Thesis (M.S.)--Boston University

Thesis (M.S.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / 2031-01-01

Thesis (M.S.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / 2031-01-01

Thesis (M.S.)--Boston University

Thesis (M.S.)--Boston University.

The purpose of this study was to explore the experiences of older working nurses and the reason they were still in the workforce while the majority of their cohort had exited from active nursing. New Zealand's legislative changes in the Human Rights Act, 1993 and the Employment Relations Act, 2000 makes it unlawful to discriminate on the grounds of age. In effect, this means the abolishment of mandatory retirement as the individual is now able to exit from the workforce by choice. For nurses the choice for exiting the workforce occurs noticeably in the 50-54 age group with further declines in subsequent years. This research study revealed a group of older nurses who valued autonomy in their nursing practice and valued the contribution they made as experienced practitioners in a variety of health sectors in the Waikato. As the demographic shift in New Zealand's population is towards older age groups and likely to require future nursing care, it becomes essential to retain experienced nurses in the workforce. This small scale qualitative study interviewed ten registered nurses over the age of 60 to discover how social life was constructed as they aged.

Nurses espouse a caring ethic and demonstrate effectiveness in prevention of patient falls but are often observed taking risks with patients’ safety. These actions reflect poor congruence between espoused values and behaviours. Attitudes, values and involvement in decision- making are factors that influence work behaviours. Nurses’ attitudes are held to be a definitive factor in prevention work; however, few studies have focused on adherence with best practice principles of fall prevention. Yet nurses claim no authority to change their work. It was assumed that increased adherence would be achieved by improving nurses’ attitudes through participation in decision- making surrounding fall prevention practice. This study aimed to tes t this assumption by empowering nurses working in two medical wards with high numbers of patient falls to improve their ownership of practice by utilising critical social theory and action research. Nurses’ attitudes, including self-esteem, professional values and work satisfaction were established before and after a practice development project using action research. Mixed methods were employed by praxis groups meeting fortnightly for a year reflecting on, and re-engineering practice. Action research occurred in cycles focusing on assessment, communication, everyday work, and performance. Nurses’ work was re-organised to gain time to spend in prevention work. Patients’ environments were made safer and more patient-centred. New and effective ways of assessing risk to fall, communication of risk and monitoring nurses’ performance of prevention work were created and evaluated. Analysis demonstrated that nurses had good self-esteem and professional values but were not satisfied with their work. Self-esteem and professional values were unaffected by participation in work-related decisions however, nurses expressed increased sense of ownership, more satisfaction and were observed to engage in more prevention work. In conclusion, manipulation of attitudes and values is not warranted if attitudes and values are good. However, participation in work-related decision- making engages practitioners and leads to greater congruence between values and behaviour. The “unspoken rules” constraining practice that were exposed in the action research oblige nurses to assume authority, confronting and dispelling these constraints to enable more therapeutic care to emerge. Recommendations include promoting practice development as the preferred means for cultural change and improving person-centred care whilst recognising its fragile nature and dependence on clinical leadership.

