There were tremendous increasing numbers of hospitals to adopt Clinical Nurse Spcialist (CNS) to assist health care delivery from 1986 to 1988. In year 2000, The Legislative Yuan of Taiwan approved the laws of accreditation and licensure of CNS. However, what are the recognition and impression of the accreditation of clinical nurse specialist form nursing? This study examines the associations among recognition, job characteristic, job satisfaction, and job commitment related to the CNS. This study used self-developed survey research to ask 386 nurses, including 43 nursing directors, 45 nursing supervisors, 134 nurse managers, 52 PAs and NSPs, and 115 registered nurses. The survey period was from March 10 to April 31 of 2002. The overall alpha of the instrument was 0.97. Descriptive analysis and ANOVA were used to attain the purposes of this study. The major findings from this study include 1) Education and position make differences in the perception of CNS. There are no differences in ownership and level of accreditation; and 2) The perception of CNS is positively associated with the constructs of job characteristics, job satisfaction, as well as organizational commitment. It suggests that the promotion to the CNS path will assist the nursing turnover in the future.

Organizational restructuring and reform in the health care system has impacted the ability of Clinical Nurses (CNs) to participate in and influence decision making that affects the delivery of patient care. Clinical nurses maintain and advocate a professional responsibility to practice according to specific standards, policies and procedures, and to meet the needs of the patient and family members. Clinical nurses participation in decision making at the patient, unit and administrative levels recognizes their abilities and skills as professionals; however, CNs continue to experience a limited role in the decision making and control over nursing practice at all of these levels.<p> The literature overview examines control over nursing practice including how this complex concept is difficult to define and undervalued within the CNs professional practice environment. It is evident in the literature that control over nursing practice is important to the CNs professional practice environment ultimately affecting job satisfaction, recruitment/retention, and patient outcomes. Control over nursing practice is explored in relation to internal and external factors that affect the professionalism of the CN. Internal factors are those that are more closely related to the CNs scope of practice and include professionalism (influence in decision making including policies and procedures, collegial relations, and professional development), CN satisfaction (workload, scheduling, health, safety and security concerns, supportive management, and opportunities for leadership), safe quality patient care (staffing, education, and specialization), empowerment, and autonomy. The external factors are outside the immediate scope of the CN yet directly and indirectly affect the CNs control over nursing practice including health care restructuring, organizational influence, work environment models (shared governance and magnet hospital environments), and nursing leadership. <p>This study provided CNs employed in the provincial hospitals in Saskatchewan an opportunity and a voice to share their perceptions of who governs their professional practice environment including control over nursing practice. This mixed method descriptive survey design used Hess Index of Professional Nursing Governance ([IPNG], 1998) along with five questions geared to elicit qualitative responses to study the perceptions of who governs CNs professional practice environment including control over nursing practice in provincial hospitals in Saskatchewan. Section one of the IPNG contains a demographic section including information on age, gender, nursing education, and employment information. The second section of IPNG consists of 86 questions that are further divided into six subscales asking respondents to indicate who has control over nursing practice in a number of areas within their particular health facility. The six subscales include Subscale I Professional control relating to who has control over professional practice in the organization, Subscale II Organizational influence examining who participates in governance activities within the organization, Subscale III Organizational recognition identifying who controls nursing personnel and related structures, Subscale IV Facilitating structures indicating who