Psychometric Testing of a Structured Assessment Instrument for Non-technical Skills (NANTS-no) for Use in Clinical Supervision of Student Nurse Anesthetists.

BACKGROUND: This study evaluated psychometric properties of a structured behavioral assessment instrument, Nurse Anaesthetists' Non-Technical Skills-Norway (NANTS-no). It estimated whether reliable assessments of nontechnical skills (NTS) could be made after taking part in a workshop. An additional objective was to evaluate the instrument's acceptability and usability. METHODS: An explorative design was used. Nurse anesthetists (n = 46) involved in clinical supervision attended a 6-hour workshop on NTS, then rated NTS in video-recorded simulated scenarios and completed a questionnaire. RESULTS: High reliability and dependability were estimated in this setting. Participants regarded the instrument as useful for clinical supervision of student nurse anesthetists (SNAs). CONCLUSIONS: Findings suggest that NANTS-no may be reliable for performing clinical assessments of SNAs and encouraging critical reflection. However, further research is needed to explore its use in clinical settings.

Managerial competencies of head nurses: a model and assessment tool.

Head nurses' performance plays an important role in the successful operation of hospitals. Identification and prioritisation of managerial competencies required for these supervisors and evaluation of their performance on this basis are necessary. This study aimed to provide a valid tool for assessing managerial competencies of hospital department head nurses. First, through literature review, Delphi technique and expert panel, a competency model was developed. Then using the analytic hierarchy process, competencies were weighted and prioritised. Finally, based on the model, an instrument was designed to measure the competencies of head nurses. Validity and reliability of the instrument was also checked. The proposed framework included 27 competencies categorised by four main managerial tasks: planning, organising, leadership and control. Findings revealed that the highest priority was given to strategic thinking (0.1221) and the lowest priority was given to evidence-based decision making (0.007). Based on impact score and content validity ratio results, the content validity of all questions has been proved. Furthermore through the use of a content validity index, 11 questions were omitted or modified. The study presents a valid and comprehensive model for assessing managerial competencies of hospital department head nurses in order to take an important step towards improving their performance.

[Should nurses be managed by doctors or nurses?]. / La separazione tra clinica e assistenza o tra medici e infermieri?

A recent verdict of the administrative court of Lazio Region abrogated a Decree that originally stated that nurse managers (and not the head of the medical department) should be responsible for the management of the nursing personnel, and that had set up the premises for the Nursing Departments. The verdict contrasts with a previous pronouncement of the same court (same members, same president) that supported the wards organized by intensity of care and run by nurses. The organization should be flexible and be shaped not by power struggles but by patients needs: while patients in acute care require mostly medical interventions, chronic patients require more educational and nursing interventions. The verdict is the occasion for reflections on the never ending contrasts between doctors and nurse, that often move to the background patients' priorities and care.

The Self-assessment for Organizational Capacity Instrument for evidence-informed health policy: preliminary reliability and validity of an instrument.

BACKGROUND: Health policymakers work in organizations that involve multiple competing demands and limited time to make decisions. Influential international policy organizations continue to publish guidance and recommendations without the use of high-quality research evidence. Few studies have described the process with which governments, including health ministries, use evidence to support health policymaking decisions. Research is needed to better understand the psychometric properties of instruments that assess health policy organizations' capacity to use research evidence. AIM: The purpose of this study was to assess the preliminary psychometric properties of an instrument which assesses organizational capacity for evidence use. METHODS: The instrument was administered by telephone survey from January to June 2011 using a purposeful sample of 57 Canadian health policymakers (policy analyst and senior management levels). Reliability of the instrument was assessed with Cronbach's α coefficient and item-to-total correlation for internal consistency; interitem coefficients were used to identify particular item redundancy. Discriminant validity was assessed using the known-group comparison approach, with the independent sample t-test to assess subscale responses of policy analysts and senior managers. FINDINGS: Cronbach's α indicated acceptable internal consistency across its subscales. Discriminant validity analysis revealed a statistically significant difference between policy analysts and senior managers for one subscale. LINKING EVIDENCE TO ACTION: Our study provides a first look at the Self-assessment for Organizational Capacity Instrument's psychometric properties and demonstrates that this instrument can be useful when evaluating government and other organizations' use of evidence to inform decision making. Further testing of this instrument is needed using large and varied samples of policymakers, from policy analysts to senior managers, across varied policymaking contexts. This instrument can be a starting point for government and related organizations to better understand how well it supports evidence use, including its acquisition, appraisal, and use in health policy decision making.

