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Satisfactory, good and outstanding nurses: perceptions of nurses, their colleagues and patients

Medigovich, Kristina (2012) Satisfactory, good and outstanding nurses: perceptions of nurses, their colleagues and patients. PhD thesis, Murdoch University.

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All nurses must accept responsibility for their own professional competence and performance but it is often the case that there is a large disparity between those nurses who perform very well and those who perform less well. The study was undertaken in response to the paucity of research findings to define what is an outstanding, good and satisfactory nurse, and how these differences in level of performance are enacted in clinical practice. The overall purpose of this study was to explore perceptions of the key attributes and characteristics of outstanding, good and satisfactory nurses practising in acute care clinical settings from the perspective of a number of stakeholders. The study was devised on the premise that this information would provide a significant basis for change in the way nurses are educated and assessed. A qualitative interpretive approach guided the study. Forty-six people were interviewed on their perceptions of the distinction between satisfactory, good, and outstanding nurses. The sample included patients, doctors, nurses, physiotherapists, social workers and occupational therapists, all of whom had recent or current professional contact with registered nurses. Subsequently, participants were again contacted to verify the findings of the first phase of the study.

There were discernable differences in participants’ descriptions of satisfactory, good and outstanding nurses. Five distinct themes emerged in the data analysis regarding outstanding nurses. The major themes were: Sustaining a High Level of Performance, Modelling Exemplary Professional Behaviours, Balancing the Personal and the Professional, Managing Self and Others and Forming Personal and Therapeutic Relationships. ‘Good’ nurses were seen to perform well in the clinical setting with some reservations. The five themes identified were Reservations about Clinical Competence, Limitations in Communicating, Inconsistencies in Working Collaboratively, Caring Style and Coping. ‘Satisfactory’ nurses were perceived to perform at a basic minimum standard which met patient safety standards. The major themes identified were Primarily Attending to Physical Care, Providing a Minimum Standard of Care, Selective Caring, Lack of Demonstrated Problem Solving Skills and Limited Personal and Interpersonal Capabilities.

This research study provides unique insights into how nurses are perceived by those who interact with them in the acute care clinical setting. The findings present unmistakable evidence that some nurses in clinical practice are outstanding, in particular at the ward/unit level within acute care general and mental health facilities. The outstanding nurses were not only considered high performing nurses, but they were able to facilitate and ensure a high level of performance from other staff members. Their professional behaviours were exemplary. They were also seen as having the ability to balance their personal and professional life so that problems or stressors in their personal life did not ‘leak’ across into their professional life. The outstanding nurses were not only good leaders, they were good managers, managing themselves and others. Prolific comments were forthcoming about how they were able to maintain relationships with others well, and they did so with effective communication strategies.

There was clear evidence that nurses who were perceived to be ‘good’ nurses performed well. At times there were limitations with this group of nurses, with some lacking the detailed specific knowledge and assessment skills of the outstanding nurse and creating the impression that they were ineffective in some of their actions. However there didn’t seem to be a compromise to patient safety.

Participants believed that when the nursing care provided was mainly physical in nature the nursing care was considered adequate. Satisfactory nurses were considered safe but not holistic in the nursing care they provided. They tended to focus on physical care, with limited attention to the psychosocial aspects of nursing. This left the impression that the satisfactory nurse was task orientated, principally able to follow a plan of care, much like a job list of tasks, which represented a narrow focus of practice. The findings of this study suggest a number of recommendations to enhance nursing education, improve clinical performance in the practice setting and extend nursing knowledge through further research. There is an immediate imperative to address the problem of underperforming nurses in the profession which may include ongoing national dialogue about how to identify students who may underperform in the fully fledged role of a registered nurse.

Item Type: Thesis (PhD)
Murdoch Affiliation(s): School of Nursing & Midwifery
Supervisor(s): McMurray, Anne and Jones, Bronwyn
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