• Users Online: 128
  • Home
  • Print this page
  • Email this page
Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 

 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 15  |  Issue : 1  |  Page : 62-70

Staff nurses expected role versus actual role at South Valley University


1 Department of Nursing Administration, Faculty of Nursing, South Valley University, Qena, Egypt
2 Department of Nursing Administration, Faculty of Nursing, Cairo University, Cairo, Egypt
3 Department of Nursing Administration, Faculty of Nursing, Beni Suef University, Beni Suef, Egypt

Date of Submission02-Jul-2017
Date of Acceptance30-Jan-2018
Date of Web Publication3-Sep-2018

Correspondence Address:
Azza Abd El Mawgod Abd El Hamid
Department of Nursing Administration, Faculty of Nursing, South Valley University, Qena
Egypt
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ENJ.ENJ_30_17

Rights and Permissions
  Abstract 


Aim Of this study is to assess the expected roles of staff nurses versus their actual role.
Background Nursing role and practice is based on specialized knowledge and skills derived from principles of basic, applied sciences, and standards of professional performance. Each individual within an organization should have a specified role, which is reflected in the job description. However, roles could be seen from AQ8 different perspectives. It can be looked at as the expectation of the focal persons, or the organization’s expectation which is reflected in the job description, or the role behavior of the focal person. To avoid overlapping functions among many different roles, there should be a clear written job description of a nurse’s role.
Method A descriptive correlational research design was utilized on a sample of 42 nurses at the Medical and Surgical Departments at the university hospital. Two data collection tools for the medical and surgical units were developed by the investigator based on the related literature and guided by the developed job description from the Ministry of Health, to assess the staff nurses expected and actual roles.
Results The study indicated that there was low expectation of the staff nurses to various dimensions of their role at the medical unit, and there was a statistically significant difference between the surgical staff nurses’ expectation of their role and their actual practice in their direct, indirect, and educational roles. When comparing the medical and surgical staff nurses’ total expectation of all dimensions of their role, there was low expectation of the staff nurses to various dimensions of their role for both medical and surgical units, but there were discrepancies for their direct, educational, and actual roles. A statistically significant difference between the staff nurses expectation of their role and their actual practice according to sex and their nursing qualifications, as the bachelor nurses have a higher mean score at their actual performance than the technical nurses, and female nurses have a higher mean score than male nurses.
Conclusion It is recommended that there was a need for job description and it should be drawn up in consultation with the employees, to increase commitment, and to reduce role ambiguity. Also a systematic training policy should be established, with orientation programs and continuing educational courses.

Keywords: actual role, expected role, staff nurses


How to cite this article:
Abd El Hamid AA, El Mola M, Mohamed SA. Staff nurses expected role versus actual role at South Valley University. Egypt Nurs J 2018;15:62-70

How to cite this URL:
Abd El Hamid AA, El Mola M, Mohamed SA. Staff nurses expected role versus actual role at South Valley University. Egypt Nurs J [serial online] 2018 [cited 2018 Nov 13];15:62-70. Available from: http://www.enj.eg.net/text.asp?2018/15/1/62/240351




  Introduction Top


Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups, and communities, sick or well and in all settings. Nursing includes the promotion of health, prevention of illness, and the care of the ill, the disabled, and the dying people. Advocacy, promotion of a safe environment, research participation in shaping health policy and in patient and health systems management, and education are also key nursing roles (International Council of Nurses, 2010).

Roles are classifications of behavior, whereas positions are classifications of people. The staff nurse role is a position-related role. A position-related role has three basic elements: the job description (the job one is hired to do), the social expectations, and personal enactment. The new nurse will find that the staff nurse role entails more than the job description and is shaped by both the norms (expectations) of the work group and the personal attributes and values one brings to the role (Loveridge and Cummings, 2008).

Each role has its own characteristics and the expectations for one position could be in conflict with demands of the other roles. Therefore, when the expectations for one role create conflict with another, role conflict occurs (Schulz, 2013). In contrast, role conflict is concerned with problems, which emerge as the result of role incompatibility (Hosein et al., 2014).

Nurses’ roles concern the tasks and functions for which nurses are held accountable, such as assessment and education. Role performance relates to how successfully a nurse plays his or her roles as advised to them to meet the expectations. Role performance improves as a nurse clinician gains knowledge and experience, and is influenced by their attitudes, beliefs, values, as well as the context in which the role is performed (Sharon, 2014).

