Decision making: the context of nurse prescribing

From October 1994 qualified district nurses and health visitors from eight demonstration sites in England have been able to prescribe from a limited list of formulary items. Data collected from nurses formed only one part of the evaluation of nurse prescribing. These data highlighted a number of areas where prescribing nurses were faced with difficult decisions. A number of authors have considered how both doctors and nurses make decisions, and the factors which may influence the decision making process. With reference to the literature this paper focuses on the findings related to decision making in the context of nurse prescribing.     

Perspective: Economically speaking about nurse staffing

Evidence exists telling us that we are currently in the early stages of a nursing shortage, and at the same time consumer demands for health care continues to increase. Principals of economics, when applied to such a state forewarn of changing times and can help us to predict a future very different that what we now see.     

Variability in nurse staffing research

Variability in nurse staffing research has existed and still exists in two major areas: the method of data collection and analysis, and the method of reporting. The authors take a broad look at these two areas of variability and consider the implications for future nurse staffing research. It has become imperative that nurses take responsibility for the determination of what constitutes nursing work and who should perform that work.     

Methodological issues in nurse staffing research

The purpose of this article is to identify and describe four issues in nurse staffing research that must be addressed before the evidence base for the relationship between nurse staffing and quality of care can be said to be theoretically and empirically sufficient. The issues are the need to build well-developed theory, use valid and reliable databases, appropriate risk-adjustment systems, and address issues of causal inference in nonexperimental research.     

Hospital ward layout and nurse staffing

This literature review discusses the evidence that modern wards divided into small bedrooms or bays, require higher nurse staffing levels. Aspects of ward design and operation such as patient privacy, nursing efficiency, patient dependency and ward organization are outlined and methods for establishing staffing levels which take ward design into account are described. The majority of ward evaluation studies concerned with nurse staffing concentrate on two areas, the use of the nurses' time (particularly in travel) and user opinion of wards. The conclusions drawn suggest that the two main measures of ward layout which relate to effective and efficient nursing care are short travel distances and features which facilitate the maximum contact between nurses and patients. Further, how these two principles are incorporated effectively into a ward will depend upon a number of other factors which effect nursing work viz, the number and characteristics of the patients and ward staff and the policies and practices of the nurses themselves.