Nursing Work in Long-Term Care: An Integrative Review

Abstract

Evidence suggests that delivery of good nursing care in long-term care (LTC) facilities is reflected in nurses' descriptions of the factors and structures that affect their work. Understanding the contemporary nature of nursing work in aged care will influence policies for improving current work structures in this practice setting. The current review aims to present a contemporary perspective of RNs' work in LTC facilities. A comprehensive search and purposeful selection of the literature was conducted using CINAHL, PubMed, Medline, Scopus, and Google Scholar databases. Nine studies were eligible for review. Common themes revealed that nursing work in aged care settings is characterized by RNs providing indirect care tasks-primarily care coordination, engaging in non-nursing activities, and having an expanded and overlapping role. As care providers, aged care RNs do not always provide direct care as part of their nursing work. The scope of RN work beyond its clinical nature or performance of non-nursing tasks adds complexity in clarifying RN work roles in aged care. [Journal of Gerontological Nursing, 43(11), 41-49.].

Registered Nurse Burnout, Job Dissatisfaction, and Missed Care in Nursing Homes

“…11 These are clinical activities that all fall under the leadership of RNs. 12,13 Yet, among RNs in our study, 28% said they lacked the time or resources to perform adequate patient surveillance, 20% left treatments or procedures undone, and 28% left care plans unfinished. Among Figure 1.…”

“…Just over two‐thirds of these events were classified as preventable due to inadequate monitoring, failure to provide necessary treatments, substandard treatment, or inadequate/incomplete care plans . These are care activities that all fall under the leadership of RNs who are responsible for supervising other nursing personnel, managing medications, coordinating care and organizing care plans, conducting patient surveillance, and overseeing infection control and wound care programs in this setting …”

Nursing home staff experiences of implementing mentorship programmes: A systematic review and qualitative meta‐synthesis

“…Mentors play an educational and leadership role and are required to have rich work experiences, a willingness to share knowledge, and an enthusiasm for teaching and for the success of mentees (Burgess, van Diggele, & Mellis, 2018). The scope of nurses' work beyond its clinical nature or the performance of non-nursing tasks, such as teaching, adds complexity to the learning process in both hospitals and nursing homes (Montayre & Montayre, 2017). In addition, there are similar barriers to implementing effective mentorship programmes, for example conflicts of interest between mentors and mentees; an imbalance of power; poor communication; and lack of trust and support (Eller, Lev, & Feurer, 2014).…”

Skill mix: The potential for personal assistants to undertake health‐related tasks for people with personal health budgets

“…Spilsbury et al () predicted that in England, line management skills would become more important for community nurses tasked with the responsibility of managing such assistants. Similarly, Montayre and Montayre () reviewed international literature about nurses working in long‐term care facilities and concluded nurses’ work was characterised by expanded and overlapping roles of care coordination rather than direct care. Our sample of PAs did not see themselves as prospectively managed by nurses, but by their employers, and this may be a tension that is more likely to arise in PHB arrangements than it is for PBs.…”