Showing papers in "Journal of Nursing Management in 2007"

The relationship between nursing leadership and patient outcomes: a systematic review update

Abstract: Aim Our aim was to describe the findings of a systematic review of studies that examine the relationship between nursing leadership practices and patient outcomes. Background As healthcare faces an economic downturn, stressful work environments, upcoming retirements of leaders and projected workforce shortages, implementing strategies to ensure effective leadership and optimal patient outcomes are paramount. However, a gap still exists in what is known about the association between nursing leadership and patient outcomes. Methods Published English-only research articles that examined leadership practices of nurses in formal leadership positions and patient outcomes were selected from eight online bibliographic databases. Quality assessments, data extraction and analysis were completed on all included studies. Results A total of 20 studies satisfied our inclusion criteria and were retained. Current evidence suggests relationships between positive relational leadership styles and higher patient satisfaction and lower patient mortality, medication errors, restraint use and hospital-acquired infections. Conclusions The findings document evidence of a positive relationship between relational leadership and a variety of patient outcomes, although future testing of leadership models that examine the mechanisms of influence on outcomes is warranted. Implications for nursing management Efforts by organisations and individuals to develop transformational and relational leadership reinforces organisational strategies to improve patient outcomes.

Rate, causes and reporting of medication errors in Jordan: nurses’ perspectives

Abstract: Aim The aim of the study was to describe Jordanian nurses’ perceptions about various issues related to medication errors. Background This is the first nursing study about medication errors in Jordan. Methods This was a descriptive study. A convenient sample of 799 nurses from 24 hospitals was obtained. Descriptive and inferential statistics were used for data analysis. Results Over the course of their nursing career, the average number of recalled committed medication errors per nurse was 2.2. Using incident reports, the rate of medication errors reported to nurse managers was 42.1%. Medication errors occurred mainly when medication labels/packaging were of poor quality or damaged. Nurses failed to report medication errors because they were afraid that they might be subjected to disciplinary actions or even lose their jobs. In the stepwise regression model, gender was the only predictor of medication errors in Jordan. Conclusions Strategies to reduce or eliminate medication errors are required.

The effects of structural and psychological empowerment on perceived respect in acute care nurses.

Abstract: Background The recruitment and retention crisis has catalyzed interest in workplace empowerment for nurses. Many nurses feel that they do not receive the respect they deserve in hospital settings; however, there are few systematic studies of respect for nurses. Objective The purpose of this study was to examine the relationships between structural and psychological empowerment and their effects on hospital nurses’ perceptions of respect. Method A secondary analysis was conducted of data from a larger study of 500 randomly selected hospital staff nurses. A predictive, non-experimental survey design was used to test a hypothesized model derived from Kanter’s Work Empowerment Theory. Results Both structural and psychological variables were significant independent predictors of respect, although structural empowerment had considerably greater explanatory power. Conclusions The findings support Kanter’s theory. Hospital nurses who perceive themselves to be structurally and psychologically empowered are more likely to feel respected in the workplace. Implications for nursing management Changing workplace structures is within the mandate of nurse managers in their roles as advocates for and facilitators of high-quality care. Nurse managers have the influence and resources to facilitate empowering work conditions that can increase nurses’ feelings of being respected. In addition, promoting collaborative inter-professional and intra-professional relationships and assuring continuous support to nurses are particularly important strategies for building respect.

Intention to 'leave' or 'stay' in nursing.

Abstract: Background Turnover in nursing and midwifery has recently become a problem in the Republic of Ireland and Irish health-care managers are constantly challenged to retain qualified nurses. The literature suggests that intention to stay or leave employment is the final step in the decision-making process. It is, therefore, reasonable to suggest that understanding ‘intent to stay or leave’ might facilitate nurse managers in introducing of appropriate retention strategies. Aim The aim of this study was to investigate registered nurses ‘intent to stay or leave’ employment. Methods A cross-sectional quantitative design was utilized. A questionnaire was designed and these were randomly distributed to 352 registered nurses at 10 hospital sites throughout the Republic of Ireland. Results Almost 60% of the sample, comprising of young, female, college educated nurses, expressed an intent to leave their current post. The most statistically significant predictors of intent to leave were ‘kinship responsibilities’ (P < 0.05) and ‘job satisfaction’ (P < 0.0001). Conclusion ‘Intent to leave’ has serious implications for workforce planning. Investigating the impact of focussed interventions in relation to job satisfaction and kinship responsibilities may be key retention strategies for nurse managers.

