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International

ANCC's prestigious recognition programs for healthcare organizations are now accepting international applications.

ANCC's prestigious recognition programs for healthcare organizations are now accepting international applications.

Healthcare organizations around the world are searching for ways to improve patient care and quality. Our organizational accreditation programs for nursing excellence offer proven strategies to reach these goals.

For hospitals located outside of the United States, ANCC offers additional support and resources to assist you in pursuing Pathway designation. For more information, contact pathwayinfo@ana.org

Educational Requirements and Validation of Credentials

International applicants for the Pathway to Excellence Program must meet the CNO eligibility requirements for academic preparation and licensure.

Commission on Graduates of Foreign Nursing Schools (CGFNS)
To validate international credentials, applicants must present verification from CGFNS International.

ANCC will not accept verification documents from other credential evaluating organizations.

Eligibility Criteria

The following eligibility requirements apply to organizations applying for the Pathway to Excellence Program.

Chief Nursing Officer and Nursing Leadership
The applicant organization must designate one individual as the chief nursing officer (CNO) who is ultimately accountable for the standards of nursing practice throughout the organization.

The CNO is responsible for all nursing practice; therefore, all areas and campuses under the CNO's accountability where nursing is present must be included in the application, regardless of reporting relationships.
The CNO, as part of the organization's highest governing, decision- making, and strategic-planning body, advocates for nursing to the Board of Directors.
At the time of application, the CNO must hold, at a minimum, a baccalaureate degree in nursing.
All requirements must be maintained through the application phase, the review phase, and designation as a Pathway to Excellence organization.
Appointees as interim CNOs and subsequent CNOs must also comply with all requirements.

Organizational Structure
Individual organizations within the system may apply; however, a multi-facility healthcare system cannot apply as a whole. (For those with campuses, please refer to the campus definition below.)

Compliance
The organization must be compliant with all state and/or federal laws as they relate to registered nurses in the workplace.

Announcement:
Effective 2/1/2021: Commission on Pathway to Excellence has unanimously approved the inclusion of non-RN midwives in the Pathway Nurse Survey phase of the Pathway to Excellence® application.

Definition of Midwife

Completed midwifery education program based on ICM Essential Competencies for Basic Midwifery Practice and framework of ICM Global Standards for Midwifery Education. Click on

https://www.internationalmidwives.org/our-work/policy-and-practice/icm-definitions.html for more information on the Scope and Practice of a Midwife.

Persons not eligible to participate in the Pathway Nurse Survey include Auxiliary Midwife, as defined by the WHO: https://apps.who.int/iris/bitstream/handle/10665/128037/WHO_RHR_14.22_eng.pdf;jsessionid=0865667ABAAAF165C7E35C77CC69ED6C?sequence=1.

Questions? Contact pathwayinfo@ana.org

Terms Defined

Campus
For Pathway purposes, campuses are remote care sites of an applicant organization. The CNO of the applicant organization is accountable for nursing practice at the remote sites. Campuses typically provide services to augment the full set of services offered at the primary site.

Chief Nursing Officer
The highest-level nurse with ultimate responsibility for all nursing practice within the organization. In long-term care, this role is synonymous with the "Director of Nursing" (DON).

Nurse Manager
A registered nurse responsible for the supervision of registered nurses and other health care providers who deliver nursing care in an inpatient or outpatient area. The nurse manager’s primary domains of activity are planning, organizing, leading, and evaluating. The term “nurse manager” is not synonymous with the chief nursing officer. In long-term care, “nurse manager” may be used interchangeably with “associate director,” “charge nurse,” or “supervisor.”

ANCC has successfully achieved ISO 9001:2015 certification for all of its credentialing programs.

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Library of Pathway Associated Concepts

Notes on Selected Research Studies Relevant to Pathway to Excellence^® Standards

The tables below list selected research studies that found a favorable association between a variable we interpret to be consistent with a Pathway to Excellence characteristic and patient, nurse, or organizational outcomes.

