Delegating and supervising unregistered professionals: the student nurse experience

Reducing Team Burnout Through Enhanced Scope of Practice for Nursing Assistive Personnel

Persistent nursing workforce shortages, in conjunction with the COVID-19 pandemic and increased patient acuity, have led to increased utilization of nursing assistive personnel (NAP) within acute care settings. Although the work demand of NAPs continues to increase, their delegated work autonomy remains ambiguous and diverse. This lack of clarity impacts effective teamwork, collaboration, and delegation. This study successfully enhanced the scope of practice for NAPs, resulting in increased staff and patient satisfaction.

Integrative review: Factors impacting effective delegation practices by registered nurses to assistants in nursing

AIM

To identify the evidence on factors that impact delegation practices by Registered Nurses to Assistants in Nursing in acute care hospitals.

DESIGN

An integrative review.

DATA SOURCES

Database searches were conducted between July 2011 and July 2021.

REVIEW METHODS

We used the 12-step approach by Kable and colleagues to document the search strategy. The (Whittemore & Knafl. 2005. Journal of Advanced Nursing, 52(5), 546-553) integrative review framework method was adopted and the methodological quality of the studies was assessed using Joanna Briggs critical appraisal instruments.

RESULTS

Nine studies were included. Delegation between the Registered Nurse and the Assistant in Nursing is a complex but critical leadership skill which is impacted by the Registered Nurse's understanding of the Assistant in Nursing's role, scope of practice and job description. Newly qualified nurses lacked the necessary leadership skills to delegate. Further education on delegation is required in pre-registration studies and during nurses' careers to ensure Registered Nurses are equipped with the skills and knowledge to delegate effectively.

CONCLUSION

With increasing numbers of Assistants in Nursing working in the acute care environment, it is essential that Registered Nurses are equipped with the appropriate leadership skills to ensure safe delegation practice.

The introduction of registered undergraduate students of midwifery in a tertiary hospital: Experiences of staff, supervisors, and women

BACKGROUND

The Registered Undergraduate Student of Midwifery (RUSOM) workforce model provides final year midwifery students an opportunity of paid employment and gain experience as an assistant to midwives. A RUSOM supports the work of midwives by providing care to women and their newborns. Little is known about how the RUSOM role impacts the range of stakeholders in maternity care settings.

AIM

To evaluate the acceptability of the RUSOM role, how it is experienced by staff and women, and its impact on quality of care.

METHODS

A mixed-methods approach including 9 qualitative focus groups (n = 41) and 4 descriptive surveys (n = 135) was used.

FINDINGS

The introduction of the RUSOM role has numerous benefits for the service, midwifery staff, women, and the RUSOM themselves. The RUSOM relieved the burden on the postnatal ward, giving midwives more time to work at their higher end of scope in direct clinical care. Having a clear scope of practice for the role ensured there were clear boundaries between the RUSOM and the midwife, resulting in the positive satisfaction for the maternity services team and women in their care.

DISCUSSION

Employing RUSOM staff has both immediate and long-term benefits for maternity services. The role had the potential to improve the professional development of upcoming midwives, leading to high quality and experienced graduates that are an invaluable asset to a maternity service.

CONCLUSION

The positive outcome from this evaluation provides evidence for the expansion of the RUSOM model which can enhance the quality of care for women.

The impact of care experience prior to commencing pre-registration nurse education and training: A scoping review

OBJECTIVES

Compassion in nursing and interventions to support it are of international relevance and concern. Prior care experience as a prerequisite for entry into pre-registration nurse education is suggested as a means of improving compassion. The impact of prior care experience has not been comprehensively reviewed, therefore the potential effectiveness of prior care experience as a means of improving compassion is unknown. The scoping review question was 'What is known about the impact of care experience prior to commencing pre-registration nurse education and training?' The primary objective was to scope and synthesise existing literature relating to the topic and ascertain key themes pertaining to impact. A secondary objective was to appraise literature, to contextualise findings and assess the state and stage of knowledge and research in the area.

DESIGN

The review was guided by Arksey and O'Malley's methodological framework and is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews Checklist.

