Differences in the performances of baccalaureate, associate degree, and diploma nurses: a meta-analysis

Creating a culture of support for nursing surveillance

BACKGROUND

An estimated 98,000 deaths annually result from medical errors. Preventing these deaths must be a US healthcare goal. Surveillance decreases adverse events. Surveillance is essential for patient safety. Creating a unit culture that supports surveillance requires attention to its antecedents (nurse education, nurse expertise, nurse staffing, as well as organizational culture).

METHOD

The current literature on topics salient to creating a culture of nursing surveillance including its antecedents and its attributes were reviewed. The findings are summarized and presented.

DISCUSSION

Suggestions and tools enhancing a culture of safety allow the transition from one set of behaviors to another. An organizational culture that strives for excellence promotes surveillance which results in improved patient outcomes and better qualified nurses.

CONCLUSION

Unit change resulting in support for surveillance can minimize failure to rescue and promote interruption of adverse events. The patient outcomes include decreased morbidity and mortality.

Midwifery Qualification in Selected Countries: A Rapid Review

BACKGROUND

While the global maternal mortality ratio (MMR) shows a decreasing trend, there is room for improvement. Midwifery education has been under scrutiny to ensure that graduates acquire knowledge and skills relevant to the local context.

OBJECTIVE

To review the basic professional midwifery qualification and pre-practice requirements in countries with lower MMR compared with Malaysia.

METHODS

A rapid review of country-specific Ministry of Health and Midwifery Association websites and Advanced Google using standardised key words. English-language documents reporting the qualifications of midwives or other requirements to practise midwifery from countries with a lower MMR than Malaysia were included.

RESULTS

Sixty-three documents from 35 countries were included. The minimum qualification required to become a midwife was a bachelor's degree. Most countries require registration or licensing to practise, and 35.5% have implemented preregistration national midwifery examinations. In addition, 13 countries require midwives to have nursing backgrounds.

CONCLUSION

In countries achieving better maternal outcomes than Malaysia, midwifes often have a degree or higher qualification. As such, there is a need to reinvestigate and revise the midwifery qualification requirements in Malaysia.

Individual and Organizational Characteristics Associated With Workplace Bullying of School Nurses in Virginia

The prevalence and contributing factors of workplace bullying (WPB) are unknown among school nurses (SNs) in kindergarten to 12th grade programs. The aim of this cross-sectional study was to examine individual and organizational characteristics of WPB in a sample of SNs in Virginia. Based on the Short-Negative Acts Questionnaire, 40% of nurses did not experience bullying behavior, 34.8% of nurses faced occasional bullying (now and then or monthly), and 25.3% of nurses were frequently bullied (weekly or daily). Backward stepwise regression demonstrated the predictor variables of being non-White, a licensed practical nurse, or not involved in student individual education plans were significantly associated with being bullied. Administrators/supervisors need to be aware of the existence of WPB.

Nursing professionalization and welfare state policies: A critical review of structural factors influencing the development of nursing and the nursing workforce

Nursing professionalization is both ongoing and global, being significant not only for the nursing workforce but also for patients and healthcare systems. For this reason, it is important to have an in-depth understanding of this process and the factors that could affect it. This literature review utilizes a welfare state approach to examine macrolevel structural determinants of nursing professionalization, addressing a previously identified gap in this literature, and synthesizes research on the relevance of studying nursing professionalization. The use of a welfare state framework facilitates the understanding that the wider social, economic, and political system exercises significant power over the distribution of resources in a society, providing a glimpse into the complex politics of health and health care. The findings shed light on structural factors outside of nursing, such as country-level education, health, labor market, and gender policies that could impact the process of professionalization and thus could be utilized to strengthen nursing through facilitating increased professionalization levels. Addressing gender inequalities and other structural determinants of nursing professionalization could contribute to achieving health equity and could benefit health systems through enhanced availability, skill-level, and sustainability of nursing human resources, improved and efficient access to care, improved patient outcomes, and cost savings.

Educational background of nurses and their perceptions of the quality and safety of patient care

Background

International health systems research confirms the critical role that nurses play in ensuring the delivery of high quality patient care and subsequent patient safety. It is therefore important that the education of nurses should prepare them for the provision of safe care of a high quality. The South African healthcare system is made up of public and private hospitals that employ various categories of nurses. The perceptions of the various categories of nurses with reference to quality of care and patient safety are unknown in South Africa (SA).

