Relationships between certification and job perceptions of oncology nurses.

PURPOSE/OBJECTIVES: To explore relationships between oncology nursing certification and oncology nurses' job perceptions. DESIGN: Descriptive, correlational. SETTING: Questionnaire mailed to homes of Oncology Nursing Society (ONS) members. SAMPLE: 703 certified and 514 noncertified ONS members (N = 1,217; 50% response rate). METHODS: Data were collected using survey methods and grouped by respondents' certification status for statistical analysis. MAIN RESEARCH VARIABLES: Certification, group cohesion, organizational commitment, and job satisfaction. FINDINGS: Certification was weakly correlated with cohesion, commitment, and satisfaction. Work setting, rather than certification, accounted for differences in job perceptions. Job perceptions were most positive in settings characterized by a high percentage of patients with cancer (> 75%), a high percentage of RNs (> or = 80%), and monetary support for continuing education. CONCLUSIONS: The hypothesis that oncology nurses' certification status is associated with job perceptions that are valued by employers was not supported. IMPLICATIONS FOR NURSING PRACTICE: Nurses' job perceptions have been linked to control over nursing practice and participation in organizational and clinical decision making. Managerial strategies that empower certified nurses to practice with more autonomy and participate in decisions that affect patient care should be emphasized.

Recovery from coronary artery bypass surgery: age-related outcomes.

As people age, their incidence of coronary heart disease increases. The majority of persons undergoing invasive procedures such as coronary artery bypass surgery are 65 and older. Because of population trends related to aging, it is projected that there will be exponential increases in the numbers of people requiring treatment for this health problem in the future. Changes in health care reimbursement have significantly decreased hospital length of stay, resulting in many patients completing their recovery either in a rehabilitation facility or at home. Patients with multiple preoperative comorbidities are at risk for postoperative complications. Older patients usually have more health problems after coronary artery bypass surgery because they have more risk factors prior to the procedure. It is not known whether there are differences in outcomes between comparatively older and younger patients when they are matched by risk classification. Information on the recovery of patients at home will enable nurses to meet their care needs prior to surgery and after discharge from the hospital.

Student contributions to clinical agencies: a comparison of adult health and psychiatric staff nurses' perceptions.

Clinical rotations in acute medical and psychiatric inpatient facilities are an essential component of the education for undergraduate nursing students. The benefits students receive from these clinical experiences have been documented, but no data have been reported regarding the advantages that students may bring to agencies. This exploratory study, which used a mail-back survey, asked adult health/medical-surgical nurses and mental health/psychiatric nurses in acute care units about the effects undergraduate nursing students had on staff time, staff development, quality of care, staff's personal satisfaction, and unit standards and practices during their clinical rotations. Results indicated that students contribute to the personal and professional satisfaction of the staff by offering opportunities for mentoring and reciprocal learning and allowing nurses to participate in students' professional development. Students also contribute to patient care.

Coming full circle: mentorship in HIV/AIDS care.

The role of the mentor has been found to be crucial for learning, yet mentorship in HIV/AIDS nursing care has not been well documented. The purpose of this study was to (a) examine the characteristics of a nurse mentor in HIV care as perceived by nursing and medical students and HIV staff, and (b) explore an HIV nurse mentor's perceptions of her role and responsibilities in the professional development of students and staff. Mentorship, as a process of "coming full circle," was highlighted by the mentor's accounts of early influences in her career as well as students' and staff members' intents to facilitate the professional development of the next generation. The legacy of excellent HIV nursing care can be continued if expert HIV nurse mentors are identified and encouraged to work with students, inexperienced nurses, and health care providers. Health care institutions have a responsibility to foster mentorship in HIV/AIDS care to assure quality health care for clients and the professional development of expert nurses in HIV/AIDS care.

Cardiac surgery's calculated risk.

Nurses can evaluate preoperative risk and place cardiac surgery patients in four risk categories to predict patients' postoperative clinical and nursing resource needs.

A national survey of certified, recertified, and noncertified oncology nurses: comparisons and contrasts.

