Telehealth was associated with a reduction in all-cause 30-day readmission for one mid-sized Medicare-certified home health agency. A description of the program is presented as well as lessons learned that have significantly contributed to this program's success. Future expansion of the program is planned. Telehealth is a promising approach to caring for a chronically ill population while improving a patient's ability for self-care.

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Leading and effecting meaningful change in a nursing division culture, such as the type required to achieve Magnet designation, entails senior nurse executives to be well-acquainted not only with the facts and figures of their business but also with the nuances, myths, and cultures that either enable or block a change from occurring. Expert nurse leaders embrace the story being told by data on dashboards and the quality outcomes achieved and look beyond those points of information out to the edges of their division. These nurse executives also seek to understand the pivotal, perhaps seemingly inconsequential things (notions, beliefs, cultural beliefs, and stories) that will block or tip a culture to change and achieve success. At the Hospital of the University of Pennsylvania (HUP), a Magnet-designated organization, the road to Magnet was not straightforward. Instead, the path was a winding, learning journey. Through authentic leadership and the conception and actualization of a professional practice model, the HUP Nursing Excellence in Professional Practice (HUP NEPP) model, Magnet designation was achieved and a nursing culture was transformed.

Care delivery models are an integral component for delivering patient care. Although models may be abstract, nursing care delivery models need to be evolving and reality-based, as they serve to organize the allocation of nursing resources. How nursing resources are allocated is associated with patient and professional RN satisfaction, RN perceived autonomy, and quality outcomes. Care delivery models must be evolving within today's dynamic healthcare environment and must be structured within the context of a professional practice model. At the Hospital of the University of Pennsylvania, a Magnet-designated organization, a blend of traditional primary nursing and the updated relationship-based care has been developed and actualized. This model, Integrated Primary Nursing, exists within the framework of the Hospital of the University of Pennsylvania Nursing Excellence in Professional Practice. The coalescence of the 2 has yielded a care delivery model for the 21-st century RN knowledge worker.

Internationally Educated Nurses (IENs) are, and will continue to be an important part of the nursing workforce in the United States and throughout the world. They bring a variety of knowledge, skills, and experience to their new practice areas. Although the benefits of their knowledge, skills, and experience can be enhanced by successfully integrating them in the healthcare system of their new country, this may be a challenging process. The transition challenges of IENs are not due to lack of knowledge or clinical skills, but rather are linked to socio-cultural differences, including the structure of the healthcare systems; language subtleties such as use of idioms, acronyms, and abbreviations; and unfamiliarity with their new surroundings. Transitional programs can serve to bridge the practice gaps between IENs’ previous and new experiences. The Hospital of the University of Pennsylvania TIENS (Transitioning Internationally Educated Nurses for Success) Program is presented as a model to help organizations develop programs for IENS to ease their transition into the U.S. healthcare system. This article explains why IENs are a key component of the U.S. nursing workforce now and for the foreseeable future, presents a rationale for transition programs that support successful integration of IENs to the U.S. practice environment, describes a model Transition Program, and advocates for the development of a national policy to standardize transition programs for IENs in the United States.

Currently, change is rampant in healthcare. Amid the economic pressures of managed care, nursing leaders find themselves pouring over financial spread-sheets and crunching numbers at the expense of staff interaction. While staff members feel overwhelmed by the whirlwind of change around them, nursing leaders struggle to balance staff needs with countless other responsibilities. The assessment and intervention strategy presented provides nursing leaders with a straightforward and efficient means of identifying and addressing issues that affect staff productivity, retention, and satisfaction.

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