The scope of nursing in Australia: a snapshot of the challenges and skills needed

Exploring the Impact of a Dual Occupancy Neonatal Intensive Care Unit on Staff Workflow, Activity, and Their Perceptions

In 2012, a tertiary neonatal intensive care unit (NICU) transitioned from an open plan (OP) to a dual occupancy (DO) NICU. The DO design aimed to provide a developmental appropriate, family-centered environment for neonates and their families. During planning, staff questioned the impact DO would have on staff workflow and activity. To explore the impact of changing from an OP to a DO NICU, a prospective longitudinal study was undertaken from 2011 to 2014, using observational, time and motion, and surveys methods. Main outcome measures included distance walked by staff, minutes of staff activity, and staff perceptions of the DO design. Results highlighted no significant difference in the distances clinical nurses walked nor time spent providing direct clinical care, whereas technical support staff walked further than other staff in both designs. Staff perceived the DO design created a developmentally appropriate, family-centered environment that facilitated communication and collaboration between staff and families. Staff described the main challenges of the DO design such as effective staff communication, gaining educational opportunities, and the isolation of staff and families compared to the OP design. Our study provides new evidence that DO provides an improved developmentally environment and has similar positive benefits to single-family room for neonates and families. Such design may reduce the larger floor plan's impact on staff walking distance and work practices. Challenges of staff transition can be minimized by planning and leadership throughout the development and move to a new design.

Clinical role of the nurse: concept analysis

AIMS AND OBJECTIVES

To identify the attributes of the concept 'clinical role of the nurse' in the literature.

BACKGROUND

The concept of nurses' clinical role is frequently mentioned in literature, but hardly explored in conceptual terms. This has implications for nursing practice and education.

DESIGN

Qualitative and descriptive study, which corresponds to the first phase in the concept development of the qualitative concept analysis method - identification of concept attributes.

METHODS

The critical literature analysis method was used to identify the antecedents, defining attributes and consequences of the nurse's clinical role. A systematic literature search was undertaken in International Literature in Health Sciences, Cumulative Index to Nursing and Allied Health Literature and Latin American and Caribbean Health Sciences.

RESULTS

The clinical role was shown to be a process of complex interaction between nurse and patient, with critical thinking, informed experience and a sense of clinical autonomy as its antecedents. Consequences of nurses' clinical role include transformations in the organisation and process of nursing practice. A theoretical proposal was elaborated for the concept of the clinical role of the nurse, identifying the defining attributes, antecedents and consequences.

CONCLUSIONS

The clinical role of the nurse concept that was developed represents innovative evidence on the theme. Nevertheless, a deeper understanding of nurses' clinical role is needed, as well as refinement of its conceptual components. This study should be integrated into a field research project, designed to illuminate how nurses manifest and articulate the concept in clinical practice.

RELEVANCE TO CLINICAL PRACTICE

Knowledge of clinical role attributes, associated with nursing competencies, can contribute to reflection on the dimensions involved in nursing practice and inform not only teaching and professional practice, but also health policies.

Work readiness of graduate nurses and the impact on job satisfaction, work engagement and intention to remain

BACKGROUND AND AIM

Graduate work readiness is a relatively new construct that can predict graduate potential. Its impact on graduate work outcomes however, is unknown. The current study aimed to explore the relationships between work readiness and a number of work outcomes (job satisfaction, work engagement, and intention to remain).

DESIGN AND PARTICIPANTS

A survey design was used. A sample of 96 graduate nurses from two regional hospitals in Victoria, Australia participated in this study.

METHOD

Data were collected using quantitative surveys

RESULTS

Three of the four work readiness dimensions (organisational acumen, clinical competence and social intelligence) were found to predict job satisfaction and work engagement. Moreover, both job satisfaction and work engagement were found to mediate the relationship between organisational acumen and intention to remain. The findings indicate that dimensions of work readiness uniquely predict work outcomes.

CONCLUSION

Findings support prior research, which suggests that graduate work readiness is a multidimensional construct comprising skills and attributes beyond discipline-specific competence.

The changing skill mix in nursing: considerations for and against different levels of nurse

AIM

To investigate the current literature to gain an understanding of skill mix, why it is being manipulated and how it affects patient care and health-care costs.

