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.     

Health care and nursing in Saudi Arabia

Aim:  This paper reviews healthcare provision in Saudi Arabia and the development of nursing together with its current challenges.
Background:  Health care in Saudi Arabia is developing fast with multiple governmental and independent service providers. Economic growth has impacted upon health needs through population and health behaviour change. The development of the indigenous nursing workforce has been slow resulting in much nursing care being delivered by migrant nurses.
Conclusion:  There is a need to increase the proportion of indigenous nurses so that culturally appropriate holistic care can be delivered. Without shared culture and language, it will be difficult to deliver effective health education within nursing care to Saudis.     

Care of patients with chronic obstructive pulmonary disease in primary health care

Aim.  This paper is a report of a study of nurses' perceptions of caring for patients with chronic obstructive pulmonary disease.
Background.  Chronic obstructive pulmonary disease is a global health problem and the number of patients being treated with this disease in primary healthcare settings is increasing. This places new demands on the nurses involved.
Method.  A phenomenographic approach was adopted, using a purposive sample. Data were generated between February and May 2003 from 20 interviews with district nurses and general nurses who cared for patients in primary healthcare settings with chronic obstructive pulmonary disease.
Findings.  In most cases, nurses cared for older people with moderate to severe chronic obstructive pulmonary disease. They described this care from two overall orientations: task and individual. The nurses' perceptions of the care of these patients were described as creating commitment and participation by establishing a good relationship with patients and supporting them in their personal care, educating patients by supplying information and knowledge in various ways, co-operation by co-operating with or referring to other caregivers, and arranging and implementing clinical examinations and treatments.
Conclusion.  The type of care depended on who the patient met: either a task-oriented nurse or an individual-oriented nurse. Therefore, nursing programmes should pay special attention to the support and guidance of new and inexperienced and task-oriented nurses. Healthcare planners should take into consideration the need for individualized care when organizing care and allocating resources for chronically ill people.     

The leadership concept in Iranian nursing

Background:  Although greater emphasis has been placed on leadership skills in nursing management in the last decade, the concepts are often confused or used erroneously by Iranian nurses. At the same time we have observed that wide variations in nurses' clinical practice appeared to be related to the presence or absence of leadership skills among senior nurses.
Aim:  To begin to identify the concepts used for expressing leadership in nursing within the Iranian cultural context.
Methods:  A qualitative approach was adopted using content analysis of semi-structured interviews carried out with 10 nurse managers from hospitals in Teheran. The data were analysed using the constant comparative method.
Findings:  Fifty-five primary codes were identified from the respondents' experiences and from these three main themes were abstracted for describing the leadership concept. These were 'personality traits', 'being a model', and 'being a spiritual guide for the nursing profession'.
Conclusion:  Implementing the culture of patient safety and dignity needs leadership. From Iranian nurse managers' perspectives a leader as a spiritual guide should empower nurses spiritually; it means he/she has a vision for nursing; has clear and explicit objectives; and has a commitment to nursing. Nurses who are confident about the underlying concepts of leadership in their culture can help to adapt nursing to an ever-changing healthcare environment.     

Beyond profession: nursing leadership in contemporary healthcare

Aim(s)  To examine nursing leadership in contemporary health care and its potential contribution to health service organization and management.
Background  As the nursing profession repositions itself as an equal partner in health care beside medicine and management, its enhanced nursing standards and clinical knowledge are not leading to a commensurate extension of nursing's power and authority in the organization.
Method(s)  An ethnographic study of an ICU in Sydney, Australia, comprising: interviews with unit nursing managers (4); focus groups (3) with less experienced, intermediate and experienced nurses (29 in total); and interviews with senior nurse manager (1).
Results  Inter- and intra-professional barriers in the workplace, fragmentation of multidisciplinary clinical systems that collectively deliver care, and clinical and administrative disconnection in resolving organizational problems, prevented nurses articulating a model of intensive and end-of-life care.
Conclusion(s)  Professional advocacy skills are needed to overcome barriers and to articulate and operationalize new nursing knowledge and standards if nurses are to enact and embed a leadership role.
Implications for nursing management  The profession will need to move beyond a reliance on professional clinical models to become skilled multidisciplinary team members and professional advocates for nurses to take their place as equal partners in health care.     

