Assertiveness training for nurses in a general hospital

This article describes the first stage of an assertiveness training program for staff and managerial nurses in a general hospital. Special problems were raied in the group and their origins discussed. The group focused on the role of the professional nurse and the relationships between doctors, nurses, and patients.     

Nurses' reports on hospital care in five countries

The current nursing shortage, high hospital nurse job dissatisfaction, and reports of uneven quality of hospital care are not uniquely American phenomena. This paper presents reports from 43,000 nurses from more than 700 hospitals in the United States, Canada, England, Scotland, and Germany in 1998-1999. Nurses in countries with distinctly different health care systems report similar shortcomings in their work environments and the quality of hospital care. While the competence of and relation between nurses and physicians appear satisfactory, core problems in work design and workforce management threaten the provision of care. Resolving these issues, which are amenable to managerial intervention, is essential to preserving patient safety and care of consistently high quality.     

Nurses' perceptions of inter- and intra-professional relationships: an analysis of support from nursing and physician colleagues in rural hospitals.

Nurses employed in ten rural hospitals in Canada completed questionnaires designed to examine their perceptions of the strength of the professional relationship which existed among nurses and between nurses and physicians. Four questions addressed the availability of nursing education programs and the attendance of nurses and physicians at such programs. Seven questions examined the nurses' perception of physician interest in nursing education and the encouragement received from their nursing colleagues to participate in learning activities and medical management decision making. Chi square analysis was undertaken to determine whether the colleagial relationships differed by hospital or medical staff characteristics. Forty percent of the nurses felt that the majority of of physicians were supportive of continuing nursing education. Sixty-three percent indicated their nursing colleagues encouraged them to attend educational programs. The results indicate that physician participation in nursing continuing education was greatest in communities with the fewest health resources (an acute hospital with fewer than 50 beds). In contrast, encouragement to participate in continuing nursing education was highest in settings where the hospital provided both acute and extended care services, had more patient admissions and a greater availability of educational programming.     

Psychiatric morbidity and emotional exhaustion among hospital physicians and nurses: association with perceived job-related factors

The objective of this study was to evaluate psychiatric morbidity and emotional exhaustion among physicians and nurses of a general hospital in central Italy, examining the association with perceived job-related factors. Anonymous questionnaires were distributed to all 323 hospital physicians and 609 nurses of a nonprofit health organization in Rome, Italy. Standardized instruments were used to evaluate psychiatric morbidity (General Health Questionnaire), burnout (Maslach Burnout Inventory), and perceived job-related factors. Logistic regression was used to examine the association between job-related factors, psychiatric morbidity, and burnout, controlling for demographic factors. Questionnaires were returned by 155 physicians and 216 nurses (overall response rate 40%). Estimated prevalence of psychiatric morbidity was 25% among physicians and 36.9% among nurses. Burnout on the emotional exhaustion scale affected 38.7% of physicians and 46.4% of nurses. Personnel with emotional exhaustion was at higher risk of psychiatric morbidity (p < .001). The likelihood of psychiatric morbidity among physicians was increased by perceived insufficient recognition of personal commitments by the unit's head (odds ratio [OR] = 4.21; 95% confidence interval [CI] 1.2-15.1; p = .027), insufficient managerial ability of the unit's head (OR = 3.45; 95% CI 1.2-10.1; p = .023), and unsatisfactory communication (OR = 5.30; 95% CI 1.6-17.6; p = .006). Among nurses, psychiatric morbidity was associated with insufficient ability of the unit's head to solve conflicts, insufficient decisional power in relation to responsibilities, insufficient economic rewards and career possibilities, and working in surgery. Similar job-related factors were associated also with emotional exhaustion. Psychiatric morbidity and emotional exhaustion were relatively high, particularly among nurses. Specific job-related factors were associated with psychiatric morbidity and burnout. Improving these aspects is important for the well-being of hospital staff and the quality of patient care.     

Moral Judgments in the Rationing of Health Care Resources

ABSTRACT

Social workers, physicians, and nurses from a major urban teaching hospital were assessed and compared regarding their attitudes toward the rationing of health care. Responses to eighteen statements of considered moral judgments in the rationing of health care resources were analyzed in terms of levels of agreement with each. All three professional groups rejected rationing based on patient age and socioeconomic worth. However, social workers and physicians were more likely than nurses to consider such factors as cost-benefit ratios, quality of life, relative strength of a patient's moral claim, and scarcity of resources in rationing decisions. Study findings appear to portray social workers and physicians as being more utilitarian and nurses more egalitarian in rationing decisions. Implications for practice in a managed care environment are presented.     