BACKGROUND

Due to workforce shortages, economic constraints and increasing patient acuity, employers are looking at methods of providing patient care whilst maintaining costs. Registered nurses make up a large percentage of the health-care budget. The manipulation of skill mix (i.e. the percentage of registered nurses available for patient care) is seen as one method of managing the increasing cost whilst still ensuring patient care.

EVALUATION

Research literature was used to determine the current use of skill mix and its impact on patient care and health-care costs.

KEY ISSUE

The use of a higher proportion of registered nurses is associated with better health outcomes, shorter length of stay and reduced patient morbidity.

CONCLUSION

Economic savings from substituting registered nurses with other health professionals may be offset by increased patient length of stay in hospital and increased patient mortality.

IMPLICATIONS FOR NURSING MANAGEMENT

When evaluating nursing skill mix, a higher percentage of registered nurses may result in health-care facility cost savings by providing a shorter length of stay and decreased patient complications.

The experiences of undergraduate Assistants in Nursing (AIN)

BACKGROUND

University academic timelines and a shortage of clinical placements available for students have created challenges for universities to provide maximum clinical exposure and preparation for practise. A State-run health system in Australia developed an incentive whereby students are actively recruited to work as Assistants in Nursing (AINs) whilst completing their undergraduate nursing programme, enabling them to enhance clinical skills learned during university. There have been no previous studies that reflect their experiences.

AIM

This study aimed to explore and describe experiences of undergraduate AINs in the nursing workforce.

METHOD

Semi-structured interviews were used to obtain in-depth accounts of the undergraduate AIN experience. Six participants who were employed at various healthcare facilities around the Sydney metropolitan area comprised the sample. Interviews were digitally recorded and transcribed verbatim. Data were thematically analysed.

FINDINGS

Three main themes emerged from the data: becoming part of the team, understanding the scope of the AIN role, and working outside your comfort zone.

CONCLUSION

Findings can add to international discussions in the literature related to the training and education of ancillary nursing staff. Furthermore findings provide insights into some of the challenges faced by tertiary institutions in preparing students for the clinical work environment. Whilst the employment of undergraduate AIN's can be an effective strategy, the lack of formalised guidelines to inform those working with undergraduate AINs may hinder the full potential of their employment.

Conflict management and job satisfaction in paediatric hospitals in Greece

AIM

To assess the major causes of conflict and to identify choices of strategy in handling conflicts.

BACKGROUND

Conflict is inherent to hospitals as in all complex organizations, and health personnel deal with internal and external conflicts daily.

METHODS

The sample consisted of 286 participants. A five-part questionnaire, specific for conflicts in hospitals, was administered to health personnel.

RESULTS

Of the participants 37% were physicians and 63% were nurses and nursing assistants. As far as choice of strategy in conflict management is concerned, avoidance was found to be the most frequent mode chosen while accommodation was the least frequent mode. Organizational problems were the main issue creating conflicts since 52% of nurses and 45% of physicians agreed that receiving direction from more than one manager may lead to conflicts (P=0.02). Educational differences and communication gaps were reported as another cause of conflicts, with nurses supporting this statement more than the other groups (P=0.006).

CONCLUSION

To become effective in conflict management nurses and physicians must understand causes and strategies in handling conflicts.

IMPLICATIONS FOR NURSING MANAGEMENT

Major changes are needed regarding human resource management, work incentives and dynamics of teamwork in order to improve working conditions in Greek public hospitals.

Using a voice-centered relational method of data analysis in a feminist study exploring the working world of nursing unit managers

In this article, we discuss the application of a data analysis method used in a feminist study that explored the working world of nursing unit managers in Australia. The decision to use a voice-centered relational approach to the data was based on a desire to delve into the working world of nursing unit managers and uncover the layers within the narratives that specifically related to their perceptions of themselves, their world, and the context in which they work. Throughout this article, the focus is on how this method was applied to uncover multiple layers of meaning within the data, rather than on the researchers' and participants' roles in the coconstruction of interview data. An excerpt from an interview transcript is used to illustrate how the stories of the participants were explored using this method.

Paths to nursing leadership

AIM

The aim was to explore why nurses enter nursing leadership and apply for a management position in health care. The study is part of a research programme in nursing leadership and evidence-based care.

BACKGROUND

Nursing has not invested enough in the development of nursing leadership for the development of patient care. There is scarce research on nurses' motives and reasons for committing themselves to a career in nursing leadership.

METHOD

A strategic sample of 68 Finnish nurse leaders completed a semistructured questionnaire. Analytic induction was applied in an attempt to generate a theory.