determines and participates in governance decisions within the organization, Subscale V Liaison exploring who influences the resources that support professional practice, and Subscale VI Alignment identifying who sets and negotiates conflict within the organization. These questions are rated on a 5 point Likert scale according to the following response possibilities: 5 = staff nurses only; 4 = primarily staff nurses with some nursing management/administration input; 3 = equally shared by staff nurses and nursing management/administration; 2 = primarily nursing management/administration with some staff nurse input; 1 = nursing management/administration only. Section three the qualitative questions, contained one closed ended and four open ended questions that provided CNs an opportunity to share a more personal perspective regarding their perceptions of control over nursing practice in their work environment. These questions included: 1. What does control over nursing practice mean to you? 2. How could control over your practice be changed significantly? 3. Do you feel you have enough control over practice in your work environment? 4. What limits your control over practice in an area that interests you? and What enables your control over practice in an area that interests you? <p>The total population of 1804 CNs in provincial hospitals in Saskatchewan was invited to participate in this study. One hundred and seventy two CNs (9.53%) responded to this study, including 118 from Saskatoon (11.8%) and 54 from Regina (6.7%). The descriptive data provides data on gender and average age of CNs that is similar to Canadian Institute for Health Information ([CIHI], 2006) and Health Canada (2006a). A greater number of CN respondents indicated their basic nursing education was a diploma and more CNs had attained a baccalaureate degree as their highest level of education when compared to the CIHI data. Twice as many CNs indicated having specialty certification and a higher number were working full time in comparison to the CIHI data. The quantitative data obtained from the IPNG subscales indicates CNs perceive limited control over nursing practice and this is by in large held mainly by nursing management/administration (1) and nursing management with some staff nurse input (2). The subscale results include Professional control (M = 1.72), Organizational influence (m = 2.13), Organizational recognition (M = 1.73), Facilitating structures (M = 1.82), Liaison (M = 2.1), and Alignment (M = 2.1). Overall, the results from the IPNG subscales provide scores of less than 3 on the Likert scale indicating CNs perceive limited control over nursing practice in their professional practice environment. There were no significant differences within the provincial hospitals or between the health regions regarding CNs perceptions of control over nursing practice. In their qualitative responses, CNs provided information related to both the internal and external factors as discussed in Chapter Two. Clinical nurses indicate they face many challenges regarding control over practice including lack of influence in decision making in issues related to policy and procedure, quality patient care, staffing ratios, self-scheduling, and educational opportunities. They also identified external factors affecting their control over nursing practice including a lack of support by management in relation to decision making, a lack of provision of and access to an adequacy of resources, and a lack of communication and collaboration. Many CNs indicated their only influence in decision making was related to direct patient care. Clinical nurses described that being valued, supported, and recognized for their experience and education in decision making positively affects control over nursing practice and more specifically, quality patient care. <p> Study results offer government officials, practitioners, regulatory bodies, researchers, administrators, educators, nurses, the public, professional association, employers, unions, and any other stakeholders information that provides an opportunity to increase their awareness and understanding of the impact that control over nursing practice has for CNs in their practice environment. If stakeholders are serious in their attempts to recognize CNs concerns regarding control over nursing practice in their work environment, the results from this study will provide information facilitating change in the CNs control over nursing practice. Ultimately, this affects the CNs professionalism and ability to provide quality patient care.

