Nursing practice PICOT

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The practice of nursing is a crucial occupation in the health sector. In order to ensure that patients' health condition is not in danger, nurses play a vital role. Although it is a lucrative profession to pursue, the health industry's numerous issues make it difficult for it to operate soundly. Sometimes outside sources may be the source of the issues. This essay will concentrate on nurse compensation and the effects the issue has on patients and clinical under the various issues affecting nursing practice. A nurse who receives insufficient pay becomes demotivated and may even affect the patient's health. Nurses are persons who pursue academics for the longest period ever compared to other types of professions. However, it happens that, they are among the individuals who are being remunerated poorly in many parts of the world. It is quite evident due to peaceful demonstrations that the nurses hold. The go-slows subject the life of patients at stake of dying (Wenneras & Wold, 2001). Therefore, the group that suffers the most in this context are patients because nurses and doctors lack the drive and the will power to execute their duties with below average compensation or remuneration.

Various issues that arise from clinical care involves patients’ suffering more pain due to high staff turnover as a result of understaffing. The understaffing in clinical care arises due to low remuneration in public health sector. Therefore, more nurses end up starting their hospitals or seek employment in private sector where the pay is good and pleasing. Resentfulness is also a factor that inhibits the highly talented individuals from joining the industry due to a low level of remuneration. It mostly affects those nurses in busy departments that require a lot standing and a lot of practical work such as surgery and pediatric departments. It reaches a point where the zeal to perform their work is lost at the expense of high compensation. Other issues that may arise include depression, increased deaths, pain, coping and inadequate training and increased sufferings on patients. Quantitatively, the global health workforce deficit forecasted to hit 12.9 million personnel by the year 2035 (Strachota, 2003). The latter presents both an opportunity and dilemma for nurses worldwide especially for colleagues in low-income countries. A high proportion represents nurses amounting to more than 35 million nurses. More often, nurses in low-income countries contend with an overwhelming disease burden and persistent health human resources crisis that manifest in deep personnel shortages, poor skill mix, and unequal distribution of workers. In the US nurses receive high compensation than nurses in other parts of the world. It is according to the Association of Perioperative Registered Nurses Organization. In Pacific region nurses makes about $18000 more than the average staff nurse. Nurses in Mid-Atlantic region make about $14800 more than average (Moscaritolo, 2009). However, nurses in East South Central regions make $4300 less than average. The data shows the disparity that subsists between different parts of the world. There is also differences in pay based on genders. Male registered nurses earn $5000 more than female nurses. This shows how the disparity in compensation have affected nurses and health industry as a whole (Peterson, 2001).


PICOT Question

Can better remuneration among the nursing professionals significantly improve patient care during admission in public healthcare facilities?


Nursing professionals have been staging peaceful demonstrations and go-slows in most countries as a strategy to voice their grievances regarding poor remuneration. Compared to other healthcare professionals such as doctors and pharmacists, nurses are paid poorly which is ironical compared to their critical role in overall patient treatment and care. According to Wenneras and Wold (2001), nurses are among the most critical health workers in health facilities who deal with the largest number of patients and are found in most of the hospital departments. For instances, nurses work in consultations area, wards, accident and emergency departments, theaters, immunization centers among others. Being primary care providers and such an important part of a working healthcare system, nurses deserve better working conditions and remuneration which will not only motivate them and increase their level of involvement with patients but also ensure that the government is not losing qualified and experienced nurses to the private sector. The shortage of nurses in the public sector due to poor remuneration has adversely affected emergency preparedness (Peterson, 2001).

Although the government does improve nurses compensation over time as required for all civil servants, it is important to consider the critical role played by nurses as well as the risks they are exposed to every day in safeguarding the health of the patients. This, therefore, implies that in addition to the salary increment set aside for the civil servants, nurses should be given special attention as primary health care providers.


There are multiple evidence-based interventions which the government can employ to resolve the issue of nursing professional’s compensation and ensure that they chose to practice in the public sector. Boswell and Cannon (2012) suggest that an increase in the national investment in both nursing education, as well as the workforce infrastructure, will attract more people into the profession which will ensure that the public healthcare facilities are not hit by the looming shortage. Secondly, the government can also increase the incentives for the public hospitals to ensure that nurses are well managed and compensated to reciprocate the same to patient care.


