Objective: To examine how authentic leadership influences the nursing practice environment in a multihospital system. Methods: A cross-sectional assessment of 431 nurses across 7 hospitals used validated leadership and work environment measures. Data were analyzed using structural equation modeling. Results: Leadership behaviors explained up to 45.8% of nurses’ perceived leadership support and were associated with participation, staffing perception, and collaboration. Conclusions: Authentic leadership is a strategic lever to improve workforce stability, engagement, and care outcomes.
The Memorial Sloan Kettering Cancer Center Nursing Research Fellowship (NRF) is a structured, mentorship-driven program designed to strengthen clinical nursing research capacity across health systems. Originally developed within a single academic medical center, the fellowship expanded to a multi-institutional model providing protected time, PhD-prepared mentorship, and a standardized curriculum without requiring development of independent research infrastructure at each site. This article describes the NRF’s structure, implementation across partner institutions, and organizational value, including key facilitators, barriers, and leadership considerations. The NRF demonstrates a scalable approach for nursing leaders seeking to build sustainable research capacity, support professional development, and integrate nurse-led inquiry into clinical practice across diverse care settings.
OBJECTIVE:Evaluate the influence of a newly implemented acuity and scheduling system on nurses' perception of staffing adequacy and scheduling satisfaction. BACKGROUND:Research shows an association between nurse staffing and scheduling and job satisfaction, but there is limited research on how staffing and scheduling affect this relationship. METHODS:A convenience sample of nurses completed surveys measuring satisfaction with staffing and scheduling before and after implementation of a new scheduling and acuity system in the hospital setting. Comparison of pre-post survey responses was analyzed with Mann-Whitney U tests. RESULTS:Participants (n = 1100) were primarily females (78%), registered nurses in their late 30s, with a college degree, working in the inpatient unit. There were statistically significant improvements in staff satisfaction with scheduling and staffing processes with the new system ( P < 0.05). CONCLUSIONS:Implementing an empowered scheduling system significantly enhances engagement, improves satisfaction, and can strengthen organizational capacity to sustain a stable and resilient workforce.
The American Organization for Nursing Leadership (AONL) convened a dialogue among a group of chief nursing officer (CNO)-chief financial officer (CFO) dyads, with support from the Healthcare Financial Management Association. An AONL subcommittee used the dialogue results to develop guiding principles to assist leaders in creating and strengthening CNO-CFO partnerships. This work suggests that leaders can approach the CNO-CFO relationship as strategic rather than transactional. As nurse executives strengthen leadership competencies, they can build trust, engage finance partners early, create shared measures of success, and align nursing priorities with enterprise value.
OBJECTIVE:To psychometrically test the newly developed Casey-Fink Nurse Leader Role Transition Survey©2025. BACKGROUND:Nurses transitioning into formal nursing leadership roles experience stress and shifting responsibilities both personally and professionally. Without intentional preparation and support, these challenges can become overwhelming. METHODS:In 2025, an expert panel (N=10) assessed content validity of this new scale. Psychometric properties were analyzed with responses from 477 nurse leaders with ≤24 months' experience in the role who may or may not have participated in a nurse leader onboarding program in a healthcare organization in the US Exploratory factor analysis was conducted to assess construct validity, and Cronbach alpha was calculated to evaluate internal consistency reliability. RESULTS:The final analysis resulted in a 47-item instrument, with strong reliability and validity across 10 subscales, offering a comprehensive picture of nurse leader responsibilities. CONCLUSIONS:This valid and reliable instrument measures nurse leader role transition experiences.
OBJECTIVE:This study examined the prevalence of alcohol and drug use among middle-level nurse managers (MLNMs) and explored the associations between individual and workplace characteristics and substance use. BACKGROUND:Substance use (SU) among nurses is a longstanding concern, yet MLNMs who carry substantial clinical and administrative responsibilities remain largely overlooked in the literature. METHODS:A national sample of 234 MLNMs completed an online, cross-sectional survey. Binary logistic regression was used to explore the relationships between work-related factors and substance use. RESULTS:13.42% of MLNMs screened positive for unhealthy alcohol use, and 75.63% reported some level of drug use. Mid-career to late-career MLNMs had higher odds of drug use. Master's-prepared MLNMs showed lower odds of both drug use and alcohol use problems, and longer registered nurse experience was linked to lower odds of drug use. By specialty, medical-surgical and pediatrics were associated with higher odds of drug use. CONCLUSIONS:These findings highlight the need for wellness-focused leadership development and structural changes to reduce work-related risks.
