Advocating for nurses and nursing

Every nurse has the opportunity to make a positive impact on the profession through day-to-day advocacy for nurses and the nursing profession. In this article the author defines advocacy; describes advocacy skills every nurse can employ to advocate for a safe and healthy work environment; and explains how nurses can advocate for nursing as part of their daily activity whether they are point-of-care nurses, nurse managers, or nurse educators. The advocacy practices discussed are applicable whether advocating on one's own behalf, for colleagues at the unit level, or for issues at the organizational or system level.     

Wanted-nurses. Ethical issues and the nursing shortage

The persistent nursing shortage is challenging the values and beliefs of the nursing profession and causing nurses to ask how they can fulfill their ethical responsibilities to patients when there are an insufficient number and a maldistribution of nurses. Nurses are expressing job dissatisfaction, experiencing moral distress, and wondering about their inability to provide quality patient care. In this article, the author addresses the commitment to care for patients and the ethical dilemma with which nurses are grappling: caring for self versus caring for others. Recommendations for possible action include reenvisioning the profession of nursing, empowering nurses, providing support, and restructuring the work environment. Taken together, these actions have the potential to reduce the moral distress that nurses are experiencing and to enable them to honor their commitment to patient care.     

Newly trained operating room nurses’ experiences of nursing care in the operating room

There is limited research on nurses’ experiences of nursing care in the operating room. The operating room nurses’ responsibility is to ensure good nursing care before, during and after surgery. In an increasingly technological health care environment, there is always a risk of turning the focus away from nursing care towards technology and medicine. Integration of past experiences into the role as an operating room nurse becomes a challenge for those who recently worked as general nurses. The present study aimed to explore newly trained operating room nurses’ experiences of nursing care in an operating room. Semi-structured interviews were performed with ten operating room nurses with a maximum three years’ work experience from an operating room. The interviews were subjected to qualitative content analysis. The findings revealed three themes describing operating room nurses’ searching for their new role. They experienced a gap between theory and practice, felt alone and insignificant and had to find their own place. The operating room nurses’ experienced threats to safe nursing when they lacked time for the patients as well as for their own recovery, and they lacked feedback in order to improve care. They ensured security for patients by establishing one-to-one contact, protecting patients’ well-being and working in teams for the patients’ best interest, participants also focused on the task at hand instead of the patient as a person. New ways of organising work in operating units, and well-functioning teams can be a key to a successful integration of experiences from ward nurse to an operating room nurse, and provide support so that they feel more visible, at ease and safe in their new profession.     

The divergent opinions of nurses,nurse managers and nurse directors: the case in Lebanon

badr l., rizk u. & farha r. (2010) Journal of Nursing Management 18, 182–193
The divergent opinions of nurses, nurse managers and nurse directors: the case in Lebanon Aim The present study provides an overview of the status of the nursing profession in Lebanon and compares and contrasts the opinions of directors, nurse supervisors/managers and nurses regarding the nursing profession and the workplace. Background There are limited publications concerning the working conditions of nurses in Lebanon, and no studies on the views of directors, supervisors/managers and nurses regarding the priorities of the nursing profession. Such data are necessary to build a sound theoretical basis on which recommendations for improving the nursing profession in Lebanon are made as well as to compare and contrast cross cultural findings. Method Data were collected from 45 hospitals using a mixed methods design. Qualitative data was obtained from 45 nursing directors whereas quantitative data were collected from 64 nursing supervisors and 624 nurses. Results Similarities and differences in the opinions of nurses, nurse supervisors/managers and nurse directors regarding critical issues for the nursing profession are discussed and contrasted. Conclusions/implications Nurses are more likely to be satisfied and committed to their profession when they feel that their opinions are being heard and that their work environment promotes professional advancement.     

An exploration of undergraduate nursing and physiotherapy students’ views regarding education for patient handling

Aims and objectives. To ascertain the views of undergraduate student nurses and physiotherapists regarding their education in patient handling. Background. Musculo‐skeletal injuries are an important cause of staff sickness absence and attrition from the nursing profession and are a recognised problem within the physiotherapy profession. Nurses and physiotherapists are at risk of musculo‐skeletal injuries as a result of their role in assisting patients with movement. Methods. A questionnaire survey was undertaken of undergraduate nursing and physiotherapy students (n = 371) at one university. Results. Most students agreed that university teaching about moving and handling prepared them for clinical practice (64%). Over a third reported that they had never undertaken a written moving and handling risk assessment in clinical practice (38%). Almost half of the sample (40%) admitted undertaking unsafe moving and handling activities. Half (50%) also stated that they would rather ‘fit’ into the team than challenge unsafe practice. Almost a third (29%) stated that they had begun to experience pain since becoming a student. There were significant differences between nursing and physiotherapy students. Physiotherapy students were more likely to report being supervised when moving and handling and reported being more assertive about adhering to safe practice. Conclusions. The well‐being of both nursing and physiotherapy undergraduate students is threatened when students undertake work placements in clinical settings. University‐based education in safe patient handling, though important, can be undermined by workplace settings where unsafe practices occur. Collaboration is needed between university educators, managers and practice‐based mentors to support students to maintain safe approaches to moving and handling patients. Relevance to clinical practice. A third of students reported developing pain since becoming a healthcare student. Students entering their professions already injured may leave the workforce owing to poor physical well‐being. It is vital that the clinical workplace supports safe systems of working.     

