Hospital nurses' perceptions of the geriatric care environment in one Canadian health care region.

PURPOSE: To identify and compare perceptions of the geriatric care environment among nurses in three different urban hospital types in one health authority in a Midwestern Canadian province. DESIGN: The Geriatric Institutional Assessment Profile developed by the Nurses Improving Healthsystem Elders (NICHE) program was administered to staff in eight urban hospitals between 2005 and 2006: two geriatric-chronic care hospitals, four community hospitals, and two tertiary hospitals. The study focused on 1,189 nurses who completed the survey (n= 298 for geriatric-chronic care hospitals; n= 387 for community hospitals, n= 504 for tertiary hospitals). METHODS: Analyses focused on items related to the concept of the geriatric nursing practice environment, including a composite measure of overall perceptions and three subscales (institutional values regarding older adults and staff, resource availability, and capacity for collaboration). Nurses' perceptions of the extent to which facilities supported the provision of aging-sensitive or aging-relevant care to older adults and their families was also examined. Univariate analysis of variance was performed to determine significant group differences among nurses in the three hospital types. FINDINGS: Perceptions of the geriatric nurse practice environment (both in terms of the composite scale and the three subscales) were least positive among nurses in community hospitals relative to the other two hospital types. Perceptions in tertiary hospitals were significantly more positive than those in community hospitals in terms of institutional values and resource availability, albeit not capacity for collaboration. Perceptions were most positive in the geriatric-chronic care hospitals. Perceptions of aging-sensitive care delivery were also less positive in community and tertiary hospitals, relative to geriatric-chronic care hospitals; perceptions in community and tertiary hospitals did not differ from each other. CONCLUSIONS: In this Canadian study, nurses' perception of the care environment varied by hospital type, with nurses in community hospitals expressing the most concern and nurses in geriatric-chronic care hospitals being the most positive. This research highlights the importance of the hospital setting in understanding nurses' ability to provide quality geriatric care. CLINICAL RELEVANCE: Enhancing the quality of care for older patients requires an understanding of the challenges and obstacles experienced by nurses. Assessing their perceptions of the care environment they work in, therefore, becomes a key issue in targeting policy and programs.

"Hit the ground running": perspectives of new nurses and nurse managers on role transition and integration of new graduates.

The workplace for new graduates must be a constructive learning environment to facilitate their development. Nurse managers need new graduates who can "hit the ground running." Conflict between the needs of new nurses and the realities of the workplace often creates role confusion and tension in new graduates and threatens employers' ability to retain them. As part of a larger study that examined the effectiveness of a new strategy on new nurse retention and workplace integration, we conducted focus groups with new nurses and nurse managers. This paper discusses the perspectives of new nurses on their role transition from graduates to practising professionals and the perspectives of nurse managers on the workplace integration of new nurses. The thematic findings integrate new nurses' perspectives on their needs during role transition with the perspectives of nurse managers in meeting those needs. The discussion includes strategies to facilitate successful transition and integration of new nurses into the workplace within the context of recruitment and retention.