In Australia, like other countries, two levels of nurse are registered for entry to practice. Edu... more In Australia, like other countries, two levels of nurse are registered for entry to practice. Educational changes for second level nurses in Australia have led to questions regarding roles and career options. This paper reports on interviews with nursing course coordinators to examine educator expectations of roles and career pathways of registered and enrolled nurses. Coordinators of eight degree (registered) and diploma (enrolled) nursing programs were interviewed to determine their opinions on roles and careers that students were prepared for. Transcripts were thematically analysed. Educators reported similar graduate roles, although high acuity care was primarily the role of registered nurses. Career expectations differed with enrolled nurses having limited advancement opportunity, and registered nurses greater career options. Health organisations were unprepared to accommodate increased practice scope of enrolled nurses and limited work practice through policies stipulating who...
The diversity of first year students is increasing with new schemes promoting access to higher ed... more The diversity of first year students is increasing with new schemes promoting access to higher education courses. It is important to assess the learning styles of students in order to cater for their differing learning needs. The aim of this study was to profile first year nursing/midwifery students at two campuses of Australian Catholic University, to investigate their learning preferences and the effect demographic background has on these preferences. We designed a survey to collect demographic data and incorporated the VARK (visual, aural, read-write and kinaesthetic) questionnaire to investigate the students' preferred learning modes. The kinaesthetic score of our students was the highest (7.34 ± 2.67), significantly differing from the other three modes (p b 0.001). Demographic factors such as gender and age group did not influence mean scores of each sensory modality. The predominant preference was quadmodal utilising all four learning styles. The distribution of students preferring to learn by unimodal, bimodal, trimodal and quadmodal styles varied between demographic groupings. The rural students had significantly higher visual and kinaesthetic scores compared to their metropolitan counterparts. Students attending the rural campus had higher visual and read-write scores. Visual and aural scores were significantly lower for students from non-English speaking backgrounds. These findings have significant teaching and research implications.
Objective: The increase in level of academic qualifications for enrolled nurses in Australia has ... more Objective: The increase in level of academic qualifications for enrolled nurses in Australia has resulted in them graduating with an increased knowledge and skill base to previous enrolled nursing graduates. This has resulted in a higher level of practice role overlap between degree prepared registered nurses and diploma prepared enrolled nurses in Australia. This paper reports on a study undertaken to ascertain the role expectations of registered and enrolled nursing students in the final year of their education prior to registration. Main points: Students were also asked to indicate how well prepared they felt for the roles they expected to perform. The study used a self-reporting survey to explore the role expectations of graduate nurses from the different nursing educational institutions in Victoria, Australia. Comparison of role expectations will be explained across a range of variables including patient care, administration, teamwork, supervision/leadership, education and rese...
Similar to the U.S.A., New Zealand and Singapore, Australia registers two levels of nurse, the de... more Similar to the U.S.A., New Zealand and Singapore, Australia registers two levels of nurse, the degree or postgraduate entry prepared registered nurse and diploma or certificate-prepared enrolled nurse. Over the past decade, significant changes have occurred in educational preparation of enrolled nurses. This has resulted in enrolled nurses undertaking many roles and responsibilities previously undertaken only by registered nurses. An exploratory qualitative research study using interviews with educators of both registered and enrolled nurses was undertaken to investigate differences in educational preparation of registered and enrolled nurses in Australia. This paper describes perceptions around how participants viewed educational approaches and different cohorts, types and levels of students. Similarities included topics covered and the majority skills taught, although high acuity skills remain a difference between the levels of nurse. Differences were also found in type of student...