Crossing our quality chasm: heeding the case for graduate preparation of nurse managers and leaders.

As outlined by the Institute of Medicine's Future of Nursing, it is expected that nurses in direct care will be baccalaureate prepared. What then should be the expectation for educating nurse managers? This article compares the Baccalaureate Essentials with the American Nurses Credentialing Center and American Organization of Nurse Executives certification examination content for nurse managers to evaluate if baccalaureate education prepares these leaders for management roles in order to provide additional support for graduate education of nurse managers.

Midwives and supervisors of midwives' perceptions of the statutory supervision of midwifery within the United Kingdom: a systematic review.

UNLABELLED: Within the United Kingdom, the statutory supervision of midwives has a central role in both the provision of safe, high-quality maternity services and in the regulation of midwifery practice. Despite its long history, little is currently known about how midwives and their supervisors perceive and experience the statutory supervisory process. OBJECTIVE: to review and synthesise published research on midwives and supervisors of midwives' perceptions of the statutory supervision of midwives within the United Kingdom. METHODS: a systematic review of published, empirical literature was undertaken. This comprised a systematic search of six electronic databases, supplemented by hand-searching and contact with five subject experts. Each of the 19 papers that met the inclusion criteria were critically appraised, thematic analysis was used to systematically extract key themes and a narrative approach to data synthesis was adopted, giving greatest weight to studies of higher methodological quality. FINDINGS: three studies were rated as high quality, 12 good quality and four poor quality. Four overarching themes were identified; within each theme a range of perspectives were reported. These encompassed very positive views at one end of the continuum to very negative views at the other. The four themes reported variable understanding of the statutory supervisory framework and engagement with supervisory processes; contradictory views regarding the value of supervision and inconsistent relationships were described across the literature. Supportive relationships and high quality leadership were described as being empowering and developmental while perceived power imbalances resulted in supervision being portrayed as punitive and destructive. Resourcing supervision, by way of protected time and recompense was recognised to be a challenge. KEY CONCLUSIONS: this review highlighted considerable variability in both midwives' and supervisor's understanding of the nature and purpose of supervision as part of the NMC statutory framework. In particular, the potential for supervision to enhance personal development and midwives' practice varied according to the nature of the relationship between midwife and supervisor. The importance of supervision being fit for purpose and supervisors possessing the requisite knowledge, skills and attitudes to execute their role and responsibilities effectively cannot be underestimated. More research is needed to examine ways in which statutory supervision contributes to patient safety and high quality care and what opportunities there may be for the statutory framework to develop and empower midwives to work within current, and future, contexts of maternity care. IMPLICATIONS FOR PRACTICE: as 13 of the 19 studies included within this review were conducted prior to publication of the current rules and standards underpinning the statutory framework for midwifery within the UK (NMC, 2004, 2006), it is plausible that the evidence base does not reflect contemporary midwifery and statutory supervisory practice. Notwithstanding, the research included within this review clearly suggests a need to increase both midwives and supervisors of midwives' knowledge and understanding of the statutory framework.

The skills gap in nursing management in the South African public health sector.

