Meeting FNP students' and faculty clinical needs: Two perspectives.

Appropriate clinical practice sites with skilled preceptors are the backbone of family nurse practitioner (FNP) students' education. Faculty are also in need of practice sites to stay abreast of current clinical practice and maintain clinical hours for certification. The purpose of this article is to relate the process of developing a practice model to meet the needs of the FNP student and faculty. Academia and student life professionals collaborated to use an existing student health center on campus as an education site with an FNP nursing faculty member as a preceptor. This qualitative descriptive study presents reflections of the experience from the student perspective. Three main themes were identified: independence, confidence, and trust. Lessons learned from the faculty perspective are also reviewed. Benefits of the project ultimately outweighed barriers. The interdepartmental precepted practice experience completed its fourth successful year and maintains support through the university's student life division. The model may provide strategies, particularly for FNP programs and faculty in smaller universities, to increase and diversify clinical experiences and provide a faculty practice site.

Trends in cardiovascular management of people with diabetes by primary healthcare nurses in Auckland, New Zealand.

AIMS: The study aim was to re-examine current work practices and evaluate time trends in the cardiovascular management of people with diabetes consulted by primary healthcare nurses in New Zealand. METHODS: Primary healthcare nurses in the Auckland region were surveyed in 2006-2008 and 2016, with about one-third of practice, home care and specialist nurses randomly selected to participate. Nurses completed a self-administered questionnaire about demographic and workplace details, and a telephone interview about clinical care provided for people with diabetes during nursing consultations. Information was collected on a representative sample of people with diabetes consulted on one randomly selected work-day in the previous week. RESULTS: Of all people with diabetes consulted by nurses, practice nurses consulted significantly more in 2016 (83%) compared with 60% in 2006-2008, whereas specialist nurse consultations decreased from 23% to 8% (P = 0.01). In 2016, in people with diabetes, BMI was higher, and total cholesterol lower, yet the proportions of those receiving lifestyle advice (dietary and activity) remained unchanged from 2006-2008 levels. Smoking prevalence in people with diabetes was unchanged between the two surveys, although more people were asked if they wished to stop in 2016 compared with 2006-2008 (98% vs. 73%). In 2016, hours of nurses' diabetes education were associated with increased routine assessments of risk factors in people with diabetes and checking laboratory results. CONCLUSIONS: Practice nurses are undertaking an increasing proportion of diabetes consultations. Although BMI in people with diabetes is increasing, the proportion of nurses offering lifestyle advice remains unchanged. Increasing diabetes education could strengthen the management of people with diabetes by community nurses.

Ansiedad en técnicos de enfermería de atención primaria / Ansiedade em técnicos de enfermagem da atenção básica / Anxiety in primary care nursing technicians

Objetivo: Evaluar el nivel de ansiedad en el personal de enfermería de la Estrategia Salud de la Familia, con énfasis en los aspectos clave para la aparición de la ansiedad. Método: Estudio descriptivo, enfoque cuantitativo transversal, constituido por 28 técnicos de enfermería, mediante el Inventario de Ansiedad Traço-Estado (IDATE) como una herramienta para la recolección de datos. Resultados: 8 técnicos de enfermería mostraron niveles de alta ansiedad alta 20 baja ansiedad. Hubo un aumento en la puntuación en el IDATE-E en el momento durante la realización de actividades, con diferencia estadísticamente significativa en relación al momento antes. Los bajos salarios, la carga de trabajo y la devaluación profesional fueron identificados como factores responsables de causar la aparición de la ansiedad en el contexto del trabajo. Conclusión: El estudio muestra un predominio de baja ansiedad entre la población estudiada, sin embargo, fue posible detectar factores desencadenantes de ansiedad, lo que indica que estos aspectos pueden dañar la peculiaridad de la asistencia a los usuarios

Objetivo: A valiar o nível de ansiedade em técnicos de enfermagem da Estratégia de Saúde da Família, enfatizando os aspectos determinantes para o surgimento da ansiedade. Método: Estudo de característica descritiva, transversal, abordagem quantitativa, constituído por 28 Técnicos de Enfermagem, utilizando o Inventário de Ansiedade Traço-Estado (IDATE) como instrumento para a coleta de dados. Resultados: 8 técnicos de enfermagem apresentaram níveis de alta ansiedade e 20 de baixa ansiedade. Houve um aumento no escore no IDATE-E no momento durante a realização das atividades, com diferença estatística em relação ao momento antes. A baixa remuneração, sobrecarga de trabalho e desvalorização profissional foram apontados como fatores responsáveis por provocar o aparecimento da ansiedade no âmbito de trabalho. Conclusão: O estudo evidencia uma predominância da baixa ansiedade entre a população estudada, porém, foi possível detectar fatores desencadeadores da ansiedade, apontando de que tais aspect os podem vir a prejudicar a peculiaridade da assistência ao usuário

