Faculty Bibliography

The Patient Protection and Affordable Care Act (PPACA, 2010) and the Institute of Medicine's (IOM, 2011) Future of Nursing report have prompted changes in the U.S. health care system. This has also stimulated a new direction of thinking for the profession of nursing. New payment and priority structures, where value is placed ahead of volume in care, will start to define our health system in new and unknown ways for years. One thing we all know for sure: we cannot afford the same inefficient models and systems of care of yesterday any longer. The Data-Driven Model for Excellence in Staffing was created as the organizing framework to lead the development of best practices for nurse staffing across the continuum through research and innovation. Regardless of the setting, nurses must integrate multiple concepts with the value of professional nursing to create new care and staffing models. Traditional models demonstrate that nurses are a commodity. If the profession is to make any significant changes in nurse staffing, it is through the articulation of the value of our professional practice within the overall health care environment. This position paper is organized around the concepts from the Data-Driven Model for Excellence in Staffing. The main concepts are: Core Concept 1: Users and Patients of Health Care, Core Concept 2: Providers of Health Care, Core Concept 3: Environment of Care, Core Concept 4: Delivery of Care, Core Concept 5: Quality, Safety, and Outcomes of Care. This position paper provides a comprehensive view of those concepts and components, why those concepts and components are important in this new era of nurse staffing, and a 3-year challenge that will push the nursing profession forward in all settings across the care continuum. There are decades of research supporting various changes to nurse staffing. Yet little has been done to move that research into practice and operations. While the primary goal of this position paper is to generate research and innovative thinking about nurse staffing across all health care settings, a second goal is to stimulate additional publications. This includes a goal of at least 20 articles in Nursing Economic$ on best practices in staffing and care models from across the continuum over the next 3 years.

In this clinical practice exchange, we discuss how faculty at the New York University College of Nursing (NYUCN) and nurse executives at NYU Langone Medical Center (NYULMC) partnered with staff nurses to implement an attending nurse model and further describe how the model facilitates collaboration as well as clinical knowledge development in practicing nurses. The attending nurse model hastens the experiential learning essential for practice development by having faculty and nurse executives provide situated learning, teaching and coaching to advanced beginner and competent practicing nurses. The model supports the fact that learning in the patient care setting is inextricably linked to the delivery of patient care and shows how faculty can contribute to effective outcomes for patients. By modeling professional comportment, helping nurses to put language to salient issues, and coaching nurses about how to participate in interdisciplinary rounds, attending nurses help young clinical staff become active participants in interprofessional dialogue. Nurse executives recognize this model as an innovative and cost efficient way to help clinical staff gain essential knowledge and skill of the practice. For faculty, teaching is enhanced by engagement in actual patient situations which are richer and more complex than theoretical models and serve as a reminder of the centrality of the nurse-patient relationship in both the work of the discipline and the organization

OBJECTIVE: The aim of the pilot study was to design an innovative model of leadership development, Leadership Laboratory (LL), grounded in the lived experiences and peer best practices of 43 cross-disciplinary nurse managers. BACKGROUND: The Institute of Medicine/Robert Wood Johnson Foundation study, The Future of Nursing, reinforces the need to prepare nurses for leadership positions. METHODS: A 1-year participatory action research study was designed to develop 3 LLs involving nurse managers as participants, co-creators, and evaluators of the unique learning format. RESULTS: Analysis of qualitative and quantitative data revealed consistent and significantly positive results in leadership skill areas in all 3 LLs. Participants identified elements that distinguished LLs from traditional seminars and trainings sessions, including opportunities to gain from peer-to peer consultation, strategies, and support. CONCLUSIONS: Participants in the 1-year pilot demonstrated significant learning based on postsession and postproject assessments of the LLs. Data also described the unique attributes of a peer-driven approach to leadership development.

The discipline of nursing continues to evolve in keeping with the dramatic expansion of scientific knowledge, technology, and a concomitant increase in complexity of patient care in all practice settings. Changing patient demographics require complex planning for co-morbidities associated with chronic diseases and life-saving advances that have altered mortality in ways never before imagined. These changes in practice, coupled with findings from sophisticated nursing research and the continuous development of new nursing knowledge, call for realignments of the relationships among academic faculty in schools of nursing, advanced practice nurse administrators, and staff nurses at the forefront of practice. This article offers a model designed to bridge the gaps among academic settings, administrative offices and the euphemistic "bedsides" where staff nurses practice. Here we describe the nurse attending model in place at the New York University Langone Medical Center (NYULMC) and provide qualitative data that support progress in our work.

OBJECTIVE: This initiative was designed to develop a reliable instrument to measure the activities of acute care nurse practitioners (ACNPs). A sound, standardized method for measuring ACNP productivity will assist nursing leaders and administrators to demonstrate the effectiveness and productivity of ACNPs in and across institutions and systems. BACKGROUND DATA: Current research on ACNPs uses many different methodologies and research designs, and fails to provide standard definitions to measure practice patterns, making it difficult to generalize across settings. METHODS: Advisory groups from 2 New York academic health science centers developed a survey that covered the demographic, educational, and employment characteristics of ACNPs, and a 20-item classification of advanced practice nursing activities. Sixty-one ACNPs completed surveys, a 58% response rate. RESULTS: The survey found strong similarities at both institutions. ACNPs spend most of their time in 5 activities involving direct care and 4 activities within indirect care. Strong Cronbach alphas confirmed that the instrument was reliable. CONCLUSIONS/IMPLICATIONS: The availability of a reliable instrument for measuring ACNP practice patterns provides administrators with a powerful tool to demonstrate the contributions of their ACNPs. In addition, a standardized method for data collection can contribute to healthcare workforce policy discussions