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Lecture 5

Week 5 - Nature of Nursing Work and Impact on New Nursing.pdf

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Ryerson University
NSE 407
N S E407

Week 5 - Nature of Nursing Work and Impact on New Nursing October-25-12 11:19 AM Evolution of NursingWork • Lack of clarity between nursing work and non-nursing work in the past. • Changes in structures/nature of work among auxiliary workers. • Clients are more acutely ill, nursing care complex • Declining supply of nurses to fill current positions • Lack of consensus about what is nursing work and what it is not ○ Is mopping floors, cleaning toilets, cooking, nurses work? ○ Are bed baths nursing work? Issues Related to Nursing Work • What is the impact of these issues on nurses? ○ Increasing demands of nurses' work ○ Incongruities between what is taught and practiced ○ Lack of support for nurses' work ○ Workplace isolation - commitmentto their organization decreased ○ Disrupted workplaces - fewer resourcesfor mentoring and continuing education From the Research • What findings were discussed in each of the following issues: ○ Lack of support for nurses' work and workplace isolation  Workplace isolation is no different than oppression. Peoplecan be put down and pushed aside.  Addictions, suicides  Nurses do not feel close or connected ○ Nursing shortage  Some argue that the nursing shortage is both real and false. Why is that? □ Because of the lack of support, there are bodies to do the work but not the willingness. What does that imply?  That the institution needs to change.  In Canada - by 2011expected to be a shortage of 78,000nurses.  To address the issue, the following recommendationshave been made by researchers: □ Recruit and educate more nurses □ Provide entry-to-practiceinitiatives  In Canada, entry into BScN programmesincreased by 65% since 1999.  Problem:CAN 2000reported that many new graduates are leaving their jobs within 2 years of graduation. Why? □ We are not sure □ Burn out? □ Job Dissatisfaction? □ Poor work environmentquality?  Lavoie-Tremblay(2008):nurses who planned to quit perceived an imbalance between effort expended and reward received. □ Nurses can be upset. Should I stay or should I go? • Characteristics of Quality PracticeEnvironments Newly licensed registered nurses' perceptions of job difficulties, demands and control: individual and organizational predictors - Unruh & Nooney (2011) Introduction • In spite of a slight easing of the nursing shortage, severeshortages of RNs continue to be predicted for the future. • Primary drivers of long term shortage: Ageing population ○ Ageing population ○ Ageing nurse workforcedue to retire • Increasing output of new graduate RNs remains a central strategy for resolving the shortage, yet it is unclear whether this strategy will be truly effective. • If NLRNs are not retained within the profession,scarce educational resourcesare wasted. • It is known that NLRNs often work under very stressful conditions. • Nursing education may not fully prep them for the reality of nursing work, and they may not be given adequate orientation in their initial employment. • By better understanding factors that are related to new RN's perceptions of job difficulties and demands, hospitals will be able to reorganize work to retain these nurses not only at the job level but also at the professional level. • Purpose: Informationobtained from the present study is used to develop a set of recommendationsfor retaining NLRNs from both their jobs and the nursing profession. Background • In past studies, work conditions described as stressful. • RNs have feelings of stress, lack of self-confidence, lack of preceptor support and disillusionment. • NLRNs have reported that they face high rates of overtimeand injury and that they need more supervisory support. • Perceivedconflict on the job has also been found to be correlated with job satisfaction of new RNs. • Some studies indicate experiences of new RNs improveover time. • Job stress and dissatisfaction of NLRNs contributes to intent to leave their job and actual job turnover early in their careers. • Patient care issues such as unsafe nurse-patient ratios were the most frequent reason for RNs leaving their first job. • RNs who are more satisfied with their jobs are less likely to intend to leave. • New RN's positive experiencestend to be related to job satisfaction and commitment. Predictorsof job difficulties,job demands and job control • Job difficulties defined as organizational constraints that could impede the individual's ability to perform well and could give rise to frustration, demoralization,dissatisfaction and burnout. ○ Componentsof job difficulties include:  Inadequate resources  Role conflict  Supervisory issues and workload • Job demand defined as stressorspresent in the work environmentsuch as: ○ Time pressure ○ Heavy workload ○ High work pace ○ Difficult and mentally exhausting work • High job demands have been found to lead to job dissatisfaction ○ Lack of time to get work done contributes to lower job satisfaction • Nurses experiencing high work demand or high work tempo are more likely to intend to quit. • Job control is the authority a worker has to make decisions for his/her own activities. ○ Thought to reduce job stress and strain • Some studies revealed that personal characteristics like age, sex, educational level and marital status are related to job stress. ○ Nurses who made greater use of constructivecoping mechanisms were less likely to experience occupational stress and physiological and physical ill health, and they were more likely to be satisfied with their job. • Communicationdifficulties, lack of knowledge and confidence, unfamiliarity with equipment and dealing with ambiguous or unfamiliar orders were major sources of equipment and dealing with ambiguous or unfamiliar orders were major sources of job stress in NLRNs. • Authors hypothesized that individual and organizational characteristicspredict newly licenced RNs' perceptions of job difficulties, job demands and job control. Results Positive impact   Negative impact    •Self reported good health related to •Working more hours per week was related fewer reports of job difficulties as a to perceptions of job difficulties. result of conflicting demands. •NLRNs with higher patient loads more likely •NLRNs with perceptions of better to perceive job difficulty. orientation adequacy were significantly •Nurses with advanced degrees more likely to less likely to report job difficulty. report having more work than can be done •Older RNs less likely to report they well. have to work very fast. •Working day shifts associated with •RNs who got adequate orientations perceptions of increased job demands. less likely to report having no time to •Higher patient loads associated with get things done. perceptions of increased job demand. •Nurses with longer professional tenure •Floating associated with negative work were more likely to feel they could environment. make and carry out decisions. •Nurses who had children in the home reported less interruptions at work. •Positive work environments associated with less reported job difficulty New Nurses' Experience of Their Role Within InterprofessionalHealth Care Teams in Mental Health - Schwartz, Wright, Lavoie-Tremblay (2011) Literature Review • IHTs - Interprofessional Health care Teams • Interprofessionalcollaboration has been assoc
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