Nurses In Alberta Research Articles

Framing Unions and Nurses

Union communication and framing are important for how union members, as well as how unions as organizations, are represented. In the context of declining union density and therefore fewer direct union members, unions’ daily communication material on social media may be one of the most common interactions people have with unions. This case study focuses on United Nurses of Alberta, the union for most registered nurses in Alberta, Canada, where unionization rates are among the lowest in Canada. This case study shows how United Nurses of Alberta uses two collective action frames, nurses-as-distinct and nurses-as-advocates, in their daily communication to members and the public. In creating and promoting these frames, United Nurses of Alberta draws from and pushes against the industrial relations framework under which they operate and the historical narrative of nurses as caring and self-sacrificing, which may reinforce common understandings of nursing and also limit United Nurses of Alberta’s ability to represent their members.

Nursing Role Ambiguity in Alberta: The Impact and Institutional Influences

Increasing health system demands and costs, in an economically strained environment, places extraordinary challenges on Alberta’s workforce planners who continue to address critical gaps. In addition to routine operational planning, unpredictable and often-reactive market demands continuously influence workforce needs. The role and scope of health care providers’, particularly nurses, is constantly evolving which leads to difficulty interpreting their differences. To achieve successful shifts toward team-based collaborative care, alignment of the most appropriate health care provider to patient groups and settings is required. This is challenging when skill sets, and scope are confusing to administrators. Scope changes impact academic programming, regulatory processes and can create confusion and ambiguity for many providers, especially nurses. Role ambiguity among nurses, unabated by key institutions, contributes to inefficiencies and can be potentially harmful to patients. Hence, role ambiguity in nursing creates challenges for employers, educators, regulators, and nurses themselves. Historical reports of role ambiguity pertaining to Alberta nurses do exist however the current state is ambiguous, as are the mitigating strategies. The purpose of this paper is to critically examine the literature that defines role ambiguity, its impact, highlight antecedents and explore the role of key stakeholder institutions best positioned to address the issue in Alberta.

Licenced practical nurses' perceptions of their work environments and their intention to stay: A cross-sectional study of four practice settings.

Aims and objectivesThis study aimed to understand how licenced practical nurses perceive their work environments across different work settings and to analyse the association between these nurses’ perceptions of their work environments and their intentions to stay employed at their current nursing unit.DesignA cross‐sectional descriptive survey was conducted with Licensed Practical Nurses in Alberta, Canada.MethodsThe study population consisted of 598 licenced practical nurses. Survey measures included demographic information, the Perceived Work Environment‐Nursing Work Index, and an intention to stay scale. Descriptive statistics were calculated and mean scores for perceptions about the work environment were compared by work setting. The associations between perceived work environment and intention to stay were analysed using linear regression.ResultsOverall, licenced practical nurses rated their work environment as mixed, with statistically significantly lower scores in acute care settings. Nurse manager ability and adequate staffing and resources were the highest contributing variables.

Leader empowering behaviour: relationships with nurse and patient outcomes

PurposeThis study aims to test a model examining the impact of leader empowering behaviour on experienced nurses’ self-efficacy, interprofessional collaboration, job turnover intentions and adverse patient outcomes.Design/methodology/approachStructural equation modelling in Mplus was used to analyse cross-sectional survey data from experienced nurses in Alberta, Ontario, and Nova Scotia, Canada (n = 478).FindingsThe results supported the hypothesized model: (164) = 333.021, p = 0.000; RMSEA = 0.047; CFI = 0.965; TLI = 0.959; SRMR = 0.051. Indirect effects were observed between leader empowering behaviour and nurses’ assessment of adverse events and leader empowering behaviour and nurses’ job turnover intentions through interprofessional collaboration.Research limitations/implicationsLeader empowering behaviour plays a role in creating collaborative conditions that support quality patient care and the retention of experienced nurses.Practical implicationsThe findings will be of interest to academic and hospital leaders as they consider strategies to retain experienced nurses, such as nurse manager selection, development and performance management systems.Originality/valueThe influx of new graduate nurses to the nursing profession and changing models of care requires the retention of experienced nurses in the workforce. The findings suggest that leader empowering behaviour and interprofessional collaboration are important factors in supporting quality patient care and stabilizing the nursing workforce.

