Leveraging palm technology in the advanced practice nursing environment

The use of personal digital assistants (PDAs) in healthcare has expanded exponentially in the past several years. In addition to common feature functions such as contact lists, calculators, calendars, and expense logs, current PDAs boast a wide variety of practical healthcare-related applications such pharmacologic databases, infectious disease programs, medication calculators, and patient scheduling and billing applications. This article examines PDAs in general and the Palm series of handheld devices in particular for use in the advanced practice setting. These devices have several implications for advanced practice nursing including support of both differential diagnosis and diagnostic reasoning, reduction of medication errors, and development of effective treatment protocols. Personal digital assistant technology will inevitably become part and parcel of advanced practice nursing. The rapid, almost daily, changes in the healthcare environment require immediate access to the myriad resources and databases used by advanced practice nurses. Personal digital assistant technology provides such access.

The effect of LPN reductions on RN patient load

OBJECTIVE

This study explores the effect of licensed practical nurse (LPN) reductions on registered nurse (RN) staffing.

BACKGROUND

RN staffing is usually evaluated by assessing RN/patient and RN/nursing staff ratios. Using these measures, researchers generally have not found deterioration in RN staffing. Despite differences in roles, RNs and LPNs frequently share a substantial amount of patient load. Given reductions in LPNs, adequate RN staffing can be assessed more completely by looking at the changes in the staffing of licensed nurses (RNs and LPNs combined).

METHODS

This study measures the percent change in RN, LPN, and licensed nurse staffing from 1991 to 2000 in 185 to 215 Pennsylvania hospitals. Paired sample t tests measure the significance of change from year to year and for the period overall.

RESULTS

A 29% reduction in LPNs during the years 1991 to 2000 affected RN staffing through an increase in licensed nurses' patient load and a slight decrease in skill mix. When adjusted for acuity, both RN and licensed nurse patient load increased significantly.

CONCLUSIONS/IMPLICATIONS

These results help explain the perception that hospitals are understaffed. Future research and managerial decision-making should consider the adequacy of licensed nurse staffing, and its impact on cost, performance, and quality.

Practical nurses in elder care and changes in Finnish society - a biographical study

BACKGROUND

Substantial changes in the socio-economic circumstances in Finnish society over the past century have resulted in major changes in the case of older people, and in the status of nursing staff who care for them.

AIM

The purpose of this study was to describe and analyse the work of practical nurses in elder care through the experiences and life cycles of two practical nurses with a long working experience.

METHODS

The data consisted of oral biographical narratives produced by the two nurses in repeated interviews. The data were analysed using inductive content analysis.

FINDINGS

The following chronological stages and periods of the work of the informants emerged as the core themes of elder care: (1) Collective institutionalized care in the 1950s-1970s: The lowest caste in training, obedient subordinates, undemanding service and routine work; (2) Elderly orientated institutionalized care in the 1980s and 1990s: From subordination to co-operation as an experienced nurse, recognizing the specific qualities of the elderly; (3) Prospects of elder care from the 1990s onwards: Returning to custodial care?

CONCLUSIONS

The themes are related to the more general changes that have taken place in Finnish society and health care. The future prospects of practical nurses seem challenging because the principles of social work and health care in Finnish society have shifted from institutionalization towards community care. As a consequence, practical nurses are required to have higher qualifications.

Contemporary enrolled nursing practice: Opportunities and issues

Over the last decade, Australia, as with the rest of the developed world, has experienced a widespread labour market decline in the numbers of nurses in the health workforce. Concurrent with this nursing shortage, the second level nurse has, in many countries, ceased to be recognised as a legitimate nursing role. In Australia, recent research indicates that the enrolled nurse role, though contentious, is consolidating as a core component of the health care workforce. This paper reports on national research that examined the role and function of the enrolled nurse in Australia and reviewed the Australian Nursing Council Inc (ANCI) National Competency Standards for Enrolled Nurses. Specific issues related to the contemporary role and function of enrolled nurses, namely supervision, scope of practice and education, are also discussed.

