Do different types of nurses give different triage decisions in NHS Direct? A mixed methods study

Objectives: To determine whether nurses with different clinical backgrounds make different triage decisions in NHS Direct, the 24-hour telephone helpline staffed by nurses.

Methods: Mixed methods including semistructured interviews with 24 nurses and a multilevel analysis of 60 794 calls triaged by 296 nurses.

Results: Nurse accounts helped to identify nurse characteristics that might affect decision-making. The proportion of calls triaged to self-care was 40% (24 049/60 794), varying by individual nurse from a 10th centile of 22% to a 90th centile of 60%, after adjustment for the age and sex of the patient and the time of the call. Variability was partly explained by the length of clinical experience of nurses and the type of software used: nurses with more than 20 years clinical experience were more likely to triage callers to self-care than those with less than ten years experience (42% versus 36%, respectively; odds ratio = 1.41, 95% confidence interval 1.13, 1.78). Proportions triaged to self-care differed by the type of clinical decision support software used: 31%, 37% and 44%. There was no evidence that the clinical background of nurses (hospital or community), their length of experience in NHS Direct, the range of their experience, or their gender affected triage decisions. Interviews identified that nursing characteristics affected individual nurses in different ways and helped to generate a hypothesis for future research – that individual nurses' approaches to risk may influence triage decisions.

Conclusion: There is no likely benefit in narrowing nurse recruitment to particular clinical backgrounds. The appropriateness of triage decisions still needs to be evaluated.

Competency Skills Assessment: Successes and Areas for Improvement Identified During Collaboration Between Informaticists and a National Organization

The Association of periOperative Registered Nurses (AORN) approached the Nursing Informatics Research Team (NIRT) with a request to collaborate and conduct a competency assessment for their organization. An online tool was developed to determine current technology in perioperative settings. This presentation shares the process used to conduct research that led to a method for assessing perioperative nurses' competencies skills in their practice as well as identified gaps in curricula that faculty could address. Both successes and areas for improvement are detailed. The outcome of the process demonstrated a need to understand what skills are being assessed as AORN did not know what technology existed or how existing equipment was being used.

A Rasch Rating Scale Analysis of the Presence of Nursing Scale-RN

The phenomenon of nursing presence encompasses the emotional connection between nurse and patient, and technical skills performed by the nurse. The Presence of Nursing Scale-RN version (PONS-RN) was developed to measure nurses' perceptions of their ability to be present to their patients. This study summarizes the process of re-evaluation of the psychometric properties of the PONS-RN instrument. A sample of 76 registered nurses providing direct patient care responded to the 31-item questionnaire. The Rasch rating scale model was used for assessing construct validity of PONS-RN data. A principal component analysis (PCA) of residuals supported appropriateness of the subscales defined by a 2-dimensional structure. The results of item and person fit analysis, rating scale functioning analysis and reliability analysis have demonstrated that the thirty-one item Presence of Nursing Scale-RN instrument yielded measures with high validity and reliability as two sub-scales.

Caring for Older Adults With Complex Needs: Drafting an Interdisciplinary Team

Providing dental care for seniors with complex medical and/or social needs can seem daunting. Many dental providers may question their resources to manage such patients. However, many of these patients have teams in place that can be accessed to improve the efficacy and satisfaction in providing care to them. Seeking out patients' other health care providers, and understanding how to work effectively with them, is important to improve total patient care, comfort, function and dignity.

Exploring the links between macro-level contextual factors and their influence on nursing workforce composition

Research that links macro-level socioeconomic development variables to health care human resources workforce composition is scarce at best. The purpose of this study was to explore the links between nonnursing factors and nursing workforce composition through a secondary, descriptive analysis of year 2000, publicly available national nursing human resources data from Mexico. Building on previous research, the authors conducted multiple robust regression analysis by federal typing of nursing human resources from 31 Mexican states against macro-level socioeconomic development variables. Average education in a state was significantly associated in predicting all types of formally educated nurses in Mexico. Other results suggest that macro-level indicators have a different association with each type of nurse. Context may play a greater role in determining nursing workforce composition than previously thought. Further studies may help to explain differences both within and between countries.