Objective : To evaluate the level of anxiety in nursing technicians of the Family Health Strategy, emphasizing the determinant aspects for the emergence of anxiety. Method: A descriptive, cross-sectional, quantitative approach, consisting of 28 Nursing Technicians, using the State-Trait Anxiety Inventory (STAI) as an instrument for data collection.Results: Eight nursing technicians presented levels of high anxiety and 20 of low anxiety. There was an increase in the S-Anxiety Scale score during the activities, with statistical difference in relation to the moment before. The low remuneration, work overload and professional devaluation were pointed out as factors responsible for provoking the appearance of anxiety within the scope of work. Conclusion: The study evidences a predominance of low anxiety among the study population; however, it was possible to detect factors triggering the anxiety, pointing out that such aspects may come to harm the peculiarity of the assistance to the user

Use of risk mitigation practices by family nurse practitioners prescribing opioids for the management of chronic nonmalignant pain.

BACKGROUND: Ongoing opioid analgesic use in patients suffering from chronic nonmalignant pain (CNMP) has been associated with the development of opioid misuse, abuse, addiction, and overdose. To prevent these adverse outcomes, it is important that family nurse practitioners (FNPs) implement recommended risk mitigation practices (RMPs) when treating CNMP patients with opioids. METHODS: A national sample of 856 FNPs was invited to answer an online survey about their utilization of opioids and RMPs in treating CNMP. RESULTS: One hundred sixty-eight FNPs responded (20% response rate), of whom 51.2% affirmed that they prescribe opioids for CNMP. Of the 86 FNPs who prescribe opioids, 66.7% said that less than 25% of their patients were receiving ongoing opioid therapy. The most frequently prescribed opioids were hydrocodone (77.9%) and oxycodone (58.1%). With respect to RMPs, 50 of the 86 opioid-prescribing FNPs (58.8%) reported using treatment contracts with their CNMP patients. Far fewer (20.9%) used formal screening tools to gauge the risk of opioid abuse and misuse. Most respondents (54.94%) reported using prescription monitoring programs, whereas only 33.0% reported using urine toxicology to monitor opioid use. Of the prescribing FNPs, 15.1% reported using abuse-deterrent opioid formulations. Age was found to be a correlate for prescribing opioids for CNMP, with those under 40 years of age less likely to use urine toxicology than those over 41 (45.2% vs. 4.2%; χ2(6) = 11.90, P = .06). Additionally, respondents who did not use treatment contracts reported significantly fewer years in practice (10.5 years, SD = 6.1) than those who did (13.6 years, SD = 1.54, df = 2.82, P = .02). CONCLUSIONS: Although RMPs are recommended for use in all CNMP patients receiving ongoing opioid therapy, FNPs do not consistently implement them. In the midst of the current opioid epidemic, FNPs must be vigilant about using appropriate opioid prescription practices.

Contexto de trabalho e Síndrome de Burnout na equipe de enfermagem da Estratégia Saúde da Família / Contexto laboral y el síndrome de burnout en el equipo de enfermería de Salud Estratégica de la Familia / Work Context and Burnout syndrome in the nursing team of the Family Health Strategy

Objetivo: Verificar a relação entre o contexto de trabalho e a Síndrome de Burnout dos profissionais de enfermagem da Estratégia Saúde da Família de um município mineiro. Método: Estudo seccional, de abordagem quantitativa. O grupo de estudo foi composto por 50 profissionais de enfermagem que responderam o questionário de caracterização sociodemográfica e profissional, Escala de Avaliação de Contexto de Trabalho (EACT) e Inventário da Síndrome de Burnout. Foram utilizadas análises exploratória e bivariada, considerando nível de significância de 5%. Resultados: A dimensão Exaustão Emocional apresentou correlações significativas com todos os fatores da EACT; Despersonalização apresentou diferença com as Relações Socioprofissionais e Organização do Trabalho; Diminuição da Realização Pessoal correlacionou-se com Organização do Trabalho. Conclusão: Quanto pior sejam as condições e organização do trabalho e as relações socioprofissionais, maior a possibilidade de insatisfação, desenvolvimento de atitudes de insensibilidade, adoecimento e exaustão emocional do profissional de enfermagem da atenção primária (AU)