Nurse Responses to Re-tooling Practice, Education, and Management Roles

BACKGROUND

The purpose of this article is to report the results of a survey conducted by one of the nine Area Health Education Centers in North Carolina to inform regional work force planning by ascertaining nurses' views of the need to re-tool for practice, education, and management roles.

METHOD

A work force planning group represented by nursing service and education surveyed 1,050 nurses. Four hundred thirty-two (41%) nurses responded: 87% believed they needed to re-tool and 92% were willing to do so.

RESULTS

Critical thinking was rated as very important to nurse managers, staff RNs, and LPNs, and educators rated teaching as the area most in need of re-tooling.

CONCLUSION

Nurses are clearly interested in re-tooling. Staff development, continuing education, and degree programs can respond to this willingness.

Have enrolled nurses just been reinvented?

The Ashworth branch of the RCN is petitioning this year's RCN Congress to establish a category of membership that will enable healthcare assistants with nursing related S/NVQs, at level 3 and above, to become members of the RCN. As healthcare assistants comprise an everincreasing part of healthcare teams it is easy to understand how they might wish to establish a group identity and gain formal recognition for their contribution to the provision of direct care to patients. Membership of the RCN might be perceived as helping this process. In addition, the benefits of membership of a trade union familiar with the needs and difficulties of those in caring roles might well appear attractive.

[A study of nursing systems in transition in developed countries]

The present study was designed to investigate nursing systems in other countries in comparison with the current system in Japan, and thereby assess how nursing personnel should be in order to improve the quality of nursing. The study focused on the actual situation of the nursing system and licensed practical nurses (LPNs) or second-level nurses similar to LPNs in other countries. The survey was conducted in regard to six countries considered to be advanced in the development of nursing activities and likely to provide useful suggestions for the future direction of nursing in Japan: Australia, Canada, France, Sweden, the United Kingdom and the United States. Questionnaires were sent to the heads or staff of a total of 29 organizations, including WHO Collaborating Centers and professional organizations for nursing, in these countries. Nineteen organizations responded (response rate: 65.5%), and an effective response with completed questionnaire forms was obtained from 15 organizations. In addition, an interview survey was conducted on three nursing administration and education experts in the United States in order to acquire clear understanding of the actual state of nursing in health care practice. The results were as follows: 1. Six countries (Japan included) excluding France had LPNs. Educational preparation for LPNs has been discontinued in the United Kingdom. 2. The number of nurses per 1,000 population was lowest in Japan: the total number of registered nurses (RNs) and LPNs in Japan was less than the number of RNs in the United Kingdom. Only in Japan the proportions of LPNs and RNs were similar, while in other countries of number of LPNs was one-third to one-fourth of the number of RNs. 3. In the five other countries having LPNs, the nurse's competency or scope of practice was clearly defined for both LPNs and RNs. In contrast, no clear line was drawn between the two in Japan. 4. The length of education required for LPNs ranged from 11 to 14 years (including the period of compulsory education) and was shortest in Japan (11 years). The educational requirement for admission to LPN school in Japan was 9 years of compulsory education (graduation from junior high school), whereas in other countries it was at the level of senior high school graduation. 5. Four countries had conversion programs for LPNs to become RNs, and the conversion courses were positioned within the framework of higher education comparable to the university level. 6. In the United Kingdom, where the educational preparation for LPNs has been discontinued, nurses are included in a single higher level profession. At the same time there was found to be a need to train and educate auxiliary personnel in order to maintain multi-level care services. Because of the increasing tendency toward advanced medical technology and highly specialized medical care associated with the rapidly increasing care needs in the community, the current educational preparation for LPNs in Japan in unsatisfactory as a training and educational system for nursing manpower to cope with the current situation. The above findings suggest that the education system for LPNs be reviewed with a view to discontinuing it and consolidating nursing education in Japan.

Enrolled nurses: where do they go from here?

This paper reviews the circumstances which have affected the development of and change in the role and status of enrolled nurses. Factors which have contributed to the drive to provide conversion pathways for enrolled nurses are examined and current opportunities are described. The paper highlights prospects for newly converted enrolled nurses and for those who do not wish to convert and argues that both groups continue to have educational and professional status needs which must be recognized and taken account of.