Standard 1. Shared Decision-Making
Study:	Pathway-relevant measure(s):	Associated outcome(s):
Clarke (2007) — 11,512 nurses in 188 hospitals in Pennsylvania	higher nurse participation in hospital affairs	lower needle or sharps injuries
Flynn et al. (2012) — 686 RNs in 82 medical-surgical units in 14 hospitals in New Jersey	higher nurse participation in hospital affairs	higher error interception practices, which linked to lower medication errors
Friese & Himes-Ferris (2013) — 242 outpatient oncology nurses in a large southeastern state	higher nurse participation in practice affairs	higher intent to stay
Gregory et al. (2010) — 548 acute care nurses in Canada	higher control/empowerment and input into decision-making	higher nurse perceptions of quality of care, standards of care, and safety issues
Hanrahan, Aiken, et al. (2010) — 353 direct inpatient care psychiatric nurses in 67 hospitals in Pennsylvania	higher nurse participation in hospital affairs	lower emotional exhaustion
Kutney-Lee et al. (2016) — 20,674 RNs in 425 hospitals in California, New Jersey, Pennsylvania, and Florida	higher engagement in shared governance	lower nurse reports of high burnout high job dissatisfaction intent to leave poor quality of care and patient safety experience of care hospital rating willingness to recommend hospital higher patient reports of experience of care hospital rating willingness to recommend hospital
Laschinger (2008) — 234 nurses in tertiary care hospitals in Ontario	higher nurse participation in hospital affairs	higher job satisfaction higher RN ratings of quality of care on unit
Laschinger et al. (2009) — 247 new graduate nurses from hospital inpatient units in Ontario	higher nurse participation in hospital affairs	lower emotional exhaustion
Laschinger & Leiter (2006) — 8,597 acute care nurses in Ontario and Alberta	higher nurse participation in hospital affairs	lower nurse-reported adverse events
Leineweber, Chungkham, et al. (2014) — 8,948 medical/surgical RNs in 53 hospitals in Sweden	higher nurse participation in hospital affairs	lower work-family conflict
Leiter & Laschinger (2006) — 8,597 nurses in acute care hospitals in Ontario and Alberta	higher nurse participation in hospital affairs	lower burnout
Nowrouzi et al. (2015) — 506 registered practical nurses in Ontario, Canada	higher involvement in decision making	higher intent to stay in current position for next 5 years
Papastavrou et al. (2015) — 1,163 RNs and LPNs in 91 wards in 34 hospitals in Cyprus, Finland, Greece, Portugal, Sweden, Turkey, and the state of Kansas	higher control over practice	higher nurse perceptions of individualized care successfully provided to patients in latest shift
Zaheer et al. (2015) — 2,495 nurses (81%), physicians (13%), and pharmacists (6%) in 13 hospitals in Ontario, Canada	higher levels of participative leadership	stronger frontline staff perceptions of patient safety climate (senior and supervisory leadership support for patient safety)

