What Do Nurses Need to Practice Effectively in the Hospital Environment? An Integrative Review With Implications for Nurse Leaders (original) (raw)

Worldviews on Evidence-Based Nursing

Background: When staffing legislation was introduced, New Jersey nurse leaders recognized from the research and their years of clinical leadership experience that the work environment is a multidimensional concept and that staffing is not the only variable related to nurse and patient outcomes. Thus, an understanding of what nurses need in their hospital environment to practice nursing effectively was sought. Aims: The aim of this study was to examine the evidence regarding clinical nurses' perception of what they need to practice nursing effectively in the acute care hospital environment. Methods: The following population, intervention, comparison, outcome question was used to search the literature databases PubMed, CINAHL, Johanna Briggs, and the Sigma Theta Tau Henderson Library: In the hospital environment what do nurses perceive as needed to practice nursing effectively? Specific search criteria and the Johns Hopkins nursing guidelines and tools were used to identify relative studies. Results: The final review, which addressed what nurses in the hospital environment need to practice nursing effectively, included 25 articles: 20 were an evidence level III, and five were evidence level II. From this review, five key concepts were identified: Leadership, autonomy/ decision making, respect/teamwork, resources/staffing, and organizational commitment to nursing. Linking Evidence to Action: This integrative review, which explored nurses' perceptions of what is needed to provide effective quality care, identified that providing quality care is multifactorial in nature. Resources, including but not limited to staffing, and leadership were identified as important by nurses as a key factor in supporting quality care. Nurses must be provided with resources and infrastructure to do their jobs, in an environment supported by authentic transformational leadership. BACKGROUND "What makes your hospital a good place for nurses to work?" This was the question posed to staff nurses and directors, in the seminal study from which American Nurses Credentialing Center (ANCC) Magnet ®-designated hospitals evolved, and continues to be contemplated by nurses and nurse leaders (McClure et al., 1983, p. 91). Due to growing concern about the nursing shortage in the late 1970s, which was exacerbated by nurse job dissatisfaction and poor nurse retention, a group of researchers investigated why some hospitals were better able to attract and retain nurses, acting like "magnets" for nurses, despite the nursing shortage (McClure et al., 1983). From this qualitative inquiry, it was discovered that these hospitals all shared a common set of organizational characteristics, which marked the beginning of nursing research focusing on nurse work environment. Since McClure et al.'s (1983) seminal work, much research has been conducted linking features of a positive nurse practice environment to better nurse and patient outcomes. In addition, organizations, such as the American Association of Critical-Care Nurses (AACN), have established standards for healthy work environments: skilled communication, true collaboration, effective decision making, appropriate staffing, meaningful recognition, and authentic leadership (AACN, 2005).