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Meredith P, Turner L, Saville C, Griffiths P. Nurse understaffing associated with adverse outcomes for surgical admissions. Br J Surg 2024; 111:znae215. [PMID: 39313222 PMCID: PMC11419734 DOI: 10.1093/bjs/znae215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 07/30/2024] [Accepted: 08/06/2024] [Indexed: 09/25/2024]
Abstract
BACKGROUND Nurses play a crucial role in maintaining the safety of surgical patients. Few nurse staffing studies have looked specifically at surgical patients to examine the impact of exposure to low staffing on patient outcomes. METHODS A longitudinal patient analysis was conducted in four organizations in England using routine data from 213 910 admissions to all surgical specialties. Patients' staffing exposures were modelled as counts of understaffed registered nurse and nurse assistant days in the first 5 inpatient days. Understaffing was identified when staffing per patient-day was below the mean for the ward. Cox models were used to examine mortality within 30 days of admission and readmission within 30 days of discharge. Generalized linear models were used to investigate duration of hospital stay and occurrence of hospital-acquired conditions. RESULTS Increased exposure to registered nurse understaffing was associated with longer hospital stay and increased risk of deep vein thrombosis, pneumonia, and pressure ulcers. This was also true for nurse assistant understaffing, but the effect sizes tended to be smaller. In the Cox models, there were similarly increased hazards of death for registered nurse understaffing (HR 1.09, 95% c.i. 1.07 to 1.12) and nurse assistant understaffing (HR 1.10, 1.08 to 1.13), whereas the effect size of registered nurse understaffing for readmission (HR 1.02, 1.02 to 1.03) was greater than that seen with nurse assistants (HR 1.01, 1.01 to 1.02). CONCLUSION Understaffing by both registered nurses and nursing assistants is associated with increased risks of a range of adverse events, and generally larger effects are seen with registered nurse understaffing.
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Affiliation(s)
- Paul Meredith
- School of Health Sciences, University of Southampton, Southampton, UK
- Research and Innovation, Portsmouth Hospitals University Trust, Portsmouth, UK
- National Institute for Health Research Applied Research Collaboration Wessex, Southampton, UK
| | - Lesley Turner
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Christina Saville
- School of Health Sciences, University of Southampton, Southampton, UK
- National Institute for Health Research Applied Research Collaboration Wessex, Southampton, UK
| | - Peter Griffiths
- School of Health Sciences, University of Southampton, Southampton, UK
- Research and Innovation, Portsmouth Hospitals University Trust, Portsmouth, UK
- National Institute for Health Research Applied Research Collaboration Wessex, Southampton, UK
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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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Serra N, Botti S, Guillari A, Simeone S, Latina R, Iacorossi L, Torreggiani M, Guberti M, Cicolini G, Lupo R, Capuano A, Pucciarelli G, Gargiulo G, Tomietto M, Rea T. Workload, Job Satisfaction and Quality of Nursing Care in Italy: A Systematic Review of Native Language Articles. Healthcare (Basel) 2023; 11:2573. [PMID: 37761770 PMCID: PMC10531217 DOI: 10.3390/healthcare11182573] [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: 06/23/2023] [Revised: 09/06/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023] Open
Abstract
Nursing research is rapidly increasing, yet contributions from numerous countries that may interest the international nursing community are impeded because many research articles are published in authors' native language and not in English. The objectives of this work were to systematically review papers published in Italian related to job satisfaction and the quality of nursing care, and to discuss their findings in light of the international literature. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method was used. The Directory of Open Access Journals (DOAJ) and Indice della Letteretura Italiana di Scienze Infermieristiche (ILISI) databases were consulted for eligible studies published from January 2015 to November 2022. Two hundred sixteen papers were identified, 11 of which were selected for review: 8 on job satisfaction, two on workload issues, and 1 on quality of nursing care. The quality of included studies was assessed through the Effective Public Health Practice Project quality assessment tool (EPHPP). The results of our review were in line with those of international literature, and they can help to fill the knowledge gap on the quality of nursing performance in Italian care settings. In addition, the proposed method can provide further elements of discussion among literature providers and reviewers.
