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PubMed1997

Physician perceptions of health care reform: national versus state knowledge, input and support.

Health care reform directly impacts physicians and the practice of medicine. A questionnaire was sent to a random sample of 2,000 physicians in the state of Florida to obtain physician perceptions of health care reform. Physician knowledge, input, and support of both state and national health care reform were reported in the lowest categorizations. Issues deemed most important for support were tort reform and physician autonomy. The approach of the Florida plan, managed competition, was viewed as ineffective in addressing the issues of cost and access. Experience with the managed competition model and objective evaluations may alter perceptions and increase physician support.

Attitude of Health Personnel↗

PubMedDate not supplied

Impact of a CareMap and case management on patient satisfaction and staff satisfaction, collaboration, and autonomy.

The purpose of this research was to evaluate the effect of a CareMap and nursing case management on patient satisfaction and staff job satisfaction, collaboration, and autonomy. The patients who had a CareMap and a nurse case manager were more satisfied with their care. The multidisciplinary staff who worked on the experimental unit had increased job satisfaction and nurses who applied and were selected for case management positions had higher levels of collaboration and increased autonomy. Multidisciplinary team members who developed the CareMap also had higher levels of collaboration than other multidisciplinary staff on the experimental unit and their job satisfaction with quality of care increased under this new care delivery system.

Case Management↗

PubMed1995

Staff nurse work empowerment and perceived autonomy. Testing Kanter's theory of structural power in organizations.

Nurse executives have been striving for the means to equalize the power base in healthcare settings. They also have been seeking ways to overcome the perceived powerlessness of their staffs. Empowerment and increased autonomy in the work setting often are described as mechanisms to achieve these goals. This study, based on Kanter's theory of the structural determinants of behavior in organizations, examined formal and informal power as predictors of job-related empowerment and autonomy. Results of the study lend support to the use of the theory in healthcare settings as a way for nurse executives to develop increased access to the sources of job-related empowerment for their staffs.

Adult↗

PubMed1995

An instrument for measuring autonomy-related attitudes and behaviors in women nursing students.

For the past 30 years, researchers have attempted to measure the characteristic of autonomy in nursing students, yet for the most part, the findings reflect neither an accurate nor current profile. Historically, there has been a misunderstanding of how women manifest autonomy due to the tradition of defining autonomy based on the male model, i.e., autonomy through power and separation. Nurse researcher-educators are in a unique position to develop instruments, conduct research, and interpret findings concerning characteristics identified as important for women nursing students. The purpose of this study was to design an instrument for quantitative measurement of autonomy-related attitudes and behaviors specific to women nursing students based on the female model, i.e., autonomy through caring and affiliation. Stability reliability (test/retest = 0.90), internal consistency (Cronbach's alpha = 0.84), and content and construct (factor analysis, contrasted groups, experimental manipulation, and convergent) validity have been established for this instrument. It is intended that the instrument be used to evaluate the efficacy of the socialization process in nursing education.

Attitude of Health Personnel↗

PubMed1992

Maintaining autonomy: the struggle between occupational therapy and physical medicine.

In 1948, several physiatrists, representing the emerging medical specialty of physical medicine, held a meeting at which they aggressively attempted to wrest control of occupational therapy's educational programs and national registry from the jurisdiction of the American Occupational Therapy Association. This paper offers one view of the events that led up to that meeting and the consequences of that struggle for occupational therapy autonomy. It focuses on several critical incidents in the struggle, the salient issues debated, and the strategies used by both physical medicine and occupational therapy to influence the outcome. The consequences of the confrontation as they affected occupational therapy education and practice are discussed.

Conflict, Psychological↗

PubMed1993

Physician leadership for the 21st century.

This article examines how rapidly evolving health care delivery structures are radically altering the traditional clinical and organizational autonomy enjoyed by physicians. These changes may render maintenance of prior levels of physician autonomy virtually impossible. The author calls for the emergence of a new breed of physician leaders who will preserve the best of traditional medical practice culture but also effectively implement a nascent form of integrated health care practice.

Ambulatory Care↗

PubMedDate not supplied

Job satisfaction of home health nurses.

Job satisfaction is a key to the retention of quality nurses. To promote staff retention and reduce costs, nursing administrators need current research on job satisfaction of home health nurses. In a study of job satisfaction of 66 home health nurses, research indicates that the most satisfying aspects of home care nursing include autonomy and independence, close nurse-client relationships, work hours, flexibility in scheduling hours, and satisfaction with peers and supervisors. When nursing administrators capitalize on these job satisfiers, staff turnover is reduced and costs are contained.

