Factors impacting nursing assistants to accept a delegation in the acute care settings: A mixed method study.

AIMS: To investigate the experience of nursing assistants being delegated nursing tasks by registered nurses. DESIGN: Mixed method explanatory sequential design. METHODS: A total of 79 nursing assistants working in an acute hospital in Australia completed surveys that aimed to identify their experience of working with nurses and the activities they were delegated. The survey data were analysed using descriptive statistics. Interviews with 11 nursing assistants were conducted and analysed using Braun and Clarke's thematic analysis. Results were triangulated to provide a richer understanding of the phenomena. RESULTS: Most nursing assistants felt supported completing delegated care activities. However, there was confusion around their scope of practice, some felt overworked and believed that they did not have the right to refuse a delegation. Factors impacting the nursing assistant's decision to accept a delegation included the attitude of the nurses, wanting to be part of the team and the culture of the ward. Nursing assistants who were studying to be nurses felt more supported than those who were not. CONCLUSIONS: Delegation is a two-way relationship and both parties need to be cognisant of their roles and responsibilities to ensure safe and effective nursing care is provided. Incorrectly accepting or refusing delegated activities may impact patient safety. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Highlights the need for implementing strategies to support safe delegation practices between the registered and unregulated workforce to promote patient safety. IMPACT: Describes the experiences of nursing assistants working in the acute care environment when accepting delegated care from nurses. Reports a range of factors that inhibit or facilitate effective delegation practices between nurses and nursing assistants. Provides evidence to support the need for stronger education and policy development regarding delegation practices between nurses and unregulated staff. REPORTING METHOD: Complied with the APA Style JARS-MIXED reporting criteria for mixed method research. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Introduction of a Registered Undergraduate Student of Nursing workforce: A qualitative study of student and registered nurses.

AIM: To explore the benefits and challenges of a recently introduced Registered Undergraduate Student of Nursing workforce from the perspective of Nurses and Registered Undergraduate Students of Nursing, in a major metropolitan hospital in Australia in 2020. DESIGN: A qualitative descriptive study was undertaken using individual interviews and focus groups. METHODS: Purposively selected employed Registered Undergraduate Students of Nursing and nurses who worked with them were interviewed, using a semi-structured format. Recordings were transcribed and coded using NVivo software. Reflexive thematic analysis using an inductive approach was undertaken. RESULTS: Four major themes were revealed: (i) Navigating the programme, (ii) Belonging and integration; (iii) Patient care; and (iv) Continuing Development. Initial challenges were common, often related to clarifying the scope of practice for the new role. Ongoing issues were associated with gaps in understanding the role and lack of integration into the team. Mostly, nurses and Registered Undergraduate Students of Nursing built positive, professional relationships. Nurses valued the Registered Undergraduate Student of Nursing knowledge and skill level, reporting improved workload and work experiences when the Registered Undergraduate Student of Nursing was on shift. Nurses believed that the Registered Undergraduate Students of Nursing enhanced patient care. Registered Undergraduate Students of Nursing described positive, therapeutic relationships with patients. Registered Undergraduate Student of Nursing employment provided opportunities for new learning, leading to increased efficiency and confidence on clinical placement. CONCLUSIONS: This employment model benefited the Registered Undergraduate Students of Nursing and nurses who worked with them. In the absence of adequate training and support, challenges remained unresolved and negatively impacted the experience for nurses. In addition to university-level education and clinical placement, the employment model can create a third space for student learning via on-the-job training. The study supports the ongoing employment of student nurses through the Registered Undergraduate Student of Nursing model. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Impact This study contributes to the very small body of literature investigating Registered Undergraduate Student of Nursing workforces in Australian hospitals. It is the first to explore the experiences of both nurses and students working together in a major metropolitan setting and also the first in the context of the COVID-19 pandemic. This study reflected a mostly positive experience for Registered Undergraduate Student of Nursing and the nurses who worked with them and highlighted the importance of adequate oversight and support in the implementation and maintenance of a Registered Undergraduate Student of Nursing workforce. Employed Registered Undergraduate Students of Nursing reported improved confidence, skills, and felt like they started clinical placement at an advantage, ready to step up and learn the Registered Nurse scope of practice. In addition to university-level education and clinical placement, this employment model creates a third space for learning via on-the-job training. REPORTING METHOD: COREQ guidelines were followed in the reporting of this study. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

The perspectives of internationally qualified nurses regarding their specialty skill transition to Australia: A cross-sectional survey.