OBJECTIVES: Nurse managers are central to health delivery in South Africa. However, there is a paucity of research that analyzes their competence to successfully discharge their managerial role. To identify the competencies perceived to be important for effective nursing management in the South African public sector and the managers' self-assessed proficiency in these. DESIGN AND SAMPLE: A cross-sectional survey using a self-administered questionnaire. 215 senior nursing managers at South African public sector hospitals. MEASURES: Respondents rated the level of importance that 51 proposed competencies had in their job and indicated their proficiency in each. RESULTS: Public sector managers ranked controlling as the most important competency, followed by leading, organizing, and self-management. Health/clinical skills, planning, and legal/ethical competencies were ranked as being relatively less important. They assessed themselves as being most competent in self-management, followed by planning, controlling, leading, and specific health skills. The competency gap was the largest for legal/ethical issues, organizing, and controlling. The competency gap for planning and self-management was relatively smaller. CONCLUSIONS: This research confirms that there is a lack of management capacity within the public health sector and also identifies the areas in which the lack of knowledge or skills is most significant.

Infection control nurses' perceptions of the Code of Hygiene.

AIM: The aim of the study was to understand senior infection prevention and control nurses' experiences and perceptions of implementing the day to day aspects of the Code of Hygiene. BACKGROUND: The Code of Hygiene is legislative and sets out compliance standards in order to reduce infection rates. It details standards by which health-care providers failing to comply with infection control standards can be subject to improvement notices and actions. METHODS: Senior nurses from five infection prevention and control teams in England participated in taped, qualitative interviews which were analysed. FINDINGS: Two themes emerged from the data: 'Interventions' and 'Barriers to compliance'. Interventions were driven by senior NHS managers and necessitated organizational change. It was senior NHS managers who were considered as being the force for change and who intervened and took responsibility for implementation. Change was achieved by a top-down approach and was driven by senior managers' fear of external censure. At the same time, participants felt they had more authority as a consequence of these changes as they too, felt they could enforce change. Barriers to compliance were identified as: a lack of facilities, specifically a lack of side rooms and isolation facilities, and the non-engagement of medical staff. IMPLICATION FOR NURSING MANAGEMENT: Compliance was achieved by organizational change and senior managerial intervention. Barriers to compliance must be addressed to meet the Code of Hygiene's compliance criteria.

Implementation of a competency assessment tool for agency nurses working in an acute paediatric setting.

AIM: This paper reports on the implementation of a competency assessment tool for registered general agency nurses working in an acute paediatric setting, using a change management framework. BACKGROUND: The increased number of registered general agency nurses working in an acute children's hospital alerted concerns around their competency in working with children. These concerns were initially raised via informal complaints about 'near misses', parental dissatisfaction, perceived competency weaknesses and rising cost associated with their use. METHOD: [Young's (2009) Journal of Organisational Change, 22, 524-548] nine-stage change framework was used to guide the implementation of the competency assessment tool within a paediatric acute care setting. IMPLICATIONS FOR NURSING MANAGEMENT: The ongoing success of the initiative, from a nurse manager's perspective, relies on structured communication with the agency provider before employing competent agency nurses. Sustainability of the change will depend on nurse managers' persistence in attending the concerns of those resisting the change while simultaneously supporting those championing the change. These key communication and supporting roles highlight the pivotal role held by nurse managers, as gate keepers, in safe-guarding children while in hospital. Leadership qualities of nurse managers will also be challenged in continuing to manage and drive the change where resistance might prevail.

The pivotal plan: a 3-step approach to decrease staffing costs and improve quality.

This article reviews how the nurse leaders of a 136-bed medical/surgical service developed and implemented a methodical plan to fill RN vacancies, decrease labor costs, and improve quality. This simple, straight-forward approach was designed to rapidly fill core staff positions while minimizing the impact of the vacancies and ultimately eliminate the use of temporary nursing staff. The detailed components of the plan provided a way to assess vacancy data, time temporary replacements, and structure beneficial hospital partnerships, all of which were instrumental in the success of the plan. The plan was implemented throughout the facility because of proven success in the medical/surgical service. The leaders' focus on decreasing labor costs resulted in hiring a stable core staff that was able to attain established quality initiatives. The financial and quality outcomes of the service demonstrate the ability to sustain excellent results over time.

