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Job description for the Certified Nephrology Nurse: professional and legal aspects.

As in many European countries, in Germany, practice and responsibilities of the Certified Nephrology Nurse (CNN) are still affected by a slowly changing structure in health care-providing institutions and the developing qualification process of the nurse working in the renal field. It is evident that parallel to the development and implementation of the European Core Curriculum the scope of practice for the CNN needed to be defined and published by a group of clinical experts working in the renal nursing field. A task force composed of members of the EDTNA-ERCA and the German National Renal Care Association was set up to tackle all aspects of the professional profile. A lawyer experienced and recognised in the medical field supported the group. In this paper information about the background and content of the document is presented, as are the core areas of practice and responsibilities and areas where junior nurses or helpers may work under the guidance of CNN, also the professional and legal aspects of the CNN profile are addressed, discussing possible benefits and problems for colleagues in practice when using and implementing the documents in different structures of renal care-providing organisations. This document was published and sent to all important national Bodies in Germany, having an immediate impact in units where areas of practice and responsibilities were undefined for certified renal nurses and nurses auxiliaries.

Certification↗

School nursing: a study of perceptions and visions.

The complex and changing health needs of students and lack of consistency between school districts have led to some role confusion among school nurses. Ten school nurses participated in this qualitative, descriptive study, which elicited their perceptions and visions of their practice. Constant comparative analysis was used to find meaning in the data. Five conceptual categories--preparation for school nursing practice, essence of school nursing, scope of practice perceptions, powerlessness, and future outlook--emerged from the data. The results indicated the need for specialty education and peer mentoring as participants developed in their autonomous role as school nurses. The collective data from the categories provide direction for school nurses, for university school nursing educators, and the national association in advancing role development for school nursing practice.

Attitude of Health Personnel↗

Health correlates of autonomy, control and professional relationships in the nursing work environment.

BACKGROUND: Internationally, nursing is facing a variety of challenges including changes in health systems, an ageing workforce and escalating shortages of Registered Nurses. New Zealand is no exception. Here as elsewhere these challenges are taking their toll on the resources and demands of hospital environments, on the health and well-being of nurses themselves and most certainly on the people for whom they care. In the United States of America (USA), three aspects of the nursing work environment--autonomy, control and nurse-physician relations--have been identified as linked to staff retention, levels of staff burnout and needlestick injury, as well as to a range of patient outcomes. AIM: To examine the New Zealand nursing situation and to see whether aspects of the work environment are associated with health status. METHODS: A total of 225 Registered Nurses in a general hospital completed the Revised Nursing Work Index (NWI-R) and Medical Outcomes Study (MOS) 36-Item Short-Form Health Survey (SF-36). RESULTS: Ratings indicated that the New Zealand hospital environment was characterized by less autonomy and control and better nurse-physician relations than in USA hospitals. Results of correlations demonstrated that more positive ratings of the three workplace attributes were associated with better health status amongst the nurses. The results of regression analyses were indicative either of a confounding relationship or of a mediating relationship such that nurses' relations with physicians, administration and other departments mediate the associations between autonomy, control and health status. CONCLUSIONS: The study offers an insight into a New Zealand hospital environment and suggests the importance of good relationships with physicians and other departments for the health of nurses.

Adult↗

Role stress and career satisfaction among registered nurses by work shift patterns.

OBJECTIVE: This study examined the variation in role stress and career satisfaction among hospital-based registered nurses (RNs) by shift length. SUMMARY BACKGROUND DATA: Many hospitals have reorganized care delivery into 12-hour work shifts to improve RN recruitment, retention, and cost effectiveness. Yet little is known about the effects of 12-hour shifts on RN role stress and career satisfaction. As an unprecedented RN shortage approaches, factors that contribute to satisfying and healthy practice environments must be identified. METHODS: This study used a descriptive cross-sectional research design. Five hundred RNs were randomly selected to receive a mailed questionnaire packet. RESULTS: Initial findings indicate RNs working 12-hour shifts were younger, less experienced, and more stressed than colleagues working 8-hour shifts. When differences in nursing experience were controlled, similar RN stress levels were found. Although overall career satisfaction was comparable between groups, significant differences were found in the areas of salary and professional status. Pay, autonomy, and professional status were the most important determinants of career satisfaction for all RN participants. CONCLUSIONS: These findings suggest that RNs may experience greater professional fulfillment when strategies are implemented that promote autonomous practice environments, provide financial incentives, and recognize professional status. Proactive decision-making may avert RN disillusionment and avoid other negative consequences that impact quality of care.

Adult↗

Discontinuing dialysis in persistent vegetative state: the roles of autonomy, community, and professional moral agency.

This report proposes a policy for discontinuing dialysis in persistent vegetative state (PVS) patients and attempts to address autonomy and community-based values while maintaining professional moral agency. It is recommended that the policy be adopted at a regional level (eg, the ESRD Network). The involved physicians and ethicists would communicate with the next-of-kin and surrogate decision-makers, and the local ethics committee would perform a double review of the case to assure the appropriateness of the policy to the case. Given the unique nature of PVS with its permanent loss of consciousness and autonomy, we hold that a community-based consensus can form a guideline that limits futile dialysis while respecting patient and professional moral agency. Prior consent of dialysis patients to the regional policy at a time shortly after initiating dialysis will add to its ethical impetus.

