SarahEAW

We are having some hand-off issues between pre-op nurses and OR staff who need to know what time antibiotics were hung. In my previous institution we always timed, dated, & intialed any IV bag we hung. It is not required by policy where I work now. What is the standard where you practice?

There are alternatives to meds. To cope w anxiety. Perhaps some positive affirmation recordings, cognitive therapy, etc. Many nurses "shake" and have confidence issues, so don't beat yourself up. In the end if the floor you are on is too chaotic there are many types of nursing. In our dept. If a new nurses isn't working well in our dept. We work w HR to find a better fit for the nurse.

Yes, I think they are just different; and that both have a place in the future. :)

I would agree that nursing has been struggling a bit from an identity standpoint. As I mentioned in my first post, nursing is a young science. I believe a lot of this is about that growth. The early PhD nurses had to get their degrees in other fields like psychology or education. I am thankful to those who have forged these educational pathways & believe the "dust will settle." Nursing needs DNPs & PhDs so that we can have credibility and a seat at the policy table and be stronger as a profession. The ROI for me may be more intrinsic, perhaps a longer and more varied career, and an opportunity to help the younger generation of nurses. So it is not necessarily a financial gain.

I really feel like LPNtoRN is on to something. We are non-smoking, which I love,,, cause I don't like the smell and the breaks .. etc. But, I see a day when your BMI will have to be below a certain level. Honestly, that might be ok if they allotted time during the work day for physical training..

Critical Review of an Instrument* by Sarah E. A. Woolsey, BA, BSN, RN Psychometric instruments help researchers gather information for scientific study. A well-constructed instrument uses items to measure constructs or latent variables in phenomenon that are not otherwise measurable (DeVilles, 2012, pp. 11-12). This paper is a critical review of a psychometric instrument in use in nursing research called the Nurse Stress Index (NSI). The NSI was developed over a three year period by Harris, Hingley, & Cooper (Harris, 1989; Williams & Cooper, 1997). The Construct The ability to measure social and psychological phenomenon is paramount to scientist who want to work in research with intangible constructs (DeVilles, 2012). The NSI construct of interest is occupational nursing stress (Harris, 1989; Williams & Cooper, 1997). Application & Target Population The developers sought to create a diagnostic measure for identifying sources of stress” in nurses with some managerial responsibility at work (Harris, 1989, p. 343). Procedures The NSI was developed in three stages. In Stage 1 exploratory work qualitative, unstructured interviews were conducted. Data was analyzed and 140 original items relating to occupational stress in nursing were pooled. After 140 items were distilled to 71 by a panel of experts, factor analysis was conducted and 8 factors and 52 items emerged (Harris, 1989, pp. 336-337; Williams & Cooper, 1997, p. 246). Stage 2 of the NSI included re-examination of the 52 items identified in the factor analysis and comparing the results to sum pressure scores from the 71 Stage 1 items and a repeat survey (Harris, 1989, p. 342). Repeat factor analysis resulted in 44 items in 6 factors. Stage 3 developed a short form of NSI that was reliable and valid. Expert nurses assisted the developers in reducing the 44 items to 30 items in 6 sub-scales with 5 items in each. Cronbach's alpha was computed and all included items were found to be reliable (Harris, 1989, p. 338). The final short form was not re-tested. Psychometric Properties Reliability Reliability is how well an instrument measures a latent variable or construct without error. Without reliability an instrument cannot be valid. To test reliability researchers use factor analysis, the reliability co-efficient alpha, and other methods to ensure an instrument scale and the items within it measure the construct (DeVilles, 2012; Portney & Watkins, 2009). The construct of occupational stress in nurses was tested for reliability during NSI development primarily through factor analysis and computation of coefficient alpha. Validity Validity is important in instruments to demonstrate that it is measuring what it is supposed to in a reasonably error-free way and that the latent variable is the cause of any variation (DeVilles, 2012; Portney & Watkins, 2009)Validity in the NSI was achieved utilizing through content validity, concurrent validity, and discriminate validity. Content validity is achieved when items adequately sample content domain and meet investigator intent (DeVilles, 2012, p. 59). The NSI developers met content validity by including large numbers of the target population in item development. Experts were also utilized to review items (Note: more discussion is in the longer version of this article). Norms Norms refer to established typical or standard” values for a population (Portney & Watkins, 2009, p. 304). No normative data was reported by Harris (1989). Conclusion The process of developing the NSI demonstrates a systematic and thorough method of psychometric instrument development beginning with qualitative work, item/factor development, and validation of factor constructs through statistical factor analysis. Researchers and consumers of research should not just report reliability & validity for an instrument from other studies. Statistical reliability & validity testing should also be done on the sample population being studied. * A longer version of this article is available from the author at [email protected] References Berman, B. A., Read, L. L., Marcus, A. C., & Gritz, E. R. (1992). Nurses enrolled in a stop smoking program: The role of occupational stress. Journal of Women's Health, 1(1), 41-46. Costa Pereira, M., & de Sousa, S. (2011). Stressors in nurses working in intensive care units. Revista Latino-Americana De Enfermagem (RLAE), 19(4), 1025-1032. doi:S0104-11692011000400023 DeVilles, R. F. (2012). Scale development: Theory and applications (3rd ed.). Los Angeles: Sage. Flanagan, N. A. (2006). Testing the relationship between job stress and satisfaction in correctional nurses. Nursing Research, 55(5), 316-327. Harris, P. E. (1989). The nurse stress index. Work & Stress, 3(4), 335-346. Healy, C. M., & McKay, M. F. (2000). Nursing stress: The effects of coping strategies and job satisfaction in a sample of australian nurses [corrected] [published erratum appears in J ADV NURS 2000 apr; 31(4): 989]. Journal of Advanced Nursing, 31(3), 681-688. McGowan, B. (2001). Self-reported stress and its effects on nurses. Nursing Standard, 15(42), 33-38. Michie, S., Ridout, K., & Johnson, M. (1996). Clinical management. stress in nursing and patients' satisfaction with health care. British Journal of Nursing (BJN), 5(16), 1002-1006. Nunnally, J. C., & Bernstein, I. H. (1994). Psychometric theory (3rd ed.). New York: McGraw-Hill, Inc. Portney, L. G., & Watkins, M. P. (2009). Foundations of cinical research: Applications to practice (3rd ed.). Upper Saddle River, NJ: Pearson Prentice Hall. Segerstrom, S. C. (2010). Resources, stress, and immunity: An ecological perspective on human psychoneuroimmunology. Annals of Behavioral Medicine, 40(1), 114-125. doi:10.1007/s12160-010-9195-3 Selye, H. (1976). The stress of life (revised ed.). New York: McGraw-Hill. Tagliacozzo, R., & Vaughn, S. (1982). Stress and smoking in hospital nurses. American Journal of Public Health, 72(5), 441-448. doi:10.2105/AJPH.72.5.441 Williams, S., & Cooper, C. L. (1997). Nurse stress index. In C. P. Zalaquett, & R. J. Wood (Eds.), Evaluating stress: A book of resources (pp. 245-276). Lanham, Maryland: The Scarecrow Press, Inc.

