(1)
Flexible working & nurses 50+
(J. Clendon & L Walker)
• Ageing nursing workforce• Ageing population• Anticipated nursing workforce shortages• Need to increase nursing numbers
– Recruitment– Retention
Flexible working defined as:
‘…practices that enable employees to exercise greater choice over how, where and when they work in order to more effectively meet their work-life balance needs…’
Examples include:• Job share• Part time hours• Casual hours • Time in lieu
Literature:Impacts of flexible working
Advantages include:• Increased job satisfaction• Improved retention• Lower incidence of work-related stress• Reduced absenteeism• Reduced turnover• Higher organisational commitment• Improved work-life balance
Method
• Ethics approval• Recruitment of District Health Boards• Individual interviews• Focus groups
Results – nurses
Scope: 44 RN, 1 NP, 1 EN
Ethnicity: 35 NZ European, 2 Māori, 6 other European
Age: 26 aged 51-60, 17 aged 60-65
Finding the balance
I thought of it from both perspectives… from the employer’s perspective to meet the needs of the service but also from the individual perspective where there might be times within your working life where you need changes to hours and that can be accommodated depending on what’s happening in your personal life.
Frustrations and barriers
I’ve been told that if I want to cut down then I have to take it as annual leave and I don't want to drip feed my annual leave.
Our charge nurse here’s really flexible about that and she can authorise annual leave or flexible hours. At this unit level it’s extremely flexible, and it’s just the dictates from above that restrain you...
Results - policy
• 11 DHBs (out of a possible 20) provided information on flexible working hours and/or career planning policies.
• Telephone interviews with regard to these policies were undertaken with either Directors of Nursing (n= 7), human resource advisors (n=7).
Recommendations• Organisations should have clear policies &
procedures around flexible working• Unit managers must be aware of these policies
& enact them with respect & acknowledgement• Organisations may wish to explore job sharing
opportunities in more depth• Enabling older nurses to take on roles in
mentorship may facilitate both retention & succession planning
(2)
Nursing skill mix in Primary Care
(L. Walker, J. Clendon, Kathy Nelson)
Understanding evolving nursing roles in primary care
Methods
•Ethical review
•Practice recruitment
•Document review – policies, Standing orders
•Interviews
•Observation
Analysis
• Integrated pictures of each case were developed;
• Data sets were combined & compared to capture specific similarities, differences & perspectives;
• A skill-mix framework was used to compare findings related to nursing skill mix across case studies.
Case study 1 Broad description of practice setting
Small, semi-rural practice, situated in a small town.Privately owned and run by a GP and a RN as equal partners
Patient roll and demographics Around 2000 enrolled patients, aged 0-90+, of all ethnicities, and all socio-economic groups. High proportion of over 65s, and high proportion of Care Plus funded patients.
Description of staffing (clinical team)
2 GPs (1.8 FTE)2 RNs (1.2 FTE) (referred to as Family Nurse Specialists)1 PCPA (0.8 FTE)All including the practice manager were interviewed.
Broad description of services Full range of general medical services; acute care, management and monitoring of long term conditions, women’s health, immunisations, smoking cessation, after hours on call, patient education, home visits, falls prevention classes, occupational health and palliative care
Unique features / model of interest
Model of care is interdisciplinary in nature; work collaboratively both within the practice and with clinicians in other organizations. RNs use of Standing Orders extensively. PCPA is used to improve patient flow and the regular measurement and recording of relevant clinical and social data to enhance continuity. Onsite dispensary with limited medicines related to Standing Orders available.
Case study 2 Broad description of practice setting
Large multidisciplinary practice in a small town.Privately owned and run by 6 GPs
Patient roll and demographics Patient roll is around 10,000, relatively affluent population, but also a much higher than average number of over 65 year olds, so many with long term conditions and complex multiple co-morbidities.
Description of staffing(clinical team)
11 GPs (5 employed, 6 partners)12 RNs (1 mobile, 1 occupational health nurse, 1 NETP nurse)2 EN (1 mobile)1 Health Care Assistant1GP, 3 RNs 1 EN, the nurse manager and the practice manager were interviewed.
Broad description of services General medical services, wound clinic, ear suction clinic, plastering, on site radiology, immunisations, patient education, warfarin management, blood pressure clinic, women’s health, podiatry, optometrist. About to launch an insulin initiation service.
