ALSN & ANF Joyce J. Fitzpatrick Leadership Research Award

Linking Nursing Leadership and Workplace Bullying Science to Strengthen Nurse Leader Empowerment

Co-investigators:

• Laura Cox Dzurec, PhD, PMHCNS-BC, ANEF, FAAN; Nursing Research Scientist at Hartford Hospital, Hartford, CT
• Jennifer Hehl, RN, PhD, CNOR, ONC; Nurse Scientist – Bone and Joint Institute at Hartford Hospital, Hartford, CT

The purpose of this study is to support nurse leaders’ effectiveness in addressing workplace bullying. Its aim is to develop an instrument to help nurse leaders reframe (Tarasenko et al., 2023) their understanding of workplace bullies’ subtle communication dynamics. In follow-up of a realist review of published literature, the investigators are extracting examples of workplace bullies’ apparent communication processes (Pawson et al., 2005; Pearsons et al., 2023a, 2023 b; Sukhera et al., 2020; Sukhera et al., 2022) and from those processes, identifying the negative effects of those communications. Ultimately, individual instrument items will capture, for example, behaviors that serve to belittle, humiliate, gaslight, or marginalize.

We will use multiple steps to test and refine the instrument. Step one involves review of an initial draft of the instrument by a focus group of scientists who have studied bullying in multiple settings. Step two will involve piloting the instrument, as reviewed and edited by the focus group, with a group of nursing leaders geographically local to the investigators. In step three of the project, the final edited version of the survey will be sent electronically to approximately 3000 nurse leaders identified across the US. On the basis of those responses, we plan to conduct an Exploratory Factor Analysis to establish dimensionality of individual items and a Confirmatory Factor Analysis to address the instrument’s overall psychometric quality.

There is no available, simple picture to understand or explain the scope of nurse leaders’ complex work (Cummings et al., 2008, 2021; Grubaugh et al., 2023; Richey & Waite, 2019), much less to understand or explain the impact of workplace bullies’ complex communications on nurse leaders’ effective practice (Francioli et al., 2018). Confronted with subtle bullying behaviors, nurse leaders are challenged to develop insight into how bullies’ process traumatizes individual stakeholders and the nursing unit as a whole. We believe the proposed instrument will help to fill a significant gap in nurse leaders’ ability to respond to workplace bullying. As they describe their own workplace bullying experiences in response to proposed instrument items, nurse leaders participating in the study will help to establish the dependability and confirmability of the instrument and its items, ultimately demonstrating its utility in drawing a ‘simple picture’ (Willard, 1994) to clarify workplace bullying’s complexity. Simple pictures are best.  References are available upon request.

ALSN Foundation Pilot Award

Examining the Impact of Geographic Clustering of Nursing Care Assignments on Nursing Outcomes (Efficiency, Workload, Missed Care, and Satisfaction) and Patient Outcomes (Responsiveness, Emergency Response Team Activations, Falls, Hospital Acquired Pressure Injuries, and Satisfaction)

Principal Investigator:

• Amy M. Knupp, PhD, RN, APRN-CNS, CPPS; Nurse Scientist & Continuing Professional Development Program Director;The Ohio State University Wexner Medical Center; Columbus, Ohio

• Esther Chipps, PhD, RN, NEA-BC, FAONL (senior researcher); Clinical Nurse Scientist, The Ohio State University Wexner Medical Center; Professor of Clinical Nursing, The Ohio State University College of Nursing
• Carolyn Sommerich, PhD, CPE, FHFES; Professor - Engineering Laboratory for Human Factors/Ergonomics/Safety, The Ohio State University Dept. of Integrated Systems Engineering

