Retaining a viable workforce: a critical challenge for nursing

Concepts of courage and resilience in nursing: A proposed conceptual model

Background: To overcome the challenges of delivering patient care in the twenty-first century, it is essential to foster the professional and personal qualities of courage and resilience in the nursing workforce. The logical place to do so is in nursing education and training.Objectives/Hypotheses: This paper discusses the constructs of courage and resilience in nursing and the application of the constructs in nursing education.Design: This is a discussion article drawing on the relevant literature and the professional experiences of the authors to develop a conceptual model for teaching courage and resilience.Results: To promote nursing students' coping strategies and their general well-being, nurse educators should foster resilience and courage through various educational interventions.Conclusion: The proposed conceptual model shows that nurse educators should train nurses to be more resilient and courageous in order to promote patient safety, handle the demands of the profession, and function as advocates for the discipline.

Project Possibility: A model of care and the politics of change

As a strategy to counter the current crisis of recruitment and retention in nursing a new model of care designed to introduce the second and third level of nurse into what was previously an almost exclusively registered nurse workforce, has been implemented in collaboration with clinicians, educators and managers, at a leading private hospital. This paper articulates the salientfeatures of the model, key processes involved in the model's introduction to the staff and explores the complex politics surrounding its implementation and ongoing evaluation.

[Is subjective well-being perceived by non-health care workers different from that perceived by nurses? Relation with personality and resilience]

Subjective well-being (SWB), usually called 'happiness', is influenced directly by psychological factors. Personality and resilience (capacity of recover from adversity) are included among these factors. Empirical evidence has demonstrated that resilience is an essential and inherent characteristic for the nursery staff. This study has aimed to analyze personality factors (including resilience) related with SWB (satisfaction with life, positive and negative affect) in a nursery staff sample (n=59) of intensive care and cardiological units, and a non-health care workers sample (n=50) mainly made up of government employees and teachers. Multiple regression analyses showed that SWB was associated with more resilience and less neuroticism in the nursery staff. Extraversion and conscientiousness (positively related), and neuroticism (negatively related) were the significant predictors of SWB in the non-health care workers group. Finally, mediational analyses revealed that resilience measured the relationships between extraversion (total mediation) and neuroticism (partial mediation) with SWB in the nursery staff group, but not in the group of non-health care workers. The results show the importance of resilience for nursery staff of intensive care units, since they are constantly exposed to human suffering and to a continually adverse occupational environment. Likewise, the discussion stresses that resilience is a means for nursing staff to cope with the occupational stress and that resilient nurses are a crucial element in our health care system.

Valuing the gap: a dialectic between theory and practice in graduate nursing education from a constructive educational approach

Within nursing education, graduate pedagogies are relatively unexplored, with research commonly focused upon undergraduate and continuing education. In order to address the increasingly complex organisational challenges in the workplace, mid-career nurses and midwives are turning to graduate education. In one graduate course on cultures of learning in the workplace, a constructivist approach to learning was adopted. Post-course analysis of data, from the feedback on the course from students, student choice of assignment topics, and reflections of the course facilitators, revealed three pedagogies unique to graduate education. The pedagogies were labelled 'keeping the space open', 'theoretical concepts as tools', and 'resonance and action as praxis'. The intended outcome of the course is revealed in a fourth theme, 'developing practice in the workplace'. This evaluation suggests that constructivist pedagogies used with graduate students may be different to those pedagogies used with undergraduate and continuing education students. We argue that graduate pedagogies move nursing education beyond strategies that seek integration of theory and practice, towards a dialectic between theory and practice.

Reducing violence against nurses: the violence prevention community meeting

Research was undertaken to validate the efficacy of a new, nurse-led treatment, the Violence Prevention Community Meeting (VPCM), for reducing patient violence on an acute-care inpatient psychiatry unit. Nursing staff members carried event counters and recorded verbal and physical violence as it occurred over the 20-week study. Significant decreases in patient violence were found across day, evening, and night shifts for pre-treatment vs. treatment and pre-treatment vs. post-treatment comparisons. For the day shift, when twice-weekly VPCM treatment took place, violent incidents decreased 89% from pre-treatment to treatment and 57% from pre-treatment to post-treatment.