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Affiliation(s)
- Nicola Serra
- Biostatistics Unit, Department of Public Health, University Federico II of Naples, 80138 Naples, Italy;
| | - Stefano Botti
- Hematology Unit, Azienda USL-IRCCS of Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Assunta Guillari
- Department of Public Health, University Federico II of Naples, 80138 Naples, Italy; (A.G.); (T.R.)
| | - Silvio Simeone
- Clinical and Experimental Medicine Department, “Magna Graecia” University, 88100 Catanzaro, Italy;
| | - Roberto Latina
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialities, Università degli Studi di Palermo, 90133 Palermo, Italy;
| | - Laura Iacorossi
- Nursing Research Unit IFO, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy;
| | - Martina Torreggiani
- Research and EBP Unit, Health Professions Department, Azienda USL-IRCCS of Reggio Emilia, 42421 Reggio Emilia, Italy; (M.T.); (M.G.)
| | - Monica Guberti
- Research and EBP Unit, Health Professions Department, Azienda USL-IRCCS of Reggio Emilia, 42421 Reggio Emilia, Italy; (M.T.); (M.G.)
| | - Giancarlo Cicolini
- Department of Precision and Regenerative Medicine and Ionian Area—(DiMePRe-J), University of Bari “Aldo Moro”, 70124 Bari, Italy;
| | - Roberto Lupo
- San Giuseppe da Copertino Hospital, Local Health Authority, 73043 Copertino, Italy;
| | - Angela Capuano
- Department of Emergency, AORN Santobono-Pausilipon, 80122 Naples, Italy;
| | - Gianluca Pucciarelli
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy;
| | - Gianpaolo Gargiulo
- Hematology and Haematopoietic Stem Cell Transplantation Centre, University Federico II of Naples, 80138 Naples, Italy;
| | - Marco Tomietto
- Department of Nursing, Midwifery and Health, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne NE1 8ST, UK;
| | - Teresa Rea
- Department of Public Health, University Federico II of Naples, 80138 Naples, Italy; (A.G.); (T.R.)
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Wilson NJ, Pracilio A, Morphet J, Kersten M, Buckley T, Trollor JN, Cashin A. A scoping review of registered nurses' delegating care and support to unlicenced care and support workers. J Clin Nurs 2023; 32:6000-6011. [PMID: 37149737 DOI: 10.1111/jocn.16724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 03/14/2023] [Accepted: 04/05/2023] [Indexed: 05/08/2023]
Abstract
AIM To scope the international literature about registered nurses delegated models of care to unlicenced workers, identify gaps and reflect upon how the evidence relates to nursing in multiple contexts. DESIGN Scoping review of the peer reviewed literature from the year 2000 onwards, using the PRISMA-ScR checklist. METHODS The study searched the following databases in February 2022: CINAHL, Medline, ProQuest, and SCOPUS, and included keywords, Boolean operators and subject headings relevant to registered nurses delegating the provision of care to unlicenced workers. RESULTS A total of 49 articles met the eligibility criteria for this study, and relevant data were extractedThree models of delegation were highlighted within the literature: direct, indirect and a mixture of both. The data highlighted that direct delegation mainly occurred in acute contexts, with delegation decreasing with increasing patient acuity and/or complexity but the threshold of when this would occur was not clear. There was one intervention study that measured patient outcomes which could aid in the determination of what is effective delegation. For studies that did report on it (n = 6), there were few examples of better patient outcomes in cases where care was delegated from registered nurses to unlicenced workers. CONCLUSIONS The scoping review highlighted heterogeneity in practice areas and methods of delegation practice. A key gap in literature is the absence of studies focusing on patient outcomes, with a clear baseline to measure and identify effective delegation practices. Additionally, the legal and logistical implications presented in both direct and indirect delegation practices is not evident in the literature. IMPLICATIONS FOR THE PROFESSION Decisions related to delegation are often made at the service level and prescribed to those who work within the service, suggesting that models of indirect delegation are in fact not delegation at all, rather a re-distribution of nurses' work. RELEVANCE TO CLINICAL PRACTICE Delegation is a vital component of the scope of practice of registered nurses. This review has highlighted unique differences in delegation by practice context, where the proliferation of unlicensed workers in certain contexts places a vastly different professional and legal burden on the registered nurse.
