NursingPlus Open最新文献

Background

The period of transition from registered nurse to nurse practitioner is often challenging. While adjusting to their autonomous role, nurse practitioners need to create and define a distinct role for themselves within practice contexts that may be unfamiliar, sometimes unwelcoming and inhospitable. During this time of transition, nurses need well developed negotiation skills and personal attributes including resilience, tenacity, fortitude and determination.

Purpose of the research

The purpose of the research reported in this paper was to explore the transition experiences of 10 newly endorsed nurse practitioners in Australia during their first year of practice. This paper focuses on power, control and political manoeuvring that negatively impacted the ׳nurse practitioners׳ transition. A qualitative approach using a modified version of Carspecken׳s five stage critical ethnography, informed by focused ethnography, was the methodology selected for this study. Methods included observations of practice, journaling, face to face and phone interviews which were recorded, transcribed and analysed thematically.

Results

“The enemy within” emerged as a dominant theme highlighting issues of power, powerlessness and politics dominating the participant׳s experiences. Power struggles amongst nurses, both overt and covert, and the deliberate misuse of power were frequently encountered. Many of the participants felt powerless and ill-prepared to negotiate the challenging situations in which they found themselves. Many lacked the skills needed to address the negative behaviours they experienced.

Conclusions

This paper reports on the experiences of 10 newly endorsed nurse practitioners during their transition to the nurse practitioner role. The impact of the political climate at the time of this study had an undeniable influence on many of the participants׳ transition experiences. Competition for the limited numbers of designated nurse practitioner positions led to hostility between senior nurses and, in some contexts, a jostling for power, control, prestige and position. Rather than camaraderie, cooperation and collaboration, many of the participants described feeling besieged, undermined and alienated. The new nurse practitioners felt isolated, unwelcomed and unsupported. Several felt burnt out and abandoned their aspirations to be become a nurse practitioner. They left and returned to practice as a registered nurse.

In Western forms of health care delivery around the globe, research tells us that nurses experience excessive workloads as they face increasingly complex needs in the populations they serve, professional conflicts, and alienation from leadership in health care bureaucracies. These problems are practical and ethical as well as cultural. Cultural conflicts can arise when health care providers and the populations they serve come from diverse economic, ethnic, and cultural backgrounds. The purpose in this paper is to draw from Almutairi’s research with health care teams in Saudi Arabia to show the complexity of culturally and morally laden interactions between health care providers and patients and their families. Then, I will argue for interventions that promote social justice and cultural safety for nurses, other health care providers, and the individuals, families, and communities they serve. This will include addressing international implications for nursing practice, leadership, policy and research.

A limited number of randomized controlled trials (RCTs) including economic analysis have supported the cost-effectiveness of nurse practitioners and clinical nurse specialists delivering care in a variety of settings. Our objective was to examine the quality of economic evaluations in this body of literature using the Quality of Health Economic Studies (QHES) tool, and highlight which questions of the quality assessment tool are being addressed adequately or require further attention within this body of literature. Of 43 RCTs included in our systematic review, the majority (77%) fell in the poor study quality quartile with an average total QHES score of 39 (out of 100). Only three studies (7%) were evaluated as high quality. Inter-rater agreement (prior to consensus process) was high (83% agreement). Four criteria for the quality of economic evaluations were consistently addressed: specification of clear, measurable objectives; pre-specification of subgroups for subgroup analyses; justified conclusions based on study results; and disclosure of study funding source. A clear statement of the primary outcome measures, incremental analysis, and assessment of uncertainty were often unclear or missing. Due to poor methodological quality, we currently lack a solid evidence base to draw clear conclusions about the cost-effectiveness of nurse practitioners and clinical nurse specialists. Higher quality economic evaluations are required to inform these questions.

Objective

This study examined factors that lead Generation Y nurses to consider or reject nursing leadership roles.

Background

Almost half of the current nurse leaders in the country are expected to retire by the end of the decade. Generation Y will soon comprise 50% of the nursing workforce and organizations look to them to assume leadership roles. Learning how to effectively recruit, motivate and retain Generation Y nurse leaders will be critical to the future of nursing.

Methods

This was a qualitative study that used a ConCensus™ process approach to collect the themes and factors of importance to participants related to nursing leadership roles. Three focus groups were conducted during 2013 and 2014 with 32 Generation Y Registered Nurses, not currently in leadership positions and born on or after January 1st, 1981.

Key findings

Feedback from current nurse leaders about their roles is primarily negative. The strongest incentive for Generation Y nurses to seek leadership roles is the potential to create meaningful change in healthcare. Fear of failure in the role and lack of work-life balance are significant deterrents to accepting a leadership role.

Conclusions

Generation Y nurses do see the value and importance of nursing leadership in making a difference in patient care but have concerns about the level of support that will be available to them as they assume these roles. Attention must be directed toward providing resources and strategies to develop skilled Generation Y nurse leaders in order to promote effective succession planning.