The practice of medical–surgical nursing requires specialized knowledge and clinical skills to manage actual or potential health problems that affect individuals, their significant others, and the community. The role of the medical–surgical nurse includes caregiver, care coordinator, client educator, case manager, counselor, client advocate, consultant, researcher, administrator/manager, staff educator, and expert witness (Academy of Medical–Surgical Nurses, 2012, p.4).

Role theory claims that when employees receive inconsistent expectations and little information, they will experience role conflict, which leads to stress, dissatisfaction, and ineffective performance. Multiple lines of authority disrupt, divide authority between profession and organization, and create stress (Roussel, 2006).

To avoid overlapping functions among many different roles, it is recommended that a relevant job description must be developed to delineate and clarify such responsibilities, and to avoid expected conflicts. Clear written job description of a nurse’s role that explains the duties and responsibilities of different nurse’s jobs must be available. Also, specification of the functions and scope of responsibilities should be commensurate to the types of qualification and training of each category as recommended by Roussel (2006).

A job description identifies essential and nonessential tasks that are assigned to a specific position. It also identifies reporting relationships and may also describe the required qualifications, minimum requirements, working conditions, and desirable qualifications. Supervisors are responsible for developing and maintaining accurate and current job descriptions for their staff. The duties should be appropriate for classification and are consistent with the class specification (Bodnarchuk, 2012).


  Aim Top


The aim of this study is to compare the actual roles of staff nurses versus their expected role at the medical and surgical units at South Valley University Hospitals.

Research questions

  1. What is the actual role of staff nurses?
  2. What is the expected role of staff nurses?
  3. Is there a difference between the actual role of the staff nurses and their expected role?



  Patients and methods Top


Research design

A descriptive, comparative research design was utilized in the current study.

Setting

The study was conducted at the Medical and Surgical Departments at South Valley University Hospital which is affiliated to the South Valley University.

Patients

A sample of 42 nurses (20 nurses at the medical unit and 22 at the surgical unit) were included in the current study, representing all the staff members in the selected medical and surgical units at South Valley University Hospital.

Data collection tool

Two data collection tools (one for the medical unit and the second for the surgical unit) were utilized to collect data pertinent to the current study. They were developed by the investigator based on the related literature and guided by the developed job description from the Ministry of Health. The sample tools were used to assess the staff nurses’ expected roles and were used also by the investigator to observe the staff nurses actual role.

The staff nurses’ role assessment tools have two parts: The first part concerned with the demographic and work-related data of the study sample, such as age, sex, level of education, years of experience in the current hospital, etc.

The second part: Two staff nurses’ role assessment tools, in a form of checklist, one for the role of the staff nurses at the Medical Department and the other for the Surgical Department to assess the expected staff nurses’ role such as direct patient care role, indirect patient care role, administrative role, etc. Those activities are categorized into seven major sections of nursing care activities namely: direct care role, indirect care role, administrative role, communicator role, educator role, advocate role, and researcher role. The first section for the direct care role (30 items), the second section for the indirect role (32 items), the third section for the administrative role (six items), the fourth section for the communicator role (five items),the fifth section for the educator role (five items), the sixth section for the advocator role (five items), and the seventh section for the researcher role (five items). The responses of the participants related to their actual role were checked on either done or not done: done will be scored (1), not done=(0). The responses of the participants related to their expected role were checked on either Yes, No, and I don’t know, scored on yes=(1), No and I don’t know=(0). The tool has high reliability with Cronbach’s α coefficients 0.89 for the total scale, the tools were rigorously reviewed by a panel of experts: professors from the Nursing Administration Department at the Faculty of Nursing, Cairo University. They were asked to examine the questionnaires for their content coverage, clarity, length, wording, format, and overall appearance. On the basis of experts’ comment and recommendations some changes had been made at the data collection tools.

Pilot study

A pilot study was carried out to test the questionnaire’s feasibility and clarity, and to estimate the time consumed for filling in the forms. It included 10 staff nurses from different medical and surgical departments.

Procedure

Upon securing the necessary permission, the fieldwork was started in May 2016, and was completed by the end of July 2016. The investigator visited the selected settings on a daily basis, explaining to the study participant the aim and procedures of the study to obtain their written consent to participate. They were handed the data collection forms after having a full instruction on how to fill them in, it took from 10 to 15 min to complete the form. The filled forms were collected and revised to check for any missing data.