Professional Identity in Nursing: The Role of Efficacy in Navigating the Work Environment

A well-established professional identity in nursing (PIN) is considered essential to maximize the health and well-being of the nurse, as well as those for whom they provide care. Professional identity promotes effective decision-making, open communication, and collaborative teamwork leading to job satisfaction, retention, and most importantly safe, high-quality care in a healthy work environment. Given the reciprocality of PIN and the work environment, strategies to increase PIN through strengthening both self (nurse) and collective (team/profession) efficacy of nurses can further improve both the work environment and nurse professional identity at the individual and profession levels.     

Nursing education and professional practice: a collaborative approach to enhance retention.

Factors that have led to the current shortage of nurses include a decrease in school of nursing enrollments, an aging workforce leading to retirement attrition, and a decrease in the numbers of nurses remaining within the profession. Compounding the workforce shortage problem, nurses are becoming more frustrated with work and their work environment. Negative work environment can lead to turnover, or worse still, nurses leaving the profession entirely. The purpose of this article is to identify how schools of nursing can work together with hospitals to achieve quality educational preparation for graduates, promote positive experiences for the student nurse, and assist hospitals with maintaining a positive nurse-friendly environment for the nursing staff.     

Changing the image of nursing in Jordan through effective role negotiation.

As with other nurses worldwide, image, status and role definition are prominent issues in Jordan. Here nursing is considered menial work and the roles and responsibilities of the nurse have not yet been formally defined by royal decree, Jordanian courts or the nursing profession. Moreover, while nursing curricula ordinarily influence scope of practice, nurse educators have long noted an incongruity between nurses training and their roles in practice. Although Jordanian nurses are educated to be change agents, patient advocates, health educators and critical thinkers they function more like medical assistants and housekeepers.     

Keeping nurses in nursing: the profession's challenge for today

Urologic nurses and the nursing profession face incredible challenges in caring for patients and their families after a trend of the continued decline in nursing school enrollment, the nursing shortage, and increasing staff nurse dissatisfaction with the current workplace environment. Is it possible to retain staff nurses during this current crisis? Many factors contribute to nurse dissatisfaction and subsequent turnover and burn out. In light of the current nursing shortage, it is essential and cost effective to retain nurses in their specific jobs and within the profession. There is no single, simple reason or solution for professional staff nurse turnover. Some of the current contributing factors to staff nurse dissatisfaction and satisfaction will be discussed in an effort to discern ways to promote staff nurse retention.     

Nursing work in Jordan: an example of nursing work in the Middle East

Aim. The study aimed to investigate Jordanian nurses’ perceptions of their role in clinical practice. Background. The lack of regulation of nursing practice by the profession across the Middle East until now has led to each institution setting its own policies regarding the role of the nurse and the practice of nursing. No study to date has examined the role of the nurse working in the acute hospital environment nor explored the practice of nursing in this region. Design and methods. A cross‐sectional questionnaire survey was conducted using a quota sample. A total of 348 medical‐surgical staff nurses and practical nurses from the three healthcare sectors in Jordan participated in the study with a response rate of 77%. The results were analysed by constructing multiple response tables, chi‐square test, anova and log‐linear analysis. Results. Staff nurses in Jordan were expected to carry out the majority of nursing care activities. The role of the practical nurse was limited to the physical and professional domains of nursing care. Activities requiring higher levels of emotional or intellectual labour and interdisciplinary communication were attributed only to the staff nurse. The majority of the respondents reported nursing had not been their first choice of career. Male nurses had a higher intention to leave the nursing profession. The predominant method of care delivery used by nurses was task‐oriented. Conclusion. There was a general consensus regarding what constituted the nurse's work in the clinical area across the three healthcare sectors in Jordan. Role delineation between the two levels of nurses was also clear. There is a need to move from task‐oriented to patient‐centred care to promote quality patient care. Relevance to clinical practice. This study explores the role of the nurse working in the acute hospital environment in Jordan.     

