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

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.

The association of registered nurse staffing levels and patient outcomes: systematic review and meta-analysis

OBJECTIVE

To examine the association between registered nurse (RN) staffing and patient outcomes in acute care hospitals.

STUDY SELECTION

Twenty-eight studies reported adjusted odds ratios of patient outcomes in categories of RN-to-patient ratio, and met inclusion criteria. Information was abstracted using a standardized protocol.

DATA SYNTHESIS

Random effects models assessed heterogeneity and pooled data from individual studies. Increased RN staffing was associated with lower hospital related mortality in intensive care units (ICUs) [odds ratios (OR), 0.91; 95% confidence interval (CI), 0.86-0.96], in surgical (OR, 0.84; 95% CI, 0.80-0.89), and in medical patients (OR, 0.94; 95% CI, 0.94-0.95) per additional full time equivalent per patient day. An increase by 1 RN per patient day was associated with a decreased odds ratio of hospital acquired pneumonia (OR, 0.70; 95% CI, 0.56-0.88), unplanned extubation (OR, 0.49; 95% CI, 0.36-0.67), respiratory failure (OR, 0.40; 95% CI, 0.27-0.59), and cardiac arrest (OR, 0.72; 95% CI, 0.62-0.84) in ICUs, with a lower risk of failure to rescue (OR, 0.84; 95% CI, 0.79-0.90) in surgical patients. Length of stay was shorter by 24% in ICUs (OR, 0.76; 95% CI, 0.62-0.94) and by 31% in surgical patients (OR, 0.69; 95% CI, 0.55-0.86).

CONCLUSIONS

Studies with different design show associations between increased RN staffing and lower odds of hospital related mortality and adverse patient events. Patient and hospital characteristics, including hospitals' commitment to quality of medical care, likely contribute to the actual causal pathway.

Assessment of clinical practice in intensive care: a review of the literature

Nursing is a practice-based discipline, with clinical practice forming the heart of any programme of study. The major goal of all programmes should be on facilitating students to develop the skills necessary for competent and compassionate practice. Assessment of clinical competence is a fundamental aspect of programme development and as such deserves attention during the curriculum design process. The literature on assessment of students in clinical practice suggests that the tools used have evolved through various stages, ranging from the use of simple check list and rating scale to the development of competence assessment tools. Each stage has been fraught with difficulties and has taxed nurse educators, clinical assessors and students alike. The literature also indicates that there is a limited range of research available on clinical assessment tools, especially with an intensive care context. In part one of this two-part paper, the literature on assessment of clinical practice is explored, with specific emphasis on the assessment of competence with the Intensive Care environment. Part two of the paper reports on the findings of a study on students perceptions on a clinical competence assessment tool, used in an Intensive Care environment.

Undergraduate student nurses' expectations and their self-reported preparedness for the graduate year role

AIMS OF THE STUDY

The study identifies third-year nurses' expectations of the graduate nurse role and ascertains how prepared they feel to fulfil this role.

BACKGROUND

The literature substantiates that the university-workplace transition is marked by differences between students' expectations of the graduate year and the realities of practice they encounter in the workforce setting. Nursing professionals and health service employers continue to debate the expectations required of the new nurse graduate. Yet there is little assessment of graduate nurses' expectations of the workplace. This study describes student nurses' expectations of the graduate year and the extent to which they regard themselves as well- or ill-prepared.

DESIGN

Third-year student nurses (n=105) from a 3-year Bachelor of Nursing (BN) course at a large Metropolitan University in Australia were surveyed. A group of nursing academics and their senior colleagues in the clinical setting designed a questionnaire in light of common themes derived from literature on the graduate year role. Responses were examined and analysed using descriptive statistics.

RESULTS

Responses revealed that student nurses tended to favour large public hospitals, and sought a good graduate programme with associated opportunities for guidance and support. Most expected to achieve good working relationships with both professional colleagues and patients. Final year students expressed some apprehension about meeting the performance expectations of the workplace, given their self-perceived lack of clinical experience.

CONCLUSION

When asked about their initial expectations of the workplace, third year student nurses expressed little apprehension and reported high levels on scales of organizational commitment and professionalism. The research literature suggests that divisions exist between students' expectations of the graduate year and the actual work experience. The expectations of the graduate year described in this study offer a student-centred perspective that contributes to future planning and policy directions of undergraduate curricula, graduate year programmes and nurse retention.

Skilled nursing practice -- a qualitative study of the elements of nursing

An understanding of skilled nursing practice has implications for the identity of nursing in service delivery, and for the learning environment of the developing nurse. Here I report a qualitative study, largely reliant on ethnography, which became a journey of exploration through accounts and descriptions given by nurses in a number of different practice settings. This journey is founded in an understanding of what I have called a phenomenological and psychosocial tradition, recognising the importance of a postmodern influence, which is in tension with a scientific and behavioural tradition. The emergence of four domains of skilled nursing practice in a contextualised narrative would seem to offer justification of assumptions concerning the value of embedded knowledge and intuitive clinical judgement in nursing practice, and lay a foundation for a qualitative study of the developing nurse.

Autonomy: an important component for nurses' job satisfaction

This quantitative pilot study (n=178), conducted in a large Brisbane teaching hospital in Australia, found autonomy to be the most important job component for registered nurses' job satisfaction. The actual level of satisfaction with autonomy was 4.6, on a scale of 1 for very dissatisfied to 7 for very satisfied. The mean for job satisfaction was 4.3, with the job components professional status and interaction adding most substantially to the result. There was discontentment with the other two job components, which were task requirements and organisational policies. Demographic comparisons showed that nurses who were preceptors had significantly less job satisfaction than the other nurses at the hospital.

A Comprehensive Approach to Clinical Evaluation

Historically, the summative clinical evaluation of nursing students has been problematic. Tools of measurement for clinical performance have been subjective and, at times, biased at several levels. With these thoughts and past experiences in mind, the faculty in an associate degree nursing program developed a comprehensive approach to summative clinical evaluation. The process began with the development and implementation of a Clinical Performance Manual (CPM) describing five components of the summative evaluation process. These included the: ability to consistently exhibit professional behaviors; random skills performance examination; plan of care examination; critical situations examination; and required course assignments. These components were developed with the intent of objectifying the measurement of cognitive, affective, and psychomotor skills of students. After 1 year of implementing this process with 250 students, feedback received from faculty and students was reviewed and discussed. Reliability and validity studies have been conducted. A decision was made to continue with this new method of evaluation. Recommendations include piloting and implementing the process in others schools and programs.

Competency through being: the enemy within?

Nurses are taking on more medical tasks but is this appropriate? If so, does this advance nursing practice? The issue hinges on the nurse's competency which is central to professional nursing practice.