A multi-country perspective on nurses’ tasks below their skill level: Reports from domestically trained nurses and foreign trained nurses from developing countries

doi:10.1016/j.ijnurstu.2012.06.013

International Journal of Nursing Studies

Volume 50, Issue 2, February 2013, Pages 202-209

https://doi.org/10.1016/j.ijnurstu.2012.06.013 Get rights and content

Abstract

Background

Several studies have concluded that the use of nurses’ time and energy is often not optimized. Given widespread migration of nurses from developing to developed countries, it is important for human resource planning to know whether nursing education in developing countries is associated with more exaggerated patterns of inefficiency.

Objectives

First, to describe nurses’ reports on tasks below their skill level. Second, to examine the association between nurses’ migratory status (domestically trained nurse or foreign trained nurse from a developing country) and reports on these tasks.

Design

The Registered Nurse Forecasting Study used a cross-sectional quantitative research design to gather data from 33,731 nurses (62% response rate) in 486 hospitals in Belgium, England, Finland, Germany, Greece, Ireland, the Netherlands, Norway, Poland, Spain, Sweden and Switzerland.

Methods

For this analysis, nurse-reported information on migratory status and tasks below their skill level performed during their last shift was used. Random effects models estimated the effect of nurses’ migratory status on reports of these tasks.

Results

832 nurses were trained in a developing country (2.5% of total sample). Across countries, a high proportion of both domestically trained and foreign trained nurses from developing countries reported having performed tasks below their skill level during their last shift. After adjusting for nurses’ type of last shift worked, years of experience, and level of education, there remained a pronounced overall effect of being a foreign trained nurse from a developing country and an increase in reports of tasks below skill level performed during the last shift.

Conclusion

The findings suggest that there remains much room for improvement to optimize the use of nurses’ time and energy. Special attention should be given to raising the professional level of practice of foreign trained nurses from developing countries. Further research is needed to understand the influence of professional practice standards, skill levels of foreign trained nurses from developing countries and values attached to these tasks resulting from previous work experiences in their home countries. This will allow us to better understand the conditions under which foreign trained nurses from developing countries can optimally contribute to professional nursing practice in developed country contexts.

Section snippets

Background

System-level interventions like increasing nurse staffing and creating superior work environments have been associated with improved patient safety outcomes and a higher degree of nurse wellbeing (Aiken et al., 2012, Kelly et al., 2011). Also central to the efficient structuring of nurses’ work is optimizing the use of their time and effort. When asked about their last shift however, nurses across three countries (US, Canada, Germany) consistently reported high percentages of non-nursing tasks

Study design

The RN4CAST study favoured a rigorous quantitative multi-country cross-sectional design on the basis of research methods used in a five-nation study of critical issues in nurse staffing and the impact on patient care (Aiken et al., 2001). Data were gathered via four data sources (nurse, patient and hospital profile surveys and routinely collected hospital discharge data). The design of the RN4CAST-study is described in detail by Sermeus et al. (2011). For this analysis, nurse-reported

Foreign trained nurses

2107 nurses (6.2% of total sample) indicated they were trained in another country than where they were currently employed, of which 832 were trained in a developing country (2.5% of total sample). There was large variation in the share of foreign trained nurses between countries: Ireland (38.6%), Switzerland (22.1%) and England (16.7%), Norway (5.5%), Germany (5.1%), Greece (5.1%), Belgium (3.1%), Netherlands (2.4%), Sweden (2.3%), Spain (1.3%), Finland (.9%). In Poland, all nurses that

Discussion

This study documented high proportions of nurses across twelve countries indicating they had performed tasks below their skill level during their last shift. These findings support the previous studies of Aiken et al. (2001), Desjardins et al. (2008) and Hendrich et al. (2008) in which nurses reported much time spend on non-nursing tasks or much time wasted during their last shift.

Findings also revealed that, while a high share of all nurses reported having performed tasks below their skill

Conclusion

The findings suggest that there remains much room for improvement to optimize the use of nurses’ time and energy. Human resources management should give more attention to professional socialization and life-long learning for nurses to improve their priority setting and time management as well as ensuing that non-nursing resources are designated to carry out tasks that do not require the unique training of professional nurses. Nurses from developing countries may be particularly in need of

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Citation Excerpt :
An increased concern has recently emerged internationally regarding the amount of non-nursing tasks expected of nurses (Bruyneel et al., 2013; Veličković et al., 2014), which have been reported as occupying from 35% (Fitzgerald et al., 2003) to 62% of the entire nursing-shift duration (Bruyneel et al., 2013).
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Two bachelor of nursing degree programmes located in Northern Italy, three years in length and requiring night shifts for students starting in the second semester of the 1st year, were involved.
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¹: For the RN4CAST consortium, see Appendix A.

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A multi-country perspective on nurses’ tasks below their skill level: Reports from domestically trained nurses and foreign trained nurses from developing countries

Abstract

Background

Objectives

Design

Methods

Results

Conclusion

Section snippets

Background

Study design

Foreign trained nurses

Discussion

Conclusion

Nurses’ reports on hospital care in five countries

Health Affairs

Patient safety, satisfaction, and quality of hospital care: cross-sectional surveys of nurses and patients in 12 countries in Europe and the United States

British Medical Journal

Factors contributing to nursing task incompletion as perceived by nurses working in Kuwait general hospitals

Journal of Clinical Nursing

The Hospital Nursing Workforce in New York: Findings from a Survey of Hospital Registered Nurses

A work sampling study of variations in nursing work load

Hospitals

Reorganizing nursing work on surgical units: a time-and-motion study

Nursing Leadership

Does international nurse recruitment influence practice values in U.S. hospitals?

Journal of Nursing Scholarship

A 36-hospital time and motion study: how do medical-surgical nurses spend their time?

The Permanente Journal

Career Progression of Migrant Nurses in Ireland: Nurse Migration Project Policy Brief 5