Challenges and leadership strategies for managers of nurse practitioners

AIM: The aim of this paper is to report on the findings from our research into the recent introduction of nurse practitioners in Alberta, Canada. Through an organizational research perspective, we identify the critical role of health care managers in developing a sustainable nurse practitioner role. BACKGROUND: Previous literature has focused on nurse practitioners themselves as the key factor in their integration into the health care system. Although they are qualified and organizationally well placed, managers of nurse practitioners have been overlooked as a critical part of implementation strategies. KEY ISSUES: We interviewed 25 nurse practitioners and seven of their managers. Through our data analysis we identified three major challenges for managers: (1) clarifying the reallocation of tasks; (2) managing altered working relationships within the team; (3) continuing to manage the team in an evolving situation. Associated with these challenges, we propose leadership strategies that managers may find useful as they work through the consequences of introducing the nurse practitioner role. These strategies are: * encourage all team members to sort out 'who does what'; * ensure that task reallocation preserves job motivating properties; * give consideration to how tasks have been allocated when issues identified as 'personal conflict' arise; * pay attention to all perspectives of the working relationships within the team; * facilitate positive relationships between team members; * lead from a 'balcony' perspective; * work with the team to develop goals that are not over focused on the nurse practitioner; * regularly share with other managers the experiences and lessons learned in introducing nurse practitioners. CONCLUSION: For managers to be most effective, they need to address three challenges that are of a managerial, not clinical, nature. By implementing specific leadership strategies, managers of nurse practitioners can facilitate the introduction of the new role and improve its sustainability in health organizations.     

深圳市龙岗区护理人员工作满意度的影响因素分析

目的 探讨影响深圳市护理人员工作满意度的相关因素，为改善护理人员的工作满意度、提高护理质量、减少护理人员流失、完善护理人力资源管理制度提供依据。方法对在深圳市龙岗区医院工作的445名护理人员，采用一般资料问卷、明尼苏达满意问卷（MSQ）、组织承诺量表（OCQ）、离职意愿量表进行调查，分别以工作满意度量表、组织承诺量表、离职意愿量表总分为应变量，以护理人员的年龄、学历、婚姻、职称、职务、劳动关系、工龄、是否注册护士和其他两个量表总分为自变量进行多元逐步回归分析。结果护理人员工作满意度与组织承诺、年龄呈正相关，与劳动关系和离职意愿呈负相关（P〈0．001）。结论护理人员的工作满意度与组织承诺、年龄、劳动关系和离职意愿等因素关系密切。需采取有针对性的干预措施，提高护理人员的工作满意度。     

护理组织承诺与工作绩效的相关研究

[目的]探讨护理组织承诺与工作绩效的关系。[方法]用组织承诺量表和工作绩效量表对187名护士进行测查。然后进行相关和回归分析。[结果]护理组织承诺的总分及其各维度都与工作绩效总分存在显著相关；组织承诺各维度对工作绩效都具有一定的预测性，其中，感情承诺对工作奉献的预测性最大；规范承诺对人际促进和任务绩效的预测性最大。[结论]护理组织承诺对工作绩效具有一定的预测性，护理管理者应通过加强护理组织承诺方面的管理来提高其工作绩效。     

Transformation of Accessible Chromatin and 3D Nucleome Underlies Lineage Commitment of Early T Cells

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Effectiveness of Community Treatment Orders: The International Evidence: Efficacité des ordonnances de traitement en milieu communautaire: Les données probantes internationales

Objective:

Community treatment orders (CTOs) exist in more than 75 jurisdictions worldwide. This review outlines findings from the international literature on CTO effectiveness.

Method:

The article draws on 2 comprehensive systematic reviews of the literature published before 2013, then uses the same search terms to identify studies published between 2013 and 2015. The focus is on what the literature as a whole tells us about CTO effectiveness, with particular emphasis on the strength and weaknesses of different methodologies.

Results:

The results from more than 50 nonrandomized studies show mixed results. Some show benefits from CTOs while others show none on the most frequently reported outcomes of readmission, time in hospital, and community service use. Results from the 3 existing randomized controlled trials (RCTs) show no effect of CTOs on a wider range of outcome measures except that patients on CTOs are less likely than controls to be a victim of crime. Patients on CTOs are, however, likely to have their liberty restricted for significantly longer periods of time. Meta-analyses pooling patient data from RCTs and high quality nonrandomized studies also find no evidence of patient benefit, and systematic reviews come to the same conclusion.