Adult↗

PubMedDate not supplied

Rural hospitals: organizational alignments for managed care contracting.

In order to facilitate the process of determining how best to respond to the recent growth of rural managed care, this study discusses various organizational alignments for managed care contracting. The organizational alignments are divided into three categories: remain independent, enter into a contractual arrangement, or develop an informal agreement. For each category, the article explains the option, examines advantages and disadvantages, and presents empirical evidence about the observed effects. The purpose is to present a comprehensive menu of possibilities so that rural hospitals, given their own needs and objectives, may evaluate the options. Although situations differ for individual hospitals, certain general conclusions emerge. First, contracting with managed care organizations as an independent entity is likely to be most attractive to rural hospitals that have a strong patient base. Second, rural hospitals will be more likely to enter into contractual arrangements for managed care contracting when financial pressures dominate the potential loss of autonomy and control. Finally, developing an informal agreement with other healthcare providers for purposes of managed care contracting is likely to be desirable as an intermediate step, or way of experimenting with collective action before entering into a contractual arrangement.

Contract Services↗

PubMed1998

Managing mergers without alienating physicians.

Mergers and acquisitions have become perhaps the most pervasive and important business activity in the healthcare industry. Physicians, however, frequently dread becoming involved in mergers because they fear loss of autonomy, income, and even their jobs. In merged organizations, the best managers look for ways to extend the benefits of mergers to physicians to prevent them from perceiving themselves as victims and becoming alienated from the organization.

Attitude of Health Personnel↗

PubMed1993

Doctors as workers: work-hour regulations and interns' perceptions of responsibility, quality of care, and training.

OBJECTIVE: To study residents' perceptions of their responsibility for patients, the quality of patient care, and their learning experiences in light of new work-hour regulations. DESIGN: Inductive analysis of in-depth, semistructured, recorded interviews with a cohort of interns in internal medicine in the last month of their first postgraduate year. Questions were grounded in an examination of issues related to going off duty and delegating tasks to colleagues. Transcripts were independently analyzed by an interdisciplinary team. SETTING: New York University/Bellevue Hospital Center's residency program in internal medicine (in New York City). PARTICIPANTS: A cohort of 21 of a possible 24 interns in medicine on rotation at Bellevue Hospital Center. RESULTS: The interviews revealed: 1) intense concern harbored by interns for their patients with resulting difficulty in maintaining realistic boundaries between work and personal lives; 2) an open-ended workday and competing considerations confronting interns when deciding to leave the hospital--including concerns about leaving patients at critical junctures in their care, confidence in the colleague to whom they were signing out, regard for the workload of this colleague, and uneasiness about the educational consequences; 3) deterrents to acknowledging and acting on one's limits in performing medical work; and 4) a recurrent conflict between delegating responsibility and retaining control over patient care. CONCLUSION: Values traditionally learned in training emphasize autonomy and individual accountability. They may conflict with the shared decision making and collective responsibility among peers necessitated by work-hour limitations and associated changes in program structure.

Attitude of Health Personnel↗

PubMed2000

'I don't want to be a psychiatric nurse': an exploration of factors inhibiting recruitment to psychiatric nursing in Ireland.

Ireland has experienced a decline in recruitment to preregistration psychiatric nursing programmes (An Bord Altranais 1999). Social care workers often do similar psychosocial work with similar client groups served by psychiatric nurses. In marked contrast to psychiatric nursing, Irish social care diplomate and degree programmes are generally over subscribed. Yet graduates working in social care often experience inferiority in terms of pay, conditions and career structure compared to their psychiatric nursing counterparts (McElwee 1998). The question that therefore needs to be asked is why school leavers opt for such courses in preference to psychiatric nursing. This article describes the results of a pilot study, utilizing a focus group approach, to examine reasons for course and career choice among school leavers, psychiatric nursing students and social care students. Results indicate that school students rely on stereotypical views as part of their decisionmaking process in shaping occupational decisions. School students tend to conceptualize psychiatric nursing as being a job involving menial and physical tasks. Social care students saw psychiatric nursing as lacking autonomy and to be institutional in nature. Psychiatric nursing students themselves felt exploited and 'second class' compared to general nurses. Current recruitment campaigns and careers guidance within schools need to be more targeted on differentiating psychiatric nursing from its general nursing counterpart.

Career Choice↗

PubMed1996

The job satisfaction of physical therapists.

