The ageing nursing workforce: a global challenge

Factors related to work ability among nursing professionals from urgent and emergency care units: A cross-sectional study

BACKGROUND

Nursing professionals are on the front line of health systems in Brazil as well as worldwide. Studies on the work ability of nursing professionals are especially relevant as care demands increase and health care workforce shortages are expected. As the population of Brazil ages, the need for nursing care will increase.

OBJECTIVE

To identify levels and predictors of work ability among Brazilian nursing professionals.

METHODS

A cross-sectional study with 267 nursing professionals (72 nurses and 195 nursing technicians and nursing auxiliary) from public emergency and urgent care units was conducted. Measures included the following: Work Ability Index; Questionnaire of Socio-demographics, Lifestyle and Work and Health Aspects; and Violence at Work questionnaire. Generalized linear regression and Poisson models were used for data analysis.

RESULTS

The mean work ability was 40.4 (range: 22 to 49). Almost 79.6% (n = 211) of participants reported good or excellent work ability, and 20.4% (n = 54) reported moderate or poor work ability. Better perceptions of health and job satisfaction, absence of health issues (past 15 days), lower stress levels, and having a partner were associated with better work ability. Victims of workplace violence were less likely to have good or excellent work ability than non-victims (prevalence ratio = 0.80; 95% CI 0.72 to 0.90). Professionals with cumulative experiences of workplace violence were less likely to report better work ability.

CONCLUSIONS

The prevalence of good or excellent work ability was 79.6%. Our findings indicate that the following factors are predictors of work ability: self-reported perception of health, health issues in the last 15 days, workplace violence, job satisfaction, stress, and marital status.

Therapeutic use of the humanoid robot, Telenoid, with older adults: A critical interpretive synthesis review

This review sought to critically evaluate the use of the teleoperated humanoid robotic communications device, Telenoid, for therapeutic purposes with older adults, and identify and highlight key considerations for future research and clinical practice within gerontechnology. A critical interpretive synthesis was conducted, with nine electronic databases and online sources searched using the keyword "Telenoid." Studies were included in the review if they were: written in English; reported primary research; employed a qualitative, quantitative, or mixed-method design; and described or measured effects, experiences, or perceptions of using Telenoid for therapeutic purposes with older adults. Critical engagement with the studies identified key themes, as well as opportunities to advance future research. Ten studies involving Telenoid were identified, with eight focused on older adults living with dementia. Study findings centered around two themes: effects (including positive effects and negative reactions), and challenges and considerations (including technical issues, operator training, acceptability, and dosage). Although several issues currently challenge the use of Telenoid, available studies show some therapeutic potential of using Telenoid with older adults, including those living with dementia, particularly for communication and mood. Higher-quality studies are required to advance understanding, and considerations for the field are outlined to aid development.

Keeping nurses in nursing: a qualitative study of German nurses' perceptions of push and pull factors to leave or stay in the profession

Background

The increasing nursing shortages worldwide has focused attention on the need to find more effective ways to recruit and retain nurses. The aim of this study was to gain understanding of factors that keep German nurses in nursing and explore their perceptions of factors that contribute to nurses leaving or staying in the profession.

Methods

An explorative qualitative study was undertaken at four different hospitals (two university hospitals and two public hospitals) in Baden-Wuerttemberg, a state in South Germany. Semi-structured face-to-face or telephone interviews were conducted with 21 state-qualified nurses who had graduated from a German nursing program. Each interview was pseudonymized and transcribed. Transcripts were coded according to Qualitative Content Analysis with data structured into themes and subthemes. The study was reported according to the Consolidated Criteria for Reporting Qualitative Studies (COREQ) checklist for qualitative research.

Results

Two themes emerged from the analysis and each theme had several subthemes: a) PUSH FACTORS i.e. factors that may push nurses to consider leaving the profession included limited career prospects, generational barriers, poor public image of nursing, and workplace pressures; b) PULL FACTORS i.e. factors that nurses wished for and could keep them in the profession included professional pride, improved remuneration, recognition of nursing, professionalisation, and improving the image of nursing as a profession.

