Agency nursing in Melbourne,Australia: a telephone survey of hospital and agency managers

BACKGROUND: Agency nursing is a poorly understood and under-researched phenomenon. Despite the considerable costs and possible benefits of using agency nurses, little is known about the nature of agency nursing from different perspectives, including hospital and agency managers. AIM: To describe the professional relationship between hospitals and nursing agencies, utilization trends of agency nurses, and institutional policies relating to the employment of agency nurses. METHODS: A telephone survey was conveyed to managers of 70 acute hospitals (service purchasers) and 26 agencies (service providers) to provide baseline information on the utilization of agency nurses in acute hospitals in Melbourne, Australia. Introductory telephone calls were made to the chief nursing officers of the hospitals and the chief executive officers of nursing agencies in order to explain and seek approval for the proposed project. Approval to conduct telephone interviews was obtained from 30 acute hospitals and six agencies, representing a response rate of 43% and 23%, respectively. Separate questionnaires were used for the two categories of respondent. In some cases the questionnaire could not be completed using the telephone and a copy was then sent by post for completion. RESULTS: Findings revealed the high utilization of agency nurses in hospitals, the limited nature of continuing education for agency nurses, tensions between matching agency nurse qualifications with acute specialty needs and the notion that agencies preferred nurses to be flexible in their work assignments. CONCLUSIONS: The study was limited by the fact that the final sample was small (30 hospitals and six agencies), and therefore may not be representative of the wider population of Melbourne hospitals or agencies. However, it provided evidence on the utilization of agency nurses in public and private hospitals that will help shape policy on the regulation of the agency nursing workforce.     

Agency-nursing work: perceptions and experiences of agency nurses

This paper explores agency-nursing work from the perspective of agency nurses to gain in-depth understanding of their clinical practice, their relationships with the employing agency, hospitals and permanent nurses, and their professional status. For this study, individual interviews were conducted with ten agency nurses who were registered with one of three nursing agencies in Melbourne, Australia. Five major themes emerged from interview data: orientation, allocation of agency nurses, reasons for doing agency-nursing work, experiences with hospital staff, and professionalism. The findings reveal that the primary reason for nurses engaging in agency-nursing work is for the flexibility it offers. While agency nurses described a commitment to professionalism, the findings emphasise the need to establish effective communication networks between agency nurses, nursing agencies and hospital institutions. Such communication between stakeholders is important to facilitate discussion of issues such as appropriate notification of shift availability, appropriate assignment of work and recognition of the agency nurse as a valuable member of the health care team. In particular, the findings highlight the importance of comprehensive orientation and education for agency nurses to shift the focus of their daily work from task completion to more comprehensive patient care.     

Us and them: Experiences of agency nurses in intensive care units

ObjectiveThis qualitative case study describes the work experiences of agency nurses from their perspective. It explores their interactions with intensive care unit managers to whom they report in their designated intensive care units and their relationships with fellow permanent nurses.MethodsA qualitative study was undertaken in three intensive care units at a public hospital in South Africa. Face-to-face interviews were used to collect data from eleven agency nurses. Thematic analysis of the data was undertaken.FindingsThe challenges of agency nursing work were haphazard clinical allocation, a lack of self-efficacy and competence, and feelings of exclusion. Positive aspects of the agency nurse experience included feedback and support from permanent nurses and intensive care unit managers and occurrences of belonging and acceptance.ConclusionThe findings of this study point to the importance of agency nurse relationships with managers and fellow permanent nurses. To ensure patient care is not compromised, managers and nurse managers have a responsibility to ensure a welcoming, inclusive and nurturing environment for all staff tasked with intensive care unit responsibilities.     

Human resource development in nursing: views of nurse managers and nursing staff

Aim  This study describes the views of nurse managers and staff members on human resource development (HRD) in health care. Our interest here is whether there are any differences between these two groups.
Background  The need for HRD in order to cope with an ageing workforce and a diminishing number of younger nurses.
Methods  A postal questionnaire was sent to a random sample of nursing staff ( n  =   653) and all nurse managers ( n  =   302) in six Finnish hospital districts in spring 2005. The data were analysed by statistical methods.
Results  The nurse managers placed more emphasis on human resource development than did staff members. In general, both the nurse managers and nursing staff held positive views on human resource development, but they reported that HRD practices were quite under-developed. Some differences emerged between the groups.
Conclusions and implications for nursing management  These findings underline the importance of human resource development and its practices in health care. Nurse managers need to implement strategically steered HRD in order to maintain high quality of care in the future.     

