Survey and critique of studies related to unlicensed assistive personnel from 1975 to 1997, Part 2

Addressing the mental health nurse shortage: undergraduate nursing students working as assistants in nursing in inpatient mental health settings

The population of mental health nurses is ageing and in the next few years we can expect many to retire. This paper makes an argument for the employment of undergraduate nursing students as Assistants in Nursing (AINs) in mental health settings as a strategy to encourage them to consider a career in mental health nursing. Skill mix in nursing has been debated since at least the 1980s. It appears that the use of AINs in general nursing is established and will continue. The research suggests that with the right skill mix, nursing outcomes and safety are not compromised. It seems inevitable that assistants in nursing will increasingly be part of the mental health nursing workforce; it is timely for mental health nurses to lead these changes so nursing care and the future mental health nursing workforce stay in control of nursing.

Delegation Guided by School Nursing Values: Comprehensive Knowledge, Trust, and Empowerment

As health care institutions in the United States respond to shrinking budgets and nursing shortages by increasing the use of unlicensed assistive personnel (UAP), school nursing practice is changing from providing direct care to supervising activities delegated to UAP. Therefore, delegation is a critical area of concern for school nurses. The purpose of this qualitative research study was to explore values guiding the delegation of health care tasks to UAP in school settings from the perspective of the school nurse. An inquiry focus group was conducted with 64 Florida school nurses. Values guiding delegation were comprehensive knowledge, trust, and empowerment. These values provided a framework for guiding the delegation process.

A Comparison of Wait Times and Patients Leaving Without Being Seen When Licensed Nurses Versus Unlicensed Assistive Personnel Perform Triage

INTRODUCTION

In today's health care environment, nurses are sometimes substituted with unlicensed assistive personnel (UAP), despite the lack of research into the possible negative effects. This study compared the wait time and the number of patients who left without being seen (LWBS) between triage systems that use nurses (including licensed practical nurses, nurses with an associate's degree, and nurses with a baccalaureate degree) versus UAP.

METHODS

This study was a comparative descriptive retrospective chart review. The sample consisted of 2 parts: Part 1 involved charts for every fifth patient presenting to the emergency department during the second shift in April 1997 (N = 323) and April 1998 (N = 281). Part 2 included the monthly number of patients who LWBS between January 1997 and April 1998. Data were collected from department-generated reports with use of investigator-designed forms. Specific time increments were calculated and compared between triage systems via 2-tailed t tests. The number of patients who LWBS was analyzed for trends.

RESULTS

Wait time decreased by 73 minutes and the number of patients who LWBS decreased by 85% when nurses performed triage.

DISCUSSION

Results of this study show that a triage system using nurses provided more services during triage and were associated with less wait time after triage and a decreased likelihood of patients LWBS compared with the triage system using UAP.

Nurses' Beliefs About Their Abilities to Delegate Within Changing Models of Care

Changing models of nursing care have resulted in a more diverse work force composition. Nurses (RNs and licensed practical and vocational nurses) have greater responsibilities for delegation and supervision of unlicensed assistive personnel providing direct nursing care. This study describes nurses' beliefs about their abilities to delegate and supervise direct nursing activities and explores differences based on professional and job-related factors. A national sample of 148 licensed nurses working in three practice settings was surveyed. In general, nurses reported a high level of comfort, frequency, preparedness, confidence, competence, and control. Differences found in nurses' beliefs were based on education, practice setting, and type of work responsibilities.

The impact of staffing and the organization of work on patient outcomes and health care workers in health care organizations

BACKGROUND

Numerous reports in the popular press express concern about the restructuring or lowering of staffing levels in health care organizations and the impact on the quality of patient care. Overtime and other extended shifts also represent work stresses for health care workers. This article reviews the research literature on the relationships among staffing, organization of work, and patient outcomes, and it discusses research findings on the relationship between staffing and the health of health care workers. RESEARCH ON STAFFING, ORGANIZATION, AND PATIENT OUTCOMES/STAFF WELL-BEING: Safe staffing level requirements have been identified for nursing homes, but only in extremely limited cases for hospitals, home care, or other health settings. There is little information about the impact of staffing levels and the organization of work on health personnel or on patient outcomes. There is almost no information about staffing and patient outcomes in home health and ambulatory care. Much of the research on staffing and quality has been discipline specific; future research should reflect the interdisciplinary nature of health care delivery rather than the impact of a particular occupation.

RESEARCH USE

Research is conducted to increase the scientific base per se and to inform decision making. Who should decide staffing levels and the organization of work? Professionals, employers/owners, the government, and consumers all have significant interest in staffing levels and the organization of care. Improving health care quality requires research about the critical staffing and organization of work variables. This requires obtaining appropriate data, conducting the research, and widely disseminating the findings.

The evolving role of advanced practice nurses in surgery

Health care reform has created many opportunities for advanced practice nurses and for OR nurses who want to go beyond traditional circulating and scrub roles. This article will briefly differentiate between expanded and advanced nursing practice and offer a definition and conceptual model for the surgical arena. Literature will be reviewed related to development, evaluation, and practice issues of the emerging role of the surgical advanced practice nurse.