Effects of rotating night shifts: literature review

AIM: This paper reports a review examining the concept of sleep and its antithesis of fatigue, and considers the evidence on nurses' ability to cope with the demands of continually changing hours of work, their safety, and the impact any manifestations of sleep disruption may have on the care of their patients. While many aspects of this paper may apply to nursing in general, special consideration is given to nurses in the critical care environment. BACKGROUND: Night duty rotations are common practice in nursing, and particularly in specialist units. It is essential that nurses working in these environments are able to maintain careful and astute observation of their vulnerable patients, and concern arises when they may be unable to do so. Research suggests that fatigue can negatively affect nurses' health, quality of performance, safety and thus patient care, and that the effects of fatigue may be exacerbated for nurses over 40 years of age. METHOD: The literature was examined for the 10-year period up to December 2003. The databases searched were Ovid, Proquest, Blackwell Science, EBSCO Online, Australian Health Review and WebSPIRS, using the keywords of, shiftwork, rosters, intensive care, fatigue, sleep deprivation and sleep studies. FINDINGS: There is consensus amongst researchers on the adverse psychological and physiological effects of night rotations on nurses when compared with their permanent night duty peers, particularly for those over 40 years of age. Evidence also suggests that the effects of fatigue on nurse performance may negatively affect the quality of patient care. CONCLUSIONS: The literature reinforces concerns about the adverse relationship between fatigue and performance in the workplace. Optimal standards for patient care may be difficult to achieve for more mature nurses, who may suffer from sleep deprivation and health problems associated with rotational night work and disrupted physiological rhythms.     

CLINICAL SUPERVISION OF NURSES WORKING WITH PATIENTS WITH BORDERLINE PERSONALITY DISORDER

Some nurses describe individuals diagnosed with borderline personality disorder (BPD) as among the most challenging and difficult patients encountered in their practice. As a result, the argument has been made for nursing staff to receive clinical supervision to enhance therapeutic effectiveness and treatment outcomes for individuals with BPD. Formal clinical supervision can focus on the stresses of working in a demanding environment within the work place and enable nurses to accept accountability for their own practice and development (). A psychiatric-mental health clinical nurse specialist can provide individual and/or group supervision for the nursing staff, including education about patient dynamics, staff responses, and treatment team decisions. A clinical nurse specialist also can provide emotional support to nursing staff, which enhances job satisfaction, as they struggle to maintain professional therapeutic behavior with these individuals.     

工作年限5年内护士对生活护理认知现状的调查分析

目的:了解工作年限5年内护士对生活护理的认知现状及其影响因素,为有效地落实生活护理提供依据。方法:采用随机抽样的方法对符合入选标准的538名工作5年内护士进行问卷调查。结果:调查对象对生活护理的认知水平得分最低的条目依次是:生活护理是护理专业价值的体现,生活护理得好坏能反映护士的伦理道德观,生活护理需要运用护理专业的知识和技能,生活护理是护士的工作职责。89.8%的调查对象对护士在生活护理中角色认知不全面。对于生活护理的执行者,13.4%的调查对象认为应由护工及家属承担,有13.2%认为应是护工,有7.6%认为应是家属。调查对象职业满意度相关的问题与生活护理的认知得分之间呈正相关(均P<0.01)。影响调查对象生活护理认知水平的因素依次是:是否愿意从事临床护理工作,工作是否得到领导、同事及患者的认可,能为患者提供护理服务是否是有意义的工作及其学历(均P<0.001)。结论:调查对象对生活护理的认识存在误区,影响调查对象对生活护理认知现状的因素是多方面的,加强其对生活护理的认知教育及正确引导已经成为当务之急。     

Reasons why Dutch novice nurses leave nursing: A qualitative approach

Shortages in the nursing profession are increasing. It is, therefore, imperative to understand why novice nurses are leaving the profession. This qualitative study explores Dutch novice nurses’ motives for leaving the profession. Individual semi-structured interviews were held with seventeen former novice nurses who had decided to leave nursing within two years after graduation. Data was collected and analysed following the principles of Thematic Analysis, leading to six themes; 1) Lack of challenge; ambitious to progress further in management or research roles. 2) Lack of passion; no feeling of passion for patient care. 3) Lack of perceived competence; not feeling “up to the challenge”. 4) Lack of job satisfaction due to heavy workload; work-life imbalance and inability to deliver high-quality care. 5) Lack of work capacity due to non-work-related health conditions; unmet requirements for job or work environment adjustment. 6) Lack of feeling of belonging; suffering from a negative attitude of colleagues to one another. To prevent novice nurse professional turnover, measures such as capacity building, supervisor support and a tailored personal development plan could be taken. To make novice nurses feel safe and reassured, support from colleagues and supervisors is important. Such measures require thoughtful implementation and evaluation.     