Objective

To determine the relationship between the educational background of nurses and their perceptions of quality of care and patient safety in private surgical units in SA.

Methods

A descriptive correlational design was used. A questionnaire was used for data collection, after which hierarchical linear modelling was utilised to determine the relationships amongst the variables.

Results

Both the registered- and enrolled nurses seemed satisfied with the quality of care and patient safety in the units were they work. Enrolled nurses (ENs) indicated that current efforts to prevent errors are adequate, whilst the registered nurses (RNs) obtained high scores in reporting incidents in surgical wards.

Conclusion

From the results it was evident that perceptions of RNs and ENs related to the quality of care and patient safety differed. There seemed to be a statistically-significant difference between RNs and ENs perceptions of the prevention of errors in the unit, losing patient information between shifts and patient incidents related to medication errors, pressure ulcers and falls with injury.

Nursing education reform in South Africa--lessons from a policy analysis study

BACKGROUND

Nursing education reform is identified as an important strategy for enhancing health workforce performance, and thereby improving the functioning of health systems. Globally, a predominant trend in such reform is towards greater professionalisation and university-based education. Related nursing education reform in South Africa culminated in a new Framework for Nursing Qualifications in 2013.

OBJECTIVE

We undertook a policy analysis study of the development of the new Nursing Qualifications Framework in South Africa.

DESIGN

We used a policy analysis framework derived from Walt and Gilson that interrogated the context, content, actors, and processes of policy development and implementation. Following informed consent, in-depth interviews were conducted with 28 key informants from national and provincial government; the South African Nursing Council; the national nursing association; nursing academics, managers, and educators; and other nursing organisations. The interviews were complemented with a review of relevant legislation and policy documents. Documents and interview transcripts were coded thematically using Atlas-ti software.

RESULTS

The revision of nursing qualifications was part of the post-apartheid transformation of nursing, but was also influenced by changes in the education sector. The policy process took more than 10 years to complete and the final Regulations were promulgated in 2013. The two most important changes are the requirement for a baccalaureate degree to qualify as a professional nurse and abolishing the enrolled nurse with 2 years training in favour of a staff nurse with a 3-year college diploma. Respondents criticised slow progress, weak governance by the Nursing Council and the Department of Health, limited planning for implementation, and the inappropriateness of the proposals for South Africa.

CONCLUSIONS

The study found significant weaknesses in the policy capacity of the main institutions responsible for the leadership and governance of nursing in South Africa, which will need to be addressed if important nursing education reforms are to be realised.

Impact of a Script-based Communication Intervention on Patient Satisfaction with Pain Management

Pain is a common complaint among hospitalized patients no matter the diagnosis. Pain has a negative effect on many aspects of a patient's life, including quality of life, sleep, and activities of daily living as well as increased health care expenses. The aim of this study was to evaluate the effectiveness of an intervention (script-based communication, use of white boards, and hourly rounding) related to pain management on patient satisfaction with nurses' management of pain. A prospective, quasi-experimental pretest-posttest design was used. Data were collected from two units that provided care for patients with a variety of medical-surgical diagnoses in a hospital located in an academic health sciences center in the southern United States. When nurses used clear and consistent communication with patients in pain, a positive effect was seen in patient satisfaction with pain management over time. This intervention was simple and effective. It could be replicated in a variety of health care organizations.

BSN in 10: what is your opinion?

The purpose of this project was to elicit the opinions of members of AORN of Central Ohio regarding Ohio's BSN-in-10 initiative. Using a focus group, we sought to answer the following question: is there a need to legislate that newly licensed RNs in Ohio obtain a bachelor's degree in nursing (BSN) within 10 years? Participants valued higher education but were not informed about the need for more BSN-prepared nurses. They also were not aware of the professional and financial effects of obtaining a baccalaureate degree, the available resources to assist them in obtaining one, or collaborative nursing association partnerships that advocate for BSN-in-10 legislation. The results suggest that health care policy advocates need to find alternative means to communicate essential information to RNs.

Job satisfaction in mainland China: comparing critical care nurses and general ward nurses

AIM

To explore the level of nurses' job satisfaction and compare the differences between critical care nurses and general ward nurses in Mainland China.