DATA SOURCES

Health sciences databases CINAHL, Medline and PubMed.

METHODS

Databases were searched in February 2019, updated August 2021. Data (study characteristics, findings, methodological observations) were extracted from papers meeting inclusion criteria (including peer-reviewed empirical papers with English language, electronic full-text available) and findings thematically analysed.

RESULTS

Forty-five papers from 14 countries were included. The majority (64.4 %) were published in Europe (31.1 % in the United Kingdom) between 2010 and 2021 (69 %), 60 % from 2013. Four qualitative themes (compassionate care, commitment, competence and communication) describe the impact of prior care experience, which was variable.

CONCLUSIONS

Evidence to support the effectiveness of prior care experience as a prerequisite for entry into nurse education to improve compassion, is inconsistent and insufficient. The literature displays methodological limitations and conclusions should be interpreted in light of these caveats. Recommendations are made for future research, to improve quality and comparability.

How pre-registration nursing students acquire delegation skills: A systematic literature review

AIM

To discover what is known about how nursing students acquire delegation skills.

DESIGN

A systematic search was conducted utilising databases: CINAHL, AMED, MedLine, PsycINFO, Web of Science, PsychArticles, PubMed Central and Science Direct. The objectives were to: conduct a systematic literature review of the available literature on how nursing students acquire delegation skills; to identify factors that promote synthesis of delegation skills into clinical practice and understand how students learn these skills; and to identify any gaps in the literature.

RESULTS

Fifteen papers, which use a range of methodologies, were included in the review. The author identified that acquiring delegation skills is an ongoing process and cannot be fully learnt during a single intervention. Furthermore that there are multiple factors that may promote the acquisition of this skill. These include simulation, clinical practice and theoretical curriculum. Delegation links to other skills such as critical thinking, decision making, prioritisation and communication.

CONCLUSION

Delegation should not be considered in isolation to these underpinning skills. Furthermore, it is evident that delegation is an often-misunderstood concept and something that newly qualified nurses feel unprepared for. It is therefore vital that preregistration nursing education (as well as other pre- and post-qualification training) incorporate the development of this essential skill.

Use of Simulation in Teaching Nursing Leadership and Management Course: An integrative review

Nursing education is strategically positioned to prepare nursing students for management and leadership skills necessary for future professional nursing roles. This review appraised and synthesised the outcomes of using simulation in pre-licensure nursing management and leadership courses. This is an integrative review of original articles published between 2008 and 2018. In January 2019, PsychINFO, CINAHL, PubMed and SCOPUS were searched to identify relevant articles using the following terms: ‘management’, ‘leadership’, ‘simulation’, ‘nursing’, ‘education’ and ‘student’. A total of 10 articles were included in the review. Four essential themes were identified from the content analysis: acquisition of skills or understanding of delegation, enhanced teamwork or collaboration capacities, improved decision-making and problem-solving skills and increased communication skills. Incorporation of simulation in the nursing management and leadership courses has the potential to enhance nursing students’ skills regarding delegation, problem-solving capacities, decision-making and communication and teamwork.

Psychometric properities of the Polish version of clinical learning environment inventory

Background

Clinical experience is a crucial activity for nursing students. The way students` perceive clinical placement exerts an immense influence on the learning process. This study aims to test the psychometric properties of a 19-item version of the Clinical Learning Environment Inventory under Polish clinical conditions.

Method

For this study, Discriminant validity and Cronbach’s alpha reliabilities were computed. In order to measure content validity, the criterion validity Generalized Self Efficacy Scale and the Life Orientation Test - Revised were used.

Results

Cronbach’s Alpha for the Clinical Facilitator Support of Learning Scale and the Satisfaction with Clinical Placement scale is 0.949 and 0.901, respectively. The Spearman’s rank correlation coefficient indicates the existence of a positive correlation between the students’ satisfaction with clinical placement and their [overall] life optimism. Age correlates negatively with perceived teacher support and positively with satisfaction with clinical placement. The sense of self-efficacy correlates negatively with their satisfaction with clinical placement. Clinical Learning Environment Inventory − 19 could be a useful tool to evaluate the quality of the clinical learning process in Polish conditions.

