The Nurses who Specialise in Savings

Specialist nurses are far from just the 'icing on the cake' - in inflammatory bowel disease alone they are consistently preventing emergency attendances and ensuring the most appropriate use of services.

A passport to better care

Having worked as a healthcare assistant (HCA) for almost 20 years, Lorraine Ramnath found training to become a nurse at the Open University gave her a new insight into patient care.

£2.5m for specialist nurses in Scotland

An online campaign has helped secure an additional £2.5 million for specialist nurses in Scotland and double the number of nurses caring for patients with motor neurone disease.

Clinical nurse specialist - a serious shortfall in numbers

There is a shortage of between 120 and 214 multiple sclerosis (MS) specialist nurses in the UK and some have caseloads of almost double the recommended number of patients.

The case for renewed investment in the district nursing specialist practitioner qualification

District nursing as a profession has been under significant threat over the last few years due to a lack of foresight and funding, resulting in an undervalued and underinvested workforce. The once-heralded specialist practitioner programme was slowly decommissioned in all but a handful of universities, leaving no alternative but for community trusts to employ staff nurses in team leader roles without the development the added qualification gave them. In light of the renewed focus on the fundamental advancement of district nurses and recent Government publications clearly reinforcing the district nurse's role, this article argues for the need for educational commissioners and workforce planners to commit to continued investment in this vital profession.

[Hypnotherapist nurse, a speciality to promote]

Rémi Etienne is a nurse. Since 2007, he has been working in a cancer centre. Having taken a training course in hypnosis, he offers, in addition to his nursing practice, hypnosis as a form of pain relief.

The research and policy importance of nursing sample surveys and minimum data sets

This article reviews the information gathered by the National Sample Survey of Registered Nurses (NSSRN) and other sources of data on the registered nurse (RN) workforce. It examines how the data have been used to create knowledge about the RN workforce and highlights the relative strengths and weaknesses of different data sets. Recommendations for future data collection affirm the Institute of Medicine's recommendation that both license-record based minimum data and the NSSRN be collected in order to help the United States and states meet current and future nursing needs.

Specialist nurses for older people: implications from UK development sites

AIM

This paper is a report of a study to explore the development of specialist staffing for older people in six case study sites in the United Kingdom.

BACKGROUND

In the United Kingdom there has been some concern about the health care available to older people, leading to the development of a National Service Framework. A key theme of this framework is the development of specialist staff skilled in providing services tailored to the needs of older people.

METHOD

A soft systems methodology was used in 2004-2005 to carry out interviews with key people, including specialist nurses for older people, other service providers, patients and informal carers (n = 132) in six case study sites identified from a national questionnaire. Interviewees were asked to describe their perceptions of the development, its history and its impact.

FINDINGS

The development of specialist nursing services seemed to be shaped by national policy drivers for service development, which may not have been directly linked to the needs of older people. The ideal qualities of a specialist nurse for older people were described by participants as including not only knowledge and skills, but also personal characteristics.

CONCLUSION

While progress has been made in establishing specialist posts, much remains to be explored about the roles of postholders, the qualities needed, and the support and preparation required. While advanced practice is a professional aspiration, a number of questions arise about the development of nursing as a self-directing profession in diverse international settings. Theories of specialist nursing practice also need to address the tensions between universal and local models and to consider theories about nursing older people.

Factors influencing female registered nurses' work behavior

OBJECTIVE

To analyze factors that are related to whether registered nurses (RNs) work (WK) or do not work (NW) in nursing; and if the RN works, whether she works full- (FT) or part-time (PT).

DATA SOURCES

Secondary data from National Sample Survey of Registered Nurses 2000 (NSSRN), the InterStudy Competitive Edge Part III Regional Market Analysis (2001), and the Area Resource File (2002).

STUDY DESIGN

Using a cross-sectional design we tested the relationship between WK or NW and FT or PT; and demographic, job-related, and metropolitan statistical area (MSA)-level variables.

DATA COLLECTION/EXTRACTION METHODS

We combined the data sources noted above to produce the analytic sample of 25,471 female RNs.

PRINCIPAL FINDINGS

Working in nursing is not independent of working FT or PT. Age (55 and older), other family income, and prior other work experience in health care are negatively related to working as an RN. The wage is not related to working as an RN, but negatively influences FT work. Age, children, minority status, student status, employment status, other income, and some job settings have a negative impact on working FT. Previous health care work has a positive effect on whether married RNs worked. Married RNs who are more dissatisfied are less likely to work FT. A greater number of market-level factors influence FT/PT than WK/NW behavior.

