Michelle Lalonde

Decision making for nurse staffing: Canadian perspectives.

The effectiveness of methods for determining nurse staffing is unknown. Despite a great deal of interest in Canada, efforts conducted to date indicate that there is a lack of consensus on nurse staffing decision-making processes. This study explored nurse staffing decision-making processes, supports in place for nurses, nursing workload being experienced, and perceptions of nursing care and outcomes in Canada. Substantial information was provided from participants about the nurse staffing decision-making methods currently employed in Canada including frameworks for nurse staffing, nurse-to-patient ratios, workload measurement systems, and “gut” instinct. A number of key themes emerged from the study that can form the basis for policy and practice changes related to determining appropriate workload for nursing in Canada. These include the use of (a) staffing principles and frameworks, (b) nursing workload measurement systems, (c) nurse-to-patient ratios, and (d) the need for uptake of evidence related to nurse staffing.

Strategies for retaining midcareer nurses.

One method of reducing predicted shortages because of the aging nursing workforce is to increase retention. Few studies have examined the unique needs of midcareer nurses. A mixed-method approach including surveys and focus groups was used to identify key retention strategies and desires for midcareer nurses. Salary, benefits, positive working relationships, flexible scheduling, and the opportunity for continued education were identified as key retention strategies from this study. Registered nurses in this study reported higher perceptions of their work and work environment than licensed practical nurses did. Differences in work outcomes were evident across sectors, with community nurses reporting higher levels of job satisfaction and perceptions of work quality than nurses in acute and long-term care. Findings suggest that recruitment opportunities may exist with midcareer nurses seeking employment to return to work after time off to have a family. Proactive retention policies that focus on the needs of midcareer nurses would demonstrate a commitment and interest in keeping them in their work positions and in the profession.

People are failing! Something needs to be done: Canadian students' experience with the NCLEX-RN

BACKGROUND Canadas nurse regulators adopted the NCLEX as the entry-to-practice licensing exam for Canadas registered nurses effective January 2015. It is important to determine whether any issues from this change emerged for nursing students in preparing for and taking this new exam. OBJECTIVES To explore the experiences of Canadian graduate student nurses who were the first to write the NCLEX examination for entry to practice in Canada, determine whether any issues with implementation were identified and how these could be addressed. DESIGN A qualitative study. METHODS Thematic analysis of semi-structured interview data obtained through interviews with 202 graduate Canadian nursing students was the methodology employed in this study. RESULTS The predominant theme that emerged from the interview data was policy related issues that students identified with preparing for and taking the NCLEX. Sub-themes included: a) temporary test centre concerns, b) perceptions of American context and content on the exam, c) lack of French language resources and translation issues, d) the limited number of opportunities to write the exam, e) communication and engagement with regulators, f) financial costs incurred and g) reputational costs for the Canadian nursing profession. CONCLUSIONS The experiences of study participants with NCLEX implementation in Canada were less than positive. This is of critical importance given the pass rates for first-time NCLEX writers in Canada were reported as 69.7%, substantially lower than pass rates on the previous Canadian entry-to-practice exam.

Changing nurse licensing examinations: media analysis and implications of the Canadian experience

AIM This study examines perceptions of the implementation of National Council Licensing Examination in Canada through a content analysis of articles in the media. BACKGROUND Public opinions of nursing in the media have been acknowledged as important for the profession, specifically in relation to their portrayal of nursing. INTRODUCTION The Canadian Council of Registered Nurse Regulators began using the US-based National Council Licensing Examination as entry examination (also known widely as NCLEX) for Canadas registered nurses, discontinuing the previous Canadian Registered Nurse Examination in 2015. METHODS A qualitative content analysis was conducted of media reports that emerged following adoption of the National Council Licensing Examination in Canada, and highlight the image of nursing portrayed in the media during this key regulatory policy change. RESULTS Release of the examination results for the first three quarters of 2015 identified a much lower overall Canadian pass rate than with the previous exam. Media reports highlight differences in perception of the examination between Canadian regulators and other stakeholders in the context of the examination experiences reported and test results. Issues around applicability of the examination to Canadian nursing practice, curriculum alignment, language translation concerns and stakeholder engagement were identified. DISCUSSION The implementation of the National Council Licensing Examination in Canada highlighted lack of communication among nursing stakeholders in the country. CONCLUSIONS Most of the media reporting has been negative and poses a reputational risk to the Canadian nursing profession. IMPLICATIONS FOR NURSING POLICY This change in the licensing requirement has significant policy implications for nursing in Canada and globally. Issues such as appropriate examination translation, access to appropriate test preparation materials, assurance that the examination reflects distinctive aspects of a countrys healthcare system and the need for stakeholder engagement were identified.

