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Issue 154 - 1 Oct 2010


1. Education and Professional development
By Cook, Mike. Journal of Nursing Management, Jul 2009, Vol. 17 Issue 5: p519-522
An introduction to the journal is presented, the focus of which is education and professional development for nurses.

2. The times they are a changin
By Thomas, Mike. Journal of Nursing Management, Jul 2009, Vol. 17 Issue 5: p523-531
A discussion paper outlining the potential for a multi-qualified health practitioner who has undertaken a programme of study incorporating the strengths of the specialist nurse with other professional routes.
Background and rationale: The concept and the context of ‘nursing’ is wide and generalized across the healthcare spectrum with a huge number of practitioners in separate branches, specialities and sub-specialities. As a profession, nursing consists of different groups in alliance with each other. How different is the work of the mental health forensic expert from an acute interventionalist, or a nurse therapist, from a clinical expert in neurological deterioration? The alliance holds because of the way nurses are educated and culturalized into the profession, and the influence of the statutory bodies and the context of a historical nationalized health system. This paper discusses the potential for a new type of healthcare professional, one which pushes the intra- and inter-professional agenda towards multi-qualified staff who would be able to work across current care boundaries and be more flexible regarding future care delivery. In September 2003, the Nursing and Midwifery Council stated that there were ‘more than 656 000 practitioners’ on its register and proposed that from April 2004, there were new entry descriptors. Identifying such large numbers of practitioners across a wide range of specialities brings several areas of the profession into question. Above all else, it highlights how nursing has fought and gained recognition for specialisms and that through this, it may be argued client groups receive the best possible ‘fit’ for their needs, wants and demands. However, it also highlights deficits in certain disciplines of care, for example, in mental health and learning disabilities. We argue that a practitioner holding different professional qualifications would be in a position to provide a more holistic service to the client. Is there then a gap for a ‘new breed’ of practitioner; ‘a hybrid’ that can achieve a balanced care provision to reduce the stress of multiple visits and multiple explanations?
Methods: Review of the literature but essentially informed by the authors personal vision relating to the future of health practitioner education. Implications for nursing management This article is of significance for nurse managers as the future workforce and skill mix of both acute and community settings will be strongly influenced by the initial preregistration nurse education. [ABSTRACT FROM AUTHOR]

3. Delphi survey of research priorities
By Wiener, Barry. Journal of Nursing Management, Jul 2009, Vol. 17 Issue 5: p532-538
Aim - To identify nurses’ priorities for topics and issues to be addressed by a developing nursing research program at a county hospital.
Background: Delphi surveys have been effective at other hospitals to identify research priorities of nurses.
Methods: A Delphi survey was performed in two rounds. Questionnaires were distributed to all 415 nurses who worked at the hospital.
Results: A total of 274 nurses returned the Round I questionnaire (response rate, 66%), and 249 returned the Round II questionnaire (response rate, 60%).
Conclusions: The Delphi survey was successfully used to identify nurses’ research priorities at a county hospital A total of 39 topics were identified from content analysis of research areas described by nurses. Factor analysis revealed three factors: work environment, newborn issues and effects of leadership. Implications for nursing management: The Delphi survey is a useful way to begin a program of research. Nurses who have a successful experience with research are more likely to become further involved in research, which will allow them to more effectively participate in decision making and improving the work environment. In addition, items were identified that needed to be addressed by nursing managers. [ABSTRACT FROM AUTHOR]

4. Evaluating a preceptorship programme in South West Ireland: perceptions of preceptors and undergraduate students.
By Heffernan, Catrina et al. Journal of Nursing Management, Jul 2009, Vol. 17 Issue 5: p539-549
The study sought to evaluate stakeholder perspective of preceptor preparation and attributes.
Background: In Ireland, undergraduate students are supported by a named preceptor on clinical placement. A preceptor is a registered nurse who has completed a teaching, assessment and preceptorship programme. Preceptor preparation is costly in terms of facilitation and staff release/replacement. To date, in Ireland, research has not explored the effectiveness of preceptor preparation.
Method: An utilization-focussed approach was adopted incorporating a two-phase research process; Phase 1 being exploratory while Phase 2 aimed to validate inductions derived from the previous stage. Results The programme is effective in meeting its learning outcomes. The  findings are categorized into four theme areas: the importance of preceptor characteristics, the demonstration of these characteristics, knowledge demonstrated by the preceptors and the skills demonstrated by the preceptor.
Conclusion(s): Preceptors, to be effective within the preceptor/student relationship, need to integrate both their professional and personal attributes to effectively socialize students to the profession of nursing.
Implications for nursing management: The preceptor role is invaluable within nurse education. This study supports the release of registered nurses to attend preceptor preparation programmes. It highlights the importance of nursing management in preceptor selection, release, support and monitoring in order to create an effective clinical learning environment. [ABSTRACT FROM AUTHOR]