Purpose

The purpose of this nursing research study is to strengthen the body of evidence related to the use of geographic clustering (GC) of nursing care assignments and the effect on staff efficiency, staff workload, missed care, staff satisfaction, responsiveness, emergency response team (ERT) activations, patient falls, patient hospital-acquired pressure injuries (HAPIs), and patient satisfaction, and to describe staff members’ experiences working on the unit with GC nursing patient care assignments. This be will a mixed methods research study. Phase 1a and Phase 1b will use a quasi-experimental design. Phase 2 will use qualitative methods, specifically focus groups. During Phase 1a, staff efficiency will be examined by using a step counting device on nursing staff members who volunteer to have their steps collected, and in Phase 1b, GC of nurse-patient care assignments will be implemented on the intervention unit, and staff workload and missed care data will be collected by surveying the staff members on both the intervention and the control units. Staff efficiency data will be collected for each participant for 36 hours prior to implementation and 36 hours following implementation of the GC intervention (72 hours total). Staff workload and missed care data will be collected for one month prior and one month after implementation of the GC intervention. Also, during Phase 1b, responsiveness data will be accessed from the call-light system and will be collected for a three-month period prior to the intervention. ERT activation, patient fall, and patient HAPI data will be obtained from the nursing unit and/or hospital quality scorecard, and patient satisfaction data will be retrieved from the Press Ganey HCAHPS (Detwiler & Vaughn, 2020) monthly patient satisfaction report. ERT, patient fall, patient HAPI, and patient satisfaction data will be collected for a three-month period before and after implementation of the intervention. This study offers an innovative approach in redesigning nurse-patient assignments to focus on nursing workflow and patient safety, and it promotes interprofessional collaboration with an engineer to help understand the physical impact of nursing work. Additionally, this research study will advance the Association for Leadership in Science in Nursing’s (ALSN’s) research priority areas of:

• Developing and managing a nursing workforce to meet current and future healthcare needs
• Healthy work and practice environments for direct care nurses
• Healthy work and practice environments for nurse leaders

Study Aims

• To compare GC to standard nurse-patient assignments
• To determine the impact of using GC of nursing patient assignments on staff efficiency, staff workload, and missed care, as well as responsiveness, ERT activations, patient falls, patient HAPIs, and patient satisfaction.
• To describe staff members’ experiences (staff satisfaction) working on the unit with GC nursing patient care assignments.

ALSN Foundation Pilot Award

The Prevalence of Well-Being Among New Nurses and the Impact on Patient Safety

• Principal Investigator: Cory D. Church, PhD, RN, NPD-BC, Associate Professor, Texas Tech University, Health Science Center

The concern for the well-being of the nation’s largest healthcare workforce has been intensifying for several years. Research demonstrates that the healthcare work environment is increasingly demanding, leading to high levels of stress, burnout, and suicide among nurses. One population of nurses facing threats to their well-being is new nurses, defined as registered nurses practicing for one year or less. With national calls to address well-being and the recent global pandemic upending the workforce, it is imperative to understand the well-being of new nurses. The purpose of this study is to identify the prevalence of well-being and its relationship to job satisfaction, turnover intent, and patient safety issues among new nurses.

The aims of the study include:

1. Measuring the well-being of new nurses .
2. Measuring the relationship between well-being and job satisfaction, turnover intent, and patient safety issues.

ALSN Foundation Pilot Award

The Effect of Mini-Mindfulness and Narrative Nursing Interventions to Promote Nurse Leaders’ Resilience and Well-being 

• Principal Investigator: Minjin Kim, PhD, RN; Assistant Professor, College of Nursing, University of Cincinnati
• Joyce J. Fitzpatrick, PhD, MBA, RN, FAAN, FNAP; Director, Marian K. Shaughnessy Nurse Leadership Academy; Elizabeth Brooks Ford; Professor of Nursing; Frances Payne Bolton School of Nursing; Distinguished University Professor; Case Western Reserve University
• Rebecca Owens, DNP, MBA, MSN, RN-BC; Chief Nursing Officer; New York State Psychiatric Institute
• Stephanie Nolan, DNP, MBA, RN, CPAN, NEA-BC; Executive Director Acute Care Nursing; Providence Little Company of Mary San Pedro
• Sharon Tucker, PhD, APRN-CNS, NC-BC, FNAP, FAAN; Grayce Sills Endowed Professor in Psychiatric Mental Health Nursing; Director, DNP Nurse Executive Core; Director, Implementation Science Core, Fuld EBP Institute

In this study, we investigate the effects of a 3-minute mindfulness breathing intervention (3MBS) and a Narrative Nursing (NN) intervention to promote nurse leaders’ well-being and resilience. We will conduct a three-arm randomized controlled trial (RCT), 1) 3MBS group, 2) NN intervention group, and 3) 3MBS/NN intervention group and test effects on well-being and resilience among nurse leaders working in acute care settings.  

