A registered nurse-licensed vocational nurse partnership model for critical care nursing.

The development, implementation, and evaluation of a program that incorporates a registered nurse and licensed vocational nurse partnership model into the critical care practice setting is described. This model can be used by nurse executives to alleviate some of the immediate consequences of the nursing shortage and potentially to achieve a longer-range solution by expanding the pool of registered nurses. Evaluation of the program revealed statistically significant increases in nurse job satisfaction; perceptions of reduced workload and stress; a perception by registered nurses and physicians of increased nursing care quality; decreased registered nurse turnover and sick time; and a positive perception of the role of the licensed vocational nurse in the critical care unit.     

Education for rehabilitation nursing

An increasing shortage of rehabilitation nurses is anticipated in the coming decade. This article describes one potential answer to the nursing shortage through a course in rehabilitation nursing for senior baccalaureate students. The unique features of the course included the use of holistic learning experiences that integrate theory and practice. Clinical experiences in critical care units, in intensive rehabilitation settings, and in a variety of outpatient facilities, as well as travels with rehabilitation nurse consultants in the field, provided students with rich perspectives on the scope of rehabilitation nursing practice. Replication of this successful course in other settings has the potential to enhance the recruitment of new graduates into the field of rehabilitation nursing.     

Alleviating the nurse faculty shortage: designating and preparing the academic nurse educator as an advanced practice registered nurse

A lack of qualified nurse faculty is a persistent problem in the discipline of nursing. It limits the number of nurses prepared to provide safe, quality care in settings around the world. Many individuals, groups, and organizations have studied the nurse faculty shortage and recommended resolutions, yet the shortage persists. This opinion paper contends that designating the academic nurse educator (ANE) as an advanced practice registered nurse and identifying an educational pathway that ensures academic preparation for the role could help to alleviate the nurse faculty shortage. Evidence disseminated by national and international constituents that influence nursing and nursing education supports the perspective and serves as the basis for recommendations that could attract more nurses to faculty positions in nursing education and ensure preparation of ANEs for their role.     

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.     

The nursing shortage: dynamics and solutions. A supportive clinical practice model

In a large VA teaching hospital, the primary nursing care delivery model is established with an all-RN staff. Several new initiatives and incentives have been implemented to maintain nurse satisfaction during this period of nurse shortage, but the primary nurse's relationship with her or his patient is the most satisfying and rewarding opportunity in this setting. The professional profile of the nurse staff reflects high academic preparation, certification in clinical area of practice, and involvement in nursing organizations. Primary nursing is successful because of the availability of support services, which enable the nurse to remain with the patient on the nursing unit. The primary nursing care delivery model and staffing were evaluated and revised to include licensed vocational (practical) nurses as associate nurses. Nurses on staff affirm their authority and autonomy to make and carry out clinical decisions about the nursing care of their primary patients. Physicians recognize nurses as the co-primary care provider in a clinical practice atmosphere of mutual respect and collaboration. New opportunities for professional growth and self-actualization enrich the work environment.     

The importance of work environment: evidence-based strategies for enhancing nurse retention

As the nation faces a growing nursing shortage, it is imperative that home care leaders implement evidence-based strategies to improve nurse recruitment and retention. Previous research indicates that characteristics of the work environment that support nursing practice enhance nurses' job satisfaction and reduce turnover. Yet, there is little evidence to assist in prioritizing initiatives to improve the work environment of nurses. In this nationwide survey, home care nurses were asked to rate the importance of specific agency work environment traits, as listed on the Nursing Work Index-Revised, in supporting their home care practice. The 10 agency traits rated as most important are presented, and evidence-based recommendations for creating a culture of nurse retention are discussed.     

Preparing the nursing workforce for the next era: Re-classifying and reframing enrolled nursing knowledge

Health systems are being transformed and redesigned in Australia to better respond to changing health needs, technological advances, and new capabilities needed for safe and quality care. A capable and responsive nursing workforce, at both enrolled and registered nurse levels, is one of the mechanisms required for achieving effective health care reform.This paper situates a critical discussion of enrolled nurse education within a symbiotic relationship model to consider how nursing knowledge can enhance workforce performance and contribute to improved function of health systems. Discussion focusses on classification, or what constitutes nursing knowledge, and how that knowledge can be presented, or framed, in nursing education.It is contended that different nurse education systems in Australia mean the construction of professional enrolled nurse knowledge differs in form and structure from registered nurse professional knowledge. While different courses are needed for enrolled and registered nurses to reflect their different scope of nursing practice, it is important enrolled nurse education classified and frames nursing knowledge in ways that prepare graduates for complex nursing practice to safeguard the public.     