Transparent teamwork: The practice of supervision and delegation within the multi-tiered nursing team

Supervision and delegation are important leadership skills that nurses require when practising within the multi-tiered nursing team. In response to increasing demands globally on healthcare systems, Nursing Assistants are becoming more prevalent members of the nursing workforce in the acute care setting. An exploratory descriptive research design was used to examine supervision and delegation of Nursing Assistants in an acute hospital setting in Victoria, Australia. It was found that supervision and delegation in the context of a multi-tier nursing team required a complex assessment and decision-making process which was influenced by multiple factors. This research promotes developing transparent nursing practices and mutual understanding in the multi-tier nursing team to facilitate effective supervision and delegation based on informed decision-making and culture of openness and trust. Pre-registration education and continuing education and support for nurses are important to build transparent supervision and delegation practices and teamwork, empowering the nursing team to practice to their full scope of practice to provide high-quality patient care.

Nursing Students' Experiences Related to Operating Room Practice: A Qualitative Study

PURPOSE

The purpose of this study was to examine the experiences of nursing students concerning operating room (OR) practice.

DESIGN

A qualitative design was used in this study.

METHODS

Data were collected from second-year nursing students using the semistructured interview form including open-ended questions about their OR experiences. Perspectives of phenomenological approach including existentials of lived body, lived relations, lived space, and lived time were used in data analysis.

FINDINGS

The study data regarding experiences of nursing students concerning OR practice were organized under three themes, namely, "OR environment," "emotions," and "career plans after graduation." Nine subthemes emerged: educational experience, teamwork, and communication, excitement, enjoyment, anxiety, fear, different emotions, working as a surgical nurse, and working in departments other than OR.

CONCLUSIONS

In clinical environments, student nurses should be supported by staff and instructors to facilitate learning and create meaningful learning experiences.

Healthcare workers' perceptions and experiences of implementing voluntary medical male circumcision in KwaZulu-Natal, South Africa

Background

Voluntary Medical Male Circumcision (VMMC) is an effective HIV prevention strategy prioritized by the World Health Organisation (WHO) for regions of high HIV prevalence, South Africa (SA) and in particular KwaZulu-Natal (KZN) is one of such regions. Since the roll out of VMMC in 2010 there has been little research conducted on the implementation of this service. Existing studies on the uptake of VMMC have mainly focused on service users resulting in a paucity of data on health care workers perspectives on the intervention.

Aim

To analyse health care workers’ perceptions and experiences of implementing voluntary medical male circumcision in KZN, SA.

Setting

The study took place at six different health districts and their six respective rural clinics in the KZN province of SA.

Methods

A qualitative approach using a phenomenographic design was employed. Data were collected from a sample of 18 participants comprising of health care providers (n = 12) and health policy makers (n = 6). Individual, face-to-face interviews were conducted using a semi-structured interview guide. An audiotape was used to record the data, which were transcribed verbatim and then analysed using a step-wise phenomenographic data analysis procedure.

Results

Participants reported that VMMC was implemented by the department of health with support from non-governmental organisations and private general practitioners. Negative perceptions and negative experiences regarding VMMC and implementation were reported.

Conclusion

The implementation of VMMC is compromised due to poor preparation and training of healthcare workers for implementing the service. Addressing health care workers’ needs for training and preparation is crucial for successful implementation of VMMC.

