Canadian journal of nursing administration最新文献

This paper traces the evolution and proposed merger of the two major advanced practice nursing roles, the clinical nurse specialist and nurse practitioner. The paper presents a review of the differences in the origins of the roles of the clinical nurse specialist and nurse practitioner, and analyzes the changes in these roles since the 1970's in Canada and the U.S. The positive and negative aspects of merging the clinical nurse specialist and nurse practitioner roles are also analyzed with respect to current issues and future trends. Changes in nursing roles, functions and education have occurred since the inception of the profession. Concurrently, there has been debate and conflict about the direction that these changes should take. Since the 1980's, the nursing literature has reflected these discussions, particularly with respect to the development of advanced practice nursing. The purpose of this paper is to review and analyze the differences in the origins of the roles of clinical nurse specialist (CNS) and nurse practitioner (NP), and to examine the benefits and costs of merging the roles.

Professional nurses across Canada are being affected by health reform initiatives designed to deinstitutionalize the health care system. This panel study examined the impact this restructuring has had on nurses' overall job satisfaction as well as their satisfaction with various aspects of their job and work environment. The participants consisted of 345 nurses employed in 3 community hospitals in southwestern Ontario. Hospital downsizing had relatively little effect on overall job satisfaction, satisfaction with kind of work, amount of work, and physical work conditions. However, compared to before the downsizing, nurses reported a significant deterioration in satisfaction with their career future, hospital identification, supervision, and co-workers following the implementation of restructuring initiatives. We discuss the organizational and management implications of these findings and suggest ways that hospital administrators can minimize the negative effects of downsizing on nursing professionals.

In Part One, an overview of the theory related to validity and reliability of workload measurement systems (WMSs) was reviewed. In this article, the MEDICUS WMS is used to provide a concrete example of the type of comprehensive validity and reliability programs that can be established, in an inpatient setting, on the basis of this theory. Practical strategies for monitoring validity and reliability are identified. Administrators can adapt the approaches specified to fit the methodology underpinning other WMSs.

Economic restraints are forcing hospitals to develop and implement patient centered, cost-effective care approaches. This article describes how the quality of care to older patients with hip fractures was improved using Continuous Quality Improvement (CQI) and Managed Care processes. During a six month project, twenty five female patients were treated. Outcomes demonstrated that using CQI and Managed Care are effective in reducing mortality, complications and length of stay. As well, staff and patient satisfaction were very high. The structure, process and outcomes of this project are discussed.

Canadian nurses are experiencing profound and often disturbing changes in the health care sector. Not only have the number of jobs decreased but the nature and expectations of those jobs are changing dramatically. While these changes have raised nurses' anxiety, the changes simultaneously have presented nurses with an opportunity to transform their vision of nursing and their role in health care. This article describes a career planning pilot project for nurses which employed Freire's model of emancipatory learning. Based on the theoretical foundations of narrative psychology and critical social theory a series of four workshops were offered. Comments from the evaluation results indicate that the workshop was a transformative experience for the participants. Future implications for career planning for nurses are discussed.

The continuous enhancement of the quality of patient care is the prime directive of a Nursing Quality Improvement Program. A decentralized approach, using a Unit Based Quality Improvement model, was used in one hospital. In this paper, the author examines the process from conceptualization to implementation and evaluation of the decentralized approach.

The article discusses how one hospital with a large outpatient service, evaluated the role of nursing in ambulatory care. Using a validated conceptual framework consisting of Ambulatory Care Areas of Responsibility and Nursing Activities, data was collected and a profile was created detailing the nursing role in each clinic or service.