Conclusion

The decision to leave or stay in nursing is influenced by a complex range of dynamic push and pull factors. Nurse Managers responsible for stabilizing the workforce and maintaining their health system will continue to have to navigate challenges until working conditions, appropriate wages and career development opportunities are addressed. A key to tackling nursing shortages may be focusing on pull factors and nurse managers listening in particular to the perspectives of junior nurses directly involved in patient care, as giving them opportunity to further develop professionally, reinforcing a strong and supportive workplace relationships, paying an appropriate salary, and improving the public image of nursing profession.

Registration number

The study has been prospectively registered (27 June 2019) at the German Clinical Trial Register (DRKS00017465).

Job satisfaction of advanced practice nurses in cancer care: A systematic review

PURPOSE

To identify, evaluate, and summarise evidence about advanced practice nurses' (APNs') job satisfaction in cancer care and its related factors.

METHODS

A systematic review was performed including a narrative synthesis. Relevant evidence was identified from searches of three databases: Medline (PubMed), EBSCO (CINAHL), and PsychInfo. This systematic review searched for relevant articles published in English between 2000 and 2020. A structured process according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement was followed. The articles critical appraisal was based on the Mixed-Methods Appraisal Tool. Narrative data synthesis was based on the extracted data (study characteristics, type of questionnaire, level of job satisfaction, related factors, and risk of bias).

RESULTS

Just four articles met the inclusion criteria and were included in the systematic review. Job satisfaction of APNs providing cancer care in different care settings varied from low to high. Satisfying factors were personal, role, work, and institutional factors, whereas dissatisfies included the work setting and stress factors. Different measurement tools of the job satisfaction level were used, which might lead to non-comparable results.

CONCLUSION

The number of included studies and the findings from this systematic review present underinvestigated content according to the influence of patient group demands on APNs' job satisfaction. Evidence of patient group-specific factors relevant to APNs' job satisfaction could not be found. Further research is needed to address the influence of advanced nursing practice and patient group-related factors on job satisfaction.

Undergraduate nursing students' self-reported professional behaviour at the University of Namibia

Background

Development of professional behaviour in nursing students is an important part of a nurse’s overall competence. Self-evaluation is one way of measuring professional behaviour amongst nursing students. However, studies on self-reported professional behaviour of nursing students are limited in Namibia.

Aim

This study aimed to investigate nursing students’ self-reported professional behaviour at the University of Namibia.

Setting

The setting was a university campus offering a Bachelor of Nursing Science degree in Namibia.

Methods

A quantitative descriptive contextual design was used with 100 nursing students. Data were analysed descriptively using a non-parametric Kruskal–Wallis and ANOVA tests of variance and statistical significance.

Results

High mean scores were found in the areas of utilising evidence-based solutions (4.78 ± 0.58), promoting clinical teaching (4.46 ± 0.94), willingness to implement quality improvement initiatives (4.34 ± 0.518), and protecting health, safety and patient’s rights (4.28 ± 0.55). The lowest mean scores were recorded in projecting professional image (2.22 ± 1.27), rendering evidence-based care (4.08 ± 0.44). The study found statistical significance difference between self-reported professional competency (p = 0.01) and quality care improvements (p = 0.02).

Conclusion

In this study, nursing students’ self-reported professional behaviour was rated high (mean scores > 4.0 out of 5). Despite this high rating, it cannot be concluded that the students were professionally competent. We recommend that professional behaviour be measured from both students’ and nurse educators’ or patients’ perspectives.

Contribution

The findings from this study provide supplementary evidence on self-reported professional behaviour with implications on nursing education and practice.

Unprofessional conduct by nurses: A document analysis of disciplinary decisions

Background:

A small minority of nurses are investigated when they fail to meet the required professional standards. Unprofessional conduct does not just affect the nurse but also patients, colleagues and managers. However, it has not been clearly defined.