Developing the scope of practice and education for advanced practice nurses in Finland

Background:  The reorganization of Finnish healthcare services has required a restructuring of the areas of responsibility between healthcare professionals.
Aim:  To describe the need for Advanced Practice Nurses in Finland and the development process of a Master's programme in Health Promotion, Advanced Clinical Care.
Methods:  The study consisted of a survey of nurse managers (24) and focus group interviews with clinical nurse specialists (46).
Findings:  The expanded role includes advanced clinical skills and responsibility for health prevention and promotion, education, supervision, leadership, research and development.
Conclusions:  The legislation, scope and models have to be supported and further developed to promote the full scope of advanced practice.     

Caseload management skills for improved efficiency

This article provides information about caseload management, which was one of a group of six competencies identified by nurse administrators as needed by new baccalaureate graduates. Caseload management is an important skill for nurses who work with caseloads of patients or clients (e.g., home health nurses, public health nurses, case managers, ambulatory care nurses). Because inadequate information about caseload management is contained in community health nursing textbooks, continuing education and staff development programs need to include caseload management skills to improve the efficiency and quality of nursing care.     

亚专业化护理模式对护士核心能力的影响

目的探讨亚专业化护理模式对护士核心能力的影响,分析和评价新模式的临床应用效果。方法采用“注册护士核心能力量表”评估我科31名护士在亚专业护理模式实施前后核心能力的情况,使用SPSS13．0统计学软件进行配对t检验,以分析护士核心能力的差异,评价新模式的临床应用效果。结果亚专业护理模式前后我科护士核心能力总分差异有显著意义（P=0．004）;批判性思维／科研、临床护理、领导能力、人际关系、专业发展及教育／咨询等各个能力得分的差异有显著意义（P〈0．05）,法律／伦理能力得分的差异无显著意义（P=0．173）。结论亚专业化护理模式促进了护士核心能力的培养,改进了科室医疗护理质量。     

Nursing Best Practice Guidelines: reflecting on the obscene rise of the void

Aim(s)  Drawing on the work of Jean Baudrillard and Michel Foucault, the purpose of this article is to critique the evidence-based movement [and its derivatives – Nursing Best Practice Guidelines (NBPGs)] in vogue in all spheres of nursing.
Background  NBPGs and their correlate institutions, such as the Registered Nurses' Association of Ontario (RNAO) and 'spotlight' hospitals, impede critical thinking on the part of nurses, and ultimately evacuate the social, political and ethical responsibilities that ought to distinguish the nursing profession.
Evaluation  We contend that the entire NBPG movement is based on the illusion of scientific truth and a promise of ethical care that cannot be delivered in reality. We took as a case study the Registered Nurses' Association of Ontario (RNAO), in the province of Ontario, Canada.
Key issues  NBPGs, along with the evidence-based movement upon which they are based, are a dangerous technology by which healthcare organizations seek to discipline, govern and regulate nursing work.
Conclusion(s)  Despite the remarkable institutional promotion of 'ready-made' and 'ready-to-use' guidelines, we demonstrate how the RNAO deploys BPGs as part of an ideological agenda that is scientifically, socially, politically and ethically unsound.
Implications for nursing management  Collaborations between health care organizations and professional organizations can become problematic when the latter dictate nursing conduct in such a way that critical thinking is impeded. We believe that nurse managers need to understand that the evidence-based movement is the target of well-deserved critiques. These critiques should also be considered before implementing so-called 'Nursing Best Practice Guidelines' in health care milieux.     

Reformation of the nursing administration and management system

In today's rapidly changing healthcare environment, nursing administrators and managers must enhance their abilities to anticipate and manage change in order to minimize the impact of such on healthcare delivery systems. To maintain patient care quality, nursing leaders should be familiar with change trends and implement innovative strategies that improve the work environment for nurses. This paper describes current major challenges faced by nursing administrators and introduces the concept of change and related strategies and available change management tools. This paper used five core competencies proposed by the Institute of Medicine (IOM) to illustrate and share experiences of managing change in clinical settings.     

