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Kagonya VA, Onyango OO, Maina M, Gathara D, English M, Imam A. Characterising support and care assistants in formal hospital settings: a scoping review. HUMAN RESOURCES FOR HEALTH 2023; 21:90. [PMID: 38012737 PMCID: PMC10680191 DOI: 10.1186/s12960-023-00877-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 11/16/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND A 15 million health workforce shortage is still experienced globally leading to a sub-optimal healthcare worker-to-population ratio in most countries. The use of low-skilled care assistants has been suggested as a cost-saving human resource for health strategy that can significantly reduce the risks of rationed, delayed, or missed care. However, the characterisation, role assignment, regulation, and clinical governance mechanisms for unlicensed assistive workforce remain unclear or inconsistent. The purpose of this study was to map and collate evidence of how care assistants are labelled, utilised, regulated, and managed in formal hospital settings as well as their impact on patient care. METHODS We conducted a scoping review of literature from PUBMED, CINAHL, PsychINFO, EMBASE, Web of Science, Scopus, and Google Scholar. Searches and eligibility screening were conducted using the Participants-Context-Concepts framework. Thematic content analysis guided the synthesis of the findings. RESULTS 73 records from a total of 15 countries were included in the final full-text review and synthesis. A majority (78%) of these sources were from high-income countries. Many titles are used to describe care assistants, and these vary within and across countries. On ascribed roles, care assistants perform direct patient care, housekeeping, clerical and documentation, portering, patient flow management, ordering of laboratory tests, emergency response and first aid duties. Additional extended roles that require higher competency levels exist in the United States, Australia, and Canada. There is a mixture of both positive and negative sentiments on their impact on patient care or nurses' perception and experiences. Clinical and organisational governance mechanisms vary substantially across the 15 countries. Licensure, regulatory mechanisms, and task-shifting policies are largely absent or not reported in these countries. CONCLUSIONS The nomenclature used to describe care assistants and the tasks they perform vary substantially within countries and across healthcare systems. There is, therefore, a need to review and update the international and national classification of occupations for clarity and more meaningful nomenclature for care assistants. In addition, the association between care assistants and care outcomes or nurses' experience remains unclear. Furthermore, there is a dearth of empirical evidence on this topic from low- and middle-income countries.
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Affiliation(s)
- Vincent A Kagonya
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya.
| | - Onesmus O Onyango
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Michuki Maina
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - David Gathara
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- MARCH Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Mike English
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Nuffield Department of Medicine, Health Systems Collaborative, University of Oxford, Oxford, United Kingdom
| | - Abdulazeez Imam
- Nuffield Department of Medicine, Health Systems Collaborative, University of Oxford, Oxford, United Kingdom
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Nursing Assistant Staffing Model: Implementation and Outcome Evaluation in Taiwan Hospitals. THE JOURNAL OF NURSING RESEARCH : JNR 2023; 31:e254. [PMID: 36626236 DOI: 10.1097/jnr.0000000000000540] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND A key policy of the Taiwan healthcare system is promoting the hiring of nursing assistants (NAs) to reduce the workload of nurses. However, few studies in the literature have compared the relative effectiveness of different nurse staffing policies, and no studies have addressed the impact of the NA staffing (NAS) model. PURPOSE This study explored the current status of the NAS model as implemented in Taiwan hospitals and to investigate the methods used to evaluate the outcomes of NAS model implementation. METHODS A cross-sectional online survey was performed in hospitals nationwide from June 1 to December 31, 2018. There were 153 government-accredited hospitals being invited to participate in the survey. RESULTS Of the 139 hospitals that completed the online survey, 26% (36 hospitals) had implemented the NAS model. Many of the hospitals had hired full-time, certified NAs. Most of the tasks assigned to NAs were in the nonprofessional/general and technical work categories. In addition, medical wards were the most frequently assigned workplace, especially on day shifts. Few of the surveyed hospitals had evaluated the effectiveness of the NAS model. Improvement after implementation of the NAS model (based on the 35 outcome indicators) was found to vary significantly. The most commonly used outcome indicator was patient satisfaction. All the stakeholders, including patients, family caregivers, nurses, and nurse supervisors, supported implementation of the NAS model. However, some of the participants expressed concerns regarding the difficulties involved with model implementation. CONCLUSIONS/IMPLICATIONS FOR PRACTICE Although the NAS model may be beneficial, further empirical research is necessary to confirm the contributions of NAs. Additional evidence regarding the benefits of the NAS model for hospital performance and patient outcomes may be expected to motivate more hospital administrators to adopt this model.
