Canadian journal of nursing administration最新文献

Today, most health care programs must operate within a framework of: 1) competing demands for resources, 2) pressure to reduce staffing levels, and 3) consumer demands for high quality service. Competing demands for resources means that there is a need to continuously justify a program by providing critical evaluations of program components and identifying effective outcome measures. Within a geriatric psychiatry program that provides assessment and short term treatment, various evaluation measures were tried. While none of the measurement techniques was completely satisfactory, it became very apparent that the psychosocial nursing skills that were critical in the care of this population were not accounted for by any of the current tools. Given the need to justify the high ratio of RN staffing to other categories, eg. CCA or LPN, two measures specific to nursing were tried on a pilot basis. This paper reports on the initial measurement techniques used and the results from the trial of new measures.

There is a belief in society that nursing is a profession and therefore that nurses are professional. There is also a belief that nurses care, that is, they care for their patients and consequently are a caring profession. However, we see and hear instances in which nurses do not act in a caring manner. Where this is the case, can they still be considered individually a professional, and collectively a profession? Is there a connection between caring and profession? Can a nurse be one without the other? The assertion of this paper, is that to be a professional nurse, a nurse must care. "Caring" and "profession" are defined and the components for a model of a professional relationship proposed. Nurses are challenged to find ways in which to reclaim their professional status by recapturing their commitment to caring.

The authors report on a job-share experience of Director of Nursing position at a large teaching hospital. A number of methods are used to evaluate this interim four month experience. Using aspects of administrative theory and the results of this evaluation, a conceptual framework is provided and suggestions are made that they may assist nurse and non-nurse administrators when considering future middle management job sharing arrangements in their organizations.

As medical technology becomes more sophisticated, end-of-life treatment decisions become more complex for patients and for the professionals who care for them. The authors surveyed 448 members of the general public to determine their attitudes regarding end-of-life treatment decisions and attitudes towards the provision of advance end-of-life directives. A slight minority of respondents indicated they would leave major decisions to their physicians. An overwhelming majority believe that living wills are important. Most respondents indicated they would not wish their lives to be prolonged if elderly and ill or if their minds failed. A majority of respondents also were in favour of donating their organs after death. The article reports the socio demographic variables which significantly influenced these responses and suggests the implications of these results for nurse clinicians and for nursing administrators. Enhancing clients' abilities to communicate their wishes and being sensitive to social-cultural differences in perspectives about these issues, are key implications for nurse clinicians. Ensuring sound policies and guidelines are developed and that adequate education is provided in ethical and legal dimensions surrounding end-of-life treatment directives, as well as multi-cultural orientation, are responsibilities for nursing administrators.

The Delphi methodology is used to determine, predict and explore group attitudes, needs and priorities. This paper, the first of a two part series on the Delphi methodology, will provide nurse administrators with the basic information necessary to participate in and conduct projects using the Delphi methodology. The methodology will be defined and issues related to design, sampling, instrumentation and methods of data analysis discussed. The role of the nurse administrator, when the Delphi methodology is used, will then be addressed. In the second paper, administrative applications of the Delphi methodology will be addressed.

This investigation used a multivariate approach to examine similarities and differences between the job satisfaction, propensity to leave, and burnout of registered nurses (RNs) (n = 623) and registered nursing assistants (RNAs) (n = 231). At best, both groups were only moderately satisfied with their jobs, and there were no significant differences between the groups on the outcome measures of satisfaction, burnout or propensity to leave. However, RNs with more years of work experience reported highest job satisfaction, lowest levels of burnout, and were less likely to leave their positions. None of these variables were related to the length of time RNAs were employed. When comparative analyses were conducted by unit types, RNs in psychiatric settings were least satisfied with their jobs, more likely to leave their positions, and reported more burnout than did RNs in other settings. Implications of the study for interventions and future research are discussed.

The purpose of this paper is to assess some of the issues surrounding the use of the Alberta Patient Classification System for Long Term Care Facilities (APCS) to fund Ontario long term care by attempting to answer the following questions: 1) Is the APCS valid for classifying Ontario long term care patients?; 2) Is it appropriate to use the APCS to fund Ontario long term care?, and; 3) What is required to develop a valid long term care patient classification and funding system appropriate for Ontario? The paper discusses why it may be inappropriate to use the APCS to classify Ontario long term care patients, some of the important financial consequences to a long term care facility if the APCS is inappropriate, and what might be necessary for a better patient classification and funding strategy. The potential and pitfalls of adopting patient classification systems developed in a different health system should be of interest to nurse managers in all provinces.

In recent years, nursing strikes have become more common. Within the last decade, nurses in five of our ten provinces have all taken strike action. If this trend continues, more strikes could very likely occur. Administrative nurses provide direction and leadership for the nursing department. With the prospect of a withdrawal of nursing services, they are key players in preparing for the strike. They must ensure a standard of care during the strike, as well as facilitate the return of the unionized nurses following the strike. To assist administrative nurses who may some day be involved in a withdrawal of nursing services, this manuscript contains an account of the pre-strike preparations, putting these plans into action during the strike, and the immediate post-strike period at the Plains Health Centre, a tertiary care facility in Regina, Saskatchewan.

Nursing administrators, educators and clinicians are continually striving to incorporate research into practice. A number of research utilization models have been developed to help meet this challenge. This article describes how the Conduct and Utilization of Research in Nursing (CURN) approach was used in a maternal-child area of a Canadian tertiary care hospital. One patient care problem was identified by practising nurses that required acquisition and application of recent research findings. A thorough literature search and critique was conducted based on this patient care problem and research results were used to develop nursing care guidelines for this priority concern.

Self-directed work teams are innovative tools used in industry to improve productivity and quality. Work teams are complementary to the process of Total Quality Management (TQM) and build on the same foundations of customer satisfaction, goal setting, and staff education and training (Arikian, 1991; Sheehy & Musselwhite, 1990). The Collaborative Healthcare Utilization Model (CHUM) encompasses a self-directed team which enables nurse managers and physicians to lead a busy, tertiary care surgical service. The opportunity to develop CHUM arose when a middle management (director) position was removed from the nursing division. Development of the self-directed team included "selling" the idea and piloting the venture in an environment where work teams are not part of the organizational structure. The authors describe their experience in introducing a self-directed team into a hospital setting.