Background
Over the past decade, professional challenges for hospital nurses have increased due to factors including financial pressures and higher patient acuity. Solutions for these challenges, however, often focus on single factors, eclipsing systemic solutions that could strengthen hospitals in dealing with continual change. Professional culture and systems of care significantly impede hospitals from developing effective team strategies, new practice patterns, or appropriately using information technology. This environment negatively affects nurse retention, makes young people hesitant to pursue nursing careers, and is correlated with deleterious effects on patient safety. One of the most promising responses to these challenges has been the development of stable, effective leadership in nursing-related care.
In early studies of the current nursing shortage, the Center for the Health Professions identified institutions that successfully recruited and retained nurses and had better than expected patient care outcomes. Some of these hospitals had achieved Magnet status, but others had exhibited qualities of leadership, team development and problem solving that made them effective without being formally credentialed as a Magnet hospital. While these examples were hopeful, they constitute a small fraction of licensed hospitals. Two key questions remain:
- What are the core elements that make for a productive clinical environment in hospitals?
- How can more hospitals create such environments and sustain them over time?