Gender differences in the roles and functions of inpatient psychiatric nurses

This study explored the difference between male and female psychiatric nurses' job performance and job satisfaction levels on an acute care inpatient unit. The amount of time male (n = 28) and female (n = 45) nurses spent on 10 specific functions and roles during a shift were observed and recorded. The nurses also self-rated the amount of time they spent on these specific functions and roles. The observed and self-rated functions were then correlated with job satisfaction. Female nurses were observed and self-rated as spending significantly more time on patient care activities, and these activities were significantly correlated with higher job satisfaction levels. Male nurses who self-rated spending more time on patient care activities had significantly lower job satisfaction scores. Findings confirm the concepts from social role theory that gender identity and expectations influence job performance in psychiatric nursing. The results offer insight for increasing job satisfaction and recruitment/retention efforts.     

Compensation of Foreign and Domestic Nurses in the US

This study tests the union skill homogeneity hypothesis by examining whether the erosion of foreign-domestic wage differentials reported in past studies varies by union status. We argue that the common practice of unions negotiating standardized wages promotes skill homogeneity that allows high credential-low unmeasured skill foreign nurses the opportunity to receive wages that match high credential domestic nurses without foreign nurses relying heavily on their labor mobility. Findings show returns to domestic experience accrue faster for foreign nurses belonging to a union compared to returns for non-union foreign nurses. In general, findings on pension coverage indicate foreign nurses also benefit from belonging to a union, while findings on employer sponsored health care benefits indicate a lack of any notable differences in the receipt of this compensation by foreign and union status.     

Effects of government policies on the work of home care personnel and their occupational health and safety

The health sector in Québec (Canada) is dealing with profound macro-economic and macro-organizational changes. This article is interested in the impact of these changes on the work of home health aides (HHAs) and home care nurses and their occupational health and safety (OHS). The study was carried out in the home care services (HCS) of four local community service centres (CLSC) with different organizational characteristics. It is based on an analysis by triangulation of 66 individual and group interviews, 22 observed workdays and 35 observed multidisciplinary or professional meetings, as well as on administrative documents. HHAs are experiencing an erosion of their job because the relational and affective aspects of their work are disappearing. This may be due to an increase in their physical workload, leading to an increase in musculoskeletal problems and, to a lesser extent, in psychological health problems. Nurses are seeing an increase in the volume of invisible work that they have to do, which also has the effect of decreasing the relational aspects of their activity. The increasingly numerous psychological health problems are the consequence of this change in their profession. This study also shows that managers' decisions at the local level can reduce or increase the work constraints of HHAs and nurses. Examples of good practices for HHAs are the stabilization of clienteles and the possibility of organizing their itinerary, while for nurses, it is in how clientele follow-up tools are implemented. This article discusses the effects of government policies and decisions on the work and OHS of home care personnel. To address this subject, we use a specific analysis of the workload of home health aides (HHAs) and nurses. We will show the relationships between managers' organizational choices to respond to governmental constraints and the resulting work changes. We will also look at their consequences on occupational health and safety (OHS) and on the work of different personnel.     

Ergonomics in the operating room

Surgical staff is considered to have several ergonomic risk factors, but their physical workload and musculoskeletal health have seldom been evaluated. Clinical examinations of neck and upper extremities were performed in 99 theatre nurses and 93 assisting nurses, all females. Their physical workload was assessed by questionnaire, and by technical measurements of postures, movements and muscular load in subgroups of both categories. The prevalences of diagnoses in neck/shoulders were not remarkably high in the nurses, compared to other occupational groups. In elbows/hands though, the prevalence was rather high among assistant nurses, 13 vs. 5 % in theatre nurses; POR 3.0 (CI 95 % 1.0 - 8.9). Theatre nurses experienced prolonged static postures in the questionnaire, whilst assistant nurses reported high physical load. Accordingly, the technical measurements showed more strenuous working postures in the theatre nurses, but lower wrist angular velocities. The time proportion of muscular rest in m.trapezius was rather high in both groups. Although both groups had some stressful loads they had relatively low prevalence of diagnoses in neck/shoulders. The high proportion of muscular rest may be protective. The elevated risk of elbows/hands diagnoses among assistant nurses may be explained by strenuous work tasks of short duration.     