Standard 2. Leadership
Study:	Pathway-relevant measure(s):	Associated outcome(s):
Boev (2012) — 671 nurses and 1,532 discharged patients from 4 critical care units in a New York hospital	higher perceptions of nurse manager ability, leadership, and support	higher patient reports of satisfaction with nursing care
Carter & Tourangeau (2012) — 17,707 RNs and midwives at 147 acute and 20 specialist hospitals in England	better relationships with and support from manager	less intention to leave
Duffield et al. (2010) — 1,559 nurses in 91 wards in 21 public hospitals in 2 Australian states	higher perceptions of senior nursing administrator who is highly visible and accessible to staff nurses actively participating in efforts to control costs a nurse manager who is a good manager and leader	higher job satisfaction
Flynn et al. (2012) — 686 RNs in 82 medical-surgical units in 14 hospitals in New Jersey	higher perceptions of nurse manager ability, leadership, and support	higher error interception practices, which linked to lower medication errors
Friese (2005) — 1,956 nurses in 22 hospitals	higher perceptions of nurse manager ability, leadership, and support	lower emotional exhaustion lower job dissatisfaction higher RN ratings of quality of care
Hanrahan, Aiken, et al. (2010) — 353 direct inpatient care psychiatric nurses in 67 hospitals in Pennsylvania	higher perceptions of nurse manager ability, leadership, and support	lower nurse reports of emotional exhaustion depersonalization of patients
Hanrahan, Kumar, et al. — 353 direct inpatient care psychiatric nurses in 67 hospitals in Pennsylvania	higher perceptions of nurse manager ability, leadership, and support	lower nurse-reported frequency of work-related staff injuries patient falls with injuries
Jourdain & Chenevert (2010) — 1,636 RNs working in hospitals in Canada	higher support from supervisor	lower depersonalization of patients, which in turn related to higher professional commitment and lower intent to leave the profession
Laschinger (2008) — 234 nurses in tertiary care hospitals in Ontario	higher perceptions of nurse manager ability, leadership, and support	higher job satisfaction higher RN ratings of quality of care on unit
Laschinger et al. (2009) — 247 new graduate nurses from hospital inpatient units in Ontario	higher perceptions of nurse manager ability, leadership, and support	lower emotional exhaustion
Laschinger & Leiter (2006) — 8,597 acute care nurses in Ontario and Alberta	higher perceptions of nurse manager ability, leadership, and support	lower nurse-reported adverse events
Leineweber, Westerlund, et al. (2014) — 8,620 RNs in 53 hospitals in Sweden	better leadership and support for RNs	reduced risk of emotional exhaustion depersonalization of patients
Leiter & Laschinger (2006) — 8,597 nurses in acute care hospitals in Ontario and Alberta	higher perceptions of nurse manager ability, leadership, and support	lower burnout
Roche et al. (2015) — 1,673 nurses in 62 wards in 11 hospitals in 3 states in Australia	higher perceptions of nurse unit manager leadership skills	lower intent to leave within 12 months
Sawatzky & Enns (2012) — 261 RNs in adult emergency departments in Manitoba, Canada	higher perceptions of nursing management	higher engagement, which in turn related to lower intent to leave current position
Van Bogaert et al. (2013) — 1,201 RNs in 116 units in 8 hospitals in Belgium	higher perceptions of nurse management at the unit level	higher nurse-assessed quality of care higher nurse job satisfaction, intent to stay in the hospital, and intent to stay in nursing

Standard 3. Safety
Study:	Pathway-relevant measure(s):	Associated outcome(s):
Chang & Mark (2011) — 4,954 medical-surgical RNs in 286 units in 146 US hospitals	stronger learning climate (communication and thinking about errors)	lower medication errors
Houser et al. (2012) — 420 nurses in 54 units in 9 hospitals in Colorado	higher RN involvement in planning for staffing	higher unit-level indicators of patient satisfaction with nursing care
Mark et al. (2007) — approx. 4,000 nurses in 143 hospitals	stronger safety climate	fewer back injuries
Richter et al. (2016) — 237,409 clinical staff in 1,046 hospitals	higher perceptions of management support for safety	higher perceptions of successful handoffs
Rosen et al. (2010) — 4,581 VA hospital workers in 29 hospitals	higher overall emphasis on safety	lower rates of decubitus ulcer iatrogenic pneumothorax
Steyrer et al. (2013) — 549 nurses, 185 physicians, and ICU 378 patients in 57 hospitals in Austria, Germany, and Switzerland	more positive safety climate (management commitment to patient safety, organizational learning, communication and cooperation, and attitude toward safety management)	lower rates of medical errors
Tvedt et al. (2012) — 3,618 nurses in surgical and medical wards in 35 hospitals in Norway	higher patient safety management	nurse-reported: higher quality of nursing care higher patient safety ratings higher ratings of patients' self-care ability lower frequency of adverse events
Vaughn et al. (2004) — 1,454 healthcare workers (1,047 RNs) in 84 Iowa hospitals	higher management support for safety	more consistent adherence to safe needle precautions
Zaheer et al. (2015) — 2,495 nurses (81%), physicians (13%), and pharmacists (6%) in 13 hospitals in Ontario, Canada	higher ease for reporting events	stronger frontline staff perceptions of patient safety climate (senior and supervisory leadership support for patient safety)