The purpose of this study was to examine the relationship between characteristics of refreshed registered nurses and reemployment in the nursing workforce post Refresher programme. The application forms completed by the participants of the six programmes conducted by the ACT Health Authority (ACTHA, now Department of Community Services and Health ACT) provided data for a profile analysis. Employment data was derived mostly from statistics compiled by the Research Officer, Nursing, ACTHA. The findings of this study demonstrated that inactive registered nurses do return to nursing from periods of non-participation as nurses, following completion of Refresher programmes. Moreover, significant numbers of these returning nurses remain in nursing employment. In relation to that aspect of workforce planning which considers sources of supply for the registered nurse labour market an area for further study would be to explore the area of patient care in which the greater concentration of refreshed nurses were to be found post programme: acute care settings or extended care facilities. The study found that predictions of the successful reentry to nursing of the individual refreshed nurse and of retention in the nursing workforce could not be based on the characteristics of that person, alone. These findings supported the study's hypothesis that there would be no statistically significant difference between the characteristics of refreshed registered nurses who returned to, and remain in, the nursing workforce and those refreshers who either did not reenter nursing post programme or who left during the following twelve months. The characteristics examined were age, family status, post registration nursing experience, post registration nursing courses, worked as a nurse in the ACT prior to the programme, previous employment status, and time inactive from nursing pre-Refresher programme. Trends were identified which indicated that with some characteristics there was a greater likelihood of post programme reemployability in nursing. Refreshed nurses who reentered and remained in the nursing workforce tended to be younger.than those not working as nurses. There was a trend for post programme participators in the nursing workforce to have had fewer years of post registration nursing experience and to be more likely not to have obtained post registration nursing qualifications than their counterparts not working in nursing positions. Perhaps not surprisingly the study found that a higher proportion of the refreshers employed as nurses had previously worked at some stage in ACT health care facilities as registered nurses. A somewhat unexpected finding was that amongst the group of refreshed nurses working in nursing the largest contingent had been inactive from nursing for more years than was the case for those not working as nurses. The majority of refreshed registered nurses, whether they were working as nurses post programme or not had a family status of partner/husband and child(ren) and were unemployed before undertaking the Refresher programme. Refreshed registered nurses have provided a source of supply to the nursing workforce during a period of shortage of qualified nurses in the health care system. In the latter part of the 1980's there have been indications that shortage is largely confined to nurses with specialised skills. The findings from this study should assist the nursing profession in deciding the future role of programmes of reentry for inactive registered nurses who require reskilling for current clinical competence for general patient care areas.

A questionnaire survey of a stratified random sample (n=180) of registered nurses employed at two hospitals in the Australian Capital Territory was conducted to identify factors contributing to their job satisfaction and measure levels of satisfaction of registered nurses Grade 1, Grade 2 and Grade 3. The response rate was 75%. The survey found that registered nurses were satisfied with the scheduling, opportunities to utilize skills, working conditions, working relationships, leadership, decision making on patient care and intrinsic components of Job satisfaction and dissatisfied with the salary component. Registered nurses Grade 2 were more satisfied than the Grade 3 group and registered nurses Grade 1 were least satisfied (P=< .05).

Health personnel, especially nurses, are often victims of workplace violence. Unfortunately, little is known about the nurses' experience of violence. A research study was initiated to further explore the nurses' accounts of workplace violence so as to make dimensions of the nurses' experience visible and more fully understood. Interpretive description was the research methodology adopted for this study. Using theoretical sampling, ten Registered Nurses from the lower mainland and Vancouver Island, British Columbia participated in semi structured, audiotaped interviews. In this research, the nurses' experience of workplace violence emerged as a highly complex entity, deeply embedded in relationships and context. How nurses perceive the contextual factors of the organization, their immediate work environment and their individual attributes were found to play a significant role in how they respond to the phenomenon. The findings of this study suggest that organizational culture is an important determinant in managing workplace violence and that policy and administrative personnel play a pivotal role in influencing the problem. Nursing culture also influences the nurses' expectations, assumptions and actions towards violence. Participants voiced that role conflict often challenged their ability to enact acquired professional ideals and that that they routinely undertake roles in dealing with violence that are not appropriate to their level of knowledge or skill. Within the nurses' immediate work environment, bullying as well as physical and verbal abuse was commonplace. Overcrowding, long waits for service, poor environmental design and inadequate staff to patient ratios were seen as factors that increased nurses' risk. Individual factors were associated with emotional and psychological harms that nurses endured. Workplace violence affected self-concept, self-esteem, self-efficacy and the nurses' sense of control. Moral distress, self-blame, feelings of failure, loss of motivation and leaving the nursing profession were significant findings. The results of this study demonstrate a need to re-think how we can address workplace violence in nursing. Research and intervention is needed to further explore organizational policy and governing structures, the culture and climate of practice environments, and the fundamental role nursing education programs have in preparing nurses to manage workplace violence.