaging
• Empathy mapping: Documented Veteran and employee (hear, say, think, do) to identify friction points
• Service delivery table: Analysis of roles, locations, and services across telehealth and eye clinics

The project involves collaboration with primary care, telehealth, optometry, and ophthalmology stakeholders across the Interdisciplinary Coordinated Care Delivery Model. The long term aim is to shift from fragmented care to a more reliable, standardized, and patient centered system. Implementation will focus on clarifying scheduling pathways, establishing consistent referral processes, and redefined roles across clinical teams.

Analysis of the DMA phase phase indicates that fragmentation—not Veteran non-adherence—is the primary driver of screening gaps. Findings indicate that system redesign is expected to significantly strengthen workflow reliability and increase screening completion rates. By addressing sources of confusion and access barriers, the project aims to reduce missed opportunities and improve screening adherence.

This initiative demonstrates that FNPs, supported by the Quality Post-Doctoral structure, are uniquely positioned to lead interdisciplinary stakeholders in shifting from fragmented care to a reliable, patient-centered system.

Learning Objectives:

1. Describe how QI methodologies identify system level contributors to missed preventive screenings.
2. Explain how leadership can apply QI tools to understand preventive screening gaps.
3. Define critical components of a high reliability system redesign in a complex integrated network.

The Trust and Distrust Pathways: A Leadership Science Model with Implications for Nursing Education and Practice

Lynn Varagona

Interpersonal interactions in nursing education and practice environments shape engagement, performance, and retention, yet the processes through which these interactions influence outcomes remain underexplored. Guided by Affective Events Theory, this qualitative study analyzed longitudinal focus group data from prelicensure nursing students (N = 77) at a large public university in the southeastern United States. Analysis identified two distinct pathways: a Trust Pathway, characterized by positive interactions leading to favorable affective reactions, positive attitudes, increased engagement, and enhanced performance; and a Distrust Pathway, initiated by negative interactions and associated with adverse affective reactions, negative attitudes, and negative affect-driven behaviors (e.g., disengagement, incivility), ultimately resulting in diminished performance. Findings highlight how early interpersonal events function as critical inflection points that shape attitudes and behaviors over time. The resulting Trust and Distrust Pathway models provide a theoretically grounded framework for understanding relational dynamics in nursing and offer actionable insights for educators, leaders, and researchers to strengthen engagement, improve performance, and foster healthier work environments.

Adjunct Pain Treatment with Music Listening to Impact Post-operative Pain

Lyn Merritt

Postoperative pain remains a persistent challenge among adult surgical patients and may contribute to delayed recovery and increased reliance on pharmacologic management. At the project site, no standardized process existed for implementing adjunct nonpharmacologic interventions to improve postoperative pain outcomes, so an evidence-based solution was sought. The purpose of this quality improvement project was to determine if the implementation of the American Music Therapy Association's Music Listening Guidelines, specifically Appendix C: Music Listening Frequency & Delivery, would impact postoperative pain scores among adult patients. The project was piloted over an eight-week period in a rural community hospital in Minnesota. Jean Watson’s theory of human caring and John Kotter’s 8-step change model provided the scientific underpinnings for the project. Data were collected from the electronic health record on a total sample of 156 patients measured at baseline and post-implementation. A paired-samples t-test demonstrated a statistically significant reduction in pain scores, t (156) = 8.71, p = .001. Clinical significance was supported by a 39% reduction in reported pain levels. Based on the results, the implementation of the American Music Therapy Association's Music Listening Guidelines may impact postoperative pain scores among adult patients. Recommendations include continuing the intervention at the project site, expanding the project implementation to similar sites, and disseminating the findings. Keywords: Postoperative pain, American Music Therapy Association, Appendix C: Music Listening Frequency & Delivery, non-pharmacological intervention, perioperative care, pain management, Jean Watson's theory of human caring, John Kotter’s 8-step change model, surgical patients.

From Moral Distress to Moral Resilience: Preparing the Nursing Workforce Through Early Intervention

Lynn Varagona

Moral distress is widely documented among practicing nurses and is associated with burnout, job dissatisfaction, compromised performance, and poorer patient outcomes. Emerging evidence indicates that moral distress begins during prelicensure education, where students encounter ethical challenges shaped by power imbalances, limited decision-making experience, and fear of repercussions. These early experiences occur during a critical period of professional identity formation and may influence long-term workforce outcomes. Guided by an integrative review methodology, this study synthesized evidence on interventions designed to address moral distress among nursing students. A systematic search of multiple databases and AI-assisted platforms identified five eligible studies published between 2014 and 2024. Study quality was appraised using the Johns Hopkins Evidence-Based Practice tool, and data were analyzed using Braun and Clarke’s thematic analysis process. Interventions included simulation-based learning, structured ethics education, reflective dialogue, instructor facilitation, and self-compassion training. Across studies, interventions were associated with improvements in moral sensitivity, ethical reasoning, emotional regulation, and indicators of moral resilience. Instructor support emerged as a central mechanism, fostering psychological safety and enabling deeper ethical reflection, while active learner engagement strengthened moral agency. Findings suggest that interventions addressing both ethical competence and emotional capacity may help mitigate the effects of moral distress during professional formation. For nurse leaders, these findings highlight the importance of moving from reactive approaches that address moral distress after workforce entry to proactive, developmentally informed strategies embedded in prelicensure education. Early intervention may help prepare a more resilient nursing workforce and contribute to improved engagement, reduced burnout, and enhanced retention.

Artificial Intelligence as a Novice Nurse: A Leadership Analogy for Safe Clinical AI Integration

Asiah Ruffin

Clinical artificial intelligence (AI) technologies are increasingly embedded in healthcare environments, influencing clinical decision-making, workflow processes, and patient safety. As adoption accelerates, nurse leaders are expected to oversee technologies that introduce new forms of operational complexity and risk. However, many healthcare organizations lack accessible conceptual approaches that help leaders understand the ongoing oversight responsibilities required for safe AI integration.

The purpose of this abstract is to introduce a leadership-oriented analogy that compares the integration of clinical AI systems to the development of novice nurses into practice, supporting nurse leaders in understanding the ongoing oversight, monitoring, and adaptation required for safe AI implementation in healthcare environments.

This abstract introduces a leadership-oriented analogy that compares stages of nursing professional development with key processes in clinical AI system management. Foundational stages of nursing professional development ( i.e. orientation, preceptorship, supervision, performance review, remediation, competency, and continuing education) were conceptually compared to parallel processes in AI system training (i.e. validation, deployment oversight, monitoring, retraining, calibration, and updating). The analogy was developed to translate technical AI lifecycle concepts into clinically meaningful language for nurse leaders.

The analogy illustrates how both novice clinicians and AI systems require structured supervision, ongoing evaluation, and adaptation to maintain safe performance. Several risks associated with treating AI systems as autonomous experts were identified, including workflow disruption, automation bias, model drift, and workforce uncertainty. The comparison highlights the importance of sustained oversight rather than reliance on initial system readiness.

Learning from Newly Licensed Nurses’ Experience: Best Practices for Developing Professional Confidence

Andrea Schuermann, Victoria Loerzel

New graduate nurses (NGNs) constitute a large share of the nursing workforce but face high risks of turnover, stress, and burnout. As novices with limited experience, they struggle to navigate complex healthcare systems. Understanding how NGNs build professional confidence by integrating knowledge, skills, and abilities could help develop more effective support strategies. Professionally confident nurses are essential for sustaining the workforce and thriving in today's healthcare environment. The purpose of this dissertation is to explore professional confidence among newly licensed nurses. An exploratory qualitative study was conducted with 10 newly licensed nurses in the United States with less than 2 years of nursing experience. Semi-structured individual virtual interviews were conducted via an electronic platform and recorded. Interviews were analyzed using inductive content analysis. Findings revealed that the transition-to-practice process and practice-gap experiences form the foundation for developing professional confidence. Five themes emerged: peer support, preceptor engagement, experiences with nurse leaders, work environment, and personal factors. Newly licensed registered nurses described their professional growth and the factors influencing their professional confidence. Healthcare organizations aiming to reduce turnover will need to rely on evidence-based strategies and research to improve patient outcomes. Developing professional confidence is likely crucial for fostering competent nurses capable of providing effective patient care.

