Nurses as family caregivers - barriers and enablers facing nurses caring for children, parents or both.

AIMS: To examine the dual caregiving and nursing responsibilities of nurses in New Zealand with a view to identifying potential strategies, policies and employment practices that may help to retain nurses with caregiving responsibilities in the workplace. BACKGROUND: As the nursing workforce ages, child-bearing is delayed and older family members are living longer, family caregiving responsibilities are impacting more on the working life of nurses. This may complicate accurate workforce planning assumptions. METHOD: An explorative, descriptive design using interviews and focus groups with 28 registered nurses with family caregiving responsibilities. RESULTS: A depth of (largely hidden) experience was exposed revealing considerable guilt, physical, emotional and financial hardship. Regardless of whether the nurse chose to work or had to for financial reasons, family always came first. CONCLUSIONS: Demographic and societal changes related to caregiving may have profound implications for nursing. Workplace support is essential to ensure that nurses are able to continue to work. IMPLICATIONS FOR NURSING MANAGEMENT: Increased awareness, support, flexibility and specific planning are required to retain nurses with family caregiving responsibilities.

The juxtaposition of ageing and nursing: the challenges and enablers of continuing to work in the latter stages of a nursing career.

AIMS: To identify why some nurses cope well with continuing to work as they age and others struggle. BACKGROUND: There is a need to understand better the challenges older nurses face and how they manage them. DESIGN: Secondary analysis of existing data. METHODS: Data collected in two separate studies were analysed. The first study (2012) was an online, anonymous survey that collected free text (qualitative) and categorical data (n = 3273, 57·6% response rate). The second (2014) was an explorative, descriptive study that collected data through focus groups and interviews (n = 46). Qualitative data from both studies were analysed using David Thomas' () general inductive approach. Research Ethics Committee approval was gained for the 2012 and 2014 studies. RESULTS: Data were categorised in two themes: the challenges of ageing and nursing; and factors that enable nurses to continue to practice. Physical challenges, fatigue, guilt, ageism and demands to complete continuing education were considered challenges. Maintaining personal fitness, self care, flexible working and a strong belief in their ability to contribute to the profession were present in older nurses who continued to practice. CONCLUSION: While older nurses face growing physical and cognitive challenges as they age, they demonstrate strong resilience in the face of these challenges. It is recommended nurses seek support from their workplaces early to address challenges. Organisations must address ageism in the workplace and provide practical interventions such as supporting changes to work hours, shifting nurses to less physical roles and providing career planning to support resilience in older workers.

Nurses aged over 50 and their perceptions of flexible working.

AIM: To explore the experiences and needs of older nurses in relation to flexible working and the barriers and facilitators to implementation within workplaces. BACKGROUND: An ageing nursing workforce and anticipated nursing workforce shortages require effective approaches to workforce retention. METHOD: A mixed method approach (focus group and individual interviews) with nurses aged over 50 (n = 46) combined with analysis of district health board (DHB) flexible working policies. RESULTS: Participants had a good understanding of flexible working and recognised the importance of balancing their own needs with those of their organisation. Participants had legitimate reasons for making requests and became frustrated when turned down. They recommended job sharing, shorter shifts, no night shift and greater recognition of their work to improve retention. There was discrepancy between organisational policy (where this existed) and implementation. CONCLUSION: Organisations should review flexible working policies, ensuring these are understood and implemented at the unit level. Training of nurse managers is recommended. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers must recognise the individual needs of nurses, be cognisant of workplace policies regarding flexible working, ensure these are implemented consistently and make the effort to recognise the work of older nurses.

Integrating technology into practice.

A recent NZNO study has shown patchy use by nurses of electronic devices and files. Nurses need more education and support if e-health is to be integrated successfully into nursing practice.

Walking in two worlds.

It has been nearly quarter of a century since nursing educator Irihapeti Ramsden wrote the guidelines on cultural safety (Kawa Whakaruruhau), ratified in 1992 and subsequently much revised (most recently in 2011) by the Nursing Council. The Te Puna Hauora Kaupapa Nursing Service at Tauranga Hospital has been in existence for more than 18 years. Despite this, the experiences of Maori nurses described here, and the lack of adoption of truly bicultural nursing services in other parts of the country, indicate far more investment is needed in Maori nursing. What all those working in the health-care system need is the capacity to deliver whanaungatanga models of care, through cultural awareness education, and through the development of cultural competencies.

Nurses aged over 50 years and their experiences of shift work.