Predictors of nurses' perceptions of barriers to research utilization.

Abstract: Aim To identify predictors of nurses’ self-reported barriers to using research findings in clinical practice. Background Several studies have shown that nurses perceive barriers to research utilization but to our knowledge predictors of nurses perceptions of barriers to research utilization have not been identified before. Methods Three questionnaires were answered by 833 nurses: the Barriers Scale, the Quality Work Competence questionnaire and a questionnaire including questions on professional issues. Results Dissatisfaction with support from immediate superiors for participating in research and/or development projects, having no academic degree and unclear and unrealistic workplace goals were identified as factors increasing the risk of perceiving barriers to the use of research findings in clinical practice. Conclusions The results imply that head nurses, nursing managers and other health care leaders should create strategies for supporting nurses’ professional development and possibilities to implement research findings in clinical practice. Implications for nursing management To support research utilization and evidence-based care health care leaders, head nurses and nurse managers should create clear and realistic goals for the work place including demands on evidence-based care. It is also important for head nurses and nurse managers to create strategies for supporting nurses’ professional development and possibilities to implement research findings in clinical practice.

The relationship between multidimensional leadership and burnout among nursing staff.

Abstract: Aim and background The purpose was to explore the relationship between multidimensional leadership and burnout among nursing staff. There exists little research evidence of the relation between these phenomena. Method The study used a non-experimental survey design. The sample consisted of 601 nurses and nurse managers working in different health care organizations. Results Rewarding transformational leadership seems to protect particularly from depersonalization. Active management-by-exception protected from depersonalization and increased personal accomplishment. Passive laissez-faire leadership functioned as an exposing factor for emotional exhaustion as well as a decreasing factor for personal accomplishment. However, the employment status and the character of work tasks affected the connection between leadership and burnout. Conclusions The relation between leadership and burnout is complex, affected by situational factors of leadership and the ambiguous nature of burnout. Nurses of various ages, at different stages of career development and participating in different work tasks require different kinds of leadership.

Factors influencing nurses' decisions to raise concerns about care quality.

Abstract: Aim To explore factors that influence nurses’ decisions to raise concerns about standards of practice Background Health care practitioners have a key role in monitoring care quality Nurses are required by their professional body to raise concerns about standards; however, under-reporting is the norm Method Grounded theory was used to collect and analyse data from semi-structured interviews with 142 practising nurses, theoretically sampled from three Acute NHS Trusts in England Findings Fear of repercussions, retribution, labelling and blame for raising concerns, about which they predicted nothing would be done, were identified as disincentives to raising concerns Reporting was perceived as a high-risk:low-benefit action Nurses lacked confidence in reporting systems Conclusions Disincentives to reporting need to be addressed if an open culture, which promotes quality, safety and learning, is to be developed Findings give cause for concern and indicate a need to review organizational and professional guidelines, and organizational reporting systems

The origin of workplace bullying: experiences from the perspective of bully victims in the public service sector.

Abstract: Background Workplace bullying has attracted increased attention during the last decade due to its severe consequences on health. However, the origin of bullying has, so far, been insufficiently described. Aim This study investigates the manner in which bullying is initiated at workplaces in the public service sector. Method Twenty-two bully victims were interviewed in-depth and data were analysed according to grounded theory methodology. Results The findings of this study demonstrated that bullying was preceded by a long-standing struggle for power. This power struggle emanated from conflicts of values caused by organizational conditions, leadership styles and the involved parties’ work expectations. In particular, individuals who perceived themselves as strong and competent or as vulnerable and sensitive persons were targeted in these types of power struggles. Conclusions In these cases, if values conflicts were solved, the power struggle ebbed. When values conflicts remained unsolved, the gap widened between the targeted individual and that person's opponents. Thereby, the conflict escalated and grew into one characterized by systematic and persistent bullying.

Competence profiles of recently registered nurses working in intensive and emergency settings.

