Reluctant but resourceful middle managers: the case of nurses in the NHS

This study counters the widely held view that middle managers have little to contribute to strategic change in health care organizations. In particular, it argues that middle managers with a nursing background that manage clinical activity should be involved in strategic change beyond mere implementation of decisions made by executive management. Constraints upon this are noted - the power of doctors and central government intervention - that means middle managers enact a semiautonomous strategic role. Antecedents for the semiautonomous role are investment in organization and management development, developing lateral organizational structures that allow middle managers to make a contribution to the development, as well as the implementation of strategy and allowing middle managers to interact with other stakeholders outside the confines of the organization.     

Measuring how well the NHS looks after its own staff: methodology of the first national clinical audits of occupational health services in the NHS

Rationale, aims and objectives Little is known about the quality of occupational health care provided to National Health Service (NHS) staff. We designed the first national clinical audits of occupational health care in England. We chose to audit depression and back pain as health care workers have high levels of both conditions compared with other employment sectors. The aim of the audits was to drive up quality of care for staff with these conditions. The object of this paper is to describe how we developed an audit methodology and overcame challenges presented by the organization and delivery of occupational health care for NHS staff. Methods We designed two retrospective case note audits which ran simultaneously. Sites submitted up to 40 cases for each audit. We used duplicate case entry to test inter‐rater reliability and performed selection bias checks. Participants received their site's audit results, benchmarked against the national average, within 4 months of the end of the data entry period. We used electronic voting at a results dissemination conference to inform implementation activities. Results Occupational Health departments providing services to 278 (83%) trusts in England participated in one or both audits. Median kappa scores were above 0.7 for both pilot and full audits, indicating ‘good’ levels of inter‐rater reliability. In total, 79% of participants at a dissemination conference said that they had changed their clinical practice either during data collection (52%) or following receipt of their audit results (27%). Conclusions Clinical audit can be conducted successfully in the occupational health setting. We obtained meaningful data that have stimulated local and national quality improvement activities. Our methodology would be transferable to occupational health settings outside the NHS and in other countries.     

Maternal expectations of the child health nurse

The main aim of this study was to identify what first-time mothers in Sweden expected of Child Health Nurses. A further aim was to investigate what help and support was received by the new mothers and whether they felt that anything was missing. Twenty new mothers were interviewed according to grounded theory and the data were analyzed by the constant comparative method. It was found that first-time mothers expected Child Health Nurses to have faith in a new mother's own strength and to be accessible, approachable and knowledgeable, providing advice and support. New mothers indicated that they had experienced most of these characteristics, especially accessibility and approachability, but some felt that there were deficiencies (e.g. a lack of continued interest in their own bodies and health, as well as a lack of support when they ceased to breast-feed). The Child Health Service was taken for granted by new mothers. First-time mothers indicated that they appreciated the service, particularly those mothers who did not have a good social network. However, some of the new mothers expressed negative feelings regarding the Child Health Service provided.     

Promoting continuity of care for people with long-term neurological conditions: the role of the neurology nurse specialist

Aspinal F., Gridley K., Bernard S. & Parker G. (2012) Promoting continuity of care for people with long-term neurological conditions: the role of the neurology nurse specialist. Journal of Advanced Nursing68(10), 2309-2319. ABSTRACT: Aims. To identify service models that provided care co-ordination for people with long-term neurological conditions in the UK. Background. The successful management of long-term neurological conditions needs sophisticated management across several health, social care and other service boundaries, as well as involvement of people with long-term neurological conditions and their support network. Yet, fragmentation of, and limited access to, support has been evident for over 20?years. Design. This study employed a mixed-method approach, including a systematic review, qualitative case studies and a quantitative national survey. This paper reports findings from the qualitative case study element of the research. Methods. In-depth (qualitative) case studies were conducted in six neurology 'service systems' in the UK representing geographic and demographic diversity. The research took place between November 2007-May 2008. The concept of 'continuity of care' was used as a framework for our case studies. Qualitative methods, including telephone and face-to-face interviews, were used to explore people's experience of continuity of care. Data were managed and analyzed using the Framework technique. Findings. Neurology nurse specialists were able to contribute to all elements of continuity of care for people with long-term neurological conditions. Conclusion. Their specialist knowledge about the condition and local services, flexibility, co-ordinating role, and their holistic and collaborative approach to practice, are key factors in nurse specialists promoting continuity of care. Nurse specialists exist in many different clinical areas and in many countries. Findings about the importance of their role in promoting continuity of care have important implications for UK and international policy and practice.     

