Page 558 - Encyclopedia of Nursing Research

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is “medically fragile.” Ultimate responsibil- cnA work experience and why they chose to
ity and accountability bears on the Rn who work in long-term care (i.e., a nursing home);
needs to be aware of the education, training, (2) changes needed in wages, benefits, and U
and experience of the UAP and periodically career opportunities that would make the
assesses the UAPs performance of the spe- cnA job more attractive and retain current
cific task. A qualitative analyses of narra- workers; and (3) to develop a framework for
tives (based on the Five Rights of Delegation) evidence-based research and practice initia-
about a delegated task that resulted in pos- tives that would address workforce issues.
itive and negative outcomes—revealed that Key subject areas were recruitment, educa-
nurses attributed negative outcomes to UAPs tion (initial and ongoing), job history, family
performing nursing activities that had not life, quality of management and supervision,
been delegated to them (e.g., administering work load and recognition for value of the
a tube feeding) and their failing to receive cnAs work, growth opportunities within
or follow directions or established policy the organization, job satisfaction, workplace
(Standing, Anthony, & Hertz, 2001). A nurse’s attitudes and environment, on-the-job inju-
experience and longevity in practice is more ries, and demographics. Interviewees who
associated with their readiness for, and com- no longer worked at the nH were asked why
fort with, delegation than with their being they left, current work arrangements, and if
educated on how to delegate. A facility’s job they would recommend the nH to a fam-
description for UAPs constitutes “implicit” ily or friend. Data from the nnHS, nnAS,
delegation but is not always recognized as and the minimum data set will be combined
such by nurses. explicit delegation is more to look at associations between facility and
concretized by nurses and constitutes more worker characteristics, perceptions, experi-
than just the patient assignment. ences, and resident care outcomes (Squillace,
A growing number of states permit spe- Remsburg, Bercovitz, Rosenoff, & Branden,
cially trained UAPs to administer some types 2007). Analysis of nnAS, nnHS, and Area
of medications (generally, oral medications), Resource File data revealed that economic fac-
in which case the UAP is certified as a “med tors (i.e., wages and benefits) for low-income
tech” or “med aide.” There is no difference nH workers was significantly associated
in the medication error rate between assisted with turnover as are job security and other
living community (ALc) med techs/aides opportunities for employment in the geo-
and licensed nurses with regard to errors graphic area (Weiner, Squillace, Anderson, &
with potential moderate-to-significant harm Khatusky, 2009).
(center for excellence in Assisted Living/ Studies indicate that UAPs working
University of north carolina, 2009). Most in long-term care (i.e., nH, ALc, and home
errors were errors of time, that is, outside the care) want, above all, respect and recogni-
2-hour administration window. Medication tion from their supervisors/superiors for the
errors of any kind were associated with poor work they do (Barry, Brannon, & Mor, 2005;
scores on a written test of medication admin- Kemper et al., 2008; Pennington, Scott, &
istration and knowledge. Magilvy, 2003). Regardless of setting, UAPs
The national nursing Assistant Survey want a leadership style that is trusting and
(nnAS) was first conducted in 2004 as a supports teamwork (Pennington et al., 2003),
supplement to the national nursing Home management practices that support empow-
Survey (nnHS). Designed as a probabil- erment and input into care decisions to effec-
ity study, nnAS data were collected via tuate quality outcomes (Barry et al., 2005;
computer-assisted telephone interview from Pennington et al., 2003), and better commu-
slightly over 3,000 cnAs. The three main nication (Kemper et al., 2008). empowerment
purposes of the nnAS were (1) to describe variables include nurse aides working on