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Expanding nurses' authority - Physicians' and nurses' attitudes. Appl Nurs Res 2022; 63:151550. [PMID: 35034693 DOI: 10.1016/j.apnr.2021.151550] [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: 07/15/2020] [Revised: 11/22/2021] [Accepted: 12/04/2021] [Indexed: 11/22/2022]
Abstract
AIM To examine and compare the attitudes of physicians and registered nurses regarding extending nurses' authority. DESIGN This was a comparative quantitative study, which used a questionnaire that examined the attitudes of nurses and physicians regarding expanding nurses' authority. METHODS The study comprised a sample of 134 nurses (62.7%) and physicians (37.3%), who filled out the self-report questionnaire that included sociodemographic data and questions designed to examine the participants' attitudes and perceptions on expanding nurses' authority. The general reliability of the questionnaire was Cronbach's α = 0.931. Participants were sampled through the convenience-snowball method. RESULTS Differences were found between the attitudes of physicians and nurses to expanding nurses' authority. Nurses tended to be in favor, whereas physicians tended to be against (t(86.29) = 7.713; p < 0.05). Nurses' attitudes are also more positive specifically to procedures related to drug administration (t(132) = 6.894; p < 0.05) and resuscitation (t(132) = 2.974; p < 0.05), compared to physicians. CONCLUSIONS Nurses have more positive attitudes toward expanding nurses' authority than physicians do, specifically toward drug administration and resuscitation. Further study is proposed to identify factors which affect the physician-nurse relationship and attitudes on a large scale through a qualitative study.
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Pertiwi B, Hariyati RTS, Pujasari H. "Hoping to be recognized, appreciated, and given clinical privilege": A phenomenology study of new nurses' experiences during orientation. ENFERMERIA CLINICA 2021. [PMID: 33849234 DOI: 10.1016/j.enfcli.2020.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
New nurses who have just worked have not been given clinical privilege during their orientation. Feelings, experiences, and expectations can influence the quality of nursing services. This study aimed to explore the experiences of new nurses, especially in the orientation period, before they are given the clinical privilege. This research applied a descriptive qualitative phenomenology design-semi-structured, in-depth interviews. Data were analyzed by the Colaizzi method using thematic analysis. Four themes: new nurses lack understanding of clinical privilege; new nurses provide nursing care based on senior orders; new nurses want to be recognized, appreciated, and given clinical privilege; and hospitals need to facilitate the process of adaptation of new nurses. This study shows that the new nurse carries out nursing care in the hope of being recognized and developing skills. Nurse managers are expected to provide appropriate orientation programs.
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Affiliation(s)
- Bela Pertiwi
- Faculty of Nursing Universitas Indonesia, West Java, Indonesia; Lahat General Hospital, South Sumatera, Indonesia
| | | | - Hening Pujasari
- Faculty of Nursing Universitas Indonesia, West Java, Indonesia
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Pursio K, Kankkunen P, Sanner-Stiehr E, Kvist T. Professional autonomy in nursing: An integrative review. J Nurs Manag 2021; 29:1565-1577. [PMID: 33548098 DOI: 10.1111/jonm.13282] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 01/15/2021] [Accepted: 02/02/2021] [Indexed: 11/30/2022]
Abstract
AIM To summarize knowledge of professional autonomy in nursing. BACKGROUND Professional autonomy is associated with experienced meaningfulness of the work. This refers to participation in decision-making and the ability to influence working practices. EVALUATION In an integrative review, relevant studies were retrieved from four databases. Quality was systematically evaluated using critical appraisal tools. PRISMA guidelines were followed. Inductive content analysis was used to analyse current knowledge of the focal subject. KEY ISSUES The search identified 27 relevant studies published between 2000 and 2019. Elements describing nurses' professional autonomy were independence in decision-making and ability to utilize one's own competence. Themes relating to nurses' professional autonomy were shared leadership, professional skills, inter- and intra-professional collaboration and healthy work environment. CONCLUSION Understanding the multidimensional nature of professional autonomy is essential to create attractive work environments. It is important to enable nurses to participate in decision-making and develop nursing through shared leadership to enhance the recruitment and retention of a skilled workforce. IMPLICATIONS FOR NURSING MANAGEMENT The findings have anticipated utility for supporting nursing practice and nurse leaders' understanding of approaches to foster nurses' professional autonomy.