“You Had To Just Kind Of Rub Her Cheek”: Memories and Emotions of Mental Deficiency Nurses in Alberta, Canada, 1945 - 1975

Mental deficiency nursing evolved as a distinct, yet little known field of nursing education and practice in several countries during the twentieth century. In Canada it became a separate area of nursing in only one of its provinces, Alberta, and it was tied to one large institution, called the Provincial Training School for the care of developmentally disabled children and, eventually, also adults. This paper contributes to the history of mental deficiency nursing, currently called intellectual disability nursing, an existing specialty actively practiced in the UK and Ireland for example. Alberta’s program was established in 1933 and continued until 1973. I examine this history through the lens of three mental deficiency nurses’ experiences of their education and work at the institution shared in an oral history interview. These nurses worked in the institution in the period after the Second World War. Their stories provide a unique perspective on a field of nursing work and education that grew increasingly controversial during the latter half of the 20th century when public debate arose over the institutionalization of people with developmental disability. Moreover, the institution’s entanglement within an active eugenics policy and practice maintained in the province of Alberta until 1972 added to the controversy. Their stories provide insight in the perceptions and emotions of mental deficiency nurses, experienced and remembered some sixty years later in an interview. I examine how the nurses took up this work and how their professional identity was depicted and changed, especially as public debate arose from the 1970s onward. The stories provide a unique micro-historical lens to explore larger social and cultural tensions over eugenics, disability, care and dependency, and over mental deficiency nurses’ work. Résumé Les soins infirmiers en déficience mentale ont évolué en tant que branche distincte, mais méconnue, de la formation et la pratique infirmière dans plusieurs pays au cours du 20e siècle. Au Canada, ils sont devenus une discipline séparée des soins infirmiers dans une seule province, en Alberta, et ils ont été liés à une grande institution nommée la Provincial Training School pour les soins aux enfants ayant des déficiences intellectuelles et, éventuellement, aux adultes. Cet article contribue à l’histoire des soins infirmiers en déficience mentale, à notre époque appelés soins infirmiers en déficience intellectuelle, une spécialité existante et activement pratiquée, par exemple, au Royaume-Uni et en Irlande. Le programme en Alberta a été établi en 1933 et s’est poursuivi jusqu’en 1973.

Factors Associated With Canadian Nurses' Informatics Competency.

As digital innovations continue to transform health systems in Canada, it is important to examine registered nurses' preparedness in informatics, and factors associated with informatics competency. An exploratory, descriptive, cross-sectional survey was used to determine self-perceived informatics competencies, and factors associated with competency, among practicing nurses in Alberta. Results from 2844 completed surveys showed that nurses' self-perceived informatics competency was slightly above the mark of competent. Perceptions of competency were highest on foundational computer literacy skills and lowest on information and knowledge management competencies. However, overall informatics competency mean scores varied significantly in relation to age, educational qualification, years of experience, and work setting. The quality of informatics training and support offered by employers contributed the most to variance in mean scores of total and subdomains of informatics competency. Other factors, such as age, educational qualification, work setting, previous informatics education, access to the Internet, use of health technology, access to supporting resources, informatics training, an informatics role, and continuing education in informatics, also contributed to mean scores variance in differing degrees. Findings from this study provide a basis for actionable policies to address informatics educational needs and support requirements among nurses practicing now and in the future.

Development of the Canadian Nurse Informatics Competency Assessment Scale and Evaluation of Alberta's Registered Nurses' Self-perceived Informatics Competencies.