AIM: To identify barriers and facilitators of speciality skill transfer for internationally qualified nurses in Australia from the nurses' perspective. DESIGN: A cross-sectional study. METHODS: A cross-sectional online survey was distributed through social media, snowballing and nursing professional organization. Data analysed using Statistical Package for the Social Sciences. DATA SOURCES: Online survey data from participants matching the inclusion criteria were collected from July to September 2022. RESULTS: Survey results reveal facilitators (competence, scope of practice, linguistic sufficiency, understanding of decision-making) and barriers (lack of opportunity, transition pathways, confidence in overseas education, financial instability) for internationally qualified nurses' speciality skill utilization in Australia. CONCLUSION: Identifying and addressing barriers and facilitators, along with developing tailored transition pathways, are crucial for maximizing speciality skill utilization among internationally qualified nurses. These findings have implications for policymakers, healthcare organizations and nurses. They highlight the need to address barriers, facilitate smooth transitions and implement proactive measures for internationally qualified nurses to effectively utilize their specialty skills. IMPACT: The study addresses maximizing skill usage for internationally qualified nurses, identifies barriers and facilitators for specialty skill transfer in Australia and will impact policymakers, healthcare organizations and nurses by guiding strategies for safe nursing service delivery and optimizing patient care. REPORTING METHOD: STROBE checklist. PATIENT OR PUBLIC CONTRIBUTION: A total of 71 internationally qualified nurses contributed their experiences and opinions. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: Lack of opportunity and the lack of transition pathways inhibit the use of specialty nursing skills by internationally qualified nurses. This study's findings contradict the result of other studies that suggest language is a significant obstacle to the utilization of specialty skills of internationally qualified nurses. TRIAL AND PROTOCOL REGISTRATION: The protocol is registered on OSF. The data for this study are available for sharing with the reviewers upon request. However, it is worth noting that ethical approval has not been obtained specifically for web sharing, and therefore, the data has not been posted in any repositories or public platforms.

Roles of nurse-surgeons in global surgical care: A scoping review.

AIM: To identify the roles of nurse-surgeons in the provision of surgical care. DESIGN: Scoping review. METHODS: This scoping review adhered to the JBI guideline for scoping reviews and EQUATOR Network's PRISMA-ScR checklist. Searches were performed from May 2022 to July 2022 using a combination of MeSH headings, keywords and filters via database and hand searching based on the eligibility criteria. Keywords included nurse-surgeon, nurse endoscopist, nurse hysteroscopist and nurse cystoscopist. Data sources were CINAHL, Cochrane, Google Scholar, PubMed and Scopus. Descriptive analysis was used to report the findings. RESULTS: Ninety-six included records indicated nurse-surgeon practice in 26 countries. Forty-one nurse-surgeon titles were found, the majority of which were types of nurse practitioner. A total of 5,684,198 surgeries were performed by nurse-surgeons varying from laparotomies to biopsies. Nine records reported that nurse-surgeons perform surgeries safely and on par with physicians with zero to minimal complications. Nineteen records reported improved surgical care efficiency by nurse-surgeons in terms of patient access to surgery, waiting times, surgery times, patient show rates, patient education, physician workload and junior physicians' training. Seven records reported high patient satisfaction. Nurse-surgeons were cost-effective according to five records. Thirteen records recommended the standardization of nurse-surgeon practice. CONCLUSION: Nurse-surgeons performed millions of surgeries worldwide assisting in easing the global surgical burden. This review identified the roles and benefits nurse-surgeons play in global surgical care. Research gaps on nurse-surgeon roles were discovered including the ambiguity in nurse-surgeon titles and the need to regulate nurse-surgeon practice. IMPACT: This research addressed the clinical safety, quality, contribution to timely surgical access and cost efficiency of nurse-surgeon performed surgeries, as well as the need to standardize nurse-surgeon practice and use a more consistent nurse-surgeon title to ensure role identification and monitoring.

Strategies employed by developed countries to facilitate the transition of internationally qualified nurses specialty skills into clinical practice: An integrative review.