Objective:

The objective was to identify unprofessional conduct by registered nurses by examining disciplinary decisions by a national regulator.

Design:

A retrospective document analysis.

Data and research context:

Disciplinary decisions delivered to 204 registered nurses by the Finnish national regulatory authority from 2007 to 2016. The data were analysed with quantitative statistics.

Ethical consideration:

The study received permission from the Finnish National Supervisory Authority for Welfare and Health and used confidential documents that were supplied on the basis of complete anonymity and confidentiality.

Findings:

The mean age of the registered nurses who were disciplined was 44 years and 81% were female. Two-thirds had worked for their employer for 5 years or less, 53% had two or more employers and 18% had a criminal history. All the decisions included a primary reason for why the nurses were investigated, but there were also 479 coexisting reasons. In most cases, unprofessional conduct was connected to substance abuse (96%). In addition, stealing of medicine, a decreased ability to work and neglect of nursing guidelines were reported.

Discussion:

We found that the nurses were investigated for unprofessional conduct for complex combinations of primary and coexisting reasons. Our study highlighted that more attention needs to be paid to the key markers for unprofessional conduct.

Conclusion:

Unprofessional conduct is a complex phenomenon that is connected to nurses’ individual and working backgrounds and has an impact on their work performance. More research is needed to identify how nursing communities can detect, manage and limit the serious effects and consequences of unprofessional conduct.

Being an older nurse or midwife in the healthcare workplace- A qualitative descriptive study

AIM

To explore the experiences of being an older nurse or midwife employed in the healthcare workplace.

DESIGN

A qualitative descriptive study.

METHOD

Semi-structured interviews were conducted with nurses and midwives who self-identified as older workers. All Australian states were represented and given recruitment was undertaken nationally, most interviews were conducted via telephone. Data were collected between November 2018 and October 2019. Audio recordings were transcribed verbatim and then thematically analysed.

RESULTS

A total of 50 nurses and midwives were recruited, aged between 46 and 74 years. Three themes were identified. Ageing body: Being an older worker meant increased fatigue and physical changes affecting their ability to function at full capacity. Youth focus: For many, being an older worker was about being viewed as a poor-quality worker, with limited access to education and promotional opportunities because of their age. Wise worker: For a small number of older nurses and midwives, it was about being valued and respected for their knowledge, experience and skills.

CONCLUSION

Participants self-identifying as older nurses or midwives represented a wide age range. Spanning across the age spectrum, many experienced fatigue, physical changes or loss of value to the workplace which often impacted on their working lives. The findings contributed to an understanding about what it is to be an older nurse or midwife in terms of how their contribution is regarded and valued by others in the workplace.

IMPACT

This study highlighted there is a need for support of older nurses and midwives in managing age-related fatigue and physical changes. It also suggests consideration of a wise-worker model as a means to recognize the important contribution that older workers can offer.

Development of the Role Performance Scale for Middle-Aged Generalist Nurses in Japan

AIM

The aim of this study was to develop a self-assessment tool, the Role Performance Scale for Middle-aged Generalist Nurses in Japan and confirm its reliability and validity.

METHODS

Scale items were extracted from interviews, and item and scale-level validity were rated by nursing management researchers and middle-aged generalist nurses. The resulting 36-item questionnaire was administered to clinical generalist nurses (middle-aged nurses, n = 837; young nurses, n = 800) in Japan. Exploratory and confirmatory factor analyses were performed, and the tool's internal consistency and construct validity were analyzed.

RESULTS

Valid responses obtained from 504 middle-aged and 311 young generalist nurses were included in the analysis. The final scale was composed of 25 items, which were divided into five factors: "backing up head nurses," "instructing young nurses on practices as an informal mentor," "providing young nurses with mental support," "providing empathic support to patients and their families," and "coordinating team medical care." In the confirmatory factor analysis, the indices of fitness supported these results. The Cronbach's alpha coefficient was .94 for the total scale and ranged from .72 to .91 for the five factors. The five factors explained a cumulative variance of 65.4%.

