State policies regarding nursing delegation and medication administration in child care settings: a case study

Medication administration is an essential component of quality child care, and nurses play a central role in assuring high-quality training of child care providers. Through key informant interviews and review of public documents, this case study explored the development of state statutes and regulations for medication administration training of child care providers in the state of Connecticut, nursing liability issues related to the definition of this activity, and the role of the Connecticut State Board of Examiners for Nursing. This article also examines the interpretation of the nursing role within this context as delegation versus professional activity and the impact of such designation on nursing practice, child care providers' access to medication administration training by nurses, and children's health status in child care settings. As a result of this case study, the Connecticut State Board of Examiners for Nursing revised its policies, demonstrating an exemplar linkage among research, practice, and policy.     

An interview at Robert Wood Johnson University Hospital. ProACT model

In its deliberations on the shortage of nurses, the Executive Board of NAON charged the Orthopaedic Nursing journal with bringing information to our readers concerning innovations in nursing care which have resulted partly in response to the current nursing crisis. This article presents an innovative care model implemented on an orthopaedic unit at Robert Wood Johnson University Hospital in New Brunswick, New Jersey. It describes not only the developed system but also the process that was used in implementing the design.     

Envisioning a National Board of Nursing Specialties: an interview with Jeanette Hartshorn

The Committee for the National Board of Nursing Specialties was recently established to explore ways of enhancing the professionalization of nursing through a unified approach to strengthening the process for certifying specialty nurses. In this interview, Jeanette Hartshorn, PhD, RN, FAAN, project director of the committee, explains the need for the proposed National Board of Nursing Specialties and the effects the board would have on nursing, certifying organizations, health care providers, and consumers.     

Factoring consumers' perspectives into policy decisions for nursing competence

Health care delivery competence and accountability have typically been defined from providers' perspectives, rather than those of consumers as purchasers of services. In 1999, in the face of broad public concern about nursing competence the Alabama Board of Nursing developed an accountability model that established consumers at the center of the model and placed accountability for competent nursing practice at all levels of providers including regulatory agencies, health care organizations, educators, and licensees. The Board then authorized two research projects involving first, consumers perceptions on nursing competence and regulation, and second, comparing their perceptions with those of licensees, nurse educators, and organizational leaders (N = 1,127). Comparative data evidenced significant differences between consumers' and other participants' perceptions. This article highlights how policy implications derived from research resulted in regulatory changes for nursing competence. Five years of progress in policy changes made in the interest of public safety are summarized.     

A nursing PhD specialty in health policy: University of Massachusetts Boston

This article describes the Nursing PhD Program specialty in health policy conceived and developed at the University of Massachusetts Boston. The rationale for a specialty in health policy is that nurses have valuable knowledge and a unique perspective of the health care system. Nurses belong to the largest group of health care providers and are the providers that spend the most time with patients. The nursing profession has a responsibility to help assure members of society have access to safe and effective quality health care. As a group, nurses need to be politically savvy to translate their knowledge and perspective to benefit society. Nurses need to direct their attention to understanding issues and policy arguments and to contribute to policy discussion with reasoned arguments and objectivity. The PhD program at the University of Massachusetts Boston prepares nurses as policy analysts, researchers, and educators who will positively contribute to the health of society.     

Unlicensed Personnel as Medication Technicians in Long-Term Care

The Arizona State Board of Nursing is providing the leadership to conduct and oversee a pilot program allowing the delegation of medication administration to certified nursing assistants in LTC facilities. Consensus from most major stakeholders and inclusion of those who opposed the original legislation contributed to the successful launch of the project. The complexity of both initiating the project and medication administration in LTC facilities cannot be underestimated. I believe that administration of medications by qualified CNAs who complete a rigorous training program and pass a legally defensible exam is safe, provided that the facility adopts a culture of safe medication administration by all staff. Challenges include personnel shortages, curriculum rigors, and licensed nurses' initial resistance. Benefits include freeing nursing staff for other essential functions, satisfaction of all staff, and an increased ability to meet residents' care needs.     

Promoting the community health clinical nurse specialist.

