Employment transitions for older nurses: a qualitative study

AIM: This paper aims to explore the influences on employment related decision making in respect of nurses over 50 in the United Kingdom. It investigates the retirement and labour market relationship through the diverse experiences of older nurses and stakeholders in nursing. BACKGROUND: The ageing of the United Kingdom nursing workforce constitutes a potential challenge for the National Health Services. There is evidence of increasing efforts to address this issue by encouraging older nurses to remain in the profession, dissuading early retirement and attracting nurses who have retired to return to nursing. However, decision-making by older nurses is influenced by a wide spectrum of factors and perceived employment options. BACKGROUND: The paper is based on research commissioned by the Joseph Rowntree Foundation as part of its Transitions Over 50 programme. It derives from concern about inadequate knowledge of, and under-developed policy responses to, the ageing United Kingdom workforce and the specific implications of this age shift for the nursing labour market. The research consisted of interviews with nurses over 50 and key stakeholders in nursing in the United Kingdom. Stakeholders included employers, advisers and policy makers in nursing. METHOD: Interviews with older nurses and stakeholders in nursing were conducted over a period of 12 months. They included face-to-face and telephone semi-structured interviews with 84 nurses over 50 and 18 key stakeholders in nursing in the United Kingdom. Stakeholders included employers, advisers and policy-makers. FINDINGS: Employers, policy makers and advisers and older nurses all identified a range of influences on nurses' employment decisions including a lack of flexible hours, the stress of work, pension-related expectations and the pace of change. Some of these related to negative aspects of work that led nurses to leave ('push' factors), and others to the presence of positive factors in nursing or in pension options ('pull' factors). CONCLUSION: The study highlighted the need for increased implementation of more flexible hours of work and greater availability of part-time hours for older nurses. It revealed the salience of improved pay, adequate and flexible pensions provision, and opportunities for continued professional development to the recruitment and retention of older nurses.     

心血管内科新入职护士专业化培训方法研究

目的探讨对心血管内科新入职护士进行专业化培训的方法与效果。方法对新入职护士进行为期1年的专科化培训,采用一对一跟班培训、科室集中培训、情境模拟训练、个案分析讨论的方法对专科理论、仪器操作、专科技能等内容进行培训。通过培训考核成绩和问卷调查结果对培训效果进行评价。结果新入职护士专科理论、基础护理操作和临床综合能力考核成绩优秀。100%新入职护士认为通过培训能促进个人成长和专科进步;93.3%认为专业化培训能使其短时间内掌握专科知识,胜任心内科临床工作。结论专业化培训能使新入职护士尽快掌握等科知识和技能,从而能胜任心内科的护理工作。今后应增加培训中的过程评价,保证培训效果。     

Getting going with clinical supervision: an introductory seminar

Clinical supervision is an emerging force in nursing practice in the United Kingdom. However, much of the nursing literature suggests uncertainty with regards to what clinical supervision is and the resources needed for safe professional practice. This paper explores a method of introducing clinical supervision to nurses in such a way as to model the skills and competencies required for developing productive working relationships. The main recommendation of this paper is that procedures for introducing clinical supervision mirror qualities required for developing effective nursing relationships.     

A new paradigm for practice education

This paper explores the complex nature of professional practice. It suggests that educating for all practice disciplines is about to undergo a paradigm shift whereby the value of practical education and experience will be better understood, more rigorously analyzed and integrated with propositional knowledge in the construction of personal professional knowledge and identity. It relates this cross disciplinary position to the present problems of skills deficits which are evident in nurses at the point of registration and demonstrates how routinization and internalization of process and tacit knowledge can create problems for students and newly qualified staff nurses. It also suggests how this can be addressed.It discusses the present culture of 'clinical education by default', unavailability of mentors and resources, and general lack of formal collaborative structures between education and service institutions and suggests that the present system cannot sustain the complex demands, expectations and pace of the clinical context and the evolution of nursing practice. Clinical credibility is an issue as is the current heavy clinical workload of staff nurse mentors, and several collaborative clinical education models are outlined which ensure that staff nurses or resident clinical educators are available and can make clinical teaching their priority. History and the present crisis in nursing suggest that there is a case for mandatory collaborative education/service structures to ensure adequate funding and to monitor the effectiveness of selected models so that staff nurse mentors can work with lecturer colleagues to articulate and teach the complexities of clinical practice through related research.It is predicted that this collaborative approach is capable of addressing both the skills deficits and the wider intellectual challenge of developing a new paradigm of practice education and providing an integrated base for continuing professional development.     