The leadership and executive potential of physicians in an era of managed care systems

The emergence of managed care signals a need for an expanded role for physicians. Physician executives, trained in management, have the potential to become champions of clinical integrity, negotiators with patient agent organizations, public interpreters of hospital performance data, consultants to the profession, and designers of health care systems. Nonclinically trained administrators have been slow to recognize the unique skills and perspective that physicians bring to the managerial suite. The clash of professional and managerial cultures has often been perceived as precluding a strong working alliance between physician and nonphysician executives. As hospital margins are threatened, decision protocols must not be designed to incorporate teams of leaders who are able to overcome the managerial/clinical divide. The management of this interface will demand the attention of both administration and boards and may require the establishment of new structures in health care organizations.     

Health staff perception regarding quality of delivered information to inpatients.

BACKGROUND: Accreditation usually requires that healthcare staff assess the quality of care delivered to patients in their own hospitals. It is unknown whether this assessment depends on the workplace rather than on the professional category of health personnel. OBJECTIVE: We aimed to identify major determinants of the perception of various categories of healthcare professionals concerning the quality of delivered information to inpatients in their ward, with a perspective to help the development of recommendations on how to compose self-assessment teams for the accreditation process. METHOD: A self-administered questionnaire survey was conducted in nine wards from five short-stay hospitals in Paris, France. Three hundred and fifteen healthcare professionals (physicians, nurses and nursing assistants) were included. The views of various categories of healthcare professionals regarding the compliance with a set of quality standards were compared by nonparametric statistical analyses. Determinants of the self-assessment of quality of care, including ward effect, were identified by fitting the data to a hierarchical model. RESULTS: The participation rate was 86%, with 272 respondents (58 physicians, 149 nurses and 65 nursing assistants). Overall perceptions of various categories of healthcare professionals were not different. The final hierarchical model showed a strong ward effect (intracluster correlation coefficient=0.06, P<0.01) and a significant relationship between age of professionals and their opinion about quality of care. CONCLUSION: We observed a ward cluster effect on healthcare staff perception of quality, but the category of healthcare professional was not a determinant. A satisfactory representativeness on age of professionals selected into the teams in charge of self-assessment during hospital accreditation is recommended.     

Gender and power: Nurses and doctors in Canada

BACKGROUND: The nurse-doctor relationship is historically one of female nurse deference to male physician authority. We investigated the effects of physicians' sex on female nurses' behaviour. METHODS: Nurses at an urban, university based hospital completed one of two forms of a vignette-based survey in January, 2000. Each survey included four clinical scenarios. In form 1 of the questionnaire the physicians described were female, male, female, and male. In form 2, vignettes were identical but the physician sex was changed to male, female, male, and female. Differences in responses to questions based on the sex of the physician in each vignette were studied RESULTS: 199 self-selected nurses completed the survey. The responses of 177 female respondents and 11 respondents who did not specifiy their sex, and were assumed to be female based on the overall sex ratio of respondents, were analysed. Persistent sex-role stereotypes influenced the relationship between female nurses and physicians. Nurses were more willing to serve and defer to male physicians. They approached female physicians on a more egalitarian basis, were more comfortable communicating with them, yet more hostile toward them. CONCLUSION: When nurses and doctors are female, traditional power imbalances in their relationship diminish, suggesting that these imbalances are based as much on gender as on professional hierarchy. The effects of this change on the authority of the medical profession, the role of nurses, and on patient care merit further exploration.     

Autonomy, job satisfaction and professional self-image among nurses in the context of a physicians' strike

This paper tests the hypothesis that structural changes in nurses' work settings, which allow nurses to autonomously exercise their knowledge and skills will lead not only to an enhanced feeling of professional autonomy, but also to an improvement in their professional self-image and to an increase in job satisfaction. An opportunity to test this hypothesis arose when physicians in Israel went on a strike which lasted 116 days. Primary care (PC) clinics were completely abandoned by physicians, leaving nurses to operate them on their own, while in hospitals, nurses continued to work as usual under physicians' supervision. The study compares the effect of the strike on head nurses in the two sectors. Data were collected by means of self administered questionnaires. The findings indicate that during the strike, PC head nurses expanded their activities and responsibilities and consequently felt more professional autonomy and job satisfaction, as well as an improvement in professional self-image. Hospital head nurses experienced significantly less changes in their work situation and, as expected, less change in all work related attitudes. It is suggested that, when given the opportunity to define for themselves roles where they can use their experience, knowledge and skills, senior nurses stand up to the challenge and consequently are more satisfied and their professional self-image improves.     