优质护理服务示范病房责任护士职责及任职资格的调查分析

目的:通过对优质护理服务示范病房责任护士岗位进行工作分析,明确优质护理服务中责任护士的职责及任职资格。方法:自行设计优质护理服务示范病房责任护士岗位工作分析调查问卷,对某三级甲等综合性医院130名护理人员进行调查。结果:优质护理服务示范病房责任护士的岗位职责认同率均达到95.00%,结果显示,年龄30～35岁,工作5年以上,大专及以上学历,护师及以上职称,身体、心理素质较好的才能胜任责任护士资格。结论:对责任护士职责及任职资格的工作描述为优质护理服务示范病房责任护士的科学管理提供了理论依据,为优质护理服务中护理质量的持续改进奠定了坚实的基础。     

Assessment of nursing management and utilization of nursing resources with the RAFAELA patient classification system--case study from the general wards of one central hospital

Background. RAFAELA is a new Finnish PCS, which is used in several University Hospitals and Central Hospitals and has aroused considerable interest in hospitals in Europe. Aims and objectives. The aim of the research is firstly to assess the feasibility of the RAFAELA Patient Classification System (PCS) in nursing staff management and, secondly, whether it can be seen as the transferring of nursing resources between wards according to the information received from nursing care intensity classification. Methods. The material was received from the Central Hospital's 12 general wards between 2000 and 2001. The RAFAELA PCS consists of three different measures: a system measuring patient care intensity, a system recording daily nursing resources, and a system measuring the optimal nursing care intensity/nurse situation. The data were analysed in proportion to the labour costs of nursing work and, from that, we calculated the employer's loss (a situation below the optimal level) and savings (a situation above the optimal level) per ward as both costs and the number of nurses. Results. In 2000 the wards had on average 77 days below the optimal level and 106 days above it. In 2001 the wards had on average 71 days below the optimal level and 129 above it. Converting all these days to monetary and personnel resources the employer lost €307,745 or 9.84 nurses and saved €369,080 or 11.80 nurses in total in 2000. In 2001 the employer lost in total €242,143 or 7.58 nurses and saved €457,615 or 14.32 nurses. During the time period of the research nursing resources seemed not have been transferred between wards. Conclusions. RAFAELA PCS is applicable to the allocation of nursing resources but its possibilities have not been entirely used in the researched hospital. The management of nursing work should actively use the information received in nursing care intensity classification and plan and implement the transferring of nursing resources in order to ensure the quality of patient care. Relevance to clinical practice. Information on which units resources should be allocated to is needed in the planning of staff resources of the whole hospital. More resources do not solve the managerial problem of the right allocation of resources. If resources are placed wrongly, the problems of daily staff management and cost control continue.     

Exploring ethical perspectives of nurses and nurse managers

With nursing shortages reaching crisis proportions, staff nurses need to believe that nurse managers are supportive. However, evidence exists that staff nurses view nurse managers as moving away from basic nursing values. Using an exploratory philosophical approach, the authors examine this issue as a function of differing ethical frameworks used by nurses and nurse managers. The main question is whether nurse managers are expected to subscribe to a corporate ethic versus a nursing ethic in making decisions, and whether these approaches are fundamentally different. The authors' supposition was that exposing differences might account for some dissatisfaction that nurses express with regard to nursing leadership. They conclude that there are differences of emphasis in ethical principles that may cause tension. Incongruencies between corporate and individual values emerge under fiscal constraints and with differing perceptions, expectations and decision-making criteria. This paper offers suggestions to help staff nurses and nurse managers reduce tensions experienced when difficult choices, particularly those of resource allocation, are required.     

Nursing practice environment,quality of care,and morale of hospital nurses in Japan

The purpose of this study was to describe Japanese hospital nurses' perceptions of the nursing practice environment and examine its association with nurse‐reported ability to provide quality nursing care, quality of patient care, and ward morale. A cross‐sectional survey design was used including 223 nurses working in 12 acute inpatient wards in a large Japanese teaching hospital. Nurses rated their work environment favorably overall using the Japanese version of the Practice Environment Scale of the Nursing Work Index. Subscale scores indicated high perceptions of physician relations and quality of nursing management, but lower scores for staffing and resources. Ward nurse managers generally rated the practice environment more positively than staff nurses except for staffing and resources. Regression analyses found the practice environment was a significant predictor of quality of patient care and ward morale, whereas perceived ability to provide quality nursing care was most strongly associated with years of clinical experience. These findings support interventions to improve the nursing practice environment, particularly staffing and resource adequacy, to enhance quality of care and ward morale in Japan.     

