The impact of nurse extenders on the curriculum

Nurse extenders are helping nurses perform an increasing number of nursing activities. The expanding roles of nurse extenders are thus influencing the accountability and responsibilities of registered nurses as their role relationships are redefined. The author discusses curricular issues related to the use of nurse extenders.     

Adapt use of physician extenders for your needs

Know the scope of practice for all physician extenders--not only for those who work solely in your department but for other hospital specialties. The Joint Commission on Accreditation of Healthcare Organizations requires you explicitly follow the bylaws of your medical staff concerning allied practitioners. You can create a more limited scope of practice than outlined by the state but not a more expansive one. Make sure a mechanism is in place for checking the privileges of extenders in the ED who come from other departments.     

Factors related to nurse communication with elderly people

This study explores variables that might influence nurses' communication with elderly patients. Three groups of variables arise from the literature that seem to affect the quality or quantity of nurse-patient communication: variables related to nurses, to patients, and to the setting in which nursing care takes place. The study was conducted in two different care settings: a home for elderly people and a home care organization. In a sample of 181 video-taped nursing encounters, involving 47 nurses and 109 patients a study was made of nurse-patient communication. In addition, relevant data related to patients, nurses and situation were gathered by questionnaires and were combined with the results of observations of videotaped nurse-patient interactions. It was found that the educational level of nurses was related most strongly to the way nurses communicate with their elderly patients. Patient characteristics such as age, gender and subjective state of health appeared to play a minor role in the way nurses communicate.     

Barriers to the use of web-based learning in nurse education

Amongst the themes that emerge and recur in the recent educational literature on the subject of web-based learning and teaching are how socio-economic factors and gender might influence the use of information technology (IT) by students. Writers often enthuse about how web-based learning will somehow reduce inequalities in student's access to education. However, in this paper it will be argued that most of the accounts in the literature of the potential of web-based learning take too little account of the potential problems and limitations of the medium. It could be argued that web-based learning underscores and may in fact increase inequalities rather than eliminate them. The aim of this paper is therefore twofold. First, it will examine the development of web-based learning and the potential ways it can be used. It will however be argued that the adoption of the medium has inherent difficulties, which are often overlooked or played down. Secondly, this paper will focus on those variables that could influence or inhibit student usage of web-based learning materials, in particular the influence of socio-economic factors and gender.     

Issues related to staff retention and turnover

Retention and turnover of staff, particularly highly skilled nurses, are important issues for administrators in the current health care environment. The purpose of this article is to review the literature to improve our understanding of factors related to staff retention. Group cohesion, job stress, manager style, and autonomy are examined. Strategies to improve retention, which focus on these critical factors, are described.     

Issues in the use of kappa to estimate reliability

Selected issues regarding the application of the kappa statistic in assessing the reliability of measures to classify patients are discussed. Data are used to illustrate how the methods used to estimate reliability can influence the resulting coefficient. Suggestions for a more comprehensive approach to the study of the psychometric properties of measures of patient classification are then offered.     

Physician attitudes toward physician extenders: a comparison of nurse practitioners and physician assistants.

A survey of all physicians in the Eighth District Medical Society (Western New York) was conducted in 1975 to determine physician attitudes toward employment of and task delegation to nurse practitioners. The results of this study and one other similar study of nurse practitioners are compared to results of two previous studies examining physician attitudes toward physician assistants. It appears that physicians are somewhat more willing to employ and delegate tasks to a physician's assistant. Some correlates of physician attitudes toward each of the two types of physician extenders are also compared and discussed.     

Relating new graduate nurse competence to frequency of use

The healthcare workplace can be a stress-laden environment for new graduates and job performance indicators are an important sign of developing confidence and expertise that will lead to improved patient outcomes. What is not evident from nursing studies is whether new graduate nurse competencies relate to the frequency of their use. This study sought to determine the relationship between perceived nursing competence and self-assessed frequency of use by new graduate nurses. Three cohorts (n = 116) of new graduate nurses undertaking year-long transition to graduate practice programs responded to a questionnaire that utilised the 2001 ANCI competencies and the Nurse Competency Scale and a Visual Analogue scale to self assess their perceived competence and the relative frequency of use for specific competence items. Results indicate that a relationship exists between perceived competence and frequency of use and that research competency scores are substantially lower than all other categories of competency. Implications for education and practice indicate that assessment of nurse competency for the new graduate nurse should focus on the development of generic nursing competencies rather than current expectation of advanced and workplace specific nurse competencies.     

Suprascapular neuropathy related to the use of crutches

A 41-year-old man with shoulder pain was found to have a suprascapular neuropathy. The nerve injury was believed to be secondary to improper crutch usage. The pathophysiology of this unusual cause of suprascapular neuropathy involves injury to the nerve due to exaggerated movements around the shoulder joint. Suprascapular entrapment neuropathy is another potential hazard of improper crutch usage. Therefore, properly fitted crutches and adequate crutch training are essential for the prevention of additional disability.     

Nurses' education related to the use of restraints

Given that the use of restraints is common and this use may be hazardous, it is important that the education of health-care providers include acquiring knowledge, skills, and attitudes related to restraint use. Teaching methods should include lectures, demonstrations, case studies, simulations, interactive videos, films, discussions, debates, clinical assignments, and examinations. To meet the need for nursing education related to the current use of restraints, model education programs need to be developed, implemented, and evaluated.     

Issues related to children participating in clinical research

Research involving children is necessary to bridge the gap created by years of applying the findings of adult clinical trials to children. Given the mandate from the National Institutes of Health to include children in clinical trials, pediatric nurses will undoubtedly be asked to assist with pediatric research projects. Nurses working with children must consider the unique legal and ethical issues surrounding children as study participants. The purpose of this article is to examine issues related to children participating in clinical research. A review of pertinent literature is summarized, and practical approaches to the recommendations are discussed.     

Work climate related to job satisfaction among Dutch nurse anesthetists

Finding ways to retain nurse anesthetists in the profession to meet the increasing demands of the healthcare system is of paramount importance. The present study investigates the relationship between work climate and job satisfaction among Dutch nurse anesthetists. A questionnaire was distributed to Dutch nurse anesthetists to assess their perceptions of their work climates, and their levels of job satisfaction. Multiple regression analyses were performed to obtain the predictive value of work climate for job satisfaction. All of the work climate characteristics had statistically significant correlations to job satisfaction, and explained 20% of the variance in job satisfaction. To achieve a higher level of job satisfaction among nurse anesthetists, it is necessary to improve some essential work climate characteristics, such as: (1) making the nurse anesthetist feel an important part of the organization's mission statement, (2) discussing progress at work, (3) giving recognition for delivered work, (4) encouraging development, and (5) providing sufficient opportunities to learn and to grow.