Abstract: Background Preceptorship is an essential method of supporting nurse competence, guaranteeing high quality care and increasing job satisfaction. Aim To describe recently registered nurses’ perceptions of their competence level, and to identify factors influencing these perceptions. Method The survey was conducted by using Meretoja's Nurse Competence Scale. The sample comprised 235 registered nurses working in intensive and emergency settings. The data were analysed by using statistical methods. Results Nurses’ self-assessed competence level ranged from moderate to good. A statistically significant association was seen between competence level and age, length of current work experience and the frequency of using competencies. Conclusions The results shed useful light on the educational needs of nurses and provide important clues for the development of preceptorship programmes. The Nurse Competence Scale proved to be a reliable and valid instrument in assessing the competence of recently registered nurses. Implications for nursing management We recommend that management strategies be developed to enhance and support positive learning environments for competence development. We recommend preceptorship programmes based on systematic competence assessments made by nurses themselves, their preceptors and managers.

Interdisciplinary teamwork: is the influence of emotional intelligence fully appreciated?

Abstract: Aim The purpose of this study is to discuss how emotional intelligence affects interdisciplinary team effectiveness. Some findings from a larger study on interdisciplinary teamworking are discussed. Background Teams are often evaluated for complementary skill mix and expertise that are integrated for specialist service delivery. Interactional skills and emotional intelligence also affect team behaviour and performance. An effective team needs both emotional intelligence and expertise, including technical, clinical, social and interactional skills, so that teamwork becomes greater or lesser than the whole, depending on how well individuals work together. Key issues Team diversity, individuality and personality differences, and interprofessional safety are analysed to raise awareness for nurse managers of the complexity of interdisciplinary working relationships. Conclusion If nursing input into interdisciplinary work is to be maximized, nurse managers might consider the role of emotional intelligence in influencing team effectiveness, the quality of client care, staff retention and job satisfaction.

Relationship between how nurses resolve their conflicts with doctors, their stress and job satisfaction.

Abstract: Background A significant source of stress in nursing is conflict with physicians. There is evidence in the published literature that different ways of resolving conflicts generate more or less stress for those involved. Aim This research examines what tactics nurses adopt to resolve conflicts with doctors and how the different tactics affect their level of stress and job satisfaction. Method Seventeen nurses of varying seniority answered four questionnaires. Results The integrating and dominance approaches to conflict resolution are associated with low occupational stress levels, whereas the obliging and avoidance approaches are linked to higher stress. There is evidence that the seniority and status of nurses affect both their choice of conflict-resolution tactics and the associated stress and job satisfaction levels. Conclusion Both nurses and physicians should be made more aware of the conflicts between them and better trained to understand how they can be constructively resolved.

The Nursing Worklife Model: Extending and Refining a New Theory

Abstract: Aims We tested a modification of Leiter and Laschinger’s Nursing Worklife Model by examining the impact of structural empowerment on professional work environment factors that lead to nursing job satisfaction. Background The original model explains how five magnet hospital practice domains described by Lake (2002) interact to influence nurses work lives by either contributing to or mitigating burnout. Methods A non-experimental design was used. Five hundred randomly selected nurses in Michigan were surveyed (response rate 66%, n ¼ 332). Instruments included the Conditions for Work Effectiveness Questionnaire-II, the Practice Environment Scale of the Nursing Work Index, and the Index of Work Satisfaction. Path analysis was used to test the model. Results The final model fit the data well (v 2 ¼ 96.4, d.f. ¼ 10, NFI: 0.90, CFI: 0.43,

Organizational factors that support the implementation of a nursing best practice guideline.

Abstract: Background The context of the healthcare setting may play a crucial role in influencing the implementation of best practice guidelines in nursing. Further study is required to understand these organizational factors. Two variables, organizational culture and leadership, are thought to influence the adoption of best practice guidelines. Aim A discussion of organizational factors that influence best practice guideline adoption is presented. A small pilot study is provided as an example of methods for further research. Methods A quantitative survey of nursing staff was conducted. Results Results from the pilot study reveal variability in best practice guideline implementation despite the presence of a culture of organizational learning and transformational leadership. Conclusions There is beginning evidence in the literature that culture and leadership are key elements influencing guideline implementation. In this pilot work on two inpatient units where a nursing best practice guideline was implemented, a supportive organizational culture and key people leading change were present. Implications for further studies are offered. Implications for nursing management Nursing leaders interested in promoting the use of best practice guidelines must pay attention to the organizational context in which nursing care occurs. A supportive culture where learning is valued coupled with transformational leadership may be key factors in the implementation and the sustainability of best practice guidelines.