Unique features / model of interest
EN-led wound clinicMobile RN / EN pairing Occupational health serviceNurse led phone line for prescription repeats
Case study 3 Broad description of practice setting
Busy mid-sized urban NGO-managed practice with salaried GPs and nurses (this practice is part of a more complex 3 practice organisation).
Patient roll and demographics 10,200 patient roll. High Māori population, low socioeconomic patient population with subsequently high needs.
Description of staffing(clinical team)
1 NP4 GPs9 RNs (Community RN, Disease State Management (DSM) RN & Outreach Practice nurse, 6 Practice Nurses)KaimahiPCPA (called a nursing assistant (NA) in this setting)Social worker* / Low cost dentistry*The CEO, NP, DSM, NA, clinic coordinator, practice manager and 2 RNs were interviewed.
Broad description of services General medical servicesMobile Disease State Management service
Unique features / model of interest
NP, NA, DSM RN and broader liaison with whānau ora / non health services
Evolving nursing roles
• Nurse led clinics• Outreach & proactive LTC management• Nurse Practitioners• Nurses as business partners• Nurse led discharge & community follow
up• Primary Care Practice Assistants freeing
up nurses to deliver more advanced nursing care
(3) Nursing Professionalism
(L. Walker, J. Clendon, & Jo Walton)
Exploring the attitudes & understandings of nurses in New Zealand towards nursing professionalism & its impact on patient care & safety.
Awareness of Codes of Ethics and Codes of Conduct
aware not aware 0
50
100
150
200
250
Awareness of Codes of Ethics & Codes of conduct (N= 224)
NZNO Code of Ethics NCNZ Code of conduct
Perception of compliance with Nursing Council Code of conduct
Always fully compliant
Mostly fully compliant
Rarely fully compliant
0 20 40 60 80 100 120 140 160 180 200
Perception of compliance with Code of Conduct (N= 224)
Focus group dataProfessionalism themes Illustrative quotes
Adherence to the Code of Conduct Adherence to a Code of Conduct, Code of Ethics and all other documents which underpin best practice
Integrity, trust, honesty and ethical behaviour To be trustworthy and honourableThat I am scrupulously trust worthy in my dealings with my patients
Keeping focus on the patient Ensuring the safety of the patientsMaking sure patients are at the heart of everything we do
Maintaining patient confidentiality Being constantly mindful of patient confidentiality
Taking responsibility for competence Acknowledging one’s own limitations and knowing when to ask for help
Boundaries and the need to limit self-disclosure Professional boundaries.Maintaining nurse patient boundaries
Focus group dataProfessionalism themes Illustrative quotes
Commitment to cultural safety Culturally safe nursing.Able to listen, and respectful of their needs
Empathy, caring &compassion Compassion, integrity, genuine caring, and commitment to doing your best for those who need you
Good communication & interpersonal skills
Planning of care and communicating it to colleagues, patients and their families.
Self-awareness, remaining non-judgemental
Being non-judgmentalBeing resilient and self-aware
Showing knowledge & technical competence
A nurse who knows what they are doing. Has good clinical skills, practices safely
Commitment to ongoing education & updating nursing knowledge
Ensuring you keep up with current practice. Reading journals, attending conferences
Hot debates
• relative importance of knowledge and technical competence
• selection of candidates for nursing education
• Appearance and standard of dress
Paper(s) available
Other research projects
• Impact of 12 hour shifts on error rates• 2015 Employment Survey
• Intergenerational Teams• Nurses as care givers• Health of nurses
• Suggestions?
Problem identification
The contribution of nursing and the value that it adds continues to be largely unrecognised and when tough choices or decisions are made about health system change frequently nursing becomes the first target and the nursing voice is unheard by those in power.
Campaign purpose
• Reinforce professional pride• Promote nursing• Raise nursing’s profile and image
• Raise awareness of the professional association profile of NZNO
Campaign outcomes
• Nurses conveying pride in nursing• Nurses projecting professionalism• Members empowered to articulate the
value of nursing• Demonstration of the value of nursing to
the public, funders and providers• Nurses become known as knowledgeable,
skilled health professionals • Improved engagement at all levels
Activities so far….• Project team• Market research focus groups• Campaign slogan and branding developed• Resource development• Leader identification, development,
activation• Member awareness & involvement