This chapter describes the various roles and functions of the treatment program or clinical management staff in the residential facility. It characterizes the roles of support staff and agency personnel. Teachers, physicians, nurses, psychologists, social workers, lawyers, and accountants in the TC ply their professions in the usual way. The relationship between staff and peer roles is rooted in the evolution of the Therapeutic Community (TC). In the TC approach, the role of staff is complex and can be contrasted with that of mental health and human service providers in other settings. An array of staff activities underscores the distinctively humanistic focus of the TC. The chapter describes how primary clinical staff in the treatment program supervise the daily activities of the peer community through their interrelated roles of facilitator, counselor, community manager, and rational authority. Other staff provide educational, vocational, legal, medical, and facility support services.

This chapter explains how chaos and confusion impacts staff as they move through the second phase of transition toward a new way of being. When departments or organizations merge, multiple policy and procedure manuals are supposed to merge as well, but this rarely happens fast enough. In the meantime when nurses are challenged by a practice issue and go looking for the correct policy or procedure to follow, they may find several or none. When this happens, staff can feel confused, anxious, frustrated, and fearful for patient safety. They may feel patients are being cheated of quality care and feel guilty about it, but not necessarily motivated enough to change. Mixed emotions, accommodating different practices, and mental and physical exhaustion can cause staff to more readily call in sick and feel less inclined to go the proverbial extra mile. The chapter provides tips for managing chaos and confusion.

This chapter presents two evidence-based practice (EBP) scenarios that illustrate how implementation of EBP requires an interprofessional collaborative team approach and a well-designed implementation plan. Nurses are at the heart of implementing EBP, and when they do not have team support, collaboration, and a well-thought-out implementation plan, success of an EBP project is unlikely. The chapter provides a review of fundamental concepts and strategies that must be considered with any model when implementing EBP projects. While not detracting from EBP models, the chapter provides suggestions and reminders for selecting key implementation strategies. EBP is becoming the standard for delivery of the best and most up-to-date patient-centered care. Undoubtedly, EBP implementation strategies are becoming a necessary component of the nurse's repertoire for the delivery of optimal care. The chapter outlines useful approaches to EBP implementation spanning from the inception of an EBP idea to the dissemination of the final EBP product.

Neediness cannot be banished, but it’s possible to learn from each shortcoming, determined not to be derailed by either hubris or core anxieties. Taking on new leadership roles, we have to get in touch with warring expectations on the way to a more textured view of leadership and our sense of ourselves as leaders. There are a number of normal-crazy thoughts that get in the way of leadership; for example, wanting to be liked by everyone; believing that if you’re not perfect then you’re no good; thinking things should not go wrong. To succeed, nurses must realize that failure is commonplace. Expect failure, recognize root causes, and then proceed to learn from the experience—this process builds personal resilience. Learning environments that foster a culture of potentiality enable fledgling practitioners to persist in the face of failure because the emphasis is on improving over time.

This chapter helps the reader to explain the significance of clinical practice guidelines (CPGs), describe the relationship between CPGs and evidence-based practice (EBP) and to describe the Institute of Medicine (IOM) standards for CPG development. It also helps the reader to discuss CPG appraisal and implementation and identify factors that promote or inhibit CPG adoption. Nurses are demonstrating commitment to EBP and the most effective methods for translating appropriate evidence into a clinical context. CPGs are an effective method to facilitate appropriate patient-centered care based on best evidence and broad expert consensus. The nurse and healthcare organization deciding to use a guideline must ensure the CPG was developed appropriately using a standardized and acceptable methodology. By understanding the factors that influence adoption and utilization of a CPG, better planning for implementation in the clinical setting can occur.

This chapter is titled somewhat provocatively, equating leadership with telling others what to do. One cannot expect others to be mindreaders, so one cannot expect others to do what one wants done without telling them. Being able to be clear with others about expectations, next steps, processes, and direction is integral to leadership, no matter the position held. Leaders have interests, responsibilities, and a purview that span boundaries, making them knowledgeable about how the pieces fit within the organization; therefore, they have a responsibility for making sense of why a course of action is necessary. Providing a context so the work ahead makes sense also means explaining what one do in our leadership position to support the efforts of others and further institutional goals. Successfully functioning teams and committee work are the lifeblood of complex organizations, so all nurses need high-level meeting- management skills.

This chapter reviews patient and nursing care models, patient classification systems (PCSs), staffing and scheduling models, leader and manager staffing and scheduling responsibilities, and ways to make self-scheduling a positive experience for nurses. The primary/total patient care delivery model is the oldest model with its origins coming from the work of Florence Nightingale, and echoed in patient care provided by nursing students. PCSs are used to provide a quantitative measure of workload for the determination of staffing needs by measuring the amount of care a patient requires using objective measures such as vital signs, treatments, and number of medications. According to the American Organization of Nurse Executives competencies for nurse managers, the responsibilities of the manager include the following: staff selection, evaluation of staffing patterns, matching staff competencies to assignments, defining the role of the staff members within their scope of practice, and completing and evaluating the orientation process.

Providing the highest quality of care to clients, and keeping them safe, is a priority for all nurses. This chapter presents an evolving case scenario that will follow a nurse's exploration of quality and safety on her patient care unit. It helps the reader to define quality improvement and safety in healthcare. The chapter describes approaches that nurses can take to evaluate the quality of care through measurement and benchmarking. It helps the reader to explain the influence of variation on the quality of care and apply a framework to improve reliability. The chapter differentiates prepatient events, safety events, and serious safety events and describes how human factors contribute to events of harm. It defines the culture of safety and its elements, including event reporting, event disclosure, and accountability in a just culture. The chapter finally explains the process for determining actual and potential failures in processes.

This chapter focuses on systematically developing a clinical question so that each component of the question is clear. Clinical questions are the indisputable driving force behind evidence-based practice (EBP), and without questions EBP would be unnecessary. The chapter presents the mnemonic PICOT (patient population, intervention, comparison, outcome, time frame), along with several opportunities to explore sample clinical questions that are under development and that are well written. It discusses the role of PICOT-digital data (PICOT-D) for nurses educated at the doctor of nursing practice level. Reflecting on the scope of the clinical questions presented as samples in the chapter exemplifies that PICOT can be applied in any nurse-patient interaction to improve patient outcomes. Patients can potentially benefit from direct care nurses being well versed in EBP. Nurses who are skilled at writing PICOT questions have a positive impact on patient outcomes, such as quality of life, satisfaction, and safety.

Retirement isn’t a single event, but a process that varies in when it happens and how long it takes before the person adjusts to a new way of life. Planning for retirement should include developing financial literacy at the start of a career so earnings and savings are smartly invested; preparing for the time by figuring out how to structure newfound freedom; not stopping all work abruptly but providing for some period of transition; beginning to take on more activities that one prefers to do rather than what one has to do; and giving some thought to facilitating a smooth relationship with successors. Both those letting go and those coming on occupy different psychological and generational space, and their differences in perspective are normal. One’s perspective is no more right than the other’s, but they are viewing matters through different lenses, setting the stage for potential misunderstandings.