Face attack and patients’ response strategies in a Kenyan hospital1

Social power can be exercised by face attack where power differentials are sufficiently great and significant retaliation or sanctions are unlikely. Such exercise of social power is common in military contexts. It is not commonly observed in hospital settings yet some nurses in Kenya's public hospitals routinely attack the face of their patients. Using data from interactions observed in a provincial hospital, it is illustrated how nurses initiate conflict and how patients counter the face‐attacking moves. The investigation shows that nurses use a high frequency of utterances that violate the dignity of patients while the latter prefer conflict avoidance strategies. Nurses generally make no attempt to mitigate the impact of most of their face‐threatening utterances while patients demonstrate awareness of the need to preserve mutual face and reclaim dignity. Three strategies used by patients to reclaim dignity – namely silence, retaliatory face damage and face repair – are illustrated. Nguvu za kijamii zinaweza kutekelezwa kwa kushambulia uso mahali kadri za nguvu ni mazito mno na ulipizaji kisasi wala vikwazo haviruhusiwi. Utekelezaji huu wa nguvu hudhihirika sana katika mazingira ya kijeshi. Hauonekani sana katika hospitali. Ingawaje, baadhi ya manesi katika hospitali za umma nchini Kenya mara kwa mara hushambulia uso ya wagonjwa wao. Huku tukitumia data ya miingiliano iliyotazamwa katika hospitali moja ya mkoa, twaonyesha jinsi manesi hubuni migogoro na vile wagonjwa hukabiliana nayo. Uchunguzi huu unaonyesha kuwa manesi hukiuka hadhi ya ubinafsi ya wagonjwa pakubwa ilhali wagonjwa huchagua mikakati ya kuepuana na migogoro. Kwa ujumla, manesi hawaonyeshi nia ya kupunguza athari za shambulio la uso katika matamshi yao ilhali wagonjwa huonyesha ufahamu wa kuhifadhi heshima na kudai tena hadhi. Mikakati mitatu ya wagonjwa ya kudai tena hadhi ikiwemo kimya, ulipizaji kisasi na urekebishaji uso inaelezwa humu.     

Fatigue and sleep quality in nurses

Fatigue is a critical issue for nurses that may lead to medical errors, degradation in performance, decreased mental acuity, and social problems. Poor sleep quality is also a contributing factor in fatigue that nurses experience. Therefore, the purpose of this study was to examine the differences in perceptions of fatigue between night-shift and day-shift nurses, as measured by scores on the Brief Fatigue Inventory (BFI) and to examine differences in sleep quality between the two groups, as measured by responses on the Pittsburgh Sleep Quality Index (PSQI). Univariate analysis of variance showed significant differences between the two groups on the BFI, with the night-shift cohort reporting higher mean scores on the BFI. Significant differences were also found between the two groups on PSQI mean scores, with the night-shift cohort reporting higher mean scores. Findings from this study suggest that night-shift nurses, compared with day-shift nurses, perceived a much higher level of fatigue and had poorer sleep quality. Further research is needed to evaluate interventions that might decrease fatigue in nurses and improve their sleep quality.     

Recruitment & retention. A successful model in forensic psychiatric nursing

1. The recruitment and retention of forensic psychiatric nurses in this highly competitive environment has been identified as a critical issue. 2. In response to the need to expand services, the development, implementation, and evaluation of an innovative model that has demonstrated success in the recruitment and retention of nurses for this highly specialized area of practice are described. 3. The successful recruitment and retention of forensic psychiatric nurses may be facilitated by developing and implementing strategies that integrate the goals and objectives of the organization with the needs of individual nurses.     

Coordinating psychosocial nursing care across treatment settings

A criticism sometimes made of nurse practitioners is that they want to be or think they are doctors. Who has not heard a nurse administrator accused of having lost her nursing identity, or of a faculty person who no longer knows nursing? Before BSN degrees were common, there were stories of 4-year nurses who believed they were above providing direct care and identified only with the administrative roles on the unit. These criticisms have been made by nurses. It is only recently that nurses are recognizing that fragmentation of the profession along these and other lines disempowers us and may result in non-nurses delineating what our practice will be. Perhaps stimulated by the nursing shortage and an increased awareness of our collective power, nurses are more vocal and we are owning our identity as nurses. Psychosocial nurses, perhaps because of conflicts related to professional territory with psychiatry, psychology, and social work, or because of the ramifications of third party payments, are less likely to assume the generic title of "therapist" than in the past. More often, there seems to be a coming together of psychosocial nurses with each other and with the nursing community as a whole. This coming together enhances the potential for nurse-to-nurse communication and sets the stage to allow nursing to become the bridge needed by consumers of mental health services. I am hopeful that psychosocial nursing will meet this challenge.     