BACKGROUND: Recruitment of internationally qualified nurses as a labour source is a long-standing human resource strategy being implemented to address the current and increasing global nursing shortage. Internationally qualified nurses transitioning into the health workforce of developed countries following immigration often possess specialty skills. A lack of a clear pathway of specialty skill utilisation makes recognising and using these specialty skills complex for many nurses. The ability for nurses to transition between countries and maintain specialty practice demands immediate attention in the current atmosphere of the global pandemic and the predictions to recruit more specialist nurses from overseas. AIM: To identify and synthesise strategies taken by various developed countries in transitioning specialist internationally qualified nurses into practice. METHODS: An integrative review was conducted to identify common themes, patterns, and best practices in order to inform policy development and improve the successful integration of internationally qualified nurses into the healthcare systems of developed countries. The study employed the Whittemore and Knafl five-stage integrative review approach. To conduct a comprehensive search, four electronic databases, namely Medline, CINAHL Complete, ProQuest Health, and EMBASE, were systematically searched in October 2021. The search was updated in March 2022 to ensure the inclusion of the most recent literature. Additionally, Google Scholar was utilised to avoid overlooking any important articles. Prior to the full-text review, three reviewers independently evaluated titles and abstracts. The included papers' quality was determined using the JBI critical appraisal tools. RESULTS: This study included 10 papers, comprising three studies and seven reports. However, none of these documents provided information on how internationally qualified nurses could transfer their specialty skills acquired overseas to developed countries after immigrating. The guidelines and policies reviewed only offered generic advice on becoming a specialist nurse. Although some countries mentioned that post-graduate qualifications were not mandatory for nurse specialists, the majority of documents in this review emphasised the need for a national framework of education at level eight or higher (equivalent to a post-graduate level) to attain the status of a nurse specialist. Moreover, the included documents did not provide clear information on whether an international specialisation degree would be recognised during the registration process. As a result, confusion persists regarding the requirement of post-graduate qualifications for nurses aiming to specialise and the recognition of international specialisation degrees during the registration process. DISCUSSION: The lack of consistency in defining nurse specialty and the skill transferability among institutions and state borders were evident in this review. According to all the 10 documents analysed, developed countries appear to have minimum policies on the transfer of internationally qualified nurse's specialty skills. Recommendations for policymakers, employers, and aspirant migrants have been proposed. Limited research has been done on how developed countries used their internationally qualified nurses' overseas-acquired specialist skills after immigration, indicating a lack of a distinct specialist skill transition pathway. CONCLUSIONS: This review presents data to support the need for greater research in this area to better utilise the abilities that internationally qualified nurses bring from their home country and put them to constructive use in the host country, especially in the context of a global pandemic.

A Massive Open Online Course Delivered Just-in-Time: A Cohort Study.

BACKGROUND: Just-in-time education enables knowledge improvement during health crises. This study was conducted to determine whether nurses' knowledge improved after participating in an innovative online education intervention designed to upskill subacute nurses to prepare for a health crisis. METHOD: The intervention was developed by university nursing academics and supported and promoted through a partnership with a government health department and clinical nurses. Quantitative data obtained with a pretest/post-test knowledge survey were analyzed with independent samples and paired t tests. RESULTS: Statistically significant improvements were seen in nurses' knowledge according to qualification level. The mean difference for knowledge improvement for registered nurses was 1.90, SD = 2.54, and the mean difference for knowledge improvement for enrolled nurses was 2.93, SD = 2.43 (mean difference = 1.03; 95% CI [0.04, 2.03]. CONCLUSION: The intervention was highly effective during the emergent and ongoing phases of the coronavirus disease 2019 pandemic. This study showed that delivering just-in-time education can improve nurses' knowledge. [J Contin Educ Nurs. 2023;54(10):472-479.].

Graduate enrolled nurse readiness to practice: A scoping review.