5. Implementing graduate entry registration for nursing in England: a scope review
By Debell, Diane et al. Journal of Nursing Management, Jul 2009, Vol. 17 Issue 5: p550-558

Abstract: A graduate entry workforce for nurse registration has been approved for England by 2010/11. The aim of this research was to discover the immediate tasks facing nurse managers in implementing that change. Previous research has focused on making the case for change rather than on implementation.
Background:  Similar to the implementation of Project 2000, this change in nurse education and employment will raise questions for employers and for higher education institutions. It will also raise questions about nurse recruitment numbers, workforce development, and the profiles of entrants to a changing workforce.
Method:  In preparation for these changes, we conducted a scope review of published and grey literature in the English language. We also reviewed the earlier experiences of transfer to graduate status amongst other workforces such as teaching and social work and we investigated reported practice in other industrialised countries.
Results: The education provider changes necessary for such a large professional workforce will need considerable leadership skills from within nursing and nurse management. At present, there are too many employers and education providers in England who appear to be relatively unaware of the changes facing nurse education and professional practice and the urgency needed to lead that change.
Conclusions: Education, training and development as well as employer/commissioner practice will rely on leadership from within the nurse profession itself. For nurse managers, this requires a rapid planning process in order to ensure smooth implementation. The danger is that either education providers or commissioners of nursing services will react rather than proactively plan for the changes that are already in progress.

6. What should we assess in practice?
By Parker, Pam. Journal of Nursing Management, Jul 2009, Vol. 17 Issue 5: p559-569
This article reports on a PhD study and follow up work undertaken to review and develop a tool for assessment of practice.
Background:  The assessment of practice in nursing and midwifery education and, other health professions has been the source of concern, criticism and research for a number of years with the conclusion that it might not be possible to develop an assessment tool that could encompass all aspects of professional practice.
Methods:  A qualitative evaluation study was undertaken using the naturalistic method of inquiry. A combination of tools was used in order to collect the data and enable progressive focusing and cross checking of the findings. These included documentary analysis, a questionnaire and focus group and individual interviews. The data was collected from documents analysis, focus group interviews, individual interviews and questionnaires.
Results:  The results showed that the assessment tool in use at the time did not encompass all criteria assessors used and six areas were identified as those to include in any future tool.
Conclusion: The six areas identified by subjects as those to include in any assessment tool were further developed with specific statements so that they could be used within a tool. Implications for nursing management  and education:  Within the changing nature of health care there is a need to review whether the tool used for assessing pre-registration education of nursing and midwifery students practice is ‘fit for purpose’.

7. Nursing first year of practice, past, present and future: documenting the journey in New Zealand.
By Adlam, Kerry-Ann et al. Journal of Nursing Management, Jul 2009, Vol. 17 Issue 5: p570-575
Aim - Documenting the journey of graduate nurse support in New Zealand from local programmes to a nationally
consistent framework. Background Education of nurses in New Zealand has changed over the decades, from apprenticeship-style hospital-based training to academically prepared registered nurses. Newly graduated nurses require time to become confident within the clinical setting. To achieve this, a well-supported graduate nurse programme is required.
Evaluation: The authors utilized historical reviews of nursing education within New Zealand and current work being undertaken by a national working party to implement a nationally consistent
graduate nurse programme. Key issues Disparity between locally delivered graduate programmes. Lack of funding to provide a well-structured programme and the impact on the recruitment and retention of new nurses.
Conclusions: It was identified that there was a strong need to ensure graduate nurse programmes were consistent across New Zealand in order to support graduate nurses and retain them in the workforce.
Implications for nursing management: The first year of practice remains a challenging transition time with a need for a well-structured and supported programme. Key needs include learning activities grounded in practice experience, robust programme coordination, skilled clinical educators, preceptors, and a structured learning framework. [ABSTRACT FROM AUTHOR]

