The adoption of a " nursing " model in practice and education is discussed in relation to the socio-cultural and organisational factors which have shaped the traditional care giver role. Issues arising out of this change in the "practitioner" role are identified. The changing roles of the nurse and the teacher are described and discussed. The move toward an autonomous role for the clinical nurse is seen to require a change in the nurseteacher relationship. Learning contracts are perceived to be a vehicle for implementing the new roles of the nuise and the teacher. The writer in the role of an observer-who-participates negotiates learning contracts with nurses working in four wards of four hospitals in one Health Authority. The clinical areas are described as one community hospital, one long-stay geriatric unit, one psychiatric rehabilitation unit and one psycho-geriatric assessment unit. Thus, community, general and psychiatric nursing are included in this study of the management of knowledge and change in nursing practice. A variety of data collecting techniques are employed to give an illuminative evaluation of the outcomes of the learning contracts and the effect formal and non-formal education have on the implementation of the nursing process. The formal approach to education takes the form of the Diploma in Nursing (London University, Old and New Regulations) and the Joint Board of Clinical Nursing Studies Course in Care of the Elderly (940/941). The non-formal inputs are the clinically based learning contracts negotiated with the nurses in the four clinical areas.The data are presented as comparative case studies which record the organisational policies adopted by the Health Authority and the outcomes of the learning contracts in the four clinical areas. From the case studies two "themes" emerge: that of role conflict and the problems of assessing thedegree of change achieved. A theoretical framework of "codes and control" is developed from that originally presented by Bernstein (1975) for general education and adapted to health care organisations by Beattie and Durguerian (1980). This framework is used to interpret the changing roles of the nurse and the teacher, and the division of labour between the professional nurse and the woman in her own home. It is argued that the implementation of the "practitioner" role demands a redistribution of power and control in favour of the patient and the nurse vis-a-vis the manager, the teacher and the doctor. Further, in addition to the teacher's and the clinical nurse's dependence on the manager for the resources required to implement the desired change in practice, nurse-practitioners are dependent on the knowledge held by doctors, clinical psychologists and occupational therapists to implement the nursing process. In the presence of an inadequate basic education programme and a limited access to continuing education, the data suggest that the literature on the nursing process and the key documents distributed by the R.C.N. (1981) and the U.K.C.C. (1982) are making demands upon the clinical nurse with which she is unable and sometimes unwilling, to comply. It is argued that a "codes and control" framework identifies the complexities of the change toward the "practitioner" role and thereby, clarifies the existing role. In this way concepts of care held by the nursing staff are identified which in turn, can be utilised in model building to promote a "grounded" theory of nursing in the cultural and organisational context of nursing in the United Kingdom. Thus the use of learning contracts which identify the nurse's need for continuing education, in conjunction with an action research mode utilising case studies, can assist in the development of a theory for nursing practice and education. In this way the theory for nursing has its basis in clinical practice, is refined through research, and is returned to practice through the education programme. It is therefore argued that learning contracts have a useful role to play in bridging the gap between theory and practice in the school of nursing and institutions of higher education. The data recorded in the case studies suggest that in the absence of a redistribution of power and control and/or supportive education programmes during and after the period of transition between the old and new roles, the implementation of the nursing process will merely continue the existing Nightingale strategies. The formalisation of the present problem-solving approach to care in the form of care plans will not necessarily promote the "practitioner" role desired by the profession. Instead the clinical role will continue to be defined by physicians and management will consolidate its position in the hierarchy of the bureaucratic organisation of the National Health Service. This will not be challenged by nurses in that it will continue the existing strategy of "reifying" the presence of the "professional" nurse and an particular, her position in institutions of higher education. Such a strategy although satisfying in terms of status will lead to the clinical nurse being asked to implement a role with which she is unable to comply. This in turn will lead to role conflict and a greater division between the "theory" of the school and the "reality" of the ward.

This study explores and analyses the experiences and perceptions of community nurses (District Nurses, Health Visitors and School Nurses) involved in mentoring Project 2000/Diploma in Higher Education student nurses within one site of a College of Nursing. It addresses the significance of mentorship in nursing education and in particular, the mentoring role of community nurses from their own perspective. Conceptual frameworks derived from the literature review on mentorship in nursing education are adopted in operationalising the research aims and the formulation of questions for data collection. The exploratory and descriptive nature of the study lends itself to utilising two methods of gathering data: postal survey questionnaires and semi-structured interviews. One hundred (100) respondents participated in the former, while twenty (20) informants took part in seventeen (17) interviews carried out by the researcher over a period of four months. The findings of the study indicate that mentoring Project 2000 student nurses is a complex, time consuming and skilled activity, and that there are positive as well as constraining factors which affect the effectiveness of the mentoring process and the quality of the mentors. It also suggests that mentors require educational and managerial support, continuing professional development, and recognition for their role. Recommendations are made for improving the mentoring process and the quality of mentors. It is hoped that the information will improve the quality and utility of nurse education, and enhance the quality of interpersonal relationships between mentors, students, and clients or patients in the community.