Building the capacity for evidence-based clinical nursing leadership: the role of executive co-coaching and group clinical supervision for quality patient services.

Abstract: Aim The general aims of this article were to facilitate primary care nurses (District Nurse Team Leaders) to link management and leadership theories with clinical practice and to improve the quality of the service provided to their patients. The specific aim was to identify, create and evaluate effective processes for collaborative working so that the nurses’ capacity for clinical decision-making could be improved. Background This article, part of a doctoral study on Clinical Leadership in Nursing, has wider application in the workplace of the future where professional standards based on collaboration will be more critical in a world of work that will be increasingly complex and uncertain. This article heralds the type of research and development activities that the nursing and midwifery professions should give premier attention to, particularly given the recent developments within the National Health Service in the United Kingdom. The implications of: Agenda for Change, the Knowledge and Skills Framework, ‘Our Health, Our Care, Our Say’ and the recent proposals from the article Modernising Nursing Career, to name but a few, are the key influences impacting on and demanding new ways of clinical supervision for nurses and midwives to improve the quality of patient management and services. Method The overall approach was based on an action research using a collaborative enquiry within a case study. This was facilitated by a process of executive co-coaching for focused group clinical supervision sessions involving six district nurses as co-researchers and two professional doctoral candidates as the main researchers. The enquiry conducted over a period of two and a half years used evidence-based management and leadership interventions to assist the participants to develop ‘actionable knowledge’. Group clinical supervision was not practised in this study as a form of ‘therapy’ but as a focus for the development of actionable knowledge, knowledge needed for effective clinical management and leadership in the workplace. Findings • Management and leadership interventions and approaches have significantly influenced the participants’ capacity to improve the quality of services provided to their patients. • Using various techniques, tools, methods and frameworks presented at the sessions increased participants’ confidence to perform. • A structured approach like the Clinical Nursing Leadership Learning and Action Process (CLINLAP) model makes implementing change more practical and manageable within a turbulent care environment. The process of Stakeholder Mapping and Management made getting agreement to do things differently much easier. Generally it is clear that many nurses and midwives, according to the participants, have to carry out management and leadership activities in their day-to-day practice. The traditional boundary between the private, the public and the voluntary sector management is increasingly becoming blurred. Conclusion It is conclusive that the district nurses on this innovative programme demonstrated how they were making sense of patterns from the past, planning for the future and facilitating the clinical nursing leadership processes today to improve quality patient services tomorrow. Their improved capacity to manage change and lead people was demonstrated, for example, through their questioning attitudes about the dominance of general practitioners. They did this, for example, by initiating and leading case conferences with the multi-disciplinary teams. It became evident from this study that to use group clinical supervision with an executive co-coaching approach for the implementation and to sustain quality service demand that ‘good nursing’ is accepted as being synonymous with ‘good management’. This is the future of ‘new nursing’.

RN-BSN education: 21st century barriers and incentives

Abstract: Design Qualitative using phenomenological inquiry. Methods Purposive sample of six RN-BSN students participated in focus group interviews. Data were analysed using Colaizzi's phenomenological method. Findings Incentives included: (1) being at the right time in life; (2) working with options; (3) Achieving a personal goal; (4) BSN provides a credible professional identity; (5) encouragement from contemporaries; and (6) user-friendly RN-BSN programmes. Barriers included: (1) time; (2) fear; (3) lack of recognition for past educational and life accomplishments; (4) equal treatment of BSN, ASN and diploma RNs; and (5) negative ASN or diploma school experience. Conclusions RN-BSN educational mobility is imperative as: (a) 70% of practicing RNs (USA) are educated at the ASN or diploma level; (b) nurse academicians and leaders are retiring in large numbers; and (c) research links BSN-educated RNs with improved patient outcomes. Implications for nursing management RN-BSN educational mobility is imperative to nurse managers and nurse administrators because: (a) research links BSN-educated RNs with improved patient outcomes; (b) nurse leaders and academicians are retiring in large numbers; and (c) approximately 70% of practicing RNs (USA) are educated at the associate degree or diploma level with only 15% moving on to achieve a degree past the associate level. Measures to foster incentives and inhibit barriers (caring curricula and recognition of different educational levels) should be implemented at all levels of nursing practice, management and academia.