Ethical consideration

Before starting work, an official letter was issued from the Director of South Valley University Hospitals to request permission to conduct the study. Before recruitment of nurses, the investigator provided a verbal explanation of the nature and the aim of the study to staff nurses to obtain their informed consent to participate. They were informed about their rights to refuse or to withdraw from the study at any time without giving any reason. They were also reassured that the information would be confidential and used for the research purpose only.

Statistical analysis

Data entry and statistical analysis were done using the statistical package for social sciences, version 20.0 that was developed by SPSS Inc. and acquired by IBM in 2009. Cronbach’s α test was used to assess the reliability of the scales. Descriptive and inferential statistics were done such as mean and SDs, frequency, percentage and independent t-test and analysis of variance. Statistical significance was considered at P-value less than 0.05.


  Results Top


[Table 1] showed that about half of the staff nurses at both medical and surgical units were working on morning shift, whereas the least percentage was reported for morning/afternoon shift; slightly more than half of them were graduated from the Technical School of Nursing and the Technical Institute of nursing, whereas others have a bachelor’s degree. Their age ranged between 20 and 24 years. At the medical unit, about two-thirds of the studied sample were women, and more than three-quarters of the studied sample have less than 5 years of experience.
Table 1 Sociodemographic and work-related characteristics for medical staff nurses (n=20) and surgical staff nurses (n=22)

Click here to view


For the surgical unit, the majority of their age group ranged between 20 and 29 years, whereas others ranged between 30 and 39 years. More than three-quarters of the studied sample were women, and slightly more than half of them have less than 5 years of experience, whereas others have 5–10 years of experience.

[Table 2] shows that there was an insignificant difference between the medical staff nurses’ total expectation of all dimensions of their role and their actual observed practice, whereas the highest percentage of agreement (50%) was for their role in communication, the lowest percentage (25%) was for their researcher role for both expected and actual roles.
Table 2 Comparison between actual versus expected staff nurses role among medical staff nurses (n=20) and surgical staff nurses (n=22)

Click here to view


Regarding the surgical unit, there was a statistically significant difference between the surgical staff nurses’ expectation and their actual observed practice in their direct role, indirect role, and in educational role. Although the highest percentage of the surgical staff nurses’ expected role was 54.5% for their indirect care role, the lowest percentage (22.7%) was for their researcher role. For their actual role the highest percentage (40.9%) was for their role in communication, whereas the lowest percentage (9.1%) was for their researcher role.

[Table 3] shows that there was an insignificant difference between the staff nurses’ expectation of their role and their work-related characteristics in both medical and surgical units.
Table 3 Relation between medical nurses’ expectation of their role and their work-related characteristics among medical staff nurses (N=20) and surgical staff nurses (N=22)

Click here to view


[Table 4] shows that there was a statistically significant difference between the staff nurses actual observed practice and their working shifts for the afternoon shift, and their sex for female nurses at the medical unit, and between the actual observed practice of the staff and their sex for female nurses, and their qualification for baccalaureate degree at the surgical unit.
Table 4 Relation between the staff nurses’ actual observed practice and their characteristics among medical staff nurses (n=20) and surgical staff nurses (n=22)

Click here to view


[Table 5] shows that there was an insignificant difference between the medical and surgical staff nurses’ expectation of their role.
Table 5 Comparison of medical and surgical staff nurses’ expected role

Click here to view


[Table 6] shows that there was a statistically significant difference between the medical and surgical staff nurses’ actual observed practice in their direct care role and in their educational role.
Table 6 Comparison of medical and surgical staff nurses total actual observed practice

Click here to view



  Discussion Top


In the present study, seven areas of the staff nurses’ role at the medical and surgical units were examined to assess the expectation of the staff nurses’ role and their actual role at South Valley University Hospital.

The present study revealed that the age of the staff nurses at the medical unit ranged between 20 and 29 years, but for the surgical unit, the age of most of the staff nurses was less than 30 years and minority of the staff nurses were 30–39 years. This result was supported by that of Abd El Menem (2007), who reported approximately similar findings. As regards years of experience, most of the staff nurses at both medical and surgical units, had less than 5 years of experience, whereas others had 5–10 years of experience. This result is in accordance with the study of Abd El Menem (2007), p.109, that was carried out at the surgical wards in El-Demerdash University Hospital. On a 120 staff nurses working in surgical wards to develop an assessment of training needs tool for surgical staff nurses, she emphasized that insufficient knowledge and practice of some nursing tasks could be the result of lack of experience in a particular area of clinical nursing with proper instruction and supervised practice. For example, in a study that used the patient care unit as the level of analysis, researchers found that a higher proportion of nurses with at least 5 years of experience was associated with fewer medication errors and lower patient fall rates (Blegen et al., 2013, p.90).