BACKGROUND

Hospitals continue to experience high nurse turnover. Job satisfaction is a key factor to retain skilled nurses. The differences in job satisfaction among critical care nurses and general ward nurses are unknown.

DESIGN

A cross-sectional design was selected for this descriptive correlation study.

METHODS

Cross-sectional study of critical care nurses (n = 446) and general ward nurses (n = 1118) in 9 general hospitals by means of questionnaires that included the Chinese Nurses Job Satisfaction Scale and demographic scale. The data were collected from June 2010-November 2010.

RESULTS

Chinese nurses had moderate levels of job satisfaction, were satisfied with co-workers and family/work balance; and dissatisfied with pay and professional promotion. Critical care nurses were younger; less educated and had less job tenure when compared with nurses working on general wards. Critical care nurses were significantly less satisfied than general ward nurses with many aspects of their job.

CONCLUSION

Levels of nurses' job satisfaction can be improved. The lower job satisfaction of critical care nurses compared with general ward nurses should warn the healthcare administrators and managers of potentially increasing the critical care nurses turn over. Innovative and adaptable managerial interventions need to be taken to improve critical care nurse' job satisfaction and retain skilled nurse.

Preparing the nursing workforce of the future

Nurse shortages coupled with the need for national healthcare reform present a challenge. We are not preparing enough nurses nor are we preparing nurses with the right skills to fully participate in a reformed healthcare system. Historical forces in nursing education have resulted in multiple levels of entry into nursing practice and an inadequate nursing workforce. Today's environment of expanding knowledge, the call for interdisciplinary healthcare delivery teams, and evidence of the relationship between nurse education and improved patient outcomes strongly indicate the need for nurses prepared at the baccalaureate level. Requiring a baccalaureate degree for entry into nursing practice, and as the initial degree of nursing education would prepare nurses earlier for graduate education and the much needed roles of educator, researcher and advanced practice nurse. The nursing profession should take the lead in advocating for educational policies that would adequately prepare the nurse workforce of the future.

Strengths and challenges of the first prelicensure baccalaureate of science in nursing program in Pakistan

With the increasing complexities of health care and the associated strong advocacy for baccalaureate of science in nursing (BScN) program as entry to practice in the developing countries, gradually, nurse leaders are moving in that direction. Although extensive information is available in the literature about the outcomes of prelicensure BScN programs in developed countries, little is known about the outcomes of such programs in developing countries. In this article, we report strengths and challenges of the first prelicensure BScN program in Pakistan. Using a focused ethnographic approach, data for this study were collected mainly through semistructured interviews of the graduates from the first five cohorts of the BScN program and their supervisors at Aga Khan University, Pakistan. Interviews were tape-recorded, transcribed verbatim, and content analyzed for explicit and implicit patterns of themes, meanings, and understanding about the program. Findings of this study affirmed the worth of BScN program for preparing competent nurses that can contribute to the development of nursing in Pakistan. However, various contextual issues and challenges in the nurses work environment have affected the utilization and retention of these graduates and hence the perceived outcome of the program.

Advancing the science in the measurement of health care quality influenced by nurses

A robust set of quality measures is essential to provide consumers with a vehicleto evaluate nurses' contributions to the care of hospitalized patients, providers, and systems with a set of nursing processes and outcomes to guide quality improvement, and insurers with indicators to reward hospitals for high quality nursing services. The processes employed by the Nursing Care Performance Measures Steering Committee convened by the National Quality Forum (NQF) in 2004 resulted in the endorsement of 15 indicators of health care quality influenced by nurses and contributed to the identification of significant gaps in measurement and priority areas for future research. This critical review of the state of the science related to health care processes and outcomes that reflect nurses' contributions to the quality of care for hospitalized patients is intended to push the boundaries in the measurement of nursing performance. Specific recommendations for future research and measure development are presented.

Effect of educational preparation on the accuracy of linear growth measurement in pediatric primary care practices: results of a multicenter nursing study

Consistently monitoring a child's linear growth is one of the least invasive, most sensitive tools to identify normal physiologic functioning and a healthy lifestyle. However, studies, mostly from the United Kingdom, indicate that children are frequently measured incorrectly. Inaccurate linear measurements may result in some children having undetected growth disorders whereas others with normal growth being referred for costly, unwarranted specialty evaluations. This study presents the secondary analysis of a primary study that used a randomized control study design to demonstrate that a didactic educational intervention resulted in significantly more children being measured accurately within eight pediatric practices. The secondary analysis explored the influence of the measurer's educational level on the outcome of accurate linear measurement. Results indicated that RNs were twice as likely as non-RNs to measure children accurately.

