How the reliability and validity of the patient classification system can be ensured in daily nursing work? A follow-up study.

AIMS AND OBJECTIVES: This study aimed to determine the reliability and validity of the RAFAELA patient classification system (PCS) for qualified and efficient nurses. BACKGROUND: The number of patients per nurse or diagnosis-based determination of nursing workload are imprecise measures that do not consider the variation in patients' care needs. Ensuring the reliability and validity of the RAFAELA is important for the efficient allocation of nursing resources. METHODS: In this study, we investigated how the maintenance (parallel classification measurement and professional assessment of optimal nursing care intensity level measurement) of the RAFAELA was done with 9 years of follow-up data. The results were analysed using quantitative methods supplemented with qualitative audit descriptions. The STROBE checklist was used. RESULTS: The RAFAELA was used continuously in 44 units (40%). The length of use of the RAFAELA influenced the success of parallel classification measurements. Six per cent of units passed parallel classification measurement over 75% after 1-3 years' use, 42% after 4-6 years and 83% after 7-9 years. Among the units that used the RAFAELA PCS continuously, only four (9%) passed the professional assessment of optimal nursing care intensity level measurement. CONCLUSIONS: This study shows that ensuring the reliability and validity of the use of the RAFAELA is laborious, requires several years of use and continuous investments in nurses' skills and motivation. RELEVANCE TO CLINICAL PRACTICE: Qualified use of PCS is challenging, and organisations should invest to maintenance, training, support and user motivation. Each patient should be classified comprehensively, and nursing resources should be calculated correctly. In addition, utilisation of the nursing intensity level should be maximised. CLINICAL TRIAL REGISTRATION NUMBER: Kuopio University Hospital organisation permit number 73/2014. PATIENT OR PUBLIC CONTRIBUTION: Information regarding individual patients or nurses was not available to the researchers. All materials are in the form of summary tables.

Hospital mortality and optimality of nursing workload: A study on the predictive validity of the RAFAELA Nursing Intensity and Staffing system.

BACKGROUND: Patient classification systems have been developed to manage workloads by estimating the need for nursing resources through the identification and quantification of individual patients' care needs. There is in use a diverse variety of patient classification systems. Most of them lack validity and reliability testing and evidence of the relationship to nursing outcomes. OBJECTIVE: Predictive validity of the RAFAELA system was tested by examining whether hospital mortality can be predicted by the optimality of nursing workload. METHODS: In this cross-sectional retrospective observational study, monthly mortality statistics and reports of daily registrations from the RAFAELA system were gathered from 34 inpatient units of two acute care hospitals in 2012 and 2013 (n=732). The association of hospital mortality with the chosen predictors (hospital, average daily patient to nurse ratio, average daily nursing workload and average daily workload optimality) was examined by negative binomial regression analyses. RESULTS: Compared to the incidence rate of death in the months of overstaffing when average daily nursing workload was below the optimal level, the incidence rate was nearly fivefold when average daily nursing workload was at the optimal level (IRR 4.79, 95% CI 1.57-14.67, p=0.006) and 13-fold in the months of understaffing when average daily nursing workload was above the optimal level (IRR 12.97, 95% CI 2.86-58.88, p=0.001). CONCLUSIONS: Hospital mortality can be predicted by the RAFAELA system. This study rendered additional confirmation for the predictive validity of this patient classification system. In future, larger studies with a wider variety of nurse sensitive outcomes and multiple risk adjustments are needed. Future research should also focus on other important criteria for an adequate nursing workforce management tool such as simplicity, efficiency and acceptability.

Who benefits from clinical supervision and how? The association between clinical supervision and the work-related well-being of female hospital nurses.