Towards a model of Strategic Roster Planning and Control: an empirical study of nurse rostering practices in the UK National Health Service

Despite the criticality of nurse rostering practices, there is a surprising lack of attention paid to this managerial activity both in practice and in the health-service management literature. This paper reports the results of an inductive, empirical study of rostering practices in the UK National Health Service with a view to developing a shared understanding of roster planning processes and of what constitutes rostering effectiveness. A survey of rostering practices in 50 wards, followed by five in-depth, longitudinal case studies, revealed the complexity of rostering activities, and identified the main design parameters, which were used to specify rostering systems and to prepare periodic rosters. Rostering activities were perceived to directly impact upon service delivery, resource utilization and nurse retention. A number of poor rostering practices were identified, which could lead to dysfunctional behaviour. This analysis points to a clear managerial imperative to improve local competencies in roster planning and control, recognizing their strategic significance in contributing to hospital effectiveness. A ‘Strategic Roster Planning and Control (SRPC)’ model is proposed, which may provide a framework for evaluating rostering effectiveness, and a platform for the sharing of best practice, in order to stimulate organizational learning and achieve nationwide improvements in hospital performance.

Personal resilience as a strategy for surviving and thriving in the face of workplace adversity: a literature review

AIM

This paper is a report of a literature review to explore the concept of personal resilience as a strategy for responding to workplace adversity and to identify strategies to enhance personal resilience in nurses.

BACKGROUND

Workplace adversity in nursing is associated with excessive workloads, lack of autonomy, bullying and violence and organizational issues such as restructuring, and has been associated with problems retaining nurses in the workforce. However, despite these difficulties many nurses choose to remain in nursing, and survive and even thrive despite a climate of workplace adversity.

DATA SOURCES

The literature CINAHL, EBSCO, Medline and Pubmed databases were searched from 1996 to 2006 using the keywords 'resilience', 'resilience in nursing', and 'workplace adversity' together with 'nursing'. Papers in English were included.

FINDINGS

Resilience is the ability of an individual to positively adjust to adversity, and can be applied to building personal strengths in nurses through strategies such as: building positive and nurturing professional relationships; maintaining positivity; developing emotional insight; achieving life balance and spirituality; and, becoming more reflective.

CONCLUSION

Our findings suggest that nurses can actively participate in the development and strengthening of their own personal resilience to reduce their vulnerability to workplace adversity and thus improve the overall healthcare setting. We recommend that resilience-building be incorporated into nursing education and that professional support should be encouraged through mentorship programmes outside nurses' immediate working environments.

The problem of workforce for the social world of Australian rural nurses: a collective action frame analysis

AIM AND BACKGROUND

Globally, nursing workforce shortages are a hot topic for discussion among politicians, academics and clinicians. This paper uses collective action framing to analyse the literature about the problem of workforce for Australian rural nurses.

EVALUATION

As part of a larger constructivist grounded theory study, we utilize collective action framing to bridge social world mapping and the literature. Data sources included journal databases, newspapers, newsletters and websites. We limited the years searched from 2000 to 2005. This analytical heuristic categorizes text into three main categories: diagnoses of a problem, postulations of solutions and actions to motivate change.

KEY ISSUES

Having mapped the social world of Australian rural nurses as comprising four groups of collective actors - community, advocates, academics and government - we trace the texts that they have produced with a focus on mentoring as a potential solution to the problem of workforce.

CONCLUSIONS

Mentoring entered the literature about the problem of workforce for Australian rural nurses because of a combination of political and academic will. These collective groups are now changing how they are framing the problem of workforce to focus instead on the globalization of nursing workforce shortages, which is resulting in diminished support for mentoring activities in clinical practice.

A comparative analysis of contemporary nurses' discontents

AIM

This paper reports a study to evaluate and increase understanding of contemporary Registered Nurses' discontents, and to compare these discontents and their effects with those of nurses 20 years ago.

BACKGROUND

In 1986, Turner argued that nurses' discontents were reflected in a discourse or 'vocabulary of complaint' that provided a sense of solidarity amongst practising nurses, and defused their frustrations rather than channelling them into demands for workplace reform. In this paper, we revisit Turner's notion of a vocabulary of complaint in the context of a study of nurse retention in the contemporary Australian healthcare workplace.

METHODS

This paper draws on the qualitative data from a larger project (completed in 2001) exploring the relationship between job satisfaction and self-concept in both recently graduated and experienced nurses. Here, we elaborate on thematic analyses of the comments of 146 Australian Registered Nurses with more than 5 years' nursing experience.

FINDINGS

There is still a high level of discontent amongst contemporary practising nurses, although the focus of their complaints and their responses to them have changed since Turner's study. Conflicting expectations of nurses and managers and lack of opportunity to provide comprehensive care emerged as the most important issues for experienced nurses today. Rather than contributing to a sense of solidarity as in Turner's study, contemporary nurses' discontents reflect intense personal frustration and underpin individual nurses' decisions to leave, or plan to leave, the workforce.

