The community nurse in Australia. Who are they? : a rapid systematic review

Aim: This study aimed to profile the community nurse in Australia. Background: The need for nurses in the community health care sector is increasing in response to shorter hospital stays, an aging population and chronic disease. The increase in demand has not been followed by appropriate workforce planning, leading to structural issues and lack of qualified nursing workforce in the community sector. Evaluation: MEDLINE and ProQuest Public Health and grey literature were searched for records published between 2010 and 2020 relative to the profile of the community nurse in Australia. Twenty-five records (21 publications, 2 databases and 2 reports) were included in the review. Abstracted data followed the principles of workforce planning and included demographics, qualifications and roles. Key Issues: Inconsistent definitions, self-reported data and a focus on practice nurses have contributed to data irregularities. Little is known about the specific aspects of community nursing work. Conclusion: A lack of concrete data has overshadowed a community nursing workforce crisis with implications for patients' health and safety across the lifespan. Implications for Nursing Management: There is urgent need for nurse managers globally to refocus nursing recruitment to the community sector to maintain quality and ensure sustainability of the nursing workforce

An integrative review of enrolled nurse recruitment and retention

Background: Australia is facing a severe shortage of Enrolled Nurses. Jurisdictions have introduced strategies in attempts to recruit and retain Enrolled Nurses in the health workforce. Aim: To explore factors impacting recruitment and retention of Enrolled Nurses. Methods: A systematic search of literature published in the English language from 2000 to 2018 that addressed the recruitment or retention of aspiring and current Enrolled Nurses (or global equivalents). The search yielded 6955 publications; 20 articles were retained for full-text review and eleven articles were included in the final review. Findings: Three major themes (Nursing work and the EN role, Educational structure and support, and Personal attributes) were identified that covered enablers and barriers to the recruitment of Diploma of Nursing students and Enrolled Nurses. Evidence of the efficacy of programs designed to integrate and retain Enrolled Nurses in the health workforce is scant. Enrolled Nurses viewed participation in a Transition to Practice Program as an integral step in the pathway to becoming a registered nurse. Discussion: Continued debate around scope of practice is contributing to organisational and collegial confusion and discriminatory practices with negative consequences for the recruitment and retention of Enrolled Nurses. Conclusion: The value of Enrolled Nurse Transition to Practice Programs for recruitment and retention is questionable. Greater recognition of Enrolled Nurses’ contributions to patient care is essential and could provide Assistants in Nursing with a career opportunity

Historical exploration of the work and workload of the WW1 nurse in an Australian auxiliary hospital

Background: Following stabilisation in hospitals and on hospital ships wounded and sick servicemen in World War 1 were transferred to auxiliary (also known as convalescent) hospitals for convalescence and rehabilitation. Exploration of the work of the auxiliary (convalescent or rehabilitation) nurse is sparse. Aim: To identify the Australian trained and untrained nurses and their nursing work in an Australian auxiliary hospital in England during WW1. Methods: Digitised primary and secondary sources were used to identify nurses and their work. To account for names and spelling variances a process of data validation was employed. Findings: Formally unrecognised, auxiliary (rehabilitation) nurses had a high patient load and worked long hours. Nursing activities spanned the acute, mental health and rehabilitation domains. Discussion: Analogies can be made between perceptions of wartime auxiliary nursing work and the continued debate around contemporary rehabilitation nurses’ scope of practice. Conclusion: The complexity of WW1 auxiliary (rehabilitation) nurses’ work and workload was underestimated. Rehabilitative techniques gaining recognition today were embraced by auxiliary nurses over a century ago

A systematic review of activities undertaken by the unregulated nursing assistant

Aim: To identify activities performed by Nursing Assistants in acute and primary healthcare. Design: Systematic review. Data sources: The databases MedLine/PubMed, ProQuest and Google Scholar were searched for empirical studies published in the English language between 2008 and 2018 that addressed the work of Nursing Assistants. Review methods: From an initial yield of 2,944 publications, 71 publications were retained for full text review and 20 publications included in this review. Activities undertaken by Nursing Assistants from eight countries were extracted and categorized into one of six categories. Results: Over 200 activities were identified as being delegated to Nurse Assistants globally. Many of these activities are beyond the training of the Nurse Assistant and are being performed with limited Registered Nurse supervision. Conclusion: Patient safety is at risk. Nurse Assistants' roles vary widely, with some seeing their role as similar to that of a regulated nurse, while recognizing their need for additional training. Impact: Over 31% of activities delegated to Nurse Assistants require skill and comprehension beyond their level of training. Patients and regulated nurses need to have confidence that Nursing Assistants responsible for care provision are appropriately trained and practicing within regulatory standards

Assistants in nursing : scope of practice and pressure injury prevention

There is greater focus on patientcentred care supported by the National Safety and Quality Health Service Standards (ACSQHC 2017) as well as a focus on Hospital Acquired Complications (ACSQHC 2018). In NSW one model has been the introduction of Assistants in Nursing (AIN) as part of the nursing skill mix. The AIN role was initially introduced to provide basic support to qualified nurses by assisting patients with personal care needs (Afzal et al. 2018). With current nursing workforce shortages and changing healthcare environments hospitals are increasingly utilising AINs in the acute care environment (Duffield et al. 2014). The AIN role now includes activities that were previously undertaken by regulated nurses. The AIN has become a member of the nursing acute care team. As an unregulated position, qualifications for AINs are not mandatory (Mason 2013). Courses designed for AINs are available in both the public and private sector but these courses vary in both length and content. In NSW, an AIN can have completed preparation for the role ranging from a six week course; a nationally recognised qualification such as the Certificate III Health Services Assistance; one year of an undergraduate nursing course, or ‘equivalent experience’ (NSW Health 2018). Therefore, an individual AIN’s knowledge and experience can vary, leading to confusion around AINs scope of practice and clinical competency