Task shifting to non-physician clinicians for integrated management of hypertension and diabetes in rural Cameroon: a programme assessment at two years

BACKGROUND

The burden of non-communicable chronic diseases, such as hypertension and diabetes, increases in sub-Saharan Africa. However, the majority of the rural population does still not have access to adequate care. The objective of this study is to examine the effectiveness of integrating care for hypertension and type 2 diabetes by task shifting to non-physician clinician (NPC) facilities in eight rural health districts in Cameroon.

METHODS

Of the 75 NPC facilities in the area, 69 (87%) received basic equipment and training in hypertension and diabetes care. Effectiveness was assessed after two years on status of equipment, knowledge among trained NPCs, number of newly detected patients, retention of patients under care, treatment cost to patients and changes in blood pressure (BP) and fasting plasma glucose (FPG) among treated patients.

RESULTS

Two years into the programme, of 54 facilities (78%) available for re-assessment, all possessed a functional sphygmomanometer and stethoscope (65% at baseline); 96% stocked antihypertensive drugs (27% at baseline); 70% possessed a functional glucose meter and 72% stocked oral anti-diabetics (15% and 12% at baseline). NPCs' performance on multiple-choice questions of the knowledge-test was significantly improved. During a period of two years, trained NPCs initiated treatment for 796 patients with hypertension and/or diabetes. The retention of treated patients at one year was 18.1%. Hypertensive and diabetic patients paid a median monthly amount of 1.4 and 0.7 Euro respectively for their medication. Among hypertensive patients with ≥ 2 documented visits (n = 493), systolic BP decreased by 22.8 mmHg (95% CI: -20.6 to -24.9; p < 0.0001) and diastolic BP by 12.4 mmHg (-10.9 to -13.9; p < 0.0001). Among diabetic patients (n = 79) FPG decreased by 3.4 mmol/l (-2.3 to -4.5; p < 0.001).

CONCLUSIONS

The integration of hypertension and diabetes into primary health care of NPC facilities in rural Cameroon was feasible in terms of equipment and training, accessible in terms of treatment cost and showed promising BP- and FPG-trends. However, low case-detection rates per NPC and a very high attrition among patients enrolled into care, limited the effectiveness of the programme.

[Operating theatre and medical ward nurses: two different ways of perceiving one's organizational health]

BACKGROUND

It is widely recognized that the working environment is crucial in the genesis of stress and other disorders that may affect nurses' health. The specific job context and the tasks performed by nurses in different clinical settings can be positive or negative predictors of organizational health.

OBJECTIVES

The aim of this study was to describe and compare organizational health among nurses working in operating theaters and medical wards.

METHODS

For the study 670 nurses from six university hospitals in Italy were asked to participate and a total of 542 nurses constituted the final sample. The Nursing Organizational Health Questionnaire was used to collect the data and was administered from January to March 2010. A descriptive/comparative design was used.

CONCLUSIONS

The results showed that nurses assigned to medical wards perceived their working environment as healthy and were significantly more satisfied and had less psychosomatic complaints than their colleagues working in operating theaters.

Who attended the NI training programs in Taiwan?

We promoted the Nursing Informatics since 2002 and started to hold a variety of NI training programs and workshops since 2003. In the period of 2003-2006 more than 310 participants have attended 24 training programs. The majority of attendants were from clinical settings, especially medical centers, and from northern Taiwan in which healthcare resources are more sufficient. We observed the needs in clinical settings and imbalanced distribution of HIS resources.

Unit type differences in RN workgroup job satisfaction

Using cross-sectional data from the 2004 National Database of Nursing Quality Indicators (NDNQI) RN Satisfaction Survey, differences in RN workgroup job satisfaction were examined among 10 unit types--medical-surgical, step-down, critical care, pediatric, maternal-newborn, psychiatric, emergency department, rehabilitation, surgical services, and outpatient clinics and labs. The national sample included RN workgroups in 2,900 patient care units (55,516 RNs; 206 hospitals in 44 states). Workgroup satisfaction across all unit types was moderate. RN workgroups in pediatric units were the most satisfied, whereas those in surgical services and emergency department unit types were least satisfied. A consistent finding across all unit types was high satisfaction with the specific domains of nurse-to-nurse interaction, professional status, and professional development versus much lower satisfaction with task, decision making, and pay. Findings can be used to inform and develop investigations that examine specific aspects of the work environment for RN workgroups in various unit types.

