Current Challenges and Issues Facing Nursing in Australia

Consensus on an Australian Nurse practitioner specialty framework using Delphi methodology: results from the CLLEVER 2 study

AIM

The aim of this study was to achieve profession-wide consensus on an Australian nurse practitioner specialty framework.

BACKGROUND

Since its introduction in 1998, the Australian nurse practitioner profession has grown to over 1300 endorsed practitioners, representing over 50 different specialties. To complement better a generalist learning and teaching framework with specialist clinical education, prior research proposed a broad framework of Australian nurse practitioner specialty areas termed metaspecialties.

DESIGN

This study employed an online three-round modified Delphi method.

METHOD

Recruitment using purposive sampling and snowballing techniques identified an eligible sample from a population of nurse practitioners with at least 12 months' postendorsement experience (n = 966). Data were collected using online survey software from September 2014-January 2015 and analysed using descriptive statistics and content analysis. The Content Validity Index and McNemar's Test for Change were used to determine consensus on the nurse practitioner metaspecialties.

RESULTS

One-fifth of the total eligible population completed the study. Participants achieved high consensus on four metaspecialties, including: Emergency and acute care, primary health care, child and family health care and mental health care. Two metaspecialties did not achieve consensus and require further investigation.

CONCLUSION

A large sample of nurse practitioners achieved consensus on an Australian metaspecialty framework, increasing the likelihood of widespread acceptance across the profession. This technique may be appropriate for use in jurisdictions with smaller populations of nurse practitioners. Ongoing research is needed to re-evaluate the metaspecialties as the profession grows.

Speech and language therapy students: how do those with 'non traditional' university entry qualifications perform?

BACKGROUND

Entry to speech and language therapy (SLT) undergraduate pre-registration programmes in the UK is usually achieved through qualifications attained at school (e.g. A-levels). A smaller number of people who did not succeed academically at school enter through qualifications achieved post-schooling, e.g. Access to Higher Education courses. This second group of students are attractive recruits to SLT training programmes as they bring different experiences and backgrounds to the programme and to the SLT profession. However, there are no published studies that explore the academic performance or degree and employment outcomes of students who enter university through this route.

AIMS

To investigate the success of non-traditional entry students, specifically those with Access qualifications, on one pre-registration SLT undergraduate degree at a university in the UK. Success is measured in terms of module results, obtaining a degree, the ability to register as an SLT and first employment destination post-graduation.

METHODS & PROCEDURES

University applications were reviewed and students who entered via an Access course were identified for a ten-year period. Results for modules, individual assessments and final degree classification were obtained from their files and were compared against the mean score of traditional entry students on the years of the course covered by this study using a series of one sample t-tests.

OUTCOMES & RESULTS

The students who entered through the non-traditional academic route are generally successful in completing their degree and in registering to work as an SLT. However, as a group they perform less well on the degree overall, on individual modules and on written examinations and they do not close this performance gap over the four years of the degree. In contrast, however, they perform on a par with their peers on other types of assessment (e.g. clinical placement, case study, data exercise). The Access students were more likely than traditional entry students to be working as an SLT six-months post-qualification.

CONCLUSIONS & IMPLICATIONS

These results suggest that some types of assessment may be more effective at tapping the skills of students from non-traditional academic backgrounds, and that more tailored support could be provided for this group of students in tackling university written examinations throughout all years of the programme. Despite limited preparation for university-level study and mixed performance on assessment, students from non-traditional academic backgrounds can do well at university and successfully gain employment as SLTs.

Nurses' perceptions of standardised assessment and prevention of complications in an ICU

AIMS AND OBJECTIVES

To describe nurses' perceptions of evidence-based recommendations to prevent complications in a Malaysian intensive care unit.

BACKGROUND

Ventilator-associated pneumonia, catheter-related blood stream infection and pressure ulcer are three frequent adverse events in the intensive care unit. Implementing evidenced-based practice is critical in prevention of these complications.

DESIGN

A qualitative focus group study.

METHODS

Focus groups were conducted with nurses in the intensive care unit of a regional hospital in Malaysia following evidence-based interventions. Focus group transcripts were analysed using the method of thematic analyses.

RESULTS

Thirty-four nurses participated in eight focus groups. The main themes derived from the interviews: (1) nurses' knowledge impacts on the change process; (2) initial resistance, ambivalence and movement to acceptance; and (3) hierarchical organisational structure can hinder the change process.

CONCLUSION

Enhancing nurses' knowledge and attitudes of evidence-based practice, providing them with tools to monitor their clinical practice, and empowering them to change practice are likely to be important in influencing clinical outcomes. Increasing the emphasis on evidence-based practice in nursing curricula and engaging in cultural change processes in the workplace are necessary to improve clinical outcomes.

