A survey was conducted to obtain information regarding adult intensive care unit (ICU) orientation and postorientation practices throughout the nation. This article presents the results of a random sampling of ICUs throughout the nation regarding orientation practices of newly licensed registered nurses (RNs), experienced RNs new to the ICU setting, and experienced ICU RNs. Twenty-four hospitals from 7 geographic regions within the United States were surveyed. Classroom training remains the predominant method of instruction outside the ICU. Most hospitals offer a formalized training for new preceptors. When provided, preceptor incentives include both monetary recognition and professional growth/recognition. Postorientation support for new ICU nurses varied. Geographic regional differences in orientation practices were not found. The major limitation of this study was the small sample size. Results from this survey are the beginning steps in understanding a national perspective of comprehensive orientation practices for new ICU nurses.

Interprofessional collaboration is a key element in providing safe, holistic patient care in the acute care setting. Trended data at a community hospital indicated opportunities for improvement in collaboration on micro, meso, and macro levels. The aim of this survey study was to assess the current state of collaboration between frontline nurses and physicians at a non-academic acute care hospital. A convenience sample of participants was recruited with a final respondent sample of 355 nurses and 82 physicians. The results indicated that physicians generally perceived greater collaboration than nurses. Physician ratings did not vary by primary practice area, whereas nurse ratings varied by clinical practice area. Nurse ratings were the lowest in the operating room and the highest in the emergency department. Text-based responses to an open-ended question were analysed by role and coded by two independent research teams. Emergent themes emphasised the importance of rounding, roles, respect, and communication. Despite recognition of the need for improved collaboration and relational behaviours, strategies to improve collaborative practice must be fostered at the meso level by organisational leaders and customised to address micro-level values. At the study site, findings have been used to address and improve collaboration towards the goal of becoming a high reliability organisation.

The work of moving into a new hospital does not end with construction. Planning a move must include preparing staff and physicians for the changes in their usual routines in care delivery. This bimonthly department expands nurse leaders' knowledge and competencies in health facility design and enables them to lead in transition planning for operations in a new setting. As editor of the Health Facility Design department, I asked the guest authors to describe their use of conceptual frameworks and change acceleration processes to ensure a successful transition to a new hospital tower.

Technology holds potential to improve the quality of healthcare delivery. The use of remote patient monitoring, or telehealth (TH), has been widely adopted by many home care agencies to facilitate early identification of disease exacerbation, particularly for patients with chronic diseases such as heart failure. TH has been successfully used to improve symptom detection and potentially reduce rehospitalization rates. Quantifying program effectiveness through data analysis is a critical step for program improvement, resource allocation, and future strategic planning. Using the Outcome and Assessment Information Set-C database, a retrospective analysis was conducted examining 22 months of heart failure patient data from one home care agency in southern California. Seventy patients receiving TH were compared to patients who received usual home care nursing services. No major differences in baseline socio-demographics were found between the 2 groups. While receiving home healthcare services, the non-TH patients had a 21% all-cause hospital readmission rate, compared to the home TH patients with a 10% all-cause readmission rate. Statistical differences were found between groups on the variables of fall risk, vision, smoking, shortness of breath, the ability to bathe and take oral meds, along with having been discharged from a skilled nursing facility in the last 2 weeks. These results indicate that aggregate data analysis is useful in providing insight into program effectiveness. This study suggests TH programs have the potential to reduce the burden associated with rehospitalizations in the heart failure population.