Combining the 3MBS and NN interventions may be a new relevant, and potentially effective tool to promote healing and well-being among nurse leaders during and beyond pandemic stressors. Increased self-regulation skills and ability to make sense of their own and others’ experiences, creating a sense of connectedness, providing personal resilience, and decreasing stress can enable front-line nurse leaders to manage pandemic-related care demands and the ensuing repercussions effectively. Therefore, we bring together investigators’ clinical and research expertise and previous collaborative research in the area of nurses’ well-being and resilience, mindfulness practice and intervention, narrative nursing intervention, and online-based experimental studies to investigate the effects of the combination of a 3MBS and a NN intervention to promote nurse leaders' well-being and resilience in a 3-arm RCT.

Versant Center for the Advancement of Nursing Pilot Award

Nurses' Fatigue, Sleepiness, Sleep Quality and Experience Working Night Shift 

• Susan H. Weaver, PhD, RN, CRNI, NEA-BC
  Nurse Scientist, Ann May Center for Nursing and Allied Health
  Hackensack Meridian Health
  Neptune, New Jersey
  
  
• Theresa A. Wurmser, PhD, MPH, RN, NEA-BC
  Vice President, Ann May Center for Nursing and Allied Health
  Hackensack Meridian Health
  Neptune, New Jersey

Project Summary: The purpose of this pilot study is to assess fatigue, sleepiness, and sleep quality in clinical nurses and administrative supervisors and improve the experience of working night shift. This will be accomplished by:

1. Investigating fatigue, sleepiness, and sleep quality of day and night shift clinical nurses and administrative supervisors and exploring the night shift clinical nurses and administrative supervisors’ perception of their experience working night shift,
2. Providing education sessions for nurses on how to manage fatigue, and
3. Holding listening sessions (focus groups) with night shift clinical nurses exploring fatigue countermeasure initiatives and initiatives to improve their experience working night shift.
   

Aim 1: To identify if a difference exists in fatigue, sleepiness, and sleep quality between day shift and night shift clinical nurses and day shift and night administrative supervisors.

Aim 2: To describe the relationship between fatigue, sleepiness, and sleep quality in day shift and night shift clinical nurses and administrative supervisors and demographics such as years of experience on night shift, having a second job, and fatigue-related clinical error or near miss.

Aim 3: To describe night shift clinical nurses and administrative supervisors’ experience working night shift and the initiatives to improve their experience working night shift.

COVID-related Stressors, Burnout, Turnover Intention, and Resilience during the Pandemic among Nurse Leaders

• Aoyjai P. Montgomery, PhD, BSN

Educational Affiliation: University of Alabama at Birmingham (UAB)

Project Summary: It is my great honor to be the recipient of the ALSN research grant 2020-2021 sponsored by the Versant Center for the Advancement of Nursing (VCAN). The COVID-19 pandemic introduced new stressors to nurse leaders, e.g., managing the complex staffing situation (staff shortages, reassigning nurses to cover COVID-19 units, limited bed capacity, high patient acuities, shortage of personal protective equipment), while supporting their staff nurses. However, there is little evidence on COVID-related stressors, burnout, turnover intention, and resilience among nurse leaders. Therefore, this funding has allowed me to conduct a survey study asking nurse leaders about their COVID-related stressors, burnout, turnover intention, and resilience. My goals are to advance our understanding of COVID-related stressors contributing to burnout, turnover intention, and resilience among nurse leaders during COVID-19 and to provide baseline data to inform the development of actionable interventions to prevent or at least reduce burnout and turnover intention and possibly increase resilience. Attending to the well-being of nurse leaders may have second order effects of improving staff nurses’ work-related outcomes as well as patient outcomes. Thus, the results of this study will ultimately improve the quality of care and health outcomes of patients during a global health crisis.

List of publication citations using APA format:

• Montgomery, A. P., & Patrician, P. A. (2022). Work environment, resilience, burnout, intent to leave during COVID pandemic among nurse leaders: A cross‐sectional study. Journal of Nursing Management. https://doi.org/10.1111/jonm.13831
• Montgomery, A. P., & Patrician, P. A. (Under Review). COVID-19 Stressors and Resilience among Nurse Leaders.

List of presentation citations using APA format:

Webinar

• Montgomery, A.P, & Patrician, P. A. (2022, June). Nurse leaders’ experiences during COVID. Webinar Presentation: Association of Leadership Science in Nursing (ALSN), Zoom.

