Traditional Nursing Roles Research Articles

Expanding the emergency nurse role to meet demand: nurse and physician perspectives.

Emergency departments (EDs) in New Zealand are experiencing growing demand because of rising attendances, and this is having a negative effect on patients, staff and organisations. The expansion of traditional nursing roles is one solution that has been explored internationally to ameliorate the adverse effects of increasing patient attendances. To explore the attitudes of registered nurses and physicians employed in emergency medicine towards an expanded role for registered nurses in the ED setting. A mixed-methods approach was adopted, in which data were collected in two phases, using interviews and questionnaires. Semi-structured, face-to-face interviews were held with clinical and non-clinical staff employed in emergency medicine, and questionnaires were distributed to 140 physicians and nurses employed in one ED. The data were analysed to identify themes and to determine the differences between nurse and physician respondents. Ten ED staff were interviewed, including non-clinical managers (n=4), physicians (n=2) and nurses (n=4). Analysis of the interviews identified five themes: driving change; expanded nurse role; optimal environment; facilitating change; and optimising outcomes for patients. A total of 70 questionnaires were returned, with 63 from nurses and seven from physicians. Nurse respondents were more supportive than their physician colleagues of the need to expand the nursing role in the ED. The existing New Zealand nursing scope of practice has the capacity to develop roles, with nurses supporting this change more than physicians. If role expansion is undertaken, serious consideration needs to be given to developing clear professional boundaries to maintain patient safety and department flow.

The perspective of allied health staff on the role of nurses in subacute care.

To explore allied health staff perceptions on the role of nurses in subacute care wards. A consequence of earlier discharge from acute hospitals is higher acuity of patients in subacute care. The impact on nurses' roles and required skill mix remains unknown. In the same way, nurses' integration into the rehabilitation team is ambiguous. Descriptive qualitative inquiry. Semistructured interviews conducted with 14 allied health staff from one subacute care facility in Melbourne, Australia. Interviews were audio-recorded and transcribed verbatim. Analysis using the framework approach. Three main themes were evident: (a) the changing context of care: patient acuity, rapid patient discharge and out-dated buildings influenced care; (b) generalist as opposed to specialist rehabilitation nurses: a divide between traditional nursing roles of clinical and personal care and a specialist rehabilitation role; and (c) interdisciplinary relations and communication demonstrated lack of respect for nurses and integrating holistic care into everyday routines. Allied health staff had limited understanding of nurses' role in subacute care, and expectations varied. Power relationships appeared to hamper teamwork. Failure to include nurses in team discussions and decision-making could hinder patient outcomes. Progressing patients to levels of independence involves both integrating rehabilitation into activities of daily living with nurses and therapy-based sessions. Promotion of the incorporation of nursing input into patient rehabilitation is needed with both nurses and allied health staff. Lack of understanding of the nurses' role contributes to lack of respect for the nursing contribution to rehabilitation. Nurses have a key role in rehabilitation sometimes impeded by poor teamwork with allied health staff. Processes in subacute care wards need examination to facilitate more effective team practices inclusive of nurses. Progressing patients' independence in rehabilitation units involves activities of daily living with nurses as much as therapy-based sessions.

Development of a skill mix and study planning tool for research teams.

There are various tools available in acute and primary care settings to support decision making about safe-staffing levels. Calculating safe staffing levels is about more than just the number of people on duty. It must reflect skill mix and tasks, and this is more complex outside traditional nursing roles. It is essential that research nurses, who work in multidisciplinary teams collecting the evidence that underpins safe and effective healthcare, are equipped to practise safely, but staffing level tools do not take their unique roles into account. This article describes University Hospitals Bristol Research Work Plan Tool (BRIS-TOOL), developed to enable research managers to identify skill mix in their teams and support effective study planning. It also discusses how the tool accurately reflects research teams' productivity. Finally, the article suggests that the tool can be used to profile research posts, illustrate the breadth of work undertaken in these posts, inform study design and help clinical colleagues to understand research roles better.

Stress amongst nurses working in a healthcare telephone‐advice service: relationship with job satisfaction, intention to leave, sickness absence, and performance

This paper is a report of a study, which assessed levels of stress amongst nurses working in a healthcare telephone-advice service. We explored whether stress related to performance, sickness absence, and intention to leave. Nurses report high levels of stress, as do call-centre workers. The emergence of telephone health advice services means many nurses now work in call-centres, doing work that differs markedly from traditional nursing roles. Stress associated with these roles could have implications for nurses, patients, and service provision. This paper reports cross-sectional survey results. The design of the overall study included longitudinal elements. A comprehensive study of stress was conducted amongst nurses working for a telephone-advice service in Scotland (2008-2010). All nurse-advisors were approached by letter and invited to participate. A total of 152 participants (33%) completed a questionnaire including General Health Questionnaire-12, Work Family Conflict Questionnaire, Job Satisfaction Scale and a measure of intention to leave the telephone-advice service and rated the perceived stress of 2 working shifts. Nurses' employers provided data on sickness absence and performance. Overall levels of psychological distress were similar to those found amongst Scottish women generally. In multiple regression, work-family conflict was identified as a significant predictor of job satisfaction and intention to leave, and significantly related to sickness absence. There were significant correlations between General Health Questionnaire scores and perceived stress of shifts and some performance measures. Work-family conflict is a significant predictor of job satisfaction, intention to leave, and sickness absence amongst telephone helpline nurses. Minimizing the impact of nurses' work on their home lives might reduce turnover and sickness absence.

