The nature of long-term care nursing work

Data from a pilot study on the nature of nursing work in long-term care (LTC) facilities are compared with data on nursing work in intensive care units (ICUs). The comparison suggests that the LTC nursing work environment is a complex, demanding, and interesting one that is different from, not less than, nursing work in acute care environments. The data also suggests that nursing educators and researchers should reconsider LTC nursing work environments. Long-term care nursing offers an ideal, relatively controlled environment for research on what nursing work is and how nursing interventions affect patient outcomes. Long-term care nurses, whose daily work has always involved working with a variety of professional and unlicensed staff members, can serve as models for delegation and interpersonal skills. Finally, the LTC setting offers the ideal environment for clinical sites in connection with the proposed curriculum changes in end-of-life care for patients and their families.     

Ethics and Health Policy—Introduction

Stories of nurses who provide direct patient care were the impetus for this health policy feature. Nurses talk poignantly about value conflicts as they try to practice in today's health care environment. They believe economics rather than patient care needs drives decisions about the care patients receive. They say they provide the bare minimum of care, often leaving the workplace knowing they have left much undone. Their pleasure in being able to give nursing care as they wish diminishes daily, while their fatigue and stress increase. When asked to rank their values and the values of the health care institution where they work, they report economic and organizational survival to be the highest value in their workplace and quality of care the highest personal value (Brown, 1997).     

Effects of rotating night shifts: literature review

AIM: This paper reports a review examining the concept of sleep and its antithesis of fatigue, and considers the evidence on nurses' ability to cope with the demands of continually changing hours of work, their safety, and the impact any manifestations of sleep disruption may have on the care of their patients. While many aspects of this paper may apply to nursing in general, special consideration is given to nurses in the critical care environment. BACKGROUND: Night duty rotations are common practice in nursing, and particularly in specialist units. It is essential that nurses working in these environments are able to maintain careful and astute observation of their vulnerable patients, and concern arises when they may be unable to do so. Research suggests that fatigue can negatively affect nurses' health, quality of performance, safety and thus patient care, and that the effects of fatigue may be exacerbated for nurses over 40 years of age. METHOD: The literature was examined for the 10-year period up to December 2003. The databases searched were Ovid, Proquest, Blackwell Science, EBSCO Online, Australian Health Review and WebSPIRS, using the keywords of, shiftwork, rosters, intensive care, fatigue, sleep deprivation and sleep studies. FINDINGS: There is consensus amongst researchers on the adverse psychological and physiological effects of night rotations on nurses when compared with their permanent night duty peers, particularly for those over 40 years of age. Evidence also suggests that the effects of fatigue on nurse performance may negatively affect the quality of patient care. CONCLUSIONS: The literature reinforces concerns about the adverse relationship between fatigue and performance in the workplace. Optimal standards for patient care may be difficult to achieve for more mature nurses, who may suffer from sleep deprivation and health problems associated with rotational night work and disrupted physiological rhythms.     

Performance obstacles of intensive care nurses

BACKGROUND: The work environment of intensive care nurses may have substantial impact on both nursing outcomes and patient safety. The factors in a nurse's immediate work environment, in the local work context, have not been studied in detail to provide useful, specific information for work redesign efforts to improve nurse's work and patient safety. Performance obstacles are the factors that hinder intensive care nurses' capacity to perform their jobs and that are associated closely with their immediate work environment. OBJECTIVES: To identify the performance obstacles experienced by intensive care nurses in their work environment. METHODS: A multisite, cross-sectional study was conducted. Data were collected using a 36-item questionnaire and analyzed using univariate statistical analysis. The frequencies of performance obstacles reported by intensive care nurses were computed. RESULTS: Nurses (n = 272) from 17 intensive care units (ICUs) of seven hospitals in Wisconsin participated in the study. The most frequently experienced performance obstacles included noisy work environment (46%), distractions from families (42%), hectic (40%) and crowded work environments (37%), delay in getting medications from pharmacy (36%), spending considerable amount of time teaching families (34%), equipment not being available-someone else using it (32%), patient rooms not well-stocked (32%), insufficient workspace for completing paperwork (26%), seeking for supplies (24%) or patients' charts (23%), receiving many phone calls from families (23%), delay in seeing new medical orders (21%), and misplaced equipment (20%). DISCUSSION: Intensive care nurses experience a variety of performance obstacles in their work environment. Future research should investigate the impact of various performance obstacles on nursing workload, nursing quality of working life, and quality and safety of care, as well as the impact of interventions aimed at redesigning the work system of ICU nurses to remove performance obstacles.     