Piloting Ambient Listening Technology to Enhance Nursing Workflows in Medical Surgical Units

Monique Bouvier, Roberta Kaplow

The modest improvements in the workload dimensions highlight that the psychological relief provided by AI may be just as vital as the time saved. While manual documentation "clicks" and "minutes" decreased, the rise in patient satisfaction suggests that removing the digital barrier allows for more meaningful nursing presence. Key lessons include the necessity of iterative feedback loops and the value of simulation-based training to flatten the learning curve for emerging AI technologies. The purpose of this project was to determine if implementing ambient listening technology for nursing documentation would improve nursing documentation practices. A large academic health system deployed ambient listening for nursing documentation, which was called "Caring Out Loud", on two medical-surgical units. Grounded in principles of human-centered design and iterative Plan-Do-Study-Act (PDSA) cycles, several sessions were held with nurses to educate and understand how to implement this platform into their workflow. It was determined from the introductory sessions that the nurses would benefit from a local simulation lab to have hands-on training with the new nursing documentation method before go-live. These sessions included patient and family advisors to refine capture skills and feedback loops to integrate the technology seamlessly into existing nursing care delivery. System-level leaders led the simulation sessions, and all the registered nurses (RNs) and patient care technicians (PCTs) were required to complete at least four simulation sessions. A pre/post implementation usability survey was created to assess perceived workload and ease of use. Over 85% of the RNs and PCTs have used the ambient listening technology more than once, with more than 17000 recordings over the past three months. Comparative pre/post-implementation surveys showed modest improvements in usability and meeting clinician needs. Most notably, the "mental demand" dimension of workload improved by 1.3 points. Post-implementation data confirmed a decrease in time spent on flowsheets and total clicks, while nurse communication patient satisfaction scores increased by up to 10%. The modest improvements in the workload dimensions highlight that the psychological relief provided by AI may be just as vital as the time saved. While manual documentation "clicks" and "minutes" decreased, the rise in patient satisfaction suggests that removing the digital barrier allows for more meaningful nursing presence. Key lessons include the necessity of iterative feedback loops and the value of simulation-based training to flatten the learning curve for emerging AI technologies.

Expanding Governance and Influence: The Impact of Nursing Support Teams

Joan Halpern, Michele Dziedzic

An urban academic medical center identified an opportunity to strengthen engagement and empowerment among nursing clinical support staff, including nurse aides, patient care technicians (PCTs), and unit clerks. Although a robust professional governance (PG) structure was in place, it primarily represented clinical nurses and excluded approximately 20% of the nursing workforce. This gap was significant, as support staff maintain a constant presence at the bedside and play a critical role in patient experience and care continuity. While evidence strongly supports workforce engagement as essential to improving patient outcomes, employee satisfaction, and organizational sustainability, literature regarding engaging support staff remains limited. To foster a culture of shared accountability and inclusivity, nursing leadership intentionally designed initiatives to elevate support staff voices within PG. Dedicated forums were established through the creation of two councils: the Nursing Support Staff Council, representing clinical support roles, and the Unit Clerk Council, representing administrative support roles. These councils were led by support staff members who were mentored by nursing leaders to effectively chair meetings, align initiatives with organizational goals, and participate in strategic planning and PG workshops. Council leaders now hold seats on the Nursing Staff Advisory Board, meeting regularly with the Chief Nursing Officer to influence practice and organizational priorities. Recognizing a lack of formal recognition for support staff contributions, leaders expanded inclusion within the Recruitment, Retention, Recognition, and Respect (R4) Committee. This collaboration led to the creation of the Sunflower Award to honor the impact of support staff on patient care. Support staff actively participate in promoting the award and hosting recognition events. Additionally, a multidisciplinary Recognition Voting Committee was formed to ensure equitable representation in organizational award decisions. These initiatives led to measurable improvements in engagement and workforce outcomes. Nursing participation in the Gallup survey increased to 90%, with engagement scores rising from 4.09 to 4.12. Vacancy and turnover rates declined significantly, with support staff turnover outperforming national benchmarks. Unit clerk, nurse aide, and PCT turnover decreased by 25% to 67% compared to 2023. Qualitative feedback indicates support staff feel valued, included, and empowered in shared decision making, resulting in staff led initiatives such as the creation of an emergency department wellness committee. Future efforts will focus on expanding support staff representation across additional PG councils to further strengthen organizational alignment and outcomes.

When Unit-Based Nurses Float: Floating Patterns and Associations with Home Unit Nurse-Sensitive Indicators

Catherine Stephens, Danielle Walker

Abstract

Background:

Unit-based nurse floating is a common staffing strategy used to address short-term staffing imbalances in hospitals, where nurses assigned to a home unit are temporarily reassigned to other units to meet staffing needs. Problem Floated unit-based nurses experience increased stress and cognitive workload due to disrupted workflows and unfamiliar environments, although increased stress may be temporary with strong managerial support. Floating has also been associated with decreased job satisfaction, an increase in nursing burnout, disrupted teamwork, and understaffed home units, thereby increasing strain on the remaining staff. Significance Despite widespread use, the impact of unit-based nurse floating on patient outcomes remains unclear. Examining its association with nurse-sensitive indicators (NSIs) may inform evidence-based staffing practices.

Purpose:

The aim of this study was to

1. identify floated unit-based nurse patterns within a healthcare system and
2. examine whether the frequency of unit-based nurse floating was associated with home unit rates of four NSIs: falls, pressure injuries (PI), central line-associated bloodstream infections (CLABSI), and catheter-associated urinary tract infections (CAUTI).

Methods:

This study was guided by Donabedian’s Structure–Process–Outcome framework, which proposes that staffing structures influence patient outcomes. A cross-sectional study was conducted within a southern United States healthcare system, comprising one academic hospital and two community hospitals with a total of 25 adult medical–surgical and intensive care units. Staffing data were obtained from time clock records, where float shifts were recorded by date, home unit, receiving unit, and shift length. Monthly unit-level NSI data were obtained from the National Database of Nursing Quality Indicators®. Data collected April 2024–April 2025 yielded 300 unit-month observations. Logistic regression was performed with units stratified into quartiles based on float shift frequency.

Results:

A total of 11,874 float shifts occurred across units. Floating frequency varied widely, with the highest count at Community Hospital 1 (Med/Surg C: 2,259) and the lowest at the Academic Hospital (Burn: 20). Floating patterns differed across hospitals, with strong sister-unit pairings at Community Hospital 1 (e.g., 88–99% of shifts). Higher floating frequency was significantly associated with increased odds of pressure injuries, with units in the third quartile (OR = 2.81, 95% CI [1.03, 7.65]) and fourth quartile (OR = 3.31, 95% CI [1.24, 8.80]) demonstrating greater risk compared to those in the first quartile. No significant associations were observed for falls, CLABSI, or CAUTI.

Conclusions:

Units with more frequent unit-based nurse floating had approximately 2 to 3 times the odds of PIs than units with the lowest floating frequency, supporting prior evidence linking nurse floating to increased pressure injuries. These findings contribute to the science of nursing leadership by highlighting how floating patterns may influence patient outcomes in home units.

Implications:

These findings highlight the need for nursing leaders to evaluate floating patterns and staffing practices when making workforce decisions. Staffing flexibility must be balanced with patient safety and the need to maintain adequate staffing on home units. Further research is needed to better characterize local variation in staffing and inform evidence-based staffing policies.