Standard 4. Quality
Study:	Pathway-relevant measure(s):	Associated outcome(s):
Brooks et al. (2009) — 1,578 patients in 12 Midwest acute care hospitals	intervention of evidence-based pain management practices	lower total cost per inpatient stay, cost per day, and length of stay
Doran et al. (2014) — 338 nurses and 939 clients from 13 home care offices in Ontario, Canada	higher number of nursing sensitive EBP interventions documented in client records	improvements in risk of dyspnea on discharge pain frequency number of falls pressure ulcer occurrences
Gittell et al. (2000) — 338 care providers (nurses and physicians) from 9 hospitals, 878 orthopedic patients	higher mutual respect, shared goals, and frequency of communication (dimensions of “relational coordination”)	lower length of stay higher quality of care higher postoperative freedom from pain higher postoperative functioning
Gregory et al. (2010) — 548 acute care nurses in Canada	higher satisfaction with managerial and interdisciplinary relations	higher nurse perceptions of quality of care, standards of care, and safety issues
Hickey et al. (2013) — 3,413 pediatric critical nurses with 26,158 congenital heart disease patients in 38 children’s hospitals	participation in national quality metric benchmarking	lower odds of in-hospital mortality
Titler et al. (2009) — 669 hospitalized older adults in 12 Midwest acute care hospitals	intervention of evidence-based pain management practices	lower mean pain intensity

Standard 5. Well-Being
Study:	Pathway-relevant measure(s):	Associated outcome(s):
Carter & Tourangeau (2012) — 17,707 RNs and midwives at 140 acute and 20 specialist hospitals in England	better ability to achieve good work-life balance	lower intention to leave
Duffield et al. (2010) — 1,559 nurses in 91 wards in 21 public hospitals in 2 Australian states	higher availability of flexible or modified work schedules higher praise and recognition for a job well done	higher job satisfaction
Estryn-Behar et al. (2010) — 866 nurses in Belgium, Germany, Finland, France, Italy, the Netherlands, Poland, and Slovakia	work schedule difficulties	exited organization in past year
Leineweber et al. (2016) — 23,076 RNs Belgium, England, Finland, Germany, Greece, Ireland, the Netherlands, Norway, Poland, Spain, Sweden, and Switzerland	higher satisfaction with scheduling flexibility	less likely to leave hospital leave nursing profession
Penz et al. (2008) — 944 RNs in rural hospitals in Canada	higher satisfaction with scheduling and shifts	higher job satisfaction
Tourangeau & Cranley (2006) — 6,856 RNs and 1,325 RPNs in Ontario, Canada	higher satisfaction with praise and recognition	higher intention to remain employed in current hospital

Standard 6. Professional Development
Study:	Pathway-relevant measure(s):	Associated outcome(s):
Boyle et al. (2016) — 5,144 patient care units in 857 hospitals	higher unit-level rates of specialty certification	better quality on a composite index of pressure ulcer and fall rates
Boltz et al. (2013) — 44 medical and medical-surgical units serving older adults in 25 hospitals	higher percent unit RNs certified in any specialty	lower fall rates
Carter & Tourangeau (2012) — 17,707 RNs and midwives at 140 acute and 20 specialist hospitals in England	more perceived developmental opportunities	lower intention to leave
Covell & Sidani (2013) — 91 units in 6 hospitals in Ontario and Quebec	higher unit-level proportion of RNs with specialty certification	lower rates of hospital- acquired infection lower vacancy rates (less unfilled positions) lower reruitment rates (less need to hire nurses)
Estryn-Behar et al. (2010) — 866 nurses in Belgium, Germany, Finland, France, Italy, The Netherlands, Poland, and Slovakia	dissatisfied with development opportunities	exited organization in past year
Flinkman et al. (2008) — 147 nurses in 6 hospital districts in Finland	lower rating of development opportunities	more frequent thoughts of leaving nursing in the last 12 months
Kendall-Gallagher & Blegen (2009) — 48 ICUs in 29 hospitals	higher proportion of certified staff RNs in unit	lower annualized rate of falls
Rondeau et al. (2009) — 680 CNOs and others responsible for nursing function at 232 hospitals and 473 long-term care facilities in Canada	higher intensity of staff training and development across 10 broad areas (e.g., workplace safety, clinical skills, quality improvement, and team effectiveness)	lower turnover (percentage of RNs that voluntarily left the organization in the past year)
Rush et al. (2015) — 245 new graduate nurses in acute care settings in British Columbia	participation in formal new graduate transition program	higher scores on transition experience (workplace integration)
Spector et al. (2015) — 486 new graduate nurses in 51 hospitals in Illinois, North Carolina, and Ohio	participation in established (vs. limited) onboarding/transition program	nurse self-reports of: fewer patient care errors fewer negative safety practices employed higher competency levels lower work stress better job satisfaction organization reports of: higher retention rates
Trinchero et al. (2013) — 827 nurses in 6 public and private hospitals in Italy	higher satisfaction with training and development provided by the hospital	higher employee engagement
Unruh & Zhang, 2014a — 533 newly licensed RNs in Florida	higher perceptions of having a good orientation	lower turnover (nurse reports of leaving a job within 1.5-2.5 years of graduating)
Unruh & Zhang, 2014b — 414 newly licensed RNs in Florida	more positive orientation experience	higher job satisfaction
Vander Elst et al. (2016) — 633 nurses from a large home healthcare organization in Belgium	more opportunities provided in the job situation to learn and to develop	higher work engagement lower burnout
Warshawsky et al. (2016) — 348 nurse managers working in 9 healthcare systems	organizational support for ongoing development of nursing leaders (culture of generativity)	higher job satisfaction lower intent to leave