RELEVANCE TO CLINICAL PRACTICE

These findings provide valuable information for implementing clinical practice improvement interventions.

The Study of Nursing Care project: back to the future for contemporary nursing research?

AIMS

  To discuss the Study of Nursing Care project, an initiative from the late 1970s in the UK. The article explores the impact of the Study of Nursing Care on nursing research, and considers to what extent it presents a useful model for contemporary nursing research.

BACKGROUND

  It is acknowledged internationally that the nursing academic workforce is ageing and dwindling. Many possible solutions are being debated with all agreeing that the next generation of evidence based nurse leaders is urgently required.

DATA SOURCES

  In this article, the authors survey existing workforce schemes, describe the Study of Nursing Care series, published in the 1970s, and draw on interviews and correspondence conducted in 2009 with four of the original Study of Nursing Care research assistants.

DISCUSSION

  The Study of Nursing Care project poses a potential response to academic workforce issues. This article discusses the evolution of the project, its methods and operation and considers its possible implications for contemporary practice. Implications for nursing.  The Study of Nursing Care model demonstrates the clear benefits of fully committed funding, a programmatic approach towards research development, and the importance of selecting the right kind of people for the work, in a national scheme.

CONCLUSION

  The authors argue that although the clinical outcomes it set out to achieve remain elusive, the project produced a cohort of nurse researchers who went on to give important leadership in nursing, including in nursing academia/research. A contemporary version of the Study of Nursing Care has important potential to generate the next generation of nurse researchers, and leaders, into the twenty-first century.

What predicts the selection of nursing as a career choice in 5th and 6th year school students?

Demand for nursing care, and nurses, is growing in the United Kingdom given an increasingly ageing patient population with long-term co-morbidities. An ageing nursing workforce and fewer school leavers entering nursing are key barriers to student nurse recruitment. This paper aims to identify the socio-demographic and correlates nursing as a career choice in 5th and 6th year school students. This cross-sectional descriptive study gathered self-administered questionnaires from a total cohort of 5th and 6th year school students (n=1059) in one educational authority in Scotland. A response rate of 100% was achieved, with 702 students expressing a career choice. Some 71.7% (n=503) of students providing a full data set would never consider nursing, even if they obtained poor grades. Only 28.3% (n=199) would ever consider nursing. Students cited nursing as a career choice if they were female, of average to below average academic ability/achievement, expressed a positive attitude to nursing as a degree subject which was shared by their career guidance teacher. Each additional higher reduced the likelihood of nursing as a career choice by 22%. Nursing is an unpopular career choice amongst school students. Strategies are required to improve the occupational image of nursing in secondary education.

Expanding the clinical placement capacity of rural hospitals in Australia: displacing Peta to place Paul?

In order to identify opportunities to build capacity for clinical placements, we mapped and described the organisation of student placements at three hospitals, each with multiple education providers, in rural Victoria, Australia. Using a cross-sectional, mixed method design, data were collected by survey, interviews and discussion with student placement coordinators representing 16 clinical health disciplines. Teaching and supporting students was regarded as an important part of the service each hospital provided and a useful staff recruitment strategy. There were peaks and troughs in student load over the year, though this was less marked for medicine and dentistry than for nursing and allied health disciplines. Whilst placements were managed largely on a discipline basis, each hospital had taken steps to communicate information about student placements across disciplines and to identify opportunities for interprofessional education (IPE). Placement capacity could be increased by sharing placement data within hospitals, smoothing the utilisation patterns across the year, capitalising on opportunities for IPE when there is concurrent placement of students from different disciplines, and through better employment of underutilised clinical areas.

Factors contributing to the shortage of nurse faculty: a review of the literature

There is an abundance of literature documenting the shortage of nurse faculty, both in Australia and internationally. This shortage has repercussions for the next generation of nurses, contributes to the overall nursing workforce shortage, and holds implications for the development of nursing research and continued practice development. The literature suggests a multitude of factors contributing to the shortage, including the ageing of current nurse faculty, and an undersupply of doctorally prepared nurses to take their place. To date, most nurse academics come from a clinical background with little preparation for the complex faculty role; despite this there is little exploration of their experiences transitioning to academia. The limited available evidence suggests that this new role may be accompanied by feelings of uncertainty, anxiety and isolation associated with changed responsibilities, an emphasis on scholarly activities and teaching, and the unique culture of the academic environment. The aim of this paper is to provide a critical review of the literature, identify issues relevant to the nurse faculty shortage and provide direction for further research.

Factors contributing to nurse job satisfaction in the acute hospital setting: a review of recent literature

AIM

To explore and discuss from recent literature the common factors contributing to nurse job satisfaction in the acute hospital setting.