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Affiliation(s)
- Nathan J Wilson
- School of Nursing and Midwifery, Western Sydney University, Penrith, New South Wales, Australia
| | - Amy Pracilio
- Faculty of Health and Human Sciences, Southern Cross University, Lismore, New South Wales, Australia
| | - Julia Morphet
- Head of School, Nursing & Midwifery, Monash University, Clayton, Victoria, Australia
- College of Emergency Nursing Australasia (CENA), Melbourne, Victoria, Australia
| | - Michelle Kersten
- Faculty of Health and Human Sciences, Southern Cross University, Lismore, New South Wales, Australia
| | - Thomas Buckley
- Deputy Head of School, Susan Walki School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Julian N Trollor
- Chair, Intellectual Disability Mental Health and Head, Department of Developmental Disability Neuropsychiatry, Discipline of Psychiatry and Mental Health, UNSW Medicine & Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Andrew Cashin
- Faculty of Health and Human Sciences and Health Clinic, Southern Cross University, Lismore, New South Wales, Australia
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Cottrell C, Adlesic M, Albert N. Factors associated with retention of nurse assistants in a hospital setting: A qualitative study. Nurs Manag (Harrow) 2023; 54:38-44. [PMID: 36998185 DOI: 10.1097/01.numa.0000921900.52255.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
Affiliation(s)
- Constance Cottrell
- Constance Cottrell is a nurse scientist in the Cleveland Clinic's Office of Nursing Research and Innovation in Cleveland, Ohio. Melanie Adlesic is an assistant nurse manager on the observation unit at Cleveland Clinic South Pointe Hospital in Warrensville Heights, Ohio. Nancy Albert is the associate CNO for the Cleveland Clinic's Office of Nursing Research and Innovation, within the Zielony Nursing Institute; a clinical nurse specialist in Cleveland Clinic's George M. and Linda H. Kaufman Center for Heart Failure Treatment and Recovery in the Heart, Vascular & Thoracic Institute; and consultative staff in the Lerner Research Institute in Cleveland, Ohio
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Roche MA, Glover S, Luo X, Joyce M, Rossiter C. Extending the role of nursing assistants in mental health inpatient settings: A multi-method study. Int J Ment Health Nurs 2021; 30:1070-1079. [PMID: 33742529 DOI: 10.1111/inm.12859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/17/2021] [Accepted: 02/18/2021] [Indexed: 11/30/2022]
Abstract
With continued growth in the demand for nursing care, many organizations have incorporated nursing assistants into the acute care workforce. However, role descriptions are often generic and do not provide clarity in specialist areas such as mental health inpatient settings. Issues have been noted regarding the role of assistants, delegation, and their integration with the nursing team. This study extended an existing set of care activities and explored the perceptions of nursing assistants and registered nurses regarding these activities. A modified Delphi approach added 14 new care activities for nursing assistants. A follow-up survey found significant differences between nursing assistants and registered nurses regarding utilization of the activities, delegation, teamwork, and role clarity. Future research must incorporate the perspectives of those with lived experience of mental health issues, and develop an understanding of the interactions between nursing assistant care activities and other factors such as local supports, skillmix, and the practice environment, as these may impact how an organization can introduce nursing assistants to specialty areas while maintaining consumer and staff safety.
