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One of nursing major concerns in this era of health care reform is the supervision of unlicensed assistive workers in ambulatory settings. The downsizing of acute care hospitals has had two results, the increase in very sick patients in ambulatory care settings and in jobs for experienced nurses in such settings. This experience, however, sometimes does not extend to supervisory skills. Effective supervisors should know their assistive workers, block out time for supervision, adhere to patient care standards, and give timely positive and negative feedback., Many of the concerns related to health care reform, downsizing, and the implementation of care delivery models employing multiple levels of assistive personnel have been identified and discussed as they [...]

The growing movement toward specialty certification in nursing has resulted in an increased demand for continuing education that supports specific areas of specialty practice and certification status. In examining a number of the specialty practice core curricula documents, it is evident that there is a tendency to organize nursing content using the medical model as a framework. A method by which core curricula for specialty practice are organized and developed from a distinctly nursing perspective is needed. The authors suggest that conceptual frameworks, developed by nurses who are expert in a specific clinical practice area, are a practical method for the development of such curricula.

Through a series of semistructured interviews with 12 nurses delivering direct patient care in acute, long-term and home care settings, information was sought regarding the ethical concerns of practicing nurses. Although these nurses frequently did not specifically identify the areas of expressed concern as ethical in nature, thematic analysis of the transcribed interviews uncovered four major ethical areas of concern common to these 12 nurses. These areas are: (1) Withholding of information and truth-telling; (2) Unequal access or inequalities in care; (3) Differences between business and professional values; (4) Breaking and reporting broken rules. Several reasons are offered to explain the failure of nurses accurately to identify specific practice dilemmas as ethical in nature and the sequelae of these failures. Possibilities involving ongoing education and mentored experiences in practice areas are reported.