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The purpose of the study was to explore in literature what different leadership styles and behaviors of head nurses have a positive influence on the outcomes of patient safety or quality of care.

We reviewed the literature from January 2000 until September 2011. We searched Pubmed, Embase, Cinahl, Psychlit, and Econlit.

We found 10 studies addressing the relationship between head nurse leadership and safety and quality. A wide array of styles and practices were associated with different patient outcomes. Transformational leadership was the most used concept in the studies. A trend can be observed over these studies suggesting that a trustful relationship between the head nurse and subordinates is an important driving force for the achievement of positive patient outcomes. Furthermore, the effects of these trustful relationships seem to be amplified by supporting mechanisms, often objective conditions like clinical pathways and, especially, staffing level.

This study offers an up-to-date review of the limited number of studies on the relationship between nurse leadership and patient outcomes. Although mostly transformational leadership was found to be responsible for positive associations with outcomes, also contingent reward had positive influence on outcomes. We formulated some comments on the predominance of the transformational leadership concept and suggested the application of complexity theory and political leadership for the current context of care. We formulated some implications for practice and further research, mainly the need for more systematic empirical and cross cultural studies and the urgent need for the development of a validated set of nurse-sensitive patient outcome indicators.

Federal and state governments collaborate on state Medicaid nursing facility long-term care (SMNF-LTC) programs. These programs are increasingly expensive as the baby-boomers retire. Yet serious resident outcome problems continue in spite of the Centers for Medicare and Medicaid Services’ (CMS) extensive process-focused regulatory efforts. This study identifies a promising and simpler auxiliary path for improving resident outcomes.

Drawing on a longitudinal (1997–2005), 48-state data set and panel-corrected, time-series regression, we compare the effects on resident outcomes of CMS process-focused surveys and four minimally regulated program structural features on which the states vary considerably.

We find that each of these four structural features exerts a greater effect on resident outcomes than process quality.

We suggest augmenting current process-focused regulation with a less arduous approach of more extensive regulation of these program features.

To date SMNF-LTC program regulation has focused largely on member facility processes. While regulating processes is appropriate, we show that regulating program structural features directly, an arguably easier task, might well produce considerable improvement in the quality of resident outcomes.

Residents in under-resourced/high-Medicaid (85% or higher) nursing homes on average receive care from relatively lower quality providers and have worse health outcomes, which may increase the risk of higher COVID-19 incidence. This study aims to evaluate if having a culture that encourages employee empowerment results in better quality (lower COVID-19 deaths) in times of crisis, such as the current pandemic. The study combined primary survey data from 391 Directors of Nursing (response rate of 37%), with Centers for Medicare and Medicaid Services’ (CMS) Nursing Home COVID-19 Public File, LTCFocus, Area Health Resource File, and Nursing Home Compare. The dependent variable consisted of the number of COVID-19 death as of November 25, 2021. The independent variables consisted of Likert scale for employee empowerment (Cronbach alpha= 0.82). Control variables consisted of organizational factors (e.g., size, location, and ownership), as well as community factors (e.g., poverty, unemployment, and competition). The results indicated that one unit increase in employee empowerment was associated with 6% lower likelihood of having COVID-19 deaths. Nursing homes, particularly those under-resourced, face difficulty improving the quality of care due to financial constraints. However, the results suggest that adopting a culture that fosters employee empowerment may give nursing homes an edge in improving quality outcomes in crises.

Background – Reliable and valid hospital nurse staffing measures are a major requirement for health services research. As the use of these measures increases, discussion is growing as to whether current nurse staffing measures adequately meet the needs of health services researchers.

Objective – This study assesses whether the measures, sampling frameworks, and data sources meet the needs of health services research in areas such as staffing assessment; patient, nurse, and financial outcomes; and prediction of staffing.

Methods – We performed a systematic review of articles from 1990 through 2007, which use hospital nurse staffing measures in original research, or which address the validity, reliability, and availability of the measures. Taxonomies of measures, sampling frameworks, and sources were developed. Articles were analyzed to assess what measures, sampling strategies, and sources of data were used and to ascertain whether the measures, samples, and sources meet the needs of researchers.

Results – The review identified 107 articles that use hospital nurse staffing measures for original research. Multiple types of measures, some of which are used more often than others and some of which are more valid than others, exist in each of the following categories: staffing counts, staffing/patient load ratios, and skill mix. Sampling frameworks range from hospital units to all hospitals nationally, with all hospitals in a state being the most common. Data sources range from small-scale surveys to national databases. The American Hospital Association Annual Survey is the most frequently used data source, but there are limitations with its nurse staffing measures. Arguably, the multiplicity of measures and differences in sampling and data sources are due, in part, to data availability. The limitations noted by other researchers and by this review indicate that staffing measures need improvements in conceptualization, content, scope, and availability.

Discussion – Recommendations are made for improvements to research and administrative practice and to data.