Recent research by Boyd et al (2009) and Murray (2007) designed to explore the experiences of new academics moving into higher education from vocational and professional backgrounds, indicates that the transition from clinical practice to academic roles can be challenging. Additional research by Hurst (2010) further demonstrates that despite having established successful clinical careers, clinicians often experience feelings of uncertainty and inadequacy following such a move, taking between 1.5 and 3 years to socialise into their new academic roles (Hurst, 2010). In addition, the transition of pre-registration nurse training into higher education is relatively recent, following its wholesale relocation from schools of nursing located in the National Health Service to higher education institutions in the early 1990s. This move was initiated in response to growing concerns that the traditional apprentice model of pre-registration training, with its focus on functional competency, failed to give nurses the freedom or status required for professional development (UKCC, 1986). Therefore, given the relative recency of the move and growing evidence of the difficulties experienced by health professionals, it is pertinent to examine how they have managed the transition. Therefore, the purpose of this constructivist study is to investigate the academic role of the nurse educator and its contribution to the formation of personal academic identity. Undertaken over a three year period, this study uses intensive interviews with 14 academics employed in pre-1992 and post-1992 universities. Data analysis using grounded theory techniques provides a rich and detailed picture of nurse educators' personal academic identities, juxtaposed by a number of institutional, social and professional drivers. The main findings also signify congruence with previous studies (Boyd et ai, 2009, Murray, 2007) and indicate academics experience multiple challenges when making the transition into higher education. Challenges inhibit their ability to assimilate into an academic identity and realise academic roles, a position leading respondents to express concern about the efficacy of the competency based curricula and their ability to meet the wider educational needs of pre-registration nursing. The reciprocal processes of data collection, analysis and theory generation leads to the production of a model of academic identity transformation and explicit recommendations that may be used to direct the ongoing development of nurse education.

Critical care nursing is a clinical specialist nursing practice discipline. The critical care nurse provides a constant presence in the care of a critically ill patient. She/he creates a thread of continuity in care through the myriad of other health care professionals and activities that form part of a patient’s stay in the critical care environment (World Federation of Critical Care Nurses [WFCCN], 2007). During conversations with people who have had intimate experience of the critical care environment, they have offered anecdotes that describe their interaction with critical care nurses who they perceive to be different from and better than other critical care nurses they encountered. Despite having met common professional requirements to be registered as a clinical specialist nurse, these distinctive, unique abilities that seem to be influential in meeting the complex needs and expectations of critically ill patients, their significant others as well as nursing and medical colleagues, are not displayed by all critical care nurses. While students of accredited postgraduate nursing programmes are required to advance their nursing knowledge and skill competence, many students do not seem to develop other, perhaps more tacit, qualities that utilisers characterise in their anecdotes of ‘different and better’ nursing practice. The overarching research question guiding this study was how can ‘different and better’ critical care nursing practice as recognised by a utiliser be explained? The purpose of this study was to develop an understanding of the qualities that those people who use critical care nursing practice recognise as ‘different and better’ to the norm of nursing practice they encounter in this discipline. The participant sample included patients’ significant others, nursing colleagues and medical colleagues of critical care nurses, collectively identified as utilisers. The stated aim of this work was to construct a grounded theory to elucidate an understanding of the qualities that a utiliser of critical care nursing recognises as ‘different and better’ critical care nursing practice in order to enhance the teaching and learning encounters between nurse educators and postgraduate students in learning programmes aiming to develop clinical specialist nurses. The method processes of grounded theory are designed to reveal and confirm concepts from within the data as well as the connections between these concepts, supporting the researcher in crafting a substantive theory that is definitively grounded in the participants’ views and stories (Streubert & Carpenter, 2011: 123, 128-129). Two data collection tools were employed in this study, namely in-depth unstructured individual interviews and naïve sketch. Constant comparative analysis, memo-writing, theoretical sampling, theoretical sensitivity and theoretical saturation as fundamental methods of data generation in grounded theory were applied. The study unfolded through three broad parts, namely: Forming & shaping this grounded theory through exploration and co-creation; Assimilating & situating this grounded theory through understanding and enfolding; Reflecting on this grounded theory through contemplating and reconnecting. The outcome of the first part of the study was my initial proposition of a grounded theory co-created in the interactions between the participants and myself. This was then challenged, developed and assimilated through a focussed literature review through the second part of the study. Through these two parts of this study, an inductively derived explanation was formed and shaped to produce an assimilated and situated substantive grounded theory named Being at Ease. This grounded theory articulates how ‘better and different’ nursing is recognised from the point of view of those who use the nursing ability of critical care nurses through the core concern ‘being at ease’ and its four categories ‘knowing self’, ‘skilled being’, connecting with intention’ and’ anchoring’. The final part of this study unfolded in my reflections on what this grounded theory had revealed about nurses and elements of nursing practice that are important to a utiliser in recognising ‘different and better’ critical care nursing. I suggest that as nurses we need to develop a language that enables us to reveal with clarity these intangible and tacit elements recognised within the being and doing of ‘different and better’ nursing. I reflected on the pivotal space of influence a teacher has with a student, and on how the elements essential in being and doing ‘different and better’ nursing need to be evident in her/his own ways of being a teacher of nursing. Teaching and learning encounters may be enhanced through drawing what this theory has shown as necessary elements that shape ‘different and better’ nurses through the moments of influence a teacher has in each encounter with a student.