8. The development and evaluation of a succession planning programme in nursing, in Australia
By Brunero, Scott et al. Journal of Nursing Management, Jul 2009, Vol. 17 Issue 5: p576-583
This study reports on a locally organized model of succession planning in a 550-bed general hospital.
Background: Within healthcare, succession planning has traditionally been considered for people at the executive director level and little research has been published with nurses working at the clinical level.
Method: A succession planning model was developed from the literature and through a process of consultation with senior staff. The model was then evaluated from a customer satisfaction, programme progress, effective placement and organizational results perspectives. Nurses who were successful in obtaining a new role were surveyed after 6 weeks in the position. Descriptive statistics, including numbers of placements and types of positions filled, were recorded. A checklist for conducting a programme evaluation of succession planning was also used.
Results: Twenty-five nurses participated, with 31 positions succeeded to. Nurses reported positively that the programme was beneficial, increased their sense of career planning and gave them a greater understanding of their career pathway. Conclusions: The succession planning programme provided an opportunity for the organization to identify new leaders. The study outcomes have identified potential improvements to the way succession planning is conducted at the hospital. Implications for nursing management Nurse Managers are in key positions to develop effective succession planning models. This study offers a process for managers to develop effective succession planning programmes within their organization. [ABSTRACT FROM AUTHOR]

9. The management of advanced practitioner preparation: a work-based challenge
By Livesley, Joan et al. Journal of Nursing Management, Jul 2009, Vol. 17 Issue 5: p584-593
This paper explores the collaborative development of a Master’s level advanced practice programme in the context of the radical reform and remodelling of the UK’s National Health Service. Some of the educational, managerial and practice challenges are discussed.
Background:  Changes to education and training in response to key strategic reviews undertaken by the Greater Manchester Strategic Health Authority (North West of England) established a need to develop nurses and allied health care practitioners to advanced practitioner level. This paper considers how employers, commissioners and educationalists worked together to produce a Master’s level programme to prepare nurses and other health care practitioners for sustainable advanced practice roles. Key issues 
Developing innovative and effective curricula to meet the needs of post graduate students from varied backgrounds preparing to practice in different contexts with different client groups is challenging. However, the development of individual learning pathways and work-based learning ensures that the student’s work and intended advanced practice role remains at the centre of their learning. Analysis of each student’s knowledge and skill deficits alongside an analysis of the organization’s readiness to support them as qualified advanced practitioners (APs) is instrumental in ensuring that organizations are ready to support practitioners in new roles.
Conclusion:  Work-based learning and collaboration between students, employers and higher education institutions can be used to enable managers and students to unravel the network of factors which affect advanced practice in health and social care. Additionally, collaborative working can help to create opportunities to develop strategies that will facilitate change.
Implications for nursing management:  Sustainable change concerned with the introduction of advanced practitioner roles present a real challenge for managers at a strategic and operational level. Commissioning flexible, collaborative and service-led educational programmes can assist in ensuring that change is sustainable and produce practitioners who are fit for practice, purpose and award. [ABSTRACT FROM AUTHOR]

10. Twenty-four hour care: implications for the role and developmental needs of nurses in acute and community settings.
By Kelly, Daniel et al. Journal of Nursing Management, Jul 2009, Vol. 17 Issue 5: p594-602
The aim of this study was to explore the challenges of providing continuity within the 24-hour nursing service. It explored why nurses work at night and what issues this raises for them. Background The manner in which new ways of working affect the work or CPD (Continuing Professional Development) requirements of ward-based nurses or their community counterparts has received little attention. The aim of this study was to explore these issues with a diverse sample of practitioners. Method(s): Twenty-seven staff from four settings (two acute trusts and two community teams) participated in this qualitative study employing focus groups and interviews.
Results: The nature of night nursing is changing; expanded roles and responsibilities are common. However, CPD remains problematic, as a result of constraints around time and access. Context-specific issues shape the nature of night working in acute and community settings and should be considered when planning CPD.
Conclusion(s): There is a need to re-examine what CPD is available for practitioners providing care around the clock. Traditional forms of CPD may not reflect the evolving reality of practice at night. Implications for Nursing Management There is a need to ensure CPD opportunities are reviewed regularly to reflect changing 24-hour service demands in all settings. [ABSTRACT FROM AUTHOR]