The diversity of first year students is increasing with new schemes promoting access to higher ed... more The diversity of first year students is increasing with new schemes promoting access to higher education courses. It is important to assess the learning styles of students in order to cater for their differing learning needs. The aim of this study was to profile first year nursing/midwifery students at two campuses of Australian Catholic University, to investigate their learning preferences and the effect demographic background has on these preferences. We designed a survey to collect demographic data and incorporated the VARK (visual, aural, read-write and kinaesthetic) questionnaire to investigate the students' preferred learning modes. The kinaesthetic score of our students was the highest (7.34 ± 2.67), significantly differing from the other three modes (p b 0.001). Demographic factors such as gender and age group did not influence mean scores of each sensory modality. The predominant preference was quadmodal utilising all four learning styles. The distribution of students preferring to learn by unimodal, bimodal, trimodal and quadmodal styles varied between demographic groupings. The rural students had significantly higher visual and kinaesthetic scores compared to their metropolitan counterparts. Students attending the rural campus had higher visual and read-write scores. Visual and aural scores were significantly lower for students from non-English speaking backgrounds. These findings have significant teaching and research implications.
Autophagy has emerged as an important process in the pathogenesis of cardiovascular diseases, but... more Autophagy has emerged as an important process in the pathogenesis of cardiovascular diseases, but the proximal triggers for autophagy are unknown. Angiotensin II plays a central role in the pathogenesis of cardiac hypertrophy and heart failure. In this study, we used angiotensin II type 1 (AT 1 ) and type 2 (AT 2 ) receptor-expressing adenoviruses in cultured neonatal cardiomyocytes to provide the first demonstration that neonatal cardiomyocyte autophagic activity is differentially modulated by AT 1 and AT 2 receptor subtypes. Angiotensin II stimulation (48 hours) of neonatal cardiomyocytes expressing the AT 1 receptor alone (Ad-AT 1 ; 10 multiplicities of infection) induced a significant increase in the number of HcRed-LC3 autophagosomes per cell (17.3Ϯ1.6 versus 33.3Ϯ4.1 autophagosomes per cell; PϽ0.05). Coexpression of a high ratio of AT 2 :AT 1 (Ad-AT 2 :Ad-AT 1 multiplicity of infection ratio: 20:5) receptors completely abrogated the AT 1 -mediated increase in autophagy (9.3Ϯ1.4 versus 33.3Ϯ4.1 autophagosomes per cell; PϽ0.05). Treatment with the AT 2 receptor antagonist PD123319 did not reverse the AT 2 -mediated antiautophagic effect. AT 1 -and AT 2 -mediated autophagic responses were also assessed in cardiomyocytes from a genetic model that exhibits neonatal myocardial growth suppression. In these neonate myocyte cultures, AT 1 receptor activation induced a marked increase in the number of myocytes containing cytoplasmic vacuoles compared with the control (22.7Ϯ4.1% versus 1.1Ϯ0.6%; PϽ0.001) and was characterized by a nonapoptotic autophagic phenotype. The incidence of cardiomyocyte autophagic vacuolization in this myocyte population decreased dramatically to only 0.4Ϯ0.2% in myocytes infected with a high ratio of Ad-AT 2 :Ad-AT 1 . This study provides the first description of reciprocal regulation of cardiomyocyte autophagic induction by the AT 1 and AT 2 receptor subtypes. (Hypertension. 2009;53:1032-1040.) Key Words: angiotensin II Ⅲ angiotensin II type 1 receptor Ⅲ angiotensin II type 2 receptor Ⅲ autophagy Ⅲ hypertrophic heart rat Ⅲ hypertrophy Ⅲ neonate
Angiotensin II (Ang II) has important actions on the heart via type 1 (AT 1 ) and type 2 (AT 2 ) ... more Angiotensin II (Ang II) has important actions on the heart via type 1 (AT 1 ) and type 2 (AT 2 ) receptors. The link between AT 1 receptor activation and the hypertrophy of cardiomyocytes is accepted, whereas the contribution of the AT 2 receptor, which reportedly antagonizes the AT 1 receptor, is contentious. This ambiguity is primarily based on in vivo approaches, in which the direct effect of the AT 2 receptor and its modulation of the AT 1 receptor (at the level of the cardiomyocyte) are difficult to establish. In this study, we used adenoviruses encoding AT 1 and AT 2 to coexpress these receptors in isolated