Promoting the Holistic Care Approach to Increase Use of Aromatherapy on a Surgical Unit

Roberta Pawlak, Melissa Anibas

Aromatherapy can be described as a natural method involving the utilization of essential oils. Administration of aromatherapy can be part of a holistic care approach to promote balance, overall health, and assist in improving psychological and physical well-being. However, nurses do not always understand the mechanism of use of aromatherapy and may not plan and offer its administration to patients as a result. The goal of this quality improvement project was to increase staff nurses’ knowledge of and comfort level with administration, reduce barriers in the administration, and increase use of aromatherapy as a holistic nursing intervention on an acute care surgical unit. This project followed the Plan-Do-Study-Act (PDSA) model and was further informed by the holistic theoretical framework of aromatherapy. Current state determined an opportunity for improvement by informing the creation of a new aromatherapy station and a system of providing access to quick reference materials for staff nurses. Quantitative data surrounding aromatherapy administration were gathered through chart reviews. Qualitative data were gathered through observation of staff and interviews with staff and key stakeholders. Connection with governance committee members, staff rounding, as well as interprofessional collaboration with pharmacy were utilized as improvement methods in the QI process. This project informed nurses’ knowledge and comfort level with aromatherapy, a storage and access improvement flow of aromatherapy products, and a reported ease of and increased use for aromatherapy administration by nurses. This led to patients experiencing subsequent benefits related to being offered aromatherapy as part of a holistic approach to their treatment plan.

Collaborative Planning with State and Professional Organizations addressing Nursing and Educator Workforce Surveys – strengthening the organized response to state statute with a ‘Data Committee’

Roberta Pawlak

Licensed Nurses (RNs, LPNs, APNs) comprise a large and essential part of the healthcare workforce in the US. Wisconsin state statute requires survey of nurses during re-licensure to inform workforce needs and issues. Further, a priority exists to survey the Nursing schools within the state to address volume and needs of nurse educators. The purpose of this presentation is to describe the innovative planning structure and process of these surveys amongst designated academicians with their state and professional counterparts. Coordination and collaboration with state and professional agencies are supported by a “Workforce Data Committee” that includes Schools of Nursing, Wisconsin Center for Nursing (WCN), and the Department of Workforce Development (DWD) who is responsible to the Department of Safety and Professional Services (DSPS) who administers the survey with biannual re-licensure. Further collaborations involve the Wisconsin Nurses Association (WNA), Wisconsin Organization of Nurse Leaders (WONL), and the Administrators of Nursing Education of Wisconsin (ANEW) organizations. The collaborative ‘Data Committee’ meets regularly to discuss topics such as data analysis and interpretation results, policy influences and dissemination including state legislature and governor communications, trend results, state and legislative impacts, process for data access, creation of survey questions and survey form, publication collaborations, and coordination with state agencies who are required by statute to collect the data. The results of this effort assist leaders in all realms of health services to plan and strategize solutions to address nurse educator and nursing workforce issues that impact supply and well-being of the nurse workforce.

PACU Throughput Optimization

Gabrielle Johnson, Eli Ebrahimdoost

Background: It is essential to promote throughput through the Post Anesthesia Care Unit (PACU). Failure to do so will likely result in the PACU being full and patients having to recover from anesthesia in the operating room (OR). This prevents new cases from starting in an OR suite because the room is occupied by a patient who should be in PACU. It is estimated that for each minute an OR suite is not being used when it should be, it costs the hospital $100 to $150 per minute. This translates into significant financial loss.

Purpose: The purpose of this quality improvement project is to improve efficiency in patient throughput and mitigate OR hold costs.

Methods: A Plan-Do-Study-Act process was used. Our Nurse Manager with some of our direct care nurses spearheaded a process that entails ongoing collaboration with the PACU Anesthesia Attending and the PACU Anesthesia Resident (hereafter, PACU Anesthesia Team). Here, the PACU Anesthesia Team round on each patient to discern whether the patients have successfully met PACU discharge criteria and are ready to move to the next phase of care. The PACU charge nurse notifies the PACU Anesthesia Team when there are only a predetermined number of bays in PACU open and available for admissions. This prompts the PACU Anesthesia Team to, once again, review each patient’s clinical status and readiness for discharge. Our NM is in constant contact with our Capacity Command Center (which coordinates patient placement throughout the hospital) to help promote throughput.

Results: This seamless interprofessional collaboration and process has been successful in minimizing the number of OR holds due to lack of beds available in PACU for patient recovery from anesthesia. We decreased our PACU hold time from 1600 minutes to 187 minutes. This equates to 1,413 minutes or $141,300 per month of savings.

How to Solve the Evidence Based Practice Puzzle- A Unit Council Approach

Erica Adkins, Caitlin Totino

Background: Evidence‑Based Practice (EBP) is a foundational element of nursing care; however, many nurses report limited confidence in initiating EBP projects, and nurse leaders often lack practical strategies to teach EBP skills to others. To address these challenges, an innovative, team‑based educational initiative was developed that leveraged EBP mentorship and the jigsaw journal method to make evidence review and synthesis more efficient, collaborative, and achievable.

Purpose and Aim: The purpose of this project was to increase EBP competence and confidence among a diverse unit‑based council by introducing a structured, mentored approach to evidence review. The aim was to equip nurse leaders and frontline nurses with practical tools that enable rapid synthesis of evidence and development of evidence‑based recommendations within a single working session. Framework: The Advancing Research and Clinical Practice Through Close Collaboration (ARCC) model served as the guiding framework for the initiative. The ARCC model emphasizes the role of EBP mentors in building organizational capacity for evidence‑based implementation through mentorship, collaboration, and support.

Methods: This initiative was an offshoot of the author’s doctoral work focused on implementing a learning platform for organizational EBP mentors. Evidence synthesized from that work, combined with literature supporting the jigsaw method of learning, informed the design of this initiative. Participants engaged in a facilitated jigsaw journal session, where teams reviewed, critically appraised, and synthesized assigned evidence. Learning objectives included applying the jigsaw journal method, collaborating to create evidence tables, and developing actionable EBP recommendations by the end of one gathering.

Evaluation: Outcomes were measured using the Evidence‑Based Practice (EBP) Competency Scale administered pre‑ and post‑implementation. This validated tool measures self‑reported competence across 24 EBP competencies using a 5‑point Likert scale. Qualitative feedback was also collected to capture participants’ perceptions of the learning experience.

Results: The largest areas of improvement were observed in participating in the formulation of clinical questions using the PICOT format, participating in the critical appraisal of pre‑appraised evidence, and participating in strategies to sustain an evidence‑based practice culture. Qualitative feedback indicated that participants initially experienced confusion or discomfort with the structured, shared process; however, confidence and understanding increased as the session progressed. Participants reported improved collaboration, greater awareness of personal bias when interpreting evidence, reduced anxiety related to literature review, and increased readiness to engage in future EBP activities.

Conclusion: This initiative demonstrates that combining EBP mentorship with the jigsaw journal method is an effective and efficient strategy for building EBP competence and fostering a culture of evidence‑based practice. The approach is replicable, scalable, and supports nurse leaders in teaching EBP skills in a practical, time‑efficient manner.

Nurse's Perceptions of Machine Learning-Decision Support Systems and Influence on Nursing Practice

Ryan Chan, Richard Booth, Gillian Strudwick

Nurses’ clinical decision-making process is of critical importance as each clinical decision directly impact the health, safety, and well-being of patients. The ability to engage in complex clinical decision-making and formulate appropriate clinical decisions related to medical diagnoses, treatment plans, and health interventions has been regarded as one of the most valued components of nurses’ clinical competency. With the emergence of advanced technologies containing artificial intelligence and machine learning functionalities, what was once considered to be nurses’ unique expertise of clinical decision-making has begun to be contested by these forms of intelligent technologies.

The research objectives were: (i) to explore nurses’ perceptions of ML-DSS (Machine Learning-Decision Support Systems) within clinical settings; and (ii) to develop theoretical insights related to nurses’ clinical decision-making process with ML-DSS.

A constructivist grounded theory (CGT) methodology was used in this research study to develop greater theoretical understandings of nurses’ clinical decision-making process with ML-DSS. A total of 25 nurses participated in this study. Data was collected via semi-structured interviews, and data collection and analysis occurred concurrently.

The findings of this research study provided timely contributions by broadening the current understanding of nurses’ clinical decision-making process in light of ML-DSS. The findings generated from this study will further expand existing evidence related to how advanced technologies that possess the ability execute unique human cognitive functions may subsequently shift nursing care within clinical settings.