Promoting work ability and well-being in hospital nursing: the interplay of age, job control, and successful ageing strategies

Previous research shows that work ability of nurses decreases with age. In our study we therefore addressed the following questions: Do successful ageing strategies at work in terms of selection, optimization, and compensation (SOC) support the work ability of nurses? Does SOC mediate the relationship between job control (i.e., decision opportunities at work) and work ability? Does the mediation differ between age-groups? 438 nurses (Age Range 21-63 years) completed a questionnaire in the course of an employee survey. Results show that SOC is positively related with work ability. The positive effect of job control on work ability is significantly mediated by SOC. There are stronger mediating effects for elder nurses than for younger nurses. Results indicate that the interplay of job control and SOC at work helps to maintain the work ability of nurses in nursing care.     

Psychiatric nursing & medication adherence

A survey was developed to determine whether the rapidly changing context of mental health care has significantly influenced how psychiatric nurses assess and intervene in issues related to medication adherence. A sample of 126 psychiatric nurses working in Veterans Affairs mental health treatment facilities in northern California, Hawaii, and Nevada identified the most effective methods for tracking medication adherence, as well as successful adherence interventions. Despite the challenge imposed by changing work environments, psychiatric nurses use creative and innovative approaches to improve their patients' medication adherence. Interventions for enhancing patient adherence with prescribed regimens are identified. Essential role dimensions related to medication adherence defined by the nurses in this survey included providing medication education, tracking patient adherence, assessing medication effectiveness, providing individualized, tailored adherence interventions, and collaborating with other health care providers in medication planning. Study findings support using nurses to their full potential and highlight nurses' need for more educational opportunities and consultation with experts (e.g., clinical pharmacists).     

WHEN MEN ARE THE MINORITY: The Case of Men in Nursing

Based on in-depth interviews with a nonprobability sample of male nurses, this study argues that while male nurses do experience the interaction dynamics associated with tokenism as outlined by Kanter (1977a, 1977b), their experience is substantially different from that of female tokens because of socio-cultural factors that interact with group proportions in forming patterns of group interaction. Not only do male nurses react differently to the dynamics of visibility, polarization, and assimilation, but gender-related issues of status and stigma are also important to them. Although Kanter's framework is applicable to male nurses, many of the differences they experience compared to female tokens are attributable to socio-cultural definitions of masculinity and femininity as well as gender-based issues of status rather than group proportions alone. Thus, these findings suggest that socio-cultural factors, interacting with group proportions, strongly influence patterns of interaction among nurses.     

Helping the medicine go down. Nurses' and patients' perceptions about medication compliance

The issue of medication compliance is a multidimensional phenomenon that rests not only with the patient, but also with the interactions of caregivers. Study results revealed that nurses and patients generally perceive estimated frequency of medication compliance to be similar, although increased length of time as a psychiatric nurse was associated with nurses perceiving patients as being less compliant. Reasons given by patients and nurses for medication noncompliance differed. Patients' responses were characterized by being more concrete and varied in nature than those of the nurse.     

Some Implications of Training Psychiatric Nurses in Family Therapy

Psychiatric nurses were included in family therapy training, but few of them applied their new skills in their work settings. A seeming paradox was the lack of support given these trainees by the nursing administration. The situation became understandable when analyzed as a "family" problem; the nurses being members of the larger social system comprising the psychiatry department. Strategies were accordingly adopted to modify aspects of the system, and this facilitated more positive contributions by nurses as family therapists.     

Intimacy boundaries: between mental health nurses & psychiatric patients

This was the first research study in Canada to explore intimacy boundary violations and sexual misconduct between nurses (both RNs and registered psychiatric nurses) and patients. Using a researcher-generated survey, a total of 923 mental health nurses commented on their sexual attraction to patients, and dating and sexual intercourse patterns with patients. The findings indicated that very few nurses had dated or engaged in sexual intercourse with discharged patients, and the few nurses who had done so tended to be younger men prepared at the registered psychiatric nursing diploma level. A small number of nurses believed it was permissible to have a sexual relationship with a patient while the patient was hospitalized, but none reported having a current relationship. Given the severity of this intimacy boundary violation, nurses need to be educated regarding the serious and dangerous psychiatric effects that can result for patients from engaging in a sexual relationship with nurses. The Code of Ethics of the Canadian Nurses Association and nurses' obligation to follow it needs to be reinforced. Nurses engaging in intimacy boundary violations are vulnerable to patient-initiated lawsuits.     

Discrepancies in pain presentation caused by adverse psychosocial conditions as compared to pain due to high physical workload?