Comparing the level of patient care and the level of satisfaction among both the patients and the nurses before and after the intervention is the ultimate goal of comparison. This acts as an essential gold standard that will aid in verifying the effectiveness of the measures and interventions put in place. Also, once the interventions are completed, the level of care offered by the nurses in the public healthcare facilities can be compared with the care provided in the private sector to determine the effectiveness of the increment in remunerations.


According to studies done in the area of nurse remunerations, it is evident that better infrastructure for both the nursing students and the practitioners improve their level of engagement with the patients. Furthermore, the studies suggest that well-paid professionals are more likely to forgo the idea of venturing in private practice which minimizes issues such as shortage of health care workers in the public health facilities.


The time frame refers to the period the patients are admitted to the public health facilities and the time they leave the facilities. The period taken for hospital admission and recovery is critical and should be as short as possible to avoid cases of nosocomial infections as well as minimize on hospital bill expenditure. The surest way of minimizing this time is by ensuring that the patient is accorded the best care possible. Motivated nurses are likely to ensure that this happens by providing patient-centered care.

Qualitative Critique

A Critical Appraisal of Interventional Strategies to Decrease Nursing Student Anxiety in the Clinical Learning Environment

Summary of the Study

In examining the interventional strategies to decrease nursing student anxiety in the clinical learning environment, Moscaritolo sought to explore the solutions to stressful demands of clinical education among the undergraduate students. Notably, anxiety and stress among students pursuing clinical studies result into poor coping abilities as well as low performance. Other problems that are caused by anxiety and stress include the inability to solve problems, reduced concentration, and loss of memory. As a result, the article purposely intended to provide insight on how humor, mindfulness training and peer instructors, and mentors could be used to reduce anxiety and stress in the clinical learning environment among the undergraduate nursing students. The study further applied the Neuman Systems Model as the conceptual framework as a means of exploring the interventional strategies to reduce stress among undergraduate nursing students. Neuman System Model classifies stress factors into three categories that are intrapersonal, interpersonal, and extrapersonal.

Consequently, in discussing the interventional strategies, Moscaritolo shows how humor can be used in reducing anxiety among nursing students through its ability to strengthen social relationships, increasing self-esteem, and focusing attention on other benefits (Moscaritolo, 2009). Also, peer instruction and mentoring strategies are effective ways applicable in reducing anxiety among undergraduate nursing students. According to the study, Neuman System Model considers both peer education and mentoring as primary intervention due to their role in protecting student's line of defense. Additionally, peer instructors can be used to help students identified as having stress and anxiety develop resistance. Notably, there are ethical considerations that ought to be captured in the use of the suggested strategies but have been omitted. Nevertheless, the purpose of the research, the literature reviewed and the conceptual framework reveals a strong congruency.

Background to the Study

Stress and anxiety are real problems that face baccalaureate nursing students in the learning environment. Providing an insight into the interventional strategies to decrease nursing student anxiety in the clinical learning environment is significant to nursing in two major ways. First, it results in success in clinical rotation through successful completion of nursing studies. Secondly, it promotes a supportive learning environment to undergraduate nursing students as a prerequisite to better performance and competency as young professionals. Therefore, the objective of undertaking the study that is the use of mindfulness training, humor and peer instructors, and mentors to mitigate anxiety and stress among students in clinical learning environments is in agreement with the topic.


It is apparent that the research involved the review of scientific and empirical studies to demonstrate the effects of stress and anxiety among nursing students. Some of the original studies used include Beddoe and Murphy research which examined how mindfulness decrease stress and enforce empathy among nursing students. Moscaritolo also used Tanaka, Tekehara and Yamauchi’s empirical studies which involved examining the relationship between task performance and state anxiety arousal among 53 undergraduate students. In as much as most of the sources of literature reviewed are authentic, the study does not outlay the process used in the selection of these articles. Moreover, the studies do not capture any positive aspect of anxiety and other likely courses from without the learning environment.