Organizational restructuring and reform in the health care system has impacted the ability of Clinical Nurses (CNs) to participate in and influence decision making that affects the delivery of patient care. Clinical nurses maintain and advocate a professional responsibility to practice according to specific standards, policies and procedures, and to meet the needs of the patient and family members. Clinical nurses participation in decision making at the patient, unit and administrative levels recognizes their abilities and skills as professionals; however, CNs continue to experience a limited role in the decision making and control over nursing practice at all of these levels.<p> The literature overview examines control over nursing practice including how this complex concept is difficult to define and undervalued within the CNs professional practice environment. It is evident in the literature that control over nursing practice is important to the CNs professional practice environment ultimately affecting job satisfaction, recruitment/retention, and patient outcomes. Control over nursing practice is explored in relation to internal and external factors that affect the professionalism of the CN. Internal factors are those that are more closely related to the CNs scope of practice and include professionalism (influence in decision making including policies and procedures, collegial relations, and professional development), CN satisfaction (workload, scheduling, health, safety and security concerns, supportive management, and opportunities for leadership), safe quality patient care (staffing, education, and specialization), empowerment, and autonomy. The external factors are outside the immediate scope of the CN yet directly and indirectly affect the CNs control over nursing practice including health care restructuring, organizational influence, work environment models (shared governance and magnet hospital environments), and nursing leadership. <p>This study provided CNs employed in the provincial hospitals in Saskatchewan an opportunity and a voice to share their perceptions of who governs their professional practice environment including control over nursing practice. This mixed method descriptive survey design used Hess Index of Professional Nursing Governance ([IPNG], 1998) along with five questions geared to elicit qualitative responses to study the perceptions of who governs CNs professional practice environment including control over nursing practice in provincial hospitals in Saskatchewan. Section one of the IPNG contains a demographic section including information on age, gender, nursing education, and employment information. The second section of IPNG consists of 86 questions that are further divided into six subscales asking respondents to indicate who has control over nursing practice in a number of areas within their particular health facility. The six subscales include Subscale I Professional control relating to who has control over professional practice in the organization, Subscale II Organizational influence examining who participates in governance activities within the organization, Subscale III Organizational recognition identifying who controls nursing personnel and related structures, Subscale IV Facilitating structures indicating who determines and participates in governance decisions within the organization, Subscale V Liaison exploring who influences the resources that support professional practice, and Subscale VI Alignment identifying who sets and negotiates conflict within the organization. These questions are rated on a 5 point Likert scale according to the following response possibilities: 5 = staff nurses only; 4 = primarily staff nurses with some nursing management/administration input; 3 = equally shared by staff nurses and nursing management/administration; 2 = primarily nursing management/administration with some staff nurse input; 1 = nursing management/administration only. Section three the qualitative questions, contained one closed ended and four open ended questions that provided CNs an opportunity to share a more personal perspective regarding their perceptions of control over nursing practice in their work environment. These questions included: 1. What does control over nursing practice mean to you? 2. How could control over your practice be changed significantly? 3. Do you feel you have enough control over practice in your work environment? 4. What limits your control over practice in an area that interests you? and What enables your control over practice in an area that interests you? <p>The total population of 1804 CNs in provincial hospitals in Saskatchewan was invited to participate in this study. One hundred and seventy two CNs (9.53%) responded to this study, including 118 from Saskatoon (11.8%) and 54 from Regina (6.7%). The descriptive data provides data on gender and average age of CNs that is similar to Canadian Institute for Health Information ([CIHI], 2006) and Health Canada (2006a). A greater number of CN respondents indicated their basic nursing education was a diploma and more CNs had attained a baccalaureate degree as their highest level of education when compared to the CIHI data. Twice as many CNs indicated having specialty certification and a higher number were working full time in comparison to the CIHI data. The quantitative data obtained from the IPNG subscales indicates CNs perceive limited control over nursing practice and this is by in large held mainly by nursing management/administration (1) and nursing management with some staff nurse input (2). The subscale results include Professional control (M = 1.72), Organizational influence (m = 2.13), Organizational recognition (M = 1.73), Facilitating structures (M = 1.82), Liaison (M = 2.1), and Alignment (M = 2.1). Overall, the results from the IPNG subscales provide scores of less than 3 on the Likert scale indicating CNs perceive limited control over nursing practice in their professional practice environment. There were no significant differences within the provincial hospitals or between the health regions regarding CNs perceptions of control over nursing practice. In their qualitative responses, CNs provided information related to both the internal and external factors as discussed in Chapter Two. Clinical nurses indicate they face many challenges regarding control over practice including lack of influence in decision making in issues related to policy and procedure, quality patient care, staffing ratios, self-scheduling, and educational opportunities. They also identified external factors affecting their control over nursing practice including a lack of support by management in relation to decision making, a lack of provision of and access to an adequacy of resources, and a lack of communication and collaboration. Many CNs indicated their only influence in decision making was related to direct patient care. Clinical nurses described that being valued, supported, and recognized for their experience and education in decision making positively affects control over nursing practice and more specifically, quality patient care. <p> Study results offer government officials, practitioners, regulatory bodies, researchers, administrators, educators, nurses, the public, professional association, employers, unions, and any other stakeholders information that provides an opportunity to increase their awareness and understanding of the impact that control over nursing practice has for CNs in their practice environment. If stakeholders are serious in their attempts to recognize CNs concerns regarding control over nursing practice in their work environment, the results from this study will provide information facilitating change in the CNs control over nursing practice. Ultimately, this affects the CNs professionalism and ability to provide quality patient care.

