Internationally recruited neonatal nurses' experiences in the National Health Service in London

The aim of this study was to explore internationally recruited neonatal nurses' (IRNNs) perceptions of their experiences of working in the National Health Service (NHS) in London. This was an exploratory study. A purposive sample of 13 nurses (all females) from two teaching hospitals in London participated in this study. Semi‐structured face‐to‐face interviews were used to capture IRNNs views of working in the NHS in London. Five themes emerged, namely: motivation to migrate, lack of preparation for neonatal nurses, environmental conditions impacting on care delivery, neonatal nurses deskilling, and role restrictions as well as professional development. The findings of this study provide first‐hand insights from the subjective perspectives of IRNN experiences. IRNNs experienced some challenges to their working lives; however, good preparation is important when recruiting them to work in the NHS.     

Enrolled nurse conversion: a review of the literature

AIM: The aim of this literature review was to examine the policies and professional literature from the last 50 years about the introduction, the role and subsequent plight of the enrolled nurse (also known as second level nurses), and the need to convert to the first level of the UKCC nursing register. BACKGROUND: Nurse shortages within the NHS have been cyclical since its inception in 1948. The policy decision to cease the training of enrolled nurses within the frame of modernizing the education and training of the nursing workforce had two distinct implications for enrolled nurses. Firstly, they could choose to stay as enrolled nurses or convert to first level nursing. Nevertheless, enrolled nurses have cited the lack of funded conversion course places, and managerial support for non-conversion. METHODS: A critical review of the national policies and professional literature concerned with the evaluation of enrolled nurses' contribution to the NHS. FINDINGS: It was argued that national policy needs to be supported on the ground, whereby enrolled nurses are proactively supported to come forward for conversion and/or meaningful roles are created and sustained where enrolled nurses continue to make a valuable contribution to the NHS agenda. Finally, the paper challenges all NHS organizations to consider the profile and value of enrolled nurses and become proactive in their recruitment and retention of this nursing group.     

Back-to-basics with a surgical rotation programme

This article describes the development and implementation of a rotation programme for Band 5 nurses within the surgical directorate at Heart of England NHS Foundation Trust. The article highlights the challenges raised for nurses with health service modernization and develops the rationale for the need for a different way of thinking. At Heart of England NHS Foundation Trust, the authors evaluation has led to the development of the surgical rotation programme for Band 5 nurses. This rotation programme challenged basic clinical practice and traditional modes of staff placement. Indications, so far, are that quality of care for patients has improved and nurses satisfaction has increased as a result of the implementation of the Band 5 surgical rotation programme.     

The pathophysiology of emphysema: Considerations for critical care nursing practice

Emphysema is caused by exposure to cigarette smoking as well as alpha(1)-antitrypsin deficiency. It has been estimated to cost the National Health Service (NHS) in excess of 800 million pounds per year in related health care costs. The challenges for Critical Care nurses are those associated with dynamic hyperinflation, Auto-PEEP, malnutrition and the weaning from invasive and non-invasive mechanical ventilation. In this paper we consider the impact of the pathophysiology of emphysema, its effects on other body systems as well as the impact acute exacerbations have when patients are admitted to the Intensive Care Unit.     

Health of community nurses: a case for workplace wellness schemes

Community nursing is associated with stress and burnout, which can impact heavily on the individual and the NHS both economically and on the quality of patient care. Recent Government publications have called for an increase in workplace health schemes, with the public sector 'leading by example'. As the largest employer in Europe, the NHS is well placed to develop workplace wellness schemes to address the health needs of staff and to indirectly influence primary prevention among patients. Lessons from an innovative employee wellness programme in an NHS hospital setting demonstrates that such schemes may positively alter individual health and attitudes towards the employer. There is scope for development of such schemes to improve health and well-being in community nurses.     

Policy and management of human resources in the health care system of Portugal

Portugal has adopted the Beveridgian model of National Health Service after the revolution of 1974. However, certain principles have been proclaimed long before that date. In particular, equity in access to and solidarity in financing of health care have been emphasized since many decades, although not yet completely implemented nowadays. The NHS is managed by the Ministry of Health who employed in 1999 approximatively 115,500 professionals. In 1998, the Portuguese NHS had 245 medical doctors and 334 nurses per 100,000 population. As concerns ambulatory care, the NHS deploys throughout the country health centers where GPs act as gatekeepers. The NHS is plagued by several chronic shortcomings: politics and politicians are deeply involved in its decision-making process, its information system is weak, manpower planning is lacking, the medical careers outside hospitals are not appreciated, continuing education of health workers is neglected, the working conditions and skill-mix are deteriorating and, finally, the remuneration system is outdated.     