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Affiliation(s)
- Katja Pursio
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Päivi Kankkunen
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.,Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland
| | | | - Tarja Kvist
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
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Kerzman H, Van Dijk D, Siman-Tov M, Friedman S, Goldberg S. Professional characteristics and work attitudes of hospital nurses who leave compared with those who stay. J Nurs Manag 2020; 28:1364-1371. [PMID: 32654342 DOI: 10.1111/jonm.13090] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 06/10/2020] [Accepted: 07/02/2020] [Indexed: 12/01/2022]
Abstract
AIM To compare characteristics and attitudes of nurses who resigned and those who remained in two Israeli hospitals and assess the reasons for leaving. BACKGROUND Nurse turnover is a current global problem in health care system, especially given the severe nurse shortages. Retention of nurses requires an understanding of the characteristics of the resigning nurses, their attitudes and their reasons for leaving. METHODS A matching case-control study was conducted among 100 resigning nurses and 200 matched remaining nurses. Questionnaires were used to survey the professional characteristics and attitudes of the participating nurses. In addition, exit interviews were used to assess the reasons to leave of resigning nurses. RESULTS Resigning nurses had higher education, less seniority and fewer managerial positions compared with remaining nurses. In addition, resigning nurses had lower professional autonomy and higher aspirations for professional advancement. The reasons to leave cited by the resigning nurses were distance of the workplace from home and working conditions as well as aspiring for professional advancement. CONCLUSIONS The interface between high education and having few opportunities for advanced positions may lead to resignation. IMPLICATIONS FOR NURSING MANAGEMENT We recommend organisational interventions for training new hospital nurses through professional career path development, such as mentoring programme.
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Affiliation(s)
- Hana Kerzman
- Nursing Division, Chaim Sheba Medical Center, Tel-Hashomer, Tel-Hashomer, Israel
| | - Dina Van Dijk
- Department of Health Systems Management, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Maya Siman-Tov
- School of Public Health, Tel-Aviv University, Tel-Aviv, Israel
| | | | - Shoshy Goldberg
- Nursing Administration at the Ministry of Health, Jerusalem, Israel
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Bam V, Diji AKA, Asante E, Lomotey AY, Adade P, Akyeampong BA. Self-assessed competencies of nurses at an emergency department in Ghana. Afr J Emerg Med 2020; 10:8-12. [PMID: 32161705 PMCID: PMC7058887 DOI: 10.1016/j.afjem.2019.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 07/12/2019] [Accepted: 09/12/2019] [Indexed: 12/03/2022] Open
Abstract
Introduction The nature and scope of emergency nursing exposes nurses to a wide array of patient populations with rapidly changing and unexpected clinical conditions, sophisticated logistics and procedures. Hence, emergency centre (EC) nurses ought to be ready to face diverse clinical challenges and deliver care to patients in a timely cost-effective manner and with the needed competence. The current study aimed at examining the self-assessed competencies of nurses, and comparing ratings among certified emergency nurses (ENs) and general nurses (GNs) working at an EC of a tertiary hospital in Ghana. Methods A descriptive cross-sectional quantitative study was carried out among 109 conveniently sampled nurses. Participants evaluated their perceived competencies on a validated instrument under five domains, namely: diagnostic function (DF), administering and monitoring therapeutic interventions (AMTI), effective management of rapidly changing situations (EMRCS), organisational and work load competency (OWLC), and the helping role (HR). Descriptive and inferential data analyses were by SPSS version 25. Results Participants generally had good competencies in the performance of emergency nursing procedures. Highest scores were obtained in OWLC (median score of 83.3%) while EMRCS recorded the least scores (median score of 57.9%). With the exception of the DF domain (p = 0.166), ENs perceived themselves as significantly more competent than their counterpart GNs in 4 (OWLC, HR, AMTI, EMRCS) out of the five studied domains (p < 0.05). Discussion Specialist training enhances nurses' perceived competences in emergency nursing procedures. This reiterates the need for regular theory and practice-based education for GNs on intermediate and advanced procedures as they prepare to enrol in specialist programmes. As nurses take on expanded professional roles in this emerging nursing specialty in low- and middle-income countries, it is important the needed capacity is developed to adequately address the needs of patients and families that require services in ECs.
