Models represent or describe reality.1 Nurse leaders may assert that they have model employees or model students. Similarly, nursing administration and leadership are often described in the language of models. As a science, the discipline of nursing administration sculpts, forms, and shapes models to help leaders understand and intervene in the healthcare environment. When it comes to models, we may be wise to listen to a noted philosopher of science who, himself, serves on the faculties in schools of nursing-Dr Frederick Suppe.
All Models Are Flawed; Some Are Useful
Suppe2,3 is a farmer, teacher, and philosopher. He served as an esteemed professor of nursing science at the University of Maryland at Baltimore School of Nursing and, more recently, Texas Tech University. Suppe, who wore his hallmark blue jeans to teach, was known to say that although all models are flawed, some are useful. This issue of the Journal of Nursing Administration focuses the administration lens on several models in professional nursing practice. Authors did what we are all encouraged to do-test, enrich, and challenge models. The models they describe are necessarily flawed but, as Suppe might say, useful.
The American Organization of Nurse Executives (AONE)4 enthusiastically supports testing and refining models and ideas useful for nursing leadership that promote positive outcomes for patients and staff. The 2007 Education and Research Priorities of AONE specify 4 main areas of emphasis.
* Design of Future Patient Care Delivery Systems
* Healthful Practice Environments
* Leadership
* Positioning Nurse Leaders as Valued Healthcare Executives and Managers
Collectively, authors in this special AONE research issue of the Journal of Nursing Administration tested, enriched, and challenged models that support areas identified in AONE's 2007 Education and Research Priorities.
Testing Models
Lashinger, Purdy, and Almost engaged in model testing. The authors discuss the powerful impact of situational and dispositional variables on the job satisfaction of nurse managers. In essence, the authors hypothesized that, among nurse managers, (1)relationships with supervisors would work through empowerment to influence job satisfaction and (2) nurse managers' views of their own core personality traits would have a positive direct effect on supervisory relationships and job satisfaction.
In a nonexperimental, cross-sectional, predictive design, Lashinger et al administered 5 reliable and valid self-report measures to a random sample of acute care nurse managers. Structural equation modeling, a method to determine complex relationships and paths, revealed that although the hypothesized model was supported statistically, there was something missing. The authors improved the goodness of fit-or the missing link-with the addition of dispositional variables. Thus, it seems that it is not only the situation, or quality of relationships, that matters; it also seems that one's own disposition contributes to levels of job satisfaction. We sometimes casually say, in an overused phrase, it is not about you. However, the research of Lashinger et al suggests that it is about you and it is about relationships. Lashinger and her coauthors' work goes a long way to support AONE's 2007 Educational and Research Priority: Healthful Practice Environments.
Way, Gregory, Davis, Baker, LeFort, Barrett, and Parfrey collaborated to test a predictive model among nurse managers. Their hypothesized model examined potential linkages among key factors thought to be influenced by major health system changes such as restructuring and consolidation and thought to influence turnover intentions. As hypothesized, perceptions of organizational culture were related to greater trust, satisfaction, commitment, and intent to stay. The investigator team confirmed, not surprisingly, that the trust nurse managers hold in their employers is an important predictor of intent to leave.
This research aligns with AONE's 2007 Healthful Practice Environment priority. As a caution, Clarke,5(p255) a scholar in the area of organizational culture, comments candidly that "nurses and others have expressed a great deal of interest in the potential for incorporating notions about organizational culture and climate in research and practice aiming to improve healthcare safety." Clarke goes on to comment that the state of the science in organizational culture is not as strong as one might hope because of inconsistencies in definitions and large number of instruments for measurement. Therefore, implications for practice, unfortunately, remain unclear. The Way et al article in this month's issue continues the pioneering work in this complex area of science.
Mensik examined the perceptions of a well-respected model in a new setting. Her innovative research reviewed the Essentials of Magnetism in the home healthcare setting. Mensik's pioneering work involved comparing responses from registered nurses in home health with those in acute care settings. Comparing results across settings, especially as care migrates into the community, makes a critical contribution to nursing knowledge. The author points to the fact that between the year 2000 and 2020, the need for home healthcare nurses is growing at twice the rate of nurses over all. Mensik's work supports AONE's education and research priority on leadership, specifically, the priorities to work with a diverse workforce and a diverse patient population and in the area of workforce shortages, in this case, home healthcare.
Enriching Models
Authors Ulrich, Buerhaus, Donelan, Norman, and Dittus enriched a model. These seasoned researchers based the research reported in this issue on the Magnet Recognition process or model. Their research pointed to a clearer understanding that we no longer should view healthcare facilities in simply a binary sense as Magnet or non-Magnet. Their national survey compared how registered nurses view the work environment and the nursing shortage based on the Magnet status of their organization. Their work confirmed Margaret McClure's visionary perspective as presented by Steefel;6 that is, it does not matter whether an institution is ready and/or able to attain (American Nurses Credentialing Center) Magnet status-it can learn many concepts and processes for improving its professional environment. Depending on Magnet status of the institution, the researchers detected significant differences in registered nurses' views about the emphasis on patient care, opportunities for professional development and advancement, opportunities to influence decisions, and nurse-physician teamwork, to name a few. They confirmed what we suspected. Just the pursuit of Magnet recognition yields positive outcomes.
The research of Ulrich et al aligns with many of AONE's 2007 Education and Research Priorities, most especially, "Healthful Practice Environments" and "Leadership." Their research enriched the Magnet Designation model or process to include thought-provoking considerations including pursuit of Magnet and life after Magnet.
Challenging Systems
Upenieks, Akhavan, Kotlerman, Esser, and Ngo challenged a system. In a prospective workflow study using Palm Pilot personal digital assistant technology on 3 comparison units in an academic medical center hospital, the research of Upenieks et al challenged one state's legislatively mandated and frequently disputed system of nurse-to-patient ratios. The researchers gained confidence in the more sensible Robert Wood Johnson Initiative: Transforming Care at the Bedside approach to gauging nursing intensity because workload varied to such an extent that simple ratios would be inadequate and unsafe.
The research of Upenieks et al addresses AONE's Education and Research Priority relating to Design of Future Patient Care Delivery Systems. The authors used personal digital assistant technology to test and ultimately reject 2 hypotheses about nursing workload. They acknowledged limitations in their study while asserting the importance of measuring nursing value.
Putting Models in Work Clothes
Where do we stand with respect to nursing models and nursing science in general? Fitzpatrick and Stevenson7 published a review of the most recent decade of nursing research published in the Annual Review of Nursing Research. Their conclusions included the finding that there remains a disconnect between areas of knowledge development and implementation in practice settings. From where I stand, schools of nursing can help bridge the gap by preparing leaders who are willing and able to lead in the manner needed for today's healthcare environment.8,9 The Journal of Nursing Administration can be an effective intermediary by providing articles that inform nurse leaders about what is ready for research utilization. There remains much learning to integrate and synthesize. The goal is to move toward new models-models in work clothes-that represent and lead us to a higher quality, safer experience for nurses, patients, and, yes, all stakeholders. No model will ever be perfect. But it is a very good place to start.
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