Positioning Nurse Manager Recognition as a Strategic Priority: The Role of the Chief Nurse Executive

M.Lindell Joseph, Kimberly Hunter, Kayla Piplani

Background: Nurse managers are central to healthcare system performance, yet their contributions are often underrecognized at executive and governance levels. Chief Nurse Executives (CNEs) and Chief Nursing Officers (CNOs) are uniquely positioned to advocate for nurse manager recognition; however, limited evidence describes how executive priorities are constructed and advanced within healthcare organizations.

Purpose: The purpose of this qualitative study was to examine how priorities are formed within healthcare systems and to identify best practices for positioning nurse manager recognition as a strategic priority at the governing board and senior leadership levels.

Methods: A national Delphi design was used to survey CNEs and CNOs across the United States. Phase 1 employed conventional content analysis, with observation codes derived inductively from participant narratives through repeated immersion, iterative coding, and constant comparison, resulting in an emergent theoretical framework. Phase 2 utilized descriptive statistics to report means and standard deviations for executive level priorities and best practices.

Findings: Advocacy for nurse manager recognition was most effective when the CNE or CNO was embedded within the C suite or aligned directly with the CEO, enabling articulation of nurse manager value and organizational return on investment (ROI). Three advocacy strategies emerged: use of metrics, strategic storytelling, and demonstration of nurse manager impact. High impact and feasible best practices included executive rounding, structured and public recognition, and brief reflection moments during executive meetings.

Conclusions: Executive prioritization of nurse manager recognition depends on explicitly linking contributions to organizational ROI and strategic outcomes.

Evaluating International Engagement in Nursing Leadership Science: Insights from ALSN’s Global Webinar and Virtual Conference

Edmund Walsh, Cindy Zellefrow, Mary Dolansky, Jihane Frangieh, Kay Kennedy, Kim Crawford, Dujonette Bonitto

Although ALSN is an international organization, membership has remained largely U.S.-based, with only a small number of international members in recent years. Limited awareness of ALSN in other countries, along with barriers such as cost, currency exchange, and travel requirements, may contribute to lower participation outside the U.S. ALSN is committed to expanding its international membership. Global engagement is important to ALSN because it offers opportunities to exchange diverse perspectives, build partnerships across countries, and strengthen nursing leadership science worldwide. Expanding international membership may also support broader dialogue and shared learning. This work aligns with the ALSN 2025–2027 Strategic Plan, which includes an objective to expand and strengthen global membership through initiatives such as the International Ambassador Program and a global virtual conference. In support of this objective, the International Ambassador Program was established and launched at the 2025 annual conference. The program engages 11 international nursing leadership academics who collaborate with ALSN to provide insight into nursing leadership science in their respective countries and to help identify barriers and facilitators to participation.

This presentation focuses on the evaluation of a webinar and virtual conference developed as part of ALSN’s global engagement strategy. These initiatives were intentionally designed to reduce barriers to participation, including cost, geographic distance, and time zone differences. This presentation describes the development and implementation of these events, outlines the program evaluation approach, and discusses how attendee feedback will inform future ALSN international initiatives. This work also supports the Membership Committee’s broader goal of expanding international membership.

The webinar, titled “Navigating the Future Together: Shaping Global Nursing Leadership Through Collaborative Science and Practice,” is scheduled at a time intended to support international participation and is free of charge. The virtual conference, titled “Global Voices in Nursing Leadership Science: Building Bridges Across Borders,” will feature presentations from the 11 international ambassadors, who will share nursing leadership perspectives and research from their respective countries. To further reduce barriers and support global participation, the virtual conference will include two sessions scheduled with time zones in mind. Reduced-cost global access registration and sponsorship opportunities will also be available. To accommodate those unable to attend live, a recording of each event will be shared with its respective registrants. International Ambassador Program facilitators are responsible for organizing the events, while the ambassadors collaborate by presenting at the virtual conference. Post-event program evaluation will be conducted using online surveys to gather attendee perspectives related to access and engagement. In addition, the planning group will engage in discussions to assess what worked well and what may be improved in future ALSN initiatives.

Findings from the post-event evaluations will be presented, with a focus on attendee perceptions of accessibility and overall experience. These insights are expected to inform future ALSN international initiatives, including decisions related to program design and strategies to increase global participation. Lessons learned from these events are expected to support ongoing efforts to expand ALSN’s international reach and to develop programming that is accessible, relevant, and responsive to a global nursing leadership audience.

Reimagining Nurse Executive Board Certification: Aligning Credentialing With Doctoral-Level Leadership Preparation

Stephan Davis, Sandra Galura, Heather Nelson-Brantley

The preparation of nurse leaders has advanced significantly, with increasing emphasis on doctoral education for individuals functioning in executive and system-level roles. However, nurse executive board certification pathways have not evolved in parallel, resulting in a misalignment between educational preparation, competency expectations, and credentialing structures. Existing certifications demonstrate redundancy across three primary pathways and insufficient differentiation based on level of academic preparation, particularly for leaders prepared at the doctoral level. This misalignment is consequential given the well-established relationship between effective nursing leadership and outcomes related to patient care, organizational performance, and workforce sustainability.

A comprehensive synthesis of the literature examined relationships among nursing leadership, certification, educational preparation, and outcomes. Evidence consistently demonstrates that relational, transformational, and evidence-based leadership approaches are associated with improved patient safety, enhanced satisfaction, stronger organizational culture, and reduced nurse turnover. Leaders prepared at the doctoral level demonstrate higher engagement, reduced burnout, and greater effectiveness in complex healthcare environments. Concurrently, national expectations for doctoral preparation among executive nurse leaders have advanced, while certification frameworks have remained largely unchanged.

Guided by these findings, an evidence-based proposal and call to action was developed to address this gap. The proposal establishes a differentiated nurse executive certification pathway aligned with doctoral-level preparation and directly addresses redundancy within current certification structures by differentiating pathways based on academic preparation. Eligibility criteria include completion of a doctoral degree, leadership-focused academic preparation, and scholarly work relevant to nursing leadership practice. Consistent with advanced practice certification models and the AACN Essentials, the proposal includes a pathway for certification eligibility upon completion of the terminal degree, supporting timely recognition of advanced leadership competencies.

The primary outcome of this initiative is a rigorous, evidence-based proposal that aligns credentialing with contemporary standards for nurse executive preparation and practice. Implications include enhanced role clarity, improved alignment between academic preparation and professional validation, and strengthened credibility of nurse executives functioning at organizational and system levels. This work represents a call to action to align nurse executive certification with the increasing complexity of healthcare leadership and the progression of doctoral-level nursing education.

Evaluating the Impact of Human-Centered Leadership on Nurse Practitioner Onboarding, Wellbeing and Competency

Honore Kotler, Margie Sipe

BACKGROUND/PURPOSE: The United States Bureau of Labor Statistics projects nurse practitioner employment, the fastest growing occupation of all those measured, to grow by 45% by 2031. Likewise, the AANP reports similar trends in nurse practitioner program graduates year over year. Health systems and medical centers must develop solutions to address transition to practice and onboarding needs of this group, as they enter or continue nurse practitioner practice with varied educational training, preceptorship, and practice experience. This has resulted in an assortment of onboarding practices demonstrating variability in support and resources for new hire NPs. This quality improvement pilot project aimed to evaluate the impact of a structured four-week, mentoring and competency-based NP onboarding program on NP wellbeing and competency at an academic medical center in Los Angeles, CA. THEORETICAL FRAMEWORK This project was designed based on the Human-Centered Leadership (HCL) framework. HCL aligns well with the program objectives of addressing individual NP onboarding needs based on training and experience, intentional mentoring relationships, and professional development grounded on the framework’s principle domains of empathy, empowerment, connection, and purpose.

METHODS:

NPs hired within the past 6 months were enrolled in an onboarding program in October, 2025 consisting of a full day, advanced practice orientation followed by 4 weeks of weekly mentoring support sessions and standard departmental onboarding. Mentors completed training on the Human Centered Leadership framework and were assigned to a new-hire NP prior to beginning the program. NP participants completed the Thriving at Work Questionnaire [short form](TFW) and the CHCI NP Residency Competency Assessment Tool (NPR-CAT) prior to beginning the program and upon completion of the program. Mentors completed the TFW Questionnaire [short form) prior to beginning the program and upon completion of the program. Both groups completed program evaluations upon completion of the program.

