Murphy Gail Tomblin, Alder Rob, MacKenzie Adrian, Cook Amanda, Maddalena Victor
School of Nursing, Dalhousie University, Halifax, NS.
Nurs Leadersh (Tor Ont). 2012 Mar;25 Spec No 2012:21-32. doi: 10.12927/cjnl.2012.22814.
The evaluation of the Research to Action project was conducted using an Outcome Mapping (OM) methodology (Earl et al. 2001) with a mixed-methods, repeat survey (before/after) study design. This design uses concurrent measurement of process and outcome indicators at baseline and follow-up. The RTA project proved effective at improving work environments and thereby promoting the retention and recruitment of nurses. Nurses involved in the RTA initiatives had a higher perception of leadership and support in their units, improved job satisfaction, increased empowerment and occupational commitment, and a greater intention to stay on the job.The pilot projects were most successful when there were clearly stated objectives, buy-in from nurses, support from the steering committee and management, and adequate communication among stakeholders. Committed coordination and leadership, both locally and nationally, were central to success.Considerable evidence has documented the challenges facing Canada's nursing human resources and their workplaces, such as high levels of turnover, excessive use of overtime and persistent shortages. There is a growing imperative to translate this research into action, and much of the available evidence presents viable policy alternatives for consideration. For example, a recent national synthesis report (Maddalena and Crupi 2008) recommended that, in consultation with stakeholders, processes should be put in place to share knowledge and best practices in nursing management, practice, staffing models and innovations in workplace health and well-being.Nurses across the country report a desire to be more involved in decisions affecting them and their patients (Wortsman and Janowitz 2006). A recent study on the shortage of registered nurses in Canada (Tomblin Murphy et al. 2009) highlighted the need for collaboration among governments, employers, unions and other stakeholders to improve working conditions for nurses. Another report notes the potential benefits of reduced turnover among nurses, the cost of which has been identified as a major burden on the Canadian healthcare system (O'Brien-Pallas et al. 2010). One of the goals of the pan-Canadian framework for health human resources (HHR) planning adopted by the Federal/Provincial/Territorial Advisory Committee on Health Delivery and Human Resources is to enhance all jurisdictions' capacity to build and maintain a sustainable workforce in healthy, safe work environments (ACHDHR 2005).Within this context, Health Canada's Office of Nursing Policy provided funding to the Canadian Federation of Nurses Unions (CFNU) and partner agencies in October 2008 to develop pilot projects across the country aimed at improving nurse retention and recruitment through various workplace improvement schemes. Each of the provincial partners contributed funds, in-kind support or both to the projects. The initiative was entitled Research to Action: Applied Workplace Solutions for Nurses (RTA). A national steering committee including representation from unions, governments and employers, each pilot project, CFNU and its national partners – the Canadian Nurses Association, the Canadian Healthcare Association and the Dietitians of Canada – was formed to oversee the development of 10 pilot projects. There was one project in each of Newfoundland and Labrador, Nova Scotia, New Brunswick, Prince Edward Island, Ontario, Manitoba, Saskatchewan, Alberta, British Columbia and Nunavut. The pilot projects, led by their own steering committees, focused on various aspects of nursing practice identified as particularly relevant to each jurisdiction, with a specific emphasis on improving the work life of nurses and transforming research knowledge into practice. The goals of the RTA initiative were to promote high-quality workplace environments, improve the retention and recruitment of nurses (RNs and LPNs), enhance the quality of patient care and engage stakeholders in collaborative partnerships. The first project began in May 2009 and the last project was completed in March 2011.
“研究转化为行动”项目的评估采用了成果映射（OM）方法（厄尔等人，2001年），研究设计为混合方法、重复调查（前后对比）。该设计在基线和随访时同时测量过程指标和结果指标。“研究转化为行动”项目在改善工作环境从而促进护士留用和招聘方面被证明是有效的。参与“研究转化为行动”倡议的护士对其所在科室的领导力和支持有更高的认知，工作满意度提高，赋权感和职业承诺增加，且留任意向更强。当目标明确、护士积极参与、得到指导委员会和管理层的支持以及利益相关者之间有充分沟通时，试点项目最为成功。在地方和国家层面坚定的协调与领导是成功的关键。
大量证据记录了加拿大护理人力资源及其工作场所面临的挑战，如高离职率、过度使用加班以及持续的人员短缺。将这项研究转化为行动的紧迫性日益增加，现有许多证据提出了可行的政策选择供考虑。例如，最近的一份全国综合报告（马达莱娜和克鲁皮，2008年）建议，应与利益相关者协商，建立相关流程，以分享护理管理、实践、人员配置模式以及工作场所健康与福祉创新方面的知识和最佳实践。
全国各地的护士表示希望更多地参与影响她们及其患者的决策（沃茨曼和贾诺维茨，2006年）。最近一项关于加拿大注册护士短缺的研究（汤布林·墨菲等人，2009年）强调，政府、雇主、工会和其他利益相关者需要合作，以改善护士的工作条件。另一份报告指出了降低护士离职率的潜在好处，其成本已被确定为加拿大医疗系统的一项主要负担（奥布赖恩 - 帕拉斯等人，2010年）。联邦/省/地区卫生服务与人力资源咨询委员会通过的泛加拿大卫生人力资源（HHR）规划框架的目标之一，是提高所有司法管辖区在健康、安全的工作环境中建设和维持可持续劳动力的能力（ACHDHR，2005年）。
在此背景下，加拿大卫生部护理政策办公室于2008年10月向加拿大护士联盟（CFNU）及其合作伙伴机构提供资金，在全国开展试点项目，旨在通过各种工作场所改善计划提高护士留用率和招聘率。每个省级合作伙伴都为这些项目提供了资金、实物支持或两者兼有。该倡议名为“研究转化为行动：护士的应用工作场所解决方案”（RTA）。成立了一个全国指导委员会，成员包括工会、政府和雇主的代表、每个试点项目、CFNU及其国家合作伙伴——加拿大护士协会、加拿大医疗保健协会和加拿大营养师协会——以监督10个试点项目的开展。在纽芬兰和拉布拉多、新斯科舍、新不伦瑞克、爱德华王子岛、安大略、马尼托巴、萨斯喀彻温、艾伯塔、不列颠哥伦比亚和努纳武特各有一个项目。试点项目由各自的指导委员会领导，关注被确定为与每个司法管辖区特别相关的护理实践的各个方面，特别强调改善护士的工作生活并将研究知识转化为实践。“研究转化为行动”倡议的目标是促进高质量的工作场所环境，提高护士（注册护士和执业护士）的留用率和招聘率，提升患者护理质量，并让利益相关者参与合作关系。第一个项目于2009年5月开始，最后一个项目于2011年3月完成。