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Affiliation(s)
- Michael A Roche
- Mental Health Drug and Alcohol Services, Northern Sydney Local Health District, North Ryde, New South Wales, Australia.,School of Nursing and Midwifery, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Suzanne Glover
- Mental Health Drug and Alcohol Services, Northern Sydney Local Health District, North Ryde, New South Wales, Australia
| | - Xiaoou Luo
- Mental Health Drug and Alcohol Services, Northern Sydney Local Health District, North Ryde, New South Wales, Australia
| | - Mark Joyce
- Mental Health Drug and Alcohol Services, Northern Sydney Local Health District, North Ryde, New South Wales, Australia
| | - Chris Rossiter
- School of Nursing and Midwifery, University of Technology Sydney, Ultimo, New South Wales, Australia
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van Schothorst-van Roekel J, Weggelaar-Jansen AMJWM, Hilders CCGJM, De Bont AA, Wallenburg I. Nurses in the lead: a qualitative study on the development of distinct nursing roles in daily nursing practice. BMC Nurs 2021; 20:97. [PMID: 34120594 PMCID: PMC8201810 DOI: 10.1186/s12912-021-00613-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 05/19/2021] [Indexed: 11/10/2022] Open
Abstract
Background Transitions in healthcare delivery, such as the rapidly growing numbers of older people and increasing social and healthcare needs, combined with nursing shortages has sparked renewed interest in differentiations in nursing staff and skill mix. Policy attempts to implement new competency frameworks and job profiles often fails for not serving existing nursing practices. This study is aimed to understand how licensed vocational nurses (VNs) and nurses with a Bachelor of Science degree (BNs) shape distinct nursing roles in daily practice. Methods A qualitative study was conducted in four wards (neurology, oncology, pneumatology and surgery) of a Dutch teaching hospital. Various ethnographic methods were used: shadowing nurses in daily practice (65h), observations and participation in relevant meetings (n=56), informal conversations (up to 15 h), 22 semi-structured interviews and member-checking with four focus groups (19 nurses in total). Data was analyzed using thematic analysis. Results Hospital nurses developed new role distinctions in a series of small-change experiments, based on action and appraisal. Our findings show that: (1) this developmental approach incorporated the nurses’ invisible work; (2) nurses’ roles evolved through the accumulation of small changes that included embedding the new routines in organizational structures; (3) the experimental approach supported the professionalization of nurses, enabling them to translate national legislation into hospital policies and supporting the nurses’ (bottom-up) evolution of practices. The new roles required the special knowledge and skills of Bachelor-trained nurses to support healthcare quality improvement and connect the patients’ needs to organizational capacity. Conclusions Conducting small-change experiments, anchored by action and appraisal rather than by design, clarified the distinctions between vocational and Bachelor-trained nurses. The process stimulated personal leadership and boosted the responsibility nurses feel for their own development and the nursing profession in general. This study indicates that experimental nursing role development provides opportunities for nursing professionalization and gives nurses, managers and policymakers the opportunity of a ‘two-way-window’ in nursing role development, aligning policy initiatives with daily nursing practices. Supplementary Information The online version contains supplementary material available at 10.1186/s12912-021-00613-3.
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Affiliation(s)
| | | | - Carina C G J M Hilders
- Erasmus School of Health Policy & Management (ESHPM), Erasmus University, Rotterdam, The Netherlands
| | - Antoinette A De Bont
- Erasmus School of Health Policy & Management (ESHPM), Erasmus University, Rotterdam, The Netherlands
| | - Iris Wallenburg
- Erasmus School of Health Policy & Management (ESHPM), Erasmus University, Rotterdam, The Netherlands
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8
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Weller-Newton JM, Phillips C, Roche MA, McGillion A, Mapes J, Dufty T, Schlieff J, Boyd L, Geary A, Haines S. Datasets to support workforce planning in nursing: A scoping review. Collegian 2021. [DOI: 10.1016/j.colegn.2020.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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9
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Taghizadeh S, Zarnag RK, Farhangi MA. Stakeholder analysis of childhood obesity prevention policies in Iran. ACTA ACUST UNITED AC 2021; 79:36. [PMID: 33731204 PMCID: PMC7967965 DOI: 10.1186/s13690-021-00557-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 03/04/2021] [Indexed: 01/23/2023]
Abstract
Background Childhood obesity is one of the most serious health challenges and risk factors for various diseases. International health organizations, such as the World Health Organization (WHO), recommend more stakeholder engagement to discuss this health problem. Therefore, this study aims to identify and analyze the stakeholders of childhood obesity prevention (COP) policy making process in Iran. Methods In this study, semi-structured interviews were conducted with 24 Iranian stakeholders in the field of COP from February 2019 to May 2020. PolicyMaker V.4 and MAXQDA V.10 software were used for the analysis of stakeholders. Results Out of 24 interviewed stakeholders, 17 were active and seven were inactive. The most powerful and supportive stakeholders were the Ministry of Health and Medical Education (MoHME) and the national and regional Offices of Community Nutrition Improvement. Although stakeholders like the Ministry of Sports and Youth, the municipalities, the Secretariat of the Health and Food Safety, the Islamic Republic of Iran Broadcasting (IRIB), and Student Organization were among powerful bodies, they showed the least support for COP policies. The remaining stakeholders showed medium or low support and power in the policy making process. Conclusions Disconnect between stakeholders, less attention to prevention strategies, and high advertising of unhealthy foods were among the main challenges facing the COP policies in Iran and worldwide. Insufficient financial resources, little attention to the young people under 18, non-aligned policies of the Student Organization and the IRIB, and insufficient support of COP policies were among the key challenges to be handled.