Purpose: To examine stakeholder participation in the primary care system change process that led to the introduction of the first Nurse Practitioner-Led Clinic in Ontario. Design: Qualitative case study guided by the principles of stakeholder and system change theory. Setting: Northern Community in Ontario, Canada. Participants: Purposeful sample of healthcare providers, healthcare managers and health policy stakeholders. Procedures: This case study was bound by place (Sudbury), time (January 2006–January 2008), activity (stakeholder participation), and process (introduction of an innovation, the first Nurse Practitioner-Led Clinic in Ontario, during a primary care system change). Semi-structured individual interviews were conducted with participants who represented the clinic, the local community, and the province. Public documents, such as newspaper articles published during the 2 year time boundary for this case and professional healthcare organization publications, were also examined. Interviews were analyzed using qualitative content analysis and public documents were reviewed for key messages to complement the interview findings. Field notes written during data collection and analysis were used to provide additional depth, contribute insights to the data, and ascribe meaning to the results. Main Findings: Sixteen interviews were conducted with key stakeholders. Twenty public documents which yielded the most specific information relevant to the case study time boundaries and activities were selected and reviewed. Six main themes are reported: felt need, two visions for change (one for a Nurse Practitioner-Led Clinic and one for Family Health Teams [FHTs]), vision processes related to ensuring the visions became or continued to be a reality in Ontario’s healthcare system (shaping, sharing, and protecting the vision), stakeholder activities, and sustaining and spreading the vision. Conclusions: In this case, stakeholder participation influenced policy decisions and was a key contributor to the primary care system change process to introduce the first Nurse Practitioner-Led Clinic in Ontario. Stakeholders are motivated by various needs to engage in activities to introduce an innovation in primary care. One of the most common needs felt by both those who supported the introduction of the first Nurse Practitioner-Led Clinic and those who were opposed to it was the need for improved patient access to primary care.

No description available.

The Physician Assistant and Nurse Practitioner professions initially began in response to healthcare shortages after the Vietnam War in the 1960s. Highly trained combat medical personnel developed into highly skilled PAs, while during this same time nurses began advanced practices that ultimately evolved into the position of NPs. Since this time, the roles and responsibilities delegated to each of these fields have drastically evolved, and are expected to continue to do so in the face of current health care reform under President Obama's Patient Protection and Affordable Care Act initiated in 2010. Originally perceived as "understudies" to physicians, PAs and NPs have become much more trained in their expertise, respected in their roles, and autonomous in their practice. Due to this, it has been predicted that PAs and NPs will become the major primary care providers in the face of increasing demands in this area of medicine. Large numbers of aging populations and up to 32 million newly insured patients seeking healthcare, coupled with physician shortages, have increased demands on PAs and NPs to fill these employment gaps. As there has been an increased demand on the PA and NP profession, there has been a paralleled increase in the number of educational programs producing graduates, larger class sizes, and larger numbers of PAs and NPs entering the workforce. The problem is posed when PAs and NPs, who desire to pay off student loans quickly and, understandably, seek high wages and professional advancement, pursue specialty and subspecialty employment versus filling in primary care gaps as anticipated. As the roles of PAs and NPs change, and more is expected of them in terms of practice and reliability, there are barriers to their growth. Professional tensions between these providers and physicians, poor understanding of what roles PAs and NPs hold by the public, unequal reimbursement for comparable services, and strict state legislation that limits the scope of practice of both PAs and NPs all inhibit these healthcare professionals from practicing to their fullest potential. This, in turn, may hinder persons becoming PAs and NPs from funneling into the ever increasingly demanding primary care field of medicine, and may pose future problems as patient populations increase under the Affordable Care Act. This paper assesses the current roles and responsibilities of PAs and NPs, how each profession is expected to grow, and the evolution of these healthcare providers as the potential "solution" to primary care needs. Statistics regarding current distributions of PAs and NPs in practice, educational expansion, obstacles that these professions must overcome, and the capabilities of PAs and NPs alike are analyzed, and conclusions drawn on what the contributions of these healthcare professionals may be in the future. Overall, it is expected that PA and NP presence in the medical field will undoubtedly increase. Whether these professionals will serve as an adequate source of primary care providers in the face of increasing demands imposed by the Affordable Care Act is yet to be seen, however. Barriers including professional tensions, reimbursement policies, wages, and strict state restrictions on the scope of practice of these individuals will need to be addressed. While it is projected that PAs and NPs will "solve" the current and future primary care physician shortage, this fact truly remains to be seen.