RESULTS:

Survey results were measured using paired sample t-test for the total TFW scores and Wilcoxon signed ranks test were used for individual questions. There was no statistical significance on any TFW question except being paid fairly. All other individual items did not achieve statistical significance, however the overall survey average and several item ratings trended upward. Multiple NPR-CAT survey items related to well-being showed statistically significant improvement post-intervention, including domains of Patient Care, Knowledge for Practice, Practice-Based Learning and Improvement, System-Based Practice, Interprofessional Collaboration, and Personal and Professional Development. CONCLUSIONS, IMPLICATIONS: While TFW results did not demonstrate significance in the majority of items for new-hire NPs or mentors, data trends show increasing scores in wellbeing that may benefit from study over a longer timeframe in both groups. NP competency self-assessment data demonstrated significant improvement in certain domains by the end of this pilot study. Program Evaluations demonstrated overall high satisfaction with the program and useful themes for future planning. A structured onboarding program incorporating competency self-assessment and mentoring showed statistically significant improvements that inform the expansion of this program to all NP new hires over a longer timeframe. Expansion of the program informed by the results of this pilot is planned for spring 2026 implementation.

Voices from the team- Interprofessional mentoring perspectives

Margot (Lisa) Hedenstrom, Susan Dyess, Roxanne Bennett

Background: Healthcare leaders are challenged to support workforce engagement, retention, and leadership development amid increasing organizational complexity. Structured mentoring has been identified as a meaningful leadership strategy to promote professional growth and interprofessional collaboration; however, implementation remains inconsistent, and leaders often lack guidance on best practices.

Purpose: This study evaluated the impact of a structured mentoring education intervention and explored the experiences of interprofessional healthcare staff and leaders participating in a mentoring program within a specialty hospital.

Methods: An IRB approved mixed methods design was used. Interprofessional healthcare staff participated in a mentoring education intervention, completed pre and post intervention mentoring surveys, and engaged in focus groups facilitated by the academic principal investigator. Quantitative data were analyzed using descriptive statistics, while qualitative data were analyzed using thematic analysis of deidentified transcripts.

Results: Preliminary qualitative findings identified leadership relevant themes including the need for protected time for mentoring, visible leadership and organizational support, meaningful recognition of mentor contributions, effective mentor matching, and a clearly defined program structure. Participants emphasized that interprofessional mentoring enhanced leadership insight, collaboration, and professional confidence. Quantitative analysis is ongoing.

Implications for Leadership: Findings suggest that structured, interprofessional mentoring programs can serve as a practical leadership strategy to strengthen workforce engagement, support leadership development, and foster a collaborative organizational culture. Insights from this study can inform leaders seeking to implement sustainable mentoring initiatives aligned with organizational goals and workforce priorities.

From Reluctance to Engagement: Assessing the Effectiveness of a Structured Advanced Practice Provider Preceptor Development Program

Melanie Reynolds

Problem When advanced practice providers (APP) struggle to transition into clinical roles, the ripple effects extend beyond the individual and impact the patients, care team, culture and retention. Preceptors are foundational to the successful transition of APPs into clinical roles, yet systemic barriers including time constraints, insufficient training, and ambiguous role expectations frequently undermine their effectiveness and engagement. Left unaddressed, these challenges contribute to preceptor burnout, inconsistent preceptee experiences, and APP workforce attrition. To confront these barriers, a standalone pediatric academic medical center developed the APP Preceptor Development Program (PDP), an evidence-based initiative designed to reduce burnout, increase preparedness, and strengthen precepting skills through targeted training in cultural competence, bias mitigation, communication, adult learning theory, and leadership. A formal evaluation was undertaken to assess the program’s impact and long-term sustainability. Evidence Appraisal and Synthesis Both the PDP and its evaluation are grounded in high-level evidence drawn from current literature. This body of evidence informed program design, evaluation methodology, and the identification of key outcome measures. Stakeholders including PDP-trained and non-trained APP preceptors, non-precepting APPs, and APP preceptees were engaged throughout the evaluation process to ensure that findings reflected diverse perspectives across the clinical learning environment. Implementation Strategies Using the 2024 CDC Program Evaluation Framework, a mixed-methods approach was employed to assess the PDP’s effectiveness, fidelity, and impact. An interprofessional stakeholder group led data collection through validated surveys, semi-structured interviews, focus groups, and participation metrics. IRB exception was obtained; interviews and focus groups were facilitated by an uninvolved third party and de-identified to protect participant privacy. Quantitative data were analyzed in collaboration with a biostatistician, summarizing demographics and calculating means for Likert-scale items. Qualitative data was thematically analyzed with a nurse scientist using a six-step framework to identify emerging patterns across participant responses. Evaluation Results Implementation of the APP PDP produced meaningful workforce outcomes. Since its 2022 launch, APP turnover decreased by 4% and preceptor engagement increased by 65%. Over 93% of participants reported the PDP was highly relevant to clinical practice and that it enhanced their confidence in teaching strategies, feedback delivery, and professional communication. Analysis across multiple data sources confirmed the program is effectively meeting preceptor training needs and cultivating a sustained teaching skills pipeline. Preceptors trained through the PDP reported meaningful application of learned strategies, while their preceptees described increased confidence and more positive clinical learning experiences. Lessons Learned This evaluation surfaced critical insights about the conditions under which precepting programs succeed. Organizational culture emerged as a powerful moderating factor: supportive environments encouraged active participation and strengthened program outcomes, while unsupportive cultures hindered both preceptor engagement and positive preceptee outcomes. Notably, the PDP did not significantly reduce precepting burnout, suggesting that burnout is more strongly linked to broader systemic and cultural factors than to training alone. These findings underscore the importance of addressing institutional culture as a prerequisite to any preceptor development initiative and point to areas for targeted program refinement and advocacy going forward.

Evaluating Readiness for Implementation of a STEMI Care Pathway at a Community Hospital

Emily Pentecost, Melesia Goolsby, Chad French, Jennifer Werthman, Heather Nelson-Brantley

Problem, Background/Significance, and Rationale

Timely reperfusion is the most important factor influencing survival in patients experiencing ST-elevation myocardial infarction (STEMI). Current guidelines recommend primary percutaneous coronary intervention (PCI) as the preferred reperfusion strategy when it can be performed within recommended timeframes. For patients presenting to non-PCI-capable facilities, PCI is recommended within 120 minutes. When this cannot be achieved, thrombolytic therapy within 30 minutes is used, although evidence shows it is a less effective treatment modality.

A 200-bed community hospital within a southeastern U.S. health system recently expanded PCI capability but continues to function primarily as a STEMI referring center. Following relocation to a new campus, increased distance to the receiving center has made it more difficult to consistently meet the 120-minute goal. As a result, thrombolytic therapy is being used more frequently despite PCI remaining the preferred reperfusion strategy when timely access is available. These delays represent a system-level challenge with implications for patient outcomes, operational efficiency, resource utilization, and cost to the health system.

Evaluating whether STEMI care can be safely implemented at the community hospital presents an opportunity to reduce treatment delays, optimize resources utilization, and improve access to definitive care. Implementation of a STEMI care pathway requires intentional coordination across emergency medicine, interventional cardiology, nursing, and hospital leadership to ensure success in the expansion of high-acuity cardiovascular services. Nurse leaders bring system-level visibility across the care continuum and play a central role in evaluating readiness, aligning interdisciplinary teams, and guiding implementation of complex care pathways.

Purpose and Project Objectives:

The purpose of this program evaluation is to identify pre-, intra-, and post-procedure facility needs for implementing a STEMI care pathway within an interventional cardiology program at a community hospital. Objectives are to evaluate current processes, identify operational gaps, and develop evidence-based recommendations to inform executive decision-making related to resource allocation, care delivery models, and system-level implementation.