BACKGROUND

Nursing dissatisfaction is linked to high rates of nurses leaving the profession, poor morale, poor patient outcomes and increased financial expenditure. Understanding factors that contribute to job satisfaction could increase nurse retention.

EVALUATION

A literature search from January 2004 to March 2009 was conducted using the keywords nursing, (dis)satisfaction, job (dis)satisfaction to identify factors contributing to satisfaction for nurses working in acute hospital settings.

KEY ISSUES

This review identified 44 factors in three clusters (intra-, inter- and extra-personal). Job satisfaction for nurses in acute hospitals can be influenced by a combination of any or all of these factors. Important factors included coping strategies, autonomy, co-worker interaction, direct patient care, organizational policies, resource adequacy and educational opportunities.

CONCLUSIONS

Research suggests that job satisfaction is a complex and multifactorial phenomenon. Collaboration between individual nurses, their managers and others is crucial to increase nursing satisfaction with their job.

IMPLICATIONS FOR NURSING MANAGEMENT

Recognition and regular reviewing by nurse managers of factors that contribute to job satisfaction for nurses working in acute care areas is pivotal to the retention of valued staff.

Nurses' perceptions of leadership in an adult intensive care unit: a phenomenology study

The purpose of this research was to explore ICU nurses' perceptions of nursing leadership in the adult intensive care unit (ICU). The nursing profession needs leaders at all levels; ward, administration and executive and in an era in which there is a shortage of ICU nurses, nursing leadership is important, as positive leadership skills correlate with enhanced recruitment and retention of these specialist nurses. Six ICU nurses with at least 5 years experience in ICU nursing were recruited from a metropolitan hospital in Australia. Qualitative phenomenological methodology was used to depict the lived experiences of nurses' leadership in the adult ICU. Data were collected through individual semi-structured interviews using open-ended questions and analysed using Giorgi's [Giorgi A. Toward phenomenologically based research in psychology. J Phenomenol Psychol 1970;1:75-98] descriptive method for data analysis. Five themes emerged and these were all inter-related: leading by example, communication, ability to think outside the management square, knowing your staff and stepping up in times of crisis. These findings highlight the importance of nursing leadership in the adult ICU and the need to ensure that all current and future nursing ICU leaders are adequately prepared and educated for this role. This information may also be used to assist in the development of leadership skills in ICU nurses.

What do high academic achieving school pupils really think about a career in nursing: analysis of the narrative from paradigmatic case interviews

As many Departments of Nursing within universities consider raising their academic entry requirements in an attempt to attract a more high academic achieving entrant and also endeavour to attract more school leavers one of the fundamental questions that needs to be answered is--are high academic achieving school pupils really interested in pursuing a career in nursing? The aim of this paper is to report on the findings from paradigmatic case interviews of high academic achieving school pupils who at one stage in their career choice process had considered nursing as a possible career choice but had ultimately disregarded nursing and had decided to pursue medicine or another health care profession. The study reports interview data from a sub-sample of (n=20) high academic achieving 5th and 6th year school pupils who participated in a larger survey of 5th and 6th year school pupils (n=1062). These were paradigmatic cases--high academic achieving school pupils who had considered nursing as a possible career choice within their career preference cluster but had ultimately disregarded nursing and decided to pursue medicine or another health care profession as a career choice. Participants reported that nursing was eventually not viewed as using their examination grades to the maximum benefit. Also the participants reported a belief that the work of the doctor is more important and academic as they cure patients whereas the work of the nurse is practical and routine as they only care for patients. The pupils in addition asserted a negative image of nursing and a low status level of nursing as a career. They also articulated the unremarkable typical school pupils they perceived would pursue nursing as a career choice and the type of school pupil that they had witnessed being encouraged toward nursing within their schools, both of which conflicted with their own typology. Ultimately the high academic achieving school pupils were doubtful and suspicious as to the credibility of a degree in nursing and nursing as a university programme. Nursing is a very contentious career choice consideration for high academic achieving school pupils. There is strong evidence from the interview data to suggest that attracting high academic achieving school pupils into nursing could be hugely problematic.

Advanced nursing roles in critical care--a natural or forced evolution?

Meeting the expectation of delivering safe, effective, and timely health care services within current financial and workforce envelopes requires all health care clinicians to refine and adapt to their clinical roles. The arena of critical care is currently receiving increasing scrutiny regarding developing dedicated advanced practice roles. This is challenging to critical care nurses who historically neither have been exposed to nor have chosen to engage in such specific role developments. The critical care nursing community has, on the whole, embraced previous role expansions within the limits of existing group practices rather than an evolution of new subspecialties. International comparisons demonstrate that critical care nurses in the United States, the United Kingdom, and Australia are all facing common health policy drivers. Although there are some similarities in addressing these challenges, the solutions remain at various stages of development. The natural history framework of Bucher [Work and Occupations 1988;15:131-147] provides a useful and supportive tool to understand how it is necessary and natural for specialties within occupational groups to emerge to meet changing health care needs. A shared concern providing challenges at national and international levels involves the coordination of educational standards as well as competencies and clear articulation of the leadership component of advanced practice roles. These areas must be addressed to enable the international critical care community to naturally transform and evolve into fully established and legitimate advanced practitioners.

