Nurse Dose as a Concept

PURPOSE

To describe the concept of Nurse Dose.

METHODS

The concept of nurse dose has been identified from decades of clinical research as a concept essential in the delivery of safe and high quality health care. The components of nurse dose were conceptualized through review of the literature from nursing, medicine, and health services research.

FINDINGS

Nurse dose is conceptualized as having three equally essential components: dose, nurse, and host and host response. Dose in the macro view includes the number of nurses per patient or per population in cities, states, regions, or countries. Dose in a micro view includes the amount of nurse time and the number of contacts. The nurse component consists of the education, expertise, and experience of the nurse. Host is represented by an organization and its characteristics (culture, autonomy, practice control) in a macro view and by the patient and characteristics (beliefs, values, culture) in a micro view. Host response includes response to the autonomy and acceptability of the nurse.

CONCLUSIONS

Greater nurse dose has been associated with decreases in patient mortality, morbidity, and healthcare costs.

Recruiting and training senior nurses using a rotational model

In order to tackle some of the recruitment and retention issues in 'hard-to-fill' community posts such as district nursing, Croydon Primary Care Trust tested a community rotational model. This article addresses some of the issues raised by the participants in the first wave of recruits. New and innovative ways of recruiting and retaining staff are needed in the present employment climate in order to meet the changing needs of clients and service provision (Newman et al, 2002). Planning and developing a vision for health and social care requires a strategy that supports individual development as well as the rapid development of the skills, knowledge and experience required to function in today's demanding clinical.. environment (Forbes et al, 2001).

The effect of state laws on the supply of advanced practice nurses

This paper considers how the decision to enter advanced practice nursing (e.g., the occupations of nurse practitioner, certified nurse-midwife, nurse anesthetist, and clinical nurse specialist) is affected by State laws on the scope of practice of APNs. We find that enrollments in APN programs are 30 percent higher in States where APNs have a high level of professional independence. Our work differs from previous studies by estimating a fixed effects model on cross-sectional and time series data, to avoid problems of endogeneity of State laws.

The practice of certified community health CNSs

PURPOSE/OBJECTIVES

This study explored the practice of clinical nurse specialists (CNSs) certified in Community Health nursing in the United States and described demographic and employment characteristics and perspectives about professional practice.

METHODS

The survey method was used. Of the 209 Community Health CNSs certified by American Nurses Credentialing Center (ANCC) invited to complete the investigator-designed mail questionnaire, 111 (53%) returned a completed questionnaire. The questionnaire contained 27 items about employment, income, years in practice, certification, career satisfaction, and educational preparation, and asked participants to indicate the fit between the Community Health CNS role and the traditional CNS subroles model described by the American Nurses Association (ANA) (The Role of the Clinical Nurse Specialist, 1986) and the updated National Association of Clinical Nurse Specialists (NACNS) CNS practice model (Statement on Clinical Nurse Specialist Practice and Education, 1998). Content validity was established by Community Health CNS reviewer feedback.

ANALYSIS

Quantifiable data were tallied and analyzed using standard spreadsheet computer software. Qualitative data were summarized for content themes.

FINDINGS

The majority of participants were white, middle-aged females who reported being satisfied with their careers as Community Health CNSs. Most indicated that they were respected by colleagues, that they had been adequately prepared by their education, and that their current work made good use of their education and expertise. When asked to identify, by percentage of effort, the fit between their job responsibilities and the traditional subroles model of practice, the mean of reported fit was as follows: educator, 35%; administrator/leader, 22%; clinician, 21%; consultant, 14%; and researcher, 8%. The fit between job responsibilities and the spheres of influence in the NACNS model of practice was reported to average 39% for patient/client, 35% for organization/network, and 25% for nurses/ nursing practice.

CONCLUSIONS

Community Health CNS is a viable specialty practice with long-term career options. The subrole functions-described by ANA-of clinician, educator, administrator/leader, consultant, and to a lesser extent researcher apply to the role. The more intergraded updated model offered by NACNS also fits Community Health CNS practice with more emphasis on patient/client and organization/ network spheres than on nurses/nursing practice sphere.

IMPLICATIONS

Schools of nursing should continue to offer the Community Health CNS programs and incorporate both the traditional functions and newer practice model into their curricula, with a greater emphasis on diversity of students to help ensure a more diverse CNS population. Further research is needed to explore the outcomes of Community Health CNS practice and the factors that contribute to role satisfaction.

Advanced practice psychiatric nurses as a treatment resource: survey and analysis

Access to behavioral health services, particularly pharmacotherapy, continues to be a significant problem. This is particularly the case for public sector beneficiaries and managed care members. The greater use of advanced practice psychiatric nurses (APPNs) with prescribing privileges could help. To better understand the availability and competence of APPNs to prescribe, the authors conducted 1) a national survey of APPNs' availability and prescribing practices, 2) a comparative analysis of pharmacy claims data generated by APPNs and psychiatrists, and 3) a comprehensive clinical record review comparing APPNs to psychiatrists. About 25% of the sample of APPNs reported having prescription authority and a private practice. The analysis of prescribing practices between APPNs and psychiatrists showed that with a few exceptions, there were no differences between the groups, as did a retrospective clinical record review. These results lead the authors to recommend greater efforts to increase the supply of APPNs.

Nurses' altered conceptions of work in a ward with all-RN staffing

1. The aim of this study was to investigate how nurses' conceptions of their patients and work changed after reorganization to all RN-staffing and the adoption of a patient-in-focus philosophy on the ward. 2. The study builds on the perspective that the individual's conception of work precedes and forms the basis for the development of knowledge, skills and attributes used in accomplishing work. 3. The findings are based on a secondary analysis of two open interviews with 22 nurses on the ward. These interviews were conducted on two occasions with an interval of 2 years. The third interview was carried out 6 months later, when 10 nurses were asked to talk about a patient's care episode in a narrative form. 4. The nurses' conceptions changed towards a holistic view of the patient, they developed a new approach to work and they used the altered circumstances in their work.

The 1990s and beyond: determining the need for community health and primary care nurses for rural populations

Increased numbers of primary care and advanced practice nurses with unique generalist skills will be required to meet the accelerating physiologic and sociocultural health care needs of rural populations. Several factors have been identified that will influence the demands and position of community-based nurses in rural practice settings during the next decade. A back-to-basics type of health care offered out of a growing elderly population; technological breakthroughs that make it possible for more chronically ill patients to live at home; serious substance abuse and other adolescent problems; AIDS; and high infant morbidity and mortality statistics are only some of the concerns that will demand nursing intervention. These changes speak to the need for improved nursing coordination, stronger collegial relationships, and better communication between physicians and nurses. Health care is moving in new directions to offer more efficient and technologically sophisticated care. These changes enhance the need for clinically expert educators who teach and jointly practice in programs with a rural focus. Telecommunications, and heightened computer literacy, will play a major role both in nursing education and clinical practice. The goals of kindergarten through 12th grade health promotion and disease prevention strategies in school health will be the norm and will require better prepared, and positions for, school nurses. More midwives and public health nurses will be needed to care for the growing population of sexually active adolescents who are in need of family planning and prenatal care. Underinsured and indigent populations will continue to fall within the purview of midlevel practitioners, as will providing anesthesia services in small rural hospitals. The transition of some rural hospitals into expanded primary care units (e.g., EACHs and RPCHs), and new models of case management will greatly influence nursing demands. This paper will further identify critical areas of advanced practice nursing within community settings, including new relationships with other health care providers, and will introduce strategies upon which rural health policy recommendations for the 1990s can be addressed.