Relationship of RN Role Responsibilities to Job Satisfaction

Actual Scope of Nursing Practice in Saudi Ministry of Health Hospitals

BACKGROUND

Articulating a clear scope of practice for all nursing categories is essential for improving patient safety, quality of care, and nurse retention. However, this is not the case in many countries, including Saudi Arabia. This study aimed to analyze the actual scope of practice for nursing staff in Saudi Ministry of Health hospitals.

METHODS

The study used a cross-sectional exploratory design. The sampling method used in the study was the quota sampling technique. The scale utilized in this study was the Actual Scope of Practice (ASCOP) scale. Data were collected in March 2021 through an electronic form questionnaire completed by 286 nurses in two hospitals in Al-Hasa province in Saudi Arabia.

RESULTS

The overall mean score for ASCOP was 4.64 out of 6. When participants were grouped according to select characteristics (various nursing staff categories, educational levels, years of experience, nationality, gender, and type of work setting), the results revealed no statistically significant differences in overall ASCOP mean scores, except for gender and nationality.

CONCLUSIONS

The overall mean scores of nursing activities performed in practice do not significantly differ across nurses with different professional categories (health assistant, nursing technician, nursing specialist, and senior nursing specialist), indicating no clear scope of practice for each nursing category, in turn leading to role overlap among them in practice. The current study's findings can guide decision-makers to develop a clear scope of practice for nurses. The findings should also urge the decision-makers to reevaluate the usefulness of having multiple professional categories of nurses who are allowed to carry out almost the same job duties.

Measuring Scope of Practice Enactment Among Primary Care Registered Nurses

BACKGROUND

Scope of practice enactment is poorly understood in the primary care setting.

PURPOSE

The following research objectives were addressed: (1) to revise and adapt the Actual Scope of Practice (ASCOP) questionnaire for use in the primary care setting, and (2) to determine internal consistency, construct validity, and sensitivity of the modified instrument.

METHODS

To address the first objective, a narrative literature review and synthesis and an expert panel review was conducted. To address the second objective, a cross-sectional survey of 178 registered nurses who worked in primary care was conducted.

RESULTS

The ASCOP, with few modifications, addressed key attributes of nursing scope of practice in the primary care setting. The modified instrument yielded acceptable alpha coefficients ranging from 0.66 to 0.91. Total mean score of 4.8 (SD  =  .67) suggests that registered nurses within interprofessional primary care teams almost always engage in activities reflected in the modified instrument.

CONCLUSIONS

The modified instrument is the first instrument validated to measure nursing scope of practice enactment in the primary care setting. Findings from this study support the use of the modified ASCOP questionnaire as a reliable and valid measure of scope of practice enactment among primary care registered nurses.

ReImagine: Amulti-Disciplinary Quality Improvement Plan to Work at Top of Scope

BACKGROUND

There is a growing need for quality, community care models centered on the care of the child with medical complexity. This quality improvement project was conducted in a community-based medical daycare program within a large, metropolitan, pediatric hospital network of care location. A multi-disciplinary team, led by a clinical nurse specialist, occupational therapist, and early childhood special education teacher, addressed staff frustrations and low morale related to barriers to working at top of scope and feelings of a chaotic care and learning environment for children.

AIMS

To improve staff satisfaction through a decrease in perceived barriers to practicing at top of scope and to refocus each discipline's role. A secondary aim was to improve child engagement through restructuring the therapeutic and learning environment and reducing distractions to better meet the unique needs of the children the program serves.

METHODS

This quality improvement (QI) project used multiple methods, including staff surveys, child observations and timecard review, to measure the project's impact on ability to work at top scope, child engagement and staff satisfaction.

RESULTS

The QI project resulted in positively impacting work culture and structure by increased time professional staff practiced at the top of scope, decreased perceived barriers to do so, improved overall job satisfaction and improved child engagement.

CONCLUSION

Increased multidisciplinary collaboration and increased structure promoted an enhanced learning environment, healthier staff environment, and a more fiscally responsible program. There is little knowledge about medical daycares and further investigations in this setting is warranted.

