Current Researchers Funded by the AONL Foundation

Sandy Galura, PhD, RN (Principal Investigator)

University of Central Florida College of Nursing

$14,985 Leadership Equity / Equitable Health Care Research Grant made possible by a generous gift from AMN Healthcare.

An Examination of Workload, Responsibilities, and Barriers to Equitable Access to Leadership Roles Peri Pandemic: A National Study of Nurse Managers

Nurse managers (NMs) are pivotal to quality outcomes. Overwhelming workload is a critical contributing factor to NM stress, job satisfaction, and intent to leave. During the COVID-19 pandemic, already stretched NMs were further tasked to operate in disrupted work environments adopting innovative practices that many organizations are now choosing to continue. These ‘moving targets’ of responsibilities and accountabilities overwhelm NMs and must be addressed. Further, as the workload of NMs is evaluated with an eye toward recruitment and retention of a leadership workforce that represents the cultural diversity of patient populations, consideration must be given to  understanding demographic barriers that may limit interest in this pivotal role. The purpose of this study is to examine and compare the work and practice environment of a diverse sample of NMs before the COVID-19 pandemic and during this peri-pandemic period to understand their evolving role responsibilities, including barriers encountered while in their leadership role and when seeking leadership roles. Using a mixed methods design, we will conduct a three-phase study. In phase 1, quantitative survey data will be examined to validate a newly created Nurse Manager Responsibilities (NMR) tool. In phase 2, we will quantify NM workload using the NMR tool and explore the relationships among aspects of the job, personal characteristics, and the NM practice environment using the Nurse Manager Practice Environment Scale (NMPES). During phase 3, we will conduct semi-structured interviews, and examine these same concepts to provide deeper insights into NM workload and responsibilities, including barriers associated with equitable access to NM roles. Findings may provide insight for future research to 1) further develop a nurse manager workload tool, 2) develop an algorithm or metrics for analyzing and comparing NM workload, 3) understand the relationship between job satisfaction, workload, and NM’s race and ethnicity, 4) develop strategies to guide NM resource allocation and innovative role support, 5) create new models for the NM work, and 6) develop potential recruitment strategies for increasing diversity among NM.

Jennifer Day, PhD, RN (Principal Investigator)

University of Maryland Medical Center

$11,995 Achieving Equity in Health Care, Diversity Among Nurse Managers Grant made possible by a generous gift from AMN Healthcare.

Nurse Managers Set the Tone: Examining the Impact of Diversity on Nursing Teams and the Patient Experience.

Background: Research suggests that lack of diversity in the healthcare workforce negatively impacts access to quality care and increases healthcare disparities. Nurse managers have a direct role in building and retaining diverse nursing teams that are engaged and able to provide culturally competent care. There is a gap in the literature confirming the role of nurse manager diversity on nursing teams and the patients’ experience of care.

Purpose: To examine the impact of diversity in the nurse manager workforce on nursing team diversity, nursing team engagement, and the patients’ perspectives of hospital experience. We are specifically interested in evaluating how nurse manager diversity, with a focus on race/ethnicity and age, impacts these outcomes.

Methods: We will use an explanatory sequential mixed methods design. Retrospective electronic human resource, HCAHPS, and Press Ganey Employee Experience survey data will be analyzed to examine the impact of diversity in nurse management on nursing team diversity, nursing team engagement, and the patients’ perspectives of their hospital experience. Qualitative interviews with a diverse group of nurse managers will be used to identify actions that nurse managers use to build nursing teams that are diverse and engaged. Quantitative results and qualitative findings will be integrated in a joint display to answer our integrated study aim. This study will take place across 13 hospitals within the University of Maryland Medical System.

Analysis: Using hospital as the level of analysis, we will look for correlations between the diversity of the nurse manager workforce and the diversity of the nursing team workforce using Pearson’s correlation. We will use separate two-way analysis of variance (ANOVA) to compare 1) independent variables of nurse manager diversity, as well as 2) nursing team diversity, with the dependent variables of nursing team member engagement and patient experience scores. Qualitative interview data will be analyzed using content analysis. We will develop a statistics-by-theme joint display to visually represent both types of data to answer our integrated aim.

Potential Impact: This study will be the first step in identifying the impact of a diverse nurse manager workforce and will lay the groundwork for interventions and future research. The next steps will be to examine health disparity and health equity impacts relating to nurse manger diversity as outlined in our conceptual framework. As a hospital-based research team, we are well-positioned to disseminate our findings with key stakeholders and equally well-positioned to act on study findings.

Cheryl Jones, PhD, RN and Donna Havens, PhD, RN

AONL Foundation CNO Turnover Study

Made possible by a generous gift from AMN Healthcare.