Similarly, Clarke et al. (2002) examined the effect of the mean nurse experience level at the hospital level on nurse needle-stick injuries; they concluded that a low mean experience level was associated with more near-miss needle-stick incidents (p.210). In another study of nursing outcomes (Kanai-Pak et al., 2008) on staff nurses in 19 acute hospitals to describe nurse burnout, job dissatisfaction, and quality of care in Japanese hospitals, and to determine how these outcomes are associated with work environment factors, they found that the odds of high burnout, job dissatisfaction, and poor-to-fair quality of care were twice as high in hospitals with 50% inexperienced nurses (i.e. nurses with less than 4 years’ experience) versus those with 20% inexperienced nurses (p.3325).

As regards qualification, slightly more than half of the studied nurses were graduated from the Technical School of Nursing and Technical Institute of Nursing, whereas for the others holding the baccalaureate degree, this could be explained by the fact that the college education programs are much smaller compared with the technical programs. Also the hospital administrators resort to technical nurses to manage nursing manpower shortage (Lynn and Redman, 2006, p.678). It was noted that hospital administrators make optimum utilization of the available baccalaureate nurses by assigning them leadership positions. In congruence with this, Abd El Menem (2007) found that the majority of nurses had technical nursing school certificate, and stated that the nurses’ level of education showed a great impact on their knowledge and skills for patient care (p.100).

As regards the nurses’ sex, the study showed that the largest percentage of the nurses were women. This could be due to the fact that male enrollment in the nursing programs is considerably recent in Egypt. Also nursing is still widely perceived as a feminine profession; accordingly the number of men enrolled into nursing is small compared with women, as reported by Gamal (2014) in her study to assess factors that influence nurse’s role as a patient advocate.

When comparing the medical staff nurses’ total expectation of all dimensions of their role and their actual observed practice, there were low expectation of the staff nurses to various dimensions of their role ranged between 50–25% and 45–15% for their actual performance. Regarding the surgical unit, there was a statistically significant difference between the surgical staff nurses’ expectation of their role and their actual observed practice In their direct role, indirect role, and in educational role, this could be due to lack of role clarity and/or inconsistency on performing these activities.

Similar findings were noted by Velhal et al. (2013), in their study that was carried out to assess awareness among nursing staff about their roles and responsibilities on 60 nurses in Topiwala National Medical College and Nair Hospital, Mumbai, India, where they found that most of the nursing staff were not aware about their roles and responsibilities and more or less there was overlapping of their roles and responsibilities. None of the sister in charge and staff nurses could inform all roles and responsibilities as per the guidelines of nursing manual. They found that nurses could not clearly separate clinical activities from administration. As a result, they were not sure who is responsible for making decisions on certain ward activities. They stated that nurses often find themselves torn between spending time on direct patient care and increased administrative duties because of poor awareness about their roles and responsibilities (p.15).

The findings of the study revealed that the staff nurses expectation about their roles was not affected by their working shifts or any of their demographic characteristics such as age, sex, experience etc. But for their actual observed practice there was a statistically significant difference between the staff nurses’ actual observed practice and their working shifts for the afternoon shift, and their sex for female nurses at the medical unit, and between the staff’s actual observed practice and their sex for female nurses, and their qualification for baccalaureate degree at the surgical unit.

This result supported by the research that was conducted by Hong et al. (2005) in mainland China, to analyze the growing literature relating to job satisfaction among nurses, it was found that the nurses’ educational level is an influencing factor on nurses’ views and experiences of their working lives, with the findings it was noted that the level of education of nurses affected how they perform their duties. A nurse whose level of education is high has more alternatives, for example, in performing her duties. There are times when important decisions have to be made by the nurse without her consulting anyone for various reasons. A nurse with grounded education will be able to face any difficult situation intelligently (p.215).

In addition, Kutney-Lee et al. (2013) in their study on Pennsylvania nurse survey and patient discharge data from 1999 to 2006 found that a 10-point increase in the percentage of nurses holding a baccalaureate degree in nursing within a hospital was associated with an average reduction of 2.12 deaths for every 1000 patients and for a subset of patients with complications, an average reduction of 7.47 deaths per 1000 patients (p.279).