Standards for nurse staffing in critical care units determined by: The British Association of Critical Care Nurses, The Critical Care Networks National Nurse Leads, Royal College of Nursing Critical Care and In-flight Forum.

BACKGROUND: Since 1967 the gold standard for nurse staffing levels in intensive care and subsequently critical care units has been one nurse for each patient. However, critical care has changed substantially since that time and in recent years this standard has been challenged. Previously individual nursing organisations such as the British Association of Critical Care Nurses (BACCN) and the Royal College of Nursing have produced guidance on staffing levels for critical care units. This paper represents the first time all three UK Professional Critical Care Associations have collaborated to produce standards for nurse staffing in critical care units. These standards have evolved from previous works and are endorsed by BACCN, Critical Care Networks National Nurse Leads Group (CC3N) and the Royal College of Nursing Critical Care and In-flight Forum. AIM: The aim of this paper is to provide an overview of the much more detailed document 'Standards for Nurse Staffing in Critical Care', which can be found on the BACCN web site at www.baccn.org.uk. The full paper has extensively reviewed the evidence, whereas this short paper provides essential detail and the 12 standard statements. METHODS: Representation was sort from each of the critical care associations. The authors extensively reviewed the literature using the terms: (1) critical care nursing, (2) nursing, (3) nurse staffing, (4) skill mix, (5) adverse events, (6) health care assistants and critical care, (7) length of stay, (8) critical care, (9) intensive care, (10) technology, (11) infection control. OUTCOMES: Comprehensive review of the evidence has culminated in 12 standard statements endorsed by BACCN, CC3N and the Royal College of Nursing Critical Care and In-flight Forum. The standards act as a reference for nursing staff, managers and commissioners associated with critical care to provide and support safe patient care. CONCLUSION: The review of the evidence has shown that the contribution of nursing can be difficult to measure and consequently support nurse staffing ratios. However, there is a growing body of evidence which associates higher number of registered nursing staff to patient ratio relates to improved safety and better outcomes for patients. The challenge for nurses is to produce accurate and meaningful outcome measures for nursing and collect data that accurately reflect the input of nursing on patient outcomes and safety.

Nursing education in gerontological clinical settings: What do elderly patients think of student-rendered care?

Gerontological units are commonly used as clinical placements for first year nursing students, but the ethics of sending novice nursing students to gerontological units for their first clinical placement is often challenged. Although this environment allows student learning at a slower pace, some believe that students are practicing on a captive population and that this undervalues the specialist knowledge and skills required to care for older patients. This qualitative study explores the perspectives of 12 older patients in long-term care hospitals who had first-year nursing students involved in their care. Data were gathered using face-to-face, semi-structured interviews. A thematic analysis of data then identified themes and patterns used by older adults to describe their perspectives of student-rendered care. Findings revealed that with the exception of one patient, this group of older patients found first-year student-nurse-rendered care to be a positive experience. The emergent themes indicated that patients enjoyed the extra care, attention, and the increased social opportunities the students provided. The patients also demonstrated an interest in participating in student learning. The findings are discussed in relation to social exchange theory and the concept of reciprocity.

Work environment and workforce problems: a cross-sectional questionnaire survey of hospital nurses in Belgium.

OBJECTIVES: This study investigated Belgian hospital nurses' perceptions on work environment and workforce issues, quality of care, job satisfaction and professional decision making. METHODS: All eligible nurses in a selection of 22 hospitals received the BELIMAGE questionnaire for a total of 13,958 potential respondents. Of these, 9941 returned study materials (response rate=71.2%) of which 9638 were valid and useable for statistical analysis (valid response rate=69.1%). RESULTS: The study identified several areas of tension in the nursing profession. The commitment to being competent providers of quality care was remarkably strong among the nurses, but they also perceived the barriers in the work environment to be multiple and complex. Concerns about the quality of leadership and management, insufficient staff, time demands and stressful work environment are experienced as obstacles in providing good nursing care. Four out of ten nurses (39.2%) would not choose nursing again as a career and more than half of the nurses (54.3%) have contemplated leaving the profession at some point in time. CONCLUSIONS: To effectively tackle the professional and workforce issues in nursing, investments should focus on redesigning a work environment that supports nurses in providing comprehensive professional care.