Practice and clinical decision-making autonomy among Hellenic critical care nurses

BACKGROUND

Nursing autonomy has been associated with better patient-outcomes; therefore, it is a priority for critical care nursing management. Low authority has been a persistent complaint of Hellenic intensive care unit nurses; however, issues of nursing autonomy have not been previously addressed empirically in Hellas.

PURPOSE

To investigate: (1) the perceived contribution to clinical decision-making, (2) the degree of autonomy in technical tasks, and (3) factors related to practice autonomy in critical care nurses in Hellas. Additionally, because of the lack of sufficient tools, this study also aimed to construct and to validate a new tool for assessing practice and clinical decision-making autonomy among Hellenic intensive care unit nurses.

MATERIALS AND METHODS

A Hellenic intensive care nursing autonomy scale, focused on technical aspects of care, was developed through literature review, a panel of experts and a pilot study in a random sample of 120 respondents. Items were refined by factor analysis, which revealed three major conceptual categories of autonomy: (1) basic technical, (2) advanced technical, and (3) clinical decision. Hellenic intensive care nursing autonomy (Likert 4, range: 38-152), was distributed to all nurses employed in intensive care units in Hellas (n = 807; attrition: 27%). Comparisons, correlation and multivariate regression were employed.

RESULTS

The Hellenic intensive care nursing autonomy scale exhibited appropriate reliability (Cronbach's alpha = 0.86) and validity properties. Autonomy scores were moderate (mean: 105.24 +/- 9.58). Highest autonomy was attributed to basic technical tasks, followed by advanced technical tasks and decision-making. Male gender and higher education were predictors of higher overall, advanced technical and decision-making autonomy (P = 0.01). Bachelor degree graduates scored higher in decisional autonomy (P = 0.03). Intensive care unit experience and type of intensive care unit were also important determinants of decisional autonomy (P = 0.02).

CONCLUSIONS

The results revealed moderate autonomy in technical tasks and low decisional autonomy among Hellenic intensive care unit nurses. Factors related to the educational preparation of nurses, gender issues and institutional characteristics might hinder intensive care unit nurses' autonomy in Hellas.

The Impact of Hospital Nursing Characteristics on 30-Day Mortality

BACKGROUND

Evidence indicates that hospital nursing characteristics such as staffing contribute to patient outcomes. Less attention has been given to other hospital nursing characteristics central to optimal professional practice, namely nurse education and skill mix, continuity of care, and quality of the work environment.

OBJECTIVE

To assess the relative effects and importance of nurse education and skill mix, continuity of care, and quality of work environment in predicting 30-day mortality after adjusting for institutional factors and individual patients characteristics.

METHOD

A cross-sectional analysis of outcome data for 18,142 patients discharged from 49 acute care hospitals in Alberta, Canada, for diagnoses of acute myocardial infarction, congestive heart failure, chronic obstructive pulmonary disease, pneumonia, or stroke between April 1, 1998, and March 31, 1999, was done. Mortality data were linked to patient demographic and comorbidity factors, institutional characteristics, and hospital nursing characteristics derived from a survey of all registered nurses working in acute care hospitals.

RESULTS

Using multilevel analysis, it was determined that the log-odds for 30-day mortality varied significantly across hospitals (variance = .044, p < .001). Patient comorbidities and age explained 44.2% of the variance in 30-day mortality. After adjustment for patient comorbidities and demographic factors, and the size, teaching, and urban status of the study hospitals in a fixed-effects model, the odds ratios (95% confidence interval) of the significant hospital nursing characteristics that predict 30-day mortality were as follows: 0.81 (0.68-0.96) for higher nurse education level, 0.83 (0.73-0.96) for richer nurse skill mix, 1.26 (1.09-1.47) for higher proportion of casual or temporary positions, and 0.74 (0.60-0.91) for greater nurse-physician relationships. The institutional and hospital nursing characteristics explained an additional 36.9%.

DISCUSSION

Hospital nursing characteristics are an important consideration in efforts to reduce the risk of 30-day mortality of patients.