When comparing the medical and surgical staff nurses’ total expectation of all dimensions of their role, there were low expectation of the staff nurses to various dimensions of their role which ranged between 54–22% at the surgical unit and 45–15% for the medical unit. Regarding their actual observed practice, there was a discrepancy between the staff nurses at the medical and surgical units for their direct role and their role in education.

This means that the staff nurses were lacking knowledge of their holistic responsibility of their direct care role as a result of absence of supervision to nurses during work and inadequate training, in addition to their role description was not disseminated to them. This result was in accordance with Frisch and Frisch (2006) as they suggested that the lack of supervision, standardized training, and continuing education of staff nurses working in hospitals contributed to shifting of their comprehensive role as providing holistic nursing care to patients and appear to be more focused on providing personal care and supportive services than on performing technical skills such as physical examination and observation of patients.

In agreement with this explanation, Hsu (2006) stated that staff nurses cannot provide the best in their role as educators to meet the needs of patients care due to lack of knowledge and attitude, in addition to absence of equipment (p.619). Also, this result supported by Young and Paterson (2007) who studied the Nurses’ Perception of Performance and Responsibility of Patient Education and noted that shortage of time is reported to be the biggest constraint to carrying out the role as an educator, a shortage of healthcare professionals and time constraints are long-standing problems that nurses face (p.279).

This perception is supported in Egypt by Fathy (2011) in her study of communication skills during patient education for the nursing students at Alexandria University clarifies that there is an inadequacy in the educational training for nurses in the field of health education, particularly in using instructional aids, perhaps due to a deficiency in clinical experiences in this field. The production of high-quality audiovisual materials for patients, along with the informed and skillful use of them, is an important aspect for the health educator which is limited in Egyptian nurses. Similarly, inability to prepare, select, and develop instructional aides for patients is considered a great barrier for communicating health messages and requires attention from nursing education (p.35).


  Conclusion and recommendations Top


On the basis of the study findings, it is concluded that the result concluded that there was low expectation of the staff nurses to various dimensions of their role, when comparing the medical staff nurses’ total expectation of all dimensions of their role and their actual observed practice that ranged between 50–25% and 45–15% for their actual performance.

Regarding the surgical unit, there was a statistically significant difference between the surgical staff nurses’ expectation of their role and their actual observed practice, in their direct role, indirect role, and in educational role and this could be due to lack of role clarity and/or inconsistency on performing these activities. These discrepancies could be related to lack of awareness about job description and would lead to role ambiguity.

The finding of the study revealed that the staff nurses’ expectation about their roles was not affected by their working shifts or any of their demographic characteristics such as age, sex, experience, etc. But for their actual observed practice, there was a statistically significant difference between the staff nurses’ actual observed practice and their working shifts for the afternoon shift, and their sex for female nurses at the medical unit, and between the staff’s actual observed practice and their sex for female nurses, and their qualification for baccalaureate degree at the surgical unit.

When comparing the medical and surgical staff nurses’ total expectation of all dimensions of their role, there was low expectation of the staff nurses to various dimensions of their role which ranged between 54–22% at the surgical unit and 45–15% for the medical unit. Regarding their actual observed practice, there were discrepancies between the staff nurses at the medical and surgical units for their direct role and their role in education.

A statistically significant difference was found when comparing the staff nurses’ expectation of their role and their actual observed practice according to sex and their nursing qualifications, as the bachelor nurses have better actual performance than the technical nurses, and also the female nurses were better than the male nurses.


  Recommendation Top


  1. Job descriptions should be drawn up in consultation with employees, to increase commitment and improving productivities.
  2. A written job description should be provided and explained to new nurses during the orientation.
  3. Job identification should be mentioned properly in job description so that the employees know their boundaries and increase competence, commitment to reduce role ambiguity, overlapping to the job, and job conflict, thus increasing performance among employees.
  4. Systematic training policy should be established, stipulating training needs assessment and training program and to assist workers to join the training so as to make them competent.


