Critical Care Nurses' Reasons for Working or Not Working Overtime.

BACKGROUND: Around the world, registered nurses are working increasing amounts of overtime. This is particularly true in critical care environments, which experience unpredictable fluctuations in patient volume and acuity, combined with a need for more specialized nurses. OBJECTIVE: To explore critical care nurses' reasons for working or not working overtime. METHODS: A semistructured interview guide was used to interview 28 frontline nurses from 11 critical care units in Ontario, Canada. Analysis was guided by Thorne's interpretive description methodology. RESULTS: Participants' reasons for working overtime included (1) financial gain (96% of participants); (2) helping and being with colleagues (68%); (3) continuity for nurses and patients (39%); and (4) accelerated career development (39%). Their reasons for not working overtime were (1) feeling tired and tired of being at work (50%); (2) having established plans (71%); and (3) not receiving enough notice (61%). CONCLUSIONS: Findings from this study provide important variations and extension of existing literature on the topic, and appear to be the first reported in Canadian critical care units. Additional research is required to understand administrative decision-making processes that lead to the use of overtime.

Potential Dangers of Nursing Overtime in Critical Care.

Around the world, registered nurses are working increasing amounts of overtime. This is particularly true in critical care environments, which experience unpredictable fluctuations in patient volume and acuity combined with a need for greater numbers of specialized nurses. Although it is commonplace, little consensus exists surrounding the effects of overtime on nursing sick time and patient outcomes. Using data from 11 different critical care units nestled within three major academic health science centres in Southern Ontario, a multilevel-model Poisson regression analysis was used to evaluate the association between nursing overtime and nursing sick time, patient mortality and patient infection incidents. Most significantly, for every 10 hours of nursing overtime worked, study findings revealed an associated 3.3-hour increase in nursing sick time. Because of the potential cost and patient care ramifications, hospitals and nurse managers are encouraged to track collective and individual paid and unpaid hours to impose appropriate limits and ensure accountability. Further qualitative research should be commissioned to explore the underlying reasons for these findings and diversify the settings and, in turn, wider application.

Critical care nurses' perceptions of the outcomes of working overtime in Canada.

BACKGROUND: Nursing overtime is being integrated into the normal landscape of practice to ensure optimal staffing levels and addresses variations in patient volume and acuity. This is particularly true in critical care where fluctuations in either are difficult to predict. PURPOSE: The goal of this study was to explore critical care nurses' perceptions of the outcomes of working overtime. METHODS: Sally Thorne's interpretive description guided the collection and analysis of data. Participants were recruited from 11 different critical care units within three large teaching hospitals in Southern Ontario, Canada. A total of 28 full- and part-time registered nurses who had worked in an intensive care unit for at least one year took part in this study. Data were collected through semistructured, audio-recorded, individual interviews that took place in rooms adjacent to participants' critical care units. Template analysis facilitated the determination and abstraction of themes using NVivo for Mac 10.1.1. FINDINGS: Major themes highlighting the perceived outcomes of overtime included (a) physical effects, (b) impact on patient-centered care, (c) balancing family and work, (d) financial gain, and € safety is jeopardized. CONCLUSIONS: Nursing managers and institutions need to be accountable for staffing practices they institute, and nurses themselves may require further education regarding healthy work-life balance. There are both negative and positive consequences of nursing overtime for nurses and patients, but nurses at large valued the option to work it.

Integrative review: an evaluation of the methods used to explore the relationship between overtime and patient outcomes.

AIMS: To analyse, critically, methods employed to explore the relationship between nursing overtime and patient outcomes to strengthen future research. BACKGROUND: Nursing overtime hours have been increasing in the Western world since the 1980's; however, research detailing its implications for patient outcomes has not kept pace. Studies exploring the relationship between nursing overtime and patient outcomes have produced conflicting results and are deficient in number and rigour. DESIGN: Whittemore and Knafl's revised framework for integrative reviews guided the analysis. DATA SOURCES: A comprehensive multi-step search (1980-2012) of literature related to nursing overtime and patient outcomes in the CINAHL, Medline, PubMED, EMBASE and PsychInfo databases was performed. Reference lists and Google searches were completed for additional sources. Nine research papers met the inclusion criteria. REVIEW METHODS: All nine articles were included in the review. A systematic, iterative approach was used to extract and reduce the data to draw conclusions. RESULTS: There appears to be a positive relationship between nursing overtime and patient outcomes, however, eight of the nine studies revealed limitations in: (1) the definition and measurement of overtime; (2) data aggregation (organizationally and temporally) and (3) recognition or control of potential confounding variables. CONCLUSION: The quality in this research sample limits the ability of this body of work to be the basis of staffing policies. Future researchers need to be explicit in detailing their methods alongside a renewed commitment from administration to develop a tracking system of important parameters at the individual and bedside level.

