Experiences Of Registered Nurses Research Articles

The experiences and perceptions of rural and remote nurses who provide care to pregnant women in the absence of midwives.

Maternity unit closures in rural and remote settings of Australia have left a substantial gap in services for pregnant women. In the absence of midwives, and when women are unable to attend a maternity facility, registered nurses (RNs) are required to fill the void. While maternity education can attempt to prepare RNs for such encounters, there is little documented to suggest it meets all their physical and psychological needs. The existing challenges for health professionals, practising a vast generalist scope of practice while living and working in a rural and remote location, have been well researched and documented. How nurses feel about the expectation that they work outside their scope of practice to provide maternity care in a rural and remote setting in Australia has not been asked until now. This study explores the perceptions and experiences of RNs who find themselves in this situation. The study utilised a hermeneutic phenomenological methodology to examine the experiences and perceptions of rural and remote nurses providing care for pregnant women. RNs working in rural and remote health facilities that had no maternity services were recruited by a purposive sampling method. Semistructured conversational interviews were recorded and transcribed verbatim. Data analysis was guided by van Manen's analytical approach. Eight nurses participated, and from the data three themes, each with several subthemes, emerged: 'being-in-the-world of the rural and remote nurse' - described how participants viewed rural and remote nursing as an entity with unchangeable aspects that could not be considered in isolation; 'scope of practice - unprepared or underprepared' described how, despite their existing and extensive nursing skills, participants felt ill-equipped theoretically, practically and mentally to care for pregnant women; 'moral distress' - participants expanded their feelings of unpreparedness to include inadequacy, fear, and appropriateness of care delivery. The realism of rural and remote nursing practice demonstrates that at some point in their career, rural and remote nurses will care for a labouring and/or pregnant woman at high risk for complications. Participants in this study appeared open and honest in their interviews, displaying pride at their extensive nursing skills and job satisfaction. However, they were unanimous in their discussions of what being a nurse and providing maternity care in a rural and remote setting meant to themselves and to pregnant women. They suggested care was fragmented and inadequate from a workforce that is inadequately prepared and stressed. This study has highlighted another concerning aspect of rural and remote midwifery care - the experiences and perceptions of eight nurses delivering care that has previously been overlooked. The united voice of the RNs in this study warrants a platform to speak from and deserves acknowledgement and attention from government and midwifery policy drivers. These nurses, and the women receiving their care, deserve more.

Factors influencing non-conveyance care encounters in the ambulance service, registered nurses experiences - a qualitative study

BackgroundThere is a notable variation in the percentage of non-conveyed patients within the ambulance service. Discharging patients at the scene includes a risk of adverse events, and both patients and ambulance clinicians experience the complexity of non-conveyance. Therefore, this study aimed to describe factors influencing the care encounter when care in the ambulance service concludes with non-conveyance.MethodA qualitative study design employing the critical incident technique for data collection through individual interviews, and a qualitative analysis based on Fridlund et al. descriptions was utilized. The study conforms to the COREQ checklist for reporting qualitative research.ResultsFourteen Registered Nurses (RN) described 30 incidents and various factors were identified as influencing the care encounter. The factors included communication, sharing information, maintaining a secure and confident approach, organizational aspects, applying person-centered care in collaboration with the patient, relatives, and other caregivers, and an overall understanding of the patient’s entire situation. These factors were integrated into the RNs’ decision-making process for non-conveyance.ConclusionThe decision-making process for non-conveyance by RNs is a multifaceted approach that incorporates several factors. Communication, sharing of information, maintaining a secure and confident approach, organizational aspects, applying person-centered care in collaboration with the patient, relatives, and other caregivers, and a comprehensive understanding of the patient’s entire situation. These findings have the potential to contribute to the development of guidelines supporting the RNs working in the ambulance service in their decisions regarding non-conveyance. Further research is needed on the patient’s and relatives’ perspective on non-conveyance otherwise, patient participation and partnership in person-centered care are not possible to achieve.

Self-efficacy in Quality Improvement Competency of Frontline Acute Care Registered Nurses.

