Nursing Competence in Norwegian Municipal in-patient Acute Care Professional Accountability, Environment, and Leadership

Background: Changes from the introduction of the Coordination Reform in Norway have induced an increase in the need for highly qualified nursing staff in the primary health care service. Among the most important initiatives of the Coordination Reform in Norway is the municipal in-patient acute care (MipAC) service. All municipalities must provide in-patient acute care for patients requiring 24-hour care or observation. The MipAC is expected to deliver safe quality care and may entail many patient and societal benefits. However, the service establishment and organisation differ per municipality, putting the service quality into question. Older and vulnerable patients constitute the largest group of patients under the MipAC service. Even though the benefits of well-educated and competent nursing staff to care for vulnerable older people are broadly recognised, the requirements for nursing competence are sparsely defined in governmental documents, and knowledge of nursing competence in the services is lacking. Aim: This study explores and describes aspects of nursing competence in the MipAC service. It answers the following question: What is the necessary nursing competence in MipAC, and how is it facilitated, maintained, and enhanced?acceptedVersio

Associations between nurse managers’ leadership styles, team culture and competence planning in Norwegian municipal in-patient acute care services: A cross-sectional study

Background Increased complexity in the primary healthcare services has followed in the wake of health reforms and reveals the need for competence enhancement in the nursing services. Effective and visionary leadership, sufficiently qualified staff and cooperation among professionals are considered as key measures to safeguard quality in the services. Aims To identify which leadership styles characterise first-line nurse managers in Norwegian municipal in-patient acute care (MipAC) units and to investigate how first-line nurse managers’ leadership styles are associated with team culture and documented nursing competence planning. Methods A cross-sectional survey was distributed to all the first-line nurse managers in Norwegian MipAC units (n = 229). Data were collected between March and June 2019. The response rate was 80.5% (n = 182). First-line managers’ background information and data about their focus on team culture and competence planning were recorded. Furthermore, we noted organisational structural characteristics, and managers’ transformational (relational) leadership and transactional (task-oriented) leadership styles. Results The managers exhibited a high degree of transformational leadership behaviour, which was significantly associated with team culture. No significant associations between leadership behaviours and documented competence planning were found. Notably, we found a significant correlation between transformational and transactional leadership styles, indicating that the managers adapt their leadership behaviours to actual requirements and situations. Organisational structural factors: the share of registered nurses (RNs) on the staff and having a position for a professional development nurse were positively associated with competence planning. Conclusion A relational leadership style promotes team culture and both factors may empower the professional nursing environment. However, first-line nurse managers need to acknowledge nursing competence planning as a central part of effective leadership. Having a professional development nurse position seems to complement leadership and ease the manager's responsibilities regarding team culture and competence planning.publishedVersio

Responssentertjenester i helse og omsorgstjenesten: behov og fremtidsbilder. Delrapport 1- 2016 fra prosjektet M4ALMO

-Rapporten er en delleveranse fra RFF-prosjektet "M4ALMO - Modeller for alarmmottak". Rapporten sammenfatter funn og dokumentere kunnskap som er utviklet gjennom en serie workshops i prosjektet avholdt høsten 2015 og våren 2016. Målet har vært å kartlegge dagens utfordringer, fange ulike synspunkter og identifisere målbilder for fremtidens alarmmottak og organisering, samt diskutere nye mulige løsninger for organisering av responssentertjenester. Bidragsytere har vært representanter fra prosjektets kommunepartnere Skien, Larvik, Drammen, Oslo, Grimstad, Kristiansand, Risør og Kvinesdal på vegne av Lister-kommunene; leverandører av responssentertjenester SOS International og Telenor Object/Aleris, teknologileverandør og prosjektpartner Imatis samt forskningspartnerne Universitetet i Agder og SINTEF. Det er lite tilgjengelig kunnskap om hvordan trygghetsalarmtjenesten faktisk fungerer i helse- og omsorgstjenestene i dag. Omfang og resultater av alarmer dokumenteres bare i liten grad, og faktisk og praktisk gjennomføring er i all hovedsak "taus kunnskap", kjent og delt kun innenfor hvert tjenestested. Rapporten bidrar dermed med et kvalitativt kunnskaps-grunnlag for fremtidige beslutninger vedrørende responssentertjenester, både på nasjonalt og kommunalt nivå. Oppdragsgiver: Regionale Forskningsfon

Responssentertjenester i helse og omsorgstjenesten: behov og fremtidsbilder. Delrapport 1- 2016 fra prosjektet M4ALMO