Perceptions of registered nurses working with assistive personnel in the United Kingdom and the United States

This study examines registered nurse perceptions of their role in acute care hospitals that use nursing care assistants (NCA) and unlicensed assistive personnel (UAP). Also studied was registered nurse (RN) satisfaction with nursing care assistants and unlicensed assistive personnel in the United Kingdom (UK) and the United States of America (USA). The purpose of this study is to assist RNs and managers in the re-design of health-care delivery systems by investigating: 1. The differences and similarities of registered nurses in the UK and the USA in the perceptions of changes in the RN role when working with nursing care assistants or unlicensed assistive personnel. 2. The differences between and similarities of registered nurses in the UK and the USA in perceptions of NCA and UAP abilities to perform delegated duties, to communicate pertinent clinical information and to provide more time for professional nursing activities. Registered nurse perceptions in the UK were compared with the findings of a previous study of RN role changes and satisfaction in the USA. Registered nurses in the UK did not perceive a profound change in their role when working with UAP and were more satisfied with their use than were RNs in the USA.     

The nursing shortage in acute and critical care settings

The nursing shortage is seriously challenging hospitals to provide safe, quality care to acute and critically ill patients. Most frequently reported are the registered nurse (RN) shortages in intensive care units (ICUs) and step-down units. Issues surrounding the nursing shortage are multifaceted and require comprehensive solutions. Although work place conditions are typically cited as the leading cause of the shortages, other factors, including a rapidly aging RN workforce, have been implicated. Furthermore, fewer young people are choosing nursing as a career and graduating classes of RNs are decreasing in size. Remedies for the acute and critical care nursing shortage will require highly innovative initiatives and multiple long-term strategies focused on forces driving the growing nursing shortage. One solution to workplace issues may lie in the philosophy of the Magnet Hospital program. The advanced practice nurse can play a significant role in providing leadership in addressing factors and designing comprehensive and innovative strategies directed at recruitment and retention of RNs in acute and critical care settings.     

Defining the scope of practice of enrolled nurses in medication administration in Australia: a review of the legislation

Changing workforce patterns and changes in models of care delivery have renewed interest in the role of the enrolled nurse in Australia. A number of major reviews have confirmed the enrolled nurse as an integral member of the Australian health workforce and identified that the role of enrolled nurses is expanding in many practice settings. Medication administration is increasingly being delegated to enrolled nurses raising issues related to role, scope of practice, educational preparation, competence and delegation and supervision of nursing activities. Published reports and studies have identified a range of issues related to scope of practice nurses in Australia that have prompted the development of decision-making frameworks and a range of policies and guidelines to better define practice parameters. A review of the literature and documents available from various Australian nursing regulatory bodies related to medication administration by enrolled nurses was undertaken to determine the scope of practice of enrolled nurses in medication administration in Australia. The review confirmed that there is considerable variation in practice between jurisdictions, individual health care settings and on a daily basis in clinical practice. Despite the availability of a number of policy and practice guidelines, there is limited evidence on how they are used in clinical practice and the impact of variable policies on registered and enrolled nursing practice.     

开展心脏康复护理的动力因素分析

目的通过对临床医院在循环内科工作过的护士的调查,分析了护理人员开展心脏康复护理的动力因素,以探讨临床护理人员实施心脏康复护理的可行性。方法以Pender的健康促进模式为理论框架,自行设计问卷,并对曾在循环内科工作过的注册护士进行问卷调查。结果总动力因素均数为高水平,动力因素的子因素均数水平按降序排列依次为:自身工作的成就感;对新知识的渴望;乐于同其他医务人员合作;可获得更高评价及医院行政部门要求。结论为了调动护理人员开展心脏康复的积极性,在护理实践、护理行政管理、及护理教育方面应制定相应措施。     

基于信息化平台网格化居家护理服务模式的构建及应用

目的基于信息化平台网格化管理构建居家护理服务新模式,以期有效解决居家康复群体医疗护理需求。方法2018年11月浙江省台州市成立居家护理服务中心和居家康复护理技能培训中心,建立网格化居家护理服务模式,落实优质护理资源下沉,让社区护士成为居家护理主力军;2019年11月建立居家护理服务信息平台,打造线上、线下一体化居家护理分级管理体系,通过信息共享,分级派单,保障居家护理服务高质、便利、安全。记录2020年1-5月网格化居家护理服务开展情况和患者满意度,评价实施效果。采用χ²检验进行统计分析。结果台州市共28所二级以上医院、123个基层医疗机构、1171名社区护士入驻居家护理信息平台。2020年1-5月护理人员共提供居家护理5274例次,其中上门护理4472例次,线上护理802例次;上门护理患者满意度为98.73%(4415/4472),线上护理患者满意度为98.25%(788/802),两种服务类型满意度比较差异无统计学意义(χ²=1.136,P=0.286)。无投诉、不良事件及护士安全问题发生。结论基于信息化平台的网格化居家护理服务模式可以充分发挥社区护士作用,拓宽居家护理服务范围,合理进行医疗资源配置,为居家康复群体解决医疗护理问题,有效推进分级诊疗。     

Issues related to the use of nurse extenders

The nursing shortage has prompted a recurring discussion about the appropriate mix of bedside care givers in nursing that can be constructed to ensure quality patient care. As nursing's role has become more professional, there has arisen a need to differentiate work tasks and develop nurse extenders. The author discusses nursing and non-nursing duties as they relate to a model of nurse extenders and related practice issues.     