OBJECTIVE:This project aimed to establish research priorities to advancing nurse governance leadership science. BACKGROUND:Nurses are called to advance science for disciplinary activities through the development and execution of research agendas. METHODS:A literature search was conducted, themes were developed and discussed with experts to establish research priorities guided by the Nine Common Themes of Good Practice Checklist for Setting Research Priorities and underpinned by the Conceptual Model for Nurses in Health Policy. RESULTS:Five research priorities and one cross-cutting priority were developed. A research consortium was proposed to operationalize the research priorities. CONCLUSIONS:A coordinated research agenda for nurse governance leadership science systematizes research efforts, facilitates collaboration, and optimizes funding efficiency.
OBJECTIVE:The Constant Observation Resource Assessment (CORA) was developed to guide prioritization of resources. INTRODUCTION:Constant observers, also called patient safety attendants, support safe, less restrictive care for high-risk patients. Staffing shortages highlight the need for structured, equitable constant observation (CO) allocation. METHODS:In this prospective pilot on 15 adult and 4 pediatric units, researchers evaluated CORA's content validity and inter-rater reliability. Over 6 months in 2021, nurses completed pre-/postimplementation surveys on transparency, fairness, accuracy, and confidence in allocation. A subset of assessments was dual-rated within the same shift to calculate the interclass correlational coefficient (ICC) (2,1). RESULTS:Staff ratings improved across all domains (P≤0.002; Cohen's d ≈ 0.74-1.31). Among 600 assessments, the total score ICC(2,1) was 0.717 [95% CI (0.647, 0.775)]; subscales ranged from 0.607 to 0.720. Cronbach's α was 0.888 (raw). CONCLUSIONS:CORA showed acceptable inter-rater reliability and initial validity, supporting its potential to standardize CO allocation. The CORA tool offers a standardized, evidence-based approach to allocating CO resources, addressing long-standing concerns about fairness and transparency in sitter assignments. Its implementation may improve patient safety, support clinical decision-making, and reduce burden on nursing staff in high-acuity inpatient settings. Future studies will assess predictive performance and refine decision thresholds.
OBJECTIVE:To examine the impact of sociodemographic factors on the self-care ability of registered nurses (RNs) in a publicly funded hospital, guided by Orem's Self-Care Framework. BACKGROUND:Self-care is essential for nurses' well-being and performance. Understanding sociodemographic factors affecting self-care provides a basis for targeted interventions. METHODS:A cross-sectional study surveyed 279 RNs using the Exercise of Self-Care Agency (ESCA) scale and a sociodemographic questionnaire. Statistical analyses, including ANOVA and regression, identified significant predictors. RESULTS:The study highlights significant relationships between sociodemographic variables and self-care abilities. Age (P = 0.02), ethnicity (P = 0.005), shift type (P = 0.03), work unit (P = 0.005), income (P = 0.041), financial situation (P < 0.001), and social support (P < 0.001) were critical determinants of self-care. CONCLUSIONS:Some sociodemographic factors influence self-care ability. Addressing financial stability, social support, ethnicity, and work conditions may be essential to promote nurses' well-being and ensure workforce sustainability.