Almost 30% of new nurse graduates leave the position within the first year of practice, and almost 60% leave within 2 years. When new nurse graduates do not effectively transition into practice, nursing satisfaction is affected, and additional costs are incurred by their organizations through continual hiring of nurses. The purpose of this project was to develop a comprehensive, evidence-based nurse residency program (NRP) for new nurse graduates working in a 16-bed intensive care unit (ICU) of a 160-bed community hospital in the mid-Atlantic region of the United States. Using a team approach, Rosswurm and Larrabee's model of evidence-based practice was used to guide the project design, which included a pretest followed by 10 educational sessions. The plan concluded with a posttest to assess knowledge gained. The curriculum focused on 3 key areas identified by the Commission on Collegiate Nursing Education: leadership, patient outcomes, and the professional role of the nurse. Evaluation of the curriculum was completed by 3 Master of Science in Nursing-prepared content experts using a dichotomous scale. An average score revealed that the content met the objectives of each session. The experts also conducted a content validation index (CVI) of each pretest/posttest item using a Likert scale that ranged from 1 (not relevant) to 4 (highly relevant). The scale-CVI average, or the average CVI of all items, was .99; the universal agreement scale-CVI, or universal agreement of all items was .98, meaning there was high agreement across raters. Nurses who participate in the nurse residency program will be better able to transition into practice in the ICU as they provide care for today's complex patients, thereby positively impacting social change in their role as nurses as well as impacting patient, family, and organizational outcomes.

Indiana University-Purdue University Indianapolis (IUPUI) / Nurse residency programs (NRPs) have been identified as a means to promote transitioning of new nurses into the professional nursing role. Questions have arisen related to which elements within those programs are most meaningful to the development of new nurses. As the nursing shortage drives the need for quick transition and development of nurses to meet workforce needs, nursing must identify what is meaningful to nurses in their transition to practice. The purpose of this multi-site study was to explicate meaning from the experiences of newly licensed registered nurses (NLRNs) who have just completed NRPs. The research question was “What factors have meaning for NLRNs who have experienced transition to practice in nurse residency programs in acute care settings?” Semi-structured interviews were used to collect data from six NLRNs from three different NRPs after completion of their programs. Using interpretative phenomenological analysis, themes and variations within those themes were derived from the descriptive narratives provided from participant interviews. Overarching themes identified were Relationships, Reflection, Active Learning, Resources and Organizational Systems. Findings have implications for practice and education as the nursing profession strives to find ways to transform nurses in an effective and efficient manner.

Indiana University-Purdue University Indianapolis (IUPUI) / New nurses report feeling unprepared, incompetent, and highly stressed, contributing to first-year turnover rates of 25% in some healthcare organizations. Turnover, combined with a preparation-practice gap, has alerted advocacy organizations and researchers to recommend the development of nurse residency programs. Nurse residency programs are a post-graduate training period where new nurses receive enhanced clinical education in the healthcare setting. While highly variable in structure and attributes, programs usually include educational sessions, clinical immersion, and role socialization opportunities. Evidence supports that new nurses participating in nurse residency programs experience positive outcomes, including increased confidence, competence, and decreased turnover rates. Despite this, only half of the hospitals nationwide have implemented a program with most designed around a single health system mission. This dissertation study aimed to identify the attributes of nurse residency programs influencing the newly licensed registered nurse. An integrative review of the literature and evolutionary concept analysis was completed to examine the state of the science of nurse residency programs. Findings revealed a lack of conceptual and theoretical design and variability among program structures, creating a gap in the literature about the attributes of programs that are most influencing new nurses. Based on the literature's noted gaps, a qualitative description study was conducted. Purposive sampling strategies were used to recruit nurses who recently completed varied program models across the United States. New nurses reported the attributes of programs and described how those positively and negatively influenced the transition to practice experience. The overarching themes revealed that new nurses need a cadre of highly supportive individuals across the clinical and educational continuum who espouse astute interpersonal and communication skills. New nurses desire engaging activities with intra and interprofessional team members for clinical skill application, knowledge advancement, and role socialization. New nurses need the structure of meetings at times and in a sequence conducive to learning; and for preceptorship experiences to be facilitated by trained preceptors, on a unit, and of a length that supports confidence for autonomous practice. Future research will include the development and testing of an evaluation tool based on the findings from this study.