References

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Boltz M, Capezuti E, Wagner L, Rosenberg MC, Secic M. Patient safety in medical-surgical units: can nurse certification make a difference? Medsurg Nurs. 2013 Jan-Feb;22(1):26-32, 37.

Boyle DK. Jayawardhana A, Burman ME, Dunton NE, Staggs VS, Berquist-Beringer S, Gajewski BJ. A pressure ulcer and fall rate quality composite index for acute care units: a measure development study. Int J Nurs Stud. 2016 Nov;63:73-81.

Brooks JM, Titler MG, Ardery G, Herr K. Effect of evidence-based acute pain management practices on inpatient costs. Health Serv Res. 2009 Feb;4(1):245-263.

Carter MR, Tourangeau A. Staying in nursing: what factors determine whether nurses intend to remain employed? J Adv Nurs. 2012 68(7):1589-1600.

Chang Y, Mark B. Effects of learning climate and registered nurse staffing on medication errors. Nurs. Res. 2011 Jan-Feb;60(1):32-39.

Clarke SP. Hospital work environments, nurse characteristics, and sharps injuries. Am J Infect Control. 2007 Jun;35(5):302-309.

Covell CL, Sidani S. Nursing intellectual capital theory: testing selected propositions. J Adv Nurs. 2013 69(11):2432- 2445.

Doran D, Lefebre N, O'Brien-Pallas L, Estabrook CA, White P, Carryer J, Sun W, Qian G, Bai YQ, Li M. The relationship among evidence-based practice and client dyspnea, pain, falls, and pressure ulcer outcomes in the community setting. Worldviews Evid Based Nurs. 2014 Oct;11(5):274-83.

Duffield CM, Roche MA, Blay N, Stasa H. Nursing unit managers, staff retention and the work environment. J Clin Nurs. 2010 20:23-33.

Estryn-Behar M, van der Heijden BIMJ, Fry C, Hasselhorn H-M. Longitudinal analysis of personal and work-related factors associated with turnover among nurses. Nurs Res. 2010 May-Jun;59(3):166-177.

Flinkman M, Laine, M Leino-Kilpi H, Hasselhorn H-M, Salantera S. Explaining young registered Finnish nurses’ intention to leave the profession: a questionnaire survey. Int J Nurs Stud. 2008;45:727-739.

Flynn L, Liang Y, Dickson GL, Xie M, Suh D-C. Nurses’ practice environments, error interception practices, and inpatient medication errors. J Nurs Scholarsh. 2012 Jun;44(2):180-186.

Friese CR. Nurse practice environments and outcomes: implications for oncology nursing. Oncol Nurs Forum. 2005 Jul;32(4):765-772.