CONCLUSION

There is an urgent need for increasing health service management and community awareness about the relationship between providing comprehensive nursing care and nurses' job satisfaction. Addressing nurses' discontents, wider nursing involvement in the international policy arena, and the politicization of nurses worldwide may contribute to alleviating the current global nursing shortage.

The Kids Into Health Careers (KIHC) Initiative: Innovative Approaches to Help Solve the Nursing Shortage

In 2001, the Northern Illinois University School of Nursing was awarded a grant from the Division of Nursing of the Bureau of Health Professions, Health Resources and Services Administration, U.S. Department of Health and Human Services, to enhance the School's advanced practice nursing program. As a recipient of this grant, the School of Nursing was required to incorporate activities to meet the goals of the "Kids Into Health Careers (KIHC) Initiative" to encourage children into health care careers. This article describes the strategies developed by the School of Nursing to meet the KIHC goals and encourage children, especially those from minorities, into health care careers. The School's approach was multifaceted and included collaboration with a variety of community organizations and groups. While there is a tremendous amount of work to be accomplished in encouraging middle and high school students to consider nursing as a career, creative strategies through which nurses take an active role in helping resolve the problem are suggested.

Clinical leadership in contemporary clinical practice: implications for nursing in Australia

BACKGROUND

Leadership in the clinical practice environment is important to ensure both optimal patient outcomes and successive generations of motivated and enthusiastic clinicians.

AIM

The present paper seeks to define and describe clinical leadership and identify the facilitators and barriers to clinical leadership. We also describe strategies to develop clinical leaders in Australia. Key drivers to the development of nursing leaders are strategies that recognize and value clinical expertise. These include models of care that highlight the importance of the nursing role; evidence-based practice and measurement of clinical outcomes; strategies to empower clinicians and mechanisms to ensure participation in clinical decision-making.

KEY ISSUES

Significant barriers to clinical leadership are organizational structures that preclude nurses from clinical decision making; the national shortage of nurses; fiscal constraints; absence of well evaluated models of care and trends towards less skilled clinicians.

CONCLUSIONS

Systematic, strategic initiatives are required to nurture and develop clinical leaders. These strategies need to be collegial collaborations between the academic and health care sectors in order to provide a united voice for advancing the nursing profession.

Reaching for the stars: Career advancement and the registered nurse

Clinical nursing has long struggled to secure the place of primacy it deserves in the profession's hierarchy of importance and worth. It is ironic that, even at the beginning of the 21st century, a clinical nurse is generally not as well-recognized, rewarded or remunerated as a colleague working in nursing management, education or research. Until the profession recognizes and takes serious action to remedy this situation, the crisis of recruitment and retention in nursing currently ravaging the globe is likely to continue. In this paper, I present a discursive account of an exciting initiative by a leading private, acute-care hospital which addresses this very problem. A new ladder for clinical nurse specialists (CNSs) introduces a rigorous and systematic approach to the appointment of three classifications of CNS, each requiring evidence of successively higher levels of competency, and which are accompanied by fiscal reward and stronger peer recognition.

Current Challenges and Issues Facing Nursing in Australia

This column is a discussion of nursing in Australia. The authors present current challenges and issues related to recruitment and retention, an aging workforce, violence and bullying, diversity, undergraduate and graduate education, professional development, information technology, clinical pathways, models of care delivery, and funding models. They also present what is happening in Australia in relation to nursing’s scope of practice, development of the nurse practitioner role, nursing leadership, and nursing research.

Why evidence-based practice now?: a polemic

Evidence-based practice (EBP) first appeared on the healthcare horizon just over a decade ago. In 2003 its presence has intensified and extended beyond its initial relation to medicine embracing as it does now, nursing and the allied health disciplines. In this paper, I contend that its appearance and subsequent growth and development are the effects of potent "regimes of truth", four of which bear the names: positivism, empiricism, pragmatism and economic rationalism. My aim is to show how EBP generates the controversy it does because its nature and methods are inextricably interwoven with the way it has become politicised and professionalised. This exegesis is an attempt to outline how the combined effects of the four forms of rationality mentioned above allow for both the methods and objectives of EBP to be constructed as they are, while at the same moment producing the particular effects of knowledge and power in terms of who sells and who buys the idea of EBP in the culture of contemporary healthcare.