Hospital nursing organizational factors,nursing care left undone,and nurse burnout as predictors of patient safety: A structural equation modeling analysis

BackgroundPromotion of patient safety is among the most important goals and challenges of healthcare systems worldwide in countries including China. Donabedian’s Structure-Process-Outcome model implies that patient safety is affected by hospital nursing organizational factors and nursing care process. However, studies are imperative for a clear understanding about the mechanisms by which patient safety is affected to guide practice.ObjectiveThe objective of this study was to explore the impact of hospital nursing work environment, workload, nursing care left undone, and nurse burnout on patient safety.DesignThis was a cross-sectional study conducted in 23 hospitals in Guangdong province, China in 2014. Data from nurses (n = 1542) responsible for direct care on 111 randomly sampled medical and surgical units were analyzed.MethodsWork environment was measured by the Practice Environment Scale of Nursing Work Index. Workload was measured by day shift unit patient-nurse ratio and non-professional tasks conducted by nurses. Nursing care left undone was measured by 12 items addressing necessary nursing activities. Nurse burnout was measured by the emotional exhaustion subscale of the Maslach Burnout Inventory-Human Services Survey. Patient safety was measured by three items indicating nurses’ perception of overall patient safety and nine items addressing patient adverse events. Structural equation modeling was used to examine a hypothesized model that supposed work environment and workload have both direct and indirect effects on patient safety through nursing care left undone and nurse burnout.ResultsThe findings generally supported the hypothesized model. Better work environment was associated with better patient safety both directly and indirectly. Lower workload primarily indirectly related to better patient safety. Nursing care left undone and nurse burnout were mediators negatively associated with patient safety.ConclusionsImproving work environment, increasing nurse staffing levels, and providing sufficient support for nurses to spend more time on direct patient care would be beneficial to patient safety improvement.     

Integrating palliative and neurological critical care

The goal of palliative care is to provide the alleviation or reduction of suffering and the support for the best possible quality of life for patients regardless of the stage of the disease. Palliative care can be provided in any patient care setting, including intensive care units. Death in intensive care units is a common occurrence, with literature suggesting that approximately 20% of deaths in the United States occur after a stay in the intensive care unit. Other studies suggest that approximately half of all chronically ill patients who die in a hospital receive care in the intensive care unit within 3 days of their deaths. Critical care nurses who work in neurological intensive care units are at the forefront of integrating palliative and critical care.     

Teaching and community hospital work environments

The Institute of Medicine report suggests that nursing work environments experience threats to patient safety related to organizational management and workforce deployment practices, work design, and organizational culture. Organizational factors contribute to nursing and potentially patient outcomes, yet few studies have examined the differences in practices perceived by nurses employed in different settings. Nurses from 16 medical and surgical units in eight randomly selected acute care hospitals representing teaching and community organizations participated in this project. Nurses working in teaching hospitals reported lower levels of role tension, yet their perceptions of the quality of work, the work environment, nursing unit leadership, quality of care, and levels of job stress and job satisfaction were higher than their colleagues in the community sites. This study highlights some important differences between teaching and community hospitals that can inform nurse executives and policy makers of the unique work-life issues for different groups of nurses.     