CONCLUSIONS

The five-factor, 25-item Role Performance Scale for Middle-aged Generalist Nurses in Japan was confirmed to have sufficient reliability and validity. Middle-aged generalist nurses can use this tool to self-assess their nursing behavior. In addition, head nurses can use it to assess the role performance of middle-aged generalist nurses and aid in their continual education.

Factors affecting work ability index among polish nurses working in hospitals - A prospective observational survey

AIMS

To assess the ability to work of Polish nurses by age groups.

BACKGROUND

The ability to work is widely discussed in the literature in the context of nurses' productivity; thus, it is necessary to identify the ability to work when facing an increasing demand for services.

METHODS

The observational study involved 349 professionally active nurses aged 46.9 ± 9.7 years, with a length of service of 23.5 ± 9.6 years. The Work Ability Index (WAI) was used to assess the nurses' ability to work.

RESULTS

The ability to work decreases with age (r_s  = -0.324, p < .000) and with seniority (r_s  = -0.257; p < .000). Nurses with higher education presented higher Work Ability Index scores. Also, the age (B = -0.25, p < .001), work seniority (B = -0.19, p < .001) and education (masters' degree: B = 1.41, p = .012; ref. secondary) affect work ability.

CONCLUSIONS

The ageing process and seniority of nurses negatively affect their ability to work. A lack of programmes to maintain physical condition for nurses can result in a shortage of staff.

IMPLICATIONS FOR NURSING MANAGEMENT

Programmes can be developed to create or improve healthy working environments to increase productivity.

The experiences of cancer nurses working in four European countries: A qualitative study

Purpose

Cancer nurses across Europe are being tasked with delivery of an increasing number of complex treatments and supportive care interventions as a result of ongoing advances in cancer research, and a rise in cancer incidence due to demographic changes. However, all health systems delivering cancer treatment innovations require access to an educated and motivated nursing workforce to meet demand.

This study by the European Oncology Nursing Society examines comparative features of cancer nursing in Estonia, Germany, the Netherlands (NL) and the United Kingdom (UK).

Methods

Descriptive qualitative study using focus groups and individual interviews drawing on the views of cancer nurses, managers and stakeholders from four European countries (n = 97). Data collection was designed around national cancer nursing conferences held in Berlin (Germany), Ede (NL), Harrogate (UK) and Tallinn and Tartu (Estonia) between May 2017 and April 2018. Participants included a mix of nursing grades and specialisms.

Findings

According to the participants education and career structure for cancer nursing was most well-developed in the Netherlands and the United Kingdom. In Germany and Estonia developments were taking place at Masters level. None of the countries had recordable qualifications in cancer nursing. Variations existed in terms of advanced practice roles and salary. Workload pressures were common, and were rising, and wellbeing initiatives were not identified. Nurses reported gaining positive feedback from caring for patients.

Discussion

As demand for cancer treatment continues to grow there is a need to ensure an adequate supply of cancer nurses with the appropriate education and career structure to support patients. This study provides insights from four countries and suggests the need for better recognition as well as working conditions, education and career structures that advance the potential of the cancer nursing role in Europe.

•

Increasingly high nursing workloads are evident in Europe alongside workforce shortages.

•

Major changes taking place in the treatment of cancer require more individualised and targeted treatment approaches.

•

In some countries, cancer nurses adopt advanced roles that include prescribing, treatment co-ordination and clinical procedures.

•

Comparative qualitative insights are provided concerning cancer nursing in Estonia, Germany, the Netherlands and the United Kingdom.

•

Despite common European Union Directives disparities exist in the availability of cancer nursing education and working across EU countries.

Contextualising missed care in two healthcare inquiries using a socio-ecological systems approach

AIMS AND OBJECTIVES

To examine missed care within two patient safety public inquiries using a socio-ecological model.