Friese CR, Himes-Ferris L. Nursing practice environments and job outcomes in ambulatory oncology settings. J Nurs Adm. 2013 Mar;43(3):149-154.

Gittell JH, Fairfield KM, Bierbaum B, et al. Impact of relational coordination on quality of care, postoperative pain and functioning, and length of stay: a nine-hospital study of surgical patients. Med Care. 2000 Aug;38(8):807-819.

Gregory DM, Way CY, Barrett BJ, Parfrey PS. Predictors of perceived health care quality for registered nurses during and after health care reform. Health Care Manag Rev. 2010 Oct-Dec;35(4):301-311.

Hanrahan NP, Aiken LH, McClaine L, Hanlon AL. Relationship between psychiatric nurse work environments and nurse burnout in acute care general hospitals. Issues Ment Health Nurs. 2010 Mar;31(3):198-207.

Hanrahan NP, Kumar A, Aiken LH. Adverse events associated with organizational factors of general hospital inpatient psychiatric care environments. Psychiatr Serv. 2010 Jun 61(6):569-74.

Hickey PA, Gauvreau K, Curley MAQ, Connor JA. The effect of critical care nursing and organizational characteristics on pediatric cardiac surgery mortality in the United States. J Nurs Adm. 2013 43(12)637-44.

Houser J, ErkenBrack L, Handberry L, Ricker F, Stroup L. Involving nurses in decisions: improving both nurse and patient outcomes. J Nurs Adm. 2012 Jul-Aug;42(7-8):375-382.

Jourdain G, Chenevert D. Job demands—resources, burnout and intention to leave the nursing profession: A questionnaire survey. Int J Nurs Stud. 2010 Jun;47(6):709-722.

Kendall-Gallagher DK, Blegen MA. Competence and certification of registered nurses and safety of patients in intensive care units. Am J Crit Care. 2009 Mar;18(2):106-116.

Kutney-Lee A, Germack H, Hatfield L, Kelly S., Maguire P, Dierkes A, Del Guidice M, Aiken LH. Nurse engagement in shared governance and patient and nurse outcomes. J Nurs Adm. 2016 46(11):605-612.

Laschinger HKS. Effect of empowerment on professional practice environments, work satisfaction, and patient care quality: further testing the Nursing Worklife Model. J Nurs Care Qual. 2008 Oct-Dec;23(4):322-330.

Laschinger HKS, Finegan J, Wilk P. New graduate burnout: the impact of professional practice environment, workplace civility, and empowerment. Nurs Econ. 2009 Nov-Dec;27(6):377-383.

Laschinger HKS, Leiter MP. The impact of nursing work environments on patient safety outcomes: the mediating role of burnout/engagement. J Nurs Adm. 2006 May;36(5):2

Leineweber C, Chungkham HS, Westerlund H. Tishelman C, & Lindqvist R. Hospital organizational factors influence work-family conflict in registered nurses: multilevel modeling of a nation-wide cross-sectional survey in Sweden. Int J Nurs Stud. 2014 May;51(5):744-51.

Leineweber C, Chungkham HS, Lindqvist R, Westerlund H, Runesdotter S, Smeds Alenius L, Tishelman C; RN4CAST consortium. Nurses’ practice environment and satisfaction with schedule flexibility is related to intention to leave due to dissatisfaction: a multi-country, multilevel study. Int J Nurs Stud. 2016 58:47-58.

Leineweber C, Westerlund H, Chungkham HS, Lindqvist R, Runesdotter S, Tishelman C. Nurses’ practice environment and work-family conflict in relation to burn out: a multilevel modeling approach. PLOS One. 2014 May;9(5):e96991.

Leiter MP, Laschinger HKS. Relationships of work and practice environment to professional burnout. Nurs Res. 2006 Mar/Apr;55(2):137-146.

Mark BA, Hughes LC, Belyea M, et al. Does safety climate moderate the influence of staffing adequacy and work conditions on nurse injuries? J Safety Res. 2007 38(4):431-446.

Nowrouzi B, Rukholm E, Lariviere M, Carter L, Koren I, Mian O. An examination of retention factors among registered practical nurses in north-eastern Ontario, Canada. Rural Remote Health. 2015 Apr-Jun;15(2):3191.

