REGISTERED NURSES REGISTERED NURSES

BEHAVIOUR ON EXPANDED ROLE BEHAVIOUR ON EXPANDED ROLE

IN PERFORMING ADVANCED IN PERFORMING ADVANCED
SKILLS SKILLS
REGISTERED NURSES REGISTERED NURSES
BEHAVIOUR ON EXPANDED ROLE BEHAVIOUR ON EXPANDED ROLE
IN PERFORMING ADVANCED IN PERFORMING ADVANCED
SKILLS SKILLS
Doreen Heng GN Doreen Heng GN
Mordiffi, Siti Zubaidah Mordiffi, Siti Zubaidah
Emily Ang Emily Ang
Purpose of the Study Purpose of the Study Purpose of the Study Purpose of the Study
To expIore registered nurses' To expIore registered nurses'
behaviour on expanded roIe in behaviour on expanded roIe in
performing advanced skiIIs: performing advanced skiIIs:
- - Venepuncture Venepuncture
- - IV cannuIation IV cannuIation
- - IV medication (BoIus) IV medication (BoIus)
#esearch Question #esearch Question #esearch Question #esearch Question
What are the registered nurses'
behaviours towards performing
venepuncture, IV cannuIation and
administering medicines intravenousIy
by boIus mode?
-ectives -ectives -ectives -ectives
To identify if Registered Nurses are aware of
their role in performing venepuncture,
intravenous cannulation and administering
medicines intravenously via bolus mode.
To determine whether Registered Nurses are
performing Advanced Skills.
To determine the possible attributing factors in
changing the behaviour of Registered Nurses in
order for them to take on the Advanced Skills.
ackground of the Study ackground of the Study ackground of the Study ackground of the Study
Expanding and evolving role of nurses
Emergence of training programmes
Venepuncture and peripheral intravenous
cannulation
Administration of medicines intravenously
via bolus mode
Are they practising?
f yes: what are the benefits reaped?
f no: what are their concerns?
iterature #eview 1 iterature #eview 1 iterature #eview 1 iterature #eview 1
Edwards, K (1995) - Nurses views on their
broadening scope of practice
Semi-structured interview on 17 nurses
Emerging themes:
Training and certification for security
Legal aspects of expanded roles over lack of
guidelines
Nurses as cheaper option of a "mini-doctor
iterature #eview 2 iterature #eview 2 iterature #eview 2 iterature #eview 2
Leonard, S (1999) nurses' perception of their existing roles,
concept of role expansion on patients, practitioners and other
health care professionals, implications for current and future
practices as well as existing and potential problems associated
with the role expansion
Self-administered questionnaires and face-to-face interviews on
70 RNs
Findings
Role and boundary issues
Expanded role issues
Benefits for patients
Benefits for other health care professionals
Benefits to nurses
Potential problems
ethodology ethodology - - #esearch Design #esearch Design ethodology ethodology - - #esearch Design #esearch Design
ross-sectional quantitative survey
questionnaire
ethodology ethodology - - Study Su-ects Study Su-ects ethodology ethodology - - Study Su-ects Study Su-ects
All registered nurses (local and foreign)
npatient areas
Passed theory examination and certified in
performing venepuncture, intravenous
cannulation and administering medicines
intravenously by bolus mode
ethodology ethodology - - Sampling ethod Sampling ethod ethodology ethodology - - Sampling ethod Sampling ethod
Stratified random sampling
of registered nurses
working in inpatient areas
acute tertiary care hospital
ethodology ethodology - - Questionnaire Questionnaire
Development Development
ethodology ethodology - - Questionnaire Questionnaire
Development Development
Source: Literature review.
Focus group interview
Questionnaire development
Proof reading by senior persons
Pilot study
62-item self-administered questionnaire
6-point Likert scale (1- "strongly agree
and 6, "strongly disagree)
ethodology ethodology - - Data Collection Data Collection ethodology ethodology - - Data Collection Data Collection
Permission obtained from Director of
Nursing
Permission and cooperation sought from
respective NMs/NCs
Completed in two weeks
Data analysis SPSS 11.5
#elia-ility Test #elia-ility Test #elia-ility Test #elia-ility Test
Factor analysis
Cronbach's Alpha coefficient computed:
Advanced skills as nurses' responsibilities 0.79
Advanced skills as other health care professionals'
responsibilities 0.74
Barriers in performing advanced skills 0.80
Factors important to nurses in performing
advanced skills 0.87
Benefits to nurses 0.94
Detriments to nurses 0.91
Benefits to patients 0.89
#08:98 #08:98
Response rate
81
"uestionnaire Response Rate "uestionnaire Response Rate "uestionnaire Response Rate "uestionnaire Response Rate
Number sent
n
Number returned
n
Percentage returned
EMD 12 12 100
CU 68 62 91
Medical wards 108 92 85
Surgical wards 84 80 95
Oncology wards 28 23 82
Others 128 78 61
Total 428 347 81
TabIe 1 Questionnaire response rates

ain Findings ain Findings ain Findings ain Findings
#esults #esults - - Expanded #ole Awareness f #s Expanded #ole Awareness f #s #esults #esults - - Expanded #ole Awareness f #s Expanded #ole Awareness f #s
1
4
4
2
28
2
0%
20%
40%
0%
80%
100%
P
e
r
c
e
n
t
a
g
e
Venepuncture CannuIation BoIus
Advanced SkiII
Not Aware
Aware
#esults #esults - - Percentage f urses Performing Percentage f urses Performing
Advanced Skills Advanced Skills
#esults #esults - - Percentage f urses Performing Percentage f urses Performing
Advanced Skills Advanced Skills
4

