A Focus Group Study of Retirement-Age Nurses: Balancing Tension and a Love of Nursing in a Changing Healthcare Environment.

OBJECTIVE: The aims of this study were to explore the experience of retirement-age nurses and identify decision-making factors and innovations to enhance retention. BACKGROUND: A national shortage of nurses has created challenges to preserving quality patient care and level of nursing competency and managing turnover costs. METHODS: A qualitative study using focus groups was conducted of nurses 55 years or older who were working or recently retired. Data were audiotaped and transcribed verbatim, with content analysis used to code in an iterative process until consensus was reached. RESULTS: The tension of balancing the love of patient care within a changing healthcare system was described. Patient acuity, competing roles, and the centrality of computers were stressors and integrally related. Flexibility in work schedules and new practice models were important to retirement decision making for work-life balance and retention. CONCLUSION: Passion for patient care dominated decisions to continue working. Innovations in practice models and scheduling offer opportunities to enhance the retention of experienced nurses.

"Finding the Balance": A Qualitative Study of the Experience of Nurses and Patients with Diabetes on an Insulin Pump in the Hospital.

PURPOSE: The purpose of this study was to explore experiences of hospitalized patients as they transition insulin pump self-management from home to hospital and the experience of nurses caring for them. Patients are often more knowledgeable about the pump than their nurses, which could lead to undiscovered challenges. Little is known about the hospital experience related to insulin pump therapy from nurses' and patients' perspectives. METHODS: A qualitative approach with interpretive descriptive design and purposive sampling was used. Eligible patients were ≥18 years of age, able to read and speak English, and admitted to non-ICU settings ≥20 hours. Eligible nurses cared for at least 1 patient using an insulin pump. Patients and nurses were interviewed separately. Interviews were audiotaped and transcribed verbatim. Data were analyzed using a constant comparative method. Coding was performed independently and jointly to reach consensus on emerging themes. RESULTS: Hospitalized patients and nurses had an array of perceptions highlighting challenges and adaption to "finding the balance" in managing diabetes when patients wore their insulin pumps. There were 4 interrelated themes representing a continuum of trust to lack of trust, control versus lack of control, effective communication to limited communication, and staff knowledge to lack of knowledge. CONCLUSIONS: Results of this study provide valuable insights into the challenges for both patients and nurses. A standardized approach to caring for this population is necessary. These findings can inform the development of nursing education programs and policies aimed at improving their experiences.

Factors Associated With Timely Blood Glucose Testing and Insulin Administration in Patients Receiving Mealtime Insulin Coverage in Medical Surgical Units.

Purpose The purpose of the study was to identify the rate and factors associated with timely mealtime capillary blood glucose (CBG) testing and insulin coverage in hospitalized patients with diabetes. Methods A descriptive-correlational design was used with a random sample of patients (n = 77) and nurses (n = 36) on a medicine and a neuroscience unit of a large Magnet hospital. After written consent was obtained, post-meal patient and nurse interviews were conducted to collect information about patient, nurse, and situational factors known to influence timely mealtime diabetes care. Results Timely CBG testing occurred on 85.7% of the patient participants, and 71.4% received timely insulin coverage. Timely CBG testing was associated (unadjusted) with telling the patient care associate to obtain a finger stick (FS) prior to meals and patient off the unit during mealtime. The odds of having insulin administered on time was significantly and independently associated with the nurse caring for fewer patients, patients waiting for insulin prior to eating, and patients knowing pre-meal FS was high. Conclusions One situational factor and 2 patient factors were independently associated with timely insulin coverage prior to meals. Interventions aimed at raising staff awareness of these factors and providing tailored education to patients may improve the odds of having insulin administered on time.