BACKGROUND: In some countries, enrolled nurses (also known as Licensed Practical Nurses) have become essential members of the healthcare team, supporting registered nurses to address patient care needs. Registered nurses' readiness to practice is well documented in the literature, however, less is known about the preparedness of enrolled nurses for practice. OBJECTIVE: To explore and synthesize the available evidence on the graduate enrolled nurse practice readiness upon completion of their nursing qualification and at the time of entering the nursing workforce. DESIGN: A scoping review was conducted. DATA SOURCES: Databases such as CINAHL Complete, Directory of access journal, Cochrane Library, Medline, PubMed, Scopus, Web of Science, ProQuest and Google scholar were searched. REVIEW METHOD: The review was conducted using The Joanna Briggs Institute Methodology for Scoping reviews. RESULTS: Seven studies were identified for inclusion and two themes were constructed as 'ambiguous roles and expectations' and 'lack of educational preparation'. Findings from the selected studies showed a lack of clarity on the role of an enrolled nurse. In some healthcare settings, enrolled nurses were expected to undertake the same role as registered nurses. Furthermore, it was expected that enrolled nurses would be educationally prepared to work in specialty areas such as mental health, acute care and aged care upon completion of their studies. Though, none of these studies provided any conclusive evidence of whether enrolled nurses were ready to transition to practice. CONCLUSION: In line with the limited evidence, there is a need to undertake further studies to understand the graduate enrolled nurse practice readiness from graduates' and industry stakeholders' perspectives. The findings will assist the education providers to strengthen their curriculum and health industry to support enrolled nurse transition to practice.

Integrative review: Factors impacting effective delegation practices by registered nurses to assistants in nursing.

AIM: To identify the evidence on factors that impact delegation practices by Registered Nurses to Assistants in Nursing in acute care hospitals. DESIGN: An integrative review. DATA SOURCES: Database searches were conducted between July 2011 and July 2021. REVIEW METHODS: We used the 12-step approach by Kable and colleagues to document the search strategy. The (Whittemore & Knafl. 2005. Journal of Advanced Nursing, 52(5), 546-553) integrative review framework method was adopted and the methodological quality of the studies was assessed using Joanna Briggs critical appraisal instruments. RESULTS: Nine studies were included. Delegation between the Registered Nurse and the Assistant in Nursing is a complex but critical leadership skill which is impacted by the Registered Nurse's understanding of the Assistant in Nursing's role, scope of practice and job description. Newly qualified nurses lacked the necessary leadership skills to delegate. Further education on delegation is required in pre-registration studies and during nurses' careers to ensure Registered Nurses are equipped with the skills and knowledge to delegate effectively. CONCLUSION: With increasing numbers of Assistants in Nursing working in the acute care environment, it is essential that Registered Nurses are equipped with the appropriate leadership skills to ensure safe delegation practice.

Factors impacting delegation decision making by registered nurses to assistants in nursing in the acute care setting: A mixed method study.

BACKGROUND: Healthcare organisations have been redesigning care delivery models in an attempt to extend, expand and supplement the registered nurse workforce by including more unregulated healthcare workers, such as the assistant-in-nursing. As the number of assistants-in-nursing grows it is essential that nurses have the requisite skills and knowledge to effectively delegate and supervise this growing workforce. OBJECTIVE: The aim of this research was to explore the factors that impact the nurse's decision to delegate to assistant-in-nursing in the acute care environment. DESIGN: This study used a mixed-method explanatory sequential design. The participants were RNs in an acute public hospital in Western Australia. The surveys completed by the registered nurses (n = 100) included their attitude to delegation, the risk management process undertaken prior to delegation and the tasks that they delegated to the assistants-in-nursing. The survey data were analysed using descriptive statistics. The findings from these data informed the questions for the semi structured interviews which formed the second phase of this research. Interviews with registered nurses (n = 12) were conducted, transcribed verbatim and analysed using Braun and Clarke's thematic analysis. Results from both phases were triangulated to provide a richer understanding of the phenomena. RESULTS: Overall, approximately half have a 'somewhat negative attitude' (n = 45, 45%); and the other half have a 'somewhat positive attitude' (n = 48, 48%) towards delegation. Concerningly, many nurses do not complete a risk assessment prior to delegating to the assistant-in-nursing. This study identified a range of factors that impact nurses' decision to delegate to the assistant-in-nursing including their level of experience, level of education pertaining to delegation, the assistant-in-nursing skills, knowledge and attributes, and the individual nurses' personality traits. CONCLUSIONS: As demand and financial constraints on healthcare systems increase, governments and health care providers are needing to reconsider how to deliver effective, cost efficient healthcare in the acute care environment. As models of care evolve to include more unregulated workers it is essential that safe, effective delegation practices occur between registered nurses and the assistant-in-nursing.

