BACKGROUND: Sleep-related worry is recognized as a significant determinant of sleep quality. Yet the prevalence and correlates of sleep worry among clinical nurses have not been well established. PURPOSE: This cross-sect...BACKGROUND: Sleep-related worry is recognized as a significant determinant of sleep quality. Yet the prevalence and correlates of sleep worry among clinical nurses have not been well established. PURPOSE: This cross-sectional study aimed to investigate the prevalence and correlates of sleep worry among clinical nurses in order to guide the development of targeted intervention strategies. METHODS: Clinical nurses employed at a large urban hospital in China from June to November 2024 were recruited for this study. A rigorously developed and validated sleep worry scale was used to assess each nurse's level of sleep worry. Correlational analysis was used to identify significant associations between variables of interest and sleep worry. Multiple linear regression analysis was used to identify significant influencing factors of sleep worry. RESULTS: A total of 285 clinical nurses were included in the study. Within this cohort, the prevalence of sleep worry was 64%; the mean sleep worry scale score was 32.14. Correlation analysis revealed significant associations between sleep worry and participants' age, work department, professional title, years of nursing experience, and number of night shifts per month. Multiple linear regression analysis identified age, work department, professional title, years of nursing experience, and number of night shifts per month as significant influencing factors of sleep worry. CONCLUSIONS: The high prevalence of sleep worry among clinical nurses underscores the need for targeted and effective intervention strategies. The identified influencing factors provide valuable guidance for the development of these strategies. Such measures are essential to effectively mitigate sleep worry among clinical nurses, thereby potentially enhancing their overall well-being and job performance.
BACKGROUND: Many patient care tasks can be safely performed by nonlicensed personnel, allowing licensed nursing staff to focus on care that requires specific clinical expertise. A shortage of nurses and patient care tech...BACKGROUND: Many patient care tasks can be safely performed by nonlicensed personnel, allowing licensed nursing staff to focus on care that requires specific clinical expertise. A shortage of nurses and patient care technicians (PCTs) often leads to missed essential nursing care, reduced job satisfaction, poorer outcomes, and increased costs. PURPOSE: The purpose of this study was to evaluate whether a newly established staffing model, which paired one nurse and one PCT for every five patients, markedly increasing the number of PCTs, could enhance patient and staff outcomes while also lowering costs. METHODS: A project proposal was developed and approved by leadership that included estimates of cost savings after the changes in staffing ratios. The study period was from July 1, 2024, to December 31, 2024. Data analysis took place from January 1, 2025, to February 28, 2025. After discussions with leadership, the acute care medical unit transitioned from a 1:4 RN-to-patient ratio and a 1:10 to 1:12 PCT-to-patient ratio to a 1:5 RN-to-patient ratio and 1:5 PCT-to-patient ratio. A MISSCARE Survey, which evaluates perceptions of and reasons for missed nursing care, as well as perceptions of a unit's working environment (teamwork), was distributed to all unit staff members before implementation of the staffing change and again six months after implementation. Quantitative data included MISSCARE Survey responses, Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) nursing communication scores, and bathing compliance, as well as the financial calculations (contingency labor hours and unit overtime and vacancy rates). Data were analyzed using descriptive statistics and Mann-Whitney tests. RESULTS: Of 51 eligible staff members, 26 completed the baseline survey and 32 completed the postimplementation survey. Of the 24 missed care items in the survey, statistically significant improvements were seen in six: complete documentation, meal setup, toileting, bathing and skin care, feeding patients, and patient teaching and education. Additionally, statistically significant improvements were observed in HCAHPS nursing communication scores and unit bathing compliance. All cost-related outcomes also improved significantly, including reduced contingency labor hours, decreased RN/PCT vacancy rate, and decreased overtime, resulting in a total of $453,228 in annual departmental savings. CONCLUSIONS: Meaningful improvements in care delivery, patient outcomes, staff experience, and unit costs were observed on this acute care medical unit after the creation of a more balanced staffing model through adjustments in the RN and PCT staffing ratios. These findings support expansion and scaling of the new model to gather longitudinal data on its potential impact.