Partnership--success factors of interorganizational relationships.

Abstract: Aim Key factors of successful interorganizational partnerships are applied to the context of nursing and midwifery education. Background Reports in nursing education emphasize the need for more collaborative partnerships between the education and healthcare sectors of nursing and midwifery education. Evaluation There is little research examining the implementation of interorganizational relationships particularly in nursing. Key issues Key success factors are grouped into seven areas of trust and valuing the partner, leadership and managing change, a partnership framework, communication and interaction, equity and involvement in decision making, power and the role of partnership coordinator. Conclusion There is a need for contextual research in relation to implementing partnership in nursing and midwifery. Implications for nursing management Partnership arrangements are essential for quality nursing and midwifery education. This article adds knowledge by way of application of these factors to organizations that provide nursing and midwifery education. Nurse managers have an important role in determining the quality of learning experience within the health service. It is essential, therefore that both nurse managers and nurse educationalist know the key factors which promote successful interoganizational relationships to ensure these factors are manifest in practice.

Challenges for new nurses in evidence‐based practice

Abstract: Aim The purpose of this article was to examine issues that new nurses encounter as they enter nursing practice, particularly in an evidence-based practice environment. Background These issues are not new. In part, these issues arise from our failure to acknowledge the developmental issues that new nurses experience on entry to practice and the lack of role models in evidence-based practice and holistic care. Evaluation This article synthesizes research reported over the last decade to delineate the issues of transition to practice and strategies that have proven effective in addressing them. Key issues The key issues relate to the need to support new nurses in evidence-based and holistic practice, the strategies needed to do so, and the nurse manager's role in this process. Conclusions We must invest resources in assisting new nurses into practice, which may have benefits in terms of both recruitment and retention of new nurses in practice.

Nurses’ perceptions of hospital work environments

Abstract: Aim To examine factors within the nursing work environment that may affect nurse outcomes. Background Primary data were acquired from unit managers and staff nurses on the study units. Secondary data were collected from health records administrative databases. The sample included adult medical and surgical units within all 19 teaching hospitals in Ontario, Canada. Methods A cross-sectional study design was employed in this study. A random sampling process was used to recruit the number of nurses (n = 1,116) required to provide a statistically adequate sample for the survey. Results Perceptions of the quality of care at the unit level were found to have a statistically significant positive influence on nurses’ job satisfaction, and a statistically significant negative influence on nurses’ job pressure and job threat. Conclusions The results of this study underscore the importance of examining the environment in which nurses’ work as a potential factor that influences outcomes experienced by patients and nurses.

Job satisfaction of Italian nurses: an exploratory study

Abstract: Aim The purpose of this research was to determine the factors that lead to feelings of job satisfaction and dissatisfaction experienced by nurses operating in three Italian hospitals. Background A high level of job satisfaction is related to a feeling of well-being, productivity and patient satisfaction. Furthermore, job satisfaction is considered capable of reducing turnover and absenteeism. Method Data were collected using the narrative interview technique. Sixty-four interviews were undertaken, resulting in the collection of 381 stories: 207 referring to job satisfaction experiences and 174 referring to job dissatisfaction experiences. Results The five job satisfaction factors are: job content; professional relationships; responsibility, independence and professional growth; relationships with patients and their families; and relationships with coordinators. The four job dissatisfaction factors are: coordinator management style; activity programming and organization; relationships with doctors; and relationships with patients. Conclusions Results indicate that the present nursing management techniques should be improved to become more effective in increasing job satisfaction. To be more precise there emerge three separate areas of improvement: investment in professional training and managerial training; renovation of organizational models; and permanent monitoring of job satisfaction.