Registered nurses (RNs) are attuned to health care quality and safety concerns but may lack competency in quality improvement (QI) to advance care quality. To describe frontline acute care RNs' self-efficacy in QI competencies, evaluate differences based on educational attainment, and evaluate relationships based on years of RN experience. The study used a descriptive, quantitative, correlational, comparative cross-sectional survey design to evaluate RNs' self-efficacy in QI competency using the 2021 American Association of Colleges of Nursing The Essentials : Core Competencies for Professional Nursing Education . Frontline RNs' overall QI self-efficacy showed variability in knowledge, skills, and attitudes, with no relationship between self-efficacy and years of RN experience, nor difference based on educational attainment. Insufficient self-efficacy signals the need for further QI focus in nursing education, nursing practice, and health care policy to harness RNs' ability to advance care outcomes.

Facilitators and barriers to the transition from registered nurse to nurse practitioner in Canada.

Understanding factors that affect integration of NPs is likely to address barriers and provide reform strategies that shape a cost-effective, sustainable, accessible, and efficient health care system. There are a limited number of current and high-quality studies examining the transition process of registered nurses (RNs) to nurse practitioners (NPs), especially in Canada. To explore the experiences of RNs transitioning to NPs in Canada. Thematic analysis of audio-recorded semi-structured interviews was conducted to explore the experiences of 17 RNs as they transitioned to NPs. A purposive sampling of 17 participants was completed in 2022. Six main themes emerged from analysis of 17 interviews. The content of themes varied according to NPs' years of experience and the NP school they attended. Peer support and mentorship programs were facilitators in the transition from RN to NP. Conversely, shortcomings in education, financial stressors, and the lack of NP role definition were seen as barriers. Legislation and regulations supportive of NPs, diverse and comprehensive education, and improved availability of mentorship programs may strengthen transition facilitators and help NPs overcome related barriers. Legislation and regulations supportive of the NP role are needed, focusing on defining the NP role and establishing an independent and consistent remuneration structure for NPs. A more in-depth and diversified educational curriculum is needed, with increased support from faculty and educators and continual encouragement of initiation and perpetuation of peer support. A mentorship program is beneficial to reduce transition shock from the role of the RN to the NP.

Left behind: Exploring the concerns of emergency department staff when personnel are utilised for inter-hospital transfer

BackgroundInter-Hospital Transfer (IHT) may require an escort from the referring hospital, either a Registered Nurse (RN), physician or both, leading to a sudden drop in staffing levels within the referring department potentially increasing risk to patients and staff. AimsTo explore the perspectives of RNs and physicians of differing experience levels when left behind due to an escorted IHT, and the decision-making protocols for IHT. MethodA qualitative exploratory approach of 5 RNs and 4 physicians selected using purposeful sampling. Data were collected through semi-structured interviews and thematically analysed.Findings: Five themes were identified: the impact of being left behind; the burden of transfer; missed care; a triangulation of competing needs upon the decision-making process; and the effect of inter-hospital transfers on staff with different experience levels. ConclusionIHT is described differently by less experienced RNs compared to their more experienced counterparts especially concerning safety and risk. Physicians described the department as vulnerable with ad-hoc decision-making protocols surrounding IHT the norm.

Education Regarding Opioid Prescribing, Opioid Tapering, and Medical Assistance in Dying (MAiD) for Nurse Practitioner Students Using Virtual Simulation Games: A Pilot Study

BackgroundChanges to Canadian government regulations allow nurse practitioners (NP) to prescribe controlled substances and participate in Medical Assistance in Dying (MAiD). MethodA single-day pilot study with 13 NP students was completed to improve knowledge, comfort, and confidence regarding opioid prescribing, tapering, and MAiD. There were three virtual simulation games (VSG): (a) opioid prescribing, (b) opioid tapering, and (c) a patient request for MAiD. Participants completed pre- and postquizzes and self-assessments, rating themselves as novice, intermediate, or competent learners. ResultsParticipants' registered nurse (RN) experience ranged from 3 to 18 years (M = 5.88). Age, gender, and years of RN experience were predictors of improved scores between pre- and postopioid quizzes. In the MAiD scenarios, no participants felt they remained novice learners. Intermediate and competent ratings increased by 60.0% and 37.04%, respectively. Novice to intermediate ratings increased by 12.73%, intermediate to competent by 18.18%, and novice to competent by 1.82%. ConclusionThe VSGs developed and pilot-tested provided a valuable learning experience for students.