AIM: The Late Career Nurse project examined views and characteristics of nurses working in New Zealand who were born before 1960. This paper focuses on the experiences of such nurses who undertake shift work. BACKGROUND: The mean age of registered nurses in New Zealand has been rising steadily, and 40% are now aged 50 years or over. While there is substantial literature on the phenomenon and consequences of the ageing nursing workforce, little is known of the particular experiences of nurses aged over 50 years who work shifts. METHOD: An anonymous online survey was emailed to eligible nurse New Zealand Nurses Organisation members aged over 50 years in February 2012. Quantitative and qualitative analyses of the 3273 responses received were undertaken. RESULT: Over 45% of respondents worked shifts or flexible hours. While shift work suited many, others noted deleterious effects on family and social relationships, physical and mental health (notably sleep patterns and fatigue), and decreasing tolerance for shift work as they age. Poor scheduling practices were particularly detrimental. CONCLUSION AND IMPLICATIONS FOR NURSING MANAGEMENT: Worldwide, workforce ageing means strategies are required to retain older nurses in the workforce. Improved scheduling practices including increasing access to flexible and part time work hours, and development of resources on coping with shift work are recommended.

The health of nurses aged over 50 in New Zealand.

The mean age of registered nurses in New Zealand has been rising steadily, and 40% are now aged 50 or over (Nursing Council of New Zealand [NCNZ], 2010). However little is known of this cohort's health-related quality of life. An anonymous on-line survey was emailed to nurses aged over 50 years and members of the New Zealand Nurses Organisation in February and March 2012. Quantitative and qualitative analyses of the 3,273 responses received were undertaken. Nurses aged over 50 remaining in the workforce report their health-related quality of life as better for all measures than standardised scores for age-matched women in New Zealand. Nurses working in more physical environments report higher pain scores than those working in less physical environments, and nurses reporting lower levels of health-related quality of life are more likely to retire sooner and to move to more casual and flexible hours of work as they age.

Nurse perceptions of the Diabetes Get Checked programme.

AIM: The Diabetes Get Checked programme provided a free annual diabetes check to people diagnosed with diabetes. The aim of the present study was to ascertain the impact this programme had on the practice of nurses; identify factors that nurses consider contributed to the success or failure of the programme in their work setting; and to elicit nurses' suggestions for future improved management and outcomes for people with diabetes. METHOD: An observational study utilising an online survey was undertaken. A total of 748 people completed the survey - the majority being nurses. Data were analysed descriptively. RESULTS: The Diabetes Get Checked programme was shown to have had a substantial impact on the practice of nurses, enabling the development of new models of nursing care, improved educational levels among nurses (and doctors), improved confidence in the management of diabetes, and increased satisfaction in their work. Nurses in the study suggested future interventions and programmes designed to support people with diabetes. These include implementation of a multi-disciplinary wrap-around approach, enhanced case management and self-management, implementing direct funding for nurse-led services, and improving population-based approaches such as policy changes and social marketing. DISCUSSION: The study sought nurse's perspectives with regard to a recently terminated programme designed to provide care to people with diabetes. It identified areas that worked well in programme implementation and those that could be improved. These findings provide useful information for funders and planners developing new programmes designed to support people with diabetes.

Development and evaluation of a matrix for assessing fatigue-related risk, derived from a national survey of nurses' work patterns.

BACKGROUND: Multiple aspects of nurses' rosters interact to affect the quality of patient care they can provide and their own health, safety and wellbeing. OBJECTIVES: (1) Develop and test a matrix incorporating multiple aspects of rosters and recovery sleep that are individually associated with three fatigue-related outcomes - fatigue-related clinical errors, excessive sleepiness and sleepy driving; and (2) evaluate whether the matrix also predicts nurses' ratings of the effects of rosters on aspects of life outside work. DESIGN: Develop and test the matrix using data from a national survey of nurses' fatigue and work patterns in six hospital-based practice areas with high fatigue risk. METHODS: Survey data included demographics, work patterns (previous 14 days), choice about shifts, and the extent to which work patterns cause problems with social life, home life, personal relationships, and other commitments (rated 1 = not at all to 5 = very much). Matrix variables were selected based on univariate associations with the fatigue-related outcomes, limits in the collective employment contract, and previous research. Each variable was categorised as lower (score 0), significant (score 1), or higher risk (score 2). Logistic multiple regression modelling tested the independent predictive power of matrix scores against models including all the (uncategorised) work pattern and recovery sleep variables with significant univariate associations with each outcome variable. Model fit was measured using Akaike and Bayesian Information Criterion statistics. RESULTS: Data were included from 2358 nurses who averaged at least 30 h/week in the previous fortnight in one of the target practice areas. Final matrix variables were: total hours worked; number of shift extensions >30 min, night shifts; breaks < 9 h; breaks ≥ 24 h; nights with sleep 11pm to 7am; days waking fully rested; and roster change. After controlling for gender, ethnicity, years of nursing experience, and the extent of shift choice, the matrix score was a significant independent predictor of each of the three fatigue-related outcomes, and for all four aspects of life outside work. For all outcome variables, the model including the matrix score was a better fit to the data than the equivalent model including all the (uncategorised) work pattern variables. CONCLUSIONS: A matrix that predicts the likelihood of nurses reporting fatigue-related safety outcomes can be used to compare the impact of rosters both at work and outside work. It can be used for roster design and management, and to guide nurses' choices about the shifts they work.