11. Provision of continued professional development for non-medical prescribers within a South of England Strategic Health Authority: a report on a training needs analysis
By  Green, Anita et al. Journal of Nursing Management, Jul 2009, Vol. 17 Issue 5: p603-614
This paper reports on a Training Needs Analysis for Non-Medical Prescribers commissioned by a south of England
Strategic Health Authority.
Background: The aim of the TNA was to inform future policy, educational provision and practice development and provide nurse managers with significant information on the perceived Continuing
Professional Development (CPD) needs of the non-medical prescribers. Methods Data were collected from a sample of 270 non-medical prescribers using an in-depth questionnaire, and telephone interviews with a purposive sample of 11 key stakeholders.
Results: The findings report:
• The qualifications that non-medical prescribers possess.
• The level of confidence described by the non-medical prescribers in their role.
• What non-medical prescribers identify as their present and future CPD requirements in relation to prescribing.
• What education and training provision non-medical prescribers have attended in relation to their prescribing role since qualifying.
Conclusions: The findings suggest, first that short courses that were specific to the non-medical prescribers role were considered to be the most popular and useful. However, courses needed to be advertised well in advance. Second, training gaps were identified. Implications for nursing management Pharmacology and prescribing are rapidly changing and require regular CPD in order to keep up to date with the latest developments. Non-medical
prescribing is a comparatively new innovation to the NHS, therefore those who are not medically qualified need mentorship from experienced prescribers, as well as the encouragement from nurse managers to be confident prescribers themselves and enhance patient care. [ABSTRACT FROM AUTHOR]

12. Mapping the introduction of Assistant Practitioner roles in Acute NHS (Hospital) Trusts in England
By Spilsbury, Karen et al. Journal of Nursing Management, Jul 2009, Vol. 17 Issue 5: p615-626
This mapping study describes current or planned introduction of assistant practitioner roles in English National Health Service Acute Hospital Trusts.
Background: In the last decade there has been a growth in nursing support workforce numbers and their scope of practice. An important United Kingdom support worker development is the
Assistant Practitioner role.
Method: A national census was carried out (April 2007) via an emailed questionnaire to Directors of Nursing. Quantitative data were analysed using descriptive statistics. Qualitative data were
analysed using thematic analysis.
Results: Eighty-five per cent (143/168) of Directors of Nursing, from all 10 English Strategic Health Authorities, responded. Forty-six per cent ( n = 66) of Trusts had introduced assistant practitioners and 22% ( n = 31) were planning to implement the role before 2009. There is wide variation in assistant practitioner numbers across and between Strategic Health Authorities, Trusts and clinical areas. Resistance to the role existed in 32% ( n = 46) of Trusts. Reasons for resistance included no perceived need for the role, lack of evidence of effectiveness, financial constraints and professional and patient safety concerns. Implications for nursing management These findings, which contribute to the international evidence-base on health care support workers roles, provide nurse managers with numbers of assistant practitioners and their
deployment. This is useful for Nurse Managers making workforce decisions.

13. Health care managers’ perspectives on new nursing and midwifery roles: perceived impact on patient care and cost effectiveness.
By Mckenna, Hugh. Journal of Nursing Management, Jul 2009, Vol. 17 Issue 5: p627-635
The aim of this study was to explore new nursing and midwifery roles and associated levels of practice from the health care providers’ perspective. This paper will present findings relating to the perceived cost effectiveness of these roles and their impact on patient care.
Background: Profound changes in the way the health care systems are organized, managed and financed have resulted in the proliferation of new nursing and midwifery roles. However, the evidence base for these workforce developments is limited, especially with regard to health care providers’ perspectives on cost effectiveness and patient outcomes.
Method: Qualitative interviews were carried out with all Directors of Nursing in the 18 Health and Social Services (HSS) Trusts and the Chief Nurses and Directors of Primary Care in the four HSS Boards in Northern Ireland.
Results: Key findings were as follows: there was widespread support for the development of these roles, they are perceived to have a positive impact on patient care; however, the need for support was recognized to ensure the continuation of such roles. Securing funding was problematic and this was influential on the kind of new roles that were developed. Implications for Nursing Management Issues relating to effective implementation and the need for further research into the efficacy and effectives of such initiatives is required. [ABSTRACT FROM AUTHOR]

