Taking on the student role: how can we improve the experience of registered nurses returning to study?

Matching nurse skill with patient acuity in the intensive care units: a risk management mandate

AIM

This paper aims to highlight the need for the traditional concept of nursing skill mix to be reconfigured within a new concept of skill matching.

BACKGROUND

Substantive literature describes staff deployment and patient-dependency models. However, limited information exists as to what informs decision making regarding nurse skill assessment and subsequent patient allocation in intensive care units.

KEY ISSUES

In intensive care units, nurse numbers, available nursing skills and patient allocation decisions, impact directly on care provision and outcomes. This paper argues that staffing decisions that are based on insufficient knowledge which lack consideration of all pertinent factors result in poor 'skill matching', potential adverse events and poor outcomes. A critical inextricable link exists between staffing decisions, patient safety and risk in the intensive care unit. Use of a multifactorial skill-matching approach within a dedicated staffing decision-support system is recommended.

CONCLUSION

This commentary paper adds a new perspective to nurse-staffing decision practices and their relationship to risk management in the intensive care unit and offers a new research direction.

'It's not like the wards'. Experiences of nurses new to critical care: a qualitative study

BACKGROUND

Critical care is both emotionally and intellectually challenging, yet little is currently known about the experience of nurses' new to this environment.

AIMS

The aims of the study were to: 1. Explore the experience of nurses' new to critical care. 2. Identify what factors influence the nurses' experiences during this time. 3. Evaluate methods used to facilitate nurses' development such as education and preceptorship.

METHODS AND PARTICIPANTS

This longitudinal qualitative study was undertaken using hermeneutic phenomenology and involved all nurses (n=14) recruited to the unit during two cohort intakes in 2002. Data collection was by means of semi-structured interviews at one, three and six months. All interviews were tape recorded, transcribed, and analysed for emerging themes and concepts.

FINDINGS

Participants described a variety of unique experiences throughout the interviews, many of these related to four key themes: support, knowledge and skills, socialisation and moving on. There were also a number of key factors influencing these experiences including foundation programme, support, preceptors, staff and pre-requisites. Although strategies such as education and preceptorship were positively evaluated, areas for improvement were also identified.

CONCLUSION

This study captures the unique experiences of nurses new to critical care and demonstrates the complexity of socialisation to the critical care milieu.

Achieving collaborative workplace learning in a university critical care course

The purpose of this paper is to describe the development, implementation and evaluation of a new critical care curriculum based on the tenets of collaborative workplace learning. It also examines lecturers' and clinical educators' issues, and explores students' evaluations of the old curriculum compared with those of the new curriculum. Three data collection methods were used for this study. Comprehensive notes were maintained of the meetings conducted with lecturers, clinical educators and representative students during the development and implementation of the course. Three focus group interviews were conducted with students before the introduction of the new curriculum and three focus group interviews were conducted during first semester following implementation of the new curriculum. Quality-of-teaching surveys were also completed by two groups of critical care course students: one group before and one group following the introduction of the new curriculum. Major findings in this study included: developing a sense of ownership of the curriculum for clinical educators, clinical educators' difficulties with addressing their responsibilities, amalgamating theoretical learning with clinical practice, and tackling students' workload. This paper demonstrates the value of using the collaborative workplace learning approach in strategically addressing the challenges of developing and conducting a university critical care course.

Certificate Programs in Continuing Professional Education

BACKGROUND

Career-long learning is a concept at the heart of professional disciplines such as nursing. Nursing shortages, especially in some areas of practice, have stimulated the need for in-depth education and training in specific knowledge content areas. One approach to career-long learning is certificate programs.

METHOD

Factors, trends, and strategies to consider in creating certificate programs are reviewed, and guidelines for developing certificate programs are presented.

FINDINGS

Certificate programs are increasingly in demand by both employers and nurses. Certificate programs provide individuals with a chance to refresh their study skills and raise their abilities and levels of confidence for mastering new learning. Certificate programs also serve as a recruitment and retention strategy for hospitals and agencies.

CONCLUSION

Certificate programs are a viable continuing professional education activity and offer opportunities for nurses to develop specific skill sets and in-depth knowledge in specialized areas of nursing practice.

[Job stress perceived by hospital medical staff]

OBJECTIVE

To identify the psychosocial risk factors related to psychological demands perceived by specialist physicians from six public hospitals in the province of Valencia in Spain.

METHODS

A qualitative study was carried out. The population studied comprised the hospitals' specialist medical staff (Oncology, Internal Medicine, Traumatology, Radiology and Intensive Care). A trained interviewer performed 47 individual, face-to-face, semi-structured interviews. To select the participants, the following structural variables were taken into account: gender, age, family responsibilities, medical specialty, professional standing, length of service, and type of contract. Interviews were tape recorded and subsequently transcribed. Finally, the content of the interviews was analyzed.

RESULTS

The main psychosocial risk factors mentioned by the participants were workload and lack of staff, mainly due to the characteristics of work organization in the hospital. Another job stressor was daily contact with suffering and death, and feeling responsible for human life. Other significant job stressors were interpersonal relations in the work environment, in the case of patients' relatives, uncertainty about diagnosis and treatment, the possibility of being sued for malpractice, and communicating bad news.

CONCLUSIONS

Hospital physicians report a large number of psychosocial risk factors. Some involve the characteristics of the medical profession (contact with suffering and death, responsibility for human life, uncertainty about diagnosis and treatment) and others concern work organization (workload and staffing shortages).

Critical care education: an examination of students' perspectives

Specialist nursing education at the tertiary level is a relatively recent occurrence in Australia. With this move to higher education a variety of issues such as course duration, award level and clinical versus theoretical outcomes provided the impetus for this study. This study examined critical care nursing students' perceptions of undertaking post-graduate education within the higher education sector. Four themes arose from analysis of eight focus group interviews with a total of 42 students from 35 courses offered in eight universities across Australia. The first theme, student burden, included subthemes of financial, heavy workload and student-work conflicts. Student benefits, the second theme, encompassed financial and other benefits. The third theme, clinical experience, incorporated clinical capability, synthesizing, support required and clinical learning. The final theme of student attitude included the subthemes of individual, technology and course. Without student evaluations, curricular improvements including assessment and clinical experience will not evolve to the best of their potential.

A consensus driven method to measure the required number of intensive care nurses in Australia

This paper describes a methodology for determining the number of nurses required to staff Australia's intensive care unit (ICU) beds. The evidence used is level IV, that is the use of expert panel opinion, and it is the strongest and most accurate attempt yet to describe how Australia's ICU beds should be staffed with nurses. The researchers provide ratios of staffing applicable to a variety of situations that should be of use to ICU managers and hospital administrators. Equally, the broader calculations explaining the national supply and demand needs provide an easy to use approach and explanation suitable to health professionals, health administrators, policy advisors, governments, politicians and the broader community. Limitations of the approach and further recommendations are made to encourage future work in this area. Finally, a strong correlation between the number of available 'open' ICU beds in Australia and the number of nurses actually working in ICU at any given time is well demonstrated using the methodology outlined in this paper. Clarification of scope and terminology: This paper focuses on the nursing requirements of ICUs only; occasionally we use the word critical care nurse--this generally refers to those nurses who have completed a generic critical care nursing course but who, for the purposes of our study, are working in ICUs. Critical care units encompass ICUs but may also encompass recovery room, cardiothoracic units, coronary care, emergency departments and many other environments where critically ill patients are cared for and treated. This paper does not cover the broader scope of critical care units, only ICUs.