However, the conceptual framework adopted that is Neuman System Model has substantive significance in exploring the interventional strategies in reducing stress and anxiety among nursing students. The model postulates that every individual has a pressure control mechanism derived from basic survival factors such as response patterns and genetic structures among others. These aspects cumulatively interact to form a standard line of defense that defines a state of wellness in an individual. Therefore, the experiences that students undergo in the clinical learning environment expose them to stress which invades the normal lines of defense causing anxiety which is referred to as variance from wellness.


In regards to humor as an interventional strategy, the study examined the concept in two ways that are a teaching strategy as well as its general use in the clinical learning environment. The integration of humor as a teaching strategy showed a positive correlation with the reduction of stress and anxiety. As instructors employed humor in their teaching approaches, students demonstrated higher levels of content grasping. Other associated benefits revealed included developing a strong social relationship, learning facilitation and focusing attention. On the other hand, the use of humor in the clinical learning indicated a decrease in fears and anxieties due to its impacts in inducing free learning environment. Peer instruction and mentoring also showed significant influence in reducing the anxiety among nursing students. In this case, peer instructors serving as teaching assistants to the students undertook roles like helping students set up experiments, guiding students in performing computer documentation, maintaining safety, and other technical skills.

Meanwhile mentoring involved the incorporation of nursing personnel in study processes within the clinical learning environment. In both cases, there were improved clinical performances indicating reduced stress and anxiety among the nursing students. Mindfulness training as another strategic intervention involving yoga, qigong, sitting meditation as well as other relaxation technics reduced anxiety among the nursing students. It became apparent that mindfulness training enhanced the capability of participants to manage stressful situations. Therefore, stressful situations that nursing students face in the clinical learning environment and classroom set up which results in anxiety could be achieved through mindfulness training which enabled students to quiet their mind. All the strategies suggested has noticeable impacts on the performance of nursing students which translates into production of the competent workforce in the nursing profession.

Ethical Consideration

It can be postulated that the sources used in suggesting the interventional strategies decrease stress and anxiety among baccalaureate nursing students incorporated the acceptable ethical standards. As a research tradition in medical realms, empirical studies in which human beings are used as a specimen, there is need to consider the principles non-maleficence, autonomy, beneficence, and justice as basic tenets of ethics. Notably, the only ethical concept expressed in the study is thinly unveiled in the cautionary aspect when applying humor as a teaching strategy. In this case, emphasis on cultural diversities is an important ethical issue. However, there is a general neglect of ethical standards in the selection of sources of information.


It is evident that anxiety and stress in the clinical learning environment are problems that even nursing students acknowledge as common and detrimental to good performance. Based on Neuman System Model, the study has revealed that interventional strategies such as humor, mindfulness training, and use of peer instructors, and mentors yielded positive outcomes in the clinical learning environment. Notably, anxiety is considered to be a performance enhancer. On the contrary, when it is accompanied by stress, it breaks students’ line of defense and jeopardizes success. The growing concerns by the clinical nursing faculties on how best to contain anxiety improve learning outcomes and increase the retention rates can adequately be addressed if the suggested interventional strategies are implemented. Empirical studies involving the application of interventional procedures may not be adequate proof. Conversely, relentless use of these methods and the resulting success serve as sufficient evidence to integrate them into clinical education. It is evident that stress associated with clinical nursing practice continues to exist. However, the quest to manage the anxiety in the clinical environment through the application of the suggested interventional strategies will help save the future of the nursing profession.

Quantitative Critique

A Critical Assessment of Hospital Nurses’ Job Satisfaction: A Literature Review by Utriainen and Kyingas


Utriainen and Kyingas succinctly examined the highly-neglected aspect of the nursing profession that is hospital nurses’ job satisfaction. In their quest to establish pragmatic issues describing the general work attitudes among nurses within the hospital environment, they employed the art of literature review in which earlier research findings formed the core of arguments. The study majorly encompassed research works in the Western countries, especially in the United States. Notably, they employed the use of electronic databases such as Abi, Medline Ovid, PsycINFO and Cinahl in the selection and analysis of the original sources. In this case, there was the use of predetermined sequence which first involved developing research plan and questions, search for original sources based on the main words such as job satisfaction and nurses, content analysis as well as a selection of the original studies based on a criterion.