Impact of pre-registration extended immersive ward-based simulation on student learning in preparation for clinical placement.

BACKGROUND: Graduate nurses commonly experience significant challenges in transitioning to professional practice. The practice readiness of graduate nurses continues to be a concern for nurse educators and industry partners. Introduction of pre-registration extended immersive ward-based simulation can provide opportunities for students to practice the role of registered nurse before graduation. It is not clear if participation in simulation-based learning transfers to increased preparedness for dealing with real-life situations following entry into the workforce. OBJECTIVE: To report on student views on how ward-based immersive simulation assisted in preparing for clinical placement and graduate practice. DESIGN: A qualitative, descriptive design was used to conduct a series of face-to-face focus groups. SETTING: School of Nursing and Midwifery metropolitan Western Australian university. PARTICIPANTS: Final year baccalaureate nursing students who had participated in six four-hour simulation workshops between February and April 2021 were selected through purposive sampling. METHODS: Focus group and interview data was transcribed from audio recordings. A six-phase approach was used to analyse data into themes and sub-themes. The study adhered to the consolidated criteria for reporting of qualitative research. RESULTS: Three focus groups and one interview were conducted. Eight themes emerged. Student learning was identified as occurring in a variety of ways, such as how to work as a team and was influenced by a number of factors, such as the capacity for students to self-reflect. CONCLUSIONS: Learning opportunities for students to practice how to think and work independently as a registered nurse is something that can be supported by pre-registration extended immersive ward-based simulation. Understanding of what will be expected of them once qualified can make students more prepared for professional practice enabling them to apply knowledge gained from simulated experiences to a similar situation as a graduate nurse.

A translational research framework for nurse practitioners.

AIMS: This study aims to explore a proposed translational research continuum for nurse practitioners. BACKGROUND: Nurse practitioners are acknowledged as clinical leaders responsible for transforming health care delivery. It is important that nurse practitioners contribute to health care knowledge using scientific processes for the implementation of evidence-based practice and evaluation of outcomes of interventions for their patient groups. EVALUATION: This paper provides a review of translational research literature including implementation science to align nurse practitioner activities to a modified translational research framework. KEY ISSUES: A translational research framework has the potential to strengthen nursing research in the nurse practitioner role. Adapting an accepted translational research continuum for nurse practitioners places the clinical nursing leaders in an equitable research position with all health care professionals. IMPLICATIONS FOR NURSING MANAGEMENT: The translational research continuum provides nursing management with a structure to benchmark nursing research. The continuum applies a modern research framework to support research engagement for the nurse practitioner role.

Impact of nurse-surgeons on patient-centred outcomes: A systematic review.

Background: Nurse-surgeons have been performing surgeries for decades. Yet, their impact on perioperative clinical outcomes has not been explored in detail. Objective: To investigate the impact of nurse-surgeons on patient-centred outcomes. Design: Systematic review. Method: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram and checklist for systematic reviews were used as the screening and reporting guideline. CINAHL, Cochrane Library, MEDLINE, and PubMed databases were searched for articles that fit the review's eligibility criteria. A combination of Medical Subject Headings, keywords and filters for each database were used. Following screening and full text review, the Mixed Methods Appraisal Tool was used for quality assessment and the Grading of Recommendations, Assessment, Development and Evaluations framework for certainty and confidence assessment. Narrative synthesis was used to report the findings due to the design heterogeneity of the included studies. Results: Forty-eight (n = 48) patient-centred outcomes were identified from 25 included studies. These outcomes were grouped into four categories: patient satisfaction and experience; waiting list; perioperative complications; and quality of surgical care. Patient satisfaction and experience was rated high to very high in 16 studies; none reported patient dissatisfaction. Waiting lists improved in eight studies. Perioperative complications were none to very low in nine studies. Mortality rates in the nurse-surgeon group were better than the physician group in three studies. The quality of care in the performance of surgeries by nurse-surgeons was either similar or better than physicians in ten studies. Conclusions: Nurse-surgeons performed safe, satisfactory, and high-quality surgeries with minimal perioperative complications similar to physicians. The use of nurse-surgeons has significantly reduced waiting lists regardless of surgical speciality. Policies around nurse-surgeon practice needs to be developed at national and international levels to streamline the delivery of much needed surgical services amidst the coronavirus pandemic in the areas of cancer diagnostic surgeries, emergency surgeries, minor surgeries, and remote and rural health.