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Affiliation(s)
- Shahnaz Taghizadeh
- Student Research Committee, Faculty of Nutrition, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Rahim Khodayari Zarnag
- Department of Health Policy and Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahdieh Abbasalizad Farhangi
- Department of Community Nutrition, Nutrition Faculty, Tabriz University of Medical Sciences, POBOX: 14711, Attar Nishabouri St., Tabriz, 5166614711, Iran.
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10
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Wise S. Staffing policy in aged care must look beyond the numbers. AUST HEALTH REV 2020; 44:829-830. [PMID: 33256893 DOI: 10.1071/ah20312] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 10/30/2020] [Indexed: 12/27/2022]
Abstract
The COVID-19 pandemic has highlighted an aged care system struggling to meet the needs of vulnerable Australians. Staffing levels and skill mix in aged care have declined, whereas the health and social needs of an older and more clinically complex population have risen. Increasing staff and improving personal care workers' skills and education are essential steps to quality aged care in Australia, but it will not be possible without funding models that foster secure employment, development opportunities and long-term career pathways.
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Affiliation(s)
- Sarah Wise
- Centre for Health Economic Research and Evaluation, UTS Business School, University of Technology Sydney, PO Box 123, Broadway, NSW 2007, Australia.
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11
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Blay N, Roche MA. A systematic review of activities undertaken by the unregulated Nursing Assistant. J Adv Nurs 2020; 76:1538-1551. [PMID: 32190928 DOI: 10.1111/jan.14354] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 02/05/2020] [Accepted: 03/09/2020] [Indexed: 11/28/2022]
Abstract
AIM To identify activities performed by Nursing Assistants in acute and primary healthcare. DESIGN Systematic review. DATA SOURCES The databases MedLine/PubMed, ProQuest and Google Scholar were searched for empirical studies published in the English language between 2008 and 2018 that addressed the work of Nursing Assistants. REVIEW METHODS From an initial yield of 2,944 publications, 71 publications were retained for full text review and 20 publications included in this review. Activities undertaken by Nursing Assistants from eight countries were extracted and categorized into one of six categories. RESULTS Over 200 activities were identified as being delegated to Nurse Assistants globally. Many of these activities are beyond the training of the Nurse Assistant and are being performed with limited Registered Nurse supervision. CONCLUSION Patient safety is at risk. Nurse Assistants' roles vary widely, with some seeing their role as similar to that of a regulated nurse, while recognizing their need for additional training. IMPACT Over 31% of activities delegated to Nurse Assistants require skill and comprehension beyond their level of training. Patients and regulated nurses need to have confidence that Nursing Assistants responsible for care provision are appropriately trained and practicing within regulatory standards.
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Affiliation(s)
- Nicole Blay
- Western Sydney University School of Nursing and Midwifery, Penrith South DC, NSW, Australia.,Ingham Medical Institute, Liverpool, NSW, Australia.,South Western Sydney Local Health District, Liverpool, NSW, Australia
| | - Michael Anthony Roche
- University of Technology Sydney, Ultimo, NSW, Australia.,Mental Health Drug and Alcohol Directorate, Northern Sydney Local Health District, North Ryde, NSW, Australia
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