Roles and functions in clinical care for registered nurses with a PhD-A systematic literature review.

BACKGROUND: Nurses are responsible for nursing care and their expertise is crucial for quality of care. One factor important to successful delivery of evidence-based care is availability of staff with the expertise to support their colleagues in this endeavour. RN/PhDs versed in scientific research with a thorough knowledge of their disciplines have the potential to help narrow the gap between theory and practice. The roles and functions of RN/PhDs involved in clinical care have not yet been well defined. AIM: To explore publications concerning clinical contributions from registered nurses who hold a PhD (RN/PhDs) regarding impact on quality and improvement of care. METHOD: A systematic literature review was conducted and qualitative content analysis was applied to the data obtained from the included studies. FINDINGS: The leadership role is considered essential for RN/PhDs, where the focus is on the pursuit of evidence-based practice and the improvement of nursing practices. The opportunity to combine the clinical and academic aspects of nursing is considered crucial in order for RN/PhDs to influence and improve care, yet few such positions are currently available. RN/PhDs cited limited career opportunities as one important reason for not combining clinical and academic work. CONCLUSIONS: In order for nursing practice to reach full potential, clinical positions with clearly defined job descriptions for RN/PhDs are needed. To fully leverage their expertise, it is important to allocate sufficient time to conduct relevant research, as well as to support colleagues and students in the improvement of clinical practice.

Is It Possible for Registered Nurses and Physicians to Combine Research and Clinical Work to Facilitate Evidence-Based Practice?

BACKGROUND: Evidence-based patient care requires clinicians to make decisions based on the best available evidence and researchers to provide new scientific knowledge. Clinician-scientists (i.e., registered nurses [RNs] and physicians with a PhD) make important contributions to health care; yet, their roles are not fully understood, supported, or recognized by healthcare leaders. Only a few studies have addressed the factors that enable RNs and physicians to simultaneously pursue both clinical work and research after earning a PhD. AIM: To explore what factors have a bearing on the ability of RNs and physicians to pursue research and clinical work simultaneously after earning a PhD. METHODS: The study used a qualitative design based on open-ended, in-depth interviews. Data were analyzed using conventional content analysis. RESULTS: Analysis of the data yielded a broad range of factors that RNs and physicians perceived to either facilitate or hinder continued research while simultaneously undertaking clinical work. Most of the perceived barriers were due to factors external to the individual. Several factors applied to both professions yet differed in impact. Factors mentioned as fundamental to continued research were financial support and allocated time for research. Maintenance of a good relationship with academia and support from management were also considered to be important. In addition, personal factors, such as motivation to pursue a research career after obtaining a PhD, were influential. LINKING EVIDENCE TO ACTION: A supportive infrastructure is important for enabling clinician-scientists to pursue research after earning a PhD. Creating favorable conditions for RNs and physicians to combine research with clinical work can facilitate evidence-based practice. This information can be used for interventions aimed at improving the conditions for clinician-scientists.

Nursing management matters for registered nurses with a PhD working in clinical practice.

AIM: To investigate what registered nurses (RNs) with a PhD working in clinical practice experience in terms of their role, function and work context. BACKGROUND: Previous studies have shown that RNs with a graduate degree contribute to better and safer care for patients. However, little is known about what further academic schooling of RNs, at PhD level, means for clinical practice. METHOD: Qualitative design, with semi-structured interviews and inductive content analysis. RESULTS: The main areas of responsibilities for RNs with a PhD working in clinical practice were related to practice development and implementation of research results. In their work, they experienced barriers to the full use of their competence; the expectations and prerequisites of the organisation were not clearly defined, and they often lacked a mandate to create conditions for quality improvement of nursing care. CONCLUSIONS: RNs with a PhD can contribute to evidence-based practice (EBP), clinical training, as well as the development of clinical research. Their roles and responsibilities need to be clarified, and for this, they need support from managers. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers have the opportunity to partner with RNs with a PhD to support the EBP process and help structure nursing practice in more efficient ways.

Factors of importance for work satisfaction among nurses in a university hospital in Sweden.

The shortage of registered nurses in the healthcare sector is a problem in most countries. Swedish nurses tend to leave or seek new positions. However, few Swedish studies have addressed questions regarding what factors are of importance for nurses to perceive work satisfaction although satisfied nurses are linked to many positive organizational outcomes, e.g. improved quality of patient care. The aim of this study was to investigate what factors are of importance for nurses at a university hospital to perceive work satisfaction. Eight hundred and thirty-three nurses responded to the mailed Quality Work Competence questionnaire and the Huddinge University Hospital Model Questionnaire. Regression analyses identifies five factors linked to the head nurses leadership contributing to the nurses' feelings of work satisfaction: 'professional competence is made good use of', 'feeling of satisfaction with immediate superior regarding support for nursing research and development', 'opportunities for developing one's own competence for the current job', 'career opportunities in one's own profession' and 'yearly dialogue for performance appraisal with immediate superior'. The nurses also reported work-related exhaustion. Few saw opportunities for making a career as a nurse. In conclusion, the study identified specific amenable factors linked to the head nurses leadership that are of importance in creating attractive workplaces for nurses.

Predictors of nurses' perceptions of barriers to research utilization.

AIM: To identify predictors of nurses' self-reported barriers to using research findings in clinical practice. BACKGROUND: Several studies have shown that nurses perceive barriers to research utilization but to our knowledge predictors of nurses perceptions of barriers to research utilization have not been identified before. METHODS: Three questionnaires were answered by 833 nurses: the Barriers Scale, the Quality Work Competence questionnaire and a questionnaire including questions on professional issues. RESULTS: Dissatisfaction with support from immediate superiors for participating in research and/or development projects, having no academic degree and unclear and unrealistic workplace goals were identified as factors increasing the risk of perceiving barriers to the use of research findings in clinical practice. CONCLUSIONS: The results imply that head nurses, nursing managers and other health care leaders should create strategies for supporting nurses' professional development and possibilities to implement research findings in clinical practice. IMPLICATIONS FOR NURSING MANAGEMENT: To support research utilization and evidence-based care health care leaders, head nurses and nurse managers should create clear and realistic goals for the work place including demands on evidence-based care. It is also important for head nurses and nurse managers to create strategies for supporting nurses' professional development and possibilities to implement research findings in clinical practice.

Why do nurses at a university hospital want to quit their jobs?

The aim of the study was to investigate to what extent the registered nurses at a university hospital intend to quit their present jobs and the reasons for this. A total of 833 nurses at a university hospital responded to two mailed, work-environment questionnaires (Quality Work Competence and Huddinge University Hospital Model Questionnaire). About 54% (n = 449) intended to quit and 35% (n = 155) had already taken steps to do so. Main reasons were dissatisfaction with the salary (65%), psychologically strenuous and stressful work (32%), a wish to 'try something new' (28%) and limited opportunities to make a professional career (19%). Nurses who intended to quit ('quitters') rated a higher work tempo (P < 0.001), experienced an increased work-related exhaustion (P < 0.001) and a lower quality of patient care (P < 0.01). They also perceived to a lower degree that their competence was made good use of (P < 0.001) and that they had fewer opportunities of developing their own competence (P < 0.001) and making a professional career. They were less satisfied with the support from their superiors for participating in nursing research and developing projects (P < 0.001). Finally, the 'quitters' knew to a significantly lesser extent (P < 0.001) why they had the actual salary they had, what the salary was based on and what to do to improve it. However, it was found that the hospital still had a 'core group' of highly motivated and dedicated nurses with an unusually high amount of mental energy left. All findings regarding the 'quitters' are factors amenable to interventions.