Siegel Elena O, Bettega Kristen, Bakerjian Debra, Sikma Suzanne
J Gerontol Nurs. 2018 Jun 1;44(6):10-14. doi: 10.3928/00989134-20180322-03. Epub 2018 Apr 2.
Nursing homes use team nursing, with minimal RN presence, leaving the majority of direct care to licensed practical/vocational nurses (LPNs/LVNs) and unlicensed assistive personnel (UAP), including medication aides. The current article describes challenges faced by nursing home directors of nursing (DONs) leading and managing a team nursing approach, including consideration of scope of practice, delegation and supervision regulations, and related policy implications. A secondary data analysis was performed of qualitative data from a study to develop and test DON guidelines for delegation in nursing home practice. A convenience sample (N = 29) of current or previous DONs and other nursing home leaders with knowledge and expertise in the DON role participated in in-depth, guided interviews. The findings highlight a core concern to nursing licensure policy and regulation: knowledge and practice gaps related to scope of practice and delegation and supervision among DONs, RNs, and LPNs/LVNs, as well as administrators, and the role of nursing leaders in supporting appropriate delegation practices. The findings offer directions for research and practice in addressing challenges in aligning team nursing practices with regulatory standards as well as the related gaps in knowledge among DONs, administrators, and nursing staff. [Journal of Gerontological Nursing, 44(6), 10-14.].
养老院采用团队护理模式，注册护士的参与度极低，大部分直接护理工作由执业护士/职业护士（LPNs/LVNs）和无执照辅助人员（UAP）承担，其中包括药物助手。本文描述了养老院护理主任（DONs）在领导和管理团队护理模式时所面临的挑战，包括对执业范围、授权与监督规定以及相关政策影响的考量。对一项研究中的定性数据进行了二次数据分析，该研究旨在制定和测试养老院实践中DONs的授权指南。一个便利样本（N = 29），由现任或前任DONs以及其他在DON角色方面具有知识和专业技能的养老院领导参与了深入的、有指导的访谈。研究结果突出了护理执照政策和法规的一个核心关注点：DONs、注册护士、LPNs/LVNs以及管理人员之间在执业范围、授权与监督方面存在的知识和实践差距，以及护理领导者在支持适当授权实践方面的作用。研究结果为解决团队护理实践与监管标准相匹配方面的挑战以及DONs、管理人员和护理人员之间相关知识差距的研究和实践提供了方向。[《老年护理杂志》，44(6)，10 - 14。]