BACKGROUND

Missed care is a care which has been omitted or rendered incomplete. Possible outcomes of missed care have been identified including poor patient outcomes such as higher mortality rates, reduced care quality and lower patient satisfaction, job dissatisfaction, staff burnout and higher attrition rates.

DESIGN

A qualitative design, specifically document analysis, was used to review two serious case reviews.

METHODS

Between August-December 2018, two public patient safety inquiries were examined using a document analysis method. Both inquiries are based in acute hospital care settings of nursing (UK) and midwifery (Ireland). The Standards for Reporting Qualitative Research checklist provided a framework to report the study methods, context, findings, analysis and interpretation.

RESULTS

Findings highlighted instances of missed care related to practice which contributed to poor patient outcomes. Missed care was located within contingency factors, such as unintended negative patient health and safety outcomes in multiple system levels which resulted in care deficits.

CONCLUSIONS

A socio-ecological model enabled consideration of how multi-system deficits combine to impact nursing and midwifery care delivery. To tackle current and future practice challenges, broader contextual issues that influence front-line cases should be identified and addressed before they create conditions which result in substandard care.

RELEVANCE TO CLINICAL PRACTICE

This paper adds to the scholarship on missed care by incorporating a greater contextual lens. Findings suggest that some factors contributing to missed care events may be systemic in origin. Practice, policy, research and education should foster nurses' and midwives' review of the totality of influencing factors impacting missed care and care deficits. Consequently, early warning signs and proactive responses at a system level should be inherent in all settings that nurses' and midwives' practice.

Factors Influencing Nurses’ Intention to Leave and Intention to Stay: An Integrative Review

Nursing retention is a critical issue for organization. High nurses’ turnover impact negatively on an organization requirement to meet patient needs and quality care. This integrative review aims to critically review and synthesize published studies to obtain better understanding of the determinants of nurse’s intention to leave or stay in the organization. Thirty-seven studies which met the inclusion criteria from different locations using a variety of instruments and research designs were identified using PRISMA guideline. Many factors including job satisfaction, organizational commitment, quality of work life, work environment, leadership style, bullying at work, family reason, and job security were identified to be associated negatively with nurse’s intention to leave and positively with intention to stay in organization. More qualitative studies are needed to understand in depth, the reasons and factors that underlie and influence turnover, intention to leave or remain in organization.

Predictors of nursing workers' intention to leave the work unit, health institution and profession

OBJECTIVE

to identify the factors related to the nursing workers' intention to leave the work unit, health institution and profession.

METHOD

cross-sectional study with quantitative approach was carried out with 267 nursing workers from seven emergency units in Brazil. For data collection, we used the Questionnaire of socio-demographic, life style and work and health aspects as well as the Work Ability Index, Workplace violence questionnaire, questions about intention to leave and the Turnover Intention Scale. The predictors of intentions to leave were evaluated through Poisson regression models.

RESULTS

workplace violence increased and better satisfaction with current job decreased the probability of greater intention to leave the unit, institution and profession. Better work ability decreased the probability of greater intention to leave the unit and profession. The more qualified workers and those who had been working in the institution longer was more likely to greater intention to leave the profession.

CONCLUSION

promoting job satisfaction, work ability and a violence-free environment is possible to decrease the workers' intention to leave the job or profession, but nursing managers need to understand the three phenomena of intention to quit individually for retention strategies.

Older nurses' experiences of providing direct care in hospital nursing units: a qualitative systematic review

BACKGROUND

Most developed countries throughout the world are experiencing an aging nursing workforce as their population ages. Older nurses often experience different challenges then their younger nurse counterparts. With the increase in older nurses relative to younger nurses potentially available to work in hospitals, it is important to understand the experience of older nurses on high paced hospital nursing units. This understanding will lend knowledge to ways of lessening the loss of these highly skilled experienced workers and improve patient outcomes.

OBJECTIVES

To identify, evaluate and synthesize the existing qualitative evidence on older nurses' experiences of providing direct care to patients in hospital nursing units.