Predictors of Professional Nursing Practice Behaviors in Hospital Settings

BACKGROUND

Many hospital nurses perform isolated, routine tasks, rather than use their professional training, because they are subject to control by organizational and medical divisions of labor. The environment may interfere with a nurse's ability to practice autonomously and according to professional standards.

OBJECTIVES

The purpose of the study was to explore how certain factors in the environment and personal characteristics interact to affect hospital nursing practice behaviors.

METHODS

The study used a nonexperimental, comparative design. Surveys were sent to a random sample of 500 nurses throughout the state of Michigan. Three instruments, measuring structural empowerment, self-efficacy for nursing practice, and professional practice behaviors, were included. Path analysis was used for statistical analysis.

RESULTS

Three hundred sixty-four nurses responded (73%), of whom 251 provided usable protocols for the final analysis. Environmental factors (structural empowerment) contributed both directly to professional practice behaviors as well as indirectly through self-efficacy. Self-efficacy mainly exerted its effect as a mediator in the relationship between environmental factors and practice behaviors. Support for the proposed theoretical model was mixed, although the proposed model fit the data well (chi = 11.02 [(5, N = 251), p < .05, CFI = .999, NNFI = .991, RMSEA = .069]). An alternative model emerged from the data analysis.

DISCUSSION

Nurses may practice more professionally when the environment provides opportunities and power through resources, support, and information. Self-efficacy may contribute to professional practice behaviors, especially in an environment that has the requisite factors that provide empowerment.

From vocation to profession: the quest for professionalization of nursing

This article examines some of the complex factors in the transition of nursing from vocation to profession. These factors include university education, knowledge, gender, and workplace environment. It argues that the conventional definitions and characteristics of the professions and knowledge are tainted with gender bias. The uniqueness of nursing knowledge lies in the combination of scientific and holistic knowledge required for patient care, which is different from other healthcare professions. It suggests an alternative means of recognizing the clinical expertise of frontline nurses so that their contribution to patient care can be acknowledged. Together with the extended and expanded role of specialist nurses and nurse managers, nurses can impose their presence and consolidate their power base in the quest for professionalization.

Educational levels of hospital nurses and surgical patient mortality

CONTEXT

Growing evidence suggests that nurse staffing affects the quality of care in hospitals, but little is known about whether the educational composition of registered nurses (RNs) in hospitals is related to patient outcomes.

OBJECTIVE

To examine whether the proportion of hospital RNs educated at the baccalaureate level or higher is associated with risk-adjusted mortality and failure to rescue (deaths in surgical patients with serious complications).

DESIGN, SETTING, AND POPULATION

Cross-sectional analyses of outcomes data for 232 342 general, orthopedic, and vascular surgery patients discharged from 168 nonfederal adult general Pennsylvania hospitals between April 1, 1998, and November 30, 1999, linked to administrative and survey data providing information on educational composition, staffing, and other characteristics.

MAIN OUTCOME MEASURES

Risk-adjusted patient mortality and failure to rescue within 30 days of admission associated with nurse educational level.

RESULTS

The proportion of hospital RNs holding a bachelor's degree or higher ranged from 0% to 77% across the hospitals. After adjusting for patient characteristics and hospital structural characteristics (size, teaching status, level of technology), as well as for nurse staffing, nurse experience, and whether the patient's surgeon was board certified, a 10% increase in the proportion of nurses holding a bachelor's degree was associated with a 5% decrease in both the likelihood of patients dying within 30 days of admission and the odds of failure to rescue (odds ratio, 0.95; 95% confidence interval, 0.91-0.99 in both cases).

CONCLUSION

In hospitals with higher proportions of nurses educated at the baccalaureate level or higher, surgical patients experienced lower mortality and failure-to-rescue rates.

Nurse experience and education: effect on quality of care

OBJECTIVE

To describe the relationships between the quality of patient care and the education and experience of the nurses providing that care.

BACKGROUND

There is a call for more nurses with baccalaureate degrees and more experienced nurses to work in hospitals. Previous research studies have examined the characteristics, abilities, and work assignments of nurses with and without baccalaureate degrees but have not examined the quality of the patient care delivered. It is generally believed that more experienced nurses provide higher-quality care, but again few studies have actually examined this issue.

