Combining clinical practice and academic work in nursing: A qualitative study about perceived importance, facilitators and barriers regarding clinical academic careers for nurses in university hospitals.

To obtain in-depth insight into the perceptions of nurse academics and other stakeholders regarding the importance, facilitators and barriers for nurses combining clinical and academic work in university hospitals. Combining clinical practice and academic work facilitates the use of research findings for high-quality patient care. However, nurse academics move away from the bedside because clinical academic careers for nurses have not yet been established in the Netherlands. This qualitative study was conducted in two Dutch university hospitals and their affiliated medical faculties and universities of applied sciences. Data were collected between May 2015 and August 2016. We used purposive sampling for 24 interviews. We asked 14 participants in two focus groups for their perceptions of importance, facilitators and barriers in nurses' combined clinical and academic work in education and research. We audiotaped, transcribed and thematically analysed the interviews and focus groups. Three themes related to perceived importance, facilitators and barriers: culture, leadership and infrastructure. These themes represent deficiencies in facilitating clinical academic careers for nurses. The current nursing culture emphasises direct patient care, which is perceived as an academic misfit. Leadership is lacking at all levels, resulting in the underuse of nurse academics and the absence of supporting structures for nurses who combine clinical and academic work. The present nursing culture appears to be the root cause of the dearth of academic positions and established clinical academic posts. A culture change would require a show of leadership that would promote and enable combined research, teaching and clinical practice and that would introduce clinical academic career pathways for nurses. Meanwhile, nurse academics should collaborate with established medical academics for whom combined roles are mainstream, and they should take advantage of their established infrastructure for success.

van Oostveen CJ ，Goedhart NS ，Francke AL ，Vermeulen H ... -  《-》

[Mixed Method Research Investigating Evidence-Based Practice Self-efficacy, Course Needs, Barriers, and Facilitators: From the Academic Faculty and Clinical Nurse Preceptors].

Oh EG ，Yang YL ，Yoo JY ，Lim JY ，Sung JH ... -  《-》

Nurse staffing issues are just the tip of the iceberg: a qualitative study about nurses' perceptions of nurse staffing.

To obtain in-depth insight into the perceptions of nurses in the Netherlands regarding current nurse staffing levels and use of nurse-to-patient-ratios (NPR) and patient classification systems (PCS). In response to rising health care demands due to ageing of the patient population and increasing complexity of healthcare, hospital boards have been implementing NPRs and PCSs. However, many nurses at the unit level believe that staffing levels have become critically low, endangering the quality and safety of their patient care. This descriptive phenomenological qualitative study was conducted in a 1000-bed Dutch university hospital among 24 wards of four specialties (surgery, internal medicine, neurology, gynaecology & obstetrics and paediatric care). Data were collected from September until December 2012. To collect data four focus groups (n=44 nurses) were organized. Additionally, a total of 27 interviews (20 head nurses, 4 nurse directors and 3 quality advisors) were conducted using purposive sampling. The focus groups and interviews were audiotaped, transcribed and subjected to thematic analysis. Nurse staffing issues appear to be merely the 'tip of the iceberg'. Below the surface three underlying main themes became clear - nursing behaviour, authority, and autonomy - which are linked by one overall theme: nurses' position. In general, nurses' behaviour, way of thinking, decision-making and communication of thoughts or information differs from other healthcare disciplines, e.g. physicians and quality advisors. This results in a perceived and actual lack of authority and autonomy. This in turn hinders them to plead for adequate nurse staffing in order to achieve the common goal of safe and high-quality patient care. Nurses desired a valid nursing care intensity system as an interdisciplinary and objective communication tool that makes nursing care visible and creates possibilities for better positioning of nurses in hospitals and further professionalization in terms of enhanced authority and autonomy. The perceived subservient position of nurses in the hospital appears to be the root cause of nurse staffing problems. It is yet unknown whether an objective PCS to measure nursing care intensity would help them communicate effectively and credibly, thereby improving their own position.

van Oostveen CJ ，Mathijssen E ，Vermeulen H 《-》

Identifying Barriers and Facilitators to Future Nurse Faculty Careers for DNP Students.

Increasing the pool of doctorally educated nurses pursuing faculty careers is imperative in the development of the nurse faculty workforce. This cross-sectional study aims to identify barriers and facilitators to academic careers for doctor of nursing practice (DNP) students. One thousand five hundred DNP students were randomly selected from nursing schools across the country to participate in our survey, and a 56.9% response rate was achieved. The study found that 32% of respondents planned to pursue faculty careers after graduating. Students with postgraduation plans for academic careers, nonacademic careers, and undecided careers did not show distinct differences in demographic and academic characteristics, except that students who planned to pursue academic careers were more likely to have full-time and part-time faculty status. However, students in the 3 groups perceived facilitators and barriers to academic careers differently. The most influential facilitators were interest in teaching and an appreciation of the impact of nursing research on patient care, and the most considered barriers were poor financial compensation and a negative perception of academia. In terms of academic preparation, a large percentage of DNP students who planned to pursue a faculty career reported that they were not confident in teaching informatics. These findings are also consistent for DNP students who were not a faculty member. The impact of DNP education appeared to have a small, although positive, impact on students' decisions to pursue academic careers.

Fang D ，Bednash GD 《-》

Nurse practitioners' perceptions of their ability to enact leadership in hospital care.

To gain insight into nurse practitioners' (NP) leadership roles in Dutch hospital care, by exploring the perceptions regarding their current leadership role and the differences with their previous role as a registered specialised nurse. To meet today's challenges of the increasing healthcare demands, the employment of NPs is proliferating. NPs have the ideal position to play a pivotal role within healthcare reforms, yet full expansion of their scope of practice and expertise is having limited success. Long-term sustainability of NPs depends on the ability to perform and develop a leading role. This qualitative descriptive study was conducted in fifteen Dutch hospitals. Data were collected from April-July 2018, and purposive sampling was used for eighteen semi-structured interviews. This study is conducted and reported according to the COREQ checklist. Three main themes concerning NPs' current leadership role emerged, and they were all linked to a successful positioning of NPs. All themes seemed to be of influence on NPs' scope of daily practice. Direct patient care was emphasised, and leadership on other levels appeared to be underused. Most NPs desired to reshape their profession. However, unprofitable use of their leadership skills especially on professional and organisational level and lack of supportive factors seemed to hinder them. An adequate use of leadership is crucial for role development and positioning of NPs. Further development of the NP profession can help to better differentiate between the tasks of registered specialised nurses and NPs. Leadership in nursing contributes to the improvement of the quality and efficiency of health care. Further positioning of the NP profession depends on a profitable use of leadership competencies. Besides, NPs should collaborate with healthcare organisations, educational institutions and professional associations to value the NP profession in the current healthcare system.

van Kraaij J ，van Oostveen C ，Vermeulen H ，Heinen M ，Huis A ，Adriaansen M ，Peters J ... -  《-》