Conclusion:

There is no evidence of patient benefit from current CTO outcome studies. This casts doubt over the usefulness and ethics of CTOs. To remove uncertainty, future research must be designed as RCTs.     

Organizational and structural reform in aged care organizations: empowerment towards a change process

Aims The aims were first to explore strategies for both structural and organizational reform by the process of action research, and second to use collective self-inquiry by all study participants as a way of examining problems and deciding on actions to bring about change. Rationale It was hoped that this process would empower the staff, aged residents and family members to own and therefore be meaningfully involved in improving practice and care standards. Background/introduction Three aged care centres expressed a desire to enhance the quality of care provided in order to meet the criteria for accreditation. They wanted to participate in a process that would assist them in critically examining their resource allocation, service delivery patterns and outcomes for residents. Research methods Original data were collected in three different aged care facilities over a three-year period from 1996 to 1998 in order to seek answers to the usefulness of action research in the change process. The methodology included participant observation, interviews and focus group discussions with all participants. Results/findings Organizational change occurred across the three centres with subsequent changes in the outcomes for both residents and staff. The themes which emerged from the data analysis process and which enhanced the participatory process included the need for flattened organizational structures and management's willingness to fully support the process and to be more transparent. The factors that inhibited the process included the organizational culture and tokenistic support by management. Discussion/conclusion Participatory action research was found to be a successful process for identifying and acting on the enhancers and inhibitors to structural and organizational reform.     

The CD8 population in CD4-deficient mice is heavily contaminated with MHC class II-restricted T cells

In experiments to study the impact of deficiency in CD4+ T cell help on the magnitude of CD8+ cytotoxic T cell response to pathogens, it was noted that in CD4 gene knockout mice, the CD8 population made significant responses to several nominally major histocompatibility complex (MHC) class II-restricted epitopes in addition to the expected responses to MHC class I-restricted epitopes. A similar response by CD8+ T cells to class II-restricted epitopes was not observed in wild-type mice, or in mice that had been acutely depleted of CD4+ T cells just before the immunization. Coincident with this unexpected response to class II-restricted epitopes, it was also observed that the CD8+ response to the class I-restricted epitopes was consistently lower in CD4-/- mice than in wild-type mice. Further experiments suggested that these two observations are linked and that the CD8 population in CD4-/- mice may contain a majority of T cells that were actually selected by recognition of MHC class II molecules in the thymus. These results have implications for understanding CD4 versus CD8 lineage commitment in the thymus, and for the practical use of CD4-/- mice as models of helper deficiency.     

临床护士专业承诺调查研究

目的：了解临床护士专业承诺现状。方法：对345名临床护士进行问卷调查。结果：临床护士专业生涯涉入意愿及专业生涯正向评价得分较低。不同年龄、工作年限、科室、用工性质、技术职称、婚姻状况、薪资及学历护士之间的专业承诺有差异。结论：建议从多方面采取措施提高临床护士对专业的忠诚度。     

Against the odds: experiences of nurse leaders in Clinical Development Units (Nursing) in Australia

AIM: This paper is a report of a longitudinal study to develop an understanding of the phenomena of Clinical Development Unit (Nursing) leadership by exploring the experiences of the nurse leaders of nine Australian units as they attempted to develop their existing wards or units into recognized centres of nursing excellence. BACKGROUND: The concept of Clinical Development Unit (Nursing) in Australia originated in the British Nursing Development Unit movement, which has been widely credited with introducing innovative approaches to developing nurses and nursing. A network of nine Clinical Development Units (Nursing) was set up in a suburban area health service in Australia. The aim was to develop existing wards or units into centres of excellence by disseminating a new vision for Australian nurses that was based on the pioneering work of the British Nursing Development Unit movement. METHODOLOGY: Principles of Heideggerian hermeneutic phenomenology provided a framework for the study. Nine Clinical Development Unit (Nursing) leaders participated in qualitative interviews from 1998 to 2002. These interviews were transcribed into text and thematically analysed. FINDINGS: Despite attempts to implement a variety of measures to nurture these Clinical Development Units (Nursing) until they had become well established, the new Clinical Development Unit (Nursing) leaders were unable to maintain the Clinical Development Unit (Nursing) vision with which they had been entrusted. This paper discusses their reactions to the problems they faced and the new understandings they developed of their Clinical Development Unit (Nursing) role over time. CONCLUSION: The findings illuminate the difficulties involved in maintaining the commitment of all levels of staff and management when attempting to introduce new nursing projects.