The Nurse in Clinical Practice

Swedish colleges and universities are now adapting their syllabuses to the new open European labour market. In this respect the syllabus for training of nurses is to be reorganized. Thinking in terms of health will be very important in the training program and will require practical experience of nursing. The aim of this study was to examine the demands made on competent nurses working in clinical practice. An open question was asked and the results were analysed by the constant comparative method. The 23 nurses interviewed had to answer the question: “What do you require of a competent nurse?” From the empirical data, characteristics of six different ideal types were described. A competent nurse has the ability—to create a good atmosphere; concentrate on the patient and always to have an ethical and humanitarian approach; to teach and instruct; to organize, make priorities, cooperate and make documentations; to use her theoretical knowledge and be able to put it to use; to be keen on development and change. The study showed that a competent nurse has a wide field of knowledge, but also highlighted the complex of the nursing profession. If the nursing student can acquire these skills she will be well prepared for her central role in clinical practice.     

Perceptions of Nurse Practitioners as Clinical Leaders in the Military

Health care systems need leaders to address complex challenges. This presents an opportunity for nurse practitioners (NPs). The United States Army is already using NPs as leaders. This study addresses the following 2 research questions: What are Army primary care clinicians’ perceptions of NPs as clinical leaders? and Are there differences in these perceptions? In this study, we used a survey that captured clinicians’ perceptions of NP leadership. Overall, respondents favored NPs as clinical leaders. Over 65% agreed that NPs were qualified as leaders within the Army. This study suggests clinicians perceive NPs as qualified and effective leaders at high levels throughout primary care.     

Roles enacted by Clinical Nurse Leaders across the healthcare spectrum: A systematic literature review

The Clinical Nurse Leader (CNL) is a master's prepared nurse envisioned to provide clinical leadership at the microsystem level to ensure safe, high quality patient-centered care. The American Association of Colleges of Nurses defined ten ‘fundamental aspects’ of CNL practice, but as the certified CNL population grows, data suggest they are filling a variety of positions besides formally designated CNL roles. This article reports the results of a systematic review of CNL literature to better understand what roles and activities certified CNLs are enacting when not hired into formally designated CNL roles. Sixty-nine articles met inclusion criteria. Roles identified include: faculty, 62%; clinical management/executive, 12%; specialty clinician, 11%; and staff nurse, 9%. In these roles, certified CNLs are reviewing literature, conducting research, and/or writing commentaries on CNL education and practice and other health foci such as alarm fatigue, insulin practices, and physical exercise for cancer-related fatigue. Results indicate that despite a lack of formal tracking of certified CNLs over time, the available information identifies a variety of roles and job titles used by this group of professional nurses. The study findings add to the body of knowledge informing overall understanding of the CNL initiative.     

Pioneering a new role: the beginning, current practice and future of the Clinical Nurse Leader

Aim  To discuss the development of a new nursing role in response to the health care crisis in the United States.
Background  The nursing shortage and fragmentation of care has contributed to the need for nurses who are prepared to laterally integrate care, bring evidence-based practice to the bedside and provide continuity of care to patients and families.
Evaluation  The CNLs review the literature, share their experiences, and discuss outcomes related to improved quality of care.
Key issues  Having clinical nurses with a global perspective acting as facilitators and integrators of care is essential to maintaining a high standard of care. Organizational and management support is critical. The more CNLs that can be embedded in an institution, the more successful the role can be.
Conclusions  The varied utilization of the CNLs in this practice setting has proven its value in a short period of time and facilitated better communication and collaboration among patients and their health care team.
Implications for nursing management  The flexibility and broad scope of this role allows for its use in any practice setting to realize gains in quality outcomes, cost savings, improved patient flow, increased safety, nurse satisfaction and increasing organizational capacity.     

临床专科护士工作职责与工作模式的调查分析

目的:为了了解我国现有的有资格认证的临床专科护士(Clinical Nurse Specialist,CNS)的工作职责和工作模式,为在国内成功推行临床专科护士制度奠定良好的基础。方法:采用自行设计的临床专科护士工作职责调查问卷对21名有资格认证的造口专科护士和ICU专科护士进行调查。结果:国内的临床专科护士的角色包含了临床、教育、咨询、研究及管理五个方面,其工作时间分配为临床护理占31％～90％,教育占10％～30％,会诊占10％～20％,研究占0～20％,管理占10％～80％。结论:目前国内临床专科护士制度的推行尚在起步阶段,出现了选拔标准不一、职责不明确等问题。要成功推行临床专科护士制度,必须借鉴国外的宝贵经验,严格规范CNS的资格认证,明确其工作职责范围和工作模式,保证CNS稳步发展。     

Clinical Development Units (Nursing): the western Sydney approach

On 24 September 1997 Western Sydney Area Health Service and the University of Western Sydney, Nepean (Australia) launched a network of nine Clinical Development Units (Nursing). The approach taken towards the development of CDU(N)s in western Sydney differs substantially from those taken elsewhere in terms of preparation for CDU(N) leadership and the role of CDU(N) criteria in the designation ('accreditation') process. The rationale underpinning the western Sydney approach, together with details of a leadership preparation programme, are discussed.     

Nurse executive director effectiveness: a systematic review of the literature

AIM: This report systematically reviews studies of nurse executive director effectiveness to identify recurring themes that might inform current practice and future research. BACKGROUND: Increasing competition in healthcare markets is increasing the demands on nurse executive directors. There is a need to identify factors that contribute to effectiveness in the role so that these can be developed and effectiveness improved. EVALUATION: Reports were identified using electronic databases, an internet search and review of references in all reports initially identified. The methodology of these reports was reviewed and recurring themes were identified. KEY ISSUES: Ten themes that might be associated with nurse executive director effectiveness emerged from the review. CONCLUSIONS: The literature relating to nurse executive director effectiveness is limited but there are sufficient recurring themes to inform current practice and to investigate in new research.     

The Leadership Gap: Supporting New Front line Leaders in Cancer Care

IntroductionAlthough an individual may have gained considerable competence and skill in their specific discipline, it is unclear what resources are required for an experienced clinician to develop to a clinical leader. As a first step for many, front line leadership positions are often the only practical way to develop behaviors suited to more advanced leadership roles in health care. A new role requires impactful change in perspective that creates intensive learning opportunities for staff and an organization. Conversely, this transition may also represent risk to those failing to adjust to new behaviors and environment. A paucity of scholarly literature on this subject makes recommendations for best practice challenging, particularly in cancer care. The goals of this project were to understand the current state of leadership orientation in a single cancer center, while encouraging collaborative dialog to connect and engage stakeholders.MethodsQualitative data were collected using a focus group with novice leaders and individual interviews with experienced leaders at a single cancer center. Novice leadership was defined as less than 2 years in a management role and experienced leadership as greater than 2 years of experience. The collective narrative was coded to identify repeating indigenous ideas and phrases. Broader review explored the relationships between concepts and categories to reveal important themes.ResultsThe narrative indicated that contributors understand the importance of support and guidance early in leadership development pathways. Additional findings revealed unmet expectations of novice leadership upon moving from individual clinical expert to front line leader and possible gaps in development support. Further examination of the data shows novice leaders are vulnerable and suggests that alongside didactic programming, peer support, mentorship, coaching with feedback, and project work underpin leadership development.ConclusionsThis project revealed positive behaviors enhancing new leader assimilation and performance while presenting possible solutions for apparent gaps in organizational support. Recommendations include creation of harmonized programming to address competency development and self-directed learning, enhanced peer support networks with job shadowing opportunities, and heightened organizational awareness of leadership transition supports.