cardiomyocytes, allowing a direct examination of the consequence of varying AT 1 /AT 2 stoichiometry on cardiomyocyte hypertrophy. In myocytes expressing only the AT 1 receptor, Ang II stimulation promoted robust hypertrophy (increased protein:DNA ratio and phenotypic changes) via activation of mitogen-activated protein kinases (MAPKs). Titration of the AT 2 receptor against the AT 1 receptor did not inhibit Ang II-mediated cardiomyocyte hypertrophy. Instead, basal and Ang II-mediated hypertrophy was increased in line with the amplified expression of the AT 2 receptor, indicating a capacity for the AT 2 receptor to enhance basal cardiomyocyte growth. Indeed, expression of the AT 2 receptor alone resulted in hypertrophy; remarkably, this was unaffected by Ang II stimulation or the AT 2 receptor-specific ligands PD123319 and CGP42112. Although previous studies have indicated that the AT 2 receptor can antagonize MAPK activation via the AT 1 receptor, we found no evidence for this in cardiomyocytes. Thus, the AT 2 receptor promotes ligand-independent, constitutive cardiomyocyte hypertrophy and does not directly antagonize the AT 1 receptor in this setting. (Hypertension. 2005;46:1347-1354.)
Diabetes in human subjects is often associated with hypertension. The aim of this study was to ex... more Diabetes in human subjects is often associated with hypertension. The aim of this study was to examine the development of cardiac fibrosis following induction of type 1 diabetes in genetically hypertensive rats. Diabetes was induced by streptozotocin (STZ) injection in 8-week-old normotensive Wistar-Kyoto (WKY) rats and spontaneously hypertensive rats (SHRs) for a duration of 16 or 24 weeks. Aged-matched, nondiabetic WKY and SHRs were used as controls. At termination of treatment, the rats were anaesthetized, hearts arrested in diastole and perfusion fixed. A comprehensive examination of cardiac fibrosis throughout the right and left ventricles was undertaken in picrosirius red-stained sections, using image analysis and by undertaking collagen type I and type III immunohistochemistry. Induction of diabetes in the SHRs led to a marked increase in the levels of interstitial fibrosis in the left ventricle plus septum (LV+S) at both 16 and 24 weeks duration (59% and 43% increase, respectively) and also in the right ventricle after 24 weeks duration of diabetes (35% increase compared to the nondiabetic SHR). Exacerbated perivascular fibrosis was also observed in the LV+S in the diabetic-hypertensive rats at the later time point. These effects of induction of diabetes were not observed in the normotensive strain. Our findings clearly demonstrate elevations in cardiac fibrosis when type 1 diabetes is combined with hypertension. Our findings thus stress the importance of closely monitoring both blood pressure and glucose levels in type 1 diabetic patients in order to prevent myocardial collagen deposition.
The aim of this study was to determine senior medical student (year 3-5) opinions of their early-... more The aim of this study was to determine senior medical student (year 3-5) opinions of their early-year (year 1-2) rural placement. We assessed the impact of MBBS early-year rural placements through a follow up of this cohort in their later years using a cross-sectional questionnaire. The questionnaire was administered to year 3-5 medical students at their clinical school. There were 97 participants (49% response rate) in the study. Twenty-nine per cent were male and 71% were female; 44% were from a rural background and 56% were from a metropolitan background; 48% were year 3 students, 32% were year 4 students and 20% were year 5 students; and 59% of the students were, at the time, situated at a rural clinical school and 41% were at a metropolitan clinical school. Closed-ended questions were quantified and statistically analysed. Open-ended responses were thematically analysed to determine what their experience of early-year rural placements were like. Seventy-nine per cent of students considered the year 1 placement length as 'about right'. Overall, most students found year 1 rural placements positive and grasped the placement aims and objectives. Most students were also pleased with year 2 rural placements, mainly due to the clinical aspects. Medical students appear to prefer shorter early-year rural placements and understand the benefits and importance of such placements. They also have a desire for greater clinical exposure during these early-year placements.
