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Children are the recognized patients when admitted to hospital but their parents can also present demands for care by nurses. Involvement in care can be stressful for parents, particularly when children are required to undergo unpleasant procedures. Parents turn to their families for support in the first instance but some also look for care from nurses. Consequently parents can present a need for care of themselves to nurses whose primary patients are children. In this paper the experiences of a group of parents who became co-clients of nurses are considered along with the views of nurses working on the same ward. The discussion arises out of a larger study of the experiences of the parents of children admitted to a surgical ward in a children's hospital. The principal purpose of the study was to examine parents' and nurses' perceptions of their participation in the care of hospitalized children. The work of caring for parents is found to be ad hoc and unpredictable. The implications of the study for practice and policy are considered.

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Workforce issues and questions of professional roles and boundaries, in the context of the "greying" community nursing workforce, demand solutions if patient/client demand is to be met over the next two decades.

This paper describes key findings and implications from analyses of activity and workload of nurses of different grades and support workers based on data collected using Nursing Information Systems for Change Management (NISCM). 'Activity' refers to the amount of time on a shift spent on different tasks, and 'workload' refers to the number of patients in a variety of wards by demand/dependency group. The activity evidence is based on data from 5,208 staff recording their activity in 535 shift blocks in 19 hospitals and the workload evidence is based on data from 38,585 shifts across 90 wards in 17 hospitals. Four of the seven main findings have been selected for presentation here: variations, division of labour, skill-mix issues and flexibility. The findings show that there appears to be substantial systematic variation between hospitals in the grade mix of nursing staff and that there is little difference in the types of task undertaken by different grades of staff. As overall staffing increases, there is little increased specialization between staff groups and little flexibility in the deployment of nursing staff according to patient demand. The overall aim of the paper is to promote discussion relating to the development of appropriate and relevant strategies for changing skill-mixes in hospitals.