A qualitative exploration of nurses leaving nursing practice in China.

AIM: This paper reports a theoretical understanding of nurses leaving nursing practice by exploring the processes of decision-making by registered nurses in China on exiting clinical care. BACKGROUND: The loss of nurses through their voluntarily leaving nursing practice has not attracted much attention in China. There is a lack of an effective way to understand and communicate nursing workforce mobility in China and worldwide. DESIGN: This qualitative study draws on the constant comparative method following a grounded theory approach. METHOD: In-depth interviews with 19 nurses who had left nursing practice were theoretically sampled from one provincial capital city in China during August 2009-March 2010. RESULTS: The core category 'Mismatching Expectations: Individual vs. Organizational' emerged from leavers' accounts of their leaving. By illuminating the interrelationship between the core category and the main category 'Individual Perception of Power,' four nursing behaviour patterns were identified: (1) Voluntary leaving; (2) Passive staying; (3) Adaptive staying and (4) Active staying.

The (mis)management of migrant nurses in the UK: a sociological study.

AIM: To examine Nepali migrant nurses' professional life in the UK. BACKGROUND: In the late 1990 s the UK experienced an acute nursing shortage. Within a decade over 1000 Nepali nurses migrated to the UK. METHOD: A multi-sited ethnographic approach was chosen for this study. Between 2006 and 2009, 21 in-depth interviews with Nepali nurses were conducted in the UK using snowballing sampling. RESULT: Nepali migrant nurses are highly qualified and experienced in specialised areas such as critical care, management and education. However, these nurses end up working in the long-term care sector, providing personal care for elderly people - an area commonly described by migrant nurses as British Bottom Care (BBC). This means that migrant nurses lack career choices and professional development opportunities, causing them frustration and lack of job satisfaction. CONCLUSION: International nurse migration is an inevitable part of globalisation in health. Nurse managers and policy makers need to explore ways to make better use of the talents of the migrant workforce. IMPLICATIONS FOR NURSING MANAGEMENT: We offer a management strategy to bring policies for the migrant workforce into line with the wider workforce plans by supporting nurses in finding jobs relevant to their expertise and providing career pathways.

The impact of safety and quality of health care on Chinese nursing career decision-making.

AIM: The aim of the study was to understand why nurses leave nursing practice in China by exploring the process from recruitment to final exit. This report examines the impact of safety and quality of health care on nursing career decision-making from the leavers' perspective. BACKGROUND: The nursing shortage in China is more serious than in most developed countries, but the loss of nurses through voluntarily leaving nursing practice has not attracted much attention. METHOD: This qualitative study draws on a grounded theory approach. In-depth interviews with 19 nurses who have left nursing practice and were theoretically sampled from one provincial capital city in Mainland China. FINDING: 'Loss of confidence in the safety and quality of health care' became one of the main categories from all leavers' accounts of their decision to leave nursing practice. It emerged from three themes 'Perceiving risk in clinical practice', 'Recognising organisational barriers to safety' and 'Failing to meet expectations of patients'. DISCUSSION: The findings indicate that the essential work value of nursing to the leavers is the safety and quality of care for their patients. When nurses perceived that they could not fulfil this essential work value in their nursing practice, some of them could not accept the compromise to their value of nursing and left voluntarily to get away from the physical and mental stress. However, some nurses had to stay and accept the limitations on the safety and quality of health care. CONCLUSION: The study suggests that well-qualified nurses voluntarily leaving nursing practice is a danger signal for patients and hospitals, and has caused deterioration in nursing morale for both current and potential nursing workforces. It suggests that safety and quality of health care could be improved when individual nurses are empowered to exercise nursing autonomy with organisational and managerial support. IMPLICATIONS FOR NURSING MANAGEMENT: The priority retention strategies need to remove organisational barriers to the safety and quality of health care. Under the current nursing shortage, Chinese hospital managers might consider recruiting nurses and care assistants of different educational levels, which would effectively improve nursing team work and support nurses' to stay and actively achieve their work values for the safety and quality of health care.

Providing hospice home care to the terminally ill elderly people with cancer in Taiwan: family experiences and needs.

We explored caregivers' experiences and needs when providing hospice home care to their terminally ill elderly patients with cancer in Taiwan for 1 year. A total of 44 caregivers were interviewed using a semistructured interview once monthly during hospice home care visits until the patients' deaths. Content analysis of the interviews revealed 5 themes, hoping for a cure, experiencing fluctuating emotions, accepting the patient's dying, regarding the patient's death as a good death, and needing emotional support and information. Caregivers in hospice home care who experienced difficulties tended to seek emotional support and information throughout the entire caregiving process. With a greater understanding of caregivers' experiences and needs, nurses can alleviate caregivers' negative emotional reactions by actively attending to their needs during this process.

When the body is past fixing: caring for bodies, caring for people.

AIMS AND OBJECTIVES: To discuss the social context within which end-of-life nursing care takes place and to consider palliative options of last resort and the differences between societal and professional views on these. BACKGROUND: The distinction between life and death is not so straightforward as was once the case. Resuscitation and the increasing capability of intensive care to 'save' patients have implications for nursing practice in a society where there is an increasing demand that individuals should be able to choose the time of their death. METHODS: This is a discursive paper. CONCLUSIONS: There are differences between the professional view on end-of-life options and the societal debates calling for a more libertarian approach. The problem for professionals is that the call for choice of the individual involves a different approach to end-of-life care, an approach that does not sit well with current professional ethics. One way forward might be a gradual reconsidering of what end-of-life care might reasonably encompass. RELEVANCE TO CLINICAL PRACTICE: Nurses are the healthcare workers who have the most prolonged and intimate contact with bodies. The way in which we conceptualise the body is central to much of the work carried out in the transition between life and death and is an important part of nursing.