8
0
20
40
0
80
100
P
e
r
c
e
n
t
a
g
e
Venepuncture CannuIation BoIus
Type of Advanced SkiIIs
Attri-uting Attri-uting
Factors Factors
Attri-uting Attri-uting
Factors Factors
#esults #esults - - urses Concerns n Performing urses Concerns n Performing
Advanced Skills Advanced Skills
#esults #esults - - urses Concerns n Performing urses Concerns n Performing
Advanced Skills Advanced Skills
72.
51.2
49.
45.1
38.5
34.7
32.9
28.5
2.8
14
13.5
32.
70.9
0 10 20 30 40 50 0 70 80 90 100
ncreased Responsibilities
Reduced Dr Workload
Litigation
ncreased Workload
Fragmented Care
Time Consuming
Reduced Nsg Activities Time
Handmaiden Role
More Stressf ul
Role Conf usion
Devalued Basic Care
Reduced Patient Contact
Reduced Clinical Skills
C
o
n
c
e
r
n
s
Percentage
#esults #esults - - Perceived arriers To Performing Perceived arriers To Performing
Advanced Skills Advanced Skills
#esults #esults - - Perceived arriers To Performing Perceived arriers To Performing
Advanced Skills Advanced Skills
1

444
44
4

8
0 10 20 0 40 0 0 0 80 0 100
InpaIpabIe Veins
Veins Not VisibIe
Busy
Doctor To Perform
Cannot Be ReIieved
Paying CIass
Taken Advantage
B
a
r
r
i
e
r
s
Percentage of RNs Who Agree & StrongIy Agree
#esults #esults - - Support Deemed Important To Support Deemed Important To
Perform Advanced Skills Perform Advanced Skills
#esults #esults - - Support Deemed Important To Support Deemed Important To
Perform Advanced Skills Perform Advanced Skills
8
8
82
28
28

0 20 40 0 80 100
Supervisors
Nursing coIIeagues
Continuous education
Staffing IeveI
MedicaI coIIeagues
Sufficient supervision
S
u
p
p
o
r
t
Percentage of RNs Who Agree & StrongIy Agree
#esults #esults - - Perceived enefits To Patient Perceived enefits To Patient #esults #esults - - Perceived enefits To Patient Perceived enefits To Patient
84
8
821
84

8 8
0
20
40
0
80
100
F
a
s
t

s
e
r
v
i
c
e
C
o
n
t
i
n
u
i
t
y
F
u
I
I

r
a
n
g
e
R
a
p
p
o
r
t
Q
u
a
I
i
t
y

c
a
r
e
H
o
I
i
s
t
i
c

c
a
r
e
W
a
i
t
i
n
g

t
i
m
e
Benefits
P
e
r
c
e
n
t
a
g
e

o
f

R
N
s

W
h
o

A
g
r
e
e

&

S
t
r
o
n
g
I
y

A
g
r
e
e
#esults #esults - - Perceived enefits To urses Perceived enefits To urses #esults #esults - - Perceived enefits To urses Perceived enefits To urses
85.8
81.7
8
88.1
88.7
90.7
94.8
80.2
74.7
4.8
0
20
40
0
80
100
P
r
o
f
e
s
s
i
o
n
a
l

m
p
r
o
v
e
d

m
a
g
e
R
e
s
p
o
n
s
i
b
l
e
A
u
t
o
n
o
m
y

n
-
D
e
p
t
h
K
n
o
w
l
e
d
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e
J
o
b
S
a
t
i
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f
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n

n
t
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C
o
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a
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a
t
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o
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P
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b
l
i
c
R
e
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o
g
n
i
t
i
o
n
P
r
o
m
o
t
i
o
n
Benefits
P
e
r
c
e
n
t
a
g
e

o
f

R
N
s

w
h
o

A
g
r
e
e

&

S
t
r
o
n
g
I
y

A
g
r
e
e
Conclusion Conclusion Conclusion Conclusion
Training alone does not elicit a change in
the behaviour of the nurses to take on
their expanded role in performing the
advanced skills.
mportant factors to address:
Nurses' attitudes / perceptions
Organisational processes
Support systems
Implementation Implementation Implementation Implementation
Address nurses' concerns on performing advanced skills
during the training and sharing sessions.
Provide more opportunity for practice with support from
experienced colleagues.
Re-engineer the job scope of the Registered Nurse to transfer
some of their basic nursing care to second level staff (i.e.
Assistant Nurses and Nursing Aides).
Garner support from supervisors by getting them to be certified
in the Advanced Skills and utilise it to assess their staff to
attain their proficiency.
Continue to track the practice of Advanced Skills monthly,
which forms part of the Wards' Balanced Scorecard.
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