Examining the impact of Diabetes Inpatient Specialist Nursing in acute trusts in London.

AIMS: To examine if the introduction of Diabetes Inpatient Specialist Nurses impacted on length of stay and rates of readmission. DESIGN: Knowledge discovery through data mining as part of a larger realist evaluation of the role. METHODS: Data from January 2017 to January 2019 was extracted and examined. A subset of performance data from July 2017-November 2018 was analysed. This consisted of 7320 records for Hospital Episode Statistics and 272 incident reports (Datix). The data were analysed via Generalised Linear Model regression routines in R. Analysis of readmission rates utilized binary logistic regression, while for the Length of Stay a count regression method was employed. RESULTS: Four trusts were found to have complete and rich data sets. All Trusts that returned complete data were found to have varying decreased length of stay and reduced readmission rates. In two trusts there were significant decreases in patient readmissions and length of stay after the introduction of the Diabetes Inpatient Specialist Nurses. A marked decrease (approximately half) in patient length of stay was found in one London trust after the introduction of the post. Issues with data quality were noted. CONCLUSION: Reduced patient length of stay and rate of readmission were found since introduction of Diabetes Specialist Nurses. Patient safety data was incomplete and varied significantly between trusts. IMPACT: The project sought to understand the impact of employing Diabetes Inpatient Specialist Nurses in hospitals in London. Overall, the specialist nurses helped reduce length of stay and the rate of readmissions. The research will have an impact on the workforce in diabetes and also people with diabetes who need hospital care.

Does the Diabetes Specialist Nursing workforce impact the experiences and outcomes of people with diabetes? A hermeneutic review of the evidence.

OBJECTIVES: The aim of the hermeneutic review was to identify and clarify the mechanisms by which the Diabetes Specialist Nursing workforce affect the outcomes of diabetes patients, with a focus on those in the United Kingdom. A clarification of diabetes specialist nurses' work is necessary in understanding and improving diabetes inpatient care. DESIGN: The design is a hermeneutic evidence review and was part of a wider evaluation of Diabetes Inpatient Specialist Nurses for which the evidence was sourced. The literature search was limited to specialist nursing workforce caring for adults with diabetes. In order to gain global understanding of the impact of specialist nursing in diabetes, worldwide literature was included. METHODS: A hermeneutic literature review of 45 publications was carried out, which included citation analysis. Relevant literature was identified from 1990 to 2018. RESULTS: Evidence suggests that Diabetes Specialist Nurses educate patients and other healthcare professionals as well as delivering direct care. The outcomes of these actions include a reduced patient length of stay in hospital, reduced inpatient harms and complications, and improved patient satisfaction. Additionally, they are cost-effective. CONCLUSIONS: The Diabetes Specialist Nursing workforce is essential in diabetes care, particularly in hospital settings. They improve patient experience and outcomes.

Nursing pay by gender distribution in the UK - does the Glass Escalator still exist?

AIMS AND OBJECTIVES/BACKGROUND: Nursing is a predominantly female profession. This is reflected in the demographic of nursing around the world. Some authors have noted that despite being a gendered profession men are still advantaged in terms of pay and opportunity. The aim of this study was to examine if the so called glass escalator in which men are advantaged in female professionals still exists. DESIGN AND METHOD: Descriptive statistics of the routinely collected national workforce datasets from across the UK central repositories and mining of a bespoke data set that has been curated which focuses on the activity of specialist advanced practice clinical nurses. RESULTS: Even in a gendered occupation such as nursing the advantage of men in terms of pay is apparent with men being over-represented at senior Bands compared to their overall proportion in the UK nursing population. From the bespoke dataset there also seem to be an advantage in term of faster attainment of higher grades from the point of registration. CONCLUSION AND RELEVANCE TO CLINICAL PRACTICE: Reward and remuneration are essential to the workforce. This work reveals a gender differential towards men in higher paid nursing work. The drivers for this are complex and further work is required to determine the factors associated with career progression with men in nursing, and the rate limiting factors with the female workforce.

Variation in job titles within the nursing workforce.

