Unlicensed persons in patient care settings. Administrative, policy, and ethical issues

The current nursing shortage is a supply-and-demand problem. Factors contributing to the shortage include increased hospital use of RNs; decreased nursing school enrollment; increased demand for RNs outside of hospitals in skilled nursing facilities, health maintenance organizations, and home health care programs; noncompetitive salaries; and lack of autonomy. The nursing shortage has triggered the development and implementation of programs to prepare non-nurse bedside technicians to work in partnership with RNs. The functions of these unlicensed persons range from housekeeping, stocking, and clerical responsibilities to several technical treatments that once fell within the role responsibilities of registered or practical nurses. The partnerships between unlicensed persons and RNs in patient care settings have given rise to several administrative, policy, and ethical issues for nurse leaders. An ethical analysis, based on the application of ethical principles and moral dilemmas found in "The Parable of the Sadhu," offers some guidelines to nursing leaders in the administrative and policy decisions inherent in the development and retention of licensed persons in patient care settings. Some conclusions drawn from the ethically based questions are: The acquisition and retention of RNs and other licensed caregivers should take precedence over the development of programs for non-nurse bedside technicians. RNs in partnership with unlicensed persons in patient care settings must know what they can legitimately delegate. The RN has personal responsibility for ensuring optimal standards of nursing practice in the delegation of duties. The partnership between professional nurses and unlicensed persons must be a participative effort, not a manipulative or coercive one. In putting the organizational principle of subsidiarity into practice, decision makers will be able to maintain respect for human dignity and the uniqueness of patients and caregivers as well. The development and retention of unlicensed persons in patient care settings depends on a well-developed personal ethic that needs to be congruent with the mission, philosophy, and codes of ethics of national and local health care organizations.     

Developing positive attitudes toward geriatric nursing among Millennials and Generation Xers

Despite the increase of the older adult population, there exists a shortage of health care professionals trained to help this population remain independent as long as possible. Ageism, common among younger adults, affects the capacity building of health care for older adults. Research has indicated that increased knowledge about older adults, as well as exposure to the elderly, may alter nursing students' attitudes regarding careers in gerontological nursing. However, questions remain as to what are the most effective ways to provide gerontological content in nursing programs and enhance attitudes toward older adults.With the understanding that younger adults see a need to balance work and play, a baccalaureate nursing program provides examples of ways to accomplish this through integration of courses, simulations, positive images of aging, and learning activities that enhance empathy for both frail and healthy older adults.     

Innovation in nursing education: a statewide grant initiative

Meeting the challenges of the nursing shortage appears to be daunting for schools of nursing across the nation as they struggle to meet educational capacity needs with limited resources. A statewide grant program was developed and implemented through legislative initiatives providing opportunities for schools of nursing to respond to the need for innovation in nursing education. This article shares some of the successes and challenges identified through the process of implementing and evaluating this grant program. Insights into the political and regulatory process are provided as a model for other states to consider. Examples of educational strategies that were successful in improving the recruitment and retention of students and faculty are discussed. Nursing and other health care leaders across the nation should look to policy initiatives such as grant programs to infuse innovation into educational programs and to address educational capacity issues compounding the nursing shortage.     

The nursing faculty shortage: Is there hope?

The present nursing faculty shortage is linked to the general nursing shortage. Without enough nurse educators to teach the increasing number of nurses that are needed, the health of U.S. residents is at stake. This article examines progress made on solutions proposed over the past decade such as increasing graduate and certificate programs for nurse educators, more aggressive recruitment of graduate students into faculty roles, and delayed retirement of current faculty. Potential new solutions are proposed. These include: fast-track bachelor's of science in nursing to doctor of philosophy curricula; recruiting advanced practice nurses (APNs) into faculty roles with arrangements made for clinical practice time; raising the image of nursing education as a prestigious career; developing national certification for nurse educators; and partnering with health care agencies. Linking the general nursing shortage with the faculty shortage may provide a stronger case for public policy and funding initiatives. There are signs that some initiatives are working. Present faculty need to maintain a culture of hope while potential solutions are being implemented.     

Enhancing baccalaureate student nursing education. Collaboration with occupational health nurses for hands-on experience

Historically, occupational health nursing has been underemphasized in most baccalaureate nursing education programs. Advances in medical technology resulting in higher costs for hospital care, increasing need and support for nursing students, and curriculum emphases on holistic health care are factors pointing to the potential for broader clinical experiences for students outside the traditional hospital setting. One school in Louisiana has found that providing opportunities for occupational health nursing affiliations with students in baccalaureate programs has benefitted practitioners, students, and faculty.     