Uncovering the Disconnect Between Nursing Workforce Policy Intentions, Implementation, and Outcomes: Lessons Learned From the Addition of a Nursing Assistant Role

The use of nursing assistants has increased across health systems in the past 20 years, to alleviate licensed nurses' workload and to meet rising health care demands at lower costs. Evidence suggests that, when used as a substitute for licensed nurses, assistants are associated with poorer patient and nurse outcomes. Our multimethods study evaluated the impact of a policy to add nursing assistants to existing nurse staffing in Western Australia's public hospitals, on a range of outcomes. In this article, we draw the metainferences from previously published quantitative data and unpublished qualitative interview data. A longitudinal analysis of patient records found significantly higher rates adverse patient outcomes on wards that introduced nursing assistants compared with wards that did not. These findings are explained with ward-level data that show nursing assistants were added to wards with preexisting workload and staffing problems and that those problems persisted despite the additional resources. There were also problems integrating assistants into the nursing team, due to ad hoc role assignments and variability in assistants' knowledge and skills. The disconnect between policy intention and outcomes reflects a top-down approach to role implementation where assistants were presented as a solution to nurses' workload problems, without an understanding of the causes of those problems. We conclude that policy makers and managers must better understand individual care environments to ensure any new roles are properly tailored to patient and staff needs. Further, standardized training and accreditation for nursing assistant roles would reduce the supervisory burden on licensed nurses.

Intentional rounding - An integrative literature review

AIMS

To establish current knowledge about the efficacy and acceptance of intentional rounding in current practice, from the perspective of nurses, patients, patient satisfaction and safety indicators.

BACKGROUND

Intentional rounding is a formal means of nursing staff checking care needs of patients in hospital settings on a regular basis.

DESIGN

An integrative literature review conducted following the Joanna Briggs Institute manual.

DATA SOURCES

A literature search from 2000 - 2017 was conducted using the following electronic databases: The Cumulative Index to Nursing and Allied Health Literature, ProQuest, PubMed, Informit, Sage and Scopus.

REVIEW METHODS

Articles were assessed for quality and rigor using the Critical Appraisal Skills Program tool and the Effective Public Health Practice Project Quality Assessment tool for Quantitative Studies. A sequential explanatory mixed studies approach was used to combine qualitative and quantitative evidence in a single review. In-depth parallel reviews of the quantitative and qualitative evidence were undertaken, and then a synthesis of the combined qualitative and quantitative evidence conducted.

RESULTS

Intentional rounding has positive outcomes on patient satisfaction and safety. Nurses perceive benefits related to intentional rounding; however, some nurses perceive it as an additional, unnecessary task. The effectiveness of intentional rounding is influenced by external factors including leadership and formal rounding education, workload, ward layout, staffing and experience level.

CONCLUSION

Intentional rounding is a positive intervention in patient safety and satisfaction generally, but needs further research and consideration about actual impact, staff delegation, education and engagement, student nurse involvement, documentation and specializing the structure of intentional rounding.

Student Preparation for Nursing Leadership: Lessons from an Undergraduate Programs Review

Facilitating student achievement of nationally recognized entry-level-competencies in nursing leadership is a critical step in building capacity to promote patient safety, quality of care, and healthy work environments. Data for this substudy were drawn from a larger multi-phased, multi-method, cross-sectional, descriptive study conducted to inform comprehensive undergraduate curricular revision. The research question for this substudy was: what are the perceptions about undergraduate program preparation for nursing leadership? Frequencies and percentages summarized relevant quantitative data from the surveys and deductive content analysis was used to further explore the category of leadership which emerged from content analysis of qualitative data in the larger study. Key findings illustrate need for additional attention to learning experiences in conflict management, delegation and supervision of clinical teams, and advocacy. Greater collaboration between educational and clinical agencies is needed to find mutually beneficial strategies to support nursing leadership development for nursing students and new graduates.

Recognition and assessment of resident' deterioration in the nursing home setting: A critical ethnography

AIMS AND OBJECTIVES

To explore the recognition and assessment of resident deterioration in the nursing home setting.

BACKGROUND

There is a dearth of research exploring how nurses and personal-care-assistants manage a deteriorating nursing home resident.

DESIGN

Critical ethnography.

METHODS

Observation and semi-structured interviews with 66 participants (general medical practitioners, nurses, personal-care-assistants, residents and family members) in two Australian nursing homes. The study has been reported in accordance with the Consolidated Criteria for Reporting Qualitative Research guidelines.