INCLUSION CRITERIA

The review considered studies which included registered nurses 45 years and over who work as direct caregivers in any type of in-patient hospital nursing unit. The phenomenon of interest was the experience of older nurses in providing direct nursing care in any type of in-patient hospital nursing unit (i.e. including but not limited to medical/surgical units, intensive care units, critical care units, perioperative units, palliative care units, obstetrical units, emergency departments and rehabilitative care units). The review excluded studies focussing entirely on enrolled nurses, licensed practical nurses and licensed vocational nurses.

TYPES OF STUDIES

Qualitative data including, but not limited to the following methodologies: phenomenology, grounded theory, ethnography, action research and feminist research.

METHODS

The databases CINAHL, PubMed, PsycINFO, Embase, AgeLine, Sociological Abstracts and SocINDEX were searched from inception; the search was conducted on October 13, 2017; no date limiters or language limiters were applied. Each paper was assessed by two independent reviewers for methodological quality using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Qualitative Research. Any disagreements that arose between the reviewers were resolved through discussion. Data extraction was conducted by two independent reviewers using the standardized qualitative data extraction tool from JBI. The qualitative research findings were pooled using JBI methodology. The JBI process of meta-aggregation was used to identify categories and synthesized findings.

RESULTS

Twelve papers were included in the review. Three synthesized findings were extracted from 12 categories and 75 findings. The three synthesized findings extracted from the papers were: (1) Love of nursing: It's who I am and I love it; (2) It's a rewarding but challenging and changing job; it's a different job and it can be challenging; (3) It's a challenging job; can I keep up?

CONCLUSIONS

Older nurses love nursing and have created an identity around their profession. They view their profession positively and believe their job to be unlike any other, yet they identify many ongoing challenges and changes. Despite their desire to continue in their role they are often faced with hardships that threaten their ability to stay at the bedside. A key role of hospital administrators to keep older nurses in the workplace is to develop programs to prevent work related illness and to promote health. Given the low ConQual scores in the current systematic review, additional research is recommended to understand the older nurses' experience in providing direct care in hospital nursing units as well as predicting health age of retirement and length of bedside nursing.

Nurses' intention to work after retirement, work ability and perceptions after retirement: a scoping review

Nurses have been identified as active workforce post-retirement. Little is known about nurses' intention to work post-retirement and their work ability and perceptions post-retirement. The aim of this scoping review is to identify studies that have investigated nurses' intention and recruitment strategies to work post-retirement and their work ability and perceptions post-retirement. PubMed, CINAHL, Web of Science, Nursing and Health Database and in addition Google scholar were searched using different keywords (retired nurses, retired RNs, work intention, work ability, work perceptions, and older nurses) and an independent reviewer cross-validated all the identified articles. Of the thirty-seven studies identified from the search, 26 papers were excluded based on exclusion criteria, with a total of 11 studies finally included in the study sample. The review found in two studies low and high intentions to work as nurses after retirement. Factors influencing both intentions and recruitment strategies to work as a nurse post-retirement focused on lighter and flexible work conditions, supportive environment, financial incentives and formal rehiring policies. Nurses working post-retirement reported benefits (intrinsic factors such as self-worth, overcoming social isolation) and barriers (such as job demands and reduced physical work ability). The review found low and high intentions to work as nurses after retirement and identified factors influencing both intentions and recruitment strategies to work as a nurse post-retirement and benefits and barriers of working as nurses post-retirement that can inform strategies to retain nurses post-retirement.

Developing a community-based nursing and midwifery career pathway - A narrative systematic review

INTRODUCTION

Community nursing and midwifery is changing in response to a shift in care from hospital to home, brought about by increasing costs to care because of an aging population and increasing chronicity. Until now, community nursing positions and scope of practice has been dependent on service focus and location, which has led to the role being unclearly defined. Lack of appeal for a career in community practice and a looming workforce shortage necessitates a review into how community nursing and midwifery transition to practice is supported.