Author response to Dickison, P. et al. 2018 Letter to the Editor re McGillis Hall, L. et al. 2018. Changing nurse licensing examinations: media analysis and implications of the Canadian experience. International Nursing Review 65, 13-23

The commentary by Dickison et al. (2018) on our study of perceptions of the implementation of the National Council Licensing Exam in Canada through a content analysis of articles in the media points out the diverse views that emerge from different readers of media materials. Dickison et al. (2018) state that the choice of a qualitative content analysis methodology demonstrates a bias by the authors towards selecting textual comments that support a particular point of view. Dickison et al. (2018) also indicate that they completed a review of the articles cited in the original paper and came to a conclusion that contradicted the authors’. The methods section of our article outlines the type of content analysis conducted in this study (i.e. media); its relevance for the topic; content selected for inclusion including timeframe; data collection process; data analysis method and procedures taken to ensure validity and reliability of the research by the authors McGillis Hall et al. (2018). Dickison et al. (2018) identify that their viewpoint emerges from their ‘own experience in which both negative feedback and positive feedback from educators, candidates, regulators and others have been expressed in a number of public forums’, an approach that differs from the content analysis methodology used by the researchers, which analysed publicly accessible media content. Their opinion is further supported through a reference made to a letter from a nursing regulatory leader to the Canadian Association of Schools of Nursing (CASN) that is described as presenting an ‘alternate hypothesis’ for the change in pass rates (A. Coghlan, Letter to CASN, 18 December 2015). This letter did not fall within the parameters of this study, as it was not publicly available, and thus ineligible for inclusion in the content analysis. The authors are aware that individual readers interpret materials differently; however, more recent publications on this topic identify similar challenges to those that emerged in this analysis, specifically from a policy perspective (MacMillan et al. 2017; Salfi & Carbol 2017).

Individual and organizational predictors of allied healthcare providers’ job satisfaction in residential long-term care

BackgroundJob satisfaction is a predictor of intention to stay and turnover among allied healthcare providers. However, there is limited research examining job satisfaction among allied health professionals, specifically in residential long-term care (LTC) settings. The purpose of this study was to identify factors (demographic, individual, and organizational) that predict job satisfaction among allied healthcare providers in residential LTC.MethodsWe conducted a secondary analysis of data from Phase 2 of the Translating Research in Elder Care program. A total of 334 allied healthcare providers from 77 residential LTC in three Western Canadian provinces were included in the analysis. Generalized estimating equation modeling was used to assess demographics, individual, and organizational context predictors of allied healthcare providers’ job satisfaction. We measured job satisfaction using the Michigan Organizational Assessment Questionnaire Job Satisfaction Subscale.ResultsBoth individual and organizational context variables predicted job satisfaction among allied healthcare providers employed in LTC. Demographic variables did not predict job satisfaction. At the individual level, burnout (cynicism) (β = −.113, p = .001) and the competence subscale of psychological empowerment (β = −.224, p = < .001), were predictive of lower job satisfaction levels while higher scores on the meaning (β = .232, p = .001), self-determination (β = .128, p = .005), and impact (β = .10, p = .014) subscales of psychological empowerment predicted higher job satisfaction. Organizational context variables that predicted job satisfaction included: social capital (β = .158, p = .012), organizational slack-time (β = .096, p = .029), and adequate orientation (β = .088, p = .005).ConclusionsThis study suggests that individual allied healthcare provider and organizational context features are both predictive of allied healthcare provider job satisfaction in residential LTC settings. Unlike demographics and structural characteristics of LTC facilities, all variables identified as important to allied healthcare providers’ job satisfaction in this study are potentially modifiable, and therefore amenable to intervention.

Une simulation interprofessionnelle : une exploration des expériences des étudiantes en sciences infirmières

BACKGROUND the literature suggests that simulation is an effective strategy to meet the learning needs of nursing students. Traditionally, simulation learning for nursing students takes place at nursing schools ; at a distance from the clinical setting, patients, and the interprofessional team. AIM the objective of this pilot project is to explore the experiences of Francophone nursing students following their participation in an interprofessional simulation in a hospital setting during their third year clinical placements. METHOD a case study using Yins (2003) approach was used to explore this phenomenon through focus groups and individual interviews. RESULTS thirteen people participated in three simulation sessions that each included two scenarios. Content analysis of the focus groups revealed four themes : 1) the need for a realistic, but safe environment ; 2) simulation helps to build self-confidence ; 3) simulation improves knowledge of the role of the nurse ; and 4) simulation improves knowledge of teamwork. Two themes emerged from individual interviews : 1) the knowledge and skills acquired during the simulation were retained over time ; and 2) perceptions of the effects on the quality and safety of patient care. CONCLUSION the use of simulation could be effective for the development of knowledge of nursing role, teamwork, and self-confidence.

The use of non-slip socks to prevent falls among hospitalized older adults: A literature review

ABSTRACT Falls among hospitalized older adults are a growing concern. Hospitals are using non‐slip socks as an alternative footwear to help prevent falls, however there is limited evidence to support their use. The aim of this article is to review the literature on the effectiveness of non‐slip socks to determine if there is sufficient evidence to support their use in the prevention of falls among hospitalized older adults. A comprehensive literature search was conducted using Medline, CINAHL, Scopus, PubMed and the Cochrane Library. Six studies were included in this review. The results suggested that there is inconclusive evident to support the use of non‐slip socks to prevent falls among hospitalized older adults. Non‐slip socks do not possess the properties of adequate footwear and have the potential to spread infection. The patients personal footwear from home is the safest footwear option while admitted into hospital.