Papastavrou E, Acaroglu R, Sendir M, et al. The relationship between individualized care and the practice environment: an international study. Int J Nurs Stud. 2015 Jan;52(1):121-133.

Penz K, Stewart NJ, D’Arcy C, Morgan D. Predictors of job satisfaction for rural acute care registered nurses in Canada. West J Nurs Res. 2008 Nov;30(7):785-800.

Richter JP, McAlearney AS, Pennell ML. The influence of organizational factors on patient safety: examining successful handoffs in health care. Health Care Manag Rev. 2016 Jan-Mar;41(1):32-41.

Roche MA, Duffield C, Dimitrelis S, Frew B. Leadership skills for nursing unit managers to decrease intention to leave. Nursing Res and Rev. 2015 5:57-64.

Rondeau KV, Williams ES, Wagar TH. Developing human capital: what is the impact of nurse turnover? J Nurs Manag. 2009 17:739-748.

Rosen AK, Singer S, Zhao S, Shokeen P, Meterko M, Gaba D. Hospital safety climate and safety outcomes: Is there a relationship in the VA? Med Care Res Rev. 2010 Oct;67(5):590-608.

Rush KL, Adamack M, Gordon J, Janke R, Ghement IR. Orientation and transition programme component predictors of new graduate workplace integration. J Nurs Manag. 2015 23:143-155.

Sawatzky JV, Enns CL. Exploring the key predictors of retention in emergency nurses. J. Nurs Manag. 2012 20:696- 707.

Spector N, Blegen MA, Silvestre J, Barnsteiner J, Lynn MR, Ulrich B, Fogg L, Alexander M. Transition to practice study in hospital settings. J Nurs Regul. 2015 Jan;4(4):24-38.

Steyrer J, Schiffinger M, Huber C, Valentin A, Strunk G. Attitude is everything?: The impact of workload, safety climate, and safety tools on medical errors: a study of intensive care units. Health Care Manag Rev. 2013 Oct- Dec;38(4):306-16.

Titler MG, Herr K, Brooks JM, et al. Translating research into practice intervention improves management of acute pain in older hip fracture patients. Health Serv Res. 2009 Feb:44(1):264-287.

Tourangeau AE, Cranley LA. Nurse intention to remain employed: understanding and strengthening determinants. J Adv Nurs. 2006 55(4):497-509.

Trinchero E, Brunetto Y, Borgonovi E. Examining the antecedents of engaged nurses in Italy: perceived organisational support (POS); satisfaction with training and development; discretionary power. J Nurs Manag. 2013 21:805-816.

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Unruh LY, Zhang NJ. The hospital work environment and job satisfaction of newly licensed registered nurses. Nurs Econ 2014b 32(6):296-311.

Van Bogaert P, Kowalski C, Weeks SM, Van heusden D, Clarke SP. The relationship between nurse practice environment, nurse work characteristics, burnout and job outcome and quality of nursing care: a cross-sectional survey. Int J Nurs Stud. 2013 Dec;50(12):1667-1677.

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Pathway Marketing Toolkit

The Marketing Toolkit contains program logos and trademark use guidelines, as well as sample press releases. To access the Online Marketing Tool Kit, please visit the Pathway Learning Community.

Pathway Learning Community

The Pathway Learning Community^™ (PLC) is an exclusive online community for nurses committed to creating positive practice environments and promoting excellence in nursing practice. The PLC provides an opportunity for nurses to connect and share best practices, resources, research, experiences, and strategies that have led to positive practice environments, quality patient care, and excellence in professional nursing practice.

The Pathway Learning Community features:

Pathway to Excellence Orientation modules and webinars
Networking opportunities with Pathway Designated and Applicant CNOs & PPCs
A discussion board where you can ask questions, share best practices with other Pathway organizations and get questions answered to assist you on your Pathway journey
Get the latest news and information from the Pathway program
Find information about upcoming events related to ANCC & Pathway

The Pathway Learning Community is available to all Pathway Designated and Pathway Applicant organizations. If you would like to learn more about the community, please fill out the PLC Contact Form or email pathwaycommunity@ana.org.

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