AimTo investigate the current literature to gain an understanding of skill mix, why it is being m... more AimTo investigate the current literature to gain an understanding of skill mix, why it is being manipulated and how it affects patient care and health-care costs.To investigate the current literature to gain an understanding of skill mix, why it is being manipulated and how it affects patient care and health-care costs.BackgroundDue to workforce shortages, economic constraints and increasing patient acuity, employers are looking at methods of providing patient care whilst maintaining costs. Registered nurses make up a large percentage of the health-care budget. The manipulation of skill mix (i.e. the percentage of registered nurses available for patient care) is seen as one method of managing the increasing cost whilst still ensuring patient care.Due to workforce shortages, economic constraints and increasing patient acuity, employers are looking at methods of providing patient care whilst maintaining costs. Registered nurses make up a large percentage of the health-care budget. The manipulation of skill mix (i.e. the percentage of registered nurses available for patient care) is seen as one method of managing the increasing cost whilst still ensuring patient care.EvaluationResearch literature was used to determine the current use of skill mix and its impact on patient care and health-care costs.Research literature was used to determine the current use of skill mix and its impact on patient care and health-care costs.Key issueThe use of a higher proportion of registered nurses is associated with better health outcomes, shorter length of stay and reduced patient morbidity.The use of a higher proportion of registered nurses is associated with better health outcomes, shorter length of stay and reduced patient morbidity.ConclusionEconomic savings from substituting registered nurses with other health professionals may be offset by increased patient length of stay in hospital and increased patient mortality.Economic savings from substituting registered nurses with other health professionals may be offset by increased patient length of stay in hospital and increased patient mortality.Implications for nursing managementWhen evaluating nursing skill mix, a higher percentage of registered nurses may result in health-care facility cost savings by providing a shorter length of stay and decreased patient complications.When evaluating nursing skill mix, a higher percentage of registered nurses may result in health-care facility cost savings by providing a shorter length of stay and decreased patient complications.
In Australia, like other countries, two levels of nurse are registered for entry to practice. Edu... more In Australia, like other countries, two levels of nurse are registered for entry to practice. Educational changes for second level nurses in Australia have led to questions regarding roles and career options. This paper reports on interviews with nursing course coordinators to examine educator expectations of roles and career pathways of registered and enrolled nurses. Coordinators of eight degree (registered) and diploma (enrolled) nursing programs were interviewed to determine their opinions on roles and careers that students were prepared for. Transcripts were thematically analysed. Educators reported similar graduate roles, although high acuity care was primarily the role of registered nurses. Career expectations differed with enrolled nurses having limited advancement opportunity, and registered nurses greater career options. Health organisations were unprepared to accommodate increased practice scope of enrolled nurses and limited work practice through policies stipulating who...
The diversity of first year students is increasing with new schemes promoting access to higher ed... more The diversity of first year students is increasing with new schemes promoting access to higher education courses. It is important to assess the learning styles of students in order to cater for their differing learning needs. The aim of this study was to profile first year nursing/midwifery students at two campuses of Australian Catholic University, to investigate their learning preferences and the effect demographic background has on these preferences. We designed a survey to collect demographic data and incorporated the VARK (visual, aural, read-write and kinaesthetic) questionnaire to investigate the students' preferred learning modes. The kinaesthetic score of our students was the highest (7.34 ± 2.67), significantly differing from the other three modes (p b 0.001). Demographic factors such as gender and age group did not influence mean scores of each sensory modality. The predominant preference was quadmodal utilising all four learning styles. The distribution of students preferring to learn by unimodal, bimodal, trimodal and quadmodal styles varied between demographic groupings. The rural students had significantly higher visual and kinaesthetic scores compared to their metropolitan counterparts. Students attending the rural campus had higher visual and read-write scores. Visual and aural scores were significantly lower for students from non-English speaking backgrounds. These findings have significant teaching and research implications.