Retaining the mental health nursing workforce: early indicators of retention and attrition.

In the UK, strategies to improve retention of the mental health workforce feature prominently in health policy. This paper reports on a longitudinal national study into the careers of mental health nurses in the UK. The findings reveal little attrition during the first 6 months after qualification. Investigation of career experiences showed that the main sources of job satisfaction were caregiving opportunities and supportive working relationships. The main sources of dissatisfaction were pay in relation to responsibility, paperwork, continuing education opportunities, and career guidance. Participants were asked whether they predicted being in nursing in the future. Gender and ethnicity were related to likelihood to remain in nursing in 5 years time. Age, having children, educational background, ethnic background, and time in first job were associated with likelihood of remaining in nursing at 10 years. Associations between elements of job satisfaction (quality of clinical supervision, ratio of qualified to unqualified staff, support from immediate line manager, and paperwork) and anticipated retention are complex and there are likely to be interaction effects because of the complexity of the issues. Sustaining positive experiences, remedying sources of dissatisfaction, and supporting diplomats from all backgrounds should be central to the development of retention strategies.

Nurses' perceptions of continuing professional development.

AIM: To investigate NHS and private sector nurses' perceptions of the value of continuing professional development (CPD), and to analyse the factors that influence these perceptions and any potential barriers to successful CPD. METHOD: Questionnaires were sent to 200 staff working in two NHS trusts and 13 nursing homes. Following analysis of the questionnaires, interviews took place with eight self-selecting respondents to explore certain issues further. Each interview was taped and lasted 30-45 minutes. The venue for the interview was arranged to suit the respondent, either in a private office in the work environment or at home. Written consent was sought before taping the interview. RESULTS: From the results of the postal questionnaires a largely positive perception of CPD was determined. However, it was shown that there were some barriers to professional development that have not previously been reported in the literature. Managers' leadership styles were found to influence nurses' perceptions of the value of CPD, as well as their ability to reflect, which affected the application of learning to practice. CONCLUSION: Influencing factors included managers' leadership styles and their responsiveness to change, as well as a reduced ability for nurses to reflect. A disassociation between post-registration education and practice (PREP) and CPD in terms of understanding the purpose of PREP was also discovered among nurses.

Rural nursing unit managers: education and support for the role.

INTRODUCTION: Nursing unit managers (NUMs) occupy the often unenviable position of first-line management in many health services in Australia. As such, their role is complex and multifaceted requiring an intertwining of their clinical and managerial responsibilities. While there is an abundance of studies that explore and describe the various management roles in many professions and industries, little is known about the experiences of nurses as managers, particularly in rural settings. This article focuses on the education and support needs of rural nursing unit managers. METHODS: A qualitative study design was used to explore the stories of a number of nursing unit managers in rural New South Wales, Australia. Data was collected using semi-structured individual interviews. Data was analysed using a voice-relational method as a framework for more clearly hearing the voices of participants. This method of data analysis is particularly useful for hearing from those who do not usually have a 'strong' voice, for gaining an understanding of the context of the interviews, and for acknowledging the role of the researcher in the research process. All NUMs employed in a single regional health authority in rural Australia were invited to participate. RESULTS: Out of 42 NUMs in the region, 20 agreed to be interviewed. Nursing unit managers were asked to reflect on their experiences prior to and during the early days within the position. In summary, all the NUMs: believed they were promoted because of their clinical expertise; felt unprepared for the managerial and administrative aspects of their role; continued to identify as nurses rather than as managers; found the role isolated them from their former peer group. Those employed in small facilities had limited opportunities for education and peer support. CONCLUSIONS: Based on the NUMs' experiences and suggestions, the following information would have helped them to cope with the demands of their new role: information and discussions about the role expectations of first-line manager, from both an employee and employer perspective; human resource and financial management skill development; leadership skills; negotiation and conflict resolution; a clear and realistic role description.