Mental health issues within the general health care system: the challenge for nursing education in Australia

The mental health content of undergraduate nursing programs has consistently been identified as inadequate in preparing graduate nurses with the knowledge and skills for, and interest in, a career in mental health nursing. Since the introduction of generic nursing education, undergraduate programs have become primarily focused on the development of generalist skills, with specialisation occurring at postgraduate level. The integration of mental health services within the broader health care system in Australia has led to a significant increase in the prevalence of mental health problems within the general health care setting. The relevant literature suggests that nurses are not well prepared to meet the mental health care needs of this population. The aim of this paper is to briefly outline the incidence of mental health problems within the general health care system, the implications for nursing, and the potential role which nursing could play in recognising, and providing appropriate care for the treatment of mental health problems. The implications for nursing education, and the need for mental health nursing skills to be considered essential for all nurses will be discussed.     

Using online learning technology to develop nurse leaders

Clearly, one of the major challenges facing nurse administrators is the need to develop and support nurse managers. The fact that there is a shortage of well-prepared nurse managers to build and maintain work environments that retain nurses while providing cost-effective, quality health care outcomes for consumers is widely accepted. The issues surrounding this shortage are multifocal and complex, including dissatisfaction with the role, lack of preparation and ongoing development for the role, the declining graduate enrollments in nursing administration programs, and the aging of nurse managers.     

A need to market nursing's 'usefulness' as a profession

The growing nursing shortage has pointed to the need for health care professionals and nurses in particular to understand general marketing principles. For nurses to be valued as competent and important health care professionals, they must continually market their 'usefulness' and work cooperatively with other professionals.     

Double-loop approach: recruitment and retention of minority nursing faculty

A culturally diverse work force is vital to meeting the health care needs of an increasingly diverse population. The lack of minority faculty has been documented as a barrier to recruitment and retention of culturally diverse nursing students. Literature that addresses the nursing faculty shortage and the shortage of minority nurse educators is investigated. A double-loop approach to recruitment and retention of minority nursing faculty is proposed and includes the strategies of focused faculty searches, emphasizing internal resources of the academic institution, traditional and distance mentoring, nursing department initiatives, welcoming activities, and campus programs.     

A conceptual framework contributing to nursing administration and research

The health care system has undergone major changes in the last decade. With greater acuity and complexity of illness, the adoption of innovative technologies and the shortage of health care personnel, the coordination and integration of health care services has become increasingly demanding for administrators. Growing dissatisfaction and concerns about safety issues are being expressed by the users of care who need to navigate through an increasingly complex system and by health care personnel who feel less efficient within the organization. Nursing administrators have a responsibility to address these issues but there is little scientific evidence to guide their actions. There are also few comprehensive models highlighting the main components of nursing administration - models that could guide nursing administration research. This paper presents a conceptual framework for nursing administration and research that links patient health care needs, nursing resources and the nursing care processes to the context of the health care system, and the social, political and cultural environments of care. A selected review of the oncology and cancer care literature is presented to demonstrate how this framework can organize existing knowledge about these concepts in the context of cancer care.     

The relevance of associate degree nursing education: past,present, future

Associate degree nursing education remains a relevant choice for students entering the nursing profession. Since its introduction fifty years ago, associate degree nursing education has had a significant impact on the registered nursing population in the United States. The climate for a new type of nurse was created by a nursing shortage, the growth of community and junior colleges, and government and consumer interest. Evaluation of initial programs revealed that desired outcomes were met. A proliferation of associate degree nursing programs followed with there currently being more than 800 associate degree nursing programs in the nation. Controversy regarding associate degree nursing as an entry level for registered nurses has been evolving since its inception. Issues related to technical nursing versus professional nursing titles and roles, and differentiated roles have been divisive for the nursing profession. Current demographics reveal that associate degree nursing continues to make a positive impact on the registered nurse population, providing almost 60% of entry level graduates each year, and attracting a greater percentage of minority groups and males. Associate degree nursing representatives should be involved in defining the future of nursing. Societal needs for health care and individual rights for access to education should be considered. Collaborative efforts among the nursing organizations are essential to promoting recruitment and retention efforts.     

The Albrecht Nursing Model for Home Health Care: Implications for Research, Practice, and Education

Home health care has become increasingly popular with consumers. Despite this movement of care away from the hospital, the literature does not contain a comprehensive nursing model of home health care. The need for a model to guide nursing research and ultimately, nursing practice and education is apparent. Four health service delivery models are available to be applied to home health care nursing; however, analysis of all four demonstrates a need for one specific to home care nursing.     

Camp nursing--a rewarding change of pace

Burnout and nursing shortage are two negative realities in today's health care system. If burnout can be averted, retention will increase and the shortage will be less severe. Camp nursing provides an appealing option for critical care nurses from adult or pediatric intensive care units who need a temporary change of pace.     

Strategies to support recruitment and retention of First Nations Youth in Baccalaureate Nursing Programs in Saskatchewan, Canada.

