The Organizational Context of Nursing Practice: Concepts, Evidence, and Interventions for Improvement

312 Pages·2018·7.774 MB·English

by  Peter Van Bogaert,Sean Clarke (eds.)

The Organizational
Context of
Nursing Practice
Concepts, Evidence,
and Interventions for
Improvement
Peter Van Bogaert
Sean Clarke
Editors
123
The Organizational Context of
Nursing Practice
Peter Van Bogaert
Sean Clarke
Editors
The Organizational
Context of
Nursing Practice
Concepts, Evidence, and Interventions
for Improvement
Editors
Peter Van Bogaert Sean Clarke
Nursing and Midwifery Sciences William F. Connell School of Nursing
Centre for Research and Innovation in Care Boston College
Faculty of Medicine and Health Sciences Chestnut Hill, Massachusetts, USA
University of Antwerp
Antwerp
Belgium
ISBN 978-3-319-71041-9 ISBN 978-3-319-71042-6 (eBook)
https://doi.org/10.1007/978-3-319-71042-6
Library of Congress Control Number: 2018930349
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Foreword
The global health agenda for the next decade focuses on Universal Health Coverage
(UHC), i.e., providing high-quality, cost-effective care and access to basic care for
all. Some other leading global concerns are the attainment of the Sustainable
Development Goals (SDG2030) and People Centered Care and the addressing of
non-communicable diseases (NCDs). At the national level, countries are continu-
ously focusing on how to manage the growing demand for healthcare services and
their associated costs. Whether the national healthcare system is publicly or pri-
vately financed, or involves a blend of the two, costs are at the heart of funding and
programmatic decisions. While there is a significant discussion about evidence-
based practice and evidence-informed policy, there isn’t sufficient appreciation and
understanding among funders and decision makers that quality care is synonymous
with cost-effective care or that investing in healthcare workers is a form of invest-
ment in cost-effective care. The 2016 UN report entitled Working for Health and
Economic Growth which was tabled by the High Level Commission on Health
Employment and Economic Growth makes a clear case that allocating resources to
healthcare workers is an important means of promoting the economic success of
nations. The report also indicates that by 2030, we will need an additional 40 mil-
lion healthcare workers, of which 22 million will be in the Organization for
Economic Co-operation and Development (OECD) countries (which include many
of the world’s most developed nations). Therefore, preparing the right number of
healthcare professionals, investing in them, and retaining them should be a major
concern for health system funders and decision makers.
There is a plethora of peer-reviewed publications in top journals in nursing and
the health sciences more broadly that have demonstrated the impacts of well-
prepared and well-managed nurse workforces can have on the patient and system
outcomes. While we are well informed of the global agenda, many healthcare pro-
fessionals, leaders, and experts are ill informed about the rich body of evidence that
has accumulated over the last three to four decades, relating to how nursing can
contribute to the global health agenda of reducing morbidity and mortality while
providing important economic and social returns on all investments. Additionally,
surprisingly few appear aware that extensive research and scholarly work have doc-
umented the organizational conditions that best draw forth nurses’ contributions.
Thus the arrival of this book is well timed. Because nurses constitute the largest
segment of the professional arm of healthcare work, it is essential to understand the
v
vi Foreword
existing evidence about nurses’ work and nursing services as we continue to trans-
form our healthcare systems toward greater productivity, effectiveness, and
efficiency.
Ensuring that nurses are able to provide the care required by various populations
should be of significant interest to governments, quasi-governmental organizations,
and executives and managers at all levels of the healthcare system, whether their
involvement is global, national, or local. This book deals primarily with the experi-
ences of nurses in hospital settings, albeit across societies and across a wide range
of specialties. However, the ideas reviewed across its chapters apply to virtually any
setting where nurses or other allied health workers or professionals work. Whether
in a hospital, community center, or primary care facility or at the level of a district
level, getting the nursing workforce “right” will lead to high-quality and cost-
effective care that strengthen the well-being of citizens who will in turn contribute
to the economic and social well-being of their communities and countries.