-Rapporten er en delleveranse fra RFF-prosjektet "M4ALMO - Modeller for alarmmottak". Rapporten sammenfatter funn og dokumentere kunnskap som er utviklet gjennom en serie workshops i prosjektet avholdt høsten 2015 og våren 2016. Målet har vært å kartlegge dagens utfordringer, fange ulike synspunkter og identifisere målbilder for fremtidens alarmmottak og organisering, samt diskutere nye mulige løsninger for organisering av responssentertjenester. Bidragsytere har vært representanter fra prosjektets kommunepartnere Skien, Larvik, Drammen, Oslo, Grimstad, Kristiansand, Risør og Kvinesdal på vegne av Lister-kommunene; leverandører av responssentertjenester SOS International og Telenor Object/Aleris, teknologileverandør og prosjektpartner Imatis samt forskningspartnerne Universitetet i Agder og SINTEF. Det er lite tilgjengelig kunnskap om hvordan trygghetsalarmtjenesten faktisk fungerer i helse- og omsorgstjenestene i dag. Omfang og resultater av alarmer dokumenteres bare i liten grad, og faktisk og praktisk gjennomføring er i all hovedsak "taus kunnskap", kjent og delt kun innenfor hvert tjenestested. Rapporten bidrar dermed med et kvalitativt kunnskaps-grunnlag for fremtidige beslutninger vedrørende responssentertjenester, både på nasjonalt og kommunalt nivå. Oppdragsgiver: Regionale Forskningsfon

Innovative Simulation of Health Care Services in the Usability Laboratory: Experiences from the Model for Telecare Alarm Services-project

In Norway, a recent health reform urged municipalities to prepare for telecare alarm services to handle alarms associated to welfare technology and telecare technology in citizens’ homes. That requires a re-organisation of health and social services in many municipalities and several are preparing to establish new telecare alarm services operated in inter-municipal response centres. In this context, the research project “Model for Telecare Alarm Services” aims to study how existing telecare alarm services in Norwegian municipalities are organised and operated, and identify critical factors when designing new models for future services. This paper presents how an innovative simulation of health care services was used in the research project, when key informants from several municipalities, research partners and industry tested different models of telecare alarm services in a usability laboratory. The lessons learned by the research group showed that laboratory simulation was an efficient way of testing different scenarios of new telecare service models, together with key informants from heterogenous end-user groups.publishedVersionNivå

Associations between nurse managers’ leadership styles, team culture and competence planning in Norwegian municipal in-patient acute care services: A cross-sectional study

Background Increased complexity in the primary healthcare services has followed in the wake of health reforms and reveals the need for competence enhancement in the nursing services. Effective and visionary leadership, sufficiently qualified staff and cooperation among professionals are considered as key measures to safeguard quality in the services. Aims To identify which leadership styles characterise first-line nurse managers in Norwegian municipal in-patient acute care (MipAC) units and to investigate how first-line nurse managers’ leadership styles are associated with team culture and documented nursing competence planning. Methods A cross-sectional survey was distributed to all the first-line nurse managers in Norwegian MipAC units (n = 229). Data were collected between March and June 2019. The response rate was 80.5% (n = 182). First-line managers’ background information and data about their focus on team culture and competence planning were recorded. Furthermore, we noted organisational structural characteristics, and managers’ transformational (relational) leadership and transactional (task-oriented) leadership styles. Results The managers exhibited a high degree of transformational leadership behaviour, which was significantly associated with team culture. No significant associations between leadership behaviours and documented competence planning were found. Notably, we found a significant correlation between transformational and transactional leadership styles, indicating that the managers adapt their leadership behaviours to actual requirements and situations. Organisational structural factors: the share of registered nurses (RNs) on the staff and having a position for a professional development nurse were positively associated with competence planning. Conclusion A relational leadership style promotes team culture and both factors may empower the professional nursing environment. However, first-line nurse managers need to acknowledge nursing competence planning as a central part of effective leadership. Having a professional development nurse position seems to complement leadership and ease the manager's responsibilities regarding team culture and competence planning

Nursing competence in municipal in-patient acute care in Norway: a cross-sectional study

Background The primary health care services are becoming increasingly complex, which presents challenges for the municipal nursing services. In Norway, municipal in-patient acute care (MipAC) has been introduced in all municipalities, and the competence at the services has been questioned. Few studies have examined the nursing services in the units. This study aims to get an overview of the nursing competence in those units across geographical regions, and different groups of organisation and localisation. Methods A cross-sectional study was conducted, and an ad hoc questionnaire was distributed to first-line leaders in all the MipAC units in Norway. Data were collected in the period between 6 March 2019 to 6 June 2019. Measures to get an overview of the nursing competence were ratio of registered nurses (RNs) in staff, count of shifts with only one RN on duty and count of RNs with master’s degrees/specialisation. Descriptive comparative statistics were used. Results Of all 226 first-line leaders invited to participate, 207 (91.6%) responded to the questionnaire. Overall a considerable variance across the sample was revealed. The median ratio of RNs in staff was 56 (IQR = 40–70), the count of shifts with only one RN on duty median 28 (IQR = 5–49), and the count of RNs with a master’s degree or specialisation median 3 (IQR = 0–5). The regions of Northern and Central Norway, MipACs located in nursing home and MipACs organised at long-term care units, showed significantly lower nursing competence in staff compared to the remaining institution and organisations. Conclusion This study generates knowledge that can inform planning, priorities and interventions that may be initiated at all organisational and political levels concerning the MipAC services. An overall conclusion is that advanced nursing competence is lacking. The study also highlights the most urgent direction for improvements regarding nursing competence in the services. It seemed to be MipACs in Northern and Central Norway, and those located at nursing homes organised together with long-term care units, that needed improvements the most