Aboriginal youth is one of the fastest growing of all populations in Saskatchewan today. This is a prime group to target for training in the health care professions. The need for strategies to support recruitment and retention in these programs is critical for maintaining our present standard and increasing demands of quality health care. Program initiatives and supports need to be implemented to encourage this population to enroll in and complete health care programs. Although only 5 years old, the University of Saskatchewan, First Nations University of Canada, and Saskatchewan Institute of Applied Science and Technology (SIAST) have created a viable northern nursing program with a retention rate of Aboriginal postsecondary students 13% greater than the provincial norm. They graduated their first class of nursing students from and for the North, May 2006.     

The nursing shortage: solutions for the short and long term

With predictions that this nursing shortage will be more severe and have a longer duration than has been previously experienced, traditional strategies implemented by employers will have limited success. The aging nursing workforce, low unemployment, and the global nature of this shortage compound the usual factors that contribute to nursing shortages. For sustained change and assurance of an adequate supply of nurses, solutions must be developed in several areas: education, healthcare deliver systems, policy and regulations, and image. This shortage is not solely nursing's issue and requires a collaborative effort among nursing leaders in practice and education, health care executives, government, and the media. This paper poses several ideas of solutions, some already underway in the United States, as a catalyst for readers to initiate local programs.     

Strategies for enhancing enrollment in one registered nurse–bachelor of science in nursing program

Associate degree and diploma graduates make up the largest number of registered nurses (RNs) in today's workforce, and only 16% return to school for a baccalaureate degree. The nursing shortage and the rapid expanding changes in the delivery of health care have created the demand for more nurses prepared at an educational level appropriate for the responsibilities required of them as professional nurses. Cost-effective and flexible RN–bachelor of science in nursing (BSN) programs are necessary to meet this need.This article describes strategies implemented in one RN–BSN program to enhance RN enrollment.     

Nigeria: the land, its people, and health care

The unique health care needs in developing countries and the responsibilities of the nursing profession in such countries place a heavy responsibility on schools of nursing involved in the education of foreign nursing students. The students in this study indicated that it was frustrating to repeat course content that was already familiar to them knowing that there are many courses that would better meet their needs. In developing countries, like Nigeria, it has been suggested that there is a need to prepare a "comprehensive nurse"--a combination bedside nurse, public health nurse, and midwife who can provide preventive and curative services in multiple settings. Such a task is awesome and illustrates the need for schools of nursing to provide an academic counselor who has some knowledge of the culture and health needs of the students' native land. When asked: "How could the school of nursing have helped you cope with your academic problems?" 43% of the students suggested a foreign student advisor or counselor. "To have a foreign student advisor who has been overseas and who will relate to the student at their level," replied one student. Only when education is relevant to the specific needs of a given country, will there be an improvement in the health of the people of that country. To educate registered nurses abroad is very costly for countries with low G.N.P. If we accept students from developing countries into our nursing programs, we have a responsibility to prepare them to be effective practitioners when they return to their homeland. The special needs of nursing students and the health care needs of the community for which they are trained must therefore be integrated into their training.     

Addressing the need for education: curriculum development for nurses about intellectual and developmental disabilities

People with disabilities and national and international agencies are voicing their views, forcing health care providers to look at how people with disabilities are treated in the health care system and to find ways to help them achieve equal access to quality care. Education about nursing care of patients with I/DD is limited in basic nursing education programs and for nurses who are in practice. A number of developmental disabilities nursing projects are addressing this need with curriculum development that has validated the need for education and has begun testing the various methods of instruction. As the curriculum is disseminated in written or Internet-accessible formats, nurses in education and practice will be able to find resources that target a specific topic area or a set of comprehensive instructions to acquire a better understanding of the comprehensive needs of people with I/DD and better ways to provide care. There is a need for a greater integration of curriculum about nursing care of people with developmental disabilities into basic nursing education at all levels and further evaluation of the impact of this curriculum on nursing care for people with I/DD. The hope is that these efforts can improve the education of nurses and other health care providers for the direct benefit of individuals with intellectual disabilities.     

A tension between genuine care and other duties: Swedish nursing students' views of their future work

There is a current need for nurses to take on new roles due to changing health care policies, economic cut-backs and shortage of staff. It is therefore important to study nursing students' view of their future profession. The theoretical framework was contemporary theories of competence development, which has shown that people's understanding of their work is expressed in their actions. The aim of this study was to describe nursing students' understanding of their future professional role in health care. A purposeful sample of 12 nursing students wrote narratives. The texts were condensed in five steps using the Empirical Phenomenological Psychological Method. The essence of the students' view of their future work was A tension between genuine nursing care and other duties. Four themes constituted this essence: professional status, working conditions and stress, evidence-based nursing contra holistic care, teamwork, co-operation and disrespect, and intensive care instead of geriatrics. This study highlights pedagogic and practical problems that need to be constructively addressed. The nursing students' eagerness to care in a holistic way needs to be acknowledged and used in a fruitful way. This core function of nursing needs to be integrated with up-to-date nursing research.