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Affiliation(s)
- Victoria Bam
- Department of Nursing, Kwame Nkrumah University of Science and Technology, Ghana
- Corresponding author.
| | | | - Ernest Asante
- Department of Nursing, Kwame Nkrumah University of Science and Technology, Ghana
| | | | - Pearl Adade
- Department of Nursing, Kwame Nkrumah University of Science and Technology, Ghana
- Korle Bu Teaching Hospital, Accra, Ghana
| | - Berlinda Asante Akyeampong
- Department of Nursing, Kwame Nkrumah University of Science and Technology, Ghana
- Korle Bu Teaching Hospital, Accra, Ghana
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Karanikola MN, Giannakopoulou M, Mpouzika M, Nicolaou C, Tsiaousis G, Vouzavali F, Koutroubas A, Papathanassoglou EDE. Perceptions of critical and emergency department nurses regarding changes in their professional role. Rev Esc Enferm USP 2018; 51:e03287. [PMID: 29562039 DOI: 10.1590/s1980-220x2017014403287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 08/29/2017] [Indexed: 11/22/2022] Open
Abstract
Objective Preliminary investigation of the way Greek critical and emergency department nurses conceptualize changes in their professional role. Method A qualitative focus-group methodology was applied. Following purposeful sampling and informed consent of participants. Results Participated eight individuals. The need for enhancement of nurses' participation in decision-making in order for an actual change in their professional role to be achieved was the central theme of participants' narratives. Perceived advancements in professional role performance regarded: evidence-based practice; technology; education, knowledge; clinical skills; research; heightened nurse-physician collaboration. Perceived reasons why these advancements failed to enhance nurses' professional role were lack of meritocracy; competitive relationships; lack of support among nurses; insufficient managerial support; budget limitations. Conclusion Despite advancements in clinical practice, participants did not deem that their professional role was enhanced significantly, as participation in decision-making and control over practice remain limited. Interventions targeted to enhance nurses' participation in clinical decision-making, and overall professional autonomy are recommended.
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Affiliation(s)
- Maria Nk Karanikola
- Nursing Department, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | | | - Meropi Mpouzika
- Nursing Department, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - Christiana Nicolaou
- Nursing Department, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - George Tsiaousis
- Nursing Department, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - Foteini Vouzavali
- Nursing Department, Technological Educational Institute of Athens, Athens, Greece
| | - Anna Koutroubas
- Nursing Department, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
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Nissanholtz-Gannot R, Rosen B, Hirschfeld M. The changing roles of community nurses: the case of health plan nurses in Israel. Isr J Health Policy Res 2017; 6:69. [PMID: 29274639 PMCID: PMC5742261 DOI: 10.1186/s13584-017-0197-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 12/11/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Israel, approximately one-third of the country's nurses work in community settings - primarily as salaried employees in Israel's four non-profit health plans. Many health system leaders believe that the roles of health plan nurses have changed significantly in recent years due to a mix of universal developments (such as population aging and academization of the profession) and Israel-specific changes (such as the introduction of extensive quality monitoring in primary care). OBJECTIVES The main objectives of the study were to identify recent changes in the roles of health plan nurses and their current areas of activity. It also explored the experience of front-line nurses with regard to autonomy, work satisfaction, and barriers to further role development. METHODS The study integrated interviews and surveys of nurses and other professionals conducted across 4 years. Data generated from earlier study components were used to guide questions and focus for later components. In 2013, in-depth interviews were held with 55 senior nursing and medical professionals supplemented by interviews in mid-2017 with the head nurses in the four health plans. In addition, a national survey was conducted in 2014-5 among a representative sample of 1019 community nurses who work for the health plans and who are engaged in direct patient care. Six hundred ninety-two nurses responded to the survey, yielding a response rate of 69%. The survey sample consisted of an equal number of nurses from each health plan, and the observations were weighted accordingly. FINDINGS Senior professionals identified general themes associated with a shift in nursing roles, including a transition from reactive to initiated work, increased specialization, and a shifting of tasks from hospitals to community settings. They identified the current main areas of activity in the health plans as being: routine care, chronic care, health promotion, quality monitoring and improvement, specialized care (such as wound care), and home care. In the survey of front-line nurses, 38% of the nurses identified "caring for chronically ill patients" as their main area of activity aside from routine care; 30% did so regarding "health promotion", and 26% did so regarding "a specific area of specialization" e.g., diabetes, wound care or women's health). In response to a separate question, 77% reported "great" or "very great" involvement in quality measurement programs. Four out of five front-line nurses were satisfied with their work to a great or very great extent, and approximately three out of four of them (73%) felt that they had autonomy at work to a great or very great extent. About half of the nurses take into account, to a great or very great extent, the financial concerns of the health plans that employ them. A large majority of the nurses (85%) indicated that the nature of their work had changed substantially in recent years, with an increase in autonomy noted as one of the key changes. Perceived barriers to further role development include attitudes on the part of some physicians and nurses, an insufficient number of dedicated nursing positions, and insufficiently attractive wage levels. CONCLUSIONS The findings, gathered over 4 years, indicate alignment between universal and Israel-specific trends in health care and the evolving roles of nurses in Israel's health plans. The findings provide support for ongoing efforts in the health plans to give nurses more authority and responsibility in the management of chronically ill patients, a more central role in health promotion efforts, more advanced training - both inter-professional and nurse-specific, and more opportunity to focus on the roles and tasks that require nursing professionals.