Methods, Collaboration, Implementation, and Evaluation Plan

This program evaluation uses the CDC Framework for Program Evaluation to guide assessment of organizational readiness. Data sources include semi-structured interviews, workflow mapping, protocol review, staffing and training assessments, and Likert-style surveys. Operational data will be analyzed to assess procedural capacity, projected STEMI case volume, and financial and operational impact.

Qualitative data from interviews with frontline staff, middle management, and physicians will be analyzed using rapid qualitative analysis to identify themes related to barriers and facilitators influencing implementation. Quantitative survey data will be analyzed using descriptive statistics to assess the interest holders’ perspectives on the feasibility, acceptability, and appropriateness of pathway implementation.

Expected Outcomes and Implications

Findings will identify barriers and facilitators within the community hospital’s infrastructure, staffing, and current processes affecting the safe implementation of a STEMI care pathway. Results will inform practical, evidence-based recommendations to improve timely access to PCI and reduce reliance on fibrinolytic therapy while providing safe, effective care at the community hospital. This evaluation demonstrates the role of nursing leadership in evaluating organizational readiness, aligning interdisciplinary teams, and guiding implementation of clinical care pathways within complex systems of care.

Enhancing Acute Care Delivery Through Virtual Nursing: A Quality Improvement Initiative

Charity Darnell, Todd Tussing, Penelope Gorsuch, Rosie Zeno

Nurse burnout continues to pose a significant threat to healthcare quality, patient safety, and workforce stability. Evidence from national organizations, including the Centers for Medicare & Medicaid Services (CMS), the Agency for Healthcare Research and Quality (AHRQ), and the National Database of Nursing Quality Indicators (NDNQI), shows strong associations between nurse burnout and higher rates of medication errors, patient falls, and hospital-acquired conditions. At Cook Children’s Health Care System, findings from the Maslach Burnout Inventory indicate elevated emotional exhaustion among nurses, driven by escalating workloads, documentation burden, and limited autonomy. In response, the organization implemented a virtual nursing program as a strategic intervention to reduce workload, enhance operational efficiency, and support high-quality pediatric care. The virtual nursing model deploys experienced remote nurses to complete admissions, discharges, and pain reassessments, thereby reducing cognitive load and documentation demands for bedside nurses. Qualitative data from this quality improvement initiative indicate perceived improvements in workflow efficiency, with nurses reporting increased capacity for direct patient care and reduced time spent navigating the electronic health record. Quantitative outcomes further substantiate these perceptions, showing decreased charting time, improved turnaround for admissions and discharges, and a 42.35% increase in timely pain reassessments. These findings suggest that virtual nursing is a sustainable and scalable strategy to mitigate burnout, strengthen patient-centered care, and improve operational performance in pediatric settings. This project contributes to the emerging evidence base supporting virtual nursing as an innovative model that enhances safety, quality, and workforce well-being.

Leading the Science of Implementation: Designing an Implementation Nurse Scientist Role to Drive Sustainable Evidence-Based Practice

Jennifer Galliers, Deana Sievert

Despite widespread emphasis on evidence-based practice (EBP), a persistent gap remains between evidence and clinical practice, with up to 30–40% of patients not receiving evidence-based care and 20–25% receiving potentially unnecessary or harmful interventions (Cassidy et al., 2021). While implementation science offers structured methods to support adoption and sustainment of EBP, many organizations lack formal leadership structures and trained implementation experts, resulting in fragmented efforts and limited sustainability (Boehm et al., 2020; McNett et al., 2021). Nursing leadership is uniquely positioned to address this gap through intentional role design that integrates implementation science into leadership infrastructure.

The purpose of this evidence-based initiative is to describe the design and operationalization of an Implementation Nurse Scientist leadership role to drive sustainable EBP. Specific aims include:

1. establishing a formal leadership role integrating implementation science within a health system
2. applying implementation science frameworks to improve adoption and sustainment of EBP initiatives; and
3. evaluating implementation outcomes including adoption, fidelity, and sustainability.

This initiative utilized a dual-component approach integrating leadership design and implementation science application. The Implementation Nurse Scientist role was intentionally designed and embedded within nursing leadership infrastructure to address gaps in EBP implementation capacity. The role bridges academic and clinical practice by aligning PhD- and DNP-prepared nurse expertise to support system-level implementation and sustainment of evidence-based practices (McNett et al., 2021). Key design elements included role clarity, reporting structure, integration with quality and safety priorities, and alignment with organizational strategic goals.

The role operationalized implementation science using CFIR to assess contextual determinants and IRLM to align barriers, strategies, and outcomes. Barriers included workflow variability, competing priorities, and inconsistent role ownership; facilitators included leadership engagement, interdisciplinary collaboration, and existing quality infrastructure, reflecting the influence of context on implementation success (Sarkies et al., 2022). Stakeholders included nurse leaders, frontline staff, physicians, informatics, and quality teams. Implementation strategies included stakeholder engagement, clinical champions, audit and feedback, targeted education, and workflow integration with iterative refinement (Leeman et al., 2018). Outcomes were evaluated using adoption, fidelity, feasibility, and sustainability (McNett et al., 2021).

Early outcomes demonstrate improved alignment of implementation strategies with clinical context, enhanced coordination of EBP initiatives, and increased frontline staff engagement. A pilot fall prevention initiative demonstrated feasibility and informed refinement, resulting in expansion to a system-wide implementation to support scalable adoption of evidence-based interventions. Evaluation included both process metrics (e.g., adherence, engagement, fidelity) and clinical outcomes. While economic outcomes are ongoing, economic evaluation is essential to understanding value and informing resource allocation (Roberts et al., 2019).

The Implementation Nurse Scientist role represents a critical advancement in nursing leadership infrastructure to support sustainable EBP. Embedding implementation science expertise enhances the ability to translate evidence into practice, optimize contextual fit, and achieve system-level improvement. This model provides a scalable approach to advancing nursing leadership impact on quality, safety, and experience outcomes.

Exploration of Professional Governance Behaviors in Nurses in Different Roles

Jessica Peterson, Marjory (Micki) Williams, Jody Collins

Background: Research has shown that professional governance has positive impacts on nurse satisfaction, engagement, hope, and resilience, as well as on patient and organizational outcomes. Little is known, however, about how professional governance behaviors manifest differently in nurses in direct care roles as compared to those in leadership or administrative positions. While literature on professional governance highlights the importance of providing voice, autonomy, and decision-making to nurses at the front line, it does not often distinguish between those providing direct patient care and nurse leaders.

Purpose: The purpose of this project is to describe and evaluate patterns of nursing professional governance behaviors across both the direct care and the leadership/administrative nursing workforce.

Methods: This study utilized a descriptive, observational cross-sectional design. Data collection occurred via online survey sent to over 14,500 nurses within the health system. Recruitment of nurses occurred via targeted emails, announcements, and internal marketing regarding the study. The Verran Professional Governance Scale (VPGS) was used to measure behaviors related to professional governance through three subscales: professional obligation, collateral relationships, and decision-making. Respondents were asked to identify their role as either direct care, administration or leadership, or other. If “other” was selected, the participant was prompted to identify his or her role in free text.

Results: Of the entire sample 67.7% identified as direct care nurses, 20.7% as leaders or administrators, and 11.7% as other. The sample was highly experienced, with the largest proportion in every role having over 20 years of experience. A greater proportion of those in leadership were educated at a Master’s or DNP level than those in direct care positions or other positions. Overall, the histograms showed very similar patterns in all responses for nurses in direct care and leadership positions. There were a few differences in those who had identified that they were in an other position, indicating slightly lower professional governance behaviors within this group.

Implications: These findings establish a vital foundational understanding of professional governance behaviors across the healthcare system. Insights gained will help shape targeted strategies that foster shared accountability and sustain a thriving culture of professional governance. Because of similar results, interventions should be targeted at both bedside staff and those in leadership and administration. Additional research will be needed to identify and address contributing to lower governance engagement among nurses in non-traditional roles and to examine how professional governance behaviors influence long term workforce outcomes and organizational culture.