RESULTS

The value of nursing assessment is poorly recognised in the nursing home setting. A lack of clarity regarding the importance of nursing assessments associated with resident care has contributed to a decreasing presence of registered nurses and an increasing reliance on personal-care-assistants who had inadequate skills and knowledge to recognise signs of deterioration. Registered nurses experienced limited organisational support for autonomous decision-making and were often expected to undertake protocol-driven decisions that contributed to potentially avoidable hospital transfers.

CONCLUSIONS

Nurses need to demonstrate the importance of assessment, in association with day-to-day resident care and demand standardised, regulated, educational preparation of an appropriate workforce who are competent in undertaking this role. Workforce structures that enhance familiarity between nursing home staff and residents could result in improved resident outcomes. The value of nursing assessment, in guiding decisions at the point of resident deterioration, warrants further consideration.

The impact of 'missed care' on the professional socialisation of nursing students: A qualitative research study

BACKGROUND

Missed care is a recently described concept that is subject to an increasing amount of international nursing research. The impact of missed care is associated with poorer patient outcomes (mortality and morbidity) and poorer levels of patient satisfaction with the services provided by the hospital. Missed care has also been linked to decreased staff satisfaction and increased intention to leave. Overall disaffection amongst registered nurses has also been reported. Professional socialisation refers to the acquisition of behaviours within cultural norms, and it has been suggested that students enter a period of professional socialisation during their programme. Whilst it has been proposed that students may absorb the characteristics of those around them, to date, no empirical studies have reported the impact of missed care on student nurses.

METHODS

The aim of this project is to explore the impact of missed care on the professional socialisation of student nurses. A qualitative study was undertaken in one higher education institute in UK with final year pre-registration nursing degree (adult field) students. Focus group interviews, utilizing a broad topic guide, were used to collect data which was analysed using thematic analysis.

FINDINGS

Student nurses were aware that some planned care is missed and these findings resonated with those identified in the literature. In addition to illuminating aspects of professional socialisation, analysis yielded five themes with regards to missed care: awareness, rationale, impact, strategies to avoid and influence of missed care on career aspiration. Student nurses exposed to missed care appear to accept this as part of their professional socialisation.

CONCLUSION

With regards to professional socialisation, student nurses developed a pragmatic acceptance that care would be missed and that this could happen in any environment. As such they did not see missed care as influencing their career aspirations.

Education of student nurses - A systematic literature review

OBJECTIVE

The aim of this review was to explore the literature on the connection between teaching strategies and nursing students' learning to clarify which teaching strategies provide optimal learning experiences and outcomes.

DATA SOURCES

Sources dating from January 2000 to November 2016 were systematically searched in PubMed, Cinahl, Scopus, Web of Science, ProQuest.

METHODS

A systematic literature review was conducted that included quantitative and qualitative studies. Quality assessment was made in accordance with Malterud's guidelines on qualitative research and Polit and Beck's guidelines on quantitative research. The analysis was guided by Patricia Benner's organisation of teaching as teaching and learning in classroom and skills laboratory and teaching and learning in clinical practice.

RESULT

In this review, 502 titles and abstracts were screened resulting in 45 read and included studies.

CONCLUSION

Teaching in skills lab and simulation laboratories provides a positive learning environment and motivates student nurses to learn. It develops critical thinking and the student nurses' ability to take part in what Benner refers to as problem-based nursing. However, there is a need to transform teaching strategies so that student nurses do not experience classroom and clinical practice teaching as separate parts during their education.

Changing the practice learning landscape

Engagement in real life practice has long been acknowledged as the most effective way to learn a trade or profession and practice learning is consistently highlighted by nursing and midwifery placement students for its impact on both their professional and personal development. The paper examines the current complexities of practice learning that have emerged from educational reform and policy and debates the increased interest in the development of alternative approaches to practice learning in the UK.

The Operating Room Experiences of Nursing Students: A Focus Group Study

PURPOSE

The purpose of this study was to evaluate operating room (OR) experiences of student nurses.

DESIGN

The focus group interview from qualitative research methods was used.