PURPOSE/OBJECTIVES: To explore opinions about the OCN credential, the ways in which it was obtained and retained, and the extent to which it is valued by employers. DESIGN: A descriptive comparison study using a cross-sectional survey design. SAMPLE: Questionnaires were mailed to a nationwide sample of 2,429 RN members of the Oncology Nursing Society; 1,217 (50%) surveys were returned. The majority of respondents were female, 30-49 years of age. Caucasian, and had practiced nursing for more than 11 years. MAIN RESEARCH VARIABLES: Certification status, work role characteristics, preparation strategies for the certification examination, and motivation for obtaining certification. FINDINGS: Oncology nurses recognize the importance and value of OCN certification. The primary reasons oncology nurses obtain and retain certification include the desire for personal achievement, professional growth, and development. OCNs were more likely to work in a setting where the employer supports professional development through continuing nursing education. IMPLICATIONS FOR NURSING PRACTICE: Because health care is increasingly delivered in ambulatory/home settings and the population is aging, oncology certification needs to be encouraged among nurses who work in these settings or with geriatric populations. Certified nurses tended to experience more job satisfaction than noncertified nurses.

Risk classification, clinical outcomes, and the use of nursing resources for cardiac surgery patients.

Several studies have used risk classification models to examine the effect of preoperative risk factors on operative morbidity and mortality. However, previous research has not linked risk classification models to factors such as frequency of postoperative complications, length of intensive care unit stay, mortality, and the use of nursing resources. This article reports on significant differences in clinical outcomes and hours of nursing care by risk classifications.

Students' decisions to select HIV services for clinical experiences.

The ever-growing numbers of persons living with HIV/AIDS emphasizes the need for highly trained healthcare professionals to care for this population. Understanding why nursing and medical students would choose HIV services for clinical rotations, and the impact of those clinical experiences on their future professional practice, is key to recruiting healthcare providers to care for this population.

Coronary artery bypass surgery in women and men: preoperative profile and postoperative outcomes.

The incidence and presentation of symptoms of coronary heart disease differ in women and men. Gender variations also have been documented in their postoperative recovery after coronary artery bypass surgery. Women undergoing this procedure are older and have more preoperative co-morbidities. The presence of these health problems translates into unequal rates of morbidity and mortality for women and men during their postoperative recovery in the hospital and has implications for adult-health nurses.

From silencing the self to action: experiences of women living with HIV/AIDS.

Feminist literature has demonstrated that women often maintain behaviors that support silencing of their voices. The critical issue is whether the silencing experience is (a) a destructive process of burying feelings and needs, (b) a protective strategy to preserve personal and professional relationships which they value, (c) a coping mechanism to divorce themselves from an androcentric/ethnocentric health care culture, or all of these. The transition from silence to action may be a process of reacting to a threat to self (i.e., HIV/AIDS diagnosis) where gender normative behaviors become irrelevant and self-advocacy becomes paramount for survival. Alternatively, the transition may be a conscious process of gaining insight into past behaviors that have been learned and culturally supported and making purposeful changes. Data for this study were extracted for secondary analysis from data from a larger study on experiences and needs of persons living with HIV/AIDS. Data were obtained from transcripts from three focus groups (N = 14 women) and six individual interviews. Women ranged in age from 21 to 55; 9 were European American, 7 were African American, and 4 were Latina American. Data were content analyzed and organized using four categories proposed by Jack (1991): (a) externalized self-perception, (b) care as self-sacrifice, (c) silencing the self, and (d) the divided self. Data supported that women with HIV/AIDS reported all four categories of silencing behaviors, particularly early in the HIV trajectory. For some women, an HIV/AIDS diagnosis ignited them to speak for themselves and to shape their own lives based on feelings and needs. For others, peer or professional support or both was the catalyst for the transition from silence to action. Findings suggest interventions that would assist women in judging themselves by internal versus external standards, putting their own needs before the perceived needs of others, expressing themselves toward action rather than avoidance, and feeling comfortable expressing anger.

Impact of risk classification on nursing resource utilization, postoperative length of stay, and hospital costs for cardiac surgical patients.

Outcomes after cardiac surgery are a concern for patients, health care providers, and insurers. Because of the current economic climate, there is a demand for positive outcomes and an evaluation of negative results. The results of this study showed significant differences in nursing resource utilization, postoperative length of stay, and hospital costs by risk classification group. Risk classification models could serve as a template for staffing patterns and reimbursement based on patients' clinical profiles.

A mobile HIV education and testing program: bringing services to hard-to-reach populations.