This book is unique in bringing together under one cover the science (evidence)
and the art (implementation) of building robust, successful, and effective systems
that serve patients, communities, staff, and systems alike. It lays out the decades of
research that studied the elements that constitute a positive work environment and
factors that contribute to nurses’ desire to stay in an organization and provide qual-
ity care. The synthesis of the research to date in this book illuminates the essential
building blocks for a positive work environment. In addition to having a “one-stop”
opportunity to learn about the key ingredients from conceptual and research per-
spectives, the book also contains numerous chapters that demonstrate how these
elements have been integrated in building quality of care and a satisfied workforce.
In addressing major global and national health concerns, it is essential to have
the right number and the right quality of nurses and other healthcare workers func-
tioning effectively. Retaining the workforce and having a satisfied workforce will
help to overcome the looming risks of severe nurse shortages that could jeopardize
our societies’ abilities to meet our populations’ healthcare needs. This book should
be a “go-to” reference for decision makers, policy makers, funders, and system
administrators interested in the evidence base regarding work environments that
will build optimal systems for staff and patients alike.
President of International Council of Nurses (ICN)
2013–2017, Geneva, Switzerland Judith Shamian
Acknowledgments
Eleven co-authors have collaborated closely on this book, sharing their expertise
and describing research projects that draw upon the ideas and assumptions described
in the chapters. I thank each of the contributors and all our colleagues who have
been involved (directly and indirectly) in the various projects described in the book.
I also thank my colleagues in the Department of Nursing and Midwifery Sciences,
the Centre of Research and Innovation in Care (CRIC), and the Faculty of Medicine
and Health Sciences at the University of Antwerp—the environment where we were
able to build this program of work.
In 2004, Paul Van Aken gave me a book—Keeping Patients Safe: Transforming
the Work Environment of Nurses, a report of the Institute of Medicine. I was a
director of nursing at Antwerp University Hospital, and Paul, a former colleague,
was at that time my chief nursing officer (CNO). Reading the book thoroughly was
a revelation for me and inspired a 10-year series of studies that I first started as a
doctoral student with little funding and that later emerged as a full-fledged research
program supported by healthcare organizations in the two regions of Belgium,
Flanders and Wallonia, as well as the Brussels-Capital Region. I am grateful to Paul
and all CNOs of the hospitals and long-term care facilities who allowed me to study
their facilities, as well as all the clinical nurses and nurse managers who participated
in or otherwise supported our studies.
In 2008, I met Dr. Sean Clarke somewhat by fluke when he and Dr. Linda Aiken
came to deliver a presentation at the Catholic University of Leuven at the invitation
of Dr. Walter Sermeus. Over the past years, Sean became one of my closest personal
friends and a trusted colleague who has supported and guided me in my research
journey. I was an experienced practitioner but a real neophyte in research and aca-
demic life. He treated me as a peer and helped me gain confidence and trust in my
abilities to set up research projects. He also provided guidance as I built my aca-
demic career. Therefore, I was very pleased to involve Sean as a co-editor in this
work as a continuation of our mutual collaboration. Sean is a sharp, independent
thinker and researcher who always goes to the heart of problems and issues by ask-
ing the right questions; he is always looking for the right answers based on evidence
and solid study designs.
The Antwerp University Hospital received their initial Magnet Recognition® as
the first hospital in Belgium and the continent of Europe, in October 2017 after an
8-year organic journey to nursing excellence and improved patient outcomes. In our
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viii Acknowledgments
journey many colleagues were inspiring and paramount for our persistent mission
starting with the CEO Johnny Van der Straeten and the hospital management com-
mittee, hospital administrators, nursing leaders, nursing managers, and above all
clinical nurses supported by their interprofessional colleagues such as physicians
and other healthcare workers as well as ancillary staff. Especially, our gratitude
goes to Nancy Van Genechten who was the driving force of two nursing councils
“mentoring” and “patient safety and infection control” and a member of the hospital
ethics committee. Unfortunately, we lost Nancy; she passed away the last year of
our journey to the initial Magnet Recognition®. We will keep strong remembrance
of her passion, expertise, and energy supporting our clinical nurses, nurse managers,
and physicians in their aims to provide excellence in care. Moreover, our deepest
respect goes to all colleagues of the American Nurses Credentialing Center, as they
called us, along with Paul Van Aken and Danny Van heusden our Magnet Program
Director, the three Van’s from Belgium; they treated us most encouraging and gave
us strong confidence in our aims, especially, Jan Moran former director and Rebecca
Graystone current director of Magnet Recognition Program® and their staff of pro-
gram analysts, Cheryl Schmitz our senior Magnet program analyst, and Dr. Donna
Havens chair of the Commission on Magnet Recognition®.