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.     

Nursing students' experiences and preferences regarding hospital and community placements

The quality of practice placements is important in the development of competent and confident professional nurses. In placements, students develop and master the attributes of professional caring, situational knowledge, competence and clinical skills through experiencing nursing in the real world. Student's experience of their placements can be mixed with some students having both positive and negative experiences. This paper reports a survey evaluating undergraduate nursing students' experience of their practice placements in one higher education institution (HEI) in Wales, United Kingdom (U.K.), with a focus on their perceptions of community placements. 440 usable responses were obtained from a possible 455 student evaluations (97%). Students were more likely to express a positive view of district nursing, intensive care, high dependency and cardiology placements, whilst evaluating health visiting and older adult placements less positively. This is discussed by suggesting that those placements perceived as more popular offer students a closer relationship with their mentors together with a positive acculturation into the community of nursing and the opportunity to practice and master clinical skills. Students' preference for district nursing rather than health visiting suggests the timing, type and preparation of students for community placements should be reviewed further.     

Experiences of African nurses in the UK National Health Service: a literature review

Aim. This review aims to highlight the experiences of black African nurses in the United Kingdom. Background. There is an acute shortage of trained nurses in the United Kingdom, which has occurred because of several factors including ageing of the nurse population and increasing demand due to an ageing population as well as under investment in nurse education during the 1980s. Government initiatives have included recruiting nurses trained overseas to meet present and future demands. Among these internationally recruited nurses, a large number came from Africa, but little is known about the experience of nurses once they are in the United Kingdom. Although it is known that ethnic minority nurses suffer discrimination in the National Health Service, experiences of internationally recruited nurses and nurses from African countries, in particular, merit attention as their nursing practices and culture in general are different from those of developed countries. Methods. A literature search was conducted using CINAHL, Medline and Cochrane databases by using the following terms in various combinations: Experiences, African nurses, international nurses, ethnic minorities, discrimination, equal opportunities, United Kingdom and NHS. Conclusions. There is very little research into the experiences of African nurses in the United Kingdom. Research has concentrated on the experience of internationally recruited nurses and ethnic minority nurses in general. There is agreement that most foreign nurses have a negative experience of working in the United Kingdom. Nurses face discrimination in pay and conditions of service and most are exploited by managers. There are also ethical questions surrounding the recruitment of nurses form developing countries and their treatment once they come to the United Kingdom. Relevance to clinical practice. As the nursing workforce in the United Kingdom becomes increasingly diverse through international recruitment, it is important to have knowledge of experiences of different groups of nurses. This helps to devise adaptation programs for smooth transition tailored to particular groups and training that will help United Kingdom nurses to work in harmony with their foreign colleagues.     

Delegation and supervision of healthcare assistants’ work in the daily management of uncertainty and the unexpected in clinical practice: invisible learning among newly qualified nurses

The invisibility of nursing work has been discussed in the international literature but not in relation to learning clinical skills. Evans and Guile's (Practice‐based education: Perspectives and strategies, Rotterdam: Sense, 2012) theory of recontextualisation is used to explore the ways in which invisible or unplanned and unrecognised learning takes place as newly qualified nurses learn to delegate to and supervise the work of the healthcare assistant. In the British context, delegation and supervision are thought of as skills which are learnt “on the job.” We suggest that learning “on‐the‐job” is the invisible construction of knowledge in clinical practice and that delegation is a particularly telling area of nursing practice which illustrates invisible learning. Using an ethnographic case study approach in three hospital sites in England from 2011 to 2014, we undertook participant observation, interviews with newly qualified nurses, ward managers and healthcare assistants. We discuss the invisible ways newly qualified nurses learn in the practice environment and present the invisible steps to learning which encompass the embodied, affective and social, as much as the cognitive components to learning. We argue that there is a need for greater understanding of the “invisible learning” which occurs as newly qualified nurses learn to delegate and supervise.     