In today's digitally enabled healthcare environment, it is vitally important to assess Canadian nurses' competency in informatics. The researchers developed the Canadian Nurse Informatics Competency Assessment Scale, a 21-item comprehensive measure based on entry-to-practice informatics competencies for registered nurses, to facilitate assessment of informatics competencies and consequent, planning of formal and continuing education in informatics. The Canadian Nurse Informatics Competency Assessment Scale was used in a cross-sectional survey to determine self-perceived informatics competencies for Alberta's practicing nurses. Results from 2844 completed surveys showed that these nurses perceived their overall informatics competency as slightly above the mark of competent. Perceptions of competency were highest on foundational information and communication technology skills, slightly lower on competencies related to professional regulatory accountability and the use of information and communication technologies in the delivery of patient care, and lowest on information and knowledge management competencies. This study shed some light on priority areas for informatics education among practicing nurses in Alberta. Implications for nursing practice and research are discussed.

Information literacy skills and training of licensed practical nurses in Alberta, Canada: results of a survey.

Although information literacy skills are recognized as important to the curriculum and professional outcomes of two-year nursing programs, there is a lack of research on the information literacy skills and support needed by graduates. To identify the information literacy skills and consequent training and support required of Licensed Practical Nurses (LPNs) in Alberta, Canada. An online survey using a random sample of new graduates (graduated within 5years) from the registration database of the College of Practical Nurses of Alberta (CLPNA). There was a 43% response rate. Approximately 25-38% of LPNs felt they were only moderately or to a small extent prepared to use evidence effectively in their professional practice. LPNs use the internet and websites most frequently, in contrast to library resources that are used least frequently. Developing lifelong learning skills, using information collaboratively, and locating and retrieving information are areas where LPNs desire more effective or increased training. The results suggest there are significant gaps in the preparedness and ability of LPNs to access and apply research evidence effectively in the workplace. There are several areas in which the training provided by Librarians appears either misaligned or ineffective.

Conflicts of conscience in the neonatal intensive care unit: Perspectives of Alberta.

Limited knowledge of the experiences of conflicts of conscience found in nursing literature. To explore the individual experiences of a conflict of conscience for neonatal nurses in Alberta. Interpretive description was selected to help situate the findings in a meaningful clinical context. Five interviews with neonatal nurses working in Neonatal Intensive Care Units throughout Alberta. Ethics approval from the Health Research Ethics Board at the University of Alberta. Three common themes emerged from the interviews: the unforgettable conflict with pain and suffering, finding the nurse's voice, and the unique proximity of nurses. The nurses described a conflict of conscience when the neonate in their care experienced undermanaged pain and unnecessary suffering. During these experiences, they felt guilty, sad, hopeless, and powerless when they were unable to follow their conscience. Informal ways to follow their conscience were employed before declaration of conscientious objection was considered. This study highlights the vital importance of respecting a conflict of conscience to maintain the moral integrity of neonatal nurses and exposes the complexities of conscientious objection.

Information and Communication Technology: Design, Delivery, and Outcomes from a Nursing Informatics Boot Camp

Information and communication technology (ICT) is integral in today’s healthcare as a critical piece of support to both track and improve patient and organizational outcomes. Facilitating nurses’ informatics competency development through continuing education is paramount to enhance their readiness to practice safely and accurately in technologically enabled work environments. In this article, we briefly describe progress in nursing informatics (NI) and share a project exemplar that describes our experience in the design, implementation, and evaluation of a NI educational event, a one-day boot camp format that was used to provide foundational knowledge in NI targeted primarily at frontline nurses in Alberta, Canada. We also discuss the project outcomes, including lessons learned and future implications. Overall, the boot camp was successful to raise nurses’ awareness about the importance of informatics in nursing practice.

Health professionals and the vaccine narrative: ‘the power of the personal story’ and the management of medical uncertainty

Some vaccine supporters interpret vaccine uncertainties as a form of public ignorance caused by patients’ online research, failed physician–patient relationships, or inadequate knowledge translation. These interpretations often portray health professionals as homogeneously accepting of all scheduled vaccines for all patients. Nonetheless, health professionals may have limited knowledge about vaccines because the demands of their profession require them to have a broad understanding of a variety of health topics. In this article, I draw on data from interviews with twenty-six physicians and seven nurses in Alberta, Canada between 2013 and 2014, to examine how they used narratives to convey confidence, uncertainty, or doubts in vaccines. All interviewees supported the culturally dominant vaccine narrative that vaccines are essential to population health, yet they also spoke about uncertainties. Interviewees managed their uncertainties through tactics that confirmed accepting vaccination was the most desirable course of action. With each of these tactics, interviewees shared narratives about communicable diseases, vaccine benefits and risks to individual patients, and their reasons for trusting in medical science. When these narratives did not fully resolve medical uncertainties, health professionals often explained that either vaccination was beyond their professional responsibilities or that their uncertainties were irrelevant.