The role of the community health nurse clinical specialist (CHNCS) has been clearly delineated by the profession as having a responsibility to the community as client. The need for this specialist has escalated as communities try to address health problems that are preventable and overwhelming their resources. Yet, a survey conducted in New Jersey and counsel from the Rutgers College of Nursing Community Health Nursing Advisory Committee suggest that nurses and agencies may not be aware of the role of the CHNCS and how to use this advanced practitioner most effectively. This article discusses the role of the CHNCS as described by the American Nurses' Association, the need for the CHNCS, a survey of the perceived need for Master's-prepared community health nurses, the role of a CHNCS in a New Jersey community health nursing agency (MCOSS, Inc.), and recommendations for promoting the role of the CHNCS.     

Evaluation of contextual influences on the medication administration practice of paediatric nurses

Title. Evaluation of contextual influences on the medication administration practice of paediatric nurses. Aim. This paper is a report of a study conducted to explore the impact of preidentified contextual themes (related to work environment and socialization) on nursing medication practice. Background. Medication administration is a complex aspect of paediatric nursing and an important component of day‐to‐day nursing practice. Many attempts are being made to improve patient safety, but many errors remain. Identifying and understanding factors that influence medication administration errors are of utmost importance. Method. A cross‐sectional survey was conducted with a sample of 278 paediatric nurses from the emergency department, intensive care unit and medical and surgical wards of an Australian tertiary paediatric hospital in 2004. The response rate was 67%. Result. Contextual influences were important in determining how closely medication policy was followed. Completed questionnaires were returned by 185 nurses (67%). Younger nurses aged <34 years thought that their medication administration practice could be influenced by the person with whom they checked the drugs (P = 0·001), and that there were daily circumstances when it was acceptable not to adhere strictly to medication policy (P < 0·001), including choosing between following policy and acting in the best interests of the child (P = 0·002). Senior nurses agreed that senior staff dictate acceptable levels of medication policy adherence through role modelling (P = 0·01). Less experienced nurses reported greater confidence with computer literacy (P < 0·001). Conclusions. Organizations need to employ multidisciplinary education programmes to promote universal understanding of, and adherence to, medication policies. Skill mix should be closely monitored to ensure adequate support for new and junior staff.     

Mobilizing nursing leadership in primary health care research

Noting the dearth of nurses with doctorates, the author calls for more practical and faster ways of preparing nurses to conduct research, especially primary health care research. The author explains that there is a need for information on how to apply primary health care to local conditions, and that nurses are in the best position to conduct this type of research. But not only do nurses seldom conduct research, most of the research they do conduct is hospital rather than community-based. Establishing a doctoral program for nurses would mean a wait of 5-10 years before any results can have an impact on public health policy. But as the experiences of the College of Nursing of Saint Louis University (SLU) in Baguio City, Philippines indicate, doctoral training is not necessary when it comes to conducting primary health research. In 1979, SLU launched a Mobile Nursing Clinic, a primarily staffed by nurses. SLU then proceeded to study the effectiveness of the MNC model in providing primary health care. While the study has not yet influenced national health policy, the research team (composed mostly of baccalaureate nursing graduates with only one introductory course in research) believes that it has positively affected the perception of the nurse's role in the community. In order to meet the need for nursing research, the author recommends that countries pull their resources together and conduct intensive research training workshops for nurses. In the Philippines, the Association of Dean of Colleges of Nursing has revised its programs to support nursing research. The curriculum is now more community-oriented and community-based, and it includes courses in other disciplines. Furthermore, students are encouraged to conduct action research in the community.     

The importance and challenge of paying for quality nursing care

Historically, the economic value that nursing brings to the patient care process has not been recognized or quantified. Improving the quality of nursing care through work environment changes or increases in staffing is viewed by many as an added cost, but the benefits in terms of money saved through improved nursing satisfaction and patient outcomes are not considered. This article introduces nine articles that were originally presented at the Economics of Nursing Invitational Conference: Paying for Quality Nursing Care held at the Robert Wood Johnson Foundation in Princeton, New Jersey, June 13 and 14, 2007. Recommendations are to conduct research on the impact of policy and payment changes on the nursing workforce and quality of care and to correct the misalignment of socioeconomic and business case incentives for quality by payment systems and other changes.     