Experiences of Western Australian rural nursing graduates: A mixed method analysis.

AIMS AND OBJECTIVES: To determine whether the current rural graduate programmes in Western Australia adequately support new graduate nurses transitioning into practice. BACKGROUND: Graduate nurse's transition to employment is a time of significant change and challenge, often resulting in periods of transition shock. These challenges are magnified in rural areas where graduates have to relocate to commence their career with limited rural nursing experience. Graduate programmes were developed to smooth the transition for university trained bachelor's degree registered nurses into the workforce. Supportive graduate nursing programmes are essential for enabling transition to practice and reduce attrition rates. DESIGN: Longitudinal convergent mixed method parallel design was informed by Duchscher's transition stage model. METHOD: Thematic analysis was applied to all interviews. COREQ checklist was completed. Descriptive statistics and content analysis were used to analyse the survey responses. RESULTS: New graduates cycled through both transition shock and honeymoon periods on commencement of employment, reporting high levels of satisfaction in simultaneity with signs of transition shock. Satisfaction dropped within 7 months indicating a transition crisis before an adjustment period occurred at the end of their graduate year. Limited resources were highlighted as obstacles to providing adequate support to rural graduate nurses. CONCLUSION: The honeymoon stage of transition co-existed with transition shock at the commencement of graduate programmes, which may obscure the need for continuing adequate support. Inadequate and/or a lack of preceptorship was evident throughout the Western Australian rural graduate programmes. Graduate programmes need to be structured but flexible to allow for individual differences in graduates' and clinical contexts. RELEVANCE TO CLINICAL PRACTICE: Structured but flexible graduate programmes allow for individual differences in graduates and clinical situations. New graduate nurses would benefit from a break midway through their graduate year to assist and overcome the transition crisis stage. Education of nurses undertaking the preceptor role is required to deliver adequate support to graduate nurses and decrease transition shock.

The impact of blood sampling technique, including the use of peripheral intravenous cannula, on haemolysis rates: A cohort study.

AIMS: To explore the relationship between blood sampling techniques and haemolysis. BACKGROUND: Haemolysis rates of blood samples have been thought to be influenced by the method of collection. There is a lack of research evidence available to clearly show the comparative risk of haemolysis across different blood sampling methods, including venepuncture and use of peripheral intravenous cannulas. DESIGN: A prospective cohort study. Reporting followed the STROBE checklist. METHODS: A trained observer was used to record blood sampling techniques over a 10-week period between April and June 2019. These records were then linked to pathology haemolysis results. Multivariable logistic regression was used to model patient and blood draw characteristics affecting haemolysis. RESULTS: Most of the blood samples were not haemolysed (n = 324, 87.1%). Multivariable analysis showed haemolysis was associated with increased tourniquet duration and if the level of tube was less than half full. Univariable analysis showed haemolysis was associated with increased age of the patient, the difficulty of cannulation/ venepuncture and increased number of attempts. No difference was found in the haemolysis rate related to the qualification of the blood collector. CONCLUSION: There was no significant difference in haemolysis rates associated with sampling blood from a PIVC compared with venepuncture. Research should be undertaken to determine whether education on the factors influencing haemolysis is useful in decreasing haemolysis rates. RELEVANCE TO CLINICAL PRACTICE: There was no association with increased haemolysis rates when drawing blood via venepuncture compared with a peripheral intravenous cannula. Haemolysis of blood samples was associated with increased tourniquet duration, if level of the tube was less than half-filled, increased age of the patient and difficulty of blood draw. Awareness of the risk of haemolysis associated with specific blood sampling methods may assist clinicians to improve care.

Does participation in extended immersive ward-based simulation improve the preparedness of undergraduate bachelor's degree nursing students to be ready for clinical practice as a registered nurse? An integrative literature review.