Career Advancement and Educational Opportunities: Experiences and Perceptions of Internationally Educated Nurses

The number of internationally educated nurses is increasing in the Canadian workforce. Recruitment of internationally educated nurses is often seen as a solution to ongoing nursing shortages. However, international recruitment needs to be accompanied by strategies to ensure long-term retention. One of the criteria for successful retention is the availability and accessibility of career advancement and educational opportunities. Little research exists on the opportunities for career advancement and education for internationally educated nurses in Canada. This interpretive descriptive study was conducted to look at the perceptions of internationally educated nurses regarding career advancement and educational opportunities in Alberta, Canada. Eleven internationally educated nurses, working as registered nurses in Alberta, were interviewed using semi-structured interviews. Five themes were identified: motherhood as a priority, communication and cultural challenges, process of skill recognition, perceptions of opportunity and need for mentorship.

Alberta: Evaluation of Nursing Retention and Recruitment Programs

Retention and recruitment strategies are essential to address nursing workforce supply and ensure the viability of healthcare delivery in Canada. Knowledge transfer between experienced nurses and those new to the profession is also a focus for concern. The Multi-Employer/United Nurses of Alberta Joint Committee attempted to address these issues by introducing a number of retention and recruitment (R&R) initiatives for nurses in Alberta: in total, seven different programs that were introduced to some 24,000 nurses and employers across the province of Alberta in 2001 (the Transitional Graduate Nurse Recruitment Program) and 2007 (the remaining six R&R programs). Approximately 1,600 nurses participated in the seven programs between 2001 and 2009. Of the seven strategies, one supported entry into the workplace, two were pre-retirement strategies and four involved flexible work options. This project entailed a retrospective evaluation of the seven programs and differed from the other Research to Action (RTA) projects because it was solely concerned with evaluation of pre-existing initiatives. All seven programs were launched without a formal evaluation component, and the tracking of local uptake varied throughout the province. The union and various employers faced challenges in implementing these strategies in a timely fashion, as most were designed at the bargaining table during negotiations. As a result, systems, policy and procedural changes had to be developed to support their implementation after they became available.Participants in the programs indicated improvements over time in several areas, including higher levels of satisfaction with work–life balance, hours worked and their current practice and profession. The evaluation found that participation led to perceived improvements in nurses' confidence, greater control over their work environment, decreased stress levels, increased energy and morale and perceived improved ability to provide high-quality care. However, no formal implementation plan had been developed or made available to assist employers with implementation of the programs. The findings highlight the need for more discipline in communicating, implementing and evaluating initiatives such as those evaluated retrospectively in this project. In particular, key performance indicators, baseline data, monitoring mechanisms and an evaluation plan need to be developed prior to implementation.

Improving accountability for children's health: Immunization registries and public reporting of coverage in Canada