An exploratory study of the sources of influence on the clinical decisions of community nurses

This paper reports a small exploratory study which identifies what community nurses consider to be the scope of their practice and the sources of influence on their clinical decisions. The study was stimulated by the emergence of the nurse prescribing initiative, which is likely to bring clinical decision making to the centre of professional debate. The study was carried out over a 5-month period and data were collected from 47 community nurses in four district health authorities. A qualitative method was employed and field work involved observation of 40 home visits and five nurse-run clinics, individual interviews and group discussions with the nurses, and scrutiny of nursing records. The data were content analysed and classified, and the categories were validated by practitioners. Findings suggest that although community nurses consider that a large proportion of their work requires a scientific basis, their practice is largely founded on experiential knowledge, and on the whole they are not positively disposed to research knowledge. The findings are discussed in the context of nurse prescribing. Questions are raised about the nature of a 'professional' knowledge base and the reclassification of scientific knowledge as nursing or experiential knowledge once it has diffused into practice.     

Doing the right thing: nursing students, relational practice, and moral agency

Registered nurses and nurse educators are often unaware of how nursing students experience the nursing profession. In the current practice climate of increased workloads, reduced funding, and higher patient acuity, nurse educators are likely to hear from colleagues how unprepared newly qualified nurses are for the needs of practice. It is difficult for many nursing students to see value in their practice because they become preoccupied with their perceived lack of knowledge and technical skills. Nurses and nurse educators should be aware of how this brands new graduates and informs their sense of developing professional identity. Despite their feelings of deficit in terms of skills and knowledge, it is clear that many nursing students are, in fact, effectively negotiating relational ethics. This article presents a collaborative account of the important relational work being undertaken by one group of nursing students in New Zealand.     

新护士岗前规范化培训真实体验的质性研究

目的深入了解新护士对岗前规范化培训的真实体验,为新护士的培训与管理提供依据。方法采用目的抽样和深入访谈法,对14名新护士进行访谈,应用Claizzi现象学分析法进行资料分析。结果新护士对岗前规范化培训的真实体验提炼出5个主题,即心理应激多,压力大;利他主义观念增强;职业价值观增强;丰富的理论授课内容有利于增强专业知识;危重症临床实训有利于提高实践技能。结论护理管理者与教育者应进一步完善岗前规范化培训,提高新护士综合素质,提升临床护理质量。     

Continuing professional education for qualified nurses: a review of the literature

Reviewed literature identifies the importance of continuing professional education and professional development for nurses subsequent to initial registration (including enrolled nurses). However, there is a lack of empirically based work analysing nurses' perceptions of their continuing professional education needs and the perceived outcomes of continuing professional education in terms of changes in knowledge accretion, attitudes, skills, job satisfaction, staff retention and career development. It is suggested that this lack of empirical work needs to be addressed if the proposed plans of the United Kingdom Council for Nursing, Midwifery and Health Visiting (UKCC) to introduce mandatory continuing professional education are to have maximum benefits for clients, nurses and the service.     

