Department of Health Dr. Bonita Jenkins PI Dr. JoAnne Joyner - CoPI Research Project funded by: The National Council of State Boards of Nursing Center for Regulatory Excellence
Background Purpose Research Questions Review of Literature Methods Analysis of Data & Results Implications
2009 Health Occupations and Revisions Act revised to include Nursing Assistive Personnel Patient Care Technicians (PCT)have been working in acute care facilities in the DC area for over 25 years PCT are assuming more duties, functioning in roles of increasing complexity Nursing assistive personnel should be regulated across multiple settings in which they work (2005 National Council of State Boards of Nursing)
Explore the titles, preparation and utilization of the PCT in acute care settings in the Washington Metropolitan area Inform the development of regulation Allow the Board to work collaboratively with practice partners for input in regulations
1. What titles are used for PCT in acute care settings in the Washington Metropolitan area? 2. What are the roles of PCT in acute care settings in the Washington Metropolitan area? 3. What is the preparation of PCT for their assigned roles in acute care settings in the Washington Metropolitan area?
4. What is the PCT self-perceived value and effectiveness in the workplace? 5. What is the perceived value and effectiveness of PCT in the acute care setting as expressed by nurses who work with them? 6. What is the relationship among demographic variables of the PCT (age range, gender, hospital, education, and job related experience) and their self-perceived value and effectiveness in the workplace?
Revealed three broad topics as expressed by nurses 1. Titles and training Title related to a number of unstandardized positions with regard to titling and training (Zimmerman, 2000; Orne, Garland, O Hara, Perfetto, & Stielau, 1998) 2. Roles and utilization Include more complex specialty areas, such as critical care, dialysis, oncology, and the emergency treatment (McGloin & Knowles, 2005; Zimmerman, 2000; and NCSBN, 2010) Guidelines: Association of Women s Health, Obstetric and Neonatal Nurses [AWHONN], 2009; Gastroenterology Nurses and Associates, 2006; and Telephone Triage Consulting Corporation, 2006
3. Role Effectiveness Context of nurse delegation and staffing patterns Quality patient care Guidelines for delegation and supervision of UAPs NCSBN and American Nurses Association (2005) Supervision and delegation of UAPs require considerable time and thought Orne et al, 1998; and Bittner & Gravin, 2009 UAPs in the nurse staffing mix has had varied results
Collected hiring/training documents Content Analysis PCT job descriptions and employee handbooks Policies and procedures (orientation, utilization of the PCT) Training manuals/modules for the PCT Survey Descriptive/Correlational Statistics Nurse Administrator or Rep PCT RNs working with PCT
Hospit al # RNs # LPNs # of PCT Superv ise PCT Delegate to PCT Education of PCT provided #1 891 3 182 RN RN, LPN RN NO #2 509 41 42 RN RN RN YES #3 684 4 152 RN RN, LPN, RN YES PA, MD #4 338 4 114 RN RN RN YES #5 406 7 157 RN, RN, LPN RN YES LPN #6 120 10 40 RN, RN, LPN, RN NO LPN MD #7 80 8 40 RN, RN, LPN RN NO LPN #8 230 6 78 RN, RN, LPN RN NO Orientatio n include Delegation
Statistic n % Cumulative % Gender 25 16.2 16.3 Male 123 80.4 96.7 Female 5 3.3 100 Age Under 20 Missing 20 29 30 39 40 49 50-59 60 or over Missing 1.7.7 35 22.9 23.6 27 17.6 41.2 45 29.4 70.6 26 17 87.6 16 10.5 98.1 3 1.9 100
Statistics n % Cumulative % Highest Education Grade School Some High School High School Diploma Some Business College or Technical Some College Business or Technical Degree College Degree Some Graduate Work Master or Higher Degree Missing Length of Time on Job 0-6 mos 7 months 1 year 13 months 2 years 2 year 1 month 5 years 5 year 1 month 10 years.35.7.7 2 1.3 2 37 24.2 26.2 20 13.1 39.2 51 33.3 72.5 11 7.2 79.7 28 18.3 98 1.7 98.7 0 0 98.7 2 1.3 100 22 14.4 14.4 10 6.5 20.9 17 11.1 32 27 17.6 49.6 33 21.6 71.2
Statistic n % Cumulative % Age 20 29 30 39 40 49 50 59 60 or over Missing Length of Time on 0-6 mos Job 13 mos - 2 years 2 years 1 mos - 5 years 5 years 1 mos - 10 years 7 mos - 1 year More than 10 years Missing 89 26.6 26.6 78 23.4 50 60 18.0 68 84 25.1 93.1 19 5.7 98.8 4 1.2 100 34 10.2 10.2 38 11.4 21.6 70 21.0 42.6 57 17.1 59.7 28 8.3 68.0 103 30.8 98.8 4 1.2 100