专科医院新护士培训初探

[目的]探讨专科医院新护士培训模式的形成,有利于新护士尽快适应工作环境,完成角色的转换。[方法]从录用、岗前培训、临床带教等几方面进行系统性、全方位的岗前培训。[结果]新护士运用新的培训计划后,能尽快地适应岗位的需要,实现角色的转换。[结论]在专科医院,寻找一条实用的符合专科特色的岗前培训模式是可行的,有利于工作的开展,在很大程度上解决了护士缺编的问题,并有利于新护士自信心的培养。     

军队医院聘用制护士应对方式与工作压力的相关性研究

目的分析军队医院聘用制护士的应对方式以及与工作压力源的相关性并提出建议。方法采用简易应对方式问卷和护士工作压力源量表,以无记名问卷调查的形式对296名护士的应对方式和工作压力源进行调查和相关分析。结果军队医院聘用制护士很少采用消极的应对方式,与健康成人相比差异具有极显著意义(P<0.01);积极应对方式和工作量与时间分配、护理专业和工作方面的问题相关性有显著意义(P<0.05);工作压力与消极应对方式呈有极相关性显著意义(P<0.01)。结论聘用制护士的应对方式较一般人群好,但工作压力与消极应对方式呈显著相关性,从而在某种程度上影响着聘用制护士的应对方式。     

LECTURE: A consultant looks at the NHS today (Part 1 of a text based on a lecture delivered by the author at the Royal London Hospital, England, UK)

Distinguished colleagues, Ladies and Gentlemen, fifty years ago decisions were made by clinicians and not academics, managers nor politicians and, for the first few years of the NHS, it was run efficiently and at low cost. Patients were only too well aware that the service that they were receiving was excellent and they were grateful. Although the academics, the managers and the politicians have caused medicine to be replaced by a costly, inefficient and incompetent health industry, the blame lies initially at the door of those clinicians who were too concerned with patient care to see the takeover which was occurring. Lord Platt, in his Harveian oration ‘Medical science: master or servant?’, points out that academic departments had not been responsible for nor even seriously involved in many of the discoveries in therapeutics or preventive medicine (Platt 1967). He goes on to state that ‘the phenomenal success of modern medical treatment seems to have depended almost wholly on non-clinicians, often non-medical scientists, frequently working in, or in close collaboration with, the pharmaceutical industry, and it would be a serious mistake to think that the role of industry has been largely in the field of commercial development. A great deal of the basic scientific work, especially chemical isolation, analysis and synthesis, has taken place there.’ It should be consolation for hard-working clinicians today to read Platt’s confirmation that ‘ideas come from lucky accidents or from the inspiration of men of imagination’ and ‘a great deal of modern Practice in medicine and surgery has been evolved from men whose researches were part of their daily clinical tasks’. So-called non-academic physicians may find amusing the friend of Lord Platt who talked about some form of research being ‘occupational therapy for the university staff’. A mild comment by myself that the active invasion of the teaching hospitals by the universities had not been an unmixed blessing (Fowler 1985) produced a dismissive response (Booth 1986).     

Relocating elderly people and nursing staff from the NHS to the independent sector

Relocating elderly people and nursing staff from the NHS to the independent sector The results of the study reported here highlight the difficulties and potential problems facing re-provision programmes of mental health services. Relocation of services affects not only patients and staff, it also has implications for the education of staff and managers. Without appropriate preparation for relocation, the potential negative effects for older patients could be life threatening. For the staff, relocation could mean new ways of working for which they may not have been prepared. The current educational format does not appear to be sensitive enough to adapt to the pace of policy changes. The management process of re-provision programmes requires more than financial accounting. Preparation for relocation of patients and staff is of paramount importance to achieve the maximum benefits.     