Routine childhood immunizations remain one of the most cost-effective preventive health interventions. As such, immunization coverage is a well-established performance measure of the primary care (1) and public health (2) systems. We have called for reporting on the performance of the Canadian public health system, including childhood immunization coverage (3), but this has not yet become universally routine or public. Canada ranks last among reporting Organisation for Economic Co-operation and Development countries for up-to-date pertussis coverage at two years of age (4), and we continue to have outbreaks of vaccine-preventable diseases. The most recent publicly available results are from the 2004 National Immunization Coverage Survey, a telephone household survey conducted by the Public Health Agency of Canada (5). Complete up-to-date coverage is very low: 61% among two-year-old children and 41% among seven-year-old children. Assigning accountability for this poor health system performance and improving coverage is complex. Provision of childhood immunizations across Canada varies both across and within provinces and territories. For example, for routine childhood immunizations, over 90% are given by physicians in Ontario, whereas close to 100% are administered by public health nurses in Alberta, Nunavut, Prince Edward Island and the Northwest Territories. However, even within one jurisdiction, a child might receive immunizations from multiple providers across a number of settings (primary series from a primary care physician, hepatitis B from a public health nurse in school or influenza from a nurse in a public health clinic). The national data, although helpful in drawing a broad picture of overall coverage, cannot be reported at the level responsible for providing immunizations (ie, public health unit or primary care practice) or identify communities of underimmunized populations. Province/territory (P/T) immunization registries, on the other hand, have the potential to serve a number of important functions, including timely reporting of coverage, identifying populations with low coverage, monitoring programs designed to achieve target rates, and generating reminders and recalls, which is shown to be one of the most effective strategies for improving coverage irrespective of the provider (6). A number of countries have achieved population-based immunization registries. The Australian Childhood Immunisation Register (7), operational since 1996, was the first complete national immunization registry. More recently, Great Britain, New Zealand and Denmark have developed registries and have achieved high rates of immunization coverage (8). In the United States, even with its challenges surrounding universal health coverage, 56% of children younger than six years of age are enrolled in a city or state registry (9).

Follow-through of triage protocol

We read with great interest the article by de Coster et al. exploring caller characteristics associated with following nurse telephone advice. We would like to congratulate the authors for their study, very well designed, reporting >170 000 calls. With the tendency for increased emergency department (ED) use and overcrowding, triage has become a critical step in ED functioning. Cost-containments efforts have focused on prescreening of patients by telephone to determine who may be redirected to a routine visit or given home advice instead of seeking in the ED. We would like to go further into the debate and highlight that compliance of both patients and clinicians with triage protocol is the corner stone of triage efficiency. And we would only point out that in real life experience, the rate of compliance of triage personnel with guidelines can be low. The use of a computerized triage system, as the software used by Alberta nurses, could theoretically improve triage by improving its completeness and enhance reproducibility. But telephone triage relies on accurate triage tools to identify major cases and compliance with the triage protocols. Wacher et al. (evaluating the implementation of a set of standardized telephone triage protocols) have found that 58% of nurses felt confined by the protocols and 42% admitted intentional deviation from them, when they believed that optimal patient care mandated that they do so. Correlation among dispositions determined by triage providers was poor, despite instructions to follow protocols as closely as possible. Although it is a basic assumption that protocols operate by standardization, these results indicate that nurses did not reliably choose the same protocol in a given case and did not reach the same triage endpoint even when they followed the same protocol. As suggested by Poole et al., nurses may decide ‘under some circumstances to follow their intuition rather than the protocol’s recommendation’. Piccotti et al. assessed the percentage of consistency with the triage process drawn up at the level of paediatric ED and concluded that there is a need for further efforts to improve compliance with the protocol and pursue a higher degree of uniformity in evaluation by triage personnel. And it was found that physicians can easily break from protocols to achieve disposition of patients, especially the more experienced one. Although patients’ compliance with advices is a key point, compliance of triage personnel with triage protocols must be evaluated, as well as under triage and over triage before targeting initiatives to improve follow-through of telephone advices. Telephone triage protocols are a complex and challenging issue, and many bias linked with poor protocols compliance or under triage can make telephone triage less seducing in practice.

Gender and professional identity in psychiatric nursing practice in Alberta, Canada, 1930–75