护理岗位管理设计与实践

对护理岗位设置与分级、护士职业发展规划进行设计,在此基础上对医院244名护士进行了护理岗位分级管理。通过护士岗位分级的绩效分配方案改进,体现多劳多得和同工同酬,较好地调动了护士的积极性。     

Changing to primary nursing in a nursing home in Finland: experiences of residents, their family members and nurses

AIM: The aim of the study was to find out how nursing home residents, their families and nurses experienced the change to primary nursing in the nursing home. BACKGROUND: This study was carried out in a nursing home in Finland. Following years of functional nursing, the change to primary nursing had started 18 months prior to data collection. The transition was preceded by staff training, planning for the change to primary nursing and discussions with staff members. Meetings were also arranged with family members to inform them of what was happening and why. Staff implemented the changeover independently with the support of the institution's management. METHODS: The data were gathered in focused interviews. There were five interview themes: change in the nursing home, the position of the resident in the nursing home, the relationship between the resident and nurse, the relationship between family member and nurse, and the role of the nurse as provider of nursing care. FINDINGS: Residents reported no major changes in nursing care or in their relationship with nurses. However, family members had noticed changes in the behaviour of the nursing staff. Staff members had become friendlier, spent more time with the residents and showed a strong job motivation. Cooperation between nurses and family members had changed very little. Some nurses in the early stages of the change tended to show signs of resistance. Others said that there had been many changes during the past year, that they acted more independently and could use their own decision-making authority more freely than before. They treated residents as individuals and gave them a greater say in decision-making. They felt responsible for the development of the workplace as a collectivity. CONCLUSIONS: Primary nursing is one way in which nurses and family members can work more closely in the best interests of older residents. The findings of this study speak in favour of making the change from functional to primary nursing and at the same time highlight certain problems and possibilities in this process.     

A study of nurses'' attitudes towards associate degree nursing students

The purpose of this study was to examine the attitudes of staff nurses towards associate degree (AD) nursing students. The null hypothesis stated there will be no significant difference in the attitudes of staff nurses towards AD nursing students and associated concepts (nursing education, patient, physician, work, nurse.) The staff nurse's value as a role model is held in high regard yet little regard is given to her attitudes towards students. Through better understanding of staff nurses' attitudes, nurse educators can better plan, develop and coordinate clinical activities to provide an optimum learning environment. The findings showed the concept AD nursing student was significantly different from the rest, indicating a less positive attitude towards the AD nursing student than the related concepts. Implications for nursing practice are threefold. Nurse administrators must create an atmosphere and a philosophy which support the educational process within their institution, and recognize nurses' attitudes towards students. Practising nurses should examine their attitudes and willingness to work with students if their hospital offers their agency as a clinical facility. Educators must look closely at the units they assign students to, continually maintaining the lines of communication between staff nurses and clinical instructors. As service and education work together a quality environment can be provided in which there is optimum learning for the student. Both groups then contribute to the future of professional nursing.     

以临床工作需求为导向的护理岗位设置与动态调配的实践

探索科学化、精细化的护理人力管理模式,寻求以实际需求为导向的护理岗位设置与动态调配方法,以满足临床服务需求为目标,实现医院精细化管理,提升护理人员工作满意度.我院自开业初期全面引进和借鉴我国台湾长庚医院的管理模式,在护理垂直管理体系下,全面探索以临床工作需求为导向的护理工作量计算方法,并以此作为护理人力配置与排班的依据...     

优质护理服务示范病房不同学历、职称、工作年限护理人员工作现状调查分析

目的:调查山东省三级综合性医院优质护理服务示范病房不同学历、职称、工作年限护理人员工作现状。方法:采用问卷调查法,对山东省6所三级医院优质护理服务示范病房546名护士工作现状进行调查。结果:优质护理服务示范病房护理工作的主力是大专学历、初级职称及工作年限1～3年的护士,夜班护理工作主要由大专学历、护士职称及工作年限1～3年的护士承担;不同学历、职称、工作年限护士从事各护理项目有所侧重,差异有统计学意义(P<0.001),但均从事所有工作项目。结论:不同学历、职称、工作年限护士任职标准、岗位职责不明确,应构建合理的优质护理服务示范病房护理人员能级体系,确保护理质量的持续改进。     

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.     

Exploring the contribution of the Clinical Librarian to facilitating evidence-based nursing