AIMS AND OBJECTIVES: To determine if extended immersive ward-based simulation programmes improve the preparedness of undergraduate bachelor's degree nursing students to be ward ready for professional practice as a registered nurse. BACKGROUND: The practice readiness of new graduate nurses to enter the workforce continues to raise concern among educators and industry. Often the transition period is a vulnerable time when the reality of clinical practice bears little resemblance of their experiences as a student. Simulation of a busy ward offers the opportunity for pre-registered nurses to practise a variety of situations they are likely to encounter once qualified in a safe and supportive learning environment. METHODS: The review considered studies that investigated the experiences and learning outcomes of nursing students following participation in extended immersive ward-based simulation. Databases searched included CINAHL, EMBASE, Medline and Scopus. Two reviewers independently assessed retrieved studies that matched inclusion criteria using standardised critical appraisal instruments. Reporting of review followed PRISMA checklist. RESULTS: Fourteen studies met the inclusion criteria. The majority of studies used a quasi-experimental mixed methods approach (10). Programme evaluations focused on self-reporting in learning satisfaction and student perceptions of performance. Six studies used a pre- and post-test design to compare the after effect on preparedness for professional practice. Two studies investigated student learning between simulated experiences and experiences gained during clinical placements. CONCLUSION: Learning satisfaction was high among students who participated in programmes that incorporated extended immersive ward-based simulation experiences. Students are able to practise what they need to know and on what will be expected of them in professional practice. Evidence on whether these programmes make a difference in workplace performance, and retention of graduate nurses is yet to be established. RELEVANCE TO CLINICAL PRACTICE: Extended immersive ward-based simulation allows educators the opportunity to meet the perceived needs of students in preparation for professional practice.

Current methods of nurse-surgeon training and education: Systematic review.

Background: The role of nurse-surgeons has recently emerged to meet patient and health system surgical demands. However, methods of nurse-surgeon training and education requirements are unclear. Objective: To identify and describe the current methods of nurse-surgeon training and education worldwide. Design: Systematic review. Method: An electronic search was conducted using Cumulative Index to Nursing and Allied Health, Cochrane Library, Medical Literature Analysis and Retrieval System Online, Public Medical Literature Analysis and Retrieval System Online, and Google Scholar databases. Key words included nurse-surgeon, training, education, and perioperative. Following screening for inclusion, a mixed methods critical appraisal tool was used to ascertain methodological rigour and the Grading of Recommendations, Assessment, Development and Evaluations framework to assess confidence in the evidence. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram and checklist for reporting systematic reviews were used. Results: A total of 18 studies was included in this review. Current methods of nurse-surgeon training were identified as surgical speciality specific (n = 18). Most training courses were at least one year in length (n = 4) with a theoretical component (n = 15). All studies included a practical requirement (n = 18), which was generally supervised by a physician (n = 16). A competency assessment was required by 15 programmes, with nine (9) using a formative assessment approach. The evidence available for this review is low in quality and certainty. Conclusions: Current methods of nurse-surgeon training have been identified to be specific to speciality areas. Overall, training has required nurse-surgeons to undergo andragogical education in theory, supervision in practice by a surgeon and assessment of competency. An implication for practice is a streamlined nursing pathway to surgical residency training which would improve global surgical health outcomes and retain young perioperative nurses.

An integrative review to identify evidence of nurse practitioner-led changes to health-care delivery and the outcomes of such changes.

AIMS: This study aimed to identify evidence of nurse practitioner-led changes to health-care delivery and the outcomes of such changes. BACKGROUND: Changing health-care delivery is synonymous with the nurse practitioner role. The literature is critical of the lack of research by nurse practitioners, reporting the effects of a change to health-care delivery. DESIGN: This study used a systematic integrative review by using Torraco's approach. DATA SOURCES: Databases Cumulative Index to Nursing and Allied Health Literature, MEDLINE, Web of Science and SCOPUS were searched for peer-reviewed publications from 2000 to 2019. REVIEW METHODS: A systematic approach was used to screen and analyse the literature. Inclusion/exclusion criteria were applied, and quality appraisal was undertaken by two reviewers. RESULTS: Eighteen articles were selected. The research projects were across the community and acute care settings. Research methodologies varied including preintervention and postintervention studies, evaluation of quality improvement projects, randomized controlled trial and descriptive studies. Multiple data collection tools were used. Two major themes were identified including evidence-based practice champions and improved patient outcomes. CONCLUSION: The nurse practitioner role is pertinent toward improving evidence-based practice in clinical settings. Positive patient outcomes and praise for clinical leadership are evident in the literature. Research by nurse practitioners to date has focused on individual services.