CONCLUSIONS

An important contribution of this study is demonstrating that MSA-level variables influence RN work behavior. The market environment seems to have little effect on whether a nurse works, but is influential on how much the nurse works, and has differential effects on married versus single nurses.

Advanced nurse roles in UK primary care

Nurses increasingly work as substitutes for, or to complement, general practitioners in the care of minor illness and the management of chronic diseases. Available research suggests that nurses can provide as high quality care as GPs in the provision of first contact and ongoing care for unselected patients. Reductions in cost are context dependent and rarely achieved. This is because savings on nurses' salaries are often offset by their lower productivity (due to longer consultations, higher patient recall rates, and increased use of tests and investigations). Gains in efficiency are not achieved when GPs continue to provide the services that have been delegated to nurses, instead of focusing on the services that only doctors can provide. Unintended consequences of extending nursing roles include loss of personal continuity of care for patients and increased difficulties with coordination of care as the multidisciplinary team size increases. Rapid access to care is, however, improved. There is a high capital cost involved in moving to multidisciplinary teams because of the need to train staff in new ways of working; revise legislation governing scope of practice; address concerns about legal liability; and manage professional resistance to change. Despite the unintended consequences and the high costs, extending nursing roles in primary care is a plausible strategy for improving service capacity without compromising quality of care or health outcomes for patients.

Nurse Dose as a Concept

PURPOSE

To describe the concept of Nurse Dose.

METHODS

The concept of nurse dose has been identified from decades of clinical research as a concept essential in the delivery of safe and high quality health care. The components of nurse dose were conceptualized through review of the literature from nursing, medicine, and health services research.

FINDINGS

Nurse dose is conceptualized as having three equally essential components: dose, nurse, and host and host response. Dose in the macro view includes the number of nurses per patient or per population in cities, states, regions, or countries. Dose in a micro view includes the amount of nurse time and the number of contacts. The nurse component consists of the education, expertise, and experience of the nurse. Host is represented by an organization and its characteristics (culture, autonomy, practice control) in a macro view and by the patient and characteristics (beliefs, values, culture) in a micro view. Host response includes response to the autonomy and acceptability of the nurse.

CONCLUSIONS

Greater nurse dose has been associated with decreases in patient mortality, morbidity, and healthcare costs.

Recruiting and training senior nurses using a rotational model

In order to tackle some of the recruitment and retention issues in 'hard-to-fill' community posts such as district nursing, Croydon Primary Care Trust tested a community rotational model. This article addresses some of the issues raised by the participants in the first wave of recruits. New and innovative ways of recruiting and retaining staff are needed in the present employment climate in order to meet the changing needs of clients and service provision (Newman et al, 2002). Planning and developing a vision for health and social care requires a strategy that supports individual development as well as the rapid development of the skills, knowledge and experience required to function in today's demanding clinical.. environment (Forbes et al, 2001).

The effect of state laws on the supply of advanced practice nurses

This paper considers how the decision to enter advanced practice nursing (e.g., the occupations of nurse practitioner, certified nurse-midwife, nurse anesthetist, and clinical nurse specialist) is affected by State laws on the scope of practice of APNs. We find that enrollments in APN programs are 30 percent higher in States where APNs have a high level of professional independence. Our work differs from previous studies by estimating a fixed effects model on cross-sectional and time series data, to avoid problems of endogeneity of State laws.

The practice of certified community health CNSs

PURPOSE/OBJECTIVES

This study explored the practice of clinical nurse specialists (CNSs) certified in Community Health nursing in the United States and described demographic and employment characteristics and perspectives about professional practice.

METHODS

The survey method was used. Of the 209 Community Health CNSs certified by American Nurses Credentialing Center (ANCC) invited to complete the investigator-designed mail questionnaire, 111 (53%) returned a completed questionnaire. The questionnaire contained 27 items about employment, income, years in practice, certification, career satisfaction, and educational preparation, and asked participants to indicate the fit between the Community Health CNS role and the traditional CNS subroles model described by the American Nurses Association (ANA) (The Role of the Clinical Nurse Specialist, 1986) and the updated National Association of Clinical Nurse Specialists (NACNS) CNS practice model (Statement on Clinical Nurse Specialist Practice and Education, 1998). Content validity was established by Community Health CNS reviewer feedback.

ANALYSIS

Quantifiable data were tallied and analyzed using standard spreadsheet computer software. Qualitative data were summarized for content themes.