Podium

• Montgomery, A.P. (2022, May). COVID-related stressors, burnout, turnover intention, and resilience during the pandemic among nurse leaders. Podium Presentation: Birmingham Regional Organization of Nurse Leaders (BRONL), Birmingham, AL. (Virtual due to Covid-19).
• Patrician, P.A., Dick, T., Montgomery, A.P., Sullivan, C. (2022, September). The Alabama nursing workforce: What COVID-19 taught us and where we go from here. Keynote Speakers: Alabama State Nurses Association (ASNA), Point Clear, AL.
• Montgomery, A.P. (2022, November). Nurse leaders’ experiences during COVID. Podium Presentation: Association of Leadership Science in Nursing (ALSN), Cleveland, OH.

Poster

• Montgomery, A. P., & Patrician, P. A. (2022, June 4-7). COVID-related stressors, burnout, turnover intention, and resilience among nurse leaders during the pandemic. Poster presentation at Academy Health Annual Research Meeting. Washington, DC.
• Montgomery, A. P., & Patrician, P. A. (2022, June 4). COVID-related stressors, burnout, turnover intention, and resilience among nurse leaders during the pandemic. Poster presentation at the 2022 Interdisciplinary Research Group on Nursing Issues (IRGNI) Annual Research Meeting. Washington, DC.
   
  

Sheila Chucta DNP, RN, APRN-CNS-CNS, CCRN

Educational Affiliation: The Ohio State University

Amy Campbell, RN, MSN, PhD

Educational Affiliation: East Carolina University

"I am very honored to be the recipient of the 2018 research grant. This funding allowed me to hold focus groups to capture the voice of the Register Nurse and Nursing Assistant and their role in patient safety. As a PhD student, this allowed me to go beyond my dissertation work and have the opportunity to do a mixed methods study. I am excited to be part of an organization that has such a wide influence on nursing leadership, education, and administration."

Educational Affiliation: University of Colorado College of Nursing

"ALSN is the perfect organization for educators of nurse leaders and I have been a member reaping benefits for several years. It was an honor to receive a research grant in 2018 for innovative action research. Over three semesters, we placed PhD and DNP health leadership students together in course work. We gathered voices of the students and constructed new knowledge describing doctoral scholarly roles and models for doctoral leadership education in health systems. Our work was accepted for publication in Advances in Nursing Science. We appreciate the support of ALSN in moving discourse forward on collaborative models for doctoral education."

Team Learning and Safety Culture in Perioperative Hospital Units: Understanding the Nursing Unit Leader Perspective

• Principal Investigator: Heather Nelson-Brantley, PhD, RN, CCRN-K; University of Kansas School of Nursing
• Joanna Veazey Brooks, PhD, MBE

Publications:

• Brooks, J.V., & Nelson-Brantley, H.V. (2023). Managing safety in perioperative settings: Strategies of meso-level nurse leaders. Health Care Management Review, 48(2), 175-184. PMID: 36745755. https://doi.org/10.1097/hmr.0000000000000364
• Brooks, J.V., & Nelson-Brantley, H.V. (2022). Managing safety in perioperative settings: Challenges and strategies of meso-level nurse leaders. Academy of Management Proceedings,1. https://journals.aom.org/doi/10.5465/AMBPP.2022.14495abstract

Presentations:

• Brooks, J.V., & Nelson-Brantley, H.V. (August 2022). Managing safety in perioperative settings: Challenges and strategies of meso-level nurse leaders. Oral presentation. Academy of Management Annual Meeting, Hybrid Conference. 
• Nelson-Brantley, H.V., & Brooks, J.V. (November 2020). Team learning and safety culture in perioperative hospital units: Understanding the nursing unit leader perspective. Oral presentation. 2020 Association for Leadership Science in Nursing International Conference, Chapel Hill, NC (virtual).
• Levina, J., & Nelson-Brantley, H.V. (March 2020). Nurse leaders’ experiences leading interprofessional teams and establishing safety culture in perioperative hospital units. Poster presentation. 2020 Midwest Nursing Research Society Conference, Virtual Conference.

Susan Weaver, PhD, RN, CRNI, NEA-BC.

Educational Affiliation: Ann May Center for Nursing, Hackensack Meridian Health

"It is an honor for myself and all administrative supervisors to have received the ALSN 2017 Research Award for research on the development of the Administrative Supervisor Practice Environment scale. Considering the lack of research on the Administrative Supervisor role, receiving this grant from ALSN reinforces the value of this research specific to this vital nursing leadership role."