AIMS AND OBJECTIVES/BACKGROUND: The work of specialist nursing has been under scrutiny for many years in the UK due to a perception that it is not cost-effective. A common issue is the lack of consistency of job titles, which causes confusion to the public, employing organisations, colleagues and commissioners of services. Lack of consistency has implications for the wider perception of advanced specialist practice in the worldwide community and the workforce more generally. This study aims to understand the variation in job titles in the UK population. METHODS: A pre-existing data set of accrued studies into the work of nurses working in specialisms was mined for insight (N = 17,960). This study used knowledge discovery through data and descriptive statistics to perform secondary analysis. RESULTS: Mining these data revealed 595 job titles in use in 17,960 specialist posts once the specialism had been removed. The most commonly used titles were Clinical Nurse Specialist, Nurse Specialist/Specialist Nurse, Advanced Nurse Practitioner and Nurse Practitioner. There were three other primary groupings. These were variants with a specialist or technical prefix of suffix, for example Nurse Endoscopist, variants of seniority such as trainee, senior nurse for [specialism] or variants of function such as Nurse Prescriber. The clustering was driven primarily by pay band. A total of 323 posts were recorded as holding titles such as Advanced Nurse Practitioner or Specialist Nurse who were not registered with the Nursing & Midwifery Council. RELEVANCE TO CLINICAL PRACTICE: In this data set, there is a large array of titles, which appear to have little relationship with other factors like education. This is confusing to the public, employers and those commissioning services. It also demonstrates that the previous assumptions by Council for Healthcare Regulatory Excellence that advanced practice labels are associated with career progression are unsound and should be addressed by the regulator.

The Experiences of Specialist Nurses Working Within the Uro-oncology Multidisciplinary Team in the United Kingdom.

PURPOSE: United Kingdom prostate cancer nursing care is provided by a variety of urology and uro-oncology nurses. The experience of working in multidisciplinary teams (MDT) was investigated in a national study. DESIGN: The study consisted of a national survey with descriptive statistics and thematic analysis. METHODS: A secondary analysis of a data subset from a UK whole population survey was undertaken (n = 285) of the specialist nursing workforce and the services they provide. Data were collected on the experience of working in the MDT. RESULTS: Forty-five percent of the respondents felt that they worked in a functional MDT, 12% felt that they worked in a dysfunctional MDT, and 3.5% found the MDT meeting intimidating. Furthermore, 34% of the nurses felt that they could constructively challenge all members of the MDT in meetings. Themes emerging from open-ended questions were lack of interest in nonmedical concerns by other team members, ability to constructively challenge decisions or views within the meeting, and little opportunity for patients' wishes to be expressed. CONCLUSIONS: Despite expertise and experience, nurses had a variable, often negative, experience of the MDT. It is necessary to ensure that all participants can contribute and are heard and valued. More emphasis should be given to patients' nonmedical needs.

Global Perspectives on Cancer Health Disparities: Impact, Utility, and Implications for Cancer Nursing.

This paper examines cancer health disparities and contributing factors at national, regional, and international levels. The authors all live in different countries and regions with different health-care systems and practices. Despite the shared cancer nursing perspective, each country or global region approaches cancer disparities differently. With globalization the world is becoming smaller, and in turn becoming interconnected and interdependent. This article focuses on cancer health disparities and global cancer nursing, exemplifying these concepts about the impact and implications of person-centered care.

A census of the advanced and specialist cancer nursing workforce in England, Northern Ireland and Wales.

INTRODUCTION: At present no detailed data on the specialist cancer nursing workforce across different cancer types and populations is routinely collected in England, Wales or Northern Ireland. This has implications for workforce planning and the future provision of cancer services. METHOD: In an attempt to establish a baseline of the workforce a census was taken. Data was collected via an Excel spreadsheet by Cancer Network Nurse Directors and Lead Nurses across England and Northern Ireland and a lead nurse in Wales. Scotland, Palliative Care and Chemotherapy posts were excluded at levels other than Consultant as these are collected via other mechanisms. RESULTS & CONCLUSIONS: The census recorded 2309.4 specialist and advanced practice posts in England (89% response rate), 204 posts in Wales (66% response rate) and 43.4 posts in Northern Ireland (100% response rate). There is a variation in terms of distribution of specialist nurses across the Networks both in number and in cancer type. 1800 adult CNS posts were recorded in England and 1 in 5 of these were breast cancer posts. The range of job titles is very wide with 17 different titles being used. In England the extent of support for posts from Macmillan Cancer Support was considerable. Around a third (31%) of all adult cancer specialist posts in England are supported by Macmillan Cancer Support (n=671.2) 607.2 of these are CNS posts equating to 34% of all CNS posts in England. 34% of all NI CNS posts and 32.5% in Wales.