METHODS

A secondary analysis of data, collected in two previous studies of the relationship between nurse staffing (hours of care, staff mix) and the quality of patient care, was used to determine the relationship between nurses' education and experience and the quality of care provided. The data were collected at the patient care unit level (42 units in study 1 and 39 units in study 2). Quality of care was indicated by lower unit rates of medication errors and patient falls.

RESULTS

Controlling for patient acuity, hours of nursing care, and staff mix, units with more experienced nurses had lower medication errors and lower patient fall rates. These adverse occurrence rates on units with more baccalaureate-prepared nurses were not significantly better.

Health care reform and the transformation of nursing in Hong Kong

Health care reform in Hong Kong in the 1990s has brought about dramatic change to the nursing discipline. This paper reports an ethnographic study which aimed at exploring the transformation of nursing in a regional hospital in Hong Kong during this period of reform. In the study, the restructuring of nursing work, its associated dynamics and resulting impacts upon the nursing profession were examined. A methodological triangulation approach to data collection encompassing interviews, participant observation and review of documents was used. The findings in this study suggest that the majority of nurses working in the case study hospital continue to be subject to medical dominance and are under management control. The emphasis on cost-effective care has however, fostered qualified nurses to claim more ownership of their professional judgement and autonomy. The health care reform has confirmed the status of two newly established groups of nurses, the nurse specialists and nurse managers. The development of the nursing profession is found to be closely connected to its work development. The preparation of the new generation of nurses, as revealed in this study, needs to emphasize the cognitive dimension of the professional competence. Some nurses need to be further educated in specialist practice and clinical management to maximize the contribution of nursing in health care delivery.

Differentiated levels of nursing work force demand

In addition to reviewing the literature about the extent to which basic nursing education is related to actual nursing practice, this article investigates the extent to which the relationship between nursing practice, education, and experience varies across specific health care settings. The literature presented no consistent or systematic association between type and amount of previous nursing experience and current nursing practice. However, the literature generally provided evidence of a consistent and systematic association between baccalaureate preparation and level of registered nurse (RN) practice. The review of practice and organizational differences across the hospital, nursing home, and ambulatory care sectors suggests that baccalaureate-prepared RNs in hospitals may have a more strongly differentiated role relative to those in nursing homes and ambulatory settings. If baccalaureate-prepared nurses continue to be perceived as capable of more complex and independent practice, and if employers believe that they can increase revenues by increasing the quality of nursing care or can save money by shifting to RNs some responsibilities now held by more costly personnel (such as physicians), then demand for baccalaureate-prepared nurses may increase.

Hospital employment of nursing personnel. Has there really been a decline?

There was a steady increase in the number of hours worked by nursing personnel in California hospitals from 1977 through 1996, mostly due to an increase in the number of hours worked by registered nurses (RNs). The hours worked by nursing personnel and RNs per case-mix adjusted discharge and per adjusted patient day also have increased. Possible explanations for the discrepancy between perceptions of declining nursing staffing and the data are discussed.

Models of differentiated practice and specialization in community nursing: a review of the literature

In most agencies for community nursing at least two types of nurse are employed. To ensure efficient use of personnel and high quality of nursing care, the principles of differentiated practice and specialization are used. It is suggested that these types of work redesign will have consequences for nurses and their work. We made a review of the literature to see how these principles are used and their effects on job satisfaction, burnout and quality of care. This review provides several views and descriptions of nursing activities, but it also shows that there is a paucity of quantitative data about the effects of differentiated practice and specialization in community nursing. To study these effects more systematically, a research model is presented. This model makes it possible to describe the changes in job characteristics caused by differentiated practice and specialization. Secondly, it allows the effects on job satisfaction, burnout and quality of care to be studied.

Education for entry into practice: an ethical perspective

Educational preparation for entry into nursing practice is an issue that has been the subject of intense debate among nursing educators and leaders, but it has yet to be resolved. This issue is surrounded by practice, licensure, and education dilemmas that are examined from an ethical perspective. The ethical principles of justice, fidelity, and utility are informed by an ethic of care and are used to analyze the implications of this issue and its associated dilemmas for the nursing student and graduate, the client and society, and the profession. Moral questions are raised that must be answered by nursing educators because the status quo in nursing practice, licensure, and education is morally unacceptable.

