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 case for end-user involvement in design of health technologies.

This paper reports a subset of data from a mixed methods project interviewing community nurses and nurse leaders/managers to explore the views, expectations, practice and attitudes of registered nurses working in the community concerning electronic health records and the use of mobile devices. Nurses displayed excellent understanding of privacy and consent concerning electronic patient records and health information technology (e-health). With targeted, individualised education, nurses use e-health and telehealth effectively. However, significant barriers were found regarding duplication of paper and electronic patient notes and multiple logins for different platforms and systems, resulting in forgotten and shared passwords. There was also evidence of some avoidance of essential systems; lack of infrastructure in some settings; inadequate systems for the use of digital cameras (e.g. tracking wound healing); and inability to access patient notes across settings to ensure integrated care. In conclusion, nurses are the largest group of health practitioners in New Zealand and are at the front line of patient care. Nurses need systems designed around their work methods and a good understanding of e-health in order to be able to use it effectively. Greater consultation with nurses is required to ensure the potential of e-health and its use is maximised.

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.

Nursing roles and responsibilities in general practice: three case studies.

INTRODUCTION: Primary care nursing teams may now comprise registered nurses (usually termed practice nurses), nurse practitioners, physician assistants, enrolled nurses, and primary care practice assistants, clinical assistants, or nursing assistants. There is a need to understand how practitioners in the different roles work with patients in the changed environment. The aim of this study was to describe the different configurations of health professionals' skill-mix in three dissimilar primary care practices, their inter- and intra-professional collaboration and communication, and to explore the potential of expanded nursing scopes and roles to improve patient access. METHODS: Document review, observation and interviews with key stakeholders were used to explore how health practitioners in three practice settings work together, including their delegation, substitution, enhancement and innovation in roles and interdisciplinary interactions in providing patient care. A multiphase integrative, qualitative and skill-mix framework analysis was used to compare findings related to nursing skill-mix across case studies. FINDINGS: Three models of primary care provision, utilising different nursing skill-mix and innovations were apparent. These illustrate considerable flexibility and responsiveness to local need and circumstances. CONCLUSION: Enabling nurses to work to the full extent of their scope, along with some adjustments to the models of care, greater multidisciplinary cooperation and coordination could mitigate future workforce shortages and improve patient access to care.

12 h shifts and rates of error among nurses: A systematic review.

OBJECTIVE: To determine the effect of working 12 h or more on a single shift in an acute care hospital setting compared with working less than 12 h on rates of error among nurses. DESIGN: Systematic review. METHOD: A three-step search strategy was utilised. An initial search of Cochrane, the Joanna Briggs Institute (JBI), MEDLINE and CINAHL was undertaken. A second search using all identified keywords and index terms was then undertaken across all included databases (Embase, Current contents, Proquest Nursing and Allied Health Source, Proquest Theses and Dissertations, Dissertation Abstracts International). Thirdly, reference lists of identified reports and articles were searched for additional studies. Studies published in English before August 2014 were included. FINDINGS: Following review of title and abstract of 5429 publications, 26 studies were identified as meeting the inclusion criteria and selected for full retrieval and assessment for methodological quality. Of these, 13 were of sufficient quality to be included for review. Six studies reported higher rates of error for nurses working greater than 12 h on a single shift, four reported higher rates of error on shifts of up to 8 h, and three reported no difference. The six studies reporting significant rises in error rates among nurses working 12 h or more on a single shift comprised 89% of the total sample size (N=60,780 with the total sample size N=67,967). CONCLUSION: The risk of making an error appears higher among nurses working 12 h or longer on a single shift in acute care hospitals. Hospitals and units currently operating 12 h shift systems should review this scheduling practice due to the potential negative impact on patient outcomes. Further research is required to consider factors that may mitigate the risk of error where 12 h shifts are scheduled and this cannot be changed.

History of the child health and development book. Part 2: 1945-2000.

This is the second part of a historical review of the New Zealand child health and development record book (also known as the Well Child/Tamariki Ora Health book or Plunket book). It focuses on the years between 1945 and 2000. The first article highlighted how the book documented the development of "scientific mothering", which marginalized women-generated mothering knowledge. The present article highlights how during the reviewed time period women began to challenge notions of "scientific mothering", these changes are signaled in the content of the Well Child/Tamariki Ora Health book over time. In addition, women's movements, such as LaLeche league and Parent Centre, reflected significant societal changes during this era in relation to mothering and child-rearing practices, the influence of which had a significant impact on the Plunket book's development. However, tensions between health professionals and women in relation to the value placed on types of knowledge continued to exist as evidenced by the language employed in the Plunket books throughout the time period reviewed. Being mindful of the tensions that exist between competing discourses and knowledge sources is important as they call us to engage with how we value and develop our relationships with women and mothers as health care professionals.

History of the child health and development book. Part 1: 1920 to 1945.

The New Zealand child health and development record book (also known as the Well Child/Tamariki Ora Health Book or Plunket book) has recorded the history of infant-rearing practices in New Zealand for almost 100 years. Since its initial publication it has been used by mothers and health professionals to track the health and development of children under the age of five years. The book also provides insight on the development of mothering practices and provides commentary on the medicalisation of mothering and the emergence of mothering as a science from the time of its inception. This article, part one of two, explores the history of the Plunket book during the years of 1920 to 1945. Information for this article stems from both primary and secondary sources, including an extensive collection of Plunket books from across New Zealand. The findings chronicle the development of a medicalised relationship between mothers and health professionals. The exploration reveals that the rise of scientific mothering coincided with the devaluing of women-centred mothering knowledge, and as a result the language that described women's mothering experiences was silenced.