Working in the care of older people
Working in the care of older people was the organizational factor most frequently associated with RNs’ practice of EBP activities. In Sweden, the care of older people has been a responsibility of the municipalities for the last 20 years and is today based on a social model of care [37]. The RNs’ work situation in this setting differs compared with RNs in hospitals, particularly with respect to the staff skills mix, e.g. professional groups and education levels [38]. The RNs working in the care of older people are not only accountable for planning the care of the older person, they are also expected to provide leadership for nurse aides and promote quality improvement and EBP [39]. Physicians are not employed by the municipalities but consulted as general practitioners, which puts higher demands on the RNs’ leadership and accountability for the quality of care, including medical care. Thus, the role of RNs in the care of older people requires considerable medical, nursing and pedagogical competence, as well as personal life experience [40]. It is therefore uncommon for RNs to begin their nursing career in the care of older people as the self-governed working conditions are considered to require extensive experience. In our sample, only 12% of the RNs worked in the care of older people, despite many available jobs in this sector and despite the fact that salaries in this sector tend to be higher compared with other areas of healthcare. This might imply that it is predominantly highly committed RNs who begin their career in the care of older people.