Few programs exist that offer a range of human immunodeficiency virus (HIV) services to multiple populations (i.e., substance abusers, individuals on probation, sex workers and their clients, court-mandated perpetrators of domestic violence) in multiple settings (i.e., courts, methadone maintenance clinics, residential and outpatient substance abuse treatment programs). The purpose of this article is to describe a model mobile HIV program, highlighting its flexibility in providing services to clients who infrequently present to traditional clinic-based testing sites. This mobile HIV program was developed to provide on-site HIV testing and counseling, education, and linkages to primary care services. The implementation of the program begins with training of agency staff, who then provide preliminary orientation with clients regarding HIV testing. Approximately 3 weeks later, the mobile program staff (HIV nurse specialist and HIV counselors) provide standardized group pretest counseling and education. Clients who decide to be tested meet with mobile program staff for individualized risk assessment and specimen collection. Two weeks later, clients meet with mobile program staff to obtain results and receive posttest counseling; risk reduction strategies are reemphasized at that time. Unique to this program is the provision of referrals for a wide range of primary care services for both seropositive and seronegative clients. Since 1994, the mobile program has been implemented at six sites, and over 1100 clients have been served. Two major outcomes from the program have been observed: 1. With adequate preparation and psychological support, 40% of hard-to-reach populations will elect to be HIV tested. 2. Through social networks of program participants, HIV-positive individuals not previously engaged in care have been referred to a comprehensive HIV primary care program.

Nurses preparing for change: their needs and concerns.

As a result of decreased lengths of stay and cost-containment initiatives, fewer nurses are needed in acute care settings. The trend for community-based health care is broadening employment opportunities for nurses to work in community settings. As nurses are considering options to base their practice in community settings, it is important to understand their concerns about making this transition. The results of a qualitative study conducted to examine the concerns and educational needs of acute care nurses related to working in the community are reported. Clinical, professional, and intrapersonal skills important for a successful transition to community-based practice are identified and discussed.

Assessing for sexual abuse.

1. Knowing the sexual abuse history of a patient contributes to a greater understanding of the patient's clinical problems and facilitates appropriate discharge planning. 2. Obtaining a history of sexual abuse is not always part of the nursing admission assessment sheet, and many staff members have little or no training on the therapeutic interventions for a history of sexual abuse. 3. The lack of staff training and the ambiguous nature of sexual abuse assessment must be examined in relationship to quality patient care.

Building nursing's minimum data set: the results of a pilot study.

Nursing's viability in health care data bases is nonexistent. If nursing is to receive acknowledgment and reimbursement for the services provided to patients, nursing data elements must be visible in national health care databases. To identify nursing data elements, this pilot project tested three instruments that could be used to identify nursing diagnoses commonly used in the peri-operative and peri-procedural care of patients. The results of the pilot project survey, the instrument of choice, and nursing diagnoses used during the pre, intra, and postoperative/procedural experience are described.

Supervision of suicidal patients in adult inpatient psychiatric units in general hospitals.

OBJECTIVE: The safety of suicidal patients is expected to be maintained during hospitalization. This study surveyed a sample of adult inpatient psychiatric units in general hospitals across the United States about their use of various levels of supervision for suicidal patients, the advantages and disadvantages of these interventions, and issues of cost and reimbursement for the services. METHODS: A 33-item questionnaire was sent to a nationwide random sample of hospital-based adult inpatient psychiatric units. A total of 105 surveys from all regions of the country were used in the analysis. RESULTS: Although 98 hospitals reported that they used one-to-one continuous observation of suicidal patients, observation of the suicidal patient every 15 minutes was the most frequently used type of supervision, ranked first or second in frequency by 69 hospitals. Patients' safety was the most frequently cited advantage of supervision, and increased staffing the most frequently cited disadvantage. In most cases, the cost of supervision for suicidal patients was absorbed by the hospital, and hospitals were not reimbursed for care based on the severity of patients' illness. CONCLUSIONS: Future research on the effectiveness of various strategies for supervision of suicidal patients should include cost-benefit analyses. Policies for reimbursement for care of suicidal patients should be based on the patient's severity of illness.

Mission, staffing, and budget data of flight programs in the United States.

INTRODUCTION: Manage care and other health care reform initiatives have forced all hospitals to evaluate their work processes. In this era of cost containment, many flight programs are examining the structure of their programs to determined whether they are functioning in an efficient, cost-effective fashion. METHODS: A survey was sent to the chief flight nurse of 240 flight programs in the United States. RESULTS: Eighty-five programs (35.4%) responded. Data were collected on demographics, management structure, mission information, staffing issues, and budgets. Results in each program varied widely. CONCLUSION: Benchmark data are available against which programs can compare themselves. Such comparisons may allow the discovery of opportunities to enhance program efficiency and cost-effectiveness.