METHODS

This review sought to identify, assess and summarize available evidence relating to transitioning into community nursing and midwifery practice as a speciality. A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses approach. A narrative synthesis was then undertaken on papers that examined community nursing and midwifery pathway perspectives which define, and enable or inhibit a contemporary pathway. Thematic analysis used a theoretical framework developed for early career and rapid transition to nursing specialty practice.

RESULTS

There is a paucity of research that identifies community nursing and midwifery as a discreet scope of practice. Twelve papers were eventually included in the review. Verbatim findings were extracted from the papers and clustered into categories based on the chosen theoretical framework. Major themes were 'the self' (professional and personal); 'transition processes'; and, a 'sense of belonging'. Sub themes included narrative identifying inhibitors and enablers in each theme.

DISCUSSION

No definition of community practice or pathway was identified in nursing, although midwifery was clearly defined. Community nursing practice was described as generalist in nature although specialist knowledge is required. Being part of the community in the professional sense and personal sense was considered important. The importance of transition was identified where pre-entry exposure to community practice was seen as important. Stages in transition to practice were recognised as pre-entry; incomer; insider; and, a sense of belonging. The process of transition should be planned and individualised acknowledging past experience whilst acknowledging the specialist nature of community-based practice.

Reimagine Health Care Leadership, Challenges and Opportunities in the 21st Century

PURPOSE

This paper spotlights human capital management, digital technology, and costs control as issues that healthcare leaders will face in redesigning the health care ecosystem in the 21st century.

DESIGN

The paper was designed to highlight the attributes that make effective leaders. It addresses how nursing leadership can take a lead to redesign the 21st Century health care system, supported by case examples.

METHODS

An expansive literature review was done using MEDLINE, SAGE, Google Scholar, and University of California San Diego Library Catalogs. The selections criteria include recent publications in English within and outside the healthcare industry.

FINDINGS

Health leadership is viewed as paramount to productivity, capacity and meeting new challenges.

CONCLUSIONS

Effective nursing leadership in a healthcare organization correlates with staff job satisfaction, retention, turnover and quality of care. Nursing leadership development must be supported by appropriate level of educational preparedness, and requisite set of competencies and skills.

Nursing curriculums may hinder a career in gerontological nursing: An integrative review

OBJECTIVE

To investigate what prevents undergraduate nursing students from choosing gerontological nursing as a career option.

DESIGN

This study utilised an integrative literature review, which allows the inclusion of previous studies with diverse research designs to gain a broader view of the reasons why nursing students do not choose a gerontological nursing career.

METHODS

An electronic database search of CINAHL (Ebsco), Scopus and Eric elicited 251 scientific peer-reviewed empirical studies, published from 2006 to March 2016 in English. After meeting the inclusion criteria, 97 qualified for closer examination. Following exclusion, the final analysis and synthesis included 21 articles.

RESULTS

Four main themes described nursing students' contributing reasons for not selecting gerontological nursing as a career option: socio-demographic factors; experiences, perceptions and knowledge about ageing; perceptions concerning the nature or status of gerontological nursing; and theoretical studies and practical education of nursing curriculum.

CONCLUSIONS

Lack of positive experiences with older people before and during nursing students' studies led to their disinterest in gerontological nursing as a career option. The nursing curriculum also reinforces the perception of modern nursing as technical, with more emphasis on acute and critical care. The findings emphasise the need to implement an age-friendly curriculum and have nurses that specialise in gerontology to serve as mentors and role models. It is important to assist nursing students in identifying the potentials for career advancement in terms of gerontological nursing. There is also a need for nursing faculties to liaise with other stakeholders to develop or improve upon the clinical atmosphere for nursing students during gerontological nursing placement.

IMPLICATIONS FOR PRACTICE

Nursing faculties must review their curriculum to ensure that there is sufficient focus on the needs of older people within the curriculum for every student. Furthermore, respected role models who are knowledgeable and enthusiastic about issues related to older people must teach gerontological nursing courses.