Research Question # 1- What are the titles? Technician with a qualifier was the most commonly used title For example: Med-Surg tech, ED tech, and ICU tech
Hospit al Med/ Surg ICU ED OR PACU Women & Mother/ Baby Diagnosti c Procedur es #2 X X #3 X X X #4 X X X #5 X X X X X X X #6 X X #7 X X X X #8 X
8 categories of roles and functions Basic nursing care Basic data collection of physiologic parameters Environmental management Interpersonal skills Reporting and recording Teamwork Educational/growth and development Special skills
Uniformity in initial preparation nursing assistant, Medic/Corpsmen, EMT High school diploma (n = 8) Completion of a nursing assistant course (n=7) Literacy in the English language (n=8) Basic computer skills (n=4) Additional prior experience of min 6 mos for Advanced Roles Experience accepted: EMT, military experience as a medic or corpsman, or a student nurse Variations in requirements at the advanced and specialty levels
PCT Self-Perceived Job Dimensions Scale Minimu Maximu m m Skill Variety 1.66 7.00 Task Identity Task Significance 1.66 7.00 4.91 M SD SE Skewnes s 4.88.099 1.10.10 -.39.09 -.12 3.66 7.00 6.02.99.08 -.71 Autonomy 1.66 7.00 4.90 1.17.09 -.32 Feedback from Job Feedback from Nurse Dealing with Note: N = 153 Others 2.33 7.00 4.91.99.081.02 1.00 7.00 4.87 1.45.12 -.36 2.30 7.00 6.01 1.11.09-1.20
Note: N = 152
Scale Minimu m Maximu m M SD SE Skewn ess Skill Variety 1.30 7.00 4.66 1.22.067 -.224 Task Identity 2.00 7.00 4.82.99.05 -.19 Task 2.30 7.00 6.10.99.05-1.06 Significance Autonomy 1.00 7.00 4.81 1.12.06 -.15 Feedback from Job Feedback from Nurse Dealing with N = 334 Others 1.30 7.00 4.89 1.09.06 -.26 1.33 7.00 5.12 1.28.07 -.45 2.66 7.00 5.92.99.05 -.75
Characteris tic Skill Variet y Task Identi ty Task Significan ce Autono my Feedba ck Job Feedba ck Nurse Dealin g with Others General Satisfacti on Gender.09 -.10 -.05.02 -.11 -.17 -.13 -.12 Age -.02.14 -.04 **.10 **.02 -.17 ** -.20 **.16 Highest Education Time in Job Characteris tic Internal Satisfacti on Pay Satisfacti on Security Satisfacti on Social Satisfacti on Supervis ory Satisfacti on Growth Satisfacti on Individu al Growth Motivati ng Potentia l Score Gender -.04.02 -.06 -.05 -.10.00 -.02 -.07 Age -.05 **.05 **.04.10 **.08 **.16.08 **.10 ** Highest Education -.07 -.12 **.09.03.11 **.27.22.02 **.11.10 **.12.17.10 **.10 -.05 -.02 **.09 -.02 -.02 ** -.12 -.03 -.12 **.07.06 Time in **p <.01 (2 tailed),.02 * p <.05 -.11 (2 tailed) -.10 **.02.00 -.01 **.01.21 Job
Regression Analysis of Hospital with JDS Variable B SE Beta β Dealing w Others -.10.04 -.20* General Satisfaction -.11.05 -.21* Social Satisfaction -.08.04 -.20* Regression Analysis of Age with JDS Variable B SE Beta β General Satisfaction.28.09.31** Growth.18.08 Satisfaction Regression Analysis of Highest Education with JDS.22* Variable B SE Beta β Individual Growth Need.16.08.18* Regression Analysis of Length of Time on the Job with JDS Variable B SE Beta β Feedback from Nurse.18.07.23** Pay Satisfaction -.19.09 -.20* Motivating Potential Score 7.10 2.81.23*
Boards of Nursing Uniformity in the titling of beginners and advanced PCT Uniformity in education and preparation for beginners and advanced PCT Consideration for other training i.e. Military, EMT, nursing students emphasis on skills/competencies versus NA certification Realize that the increase utilization of PCT has diminished the role of LPN in acute care LPN training may not include acute care experiences
Hospitals PCT and Nurses need clarification of PCT function/ duties Differentiate between NA (CNA) and PCT Clarification of delegation and supervision roles of PCT by nurses (reporting) Include delegation in PCT and Nurses orientation Consider the staffing number for PCT Comment seem to request an increase Consider the pay scales for PCT Should reflect equitable distributions even with longevity
The results influenced the following: Qualifications for PCT Including information about supervision of PCT by nurse PCT Certification Exam Defining the specific task permitted
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