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.     

Nurse-led case management for community dwelling older people: an explorative study of models and costs

Aim To compare community matrons with other nurses carrying out case management for impact on service use and costs. Background In England, nurses working in general practice, as district nurses and disease-specific nurses, undertake use case management. Community matrons were introduced to case management to reduce unplanned hospitalizations of people with complex conditions. Methods Managers in three Primary Care Trusts (PCTs) identified four nurses/matrons engaged in case management. Nurses/matrons recruited five community-dwelling patients referred to them for case management. Patients reported use of health/social services for 9 months, 2008 to 2009. Nurses/matrons completed activity diaries. Results Service use data were available for 33 patients. Compared with other nurse case managers, community matrons had: smaller caseloads; more patient contact time (mean 364 vs. 80 minutes per patient per month); and older patients (mean age 81 vs. 75 years, P = 0.03) taking more medications (mean 8.9 vs. 5.6, P = 0.014). Monthly costs were significantly higher for patients managed by community matrons (add £861), and who lived alone (add £696). Hospitalizations were not associated with patient or service delivery factors. Conclusion Further research on cost-effectiveness of case management models is required. Implications for Nursing Management The case for continued investment in community matrons remains to be proven.     

加强社区护士的高血压病健康教育知识培训

目的 提高社区的诊疗技术及医护人员的综合业务素质和工作能力.方法 共150人,分19个小组,每小组7～8人进行授课培训.结果 (1)提高了社区护士的专业理论知识及综合素质;(2)增强了社区护士对高血压病患者进行健康教育的意识;(3)更新了护士的服务理念,变被动服务为主动服务.结论 加强社区护士的高血压病健康教育知识培训很有必要.     

手术室护士工作压力源与心理健康状况相关性研究

目的了解手术室护士工作压力源与心理健康状况的相关性,并研究其应对策略,为提高手术室护士的心理健康水平提供依据。方法本研究从本市4所医院在手术室工作一年以上的护士随机抽取70名作为调查对象,采用国内认可的SCL90症状自评量表和护士工作压力源量表作为调查工具,将收集的资料通过SPSS11．0软件包进行统计学分析和处理。结果手术室护士工作压力状况显示在工作量及时间方面和压力总分有显著性差异。手术室护士心理健康状况与护理专业及工作方面相关性不大,在工作量及时间分配、工作环境及资源、患者护理及管理和人际关系等方面具有显著相关性。结论诸多手术室工作压力方面的问题,以及一些引起手术室护士心理压力增加的相关因素存在,严重影响着手术室护士的心理健康,乃至影响护理质量。手术室的护理管理者应了解护士的心理需求,实行人性化管理,提供继续教育和参加应对工作压力能力训练的机会;护士要正确对待压力,提高心理防御能力,学会自我减压,保持良好的心理状态,以更高的热情投入到工作中去。     

The role of the neonatal intensive care nurse in decision-making: advocacy, involvement in ethical decisions and communication

Neonatal intensive care unit (NICU) nurses are often faced with complex clinical and ethical problems. Little is known about the role of the NICU nurse in ethical decision-making, or processes that inform decision-making in this setting. The purpose of this study was to explore and describe nurses' perceptions of their role as patient advocate, clinical situations that cause them concern and the extent of their involvement in ethical decision-making. A combined quantitative and qualitative research design was used. A questionnaire was administered to nurses working in the NICU of the sole perinatal tertiary referral centre of Western Australia, Australia. Findings showed that NICU nurses saw their role in ethical decision-making primarily as advocating for the best interests of the infant and family, that they used clinical knowledge and experience to guide ethical decision-making, they were able to clearly articulate ethical problems and respond to them according to the clinical scenario and, while being primarily assertive in presenting their views, some nurses took a more passive approach. These findings support the need for development of a multidisciplinary model for ethical decision-making, where the view of all team members are considered.     