The resulting findings revealed an interplay of three significant aspects that determine hospital nurses’ job satisfaction that is patient care, an organization of nursing work, and interpersonal relationships. In this case, high-quality patient care demonstrated through receipt of personal praise from patients and their families, and the joy of seeing patients' condition improve are significant in nurses’ job satisfaction. On the other hand, an interpersonal relationship that is perceived in teamwork and a healthy social environment, as well as the organization of nursing work through adequate remuneration and concern for work-family relationships, determine the job satisfaction. The in-depth discussion of these factors shows that the findings are applicable and relevant to the current needs of nurse administrators and managers. As a means of enhancing job satisfaction among nurses in the hospital environment nurse managers should pay attention to these aspects especially interpersonal relationships and patient care.

Background of the Study

The background to the study is drawn from the fact that most research work has always revolved around stress and dissatisfaction among the nurses. Utriainen and Kyingas (2009) endeavored to consider the positive viewpoint which is a relatively neglected area in exploring job satisfaction. In this case, they attempted to establish factors that nurse managers could implement in the hospitals such as improving interpersonal relationships and quality patient care among others to enhance performance and satisfaction among the nurses. Purposely, the literature review sought to answer the question “What factors influenced nurses’ job satisfaction positively?” as a means of creating a concept of nurses’ job satisfaction based on earlier research data (Utriainen & Kyingas, 2009). Notably, the background to the study demonstrates adequate congruence because it tackles an issue of present significance while answering questions that address contemporary issues.

Study Methodology

The study was conducted using both quantitative and qualitative methods in which predetermined criteria involving the use of electronic databases resulted in a data set of 21 papers. For instance, out of the 66 papers that were established using the key words nurses and job satisfaction, eighteen of the papers met the requirement after examining their headlines and abstracts. The review further considered three papers obtained through analysis of original sources. Moreover, the study was based on recent sources that were published within a timeframe that is from the year 1997 to 2006. Further efforts involved the choice of highly scientific and original data to ensure that the resulting knowledge is applicable and relevant to the current needs. On the other hand, Utriainen and Kyingas conducted content analysis inductively guided by the findings of Polit and Hungler on the relevant processes involved in the content analysis. Meanwhile, the use of electronic database based on set strategies enabled a single information worker to undertake the whole process of establishing the relevant sources of data. It is apparent that the entire process was not based on a conceptual framework. However, the methodology used is satisfactorily founded on the acceptable standards of the literature review.

Findings and their Significance

The study revealed three sources of job satisfaction among nurses that is interpersonal relationships, patient care as well as the organization of nursing work. Interpersonal relationship as one of the essential predictors of job satisfaction among nurses was based on factors such as interaction and communication with co-workers. Apparently, nurse-nurse relationship or nurse-physician and other staff members is a source of strength as was the confession among most nurses. It resulted into harmony and togetherness which are essential attributes of teamwork. Furthermore, a social climate that enhanced free conversation, friendship and joyous events such as coffee breaks together had a positive influence on the job satisfaction among nurses as indicated in the study. Notably, the findings have a bearing on the contemporary job satisfaction because a proper decision-making processes occur when people freely interact, communicate and express their opinions in a workplace.

The results also pointed at quality patient care and organization of work as positive factors that enhanced job satisfaction among nurses. Quality patient care enabled the nurse to get personal praise from patients and their families. Moreover, the nurses demonstrated that seeing patients become get well was a source of strength and satisfaction in their roles. On the other hand, an organization of work encompassed the concern for a work-family relationship, balanced workload, autonomy, and adequate remunerations. These factors remain relevant to job satisfaction among nurses. However, the study has not proposed any further research into the suggested positive aspects that are critical in predicting nurses’ job satisfaction. In as much as the findings are based on original resources with quantitative data, failing to suggest any further examination of the results is an indication of absoluteness that is not objective.

