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Publications (8)7.21 Total impact

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    ABSTRACT: Do Nurse Residency Programs (NRPs) reflect the professional socialization process? Residency facilitators in 34 Magnet hospitals completed Residency Program Questionnaires constructed to reflect the goals, themes, components, and strategies of the professional socialization process described in the literature. NRPs in 4 hospitals exemplified the complete two-stage (role transition and role/community integration) process. In 14 hospitals, NRPs were of sufficient length and contained components that reflected the professional socialization process. In 16 hospitals, NRPs exemplified the "becoming" role transition stage. What components are most effective in the professional socialization of new graduate nurses? A total of 907 new and experienced nurses, nurse managers, and educators working on clinical units with confirmed healthy work environments in 20 Magnet hospitals with additional "excellence designations" were interviewed. Components identified as most instrumental were precepted experience, reflective seminars, skill acquisition, reflective practice sessions, evidence-based management projects, and clinical coaching-mentoring sessions. Suggestions for improvement of NRPs are offered.
    Western Journal of Nursing Research 08/2011; · 1.22 Impact Factor
  • Marlene Kramer, Brewer B Brewer, Patricia Maguire
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    ABSTRACT: Do healthy work environments (HWEs) facilitate new graduate transition into professional practice in hospitals? Are such environments related to a decrease in Environmental Reality Shock? Experienced nurses in 17 Magnet hospitals completed the Essentials of Magnetism II(©) (EOMII(©)) instrument that measures health of unit work environments. New graduates (N = 468) were then tracked with modified versions of the EOMII(©) from immediate post hire to 4, 8, and 12 months post hire to ascertain degree of Environmental Reality Shock. New graduate nurses have extremely high anticipations of unit work environments that would enable delivery of quality patient care. HWE is the most-significant variable in Environmental Reality Shock, number of related Issues and Concerns, and perceptions of quality of patient care. Suggestions of how to improve quality of unit work environments are offered.
    Western Journal of Nursing Research 04/2011; · 1.22 Impact Factor
  • Critical Care Nurse 07/2009; 29(3):77-93. · 0.90 Impact Factor
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    ABSTRACT: This mixed-methods study uses interviews, participant observations, and the CWEQII empowerment tool to identify structures and attributes of structures that promote control over nursing practice (CNP). Nearly 3,000 staff nurses completed the Essentials of Magnetism (EOM), an instrument that measures CNP, one of the eight staff nurse-identified essential attributes of a productive work environment. Strategic sampling is used to identify 101 high CNP-scoring clinical units in 8 high-EOM scoring magnet hospitals. In addition to 446 staff nurses, managers, and physicians on these high-scoring units, chief nursing officers, chief operating officers, and representatives from other professional departments are interviewed; participant observations are made of all unit/departmental/hospital council and interdisciplinary meetings held during a 4 to 6 day site visit. Structures and components of viable shared governance structures that enabled CNP are identified through constant comparative analysis of interviews and observations, and through analysis of quantitative measures.
    Western Journal of Nursing Research 09/2008; 30(5):539-59. · 1.22 Impact Factor
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    ABSTRACT: Professional nursing organizations identify nurse manager (NM) support of staff nurses as an essential component of a productive, healthy work environment. Role behaviors that constitute this support must be identified by staff nurses. In this mixed-method study, supportive role behaviors were identified by 2382 staff nurses who completed the investigator-developed Nurse Manager Support Scale. In addition, semistructured interviews were conducted with 446 staff nurses, managers, and physicians from 101 clinical units in 8 Magnet hospitals in which staff nurses had previously confirmed excellent nurse manager support. Through individual and focus group interviews with NM and chief nurse executives in the 8 participating hospitals, the organizational structures and practices that enabled NM to be supportive to staff were determined. The 9 most supportive role behaviors cited by interviewees were as follows: is approachable and safe, cares, "walks the talk," motivates development of self-confidence, gives genuine feedback, provides adequate and competent staffing, "watches our back," promotes group cohesion and teamwork, and resolves conflicts constructively. Supporting structures and programs identified by managers and leaders include the following: "support from the top," peer group support, educational programs and training sessions, a "lived" culture, secretarial or administrative assistant support, private office space, and computer classes and seminars.
    Nursing administration quarterly 09/2007; 31(4):325-40.
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    ABSTRACT: Autonomy is a multidimensional process. Clinical autonomy, the dimension in which patients are the primary beneficiaries, is the focus of this study. Despite high valuation and persistent challenges to nurses to function autonomously, the relationship between autonomous practice and patient outcomes has not been empirically established due, in large measure, to a lack of correspondence between concepts and measurement of autonomy and to a lack of knowledge of enabling structures. The purpose of the research reported here is to identify the structures, practices, elements in the environment, and interventions that nurses, nurse managers, and physicians identify as promoting staff nurse clinical autonomy. Implementation of these interventions would then enable clinical decision making at the frontline and would foster studies to determine whether the expected linkage between clinical autonomy and positive patient outcomes prevails.
    JONA The Journal of Nursing Administration 02/2007; 37(1):41-52. · 1.33 Impact Factor
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    ABSTRACT: Despite high valuation and persistent challenges to nurses to function autonomously, neither the structures fostering clinical autonomy nor the relationship between autonomous practice and positive patient outcomes has been empirically established. Much of this is caused by the lack of precision in definition and measurement of the concept and identification of autonomy-enabling structures. The goal of this multisite, evidence-based management practice study is to provide an in-depth analysis of the concept and an articulation of a grounded theory of clinical autonomy preparatory to the identification of structures supporting autonomy. This article describes the research design and methodology and explicates the grounded theory by answering the following questions: What is clinical autonomy? When and where does it occur? Suggestions and recommendations for what could be done to clarify the concept and promote clinical autonomy are provided.
    JONA The Journal of Nursing Administration 11/2006; 36(10):479-91. · 1.33 Impact Factor
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    ABSTRACT: Improving clinical nurse work environments is a major challenge faced by nurse executives today. To meet this challenge, nurse leaders must implement the "right" structures and best leadership practices so that clinical nurses can engage in the work processes and relationships that are empirically linked to quality patient outcomes. What are these "right" structures and best leadership practices? Meta-analyses of 2 sets of publications were used to identify organizational structures and best leadership practices essential to a healthy work environment, that is, a work environment that enables them to engage in the work processes and relationships needed for quality patient care outcomes. The first set was 12 publications from 7 professional organizations/regulatory bodies that advocated forces, hallmarks, and standards for a healthy work environment. The second set was 18 publications from the Essentials of Magnetism structure-identification studies, in which the aggregated results from 1300 interviews with staff nurse, manager, and physician "experts" were compared with the agency results. Broadening the categories and final aggregation yielded the 9 most important and influential structures essential to a quality work environment. Suggestions for implementing these structures are provided.
    Nursing administration quarterly 34(1):4-17.