Objective: The increase in level of academic qualifications for enrolled nurses in Australia has ... more Objective: The increase in level of academic qualifications for enrolled nurses in Australia has resulted in them graduating with an increased knowledge and skill base to previous enrolled nursing graduates. This has resulted in a higher level of practice role overlap between degree prepared registered nurses and diploma prepared enrolled nurses in Australia. This paper reports on a study undertaken to ascertain the role expectations of registered and enrolled nursing students in the final year of their education prior to registration. Main points: Students were also asked to indicate how well prepared they felt for the roles they expected to perform. The study used a self-reporting survey to explore the role expectations of graduate nurses from the different nursing educational institutions in Victoria, Australia. Comparison of role expectations will be explained across a range of variables including patient care, administration, teamwork, supervision/leadership, education and rese...
Similar to the U.S.A., New Zealand and Singapore, Australia registers two levels of nurse, the de... more Similar to the U.S.A., New Zealand and Singapore, Australia registers two levels of nurse, the degree or postgraduate entry prepared registered nurse and diploma or certificate-prepared enrolled nurse. Over the past decade, significant changes have occurred in educational preparation of enrolled nurses. This has resulted in enrolled nurses undertaking many roles and responsibilities previously undertaken only by registered nurses. An exploratory qualitative research study using interviews with educators of both registered and enrolled nurses was undertaken to investigate differences in educational preparation of registered and enrolled nurses in Australia. This paper describes perceptions around how participants viewed educational approaches and different cohorts, types and levels of students. Similarities included topics covered and the majority skills taught, although high acuity skills remain a difference between the levels of nurse. Differences were also found in type of student...
The diversity of first year students is increasing with new schemes promoting access to higher ed... more The diversity of first year students is increasing with new schemes promoting access to higher education courses. It is important to assess the learning styles of students in order to cater for their differing learning needs. The aim of this study was to profile first year nursing/midwifery students at two campuses of Australian Catholic University, to investigate their learning preferences and the effect demographic background has on these preferences. We designed a survey to collect demographic data and incorporated the VARK (visual, aural, read-write and kinaesthetic) questionnaire to investigate the students' preferred learning modes. The kinaesthetic score of our students was the highest (7.34 ± 2.67), significantly differing from the other three modes (p b 0.001). Demographic factors such as gender and age group did not influence mean scores of each sensory modality. The predominant preference was quadmodal utilising all four learning styles. The distribution of students preferring to learn by unimodal, bimodal, trimodal and quadmodal styles varied between demographic groupings. The rural students had significantly higher visual and kinaesthetic scores compared to their metropolitan counterparts. Students attending the rural campus had higher visual and read-write scores. Visual and aural scores were significantly lower for students from non-English speaking backgrounds. These findings have significant teaching and research implications.