AIM AND OBJECTIVES: The aims of this study were (1) to identify which nurses benefitted most from clinical supervision and (2) to explore whether they were healthier and more satisfied with their work than their peers who did not attend clinical supervision. BACKGROUND: To maintain quality nursing, there is currently a social call to improve the well-being of nurses at work. Restoring nurses' well-being is one of the main purposes of clinical supervision. However, research evidence on the effects of clinical supervision is scarce. DESIGN: Survey. METHODS: Questionnaires were distributed to female hospital nurses (n=304), about a half of whom (48.7%) had attended clinical supervision. Perceptions of work and health among the nurses who gave the best evaluations of clinical supervision (n=74) were compared with those of their peers who gave the worst evaluations (n=74) or who had not attended clinical supervision (n=156). RESULTS: The nurses who received efficient clinical supervision reported more job and personal resources and were more motivated and committed to the organisation than their peers. However, professional inefficacy was the only burnout dimension on which they scored lower than other nurses. CONCLUSIONS: Clinical supervision can be conceptualised as an additional job resource associated with other job and personal resources, which mutually reinforce each other, promoting well-being at work. Efficient clinical supervision is probably both an antecedent as well as a consequence of well-being at work. RELEVANCE TO CLINICAL PRACTICE: The results of this study advocate management planning to provide formal support for health care providers. Medical-surgical nurses are interested in clinical supervision. Reflecting on practice in clinical supervision generates new ideas about how to improve the quality of care and the psychosocial work environment. However, clinical supervision may be viewed as a preventive method rather than a treatment for burnout.

Does clinical supervision promote medical-surgical nurses' well-being at work? A quasi-experimental 4-year follow-up study.

AIM: The aim of the present paper is to report results of a quasi-experimental study exploring the effects of clinical supervision (CS) on the development of medical-surgical nurses' well-being at work over a 4-year period. BACKGROUND: Effective workplace interventions are needed to prevent stress and burnout. More robust scientific evidence is needed to confirm the restorative effects of CS in nursing. METHODS: A questionnaire survey on the perceptions of work and health was conducted in 2003 and 2007 on 14 units of a Finnish university hospital where 19 CS group processes had been completed between 2004 and 2007. RESULTS: Improvement in job resources as well as reduction in professional inefficacy and psychological distress were found among nurses who received effective CS (n = 41), but were not present among the nurses who found their CS less effective (n = 43) or who did not attend CS (n = 82). CONCLUSIONS: The results provide robust evidence for the positive effects of CS on medical-surgical nurses' well-being at work. IMPLICATIONS FOR NURSING MANAGEMENT: Stress is a developmental challenge in the professional growth of individual nurses. One option for management to sustain nurses' well-being at work is to develop a learning organization in the workplace making use of CS.

Stress relief or practice development: varied reasons for attending clinical supervision.

AIM: The aim of the present study was to explore the differences in the uptake of clinical supervision on the medical and surgical units of an acute hospital relating to the nurses' background and perceptions of their work and health. BACKGROUND: Considering the varied challenges of nursing in different specialities, the reasons for attending clinical supervision may also vary. METHODS: In 2003, a survey on work and health issues was conducted in a Finnish university hospital with a 3-year follow-up of the uptake of clinical supervision by the respondents. The nurses who subsequently undertook clinical supervision and their peers who decided not to undertake it were compared in five medical (n=96) and nine surgical units (n=232). RESULTS: On the medical units, stress management motivated the uptake of clinical supervision, whereas on the surgical units, reasons relating to practice development predominated. CONCLUSIONS: The reasons for attending clinical supervision can be quite different depending on the basic tasks and organizational culture of the hospital unit. IMPLICATIONS FOR NURSING MANAGEMENT: If clinical and managerial supervision are meant to support and complement each other, the nurse manager should be involved in discussions about the needs and goals of clinical supervision provided for staff.

Who attends clinical supervision? The uptake of clinical supervision by hospital nurses.

AIM: The aim of the present study was to identify which nurses decide to participate in clinical supervision (CS) when it is provided for all nursing staff. BACKGROUND: Clinical supervision is available today for health care providers in many organisations. However, regardless of evidence showing the benefits of CS, some providers decide not to participate in the sessions. METHODS: A baseline survey on work and health issues was conducted in 2003 with a 3-year follow-up of the uptake of CS by the respondents. Background characteristics and perceptions of work and health were compared between medical and surgical nurses who had undertaken CS (n=124) and their peers who decided not to undertake it (n=204). RESULTS: Differences in the perceptions of work and dimensions of burnout were found between the two groups. CONCLUSIONS: Nurses attracted to CS form a distinctive group in the unit, standing out as self-confident, committed and competent professionals supported by empowering and fair leadership. IMPLICATIONS FOR NURSING MANAGEMENT: Facilitating clinical supervision for committed and innovative nurses may be seen as part of the empowering leadership of the nurse manager.