OBJECTIVE:The aim of this study was to describe mid-career direct care nurses' intent to stay (ITS) and explore the relationship between authentic leadership, workplace belonging, opportunity, job satisfaction, and ITS. BACKGROUND:Retaining mid-career nurses is essential for patient safety and combating the nursing shortage, yet existing literature predominantly focuses on novice nurses. METHODS:A convenience sample of mid-career direct care nurses (N=138) from across the United States participated in an online survey. Researchers used descriptive statistics, correlations, and hierarchical regression to analyze the data. RESULTS:Among the mid-career direct care nurses surveyed, 19.6% indicated no ITS, 37% were neutral or undecided, and 43.5% expressed ITS. Positive correlations were found between the independent variables and ITS. Opportunity and job satisfaction emerged as significant predictors. CONCLUSIONS:To enhance mid-career nurse retention, nurse leaders should adopt a multifactorial approach, prioritizing job satisfaction and professional opportunities.
Objective: To clarify the concept of sustainability in the nursing workforce and identify its attributes, antecedents, and potential consequences. Background: While the term "nursing workforce sustainability" has been used to emphasize the critical implications of ensuring the efficiency of healthcare systems worldwide, a delineated understanding of the concept remains ambiguous in extant literature, causing uncertainty about its conceptual underpinnings. Methods: Rodger's evolutionary approach was applied. Results: The authors identified "nursing workforce sustainability" as an evolving concept with four interrelated attributes: recruitment, retention, regulation, and recognition. The antecedents included demographic, occupational, and structural issues. Consequences include policy and systemic advancements, a diverse and inclusive workforce, enhanced workforce well-being, and improved patient safety and organizational effectiveness. Conclusions: A conceptual definition and framework of nursing workforce sustainability have been developed, offering groundwork for future research and policy development in workforce planning and management.
A single leadership decision, saying yes to a new way of honoring nurses, helped catalyze a global movement in nurse recognition. In 2000, Susan Grant, Chief Nursing Officer at the University of Washington Medical Center, agreed to pilot a program that invited patients and families to define extraordinary nursing care through their own stories. That decision became the DAISY Award ® . In this interview, Dr Grant reflects on the origins of DAISY and leadership lessons for today. The message is clear: some of the most enduring innovations in nursing do not begin with metrics or technology, but with courage, humility, and a commitment to purpose.
The American Organization for Nursing Leadership (AONL) has revised the Nurse Leader Core Competencies to reflect evolving care delivery models and workforce demands. This article outlines the rationale for the update, defines the revised competency framework, and highlights its evidence base and behaviors that support measurable leadership performance. Drawing on recent literature and national reports, it underscores the importance of evidence‑aligned, competency‑based leadership development across care settings, academia, and industry.
OBJECTIVE:The purpose of this study was to explore turnover intention and engagement among medical-surgical (M/S) nurses. BACKGROUND:Nursing turnover impacts retention and patient care. Research focusing on M/S nurses is limited. METHODS:Nurses at 8 acute care hospitals in a Midwest health system were surveyed using the Turnover Intention Scale and the Utrecht Work Engagement Scale. RESULTS:Nurses with 2-5 years of experience had higher turnover intentions compared with nurses with 1 year (P=0.049), 6-10 years (P=0.045), and 21+ years (P=0.006). Nurses with 2-5 years of experience were less engaged compared with those with 21+ years on subscales vigor (P=0.005), dedication (P=0.003), and absorbed (P=0.027). CONCLUSIONS:Nurses with 2-5 years of experience posed the highest risk for turnover due to high turnover intentions and low engagement. Additional research is needed to explore differences between groups and ways to improve engagement and reduce turnover among M/S nurses.
Objective: To evaluate the impact of an 8-hour human-centered design (HCD) workshop on nurses' and other clinicians' creative self-efficacy (CSE), psychological empowerment (PE), and traits of design thinkers (TDT). Background: Despite nurses' routine problem-solving, formal training in HCD is lacking. Integrating HCD can foster intrapreneurship and innovation within healthcare systems. Methods: A mixed-methods, 1-group quasi-experimental study was conducted at a Midwestern university's Entrepreneurship Center with VA Healthcare System nurses and clinicians. Participants completed pre-workshop and post-workshop surveys measuring CSE, PE, and TDT, and qualitative reflections. Results: Among 27 participants, statistically significant improvements were observed in CSE (d=1.23), PE (d=0.43), and TDT (d=0.65). Qualitative themes highlighted collaboration, experiential learning, and a desire for continued innovation support. Conclusions: HCD workshop enhanced nurses' innovation competencies and empowered them to lead system improvements. Strategic partnerships with universities can address educational gaps and foster a culture of intrapreneurship in healthcare.