Disorders in the musculoskeletal system have been associated with a high physical workload as well as psychosocial and individual factors. It is however not obvious which of these factors that is most important to prevent. Musculoskeletal disorders in neck and upper extremity was assessed by interview and clinical examination in 79 teachers and 93 assisting nurses, all females. Psychosocial work environment was assessed by questionnaire. The physical workload was recorded by technical measurements of postures, movements and muscular load, in 9 teachers and 12 nurses. The physical workload was lower among the teachers, but they had a more demanding psychosocial work environment. Among the nurses, but not in the teachers, the neck-shoulder disorders were associated with a high body mass index (BMI). The teachers reported neck-shoulder complaints to a higher extent than the nurses, but had much lower prevalence of diagnoses in the clinical examination (12% vs. 25%; POR 0.3 CI 0.1 - 1.2; adjusted for age and BMI). The results suggest that adverse psychosocial conditions among the teachers give rise to a different kind of pain in the neck-shoulder region than from physical overload, troublesome but not as severe as the one afflicting the nurses.     

The international migration of nurses in long-term care

This article describes five major factors that are affecting patterns of international migration among nurses who work in long-term care settings: DEMOGRAPHIC DRIVERS: The aging of the populations in developed countries and the low to negative growth in the working-age population will increase the demand for international workers to provide long-term care services. GENDER AND RACE: A dual labor market of long-term care workers, increasingly made up of women of color, is becoming internationalized by the employment of migrating nurses from developing countries. CREDENTIALING: The process of credentialing skilled workers creates barriers to entry for migrating nurses and leads to "decredentialing" where registered nurses work as licensed practical nurses or aides. COLONIAL HISTORY AND GEOGRAPHY: The colonial histories of many European countries and the United States have increased migration from former colonies in developing countries to former colonial powers. WORKER RECRUITMENT: Efforts to limit the recruitment of health care workers from some developing countries have had little effect on migration, in part because much of the recruitment comes through informal channels of family and friends.     

The balance of care: Trends in the wages and employment of immigrant nurses in the US between 1990 and 2000

Abstract

Recently, the transnational migration of nurses from developing countries to developed countries has received heightened attention from policymakers, health-care practitioners, and the media. In this article, the 1990 and 2000 Census Public Use Micro Survey (PUMS) data files are used to address the issue of nurse migration. I examine changes in the number, location, wages, countries of origin, and other economic and demographic variables for foreign-born nurses and nurses' aides and US born nurses and nurses' aides over the time period 1990 to 2000. I find that foreign-born nurses and nurses' aides increasingly come from developing countries and, specifically, from Africa. This raises important ethical issues, as Africa faces a severe shortage of nurses in the context of the AIDS crisis. Foreign-born nurses are shown to have higher levels of education and higher levels of labor force attachment than US-born nurses.     

Not <Emphasis Type="Italic">Merely</Emphasis> TLC: Nurses’ Caring Revisited

The profession and practice of nursing has been studied from quite diverse scholarly perspectives in the United States and abroad. Feminist critiques focus on the gendering of caring and its knowledge/skill features, while professionalization advocates view emotive caring as secondary to other critical activities necessary for the occupational advancement of nursing. Based on ethnographic observations 30 in-depth, semi-structured interviews with nurses across different units working at a large urban hospital, this paper examines how nurses define caring as knowledge-based, skilled work. Specifically, nurses described four types of skills—observational, analytical, interactional, and comforting—that they deploy in the accomplishment of caring work at the bedside. My findings go beyond previous literature in this area by showing how nurses think of caring work in line with occupational strategies that emphasize their biomedical knowledge and diagnostic skills and uphold an advocacy or intermediary role in health care. I argue that while this ideological work may reassure nurses of their professional identity and critical role in health care, it may also reinforce the dilemma of nurse professionalization by obscuring the organizational nature of caring, as it remains an unsupported dimension of their work.     

Direct and indirect effects of unionization on the wage levels of nurses: A case study of New Jersey hospitals

This study examines the determination of wage rates for nurses in hospital employment. Of particular concern is the effect of the recent increase in unionization by nurses on their wages, both directly and indirectly via threats from competing hospitals’ unionization. To improve on earlier work, the data are disaggregated and gathered from only one state to standardize for the legal, licensing, and reimbursement systems. We also look at the difference between highly skilled professional nurses, RN’s, and more general and less professional nurses, LPN’s. The results show that working conditions and competition in the market influence the wage rate as one would expect. The unionization of nurses, however, affects the wage levels differently for the two groups. We would like to thank Professors Robert Higgs and Alan Childs of Lafayette College, Professor David Fairris of Williams College, Professor James C. Luzier of Muhlenberg College, and an anonymous referee for their helpful comments and suggestions.