For nurse managers and supervisors:
  1. Line of communication should be open and clear between staff members.
  2. Change in policies, role, and procedures should be communicated to all nurses to avoid conflict and ambiguity.
  3. Lastly, identification and elimination of factors hindering the performance of expected and actual roles is proposed.
[21]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Abd El Menem AS (2007). A tool for determining nursing training needs in surgical units [Thesis]. Cairo, Egypt: Ain Shams University. pp. 99–109.  Back to cited text no. 1
    
2.
Academy of Medical–Surgical Nurses (2012). Scope and standards of medical–surgical nursing practice. 5th ed. Sewell, NJ: Academy of Medical-Surgical Nurses. pp. 3–26.  Back to cited text no. 2
    
3.
Bodnarchuk M (2012). The role of job descriptions and competencies in an international organization case: Foster Wheeler Energia Oy [Bachelor’s Thesis]. Kuopio, Finland: Savonia University of Applied Sciences.  Back to cited text no. 3
    
4.
Blegen MA, Goode CJ, Park SH, Vaughn T, Spetz J (2013). Baccalaureate education in nursing and patient outcomes. J Nurs Adm 43:89–94  Back to cited text no. 4
    
5.
Clarke SP, Rockett JL, Sloane DM, Aiken LH (2002). Organizational climate, staffing, and safety equipment as predictors of needle-stick injuries and near-misses in hospital nurses. Am J Infect Control 30:207–216.  Back to cited text no. 5
    
6.
Fathy A (2011). Effect of role-play versus lecture teaching strategies on nursing students’ communication skills during patient education [Thesis]. Alexandria, Egypt: Faculty of Nursing, University of Alexandria. pp. 32–55.  Back to cited text no. 6
    
7.
Frisch NC, Frisch LE (2006). Psychiatric mental health nursing. 3rd ed. Clifton Park, NY: Delmar/Thomson Learning.  Back to cited text no. 7
    
8.
Gamal MM (2014). Factors influencing nurses role as a patient advocate [Thesis]. Cairo, Egypt: Faculty of Nursing, Cairo University.  Back to cited text no. 8
    
9.
Hong LU, Alison E, While K, Barriball KL (2005). Job satisfaction among nurses: a literature review. Int J Nurs Stud 42:211–227.  Back to cited text no. 9
    
10.
Hosein AP, Rahimi A, Khaghanizadeh M (2014). The effects of role conflict on nursing faculty: a systematic review. Int J Med Rev 1:1.  Back to cited text no. 10
    
11.
Hsu LL (2006). An analysis of clinical teacher behavior in nursing practicum in Taiwan. J Clin Nurs 15:619–620.  Back to cited text no. 11
    
12.
International Council of Nurses (2010). Definition of nursing. Available at: http://www.icn.ch/who-we-are/icn-definition-of-nursing/.  Back to cited text no. 12
    
13.
Kanai-Pak M, Aiken LH, Sloane DM, Poghosyan L (2008). Poor work environments and nurse inexperience are associated with burnout, job dissatisfaction and quality deficits in Japanese hospitals. J Clin Nurs 17:3324–3329.  Back to cited text no. 13
    
14.
Kutney-Lee A, Sloane DM, Aiken LH (2013). An increase in the number of nurses with baccalaureate degrees is linked to lower rates of post-surgery mortality. Health Aff 32:579–586.  Back to cited text no. 14
    
15.
Loveridge E, Cummings H (2008). Nursing management 2nd ed. London, UK: Mosby Company. pp. 133–153.  Back to cited text no. 15
    
16.
Lynn MR, Redman RW (2006). Staff nurses and their solutions to the nursing shortage. West J Nurs Res 28:678–693.  Back to cited text no. 16
    
17.
Roussel L (2006). Management and leadership for nurse administrators. 4th ed. Sudbury, MA: Jones and Barltlett publishers.  Back to cited text no. 17
    
18.
Schulz J (2013). The impact of role conflict, role ambiguity and organizational climate on the job satisfaction of academic staff in research-intensive universities in the UK. High Educ Res Dev 32:464–478.  Back to cited text no. 18
    
19.
Sharon J (2014). Roles nurses play that truly make them the heart of healthcare. Available at: http://www.nursetogether.com/6-roles-nurses-play-truly-make-them-heart-healthcare. [Last accessed 2017 May 9].  Back to cited text no. 19
    
20.
Velhal GD, Sawant S, Rao A, Mahajan H (2013). Awareness among nursing staff about roles and responsibilities in a tertiary level health care institute, India. Int J Gen Med Pharm 2:75–80.  Back to cited text no. 20
    
21.
Young LE, Paterson BL (2007). Teaching nursing developing a student centered learning environment. London, UK: Lippincott Williams & Wilkins. pp. 3–25.  Back to cited text no. 21
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Aim
Patients and methods
Results
Discussion
Conclusion and r...
Recommendation
References
Article Tables

 Article Access Statistics
    Viewed109    
    Printed2    
    Emailed0    
    PDF Downloaded13    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]