SUMMARYBackground: Silicone percutaneous endoscopic gastrostomy (PEG) tubes are associated with more short-term complications and possibly fail sooner than those made of polyurethane. Understanding the deterioration and long-term complications leading to tube failure has important clinical and cost implications. Aim: To compare dwell time and patterns of failure ofsilicone polymer and polyurethane PEG tubes. Methods: Participants randomized to receive a siliconepolymer (n ¼ 76) or polyurethane (n ¼ 62) PEG werevisited monthly for 540 days, until death or tube removal. Tube and exit site characteristics and reasons for removal were recorded. Results: Tube failure occurred in 25% of silicone PEGs and 12.9% of polyurethane PEGs. Mean tube survival

This intervention used an inexpensive, human resources-based approach to significantly reduce the incidence of falls in the population at highest risk of falling. The additional benefits to patients in terms of cognitive improvement bear further investigation.

The increasing number of inexperienced graduates, as well as other levels of nurse such as the enrolled nurse and assistant-in-nursing, requires health service and nursing managers in the acute care sector to rethink the long-preferred "patient allocation" model of care provision. As well, the escalating shortage of registered nurses and subsequent low morale among those remaining in the workforce require hospitals to re-examine skills mix and staffing ratios. This paper presents the results of two work-sampling studies conducted in a major metropolitan private hospital, the first of which was to provide a rationale for changing from the patient allocation model to a team model of care. The second study aimed to evaluate and provide data on the impact of the change. Staff were heavily involved in both studies as well as the change process. The findings highlight how effective the new model has been in redistributing certain aspects of care to make better use of each nurse HEALTH SERVICE PLANNERS are responding to staff shortages and strained finances by redesigning nursing workforces. 1 Driven by such factors as the increased age and numbers of chronically ill patients, 2 increased acuity and complexity of hospitalised patients, 3,4 the continuous introduction of new technologies, 5 shortened length of stay and increased community burden with no compensatory transfer of resources, 6 health care facilities have been implementing alternative practice models. These models attempt to sustain quality patient care, assure patient safety and satisfaction and maintain budgetary efficiency. 7,8 The current shortage of registered nurses (RNs) 1,9 has compounded the problem, making the redesign of nursing work an imperative. What is known about the topic? Nursing has long advocated the "patient allocation" model of care for a professional workforce with "team nursing" generally seen as a model from the past that is not appropriate for contemporary times. However, with the protracted crisis of recruitment and retention of registered nurses (RNs), the patient allocation model has become unsustainable in many hospitals, suggesting a need to return to team nursing. What does this paper add?Work sampling methodology identified changes in the pattern of nurses' work following changes to skill mix and staffing ratios. Our findings provide strong empirical evidence that team nursing can enhance the provision of care. What are the implications for practitioners?While the transfer of nursing education to the tertiary sector enhanced the professionalisation of nursing and made possible the idea of an all RN workforce, larger social and political forces have conspired to limit this possibility. As the long-term forecast for nursing is an increasing shortage of RNs the profession has to find ways to provide high quality and safe care to its constituencies that best use the skills of an RN while deploying less educated and skilled nurses to support and complement the work of this now precious resource.

Although the nature and characteristics of expert practice have been described in the literature, the description is incomplete. How expertise is gained is not fully understood, and definitions of expert competencies have yet to be developed. Essential issues for education arise from the demand for knowledge for expert practice. Because expertise is gained in the context of practice, expertise cannot be achieved out of context or taught as an academic exercise. A clear picture of the practice of expert nurses is necessary so that those in the profession can know and articulate expert practice and direct it to the community.