Advance Directives↗

A multi-disciplinary professional practice model: supporting autonomy and accountability in program-based structure.

This article addresses the challenge of maintaining high quality patient care in a large, diverse health care organization as it merged and moved from a functional to a program-based management structure. The article describes the Professional Practice Model (PPM) which was developed to address the professional issues inherent in a program-based management structure. The operationalization of the PPM, including the committee structures which were put in place to support it, are discussed. The final section of the article highlights the strengths and challenges which have arisen through the development and implementation of the Professional Practice Model.

Decision Making, Organizational↗

From corporate governance to hospital governance. Authority, transparency and accountability of Belgian non-profit hospitals' board and management.

As a result of multiple developments in health care and health care policy, hospital administrators, policy makers and researchers are increasingly challenged to reflect on the meaning of good hospital governance and how they can implement it in the hospital organisations. The question arises whether and to what extent governance models that have been developed within the corporate world can be valuable for these reflections. Due to the unique societal position of hospitals--which involves a large diversity of stakeholders--the claim for autonomy of various highly professional groups and the lack of clear business objectives, principles of corporate governance cannot be translated into the hospital sector without specific adjustments. However, irrespective of these contextual differences, corporate governance can provide for a comprehensive 'frame of reference', to which the hospital sector will have to give its own interpretation. A multidisciplinary research unit of the university of Leuven has taken the initiative to develop a governance model for Belgian hospitals. As part of the preliminary research work a survey has been performed among 82 hospitals of the Flemish Community on their governance structure, the composition of the governance entities, the partition of competencies and the relationship between management and medical staff.

Belgium↗

The role of ritualistic ceremonial in removing barriers between subcultures in the National Health Service.

The role of ritualistic ceremonial in removing barriers between subcultures in the National Health Service Background. One of the ways in which it is possible to achieve successful organizational change is through the elimination of those ceremonies that reinforce or preserve the negative aspects of professional and work group autonomy, thus maintaining the barriers between subcultures. Conversely, the encouraging of ceremonies which reinforce positive aspects is likely to achieve more flexible, team-orientated changes. Aim. The paper considers those ceremonies, which perpetuate barriers in a National Health Service (NHS) Trust, and explores new ceremonies which may question, weaken or eliminate current dysfunctional practices. Design. Our research approach was mainly phenomenological, as we wished to elicit the symbolic significance of organizational routines. The primary source of data was spoken language. The findings are based on purposive sampling of informants by means of semi-structured interview and observation. Other types of information were also collected, including business plans, reports and brochures. Informants included the Chief Executive and four Board members, three consultants, the director of nursing and midwifery, 10 middle managers and eight junior, nonmedical and nonmanagerial employees. Findings. Two broad bands of ceremonies have been identified - those which preserve the existing norms and autonomy of professional and worker groups, which we have named Ceremonies of Preservation, and those which encourage change, which we have called Ceremonies of Change. Considerable data are provided to help to 'tell the story'. Conclusion. The paper argues that attention to ceremonial in the wider change process may facilitate the desired, specific change or changes in practice. It suggests that changes which confront unnecessary demarcation, but which do not undermine professional integrity, can create real benefits for NHS hospitals.

Attitude of Health Personnel↗

Can staff attitudes to team working in stroke care be improved?

BACKGROUND: Teamwork is regarded as the cornerstone of rehabilitation. It is recognized that the skills of a multiprofessional team are required to provide the care and interventions necessary to maximize the patient's potential to recover from his/her stroke. LITERATURE REVIEW: Critical evaluation of team working is lacking in the literature. Indeed, there is no consensus on a precise definition of teamwork or on the best way of implementing it, beyond a general exhortation to members to work to the same therapeutic plan in a cohesive manner. The literature has highlighted many problems in team working, including petty jealousies, ignorance and a perceived loss of autonomy and threat to professional status. AIM: To determine if the use of team co-ordinated approaches to stroke care and rehabilitation would improve staff attitudes to team working. METHOD: A pre-post design was adopted using 'The Team Climate Inventory' to explore attitudes to team working before and after introducing the interventions. Local Research Ethics Committee approval was obtained. RESULTS: Improvements in attitudes towards team working suggest that the introduction of team co-ordinated approaches (integrated care pathways and team notes) did not result in greater team working. LIMITATIONS: The introduction of an integrated care pathway and team notes is based on an assumption that they would enhance team working. CONCLUSIONS: The results suggest that the introduction of team co-ordinated approaches (team notes and care pathways) do not improve attitudes to team working, teams appear to take a long time to establish cohesion and develop shared values.

Attitude of Health Personnel↗

Effect of a professional practice model on autonomy, job satisfaction and turnover.

Dissatisfaction and rapid turnover of registered nurses (RNs) challenge nurse administrators. The professional practice model (PPM) can increase the amount of personal control nurses have over their work. Use of a PPM allows innovation, promotes collegial relationships and emphasizes personal responsibility. In this study, facilitating an autonomous climate for RN practice resulted in increased job satisfaction and decreased.

Adult↗