Interprofessional Gratitude: Partnering With Registered Nurses as Embedded Participants in a Medical Education Patient Death Simulation Experience

BackgroundEmbedded participants (EPs) are non-learners trained to specific roles in simulation encounters. EPs contributing to specialized simulations may require unique skills. Partnering with health care providers with competencies complementary to desired EP roles is a possible way to address this need. Our team partnered with registered nurses (RNs) as EPs in a simulation in which the objective was for medical students to experience a imulated death in a supported environment. In this qualitative descriptive study, we address: What are medical students’ reactions to experienced RNs partnering as EPs during a simulation about the death of a patient? MethodsTwo hundred seventy-seven preclinical, second-year medical students wrote written reflections that were thematically analyzed with high levels of interrater reliability. ResultsStudents expressed gratitude for RNs partnering as EPs, described by subthemes of gratitude for nursing leadership, team-based medical care, and processing opportunities. ConclusionsRNs partnering as EPs effectively guided medical students through a patient death simulation. Simulationists should seek ways to leverage the deep, varied skill set of experienced RNs to partner as EPs in specialized medical education simulation.

Getting Familiar With the Nurse Practitioner Role: Reflection From an International Practicum

This is a reflection on a 2-month international practicum at the Bassett Medical Center as part of my elective course during my final semester of graduate school at the Zurich University of Applied Sciences. The transition from being a registered nurse (RN) to being a competent nurse practitioner (NP) presents challenges such as adapting to the new role as an experienced RN to an aspiring NP, learning about the role of autonomy, and new responsibility for patients, and fully executing the NP role. This means that becoming familiar with the role of an NP with a focus in cardiology is, in my case, of particular importance. To overcome this uncertainty, I chose an international clinical placement in a country with experienced NPs to build up knowledge for transitioning from RN to NP, professional development, and self-assurance.

Systemic barriers and facilitators to the transition of registered nurse to nurse practitioner in Canada: A scoping review.

The scope of practice of nurse practitioners (NPs) is expanding, and an increasing number of registered nurses (RNs) are advancing their careers to become NPs. Nurse practitioners are prepared to improve access to high-quality care and enhance care standards. The barriers and facilitators in the transition of RNs to NPs have been seldom studied in the Canadian context. To conduct a scoping review to identify systemic barriers and facilitators affecting Canadian RN experience in transitioning to independent practice as NPs. Four electronic databases were searched for primary studies, and several search engines were used to retrieve gray literature. Keywords included NP, transition, novice, Canada, barriers, obstacles, facilitators, and their variations. Eligible studies are those published from the inception of each respective database to 2021. Four research studies and one report in the gray literature were located. Three themes were identified from the literature review, including inconsistencies in education and the need for mentors, need for legislation supportive of NP practice, and inconsistent remuneration structures for NPs. Addressing systemic barriers and employing systemic facilitators are likely to facilitate the transition of RNs to NPs. The lack of primary evidence to explore the factors that affect the transition process from an RN to an NP in Canada indicates that further research must be done. Findings from the future research are likely to furnish a better understanding of the transition process so that the integration of new NPs into the health care system can be achieved efficiently.