Clinical supervision of nurses working with patients with borderline personality disorder

Some nurses describe individuals diagnosed with borderline personality disorder (BPD) as among the most challenging and difficult patients encountered in their practice. As a result, the argument has been made for nursing staff to receive clinical supervision to enhance therapeutic effectiveness and treatment outcomes for individuals with BPD. Formal clinical supervision can focus on the stresses of working in a demanding environment within the work place and enable nurses to accept accountability for their own practice and development (Pesut & Herman, 1999). A psychiatric-mental health clinical nurse specialist can provide individual and/or group supervision for the nursing staff, including education about patient dynamics, staff responses, and treatment team decisions. A clinical nurse specialist also can provide emotional support to nursing staff, which enhances job satisfaction, as they struggle to maintain professional therapeutic behavior with these individuals.     

Patients' and nurses' experiences of perioperative dialogues

BACKGROUND: Previous research has shown that perioperative visiting can aid the planning and implementation of nursing care by giving patients an opportunity to express their expectation and to receive information. This is in turn can reduce anxiety and stress. However, patients and nurses' experiences of this process have not been studied before. AIM: The aim of the research was to describe and interpret the meaning of nursing care experienced by patients and nurse anaesthetists or operating-room nurses (referred to as perioperative nurses) through the pre-, intra- and postoperative dialogues. METHODS: A hermeneutic approach was used when interpreting text from interviews with 10 patients after the operation and 10 nurses who were asked to write down their experiences after having conducted pre-, intra- and postoperative dialogues with their patients. The interpretation of the whole was: the common quality of the pre-, intra- and postoperative dialogues was continuity and the distinguishing quality was how the patient and nurse experienced continuity. FINDINGS: Continuity in 'the perioperative dialogue' from the patients' point of view is expressed as sharing a story and the body is in safe hands. From the nurses' point of view continuity means that professional nursing care becomes visible and that continuity gives meaning to the work. CONCLUSION: If perioperative nurses used the perioperative dialogue they could create continuity for patients and for themselves in the pre-, intra- and postoperative phases. The nurse is, in this context, the continuity and continuity gives the possibility of establishing a caring relationship and caring for the patient in a dignified way.     

Compassion fatigue and coping strategies for hospital nurses

Over-involvement in patient trauma and loss in clinical settings negatively affects nurses and may cause compassion fatigue. Compassion fatigue is associated with prolonged exposure to trauma cases, over-involvement in patient situations and over-extending caring energies. Nurses unable to adapt and cope may suffer physically and psychologically, reduce their quality of care, cause medical care costs to increase, and ultimately become frustrated and decide to leave the nursing profession. While current approaches to addressing compassion fatigue focus on evaluating individual nurse situations, adjusting attitudes, holding education programs, and bolstering support systems, little research attention has been directed toward the consequences of such on patient care or the origins of compassion fatigue in Taiwan nurses. This paper defines compassion fatigue, examines its importance and consequences, and delineates common nursing coping strategies in Taiwan. Findings expand domestic research on this phenomenon and suggest relevant theories and effective interventions to achieve remediation.     

Male Nurses—Reasons for Entering and Experiences of Being in the Profession

In order to illuminate male nurse teachers' and nurse students' reasons for choosing to become nurses, and their experiences and positions within the profession, all 13 males among a total of 184 nurse teachers and students at one nursing school in Norway were interviewed twice with a 10-year interval between the interviews. In a personal interview in 1984 all the interviewees emphasized that their desire to become nurses was connected with a wish to act in a woman's role and expressed feminine values. The interviewees' fathers disapproved while their mothers approved with their choices to become nurses. The subjects thought that female nurses did not accept that they were bedside nurses, and exerted pressure on them to adopt roles within nursing that were perceived to be male; i.e. teachers, or administrators. In a telephone interview in 1994 they were asked about their experiences and positions within the profession. Eight interviewees had worked as nurses within psychiatric care and ten had current senior positions. They stated that the most positive thing in the profession was the contact with the patients and meaning so much to someone. All said they would have made the same choice today and become nurses.     

Future trends in school health nursing

School health nursing is one of the "frontline" professional community nursing services. School nurses need both theoretical professional knowledge and practical skills. The tasks of school nurses are becoming increasingly important due to the changing social environment, changes in disease patterns, decreasing birth rates, and the increasing demands of today's customers. But the field of school health nursing enjoys a certain independence. In line with society's demands, the essential trend in school health nursing is specialization. Planned and well-arranged pre-service education is required to develop programs for school nurse specialists, and, more importantly, we need to return to the advancement system. Nurses working at schools need plenty of clinical, practical experience, ideally having completed in-service education at N3 level in a medical institution, so that they can bring their professional competence into play, and satisfy the demands of their work. In this way, the nurses work in medical institutions will still have opportunities to contribute their skills when they are elderly. This is a constructive and positive development for the nursing profession.