Nurses’ practice environment and satisfaction with schedule flexibility is related to intention to leave due to dissatisfaction: A multi-country,multilevel study

BackgroundNursing turnover is a major issue for health care managers, notably during the global nursing workforce shortage. Despite the often hierarchical structure of the data used in nursing studies, few studies have investigated the impact of the work environment on intention to leave using multilevel techniques. Also, differences between intentions to leave the current workplace or to leave the profession entirely have rarely been studied.ObjectiveThe aim of the current study was to investigate how aspects of the nurse practice environment and satisfaction with work schedule flexibility measured at different organisational levels influenced the intention to leave the profession or the workplace due to dissatisfaction.DesignMultilevel models were fitted using survey data from the RN4CAST project, which has a multi-country, multilevel, cross-sectional design. The data analysed here are based on a sample of 23,076 registered nurses from 2020 units in 384 hospitals in 10 European countries (overall response rate: 59.4%). Four levels were available for analyses: country, hospital, unit, and individual registered nurse. Practice environment and satisfaction with schedule flexibility were aggregated and studied at the unit level. Gender, experience as registered nurse, full vs. part-time work, as well as individual deviance from unit mean in practice environment and satisfaction with work schedule flexibility, were included at the individual level. Both intention to leave the profession and the hospital due to dissatisfaction were studied.ResultsRegarding intention to leave current workplace, there is variability at both country (6.9%) and unit (6.9%) level. However, for intention to leave the profession we found less variability at the country (4.6%) and unit level (3.9%). Intention to leave the workplace was strongly related to unit level variables. Additionally, individual characteristics and deviance from unit mean regarding practice environment and satisfaction with schedule flexibility were related to both outcomes. Major limitations of the study are its cross-sectional design and the fact that only turnover intention due to dissatisfaction was studied.ConclusionsWe conclude that measures aiming to improve the practice environment and schedule flexibility would be a promising approach towards increased retention of registered nurses in both their current workplaces and the nursing profession as a whole and thus a way to counteract the nursing shortage across European countries.     

The Autonomous-collaborative Care Model: meeting the future head on

As care needs continue to increase in complexity in inpatient settings, and nurses' scope of practice evolves to keep pace with these changing demands, it is imperative that nurse leaders ensure nursing care delivery models are well aligned to current realities. Older, traditional models of nursing service may no longer foster safe, effective and efficient care or contribute to job satisfaction and high-quality work life for nurses. This paper describes the Autonomous-Collaborative Care Model and its application in a continuing care setting. This innovative and flexible model fosters autonomy and accountability in nursing practice, reduces duplication in the execution of nursing tasks, enhances effective communication and outlines mechanisms for collaboration among various members of the nursing and interprofessional teams. The model has positioned the authors' organization to meet impending shortages of nursing personnel by ensuring that the right category of nurse is assigned to the appropriate patient, by reducing non-nursing work and by supporting nurses' autonomy to practise to their full scope.     

Effects of director of care support on job stress and job satisfaction among long-term care nurse supervisors

The provision of care for frail older adults in Long-term care settings is challenging. It requires not only specialized knowledge and skills, but also supportive commitment on the part of directors of care to their nurse supervisors (registered nurses and registered practical nurses) and unregulated healthcare staff. In these complex work environments, communication and leadership are critical to staff job satisfaction. Therefore, it is essential that directors of care represent a source of support for their nurse supervisors. The purpose of this multi-site study was to examine the relationships among perceived support from directors of care, and nurse supervisors' job stress and job satisfaction. Forty-five per cent of the total variance in job satisfaction of nurse supervisors was explained by supervisory support, stress and job category (registered nurse vs. registered practical nurse). Greater supervisory support was also associated with reduced job stress. These findings are essential in developing strategies to improve the nurse supervisory role in long-term care settings.     

Leadership: the key to quality outcomes

Nurse executives are charged with creating a workforce that provides quality care in a creative and cost-effective manner. Style of leadership determines how nurse executives relate to their professional nurses and ultimately how successful their health care institutions will be. The practice-based theory of nursing leadership called the Integrated Leadership Practice Model can be practiced by nurse executives to promote employee satisfaction, assure that quality care is provided based on standards and competencies, and promote an organizational culture committed to quality. This article proposes the application of integrated leadership to the practice of nurse executives and demonstrates how they can foster and support this model for nursing leadership within their nurse managers.