psychgirlRN, I think you bring up a lot of valid points. I understand your feeling about the "confusing" state of nursing education. I guess when the DNP came along, I thought it would be primarily geared toward clinicians. I see a lot of DNP students doing great research projects, yet we hear all the time that PhD is a purely research degree. I like to think that the PhD will also help to advance the profession as a science and help to bring more nurses to the policy table. I think we have to remind ourselves that nursing is a "young science." I have hopes that the "dust will settle" in the future and the various degrees will find their best place in the big picture. Keep trail blazing!

I think part of the push for the Doctoral level Nursing Degree DNP is to keep pace with other health professionals like Pharmacists, OT, PT, etc. I also believe eventually, if it is already not the plan, that NPs will be be required to have the doctoral level degree. We all have seen the endless debates about levels of entry into nursing, I think it is important for those entering nursing to understand the progressive move of education and plan accordingly. We do work in very complex work settings requiring complex skill sets. My interest in Nurse Managers was partly driven by the complexity of their roles and wide ranging scope of responsibilities.... everything from million dollar budgets to implementation of safe care standards. Advanced degrees are also becoming standard requirements for leadership roles in leading hospitals. So, I see a lot of justification for them.

Thanks for your comments. It sounds like you have a very intriguing area of research interest. I do think one has to consider the financial impact. My children have started on graduate programs, and I just told them "don't do a program unless it offers financial support." I am not sure if I really thought about that part. The PhD certainly has been a longer journey than I expected.

It sounds like they are making a good effort. I have sometime thought that physical training time should be built into the workday for nurses.... in my dream world.. lol

Pharmacy> If you don't use the mail order they will make you pay a higher co-pay. The mail order company wants you to have 90 day Rxs, but they won't let you fill a 90 day Rx at a retail pharmacy. I actually tried the mail order and didn't like the lack of contact with a pharmacist and being sure I could get my refills when needed. The point about the ER is that I know when NOT to go to ER, I have worked ER. The penalty discourages people from seeking care they may need. When you pay like 1000.00 am month for insurance, you shouldn't be penalized with high deductibles/copays for seeking needed care. The ER copay last year was 100.00. This year it is 500.00 that is a big increase. If you read about what is happening since Obama care, working people are not seeking care due to the post Obama care plans being so expensive and having such high deductibles. My son-in-law needs surgery. His deductible is 10,000.00.... It is a bigger mess than it was. Insurance companies are posting record profits. We need to go to a single payer and get employers out of the insurance business.

Be flexible and focus on the patient care & giving excellent care in the specialty that you work in.. are you certified? are you in your professional organization? Being involved there can help you stay abreast of the latest care standards. Learn where & who your resources are & where to find policies for the hospital you are working in. I used to do staffing and you have to be ok with not being "involved" in unit politics etc. I liked that part and also the great pay!

I am interested in how people chose the DNP program instead of PhD. When I went to graduate school the DNP programs were just getting started. They seem to be the more popular program. People describe the PhD as a pure research degree, but I have a lot of DNP colleagues who are doing fabulous research projects that are certainly PhD level.. Please leave positive thoughts. I am not interested in starting a debate about one degree being more or better etc.. type discussion.

I have been on this PhD journey for almost 7 years now. As they told us in orientation, it has had its highs and lows. When I think about how I can keep going, it really amounts to just doing a little and then doing a little more. If you look at the reasons people don't finish a PhD, I would say that I have had most of the feelings that people give for quitting at one time or another... things like: I'm sick of my topic, I'm bored, tired of school, I just don't want to write anything, can't make myself sit and do the work... aka procrastination. But, I trudge along each semester making one small step forward. Everyone has a story and a journey. If you are on the journey too, please let me encourage you to keep going! Cheers, sarah

Admittedly, we all discuss a lot of what is wrong in our work worlds... But what is going right? For me today, it is great staff that I work with. How about you?