This paper examines gender-specific transformations of nursing practice in institutional mental health-care in Alberta, Canada, based on archival records on two psychiatric hospitals, Alberta Hospital Ponoka and Alberta Hospital Edmonton, and on oral histories with psychiatric mental health nurses in Alberta. The paper explores class and gender as interrelated influences shaping the work and professional identity of psychiatric mental health nurses from the 1930s until the mid-1970s. Training schools for nurses in psychiatric hospitals emerged in Alberta in the 1930s under the influence of the mental hygiene movement, evolving quite differently for female nurses compared to untrained aides and male attendants. The latter group resisted their exclusion from the title 'nurse' and successfully helped to organize a separate association of psychiatric nurses in the 1950s. Post-World War II, reconstruction of health-care and a de-institutionalization policy further transformed nurses' practice in the institutions. Using social history methods of analysis, the paper demonstrates how nurses responded to their circumstances in complex ways, actively participating in the reconstruction of their practice and finding new ways of professional organization that fit the local context. After the Second World War more sophisticated therapeutic roles emerged and nurses engaged in new rehabilitative practices and group therapies, reconstructing their professional identities and transgressing gender boundaries. Nurses' own stories help us to understand the striving toward psychiatric nursing professionalism in the broader context of changing gender identities and work relationships, as well as shifting perspectives on psychiatric care.

Promoting personal safety in community health: four educational strategies.

Nurse educators must confront the issue of nursing students' personal safety in community health practice, provide the necessary knowledge and skills, and document their actions. Learning opportunities are required to assist students to recognize and evaluate risks, and prevent their consequences. Thematic analysis of interviews with 56 public health nurses in Alberta, Canada uncovered knowledge, skill, and attitudinal components of risk assessment. Categories under the theme framing personal risk in work environments and the sub-themes framing for action and framing for no action provided a conceptual framework for planning educational strategies. Based on how these nurses framed their personal risk, 4 educational strategies are presented: a checklist, small group learning activities, a template for Web-based courseware, and a problem-based learning scenario.

Workplace violence in Alberta and British Columbia hospitals

Workplace violence is a significant and widespread public health concern among health care workers, including nurses. With growing awareness of how practice environments influence patient outcomes and the retention of health professionals, it is timely to consider the impact of workplace violence in hospitals. Registered nurses in Alberta and British Columbia, Canada were surveyed on their experiences of violence in the workplace over the last five shifts. Our results suggest that nurses are experiencing many incidences of violence in a given work week, particularly in the emergency, psychiatric, and medical–surgical settings. Most violent acts are perpetrated by patients, but there is also a significant portion of violence and abuse committed by hospital co-workers, particularly emotional abuse and sexual harassment. Our results also indicate that the majority of workplace violence is not reported. We suggest that using the Broken Windows theory might be a useful tool to conceptualize why workplace violence occurs, and that this framework be used to begin to develop new violence prevention policies and strategies.

Toward a Model for Effectiveness

Effectiveness is difficult to define or measure, but is frequently associated with cost. A two phase study conducted with occupational health nurses in Alberta, Canada resulted in a beginning model for effectiveness. In 1997, Phase One of an exploratory descriptive study focused on physical assessment by occupational health nurses (N = 137) and perceptions of effectiveness in practice (n = 104). In 2001, Phase Two used focus groups (n = 7) to determine occupational health nurses' reactions to the preliminary analysis of questionnaire responses on effectiveness. The focus groups confirmed and expanded categories, and reconfigured the developing model. The model makes explicit the foundations, functions, relationships, and goals for effectiveness in occupational health nursing practice. The foundation includes registered nurse (RN) experience and baseline competence comprising occupational health nursing education, RN and occupational health nurse experience, and multidisciplinary knowledge. Ten specific functions and nine relationships describe the occupational health nursing specialty practice and promote achievement of five goals: balance, communication, continuing competence, leadership, and trust. The goal of balance needs articulation in the nursing literature.

Treatment refusal: the beliefs and experiences of Alberta nurses

This study explored the beliefs and experiences of Alberta nurses concerning withholding and withdrawal of treatments from incurably or terminally ill patients. A mailed survey containing closed and open-ended questions was used to gather data. A response rate of 47% was achieved. The majority of respondents believed patients should legally be able to request that treatments be withheld (98%) or withdrawn (97%). More than half of the respondents had received requests from patients, families or physicians to withhold or withdraw treatments. Occasionally, nurses acted without physicians’ knowledge. Three different positions with respect to decision-making in withholding and withdrawing of care, ‘subordinate’, ‘collaborative’ and ‘independent’, emerged from nurses’ written comments on the questionnaire. Consensus among health care practitioners and consumers is critical to end-of-life decision-making.