Impact of reproductive experience on women's smoking behaviour in Japanese nurses

OBJECTIVES

The objectives of this study were to describe current and past smoking behaviour of female Japanese nurses, to examine factors associated with developing and stopping a smoking habit, and to examine how their reproductive experiences affect their smoking behaviour.

STUDY DESIGN

A cross-sectional study. This study was a baseline survey of a prospective occupational cohort study.

METHODS

A self-administered survey of 1748 female Japanese nurses aged over 20 years was conducted in Gunma prefecture, Japan, in 1999.

RESULTS

Overall, 27.2% developed a smoking habit (current smokers, 19.8%; ex-smokers, 7.4%) and 72.2% were never smokers. Logistic regression analysis showed that the type of nursing certificate was statistically associated with developing a smoking habit. It also showed that the type of nursing certificate, work place, marital status and current pregnancy were statistically associated with smoking cessation. Currently pregnant women were more likely to stop smoking than non-pregnant women (adjusted odds ratio, 3.18; 95% confidence intervals, 1.25-8.06). For women aged 20-29 years, the proportions of current smokers, ex-smokers and never smokers among pregnant women were 11.5, 23.1 and 65.4%, respectively; among non-pregnant women of this age, the values were 22.3, 4.3 and 73.4%, respectively. There was a statistically significant difference in such proportions between the two groups (chi2=19.27; P<0.0001). More than half of the ex-smokers who were currently pregnant had stopped smoking in the last 12 months. Smoking behaviour showed no statistically significant difference between women who had had at least one delivery and women who had not.

CONCLUSIONS

The results suggest that pregnancy provides a good opportunity for smoking cessation, but a large proportion of women who successfully quit smoking during pregnancy relapse after delivery.

[Comparison between the psychophysical scale methods for magnitude estimation and category estimation of nurses' social perception]

This experiment aimed to rank nurses' social perception through the magnitude and category estimation methods. Study participants were high school and university students, active and retired professionals in the areas of medicine, psychology, nursing and dentistry. The results showed: (1) the characteristics neat, responsible, clean, careful and efficacious occupied the first positions in terms of nurses' social perception; whereas the characteristics useless, dishonorable, irresponsible and hateful occupied the last positions in the scales obtained by the two direct psychophysical methods, and (2) the non-metric social perception continuum has prosthetic characteristics.

Classifying general and specialist children's nursing competencies

BACKGROUND

Whilst there is evidence in the literature to support the continuation of a children's nursing qualification, the distinction between generalist and specialist nursing is insufficiently comprehensive to distinguish children's nursing from other branches of nursing.

AIM

To develop a definition of children's nursing and specialist children's nursing in terms of competencies as the basis for differentiating them from other forms of nursing.

DESIGN

A multi-method comparative design incorporating a case study approach was used. This included a nominal group technique, focus groups, Delphi survey and semi-structured interviews. Two arms of data collection were undertaken concurrently (during 1998-2000) with children's nurses (n = 146) and specialist children's nurses (children's cancer nurses, n = 37) from a number of centres in the United Kingdom (UK).

FINDINGS

The holistic competencies developed from the data exposed characteristics of knowledge, skills, abilities, values and qualities displayed in the context of professional work for both groups of nurses. A classification of competencies was developed inductively from the data by two independent researchers through the labelling, defining and ordering of competencies. The resulting hierarchy of competencies and sub-competencies illustrates relationships between children's nurses and specialist children's nurses and provides a detailed definition of children's nursing and specialist children's nursing.

CONCLUSION

There is a significant common element in these two areas of nursing practice, and generalist preparation in children's nursing is the foundation of specialist children's nursing practice. Generalist knowledge and skills are expanded in specialist practice and there is also evidence of specialist practice that is beyond the scope of general nursing practice.