            Chief Nursing Officers (CNOs) provide leadership that is critical to patient welfare, quality nursing practice and organizational performance.  Typically leading the largest group of health professionals in a healthcare organization, CNOs "... bear much of the responsibility for ensuring a positive patient experience and for keeping tabs on quality and patient safety issues" (Hendren, 2011, p. 1).  In hospitals, the CNO is responsible for developing and maintaining the capacity for care delivery, interpreting and advocating for nurses and patients, and influencing clinical, fiscal and administrative outcomes (American Organization for Nurse Executives [AONE], 2005; Caroselli, 2010; Havens, Thompson, & Jones, 2008; Jones, Havens, & Thompson, 2008; Jones, Havens, & Thompson, 2009; Kippenbrock, 1995; VHA, 2005). CNOs have long been responsible for maintaining and ensuring an adequate nurse workforce to meet patient care needs, maximize “quality of patient care, the professional satisfaction of nurses, and the goals of cost-effectiveness for the institution” (Clifford, 1998, p.5), but contemporary CNOs are responsible for demonstrating care value within and across organizational boundaries, and providing leadership during uncertain environmental changes.

            Unfortunately, data on CNO retention, turnover and stability are limited (Bacheller, 2010).  The American Organization for Nursing Leadership (AONL) and the AONL Foundation launched an important first step in 2006 by examining CNO turnover and retention on a national level.  In collaboration with researchers at the University of North Carolina at Chapel Hill (Havens and Jones), AONL conducted a multi-phased study.  Phase I gathered data via an online survey of current, interim and past CNOs to describe the CNO role, experiences with voluntary and involuntary turnover, and related CNO retention issues.  Phase II used confidential telephone interviews with the same CNO population to gain additional insights into CNO turnover that augmented the online survey findings.  Phase III surveyed staff nurses, nurse managers and directors to examine the impact of CNO turnover on care delivery. The team disseminated findings through multiple presentations and publications to raise awareness of this crucial role, the potential pending crisis and to raise awareness regarding needed strategies to ameliorate the situation.

            This is the third study in a series of work to identify and monitor the status of U.S. CNO turnover and retention, taking advantage of the opportunity to compare CNO turnover at three points in time and develop a tested method for tracking CNO turnover into the future. 

Association of Leadership Science in Nursing and AONL Foundation

Esther Chipps, PhD, RN, NEA-BC (Principal Investigator)

The Ohio State University Wexner Medical Center, The Ohio State University College of Nursing

Board Member, ALSN

M. Lindell Joseph, PhD, RN, FAAN (Co-Principal Investigator)

University of Iowa, College of Nursing

Board Member, AONL Foundation

Setting the Research Agenda for Nursing Administration and Leadership Science: A Delphi Study

Summary:

A priority for ALSN is to advance research in nursing administration and leadership. Nearly five years ago, the ALSN identified nursing administration research priority categories and significant research emerged in those eight categories: economic value of nursing, design of future nursing practice and care delivery systems, healthy practice environments patient safety and outcomes research, leadership education, effective leadership using information technology to transform care, and innovative research design and frameworks.¹ In assessing the progress since the publication of the Future of Nursing report, the National Academy of Medicine recognized the continued need to develop nurse leaders and collect workforce data to support research on new models of health care delivery that improve patient outcomes.² To advance research in nursing leadership and administration, it is time to review and identify new nursing leadership/administration research priorities in order to establish the research agenda for 2020 and beyond. We propose that this research agenda will service to identify current gaps in our knowledge and provide a research trajectory for the next 5 years.

The aims of the study are:

1. To identify nursing leadership and administration research topics of importance in the USA and Canada.
2. To prioritize and reach consensus on the identified research priorities; and
3. To develop a nursing administration research agenda for 2020-2025.

John Whitcomb, PhD and Lori Stanley, DNP, RN, NEA-BC, CENP

Clemson School of Nursing

$6,508 Sustainable Nursing Workforce Development Grant made possible by a generous gift from the Versant Center for the Advancement of Nursing®.

Innovative Teaching and Learning: Key Metrics of an Undergraduate Nursing Academic and Clinical Learning Environment

Purpose: A newly established education and practice collaborative doubled the numbers of baccalaureate registered nursing students admitted to the nursing education program. The purpose of this study is to investigate key metrics during the first two crucial launch years: (a) the perceptions of the learning environment – using the Quality Clinical Placement Evaluation (QCPE) ; (b) the percentage of student clinical placements at partnership clinical sites in relation to requested clinical placements; (c) the concurrent completion of the healthcare service’s new hire residency skills checklists as part of the nursing program of study (d) the change in the students’ critical thinking scores-- the ETS proficiency profile (5) the financial expenditures for travel nurses, RN overtime, and RN orientation. 

Background and Significance: The “Future of Nursing” and the “Manatt” reports identified the benefits of innovative academic and clinical learning partnerships to build a pipeline of bedside nurses. South Carolina is 44th worst state in health rankings and predicted to have the 4th highest nursing shortage by 2030.
 

Methods: Using a prospective, descriptive, correlational research design surveys of perceptions of clinical environments and critical thinking and other key data will be analyzed at three intervals during the students’ final semesters.
Implications: Analysis of key metrics support the nursing leaders in health care systems and in academia to capture the effects of clinical placements, make comparisons over time, and underscores the importance of the quality clinical experience during undergraduate nursing degrees, so important to the development of students as beginning health professionals.