Purpose: Investigate the relationship between the working conditions and the Burnout Syndrome of nursing professionals of Family Health Strategy town of Minas Gerais. Methods: Cross-sectional study with a quantitative approach. The study group was composed of 50 nursing professionals who answered the questionnaire of sociodemographic and professional, Work Context Assessment Scale (EACT) and Maslach Inventory Burnout. Exploratory and bivariate analyzes were used at 5% significance level. Results: The dimension Emotional Exhaustion was significantly correlated with all factors of EACT; Depersonalization presented diference with the Socio-professional Relations and Work Organization; Decreased Personal accomplishment correlated with Labour Organization. Conclusion: Worst are the conditions and organization of work and the socio-professional relations, the greater the possibility of dissatisfaction, development of nonchalance attitudes, disease and emotional exhaustion among nursing professionals in primary care (AU)

Objetivo: Investigar la relación entre el medio ambiente de trabajo y el personal de enfermería de la familia de un pueblo minero Estrategia de Salud Síndrome de Burnout. Método: Estudio transversal con un enfoque cuantitativo. El grupo de estudio estuvo compuesto por 50 profesionales de enfermería que respondieron al cuestionario sobre la escala sociodemográfica y profesional Evaluación Contexto Trabajo (EACT) e Inventario Síndrome de Burnout. Se utilizaron análisis exploratorios y bivariadas, considerando un nivel de significación del 5%. Resultados: escala de Agotamiento emocional correlacionó significativamente con todos los factores de EACT; La despersonalización era diferente de las relaciones socioprofesional y la organización del trabajo; Disminución de Cumplimiento correlacionado con la Organización del Trabajo. Conclusión: Lo peor son las condiciones y la organización del trabajo y las relaciones socioeconómicas, mayor será la posibilidad de insatisfacción, el desarrollo de actitudes de endurecimiento, la enfermedad y la atención primaria emocional de enfermera agotamiento (AU)

The evolution of nursing in Australian general practice: a comparative analysis of workforce surveys ten years on.

BACKGROUND: Nursing in Australian general practice has grown rapidly over the last decade in response to government initiatives to strengthen primary care. There are limited data about how this expansion has impacted on the nursing role, scope of practice and workforce characteristics. This study aimed to describe the current demographic and employment characteristics of Australian nurses working in general practice and explore trends in their role over time. METHODS: In the nascence of the expansion of the role of nurses in Australian general practice (2003-2004) a national survey was undertaken to describe nurse demographics, clinical roles and competencies. This survey was repeated in 2009-2010 and comparative analysis of the datasets undertaken to explore workforce changes over time. RESULTS: Two hundred eighty four nurses employed in general practice completed the first survey (2003/04) and 235 completed the second survey (2009/10). Significantly more participants in Study 2 were undertaking follow-up of pathology results, physical assessment and disease specific health education. There was also a statistically significant increase in the participants who felt that further education/training would augment their confidence in all clinical tasks (p < 0.001). Whilst the impact of legal implications as a barrier to the nurses' role in general practice decreased between the two time points, more participants perceived lack of space, job descriptions, confidence to negotiate with general practitioners and personal desire to enhance their role as barriers. Access to education and training as a facilitator to nursing role expansion increased between the two studies. The level of optimism of participants for the future of the nurses' role in general practice was slightly decreased over time. CONCLUSIONS: This study has identified that some of the structural barriers to nursing in Australian general practice have been addressed over time. However, it also identifies continuing barriers that impact practice nurse role development. Understanding and addressing these issues is vital to optimise the effectiveness of the primary care nursing workforce.

Planejamento da força de trabalho de enfermagem na Estratégia de Saúde da Família: indicadores de carga de trabalho / Planning the nursing workforce in Family Health Strategy: workload indicators

