Supporting students in practice

This article reports a project aiming to assess the effectiveness of clinical nurses employed in support roles for students in clinical practice in one UK higher education institution and its linked NHS Trusts. Focus groups and telephone interviews were used to collect data from the clinical support nurses themselves, senior nurse managers and pre- and post-registration students. Findings show that personal commitment to the role was high and that these support staff made a valuable contribution to up-to-date clinical input into classroom teaching. Managers also valued the university-clinical link role fulfilled by these staff. Students had mixed opinions, pre-registration students having had little exposure to this kind of support and post-registration students often not regarding clinical support as necessary because of their own existing clinical experience and expertise. For clinical support staff themselves, the role was a busy one and they often experienced conflict and role overload in balancing the education and clinical sides of their work. Necessary improvements for functioning of the roles were identified, including having regular meetings between university and NHS managers and support teachers for liaison purposes, joint appraisal, and formal support mechanisms for role occupants. The overall conclusion drawn is that the roles were successful in bridging the theory-practice gap for the University and NHS Trust managers, but less so for students, and that they did this at some personal cost for role holders.     

Nurse leaders' views on clinical ladders as a strategy in professional development

AIM: To investigate nurse leaders' views on clinical ladders as a strategy in professional development of nursing. BACKGROUND: Hospitals worldwide have implemented clinical ladders to boost professional development and improve quality of patient care. At ward level good leadership is vital in creating a learning environment and using nurses' new competence. METHOD: The design was explorative and data were collected in focus groups with 19 nurse leaders at the ward level and 24 executive nurse leaders at hospitals with several years of experience with clinical ladders. RESULTS: Most nurse leaders did not think strategically in promoting clinical ladders at the organizational level. Nurse leaders who considered clinical ladders a tool in developing nursing quality found motivational work challenging and rewarding. Not all nurse leaders managed to utilize clinical specialists' new competence. CONCLUSION: Further investigation into nurse leaders' actions as strategic managers of development and use of nurses' competence is warranted. Implications for nursing management It is important that managers see the close connection between professional development of individuals and development of quality and high standard in the ward. A prerequisite is therefore to engage in the strategic planning of competence at all levels of decision in the organization.     

护士角色职责的研究进展

综述了护士角色职责的基本概念,从角色职责和职业价值观两个方面阐述了国内外学者对护士角色职责的认识,总结不同时期、不同国家、不同地域的人群所认同的角色职责,为护理人员及护理管理者更全面的认识自己的角色定位提供依据。     

Nurse‐led intermediate care: an opportunity to develop enhanced roles for nurses?*

BACKGROUND: Nurse-led intermediate care units are being set up across the UK primarily as potential solutions to hospital bed crises. AIMS: This paper draws on data collected as part of a comprehensive evaluation of one 10-bedded nurse-led unit (NLU) located in the South of England. It explores the potential for enhanced nursing roles provided by such units by focusing on the views of NLU nursing staff and other professional groups within the Hospital Trust where the unit is located. METHODS: A total of 38 in-depth audio-taped qualitative interviews were conducted with NLU nursing staff and with a range of other professional groups (managers, acute ward nurses and doctors). FINDINGS: These data indicated that models of nurse-led postacute care do provide opportunities for nurses to develop enhanced nursing roles in which care associated with concepts of therapeutic nursing can be provided. However, even though the nurses derived satisfaction from their work on the NLU this model of care was seen by junior and middle grade nurses and other professional groups as being of low status. In contrast to senior nurses' views, they did not equate work on the NLU with the continuing professionalization of nursing. Senior nurses viewed the route to developing nursing on the NLU as involving nurses as doctor substitutes (extended roles) rather than as working in separate but complementary therapeutic domains (enhanced roles). CONCLUSIONS: NLUs provide opportunities for nurses to develop enhanced roles in which they can work autonomously in providing elements of therapeutic nursing aimed at improving patient outcomes at discharge. However, education, training and leadership will be needed to ensure that such opportunities are well understood and are optimized to the benefit of nurses and their patients.     

Staff nurses' perceptions of supernumerary status compared with rostered service for Diploma in Nursing students