Educators’ Perceptions of the Development of Clinical Judgment of Direct-Entry Students and Experienced RNs Enrolled in NP Programs

<h3>Background</h3> Nurse practitioner (NP) education was originally reserved for experienced nurses, but it has gradually opened to nurses with little to no clinical experience at the registered nurse (RN) level as well as to non-nurses. The existence of multiple paths to NP training and practice raises questions about the role of generalist RN experience in learning clinical decision-making and other aspects of the NP role. <h3>Purpose</h3> To describe educators' perceptions of the role of prior nursing experience in the development of clinical judgment during NP graduate education. <h3>Methods</h3> In this qualitative descriptive study, 27 NP faculty from four universities participated in individual interviews. Transcripts were analyzed using a thematic approach. <h3>Results</h3> According to participants, previous nursing experience—or any relevant experience—can either be helpful or detrimental in the development of NP students' clinical judgment. Three themes were generated: variations in students' baseline knowledge and skills, different frames of reference to grasp new content and skills, and challenges related to professional identity. In addition, participants described factors that they believe can affect the impact of different types of experience. <h3>Conclusion</h3> Students with and without prior nursing experience face distinct challenges in learning NP-level clinical decision-making and judgment, but they reach similar end-of-program competence. Educators are confronted with contradictions between generally held wisdom, their professional socialization, and first-hand observations regarding the role of experience (inside and outside nursing) in preparing students to become NPs.

Unobserved Observers: Nurses' Perspectives About Sharing Feedback on the Performance of Resident Physicians.

Postgraduate training programs are incorporating feedback from registered nurses (RNs) to facilitate holistic assessments of resident performance. RNs are a potentially rich source of feedback because they often observe trainees during clinical encounters when physician supervisors are not present. However, RN perspectives about sharing feedback have not been deeply explored. This study investigated RN perspectives about providing feedback and explored the facilitators and barriers influencing their engagement. Constructivist grounded theory methodology was used in interviewing 11 emergency medicine and 8 internal medicine RNs at 2 campuses of a tertiary care academic medical center in Ontario, Canada, between July 2019 and March 2020. Interviews explored RN experiences working with and observing residents in clinical practice. Data collection and analysis were conducted iteratively. Themes were identified using constant comparative analysis. RNs felt they could observe authentic day-to-day behaviors of residents often unwitnessed by supervising physicians and offer unique feedback related to patient advocacy, communication, leadership, collaboration, and professionalism. Despite a strong desire to contribute to resident education, RNs were apprehensive about sharing feedback and reported barriers related to hierarchy, power differentials, and a fear of overstepping professional boundaries. Although infrequent, a key stimulus that enabled RNs to feel safe in sharing feedback was an invitation from the supervising physician to provide input. Perceived hierarchy in academic medicine is a critical barrier to engaging RNs in feedback for residents. Accessing RN feedback on authentic resident behaviors requires dismantling the negative effects of hierarchy and fostering a collaborative interprofessional working environment. A critical step toward this goal may require supervising physicians to model feedback-seeking behavior by inviting RNs to share feedback. Until a workplace culture is established that validates nurses' input and creates safe opportunities for them to contribute to resident education, the voices of nurses will remain unheard.

Nurse-led normalised advance care planning service in hospital and community health settings: a qualitative study

BackgroundAdvance Care Planning (ACP) by Registered Nurses (RNs) has been emerging. However, there is limited understanding about what RNs experience as they incorporate ACP into their practice. This study aimed to elicit the experiences of ACP RNs with the implementation of a normalised ACP (NACP) service in hospital and community care settings.MethodsA qualitative descriptive study invited four ACP RNs who delivered a nurse-led NACP for a 6 months duration at two hospital and two community health care settings in New South Wales (NSW), Australia. The experiences of the ACP RNs were captured through a semi-structured interview and weekly debriefing meetings. The interview recordings were transcribed verbatim and the minutes of weekly debriefing meetings were utilized. Data were analysed by two independent researchers using thematic analysis with the Normalisation Process Theory (NPT) as a methodological framework.FindingsThe ACP RNs were females with a mean age of 43 years old. Their nursing experiences ranged 2 to 25 years but they had minimal experiences with ACP and had not attended any education about ACP previously. The following four themes were identified in the experiences of the ACP RNs; 1) Embracing NACP service; 2) Enablers and barriers related to patients and health professionals; 3) Enablers and barriers related to ACP RNs; and 4) What it means to be an ACP RN.ConclusionThe introduction of a NACP service into existing clinical systems is complex. The study demonstrated the capacity of RNs to engage in ACP processes, and their willingness to deliver an NACP service with a raft of locally specific enablers and barriers.Trial registrationThe study was retrospectively registered with the Australian New Zealand Clinical Trials Registry (Trial ID: ACTRN12618001627246). The URL of the trial registry record