Knowledge Transfer and Dissemination of Advanced Practice Nursing Information and Research to Acute-Care Administrators.

The objective of this study was to ascertain the information needs and knowledge-dissemination preferences of acute-care administrators with respect to advanced practice nursing (APN). Supportive leadership is imperative for the success of APN roles and administrators need up-to-date research evidence and information, but it is unclear what the information needs of administrators are and how they prefer to receive the information. A survey tool was developed from the literature and from the findings of a qualitative study with acute-care leaders. Of 107 surveys distributed to nursing administrators in 2 teaching hospitals, 79 (73.8%) were returned. Just over half of respondents reported wanting APN information related to model of care and patient and systems outcomes of APN care; the majority expressed a preference for electronic transmission of the information. Researchers need multiple strategies for distributing context-specific APN evidence and information to nursing administrators.

L'objectif de cette étude était de déterminer les besoins en information et les préférences en matière de transmission du savoir des administrateurs de soins actifs en ce qui concerne les pratiques infirmières avancées (PIA). Les infirmières et infirmiers en PIA doivent impérativement bénéficier du soutien de leur direction pour accomplir adéquatement leur travail. Les administrateurs ont quant à eux besoin d'information et de résultats de recherche à jour pour offrir ce soutien, mais l'information dont ils ont besoin et la façon dont ils souhaitent la recevoir demeurent incertains. Un outil de sondage a été élaboré à partir de la littérature sur le sujet et des résultats d'une étude qualitative menée auprès de dirigeants de services de soins actifs. Sur un total de 107 formulaires distribués à des administrateurs de soins infirmiers dans deux hôpitaux d'enseignement, 79 (73,8 %) ont été remplis et retournés. Un peu plus de la moitié des répondants ont indiqué vouloir de l'information liée aux PIA portant sur les modèles de soins et les résultats des PIA pour les patients et le système, et la majorité d'entre eux ont dit avoir une préférence pour l'information transmise par voie électronique. Les chercheurs doivent user de stratégies multiples pour diffuser auprès des administrateurs de soins infirmiers l'information et les résultats de recherche sur les PIA propres à divers contextes.

Factors that facilitate registered nurses in their first-line nurse manager role.

AIM: To determine the factors that attract and retain Registered Nurses in the first-line nurse manager role. BACKGROUND: The first-line nurse manger role is pivotal in health-care organisations. National demographics suggest that Canada will face a first-line nurse manager shortage because of retirement in the next decade. Determination of factors that attract and retain Registered Nurses will assist organisations and policy makers to employ strategies to address this shortage. METHODS: The study used an exploratory, descriptive qualitative approach, consisting of semi-structured individual interviews with 11 Registered Nurses in first-line nurse manager roles. RESULTS: The findings revealed a discrepancy between the factors that attract and retain Registered Nurses in the first-line nurse manager role, underscored the importance of the mentor role and confirmed the challenges encountered by first-line nurse managers practicing in the current health-care environment. CONCLUSIONS: The first-line nurse manager role has been under studied. Further research is warranted to understand which strategies are most effective in supporting first-line nurse managers. IMPLICATIONS FOR NURSING MANAGEMENT: Strategies to support nurses in the first-line nurse manager role are discussed for the individual, programme, organisation and health-care system/policy levels.

Planning for interprofessional change in primary health care: exploring the use of the Interprofessional Resource Centre.