Strengthening Workplace Safety Competence Through Unit Practice Council–Led Education: An Evidence-Based Practice Initiative for the Nursing System Float Team

Adam Fronczek, Paulina Cortez, Christine Kunkel, Katrina Smith

Title: Strengthening Workplace Safety Competence Through Unit Practice Council–Led Education: An Evidence-Based Practice Initiative for the Nursing System Float Team

Problem, Evidence, and Practice Gap Registered Nurses (RNs) and Administrative Clinical Care Partners (ACCPs) within the Nursing System Float Team (NSFT) practice across multiple inpatient settings, increasing exposure to workplace safety risks such as patient aggression and varying unit-based safety processes. Although system-level safety education exists, gaps persist in staff-reported knowledge and Safety Opportunities for Improvement (SOFI) data trends. Review of the workplace safety and adult learning literature supports the use of context-specific, case-based education delivered by frontline leaders to improve safety competence and engagement. However, limited evidence exists regarding the effectiveness of peer and educator-facilitated, team-specific safety education tailored to the unique varying practice environments of float teams.

EBP Purpose and PICOT Question This evidence-based practice initiative evaluates whether UPC-led workplace safety education interventions improved NSFT staff safety knowledge and safety-related outcomes.

PICOT Question:

For NSFT nurses and care partners (P), how does UPC-led, unit-specific workplace safety education (I), compared to existing system-level education (C), affect workplace safety knowledge and reported safety events (O) over a six-month period (T)?

Methods:

A quasi-experimental pre/post EBP design was implemented. The intervention consisted of UPC-led workplace safety sessions grounded in current evidence, SOFI trend analysis, and frontline input. Sessions emphasized case-based learning, high-risk scenario review, and practical mitigation strategies reflective of diverse unit environments. Participants: NSFT RNs and ACCPs attending scheduled education sessions during NSFT Staff Meetings. Measures:

• Pre/post safety knowledge surveys
• SOFI summary data reviewed for pre- and post-intervention
• Qualitative staff feedback on relevance and applicability

Data analysis included descriptive statistics, paired t-tests, and run-chart analysis to evaluate practice change outcomes.

Results (Projected) and EBP Implications Expected projected outcomes include significant improvement in staff safety knowledge scores, increased perceived relevance of safety education, and decreasing trends in repeat safety events involving NSFT staff. The intention is that this EBP initiative demonstrates how UPC leadership can translate evidence into practice to address workforce safety risks. Expected findings in support of UPC-led education as a scalable, sustainable EBP strategy that reinforces safety competencies, strengthens shared governance, and contributes to organizational safety culture and staff retention.

Learning Objectives

1. Describe how an evidence-based, UPC-led education initiative can improve workplace safety competence among nursing staff.
2. Evaluate the use of pre/post data and safety indicators to measure outcomes of an EBP-driven safety intervention.

Project Relief Roadmap: Standardizing Chronic Pain Management Through Interdisciplinary Leadership and Operational Design

Cecily Byron

Variability in chronic pain management across acute care settings contributes to patient dissatisfaction, opioid safety risks, inconsistent documentation, and operational inefficiencies. At an Academic teaching Hospital, baseline assessment revealed misaligned provider plans, inconsistent escalation practices, and underutilization of Complex Pain Plans (CPPs) due to unclear eligibility criteria and workflow barriers. In the context of the ongoing U.S. opioid crisis, healthcare systems must balance effective pain management with responsible opioid stewardship.

This quality improvement initiative aims to reduce variation and improve safety for patients presenting with acute-on-chronic pain not appropriate for IV opioid escalation through implementation of a standardized Chronic Pain Management Standard Operating Procedure (SOP) and optimization of CPP workflows.

An interdisciplinary Lean rapid improvement event (RIE) engaged nursing, physicians, pharmacy, informatics, and operational leaders to design and prepare for implementation across an inpatient medicine unit and emergency department. The SOP prioritizes multimodal therapy, establishes structured nurse–provider escalation pathways, and integrates standardized CPP processes supported by targeted electronic health record (EHR) enhancements and education.

Baseline findings demonstrated substantial variation in prescribing practices, escalation responses, and documentation. Early implementation has improved interdisciplinary alignment, clarified escalation processes, and increased visibility of CPPs within the EHR. Initial feedback indicates improved clinician confidence and greater consistency in care delivery.

This project highlights the critical role of nursing leadership in driving interdisciplinary collaboration, operationalizing evidence-based practice, and improving workflow reliability. The resulting framework provides a scalable, evidence-informed model to reduce unwarranted variation, strengthen opioid stewardship, and support sustainable, patient-centered pain management across healthcare settings.

DNP-PhD Nurse Scientist Collaborative Ecosystem

Kiara Whitney, Teresa Sparks

Translating nursing knowledge into consistent, timely, and measurable improvements remains a persistent challenge across healthcare systems. At a large, urban academic medical center, variability in nurse-led research, evidence-based practice, and quality improvement efforts, coupled with prolonged timelines from project initiation to implementation, revealed a significant research-to-practice gap. Traditional structures often positioned Doctor of Nursing Practice and Doctor of Philosophy-prepared nurses in parallel rather than integrated roles, limiting the full potential of nursing science to drive meaningful and sustained practice change. To address this gap, an integrated DNP-PhD Nurse Scientist collaborative ecosystem was designed, implemented, and evaluated to increase nurse-led scholarly output, accelerate translation of evidence into practice, and improve measurable clinical and operational outcomes. This model aligns complementary expertise, with DNP-prepared nurse scientists leading implementation and practice integration, and PhD-prepared nurse scientists advancing methodological rigor, evidence generation, and evaluation. The intentional integration of these roles creates a cohesive infrastructure that supports inquiry, innovation, and measurable impact at the point of care. A structured Nurse Scientist collaborative ecosystem model was implemented within a large academic healthcare institution. The core team consisted of two DNP-prepared and two PhD-prepared nurse scientists, supported by a research coordinator and scientific writer. Standardized processes were established to support clinical nurses and advanced practice registered nurses, including centralized project intake and vetting, structured mentorship, and use of established evidence-based practice and quality improvement frameworks. Nurse scientists were embedded within clinical service lines to provide real-time consultation and facilitate project development, implementation, and evaluation. A standardized project tracking system was implemented to monitor progress, timelines, and outcomes. Key metrics included the number and type of nurse-led projects, time from project initiation to implementation, and dissemination outputs. Data was collected longitudinally to evaluate patient and scholarly impact. From 2022 to 2026, nurse-led research, evidence-based practice, and quality improvement projects increased threefold, reflecting substantial growth in nursing scholarly engagement. Dissemination efforts expanded significantly, including increased podium and poster presentations as well as peer-reviewed publications. Time from project initiation to implementation decreased, demonstrating improved efficiency in translating evidence into practice. The collaborative model strengthened interdisciplinary engagement, enhanced the methodological quality of projects, and improved alignment of nursing initiatives with organizational priorities. An integrated DNP-PhD Nurse Scientist collaborative ecosystem strengthens the infrastructure required to translate nursing knowledge into practice. By aligning implementation science with methodological rigor, this model accelerates evidence translation, increases nurse-led scholarly output, and drives measurable improvements in clinical practice. This scalable and replicable framework provides a strategic approach for health systems seeking to operationalize nursing science and sustain practice transformation.