My wife and I lost three of our four parents last year over a 6-month period. All
were in their 80s (82, 86, and 89) and all three died having had extensive involve-
ment with the healthcare system: my father-in-law at home very much supported
around the clock by my 83-year-old mother-in-law and my mother and father receiv-
ing treatment in a residential aged care facility. As a family, we experienced both the
best and the worse the healthcare could offer them. As a healthcare provider and
administrator, I could make rationalizations for the deficits in care we witnessed, but
as a son, I was deeply disappointed. We were so grateful for the opportunity to learn
from our parents’ resilience in coping with their frailty and from their unwillingness
to ever give up. The latter seems to be a trait emblematic of the generation that came
of age during World War II; I saw it in the early days of my clinical career. I dedicate
this book to the memory of our parents and to the importance of doing better for all
our patients.
Peter Van Bogaert
As he says, Dr. Peter Van Bogaert and I met a decade ago—somewhat by chance—
and I have had the privilege of collaborating with him ever since. It has been an
enormous honor to watch his growth as a researcher and research leader over the
years and to witness the rapid development of the University of Antwerp’s
Department of Midwifery and Nursing and Antwerp University Hospital’s move-
ment toward evidence-informed and data-driven nursing management. I thank him
for his friendship and for the opportunity to collaborate on great projects with his
network of hardworking, insightful, and exceptionally kind and welcoming col-
leagues and trainees.
Acknowledgments ix
As we hurtle through incredible change in healthcare systems around the world,
the study of nurses’ work lives and work environments is more important than ever.
I thank the many collaborators I have worked with over the years in education, prac-
tice, and research, in the United States, Canada, Europe, Asia, and Australia, for
their inspiration of their tireless work to make healthcare better. Like Peter and the
authors of the chapters in this volume, they do critical work that impacts the lives of
patients and healthcare workers every day. I especially thank Dr. Linda Aiken who
opened the door to this field for me and who, as one of the most innovative thinkers
and leaders in nursing health services research, has had an incalculable impact on
the field and the careers of countless researchers.
Peter and Sean would both like to thank the Springer team for the support, trust,
and opportunity to publish this work, especially Nathalie Lhorset-Poulain, Senior
Publishing Editor, for her dedication to this project and commitment to advancing
nursing and nursing research.
Sean Clarke
Contents
Part I Concepts and Evidence
1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Peter Van Bogaert and Sean Clarke
2 Concepts: Organization of Nursing Work and the 
Psychosocial Experience of Nurses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Peter Van Bogaert and Sean Clarke
3 Organizational Predictors and Determinants of Nurses’ Reported
Outcomes: Evidence from a 10-Year Program of Research . . . . . . . . . . 49
Peter Van Bogaert and Sean Clarke
Part II L arge-Scale Quality Improvement Projects and Team-Based
Interventions
4 Transformation to an Excellent Nursing Organization:
A Chief Nursing Officer’s Vision and Experience . . . . . . . . . . . . . . . . . 103
Paul Van Aken
5 Productive Ward: Releasing Time to Care™ (A Ward-Based
QI Intervention) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
Mark White
6 Embedding Compassionate Care: A Leadership Programme
in the National Health Service in Scotland . . . . . . . . . . . . . . . . . . . . . . . 139
Juliet MacArthur
7 Learning and Innovation in Health-Care- Based Teams:
The Relationships Between Learning, Innovative Behavior at
Work, and Implementation of Innovative Practices in Hospitals . . . . . 161
Olaf Timmermans, Bart Van Rompaey, and Eric Franck
8 Project Management and PDSA-Based Projects . . . . . . . . . . . . . . . . . . 175
Stijn Slootmans
9 Reporting and Learning Systems for Patient Safety . . . . . . . . . . . . . . . 199
Danny Van heusden and Peter Van Bogaert
xi