Ethical Consideration

As a research tradition, ethical consideration of the study explains the validity and truthfulness in the general conduct of the research work. In regards to the study, ethical concerns were based on the choice of data sources, analysis, and originality. In this case, authentic databases such as PsycINFO and ABI/Inform were used. Additionally, there is an independent criterion involved in determining the sources. Other aspects such as validity are evident in the use of content analysis which is a scientific approach, and the involvement of two independent researchers is an indication of high ethical standards. Conversely, it is not feasible to examine other ethical aspects that involve interviews and experiment since the study was based on earlier research work. Thus, the originality of the selected sources relies on the assumption that other ethical aspects were considered.


From an intellectual standpoint, Utrainen and Kyingas’ study of hospital nurses’ job satisfaction: a literature review fills a fellow research gap due to its positive viewpoint of the subject. The study background reveals job satisfaction as a present problem that has not been adequately addressed by previous research works since they concentrated on other aspects such as stress and dissatisfaction. Additionally, the methods used in the literature review such electronic databases and content analysis established resources that are consistent with the purpose of the study which was to discuss relevant and recent literature to create a concept of job satisfaction among nurses. Thus, the study revealed three major factors that influence job satisfaction that is interpersonal relationships, quality patient care, and the organization of nursing work. Meanwhile, the whole process of the study was conducted given the ethical considerations based on validity, truthfulness, and originality. However, thin lines of weaknesses are evident in the failure to propose further research into the suggested factors that influence job satisfaction among nurses. Therefore, the stated predictors of job satisfaction among nurses are relevant and should be adopted by nurse managers to enhance performance and output.


Boswell, C., & Cannon, S. (2012). Introduction to nursing research. Jones & Bartlett Publishers.

This study is based on the Carnegie report as well as the IOM Future Nursing Report. It seeks to improve the outcomes of nursing as a profession. In addition, the study also reflects the recommendations of the Congress to improve the nursing infrastructure both at the teaching and the practice level as a step towards evidence-based patient care.

Moscaritolo, L. (2009). Interventional strategies to decrease nursing student anxiety in the clinical learning environment. Journal of nursing education, 48(1), 17-23.

As much as the clinical environment is key to nursing students, issues of anxiety and stress presented by this type of environment may prevent sound learning for the students. This is because the anxiety usually affects nursing students’ level of performance. Therefore, it is crucial that the clinical nursing facility provides the students with a conducive learning environment for learning.

Peterson, C. A. (2001). Nursing Shortage: Not a simple problem-no easy answers. Online Journal of Issues in Nursing, 6(1), 1-14.

There are various ethical issues which occur as a result of the shortage of nursing workforce in healthcare. Both the supply and demand of nursing professionals is affected by factors such as remuneration and the availability of necessary infrastructure. This has affected both the level of students recruited for nursing courses as well as the level of retention of registered nursing practitioners. In addition, the most of the nursing faculty are aging without sufficient replacements thus contributing to the shortage of nurses in healthcare facilities.

Strachota, E., Normandin, P., O’brien, N., Clary, M., & Krukow, B. (2003). Reasons registered nurses leave or change employment status. Journal of Nursing Administration, 33(2), 111-117.

Both the quality of patient care and the cost of healthcare are affected by the high turnover of nurses. In this study, the researchers seek to identify the common reasons leading to nurses changing their positions and how retention can be improved. Dissatisfaction especially in terms of overall compensation is a primary reason behind nurses leaving their positions. This has increased the burden of treatment as the cost of replacing them is also high.

Utriainen, K., & Kyngäs, H. (2009). Hospital nurses' job satisfaction: a literature review. Journal of nursing management, 17(8), 1002-1010.

The study focuses on the level of nurses’ job satisfaction. Issues such as burnouts, stress, and dissatisfaction are analyzed as potential causes of reduced level of job satisfaction among nurses. The study is conducted through a systematic review of the literature using 21 scientific articles. The studies identify both interpersonal issues as well as the relationships between the nurses and the patients as the primary factors in the level of job satisfaction.

Wenneras, C., & Mold, A. (2001). Nepotism and sexism in peer-review. Women, science and technology: A reader in feminist science studies., 46-52.

The following study is a commentary on the first-ever analysis of peer-review score for postdoctoral fellowship applications-.The system is revealed as being riddled with prejudice. The policy of secrecy in the evaluation must be abandoned.

June 19, 2023
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