METHODS

This study was carried out between February and March 2011 in an OR practice at a university school of nursing. The grounded theory method was used to collect and analyze semistructured interview. Interviews were held with a total of 26 students in three focus group interviews. Each interview was tape recorded and was supported by taking notes. The audiotapes were listened and relistened by the researchers and transcribed.

FINDINGS

Four themes were determined as a result of this study. These are information, determination of career preference, period of internship and/or rotation, and fear and/or anxiety.

CONCLUSIONS

The students stated that the period of OR practice was insufficient, the opportunities for being able to implement were limited, they mostly observed, and they experienced feelings of being alone and fear in the OR. Despite all of these, the students stated that the OR practice provided a major contribution to their education and was effective in the determination of their career preferences after graduation.

The experiences of family carers in the delivery of invasive clinical interventions for young people with complex intellectual disabilities: policy disconnect or policy opportunity?

AIMS AND OBJECTIVES

To explore the experiences of family carers in the delivery of invasive clinical interventions within community settings.

BACKGROUND

Many young people with intellectual disabilities present with complex health needs and require clinical interventions to sustain life. As the population lives into older age there is growing demand for the delivery of these interventions within the community setting.

DESIGN

An interpretivist qualitative design.

METHODS

Ten family carers of children with intellectual disabilities and complex care needs requiring invasive clinical interventions participated in semi-structured interviews.

RESULTS

There are barriers identified regarding the delivery of invasive clinical interventions in the home setting by social care support workers. These include a reluctance to carry out invasive clinical interventions both for family carers and staff, anxiety, a lack of knowledge and training and difficulties in recruiting appropriate staff.

CONCLUSIONS

There needs to be strategic policy developments focusing on this population who are cared for in the community and require invasive clinical interventions.

RELEVANCE TO CLINICAL PRACTICE

Registered Nurses have a key role in educating and preparing families and social care support workers to safely deliver invasive clinical interventions in community settings for both children and adults with intellectual disabilities.

Health Care Assistants in Home Nursing

What are the experiences of home health care workers with regard to the delegation of nursing activities, the supervision of health care assistants (HCAs), and the impact of these changes on the work of home nurses (HNs). In-depth interviews were performed with 12 HNs, 12 HCAs, and eight managers in home nursing. HCAs take care of a less care dependent patient population, allowing the HNs to spend more time on more complex, technical nursing care. However, the analysis revealed some barriers, such as a knowledge gap and insecurity felt by HCAs leading to unnecessary patient visits by HNs, unfamiliarity of HNs with the role of delegating activities and supervising HCAs, and poor face-to-face communication between HNs and HCAs.

'Doing the writing' and 'working in parallel': how 'distal nursing' affects delegation and supervision in the emerging role of the newly qualified nurse

BACKGROUND

The role of the acute hospital nurse has moved away from the direct delivery of patient care and more towards the management of the delivery of bedside care by healthcare assistants. How newly qualified nurses delegate to and supervise healthcare assistants is important as failures can lead to care being missed, duplicated and/or incorrectly performed.

OBJECTIVES

The data described here form part of a wider study which explored how newly qualified nurses recontextualise knowledge into practice, and develop and apply effective delegation and supervision skills. This article analyses team working between newly qualified nurses and healthcare assistants, and nurses' balancing of administrative tasks with bedside care.

METHODS AND ANALYSIS

Ethnographic case studies were undertaken in three hospital sites in England, using a mixed methods approach involving: participant observations; interviews with 33 newly qualified nurses, 10 healthcare assistants and 12 ward managers. Data were analysed using thematic analysis, aided by the qualitative software NVivo.

FINDINGS

Multiple demands upon the newly qualified nurses' time, particularly the pressures to maintain records, can influence how effectively they delegate to, and supervise, healthcare assistants. While some nurses and healthcare assistants work successfully together, others work 'in parallel' rather than as an efficient team.

CONCLUSIONS

While some ward cultures and individual working styles promote effective team working, others lead to less efficient collaboration between newly qualified nurses and healthcare assistants. In particular the need for qualified nurses to maintain records can create a gap between them, and between nurses and patients. Newly qualified nurses require more assistance in managing their own time and developing successful working relationships with healthcare assistants.