Computer‐supported telephone nurse triage: an evaluation of medical quality and costs

Abstract: Aim: To evaluate a telephone nurse triage model in terms of appropriateness of referrals to the appropriate level of care, patient's compliance with given advice and costs. Background: A key concern in each telephonic consultation is to evaluate if appropriate. Method: An evaluative design in primary health care with consecutive patients ( N = 362) calling telephone nurse triage between November 2002 and February 2003. Results: The advice was considered adequate in 325 (97.6%) cases. The patients’ compliance with self-care was 81.3%, to primary health care 91.1% and to Accident and Emergency department 100%. The nurses referred self-care cases (64.7%) and Accident and Emergency cases (29.6%) from a less adequate to an appropriate level of care. The cost saving per call leading to a recommendation of self-care was €70.3, to primary health care €24.3 and to Accident and Emergency department €22.2. Conclusions The telephone nurse triage model showed adequate guidance for the patients concerning level of care and released resources for the benefit of both patients and the health care system.

The quality of postoperative pain management from the perspectives of patients, nurses and patient records.

Abstract: To study the quality of postoperative pain management in a university hospital. Paired patient and nurse assessments of the patient's pain management were conducted in two departments, complemented ...

Self-scheduling for hospital nurses: an attempt and its difficulties.

Abstract: Aim To describe a pilot project on self-scheduling (self-rostering) for hospital nurses and assess its potential values and difficulties in implementation. Background Self-scheduling is one aspect of the effort to make the hospital nursing environment more accommodative of nurses’ lives. It is part of the good employment practices that nurses want and that can help recruitment, retention and – possibly – patient care. Method A self-scheduling programme was implemented on one nursing floor for a year. Its effect on nursing perceptions was gauged by an informal questionnaire, and its effect on the nurse manager was gauged by counting change requests and sick calls, as well as her time spent on scheduling and her perceived annoyance in doing it. Findings During the time of the pilot project nurses felt that they had better control of their time and were able to give better patient care. Also, change requests decreased, as did the time spent by the nurse manager and her sense of annoyance. But since the nurses did not adhere to the rules of the programme, despite repeated efforts by the nurse manager, the attempt floundered. Conclusion Self-scheduling can have positive results for nurses and benefit the nurse manager. But if nurses see this as an individual entitlement instead of a balance between individual and unit benefit, everyone loses. This experience may be of use to others trying to implement a self-scheduling system.

Organizational change and work-related empowerment.

Abstract: Aim This study describes the views of multidisciplinary teams on work-related empowerment in a transitional organization. Methods The data were collected between September 2003 and January 2004 (n = 115) and one year later (n = 112) using a self-administered questionnaire consisting of verbal and behavioural items, empowerment outcomes, and factors promoting and impeding empowerment. The target population consisted of all members working in multidisciplinary teams at the Rheumatism Foundation Hospital in Finland. The response rate was 58% at both data collections. The data were analysed statistically using SPSS software. Results The multidisciplinary teams rated their work empowerment quite highly. The number of empowerment promoting factors was lowest for the category of future orientedness, consisting of continuity of work, opportunities for advancement, and access to information. The number of impeding factors was also highest for the same category of future orientedness, consisting here of organizational bureaucracy and hierarchy, authoritarian leadership, poor access to information, and short working periods. Conclusions It is important not to underestimate the impacts of organizational changes: they have a direct effect on the work environment and may contribute to higher rates of dissatisfaction, burnout and absenteeism among health care workers.

Reasons to leave: the motives of first‐line nurse managers’ for leaving their posts

Abstract: Objective To study the reasons for first-line nurse managers to resign, their perceptions of difficult situations, experience of support and satisfaction with work. Background The intentions of fir ...

Management of change for nurses: lessons from the discipline of organizational studies

Abstract: Aim This paper explores the literature on change management from the discipline of organizational studies to provide insights that nurse managers can use in their professional practice. Background The paper will benefit nurse managers by extending the nursing discourse on change management to include wider theoretical and academic perspectives. Key issues Important aspects of change management explored are the roles of power and political behaviour, how much change can be planned and controlled, how to combine top-down and bottom-up approaches to change, the role of emotions in the change management process, a comparison of prescriptive and analytical approaches to understanding change, and the connection between theory and practice in managing change. Conclusion While nurses can draw much useful information from within the nursing discipline, they can also benefit by exploring other disciplinary areas. In the case of change management, there are many useful lessons nurses can carry over into their professional practice.