Generational Diversity-The Nexters

For the first time in recent history, the workforce includes four generations of employees--Veterans, Baby Boomers, Generation Xers, and Nexters. These generations share some common values and beliefs, but they also exhibit differences stemming from the experiences of their eras. Understanding and appreciating these differences will help decrease generational conflict and support all generations in welcoming diversity. The Nexter generation includes more than 81 million people, approximately 30% of the current population. Nexters will enter the workforce in large numbers and will influence changes in the work environment just as Baby Boomers did.

Age, developmental, and job stage influences on nurse outcomes

This descriptive study surveyed 412 nurses in three hospitals and found that older nurses and nurses in more mature developmental stages showed greater job satisfaction, productivity, and organizational commitment. Job stages of entry, mastery, and disengagement were examined, and 24% of nurses reported being disengaged from their jobs, with lower satisfaction and commitment. Implications include the compelling need for nurses and organizations to do career planning together to avoid disengagement of nurses so critical to patient and organizational outcomes.

Job stages of entry, mastery, and disengagement among nurses

OBJECTIVE

To examine the phenomenon of job stages, particularly entry, mastery, and disengagement; to identify predictors of each stage; and to determine when disengagement occurs among nurses.

SUMMARY BACKGROUND DATA

Job or career stages have been conceptualized as an aspect of growth and development and also career growth and change. Graham identified job stages of entry, mastery, and disengagement and theorized that stages are related to time on the job, skill development, and attitudes. They are levels of identification of the self and ego with the job environment. Studies on burnout as well as hardiness were also examined because of their possible relations with job stages.

METHODS

This descriptive survey queried 412 RNs, selected by random sample from three hospitals, to determine their job stage. Demographic characteristics, role, years as a nurse, years in this hospital, years in this job, and job satisfaction, productivity, and organizational commitment were also measured. Data analyses provided frequencies and percentages, and logistic regression was performed to identify predictors of each job stage.

RESULTS

Forty-eight (13%) nurses reported being in the entry stage; 224 (62%) nurses were in mastery. Mastery was predicted by several variables, including U.S. education (negative) and organizational commitment (positive). Eighty-seven (24%) nurses reported being in disengagement, and this was predicted by years in this job and negatively predicted by organizational commitment.

CONCLUSIONS

Strategic planning for mastery and avoidance of disengagement were discussed, and implications for administrators and the profession were presented.

Nursing supply and characteristics in the nonmetropolitan areas of the United States: findings from the 1988 National Sample Survey of Registered Nurses

This study examines the supply and selected characteristics of nurses working in nonmetropolitan areas of the United States using the most recent data reported in the third national sample survey of registered nurses in 1988. Nursing supply is analyzed in terms of the ratio of registered nurses per 100,000 people for three standard nonmetropolitan census county size classifications and nine regional groupings of states. Seven dimensions relating to the educational background and current professional characteristics of registered nurses are studied. Findings indicate a notable difference in the ratio of nurses per population across county size and regions of the country. In terms of characteristics selected for this study, the educational background, salary gap, and time spent in various activities differentiate nurses in rural areas from those working in urban counties. Results of this study should be particularly relevant because a variety of educational, financial, and other incentives are being considered to address what is perceived to be a crisis in rural nursing availability.

Returns to nursing education: rural and nonrural practice

This study uses data from a national sample of registered nurses to compare earnings of nurses in rural and nonrural practice. The comparisons, conditioned by the nurses' education level, are analogous to the concept of "returns to human capital investment" used in labor economics. A general linear model is applied within a framework of labor economics analysis. Results show that nurses with more education receive less for their investment if they practice in rural areas. Work experience and employment setting are also related to lower annualized earnings for rural practice. One exception to the otherwise consistent findings is that returns to advanced practice nursing are higher in rural areas. Results and policy implications are discussed.

The national Healing Web partnership. An innovative model to improve health

The authors describe the Healing Web, a partnership between nursing service and education that encourages the best use of nurses education clinical experience and personal competencies. Based on differentiated practice and education of nursing students in multi-level roles the Healing Web partnership is demonstrating at multiple institutions, that education and nursing service can work collaboratively to position the profession of nursing for maximum effectiveness in the 21st century.

