Canadian journal of nursing administration最新文献

This paper describes the development and application of a computerized workload measurement tool for use in hospital nursing education departments. The tool was developed in response to a need to gather information to facilitate resource allocation within the nursing education department in times of severe fiscal constraint. Software was developed based on a commercially available spreadsheet to keep track of the time and nature of nursing educator activity as well as its location. Analysis of the results showed that most of the nurse educators' time was spent on educational activities. The workload measurement system provided useful information for both individual educators and for the department in assessing, planning and allocating resources for educators.

There are difficulties with implementing workload measurements instruments and patient classification systems in psychiatric settings. These instruments are designed at a ratio level of measurement. This would be valid only if nursing practice existed at a similar level. The nurse-client relationship is considered to be the essence of psychiatric nursing and this phenomena is described as ordinal level phenomena. In psychiatric nursing, it is essential to consider the nurse as well as the client, and to assess the current phase of the relationship. There is a need to balance the economic pressure for justification by numbers with the realization that many aspects of nursing practice are not measurable as reducible phenomena nor exist at a ratio level.

Elder abuse in institutions is a slippery concept. Besides inherent difficulties in operationalizing definitions of elder abuse, it is well-recognized that under-reporting and methodological problems in research studies have created a knowledge base that is far from definitive. There is, however, much that can be gleaned from the literature and translated into clinical practice. Environmental factors, including both interpersonal and institutional dimensions, may contribute significantly to risk for elder abuse. A number of client characteristics such as physical impairment, social isolation, cognitive status, and aggression also appear to increase the potential for elder abuse. While professional caregivers have not yet been extensively studied in terms of their role in elder abuse, burnout, lack of training, excessive workload demands, and other stressors may be implicated as factors contributing to abusive behaviour.

Nursing workload measurement systems (WMSs) are used in inpatient and outpatient settings for staffing, scheduling, and budgeting. The nurse administrator can use WMS data to make wise decisions in these key areas providing the data are reliable and valid. Unfortunately, in most institutions, attention to issues of reliability and validity occurs only at system implementation and then the systems are left unattended. This article provides an overview of validity and reliability as it relates to WMSs. Part Two of this article will demonstrate how validity and reliability theory can be operationalized in an ongoing program for maintaining WMS reliability and validity.

Despite the plethora of articles on work environment and nursing power in the recent nursing literature, we have yet to improve nurses' experience of work in any significant way. In fact, as hospital budgets come increasingly under attack in the name of health care reform, nursing work is becoming even more demanding and, to many, less satisfying This article describes the experience of powerlessness by a sample of hospital staff nurses in British Columbia. It analyses the themes which characterize powerless work situations and explores the impact of these on nurses. It suggests some ways of bringing about change in these circumstances of work. The article intends to illuminate, for those who care to understand, the complexity and often insurmountable challenges that nurses encounter in the course of their nursing work. It urges us to create opportunities to make the increasingly difficult and frustrating circumstances of nursing work visible to key decision makers.

Kanter's structural theory of organizational behavior was used as framework to explore the relationship between perceptions of power and opportunity and level of burnout in a sample of 87 hospital staff nurses. Data were collected using a modified version of the Conditions for Work Effectiveness Questionnaire (Chandler, 1986) and the Human Services Survey (Maslach & Jackson, 1986). Consistent with Kanter's theory, perceived access to power and opportunity was significantly related to the three aspects of burnout: level of emotional exhaustion and depersonalization (r = -.3419, p = .004; r = -.2931, p = .02), and personal accomplishments (r = .3630, p = .002). The results of this study are useful for nurse administrators positioned to create organizational structures than empower staff nurses and subsequently decrease burnout.

In an age of cost containment, agency partnerships have become an essential element for future planning and program implementation. This paper describes a trisectoral collaboration of a hospital, health department, university and school of nursing to compare the efficacy and efficiency of referral decisions of hospital staff nurses to those of the public health liaison nurses (LNs). A process to identify decision criteria was undertaken and an educational programme was designed to assist the staff nurses with the referral process and to assure consistency of decision making. The two groups were then compared. The results of the study found staff nurses, using the decision criteria, identified more patients who required public health nursing visits than did the liaison nurses, refusal rate of the patients to participate was no different, staff nurses cost less than LNs and job satisfaction was not significantly altered for either group. In addition to providing information to guide administrative and clinical decision making, the project also provided a learning experience for the staff of three agencies in conducting research and in using evidence-based practice to change traditional practice.

In 1989, in response to the nursing shortage and much literature on dissatisfiers for practising nurses, the Ontario Minister of Health introduced a new regulation to the Public Hospitals Act, requiring that staff nurses and nurse managers have widespread representation on hospital committees. While involvement of nurse managers on such committees was not new, the participation of staff nurses certainly was.

To determine attributes of the registered nurse and the working environment that influence registered nurses' perception of autonomy (defined as independence within one's own practice), data were collected from questionnaires completed by 85 full time registered nurses at a 601 bed chronic/rehabilitation hospital located on two sites in the city of Toronto, Ontario, Canada. Registered nurses experienced a higher perception of autonomy given a more participative management style on the part of their nurse managers. Place of basic nursing education, which was used as an indication of cultural origin, was found to contribute to registered nurse perception of autonomy where basic education was in Canada or the United States. Increased workload (acuity) was found to detract from registered nurse perception of autonomy. Baccalaureate education, and primary or modular nursing care delivery models contributed to high autonomy, whereas diploma education, and functional or team nursing were associated with the low autonomy group in discriminant analysis. Administrative recommendations for nursing include the promotion of a participative management style on the part of nurse managers; attention to cultural diversity of nursing staff; support of advanced education in nursing; support of primary or modular nursing care delivery models; and management of registered nurses' workload in order to encourage a balance between client-focused professional practice activities and the routinized, provider-focused, task-driven activities.

This study examines the preparation, employment and functions of nurses with titles of clinical nurse specialist, nurse practitioner, and others whose scope of practice exceeds that of the staff nurse. Two established categories of nurses were identified, the Clinical Nurse Specialist (CNS) and the Clinical Nurse Specialist/Nurse Practitioner (CNS/NP). A third category was called Other Titled Nurse (OTN) because of the lack of uniformity in the position descriptions. Surveys were distributed to 379 health service agencies, 33 educational institutions and 204 members of the RNAO Clinical Nurse Specialist Interest Group. This article is based on the responses from the health service agencies and discusses issues pertaining to advanced practice nursing from an administrative perspective.