Outcomes of child care health consultation services for child care providers in New Jersey: a pilot study

This study focused on evaluation of outcomes of child care health consultation services delivered to child care providers in New Jersey. Child care centers and providers of family day care who had received child care health consultation services in New Jersey participated in the study. Sixty child care health consultation service recipients from 19 of the 21 counties in the state responded to the Child Care Health Consultation Questionnaire. Positive findings were statistically significant correlations between usefulness of services, satisfaction with services, changes at the child care site, and improvement in staff caregiving. Regression analysis indicated perceived usefulness of child care health consultation services contributes most to child care center changes (R2 = .40, p < .001) and improvement in staff caregiving (R2 = .40, p < .001). Implications for nursing are tailoring services to child care community needs, following up to evaluate quality and outcomes of services, improving marketing of child care health consultation services, and creating a statewide database of quality indicators that can be used for strategic planning.     

The future of clinical nurse specialists in psychiatric-mental health nursing

The role of the clinical nurse specialist in psychiatric-mental health nursing is undergoing transformation secondary to massive changes occurring within the health care delivery system, as well as the larger society. In order to address these changes and their influence upon the evolution of the advanced practice role of clinical nurse specialists in psychiatric-mental health nursing, an Ad Hoc Committee consisting of twelve members of The Society of Certified Clinical Specialists in Psychiatric Nursing of the New Jersey State Nurses' Association met in 1996 and 1997 in order to explore and define the future of clinical nurse specialists in psychiatric-mental health nursing. This report is a summary of salient findings by the Committee which define numerous influences upon the role of psychiatric nurses in advanced practice, including factors affecting health care changes and influences of health care changes upon clinical nurse specialists in psychiatric-mental health nursing, along with recommendations for the future by members of the Ad Hoc Committee of the New Jersey Society of Certified Clinical Specialists in Psychiatric Nursing. The report is divided into three sections and is presented in three consecutive issues. Part Three is the final segment of this three part series. It contains the committee's final recommendations for the future.     

Nursing care in fluorescein angiography

Fluoresceinic angiography of the ocular fundus is a diagnostic technique to study retinal and choroidal circulation. This technique consists of parenteral administration of 500 mg of sodium fluorescein 10% and photographing the fluorescence in the eye vessels. Although this substance is fairly safe, it may also produce mild, moderate or severe local and/or general adverse reactions. The nursing process is routinely used in hospital units but not always in outpatient clinics, even through the use of invasive procedures with intravenous medication administration is common. Therefore, nurses, as those reponsible for intravenous administration, should use the nursing process to guarantee the quality of care required by the patient. To do this, we describe an individualized care plan based on evaluation by Marjorie Gordon's functional health patterns, NANDA's nursing diagnoses Taxonomy II, Nursing Outcomes Classification (NOC), Nursing Interventions Classifications (NIC) and potential complications of the procedure.     

Directions for the development of nursing knowledge

Nurses and health care increasingly are embracing and guided by achievements and challenges of evidence-based practice and reflective practice. Nursing science advances have positioned nurses to move forward in the development of science. New directions for nursing knowledge need to emerge in several ways including the development of interdisciplinary knowledge, emphasis on the nursing care process, creation of new work-force patterns, and development of economic theories of nursing practice.     

Responding to health care reform by addressing the institute of medicine report on the future of nursing

The current health care environment has heightened the importance of achieving positive patient outcomes and excellent customer satisfaction. To remain competitive, health care organizations must adapt quickly to changing regulatory requirements, quality improvement initiatives, and customer expectations. To ensure nursing practice at the Saint Clare's Health System in Northwest New Jersey is at the forefront of leading change, the nursing staff has embraced the Institute of Medicine report The Future of Nursing: Leading Change. The empowered nursing team has applied Benner's Novice to Expert model and McCauley's Careful Nursing Theory as the foundation for nursing practice. The ability to apply evidence-based nursing research and cultivate professional development at the bedside has resulted in retention of expert nurses at the bedside. Engaging the nursing team has resulted in increased patient satisfaction and improved clinical outcomes. Advanced practice nurses play an important role to mentor the nursing staff and promote an interdisciplinary, collaborative relationship between all health care disciplines and community support programs. Nurses are recognized for their accomplishments and encouraged to obtain specialty certification, advanced degrees, and earn state and national recognition through professional organizations. The professional nurses at the Saint Clare's Health System are prepared to work in whatever environment the new normal creates.     

