Postgraduate education in psychiatric nursing in Israel: closing the gap.

Deinstitutionalization policies are being gradually implemented in Israel. Most recently, an insurance reform has been approved, in which mental health services will be included in the HMO's service package. As most Israeli mental health nurses are currently employed in institutional settings, the Ministry of Health's Nursing Division seeks to estimate their scope of employment in preparation for the anticipated changes. The aim of this study is to describe present-day professional practice characteristics of qualified psychiatric nurses and identify practice areas for which advanced training may be required. The research design is cross-sectional on a national level, including all state psychiatric hospitalization services. A countrywide sample of nurses with post-basic training in state psychiatric hospitals identified areas of practice in which further training may be required: psychotherapy intervention (60% of respondents); consultation for the elderly (60%); care prescriptions (64%); community drug treatment management (69%); and referral to professionals and community resources (56%). Nurses reported gaps in continued care and community rehabilitation activities. These findings have training implications in an era of increased focus on chronic mental illness in the community.

The Nursing Division of the Israeli Health Ministry Moves Nursing Into the Forefront of Health Care.

The Nursing Division of the Israeli Ministry of Health, with the Government Nursing Officer at its helm, plays a pivotal role in promoting the nursing profession and influencing national health policy. In terms of nursing, the division is authorized to set, upgrade, and audit professional standards; create new specialties; formulate, oversee, and accredit educational programs; and award license to practice. In terms of broad policy, it has a voice in shaping general health priorities and allocating resources. Through the strategic use of the Nursing Division's vested powers and in collaboration and consultation with stakeholders, current nursing roles are being expanded and new ones are being developed to meet the needs of the population. The aim of this article is to describe and analyze the contribution of the Nursing Division under leadership of the Government Nursing Officer in promoting nursing and health care in Israel over the last decade.

Factors influencing nursing career choices and choice of study program.

In advance of a recruitment campaign, Israeli first-year nursing students of all ethnicities were surveyed to elucidate what factors had influenced them to make nursing their career and what sort of training track they preferred. The responses made it clear that different factors influence different groups differently. There were noticeable differences by gender, age, and ethnicity. Overall, training institutions were chosen for their closeness to the student's home but other factors also operated among particular groups, such as institutional prestige and flexible entry criteria. There was a blatant preference for academic, particularly university-sited, programs over diploma programs.

Israeli emergency department nurses' attitudes to an extension of their role and powers.

AIMS AND OBJECTIVES: To investigate the opinions of Israeli ED nurses as to (1) an expansion of their powers and autonomy in treating commonly presenting ED conditions, (2) whether nurses or physicians should be responsible for giving ED patients necessary information and (3) whether ED nurses should perform triage. BACKGROUND: The development of the new emergency nurse practitioner role has relieved the pressure on emergency departments, reduced patient waiting times and raised patient satisfaction. Israel has yet to introduce either this role or the triage approach into its emergency departments. DESIGN: This investigation was designed as a cross-sectional study by self-administered questionnaire. METHODS: The researchers distributed a questionnaire they had developed and validated to 270 registered nurses working in 18 general hospital emergency departments. The responses were analysed by chi-square and t-tests and anova. RESULTS: Of respondents 60-90% agreed that they should be granted 10 out of a list of 12 new powers, and a large majority thought nurses should be responsible for performing triage. They wanted to increase the information they gave to patients, both on general ED functioning and on specific medically related matters. CONCLUSIONS: The contribution of this study is the positive response of a large representative sample of ED nurses to extending their powers. It will be necessary to establish postregistration training courses and draw up new regulations reshaping the delivery of emergency medicine. RELEVANCE TO CLINICAL PRACTICE: The study demonstrates that ED nurses are convinced that they need the authority to diagnose and treat commonly presenting ED conditions and perform triage and discharge in order for their department to optimally exploit the resources available to it. The study should promote the development of the emergency nurse practitioner role in Israel and so reduce patient waiting times.

Why do nursing students not want to work in geriatric care? A national questionnaire survey.