Nurse Staffing Norm in Iran Hospitals: What Features Should be Included for Success?

BACKGROUND

Designing and implementing a model for estimation and distribution of required nurse is one of strategies to prevent unequal distribution of nurses within and between hospitals. The purpose of this research was to determine required features for hospital nursing staff estimation model.

METHODS

We conducted a qualitative study using a Colaizzi analysis approach. We used semi-structure and in-depth interviews by purposive, quota, and snowball sampling of 32 participants (10 informed experts in area of policy making in human resources in Ministry of Health, 10 decisions making in employment and distribution of human resources in treatment and administrative chancellors of medical universities, and 12 process owners in hospitals). The data were analyzed using ATLAS.ti software version 6.0.15.

RESULTS

The ten following sub-themes emerged from data analysis: Skill mix and task shifting, work measurement, legal support, stakeholder involvement in designing a model, considering the ward activity, considering type and extent of care patients required, model development by experts predominate in nursing process, considering the nurses availability, considering the capabilities and professional merits of nurses, fitness with social, cultural, and belief of people. The main themes were occupation analysis, planning and policy making, real workload, acceptability, nurses' efficiency, and being a native.

CONCLUSIONS

Given that standardization of nursing staff estimation is announced as one of the challenges in reaching Iran's 20-year vision plan. Hence, design and implementation of a nursing staff estimation model in regard to identified features could be part of priorities in Ministry of Health in Iran.

Barriers against required nurse estimation models applying in Iran hospitals from health system experts' point of view

Introduction

One of the strategies for accessing effective nursing care is to design and implement a nursing estimation model. The purpose of this research was to determine barriers in applying models or norms for estimating the size of a hospital’s nursing team.

Methods

This study was conducted from November 2015 to March 2016 among three levels of managers at the Ministry of Health, medical universities, and hospitals in Iran. We carried out a qualitative study using a Colaizzi method. We used semistructured and in-depth interviews by purposive, quota, and snowball sampling of 32 participants (10 informed experts in the area of policymaking in human resources in the Ministry of Health, 10 decision makers in employment and distribution of human resources in treatment and administrative chancellors of Medical Universities, and 12 nursing managers in hospitals). The data were analyzed by Atlas.ti software version 6.0.15.

Results

The following 14 subthemes emerged from data analysis: Lack of specific steward, weakness in attracting stakeholder contributions, lack of authorities trust to the models, lack of mutual interests between stakeholders, shortage of nurses, financial deficit, non-native models, designing models by people unfamiliar with nursing process, lack of attention to the nature of work in each ward, lack of attention to hospital classification, lack of transparency in defining models, reduced nurses available time, increased indirect activity of nurses, and outdated norms. The main themes were inappropriate planning and policymaking in high levels, resource constraints, and poor design of models and lack of updating the model.

Conclusion

The results of present study indicate that many barriers exist in applying models for estimating the size of a hospital’s nursing team. Therefore, for designing an appropriate nursing staff estimation model and implementing it, in addition to considering the present barriers, identifying the norm required features may positively impact on norm acceptance and implementation.

The context, influences and challenges for undergraduate nurse clinical education: Continuing the dialogue

INTRODUCTION

Approaches to clinical education are highly diverse and becoming increasingly complex to sustain in complex milieu

OBJECTIVE

To identify the influences and challenges of providing nurse clinical education in the undergraduate setting and to illustrate emerging solutions.

METHOD

A discursive exploration into the broad and varied body of evidence including peer reviewed and grey literature.

DISCUSSION

Internationally, enabling undergraduate clinical learning opportunities faces a range of challenges. These can be illustrated under two broad themes: (1) legacies from the past and the inherent features of nurse education and (2) challenges of the present, including, population changes, workforce changes, and the disconnection between the health and education sectors. Responses to these challenges are triggering the emergence of novel approaches, such as collaborative models.

CONCLUSION(S)

Ongoing challenges in providing accessible, effective and quality clinical learning experiences are apparent.