Ten statements were created for the purpose of measuring job satisfaction in the practise of physiotherapy. The subjects consisted of 96 of the 106 (90%) of the physical therapists licensed with the Texas State Board of Physical Therapy Examiners, and listed as residing in El Paso, Texas, USA. To indicate their job satisfaction, subjects indicated on a seven-point scale their level of agreement or disagreement with each statement. They then indicated on a different seven-point scale how important they thought each statement was to their job satisfaction. The results indicated that subjects thought that their jobs were challenging in a positive sense; enabled them to use their abilities; and were interesting. They also thought that they had sufficient independence in decision-making; were learning and improving in their work; and were given significant autonomy. The most dissatisfying aspect of their work was the amount of paperwork. In addition, the results suggest that some subjects may feel overworked, and think their jobs may be too physically demanding and mentally stressful. The subjects felt that all the statements had validity and measured important aspects of job satisfaction in physical therapy.

Burnout, Professional↗

PubMed1992

Decision-making autonomy in nursing.

Current nursing literature has suggested that nurses may have low needs or preferences for decision-making autonomy. In this study, the authors found that nurses differed in their preferences for decision-making autonomy in three types of work-related decisions. Employed nurses with a greater preference for autonomy were more satisfied with their jobs, and those with little or no such preference were less satisfied, as they gained decision-making influence over patient care and unit management. The authors discuss implications for designing and implementing decision-making programs.

Adult↗

PubMed1995

Administrative issues for use of nurse practitioners.

As nurse administrators increasingly use nurse practitioners in healthcare delivery systems to provide high-quality, more cost-effective care, they must recognize and take action on key practice issues--autonomy, title protection, admitting privileges, physician back-up, and reimbursement. Careful attention and action directed to enhancing nurse practitioner usefulness will increase the flexibility of nurse practitioner utilization within specific institutions and across a diverse network of healthcare delivery sites structured to provide continuity of care.

Delivery of Health Care↗

PubMedDate not supplied

Higher level practice in community nursing: part two.

AIM: To establish whether or not community nurse practitioners were able to achieve a 'higher level of practice', as articulated by the United Kingdom Central Council. METHOD: Grounded theory was used as a framework for the research. Data were gathered using primary observation with some participation, and by interviewing community nurse practitioners and clinical managers. FINDINGS: 'Negotiation for autonomy' is the core category at the centre of the overall theoretical framework that emerged from the research data. Those working at a higher level of practice had the ability to negotiate for autonomy with GPs and other doctors. This ability gave them the opportunity to practise with the autonomy required to hold consultations, as first point of access, with patients with undifferentiated diagnoses, providing care through to discharge or referral to others. CONCLUSION: The research highlights that unless community nurse practitioners can negotiate their role with GPs and hospital doctors, they are unable to achieve a 'higher level of practice'.

Community Health Nursing↗

PubMed2001

Nurse prescribing: views on autonomy and independence.

The introduction of nurse prescribing throughout Scotland in the primary care setting has proved to be an interesting development for nurses. The aim of this study was to assess the impact of nurse prescribing on district nurses and health visitors in one NHS trust in Scotland. All prescribing nurses in the trust were asked to participate in the study. This explored their perceptions of autonomy and the level of dependence on GP colleagues since being able to prescribe. In addition, prescribing patterns were examined to ascertain whether there was a relationship between the area of nursing (e.g. district nursing or health visiting) or the length of prescribing experiences, and the number of prescriptions written.

Attitude of Health Personnel↗

PubMed2005

The progress of family health nursing in remote and rural Scotland.

Since 2001 the World Health Organization Europe's family health nurse (FHN) role has been developing in remote and rural areas of Scotland. In 2003, an independent evaluation identified a need for facilitation of the FHN role and family-health orientated approaches with local primary health care teams. The Scottish Executive Health Department appointed three part-time, regionally-based family health practice development facilitators (FHPDFs) in December 2003 to work over an 18-month period. This article presents findings from a small study which sought these FHPDFs' judgements on individual FHN autonomy and supportive colleague action at 24 sites where FHNs were practising. These judgements reveal a picture of mixed progress that is consistent with findings from other related research. This collective overview is presented in the form of a new typology and the resultant implications for future development of family health nursing are discussed.

Family Nursing↗

PubMed1996

Nurse practitioners in general practice: an expanding role.

At a time when the government is proposing to allow nurses to become equal partners with GPs and a consultative report commissioned by the NHSE found that nurse practitioners provide cheaper and better services for patients (NHSE 1996), this article describes the role of a nurse practitioner working in a GP fundholding practice in the UK. The author considers issues of autonomy and accountability surrounding the development of the role. Its relationship to the development of nursing and caring is examined in the light of some doctors' and nurses' scepticism and ambivalence. The benefits to patients are presented to highlight the value of a properly structured nurse practitioner role integrated into primary care provision.

Clinical Competence↗