FINDINGS

A theory, Paths to Nursing Leadership, is proposed for further research. Four different paths were found according to variations between the nurse leaders' education, primary commitment and situational factors. They are called the Path of Ideals, the Path of Chance, the Career Path and the Temporary Path.

CONCLUSION

Situational factors and role models of good but also bad nursing leadership besides motivational and educational factors have played a significant role when Finnish nurses have entered nursing leadership. The educational requirements for nurse leaders and recruitment to nursing management positions need serious attention in order to develop a competent nursing leadership.

Clinical leadership in contemporary clinical practice: implications for nursing in Australia

BACKGROUND

Leadership in the clinical practice environment is important to ensure both optimal patient outcomes and successive generations of motivated and enthusiastic clinicians.

AIM

The present paper seeks to define and describe clinical leadership and identify the facilitators and barriers to clinical leadership. We also describe strategies to develop clinical leaders in Australia. Key drivers to the development of nursing leaders are strategies that recognize and value clinical expertise. These include models of care that highlight the importance of the nursing role; evidence-based practice and measurement of clinical outcomes; strategies to empower clinicians and mechanisms to ensure participation in clinical decision-making.

KEY ISSUES

Significant barriers to clinical leadership are organizational structures that preclude nurses from clinical decision making; the national shortage of nurses; fiscal constraints; absence of well evaluated models of care and trends towards less skilled clinicians.

CONCLUSIONS

Systematic, strategic initiatives are required to nurture and develop clinical leaders. These strategies need to be collegial collaborations between the academic and health care sectors in order to provide a united voice for advancing the nursing profession.

Redesign of the model of nursing practice in an acute care ward: Nurses' experiences

OBJECTIVE

to describe nurses' experiences of the change associated with redesign of the model of nursing practice in an acute care ward in the preparatory and implementation phases.

DESIGN

descriptive case study

SETTING

a surgical ward in an acute care hospital in Greater Western Sydney

SUBJECTS

fourteen registered and six enrolled nurses working on the surgical ward volunteered to be interviewed, eight in the preparatory phase and twelve six months into the implementation phase

MAIN OUTCOME MEASURE

descriptions of nurses' experiences in the preparatory phase and six months into the implementation phase of the redesigned nursing practice model

RESULTS

many nurses felt apprehensive in the preparatory phase, however, six months into implementation phase their willingness to trial the model was evident. Negativity pervaded both phases, as did their concerns for the quality of care being given. In the preparatory phase nurses described the clinical activities coordinator (CAC) role as having potential to be beneficial and this was realised to some degree six months into implementation phase. A preference for registered nurses over enrolled nurses as a dominant component of the staff was evident in both phases

CONCLUSIONS

the struggle with the change that nurses experienced suggests redesign needs to be a more collaborative process involving strong communication and supportive education so nurses can empower themselves within the change.

The trials and tribulations of team-nursing

AIM

The aim of this study was to review the team-nursing approach to care adopted by two general medical wards in a large private hospital. The delivery model of care was reviewed to determine the factors that enhance and/or hinder the timely delivery, continuity and communication of care.

METHOD

All nursing and ancillary staff who worked on two medical wards at a private teaching hospital were invited to participate in the study. Thirty eight participants from the two wards took part in focus group discussions, individual interviews and completed the Staff Continuity of Care Questionnaire.

FINDINGS

Findings indicated that achieving functionally sound teamwork is a complex task that is affected by the interplay of a number of organisational, patient and staff factors. Its smooth application is further affected by the uncertain and changing conditions on the wards, which are difficult to control and impact on the smooth delivery of patient care. The findings revealed strengths and weaknesses in teamwork, communication of care, documentation and discharge planning. The results also highlighted factors that enhance and hinder the smooth delivery of care. This paper details the factors that influence the delivery of care from the perspectives of nursing staff and makes recommendations to enhance the delivery of patient care using a team-nursing approach.

Why do registered nurses work when ill?

The authors discuss results of a study that found a sense of tension in the nurse and between the supervisor and the team that influenced the decision to come to work when ill. The tension with the supervisor was around reporting and legitimizing illness; with the team, around responsibility, staffing concerns, and peer pressure; and in the nurse was associated with community perception, work ethic, and financial security. Together, nurse administrators and clinicians should conduct reviews of policies and procedures to build cohesive relationships and promote the self-care practices of nurses.