FINDINGS

The majority of participants were white, middle-aged females who reported being satisfied with their careers as Community Health CNSs. Most indicated that they were respected by colleagues, that they had been adequately prepared by their education, and that their current work made good use of their education and expertise. When asked to identify, by percentage of effort, the fit between their job responsibilities and the traditional subroles model of practice, the mean of reported fit was as follows: educator, 35%; administrator/leader, 22%; clinician, 21%; consultant, 14%; and researcher, 8%. The fit between job responsibilities and the spheres of influence in the NACNS model of practice was reported to average 39% for patient/client, 35% for organization/network, and 25% for nurses/ nursing practice.

CONCLUSIONS

Community Health CNS is a viable specialty practice with long-term career options. The subrole functions-described by ANA-of clinician, educator, administrator/leader, consultant, and to a lesser extent researcher apply to the role. The more intergraded updated model offered by NACNS also fits Community Health CNS practice with more emphasis on patient/client and organization/ network spheres than on nurses/nursing practice sphere.

IMPLICATIONS

Schools of nursing should continue to offer the Community Health CNS programs and incorporate both the traditional functions and newer practice model into their curricula, with a greater emphasis on diversity of students to help ensure a more diverse CNS population. Further research is needed to explore the outcomes of Community Health CNS practice and the factors that contribute to role satisfaction.

Advanced practice psychiatric nurses as a treatment resource: survey and analysis

Access to behavioral health services, particularly pharmacotherapy, continues to be a significant problem. This is particularly the case for public sector beneficiaries and managed care members. The greater use of advanced practice psychiatric nurses (APPNs) with prescribing privileges could help. To better understand the availability and competence of APPNs to prescribe, the authors conducted 1) a national survey of APPNs' availability and prescribing practices, 2) a comparative analysis of pharmacy claims data generated by APPNs and psychiatrists, and 3) a comprehensive clinical record review comparing APPNs to psychiatrists. About 25% of the sample of APPNs reported having prescription authority and a private practice. The analysis of prescribing practices between APPNs and psychiatrists showed that with a few exceptions, there were no differences between the groups, as did a retrospective clinical record review. These results lead the authors to recommend greater efforts to increase the supply of APPNs.

Nurses' altered conceptions of work in a ward with all-RN staffing

1. The aim of this study was to investigate how nurses' conceptions of their patients and work changed after reorganization to all RN-staffing and the adoption of a patient-in-focus philosophy on the ward. 2. The study builds on the perspective that the individual's conception of work precedes and forms the basis for the development of knowledge, skills and attributes used in accomplishing work. 3. The findings are based on a secondary analysis of two open interviews with 22 nurses on the ward. These interviews were conducted on two occasions with an interval of 2 years. The third interview was carried out 6 months later, when 10 nurses were asked to talk about a patient's care episode in a narrative form. 4. The nurses' conceptions changed towards a holistic view of the patient, they developed a new approach to work and they used the altered circumstances in their work.

The 1990s and beyond: determining the need for community health and primary care nurses for rural populations

Increased numbers of primary care and advanced practice nurses with unique generalist skills will be required to meet the accelerating physiologic and sociocultural health care needs of rural populations. Several factors have been identified that will influence the demands and position of community-based nurses in rural practice settings during the next decade. A back-to-basics type of health care offered out of a growing elderly population; technological breakthroughs that make it possible for more chronically ill patients to live at home; serious substance abuse and other adolescent problems; AIDS; and high infant morbidity and mortality statistics are only some of the concerns that will demand nursing intervention. These changes speak to the need for improved nursing coordination, stronger collegial relationships, and better communication between physicians and nurses. Health care is moving in new directions to offer more efficient and technologically sophisticated care. These changes enhance the need for clinically expert educators who teach and jointly practice in programs with a rural focus. Telecommunications, and heightened computer literacy, will play a major role both in nursing education and clinical practice. The goals of kindergarten through 12th grade health promotion and disease prevention strategies in school health will be the norm and will require better prepared, and positions for, school nurses. More midwives and public health nurses will be needed to care for the growing population of sexually active adolescents who are in need of family planning and prenatal care. Underinsured and indigent populations will continue to fall within the purview of midlevel practitioners, as will providing anesthesia services in small rural hospitals. The transition of some rural hospitals into expanded primary care units (e.g., EACHs and RPCHs), and new models of case management will greatly influence nursing demands. This paper will further identify critical areas of advanced practice nursing within community settings, including new relationships with other health care providers, and will introduce strategies upon which rural health policy recommendations for the 1990s can be addressed.