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A new era of demonstrable cost effectiveness in the health service has made health visitors more nervous, perhaps, than any other group of health workers. Their job involves 'unquantifiable' activities like support, prevention and health promotion. The irony is, that these activities are every bit as vital as they are hard to measure, writes Michael Traynor.
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Together with economic causes, the declining belief in the relevance of clinical skills, the omission of the hospital from the health system, and the erroneous generalisation of a complaint centred approach enhanced the decline in clinical medicine in several developing countries over the last decades. Despite a growing interest and important efforts in continuous education, basic training remains generally knowledge-directed. Clinical training should start from a realistic job description, and aim at acquiring skills instead of knowledge. Basics of clinical epidemiology can help refine clinical logic both at the health centre and the hospital level. the district hospital should be awarded a key role in pre-graduate and continuous clinical training. Awaiting a revival of the economy in most tropical countries, and especially in tropical Africa, an effective way for improving clinical practice is to invest in training, at all levels, with an emphasis on continuous medical training.
Despite the plethora of articles on work environment and nursing power in the recent nursing literature, we have yet to improve nurses' experience of work in any significant way. In fact, as hospital budgets come increasingly under attack in the name of health care reform, nursing work is becoming even more demanding and, to many, less satisfying This article describes the experience of powerlessness by a sample of hospital staff nurses in British Columbia. It analyses the themes which characterize powerless work situations and explores the impact of these on nurses. It suggests some ways of bringing about change in these circumstances of work. The article intends to illuminate, for those who care to understand, the complexity and often insurmountable challenges that nurses encounter in the course of their nursing work. It urges us to create opportunities to make the increasingly difficult and frustrating circumstances of nursing work visible to key decision makers.
PURPOSE/OBJECTIVES: To develop and implement a form that integrates nursing and clinical trials toxicity assessments and interventions. DATA SOURCES: Published books, journal articles, and toxicity scales. DATA SYNTHESIS: The combined nursing and biometry department Documentation/Toxicity Committee at the London Regional Cancer Centre designed and implemented the comprehensive Patient Assessment Record (PAR) to provide consistent nursing and toxicity data related to patients enrolled in clinical trials research protocols. Nursing interventions and evaluations are documented on the Nursing Intervention Record (NIR). CONCLUSIONS: Initial evaluation suggested that the PAR has been an effective form. Audit results indicated that the form minimizes the number of individuals collecting the same data while maintaining the quality of toxicity data. IMPLICATIONS FOR NURSING PRACTICE: The collection of toxicity data for patients enrolled in clinical trials protocols has been incorporated into primary nurses' job descriptions. This additional responsibility has enhanced their role. Both the PAR and the NIR have assisted the multidisciplinary teams in meeting their documentation needs.
A pharmacy-based program for the procurement, allocation and maintenance of infusion pumps is presented. Policies and procedures for various facets of the program, job descriptions for personnel, and training programs for pharmacy and nursing personnel are discussed. A plan for quality assurance, including in-use accuracy testing, preventive maintenance, repairs, and complete record keeping and documentation is outlined. Various aspects of equipment selection, economic justification of equipment, and revenue generation potential are addressed. It is concluded that an infusion pump program can be operated successfully by the hospital pharmacy department.
A questionnaire survey of 452 general medical practices in Victoria attracted responses from 277 practices, many of which did not employ nurses. The 93 respondents from 85 practices who were nurses reported that they enjoyed flexible working hours and stable employment. While their main reason for working in GPs' rooms was convenience, the most important aspect of their work was interaction with patients and fellow workers. Sixtyseven percent of nurses thought continuing education in specific skills was necessary for their work, 43% thought a post-registration qualification in community health nursing would be desirable and 47% thought a special interest group of nurses working in medical practices would be useful.
Sioux Valley Hospital has successfully transformed patient care units to patient-focused care in a well-established Differentiated Practice Model. Marked improvement has resulted as evidenced by increased patient, staff and physician satisfaction, cost savings and overall improvement in efficiency.
The present study considers the appearance, the essence and the significance of nurses who assist women in their pregnant puerperal cycle. Research subjects were nurses who were interviewed when working in the obstetric area. In addition, data based on participant observations of their professional daily activities, were obtained. In the investigation, the phenomenological approach was utilized as a theoretical-philosophical reference. Based on the analysis and interpretations of verbal reports and participant observations invariants emerged. Some alternatives were identified, allowing a review of the nursing practice. This strategy will help to reduce conflictant feelings by providing a increasing level of professional satisfaction.
A great deal of preparation, time, and expertise are needed to find a good staff member. Remember to be clear about your expectations and formalize your requirements with a written job description. If you plan to run a classified ad, be sure to write one that stands out from the rest. Conduct exceptional interviews that allow applicants to be themselves and demonstrate their abilities. Don't take any shortcuts. Check references, conduct working interviews, and provide training with positive feedback. Your investment of both finances and time will be rewarded when you choose and hire a highly qualified employee who will be able to contribute to the success of your practice.
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Aim of the survey was to gather information on the occupational situation of recently trained registered nurses of the Trento Province. 484 questionnaires were mailed to all the nurses that obtained their diploma from 1993 to 1995; 379 questionnaires (78%) were returned. Among the 70 subjects not working as nurses, 19 are unemployed, 12 study full time, 26 work full time in other professions, 11 are in the army, all the others work occasionally, but not as nurses. 46% are unsatisfied or partially satisfied with their job; 87.3% would choose again the nursing profession. 20% of the nurses would prefer to work on a part time basis.
Job sharing restructures a full-time position-two individuals share the responsibilities and the benefits of the position. If nurses are committed to making it work, this arrangement can succeed at the managerial level.
The authors present their findings following an exhaustive literature review of research on differentiated nursing practice (DNP) that used a number of tools to measure various aspects of DNP that are applicable across the health care delivery continuum. Issues related to DNP include: optimal nursing care, matching patient needs with nurse competencies, effective use of nursing resources, equitable compensation, career satisfaction, loyalty to employers, and enhanced prestige of the nursing profession. One 1992 Massachusetts study of a three-role oncology unit project (including patient care manager, clinical nurse, and patient care technician), showed positive change in five criteria including: standards of nursing care, actual care hours, average labor costs, job satisfaction and patient satisfaction. A 1990 Arizona study that included unit assistants concluded that DNP supported a decline in the use of supplemental staff and staff overtime which led to cost savings, and increases in the actual hours of care and nurse satisfaction.
This survey was conducted to assess the nature and extent of nursing research activities in acute care facilities and schools of nursing in New York state. A questionnaire was mailed to 269 acute care facilities and 42 schools of nursing with a response rate of 29%. Sixty-seven percent of acute facilities and 100% of schools responding reported participating in nursing research activities. Sixty-eight percent of the acute care facilities and 67% of the schools of nursing that participated in research activities reported that nursing research was included in staff job descriptions. The findings revealed that the organizational environment in schools was more supportive of research activities than in acute care facilities. Despite changes in health care, including overall downsizing and deletion of nursing research positions, acute care facilities and schools of nursing reported an increase in quality and quantity of research from 1992-1996 compared to 1988-1991.
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