Congruence of perceptions among nursing leaders and staff regarding missed nursing care and teamwork

The objective of this study was to test the congruence of the perceptions of unit-based nurse leaders (managers, advanced practice nurses) and nursing staff members (registered nurses, nursing assistants, unit secretaries) in acute care hospitals as to the extent and type of missed nursing care and nursing teamwork. Based on the leader-member exchange congruence framework (LMX), nursing staff and nursing leaders completed the MISSCARE Survey, and a segment of the participants completed the Nursing Teamwork Survey. The findings of this study show a lack of LMX congruence between leaders and nursing staff members. Nursing staff report less missed care and lower teamwork than do leaders, and nursing staff list more problems with having adequate material and labor resources than do leaders. LMX congruence has been associated with positive organizational outcomes.     

The effect of consistent nursing shifts on teamwork and continuity of care

To attract nurses to the workforce, scheduling of nurses on patient care units has evolved into a mixture of 4-, 6-, 8-, and 12-hour shifts. The result is chaotic as staff members come and go at varying times, creating the need for multiple handoffs and reassignment of patients. Effective teamwork and continuity of care are difficult, if not impossible, to achieve under these circumstances. The authors describe the effect of using just 1 shift length for all nursing staff.     

The impact of hospital restructuring on home care nursing

BACKGROUND: Health reform in many industrialized countries has prompted the shift from institutional to community care. In Ontario, this approach was instigated through the Health Services Restructuring Commission. OBJECTIVES: The purpose of this study was to determine whether changes in the hospital sector between 1996 and 2000 resulted in changes in the provision of home-care services by nurses and practical nurses. METHODS: This study was a retrospective trend analysis of linked hospitalization and home-care utilization data for Kingston for 1996 to 2000. The measures include the rate of home care and the volume and intensity of home-care services. RESULTS: Between 1996 and 2000 there was a net 4% increase in the age-gender standardized rate of admission to home-care nursing services, with a 10% rate rise between 1996 and 1997. The total volume of home-care services increased during the study, as did the average intensity of home-care service delivery over the first month post-hospitalization during the first four years. This article will give readers their first look at the changes in home-care nursing following hospital restructuring in Kingston.     

Improving nursing unit teamwork

A lack of teamwork among nursing staff affects care delivery and unit operations. Barriers present in the structure of a typical patient care unit that make it extremely difficult to achieve a high level of teamwork include large team size, lack of familiarity, instability of the work force and assignments, the absence of a common purpose and destiny, and an inhibiting physical environment. The authors discuss strategies to overcome these obstacles to teamwork.     

The nursing shortage: Its impact on the care of children

The nursing shortage is likely to have a serious impact on the various roles of pediatric nursing and the care of children. An earlier perception that there were too many “specialty” nurses is simply untrue. The future demand for pediatric nurses is expected to increase dramatically as the gap between the number of elderly people needing care and those available to provide services shifts resources away from children. Vulnerable pediatric populations at risk for poor outcomes will be adversely affected first. Short-term solutions to the nursing shortage will not directly impact pediatric nursing. Many of the roles pediatric nurses fill, such as the pediatric intensive care unit, require up to 2 years of experience. Pediatric nurses who work in the community in expanded roles require advanced practice training beyond the BSN. Given these particular workforce issues, recovery of pediatric nursing is expected to lag behind other nursing specialties.     

The impact of nursing diagnoses in a long-term care setting

Nursing diagnosis as a critical component of the nursing process provides a common taxonomy to describe problems that nurses can treat and is a convenient, logical way to reference nursing standards. Theory is translated into practice with the use of population-specific prototype care guides and a written orders system. Nurses in leadership are responsible for providing the necessary resources to promote professional growth and facilitate desired change. Recommendations to assist with the implementation of nursing diagnosis are identified in Table 1. The system is dependent on staff nurses' professional commitment to learning and willingness to actively participate in change. Involvement of staff nurses continues to be a critical factor in the improvement of nursing practice.     

The effect of a teamwork intervention on staff perception of teamwork and patient care on a medical surgical unit

As a result of the ever‐changing health care environment and patient complexity, it is difficult for nursing teams to provide safe quality care and complete all tasks, also known as missed nursing care. Missed nursing care is a global health care issue and defined as any aspect of care missed in part, in whole, or delayed. Teamwork has been found to not only positively impact the performance of a team, but also patient outcomes. Teamwork strategies are needed to help nursing teams provide the best care to their patients. Inpatient nursing teams work in complex environments and handle many patient issues making it difficult to find one workable solution. The purpose of this study was to determine if a teamwork intervention would impact the nursing team’s perception of teamwork and missed nursing care on a medical surgical unit. In this quasi‐experimental design study there was an increase in both teamwork and missed nursing care pretest and posttest survey scores. Despite the increase not being statistically significant, based on the staff feedback, the intervention shows promise to be a viable teamwork strategy. Future studies should include larger sample size and longer duration.