The professional role of the nurse

Changing aspect of nurses' work environment A comparison of perceptions in two hospitals in Sweden and the UK and implications for recruitment and retention of staff

Concerns about the recruitment and retention of nursing staff are apparent in many healthcare systems. This paper describes a study which used a common methodology to assess nurses' perceptions of their work environment and changes over the past 12 months in the UK and Sweden. A census survey of all qualified nursing staff was undertaken in a large teaching hospital in Sheffield and Jonkoping, Sweden. Analysis of results reveal similar concerns with a perceived fall in the quality of nursing care, and increased demands in terms of workload at a time when staffing levels are being reduced. Although there were common trends, Swedish nurses were far less likely than their English counterparts to feel that they had opportunities to act autonomously, to develop their skills, and to access continuing professional education. The need for remedial action to enhance nurses' work environment and to increase their autonomy is highlighted.

Clinical specialty and organizational features of acute hospital wards

Ward clinical specialty is a variable which has been largely ignored in studies of nursing organization and effectiveness. Analysis of data collected from a nationally representative sample of 83 acute medical, surgical and orthopaedic hospital wards demonstrates that while wards had similar staffing resources, differences exist in the likelihood of adopting a nursing organizational system with devolved authority, in nurses' views of prevailing hierarchical attitudes, and their perceived influence over a range of organizational features of the ward. Medical wards were more likely to have developed organizational practices associated with increasing nursing autonomy.

Competency through being: the enemy within?

Nurses are taking on more medical tasks but is this appropriate? If so, does this advance nursing practice? The issue hinges on the nurse's competency which is central to professional nursing practice.

Role determination in nursing--implications for service provision

The current changes in nursing practice which have placed a greater need than ever before for nurses to have clearly defined roles, has resulted from the demand for cost-effective care and for nurses to justify their contribution to that care. This two stage, descriptive study was undertaken as part of a larger study to determine the implications of definition of the role of nursing for service provision in Hong Kong. The initial data collected using group interviews to generate ideas about the activities of the registered nurse (RN) and enrolled nurse (EN), was followed by a questionnaire to a sample of 410 RNs, representing three different grades of nursing staff. The 5-point Likert type questionnaire asked respondents to indicate levels of agreement with 67 activities. Sixty-five of the 67 activities of the RN were agreed to and were statistically significant (P < 0.001) in the difference from the undecided position. The findings also demonstrated a lack of agreement amongst grades of staff in their perception of nursing role. Fifty-six of the same 67 activities were agreed to for the EN and were statistically significant (P < 0.001) in the difference from the undecided position. This similarity between perceptions of EN and RN activities highlights the need to reconsider the contribution of ENs to patient care within the nursing structure in Hong Kong. These findings have implications not only for the management of nursing but also for further research in determining the interpretation of role in nursing to high quality patient care.