BACKGROUND: Shared decision-making and professional governance have long been defining features of American Nurses Credentialing Center (ANCC) Magnet-designated organizations, supporting high-quality outcomes, profession...BACKGROUND: Shared decision-making and professional governance have long been defining features of American Nurses Credentialing Center (ANCC) Magnet-designated organizations, supporting high-quality outcomes, professional autonomy, and nurse engagement. Within our multi-Magnet-designated academic medical center, part of a larger academic health system, a shared governance structure had been in place for many years. However, to respond to the evolving demands of the academic medical center, the increasing complexity of health care delivery, and the need for stronger alignment between frontline practice and organizational strategy, the leadership and governance model was redesigned to fully integrate professional shared governance into the model with direct care nurses. PURPOSE: The purpose of this article is to describe how an ANCC Magnet-designated academic medical center systematically developed, implemented, and evaluated a transition from traditional shared governance to a robust professional shared governance framework by intentionally engaging nurses at all levels of the organization. This work aimed to strengthen nurses' voice in decision-making; enhance professional accountability; and hardwire structures that align nursing practice, quality, and innovation with organizational priorities. METHODS: A pre-post survey design was used to examine nurse engagement over a two-year period spanning the implementation of the professional shared governance model. Validated engagement measures were administered to nurses across the academic medical center before the redesign (2024 presurvey) and after its full implementation (2025 postsurvey). Comparative analyses were conducted to assess changes in overall engagement and in specific domains associated with professional practice, informatics, recruitment and retention, recognition, and evidence-based practice/research. RESULTS: A total of 248 and 286 nurses responded to the preimplementation and postimplementation surveys, respectively, and their responses were compared. Overall nurse engagement scores increased between the 2024 presurvey and the 2025 postsurvey, indicating stronger perceptions of involvement, influence, and professional support following implementation of the professional shared governance model. The largest gains were observed in domains related to maximizing the capabilities of clinical and information technology to support patients and families; recruitment, retention, and recognition activities; and engagement in evidence-based practice and research opportunities. Clinical nurses demonstrated increased engagement across all measured categories, mirroring the overall pattern of improvement and showing the most substantial gains in the same high-impact domains. CONCLUSION: Transitioning from shared governance to professional shared governance within an academic medical center is a complex, iterative, and developmental process that advances over time. Effective professional shared governance structures require intentional design, sustained leadership commitment, and active nurse participation at every level of the organization. To ensure these structures remain meaningful and high performing, they must be continuously evaluated, refined, and adapted to reflect contemporary practice, emerging priorities, and the evolving needs of nurses, patients, and the health system. By leveraging data-driven insights, incorporating innovative strategies, and maintaining a culture of shared accountability and collaboration, professional shared governance can remain agile, forward-thinking, and a powerful driver of nursing excellence and organizational outcomes.
BACKGROUND: In-hospital cardiac arrest is a critical issue in health care and is associated with significant mortality rates. Nurses play a crucial role in recognizing patient deterioration and responding immediately to...BACKGROUND: In-hospital cardiac arrest is a critical issue in health care and is associated with significant mortality rates. Nurses play a crucial role in recognizing patient deterioration and responding immediately to patient arrest situations. PURPOSE: The purpose of this quality improvement (QI) project was to develop and implement a code preparation training program, Code Prep Choreography-Urgent Interval (CPC-UI), and evaluate its impact on nurses' confidence in responding to a patient arrest. METHODS: A pre-post QI framework was used to develop and evaluate the training, which was implemented on two nursing units. The training utilized a hybrid approach, including an asynchronous phase followed by a hands-on phase that included role simulation. Pre- and postsurveys were used to evaluate nurses' level of confidence in each of the roles denoted in the training, as well as to garner feedback on the training's applicability and effectiveness. Paired t tests were used to determine improvements in confidence levels. RESULTS: In total, 84 nurses completed both the pre- and posttraining surveys and thus were included in the analysis. Findings revealed significant increases in nurse confidence across all CPC-UI roles. Furthermore, nurses agreed or strongly agreed that the training was applicable, facilitated new skill development, and was effective overall. CONCLUSION: The CPC-UI training allowed nurses to practice critical skills needed in the first few minutes of a patient arrest. This training may be especially important in non-critical care areas where nurses typically have less frequent exposure to patient arrest situations and consequently stand to benefit most from structured preparation. Overall, the CPC-UI training presents a valuable model for enhancing nurse preparedness in resuscitation scenarios, warranting broader implementation and ongoing evaluation.