Caring for each other: how do nurse managers 'manage' their role?

Abstract: Nursing unit managers (NUMs) are the first line ofnursing management in Australia. These nurses managea ward or clinical unit and are charged with the almostimpossible task of managing the nursing workforcethrough rostering, monitoring the budget, performing amyriad of administrative duties and ensuring the pro-vision of quality nursing care, within a workplace cul-ture that does not appear to support them (Courtneyet al. 2002a). In such a context we wanted to explorehow NUMs cope. What is it that helps them or hindersthem in their role? In particular, we wanted to identifythe level and type of support the NUMs experience intheir roles now, and what type of support they believedwould be the most beneficial to them in preparing themfor their roles. This article reports on one aspect of alarger study that explored the working world of NUMsin New South Wales, Australia (Paliadelis 2006) toaddress these questions.Drawing on interviews with 20 NUMs employed inthe public healthcare system in Australia, we found thatparticipants valued the support they gained from theirnursing colleagues, but that they received little supportfrom the organization. In moving from the role of nurseto NUM, they were unable to access formal support

Frail older people's experiences and use of health and social care services

Abstract: Aims To highlight older people's experiences and expectations of services and the consequences for service provision, service development and research. Rationale A large amount of resources have been invested in providing services for frail older people who experienced multiple hospital admissions. However, their own views are under-reported. Method Semi-structured interviews with frail older people were conducted in four Scottish Health Board areas to explore the context of emergency admissions and the use of extramural services. Outcomes Frail older people are high users of services but claim that services are not responsive to their main concerns: meeting individual needs, maximizing independence and helping to live fulfilled lives. Services not catering for these needs are often cancelled or left in abeyance. Conclusion The same people who are targeted by care services are reluctant to engage with them. Care providers need to adopt older people's priorities to provide them with responsive patient-centred care.

5-20: a model of minimum nurse-to-patient ratios in Victoria, Australia.

Abstract: Aim This study presents a critique of a new model of minimum nurse-to- patient ratio and considers its utility alongside established Patient Dependency Systems. Background Since 2001 legislation mandating minimum nurse-to-patient ratios has been enacted throughout large public hospitals in the state of Victoria, Australia. The Victorian model mandates minimum staffing of five nurses to 20 patients in acute medical and surgical wards. In conjunction with this approach, Patient Dependency Systems are employed to anticipate short-term resource needs. Key issues Although this legislation has been successful in attracting nurses back into the public sector workforce, no published empirical evidence exists to support specific ratios. In addition, neither ratio nor Patient Dependency Systems approaches account for the critical influence of skill mix on hospital, employee, or patient outcomes. Conclusion There is an urgent need for further research that specifically examines relationships between models of staffing, skill mix and quality outcomes.

Presence and availability: staff conceptions of nursing leadership on an intensive care unit.

Abstract: Presence and availability: staff conceptions of nursing leadership on an intensive care unit

Career needs, career development programmes, organizational commitment and turnover intention of nurses in Taiwan.

Abstract: Aim This study divided nursing careers into four stages: exploration, establishment, maintenance and disengagement. Besides exploring whether nurses have different career needs at different career stages, this study also examines the gap between career needs and career development programmes, and its relationship with organizational commitment and turnover intention of nurses in Taiwan. Background Although previous studies have recognized that nurses’ careers have different stages, a few studies have identified nurses’ career needs or offered programmes to respond to nurses’ needs. Method Through a literature review and in-depth interviews, this study developed a scale to measure career needs of nurses at different stages and identify the appropriate career development programmes. Additionally, regression analyses were implemented to explore the relationships objectively. Results Nurses were found to have different career needs at different career stages, and the gap between career needs and career development programmes influenced turnover intention caused by the decline in nurses’ commitment towards the hospital. Conclusions If hospitals’ administrators can provide career development programmes to satisfy career needs of nurses at different career stages, then nurses’ commitment to the hospital may increase and nurses’ turnover intention may decrease, which may lead to reciprocity between the hospital and the nurses.