Developing an immersive virtual reality medication administration scenario using the nominal group technique

AimThis paper aims to describe how the Nominal Group Technique was applied to obtain focused content to develop medication administration error scenarios for future use to educate practicing RNs with immersive virtual reality simulation. BackgroundIn the United States, medication errors account for up to $46 million in daily loss to hospital operational budgets. Each phase of prescribing, dispensing, administration, monitoring, and reconciliation is crucial in reducing potentially life-threatening outcomes associated with medication errors. Registered Nurses are responsible for safely administering diverse classifications of medications to patients in various healthcare settings. However, human and system factors can contribute to the exposure of hospitalized patients to a medication error. Virtual reality simulation-based education can be a methodology to educate practicing Registered Nurses on safe medication practices. DesignA Nominal Group Technique process was used to generate consensus from participating Registered Nurses on human and system factors that can contribute to medication administration errors. MethodsThe process consisted of (a) preparation, (b) running the group with an introduction of the subject, (c) generation of ideas, (d) listing of ideas, (e) discussion of ideas, (f) ranking of top ideas, (g) voting on top ideas, (h) discussion of the vote outcome, and (i) re-ranking and rating the top items. Human and system factor idea items encompassed medication errors during ordering, prescribing, or administering medications. Both novice and experienced Registered Nurses rank-ordered these factors as those most likely to encounter or which would most likely occur during one working shift. ResultsDescriptive statistics of frequencies and percentages were used to analyze the findings when grouped by human and system factor categories. Non-parametric testing with a Kruskal-Wallis test was conducted to compare the human and system factors by categories and years of Registered Nurse experience. Findings revealed that the factors of Time Management: getting behind, hurried, urgent (KW-H 11.2, df 4, p = .025) and Right Medication: medications have similar look and sound-alike names (KW-H 11.1, df 4, p = .025) impacted safe medication administration for both the novice and experienced nurse. ConclusionThe NGT process identified human and system factors contributing to errors and impacting safe medication administration practices. Findings will support the creation of medication administration scenarios for use with immersive virtual reality simulation.

Milestones in the journey: The story of refugees becoming registered nurses in Australia.

To explore the experiences of refugees who became registered nurses after arriving to Australia. Qualitative description using a naturalistic inquiry framework. Between February 2018 and September 2019, the lead author conducted semi-structured interviews with employed registered nurses (RNs) that are former refugees and English-speaking. Interviews were 45-90min' duration and digitally recorded. Participants provided voluntary informed consent and were sent questions beforehand. Data were collected and coded into themes. Rigor was achieved with multiple transcript readings by the research team to confirm common themes. Twelve participants discussed their story. Three major themes were identified: (1) Milestone of being a refugee; (2) Milestone of resettling in Australia; (3) Milestone of becoming a RN. Each participant's story started at a place of disadvantage. They progressed successfully through the three milestones; despite living with traumatic experiences, they learned new skills, developed English literacy, became a RN and juggled the demands of life. This paper highlights the poorly understood pockets of the current Australian RN workforce. The nuanced stories of RNs with refugee backgrounds in this study move beyond trauma and struggle and demonstrate the important journey this particular group of health professionals undertake. Increasing the contextual knowledge of the complex lives of former refugees turned nursing professionals will raise public awareness of the diversity of life experiences of RNs working in Australia.

From imperialism to inpatient care: Work differences of Filipino and White registered nurses in the United States and implications for COVID-19 through an intersectional lens.