Nurse characteristics and professional autonomy

Relationships between selected demographic characteristics and professional nursing autonomy were examined. Identification of such relationships can strengthen development of the professional nursing role. Usable responses were returned by 542 RNs in a random sample of 2,000 nurses from four states. The Personal Attributes Questionnaire (Spence, Helmreich, & Stapp, 1974) and Nursing Activity Scale (Schutzenhofer, 1987) were used. Significant relationships were noted among autonomy and the following: nursing education, practice setting, clinical specialty, functional role, membership in professional organizations, and gender stereotyped personality traits.

Appraisal of the clinical competence of registered nurses in relation to their designated levels in the Western Australian nursing career structure

This cross-sectional survey examined the relationship of the competence of 529 nurses to their designated career structure levels. The extent of the relationships between nursing education and experience with clinical competence was determined, and attitudes of nurses toward their work environment were measured. Results indicated a wide dispersion in clinical nursing skills and that nurses' designation in the Western Australian Career Structure did not reflect their clinical competence. Clinical experience and education independently exerted a significant effect on competence, but there was no interaction between these variables on increasing competence. Attitudes of the nurses were found to be affected by their work environment.

A Comparison of Preceptor and Educator Valuing of Nursing Student Clinical Performance Criteria

This comparative study investigated similarities and differences between nurse preceptors and nurse educators in their valuing of selected clinical competence criteria in evaluation of the clinical performance of baccalaureate nursing students. An assumption basic to the study was that if performance criteria were valued differently, student evaluations could differ. Analysis by multiple t tests and discriminant analysis demonstrated that preceptors and educators are more similar than different in their valuing of the selected performance criteria. Significant differences were demonstrated on individual items relating to application of theory to practice and nursing care planning. Although setting of nursing practice was a significant factor in the valuing, experience and educational preparation of the preceptors were not.

Meta-analysis for descriptive research

Although nurses have begun to use meta-analysis, a review of the nursing literature demonstrates that its use has not been maximized. Meta-analysis can be employed to synthesize descriptive as well as experimental research, yet attention in nursing has focused almost exclusively on meta-analysis techniques for, and meta-analytic studies of, experimental research. Furthermore, nursing literature has emphasized use of the effect size index (d) rather than the correlation index (r); the latter may, in some cases, be the more suitable metric, particularly with meta-analysis of correlational studies. An argument is made for the value of meta-analysis as a technique for integrating descriptive research, and an overview of different meta-analytic approaches to data analysis using the correlational index with descriptive research is provided.

Differences in patient rating of care provided by BSN and ADN students

Nursing has discussed widely and with fervor the level of education required to provide quality nursing care for clients. No clear consensus has developed but studies tend to show that especially in the hospital setting, baccalaureate (BSN) and associate degree (ADN) nurses initially practice at a similar level. No studies identified compared patient ratings of BSN and ADN nurses. In this study ratings of care provided by BSN and ADN students were compared. Patients, students and instructors rated the student sample using Watson's Patient Satisfaction Rating Scale. Using Pearson correlations and t-tests, the overall satisfaction with care was assessed as "very positive" by patients, faculty and students alike. A significant correlation was found between faculty and patient ratings. Results support earlier findings and demonstrate similarities rather than differences in care provided by the two levels of students. Implications for nursing education and practice are discussed.

A Comparison of Selected Demographic Characteristics and Academic Performance of On-Campus and Satellite-Center RNs: Implications for the Curriculum

This study compared two groups of RN students and noted that there is a difference between the profile of the on-campus student and the student in satellite areas. The demographic profile differences revealed that the RN students in satellite centers were slightly older, were employed, and worked more hours each week. They tended to work full-time, traveled farther to attend classes, had more children, and projected a longer time necessary to complete the SCN than their campus counterparts. The academic profile differences revealed that the satellite center RN students had higher ACT-PEP mean scores and transfer GPAs than their on-campus peers. On-campus RN students had higher University of Iowa GPAs and higher grades in the Pathology course and Foundations of Nursing Practice course than satellite center RN students.

Critical multiplism: a research strategy for nursing science

This paper describes critical multiplism from the perspective of the world views and models of scientific inquiry that frequently guide the work of nurse scientists. Nurse scientists may wish to consider critical multiplism as a research strategy within a dialectical model of scientific inquiry to study the multiple realities of interest to nurses. This approach to nursing knowledge development may enhance the usefulness of nursing research findings in nursing practice.