Assistant Director of Nursing (Research Development), Department of Nursing Administration, CHU Sainte-Justine, and Affiliated Professor, Faculty of Nursing, University of Montreal, Montreal, Canada.
Professor and Associate Dean, Connell School of Nursing, Boston College, Chestnut Hill, MA, USA.
J Nurs Scholarsh. 2018 Jan;50(1):56-64. doi: 10.1111/jnu.12352. Epub 2017 Sep 29.
While professional nursing, like other health professions, has a recognized educational base and a legal scope of practice that is remarkably consistent across societies, there are important variations even within the same institution or organization in the extent to which professional nurses engage in the full range of activities for which they are qualified. There has been limited study of enacted (actual) scope of nursing practice (ESOP) or of its impacts on nurse job outcomes, such as job satisfaction. The aim of this study is to measure ESOP, as well as its predictors and impact on job satisfaction, in a specialty university-affiliated tertiary referral center in one of the few remaining jurisdictions outside the United States that continue to educate registered nurses at multiple educational levels.
This was a correlational cross-sectional design using structural equation modeling. Self-administered questionnaires were completed by 301 registered nurses holding permanent positions in specific clinical areas for 6 months or longer in a pediatric hospital in the province of Quebec, Canada.
ESOP or actual scope of practice was low-on average, nurses applied the range of skills within their theoretical scopes of practice only occasionally or "less than frequently" in their daily work (3.21 out of a possible 6 points). ESOP was strongly related to decision latitude (β = 0.319; p = .012), role ambiguity (β = 0.297; p = .011), and role overload (β = 0.201; p = .012). The personal characteristics that exerted the greatest direct influence on ESOP were education level (β = 0.128; p = .015) and growth need strength (β = 0.151; p = .008). Results also showed that ESOP exerts a direct positive influence on nurses' job satisfaction (β = 0.118; p = .006). Structural equation modeling analyses revealed a good fit of the data to the hypothesized conceptual model (χ²/df ratio index = 1.68, root mean square error of approximation = 0.049, confirmatory fit index = 0.985).
Specific aspects of nurses' jobs are closely related to ESOP. ESOP is limited by certain job and personal characteristics and appears to affect nurses' job satisfaction.
Results suggest that ESOP might be improved by adjusting nursing job characteristics and practice environments and that expanding ESOP increases nurse job satisfaction and may improve other health system outcomes as well.
尽管专业护理与其他健康专业一样，在不同社会中具有公认的教育基础和法律实践范围，但即使在同一机构或组织内，专业护士从事其有资格从事的全部活动的程度也存在重要差异。对于实施（实际）护理实践范围（ESOP）或其对护士工作结果（如工作满意度）的影响，研究还很有限。本研究旨在衡量在一个专业的大学附属三级转诊中心的 ESOP 及其预测因素和对工作满意度的影响，该中心是美国以外少数几个继续在多个教育层次上教育注册护士的司法管辖区之一。
这是一项使用结构方程模型的相关性横断面设计。在加拿大魁北克省一家儿科医院，301 名持有特定临床领域永久职位且工作时间至少 6 个月的注册护士完成了一份自我管理问卷。
ESOP 或实际实践范围较低——平均而言，护士在日常工作中仅偶尔或“不常”应用其理论实践范围的技能（6 分中的 3.21 分）。ESOP 与决策自由度（β=0.319;p=0.012）、角色模糊性（β=0.297;p=0.011）和角色过载（β=0.201;p=0.012）密切相关。对 ESOP 施加最大直接影响的个人特征是教育水平（β=0.128;p=0.015）和成长需求强度（β=0.151;p=0.008）。结果还表明，ESOP 对护士的工作满意度有直接的积极影响（β=0.118;p=0.006）。结构方程模型分析表明，数据与假设的概念模型拟合良好（χ²/df 比值指数=1.68，均方根误差逼近值=0.049，验证性拟合指数=0.985）。
护士工作的某些特定方面与 ESOP 密切相关。ESOP 受到某些工作和个人特征的限制，似乎会影响护士的工作满意度。
结果表明，通过调整护理工作特征和实践环境，ESOP 可能会得到改善，扩大 ESOP 会提高护士的工作满意度，并可能改善其他卫生系统的结果。
