Staffing needs affect the nursing department's budget, staff productivity, the quality of care provided to patients and even the retention of nurses. It is unclear how the role players (the nursing agency manager, the nurse manager and the agency nurse) perceive the staffing of agency nurses in intensive care units (ICUs). The purpose of this study was to explore and describe the factors that guide nurse managers regarding the staffing of agency nurses in ICUs at private hospitals in Pretoria. A quantitative exploratory and descriptive design was used. A survey by means of a structured questionnaire was carried out. Probability sampling was implemented to obtain a study sample (n=124). One similar self-administered 5-point scale instrument was completed by the participants. Data was analysed by means of descriptive and inferential statistics. The principles of validity and reliability were adhered to and ethical considerations were also taken into account. The results indicated limitations in the determining of posts, recruitment and advertising, as well as the selection and appointment of agency nurses in ICUs at private hospitals in Pretoria. Recommendations on staffing are made to nurse managers in ICUs.

The deterioration of patients in general wards could go unnoticed owing to the intermittent monitoring of vital data. The delayed or missed recognition of deteriorating patients results in serious adverse events in general wards. These challenges have resulted in the development of a critical care outreach service. Australia was the first country to establish critical care outreach services in 1990. In South Africa, critical care outreach services were implemented in 2005 at a private hospital in Pretoria. The researcher has noticed certain phenomena supported by literature such as the hesitancy of nurses working in general wards to escalate a patient to a critical care outreach service, and incorrect interpretation of modified early warning scores which could cause delays in patients being referred to outreach nurse experts. In this study, nurses’ (professional, staff and auxiliary nurses) experiences in respect of their self-leadership in critical care outreach services were explored. To this end, a qualitative phenomenological research approach was followed. Focus groups were held with the nurses (all nurse categories) working in a South African private hospital which provides critical care outreach services. It is recommended that nurses be granted access to training sessions, workshops and information to provide appropriate nursing care. Nurses should be encouraged to focus on the positive outcomes of providing nursing care and to “applaud themselves mentally” when they have successfully assisted or cared for their patients. Nurses also need to identify and correct negative assumptions about their competence.

Background: Globally, critical care outreach services (CCOS) were implemented in health care facilities; however, compliance with guidelines is poor. The authors have noticed that a gap exists in the literature on how self-leadership might influence nurses’ implementation of CCOS. Self-leadership is about leadership applied to oneself. Critical care outreach services assist nurses with the nursing care of a patient whose health is declining. Leadership is needed for the successful implementation of CCOS.Aim: This article aims to outline the method the authors followed for developing the conceptual framework for how self-leadership amongst nurses influenced the functioning of CCOS.Setting: The research was conducted at a private hospital in Pretoria.Methods: A qualitative approach was followed to provide an accurate description of nurses’ experiences on their self-leadership in a CCOS. The practice-oriented theory of Dickoff (1968) was the reasoning map for developing and constructing the conceptual framework.Results: Bedside nurses experienced the following self-leadership strategies: constructive thought patterns, natural rewards and behaviours focused on their implementation of CCOS.Conclusion: The conceptual framework was part of another study and provided the authors with a rationale that guided the authors with the development of self-leadership strategies in a CCOS.Contribution: The conceptual framework provided the authors with an understanding of how nurses’ self-leadership influenced the implementation of CCOS. The conceptual framework can also assist in developing training programmes for nurses to improve their self-leadership and ultimately improve nurses’ competence in providing quality nursing care to patients.

Introduction Nurses are responsible for monitoring and providing nursing care to patients. The early detection of a patient who is starting to deteriorate – and the activation of critical care outreach services (CCOS) – can improve patient outcomes. However, the literature indicates that CCOS are underutilised. Self-leadership is a process whereby persons influence their own behaviour. Objective The purpose of this study was to develop strategies for the facilitation of self-leadership in ward nurses that will enable them to act proactively and promptly in utilising CCOS at a private hospital group in South Africa. Methods A sequential exploratory mixed-method research approach was followed to develop strategies for the facilitation of self-leadership in nurses that will enable them to utilise CCOS proactively when a patient starts to deteriorate. An adapted version of Neck and Milliman's self-leadership strategic framework was used as the methodological steps of the study. Results The quantitative analysis extracted eight factors, which were used as the departure point to develop strategies for the facilitation of self-leadership among nurses in a CCOS. Five strategies were developed that related to self-motivation, role models, patient outcome, assistance and guidance from CCOS, and the power of self-confirmation; these strategies aligned with the themes and categories extracted from the qualitative data analysis. Conclusion There is a need for self-leadership among nurses in a CCOS.