BACKGROUND/RATIONALE: In the Republic of Ireland, the amount of clinical teaching expected of staff nurses has increased substantially in the wake of the transfer of nursing education to universities, and the advent of supernumerary status for students. A modicum of previous research noted that staff nurses are unclear about their role in relation to facilitating the clinical learning of supernumerary students. AIMS OF THE PAPER: To explore staff nurses' perceptions of their role in the facilitation of learning for university-educated diploma students in the clinical area and their attitudes towards these students. DESIGN/METHODS: Sixteen staff nurses were interviewed in depth using semi-structured interviews. Data were analysed qualitatively, using content analysis, with the help of the software package NUD*IST. FINDINGS: Among the central themes to emerge, upon which this article is focused, was participants' perceptions of supernumerary status compared with rostered service for diploma students. Data suggested that the rostered status of students was generally favoured by staff nurses over and above supernumerary status because, unlike supernumerary students, rostered students did not disrupt the existing social structure within the clinical setting. Both structuration theory and role theory are drawn upon to explain the reproduction of the prevailing social structure, where the concentration is on getting through nursing work with little emphasis on the supervised learning of supernumerary students. STUDY LIMITATIONS: This study is constrained by eliciting only the views of staff nurses. Further studies are required of student nurses' experiences of rostered service and supernumerary status. CONCLUSIONS: Because staff nurses are part of the system within which they work, they need to modify their role to include active student teaching as a legitimate component of that role.     

Charge nurses as front-line leaders: development through transformative learning

Based on the results of a staff satisfaction survey, nurse leaders recognized that the role of charge nurse was a significant source of dissatisfaction. Little attention had been paid to how the charge nurse role was learned, and no organizational support was offered to develop nurses for this role. Collaborating with a nurse educator consultant, nurse managers developed and implemented a three-part educational program to reframe staff perceptions of the charge nurse role. Centered on principles of transformational learning, the program evaluation demonstrated that concerted efforts to improve staff satisfaction and effectiveness could be accomplished if staff were given new information and guided through focused discussion and reflection. Eighty-two percent of the attendees noted that they appreciated the time allocated for the sessions and acknowledged that this gave them an opportunity to examine their thoughts and feelings. Seventy-five percent said that they learned new words to describe and explain their experiences. After the sessions, staff described a new sense of professional pride and nurse managers observed greater confidence in nurses' decision making and assertive communication.     

Promoting evidence-based practice: the roles and activities of professional nurses' associations

AIM: This paper reports a study exploring the role perceptions and current activities in evidence-based practice promotion of professional nurses' associations in the Netherlands. Background: The promotion of evidence-based practice contributes to professional standards in nursing and good quality care for patients. As professional nurses' associations can be key players in this process, the nature of their roles and current activities deserves to be explored. METHODS: Roles and activities were explored for 43 professional nurses' associations (83% of all national associations). Data were collected using interviews with the associations' board members. Findings from the interviews were validated with those from an analysis of the associations' policy reports and other publications in the previous 2 years. RESULTS: Board members primarily thought that they had roles in the selection and distribution of evidence. The roles of participant (n = 13) and performer (n = 13) in selecting evidence, and those of facilitator (n = 12), initiator (n = 15) and performer (n = 41) in the distribution of evidence were often addressed. A few respondents reflected on roles in generating evidence and implementing evidence-based practice in patient care. A majority of the associations was contemplating activities in the promotion of evidence-based practice. Specific activities for each of six relevant aspects in the promotion of evidence-based practice were found in fewer than five associations. CONCLUSION: Professional nurses' association roles in the promotion of evidence-based practice need to be viewed in relation to the tasks to be accomplished, especially those of selecting and distributing evidence. Although many organizations expressed motivation, professional nurses' associations have a long way to go in the promotion of evidence-based practice among their members.     

Nurses' experiences of continuing professional development

Continuing professional development is regarded as part of the nursing role in the National Health Service. Health policy in the United Kingdom is built on the assumption that nurses' roles can be extended through continuing professional development which is also considered to be a key factor in nursing retention. Previous research has considered the provision of learning mainly from the perspective of managers and education providers. The purpose of this paper is to explore nurses' experiences of continuing professional development. The results presented in this paper form part of a larger survey (n=451, response rate=64.9%) designed to examine opportunities for continuing professional development and factors encouraging and discouraging uptake. An unexpectedly high number of respondents (n=125, 27.7%) commented extensively on their personal experiences of continuing professional development. These comments were analysed inductively. Five main themes emerged: who and what is continuing professional development for?; accessing continuing professional development; one size does not fit all; managing work, life and doing continuing professional development; and making the best of continuing professional development. Most responses were positive, but the demands of taking courses were perceived to encroach on life outside work, especially the need to complete lengthy assignments. Managers were perceived to operate as the gatekeepers to course admission and opportunities to implement new knowledge and expertise. No comments were received concerning the role of education staff in continuing professional development.     

Improving organizational performance. Administrative nurse specialist

The Executive Nurse Council was challenged to develop strategies designed to empower staff nurses and nurse managers and create opportunities for professional growth. Implementation of these strategies resulted in broad-sweeping changes in roles and functions of groups and individuals at all levels of the organization. The authors describe a support role, administrative nurse specialist, designed to support staff and managers striving to actualize changes in a shared governance framework.     