Trust‐based or performance‐based management—a study of employment contracting in hospitals

Hospitals are frequently changing managerial practices due to numerous public sector reforms taking place. In general, these reforms include the making and monitoring of contracts that regulate relations between the hospitals and their professional staffs. The aim of this paper is to discuss some main characteristics of the contracts that regulate the perceived relations between physicians as employees and the public hospital as employer. The theoretical framework is based on a contract theory approach. The empirical data is based on survey data from full‐time employed physicians in the medical and surgical divisions in one of the largest university hospitals in Norway. This study shows that perceived obligations and psychological contracts indicate high degree of relational contracts between the hospital and the physicians. These socio‐cultural elements should be recognized as important mechanisms of coordination and communication when policy makers and hospital managers are designing hospital management control systems. Copyright © 2009 John Wiley & Sons, Ltd.     

医护人员对血源性传播疾病职业暴露认知情况的调查分析

目的通过对部分医师、护士的问卷调查,试图了解医护人员对职业暴露的认知情况及从中寻找对策。方法采用整群抽样方法,向医院6个科室的医师、护士发放调查表。采用不记名问卷调查方法,在规定时间内回收进行统计。结果大部分人员表示对职业暴露的概念有了解,但仅小部分能真正掌握。同时医生护士均表示需增加培训及防护用品,并要求医院加强管理。结论调查显示医护人员对职业暴露的掌握有欠缺,需加强职业安全防护培训、增加相应的防护用品、加强职业暴露的管理。     

Evaluation of practices and knowledge among primary health care professionals in relation to child development surveillance

In the present study, the practices and knowledge of 40 physicians and 40 nurses from municipal health care units (UMS) and 40 physicians and 40 nurses from the Family Health Program (FHP) in Belém, Pará State, Brazil, all of whom working in primary health care, were evaluated in relation to child development surveillance. Measures of knowledge of child development showed an average of 63.7% correct answers for UMS physicians, 57.3% for FHP physicians, 62.1% for FHP nurses, and 54.3% for UMS nurses. Only 21.8% of mothers attending appointments mentioned that the health care professional had asked about their children s development, 27.6% of mothers reported that the health care professional had asked about or observed the child s development, and 14.4% mothers reported having received instructions on how to stimulate their children s development. According to this study, primary health care physicians and nurses in the municipality of Belém showed gaps in their knowledge of child development. Child development surveillance is not being conducted satisfactorily in primary health care in the municipality of Belém. It is thus necessary to raise the awareness of health care professionals concerning the problem and provide them with appropriate training.     

Have health care professionals adopted the marketing concept?

The marketing concept is a philosophical foundation of marketing which states that an organization's key task is to discover what target markets want and need, and to deliver the desired products and services with more satisfaction than does the competition. This study surveyed nurses, physicians and hospital administrators to determine the degree of acceptance of the marketing concept as a managerial orientation for hospitals.     

Managerial skills of principal physicians assessed by their colleagues. A lesson from Finland

The purpose of this paper was to discover the views of doctors regarding the managerial skills of their principal physicians and the views of doctors of their postgraduate specialist training in management. This was done by sending out a questionnaire to every second physician registered in 1977-1986 in Finland. They were asked to evaluate their principal physician's managerial skills using a visual analogue scale. A five-point Likert scale was used to inquire how much training doctors had received for different professional tasks, including management, during their specialist training. Of all the 318 principal physicians in this study, 85 percent reported that they had had too little training for managerial skills. It was found that doctors in leading positions, both in public hospitals and the primary health care sector, are aware of the need of training for managerial and leadership skills.     

Motivational patterns of management team members in a large hospital

Management teams have been introduced as a means of solving conflicts and providing highly required co-ordination between professional groups, sub-units and their individual leaders in large, complex organizations such as hospitals. This study examines the motivational patterns of the three members of management teams of four clinical departments at a large university hospital. A strong professionalism was the dominant motivational orientation of all nurse managers (nursing directors of the clinics) and to a great extent also of the physician managers (head physicians of the clinics). The business managers' dominant motivational pattern was hierarchy in two out of the four teams, and professionalism in two teams. The respective comparison groups had rather similar motivational patterns in common with their leaders: ordinary physicians and nurses had a professional and administrative staff hierarchic orientation. The comparison group of mid-level managers from private firms was also hierarchically oriented, although task orientation was also often high in their motivational pattern. The results are consistent with the educational background and differences in the tasks of the groups studied. The role of different professional cultures in determining and designing efficiently functioning management teams is an important task for further research.     

Nurses' management in the clinical practice: problems and challenges in search of competence

With the purpose to enable reflections concerning nurses' managerial performance in hospitalization units, three studies conducted in three different decades, in the same university hospital, were analyzed. From this analysis, it was observed that nurses' managerial practice has been mainly characterized by the accentuated compliance to pre-established norms, thus showing a reiterative praxis. Understanding the fragility of this managerial situation in terms of involvement with and commitment to clients and service givers, an alternative managerial conduct, which is based on the creative praxis, is presented to nurses.