Professional classifications of American nurses, 1910 to 1935

Nursing's claim to professional status is debatable. The purpose of this historical study is to describe the official classifications of American nurses as professionals or nonprofessionals, from 1910 to 1935. Labor legislation before World War I, military decisions during that war, and federal mandates during the Great Depression resulted in differing professional classifications of nurses. Although nurse leaders aspired to traditional criteria of professionalism, such as individual responsibility and a deep, distinct body of knowledge, these criteria were subsumed by political, financial, and gender issues. This study demonstrates that professional status cannot be assured by attainment of professional criteria alone, but is defined by more diverse and complex issues.

Perioperative nurses' attitudes toward continuing education

The primary purpose of this study was to determine perioperative nurses' attitudes toward continuing education (CE) and selected demographic variables. The researcher developed and administered a Likert-type questionnaire to perioperative nurses. The first part of the questionnaire related to demographic variables, length of service at the facility as a registered nurse, and certification status. The second part of the questionnaire was a 30-item attitude scale related to perioperative nurses and CE. The null hypothesis was analyzed using a t-test at a .05 level of significance. Study findings revealed no differences in attitudes toward CE between certified perioperative nurses and noncertified perioperative nurses.

Breaking with tradition: the new groups in professional nursing

Chronic shortages of registered nurses (RNs) have stimulated interest in locating non-traditional sources of RNs. A statewide survey of 2,315 newly graduated RNs compared three non-traditional groups in nursing with their traditional counterparts, identifying differences that have implications for successful recruitment and retention. Second career nurses, former LPNs and minorities comprised 41.9% of the population. Compared to the traditional groups, more second career nurses, former LPNs and some minority groups were older, married and had children. Second career vs. first career nurses placed less emphasis on selecting schools at the highest levels of academic quality, holding out for the most lucrative jobs or working with the most "interesting" patients (i.e., the acutely ill). Former LPNs, compared to other RNs, placed greater value on easy access to schools and jobs. Compared to whites, minority RNs were more inclined to value nursing's socioeconomic rewards. However, compared to non-Asian minorities in nursing, Asian RNs had higher expectations for professional advancement and were less altruistic. Our results indicate that several of the new groups view nursing less as a "calling," finding the field appealing for practical socioeconomic reasons and accessibility.

Temporary alien workers seeking classification under the Immigration and Nationality Act--Immigration and Naturalization Service. Final rule

This final rule implements provisions of the Immigration Act of 1990 (IMMACT). Public Law No. 101-649, November 29, 1990, and the Armed Forces Immigration Adjustment Act of 1991. Public Law No. 102-110, October 1, 1991, as they relate to temporary alien workers seeking nonimmigrant classification and admission to the United States under sections 101(a)(15) (H), (L), (O), and (P) of the Immigration and Nationality Act (Act), 8 U.S.C. 1101. This rule also contains technical amendments which reflect the Service's operating experience under the H and L classifications. This rule will conform Service policy to the intent of Congress as it relates to these classifications, implement new nonimmigrant classifications and requirements established by Public Law 101-649 and Public Law No. 102-110, and clarify for businesses and the general public requirements for classification, admission, and maintenance of status.

Entry: a new approach

Despite all of the protections promised through grandfathering and pathways to educational mobility, the entry movement tends to be perceived by many to be "demoting" the lives and livelihoods of hundreds of thousands of RNs who do not possess the education to meet the proposed standard. Here is a proposal for a way out of the quagmire.

Nursing: just a job? Do statistics tell us what we think?

This study considers the value of classifying attitudinal statements given by nurses in a questionnaire by the statistical procedure of latent class analysis. It demonstrates with the use of qualitative data derived from in-depth interviews how precarious are the groups derived from statistical analysis. However, it is argued that the apparent discrepancies between responses 'objectively' derived by a statistical approach and those 'subjectively' declared by respondents may focus on different levels of meaning and may well provide a useful resource. Most importantly, it is stressed that a dynamic model is needed which recognizes change and the consequences of change.

Differentiated nursing practice: concepts and considerations

Those institutions that have implemented differentiated practice based on clinical competency have increased nursing staff retention and reduced recruitment costs. Less demonstrable are very real improvements in patient safety and care.