Impact of NHS Direct on other services: the characteristics and origins of its nurses

Method: A postal survey of NHS Direct nurses in all 17 NHS Direct call centres operating in June 2000.

Results: The response rate was 74% (682 of 920). In the three months immediately before joining NHS Direct, 20% (134 of 682, 95% confidence intervals 17% to 23%) of respondents had not been working in the NHS. Of the 540 who came from NHS nursing posts, one fifth had come from an accident and emergency department or minor injury unit (110 of 540), and one in seven from practice nursing (75 of 540). One in ten (65 of 681) nurses said that previous illness, injury, or disability had been an important reason for deciding to join NHS Direct. Sixty two per cent (404 of 649) of nurses felt their job satisfaction and work environment had improved since joining NHS Direct.

Conclusion: The NHS Direct nurse workforce currently constitutes a small proportion (about 0.5%) of all qualified nurses in the NHS, although it recruits relatively experienced and well qualified nurses more heavily from some specialties, such as accident and emergency nursing, than others. However, its overall impact on staffing in any one specialty is likely to be small. NHS Direct has succeeded in providing employment for some nurses who might otherwise be unable to continue in nursing because of disability.

     

Engaging with a new reality: experiences of overseas minority ethnic nurses in the NHS

Aim and objective. The purpose of this study was to explore, describe and develop a greater understanding of the experiences of overseas black and minority ethnic nurses in the National Health Service (NHS) in the south of England. Background. For the past five decades, the NHS has been recruiting overseas black and minority ethnic nurses from several former British colonies to alleviate the manpower shortages. More recently there has been a shortage of nurses in the labour force and as a result the NHS has once again recruited overseas nurses. Despite this recruitment drive there are limited studies outlining how overseas black and minority nurses have fared in the NHS. Methods. This qualitative phenomenological study used four purposeful focus groups and all participants involved were interviewed at a place convenient for them. These all non‐white participants originated from Asia, Africa and the Caribbean. Each focus group contained six participants with an overall total of 24 participants involved in the study. Results. Following thematic analysis, the findings revealed six themes such as, the devaluation process, concept of self‐blame, discrimination/lack of equal opportunity, concept of invisibility, experiencing fear and benefits of being here. Several overseas nurses felt devalued and indicated that white UK nurses appeared to have placed little trust in them. They stated that both discrimination and lack of equal opportunity were present in the workplace and they also revealed that some white UK nurses were sometimes abusive. As a result they tolerated such behaviour for fear of being thrown out with their families. Despite such negative experiences participants indicated that the experiences gained whilst working in the NHS were useful. Conclusions. There is a need for overseas nurses to be treated fairly and with respect particularly in the light of an acute labour shortage of nurses in the NHS. The findings suggest that overseas minority ethnic nurses’ experiences have been mixed, with some positive as well as negative experiences, within a process that devalues them as workers. Relevance to clinical practice. This paper highlights a need for a re‐evaluation of equal opportunity policies and proposes more diversity training so as to prepare nurses to cope with an increasingly complex and diverse workforce.     

Creating and recreating the NHS: the importance of ensuring nurse involvement

AIM: The aim of this paper was to examine the consequences of the lack of a formal role for nurses within the administrative structure of the NHS between 1948 and 1966. BACKGROUND: UK health policy since 1997 has emphasized the need to re-create the NHS as a modern, dependable service, with clinicians leading the changes. Over the same period, restructuring of the bodies that determine the planning and provision of NHS services has resulted in fewer places for nurses on key decision-making bodies. EVALUATION: Exclusion from formal decision-making roles in the health committees of the NHS during its first two decades considerably limited the influence that nurses could exert over their own work and the circumstances in which they performed their duties. KEY ISSUES: Nurses should recognize the importance of involving themselves in the politics of health and of health service delivery. CONCLUSIONS: Nurses are unlikely to be able to deliver the changes in healthcare that current Department of Health policy anticipates without access to political and economic, as well as clinical, influence in the NHS. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing leaders should continually press the Department of Health to guarantee places for nurses at all levels of decision-making in the NHS and seek assurances that further restructuring will not result in further losses.     