Newly trained operating room nurses’ experiences of nursing care in the operating room

There is limited research on nurses’ experiences of nursing care in the operating room. The operating room nurses’ responsibility is to ensure good nursing care before, during and after surgery. In an increasingly technological health care environment, there is always a risk of turning the focus away from nursing care towards technology and medicine. Integration of past experiences into the role as an operating room nurse becomes a challenge for those who recently worked as general nurses. The present study aimed to explore newly trained operating room nurses’ experiences of nursing care in an operating room. Semi-structured interviews were performed with ten operating room nurses with a maximum three years’ work experience from an operating room. The interviews were subjected to qualitative content analysis. The findings revealed three themes describing operating room nurses’ searching for their new role. They experienced a gap between theory and practice, felt alone and insignificant and had to find their own place. The operating room nurses’ experienced threats to safe nursing when they lacked time for the patients as well as for their own recovery, and they lacked feedback in order to improve care. They ensured security for patients by establishing one-to-one contact, protecting patients’ well-being and working in teams for the patients’ best interest, participants also focused on the task at hand instead of the patient as a person. New ways of organising work in operating units, and well-functioning teams can be a key to a successful integration of experiences from ward nurse to an operating room nurse, and provide support so that they feel more visible, at ease and safe in their new profession.     

Medical emergency teams: a strategy for improving patient care and nursing work environments

AIM: This paper reports a study of nurses' perceptions about medical emergency teams and their impact on patient care and the nursing work environment. BACKGROUND: In many acute care hospitals, nurses can summon emergency help by calling a medical emergency team, which is a team of expert critical care professionals adept at handling patient crisis scenarios. Critical care nurses form the core of such teams. In addition, of all the healthcare professionals, nurses are the ones who most often need and call for medical emergency team assistance. METHODS: A simple anonymous questionnaire distributed amongst 300 staff nurses at two sites of an acute care teaching hospital in the United States of America in mid-January of 2005. RESULTS: A total of 248 nurses responded to the survey (response rate = 82.7%). Ninety-three per cent of the nurses reported that medical emergency teams improved patient care and 84% felt that they improved the nursing work environment. Veteran nurses (with at least 10 years of experience) and new nurses (<1 year's experience) were more likely to perceive an improvement in patient care than other nurses (P = 0.025). Nurses who had called a medical emergency team on more than one occasion were more likely to value their ability to call a team (P = 0.002). Nearly sixty-five per cent of respondents said they would consider institutional medical emergency team response as a factor when seeking a new job in the future. Only 7% suggested a change in the team response process, and 4% suggested a change in activation criteria. CONCLUSIONS: Most nurses surveyed had a favourable opinion of the medical emergency team. Our findings suggest that other institutions should consider implementing a medical emergency team programme as a strategy to improve patient care and nurse working environment.     

Going Boldly…Into Digitally Enabled Care Models

The health care ecosystem is experiencing a turbulent time, specifically the accelerated churn and attrition among the nursing workforce resulting from the COVID-19 pandemic. The loss of many long-tenured nurses means that short-staffed units, high utilization of temporary staff, and decreasing experience levels require additional support for nurses to continue to provide safe and quality patient care. The adoption of technology into care delivery models is 1 way to amplify the work of nursing in a safe and consistent manner and should be accelerated for care delivery. The workforce alone cannot meet the demands of patient care in today’s environment.     

Quality of life as a mediating factor in the relationship between fatigue and perception of safety among critical care nurses in the United Arab Emirates

BackgroundA scientific understanding of the relationships between intensive care unit nurses’ well-being and patient safety will allow nurse managers, administrators, and policymakers to simultaneously manage crucial organisational goals of nurses’ health and patient safety. Understanding predictors of fatigue among intensive care unit nurses may help to balance personal and organisational impacts (e.g., turnover intention, sick leave) and provide a way to positively influence their safety perception.ObjectiveThe aim of this study was to explore the association between work fatigue and perception of patient safety among nurses working in critical care units and determine whether their quality of life levels mediated this relationship.MethodsThis study used a cross-sectional correlational comparative design. Participants were a sample of 250 intensive care unit nurses recruited conveniently from three large hospitals in the United Arab Emirates. The self-reported questionnaire included the Nursing Quality of Life Scale, the Fatigue Severity Scale, and the Safety Attitudes Questionnaire (SAQ)-ICU version, as well as sociodemographic characteristics and work-related information.ResultsOf the 250 participating nurses, 76.8 % reported low QoL. There was a statistically significant correlation between nurses’ Quality of Life and fatigue levels (r = 0.234, P = 0.000). Overall, 52.8 % of the sample had high fatigue and 49.6 % had poor safety perception. Multiple regression analysis using the Baron and Kenny approach showed that QoL, marital status, gender, and work environment were predictors of nurses’ perception of safety.ConclusionIntensive care unit nurses had high levels of fatigue and poor Quality of Life. High Quality of Life and a favourable work environment were independent predictors of good patient safety perception. Efforts should be directed to maximize staffing resources that positively impact patient safety. These findings are comparable with international studies, suggesting that these issues may be ubiquitous.Implications for clinical practiceIntensive care practitioners, managers and policymakers should adopt measures to modify intensive care nurses’ exhausting working conditions and provide a supportive environment. these interventions might improve nurses’ perception of patient safety and consequently prevent safety incidents.     