以家庭为中心儿科护理模式创建与评价

目的：探索以家庭为中心儿科护理模式,提升患儿及家长的满意度和患儿安全。方法：创建以家庭为中心儿科护理模式,包括制定以家庭为中心儿科护理政策,配备数量充足和资历合格的护理人员,明确总责护士和责任护士的具体职责,对临床护理人员进行以家庭为中心儿科护理理论和实践的培训与考核,研制工具以评价护理人员执行以家庭为中心护理措施的情况,评价以家庭为中心儿科护理模式的实施效果。结果：患儿家长对以家庭为中心儿科护理模式的总体满意度为93.5%,患儿安全指标如给药错误发生率、跌倒/坠床发生率明显下降。结论：把以家庭为中心儿科护理理念转化为行动,深入到儿科护理实践的方方面面是一个长期持久的过程。而在患儿危机时刻,让家长和孩子在一起更是一个巨大的挑战,需要医护人员和患儿家长共同努力。     

'Back to the bedside': graduate level education in critical care

The need for post registration education for nurses practising at specialty level in critical care environments is widely acknowledged in nursing and educational literature. There is also clear consensus that the ultimate aim of educational preparation and practice development is to improve the delivery of nursing care to patients who are critically ill and provide support for their families. Yet the 'right' approach to educational delivery and evaluation is less clear and stimulates considerable debate amongst nursing educators, care providers, learners and regulatory bodies. The need for critical care nurses to apply advanced knowledge and technical skills to complex and dynamic practice situations necessitates the development of critical thinking and a problem-solving approach to clinical practice that can be fostered through education and experience. This paper explores the relationships within teaching, learning and practice development in critical care nursing and questions the popular assumption that 'post graduate (Master's level) education fits all'. Discussion focuses on the successful development and implementation of graduate level education for critical care nurses in the South Island of New Zealand and how this development is challenging existing approaches to the provision and evaluation of formal critical care education in New Zealand.     

Managed care organizations' arrangements with nurse practitioners: a Connecticut perspective

Executives in more than 50% of managed care organizations (MCOs) in New York and Connecticut were interviewed for information on the roles, participation, and listing of NPs as primary care providers. MCO executives are highly satisfied with their primary care provider NPs, particularly in women's health and geriatrics, secondary to spending more time teaching and explaining procedures than physicians. Among both health care professionals and the general public there is an overall lack of current knowledge and/or confusion about NPs and their practice. Eighty-two percent of executives in MCOs thought their organization should encourage the use of NPs as primary care providers. Beginning in the early 1960s, advanced practice nursing has shown steady growth. Research has found that NPs provide cost-effective, quality-driven patient care (Brown & Grimes, 1995; Cohen & Juszczak, 1997; Frampton & Wall, 1994; Hardy & Evans, 1995). Many thought health care reform would lead to an expansion of advanced practice nurses (APNs) and other nonphysician providers as primary care providers (Aiken & Salmon, 1994). Funding for and enrollment in graduate nursing programs rose nationwide (American Association of Colleges of Nursing, 1996). Anecdotal reports indicated that NPs were not included in MCO primary care provider panels. The purpose of this study was to explore MCO arrangements with nurse practitioners and the factors that influence them.     

Community children's nursing in Northern Ireland: an evaluative review

All parents taking on the responsibility of providing care for their child with complex needs in the community setting need to feel competent, confident and supported. Despite policy recommendations that reinforce the value of community children's nursing in meeting child and family needs, numbers in Northern Ireland remain small. The development of community children's nursing in Northern Ireland is examined using an evaluative module published by the Royal College of Nursing paediatric oncology nursing forum (RCN 2000). Although these services fit with regional strategies, are evaluated well by parents and reduce hospital stays, they are still fragmented and underfunded. Children's nurses need to become more politically astute, pressing the government to take action, and taking every opportunity to report their views to the Children's Commissioner.