Aim. To examine the potential role of the Clinical Librarian in facilitating evidence‐based practice of nurses in acute hospital settings and develop a model for the role. Background. There is a growing policy and professional expectation that nurses will seek out and apply evidence in their clinical practice. Studies have demonstrated that nurses experience barriers in working with an evidence‐based approach. The role of Clinical Librarian has been used in other countries and within medicine to overcome some of the barriers to evidence‐based practice. There are limitations in the previous work in terms of rigour of evaluation, scope of the Clinical Librarian role and application to nursing in a UK setting. Design. A qualitative consultation of 72 nurses in acute care settings. Methods. Six consultation group interviews of between 4–19 participants. Written records were recorded by the scribe. Content analysis was undertaken to identify the range and frequency of comments. Results. Clinical questions currently go unanswered because of barriers of time, skills deficits and access to resources. Literature searching, skills training and evidence dissemination were the main areas of work the staff requested that a Clinical Librarian should undertake. It was anticipated that the Clinical Librarian could interact and work productively with nursing staff with a limited but regular presence on the ward. Interim communication could be via e‐mail, phone and written suggestions and requests for work. It was seen to be vital that the Clinical Librarian worked in partnership with staff to build evidence‐based practice capacity and ensure clinical relevance of the work. Conclusions. This study has generated the first model for the Clinical Librarian role with an emphasis on nursing. It is derived from the views of clinical nurses. Recommendations are made for the implementation and evaluation of such a role. Relevance to clinical practice. The Clinical Librarian could be an invaluable support to promoting evidence‐based nursing.     

深化护理夜班制度改革的实践与效果

目的规范护理夜班管理,为护理人员岗位绩效薪酬制度改革奠定基础。方法调整各护理单元护理人员结构,明确各护理单元在常规情况下夜班岗位数的设置,明确各级、各类护理人员每月应完成的基本夜班数要求,实施护理夜班岗位绩效奖励制度。结果护理人员特别是高年资护理人员承担夜班工作的积极性增加,聘用护士离职率降低。结论规范夜班管理及建立夜班岗位绩效奖励制度是护理夜班安排更加合理化、人性化的重要途径。     

病房临床护理工作工时调查分析

目的:调查病房临床护理工作中的实际工时,了解临床护理工作现状,为合理配置护理人力资源提供客观数据支持。方法:在一个工作周内采用观察法对某"三甲"医院两个病房的每位护士进行随机一对一跟随记录,由此计算出护理工作量和所需护士数量。结果:其内科病房每日总工时为3717.84min,需要护士20人,直接护理时间占总工时的43.9%,潜在非护理工时占总工时的17.6%;外科病房每日总工时3042.55min,需要护士16人,直接护理时间占总工时的44.7%,潜在非护理工时占总工时的17.8%。结论:病房护理工时分配不合理,潜在非护理时间占用过多护理工时,护士编制不足。     

Nurse leaders' views on clinical ladders as a strategy in professional development

AIM: To investigate nurse leaders' views on clinical ladders as a strategy in professional development of nursing. BACKGROUND: Hospitals worldwide have implemented clinical ladders to boost professional development and improve quality of patient care. At ward level good leadership is vital in creating a learning environment and using nurses' new competence. METHOD: The design was explorative and data were collected in focus groups with 19 nurse leaders at the ward level and 24 executive nurse leaders at hospitals with several years of experience with clinical ladders. RESULTS: Most nurse leaders did not think strategically in promoting clinical ladders at the organizational level. Nurse leaders who considered clinical ladders a tool in developing nursing quality found motivational work challenging and rewarding. Not all nurse leaders managed to utilize clinical specialists' new competence. CONCLUSION: Further investigation into nurse leaders' actions as strategic managers of development and use of nurses' competence is warranted. Implications for nursing management It is important that managers see the close connection between professional development of individuals and development of quality and high standard in the ward. A prerequisite is therefore to engage in the strategic planning of competence at all levels of decision in the organization.     

Considering nursing resource as 'caring time'

The present constrained economic climate faced by health care agencies underscores the need for nurse administrators to have an in-depth appreciation of how nursing services are being used The purpose of this investigation was to increase the understanding of nursing as a resource Using phenomenological research methodology, the investigator purposefully selected six patients and a chain sample of 14 professionals responsible for their care, including nurses, nurse managers and physicians Data collection methods included in-depth interviews, document reviews, and participant observation The inductive interpretation depicts the nature of nursing resource to be 'caring time' Caring was understood primarily in terms of time and was experienced by all participants as 'spending time' Caring time was spent through 'being with' and 'doing to/doing for' the patient Study participants experienced tension with regard to how best to spend precious 'caring time' Nursing resource was inextricably linked to both quantitative and qualitative expressions of nursing, and 'being with' patients was a highly valued, under-allocated, and unintentionally provided component of nursing resource The researcher concluded that nursing administrators, nurse managers and practitioners all have leadership roles to play in achieving recognition, allocation and promotion of caring time within their agencies     

Recruitment, retention, and compensation of agency and hospital nurses

Despite the increased use and considerable cost of using supplemental nursing services, almost nothing is known about agency nurses or how they might differ from their hospital counterparts. The purpose of this study was to examine recruitment-, retention-, and compensation-related differences between agency and hospital staff nurses. The authors discuss implications for nurse administrators and provide recommendations for maximizing the work force participation of less costly part-time hospital staff nurses.