BACKGROUND: Given the severe shortage of nurses in geriatric care in Israel and the planned expansion of their role in the care of older people, the Israel Ministry of Health's Nursing Division decided to investigate the readiness of current students to work in geriatrics. OBJECTIVES: To gather last-year student nurses' views on geriatric nursing as a career choice and identify the factors behind those views. DESIGN: A cross-sectional questionnaire study was designed. SETTINGS AND PARTICIPANTS: 486 students (70% of the total last-year student nurse population) across the whole range of study settings completed the questionnaire in 2011. METHODS: On the basis of extensive data collection from focus groups of student nurses and working geriatric nurses a structured, self-administered questionnaire was compiled. The researchers distributed and collected the questionnaire in the students' classrooms. RESULTS: 61% of the 486 respondents had no intention of working in geriatrics while 12% considered the prospect favourably. 27% of the respondents were prepared to consider geriatric nursing as a career choice only after advanced specialist training in that field. 69% said that the planned expansion of the powers of geriatric nurses would incline them more favourably to work in geriatrics. A relatively high proportion of those interested in working in geriatrics were men. The students' appraisal of the content of their training programme and of the current state of geriatrics in Israel appeared not to influence career choice. Multiple regression analysis found that the factors most predictive of geriatric care as a career choice were a generally favourable attitude to older people, the expansion of nurse powers in the sector and previous experience in older people care. Studying on an academic programme as opposed to a diploma programme was a negative predictor. CONCLUSIONS: The non-influence of training programme content/design is the key finding. The chief recruitment effort should be invested in making the domain of geriatric nursing more attractive to nurses by improving its pay structure and expanding the powers of geriatric nurses to the level of Clinical Nurse Specialist, which would provide an attractive promotion track.

Registered nurses in Israel - workforce employment characteristics and projected supply.

BACKGROUND: Surveys of nursing supplies around the world have furnished a better understanding of the structure of the workforce, helped identify shortages, and plan professional training. This study aimed to examine the employment and workforce characteristics of registered nurses and the projected supply in Israel as a tool for planning. METHODS: 1. A survey of a national sample of 10% of the RNs of working age (3,200 nurses). 2. Analysis of administrative data from the Ministry of Health' Nursing Division and the Central Bureau of Statistics. RESULTS: Most registered nurses are employed (89%) - 67% work full time. The workforce is mature (45% are above 45), trained (55% qualified beyond the basic course, 48% hold a BA, 18% hold an MA or PhD), and stable: few quit the profession altogether. The likelihood of "survival" in the profession after 10 years is 93%; after 20 years - 88%. 23% have made some transition in the last 10 years (most - a single transition). Most of the transitions are from hospital to community work. Supply projections show a decrease in the total number of RNs in the nursing workforce from 28,500 in 2008 to 21,201 in 2028 - i.e., of 25% by the end of the period. As for the ratio per 1,000 population, the drop is from 4 registered nurses/1,000 in 2008 to 2/1,000 in 2028. CONCLUSIONS: The study findings provide more rigorous projections of supply than in the past on the declining rates of the nursing workforce in the coming decades, and contribute to decision making about the scope of training and recruitment. The study also points to the implications for policy decisions regarding the findings that the young nursing workforce is less stable, that there are advantages to recruiting a more mature workforce, and that post-basic education is connected with workforce stability.

Turnover of registered nurses in Israel: characteristics and predictors.

BACKGROUND: In an era of global and local nursing shortages, nursing turnover has negative consequences in terms of diminished quality of care, increased costs and economic losses and decreased job satisfaction. OBJECTIVE: To examine the turnover rate of registered nurses in Israel by assessing the varying degree of turnover between economic sectors, between hospital and community facilities, and/or between types of hospitals; and by examining potential predicting factors of turnover among registered nurses. METHODS: A national phone survey was undertaken in Israel consisting of a random sampling of registered nurses of working age (up to age 60). The subjects comprised 10% of a national database of 32,000 registered nurses. RESULTS: The turnover rate among working nurses in Israel currently stands at 23%. In addition, 13% of employed nurses have taken a temporary leave of absence for a period greater than 6 months in the past 10 years, most up to 1 year. While job satisfaction rates were relatively high (72%), Professional satisfaction rates were 60% with no significant difference between hospital and community nurses. The turnover rate of registered nurses from a hospital setting to the community was significantly higher (p<.01) than that of community registered nurses to hospitals. Predicting factors of turnover were found to be: young age, part-time work, lack of advanced professional education, academic education and low satisfaction with the nursing profession. CONCLUSIONS: The shift of nursing workforce is mainly from hospitals to community health settings. There is a need to monitor and understand the characteristics of job and professional satisfaction among hospital nurses in order to implement crucial organizational interventions and retain hospital nursing staffs. Since young nurses, nurses working part time and nurses with no advanced professional and academic education, tend to move more than others, efforts should be targeted at these specific groups.