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Affiliation(s)
- Rachel Nissanholtz-Gannot
- Department of Health System Management, Ariel University, University Hill, Ariel, Israel, 40700 and Myers-JDC-Brookdale Institute, JDC Hill, P.O.B. 3886, 91037, Jerusalem, Israel.
- Myers-JDC-Brookdale Institute, JDC Hill, P.O.B. 3886, 91037, Jerusalem, Israel.
| | - Bruce Rosen
- Myers-JDC-Brookdale Institute, JDC Hill, P.O.B. 3886, 91037, Jerusalem, Israel
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Scholze AR, Martins JT, Galdino MJQ, Ribeiro RP. Ambiente ocupacional e o consumo de substâncias psicoativas entre enfermeiros. ACTA PAUL ENFERM 2017. [DOI: 10.1590/1982-0194201700060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo Objetivo Analisar a relação entre o ambiente de trabalho e o consumo de substâncias psicoativas entre enfermeiros hospitalares. Métodos Estudo transversal e descritivo, realizado com enfermeiros de três instituições hospitalares públicas localizados em um município da Região Sul do Brasil, sendo duas de média complexidade e uma de alta complexidade. A população deste estudo foi composta por 221 enfermeiros. Com base nesse número, calculou-se o tamanho amostral por estratos, considerando-se a proporção de 50%, nível de confiança de 95% e erro máximo de 5%, o que resultou no número mínimo de 175 participantes. Mediante a estratificação proporcional por instituição definiu-se o mínimo de 103 enfermeiros da alta complexidade e 36 de cada instituição de média complexidade. Adotou-se como critérios de inclusão: trabalhar na instituição há pelo menos um ano e não estar afastado por licença. A coleta de dados foi realizada entre outubro de 2015 e abril de 2016. Na coleta de dados utilizaram-se informações sociodemográficas e ocupacionais, o Nursing Work Index - Revised e o Alcohol, Smoking and Substance Involvement Screening Test. Os dados foram analisados no programa Statistical Package for Social Sciences, versão 20.0. Inicialmente, verificou-se a normalidade pelo teste de Kolmogorov-Smirnov. Foram realizadas análises descritivas, por frequências absoluta e relativa para as variáveis categóricas; e medianas e medidas de dispersão para as numéricas. Resultados Álcool, tabaco e sedativos foram as substâncias mais consumidas. Renda mensal apresentou correlação positiva com o consumo de álcool entre enfermeiros dos hospitais de média complexidade (p=0,01). No hospital de alta complexidade, o consumo de álcool relacionou-se negativamente a relação médico-enfermeiro (p=0,03). Autonomia, relação médico-enfermeiro e suporte organizacional estiveram correlacionados negativamente ao uso de sedativos (p<0,01; p<0,01; p=0,02, respectivamente). Conclusão Quanto mais desfavorável o ambiente de trabalho do enfermeiro, sobretudo na relação com médicos, suporte organizacional e autonomia, maior foi o consumo de substâncias psicoativas.
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Interprofessional Barriers: A Study of Quality Improvement Work Among Nurses and Physicians. Qual Manag Health Care 2017; 26:63-69. [DOI: 10.1097/qmh.0000000000000129] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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