14. Empowerment, engagement and perceived effectiveness in nursing work environments: does experience matter?
By Spence Laschinger, Heather K. Journal of Nursing Management, Jul 2009, Vol. 17 Issue 5: p636-646
We examined the impact of empowering work conditions on nurses’ work engagement and effectiveness, and compared
differences among these relationships in new graduates and experienced nurses.
Background: As many nurses near retirement, every effort is needed to retain nurses and to ensure that work environments are attractive to new nurses. Experience in the profession and generational differences may affect how important work factors interact to affect work behaviours.
Methods: We conducted a secondary analysis of survey data from two studies and compared the pattern of relationships among study variables in two groups: 185 nurses 2 years post-graduation and 294 nurses with more than 2 years of experience.
Results: A multi-group SEM analysis indicated a good fit of the hypothesized model. Work engagement significantly mediated the empowerment/effectiveness relationship in both groups, although the impact of engagement on work effectiveness was significantly stronger for experienced nurses.
Conclusions: Engagement is an important mechanism by which empowerment affects nurses feelings of effectiveness but less important to new graduates’ feelings of work effectiveness than empowerment. Implications for nursing management Managers must be aware of the role of empowerment in promoting work engagement and effectiveness and differential effects on new graduates and more seasoned nurses. [ABSTRACT FROM AUTHOR]

15. Implementation of releasing time to care – the productive ward
By Wilson, Gwyneth. Journal of Nursing Management, Jul 2009, Vol. 17 Issue 5: p647-654
This paper describes the implementation of the NHS Institute for Innovation and Improvement Productive Ward – releasing time to care programme. It will discuss the benefits and key successes and provides advice for those wishing to implement the programme. In Lord Darzi’s Next Stage Review, he advocates an ambitious vision of patient centred – clinician led, locally driven NHS. The Releasing Time to Care programme is a unique opportunity for everyone working within the NHS to improve effectiveness, safety and reliability of the services we provide. Whilst being situated within a National Health Service policy environment learning from this work can be translated nationally and internationally, as the principles underpin the provision of high quality care.
Evaluation: Evaluation is currently in relation to each of the 15 modules rather than as the programme as a whole. It uses various methods including audit, observation, activity follow through, satisfaction surveys and process mapping. Each month data is colated for each of the 11 metrics which has shown a reduction in falls, drug administration errors and improvement in the recording of patient observations.
Key issues: One of the key issues is that an essential component for the success of the programme lies in the tangible support of the Trust Board/Board of Directors. Evidence shows that this programme improves patient satisfaction as it enables the provision of an increase in direct patient care by staff and subsequently improved clinical and safety outcomes. Ward Sister/Charge Nurse development includes Leadership, Project
management and Lean Methodology techniques.
Conclusion:  The Releasing Time to Care programme is a key component of the Next Stage Review. It will create productive organisations by being a catalyst for the transformation of Trust services, enabling staff to spend more time caring for patients and users. This release in time will result in better outcomes and subsequent improvement with patient and staff satisfaction and experience of the NHS as well as a cultural change for the workforce. Implications for nursing management  Releasing Time to Care, also known as the productive ward, offers a systematic way of delivering safe, high quality care to patients across healthcare settings. The Institute for Innovation and Improvement, have devised a programme of 15 modules based on ‘lean’ methodology. It has been widely piloted and in January 2008 was rolled out as a national initiative with £50 million pump priming money. Evidence shows that the programme can improve patient satisfaction as it enables the provision of an increase in direct patient care by staff and subsequent improved clinical and safety
outcomes. The programme has to be implemented in a structured manner in order to assure its success and release the benefits. Core to this success is Board level commitment. Board members need to sign up to and understand the concepts of the programme and their role in supporting the ward staff. The organisation needs to understand the benefits that the programme will bring to the organisation as well as the challenges. The Board needs to understand that the programme is focussed on improving the quality of care for patients and not an opportunity to reduce costs. [ABSTRACT FROM AUTHOR]