Implementation of a Virtual ICU (VICU) Mentorship Program to Support ICU Nurses’ Transition to Independent Practice

Michael Bagwell, Kiara Whitney

Transitioning newly hired intensive care unit (ICU) nurses to independent practice is a high‑risk period associated with increased cognitive load, variability in preceptorship, and potential threats to patient safety. Although traditional bedside preceptorship supports early skill acquisition and safety, many nurses experience reduced confidence and inconsistent support as they assume full patient responsibility. To address these challenges, a standardized Virtual ICU (VICU) Mentorship Program was implemented to provide structured, remote nursing mentorship during the final phase of ICU orientation. This quality‑improvement initiative was conducted across adult ICUs within a multi‑campus health system. All ICU new hires were screened throughout orientation using weekly clinical progression and milestone evaluations. Nurses meeting predefined readiness criteria—clinical milestone score of 3 or greater, clinical performance score of 3 or greater, and minimum competence across all domains on the AACN Knowledge Readiness Assessment—transitioned into a two‑week VICU mentorship phase. Unit educators and bedside preceptors completed weekly Microsoft Forms–based evaluations, and a standardized I‑PASS handoff was provided to the VICU prior to transition. During the mentorship phase, experienced critical‑care nurses delivered real‑time remote support using HIPAA‑compliant audiovisual technology and secure messaging. Each mentee participated in three structured Q4 check‑ins over the two‑week period, focusing on clinical priorities, communication, documentation requirements, and support for transition to independent practice. The VICU mentorship workflow was successfully integrated into existing ICU orientation processes across participating units. Standardized readiness screening and structured handoff tools supported consistent identification of appropriate candidates and streamlined transition to remote mentorship. High adherence to scheduled check‑ins demonstrated feasibility of the virtual mentorship model within routine clinical workflows. Qualitative feedback from mentees highlighted perceived benefits including increased confidence, improved situational awareness, access to real‑time clinical guidance, and a sense of “independence with a safety net.” Feedback from bedside preceptors suggested improved workload balance during the final phase of orientation as preceptors were able to return to staffing while maintaining supportive oversight for new nurses. Overall, the VICU Mentorship Program represents a feasible and scalable approach to supporting ICU nurses during the critical transition to independent practice. Standardized readiness criteria, digital workflows, and virtual mentorship may enhance safety, consistency, and nurse support during late‑stage orientation. Future phases will evaluate outcomes related to nurse retention, clinical performance progression, and patient safety indicators.

Igniting Inquiry: Empowering Nurses in Evidence-Based Practice

joan Halpern, Michele Dziedzic

Engagement of bedside nurses in evidence-based practice (EBP) and quality improvement (QI) is essential to improving patient outcomes, enhancing the patient experience, and advancing professional nursing practice. Although foundational EBP and QI structures existed within the organization, participation was inconsistent and opportunities for inquiry, mentorship, and dissemination were not fully leveraged. As a result, valuable nurse-driven improvement efforts were often fragmented and underrecognized. To address this gap, a large, urban academic medical center undertook a deliberate refocus on reinforcing and aligning existing EBP and QI best practices to more effectively integrate them into nursing culture. The purpose of this initiative was to strengthen bedside nurse engagement in EBP and QI by formalizing expectations, enhancing infrastructure, and standardizing support mechanisms already loosely in place. EBP and QI activities were more intentionally embedded into the nursing professional practice model through revitalization of the Evidence-Based Practice Council, alignment of QI participation with clinical ladder advancement, and integration of inquiry into the nurse residency program. Partnership with a nurse scientist provided consistent mentorship across all levels of practice. Additionally, an annual Nursing Poster Symposium was reestablished to promote dissemination, recognize nurse-led work, and reinforce the value of scholarly inquiry through visible leadership support. This focused reinforcement resulted in measurable improvements in nurse engagement, care processes, and patient experience. In 2025, 53 nurse-led EBP and QI projects were submitted for peer review. One project targeting routine use of PCare patient education videos improved patient experience scores related to medication communication from 74.4% to 80.8%. By realigning and strengthening existing practices, the organization fostered sustainable nurse-driven innovation and meaningful improvements in patient care and professional practice.

Empowering Frontline Clinicians: A Skin Expert Pilot Program to Reduce Hospital-Acquired Pressure Injuries

Sienna Park

This initiative demonstrates a feasible, resource-conscious strategy to decentralize wound care expertise and enhance prevention capacity. By integrating Skin Experts into daily staffing, the program creates a sustainable framework for real-time clinical support. If successful, this multidisciplinary model will serve as a blueprint for hospital-wide implementation to drive long-term, measurable reductions in HAPI.

Why Nurses Pursue Certification and What It Means for Workforce Outcomes?

Lynn Gallagher-Ford, Louise Jakubik

Nursing certification has traditionally been viewed as an indicator of clinical expertise and professional excellence. However, a 2025 scoping review by Connor et al. identified a substantial gap in empirical evidence supporting certification’s impact on workforce well being and organizational outcomes. This gap is particularly concerning given the escalating workforce crisis facing nurse leaders, characterized by rising burnout, declining retention, and eroding engagement. With limited evidence to guide strategic investment in certification programs, a national research initiative was launched to examine why nurses pursue certification and how certification relates to critical workforce outcomes. The purpose of this study was threefold:

1. to identify the intrinsic and extrinsic motivators influencing nurses decisions to pursue certification
2. to examine key workforce outcomes, including burnout, mattering, engagement, and intent to stay, among certified nurses; and
3. to compare these outcomes between nurses employed in Magnet designated and non Magnet organizations to determine whether organizational designation moderates the effects of certification. A descriptive, cross-sectional design was used, with two rounds of national data collection conducted over four months in 2025. More than 2,000 certified nurses participated, representing diverse roles, specialties, and practice settings. Validated instruments were used to measure motivators and workforce outcomes, and comparative analyses were conducted across certification status and organizational designation. Findings revealed several important insights - across all nursing roles, intrinsic motivators (professional growth, mastery, pride, and commitment to one’s specialty), were rated substantially higher than extrinsic motivators such as employer recognition and pay advancement. Only 2.2% of certified nurses reported the highest level of burnout compared to national benchmarks. 82% of the certified nurses reported high intention to stay in their current organization reflecting strong retention. 86% of the certified nurses reported moderate to high levels of mattering compared to the low levels of mattering reflected in the current literature for the general nursing population. Nurses working in Magnet-designated organizations were more motivated by the extrinsic factors than nurses in non-Magnet organizations. No significant differences in workforce outcomes were found between Magnet-designated and non-Magnet organizations. These findings carry direct implications for nursing leaders across all healthcare settings. The data provides a compelling[LJ4.1] case for investing in certified nurses as a mechanism for cultivating a healthy, engaged workforce who are far less burned out and who intend to stay (retention). The findings that certified nurses were predominantly motivated by intrinsic factors compared to external factors informs leaders in designing effective, evidence-based certification programs, based on this new understanding. The discovery that certification may serve as a protective factor related to burnout and a supporting factor for engagement, mattering and intent to stay (retention) are of note. These findings held regardless of Magnet status suggesting that leaders in any organization can make a strong business case for leveraging certification to strengthen workforce stability and wellness. As the nursing profession continues to confront unprecedented workforce challenges, these findings highlight certification as a meaningful and evidence informed strategy for cultivating a healthy, strong and sustainable nursing workforce.

Increasing Successful Transitions from Long-Term Care to Home

Stacy Jarrett

Background:

Many older adults residing in nursing facilities are capable of improving their quality of life by transitioning to their own homes with appropriate support. Despite the potential benefits, transitions from long-term care to home remain low, with only 0.7% of residents successfully transitioning in one Medicaid health insurance provider in New Mexico. Barriers include service approval delays, communication gaps, and lack of staff awareness, while consistent case manager staffing and coordinated services facilitate successful transitions. Aim This quality improvement (QI) project aimed to increase the rate of successful transitions from long-term care facilities to home by at least 10% through the implementation of a case management transition team and targeted staff education.

Methods:

The project was conducted across long-term care facilities in New Mexico. The intervention involved establishing a multidisciplinary case management transition team, developing and delivering staff training on transition processes and available services, and utilizing the Model for Improvement framework with PDSA cycles. Outcome, process, and balancing measures were tracked using control charts and qualitative feedback.

Results:

Initial interventions improved staff knowledge and increased communication efficiency. Ongoing PDSA cycles led to expanded team involvement and improved service approval processes. The project aimed for a 10% increase in successful transitions, defined as residents returning home without readmission within 30 days; ongoing monitoring included 30, 60, and 90-day follow-ups.

Conclusion:

Establishing a case management transition team and structured staff education can significantly increase successful transitions from long-term care to home, enhancing patient independence and reducing healthcare expenditures. This model offers a replicable approach for other managed care organizations.

Keywords: case management, long-term care, home transition, quality improvement, older adults, Medicaid, multidisciplinary team