Nurses are often promoted or hired into leadership positions without the benefit of a formal orientation to their new leadership positions. The challenge of navigating the various expectations of the role of clinical nurse leader (CNL) such as fiscal ownership, staffing patterns, payroll, and disciplinary action process can be overwhelming. The lack of a formalized orientation process and an identified nurse leader to function as a mentor can contribute to the novice CNL feeling unsupported and overwhelmed. The purpose of this project was to identify, develop, and evaluate a CNL orientation manual, outline, and program for newly appointed CNLs. The desired outcome for this doctor of nursing practice project was the education and preparation of CNLs who will navigate the various facets of the role and retain their positions longterm. The Association of Nurse Executives nurse leader model was used to guide the project. A panel of 5 CNL experts evaluated the manual outline and content using a 5-question Likert scale survey. Findings indicated 100% of the participants agreed or strongly agreed with the importance of the topics covered and 80% agreed with the content covered in the manual outline. The project is expected to promote positive social change by preparing new CNLs to meet the requirements of leadership positions.

No description available.

The purpose of this article is to describe the research mentoring process used with a small team of nurses by a PhD prepared nurse certified as a Nursing Professional Development Specialist and as a Critical Care Clinical Nurse Specialist. It will describe how bedside nurses were actively engaged in the research process by having them learn about research while operationalizing that knowledge as simultaneously were mentored in conducting a relevant research study. The process described and discussed in this article should be useful to nurse leaders to facilitate removing the traditional barriers to nursing research that still remain in healthcare organizations today. These include lack of time and knowledge, about the process, lack of institutional support, and lack of mentoring through the process. It should also be helpful to nurse educators in the clinical area to encourage more nurses to participate in nursing research.

The growing complexities and dramatic changes in the contemporary health care system require nurses to practice successfully with essential professional knowledge and skills required for safe and competent practice. The implication is that nurse educators are confronted with the challenge to redefine effective teaching strategies appropriate to prepare nurses for the complexities of the current practice demands. To this end, student-centered teaching (SCT) has emerged in many undergraduate nursing curricula as a tool to develop essential practice skills in nursing students. A lack of understanding of how nurse educators experience SCT may hinder its success and sustainability. This qualitative study explored the lived experience of clinical nurse educators (CNEs) using SCT in the practice settings. Ten CNEs who self-identified as using SCT volunteered to participate. Data were collected using a semi-structured interview guide and audio recorder. Additional data source included a demographic survey and a reflective journal. Analysis of the CNEs’ perspectives revealed an overarching theme entitled “SCT in a non-student-centered world” with a variety of meanings of SCT from a humanistic point of view. Participants identified individual, staff, and contextual factors including policy issues that hinder successful implementation of SCT in the practice settings. The study also unveiled that a successful paradigm shift to SCT may not be the sole responsibility of the CNEs but a joint endeavor by all stake-holders within the health care delivery system. Findings of this study may be used by nursing and health sciences faculty and administrators to guide policy and program planning that incorporates student-centered clinical education. / October 2016

Bakgrund: Studier har visat att sjuksköterskors utbildningsnivå har betydelse för patientsäkerheten på kirurgiska vårdavdelningar. I Sverige är rollen som specialist-sjuksköterska inom kirurgisk vård ganska okänd och antalet specialistsjuksköterskor inom denna specialitet är få.Syfte: Syftet var att beskriva vilka förväntningar specialistsjuksköterskor inom kirurgisk vård har på sin yrkesroll samt att ta del av och beskriva deras erfarenheter av att arbeta som specialistsjuksköterskor.Metod: Kvalitativ studie med deskriptiv design. Specialistsjuksköterskor inom kirurgisk vård (n=29) från fem olika sjukhus deltog i studien. Urvalet gjordes med bekvämlighetsurval. För datainsamling användes ett studiespecifikt formulär med öppna frågor. Data analyserades med en kvalitativ innehållsanalys.Huvudresultat: Specialistsjuksköterskornas förväntningar på yrkesrollen var att med sin kompetens kunna vara en tillgång för kollegor och patienter. De beskrev att deras kompetens behövs på vårdavdelningarna, både i det kliniska arbetet och i förbättringsarbeten. Specialistsjuksköterskorna upplevde varierande grad av stöd från chefer och kollegor. De beskrev även att det är viktigt att tydliggöra yrkesrollen.Slutsats: Specialistsjuksköterskors kompetens gör skillnad, både direkt i patientvården och indirekt via förbättringsarbeten. Det är viktigt att fortsätta arbetet med att tydliggöra yrkesrollen till exempel genom en kompetensbeskrivning, och möjlighet att söka tjänster eller förordnanden som specialistsjuksköterska. För att utvecklas professionellt behöver specialistsjuksköterskor en ledning som tror på yrkesrollen och stöd från arbetsgruppen. / Background: Several studies show that nurses’ educational level has impact on patient safety in surgical wards. In Sweden the role of the clinical nurse specialist in surgical care is quite unknown and the numbers of clinical nurse specialists are few.Aim: The aim was to describe the expectations clinical nurse specialists in surgical care have on their professional role and to explore their experiences of their work.Method: A qualitative study with a descriptive design. A convenient sample of clinical nurse specialists in surgical care (n = 29) from five different hospitals participated in the study. A study specific questionnaire with open ended questions was used for data collection. The narrative data was analyzed using a qualitative content analysis.Result: The clinical nurse specialists’ expectations of their professional role were to be able to support and contribute with their competence in clinical practice. They described that their competence is needed in clinical work as well as in the quality improvement work in the surgical ward. Furthermore, the nurses described that they received varying levels of support in their new position from managers and colleagues. The clinical nurse specialists pointed out the importance of clarifying the role.Conclusion: The competence of the clinical nurse specialist makes a difference in patient care and in quality improvement work in the surgical ward. It is important to continue the process to clarify the role and to develop national guidelines. In the professional development the clinical nurse specialist needs to be supported by the managers as well as the colleagues.