INTRODUÇÃO: Embora exista forte evidência de que a força de trabalho de saúde afeta os resultados dos usuários/família/comunidade, o quantitativo de trabalhadores de enfermagem, muitas vezes, não é fundamentado por investigações científicas. Na Estratégia de Saúde da Família é preconizado um parâmetro para o país que nem sempre atende as características socioeconômico-demográficas locais, visto que este é fundamentado em critério populacional. OBJETIVO: Propor padrões de tempo para intervenções/ atividades de enfermagem em Unidade de Saúde da Família (USF) para cálculo da força de trabalho. MÉTODO: Pesquisa metodológica de campo, multicêntrica com abordagem quantitativa e amostragem intencional em 27 USF, em 12 estados e cinco regiões geográficas. Para a identificação da carga de trabalho foi aplicada a técnica amostragem de trabalho, com observação de 34 enfermeiros e 66 técnicos/auxiliares de enfermagem a cada 10 minutos, durante a jornada de trabalho em uma semana típica de trabalho. As USF selecionadas foram avaliadas pelo Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica, como de desempenho ótimo. O instrumento de medida da carga de trabalho utilizado foi elaborado pelo grupo de pesquisadores dos Observatórios de Recursos Humanos em Saúde, para todas categorias de trabalhadores em USF. O cálculo do tempo das intervenções/atividades de enfermagem fundamentou-se na categorização proposta pelo método de planejamento da força de trabalho WISN. RESULTADOS: Foram realizadas 32.613 observações, sendo 15% amostras de reteste, com percentual de 79% de concordância entre os observadores de campo. Das 27.846 observações regulares, 9.198 (33%) foram de enfermeiros e 18.648 (67%) de técnicos/auxiliares de enfermagem. Considerando a amostra brasileira, os enfermeiros despenderam durante a jornada de trabalho: 59,1% em intervenções de enfermagem (30,5% em cuidado direto e 28,7% em cuidado indireto), 7% em atividades associada, 13,2% em atividades pessoais, 3% em tempo de espera, 14,7% em ausências e 3% do tempo de trabalho não houve observação. Os técnicos/auxiliares de enfermagem, despenderam: 40,7% em intervenções de enfermagem (24,7% em cuidado direto e 16% em cuidado indireto), 13,7% atividades associadas, 15,8% atividades pessoais, 15,6% tempo de espera, 11,7% do tempo estiveram ausentes e 2,5% do seu tempo de trabalho não houve observação. A produtividade real e potencial dos enfermeiros correspondeu a 66% e 84%, e dos técnicos/auxiliares de enfermagem 55% e 83%, respectivamente. CONCLUSÃO: Os resultados forneceram uma visão geral das intervenções/atividades de enfermagem realizadas na USF, bem como elas distribuíram-se dentro do tempo de trabalho, o que pode subsidiar a revisão de algumas práticas e otimização da força de trabalho de enfermagem para atender as necessidades de saúde dos usuários. Outro importante achado são os padrões de tempo que subsidiaram o planejamento da força de trabalho de enfermagem na ESF e a aplicação do método WISN, propiciando discussões e reflexões sobre a política atual de planejamento de trabalhadores de enfermagem para a ESF.

INTRODUCTION: Although strong evidence of health workers affecting health outcomes exists, nurses frequently do not plan the workforce based on scientific investigation. In Family Health Strategy, a single parameter is recommended to be used throughout the whole country, which does not meet the local socioeconomic characteristics, because it is based only on number of inhabitants. OBJECTIVES: to propose standard references for duration of nursing interventions / activities at Family Health Units (FHU) and to calculate nursing workforce. METHODS: It was conducted a methodological research field, multicenter with a quantitative approach and purposive sampling in 27 FHUs, in 12 states in all 5 geographical regions. The work sampling technic was used to identify the workload with observations every 10 minutes for nurses and nurse assistants during a typical working week. FHUs were selected according to the evaluation developed by National Program to improve Access and Quality of Primary Care (PMAQ). The instrument used to measure the workload was developed by a group of Human Health Resources Observatories which is applicable to all categories of workers in FHUs. The standard references were calculated based on interventions / activities proposed by Workload Indicators Staffing Need (WISN). RESULTS: 32.613 observations were conducted, and 15% was sample retest, with result in 79% agreement among observers. 27.846 observations were regular. Furthermore, 9.198 (33%) were observations of nurses and 18.648 (67%) were observations of nurse assistants. Nurses, in Brazil, spend their working time as following: 59.1% in interventions (30.5% direct care and 28.7% indirect care), 7% in unit-related activity, 13.2% in personal activity, 3% standby time, 14.7% absence and 3% was not observed. Nurse assistants, in Brazil, spend their working time as following: 40.7% in interventions (24.7% in direct care and indirect care in 16%), 13.7% unit-related activity, 15.8% in personal activity, 15.6% standby time, 11.7% absence and 2.5% was not observed. The current productivity and potential productivity of nurses, in Brazil, were 66% and 84% respectively; and of Nurse Assistants were 55% of current productivity and 83% of potential productivity. CONCLUSION: The results provide both an overview of nursing interventions / activities at FHUs, as well as how they are distributed within the working time. These results can support an eventual redesign of some practices and process optimization of nursing workforce in order to better meet the needs of users. Another important finding is the standard reference for interventions duration which gives support to the planning of the nursing workforce in FHUs and the application of the WISN method. So, these data can support discussions and reflections on the current planning policy for nursing staff at FHUs.