Challenges faced in rural hospitals: the experiences of nurse managers in Uganda.

AIM: The aim of this study was to understand nurse ward managers perceived challenges in the rural healthcare setting in Uganda. BACKGROUND: The health workforce, essential medicines and equipment and political unrest are the main factors affecting the international community in addressing the hefty disease burden in World Health Organization African regions. Nurse ward managers have an important role to play to mitigate these factors in health facilities in these regions through leadership, supervision and support for staff. METHODS: This study utilized interpretive phenomenology based on Gadamer's hermeneutical principles. Eleven nurse managers from two rural public hospitals in Uganda were interviewed. Those with more than a 2-year experience in their management role were invited to participate in the study. RESULTS: Nurse managers pointed out four major challenges with staffing, while they worked in the rural healthcare settings. These are summarized into themes: 'Numbers do matter'; 'I cannot access them when I need them at work'; 'Challenges in dealing with negative attitudes'; and 'Questioning own ability to manage health services'. DISCUSSION: Health facilities in rural areas face extremely low staff-to-patient ratio, a high level of workload, lack of essential medicines and equipment, low salaries and delayed payment for staff. CONCLUSION: Nurse managers demonstrated situation-based performance to minimize the impact of these challenges on the quality and safety of patient care, but they had less influence on policy and resource development. IMPLICATIONS FOR NURSING POLICY: It is imperative to mobilize education for nurse ward managers to enable them to improve leadership, management skills and to have a greater impact on policy and resource development.

Job satisfaction of overseas-qualified nurses working in Australian hospitals.

AIMS: The aims of this study were to explore factors associated with the job satisfaction of overseas-qualified nurses working in public hospitals in South Australia and to compare whether factors associated with job satisfaction of overseas nurses from English-speaking backgrounds differed from those from non-English-speaking backgrounds. BACKGROUND: Overseas-qualified nurses have become an essential part of the nursing workforce in Australia. Although this nurse population has different expectations and values in relation to their jobs when compared with local nurses, studies on job satisfaction among overseas nurses are scarce. METHODS: A cross-sectional survey using the Job Satisfaction of Overseas-Qualified Nurses questionnaire was conducted in five major public hospitals in South Australia. RESULTS: One hundred and fifty-one overseas-qualified nurses completed the questionnaire. Four factors were found to influence job satisfaction: Supportive work environment, interpersonal relationships, communication in English, and salary and salary-related benefits. Communication in English was the predominant factor that was associated with job satisfaction in nurses from non-English-speaking backgrounds. This group of nurses also showed a negative correlation between length of stay in Australia and satisfaction with their work environment. Participants' responses to open-ended questions revealed issues relating to discrimination and racism. CONCLUSION: Supportive work environment, interpersonal relationships, communication in English, and salary and salary-related benefits were major factors associated with job satisfaction in overseas-qualified nurses in this study. Nurses from non-English-speaking backgrounds faced additional challenges in communication in the workplace and in dealing with issues of discrimination and racism. IMPLICATIONS FOR NURSING AND/OR HEALTH POLICY: Nurses from non-English-speaking backgrounds need to be supported early in their employment, especially with their communication skills. Consideration also needs to be given to the education of local staff regarding cultural differences of overseas workers.

Chinese nurses' experience in the Wenchuan earthquake relief.

AIM: The purpose of this qualitative study is to provide an understanding of how Chinese nurses acted in response to the 2008 Wenchuan earthquake. BACKGROUND: The literature has reported that Chinese nurses played a key role in the Wenchuan earthquake. Although these nurses' intentions were well meaning, and they made enormous efforts to save lives, they considered that disaster relief practice was beyond the scope of normal daily nursing practice and found the challenges they confronted overwhelming. China is a country prone to both natural and man-made disasters that demand a good deal of preparedness for those involved in disaster nursing. However, few studies have been conducted to investigate the knowledge, skill, experience and attitudes required for nurses responding to disasters. METHODS: Gadamer's philosophical hermeneutics was used as a framework to underpin and interpret the qualitative accounts of the practice of the ten registered nurses in this study. FINDINGS: Three themes were identified from semi-structured interviews with the participants. These are described as (1) feeling under-prepared; (2) perceived challenges and coping strategies; and (3) the rediscovery of the helping and caring role. By analysing these nurses' experiences in the Wenchuan earthquake relief operation, this study has identified the numerous roles and attributes required of nurses in response to disasters. CONCLUSION: Without education and training in disaster nursing, nurses may not be prepared to function in disaster relief, especially in a manner that is productive, efficient, collaborative and less stressful. Findings suggest that a systematic, educational approach to develop the skills required in disaster nursing is essential.

Nurse educators' perceived challenges in mandatory continuing nursing education.

AIM: This paper reports a study that leads to understanding challenges facing nurse educators implementing mandatory continuing nursing education in The People's Republic of China. BACKGROUND: Mandatory continuing nursing education was instituted to maintain and develop registered nurses' competence in the context of healthcare reform in China in 1996. However, there is an increasing complaint of credit-focused and teacher-centred learning in Chinese literature. Despite an increasing appeal to improve the learning situation, little consensus has been reached. By examining nurse educators' perceived challenges and their coping strategies in implementing mandatory continuing nursing education, this study illuminates the possibilities for reform in mandatory continuing nursing education. METHODS: Data were collected through in-depth interactive dialogues between the researcher and five nurse educators in five healthcare organizations in China, utilizing Gadamer's philosophical hermeneutics. FINDINGS: Three themes were found in this study described as finding a way to support nurses' competence within a constrained situation, reconciling credit requirements and representing all stakeholders' interests. CONCLUSIONS: A tension between the mandatory continuing nursing education policy and the context of implementing the policy can contribute to credit-focused and teacher-centred learning. Regular policy review and educational support for nurse educators are crucial aspects to improve mandatory continuing nursing education.