Magister Curationis - MCur / The main benefit of simulation in nursing education is the ability to teach clinical skills in a non-threatening, safe environment where mistakes can be rectified without harm to any patient. Therefore, it is clinical facilitators who must display the knowledge and skills to impart to the student nurses during their 4-year programme of study. It is unclear how student nurses at a local nursing college view teaching and learning processes in the simulation laboratory. The purpose of this study is to explore student nurses‟ views of teaching and learning in a simulation laboratory with the purpose of describing guidelines for clinical facilitators to support student nurses in a simulation laboratory at a local College of Nursing in the Western Cape. A qualitative, exploratory, descriptive and contextual design was used in order to explore and describe the views of student nurses about teaching and learning in the simulation laboratory. The ECP (Extended Curriculum Programme), 1st, 2nd, 3rd and 4th year students (N = 880), who were registered in the R425 programme at the College of Nursing in the Western Cape, had been identified as the accessible student population of this study. A purposive opportunistic sampling population was applied. Two focus groups (20 participants) per year of study were conducted. The size of each focus group was at least 10 participants. The focus group interviews lasted around 60 minutes per group. Data gathering was conducted by the researcher who initiated, prompted, and facilitated these focus groups. For the purpose of data triangulation, voice recordings of the interviews were supported by the taking of field notes. Open coding had been used for data analysis. The credibility of the coding was checked and confirmed by an independent coder. Trustworthiness was maintained, since credibility was ensured by means of prolonged engagement in the field until data saturation occurred, referential adequacy, and member checks that followed. Dependability was ensured by establishing an audit trail. Ethical considerations were ensured by obtaining written, informed consent from participants of the study, as well as for the voice recording of the discussions. Participants could withdraw at any stage of the study. Confidentiality was explained and the researcher requested that participants do not share the information after the group discussions. In this study, student nurses experienced both opportunities and challenges with the teaching and learning in the simulation laboratory. Furthermore, the contextual demands between the first and subsequent years of study seemed to play an essential part in their experience.

Access to healthcare is needed and wanted by people of all ages and especially by those of the older population. The number of people in the 65 years of age and older population is rapidly growing with their needs expected to have a significant impact on the existing healthcare system and healthcare providers. The impact will be critical given the severe shortage of healthcare providers, especially of nurses and the rate of services being more often provided in non-hospital settings. The objectives of the study were to discover the plans of graduating nursing students as they choose their first place of employment, if they have future plans to pursue a nursing advance practice degree, and if they are very happy with their decision to become a nurse. Data for the study were obtained from a questionnaire presented to senior graduating nursing students. The findings were: (a) Most students prefer a hospital setting. (b) Younger students are three times as likely to seek out the hospital, and 1/3 of the students seek out the hospital setting because they were encouraged to become a nurse. (c) About 70% of the students want to work with their friends while 1/3 will seek the hospital worksite, as it is perceived as being the strongest resource in paying back loans. (d) Nearly 87% are considering the nursing advance practice role, and 52% have interest in the nurse practitioner role. The majority of students identified as very happy with their decision to become a nurse. This study provided insight for schools of nursing as they make curriculum decisions and to businesses as they learn of the preferences and plans of the new emerging nurses.