IMPORTANCE: Resources to support change are needed for solo practitioners who are transitioning to family health teams (FHTs) which involve multiple health disciplines working together to provide team-based care. OBJECTIVE: THE PURPOSE OF THIS PROJECT WAS: (1) to explore the use of an online resource, the Interprofessional Resource Centre (IRC), when planning for interprofessional change and; (2) to explore the experience of planning interprofessional change. DESIGN AND SETTING: Six FHTs organized under the structure of one Local Health Integrated Network (LHIN) in Ontario, Canada. INTERVENTION: Participants in six FHTs were directed to the IRC to support planning interprofessional change. In addition, two of the six FHTs participated in pilot site meetings with investigators where they received in-person support to apply the information from the IRC to an interprofessional activity. RESULTS: Pilot site participants reported the IRC was useful for planning, but they cited lack of time to use it as a key barrier. When planning for interprofessional change, providers experienced challenges with physician buy-in and team dynamics. As a strategy for change, providers would like to learn from other FHTs who have experienced success with interprofessional change; at the LHIN level, they saw a need for more educational opportunities. Participation was found to be low among those only receiving online support. CONCLUSION AND RELEVANCE: Based on the results of the study, it appears that online resource centers do have some value in knowledge translation when combined with in-person meetings. In exploring the planning of interprofessional change in primary health care teams, it was found that buy-in with physicians is a key challenge.

A concept analysis of nursing overtime.

AIM: To report a concept analysis of nursing overtime. BACKGROUND: Economic constraints have resulted in hospital restructuring with the aim of reducing costs. These processes often target nurse staffing (the largest organizational expense) by increasing usage of alternative staffing strategies including overtime hours. Overtime is a multifaceted, poorly defined, and indiscriminately used concept. Analysis of nursing overtime is an important step towards development and propagation of appropriate staffing strategies and rigorous research. DESIGN: Concept analysis. DATA SOURCES: The search of electronic literature included indexes, grey literature, dictionaries, policy statements, contracts, glossaries and ancestry searching. Sources included were published between 1993-2012; dates were chosen in relation to increases in overtime hours used as a result of the healthcare structuring in the early 1990s. Approximately 65 documents met the inclusion criteria. REVIEW METHODS: Walker and Avant's methodology guided the analysis. DISCUSSION: Nursing overtime can be defined by four attributes: perception of choice or control over overtime hours worked; rewards or lack thereof; time off duty counts equally as much as time on duty; and disruption due to a lack of preparation. Antecedents of overtime arise from societal, organizational, and individual levels. The consequences of nursing overtime can be positive and negative, affecting organizations, nurses, and the patients they care for. CONCLUSION: This concept analysis clarifies the intricacies surrounding nursing overtime with recommendations to advance nursing research, practice, and policies. A nursing-specific middle-range theory was proposed to guide the understanding and study of nursing overtime.

Knowledge gaps regarding APN roles: what hospital decision-makers tell us.

The implementation of advanced practice nursing (APN) roles can yield improvements in patient and health system outcomes, and supportive leadership is integral in facilitating the implementation of such roles. The purpose of this study was to explore the awareness and understanding of APN roles among hospital decision-makers, and to learn about the information they require and the ways in which they prefer to receive that information. Fifteen administrators and leaders from two multi-site acute care organizations were interviewed. Their practical knowledge of APN roles was based on experience developing the roles or working with APNs in hospital programs. The most common sources of APN information were internal contacts (i.e., APNs) and documents from nursing organizations. Participants reported difficulty distinguishing between the roles of nurse practitioners (NPs) and clinical nurse specialists (CNSs), and identified knowledge regarding CNS roles as their greatest need. They required specific information regarding the "value-added" benefits offered by an APN role. Strategies to address the knowledge gaps of healthcare leaders are urgently needed in order to support the implementation of new APN roles and to sustain existing ones.

Interprofessional Resource Centre: a knowledge translation strategy.

The Interprofessional Resource Centre (IRC) was based on an extensive literature search and a provincial consultative process that involved administrators, health care providers, educators, preceptors, and alternative and complementary health care providers from different disciplines. Information from the literature review was synthesized into a logic model that served as a preliminary outline for the IRC to be further developed during the stakeholder consultation. The findings from the literature were triangulated with the opinions of different groups of key stakeholders who participated in three different methods of data collection: 1) a large-scale deliberative survey, 2) an in-person dialogue, and 3) targeted questionnaires. The result of this process was an online tool that presents information on what needs to be considered when planning interprofessional practice and education within an organization with the purpose of: 1) building capacity within agencies for interprofessional, collaborative practice; 2) providing preceptors with educational strategies to develop interprofessional competencies in their students; 3) promoting the use of technology as a strategy for knowledge transfer within the agencies and between educational institutions; and 4) developing an evaluation plan to measure interprofessional practice and education.