Israel-team nursing in public health: Part 2. Practice and opinions on the use of auxiliaries in eight selected United States public health agencies

Abstract

Abstract Eight United States public health agencies employing practical nurses and aides, and representing different programs and types of agencies, were selected in order to learn of their experiences and opinions in the use of auxiliaries in public health. Fifty-three persons, including directors, supervisors, professional staff nurses, practical nurses, and aides, were interviewed individually and confidentially. The responses indicated that all eight agencies were presently employing or were considering the employment of both practical nurses and aides. Auxiliaries were first employed in the agencies because of a conviction of their role in public health, and because of staff shortages. The turnover of practical nurses and aides was very low. Comprehension of agency objectives and services lessened with decreasing responsibility and preparation of the nursing staff. The ratio of professional nurses to auxiliaries varied greatly from agency to agency, with apparent satisfaction with the status quo in most agencies. Those agencies with a higher proportion of auxiliaries seemed more ready to experiment in new areas of service. Suggested criteria for selection of practical nurses were: graduation from a practical nursing school and high school, interpersonal skills, and hospital experience. Intellectual skills, responsibility, and initiative were rarely mentioned. Criteria for selection of aides were similar. Criteria for the assignment of practical nurses covered a wide variety of services and procedures, with differences between the agencies. Criteria for the assignment of aides concentrated on nonnursing and assisting activities. Expansion of activities suggested by interviewees was practiced in at least one agency, with apparent success. Supervision of practical nurses, as reported, placed the onus of recognition and reporting of problems on the practical nurse. Orientation to a new patient consisted primarily of the description of the patient and procedures for his care. Follow-up was done by casual office contact and intermittent public health nurse visits to the patient. Some agencies were planning regular team conferences. Supervision of aides was accomplished by visits of a public health nurse or supervisor, and telephone contacts. The public health nurse emerged as the major source of supervision to both auxiliary groups. Contributions of auxiliaries primarily were better utilization of public health nurses, and meeting service needs. Orientation for practical nurses and aides was viewed as important in all agencies. In-service education was planned in all agencies for the practical nurse, with participation in all or part of the public health programs. When programs were open to both professional and practical nurses, it appeared to improve morale among the group of practical nurses. Attitudes of the professional nurse and the auxiliary to each other were reported as excellent or good by 90 per cent of the interviewees. Concepts of team nursing in public health focused on different levels of nursing personnel working harmoniously together, with a public health nurse leader, to provide improved patient care. Recommendations to an agency about to employ auxiliaries were concerned with involving all concerned in preplanning, providing orientation and continuing education to all levels, careful selection of auxiliaries, and the promotion of good communication and high morale.