Surgical Management of Multiple Rib Fractures Reduces the Hospital Length of Stay and the Mortality Rate in Major Trauma Patients: A Comparative Study in a UK Major Trauma Center.

OBJECTIVES: To investigate and assess the effectiveness of surgical fixation of rib fractures in complex traumatic chest injuries compared with traditional nonoperative management. DESIGN: Retrospective observational comparative study. SETTING: Level 1 Major Trauma Centre in North West England. PATIENTS/PARTICIPANTS: A total of 83 patients who were admitted urgently to our hospital after major trauma, between August 2012 and March 2015, and fulfilled the criteria for surgical fixation of their multiple rib fractures. Patients who had concomitant nonsurvivable injuries or did not consent for surgery were excluded. INTERVENTION: Open reduction and internal fixation (ORIF) of multiple rib fractures and flail chest segments versus traditional nonoperative management. MAIN OUTCOME MEASUREMENTS: The primary outcome of interest was the total hospital length of stay (LOS). Secondary outcomes included the incidence of intensive care unit (ICU) admission and the incidence of respiratory complications such as hospital-acquired pneumonia, need for mechanical ventilation, and/or tracheotomy. The mortality rate was also investigated. RESULTS: A total of 83 patients were included, 47 of these in the ORIF group and 36 in the non-ORIF group. The mean hospital LOS for patients in the non-ORIF group was 30.41 days (SD 30.1). This was markedly reduced in the ORIF group to a mean of 14.53 days (SD 11.7), with the difference being statistically significant (P < 0.01). Twenty-eight patients (77.7%) in the nonoperatively managed group required admission to the ICU compared with a significantly lower 48.9% (23 patients) in the ORIF group (P < 0.01). The incidence of respiratory complications was lower in the ORIF group but this difference was not statistically significant. The mortality rate was 2.1% for the group that was treated surgically compared with 13.9% for the conservative group (P < 0.05). CONCLUSIONS: Surgical fixation of multiple displaced rib fractures reduced the total hospital LOS and the overall mortality in our major trauma patients and decreased the incidence of ICU admission. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Fatigue and nurses' work patterns: An online questionnaire survey.

BACKGROUND: Fatigue resulting from shift work and extended hours can compromise patient care and the safety and health of nurses, as well as increasing nursing turnover and health care costs. OBJECTIVES: This research aimed to identify aspects of nurses' work patterns associated with increased risk of reporting fatigue-related outcomes. DESIGN: A national survey of work patterns and fatigue-related outcomes in 6 practice areas expected to have high fatigue risk (child health including neonatology, cardiac care/intensive care, emergency and trauma, in-patient mental health, medical, and surgical nursing). METHODS: The 5-page online questionnaire included questions addressing: demographics, usual work patterns, work in the previous two weeks, choice about shifts, and four fatigue-related outcomes - having a sleep problem for at least 6 months, sleepiness (Epworth Sleepiness Scale), recalling a fatigue-related error in clinical practice in the last 6 months, and feeling close to falling asleep at the wheel in the last 12 months. The target population was all registered and enrolled nurses employed to work in public hospitals at least 30 h/week in one of the 6 practice areas. Participation was voluntary and anonymous. RESULTS: Respondents (n = 3133) were 89.8% women and 8% Maori (indigenous New Zealanders), median age 40 years, range 21-71 years (response rate 42.6%). Nurses were more likely than New Zealand adults in general to report chronic sleep problems (37.73% vs 25.09%, p < 0.0001) and excessive sleepiness (33.75% vs 14.9%, p < 0.0001). Fatigue-related error(s) in the last 6 months were recalled by 30.80% and 64.50% reported having felt sleepy at the wheel in the last 12 months. Logistic regression analyses indicated that fatigue-related outcomes were most consistently associated with shift timing and sleep. Risk increased with more night shifts and decreased with more nights with sleep between 11 p.m. and 7 a.m. and on which nurses had enough sleep to feel fully rested. Risk also increased with roster changes and more shift extensions greater than 30 min and decreased with more choice about shifts. Comparisons between intensive care/cardiac care and in-patient mental health nursing highlight that fatigue has different causes and consequences in different practice areas. CONCLUSIONS: Findings confirm the need for a more comprehensive and adaptable approach to managing fatigue. We advocate an approach that integrates safety management and scientific principles with nursing and management expertise. It should be data-driven, risk-focused, adaptable, and resilient in the face of changes in the services required, the resources available, and the overall goals of the healthcare system.