Using nursing practice guidelines for the prevention of multidrug‐resistant tuberculosis among hospitalized adult patients in Bangladesh

Multidrug‐resistant tuberculosis (MDR‐TB) is one of the major public health concerns worldwide particularly in developing countries, including Bangladesh. Thus far, there are no well‐validated clinical guidelines for the prevention of MDR‐TB. This study aims to evaluate the improvement in nurses' practice using the newly developed Nursing Practice Guidelines for the Prevention of MDR‐TB (NPG: MDR‐TB) among hospitalized adult patients in Bangladesh. The guidelines were developed, disseminated and evaluated among 64 nurses by assessing nursing practice for the prevention of MDR‐TB during pre‐ and postimplementation of the guidelines. Significant differences between pretest and post‐test mean scores of nursing practice for the prevention of MDR‐TB in case finding and case holding were found in three levels of wards, including Level 0 (non‐TB), Level 1 (TB) and Level 2 (MDR‐TB) (P < 0.001). This indicated that the guidelines might be applicable to reduce the development of MDR‐TB in hospitals. However, this was a preliminary study with a limited time frame. Further evaluation is, therefore, needed.     

E-learning in wound care: developing pressure ulcer prevention education

Patients with pressure ulcers suffer pain and distress from wounds that can require treatment for many months following discharge from hospital (Havard, 2007). This initial and ongoing treatment accounts for around four per cent of the NHS annual budget (Bennett et al, 2004), therefore pressure ulcer prevention and management is beneficial not only to patients but also the NHS. Education for healthcare professionals is an important factor in the prevention and management of pressure ulcers; however, in the current climate releasing staff to attend study days is becoming difficult. In some locations staff have to travel long distances in order to attend while locally-based study days are poorly attended. Developing e-based learning was seen as a realistic option for nurses working in Trust within a large geographical area.     

Overcoming the hurdles: setting up clinical trials in three UK hospices

Three nurses, all experienced in palliative care but new to a research role, were employed by a Comprehensive Local Research Network to form part of the first network of 'research-active hospices' in the UK. This article outlines the challenges and hurdles faced by the research nurses and illustrates how their achievements can be capitalized on to ensure that future research nurses have a greater insight into the research process when undertaking clinical palliative care research studies in a non-NHS setting. The research nurses' experiences have highlighted issues that need addressing, particularly in relation to research governance-ethical and Research and Development approval for National Institute for Health Research portfolio studies being undertaken in what are effectively classed as non-NHS institutions with NHS patients. These issues are hopefully now being taken forward by those responsible for policy-making, ensuring that an ever-growing population of palliative care patients involved with hospice services has the same access to participation in research as other NHS patients.     

Job satisfaction and employment prospects for nurses

A recent media campaign has emphasized the benefits to the NHS of attracting nurses back to work. In this article, the potential for success from such a recruitment drive is acknowledged but the balance of assessment is redressed, to reflect a broader economic perspective which takes into account resource limitations. The costs of these initiatives, as well as the benefits, are considered in terms of how else the resources involved could be used. A call is made for nurses, and other individual decision makers engaged in nurse recruitment, to consider benefits with all relevant costs systematically, even if reliable information is limited. That approach would be in the spirit of the changes to NHS governance that are currently being introduced and could help to ensure that the health of patients overall is served as well as possible by the contribution to it made by nurses.     

Nurses on top

Three nurses describe their ascent to the role of chief executive of NHS trusts and the challenges and pleasure their high-profile jobs bring.     

A study of the movement of nurses and nursing skills between the NHS and the private sector in England and Wales

An investigation of 2165 qualified nurses joining eight NHS District Health Authorities (DHAs) and 72 private sector institutions was undertaken in order to measure the skills which move between these sectors and to estimate the likely impact on NHS nursing services of any future growth in the private sector. It was found that 42% (95% confidence interval: 36%, 48%) of the nurses joining private acute hospitals and 28% (95% CI: 21%, 37%) of those joining long-stay private nursing homes came directly from the NHS workforce. Fewer qualified nurses move from the private sector to the NHS. Private acute hospitals appear to attract recruits from a specific section of the NHS workforce: nurses under 30 years of age with specialist skills such as theatre nursing, renal nursing, intensive care and oncology.     