Autophagy has emerged as an important process in the pathogenesis of cardiovascular diseases, but... more Autophagy has emerged as an important process in the pathogenesis of cardiovascular diseases, but the proximal triggers for autophagy are unknown. Angiotensin II plays a central role in the pathogenesis of cardiac hypertrophy and heart failure. In this study, we used angiotensin II type 1 (AT 1 ) and type 2 (AT 2 ) receptor-expressing adenoviruses in cultured neonatal cardiomyocytes to provide the first demonstration that neonatal cardiomyocyte autophagic activity is differentially modulated by AT 1 and AT 2 receptor subtypes. Angiotensin II stimulation (48 hours) of neonatal cardiomyocytes expressing the AT 1 receptor alone (Ad-AT 1 ; 10 multiplicities of infection) induced a significant increase in the number of HcRed-LC3 autophagosomes per cell (17.3Ϯ1.6 versus 33.3Ϯ4.1 autophagosomes per cell; PϽ0.05). Coexpression of a high ratio of AT 2 :AT 1 (Ad-AT 2 :Ad-AT 1 multiplicity of infection ratio: 20:5) receptors completely abrogated the AT 1 -mediated increase in autophagy (9.3Ϯ1.4 versus 33.3Ϯ4.1 autophagosomes per cell; PϽ0.05). Treatment with the AT 2 receptor antagonist PD123319 did not reverse the AT 2 -mediated antiautophagic effect. AT 1 -and AT 2 -mediated autophagic responses were also assessed in cardiomyocytes from a genetic model that exhibits neonatal myocardial growth suppression. In these neonate myocyte cultures, AT 1 receptor activation induced a marked increase in the number of myocytes containing cytoplasmic vacuoles compared with the control (22.7Ϯ4.1% versus 1.1Ϯ0.6%; PϽ0.001) and was characterized by a nonapoptotic autophagic phenotype. The incidence of cardiomyocyte autophagic vacuolization in this myocyte population decreased dramatically to only 0.4Ϯ0.2% in myocytes infected with a high ratio of Ad-AT 2 :Ad-AT 1 . This study provides the first description of reciprocal regulation of cardiomyocyte autophagic induction by the AT 1 and AT 2 receptor subtypes. (Hypertension. 2009;53:1032-1040.) Key Words: angiotensin II Ⅲ angiotensin II type 1 receptor Ⅲ angiotensin II type 2 receptor Ⅲ autophagy Ⅲ hypertrophic heart rat Ⅲ hypertrophy Ⅲ neonate
Angiotensin II (Ang II) has important actions on the heart via type 1 (AT 1 ) and type 2 (AT 2 ) ... more Angiotensin II (Ang II) has important actions on the heart via type 1 (AT 1 ) and type 2 (AT 2 ) receptors. The link between AT 1 receptor activation and the hypertrophy of cardiomyocytes is accepted, whereas the contribution of the AT 2 receptor, which reportedly antagonizes the AT 1 receptor, is contentious. This ambiguity is primarily based on in vivo approaches, in which the direct effect of the AT 2 receptor and its modulation of the AT 1 receptor (at the level of the cardiomyocyte) are difficult to establish. In this study, we used adenoviruses encoding AT 1 and AT 2 to coexpress these receptors in isolated cardiomyocytes, allowing a direct examination of the consequence of varying AT 1 /AT 2 stoichiometry on cardiomyocyte hypertrophy. In myocytes expressing only the AT 1 receptor, Ang II stimulation promoted robust hypertrophy (increased protein:DNA ratio and phenotypic changes) via activation of mitogen-activated protein kinases (MAPKs). Titration of the AT 2 receptor against the AT 1 receptor did not inhibit Ang II-mediated cardiomyocyte hypertrophy. Instead, basal and Ang II-mediated hypertrophy was increased in line with the amplified expression of the AT 2 receptor, indicating a capacity for the AT 2 receptor to enhance basal cardiomyocyte growth. Indeed, expression of the AT 2 receptor alone resulted in hypertrophy; remarkably, this was unaffected by Ang II stimulation or the AT 2 receptor-specific ligands PD123319 and CGP42112. Although previous studies have indicated that the AT 2 receptor can antagonize MAPK activation via the AT 1 receptor, we found no evidence for this in cardiomyocytes. Thus, the AT 2 receptor promotes ligand-independent, constitutive cardiomyocyte hypertrophy and does not directly antagonize the AT 1 receptor in this setting. (Hypertension. 2005;46:1347-1354.)