Scope of nursing practice on a surgery ward: A time-motion study

AIM

To log the activities of registered nurses and nursing assistants on a visceral surgery ward.

BACKGROUND

By prioritizing their activities, nurses fail to exercise their full scope of practice even though this is essential for health care systems to function effectively and efficiently.

METHOD

A descriptive observational time-motion study was conducted over a period of 48 days. The activities of nurses (n = 24) and nursing assistants (n = 9) were logged over the course of their entire work shifts, both in the day and at night.

RESULTS

In all, 499 hr of observation were logged. Tasks that fell under the dimensions of care activities and of communication and care coordination, which cover documentation, non-care activities and delegated medical tasks, were the ones that took up most of the nurse work time. Patient assessment, relational care, therapeutic teaching/coaching, and knowledge updating and utilization were categories that nurses were under-engaged in.

CONCLUSION

The study shows that the scope of nursing practice was not optimal.

IMPLICATION FOR NURSING MANAGEMENT

The results can serve to improve the work environment of carers, optimize the use of human resources and increase the visibility and efficiency of nursing work.

Registered nurses' knowledge, attitude and practice regarding their scope of practice in Botswana

BACKGROUND

The articulation of the scope of practice in nursing is important to provide boundaries for registered nurses in which to practice. Registered nurses in Botswana have frequently experienced challenges and raised concerns with their scope of practice. Research related to registered nurses' knowledge, attitudes and practice regarding their scope of practice appears to be limited in the African context, particularly in Botswana.

AIM

The aim of this study was to develop guidelines for professional nurses to explore and describe registered nurses' knowledge, attitude and practice regarding their scope of practice in Botswana.

METHODS

A convergent parallel mixed-methods design was employed using a three-tier sampling approach to ensure a representative sample of various settings, health facilities and nurses. For the purpose of this article, the data from the qualitative component are reported. Thirty registered nurses, working in the public health sector in Botswana, participated in semi-structured interviews. Data were analysed using thematic content analysis.

FINDINGS

Data analysis revealed that registered nurses' scope of their knowledge was lacking. Registered nurses' attitudes were reflected in the adaptation process to expanded practice, as demonstrated through emotive aspects, adjustments to practice beyond scope and the learning of new skills considered beyond scope. Participants reported implementing many skills deemed beyond their scope, whilst their motive to do so included their experience of a lack of control over practice, lack of resources or they were doing so out of consideration for the patient. Guidance in terms of their scope was found to be inadequate.

CONCLUSION

As in other resource-limited countries in Africa, registered nurses in Botswana experience challenges with their scope of practice. Inadequate boundaries may result in compromised nursing care and may have detrimental consequences for both the patient and the nurse.

Influences on and outcomes of enacted scope of nursing practice: a new model

Enacted scope of practice is a major issue for nursing administrators, given the potentially negative effect on accessibility, continuity, safety and quality of care, job satisfaction, and organizational costs of nurses working at reduced scope. Optimal deployment of nurses to a fuller enacted scope of nursing practice holds much promise for addressing all of these larger challenges. In this sense, new model of the Enacted Scope of Nursing Practice presented in this article provides a number of directions for interventions that could improve health system functioning.

Measuring actual scope of nursing practice: a new tool for nurse leaders

OBJECTIVE

: This project describes the development and testing of the actual scope of nursing practice questionnaire.

BACKGROUND

: Underutilization of the skill sets of registered nurses (RNs) is a widespread concern. Cost-effective, safe, and efficient care requires support by management to facilitate the implementation of nursing practice at the full scope.

METHODS

: Literature review, expert consultation, and face validity testing were used in item development. The instrument was tested with 285 nurses in 22 medical units in 11 hospitals in Canada.

RESULTS

: The 26-item, 6-dimension questionnaire demonstrated validity and reliability. The responses suggest that nurses practice at less than their optimal scope, with key dimensions of professional practice being implemented infrequently.

CONCLUSIONS

: This instrument can help nurse leaders increase the effective use of RN time in carrying out the full scope of their professional practice.