精神科新护士易出现的问题及对策

目的规范带教方法,培养适应现代精神科护理工作的合格护士。方法针对新护士易出现的问题制定相应对策。加强专业思想教育,提高自身素质;开展岗前培训,提高认识;加强临床带教,培养扎实的专科技能;培养语言交流技巧;严格考核;上岗后加强继续教育。结果提高了新护士的自身素质和工作能力,使其很快成为临床护理骨干。结论重视和加强对新护士上岗前后的教育及业务素质培养,以适应现代精神科护理专业需要的人才。     

Minor surgery: an extended role for ophthalmic nurses in the United Kingdom

This article discusses the reasons for extending the scope of ophthalmic nursing practice in the Princess Alexandra Eye Pavilion, Edinburgh, Scotland, particularly with regard to the ophthalmic nurses' role and management of meibomian cysts (chalazions) through minor surgery to the eyelid. The article describes how the in-service teaching program was established in the hospital for those ophthalmic nurses who were interested in developing their knowledge and practical surgical nursing skills to undertake the management of meibomian cysts. The appropriate legal and ethical aspects of patient care involved in extending the scope of practice in the United Kingdom are discussed, including accountability and duty of care.     

Palliative care education and training in the united kingdom: A review

There is considerable interest in palliative care in the medical and nursing colleges of the United Kingdom, and well-documented proof that many doctors and nurses feel inadequate for their work. Every United Kingdom hospice service now has an education program for care professionals. All but one medical school includes palliative care in the curriculum, which is almost exclusively taught by physicians in palliative medicine, now a recognized specialty in the United Kingdom. Its training program is outlined in this article. This review details the considerable contribution to improved professional skills now being made by United Kingdom hospices and points to future developments and areas for research.     

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.     

Caring in nursing: investigating the meaning of caring from the perspective of cancer patients in Beijing, China

Aims. The aims of the study were to develop an understanding of caring in nursing from the perspective of cancer patients and attempt to identify the concept of caring in the Chinese cultural context. Background. Caring as a concept remains elusive, the acceptable definitions of the term care have not been reached. The expressions, processes and patterns of caring vary among cultures, but there is a lack of Chinese culture‐based study about caring in nursing. Methods. A qualitative research design was used and 20 cancer patients were interviewed using a semi‐structured interview guide. A qualitative content analysis was used to identify themes in the data. Results. Three themes emerged from the data, which suggested that caring is delivering care in an holistic way: nurses’ caring attitudes and their professional responsibility for providing emotional support, nurses’ professional knowledge and their professional responsibility for providing informational support and nurses’ professional skills and their professional responsibility for providing practical support. The caring behaviour of nurses as perceived by cancer patients involved the provision of emotional, informational, and practical support and help based on patients’ needs. A model of caring in nursing was formulated. Conclusions. Caring in nursing as perceived by cancer patients involves nurses having qualified professional knowledge, attitudes and skills in oncology and providing the informational, emotional and practical supports and help required by cancer patients. Relevance to clinical practice. Caring is manifested in nursing actions through nurse–patient communication process. Patients have their inner expectation for nurses’ caring behaviour and attitudes and nurses’ performance of caring or uncaring behaviour has a direct influence on the feelings of patients. It is necessary for all nurses to continue improving their oncology professional knowledge, attitudes and skills as well as their abilities of offering informational, emotional and practical support and help for their cancer patients.     

The impact of higher education for post-registration nurses on their subsequent clinical practice: an exploration of students' views

In recent years there has been a large increase in the number of qualified nurses in the United Kingdom, who have raised the academic level of their nursing qualification to diploma level or above. Correspondingly, there has been little research that assesses the value of post-registration education offered by universities. In particular, there is a paucity of research regarding the effects of courses on the subsequent clinical practice of participants. Studies of post-registration education appear to be small scale and limited in scope. This paper examines the views of diplomates as to the effect of a Diploma in Professional Studies in Nursing course on clinical practice. A questionnaire was sent to all nurses (n = 169), from the first seven cohorts, who successfully completed the course. A response rate of 66.8% (n = 113) was achieved. The respondents reported themselves to be more questioning, more able to apply research findings and to have a wider knowledge for practice following completion of the course. The findings are discussed, limitations of the study addressed and recommendations for further research are made.