In the United States, nursing is the largest healthcare profession, with over 3.2 million registered nurses (RNs) nationwide and comprised of mostly women. Foreign‐trained RNs make up 15 percent of the RN workforce. For over half a century, the U.S. healthcare industry has recruited these RNs in response to nurse shortages in hospitals and nursing homes. Philippines‐trained RNs make up 1 out of 20 RNs in this country and continue to be the largest group of foreign‐trained nurses today. Recently, the news media has publicized the many deaths of Filipino RNs as a result of the COVID‐19 pandemic in the United States. Given the imperial historical ties between these two countries in the context of the nursing profession and the enduring labor inequities that persist, this nationally representative study is one of the few to our knowledge to not only quantitatively examine the current work differences in characteristics and experiences of Philippines‐trained RNs and U.S.‐trained white RNs practicing in the United States today, but to also do so from an intersectionality lens. The overall aim of this paper is to illuminate how these differences may serve as potential factors contributing to the disproportionate number of Filipino nurses' COVID‐19 related vulnerability and deaths in the workplace.

Experiences of Registered Nurses in the Transition to Healthcare Professionals: A Study from Military and Civilian Hospitals in Saudi Arabia

Registered nurses (RNs) often experience substantial job dissatisfaction and stress during the transition from a student to a healthcare professional. However, multicenter studies in this area are limited, and little is known whether the transition experience of RNs in a military hospital (MH) is different from that in civilian hospitals (CH). This study presents a multicenter survey on the transition experiences of RNs and compares of transition experiences of RNs in CH and MH. A multicenter survey was conducted in military and civilian hospitals in Saudi Arabia, using a modified version of the validated Casey-Fink Graduate Nurse Experience Survey. In the survey, 278 RNs participated. Of these, 71.2%were under 25 years of age, and 56% were women. Approximately 36% of the respondents were from MH. A majority of RNs (89.9%) cited fears related to patients' safety as a difficulty in the successful transition. When compared with RNs from CH, a higher number of RNs from MH believed that improved orientation could be a support in transition (OR: 2.05, 95% CI 1.23-3.43, P=0.008); conversely, a significantly lower number of respondents from MH believed that an improved work environment could be a support in transition (OR: 0.30, 95%CI 0.16-0.55, P=0.001). Most RNs consider their fear for patients’ safety as a difficult aspect of their transition experience. RNs in MH and CH have a different perception of the least satisfying aspect of their job. Keywords: Transition experience, nurses, orientation, and work environment DOI: 10.7176/JBAH/11-6-03 Publication date: March 31 st 2021

Relational Quality of Registered Nurses and Nursing Assistants: Influence on Patient Safety Culture.

Registered nurses (RNs) working within acute care hospitals have an incredible responsibility to provide safe care in a complex environment which requires trust, teamwork, and communication. Nursing assistants (NAs) play a critical role in working with RNs to meet these growing demands of inpatient care. Minimal evidence exists exploring the relational quality between RNs and NAs within hospitals. The aim of this study is to explore RN and NA behaviors and experiences that promote patient safety and teamwork and enhance communication between RNs and NAs within the hospital environment. Qualitative analysis was used, with two focus groups which included six participants within each group (three RNs and three NAs) from two separate inpatient units. Transcripts were reviewed and coded for themes. Collaborative teamwork and two-way communication were commonly reported as behaviors that promote patient safety. Trust between RNs and NAs was identified as a key component of positive relationships between RNs and NAs. Participants identified four common behaviors that build trust, which were accountability, effective conflict resolution, collaborative teamwork, and prioritizing patient needs. Finally, teamwork was identified as a common strategy to increase communication effectiveness between RNs and NAs. High relational quality (RQ) between the RN and NA is an important component of teamwork and patient safety culture.

Associations of 4 Nurse Staffing Practices With Hospital Mortality.