Journals Table of Contents

16. From American Journal of Nursing, Volume 110, Number 9, September 2010
Another Tragedy on the Gulf Coast
16B. Nurses and the Affordable Care Act
In the News
Do Cell Phones Cause Cancer?; NewsCap: Two carotid artery approaches to prevent stroke are comparable
16D. Some Pressure Ulcers Are Unavoidable
16E. Follow-up Appointments May Not Reduce Readmission Risk in All Patients
AJN Reports
16F. Adding insult to injury: Five years after Katrina
Policy & Politics
16G. Nurse-managed health centers
Art of Nursing
Public health billboard, Guinea-Bissau
Continuing Education
16I. Conservative management of fecal incontinence
Evidence-based practice
16J. Critical appraisal of the evidence: Part 11
Putting patients first
Patient-centered care: More than the sum of its parts
Environments & health
16L. Will the BP oil spill affect our health
Cochrane corner
Acupuncture to prevent postoperative nausea and vomiting
Cultivating quality
16N. An evidence-based approach to taking charge
Think again
Preoperative fasting doesn't mean "nothing after midnight"
Safety monitor
16P. Cleaning up the discharge process [column by the Pennsylvania Safety Authority Reporting System]
I simulate, therefore I and nursed [An imaginative nursing instructor finds himself amazed by his students' empathy]

17. From The Continuing Education in Nursing, Volume 41, Number 9, September 2010
The International Year of the Nurse
Administrative Angles
Taming the Pedagogy Dragon
Clinical Updates
17C. Congestive Heart Failure: Redefining Health Care and Nursing
Teaching Tips
17D. Don’t Ignore That Call for Posters!
Original Article
17E. Managers’ Perspectives of New Graduates of Accelerated Nursing Programs: How Do They Compare With Other Graduates?
17F. Ready, Set, Teach! How to Transform the Clinical Nurse Expert Into the Part-Time Clinical Nurse Instructor
17G. Power Inequalities in the Assessment of Nursing Competency Within the Workplace: Implications for Nursing
17H. Nurse Educator Orientation: Professional Development That Promotes Retention
17I. Enhancing Pediatric Clinical Competency With High-Fidelity Simulation
17J. Effect of the Essentials of Critical Care Orientation (ECCO) Program on the Development of Nurses’ Critical Thinking Skills

Conferences, seminars, Courses

18. 4th Australian & New Zealand Falls Prevention Society Conference
Date: 21-23 November, 2010. Dunedin, New Zealand
Programme available:

Translating evidence into practice
Wednesday 29th September 2010 - One day workshop
Thursday 30th September & Friday 1st October 2010
Venue: Sydney Law Building, The University of Sydney, NSW, Australia
More information:

Older persons: The future of care

Date: 4-7 Oct 2010
Venue: Rotterdam THE NETHERLANDS
More information:

21. Rural Health Forum 2010
30 November - 1 December 2010
Venue: Intercontinental, Wellington

News - National

22. Area leading way in service
Eastern Courier - 1 Oct 2010
A departing health board member says Counties Manukau is leading the way in improving quality of service. Michael Williams says the board is focused on reducing errors with measures like using machines to dispense medication electronically.

23. 'Significant backlog' waiting for CT scans
ODT - 1 Oct 2010
Recent industrial action by medical radiographers has helped to push waiting times for urgent CT scans in Otago out to 10 weeks. Southern District Health Board chief operating officer (Otago) Vivian Blake told the hospitals' advisory committee this week that at the end of July the waiting time was three weeks, but by
mid-September the wait for 168 patients was seven weeks longer.

24. Number of obese kiwi children 'scary'
The Press - 25 September 2010
Nearly a quarter of New Zealand children are overweight or obese before they start school. Health experts say the high number of very young obese children is "scary" and the Government is doing nothing to reverse the trend. Health Ministry data released to The Press reveals that over the past two years 5.4 per cent of four-year-olds who took part in the nationwide B4 School Check were obese and 18.3 per cent were overweight. 


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