Increasing nurse first-line leader (manager) positions to improve nurse retention and quality of patient care

Quality work in long-term care: the role of first-line leaders

OBJECTIVE

To explore the first-line leaders' role in quality work in long-term care in Norway, in order to determine how that work is related to such success characteristics as leadership, staff, patients, performance, information and information technology.

DESIGN

Cross-sectional telephone survey. The text was analysed using content analysis.

SETTING

Thirty-two Norwegian municipalities stratified according to region and population size.

PARTICIPANTS

Sixty-four first-line leaders in nursing homes and home-based care. Main outcome measure The clinical microsystem approach is used as a framework by defining and designing measureable variables.

RESULTS

Thirty-six leaders described how they initiated and motivated employees to be active in quality work; the remaining leaders indicated that they played a passive role. The first-line leaders played a key role in implementing national quality policies and regulations. The quantity of other success characteristics was low.

CONCLUSIONS

The municipalities delegated the responsibility of implanting national policies to the first-line leaders. Missing were key quality success criteria such as macro- and meso-perspectives for the municipality as a whole and co-operation with other leaders in the organization and fostering of relevant learning. Quality work was fragmented rather than comprehensive and systematic.

Therapists' perspectives on the management and delivery of occupational therapy and physical therapy services

The impact of resructuring healthcare services on the day-to-day practice of occupational therapists and physical therapists was examined. Four main issues emerged: limited understanding of scopes of practice; absence of a rehabilitation perspective at decision-making tables; lack of a career ladder; and barriers to the maintenance and enhancement of professional competence. This article describes the reported impact of these issues on patient care specifically and on the healthcare system in general. Recommendations for an improved structure within an interdisciplinary management paradigm that would ensure effective and efficient use of healthcare resources are provided.