Improving research supervision in nursing.

In this paper, four experienced researchers from the UK, China and Australia offer guidance in research supervision based on their experiences and the recent document, Improving standards in postgraduate research degree programmes [Higher Education Funding Council for England, 2003. Improving standards in postgraduate research degree programmes. Formal consultation. Department for Employment and Learning, Northern Ireland, Higher Education Funding Council for England, Higher Education Funding Council for Wales, Scottish Higher Education Funding Council, HEFCE, London]. Supervision is an important aspect of not only the development of the neophyte researcher, but of academic staff and research activity in general. With increased academic accountability, good supervision should be an integral component of a quality research governance framework and resourced as such. Recommendations include: adoption of these standards; rigorous selection of research students and supervisors and development of projects; development of departmental procedures for monitoring, feedback and intellectual property; and transparency, rigour and fairness in examination procedures.

Factors influencing nurse supervisor competence: a critical incident analysis study.

AIM: The aim of the study was to identify factors related to critical incidents that influence the competence of nurse supervisors. BACKGROUND: Nurse supervisors require considerable competence in order to help supervisees to reflect on their clinical work and to interpret the needs of the patient. METHOD: A qualitative approach involving the critical incident technique was used. Critical incidents were collected by means of self-reports from 25 nurse supervisors. FINDINGS: Two main areas emerged: a professional and a personal stance. The professional stance described the nurse supervisors' awareness of the importance of creating a secure learning environment and facilitating reflection. The supervisors structured the material and created awareness of fundamental nursing values. The second main area, personal stance, described the nurse supervisors' behaviour when they gave the participating nurses the opportunity to work through the experiences gained in the daily provision of nursing care. Although they experienced lack of self-assurance during the supervision session, they also expressed security regarding their own performance as nurse supervisors. CONCLUSIONS: Nurse supervisors need to include more nursing theory and focus on the nursing process as well as being aware of their own shortcomings and resources. One way for the supervisor to scrutinize his/her actions is to discuss and examine them with a more experienced nurse supervisor colleague.

Measuring the impact of modern matrons in the ward setting.

With the The NHS Plan (Department of Health, 2000) the government made it clear there was a need to reintroduce the role of matron to establish a clear responsibility for standards in the ward setting. The role of modern matron is now considered to be a fundamental part of clinical governance, ensuring the quality of the care provided is of the highest standard. Staff at South Essex Partnership NHS Trust instituted an audit to provide an accurate picture of the impact of modern matrons.

5 competencies needed by new baccalaureate graduates.

As nurse educators prepare new graduates for practice, part of the challenge is to ensure that these nurses are capable of functioning in a broad continuum of care with increased responsibilities. To identify competencies needed by new baccalaureate graduates in today's health care environment and determine whether these competencies fall into particular dimensions, a cross-sectional survey design was used to query 363 nurse administrators from three health care settings. Nurse administrators rated the importance of 45 nursing competencies. Factor analysis was conducted on the competency items, and factor scores were calculated to determine the importance ratings by work setting groups. Findings revealed a simple six-factor competency structure (Health Promotion Competency, Supervision Competency, Interpersonal Communication Competency, Direct Care Competency, Computer Competency, and Caseload Management Competency). MANOVA indicated significant differences in the importance of these competence factors by work setting. The findings are an important beginning for evidence-based decision-making about nursing curriculum reform, both in the classroom and clinical practice areas. The study also provides a foundation for further measurement of nursing competencies.