The Clinical Nurse Leader: Addressing Health-Care Challenges Through Partnerships and Innovation

Evidence demonstrates that the American health-care system is failing to meet quality, safety, and efficiency mandates. In response to the need to raise core standards, education and practice leaders have come together to create a new master's-degree nursing role–the clinical nurse leader (CNL®). These CNL academic and clinical partnerships are producing measurable and sustainable practice outcomes that are positively affecting the quality, safety, and cost of care. The CNL initiative demonstrates the power of collaboration and the need to re-envision traditional nursing roles to meet the constantly emerging challenges of health care.

Scope of practice conflict in nursing: A new war or just the same battle?

The changing roles within health care teams reflect the rapid pace of change in contemporary health care environments. Traditional nursing roles and responsibilities are being challenged as fi scal constraints drive health reform. How nursing teams are configured in the future and the scope of practice of the individuals within those teams will require clear and unambiguous boundaries.This study explores the relationships in and between scope of practice and communication amongst teams of nurses. Six focus groups with both Registered and Enrolled Nurses were undertaken in three Sydney metropolitan hospitals in New South Wales. Nurses report that confusion surrounding scope of practice particularly in the areas of medication administration, patient allocation and workload are resulting in situations whereby nurses are feeling bullied, stressed and harassed.With the imminent widespread introduction of a third tier of nursing into acute care hospitals in Australia the findings of this study are timely and suggest that unless nursing team members clearly understand their roles and scope of practice there is potential for intra-professional workplace conflict. Furthermore the impact of the conflict may have consequences for both the individual nurse and their patients.

Overcoming boundaries

West Midlands Ambulance Service NHS Trust nursing director Gill Bennett is determined to show that traditional nursing roles can be expanded. Anita Pati reports

Impacting on improving patient care at every level

Mary Currie reflects on the path that has taken her from traditional nursing roles to a focus on service improvement and business development Mary Crie reflects on the path that has taken her from traditional nursing roles to a focus on service improvement and business development

Role theory: A framework to investigate the community nurse role in contemporary health care systems

Nurses’ perceptions of their role are influenced by societal attitudes, government policies and trends in professional issues. Dynamic factors in contemporary health environments challenge traditional nursing roles, in particular those of community nurses. Role theory is a conceptual framework that defines how individuals behave in social situations and how these behaviours are perceived by external observers. This paper reviews the role theory literature as a conceptual framework to explore community nurses’ perceptions of their role. Three theoretical perspectives of role theory have emerged from the literature review:(i) social structuralism;(ii) symbolic interactionism; and(iii) the dramaturgical perspective.These philosophical perspectives provide a useful framework to investigate the role of community nurses in the contemporary health care system.

Medical care practitioners: a necessary import?

To help patients get treated more quickly, Britain's health service wants to hire more workers to take medical histories; do physical examinations; order investigations; and diagnose, manage, and treat illnesses. Sounds like they want to hire more doctors? Not quite. The planned additions to the workforce will make up an entirely new medical profession, with an idea effectively imported from the United States. The new role, tentatively titled “medical care practitioner” for the UK, is based on the physician assistants in the US, who operate under the supervision of a doctor but can end up managing care for patients single handedly, particularly in primary care settings. The move is part of a massive upheaval of who does what in the NHS, which is deeply in debt and short of staff, particularly after the introduction of the European Working Time Directive, which has limited the hours doctors can work. The NHS says that it wants to use each type of worker to the peak of their skills, which means doctors are becoming more specialised, nurses do some jobs once restricted to doctors, and some traditional nursing roles have been handed to healthcare assistants. The new role would fit in somewhere between a nurse and a doctor. Sharing out work in an expanded medical team is a popular trend in many …

A Study for Curriculum Development for Advanced Nurse Practitioner Program

Purpose: The traditional nursing roles have become increasingly blurred. Nurses are now working in different ways and at higher levels of practice that enable nurses to adapt their roles and take on new responsibilities. The advanced role of nurses requires a different kind of master-level prepared ...

Psychiatric Nursing in a Therapeutic Community.

Holmes and Werner have written an interesting and provocative book. Content of the book reflects commitment to the trend in psychiatric treatment programs in which each person who is part of a therapeutic community is obligated to assume a high degree of serious therapeutic responsibility. The authors point out, "A new era in psychiatric nursing has begun with the advent of the therapeutic community . . . marked by loss of traditional nursing roles, increased responsibility for the therapy on the part of all disciplines, increased responsibility for therapy on the part of both patients and staff, more intense staff-patient relationships, and a whole complex of problems for nursing. . . ." It is meaningful to review a book which offers opportunity to explore some experiences of two nurses which have facilitated nursing contributions to a forward looking hospital program. The authors present an exploratory approach relating resources in nursing to problems associated