AIM: To find that changes in models of service delivery together with the dynamic nature of the contemporary health care context have changed the direction and focus of nurses' work. The aim of this paper is to explore some of the drivers for change and their impact and recommend a way forward to optimising nurses' work in the hospital environment. BACKGROUND: The healthcare workplace has been transformed over the past 20 years in response to economic and service pressures. However, some of these reforms have had undesirable consequences for nurses' work in hospitals and the use of their time and skills. RESULTS: As the pace and complexity of hospital care increases, nursing work is expanding at both ends of the complexity continuum. Nurses often undertake tasks which less qualified staff could do while at the other end of the continuum, are unable to use their high level skills and expertise. This inefficiency in the use of nursing time may also impact negatively on patient outcomes. CONCLUSIONS: Nurses' work that does not directly contribute to patient care, engage higher order cognitive skills or provide opportunity for role expansion may decrease retention of well-qualified and highly skilled nurses in the health workforce. RELEVANCE TO CLINICAL PRACTICE: In this climate of nursing shortages, we need to use nurses in a cost-effective but also, intellectually satisfying manner, to achieve a sustainable nursing workforce.
AIM: To find that changes in models of service delivery together with the dynamic nature of the contemporary health care context have changed the direction and focus of nurses' work. The aim of this paper is to explore some of the drivers for change and their impact and recommend a way forward to optimising nurses' work in the hospital environment. BACKGROUND: The healthcare workplace has been transformed over the past 20 years in response to economic and service pressures. However, some of these reforms have had undesirable consequences for nurses' work in hospitals and the use of their time and skills. RESULTS: As the pace and complexity of hospital care increases, nursing work is expanding at both ends of the complexity continuum. Nurses often undertake tasks which less qualified staff could do while at the other end of the continuum, are unable to use their high level skills and expertise. This inefficiency in the use of nursing time may also impact negatively on patient outcomes. CONCLUSIONS: Nurses' work that does not directly contribute to patient care, engage higher order cognitive skills or provide opportunity for role expansion may decrease retention of well-qualified and highly skilled nurses in the health workforce. RELEVANCE TO CLINICAL PRACTICE: In this climate of nursing shortages, we need to use nurses in a cost-effective but also, intellectually satisfying manner, to achieve a sustainable nursing workforce.