Health promotion: ensuring the health of the nurse

This article describes how health promotion to maintain the health of the nursing workforce is equally important as activities for patients.     

Consultations between nurse prescribers and patients with diabetes in primary care: A qualitative study of patient views

Background

There is a drive to improve the quality of service provision for patients with diabetes and to enable better self-management of this condition. The adoption of prescribing by nurses is increasing worldwide and can potentially enhance service provision. Evidence suggests that patients prefer services where their lifestyle factors and opinions are considered by healthcare professionals within a partnership approach. Few studies have explored patients’ views about their consultations with a nurse prescriber.

Objective

To explore the views patients with diabetes have about their consultations with nurse prescribers and any impact this may have on their medications management.

Design

A qualitative study involving semi-structured interviews and thematic analysis.

Setting

Six primary care sites in which nurses prescribed medications for patients with diabetes in England. Data was collected in 2009.

Participants

Interviews took place with 41 patients with diabetes from the case loads of 7 nurse prescribers.

Results

Findings are reported under three themes; the nurse consultation style, benefits of the nurse prescriber consultation and views on involvement and decision-making. Key aspects of the nurse consultation style were a non-hurried approach, care and rapport, approachability, continuity, and providing clear information based on specialist knowledge. Many benefits were described, including improved access to appropriate advice and medication, greater understanding and ability to self-manage, ability to address problems and improved confidence, trust and wellbeing. While patients were happy with the amount of information received and involvement they had decisions about their treatment, there was some controversy over the consistency of information provided on side-effects of treatment.

Conclusions

The study provides new knowledge about what patients with diabetes value and benefit from in respect to care provided by nurse prescribers. Continuity of relationship, flexibility over consultation length, nurses’ interpersonal skills and specialist diabetes knowledge were identified as crucial to good quality care. Patients require that nurse prescribers are skilled in providing a person-centred approach and have access to specialist training. The level of information and involvement offered to patients should reflect patients’ requirements.     

Service user and carer involvement in student nurse selection: key stakeholder perspectives

The aim of this study was to evaluate an innovation where service users and carers were involved in the recruitment of child and adult nursing students. Seventy candidates, four service users and carers and six academics who had been involved in the selection process took part in the study. A short questionnaire was administered to the nursing candidates. Two semi structured group interviews were undertaken, one with the service users and carers and another with the academics. Findings reveal that the involvement of service users and carers in student recruitment was largely viewed positively with all three major stakeholders supporting it. Nevertheless the academics were also mindful of the difficulties that may be encountered in the process. The key message to emerge from this study is that service user and carer involvement in student selection is not without its challenges but with careful planning can be beneficial for all involved.     

Decisional involvement of senior nurse leaders in Canadian acute care hospitals

wong c.a., laschinger h., cummings g.g., vincent l. & o ’connor p . (2010) Journal of Nursing Management  18, 122–133
Decisional involvement of senior nurse leaders in Canadian acute care hospitals Aim The aim of the present study was to describe the scope and degree of involvement of senior nurse leaders (SNLs) in executive level decisions in acute care organizations across Canada. Background Significant changes in SNL roles including expansion of decision-making responsibilities have occurred but little is known about the patterns of SNL decision-making. Methods Data were collected by mailed survey from 63 SNLs and 49 chief executive officers (CEOs) in 66 healthcare organizations in 10 Canadian provinces. Regression analyses were used to examine whether timing, breadth of content expertise and the number of decision activities predicted SNL decision-making influence and quality of decisions. Results Breadth of content expertise and number of decision activities with which the SNL was involved were significant predictors of decision influence explaining 22% of the variance in influence. Overall, CEOs rated SNL involvement in decision-making higher than the SNL. Conclusions Senior nurse leaders contribute to organizational processes in healthcare organizations that are important for nurses and patients, through their participation in decision-making at the senior team level. Implications for nursing management Findings may be useful to current and future SNLs learning to shape the nature and content of information shared with CEOs particularly in the area of professional practice issues.