Diabetes in human subjects is often associated with hypertension. The aim of this study was to ex... more Diabetes in human subjects is often associated with hypertension. The aim of this study was to examine the development of cardiac fibrosis following induction of type 1 diabetes in genetically hypertensive rats. Diabetes was induced by streptozotocin (STZ) injection in 8-week-old normotensive Wistar-Kyoto (WKY) rats and spontaneously hypertensive rats (SHRs) for a duration of 16 or 24 weeks. Aged-matched, nondiabetic WKY and SHRs were used as controls. At termination of treatment, the rats were anaesthetized, hearts arrested in diastole and perfusion fixed. A comprehensive examination of cardiac fibrosis throughout the right and left ventricles was undertaken in picrosirius red-stained sections, using image analysis and by undertaking collagen type I and type III immunohistochemistry. Induction of diabetes in the SHRs led to a marked increase in the levels of interstitial fibrosis in the left ventricle plus septum (LV+S) at both 16 and 24 weeks duration (59% and 43% increase, respectively) and also in the right ventricle after 24 weeks duration of diabetes (35% increase compared to the nondiabetic SHR). Exacerbated perivascular fibrosis was also observed in the LV+S in the diabetic-hypertensive rats at the later time point. These effects of induction of diabetes were not observed in the normotensive strain. Our findings clearly demonstrate elevations in cardiac fibrosis when type 1 diabetes is combined with hypertension. Our findings thus stress the importance of closely monitoring both blood pressure and glucose levels in type 1 diabetic patients in order to prevent myocardial collagen deposition.
The aim of this study was to determine senior medical student (year 3-5) opinions of their early-... more The aim of this study was to determine senior medical student (year 3-5) opinions of their early-year (year 1-2) rural placement. We assessed the impact of MBBS early-year rural placements through a follow up of this cohort in their later years using a cross-sectional questionnaire. The questionnaire was administered to year 3-5 medical students at their clinical school. There were 97 participants (49% response rate) in the study. Twenty-nine per cent were male and 71% were female; 44% were from a rural background and 56% were from a metropolitan background; 48% were year 3 students, 32% were year 4 students and 20% were year 5 students; and 59% of the students were, at the time, situated at a rural clinical school and 41% were at a metropolitan clinical school. Closed-ended questions were quantified and statistically analysed. Open-ended responses were thematically analysed to determine what their experience of early-year rural placements were like. Seventy-nine per cent of students considered the year 1 placement length as 'about right'. Overall, most students found year 1 rural placements positive and grasped the placement aims and objectives. Most students were also pleased with year 2 rural placements, mainly due to the clinical aspects. Medical students appear to prefer shorter early-year rural placements and understand the benefits and importance of such placements. They also have a desire for greater clinical exposure during these early-year placements.
AimTo investigate the current literature to gain an understanding of skill mix, why it is being m... more AimTo investigate the current literature to gain an understanding of skill mix, why it is being manipulated and how it affects patient care and health-care costs.To investigate the current literature to gain an understanding of skill mix, why it is being manipulated and how it affects patient care and health-care costs.BackgroundDue to workforce shortages, economic constraints and increasing patient acuity, employers are looking at methods of providing patient care whilst maintaining costs. Registered nurses make up a large percentage of the health-care budget. The manipulation of skill mix (i.e. the percentage of registered nurses available for patient care) is seen as one method of managing the increasing cost whilst still ensuring patient care.Due to workforce shortages, economic constraints and increasing patient acuity, employers are looking at methods of providing patient care whilst maintaining costs. Registered nurses make up a large percentage of the health-care budget. The manipulation of skill mix (i.e. the percentage of registered nurses available for patient care) is seen as one method of managing the increasing cost whilst still ensuring patient care.EvaluationResearch literature was used to determine the current use of skill mix and its impact on patient care and health-care costs.Research literature was used to determine the current use of skill mix and its impact on patient care and health-care costs.Key issueThe use of a higher proportion of registered nurses is associated with better health outcomes, shorter length of stay and reduced patient morbidity.The use of a higher proportion of registered nurses is associated with better health outcomes, shorter length of stay and reduced patient morbidity.ConclusionEconomic savings from substituting registered nurses with other health professionals may be offset by increased patient length of stay in hospital and increased patient mortality.Economic savings from substituting registered nurses with other health professionals may be offset by increased patient length of stay in hospital and increased patient mortality.Implications for nursing managementWhen evaluating nursing skill mix, a higher percentage of registered nurses may result in health-care facility cost savings by providing a shorter length of stay and decreased patient complications.When evaluating nursing skill mix, a higher percentage of registered nurses may result in health-care facility cost savings by providing a shorter length of stay and decreased patient complications.
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Papers by Angelo D'Amore