BACKGROUND: Chronic heart failure (CHF) is a complex and often progressive condition, requiring ongoing self-management and lifestyle adjustments. Empowerment, which refers to a person's ability to oversee their health a...BACKGROUND: Chronic heart failure (CHF) is a complex and often progressive condition, requiring ongoing self-management and lifestyle adjustments. Empowerment, which refers to a person's ability to oversee their health and be more involved in their care, serves as the foundation of this engagement, and health coaching has emerged as a critical strategy to help patients take an active role and manage their condition effectively. PURPOSE: This study aimed to evaluate the five RE-AIM elements-reach, effectiveness, adoption, implementation, and maintenance-of a health coaching program (H-Coaching) in empowering hospitalized patients with CHF. METHODS: An exploratory study was conducted involving 55 patients admitted to the cardiology unit of a university hospital in northern Spain, who were divided into a preintervention group (n = 25) and a postintervention group (n = 30). The intervention involved the implementation by nurses of H-Coaching to empower patients with CHF during their stay and prepare them for discharge. To measure CHF patient empowerment, the Spanish adaptation and validated version of the Patient Empowerment in Long-Term Conditions questionnaire was used. This tool assesses empowerment across three dimensions (positive attitude and sense of control, shared and informed decision-making, and information seeking and peer sharing) and was administered at two time points: before (T1) and after (T2) the intervention. RESULTS: The difference between pre- and postintervention empowerment scores was statistically significant for the positive attitude and sense of control dimension, with a mean improvement of 0.58. Furthermore, a statistically significant difference was observed for item 33, "I need to know what is happening to me and why," within the shared and informed decision-making dimension. No statistically significant difference was observed for item 35, "I have shared my knowledge about my illness with people who have similar illnesses to mine," within the information-seeking and peer-sharing dimension, although a mean improvement of 0.56 between pre- and postintervention scores was observed. CONCLUSION: The results of this study indicate that health coaching is effective in empowering patients with CHF in hospital settings. Furthermore, several factors were identified that can help ensure the successful implementation and evaluation of health coaching, such as nurse training and professional experience, a supportive environment, and active caregiver involvement. This knowledge can be used to design future interventions to empower hospitalized patients with CHF in other settings.
Guiding patients through the challenging and vulnerable moments of cancer care.Guiding patients through the challenging and vulnerable moments of cancer care.
BACKGROUND: Night shift work is known to disrupt circadian rhythms, leading to significant physical and mental health challenges, including fatigue, sleep deprivation, and long-term health risks. For nurses working the n...BACKGROUND: Night shift work is known to disrupt circadian rhythms, leading to significant physical and mental health challenges, including fatigue, sleep deprivation, and long-term health risks. For nurses working the night shift, these factors compromise both their own well-being and patient safety. Addressing these challenges is critical to improving outcomes for both staff and patients. PURPOSE: This study aimed to explore nurses' perspectives on night shift work, identify fatigue countermeasures, and elicit nurses' recommendations for improving working conditions. METHODS: This mixed-methods study was conducted in two phases. In Phase One, night shift nurses at 12 hospitals within a northeastern U.S. health care system were surveyed to assess their night shift experiences. Phase Two employed focus groups at six of those hospitals to gain insight into night shift nurses' perspectives on the challenges they face and suggestions for improvement. Descriptive statistics were used to analyze the survey data. Thematic analysis of focus group transcripts was conducted to identify themes. RESULTS: The survey results identified gaps in night shift support, including limited access to in-person education and hot, nourishing food. Recognition of night shift nurses' unique needs was the overarching theme from the focus groups. Seven additional themes further described those needs and indicated areas for improvement: safety at night--from feeling safe to being terrified; drowsy driving; need for a break; "we're tired"--napping; nourishment at night; self-care; and night work is undervalued. CONCLUSIONS: The results support findings from prior research and underscore the persistent challenges night shift nurses face. While these challenges are well documented, changes to address them have been limited. Health care organizations must move beyond acknowledging the issues to implementing evidence-based interventions and structured programs. Addressing the concerns of night shift nurses is imperative and necessary to safeguard nurses' health and well-being; reduce turnover; and ensure safer, high-quality patient care.