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Twigg DE, Kutzer Y, Jacob E, Seaman K. A quantitative systematic review of the association between nurse skill mix and nursing-sensitive patient outcomes in the acute care setting. J Adv Nurs 2019; 75:3404-3423. [PMID: 31483509 PMCID: PMC6899638 DOI: 10.1111/jan.14194] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 08/11/2019] [Accepted: 08/28/2019] [Indexed: 12/26/2022]
Abstract
AIMS To examine the association between nurse skill mix (the proportion of total hours provided by Registered Nurses) and patient outcomes in acute care hospitals. DESIGN A quantitative systematic review included studies published in English between January 2000 - September 2018. DATA SOURCES Cochrane Library, CINAHL Plus with Full Text, MEDLINE, Scopus, Web of Science and Joanna Briggs Institute were searched. Observational and experimental study designs were included. Mix-methods designs were included if the quantitative component met the criteria. REVIEW METHODS The Systematic Review guidelines of the Joanna Briggs Institute and its critical appraisal instrument were used. An inverse association was determined when seventy-five percent or more of studies with significant results found this association. RESULTS Sixty-three articles were included. Twelve patient outcomes were inversely associated with nursing skill mix (i.e., higher nursing skill mix was significantly associated with improved patient outcomes). These were length of stay; ulcer, gastritis and upper gastrointestinal bleeds; acute myocardial infarction; restraint use; failure-to-rescue; pneumonia; sepsis; urinary tract infection; mortality/30-day mortality; pressure injury; infections and shock/cardiac arrest/heart failure. CONCLUSION Nursing skill mix affected 12 patient outcomes. However, further investigation using experimental or longitudinal study designs are required to establish causal relationships. Consensus on the definition of skill mix is required to enable more robust evaluation of the impact of changes in skill mix on patient outcomes. IMPACT Skill mix is perhaps more important than the number of nurses in reducing adverse patient outcomes such as mortality and failure to rescue, albeit the optimal staffing profile remains elusive in workforce planning.
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Affiliation(s)
- Diane E Twigg
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia.,Centre for Nursing Research, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Yvonne Kutzer
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Elisabeth Jacob
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Karla Seaman
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
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Pang D, Liu Z, Wang L. Comparison of nursing aids and registered nurses mixed nursing staffing model with different ratios on the nursing outcomes and cost in Neurology and Neurosurgery Center. Ir J Med Sci 2019; 188:1435-1441. [PMID: 30903451 DOI: 10.1007/s11845-019-01988-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 02/08/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND This study aimed to investigate the effect of nursing aids (NAs) and registered nurses (RNs) mixed nursing staffing model with different ratios on the nursing outcomes and cost in China. METHODS Five thousand and ninety-one patients treated at Neurology and Neurosurgery Center were consecutively recruited in this study and divided into three groups according to the proportion of NAs and RNs: 100% RN group (N = 1756), 90% RN group (N = 1654), and 75% RN group (N = 1681). Nursing outcomes including medication error, unplanned endotracheal tube extubation, bloodstream infection, respiratory tract infection, urinary tract infection, pressure ulcer, ventilator weaning, morality, hospital stay, and nursing cost were recorded. RESULTS No difference of patients' characteristics or RNs' characteristics among three groups was observed. Three-group comparison disclosed that medication error, urinary tract infection, ventilator weaning, and nursing cost were different among three groups, while no difference of unplanned endotracheal tube extubation, bloodstream infection, respiratory tract infection, pressure ulcer, mortality, or hospital stay was found. Two-group comparison revealed that medication error and nursing cost were reduced in 75% RN group compared with 90% RN group and 100% RN group, but urinary tract infection was increased while ventilator weaning was decreased in 75% RN group and 90% RN group compared with 100% RN group. Multivariate logistic regression also validated 75% RNs independently correlated with decreased medication error, ventilator weaning, and increased urinary tract infection. CONCLUSIONS NAs and RNs mixed nursing staffing model with 75% RNs reduces medication error and nursing cost, while increasing urinary tract infection and decreasing ventilator weaning.