Ward management: education for senior staff nurses

The key professional challenges for senior staff nurses relate to managerial rather than clinical issues, but there appears to be a lack of educational preparation for the managerial roles expected of them. An educational service was developed, implemented and evaluated in a specialist paediatric unit to address senior staff nurses' concerns related to managerial aspects of their role. An organisational development model was used to negotiate a work-based learning programme that incorporated practice competencies. This was undertaken at an Agenda for Change implementation site, which enabled the Knowledge and Skills Framework (KSF) to be trialled in practice. The educational programme was evaluated positively and practice competency evaluations highlighted how the KSF dimensions provided a usable and relevant breakdown of managerial and leadership issues. The framework provided a professional development tool for staff wishing to progress their managerial knowledge and skills while under supervision.     

广州市护士职业情感现状及其相关因素分析

目的探讨广州市护士职业情感现状及其影响因素。方法采用方便抽样和问卷调查的方法对广州市各级医院工作1年以上的在职护士进行调查。结果87．7％的护士具有积极的职业情感,表现为比较热爱护理专业,工作责任心普遍较强, 改行的决心极小,但感到自身社会地位呈中等偏低水平。多元回归分析表明,护士的职业情感与家人的支持度、工龄、按职上岗呈正回归,与从业志愿、学历呈负回归。结论广州市护士具有积极的职业情感,认为家人的支持、尊重护生入学志愿、实施按职上岗、发挥高学历护士的优势、护理管理及护理教育者进一步采取有效措施,能进一步提高护士的职业情感。     

The Perceptions of Ontario Radiation Therapists and Their Managers Regarding Continuing Professional Development

Continuing professional development (CPD) is essential to maintaining a knowledgeable health care work force. Studies of many health care professionals link CPD to competence, motivation, and job satisfaction. There is little information about CPD in the field of radiation therapy. In addition, staff views on CPD have been well researched, but there is a lack of literature looking at the opinions of managers. This study examined the following questions: (1) Is there a disparity between the views of radiation therapists and their managers concerning support for continuing professional development? (2) Where does the responsibility for continuing professional development lie? (3) Are radiation therapists aware of the availability of support within their department? and (4) Is there a difference between the academic (university affiliated) versus nonacademic centres? A self-administered electronic questionnaire was sent to 14 Ontario cancer centres. Of the 700 radiation therapists surveyed, there were 161 completed e-mail replies, giving a total response rate of approximately 23%. The final number of respondents in the management category was 25. Results showed that although more radiation therapists than managers felt that the organization should be responsible for providing opportunities for CPD, more managers than radiation therapists felt that the organization did indeed provide time off to support CPD. An additional discovery in the area of organizational responsibility is that, although the nonmanagement staff results were similar in both the academic and nonacademic settings, the management results differed significantly. Conclusions and recommendations indicate the need to expand the definition of CPD, implement more transparent CPD policies and application processes, increase communication between managers and staff, and investigate the need for radiation therapist-specific research on clinical competence.     

Leadership strategies to influence the use of clinical practice guidelines

Support from nursing managers and administrators, together with the role of a dedicated project Lead, are consistently identified as important strategies for nurses to be able to use research evidence in their practice. However, little is known about the key behaviours and activities required to successfully implement and sustain research-based innovations in practice. This study describes the leadership behaviours and activities that influenced nurses' use of clinical practice guidelines. A secondary analysis of qualitative data was conducted to investigate factors that contributed to sustaining (or not) the use of clinical guidelines two and three years after implementation as part of the Registered Nurses Association of Ontario Best Practice Guidelines project. Grounded theory techniques were used to develop a theoretical model of Leadership. Findings indicated a different pattern of leadership in organizations that sustained guidelines, when compared to those that did not. Three broad leadership strategies emerged as central to successfully implementing and sustaining guidelines: (1) facilitating staff to use the guidelines, (2) creating a positive milieu of best practices and (3) influencing organizational structures and processes. Leadership for guideline implementation was found to include such behaviours as support, role-modelling commitment and reinforcing organizational policies and goals consistent with evidence-based care.     

Development of the Holistic Nursing Competence Scale

This study developed a scale to measure the nursing competence of Japanese registered nurses and to test its psychometric properties. Following the derivation of scale items and pilot testing, the final version of the scale was administered to 331 nurses to establish its internal consistency, as well as its construct and criterion-related validity. Using an exploratory and a confirmatory factor analysis, 36 items with a five-factor structure were retained to form the Holistic Nursing Competence Scale. These factors illustrate nurses' general aptitude and their competencies in staff education and management, ethical practice, the provision of nursing care, and professional development. The Scale has a positive correlation with the length of clinical experience. A Cronbach's alpha coefficient was 0.967. The Scale is a reliable and valid measure, helping both nurses and organizations to correctly evaluate nurses' competence and identify their needs for professional development.