NHS Direct and nurses--opportunity or monotony?

NHS Direct, the 24-hour telephone helpline providing information and advice about health problems, is available throughout England and Wales. It was envisaged as a nurse-led service presenting a new opportunity for the nursing profession. Free text comments from a postal survey of NHS Direct nurses revealed that a large proportion of nurses were happy with working in NHS Direct, and that it presented some nurses with the opportunity of a new and challenging role. However, a minority found the work monotonous and felt that NHS Direct is likely to face the challenge of staff retention.     

Advances in addressing technical challenges of point-of-care diagnostics in resource-limited settings

The striking prevalence of HIV, TB and malaria, as well as outbreaks of emerging infectious diseases, such as influenza A (H7N9), Ebola and MERS, poses great challenges for patient care in resource-limited settings (RLS). However, advanced diagnostic technologies cannot be implemented in RLS largely due to economic constraints. Simple and inexpensive point-of-care (POC) diagnostics, which rely less on environmental context and operator training, have thus been extensively studied to achieve early diagnosis and treatment monitoring in non-laboratory settings. Despite great input from material science, biomedical engineering and nanotechnology for developing POC diagnostics, significant technical challenges are yet to be overcome. Summarized here are the technical challenges associated with POC diagnostics from a RLS perspective and the latest advances in addressing these challenges are reviewed.     

Doctors, managers and politicians

Doctors and politicians have rarely seen eye to eye on what a health service should provide and how it should be managed. The introduction of general management in 1984, while initially successful, created new fault-lines between doctors, managers and politicians that were compounded by a succession of NHS reorganisations. These changes brought politics too close to front-line management, highlighted the incompatibility of managerially determined targets with the essence of professional practice, and have led to the development of a management agenda disconnected from healthcare. Remedies are suggested here that reflect the particular roles and contributions of each group that could restore a sense of shared purpose in the running of the NHS.     

Early findings from an evaluation of a post-registration staff development programme: The Flying Start NHS initiative in Scotland,UK

The first year post-qualifying as a nurse or midwife is often seen as a key transitional period. Flying Start NHS is the national development programme for all newly qualified nurses, midwives and allied health professionals in NHS Scotland. It is designed to support the transition from student to newly qualified health professional through supporting learning in everyday practice. It is a web-based or CD-ROM programme which seeks to increase the confidence and competence of newly qualified nurses and midwives during their first year of employment following registration. The aims of this study were to establish levels of self-report competency, self-efficacy, job demands and career intentions in newly qualified nurses undertaking Flying Start NHS programme in Scotland. The aims were met by conducting a cross-sectional survey of Flying Start NHS students. Newly qualified nurse participants (n = 97) comprised a convenience sample of newly qualified nurses who were registered as undertaking the Flying Start NHS on-line programme during Autumn–Winter 2007. Most newly qualified nurses intend to remain in the NHS although a small but important number may leave.     

Tinkering and tailoring individual consultations: how practice nurses try to make cardiovascular risk communication meaningful

Aims and objectives. To explore the perspectives of practice nurses in their role of communicating cardiovascular risk to patients. Background. Nurses in primary care have for some time been engaged in cardiovascular risk discussions with patients. With the recent introduction of the NHS Health Checks, the focus on this work is set to increase. Design. Qualitative using a framework approach. Methods. Two focus groups and 16 semi-structured interviews were conducted with nurses purposively sampled from those working in primary care. Results. The nurses' accounts revealed the need to develop a relationship of trust and establish a level of relevance with each individual patient whilst discussing cardiovascular risk. Potential aspects of these discussions were as follows: working within a highly structured data-collecting task; time constraints and consideration of the individual's context. We used the idea of tailoring to describe how nurses navigate and constantly modify and pitch their approach for each patient they see in response to these constraints. Conclusion. We suggest that in order for risk to be made meaningful to patients, practice nurses recognise the need for such information to be embedded in the more reciprocal dynamics of nurse-patient consultations. From their perspective, success is often as much about not saying something, or saying it in a particular way, as saying anything accurately or consistently. Relevance to clinical practice. For practice nurses to be instrumental in the successful delivery of health prevention policy initiatives such as the NHS Health Checks, it is important to acknowledge their views and perspectives in undertaking this work. This study suggests that the nurses recognised the need for further skills and a refinement of approach for those health professionals involved.