Situational and dispositional predictors of nurse manager burnout: a time-lagged analysis

Background  Burnout among nurses is a serious condition that threatens their own health and that of their patients. In current health care settings, nurses are particularly at risk for burnout given the increased patient acuity and the worsening nursing shortage.
Aim  This study examined the influence of effort-reward imbalance, a situational variable, and core self-evaluation, a dispositional variable, on nurse managers' burnout levels over a 1-year period.
Methods  A predictive longitudinal survey design was used to examine the relationships described in the model. One hundred and thirty-four nurse managers responded to a mail survey at two points in time.
Results  As hypothesized, both personal and situational factors influenced nurse manager burnout over a 1-year time frame. Although burnout levels at Time 1 accounted for significant variance in emotional exhaustion levels 1 year later (β = 0.355), nurses' effort-reward imbalance (β = 0.371) and core self-evaluations (β = −0.166) explained significant additional amounts of variance in burnout 1 year later.
Conclusion  Both personal and situational factors contribute to nurse manager burnout over time.
Implications for nursing management  Managers must consider personal and contextual factors when creating work environments that prevent burnout and foster positive health among nurses at work.     

Is the grass any greener? Canada to United States of America nurse migration

Aim:  Little or no attempt has been made to determine why nurses leave Canada, remain outside of Canada, or under what circumstances might return to Canada. The purpose of this study was to gain an understanding of Canadian-educated registered nurses working in the USA.
Data sources:  Data for this study include the 1996, 2000 and 2004 USA National Sample Survey of Registered Nurses and reports from the same time period from the Canadian Institute for Health Information.
Findings:  This research demonstrates that full-time work opportunities and the potential for ongoing education are key factors that contribute to the migration of Canadian nurses to the USA. In addition, Canada appears to be losing baccalaureate-prepared nurses to the USA.
Discussion:  These findings underscore how health care policy decisions such as workforce retention strategies can have a direct influence on the nursing workforce. Policy emphasis should be on providing incentives for Canadian-educated nurses to stay in Canada, and obtain full-time work while continuing to develop professionally.
Conclusion:  Findings from this study provide policy leaders with important information regarding employment options of interest to migrating nurses.
Study limitations:  This study describes and contrasts nurses in the data set, thus providing information on the context of nurse migration from Canada to the USA. Data utilized in this study are cross-sectional in nature, thus the opportunity to follow individual nurses over time was not possible.     

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     

Attitudes of nurse professionals and nursing students towards children with disabilities. Do nurses really overcome children's physical and mental handicaps?

Background:  Many health professionals and nurses, who are involved in the care of disabled children, do not exhibit the essential sensitivity and appropriate attitudes towards them, resulting in a poor quality of nursing care.
Aim:  The objective of this study was to investigate the attitudes of nurse professionals (paediatric nurses) and nursing students towards disabled children.
Patients and methods:  The present study is a comparative study. The sample consisted of 228 first-year nursing students, 90 post-diploma nurses attending MSc degree course and 123 nurse professionals who are employed in paediatric hospitals. After obtaining permission from the hospitals and the educational settings and informing about the subjects of the study, data were collected using the paediatric Attitude Towards Disabled Person Scale (ATDP).
Results:  Overall nurses' attitudes appeared to be poor (mean ATDP score 61.7 ± 14.2). However, the post-diploma nurses had significantly higher ATDP scores than first-year students and paediatric nurses ( P  < 0.001). In addition, first-year students had significantly higher scores than paediatric nurses ( P  = 0.047). Across the sample, females hold significantly more positive attitudes than males ( F  = 9.5, P  = 0.002), while age did not have any significant effect.
Conclusions:  Carefully designed curricula can influence the attitudes of nursing students towards children with disabilities. Special courses for treating disabled children should be integrated to the basic nursing studies. Moreover, continuing hospital education can change paediatric nurses' attitudes towards children with disabilities.     

Leadership: a key strategy in staff nurse retention

Nursing administrators are challenged to recruit and retain staff nurses in the midst of increasing job vacancies and staff nurse turnover rates averaging 21%. The prevailing issues related to staff nurse recruitment and retention in the current healthcare environment are briefly reviewed as introductory content. The article outlines the case from nursing administration literature that effective leadership styles of nurse managers and nurse administrators enhance staff nurse retention. As nurse administrators continue to struggle with staff nurse recruitment and retention, evidenced-based strategies are discussed that address leader preparation and organizational leadership structure including advanced education, leadership training, and shared leadership models.