Are current clinical guidelines on the use of Peripheral Intravenous Cannula for blood draws supported by evidence? An organizational case study.

Aim: To examine the quality of evidence used to inform health policies. Policies on peripheral intravenous cannulas were used as exemplars. Design: An organizational case study design was used, using the STROBE reporting guidelines. Methods: Policy guidelines were sourced between June and September 2018 from health departments in Australia. Seven documents were compared regarding intravenous cannula dwell times and blood collection use. Evidence used in the documents was critiqued using assessment guideline from the Oxford Centre for Evidence Based Medicine. Results: Large variations exist between policies regarding blood sampling and dwell time. Evidence used a variety of sources. Few references received an A evidence rating and policies differed in their interpretation of evidence.

A survey identifying leadership and research activities among Nurse Practitioners.

Background: Nurse Practitioners are identified as the ideal conduit to transform healthcare delivery internationally. Healthcare transformation requires the application of leadership and research skills. Current literature has limited information on NPs as leaders or researchers in the nursing profession.Objectives: Determine if Nurse Practitioners identify themselves as leaders in nursing. Identify the leadership and research activities and influencing characteristics of Nurse Practitioners in Ireland and Australia. Establish similarities in leadership and research activities between Nurse Practitioners in Ireland and Australia. To identify if there is a relationship between leadership and research activities.Design: A quantitative electronic survey.Methods: A survey instrument was developed by combining two previously validated instruments. Nurse Practitioners in Ireland or Australia that had practiced within the last five years, and members of the respective professional association were included. Descriptive statistics were used to describe the findings and explore relationships in the data.Results: 14% (n = 96) of Nurse Practitioners responded to the survey. Nurse Practitioners in Ireland and Australia identified themselves as leaders of the nursing profession. Nurse Practitioners work practices, leadership and research activities are similar in Ireland and Australia. The majority (n = 55, 57%), of participants reported being research active. There was an association between perceived leadership and research activities among participants.Conclusion: Nurse Practitioners in both Ireland and Australia identify themselves as leaders of the nursing profession. There is no difference in reported work practices, leadership or research activities of Nurse Practitioners in both Ireland and Australia. There is an association between perceived leadership and research activity.Impact Statement: Nurse Practitioners in Ireland and Australia percieved themselves as leaders in nursing and this perception increases with research activity.

'Ward for the day': A case study of extended immersive ward-based simulation.

BACKGROUND: Simulation is an important teaching strategy in the preparation of nursing students for professional practice. The focus of simulation has shifted from single patient encounters to multiple case studies provoking immersion in all the activities that are regularly performed on the ward. Extended immersive simulation cannot replicate completely the stresses of working on a 'real' ward, but it does provide a safe environment for students to practice the role of being a registered nurse. OBJECTIVE: To evaluate satisfaction associated with student experiences of mentorship by industry partners, self-reflection on performance, and responses to clinical situations following an episode of extended immersive ward-based simulation. DESIGN: Mixed methods case study. SETTING: School of Nursing and Midwifery metropolitan Western Australian university. PARTICIPANTS: A cohort of 278 final year students enrolled in a three-year Bachelor of Nursing program. METHOD: Eight demonstration rooms were re-configured to resemble a mixed medical/surgical ward. Nursing students and manikins in each room simulated different patient scenarios. Students were organised in three-hour shifts in which to undertake the role of a registered nurse. Industry partners undertook shift coordinator and senior nursing roles. Surveys were distributed to students at the end of the two-day simulation. Student satisfaction was evaluated using the Satisfaction with Simulation Experience scale and content analysis of open-ended questions. RESULTS: A total of 243 students (87.4%) responded to the survey. None of the scaled items had a mean score of below 4.5. Content analysis of 458 written responses identified three themes: simulation, role of registered nurse and learning. CONCLUSION: Extended immersive ward-based simulation offers the opportunity for educators to mirror what happens in clinical practice. Students value the opportunity to safely experience simulated demands of working on a busy ward and learn how to meet workplace pressures in the delivery of patient care.