Cross-sectional studies of hospital-level administrative data have suggested that 4 nurse staffing practices-using adequate staffing levels, higher proportions of registered nurses (RNs) (skill mix), and more educated and experienced RNs-are each associated with reduced hospital mortality. To increase the validity of this evidence, patient-level longitudinal studies assessing the simultaneous associations of these staffing practices with mortality are required. A dynamic cohort of 146,349 adult medical, surgical, and intensive care patients admitted to a Canadian University Health Center was followed for 7 years (2010-2017). We used a multivariable Cox proportional hazards model to estimate the associations between patients' time-varying cumulative exposure to measures of RN understaffing, skill mix, education, and experience, each relative to nursing unit and shift means, and the hazard of in-hospital mortality, while adjusting for patient and nursing unit characteristics, and modeling the current nursing unit of hospitalization as a random effect. Overall, 4854 in-hospital deaths occurred during 3,478,603 patient-shifts of follow-up (13.95 deaths/10,000 patient-shifts). In multivariable analyses, every 5% increase in the cumulative proportion of understaffed shifts was associated with a 1.0% increase in mortality (hazard ratio: 1.010; 95% confidence interval: 1.002-1.017; P=0.009). Moreover, every 5% increase in the cumulative proportion of worked hours by baccalaureate-prepared RNs was associated with a 2.0% reduction of mortality (hazard ratio: 0.980; 95% confidence interval: 0.965-0.995, P=0.008). RN experience and skill mix were not significantly associated with mortality. Reducing the frequency of understaffed shifts and increasing the proportion of baccalaureate-prepared RNs are associated with reduced hospital mortality.

Altruism and the Difficult Patient.

For some nurses, providing altruistic care to difficult patients is a challenge, leading to the use of negative coping strategies such as anger or avoidance, leaving the nurse frustrated and patients feeling rejected. Yet other nurses can deal positively with difficult patients. To study how the stress of caring for difficult patients affects the level of altruism and use of negative coping strategies in their care and to find out what positive coping strategies and interventions could be used. A mixed-methods design was used. A survey tested the level of altruism, the use of negative coping strategies, and several demographics. Thematic analysis examined narratives generated by participants to three questions regarding how to provide altruistic care to difficult patients. A purposive sample of 67 registered nurses (RNs) participated. The average level of altruism used by RNs with difficult patients was 99.7/120 points. An inverse relationship was found between the level of altruism and use of negative coping strategies (r = -0.577, p < .001). Qualitative analysis of narratives identified three themes-Developing Psychological Hardiness, Bearing Witness, and Fending for Oneself. This study provides insight into the experiences of RNs caring for difficult patients and how to ensure altruistic caring.

Enhancing nurses’ future role in antimicrobial stewardship

BackgroundAntimicrobial stewardship (AMS) requires a multidisciplinary approach to address the global emergence of antimicrobial resistance (AMR). Nurses have potential roles to influence appropriate antibiotic use. ObjectiveThe objective of the study was to investigate knowledge of registered nurses (RNs) on antibiotics, AMR and their understanding of AMS. DesignA cross-sectional survey design was used. Participants and SettingParticipants were RNs from the greater Auckland region of New Zealand. MethodsQualtrics (Provo, Utah, USA), an online survey tool was used to collect data for a three-month period. Descriptive and inferential data was analysed using IBM® SPSS® Statistics version 23. Statistical significance was established at P ≤ 0.05. ResultsTwo hundred and ninety-eight (N = 298) respondents completed the survey. The majority rated having ‘average’ knowledge of antibiotics and generally of AMR. Lack of knowledge about AMS (211/298, 71%) was viewed as the most challenging factor in integrating AMS in clinical practice. The majority (251/298, 84%) were unaware of AMS programme being implemented in the workplace despite its presence in major district health boards in Auckland. Educating patients on safe antibiotic use (292/298, 98%) and ensuring that antibiotics are initiated and administered at the correct time (289/298, 97%) were highly viewed as fundamental nursing roles as antimicrobial stewards. Younger nurses had higher expectations for antibiotics to be prescribed by their doctor for the common cold or flu than older nurses (means 2.19/5 and 1.75/5, P = 0.001). Expectations to receive antibiotics for these viral illnesses was also higher among less experienced than the more experienced RNs (means 2.21/5 and 1.64/5, P < 0.001). ConclusionNurses play an essential role in promoting AMS practices. However, a good understanding of antibiotics, AMR and AMS is needed to effectively embed these concepts in clinical practice. Hence, addressing these educational needs is of paramount importance.