Nurse experience and education: effect on quality of care

OBJECTIVE: To describe the relationships between the quality of patient care and the education and experience of the nurses providing that care. BACKGROUND: There is a call for more nurses with baccalaureate degrees and more experienced nurses to work in hospitals. Previous research studies have examined the characteristics, abilities, and work assignments of nurses with and without baccalaureate degrees but have not examined the quality of the patient care delivered. It is generally believed that more experienced nurses provide higher-quality care, but again few studies have actually examined this issue. METHODS: A secondary analysis of data, collected in two previous studies of the relationship between nurse staffing (hours of care, staff mix) and the quality of patient care, was used to determine the relationship between nurses' education and experience and the quality of care provided. The data were collected at the patient care unit level (42 units in study 1 and 39 units in study 2). Quality of care was indicated by lower unit rates of medication errors and patient falls. RESULTS: Controlling for patient acuity, hours of nursing care, and staff mix, units with more experienced nurses had lower medication errors and lower patient fall rates. These adverse occurrence rates on units with more baccalaureate-prepared nurses were not significantly better.     

Hospital nurses and stress

This study is a comparison between hospital nurses who work in "open and closed" units. In open units, patient and his family have free transit and in closed units, like critical care unit, patient and his family have limitation in transit. The results demonstrated that nurses who worked in open unit had higher stress score than nurses in closed units. For both groups, personal administration had high stress score. The nurses' education is important to improve her performance.     

Staff nurse perceptions of the work environment: a comparison among ethnic backgrounds

This study examined the relationship among ethnicity and perceptions of the work environment among staff nurses in a large urban hospital in Northern California. Moos' Work Environment Scale, System Maintenance and Change Dimensions, was used to investigate staff nurse perception of the work environment related to role clarity, managerial control, and innovation. Findings of this study suggest statistically significant differences in the way Caucasian and non-Caucasian nurses viewed the extent to which management used rules and pressures. The perception of control in the work environment is an important factor in retention and in maintaining a quality workplace.     

Best practice in management of patients with acute stroke

The management of the patient with acute stroke is very complex and covers all aspects from acute intervention to ensuring a dignified and pain-free death. Stroke has an increasing profile and with the proposed NICE paper on best practice due out in the next 18 months, the focus will be on the effective running of stroke units and the skills of nurses who work in them. It is essential that nurses keep up to date with developments and know how to provide the best, evidence-based care.     

The provision of follow-up care for patients in the home environment

Despite increasing evidence that post-myocardial infarction patients and their families suffer prolonged psychological disturbance, there appears to be little published research regarding follow-up care for these patients in the home environment.A survey of 30 coronary care units (27 responded) across England and Wales was conducted to identify the current provision of home follow-up for coronary patients.Although the majority of respondents (89.9%) felt that home follow-up for coronary coronary patients in necessary, only 3 units (11.1%) actually had such a service in their area. In these areas, the home follow-up was provided by community nurses.None of the areas who did provide home follow-up for coronary patients had analysed the impact of this intervention on patient recovery.Further research is recommended to identify the effects of follow-up care in the home environment on morbidity and readmission of coronary patients.