Nursing morale: predictive variables among a sample of registered nurses in Australia

AIM

This study investigates the determinants of morale among Registered Nurses in Queensland, Australia.

BACKGROUND

In light of the public discussions on the issues facing the future of nursing, it is critical to understand the factors that influence morale.

METHODS

A 160-question instrument sought information from Registered Nurses on their perceptions of 'self', work and morale. A response rate of 41% was achieved (n = 343) from a convenience sample of three acute hospitals.

RESULTS

Following binary logistic regression modelling for organizational morale, significant relationships were found with patient care provision and team interaction. Binary logistic regression modelling for personal morale revealed positive relationships with team interaction, consultation, professional recognition and lower levels of patient abuse.

CONCLUSION

The results point to a number of organizational and professional issues that can be considered by health care administrators and policy makers to develop workplaces that have a positive impact on the morale of nurses.

Getting to know a stranger--rural nurses' experiences of mentoring: a grounded theory

BACKGROUND

Mentoring is often proposed as a solution to the problem of successfully recruiting and retaining nursing staff. The aim of this constructivist grounded theory study was to explore Australian rural nurses' experiences of mentoring.

DESIGN

The research design used was reflexive in nature resulting in a substantive, constructivist grounded theory study.

PARTICIPANTS

A national advertising campaign and snowball sampling were used to recruit nine participants from across Australia. Participants were rural nurses who had experience in mentoring others.

METHODS

Standard grounded theory methods of theoretical sampling, concurrent data collection and analysis using open, axial and theoretical coding and a story line technique to develop the core category and category saturation were used. To cultivate the reflexivity required of a constructivist study, we also incorporated reflective memoing, situational analysis mapping techniques and frame analysis. Data was generated through eleven interviews, email dialogue and shared situational mapping.

RESULTS

Cultivating and growing new or novice rural nurses using supportive relationships such as mentoring was found to be an existing, integral part of experienced rural nurses' practice, motivated by living and working in the same communities. Getting to know a stranger is the first part of the process of cultivating and growing another. New or novice rural nurses gain the attention of experienced rural nurses through showing potential or experiencing a critical incidence.

CONCLUSIONS

The problem of retaining nurses is a global issue. Experienced nurses engaged in clinical practice have the potential to cultivate and grow new or novice nurses-many already do so. Recognising this role and providing opportunities for development will help grow a positive, supportive work environment that nurtures the experienced nurses of tomorrow.

Disentangling the effects of psychological and physical work demands on sleep, recovery and maladaptive chronic stress outcomes within a large sample of Australian nurses

AIM

This paper reports a study to determine if different types of work strain experienced by nurses, particularly those of an essentially psychological nature, such as emotional demand, mental effort and problems with peers and/or supervisors, have a differential impact on sleep quality and overall recovery from work strain, compared with physical work strains, and lead to higher maladaptive chronic fatigue outcomes.

BACKGROUND

Various studies have shown that the dominant work-demand strain associated with nursing work can vary between different areas of nursing. For example, whereas emotional strain is reported to be the principal strain associated with work in areas such as oncology, haematology and renal units, medical and surgical unit nurses report work pace and staffing issues as the dominant work strain. Purely physical strain seems to be less commonly reported as a concern.

METHOD

A large sample (n = 760) of Australian nurses working in a large metropolitan hospital completed questionnaires on their work demands, sleep quality, fatigue, and recovery between shifts in January 2004.

FINDINGS

A high work pace exacerbates the psychological rather than the physical strain demands of nursing. Psychological strain affects sleep quality and impairs recovery from overall work strain between shifts. This combination is highly predictive of serious maladaptive stress/fatigue outcomes among nurses.

CONCLUSION

Coping with psychological stressors adequately is an important requirement for nurses in order to avoid adverse health effects and maintain a long-term career in nursing. Appropriate training of undergraduate nursing students in managing the stresses they are likely to encounter would seem to be an essential requirement for the 21st century. Such training might constitute an important long-term component in overcoming the chronic nurse shortages evident in many countries.

Nursing in Hong Kong: issues and challenges

This column provides a discussion of the issues and challenges facing nurses and nursing in Hong Kong. The author introduces the role of nurses in the special administrative region and focuses on workforce, educational and practice issues, as well as on leadership in nursing. He concludes that Hong Kong needs to have a strategic plan to determine sufficient numbers of properly educated nurses.