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Affiliation(s)
- Dong Pang
- Department of Neurology, The 2nd Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, Harbin, 150001, China
| | - Zhaojun Liu
- Department of Neurology, The 2nd Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, Harbin, 150001, China.
| | - Lusi Wang
- Department of Neurology, The 2nd Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, Harbin, 150001, China
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Kouatly IA, Nassar N, Nizam M, Badr LK. Evidence on Nurse Staffing Ratios and Patient Outcomes in a Low-Income Country: Implications for Future Research and Practice. Worldviews Evid Based Nurs 2018; 15:353-360. [PMID: 30129163 DOI: 10.1111/wvn.12316] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Conclusive evidence on the effect of nurse staffing ratios on nurse-sensitive outcomes (NSOs) has not yet been achieved worldwide. AIMS To describe the relationship between nurse staffing and NSOs at a Magnet designated, university hospital a low-income country. METHODS A 48-month prospective study assessed the relationship between nurse staffing and six patient outcomes or NSOs in medical-surgical units and critical care units (CCUs). Nurse staffing was measured by nursing hours per patient day (NHPPD) and skill mix, whereas NSOs were total falls and injury falls per 1,000 patient days, percent of surveyed patients with hospital-acquired pressure injuries (HAPI), catheter-associated urinary tract infections, ventilator-associated pneumonia, and central line-associated bloodstream infections (CLABSI) per 1,000 central line days. RESULTS The odds for total falls, injury falls, HAPI, and CLABSI in the medical-surgical units were higher with lower NHPPD ratios, OR = 4.67, p = .000; OR = 4.33, p = .001; OR = 3.77, p = .004 and OR = 2.61, p = .006, respectively. For the CCUs, lower rates of NHPPD increased the odds for total falls, OR = 6.25, p = .0007, HAPIs OR = 3.91, p = .001 and CLABSI, OR = 4.78, p = .000. Skill mix was associated with total falls, OR = 2.40, p = .005 and HAPIs OR = 2.07, p = .03 in the medical-surgical units but had no effect in any NSOs in the CCUs. LINKING EVIDENCE TO ACTION Higher rates of nurses per patient were effective in improving some NSOs but not others. Skill mix had no effect on any of the six NSOs in the CCUs. As such, the results remain inconclusive as the benefits of the higher nurse to patient ratios in this low-income country warranting further multisite studies in different settings and countries.
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Affiliation(s)
- Iman Al Kouatly
- Nursing Director, Nursing Services Department, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nada Nassar
- Nurse Quality Manager, Nursing Services Department, American University of Beirut Medical Center, Beirut, Lebanon
| | - Maya Nizam
- Executive Assistant, Nursing Services Department, American University of Beirut Medical Center, Beirut, Lebanon
| | - Lina Kurdahi Badr
- Professor, School of Nursing, Azusa Pacific University, Asuza, CA, USA
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Persson U, Carlson E. Conceptions of professional work in contemporary health care—Perspectives from registered nurses in somatic care: A phenomenographic study. J Clin Nurs 2018; 28:201-208. [DOI: 10.1111/jocn.14628] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 07/02/2018] [Accepted: 07/07/2018] [Indexed: 12/01/2022]
Affiliation(s)
| | - Elisabeth Carlson
- Department of Care Science Faculty of Health and Society Malmö University Malmö Sweden
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Feng D, Su S, Yang Y, Xia J, Su Y. Job satisfaction mediates subjective social status and turnover intention among Chinese nurses. Nurs Health Sci 2017. [PMID: 28636135 DOI: 10.1111/nhs.12357] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Nurse turnover is one of the reasons for the global nurse shortage. Although previous studies have examined the determinants of turnover intention in detail, there is limited knowledge on the effect of subjective social status on nurse turnover intention. Therefore, in this study, we examined this relationship, including job satisfaction as a mediator, among Chinese nurses. This cross-sectional study employed questionnaires to assess subjective social status, job satisfaction, and turnover intention in 581 nurses who were randomly recruited from 10 hospitals in Jinan, China. The results partially supported our model. Although subjective social status exerted no significant direct effect on turnover intention, it exerted a significant indirect effect through job satisfaction. These results provide a new insight into why nurses leave their jobs, and possible new solutions to the nurse turnover problem. Efforts should be made to improve nurses' subjective social status.
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Affiliation(s)
- Danjun Feng
- School of Nursing, Shandong University, Jinan, China
| | - Shan Su
- School of Nursing, Shandong University, Jinan, China
| | - Yang Yang
- School of Nursing, Shandong University, Jinan, China
| | - Jinghua Xia
- School of Nursing, Shandong University, Jinan, China
| | - Yonggang Su
- School of Nursing, Shandong University, Jinan, China.,School of Foreign Languages and Literature, Shandong University, Jinan, China
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