OBJECTIVE:Describe the development and implementation of a theory-informed professional practice model (PPM) and examine associated workforce, quality, engagement, and financial outcomes. BACKGROUND:Healthcare organizations face persistent challenges related to workforce turnover, disengagement, and fragmented care delivery. PPMs align nursing practice, leadership, and outcomes, but are often insufficiently operationalized. METHODS:This evidence-based practice QI initiative implemented a PPM grounded in Convergent Care Theory using a structured, multiphase clinical inquiry infrastructure. Aggregated organizational data were analyzed to assess workforce, patient quality and safety, staff engagement, and conservative cost avoidance. RESULTS:More than 2500 nurses engaged in system-wide inquiry and strategic planning. One-year RN turnover decreased from 22.14% to 10.42% (P=0.002), associated with an estimated $4.6 million in conservative cost avoidance. Catheter-associated urinary tract infection rates decreased by 48%, and Leapfrog Hospital Safety Grades improved. CONCLUSIONS:Operationalizing theory through a system-wide PPM improved workforce retention, patient outcomes, engagement, and organizational cost avoidance.
With the support of AARP, a group of volunteer nurse leaders has identified national health priorities where their leadership and nursing expertise could make a difference to improve the health and well-being of the country. In the first 2 years, the nurse leaders have strengthened AARP offerings with their healthcare expertise and presentations of information to educate the public, including supporting widespread development of patient and family advisory councils.
AIM:To explore the medium-term to long-term implementation and outcomes of the Nursing Research Challenge (NRC) in a Magnet® designated university hospital. BACKGROUND:Research-driven culture advances nursing practice, yet structured, impactful initiatives in European hospitals are scarce. METHODS:A longitudinal study (2023-2025) in a private Magnet® tertiary hospital applied the Joanna Briggs Institute framework and RE-AIM model. Research capacity was assessed at T0, T1, and T2 using the validated Nursing Research Questionnaire. RESULTS:Of 515 nurses completing the Nursing Research Questionnaire (T0=116; T1=127; T2=272), significant gains occurred in knowledge (+1.48) and resource use (+0.83) (P<0.001). Research use in decision-making and scholarly activity increased; attitudes improved modestly. Satisfaction was high (4.6/5). Nurses with master's/doctoral degrees rose from 38% to 54%. CONCLUSIONS:The NRC enhanced research capacity and engagement. Success factors were baseline assessment, strategic alignment, leadership, and infrastructure. The scalable model supports global adoption of a research-oriented nursing culture.
The Magnet Recognition Program® represents a culture of nursing excellence that empowers nurses, improves patient outcomes, and sustains professional practice. From its origins during the nursing shortage of the 1980s to today's complex healthcare environment, Magnet continues to evolve, proving that when nurses are heard, care is safer, outcomes are stronger, and excellence endures.
Objective:This article describes span of control (SOC) and organizational support for nurse managers (NMs) and impact on performance outcomes.Background:NMs report excessive workloads that negatively affect personal well-being and performance outcomes. Understanding NM SOC is essential for informing strategies to enhance performance outcomes.Methods:This cross-sectional study explored the relationship between NM SOC, organizational support, and performance outcomes.Results:Data from 255 NMs, overseeing 296 units across 47 hospitals, showed nurse turnover was significantly correlated with NM to full-time equivalent (FTE) and NM-to-bed ratios. Higher fall rates were associated with higher 24-hour census and NM-to-bed ratio. No significant associations were found between SOC and hospital-acquired pressure injuries.Conclusions:Wide variations in SOC and organizational support were noted among this sample. Findings from this study suggest that smaller units with smaller teams have an advantage in creating a better nurse workforce and clinical patient outcomes. Creating manageable NM workloads may yield better nurse and patient outcomes.
