1. Nursing work in acute settings
Nursing work in acute settings: what must endure, what can change
Shelley Jones RN BA MPhil
Independent
New Zealand/Aotearoa
What must endure, what can change?
Image source:

2. What is going on in the hospital ward?

3. Scenario:
Mr Smith

4. Missed nursing care
Any aspect of required patient care that is omitted (either in part or in whole) or delayed.
Missed care has impacts on
the patient’s condition, experience and outcomes
direct and indirect costs to the hospital of complications and adverse events
nurses’ professional self-concept and job satisfaction

5. Missed observation
Knowledge and proximity are needed for ‘improved attention’ to the patient’s condition.
...without observation we shall be useless with all our devotion.
Shekelle 2013 from Aiken et al 2002.

6. The nature of nursing work in acute settings
Several studies
non-value added work (system inefficiency)
complexity compression (system demands)
no ‘flow’ in nursing workflow (continuously shifting attention and focus)
Since we are knowledge workers in a caring profession - what does this mean for mindful assessment and careful clinical reasoning? ... or for meaningful interaction with those in our care?

7. How nurses experience nursing work in acute settings
Many of the nurses I have spoken with feel frustrated that they don't have the time to care for their patients, that the care is performed by nonlicensed personnel as directed by them. 
The majority of the nurses on the floor feel they have far too many patients they are responsible for to be "on top" of everything and state they rely heavily on their assistive team members.
How nurses experience nursing work in acute settings
They feel they are constantly responding to information given them and having to "back track" to assess that information if it falls out of the norm for that patient. 
RN/Medscape

8. What does this mean for the patient?
keepcalm-o-matic.co.uk 2012
From Fiona Rowan
Medscape comment
Rowan 2016

9. Scenario:
Mr Jones
Mr Smith

10. The Triple Aim
...is not enough...it cannot be achieved without an empowered and resilient health workforce.
The Quadruple Aim
 Improving the work life of health care workers.

11. Nursing work in acute settings
Nursing work in acute settings: what must endure, what can change
What must endure, what can change?
Image source:

12. Acknowledgments
Andrea McCance (DONM) Nursing and Midwifery Leadership team
My colleagues and peer reviewers: Faith Roberts and Deb Nind
Main idea
Discussion
References