This chapter presents an overview of our evaluation of the introduction of electronic medical records (EMR) in 20 nursing homes located in the New York City region. These organizations were part of an EMR demonstration project cosponsored by the for-profit segment of the nursing home industry in the region and 1199SEIU United Health Care Workers East, the union that represented frontline staff in these organizations. We report central lessons from our evaluation, which took place over the course of four years and included multiple data sources. The primary purpose of our research was to examine the effects of EMR adoption on employment and labor relations in the participating organizations. Findings are based on a longitudinal study of EMR adoption in 15 of the 20 organizations that received the EMR technology and five “control” organizations, which did not receive the technology, employing a mixed methodological design with both quantitative and qualitative data collection methods. Results from our research inform the existing EMR adoption discussion in two ways. First, we find mixed evidence associated with EMR implementation. The adoption of this new technology enhances certain organizational outcomes, but it seems to hinder others. Second, findings from our research highlight the importance of preexisting organizational factors as predictors of EMR-associated outcomes. EMR-associated outcomes, positive or negative, are likely to be contingent on key organizational characteristics and on managerial adoption strategies. Our study's findings imply that the meaningful use of EMR needs to take into account not only the technical specifications of EMR but also the organizational characteristics of the physician practices and healthcare facilities adopting the technology. Healthcare organizations vary in their capacity and ability to make optimal use of health information technology, which should be incorporated into public policy and organizational practices designed to increase adoption.

Change within health care systems is constant as it relates to the external and internal demands that require continual adaptation by providers. This chapter provides a summary of the history and research contributions related to the study of culture and change through the lens of the nursing profession. The review focuses upon nursing research publications and the knowledge gained, ranging from the earliest to current studies. There has been a substantial increase in research interest regarding the relationship between nursing culture and ability to change; however, there is a considerable gap that remains in understanding subgroups such as individual nursing units or departments, consistent use of tools to measure culture, and interventions that have made a difference over time. From a practical perspective, this discussion provides insight into the importance of recognizing the importance of assessing culture and integrating cultural feedback into operational improvement plans.

This chapter addresses a practical industrial relations problem, namely the absence of a monitoring framework to assess and improve labor–management relations in organizations. The authors argue that assessing and improving organizational labor relations requires attention to both vertical and horizontal alignments of labor relations institutions and practices. Vertical alignment refers to the internal consistency across the strategic, functional, and workplace levels noted by Kochan, Katz, and McKersie in their strategic choice framework (1986). Drawing on two “best practice” labor relations cases, Saturn and Kaiser Permanente as well as two original case studies of healthcare organizations, the authors develop the notion of horizontal alignment, i.e., the internal consistency across labor relations processes, substantive issues, and outcomes.

Through a number of comprehensive reviews, the Institute of Medicine (IOM) has recommended that healthcare organizations develop safety cultures to align delivery system processes with the workforce requirements to improve patient outcomes. Until health systems can provide safer care environments, patients remain at risk for suboptimal care and adverse outcomes. Health science researchers have begun to explore how safety cultures might act as an essential system feature to improve organizational outcomes. Since safety cultures are established through modification in employee safety perspective and work behavior, human resource (HR) professionals need to contribute to this developing organizational domain. The IOM indicates individual employee behaviors cumulatively provide the primary antecedent for organizational safety and quality outcomes. Yet, many safety culture scholars indicate the concept is neither theoretically defined nor consistently applied and researched as the terms safety culture, safety climate, and safety attitude are interchangeably used to represent the same concept. As such, this paper examines the intersection of organizational culture and healthcare safety by analyzing the theoretical underpinnings of safety culture, exploring the constructs for measurement, and assessing the current state of safety culture research. Safety culture draws from the theoretical perspectives of sociology (represented by normal accident theory), organizational psychology (represented by high reliability theory), and human factors (represented by the aviation framework). By understanding not only the origins but also the empirical safety culture research and the associated intervention initiatives, healthcare professionals can design appropriate HR strategies to address the system characteristics that adversely affect patient outcomes. Increased emphasis on human resource management research is particularly important to the development of safety cultures. This paper contributes to the existing healthcare literature by providing the first comprehensive critical analysis of the theory, research, and practice that comprise contemporary safety culture science.

Occupational injury in the health care sector in the United States rates among the highest of all industries. Specific to hospital support service workers (e.g., Food & Nutrition, Environmental Services), studies have shown that injury rates for support service workers tend to be among the highest of hospital personnel, and yet there is a shortage of research investigating the safety climate of these workers. Therefore, the purpose of this study is to examine safety perceptions of support service workers. Surveys were used to measure safety climate leadership factors (per the AHRQ's Survey of Patient Safety Culture) to determine if they are related to individual safety perceptions, as well as ratings of work unit safety. Following established safety climate research, we examined the role of the work environment (e.g., supervisor support and work unit culture) on safety perceptions. We found that both supervisor and organizational safety leadership are positively related to individual safety perceptions and supervisor support. Organizational safety leadership and work unit culture were positively related to work unit safety rating. Our findings demonstrate that the antecedent factors and pathways that promote a positive safety climate among health care providers functions in a similar manner for support service workers. These findings contribute to a better understanding of occupational safety of this understudied work group and provide evidence to hospital administration that developing a strong safety climate among support service workers is not entirely different from what is required to promote a robust safety climate across an organization.

Research suggests that improving hospital work environments and solving the nursing shortage are critical to improving patient care. The Houston–Galveston region created an aggressive approach to this issue by forming an unusual coalition of business, university, and hospital leaders and using a quality improvement approach. Four years later, the project has achieved over 40% participation among hospitals in the 13-county region and includes 50 hospitals employing approximately 15,000 registered nurses. The data that have been collected by this collaborative to date suggests that hospitals are taking action to improve outcomes by modifying their key initiatives to address the attributed causes of poor work environments. From 2004 to 2005, executives of top performing hospitals increasingly attributed successful work environment outcomes to an emphasis on management development and executive-driven initiatives, de-emphasizing specific employee behavior, process, and outcome-based initiatives.