Australian nurses in a World War 1 Australian military hospital in the UK

Introduction: Today Harefield Hospital is a renowned cardio-thoracic hospital in the UK. In 1914 Harefield Park was a large manor house owned by Australian Charles Billyard-Leake. Charles donated his house and land to the Australian Government to be used as a hospital for wounded Australian soldiers. Apart from the matron and five Australian nurses sent to establish the hospital in 1915, little is known about the Australian nurses who worked at No. 1 Australian Auxiliary Hospital (1AAH) during the Great War. Aims and focus of the research: To identify the Australian nurses who worked at 1AAH during World War 1 and to recognise their contribution to the nursing and rehabilitation of wounded soldiers. Methods and/or sources: Multiple research methods using both published and unpublished digitised records of primary sources, newspaper reports, local historical records and photographic images of nursing were used for this study. Key areas for discussion: The frequent transfer of nurses between hospitals and casualty clearing stations in Australia, Europe, India and Egypt during WW1 hinders the identification of nurses working in one location. Registers of nurses allocated to individual sites are not available, necessitating that all records of nurses who volunteered or enlisted for duty be examined. Conclusion: Over 140 individual Australian nurses worked at 1AAH from 1915-1919. From an initial five nurses and 50 patients, the hospital rapidly expanded to 20 nurses for 550 patients and later 70 nurses for 1000 patients. A major tribute to the nurses' care is that from over 50,000 patients passing through 1AAH, only 98 died

The effect of pre-admission education on domiciliary recovery following laparoscopic cholecystectomy

Objectives: The objectives of this randomised controlled study were to determine if pre-admission patient education affects post-operative pain levels, domiciliary self-care capacity and patient recall following a laparoscopic cholecystectomy (LC). Participants were randomised to receive the standard preadmission program (SP) or an individualised, education intervention (EI). Design: A pre-operative questionnaire was administered in the pre-admission clinic to determine participants’ knowledge of LC and post-operative management. Telephone follow-up and post-operative questionnaire were conducted approximately 14 days post discharge. Setting: Preadmission clinic of a Sydney, Australia, tertiary referral hospital. Sample: Ninety-three elective LC patients. Results: EI participants experienced lower pain levels and had significantly greater recall of provided information. However, no significant differences were found between the control and intervention groups for domiciliary self-care. Conclusion: Pre-admission education intervention helps reduce post-operative pain levels following LC and significantly increases patients’ knowledge of self-care and complication management

A systematic review of time studies to assess the impact of patient transfers on nurse workload

Patients in hospital are increasingly being moved between clinical units and between bedspaces; however, the impact of patient transfers and bedspace moves on nurses’ workload is not known. Time studies are an established observational research method that can be used to determine the duration of time taken to perform an activity or process. This review systematically searched four databases for literature published between 2000 and 2013 for observational time study techniques and patient transfers as a nurse activity. Eleven publications from three countries were included in the review. All studies used timing techniques to explore nurse work associated with the transfer process. The review highlights the duration of time spent by nurses on certain aspects of the transfer process. However, as few studies published results from timings, the impact on nurse time is likely to be higher than indicated. Further research is recommended

Research into the workload and roles of oncology nurses within an outpatient oncology unit

This project evaluated the roles and workload of Registered Nurses (RNs) within an outpatient Cancer Care Centre (CCC) of a tertiary referral hospital in Sydney, Australia. The research incorporated the two distinct areas of radiation oncology and haematology oncology. Patient throughput (incorporating clinic attendance and treatments) was known to have increased substantially since the centre opened in1994.The nursing Full Time Equivalents (FTEs) for the CCC were determined when the centre opened with minimal change to the nursing establishment since then. Nursing staff perceived that their workload had increased substantially and that their roles had become more complex. Work sampling was conducted over a 3-month period and identified the range of nursing activities performed by the oncology outpatient nurse. The nurses were found to have a large administrative role while their nursing activities ranged from basic nursing tasks to more specialist activities including patient counseling and complex chemotherapy regimes

The cost of transferring a patient on nurses and nursing work

Background: Increasingly in Australia and elsewhere, patients are being transferred between and within wards during their inpatient episode (Blay et al. 2017). Transferring patients is considered to be part of the nursing role, although many nurses believe that some transfer activities could be delegated to others (Bruyneel et al. 2013). This study explores patient transfers in terms of nursing roles and nursing work. Aims: To explore the impact of transferring patients on medical-surgical nurses and nursing work in a tertiary level hospital in Australia. Methods: A direct observational-timing study of nurses undertaking transfer-associated activities between June and August 2013. Observed nursing activities were timed and categorised into pre-determined categories (Administration, Communication, Direct care, Documentation, Indirect care and Other) based on work sampling methods. Case studies were used to detail the sequence of nursing activities and nursing roles. Field notes recorded at the time of observation provide insight into the transfer process. Results: Nurses were observed and timed undertaking transfer-associated activities (n=868). Communicative activities were the most frequently undertaken activity (36%) followed by direct care 31%. The majority of nurse’s time (46%) was spent on direct care. Escorting a patient was the most time-consuming, taking nurses away from the ward for 19 minutes on average. Similar proportions of time were spent on documentation (13%) and administrative (11%) activities. Experienced nurses spent 17% of their time on indirect care and other activities such as moving beds and bedside lockers. Discussion: The frequency of patient transfers is such that nurses are spending considerable time moving patients. Results have highlighted that many transfer-associated activities were costly in terms of nursing time and could be undertaken by others