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Primary Care. Brain Injury. However, they found reciprocity in their relationships with the older persons. Several of the RNs had previously worked at the county hospital, and had not been prepared for the fact that their new workplace was organized in a completely different way. Working in a new place brought both difficulties and the chance to get inspiration to be creative.
The nurses had also experienced that there were different cultures in different organisations, making it hard to switch organisations. Starting to work in a new organisation is demanding, and if the organisation does not work, the nurse may decide to leave. Our informants expressed both admiration for those who had sustained long careers within elder care, and concerns about having the energy to get to retirement. There were also statements about negative influences from colleagues who did not get on with their work, and thoughts about looking for new jobs.
There's nothing they just said because the chance of getting a job was easy. However, the RNs said that they enjoyed working with older people, and felt that the work suited them. They appreciated their relationships with the older persons, and considered having conversations with them to be fun and rewarding. There was reciprocity in these relationships; the nurses got something back from the older persons. The work was characterized by collaboration, and relationships were created with the older persons, their relatives, and the nurse assistants. However, the nurses were not able to meet all the older persons they were responsible for; the staff members closest to the older persons were the nurse assistants.
Both with your colleagues and the staff, and with the patients and their relatives. The nurses considered the team to be important, but found it was difficult to work as a team when the organization was unstructured and communication was lacking. Those who would lead and distribute work i. The RNs said that there was a lack of clarity in the communication and cooperation between RNs, doctors, and head nurses. The nurses saw the organisation as unstructured compared with their earlier experiences. The nurses noted the importance of the team and the collaboration with the nurse assistants; it was the nurse assistants who were closest to the older persons.
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The care was designed through the team of nurses, nursing staff, and occupational therapists, and it was also the team that could initiate changes. The nurses felt the lack of a manager in the team. They saw a danger that the managers were so far away from the actual caring work that they would not be able to understand it. Otherwise I think they get too distant from the care. Have a team, sort of. Within this collaboration, the RNs and nurse assistants could learn from each other. The nurses could show the nurse assistants how they should behave towards the older persons; and the nurse assistants, who were closest to the older persons and knew them best, could show the nurses how each individual older person preferred to have their care performed.
The nurses felt the lack of a knowledgeable, involved manager who dared to make decisions and was present at the workplace. The interviews included expressions that could clearly be related to the competence of the management and their presence at the workplace. They should be engaged and all that. And I think it is important that if they say they are going to look into something, they do it, and this is where it has been lacking. However, they wanted to have a manager who knew how things worked, and who got involved and got things done. They believed that managers ought to have experience in elder care and should really stand for what they say.
The nurses made several statements about whether the manager should be a RN or not, and questioned whether a manager who was not a RN could understand the meaning of the questions asked by a RN on duty. They described having had a number of managers who did not know anything about health care. Absent management was a concern, as were uncertainties about the schedule and work times. However, it was important, regardless of profession, that the manager was a person who took responsibility and handled the problems occurring in the workplace.
However, they lacked the power the manager had to lead the work, which could be a concern when the manager was absent. They planned, organized, and administrated the care around the older person. It was important to be an authority in the management to the staff at the same time as it was important to act as a coach. The nurses had a great responsibility within the staff group, which included many agency staff. They also noted that the work should be well planned and structured. The nurses missed having a manager in the team, because they found it difficult to organise the work without having access to the powers of a managerial position.
A common thread in both the earlier and later interviews with the RNs was that they appeared to want to provide the best care possible for the older person's needs. In the earlier interviews, the RNs described the older persons as demanding, which gave them less work satisfaction. The RNs felt insufficient, and saw major deficiencies in the care they provided. There were descriptions of deficiencies in the organization, lack of supervision, and a lack of collaboration or teamwork. The RNs mainly saw obstacles, and expressed a lack of solutions and initiative to handle these problems.
The RNs saw the older persons and the nurse assistants as the most important participants in their work. These RNs saw the opportunity and took the responsibility for leading the work in a team.
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In the later interviews in , the RNs seemed to be more focused on the opportunities in their work and the possibilities to create relationships with the older persons and their relatives. They also described that they took a leadership role in the teamwork, and valued the older persons and the nurse assistants as the most important participants in the work. From a societal perspective, a number of changes occurred within Swedish elderly care during the twelve years between the interviews.
A set of national core values for the elderly were introduced in , aimed at ensuring older persons a life of dignity and well-being, and including the ethical values and norms that should direct the care of such persons [ 20 ].
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The way in which we manage this knowledge could be an essential factor in reversing the historical trend of RN work in elderly care being seen as low status, and the increasing nurse turnover. A shift in attitudes must occur, from a focus on problems to a more positive view of the meaning of working as a RN in elderly care. The interviews conducted in were interpreted as lack of a humanistic approach; disregarding behaviour was observable in the RNs descriptions of their work in elderly care, meaning that the older persons did not get the support they needed.
The RNs interviewed in seemed to be more person-oriented rather than task-oriented, which is in line with the recent movement to a more person-centred care [ 24 ]. Nevertheless, the obvious striving of the RNs to create a caring relationship with the older persons and their relatives is likely to be of decisive importance for how the quality of the care will be experienced. Collaboration was described in terms of support for the RNs and the possibility of learning from each other, but was also seen as essential in providing the best possible care to the older person.
It is well known that the extent to which different health care professionals collaborate may affect the quality and safety of care as well as patient outcomes [ 25 - 26 ]. A lack of collaboration between professionals might lead to disrupted care that diverges from the fundamentals of holistic care; this was clear in the interviews conducted in However, responsibility lies not only with the individual RN, but with the team, the organization, the care culture, the education system, and political decisions.
This is necessary not only for creating better prerequisites for being able to care for older persons, but also for encouraging young people to become interested in working in elderly care. The future of elderly care lies in our ability to recruit and retain the next generation of nurses [ 28 ], and in the development of nursing competence [ 29 ]. Price [ 28 ] has emphasized the need for realistic and contemporary portrayals of the nursing profession and the role of RNs.
- Sonnet 118.
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Conducting longitudinal qualitative research raised several methodological difficulties due to changes in the society, the elderly care i. It was impossible to conducting interviews with the same RNs due to a staff turnover over time. If we had conducted several interviews on repeated occasions with the same RN, we may have been able to provide a deeper and probably a more multifaceted picture of the meaning of working as a RN in elderly care. Another limitation might be that the earlier interviews were performed with RNs working in the same nursing home.
It may be reasonable to assume that nurses at the same workplace shared the same care culture and thus had similar reasoning.
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On the other hand, the RNs in the later interviews expressed comparable reasoning even though they worked in different nursing homes. The number of participants could be seen as limited. To ensure the quality in the study, we strove to learn from the RNs and set our own pre-understanding to one side during the interviews and analysis of the data [ 30 ].
The authors for the core include nurses, radiologists, technologists, a physicist and a pharmacist who come from academic and community medical facilities. The Certification Examination for Radiologic Nursing in Imaging, Interventional, and Therapeutic Environments is a written examination composed of a maximum of multiple-choice, objective questions. The example questions in this book were created by individuals with expertise in radiology nursing and were reviewed for construction, accuracy, and appropriateness by other expert Certified Radiology Nurses. None of the questions from the book will appear in the exam and are to be used for purpose of samples of the type of what might be seen on the exam.
The size has been created with the intent of fitting into your lab coat pocket, to be studied as your time allows. Historically our radiology nurse colleagues walked into their respective imaging departments not fully understanding their new role or how to make it reality.