Levels and predictors of knowledge and attitudes regarding pain among Israeli baccalaureate nursing students and nurses pursuing specialty certification.

This paper presents the research conducted in 2003 by the Nursing Division of the Israeli Ministry of Health regarding the level of and predictors of pain knowledge and attitudes of Israeli nursing students and certifying nurses, in the context of the Division's educational policy. Cross-sectional descriptive in design, the research included first and fourth year baccalaureate students and nurses beginning and completing certification programs (N = 1149). Knowledge and attitudes, educational level, experience and success in pain care were examined via a questionnaire based on the McCaffery and Ferrell and Riddell and Fitche tools. Student's t-test, Pearson correlations and ANOVA were used for data analysis. Educational level was the strongest predictor of knowledge and attitudes among nursing students and certifying nurses, contributing most of the 42.8% explained variance. Small significant contributions were made by other variables. This indicates that formal education is a good vehicle for enhancing knowledge and attitudes.

Do new graduates of registered nursing programs in Israel perceive themselves as technically competent?

BACKGROUND: Technical competency of graduate nurses is a much sought after commodity by nurse managers in this age of limited human nursing resources. Clinical coursework in nursing school should provide the graduate with the core skills necessary to function safely and competently in a variety of clinical sites. METHODS: The research presented in this article examines the self-reported competency of 256 recent graduates of four different types of nursing programs in Israel, with respect to 53 technical skills. Information was collected via a structured questionnaire. RESULTS: Graduates generally perceive themselves as competent, although levels of competence varied for the different skills. Type of nursing program, opportunity for skill practice in nursing school, and employment in a healthcare facility were found to be related to competency. CONCLUSIONS: Suggestions for improvement in competency levels, such as the provision of more opportunities for practice, are offered based on the specific findings of this study and in light of previous research.

State involvement in professional nursing development in Israel: promotive or restrictive.

This article describes the role of the Israeli Ministry of Health's Nursing Division in regulating the development of the nursing profession and the nursing care provided. First, factors influencing professional nursing in Israel and the development of the Ministry of Health's Nursing Division are presented. Then, examples of the Nursing Division's influence on nursing practice, the process of statutory authorization used to facilitate this influence, and future Nursing Division initiatives are discussed. The article concludes by noting that, on balance, ministerial (governmental) involvement strengthens the nursing profession and the quality of nursing care provided, yet may also restrict nurses' private concerns.

When terror is routine: how Israeli nurses cope with multi-casualty terror.

The wave of terror that has befallen the Israeli civilian population over the past two years, striking deep into the heart of towns and cities all over the country, presents a unique challenge for the health care system in general and nursing in particular. This article has a two-fold purpose: (a) to describe discussions that took place with four focus groups consisting of emergency room nurses who had recently cared for victims of terror, and (b) to delineate recommendations for policy enhancement based upon these discussions. Qualitative analysis of the data collected from focus group discussions revealed four stages of personal and professional involvement, each one eliciting a specific response from the nurses: call up to report for duty, waiting for casualties to arrive, caring for the victims, and closure of the event. Nurses identified numerous hardships and great anxiety along with a strong sense of professional fulfillment. Recommendations for policy include: incorporating stress management and debriefing skills in post-basic ER training, designing workshops and drills in trauma care for non-ER nurses who float into the ER in the wake of a multi-casualty act of terror, and developing leadership seminars for head nurses in the ER departments.